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MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT (Medina County)

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MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
December 7, 2020
Regarding: 2021 MCSE Contractor Registration
Dear Registered Contractor:
Enclosed please find an updated Contractor Registration packet for calendar year 2021 effective
January 1, 2021.
Please be sure to complete all required documentation, post the necessary bond, and comply with the
minimum Certificate of Liability Insurance requirements. Thank you in advance for your continued
cooperation. We look forward to working with you in serving Medina County water and sanitary sewer
utility customers in 2021.
Sincerely,
Jeremy R Sinko, P.E.
Jeremy Sinko, P.E.
Interim Sanitary Engineer
**Attention**
Enclosed is an electronic copy of the Medina County Sanitary Engineers (MCSE)
contractor re-registration forms. Contractor registration forms are also available on
the MCSE website (https://www.medinaco.org/sanitary/) or, a printed copy can
be picked up at the MCSE permit counter.
When filling out the 2021 contractor registration form, an email address will
be required as part of the registration submittal. If the submitted registration
form does not include an email address, the registration form will not be
processed. The email address will allow the MCSE to keep registered contractors
up to date with the latest detail/policy revisions and to send the following years
contractor registration form. Should you have any questions or concerns, please
contact Christine Hegarty at (330) 723-9580 or chegarty@medinaco.org.
Thank you!
Medina County Sanitary Engineers
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
Notice to Contractors
Contractor Registration for the year 2021
Enclosed is the Medina County Sanitary Engineer’s (MCSE) Contractor Registration Packet that outlines the items to
include when registering with MCSE to perform work installing, repairing and/or replacing water mains, sanitary sewer,
and water service connection & sanitary sewer connection to MCSE utilities.
Please be aware that ALL applications forms, evidence of liability insurance, bond documents and fees MUST be
included before the application can be approved.
It is necessary for all contractors working on or around MCSE utilities to have a thorough understanding of MCSE’s
Rules and Regulations and to abide by those requirements while preforming utility work. A copy of MCSE’s Rules and
Regulations is available on the MCSE’s website:
https://www.medinaco.org/wp-content/uploads/2019/08/Sanitary_rulesandregs.pdf
NOTES:
• All work for new water and sanitary sewer service connections, repairs and/or replacements, must be permitted by
MCSE in advance of the work and all associated permit fees paid prior to scheduling an inspection.
• Residential permits include one (1) inspection for sanitary and two (2) inspections for water: (1) inspection to
within 10’ of proposed structure, (2) water line inspection through the wall. Any additional inspections will be
billed to the contractor at the inspection rate as established in the most current charges and fees resolution.
• A road opening permit must be issued by the applicable road authority prior to scheduling work within the public
Right-of-Way. MCSE will obtain road opening permits from ODOT if work is required within a state route
Right-of-Way.
• Inspection appointments for water and sanitary sewer utility connections must be scheduled through the MCSE
website. The contractor’s registration number, location number, and permit ID number will be required to
schedule an inspection. The contractor is to contact the permit applicant to obtain the location number and permit
ID number.
• Inspections MUST be scheduled a MINIMUM of twenty-four (24) hours in advance.
• The contractor must be on-site during the scheduled inspection(s). If the contractor is not present during the
scheduled inspection, MCSE inspectors will not conduct the inspection and the contractor will be billed a
rescheduling fee.
• No work shall be covered prior to inspection and approved by the Sanitary Engineers Inspector.
• Taps for sanitary sewer or water must be scheduled a MINIMUM of 48 hours in advance. Taps are available
Monday – Friday, excluding holidays, at pre-set times of 9:00 a.m., 10:00 a.m. and 11:00 a.m. If the contractor
does not meet all excavation and safety requirements, as documented in this contractor registration packet, within
thirty (30) minutes of the scheduled tap, MCSE personnel will not perform the scheduled tap and the contractor
will need to reschedule. Additionally, the contractor will be billed for the MCSE’s personnel time and
material(s).
• Meter sets MUST be scheduled with the Permit Department a MINIMUM of 48 hours in advance.
• Contractors must utilize the MCSE website to cancel a scheduled appointment a MINIMUM of 24 hours in
advance of the scheduled inspection. Failure to cancel an inspection a minimum of 24 hours in advance will
result in the contractor being billed a rescheduling fee.
• If water and/or sewer utilities are not installed per the MCSE approved lot improvement map, MCSE inspectors
will not perform the scheduled inspection until a revised lot improvement map has been submitted and approved.
A re-inspection fee will be billed to the contractor, in addition to the plan review fee for reviewing the revised lot
improvement map.
• Rates are subject to change as established by County Resolution.
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
CONTRACTORS REGISTRATION APPLICATION
APPLICATION REQUIREMENTS
o MCSE Rules & Regulations Acknowledgment
o Ohio Workers Compensation Insurance Certificate
o Certificate of Liability Insurance –Use enclosed ACORD 25 form or equivalent – Limits must
match attached example, with X, C, U Protection – Explosion, Collapse, Underground Hazard
Protection stating Medina County Commissioners and the Medina County Sanitary Engineers
named as Additional Insured
o Contractor Indemnification Bond
o Renewal Fee: $50.00
o New Registration Fee: $100.00
Business Information
Business Name:
Federal Tax ID No. Insurance Expiration Date:
Street:
City: State: Zip:
Phone: E-mail:
Website:
Contact Information
Name:
Phone:
E-mail:
Applicant’s name here (Print): Date:
Applicant’s signature:
FOR OFFICE USE ONLY
Date Issued
Registration No.
Check No. / Cash
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
Contractor's Indemnification Bond
Known all men by these presents, that we ____________________________________________
as Principal, and _______________________________________________ of ______________, Ohio as Surety, are held
and firmly bound into the County of Medina, Ohio, on the sum of twenty five thousand dollars ($25,000), the payment of
which, well and truly to be made, we jointly and severally bind ourselves, our successors, heirs, executors, administrators
and assigns.
Witness our hands and seal this ______________ day of ____________________, 20______.
The conditions of this bond are such that whereas the said Principal has made application to the Medina County Sanitary
Engineer for a Certificate of Registration as a Contractor in the County of Medina for the year 20______.
Now, if the said Principal shall well and truly indemnify, keep and save harmless any person, firm, corporation, the
County of Medina, Ohio, or any of its agents or officials, from any loss or damages sustained from the failure to comply
with the Rules and Regulations of the Sanitary Engineer and the Medina County Commissioners, relating to the work
installing, repairing and/or replacing water mains, sanitary sewers, and water service connections and sanitary sewer
connections to Medina County utilities, then this obligation shall be void, otherwise it shall be and remain in full force and
effect.
Signatures:
______________________________________
Contractor Signature (Owner or Signatory Authority)
______________________________________
Surety (must have stamp from Insurance Company)
______________________________________
Printed Name
______________________________________
Printed Name
______________________________________
Date
______________________________________
Date
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$
$
$
$
PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS
(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBER
TYPE OF INSURANCE
LTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB
$EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$
PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT
LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
EXAMPLE
x
1,000,000
100,000
5,000
1,000,000
2,000,000
2,000,000
X,C,U Protection - Explosion, Collapse, Underground Hazard Protection
Medina County Commissioners
Medina County Sanitary Engineers
791 W. Smith Road
Medina, Ohio 44256
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
MCSE Rules & Regulations Acknowledgment
I do hereby certify that I am familiar with the requirements of the MCSE Rules & Regulations and Permit Department
policies, that all required permits will be obtained, inspections scheduled, and that all requirements will be strictly
observed subject to forfeiture of this registration.
I agree to obtain the appropriate approval of the road authority, to maintain proper registrations with the road authority,
and to obtain permits from the road authority as is necessary to perform my work.
I agree for taps to the MCSE sanitary sewer and/or water main, that I will not excavate until the day the tap is scheduled,
and I will backfill according to the requirements of the road authority.
I acknowledge my responsibility to notify the OHIO811 at 1-800-362-2764 or 811, a minimum of two (2) business days
(excluding holidays) prior to digging.
I shall comply with the documents included with this application packet, including the following:
Water Tap Excavation Requirements
OSHA Requirements
Traffic Control – OMUTCD Standards
I further acknowledge that if my failure to comply with these requirements is considered by the Sanitary Engineer's
representative to be unsafe and/or out of compliance that all work will cease and will not be permitted to proceed until the
standards are met.
I have reviewed these requirements with my employees and by signing below do hereby certify that work I, or any
employees working on my behalf, perform will be completed in compliance with the requirements of the MCSE, and that
any work found to be in non-conformance to MCSE requirements will be immediately corrected to the satisfaction of the
MCSE.
Applicant: ______________________________________
Contractor Signature (Owner or Signatory Authority)
______________________________________
Printed Name
______________________________________
Title
___________________ ________________
Date
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
NOTICE TO ALL REGISTERED CONTRACTORS
AND PROPERTY OWNERS
It is the Medina County Sanitary Engineers policy that all excavations performed in connection with water and
sewer taps MUST comply with the standards and specifications as set forth in the US Department of Labor
Occupational Safety & Health Administrations (OSHA) 29 CFR Subpart P - Excavations, 1926.650 through
1926.652. Simply stated, all excavations five foot (5') or deeper SHALL be properly boxed, shored, or laid
back to the satisfaction of the Sanitary Engineers representative at the work site. A ladder or other safe means
of ingress/egress shall be located in trench excavations.
Excavation of County owned sewer or water mains shall not take place until the day the water or sewer tap is
scheduled unless specifically permitted by the Sanitary Engineers Office.
Traffic control, including, but not limited to signs, lights and flagman, shall be provided by the contractor for all
work at the road site. All sites SHALL be protected using the specifications and standards as set forth in the
Ohio Manual of Uniform Traffic Control Devices (OMUTECD) and the ODOT Manual of Traffic Control for
Construction and Maintenance Operations.
If the trench and/or traffic control is considered deficient by the Sanitary Engineers representative and/or out of
compliance with OSHA and OMUTCD standards, all work will cease and will not be permitted to proceed until
the standards are met. Therefore, we are asking for your assistance in eliminating, or minimizing, unnecessary
delays by fully complying with all appropriate health and safety standards, guidelines, and policies.
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 WEST SMITH ROAD PO BOX 542 MEDINA, OHIO 44258
PHONE (330) 723-9585 FAX (330) 723-9661
TOLL FREE (844) 722-8404
Acceptable construction methods for sanitary sewer connections under
County/Township Roads
For all sanitary sewer connection to be installed under a County or Township Roads, the following method of
installation is acceptable:
1. Bore and Jack using a steel casing pipe with approved spacers per MCSE specifications. SDR-35 pipe
can be used inside the steel casing.
MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT
791 W. Smith Road, Medina, Ohio 44256
Phone: (330) 723-9585 Toll Free (844) 722-8404
Fax: (330) 723-9661
Water Tap Excavation Requirements
Taps need to be dug all the way around the pipe
Contractor shall not excavate to expose the county water main prior to the day the tap is scheduled to be performed by the
Medina County Sanitary Engineers.
Excavation Requirements for Plastic, Iron, and Concrete Pipe Taps and Service Line:
A minimum 4’ of water main, 1’ around the entire pipe, must be exposed to ensure that a tap is not made within 2’ of a
bell. A trench at least 2’ wide and 4’ - 5’ deep from final grade should be dug back to 1’-0” past the right-of-way or
utility easement for the installation of the water service and curb box.
Push and Receiving Pit Excavation Requirements:
A 5’ x 5’ pit is to be excavated 4’ from the edge of pavement for MCSE personnel to perform the push. A minimum of
2” - 3” of cover must be left over the water main if the main is located within the pit push. Pit should be level and directly
across from curb box location if possible. The front and back walls of the pit must be vertical. The receiving hole must be
a minimum 5’ x 3’excavated pit 4’ off edge of pavement.
If any utility is located between the push pits back wall and the road, the utility will need to be exposed prior to MCSE
personnel performing the push.
Back Wall
Road
5’ 5’
Front Back
Wall Wall 5’
Front Wall (Min 4’ off Pavement)
Roadside
Push Pit Cross Section View Push Pit Top View
CONTRACTOR IS TO SUPPLY: PUMPS, TRAFFIC SIGNS, FLAGMEN AND A MEANS
TO LIFT THE PUSH MACHINE INTO AND OUT OF THE
HOLE.
Contractor shall be responsible for researching depth, location, and any special conditions involving the
water line and/or the sanitary sewer line, at the point of proposed connection, prior to initiating
excavation.
GIVE THIS SHEET TO YOUR EXCAVATOR
Traffic Details for Medina County Sanitary Engineer’s Contractors
According to Chapter 6C. Temporary Traffic Control Elements state that a Temporary Traffic Control
(TTC) Plan “measures to be used for facilitating road users through a work zone or an incident area”.
“These plans play a vital role in providing continuity of effective road user flow when a work zone,
incident, or other temporary event disrupts normal road user flow.” TTC plans will be prepared by
someone knowledgeable (trained or certified individual) about the fundamental principles and practices
of the TTC work intended to be performed.
All contractors will have a knowledgeable person setup work safety zones with appropriate signs based
on the nature and complexity of the situation in accordance with the Chapter 6C of the Ohio Manual on
Uniform Traffic Control Devices (12
th
Edition).
Contractors assume all responsibility for proper signage and maintenance of that signage. All
contractors will have Qualified Flaggers. All qualified flaggers will have to meet the following standards
according to Chapter 6E of the Ohio Manual of Uniform Traffic Control Devices (12
th
Edition) or most
recent addition:
All flaggers should be trained in safe traffic control practices and public contact
techniques. Flaggers should be able to satisfactorily demonstrate the following abilities:
A. Ability to receive and communicate specific instructions clearly, firmly, and courteously;
B. Ability to move and maneuver quickly in order to avoid danger from errant vehicles;
C. Ability to control signaling devices (such as paddles and flags) in order to provide clear and
positive guidance to drivers approaching a TTC zone in frequently changing situations;
D. Ability to understand and apply safe traffic control practices, sometimes in stressful or emergency
situations; and
E. Ability to recognize dangerous traffic situations and warn workers in sufficient time to avoid injury
All flaggers will need to be wearing with High-Visibility safety apparel that meets Performance Class 2 or
3 requirements for ANSI/ISEA 107-2004 standards.
The distances shown in Table 6E-3, which provides information regarding for the determination of sign
spacing and other dimensions for various area and roadway types.
Table 6H-3. Meaning of Letter Codes on Typical Application Diagrams
Road Type
Distance Between Signs (Feet)**
A
B
C
Urban (low speed)*
100
100
100
Urban (high speed)*
350
350
350
Rural
500
500
500
Expressway/Freeway
1,000
1,500
2,640
*Speed category to be determined by highway agency.
** The column headings A, B, and C are the dimensions shown in Figures 6H-1 through 6H-46. The A dimension is the distance
from the transition or point of restriction to the first sign. The B dimension is the distance between the first and second signs.
The C dimension is the distance between the second and third signs. (The “first sign” is the sign in a three-sign series that is
closest to the TTC zone. The “third sign” is the sign that is furthest upstream from the TTC zone.)
The formula shown in Table 6H-4, is the formula to determining taper lengths.
Table 6H-4. Formulas for Determining Taper Lengths
Speed (S)
Taper Length (L) in Feet
40 mph or less
45 mph or more
L= WS
Where:
L = taper length in feet
W = width of offset in feet
S = posted speed limit, or off-peak 85th-percentile speed prior to work starting, or the anticipated
operating speed in mph
Most common signs that will be used are as follows: This chart can be fully referenced in the Ohio
Manual of Uniform Traffic Control Devices (12
th
Edition) or most recent addition Table 6F-1
Sign or Plaque
Sign
Designation
Section
Conventional
Road
Freeway or
Expressway
Minimum
Road Work (with
Distance)
W20-1
6F.20
36 X 36
48 X 48
30 X 30
Flagger
W20-7a
6F.31
36 X 36
48 X 48
30 X 30
Flagger (symbol)
W20-7
6F.31
36 X 36
48 X 48
30 X 30
End of Road
Work
G20-2
6F.57
38 X 18
48 X 24
-
One Lane Road
Ahead or
Distance
W20-4
5G.05
36 X 36
-
48 X 48
Below are a few examples of ideal setup for work zones which you may encounter in water and sewer
tap locations. Special situations or locations should be reviewed with our office and the contractor’s
knowledgeable person prior to construction starting. Full list of examples can be found in the Ohio
Manual of Uniform Traffic Control Devices (12
th
Edition) or most recent addition:
Lane Closure on a Two-Lane Road Using
Flaggers
Option:
1. For low-volume situations with short work
zones on straight roadways where the flagger
is visible to
road users approaching from both directions, a
single flagger, positioned to be visible to road
users
approaching from both directions, may be used
(see Chapter 6E).
2. The ROAD WORK AHEAD and the END ROAD
WORK signs may be omitted for short-duration
operations.
3. Flashing warning lights and/or flags may be
used to call attention to the advance warning
signs.
A BE PREPARED TO STOP sign may be added to
the sign series.
Guidance:
4. The buffer space should be extended so that
the two-way traffic taper is placed before a
horizontal
(or crest vertical) curve to provide adequate
sight distance for the flagger and a queue of
stopped
vehicles.
Standard:
5. At night, flagger stations shall be
illuminated, except in emergencies.
Guidance:
6. When used, the BE PREPARED TO STOP sign should be located between the Flagger sign and the
ONE LANE ROAD sign.
7. When a grade crossing exists within or upstream of the transition area and it is anticipated that
queues resulting from the lane closure might extend through the grade crossing, the TTC zone
should be extended so that the transition area precedes the grade crossing.
8. When a grade crossing equipped with active warning devices exists within the activity area,
provisions should be made for keeping flaggers informed as to the activation status of these warning
devices.
9. When a grade crossing exists within the activity area, drivers operating on the left-hand side of the
normal center line should be provided with comparable warning devices as for drivers operating on
the right-hand side of the normal center line.
10. Early coordination with the railroad company or light rail transit agency should occur before work
starts.
Option:
11. A flagger or a uniformed law enforcement officer may be used at the grade crossing to minimize the
probability that vehicles are stopped within 15 feet of the grade crossing, measured from both sides
of the outside rails.
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MEDINA COUNTY SANITARY ENGINEERING DEPARTMENT (Medina County)

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