General Permit Registration Form for Contaminated Soil and/or Sediment Management (Staging and Transfer)

Transcription

1 General Permit Registration Form for Contaminated Soil and/or Sediment Management (Staging and Transfer) Please complete this form in accordance with the instructions (DEP-SW-INST-001) to ensure the proper handling of your registration. Print or type unless otherwise noted. You must submit the Permit Application Transmittal Form (DEP-APP-001) and the registration fee along with this form. Application No. Permit No. DEP USE ONLY Part I: Registration Type Check the appropriate box identifying the registration type. This registration is for (check one): A new registration A renewal of an existing registration Please identify any previous or existing permit/authorization/registration number in the space provided. Existing permit or registration number: Part II: Fee Information The following fees must be submitted with this registration form: For registrations: $ For approval of registrations: $ For renewal of registrations: $ For renewal of approval of registrations: $ The fee for municipalities is 50% of the above listed rate. The registration will not be processed without the fee. The fee shall be non-refundable and shall be paid by check or money order to the Department of Environmental Protection. Part III: Registrant Information 1. Fill in the name of the applicant/registrant(s) as indicated on the Permit Application Transmittal Form (DEP-APP-001): Registrant: Olin Corporation Business Phone: ext. Fax: Check here if there are co-registrants. If so, label and attach additional sheet(s) to this sheet with the required information. DEP-SW-REG of 6 Rev. 09/07/06

2 Part III: Registrant Information (cont.) 2. List primary contact for departmental correspondence and inquiries, if different than the registrant. Name: Olin Corporation Mailing Address: 3855 North Ocoee Street; Suite 200 City/Town: Cleveland State: TN Zip Code: Business Phone: ext. Fax: Contact Person: David Share Title: Director, Env Remediation 3. List attorney or other representative, if applicable: Firm Name: Mailing Address: City/Town: State: Zip Code: Business Phone: ext. Fax: Attorney: 4. Facility or Equipment Operator, if different than the registrant: Name: Sevenson Environmental Services, Inc. Mailing Address: 2749 Lockport Road City/Town: Niagara Falls State: NY Zip Code: Business Phone: ext. 290 Fax: Contact Person: Alan Elia Title: Vice President 5. Owner of the property on which the activity is to occur, if different than the registrant: Name: See attached Figure 1 for properties Mailing Address: City/Town: State: Zip Code: Business Phone: ext. Fax: Contact Person: Title: 6. List any engineer(s) or other consultant(s) employed or retained to assist in preparing the registration: Name: MACTEC Engineering and Consulting, Inc. Mailing Address: 511 Congress Street; PO Box 7050 City/Town: Portland State: ME Zip Code: Business Phone: ext. Fax: Contact Person: Nelson Walter Title: Project Manager Service Provided: Consulting Engineering Check here if additional sheets are necessary, and label and attach them to this sheet DEP-SW-REG of 6 Rev. 09/07/06

3 Part IV: Facility/Site Information 1. Name of facility, if applicable: Newhall Street Neighborhood Site Street Address or Description of Location: Non-Public Properties within the Consent Order Boundary (Consent Order No. SRD-128) City/Town: Hamden State: CT Zip Code: Latitude and longitude of the exact location of the proposed activity in degrees, minutes, and seconds: Latitude: Longitude: Method of determination (check one): GPS USGS Map Other (please specify): CT Environmental GIS Data If a USGS Map was used, provide the quadrangle name: 2. Is or will the site be located on federally recognized Indian lands? Yes No 3. Is the activity which is the subject of this application located within the coastal boundary as delineated on DEP approved coastal boundary maps? Yes No If yes, and this application is for a new authorization or for a modification of an existing permit, you must submit a Coastal Consistency Review Form (DEP-APP-004) with your application as Attachment B. For forms or assistance, please call the Permit Assistance Office at ] 4. Is the project site located within an area identified as a habitat for endangered, threatened or special concern species as identified on the "State and Federal Listed Species and Natural Communities Map"? Yes No Date of Map: December 2008 If yes, complete and submit a Connecticut Natural Diversity Data Base (CT NDDB) Review Request Form (DEP-APP-007) to the address specified on the form. When submitting this permit application, please include copies of any correspondence to the NDDB, including copies of the completed CT NDDB Review Request Form, any field surveys, and any other information which may lead you to believe that endangered or threatened species may or may not be located in the area of your existing or proposed permitted activity, as Attachment C. Has a field survey been conducted to determine the presence of any endangered, threatened or special concern species? Yes No If yes, provide: Biologist's Name: Address: and submit a copy of the field survey with your application as an Attachment as specified above. 5. Is the site located within an aquifer protection area as defined in section 22a-354a through 354bb of the General Statutes (CGS)? Yes No 6. Is the site located riverward of any stream channel encroachment lines (SCEL)? Yes No 7. Is the site located within an area of special flood hazard designated by the Federal Emergency Management Agency (FEMA)? Yes No If yes, will the project utilize any state funding? Yes No DEP-SW-REG of 6 Rev. 09/07/06

4 Part V: Project Information 1. Type of project (check one): Remediation Construction Utility Other (please specify): 2. Project description: Remediation of the Newhall Street Neighborhood Site Non-Public Properties located within the Consent Order Boundary in Hamden, CT. (Consent Order No. SRD-128). Project includes: excavation of waste fill; temporary staging and characterization of excavated fill; transportation of material to off-site permitted and authorized disposal facilities; backfilling the excavation areas with clean imported borrow soil; and restoration of pre-existing features (e.g., landscaping, patios, fencing, and driveways). Project implementation will be in accordance with the following documents: Newhall Street Neighborhood Remediation Project Selected Remedy Plan; Hamden, CT; Oct 2007 Final Design - Generic Remedial Action Plan; Non-Public Properties, Newhall Neighborhood; Hamden, CT; Revision 1: January 14, Anticipated start date of contaminated soil/sediment staging and transfer operations: Fall 2009 Part VI: For Renewals of Registrations Only 1. Provide a brief description of the status of the project. 2. Provide an explanation of why the project needs a renewal of registration. 3. Provide the anticipated remaining duration of the activities being conducted. DEP-SW-REG of 6 Rev. 09/07/06

5 Part VII: Supporting Documents Please check the box by the attachments being submitted as verification that all applicable attachments have been submitted with this registration form. When submitting any supporting documents, please label the documents as indicated in this part (e.g., Attachment A, etc.) and be sure to include the registrant's name as indicated on the Permit Application Transmittal Form. Attachment A: Attachment B: Attachment C: Attachment D: Attachment E: Attachment F: An 8 1/2" by 11" copy of the relevant portion or a full-sized original of a United States Geological Survey (USGS) quadrangle map, with a scale of 1:24,000, showing the exact location of the site and the area within a one-mile radius of the site. Identify the quadrangle name and number on such copy. Coastal Consistency Review Form (DEP-APP-004), if applicable. CT NDDB Information (DEP-APP-007), if applicable. Facility Site Plan (applicable only to only registrations requiring approval) Facility Description (applicable only to only registrations requiring approval) Facility Operation and Management Plan (applicable only to only registrations requiring approval) Note: A letter must be submitted to the chief elected official of the municipality in which the subject facility is or will be located informing him or her that a registration for this general permit has been submitted to the department and, if applicable pursuant to Section 4(a)(2)(B) of the General Permit for Contaminated Soil and/or Sediment Management, to the municipal Aquifer Protection Agency. A suggested letter format is attached to this registration form for your convenience. DEP-SW-REG of 6 Rev. 09/07/06

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7 HAMDEN PARK DRIVE MILL ROCK ROAD NORTH SHEFFIELD STREET Document: C:\Documents and Settings\drpendleton\My Documents\_Projects\OLIN - Hamden\GIS\Mapdocuments\Property Status_15Jun2009.mxd PDF: C:\Documents and Settings\drpendleton\My Documents\Figure 1 - Properties Requiring Remediation.pdf 06/15/2009 3:24 PM drpendleton HAMDEN PARK DRIVE Legend 230 Properties Requiring Remediation Edge of Fill Line HAMDEN PARK DRIVE Fill Thickness Contour Line (4 ft) Fill Thickness Contour Line (10-20 ft) NPP Consent Order Boundary HAMDEN PARK DRIVE HAMDEN PARK INDUSTRIAL CIRCLE T AUGUR STREET REMINGTON STREET HARRIS STREET NEWHALL STREET PACIFIC STREET BLAKE CIRCLE BLAKE CIRCLE AUGUR STREET FARNSWORTH STREET BLAKE ROAD ROLFE ROAD GILES STREET LAMKIN STREET 0 GEM ST. COLUMBUS STREET ALLING STREET GOODRICH STREET DUDLEY STREET DUDLEY COURT ST MARY STREET MORSE STREET GOODYEAR EDWARDS STREET SHELTON AVENUE G A E H F J K P L M N R Q S Feet BUTLER STREET MARLBORO STREET MORSE STREET SHEPARD STREET GOODRICH STREET Olin Corporation Newhall Street Neighborhood Hamden, CT NEWHALL STREET NEWHALL STREET NEWBURY STREET MORSE STREET MARLBORO STREET B WINCHESTER AVENUE WINCHESTER AVENUE WINCHESTER AVENUE 1071 MILL ROCK ROAD C D BRYDEN TERRACE PROSPECT LANE WADSWORTH STREET HOMELANDS TERRACE MORSE STREET BRYDEN TERRACE PROSPECT COURT PROSPECT STREET Prepared/Date: DRP 06/15/09 Checked/Date: APP 06/15/09 Properties Requiring Remediation Project Figure 1 PROSPECT STREET

8 ATTACHMENT A USGS QUADRANGLE MAP

9 brpeters 12/03/2008 9:14 AM PDF: P:\Projects\Olin Hamden Newhall St\4.0_Deliverables\4.10_GIS\GIS\Figures\Figure 4-1 Site Location Map.pdf Document: P:\Projects\Olin Hamden Newhall St\4.0_Deliverables\4.10_GIS\GIS\Mapdocuments\SiteLocationMap_RAP_8x11P.mxd SITE LOCATION Connecticut 1:24,000 scale digital topographic map obtained from National Geographic TOPO! maps via ESRI ArcGIS Online map service: NGS_Topo_US_2D at: 0 1,000 Property-Specific Remedial Action Plan Newhall Street Neighborhood Hamden, Connecticut 2,000 Feet Prepared/Date: BRP 12/03/08 Checked/Date: DRP 12/03/08 Figure 4-1 Site Location Map

10 ATTACHMENT C CT NDDB INFORMATION

11 Connecticut Natural Diversity Data Base Review Request Form Please complete this form only if you have conducted a review which determined that your activity is located in an area of concern. Name: David Share Affiliation: Olin Corporation Mailing Address: 3855 North Ocoee Street; Suite 200 City/Town: Cleveland State: TN Zip Code: Business Phone: ext. Fax: Contact Person: David Share; Director, Env Remediation Project or Site Name: Newhall Street Neighborhood Site Project Location Town: Hamden Title: USGS Quad: New Haven Brief Description of Proposed Activities: Project includes excavation and off-site disposal of waste fill up to 4 feet deep, in accordance with Consent Order No. SRD-128. Have you conducted a State and Federal Listed Species and Natural Communities Map review? Yes No Date of Map: December 2008 Has a field survey been previously conducted to determine the presence of any endangered, threatened or special concern species? Yes No If yes, provide the following information and submit a copy of the field survey with this form. Biologists Name: Address: If the project will require a permit, list type of permit, agency and date or proposed date of application: CTDEP GPs: Contaminated Soil & Sediment Management; Discharge of Stormwater & Dewatering Wastewaters from Construction; and Discharge of Groundwater Remediation Wastewater to Sewer August 2009 (See reverse side - you must sign the certification on the reverse side of this form) DEP-APP of 2 Rev. 01/09/06

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13 brpeters 12/03/2008 9:14 AM PDF: P:\Projects\Olin Hamden Newhall St\4.0_Deliverables\4.10_GIS\GIS\Figures\Figure 4-1 Site Location Map.pdf Document: P:\Projects\Olin Hamden Newhall St\4.0_Deliverables\4.10_GIS\GIS\Mapdocuments\SiteLocationMap_RAP_8x11P.mxd SITE LOCATION Connecticut 1:24,000 scale digital topographic map obtained from National Geographic TOPO! maps via ESRI ArcGIS Online map service: NGS_Topo_US_2D at: 0 1,000 Property-Specific Remedial Action Plan Newhall Street Neighborhood Hamden, Connecticut 2,000 Feet Prepared/Date: BRP 12/03/08 Checked/Date: DRP 12/03/08 Figure 4-1 Site Location Map