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HomeMy WebLinkAboutTransfer Station Forms (DEPT. USE ONLY) OEe APPLICATION # DEPARTMENT OF ENVIRONMENTAL CONTROL TRANSFER STATION I RECYCLING CENTER PERMIT APPLICATION TYPE OF PERMIT (Check all applicabla boxes) Or-eN o RENEWAL o MOOIFlCAllON OWNERSHIP: LOCA llON: FACILITY OWNER NAME FACILITY OWNER NAME ADDRESS ADDRESS TOWN I STATE I ZIP TOWN I STATE I ZIP TELEPHONE TELEPHONE NEW YORK STATE DEC TRANSFER STATION PERMIT NUMBER EXPIRATION DATE EFFECTIVE DATE List all officers by name and title, and all persons wRh financial Interest In this application as follows: the application shall contain the na"'e of the applicant or, If a partnership or corporation, the names of all partners, officers, directors and all persons holding 5% or more of the outstanding shares of said corporation. If the applicant Is a corporation which Is wholly or partially owned by another corporation, the parent corporation shall be Identified together wRh the name of the officers and director of the parent corporation. Type of Ownership: 0 Sole Proprietorship 0 Par1nership 0 Corporation (If owned by parent corporation, provide information on additional sheet.) A. OFFICER I PARTNER B. OFFICER I PARTNER NAME NAME ADDRESS ADDRESS TOWN I STATE I ZIP TOWN I STATE I ZIP C. OFFICER I PARTNER D. OFFICER I PARTNER NAME NAME ADDRESS AODRESS TOWN I STATE I ZIP TOWN I STATE I ZIP Have you or any parson listed above been convicted of a violation of the law, other than a traffic violation? DYes o No If yes, explain: Pao81 CAPACITY REQUEST I PRELIMINARY RECOVERY ESTIMATE Types of Waste to be Accepted: o Commercial Solid Waste o Construction and Demolition Debris o Other (please specifiy) QUANTITIES TO BE ACCEPTED: MATERIALS TO BE RECOVERED: Commercial Solid Waste: tons/day vdsJday o Newspapers o Corrugated Cardboard Construction and Demolition: tons/day yds'day o Glass o Ferrous Other: tons/day vds'day o Plastic o Mixed Paper o Aluminum Other: tons/day vdsJday o Other (please specify) PLEASE DESCRIBE SEPARATION SYSTEM TO BE EMPLOYED (i.e. hand sorted or automated): LIST CARTING FIRMS FROM WHOM WASTE WILL BE ACCEPTED: (attach add/tional sheets if needed) A. FIRM 1: B. FIRM 2: NAME NAME ADDRESS ADDRESS TOWN/STATE/ZIP TOWN/STATE/ZIP TELEPHONE TELEPHONE C. FIRM 3: D. ARM 4: NAME NAME ADDRESS ADDRESS TOWN / STATE / ZIP TOWN/STATE/ZIP TELEPHONE TelEPHONE Page 2 WilL MATERIAL BE ACCEPTED FROM OUTSIDE THE TOWN 0 YES 0 NO IF YES, LIST THE CARTING FIRM AND THE JURISDICTION FROM WHERE MATERIAL WILL BE COLLECTED: (attach additional sheets il needed) FIRM I JURISDICTION FIRM I JURISDICTION FIRM I JURISDICTION FIRM I JURISDICTION FIRM I JURISDICTION FIRM I JURISDICTION PLEASE LIST MARKETS I OUTLETS FOR RECOVERED MATERIALS (NAME & LOCATION ): NEWSPAPER GLASS PLASTIC (identify types) ALUMINUM CORRUGATEDCARD80ARD FERROUS METAL MAGAZINES MIXEO PAPER PLEASE IDENTIFY DISPOSAL FACILITIES FOR RESIDUAL WASTES: NAME I LOCATION: NAME I LOCATION: NAME I LOCATION: NAME I LOCATION: Page 3 8TATE OF NEW YORK) : 8.S. COUNTY OF ) , being duly sworn, deposes and says that he/she is the of . the applicant herein; that all the information submitted with this application is true; that the applicant agrees to comply with all provisions of Chapter 21 of the Code of the Town of Islip which regulates the collection and disposal of solid waste and the operation of Transfer Stations/Recycling Centers; that the applicant understands that failure to comply with the rules and regulations of the Town of Islip or any false statements made on any part of this application shall be grounds for denial and/or revocation of this permit. SIGNATURE ACTION BY TOWN CLERK: (A) Approved: Permit No. . expires: (B) Disapproved: EFFECTIVE DATE PERMIT * PERMIT TO OPERATE TRANSFER STATION I RECYCLING CENTER EXPIRATION DATE TYPE OF PERMIT (Check an applicable boxe.): o NEW o RENEWAL o MODIFICATION PERMIT ISSUED TO: I TELEPHONE NUMBER: ( ) ADDRESS OF PERt,lITTEE: CONTACT PERSON FOR PERMITTED WORK: I TELEPHONE NUMBER: ( ) NAME AND ADDRESS OF FACILITY I COMPANY: ! DESCRIPTION OF AUTHORIZEO ACTIVITY: . . By acceptance of this permit. the permittee agrees that the permit is contingent upon strict compliance with Chapter 21 of the Town Code. all applicable regulations, the General Conditions spec.ified (see reverse side) and any special conditions included as parl of this permit. Dept. of Environmental Control Town of Islip Dept. of Environmental Control . - 401 Main Street, Isllp, NY 11151 AuthoriZed Signature Data Page 1 of GENERAL CONDITIONS Transfer Station I Recycling Center INSPECTIONS: 1. The permitted site or facility. including relevant records. is subjeClto inspection at reasonable hours and intervals by an authorized representative 01 the Department 01 Environmental Control to determine whether the permittee is complying wkh this permk and Chapter 21 01 the ToNn oIlsllp Code. A copy 01 this permit, including all referenced maps. drawings and special conditions. must be available lor inspection by the Department at all times at the project site. Failure to produce a copy 01 the permit upon request by a Department representative. Is a violation 01 this permit. PERMIT CHANGES AND RENEWALS: 2. The Department reserves Ihe righlto modify. suspend or revoke this permit when: a) the scope d the permitted activity is exceeded or a violation d any condition d the permit or provisions 01 the Chapter 21 and pertinent regulations is Iound; b) the permit was obtained by misrepresentation or failure to disclose relevant facts; c) new material informallon is discovered; or d} environmerCal conditions. reIevanI technology, or appIlcab1e law or regulationS have materially changed since the permit was issued. 3. The permittee must submit a separate written application to the Department lor renewal. modification or transfer 01 this permit. Such application must include any Iorms. lees or supplementallnlormation the Department requinls. Any renewal, modification or transfer granted by the Department must be in writing. "......,...". 4. The permittee must submit a -' appIicalionat least.30 days b8f0re.expinIlion~uf .8llJSling ~"; .~... -.' S. Unless expressly provided for the Department. issuance 01 this permit does nOt modify, supercede or rescind any order 01 determination previously issued by the Department or any ollhe terms, conditions or requirements contained in such order or determination. OTHER OBUGATIONS OF PERMITTEE: 6. The permittee has accepled expressly. by the execution 01 the application. the full legal responsibility lor all damages. direct or indirect. 01 whatever nature and by whomever suffered, arising out 01 the project described in lhis permit and has agreed to indemnify and save harmless the lOwn oIlslip from suits. actions. damages and COS1 01 every name and description resulting lrom Ihis project. 7. This permit does nol convey to the permittee any rights to trespass upon the lands or interfere with the riparian rights 01 others in order to perform the permitted WOfk nor does it authorize the Impairment 01 any rightS. tkle or interest in real or personal property held or vested in a person nO! a perty 10 the permit. 8, The permittee is responsible lor obtaining any other permits, apprlMlls, land. easements and rights-OI-way that may be required lor this project. TOWN of ISLlP DEPARTMENT OF ENVIRONMENTAL CONTROL PERMIT TO OPERATE TRANSFER STATION I RECYCUNG CENTER (Pursuant to Chapter 21 - Code of the Town of Isllp) Appendix A SPECIAL CONDITIONS 1. All applicable special conditions contained in the attached Part 360 Permit issued by New Yo!1< State Department of Environmental Conservation shall be made a part and special condi- tions of this Town of (slip Permit to Operate. This shall include a requirement that all quarterty and annual reports filed by the permittee with New Yo!1< State Department of Environmental Conservation shall be filed with the Town of Islip Office of Recycling. 2. The permittee shall maintain a record of materials separated at the facility for reuse/recycling for use by the Town in projecting the amount of commercial wastes recycled in the Town. 3. Applicant to submit a renewal application by December 1. . .. ' . .. GENERAL CONDITIONS Transfer Station I Recycling Center INSPECTIONS: 1. The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Control to determine whether the permittee is complying with this permit and Chapter 21 of the Town of Islip Code. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site. Failure to produce a copy of the permit upon request by a Department representative, is a violation of this permit. PERMIT CHANGES AND RENEWALS: 2. The Department reserves the right to modify, suspend or revoke this permit when: a) the scope of the permitted activity is exceeded or a violation of any condition of the permit or provisions of the Chapter 21 and pertinent regulations is found; b) the permit was obtained by misrepresentation or failure to disclose relevant facts: c) new material information is discovered; or d) environmental conditions, relevant technology, or applicable law or regulations have materially changed since the permit was issued. 3. The permittee must submit a separate written applications to the Department for renewal, modificallOl. or transfer of this permit. Such application must include any forms, fees or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. 4. The permittee must submit a renewal application at least 30 days before expiration date of existing permit. 5. Unless expressly provided for the Department, issuance of this permit does not modify, supercede or rescind any order of determination previously issued by the Department or any of the terms, conditions, or requirements contained in such order or determination. OTHER OBLIGATIONS OF PERMITTEE: 6. The permittee has accepted expressly, by the execution of the application, the full legal responsibility for all damages, direct or indirect, of whatever nature and by whomever suffered, arising out of the project described In this permit and has agreed to indemnify and save harmless the Town of Islip from suits, actions, damages and cost of every name and description resulting from this project. 7. This permit does not convey to the permittee any rights to trespass upon the lands or interfere with the riparian rights of others In order to perform the permitted work nor does it authorize the impairment of any rights, title or interest in real or personal property held or vested in a person not a party to the permit. 8. The permittee is responsible for obtaining any other permits, approvals, land, easements and rights-of- way that may be required for this project. TOWN OF ISLlP ~ ~ DEPARTMENT OF ENVIRONMENTAL CONTROL Christopher A. Andrade, Commissioner TRANSFER STATION/RECYCLING CENTER FACILITY INSPECTION REPORT FACILITY NAME LOCATION FACILITY NO. DATE INSPECTOR'S NAME PERSONS INTERVIEWED AND TffiES WEATHER CONDITIONS DEC PERMIT NUMBER SHEET CONTINUATION SHEET ATTACHED of DYES DNo C NIV ODD ODD ODD ODD ODD ODD ODD ODD ODD ODD ODD ODD o 0 0 ODD ODD ODD ODD ODD Violations of Town ofIslip Solid Waste Code are subject to applicable civil, administrative and criminal sanctions. Additional and/or multiple violations may be described on the attached continuation sheet. This form is a record of conditions which are observed in the field at the time ofinspection. Items marked C are in compliance, NI are inspected, and V is in violation. Permit Pending D Permit Renewed D Complaint D FACILITY MANAGEMENT I. Solid waste management facility is authorized and management occurs within approved area. 2. A sign is posted with the hours of operation and the types of solid waste accepted and not accepted. 3. Storage space is adequate for incoming solid waste. 4. Adequate fire equipment is available. 5. Operator maintains and operates facility components and equipment in accordance with the permit and their intent 6. Operational records are available where required. a. Unauthorized Solid Waste Records. b. Permit Application records. c. Monitoring Records. d. Facility Operator Records. OPERATION CONTROL 7. Solid waste, including blowing litter, is sufficiently confined or controlled. 8. Dust and dirt is effectively controlled, and does not constitute an off-site nuisance. 9. On-site vector populations are prevented or controlled, and vector breeding areas are prevented. 10. Odors are effectively controlled so that they do not constitute a nuisance. WATER II. Solid waste is prevented from entering surface waters and/or groundwaters. 12. All floors are free from standing water. ACCESS 13. Access to the facility is strictly and continuously controlled by fencing, gates, signs, natural barriers or other suitable. 14. On-site roads are passable. COMMENTS: : TOWN OF IS LIP DEPARTMENT OF ENVIRONMENTAL CONTROL 401 Main Street Islip, NY 11751 Eric M. Hofmeister, Commissioner TRANSFER STATIONIRECYCLING CENTER QUARTERLY REPORT Submit the Quarterly Report no later than 14 calendar davs after each quarter ends. Quarter I is from January 151 to March 31", Quarter 2 is from April I st to June 30th, Quarter 3 is from July I st to September 30th and Quarter 4 is from October 1st to December 31 st. Reporting of the information indicated on this Transfer StationIRecycling Center Quarterly Report form is required pursuant to Chapter 21 of the Town ofIslip Solid Waste Code. Failure to provide the required information requested is a violation of said Code. Forms should be filled out completely and returned to: Town ofIslip Department of Environmental Control 40 I Main Street Third Floor Room 302 Islip, NY 11751 Atten: Chris Andrade Entries on the report forms should be typewritten. Attach additional sheets if space on the pages is insufficient or supplementary information is required or appropriate. v , QUARTERL Y REPORT This Transfer Station/Recycling Center Quarterly Report is for the year 1st Quarter 0 2"d Quarter 0 3rd Quarter 0 4th Quarter 0 SECTION 1 Owner/Facility Information Facility Name Facility Location State Zip Facility Contact Phone No. ( ) Fax No. ( ) Town County NYSDEC Facility Code or Registration No. Registered Facility YES NO 360 Permit No._- / Issued -----.1-----.1_ Expires -----.1-----.1_ Owner Name Phone No. L--> Mailing Address State Zip SECTION 2 Ouantity of SoUd Waste Received Report the tonnages/cubic yards of solid waste received on Table A. A. Values were obtained by: (check one) Scale Weight Cubic Yards Initial Page I of6 TABLE A r Type of Solid Waste Quarter Quarter Quarter Quarter Total 1 2 3 4 Gross tons/cubic yards of mixed Solid Waste and Recyclables (Residential, Institutional & Commercial) Gross tons/cubic yards of Construction & Demolition (C&D) Debris Gross tons/cubic yards of Asbestos Waste Gross tons/cubic yards ofIndustrial Waste (Including Industrial Process Sludges) Other (Specify: \ Total Tons Received Total container's Capacity of all non-residential stops, and multiple residence stops serviced by collection vehicles. Facilitv's Service Area IdentifY the location and container capacity of all nonresidential and multiple residences stops located within the Town ofIslip. (Use separate sheet if needed) Address of Stop Container CaDacitv Initial Page 2 of6 This information will be treated by the Town as trade secrets, which if disclosed could cause substantial injury to the competitive position of the person submitting the information. SECTION 3 Material Recovered For each type of solid waste recovered, provide the weight in tons or cubic yards. Values were obtained by: (check one) Scale Weight Cubic Yards Type of Solid Waste Quarter Quarter Quarter Quarter Total Recovered 1 2 3 4 Aggregate & Concrete Wood & Wood Chips Glass Plastic Paper Cardboard Metals Other (Specify: ) Total Tons Recovered lnitial SECTION 4 Page 3 of6 Unauthorized Solid Waste Has this facility received any violations or summonses from any governmental, municipal, or other agency Yes No. If Yes, give information below. Date Issuing Agency Contact Person Type of Violation Received Has unauthorized solid waste been received at the transfer station during the reporting period? YES NO If Yes, give information below for each incident: Date Type Received Date Disposal Method & Location Received Disposed Transfer\Disposal Destination Identify the transfer or disposal destination of waste removed by indicating the name of the transfer/disposal facility, the County, State and the amount transferred. Transfer Disposal Facility County State Tons Initial Page 4 of6 " SECTION 5 Problems IdentifY any problems encountered during the reporting period (e.g. specific occurrences which have led to changes in facility procedures) and methods for resolution of the problems. List submissions (required by this section) that have been attached to this form or the reasons for not attaching a required piece of information: SECTION 6 Chane:es IdentifY any changes in the operation that have occurred during the reporting period (e.g. equipment, service area, and operational procedure changes). List submissions (required by this section) that have been attached to this form or the reasons for not attaching a required piece of information: SECTION 7 Permit/Consent OrderlRetdstration ReDOmnl! Reauirements Are there any additional permit/consent order/registration reporting requirements not covered by the previous sections of this form? Yes No If Yes, identifY the reporting requirements with their respective responses below, attaching additional sheets as necessary. List submissions (required by this section) that have been attached to this form or the reasons for not attaching a required piece of information: Initial Page 5 of6 . SECTION 8 Sipature and Date bv Owner or Operator NOTE: Owner or Operator must initial each page, sign, date and submit one completed form, with an original signature to: Town ofIslip Department of Environmental Control 40 I Main Street Third Floor Room 302 Islip, NY 11751 Atten: Chris Andrade I hereby swear or affirm that information provided on this form and attached statements and exhibits is true to the best of my knowledge and belief. Signature Date Name (Print or Type) Title (Print or Type) ! Address City ( ) Phone Number State and Zip Initial Page 6 of6 Town of Islip Transfer Station Documentation Transfer Station: Address: (Coot) Contact: Tel#__ Fax#__- NYSDEC Permit Expiration Date: Town ofIsIip Permit Expiration Date: Annual Town ofIsIip Renewal Package Mailed on: Received on: Complete: YES / NO ( If No ) Quarterly Reports Annual Report 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Year Year Year Year Year Comments: