HomeMy WebLinkAboutApplication APPLICANT 1/10/2022City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
I9PNINOFI�
(City Staff completes form)
lPermitType
Dept of Motor Vehicles -New: ❑
Land Use Compatibility Statement: ® City:
Dept of Motor Vehicles -Renewal: ❑
Project Information
Applicant: Tessle Murakami
Zoning Verification Letter: ❑ UGB: ❑
Phone: 310-483-5343
Company: ACOM Consulting Inc.
Email:
Address: 5200 SW Meadows Rd., Suite 150; Lake Oswego, OR 97035
Property Owner:
Phone:
Company:
Cell:
Address:
ASSESSOR'S MAP NO: 17-03-22-00
TAX LOT NO(S): 904
Property Address: 3365 Game Farm Rd., Springfield, OR 97477
Description of Proposal: LUCS for an
existing back up generator required by DEQ
Record.
Record No: 811-22-000015-TYP1
Date Received: January 10, 2022
Application Fee: $348.00
Technical Fee: $17.40
TOTAL FEES: $365.40
Assigned Planner:
Revised 11.2. 11 M
State of Oregon Department of Environmental Quality
M Land Use Compatibility Statement
What is a Land Use Compatibility Statement?
A LUCS is a form developed by DEQ to determine whether a DEQ permit or approval will be consistent with local government
comprehensive plans and land use regulations.
Why is a LUCS required?
DEQ and other state agencies with permitting or approval activities that affect land use are required by Oregon law to be
consistent with local comprehensive plans and have a process for determining consistency. DEQ activities affecting land use
and the requirement for a LUGS may be found in Oregon Administrative Rules (OAR) Chapter 340, Division 18.
When is a LUCS required?
A LUGS is required for nearly all DEQ permits and certain approvals of plans or related activities that affect land use prior to
issuance of a DEQ permit or approval. These permits and activities are listed in section 1.D on p. 2 of this form. A single LUGS
can be used if more than one DEQ permit or approval is being applied for concurrently.
Permit modifications or renewals also require a LUCS when any of the following applies:
1. Physical expansion on the property or proposed use of additional land;
2. Alterations, expansions, improvements or changes in method or type of disposal at a solid waste disposal site as
described in OAR 340-093-0070(4)(b);
3. A signifcant increase in discharges to water or ground;
4. A relocation of an outfall outside of the source property; or -
5. Any physical change or change of operation of an air pollutant source that results in a net significant emission rate
increase as defined in OAR 340-200-0020.
How to complete a LUCS:
Step
Who does it?
What happens?
1.
Applicant
Applicant completes Section 1 of the LUGS and submits it to the appropriate city or county
planning office.
2.
City or County
City or county planning office completes Section 2 of the LUCS to indicate whether the activity
Planning Office
or use is compatible with the acknowledged comprehensive plan and land use regulations,
attaches written findings supporting the decision of compatibility, and returns the signed and
dated LUCS to the applicant.
3.
Applicant
Applicant submits the completed LUCS and any supporting information provided by the city or
county to DEQ along with the DEQ permit application or approval request.
Where to get help:
For questions about the LUCS process, contact the DEC staff responsible for processing the permit or approval. DEC staff may
be reached at 1-800-452-4011 (toll-free, inside Oregon) or 503-229-5630. For general questions, please contact DEQ land use
staff listed on our Land Use ComoatibilitvStatement oaae online.
Cultural resources protection laws:
Applicants involved in ground -disturbing activities should be aware of federal and state cultural resources protection laws. ORS
358.920 prohibits the excavation, injury, destruction, or alteration of an archeological site or object or removal of archeological
objects from public and private lands without an archeological permit issued by the State Historic Preservation Office. 16 USC
470, Section 106, National Historic Preservation Act of 1966 requires a federal agency, prior to any undertaking, to take into
account the effect of the undertaking that is included on or eligible for inclusion in the National Register. For further information,
contact the State Historic Preservation Office at 503-378-4168, ext. 232.
Oregon DEQ Land Use Compatibility Statement
Section 1 —To be completed by the applicant
1A. Applicant Name: Calico Partnership (Verizon Wireless)
1B. Project Name: Baldy View
Contact Name: Tessie Murakami, ACOM Consulting Inc.
Physical Address: 3365 Game Farm Rd
Mailing Address: 5200 SW Meadows Rd., Suite 150
City, State, Zip: Springfield, OR 97477
City, State, Zip: Lake Oswego, OR 97035
Tax Lot #: 1703220000904801 (Acct 1858313)
Telephone: 310.483.5343
Township: Range: Section:
Tax Account #:
Latitude: 44-04-57.52 N
Longitude: 123-03-53.31 W
1C. Describe the project, include the type of development, business, or facility and services or products provided (attach
additional information if necessary):
The facility Is an existing Verizon Wireless cellular communications site. As an unmanned facility, it relies on backup/emergency power
generators to keep cell service active during any utility outages. The facility produces no physical products. For this project, the existing,
onsite backup power generator was installed and the emergency generator
was expected to have potential emissions at less than "de
minimis" levels.
-Generator Info: Manufacturer (Detroit Diesel/MTU Onsite Energy),
Model (VER50DGC6NLT3), Size (50 kw), Fuel type (Natural Gas), Install
Date (6/8/2011).
1 D. Check the type of DEO permit(s) or approval(s) being applied for at this time.
❑✓ Air Quality Notice of Construction
Clean Water Stale Revolving Fund Loan
Air Contaminant Discharge Permit
Request
Air Quality Title V Permit
❑ Wastewater/Sewer Construction Plan/
Air Quality Indirect Source Permit
Specifications (includes review of plan
❑ Parking/Traffic Circulation Plan
changes that require use of new land)
❑ Solid Waste Land Disposal Site Permit
❑ Water Quality NPDES Individual Permit
❑ Solid Waste Treatment Facility Permit
Water Quality WPCF Individual Permit (for
❑ Solid Waste Composting Facility Permit
onsite construction -installation permits use
(includes Anaerobic Digester)
the DEQ Onsite LUCS form)
Conversion Technology Facility Permit
Water Quality NPDES Stormwater General
Solid Waste Letter Authorization Permit
Permit (1200-A, 1200-C, 1200 -CA,
Solid Waste Material Recovery Facility Permit
1200 -COLS, and 1200-Z)
Solid Waste Energy Recovery Facility Permit
Water Quality General Permit (all general
Solid Waste Transfer Station Permit
permits, except 600, 700 -PM, 1700-A, and
Waste Tire Storage Site Permit
1700-B when they are mobile)
Pollution Control Bond Request
Water Quality 401 Certification for federal
❑ Hazardous Waste Treatment, Storage or
permit or license
Disposal Permit
This application is for: Permit Renewal L/ ew Permit
LPermit Modification ther:
Section 2 — To be completed by city or county planning official
Applicant name: Cellco Partnership (Verizon Wireless)
Project name: Baldy View
Instructions: Written findings of fact for all local decisions are required; written findings from previous actions are acceptable.
For uses allowed outright by the acknowledged comprehensive plan, DEQ will accept written findings in the form of a
reference to the specific plan policies, criteria, or standards that were relied upon in rendering the decision with an indication of
why the decision is'ustified based on the Ian olicies criteria, or standards.
2A. The project proposal is located: Inside cit limits
Inside UGB Outside UGB
2B. Name of the city or county that has land use jurisdiction (the legal entity responsible for land use decisions for
the subject property or land use):
2C. This project is not within the jurisdiction of any other land use, zoning, or planning entity
This project is also within the jurisdiction of the following land use, zoning, or planning entity
2D. Is the activityallowed under Measure 49 (2007)? No, Measure 49 is not applicable Yes, if yes, then check one:
Express; approved by DLCD order #:
Conditional; approved by DLCD order #:
Vested; approved by local government decision or court judgment docket or order #:
2E. Is the activit
a composting facility?
No
Yes; Senate Bill 462 (2013) notification requirements have been met.
2F. Is the activity or use compatible with your acknowledged comprehensive plan as required by OAR 660-031?
Please complete this form to address the activity or use for which the applicant is seeking approval (see 1.0 on the previous
page). If the activity or use is to occur in multiple phases, please ensure that your approval addresses the phases described in
1C. For example, if the applicant's project is described in 1C. as a subdivision and the LUCS indicates that only clearing and
grading are allowed outright but does not indicate whether the subdivision is approved, DEQ will delay permit issuance until
approval for the subdivision is obtained from the local planning official.
The activity or use is specifically exempt by the acknowledged comprehensive plan; explain:
Yes, the activity or use is pre-existing nonconforming use allowed outright by (provide reference for local ordinance):
Yes, the activity or use is allowed outright by (provide reference for local ordinance):
Yes, the activity or use received preliminary approval that includes requirements to fully comply with local requirements;
findin s are attached.
LJ Yes, the activity or use is allowed; findings are attached.
EJ No, see 2D. above, activity or use allowed under Measure 49; findings are attached.
No, (complete below or attach findings for noncompliance and identify requirements the applicant must comply with before
compatibility can be determined):
Relevant specific plan policies, criteria, or standards:
Provide the reasons for the decision:
Additional comments (attach additional information as needed):
Planning Official Signature: Title:
Print Name: Telephone #: Date:
If necessary, depending upon city/county agreement on jurisdiction outside city limits but within UGB:
Planning Official Signature: Title:
Print Name: Telephone #: Date:
Alternative formats
DEQ can provide documents in an alternate format or in a language other than English upon request. Call DEQ at
800-4524011 or email deginfo(W.deg.state.or.us.