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HomeMy WebLinkAboutApplication APPLICANT 1/10/2022City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 PERMIT REVIEW INTAKE FORM SPRINGFIELD W * (City Staff completes form) Permit Type Dept of Motor Vehicles -New: ❑ Land Use Compatibility Statement: ® City: Dept of Motor Vehicles -Renewal: ❑ Zoning Verification Letter: ❑ UGB: ❑ Project Information Applicant: Tessie Murakami 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: 17-03-35-42 TAX LOT NO(S): 10100 Property Address: 995 South A St., Springfield, OR 97477 Description of Proposal: LUCS for an existing back up generator required by DEQ Record Information Record No: 811-22-000016-TYP1 Date Received: January 10, 2022 Application Fee: $348.00 Technical Fee: $17.40 TOTAL FEES: $365.40 Assigned Planner: Revised 11.2.11 Id State of Oregon Department of Environmental Quality Land Use Compatibility Statement a� 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 LUCS may be found in Oregon Administrative Rules (OAR) Chapter 340, Division 18. When is a LUCS required? A LUCS 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 1.1) on p. 2 of this form. A single LUCS 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 significant increase in discharges to water or ground; 4. A relocation of an ouffall 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 LUCS and submits it to the appropriate city or county planning office. 2. City or County City or county planning office completes Section -2of 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 DEQ staff responsible for processing the permit or approval. DEQ 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 pace 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: Cellco Partnership (Verizon Wireless) 1 B. Project Name: Centennial Contact Name: Tessie Murakami, ACOM Consulting Inc. Physical Address: 995 S A St Mailing Address: 52005W Meadows Rd., Suite 150 City, State, Zip: Springfield, OR 97477 City, State, Zip: Lake Oswego, OR 97035 Tax Lot #: 1703354210100 (Acct 1572542) Telephone: 310.483.5343 Township: Range: Section: Tax Account #: Latitude: 44-02-40.08 N Longitude: 123 -DO -52.74W 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 American Tower Corp communications site with Verizon Wireless as a tenant. 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, on-site backup power generator was installed and the emergency generator was expected to have potential emissions at less than "de minimis" levels. -Generator Info: Manufacturer (MTU Onsite Energy), Model (DG03RJ096V1M12), Size (30 kw), Fuel type (Diesel), Install Date (10/21/2019). 1 D. Check the type of DEQ permit(s) or approval(s) being applied for at this time. F Air Quality Notice of Construction Clean Water State 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(fraffic 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 Pennit (for Solid Waste Composting Facility Permit onsite construction -installation permits use (includes Anaerobic Digester) the DEQ Onsite LLICS form) Conversion Technology Facility Permit E] 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 ✓ ew Permit Lrermit Modification ther: Section 2 — To be completed by city or county planning official Applicant name: Cellco Partnership (Verizon Wireless) Project name: Centennial 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 justified based on the plan policies, criteria, or standards. 2A. The project proposal is located: R Inside city limits R 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 sub'ect 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 activity allowed under Measure 49 2007)? FJNo, Measure 49 is not applicable I IYes, if yes, then check one: Express; approved by DLCD order #: Conditional; approved by DLCD order M Vested; a roved by local government decision or court'ud ment docket or order #: 2E. 16Nactivit 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 1 C. 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; findings are attached. Yes, the activity or use is allowed; findings are attached. 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: Plannin,q 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 800-452-4011 or email deginfo(av7dea.state.or.us.