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HomeMy WebLinkAboutApplication APPLICANT 10/8/2008 . . Return to: Amy Chinitz, Drinking Water Protection Coordinator Springfield Utility Board 202 South 18th Street Springfield, OR 97477 Phone: 541.744.3745 Email: AmyC@subutil.com Drinking Water Protection (DWP) Application Exemption Request Com an : Address: same as above Phone: see below Fax: A Iicant Name: PeaceHealth Ore 777 E. 11th Ave. P.O. Box 1479 Eu ene OR 97440 A licant's Re AICP Phone: 686-3828 Com an : Address: Fax: 335-2595 123 International Wa field OR 97477 Owner: same as a licant Phone: Fax: Com an Address: ASSESSOR'S MAP NO: 17-03-15-40 TAX LOT NO 5 : 2200 Pro ert Address: 353 Deadmond Fer Road Associated Land Use or Buildin Permit Case No.: DRC2008-00044 Planner: And Limblrd Size of Pro Property Owner: 1.07 , Pro osed Use: Nurse Midwifer Birth Center Acres I25J 5 uare Feet 0 Existin Use: Residential The undersigned acknowledges that the Information Included with thIs application Is correct and accurate. The undersigned also certifies that the total quantity of hazardous materials on the subject site will not exceed the amount J ted In this appllca Ion and wi not contain Dense Non-Aqueous Phase Liquids (DNAPLs). \-, S' Philip Farrington Print Date: Se tember 10, 2008 'd!k~~l<i.~l'f.!lli~rE:":>,t..o:~:;;:::';;;:-S..;;;',"li1o'~mz~,ti?:,'~i!,,,,,,tii%:~~i;""""~~~~j;:;'i!i~1.<~};;",;~,'t,~:~;:"?",,',';;"':<'ii,;;=l!j'~s,,,:;:~'m\)t!iS:',::::>'2;:.";::'::',;:;;:~~,-~ !'~~~~~~~itwt{~i~-ti;,~:!''!.fif;tg}1Wi~;g;:ci.~~,*j~''1!~i,Wfi,~"'i,i:ffi';iS~""~;~e~';$;;!o)t1)ij!f,iB;*.-2-~J Date Received: Planner: AL loh/ttUOf ! ! Revised 1/1/08 Molly Markarian 1 of 3 . . DWP Application Exemption Request Process Commercial and industrial facilities located within the DWP Overlay District that do not. store, use, or produce more than twenty gallons of hazardous materials and that do not contain dense non-aqueous phase liquids (DNAPLs) may choose to seek exemption from submitting a DWP application. However, even If the applicant's exemption from submitting a DWP application Is approved, th~ applicant may still be subject to DWP regulations if the Development Services Director, in consultation with the Springfield Utility Board (SUB) and the Fire and LIfe Safety Department, determine that an exempt hazardous material, activity, or facility has the potential to degrade groundwater quality. In such instances, the DWP regulations will be enforced concurrently with any associated land use application. 1. Applicant Submits a DWP Application Exemption Request to SUB . The request must conform to the DWP Application Exemption Request Submittal Requirements Checklist on page 3 of this application packet. . SUB conducts a detailed completeness check of the application. . SUB notifies the applicant in the event that submittal requirements are missing or unclear. Note: Sites may be Inspected at any time to verify Information provided in the submittal, and applicants may be requested to submit some or all Material Safety Data Sheets (MSDS) for items listed on the list of hazardous materials. . An application Is not deemed technically complete until all information necessary to evaluate the request has been provided to SUB. . Incomplete applications, as well as Insufficient or unclear data, will delay the application review process and may result in denial. 3. SUB Reviews the Application and SUB and the City Issue a Decision . SUB notifies the applicant and the Planning Division in writing regarding the decision to grant the exemption or not. . The Planner assigned to the associated land use case Incorporates the exemption decision and any applicable findings and conditions into the land use decision. . DWP application exemptions are not granted In perpetuity. If the conditions of exemption are deemed to have not been met at any point in time by SUB, a DWP application will be required. Date [?keceived: 1~/rJt7{).f . Planner: AL Revised 1/1/08 Moiiy Markarian 2 of 3 . . DWP Application Exemption Request Submittal Requirements Checklist NOTE: If you feel an item does not apply, please state the reason why and attach the explanation to this form. fZI DWP Application Exemption Request Form fZI Proposal Description - provide a very brief description of the nature of the business or operation, as well as a description of how the business or operation will 'use, store, or produce hazardous materials fZI List of All Hazardous Materials to be used, stored, or produced on the site (e.g., cleaning products, paints and paint products, pesticides, maintenance supplies, petroleum products, automotive supplies, etc.). Hazardous materials are defined as those chemicals or substances which are physical or health hazards as defined and classified in the most recently adopted or amended Fire Code by the City, whether the materials are in usable or waste condition. Commonly used office supplies do not need to be listed. The list should include the following for each hazardous material: fZI Name of the product fZI Manufacturer fZI Totai quantity of each product Date: Received: / iJ Ii ~o,f Planner: AL j-j^-e Revised 1/1/08 Molly Markarian 3 of 3 . . DWP Exemption Request - PHMG Nurse Midwifery Birth Center Proposal Description As described in the narrative for the approved DWP application (DRC2008-00044), the Applicant/Owner (PeaceHealth Oregon Region, or "PHOR") seeks to develop a new Nurse Midwifery Bit1h Center ("Birth Center") to be operated by PeaceHealth Medical Group at 353 Deadmond Ferry Road. Consistent with Condition #3 in the above- referenced DWP approval, PHOR now requests a DWP Exemption. As noted in the earlier application, the proposed BiI1h Center will not use, store or produce any DNAPLs. Also, as noted in the attached Hazardous Material Inventory Statement (HMIS) submitted with the DWP application, the Birth Center will not use, store or produce more than twenty (20) gallons of hazardous materials. Given the nature of the use - and as reflected in the HMIS - the Birth Center will have very few products that can be deemed a "hazardous material" as the tClm is used in SDC Section 3. Moreover, as noted in the HMIS, most ofthe products that will be used or stored on-site have non-hazardous ingredients per MSDS sheets, lllany do not have CAS numbers specified on the MSDS, many are commonly found topical creams or gels, and all are in relatively insignificant quantities such that they do not pose a risk to groundwater and in total quantity do not meet the 20 gallon threshold. Date r'i.eceived:--!~;; /;;006 Planner: AL Ij-" . . SI'RI',CFIELD UTII.I.IY l10ARD \Y;\.r;~:1 '::::,'::,"j" ,_"I'>:TI;){ 202 South 18th Street Springfield. OR 97477-5240 Tel 541.726.2396 F~;~: 541.747.7346 WW\....subutil.,:orll October 8, 2008 Andy Limbird Development Services City of Springfield 225 5th Street Springfield, OR 97477 RE: DRINKING WATER PROTECTION APPLICATION EXEMPTION REQUEST # DRC2008-00044 ASSESSOR'S MAP: 17-03-15-40 TAX LOT: 2200 ADDRESS: 353 DEADMOND FERRY ROAD Dear Andy: I have received the exemption request submitted by PeaceHealth Oregon Region for the Nurse Midwifery Birth Center project. The hazardous materials list indicates that the total quantity will not exceed twenty gallons and none of the products contain DNAPLs. Based on the information provided in the request, the exemption can be granted. Please note that the facility may be inspected at any time to verify the information provided in the exemption certification. Feel free to contact me at 541-744-3745 for further details or with any questions. Sincerely, ~QC,~ Amy E. Chinitz Water Quality Protection Coordinator AEC:mk cc: Philip Farrington, PeaceHealth Oregon Regioll, 1231nternaUonal Way, SprlngfiE!ld. OR 97477 Date Received:#~oP L-.. Planner: AL S:\Amy Chinitz\Businesses_DWP apps\Exemption Request Responses\Peacellcalth Nurse Midwifery Birth Center_lO-OS- OS.doc . . Property Planning & Development September 10, 2008 ~ PeaceHealth Amy Chinitz Drinking Water Protection Coordinator Springfield Utility Board 202 South 181h Street Springfield, OR 97477 ."",l\1/i'~,ti. lID :'.';j....;:;3 .1; ,t~ \-j !.- l'c::, "3't,,\.':"" . OJ e--.l~;;';- " .II" ' " '\ \) 'L~\\i\ (,.\}) " )\:\ " ,,,00\'1 j {\'-\ \~j" " n \11.-'. S\..il''"/ Dear Amy: Pursuant to Condition #3 in the recently approved DWP application (DRC2008-00044) for the proposed PHMG Nurse Midwifery Birth Center, I have attached an application for DWP Exemption, Included is the signed application form, a brief description ofthe proposal, and a list of hazardous materials (HMIS). If you need any further information, please contact me at 686-3828 or ofarrinl!ton(qlpeacehealth.orl!, Thanks for your consideration, and your usual courtesy. :lhF ' ~ Philip Farrington, AICP Director, Land Use Planning & Development PeaceHealth Oregon Region cc: Andy Limbird - City of Springfield Dedicated 10 Exceptio/lal A4edic;IIe mul Compassiollate Care Date, rteceived: Planner: AL It> 1d'/Jt1t' f I / Phone: (541) 335,2593 Fax: (541) 335-2595 RiverBend Annex 123 International Way Springfield, OR 97477 www.peacehealth.orgloregon . € ., c: -0 O)e.z ., " c: '" ~3 II U " CO li:~ -" CO ..J en o en :2 c: o "0 ., '" '" ~ rJJ " Z E o e l' o en go '0. 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