HomeMy WebLinkAboutApplication APPLICANT 10/8/2008
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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
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Date Received:
Planner: AL
loh/ttUOf
! !
Revised 1/1/08 Molly Markarian
1 of 3
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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
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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
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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-"
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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
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Property Planning & Development
September 10, 2008
~ PeaceHealth
Amy Chinitz
Drinking Water Protection Coordinator
Springfield Utility Board
202 South 181h Street
Springfield, OR 97477
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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
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