HomeMy WebLinkAboutApplication APPLICANT 5/11/2011
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Frorn:MWMC Plant Operations
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541+744+6163
04/.2011 10:50
#023 P.007/009
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Amy Chinitz, Drinking Water Protection Coordinator
Springfield Utility Board
202 South 18th Street
Springfield, OR 97477
Phone: 541.744.3745
Email: AmyC@subutil.com
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Drinking Water Protection (DWP) Application Exemption Request
- . .....
541-726-4432
A licant Name: Dave Stan e Plant erations Director
Com an :
Address:
McKenzie-Willamette Medical Center
Fax:
541-744-<i163
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Iicant's Re .. Daniel Klute, AlA
Phone
541-344-9157
541-344-8604
Com an :
Address:
Gerald McDonnell & Associates Architects PC
Fax:
860 W. Par Suite 300
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Owner: McKenzie-Willamette Medical Center
Phone
541-726-4432
Com an McKenzie-WiIlamette Medical Center
Fax:
541-744-6163
Address:
1460G
TAX LOT
4601
ASSESSOR'S MAP NO: 17-03-36-22
1460 G Street, S rin field, OR 97477
Associated Land Use or
Buildin Permit Case No.:
Acute care hospital, development area is
Existin Use:
Size of Pro
8.71 ac
Planner: Tara Jones
No change of use proposed, proposed
Pro osed Use: .
Acres
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Property
Owner:
The undersigned acknowledges that the information: included with this application Is correct and accurate. The
undersigned also certifie;t=i that the total quantity of ~azardous materials on the subject site will not exceed the
amount li~ted 1~ _~~IS_~~licatlO~:nd will not contaIn Dense Non-Aqueous Phase liquids (DNAPLs).
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Print
Date:
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Date Received:S{III, .
Planner: lM ~
Revised 1/1/08 Molly Markarian
1 of 3
From:MWMC Plant Operations
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541+744+6163
04.2011 10:50
#023 P.008/009
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 hazard6us materials and that do not contain dense
non-aqueous phase liquids (DNAPLs) may choose to:iseek exemption from submitting a DWP
application. However, even if the applicant's exemption from submitting a DWP application is
approved, the 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.
r-'- ~--~;"P.d:~
Revised 1{1{08 Molly Markarian
2 of 3
Frorn:MWMC Plant Operations ~
541+744+6163
04./2011 10:50
#023 P.009/009
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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.
I2l DWP Application Exemption Request Form
I2l 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 SEE BELOW.
I2l 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:
I2l Name of the product
I2l Manufacturer
I2l Total quantity of each product
McKenzie- WilIame/le Medical Center (MWMC) is an acute care, 114-bed hospital serving the Lane County area.
The parcel is fully developed, and the current land use application proposes minor modifications to the improvement
area. A new concrete pad will be installed for a new freezer and compressor unit, separate from existing structures
by more than 15', minimum. This accessory structure and equipment will replace an existing unit and will contain
approximately (2) gallons R 404A Refrigerant by National Refrigerants or equal in the compressor unit. The product
is not listed in the Fire Code. No new hazardous materials will be stored or produced as a result of this work.
Date Received:~
Planner: LM
Revised 1/1/08 Molly Markarian
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