HomeMy WebLinkAbout024-98 Timber Ridge Treatment Center - Backfile (2)r 6
SITE PLAN CHECKLIST
The checklist below indicates all the information that needs to be submitted as part of the site plan
application. All required information must be submitted prior to the final approval of any site plan.
The Department of Planning and Development will review the application to ensure that it is complete.
If any portion is not included or complete, the site plan application will not be accepted and returned
to the applicant(s).
Site Plan Package
1. One set of approved comment sheets are required from the following review
agencies prior to final site plan approval. It is recommended that applicants contact
the Department of Planning and Development to determine which review agencies
are relevant to their site plan application.
Virginia Department of Transportation (VOOT)
Frederick County Sanitation Authority
Department of Planning and Development
Inspections Department
Frederick County Engineer (Public Works)
Frecenck County Fire Marshal
7< Department of Parks and Recreation
2. One copy of the Site Plan application
3. Five Copies of the Final Site Plan for approval
County Health Department
_ City of Winchester
Town of Stephens City
X Town of Middletown
Airport Authority
4. One reproducible copy of the Site Plan (if required)
5. A 35mm slide of the Site Plan (if required)
7 Soil & Water Conservation District
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CASH
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RECEIPT
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ORDER
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June 9, 1998
Mr. Gary Oates
Greenway Engineering
151 Windy Hill Lane
Winchester, VA 22602
COUNTY of FREDERICK
Department of Planning and Development
540/665-5651
FAX: 540/ 678-0682
RE: Approval of Timber Ridge Dormitory Addition Site Development Plan #024-98
Dear Gary:
The Frederick County Planning Department administratively approved Site Plan #024-98 for the above
referenced site plan on June 2, 1998. This site plan, for the construction of a 13,440-square-foot dormitory
building addition to the Timber Ridge Treatment Center, meets all County requirements for development
within the RA (Rural Area) zoning district.
I have provided you with several copies of the approved site plan. Please advise the owner to keep an
approved copy for their files and maintain an approved copy on the construction site. Once the site
development has been completed, the owner should contact this office to schedule an on -site inspection.
Please contact me if you have any questions regarding this letter.
Sincerely,
Michael T. Ruddy
Planner H
MTR/cc
cc: Richard C. Shickle, Gainesboro District Supervisor
Robert Mongold, Real Estate
Joe C. Wilder, Engineering Technician
Garland Miller, Winchester/Frederick County E.D.C.
Leary Educational Foundation, Inc.
U:\MIKEIW NIMONMSITEPLAMTRIDOAPP.SPR
107 North Kent Street - Winchester, Virginia 22601-5000
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1. Project Title:
2. Location of Property
(street address)
3
4.
5
SITE PLAN APPLICATION
Property Owner: r'-�A�1r' �DUGA�oNAL FoLR,1PATIaN, lNG.
Address:
WINGHE57EP VA,
Telephone: Sao) (o (o %- 6 30 3
Applicant/Agent 69600 WA'r ti G
Address IS-1 V\1it4i>Y HI LL- LAIC 11
Wiit6HESTarz , VA. 2-6o2-
Telephone: 4 Z— 4-19 S
Designer:
cA)
al
Telephone:
,!::,A 7r� 5
Contact: GAP-` P-.
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6. Is this an original or revised site plan? Original ✓ Revised
7a. Total acreage of parcel to be developed: 0. 75 a64e
7b. Total acreage of parcel: / Z ( • 2, a Cites
8. Property Information:
a) Property Identification Number:
b) Current Zoning: /z A
c) Present Use: f2ES/t?u-y- AL. 712c-ATtvteN7"GENTeP-
d) Proposed Use: �A
e Adjoining Property Use(s) KE5/DuN7IAL-TKEAnlfENT GErJ77-iz
Adjoining Property Identification Number(s)
g) Magisterial District(s)._ GAI'yE
have read the material included in this package and understand what is required by the
Frederick County Planning Department. I also understand that all required material will be _
complete prior to the submission of my site plan.
Signature:
Date:
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COUNTY OF FREDERICK, VIRGINIA
FIRE MARSHAL'S OFFICE
LAND DEVELOPMENT COMMENTS
Control No.SP98-0023R Date Received 4/27/98 Date Reviewed 5/15/98
Applicant Greenway Engineering Plan Rev. Date:
Address 151 Windy Hill LN
Winchester, VA
Project Name Timber Ridge School
Type of ApplicationSite Plan
1st Due Fire Co. 1st Due Rescue Co.
Tax I.D. No. 6-A-18
RECOMMENDATIONS
Phone No.
Current Zoning RA
Election DistrictGainesboro
Automatic Sprinkler SystemXX Residential Sprinkler System
Automatic Fire Alarm SysteinYX Other
REQUIREMENTS
Emergency Vehicle Access
Adequate XX Inadequate Not Identified
Fire Lanes Required Yes XX No
Comments Access must be maintained during construction.
Roadway/Aisleway Widths Adequate XX
Special Hazards Noted Yes No XX
Comments
Inadequate Not Identified
1 J41
,y:
sMi r
Hydrant Locations Adequate Inadequate Not IdentifiedXX '01
�� �.'•; F _: "'\
y q q
Siamese Location Adequate Inadequate Not Identified XX:;: A�,;
Additional Comments Attached? Yes No XX
ided? Yes XX No
Signature Title
•
Request For Site Plan Comments
Frederick County Inspections Department
Mail to,• Hand deliver tc
Frederick County Inspections Dept. 107 N. Kent Sth
Attn: Building Official Fourth Floor
107 North Kent Street Winchester, VA
Winchester, VA 22601 _ (540) 665-5650
(540) 665-%50
se " fill out the information as accurately as possible in order to assist the agency with tncir
review. Please attach one (11))'copy of the site plan with this sheet.
Applicant's Name:
Address:
Phone Number.
Name of development
description of the request:
Location of property: l S 2- z I J " 0-t. -CoII,
Inspections Department's Comments: cAranents are on the back of this form.
17
Request For Site Plan Comments
Frederick County Engineerinq Department���°''�
0
Mail to:
Hand deliver to: 'FFRFOF 98
Frederick County Engineering Dept. 107 N. Kent Street Nc& Ns F
Attn: Director of Engineering Fourth Floor �o
107 North Kent Street Winchester, VA tis
Winchester, VA 22601 (540) 665-5643
(540) 665-5643
Please fill out the information as accurately as possible, in order to assist the agency with their
review. Please attach two (2) copies of the site plan with this sheet.
Applicant's Name:
Address:
6 Gt Z7� [v b Z-
Phone Number:
Name of de/,/plopmentt/and/o/r descrip/ icon of the request: t
Engineering Department's Comments: �%dn Rem
fy1
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ez a fi z P/a c
5• G vie ey. -��-e- Sly l a'-,-.. i �- a
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G}G� - ko 6yb 1 if 6-f- SI fC ,�/Gs,^
1(P Q —I-k f41.f Cl- ZG;.,42�
ti 7i�7i- elf ,0210Ie 7LV D� 700 ?
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Request for Site Plan Comments
Virginia Department of Transportation
Mail to:
Virginia Department of Transportation
Attn: Resident Engineer
P.O. Box 278
Edinburg, Virginia 22824-0278
(540) 984-5600
Hand deliver to:
Virginia Department of Transportation ---- ;
1550 Commerce :Street J . ' ..
Winchester, VA
(540) 722-3460 , ,
irr. r .) 1 1,993
Please fill out the information as accurately as possible in order to -assist the Virginia 'Department
of Transportation with their review. Please attach five (5y copies of the site plan _with,traffice
generation data and drainage calculations with this sheet
Applicant's Name:
Address:
Phone Number. 6 Z
Name of developmentand/or description of the request:
'- n. f- ^ -
rr t� A!( I.z I�jr, Z �. .� /� ,r• i� / ( C r s.
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Location of property: P-4-e . SZ Z A-t a,-� _s
l4-(0 3 ti cw �/2c
Virginia Department of Transportation's Comments:
No objection to this site plan. Present entrances is adequate for proposed
imorovements. Should business ever expand in the future, entrance s .may
need to be upgra e .
Request For Site Plan Comments
Frederick County Engineering Department .
Mail to: Nand deliver to: 61,
Frederick County Engineering Dept. 107 N. Kent Street
Attn: Director of Engineering Fourth Floor Fc�
107 North Kent Street Winchester, VA
Winchester, VA 22601 (540) 665-5643
(540) 665-5643
Please fill out the information as accurately as possible in order to assist the agency with their
review. Please attach two (2) copies of the site plan with this sheet.
Applicant's Name: 6teekzually
Address:
Phone Number.
N me of dev lopment and/or descri
I . . iT / I_
/ S¢�
the request:
(/a zzcv a z -
&4Z- ¢'lSr
Engineering Department's Comments:y2 n geLA*ew
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3 , i cc LL4 c c , •+-e
2&V-M-P c,
S�gk-- r`f- a_ 2e�I —e
f"I-e- 5 '/c P/,-:, r,,ie own.
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SITE PLAN CHECKLIST
The checklist below indicates all the information that needs to be submitted as part of the site plan
application. All required information must be submitted prior to the final approval of any site plan.
The Department of Planning and Development will review the application to ensure that it is complete.
If any portion is not included or complete, the site plan application will not be accepted and returned
to the applicant(s).
Site Plan Package
1. One set of approved comment sheets are required from the following review
agencies prior to final site plan approval. It is recommended that applicants contact
the Department of Planning and Development to determine which review agencies
are relevant to their site plan application.
Virginia Department of Transportation (VDCT)
_ X Frederick County Sanitation Authonty
Department of Planning and Development
Inspe=ons Cepartment
Frederick County Engineer (Public Works)
Fredenck County Fire Marshal
X Department of Parks and Recreation
2. One copy of the Site Plan application
3. Five Copies of the Final Site Plan for approval
County Hearth Ceoartment
x C;ty of Wincnester
_ x Town of Stephens City
4 Town of Middetown
—X Airport Authonty
f Soil 3 Water Conservation Cistnc*
4. One reprcducible copy of the Site Plan (if required)
5. A 35mm slide of the Site Plan (if required)
8
Site Plan Information Checklist
The following information must be inducted on your site plan. If your site plan is incomplete or
is missing information, it will not be reviewed and returned to you for revisions.
Administrative Information
Y N
1.
Name of proposed development.
2.
Name, address, and phone number of owner.
3.
Name, address, and phone number of developer.
4.
Name, address, and phone number of designer.
5.
Certificate of surveyor, engineer, or architect.
6.
Date plan prepared and date of revisions.
7.
A listing of all conditions placed on the site as a result of a
conditional use permit or conditional zoning approval.
8.
A space labeled 'Approved by the Zoning Administrator' for
the approval signature and date of approval.
9.
A description of setbacks or conditions placed on the site as a
result of a variance approval. (Reference the variance
application number.)
General Site Information
Y N
10
Location map (scale 1:2000)
11.
Magisterial Cistnct
12.
Scale of site plan (net :o exceed 1:50)
13.
Nora arrow
14.
Zoning of site
15
Use, zoning, and Property Identification Number (PIS of all
adjoining properties. This includes properties located across
right-af-ways, streams, and railroad tracks.
16.
Surveyed boundaries for all lots and parcels.
0
1H
General Site (can't
Y N
17.
Ac-eage of all lots included in the plan.
18.
The location and dimensions of all required setbacks and yard
areas.
_ 19.
The location and type of all dwelling units.
20.
Location and description of all recreation faclities.
21.
Location of sidewalks and pedestrian ways.
22.
Location and area of Gammon open space.
23.
The location, height, and dimensions of all signs.
24.
Location, height, and specifications of outdoor lighting fixtures.
25.
Location and nature of outdoor storage areas.
26.
Location of outdoor trash receptacles and dimensions of
structure (fencing, etc.) required to enclose receptacles.
Buildina Information
Y N
27. The height of all buildings and structures.
28. Lccation of all buildings, structures and uses.
29. The proposed use of eacti building, structure and area.
30. Ground floor area and total floor area of all buildings with PAR
calculations for commercial and industnal zoning aistnc:s.
Roads
Y N
31. Name and number of existing and planned streets on and
adjoining the site.
32. Lccadon of existing and planned streets on and adjoining the
site.
33. Posted speed limit of existing adjacent roads.
34. Location and dimensions of all proposed entrances from public
right-of-ways.
I
•
•
35. Location of all entrances an adjoining roads within 200 feet of the
proposed or existing entrance.
36. Dimensions, boundaries, width, pavement, and construction of
planned roads.
Utilities
Y N
Location of all utilities, including sewer and water lines with the
size of lines, mains, and laterals.
/ 38. Location and width of all easements, including access, utility,
and drainage easements.
39. Location and nature of fire lanes, fire hydrants, and all other
facilities necessary to meet Fire Cade requirements.
Panting
Y N
40. Calculations describing the required number of parking and
loading spaces.
41. Location and dimensions of all parking and loading spaces,
driveways, parking aisles, curbing and other features to be used.
42. Location and dimension of all disabled parking spaces and
ramps.
Natural Features
Y N
43. Existing and finished contour lines.
44. Location of steep slopes, woodlands, floodplains, wetlands,
sinkholes, and other environmental features.
45. Location of streams and drainage ways.
I
CJ
•
Landscaping
Y N
4� Landscaping plan describing location and peso is to be
used.
' 47. Location of required buffers and screening with cross sections or
profiles.
Erosion and Sediment Control
Y . N
u
48. A stormwater management plan with run off calculations and
location and description of facilities to be used.
49. Soil erosion and sedimentation control plan describing the
location and methods to be used to minimize erosion and
sedimentation during development.
12
U
Request For Site Plan Comments
Department of Planning and Development
Mail to: Hand deliver to:
Department of Planning and Development 107 N. Kent Street
Attn: County Planner Fourth Floor
107 North Kent Street Winchester, VA
Winchester, VA 22601 (540) 665-5651
(540) 665-5651
Please fill out the information as accurately as possible in order to assist the agency with their
review. Please attach two (2) copies of the site plan with this sheet.
Applicant's Name: A
Address:4-4 LEI
Phone Number: I Z -
Location of property: Ake S2 z 0 ; key-' g�1�
Planning and Development's Comments:
U.
5. P, -A 674 - 1761 "I"
' m TIMBER RIDGE SCHOOL SCHOOL: PHONE (540) 888-3456
LEARY EDUCATIONAL FOUNDATION, INC. FAX (540) 888-4511
DEVELOPMENT OFFICE: PHONE (540) 667-6303
P.O. Box 3160 • Wir(CHESTER, VIRGINIA 22604-2360 FAX (540) 722-9383
REDMI�pt�ticc
. � pdministr�°�
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-ut ,�, 0-\Jl. (&�� I
4, �TA W o-� a-�
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flu_ ^J'�m,9�"A-0-0-
p 8tifi 3�5� x zzl. ��Qsm�
Dto,�Q, hon��i. St�Vict�
Member. Virginia Association of Independent Specialized Education Facilities
National Association of Private Schools for Exceptional Children
National Association of Child Care Workers Associations, Inc.
[ •• - h 2 CrlaracterSrrnCh) Form APPr OVNJ OMB No 7000 OJ7J wODlO vJl C. prrCs J JU .,
FOriM U.S. ENVIRONMENTAL PROTECTION AGENCY
1. EPA I.D. NUMBER
INFORMATION�'
EPAConsolidatedGENERAL
Permits Program
F
C
ry
GENERAL Read (he "General /nttclions" before rtart,nc I
'
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GENERAL INSTRUCTIONS
I1 a preprinted label has been provided, affix
I. EPA 1.0. NUMBER \ \.\
;. ti� •n, �, s„-• a�a. .. ,ti _r -
\I. FACILITY ITY•NAME \ \� \ a
through It and enter the correct data In the
appropriate fill-in area below, Also, if any of
\\\
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the preprinted data is absent (the area to the
\\
left Jebel lists information
FACILITY `.`\
of the space the
V. MAILING ADDRESS ` PLEASE PLACE EL IN THIS SPACE
that should appear), please provide it in the
\ \ \
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roper fill-in area(s) below. If the label is
complete and correct, you need not complete
Items I, III, V, and VI (exceot Vl•B which
\ \ \ \
\ \
\
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rnus( be cwnpleted regardfuss'i. Complete at:
items if no label has been provided. Refer to
FACILITY
V I• \
LOCATION \
the instructions for detailed item descrip-
tions and for the legal authorizations under
\
which this data is collected.
H. POLLUTANT CHARACTERISTICS
I.':S T RUCTIONS: CamoI2te A ::trough J to determine whether you need to submit any permit application forms to the EPA. If you answer "yes" to any
`form and the supplemental form listed in the parenthesis following the question. Mark "X" in the box in the third column
c_es ions, you m s s_7mit :-is
if :~e supplemen:al fort is a-a=^ed. If you answer "no" to each question, you need not submit any of these forms. You may answer "no" if your activity
see Section C of the instructions. See also, Section 0 of the instructions for definitions of bold-faced terms.
:s ex-,!uded from e!-tit re; ,i mentz;
MARK
SPECIFIC :.. CSTIONS
rep
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IA TTACHC
SPECIFIC QUESTIONS I Tcs I ..o
ro"•.
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A. Is this fac:i: a publicly owned treatment works
resJ :s -1 3 discharge ,o waters of the U.S.?
I
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Does or will this facility (either existing or proposed
B. l
include a concentrated animal fending operation or I �(
aquatic animal production facility which results in a
=Cat 2
discharge to waters of the U.S.? (FORM 2B)
2 is :^,s a :ac"•:. .,- c- _ -:.s res.,,:s ,,,, Icnare
I I
X
oposed facility (oher than chose described
in A or B above) which will result in a discharge to :
1 \I
te U.S an thoewaters dgin
o- y - above% - - --
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water of the U.S.? (FORM 2D1 :+ . ,+
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F, Gp you J.., ::ii: y'Pu i ii. ::n;l
'o>_s 3r .Y.'! ;- s __ __., r:c•e, or ois�)ose Of ,
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rnunicipal effluent below the lowermost stratum con•
one mile of the well Pore, Xi
hazardous was, es -
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taining, within quarter
underground sources of drinkinc water? (FORM 41
_ _- a.^_ �• „ - s -a: :, 3'Y J'�C'J CEO
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ri. Do you Or win r�u Inlec: at z. :aCl{I:'j il{IIOs io. sPE-
n27?" J: J•-_ .. _, ••� =- a•a DrPug-.: to ;nE surface I
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;:. _o„ec;.;,- w.;- :=-.- c^al oil o:-a;u:al _as 7ro•
cial processes such as mining of sulfur by the Frascrl
process, solution mining of minerals, in situ compus• •Y i
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-•_= •_- e:lnarce-_ 'ecovery of Y i
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tion of fossil fuel, or recovery of geothermal energy. I
oil or na;u73: -s. r - ' -•cs for s:orao- of Mould I
(FORM 4) —
II :'a cat, S:a;IOnary Source Y.NC:: a I
J. Is this facility a proposed stationary source wniC'• ;s i I
�n :^e n.
•,a.�., !00 :ons i
NOT one of :ne 28 inaus nal categories :isteP In e :
instructions an7 'wnlch will ao;entlally emit 2�� :c^s
-_ ,_-__ ,� : _ ;-,; /
E -„^.e- ..,1ec un=e; ;he I /
per year of any air aollu:ant rEoulated under the C.ea^. ! `I
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_ �„ _-_ -_, __• or -_ osa:ee .n an I ;
Air Ac; ane may after, or be Iocated in an attainment
area? (FO^r.' 5) •�
a-ainment 3fe3
III. -NAME OF FACILITY
S K: P
:v ACILITY C0%TACT
_ IaNE A -IT'-E ..n: 4'1:
S. CITY OR TOWN C.STA TE O ZIP CODE '
'.•I FACILITY LOCH 0—N
--__- =3JTE No OR OT•+ER SPCCIFIC IDENTIFIER
_ CITY CR TO—rn DSTA 7_ C �Ir•COOC ��,lrty t
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ONlINUtU hKUM Inc —Uv I
VII. SIC CODES [Q-digir, in order ofprioriryl
' A. FIRST 8. SECONO "
(speclf)•) 1;::�J
(specift)
7
Elr n�z� tip af;rl «LNc�n� ��..,15
C. THIRD O. FOURTH
y) ` (specify)
=4(sp-1
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Vill. OPERATOR INFORMATION
.II the name fitted i'
Item V111-A
C
�A.ME
also th
owner?
8
)Ml_� j D�� S�- 1� U O YES NO
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C. STATUS OF OPERATOR (Enter the appropriate fetter into the answer box: if "Other", specify.)
D. PHONE (area code & no.)
F F DERAL M -PUBLIC (other than federal or start)
(specify)
`
011
S - STATE O - OTHER (specify)
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P - PRIVATE
E. STREET OR P.O. 8OX
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F. CITY OR TOWN
G.STATE
H. ZIP CODE
IX. INDIAN LAND 12
ttIs the facility located on Indian lands?
�1 ( �� �- l� F T F' V L L �o l� T O YES [X:NO
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X- EXISTING ENVIRONMENTAL PERMITS
A. NPOES (Discharges to Surface Water) D. Ps❑ (Air Emissions from Proposed Sources)
C C T
9 N U A, C), J, L 9 P -
G. UIC (U-der_-ct-:d )- --^Or. of Fluids)
C. OTHER (Specify/
C i T
9
(specify)
9 1 U
_. PcRA (Nc:ardous Wastes)
E. OTHER (Specify)
----
C I T I
C
I T
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(specify)
9 1 R — --
9
X 1. MAP
Attach to this application a topographic map of the area extending to at least one mile beyond property bounderies. The map must show
the outline of the facility, the location of each of its existing and proposed intake and discharge structures, each of its hazardous waste
treatment, storage, or disposal facilities, and each well where it injects fluids underground. Include all springs, rivers and other surface
water bodies in the map area. See instructions for precise requirements.
XI1. NATURE OF BUSINESS (provide a brief description)
j-uF:
XIII. CERTIFICATION (see instr%fctionsJ
/ certify under penalty of law that / have personally examined and am familiar with the information submitted in this application and all
attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the
application, I belkw that the information is true, accurate and complete. I am aware that there are significant penalties for submitting
false utfomWion, itll kding the possibility of fine and imprisonment:
A. I�Af..0 at 400 if ICIAL. TIT L.0 (typr O, print/ SI NitATURC OAT r. SIGHLO
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1. t t l (.A I ; 1. 1 I . y 1 t f , ,, . ,,. / r
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COMhttNTS POA OFrict" LXa ONLY
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MEW
EPA ID Number (copy from Item 1 of Form 1) I r•orm Approved
OMB No. 2040.0086
Please type or print in the unshaded areas only Approvaiexpires r-ir-cc
Form
2E SwEPA Facilities Which Do Not Discharge Process Wastewater
NPOES
For this outfall, list the latitude and longitude, and name of the receiving water(s).
Outfall
Latitude
Longitude
Receiving Water (name/
Number (list)
Deg Minj
Sec
Deg
Min
Sec
II. Discharge Date (/1 a new discharger, the date you expect to begin discharging)
III. Typo of Waste
A. C ecic the boxes) indicating the general type(s) of wastes discharged, Other Nonprocess
❑
Sanitary Wastes lCRit Restaurant or Cafeteria Wastes•. ❑ Noncontact Conlin Water Wastewater (Identify)
B. If any cooling water additives are used, list them here. Briefly describe their composition if this information is. available.
NA
IV. Effluent Characteristics
A. Gisiing •S,)u,-c^_- — "::.vide rnao: Lur:Te.nts fcr :he parameters lister' in the left-hand column below• unless waived by the
permitting
authority (see instructions).
B. New Dischargers — Provide estimates for the parameters listed in the left-hand column below,
unless waived by the permitting
authority. Instead of ;he number of measurements taken, provide the source of estimated values (see instructions).
(7)
(2)
(Jl fort (a)
Number of
Source of
Pollutant or
Maximum
Average Daily
Parameter
Daily Value
value (last year)
Measurements
Estimate
(include units)
(include unitsl
Taken
(if new
Mass
Concentration
Mass
Concentration
(last year/
dischargerl
emaOD)
Comanc (Bocnemical OD)
%
�n
/
Ci I L
Teal Suscer.Ce-! S,:Iies :Tssi
) ,7
1'"4
°-cal Coldorm ti/ Ze6eveo
;,resent or i/ sanitary w_„e is i
rll
^ I /1
1Lc.. c. F
discharged)
''c � tc•<' ,Y �.
7 '
Total Residual Chlcnne tit
ch/cnre is used)
I v" C
�?
Cd and Grease i - I -
I �. Lac'
C_i
t •C.`2-cal Cx-, �Cn .!n..•a.nd I It\
r n
'Total organic caryn t-OCi
Ammonia (as N)
I e i
Value
Discharge Flow
C •..
% �-'l i
L)
„H (give range/
Value
r
Temperature (Winter)
I , • I C
°
'C
iemoerature (Summer!
I i- 1 °C
,J / °C
5 L< I,
noncontaci c:ot,ng naier S ,SCharged
Pane 1 CI
EPA Form 3510.2E !9 861
V. Except for leatcs or spills, will the discharge described in this form be intermittent or seasonal? ❑
If yes, briefly describe the frequency of flow and duration. Yes 0 No
VI. Treatmem System (Describe briefly any treatment system(s) used or to be use
7-1L,/- TTcDGE �kc;C�.SS=c;i_Cc;c�?�D f 3t� S�ccNDq�y
C�AkI Fl C_A 1 lot, �. I iLC=�IN/�T�C:�1 "�(: i✓i-1LC:121lJgJ lC�� J S i
k t9 T ) 0 �1
VII. Other Information (OpuonalJ
Use the space below to expand upon any of the above questions or to bring to the attention of the reviewer any other information you 'eel
s`cufd be considered in establishing permit limitations. Attach additional sheets, if necessary.
If. Certification
/ certify under penatry of la w treat this document and all attachments were prepared under my direction or supervision in accordance with
a s ystem designed to assov a :het ,7ualrfied personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who mnna;e the system• or those persons directly responsible for gathering the information, the information submitted
,s to tho best of my &nowleo; e, and belief true, accurate, and complete. lam aware that It) era ere significant penalrves for submitting /a/se
,nforma(.on• including :he , '.-,b,bry it fine and Imprisonment for knowing violations _
0".<,4t T,llc
n Phprr (.IreJ COdC
Iy
CPA fe.... )t10 if t7 64L1 V-" : I
Discharge Point:
Lat. 390 22'48"
Long. 78018'14"
Timber Midge School
Wastewater Treatment Plant
Location Map
for outfall # 001
USGS 15' Topographic
Ridge Quadrangle
Scale: 1:24000