APPENDIX A: FORMS

NOTIFICATION FOR A PERMIT TO OPERATE
A SOLID WASTE MANAGEMENT FACILITY

REGISTRATION NUMBER ________________________ (For Agency Use Only)

FACILITY REGISTRATION

a. Name of Facility: __________________________________________

b. Name of Person or other legal entity which owns the facility: ______________________________

__________________________________________

c. Name of the operator of the facility: ___________________________________

d. Type of facility:

_________   Convenience Center

_________   Transfer Station

_________   Solid Waste Incinerator

_________   Less than one (1) acre Construction/Demolition Fill Commercial Recycling Center

If the type of facility is a commercial recycling center, please designate the following;

_________   Collection

_________   Processing

_________   Broker

e. Location of the Facility:

________________________   Longitude   ____________________   Latitude

Number of Acres ____________________

f. Street Address of the Facility. ______________________________________

City __________________   State ________   Zip Code ____________

g. Mailing Address (if different from above)_ ____________________________

City___________________   State________   Zip Code ______________

h. Contact Person at the facility: ____________________________________________

i. Phone Number at the facility: ________________________

j. Name, Address and Telephone number of person preparing application if different from above:

Name: _______________________________________

Address: ________________________________________________________________

City: ____________________   State: _________   Zip Code________________

Phone Number:________________________________

k. Questions regarding this registration should be addressed to:

Name: _______________________________________

Address: ________________________________________________________________

City: ____________________   State: _________   Zip Code________________

Phone Number:________________________________

Describe the management, processing and/or disposal activities. Include a description of the equipment, building(s) and personal used. If waste tires are to be recycled or disposed, include a specific description of the method(s) used to process the tires so as to prevent entrapment of air or water. If additional pages necessary, provide as Attachment 1. ____________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Complete Attachment 2, including the source and types of waste to be managed at the facility.

List the maximum amount of waste to be managed annually: _______ tons

Estimate the total quantity of all waste(s) to be managed annually: _________ tons

List the anticipated landfill(s) and the permit numbers to be used for disposal of waste from the transfer, incineration or residuals from recycling:

Landfill Name         Permit Number

__________________   __________________

__________________   __________________

__________________   __________________

The owner or operator of a McCracken County Solid Waste management facility permit shall keep records of the amount, source and types of municipal solid waste and waste tires received, and other information as required by the KY Natural Resources and Environmental Protection Cabinet and shall submit a quarterly summary of this information to the McCracken County Solid Waste Coordinator.

Include as Attachments 3 and 4 a site plan drawing and a locational map showing the layout of the facility and its relation to adjacent roads, streams, karst features and other distinguishing landforms and structures.

Facility Registrant Certification:

“I certify that this document and all attachments were prepared under my direction or supervision. The information submitted is, to the best of my knowledge and belief, true, accurate, and complete.”

Signature of Authorized Agent: ________________________   Date____________

Name of Authorized Agent (typed or printed) ________________________________________

Title ____________________________________________________________

Subscribed and sworn to before me by ___________________________

This the _________________ Day of _________________, 20_______

Notary Public Signature: _________________________________________

My Commission Expires: _________________________________

ATTACHMENT 2

NOTIFICATION FOR A McCRACKEN COUNTY SOLID WASTE
MANAGEMENT FACILITY PERMIT

TYPES OF WASTE, SOURCE AND WASTE MANAGEMENT METHODS

Enter information requested in the boxes below:

SOURCE	TYPE OF MATERIALS OR WASTE DESCRIPTION	MONTHLY OR ANNUAL QUANTITY (Cu.Yds)	MONTHLY OR ANNUAL QUANTITY (Tons)

 

SITING PROCEDURES

   Given the lack of critical need for additional final disposal capacity in McCracken County, it is unlikely that the need for detailed solid waste facility siting criteria will be required for some time to come. However, the need may well arise in the foreseeable future to consider the issues associated with siting facilities such as a material recovery facility, refuse derived fuel facility or a composting center at some location other than the CWI Transfer Station. In any event, the McCracken County Fiscal Court and the McCracken County Planning Commission should be prepared to consider facility siting criteria in the event a municipal or private entity should choose to develop a final disposal facility within McCracken County.

   The solid waste management facility siting evaluation matrix for McCracken County was designed to be sufficiently general so that it could be used as a siting evaluation with a wide range of waste management facility types. The siting evaluation matrix includes numerous evaluation criteria which the McCracken County Fiscal Court considers to be important considerations during the siting of any solid waste management facility. However some of these criteria might be more applicable to the siting of a landfill while others would probably be of greater importance during the siting of less intensive facilities such as a transfer station or a convenience center. It is for this reason that this matrix includes the provision for weighting each criterion based on the relative importance of that particular criterion in the opinion of the reviewers.

   The use of this evaluation matrix is quite simple although it is not perfectly objective. The reviewers must first make a decision as to the relative significance of the various evaluations criteria based upon the type of facility under consideration. The site(s) under consideration are then evaluated using the described evaluation guidelines and a points score is applied within each evaluation category for each site under consideration. The final score within each evaluation criteria is determined by multiplying the criterion weighting by the points assigned under the evaluation guidelines. All evaluation criteria final scores are then summed to determine the total site score. If more than one site is being evaluated, the relative scoring of each site makes selection relatively straightforward. If a single site is being evaluated then the reviewing group must determine the break point between what constitutes an acceptable site versus an unacceptable site. Generally, however, the reviewing group might wish to look very critically at a site which receives less than one-half of the total points possible given the selected criteria weighting schema.

(Ord. 98-4, passed 1-11-1999)