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- Form DEP-SW-REG-003 "Registration Form for a Connecticut Solid Waste Demonstration Project" - Connecticut
Form DEP-SW-REG-003 "Registration Form for a Connecticut Solid Waste Demonstration Project" - Connecticut
What Is Form DEP-SW-REG-003?
This is a legal form that was released by the Connecticut Department of Energy and Environmental Protection - a government authority operating within Connecticut. Check the official instructions before completing and submitting the form.
Form Details:
- Released on January 20, 2009;
- The latest edition provided by the Connecticut Department of Energy and Environmental Protection;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form DEP-SW-REG-003 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Energy and Environmental Protection.
Download Form DEP-SW-REG-003 "Registration Form for a Connecticut Solid Waste Demonstration Project" - Connecticut
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8Registration Form for a Connecticut
Solid Waste Demonstration Project
DEP USE ONLY
Please complete this form in accordance with the instructions
Registration No. _____________________
(DEP-SW-INST-003) to ensure the proper handling of your
Approval No. _______________________
registration. Print or type unless otherwise noted. You must submit the
Permit Application Transmittal Form (DEP-APP-001) and the registration
fee along with this form.
Part I: Registration Type
Check the appropriate box identifying the application type.
The registration is for (check one):
Please identify any previous or existing
permit/authorization/registration number in the space
A new Solid Waste Demonstration Project
provided.
A renewal of an existing registration
Existing permit/authorization/registration number:
Part II: Fee Information
A fee of $1,000.00 is to be submitted with each registration that you are submitting. Each Solid Waste
Demonstration Project requires a separate registration. The fee for municipalities is 50% of the above listed
rate. The registration will not be processed without the fee. The fee shall be non-refundable and shall be paid
by check or money order to the Department of Environmental Protection.
Part III: Registrant Information
1. Registrant information:
Registrant:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Contact Person:
Phone:
ext.
Email:
Registrant (check one):
individual
company
federal gov’t
state agency
municipality
If a Company, list company type (e.g., corporation, limited partnership, etc.):
Check if any co-registrants. If so, attach additional sheet(s) with the required information as requested
above.
DEP-SW-REG-003
Page 1 of 8
01/20/09
Registration Form for a Connecticut
Solid Waste Demonstration Project
DEP USE ONLY
Please complete this form in accordance with the instructions
Registration No. _____________________
(DEP-SW-INST-003) to ensure the proper handling of your
Approval No. _______________________
registration. Print or type unless otherwise noted. You must submit the
Permit Application Transmittal Form (DEP-APP-001) and the registration
fee along with this form.
Part I: Registration Type
Check the appropriate box identifying the application type.
The registration is for (check one):
Please identify any previous or existing
permit/authorization/registration number in the space
A new Solid Waste Demonstration Project
provided.
A renewal of an existing registration
Existing permit/authorization/registration number:
Part II: Fee Information
A fee of $1,000.00 is to be submitted with each registration that you are submitting. Each Solid Waste
Demonstration Project requires a separate registration. The fee for municipalities is 50% of the above listed
rate. The registration will not be processed without the fee. The fee shall be non-refundable and shall be paid
by check or money order to the Department of Environmental Protection.
Part III: Registrant Information
1. Registrant information:
Registrant:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Contact Person:
Phone:
ext.
Email:
Registrant (check one):
individual
company
federal gov’t
state agency
municipality
If a Company, list company type (e.g., corporation, limited partnership, etc.):
Check if any co-registrants. If so, attach additional sheet(s) with the required information as requested
above.
DEP-SW-REG-003
Page 1 of 8
01/20/09
Part III: Registrant Information (cont.)
2. Identify primary contact for departmental correspondence and inquiries, if different than the registrant:
Name:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Contact Person:
Title:
Email:
3. Identify attorney or other representative, if applicable:
Firm Name:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Attorney:
4. Identify Facility Operator:
Name:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Contact Person:
Title:
5. Identify Property Owner:
Name:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Contact Person:
Title:
6. Identify any engineer(s) or other consultant(s) employed or retained to assist in preparing the registration
or in designing the facility.
Name:
Mailing Address:
City/Town:
State:
Zip Code:
Business Phone:
ext.
Fax:
Contact Person:
Title:
Service Provided:
Check here if additional sheets are necessary, and label and attach them to this sheet.
DEP-SW-REG-003
Page 2 of 8
01/20/09
Part IV: Site Information
1. Name of facility, if applicable:
Street Address or Description of Location:
City/Town:
State:
Zip Code:
Latitude and longitude of the exact location of the proposed activity in degrees, minutes, and seconds:
Latitude:
Longitude:
Method of determination (check one):
GPS
USGS Map
Other (please specify):
If a USGS Map was used, provide the quadrangle name:
2. COASTAL BOUNDARY: Is the project site which is the subject of this registration located within the
coastal boundary as delineated on DEP approved coastal boundary maps?
Yes
No
If yes, and this registration is for a new authorization, you must submit a Coastal Consistency Review
Form (DEP-APP-004) with your registration as Attachment C.
Information on the coastal boundary is available at the local town hall or on the “Coastal Boundary Map”
available at DEP Maps and Publications (860-424-3555).
3. ENDANGERED OR THREATENED SPECIES: Is the project site located within an area identified as a
habitat for endangered, threatened or special concern species as identified on the "State and Federal
Listed Species and Natural Communities Map"?
Yes
No
Date of Map:
If yes, complete and submit a Connecticut Natural Diversity Data Base (CT NDDB) Review Request Form
(DEP-APP-007) to the address specified on the form. Please note NDDB review generally takes 4 to 6
weeks and may require additional documentation from the registrant. DEP strongly recommends
that registrants complete this process before submitting the subject registration.
When submitting this registration form, include copies of any correspondence to and from the NDDB,
including copies of the completed CT NDDB Review Request Form, as Attachment D.
For more information visit the DEP website at
www.ct.gov/dep/endangeredspecies
(Review/Data Requests)
or call the NDDB at 860-424-3011.
4. AQUIFER PROTECTION AREAS: Is the project site located within an aquifer protection area as defined
in Section 22a-354a through 354bb of the General Statutes (CGS)?
Yes
No
If yes, is the site within an area identified on a Level A or Level B map?
Yes
No
To view the applicable list of towns and maps visit the DEP website at
www.ct.gov/dep/aquiferprotection
To speak with someone about the Aquifer Protection Areas, call 860-424-3020.
5. CONSERVATION OR PRESERVATION RESTRICTION: Is the property subject to a conservation or
preservation restriction?
Yes
No
If Yes, proof of written notice of this registration to the holder of such restriction or a letter from the holder
of such restriction verifying that this registration is in compliance with the terms of the restriction, must be
submitted as Attachment E. See the instructions under this part for more details.
DEP-SW-REG-003
Page 3 of 8
01/20/09
Part IV: Site Information (continued)
6. ENVIRONMENTAL JUSTICE COMMUNITIES:
a. Does the site include a new facility or new activity located within an environmental justice community
as defined in the instructions (DEP-RCY-INST-010)?
Yes
No
If yes, you must hold an informal public meeting concerning the subject activity prior to issuance of
your permit approval. Refer to the instructions (DEP-RCY-INST-010) for more detail.
b. Does the subject registration include an activity which will occur at an existing applicable facility,
located within an environmental justice community?
Yes
No
If Yes, the registrant shall submit an Environmental Justice Public Participation Plan and adhere to the
requirements of Public Act 08-94. Refer to the Environmental Justice Public Participation Guidelines
(DEP-EJ-GUID-001) for more information (www.ct.gov/dep/environmentaljustice).
Part V: Solid Waste Demonstration Project Information
1. Describe how this proposed demonstration project (1) is necessary to research, develop or promote
methods and technologies of solid waste management that are consistent with the goals of the state solid
waste management plan; (2) does not pose a significant risk to human health or the environment; and (3)
is consistent with the federal Water Pollution Control Act, the federal Rivers and Harbors Act, the federal
Clean Air Act or the federal Resource Conservation and Recovery Act.
DEP-SW-REG-003
Page 4 of 8
01/20/09
Part V: Solid Waste Demonstration Project Information (continued)
2.
Identify the type of solid waste material proposed to be studied during the demonstration project, how it is
generated and the quantities.
3. How is this solid waste/material currently being disposed and/or managed?
4. Describe what you expect to demonstrate during this study, the proposed timeline of this study, and how
this solid waste/material could be reused, consistent with the SWMP and federal RCRA.
DEP-SW-REG-003
Page 5 of 8
01/20/09
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