DEP Form 62-673.900(4)(J) "Phosphogypsum Stack System Closure, Water Management and Long-Term Care Cost Estimate" - Florida

What Is DEP Form 62-673.900(4)(J)?

This is a legal form that was released by the Florida Department of Environmental Protection - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 2, 2005;
  • The latest edition provided by the Florida Department of Environmental Protection;
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Download DEP Form 62-673.900(4)(J) "Phosphogypsum Stack System Closure, Water Management and Long-Term Care Cost Estimate" - Florida

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PHOSPHOGYPSUM STACK SYSTEM
CLOSURE, WATER MANAGEMENT AND LONG-TERM CARE COST ESTIMATE
Date:
____________________________
Date of DEP Approval: __________________________________
Approval Signature: ____________________________________
INSTRUCTIONS:
1.
If a facility is using the current inflation factor to adjust the cost estimates, ONLY pages 1 and 2 must be completed. In addition, engineer certification is NOT
REQUIRED for Part III when using the inflation factor. When adjusting with the inflation factor, only the signature, name and title, and phone number of the
owner/operator are required for Part III.
2.
If a facility is recalculating the cost estimates using an engineer, pages 1-15 must be completed [exception: Part II(a)].
3.
This form is to be sent to: Chief
Bureau of Mine Reclamation
2051 East Dirac Drive
Tallahassee, Florida 32310
I.
GENERAL INFORMATION
Facility Name:
____________________________________________________________________________________ Facility ID #: ________________________
Facility Address: _________________________________________________________________________________________________________________________
Permittee: ______________________________________________________________________________________________________________________________
Mailing Address: ________________________________________________________________________________________________________________________
II.
ESTIMATE ADJUSTMENT
Rule 62-673.640(3)(a), Florida Administrative Code (F.A.C.), sets forth the requirement that during the life of the phosphogypsum stack system, the owner or operator
shall submit annually a closure, water management and long-term care cost estimate that is adjusted for inflation and shall re-estimate the closure, water management
and long-term care costs in conjunction with the issuance, renewal or modification of the permit.
Page 1 of 15
DEP Form 62-673.900(4)(j)
Effective July 2, 2005
PHOSPHOGYPSUM STACK SYSTEM
CLOSURE, WATER MANAGEMENT AND LONG-TERM CARE COST ESTIMATE
Date:
____________________________
Date of DEP Approval: __________________________________
Approval Signature: ____________________________________
INSTRUCTIONS:
1.
If a facility is using the current inflation factor to adjust the cost estimates, ONLY pages 1 and 2 must be completed. In addition, engineer certification is NOT
REQUIRED for Part III when using the inflation factor. When adjusting with the inflation factor, only the signature, name and title, and phone number of the
owner/operator are required for Part III.
2.
If a facility is recalculating the cost estimates using an engineer, pages 1-15 must be completed [exception: Part II(a)].
3.
This form is to be sent to: Chief
Bureau of Mine Reclamation
2051 East Dirac Drive
Tallahassee, Florida 32310
I.
GENERAL INFORMATION
Facility Name:
____________________________________________________________________________________ Facility ID #: ________________________
Facility Address: _________________________________________________________________________________________________________________________
Permittee: ______________________________________________________________________________________________________________________________
Mailing Address: ________________________________________________________________________________________________________________________
II.
ESTIMATE ADJUSTMENT
Rule 62-673.640(3)(a), Florida Administrative Code (F.A.C.), sets forth the requirement that during the life of the phosphogypsum stack system, the owner or operator
shall submit annually a closure, water management and long-term care cost estimate that is adjusted for inflation and shall re-estimate the closure, water management
and long-term care costs in conjunction with the issuance, renewal or modification of the permit.
Page 1 of 15
DEP Form 62-673.900(4)(j)
Effective July 2, 2005
(a)
Inflation Factor Adjustment
Inflation adjustment using an inflation factor may only be made when a Department approved closure, water management and long-term care cost estimate exists and no
changes have occurred in the facility operation which would necessitate modification to the closure plan. Rule 62-673.640(3)(a), F.A.C., states that the inflation factor
must be derived from the most recent Implicit Price Deflator for Gross National Product published in the U.S. Department of Commerce in its Survey of
Current Businesses.
This adjustment is based on the Department approved closure cost estimate dated ___________________.
Current Year
Latest Department Approved
Inflation Adjusted
Inflation Factor
Closure Cost Estimate:
Closure Cost Estimate:
_______________________
X
______________
=
___________________
This adjustment is based on the Departm ent approved water manag ement cost estimate dated __________.
Current Year
Latest Department Approved
Inflation Adjusted
Inflation Factor
Water Mgmt. Cost Estimate:
Water Mgmt. Cost Estimate:
_______________________
X
______________
=
___________________
This adjustment is based on the Departm ent approved long-term ca re cost estimate dated _____________.
Latest Department Approved
Inflation Adjusted Annual
Current Year
Annual Long-Term Care Cost
Long-Term Care Cost
Inflation Factor
Estimate:
Estimate:
_______________________
X
______________
=
___________________
Number of Years of Long-Term Care Remaining:
X
___________________
Inflation Adjusted Long-Term Care Cost Estimate:
___________________
=
GRAND TOTAL INFLATION ADJUSTED ESTIMATE:
___________________
Page 2 of 15
DEP Form 62-673.900(4)(j)
Effective July 2, 2005
(b)
Recalculate Estimates (see Section IV)
III.
CERTIFICATION BY ENGINEER
This is to certify that the Closure, Water Management and Long-Term Care Cost Estimates pertaining to the engineering features of this phosphogypsum stack system
facility have been examined by me and found to conform to engineering principles applicable to such facilities. In my professional judgement, the Cost Estimates are a
true, correct and complete representation of the financial liabilities for closing, water management and long-term care of the facility and comply with the requirements of
Florida Administrative Code (F.A.C.), Rule 62-673.640 and all other Department of Environmental Protection rules, and statutes of the State of Florida. It is understood
that the Closure, Water Management and Long-Term Care Cost Estimates shall be submitted to the Department annually, revised or adjusted as required by Rule 62-
673.640(3), F.A.C.
________________________________________
________________________________________
Signature of Engineer
Signature of Owner/Operator
________________________________________
________________________________________
Name & Title (please type)
Name & Title (please type)
________________________________________
________________________________________
Florida Registration Number (affix seal)
Telephone Number
________________________________________
________________________________________
Mailing Address
Owner/Operator E-Mail Address
________________________________________
Telephone Number
_______________________________________
Engineer E-Mail Address
Page 3 of 15
DEP Form 62-673.900(4)(j)
Effective July 2, 2005
IV.
CALCULATE ESTIMATED CLOSURE COST
** Third Party Estimate must be provided for each item. Attach documentation if information does not fit in space provided.
** Costs must be for a third party providing all material and labor.
DESCRIPTION
UNIT
QUANTITY
UNIT COST
SOURCE OF ESTIMATE
TOTAL
1. Engineering
Closure Plan Report
____________
____________
______________________
___________________
__
LS
Design Plans/Specifications
LS
____________
____________
________________________
___________________
Construction QA/QC
____________
____________
____________________
___________________
LS
____
Final Surveying
____________
____________
________________________
___________________
LS
Other: __________________ LS
____________
____________
________________________
___________________
(describe)
Subtotal Engineering:
___________________
2. Permitting
Permitting Fees
_____________
____________
________________________
LS
Consulting Fees
_____________
____________
_______________________
___________________
_
LS
Subtotal Permitting:
___________________
3. Monitoring Wells (New & Existing)
EA
_____________
____________
_______________________
____________________
Subtotal Monitoring Wells:
____________________
4. Slope and Fill
Excavation
CY
_____________
____________
_______________________
____________________
Placement & Spreading
_____________
____________
_________________
____________________
______
CY
Compaction
_____________
____________
_______________________
___________________
CY
Page 4 of 15
DEP Form 62-673.900(4)(j)
Effective July 2, 2005
DESCRIPTION
UNIT
QUANTITY
UNIT COST
SOURCE OF ESTIMATE
TOTAL
Off-Site Material
______________________
_____________________
_____________
____________
CY
Delivery
_____________
____________
______________________
_____________________
CY
Subtotal Slope and Fill:
_____________________
5. Cover Material
Off-Site Clay
______________________
____________________
CY
____________
_____________
Geosynthetics – 40 mil
____________
_____________
____________________
____________________
SF
__
Geosynthetics – 60 mil
____________
_____________
____________________
____________________
SF
__
Geosynthetics – 80 mil
____________
_____________
____________________
____________________
SF
__
Geosynthetics – GCL
____________
_____________
___ ___________________
____________________
SF
Geosynthetics – Geonet
____________
_____________
____ __________________
____________________
SF
Geosynthetics – Other
____________
_____________
______________________
____________________
SF
Other: ___________________ SF
____________
_____________
______________________
____________________
(describe)
Subtotal Cover Material:
____________________
6. Top Soil Cover
Off-Site Material
______________________
____________________
____________
_____________
CY
Delivery
____________
_____________
______________________
____________________
CY
Spread
CY
____________
_____________
______________________
____________________
Subtotal Top Soil Cover:
____________________
Page 5 of 15
DEP Form 62-673.900(4)(j)
Effective July 2, 2005
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