APPENDIX R INFECTIOUS WASTE TREATMENT FACILITY PERMIT TO INSTALL APPLICATION



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INFECTIOUS WASTE TREATMENT FACILITY PERMIT TO INSTALL APPLICATION Submittal Procedure - Submit four copies of the Permit to Install application (two copies to Central Office and two copies to the appropriate district office). Submit the application fee to the District Office with the Permit to Install application. - Submit one copy of the Permit to Install application to the local Board of Health within seven days after submitting the application to the Ohio EPA. - In accordance with paragraph (A)(I)(b) of Rule 3745-27-37 of the Ohio Administrative Code concurrent to submitting the Permit to Install application, the applicant must: Submit a disclosure statement to the Office of the Attorney General as required in Rules 109:6-1-01 to 109:6-l-04 of the Administrative Code. Submit to the local Board of Health of the Health District where the facility will be located, or to the Director of the Ohio EPA if he has assumed the licensing function, an infectious waste treatment facility license application, provided that the facility does not already hold such a license. Send, via certified mail, letters of intent to establish or modify an infectious waste treatment facility to the governments of the general purpose political subdivisions where the facility will be located, the single county or joint county solid waste management district, the local zoning authority, and the owner or lessee of any easement or right of way bordering or within the facility's boundaries which may be affected by the facility. Content/Formatting Requirement As of May 1, 1990, all Permit to Install applications for infectious waste treatment facilities must contain the information required by OAC Chapter 3745-27. For Permit to Install applications submitted on or after May 1, 1990, the information must be presented in the format prescribed by OAC Rule 3745-27-37. May 1, 1990 effective 1

********************************* * OFFICE USE ONLY * * Facility ID No. * *PTI * ********************************* of Facility Address of Facility County Exact Location INFECTIOUS WASTE TREATMENT FACILITY DATA SHEET (Number, Street, or Route,, Code) Township Reason for Permit: New incinerator New autoclave Newchemical treatment (cultures only) Modification of existing incinerator Modification to an existing autoclave Other modification to facility or premise Specify If modification, date of original approval Permittee: Operator of Facility: If yes,explain Landowner: State State, Modification to chemical treatment Any prior treatment facility operation experience- -. State. 2

Designer: State Registered Engineer Registered Surveyor Prior Design Experience 3

INFORMATION TO BE SHOWN ON PLANS AND/OR SUBMITTED WITH PLANS Paragraph DETAIL ENGINEERING PLAN COVER SHEET Content Plan Narrative Drawing No. Page No. (B)(1)(a) (B)(l)(b) (B)(l)(c) (B)(l)(d) (B)(l)(e) of the infectious waste treatment facility Precise geographic location, boundaries, etc. and address of the applicant and theoperator and address of thetreatment facility owner(s) and address of the person who prepared the plans PLAN DRAWINGS (B)(2)(a) (B)(2)(b) (B)(2)(c) (B)(2)(d) (B)(2)(e) (B)(3)(a) (B)(3)(b) (B)(3)(c) (B)(3)(d) (B)(3)(e) (B)(3)(f) (B)(3)(g) (B)(3)(h) (B)(3)(i) (B)(3)(j) (B)(3)(k) Property lines of all land owned or leased for the facility All public roads, railroads, anddomicles Exsisting zoning, property owners, political subdivisions, etc. The north arrow All bodies of water All existing or proposed treatment and storage areas, etc. Location of fencing, gates, and natural or other screening Location of loading and unloading zones Location of storaqe areas Location of the decontamination area Location of the ash storage area, if applicable Location of the treated waste storage area Location of the drainage structures Location of the spill containment and clean-up kits Location of communication equipment Location of fire extinguishers and other fire response equipment (B)(4) Detailed engineering plans for the infectious wastetreatment unit NARRATIVE DESCRIPTION/INFORMATION Summary (C)(1) Summary of compliance with operational and permit requirements Discussion of construction information in detail plans (C)(2)(a) (C)(2)(b) (C)(2)(c) (C)(2)(d) (C)(2)(e) (C)(2)(f) (C)(2)(g) (C)(2)(h) Treatment method Utilization of existing or proposed buildings Utilization of fencing, gates, and other screening Location and utilization of loading and unloading zones Location and utilization of storage areas Location, utilization, and drainage of decontamination areas Location and utilization of ash storage area, if applicable Location and utilization of treated waste area, if applicable 4

Paragraph Content Plan Narrative Drawing # Page # Discussion of the operational requirements (C)(2)(i) (C)(2)(j) (C)(2)(k) (C)(2)(1) (C)(2)(m) (C)(2)(n) (C)(2)(o) (C)(2)(P) (C)(2)(q) (C)(2)(r) (C)(2)(s) (C)(2)(t) --------- The facility's operating hours Staff functions, qualifications, and training or certification Operating log, include operational and maintenance procedures, etc. Water cooling and collection system for ash Particulates captured by the air pollution control system Method to distinguish hazardous waste Method to distinguish radioactive waste Quality control measures specified in (C) of rule 3745-27-32 and address of any contracted third party for quality Accident or spill containment procedures Contingency plans Coordination with local officials such as fire department, etc. Anticipated average daily waste receipt 5