Municipal Solid Waste Landfill Closure Plan (329 IAC 10-22) {50391}

MUNICIPAL SOLID WASTE LANDFILL CLOSURE PLAN (329 IAC 10-22) State Form 50391 (R / 7-06) Indiana Department of Environmental Management INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Office of Land Quality Solid Waste Permits Section - Mail Code 65-45 100 N. Senate Ave. Indianapolis, IN 46204-2251 INSTRUCTIONS This application form shall be used to submit closure plans for municipal solid waste landfills (MSWLFs) both individually and with permit applications. When completed, closure plans should be submitted, either individually or with permit applications, along with support documentation, to the address given in the box above. I. General Information Facility Name Facility Location Facility County Facility Solid Waste Permit No. (if existing permitted facility) Total Fill Acreage II. Closure Activities-General Description Provide a description of the steps that will be used to partially close, if applicable, and finally close the facility. See instructions for items that should be included Page 1 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com II. Closure Activities-General Description (continued-copy additional pages as needed) Page 2 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com III. Final Cover Description Provide a detailed description of the final cover (see instructions). Attach additional sheets as necessary. Page 3 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com IV. Labor, Materials, and Testing Provide a listing of items necessary to close the facility (see instructions). For items that will vary depending upon the number of acres to be closed, the quantities should be indicated on a per acre basis. Include items for both the closure activities and final cover noted above. Use additional sheets as needed. A. Item B. Quantity (use applicable unit as appropriate C. Units (use unit as appropriate) Page 4 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com V. Expected Year of Closure and Closure Schedule Please see instructions; attach additional sheets as necessary. A. B. C. Expected Year of Closure Total Time Required to Close Facility Time Required for Completion of Intervening Closure Activities Provide a description of intervening closure activities and the time required; see instructions. Page 5 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com VI. Estimate of Maximum Inventory of Waste Page 6 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com VII. Estimate of Cost Per Acre for Final Cover & Vegetation Please see instructions; attach additional sheets as necessary. A. Cover Material Availability, & Acquisition, Placement And Compaction Costs For Areas Closing With A Composite Bottom Liner And A Leachate Collection System-329 IAC 10-22-6(b)) 1. Percent of Final Cover Material Available from Areas That Are Controlled, and Will be Controlled Through Post-Closure, by the Owner, Operator, or Permittee. a. Methane gas venting layer material (12 inches) or landfill gas (LFG) extraction well material 1) 2) b. % of material Describe location of sources (include distance from facility) Soil barrier layer material (lower 12 inches-structural fill) 1) 2) % of material Describe location of sources (include distance from facility) c. Soil barrier layer material (upper 12 inches-structural fill) 1) 2) % of material Describe location of sources (include distance from facility) d. e. Geomembrane layer ­ not applicable-delivered to site Drainage layer material 1) 2) % of material Describe location of sources (include distance from facility) f. Top protective soil layer material (18 inches; 30 inches if geosynthetic drainage layer used) 1) 2) % of material Describe location of sources (include distance from facility) g. Vegetative Layer (topsoil) (6 inches) 1) 2) % of material Describe location of sources (include distance from facility) 2. Cost Per Acre for Acquisition, Placement & Compaction of Final Cover Layers a. Methane gas venting layer material (12 inches) or LFG Extraction System 1) Acquisition a) b) c) d) e) Quantity of material needed per acre (yd3) Excavation unit cost ($/yd3) (if obtained on-site) Purchase unit cost ($/yd3) (if obtained off-site) Delivery unit cost ($/yd3) (if obtained off-site) Acquisition cost ($/acre) Line 1.a * line 1.b (on-site) or Line 1.a * (line 1.c + line 1.d) (off-site) 1,613 yd3 2) Placement and spreading a) b) Placement/spreading cost ($/yd3) Placement and spreading costs ($/acre) line 1.a * line 2.a Page 7 of 21 Although this form is being provided to aid you in preparing your closure plan in accordance with the solid waste rules, this form is subject to review and revision. Please consult the actual rule language. American LegalNet, Inc. www.FormsWorkflow.com 3) Installation of gas well system a) b) c) Installation unit cost ($/unit) Number of units to be installed Total cost of installation Line 3.a * line 3.b 4) Testing and QA/QC a) b) c) Lab testing per QA/QC plan ($/acre) Survey cost ($/acre) Testing/CQA cost ($/acre) Line 4.a * line 4.b 5) b. Total Cost, Methane Gas Venting Layer ($/Acre) OR LFG System Line 1.e + line 2.b + line 3c +line 4c Soil Barrier Layer Material and Structural Fill (24 inches) Per Acre 1) Acquisition a) b) c) d) e) Quantity of material needed per acre (yd3) Excavation unit