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Fill Source StatementDEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT 1 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 A Fill Source Statement CERTIFIED BY A PROFESSIONAL ENGINEER OR GEOLOGIST licensed in the State of Washington is required in the following circumstances: 1.More than 50 cubic yards of fill will be imported to a project site located in Zone 1 of the Aquifer Protection Area. 2.More than 100 cubic yards of fill will be imported to a project site located in Zone 2 of the Aquifer Protection Area. Exception: A Fill Source Statement is not required if documentation is provided that the fill to be imported comes from a Washington State Department of Transportation approved source. It is required that fill material be sampled AT THE FILL SOURCE SITE and analyzed by a laboratory to rule out contamination (see #11 below). A fill source site may qualify for an ABBREVIATED FILL SOURCE STATEMENT (answer only #1 - #7 below) ONLY if the source site has never been filled, developed, or subjected to use that could have introduced chemical contamination to the site. The abbreviated format does not require sampling and analysis of fill to detect contamination and, therefore, reduces applicant costs. Please see #12 and check the appropriate certification. A SEPARATE SOURCE STATEMENT IS REQUIRED FOR EACH FILL SOURCE SITE. A copy of the Renton Municipal Code section requiring the Fill Source Statement is attached for your information (RMC 4-4-060N). CONTACT DEVELOPMENT ENGINEERING TO DETERMINE IF THE PROJECT SITE IS LOCATED IN THE APA. NOTE: The Department has the authority to request additional information regarding imported fill material and to reject a source statement if it does not demonstrate that the fill material meets City standards and/or the Department has reason to suspect that the fill material could be contaminated. Such requests or rejections shall be made in writing to the applicant. 1.Project Site Address: 2.Project Site King County Tax Assessor Account Number: 3.In which Aquifer Protection Area Zone is the project site located 1 or 2? 1 2 4.Cubic yards of fill to be imported to project site: 5.Project applicant name: 6.Fill source site address: 7.Fill source site King County Tax Assessor Account Number: FILL SOURCE STATEMENT FOR PROJECTS IN THE AQUIFER PROTECTION AREA (APA) Planning Division | Development Engineering Section 1055 South Grady Way | Renton, WA 98057 (425) 430-7200 | www.rentonwa.gov 2 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 8.Current and all previous land uses at fill source site: (attach additional information if necessary) a. b. c. d. 9.Has the fill source site appeared on the following lists of contaminated sites? a.Hazardous Sites List (per State Model Toxics Control Act) Yes No b.National Priority List (Federal “Superfund” List) Yes No 10.Is the fill to be imported native to the fill source site? Yes No 11.Attach a copy of a SUMMARY ONLY of the results of sampling and analysis of fill material from samples COLLECTED AT THE SOURCE SITE as required by RMC 4-4- 060N4 for projects located in Zone 1 and 2 of the Aquifer Protection Area. Follow sampling and analysis procedures specified in N4 of the regulations. 12.Engineer’s or Geologist’s certification: I, _________________________________________, a licensed professional engineer or geologist in the State of Washington, certify that the above information is true and correct and that the fill to be imported to the project site meets the City of Renton fill quality standards stated in the Renton Municipal Code 4-4-060N4a and b. ABBREVIATED FILL SOURCE STATEMENT CERTIFICATION: I, _________________________________________, a licensed professional engineer or geologist in the State of Washington, certify that the above information is true and correct and that the source site does not appear on the Hazardous Sites List (per State Model Toxics Control Act) or the National Priority List (Federal “Superfund List”). To the best of my knowledge, fill to be imported to the project site meets the City of Renton fill quality standards stated in the Renton Municipal Code 4-4-060N4a and b and the source site has never been filled, developed, or subjected to use that could have introduced chemical contamination to the site. Signature: Date: Mailing Address: Phone: City/State: Zip: Engineer’s or Geologist’s Stamp: 3 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 STAFF USE ONLY Imported fill sources statement accepted Yes No Reviewer Name: Date: Comments: 4 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 Renton Municipal Code 4-4-060 Grading, Excavation, and Mining Regulations N. FILLS: 1.Applicability and Exemptions: Unless otherwise recommended in the approved soil engineering report, fills shall conform to the provisions of this Section. In the absence of an approved soil engineering report, these provisions may be waived for minor fills not intended to support structures. For minor fills or waste areas, humps, hollows or water pockets shall be graded smooth with acceptable slopes. 2.Fill Location: Fill slopes shall not be constructed: a.On natural slopes steeper than two-and-one-half horizontal to one vertical (2.5:1) that are fifteen feet (15') or greater in height (except in conjunction with a modification granted per RMC 4-9-250D1 for filling against the toe of a natural rock wall – see RMC 4- 3-050N2a(ii)(b)); or b.Where the fill slope toes out within twelve feet (12') horizontally of the top of existing or planned cut slopes that are fifteen feet (15') or greater in height and steeper than two- and-one-half horizontal to one vertical (2.5:1). (Amd. Ord. 4835, 3-27-2000; Ord. 4851, 8- 7-2000) 3.Preparation of Ground: The ground surface shall be prepared to receive fill by removing vegetation, noncomplying fill, topsoil and other unsuitable materials as determined by the soil engineer, and where the slopes are five to one (5:1) or steeper, by benching into sound bedrock or other competent material. 4.Fill Material: Fill materials shall have no more than minor amounts of organic substances and shall have no rock or similar irreducible material with a maximum dimension greater than eight inches (8"). Fill material shall meet the following requirements: a.Construction, Demolition, and Land Clearing Waste Prohibited: Fill material shall be free of construction, demolition, and land clearing waste except that this requirement 5 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 does not preclude the use of recycled concrete rubble per Washington State Department of Transportation Standard Specifications for Road, Bridge, and Municipal Construction. b.Cleanliness of Fill Material: Fill material shall not contain concentrations of contaminants that exceed cleanup standards for soil specified in WAC 173-340-740, Model Toxics Control Act. c.Special Requirement for Projects Located in Zone 1 of the Aquifer Protection Area and Which Will Involve Placement of More than Fifty (50) Cubic Yards of Imported Fill: A source statement certified by a professional engineer or geologist licensed in the State of Washington shall be provided to the Department and shall be reviewed and accepted by the Department prior to stockpiling or grading imported fill at the project site. The source statement, as defined in RMC 4-8-120D19, shall be required for each source location from which imported fill will be obtained. d.Special Requirement for Projects Located in Zone 2 of the Aquifer Protection Area and Which Will Involve Placement of More than One Hundred (100) Cubic Yards of Imported Fill: The source statement described in RMC 4-8-120D19 is required for each source location from which imported fill will be obtained. e.Abbreviated Source Statement for Aquifer Protection Area: The Department may accept a source statement, as defined in RMC 4-8-120D19, that does not include results of sampling and analysis of imported fill if a professional geologist or engineer licensed in the State of Washington certifies that the source location from which fill will be obtained has never been filled, developed, or subjected to use that could have introduced chemical contamination to the site. f.Department Authority to Request Additional Information or Reject Certified Source Statement: The Department has the authority to request additional information regarding imported fill material and the source thereof and to reject a source statement or abbreviated source statement if they do not demonstrate that the fill material to be imported to a project site meets fill material standards in subsections L4a and L4b of this Section and/or the Department has reason to suspect that the fill material could be contaminated. Such requests or rejections shall be made in writing to the applicant. 6 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 g.Source Statement Not Required for Imported Fill Obtained from Washington State Department of Transportation Approved Source: The source statement defined in RMC 4-8-120D19 is not required for those projects located in the aquifer protection area if documentation is provided that imported fill will be obtained from a Washington State Department of Transportation approved source. (Amd. Ord. 4851, 8-7-2000) h.Sampling and Analysis Procedures: The licensed professional engineer or geologist or person under their supervision who samples earth materials to be used as imported fill, oversees analysis, and prepares the source statement required by subsections L4c and L4d of this Section shall follow procedures specified in WAC 173-340-820 and 173-340- 830 of the Model Toxics Control Act Cleanup Regulation. i.Permittee Subject to Required Actions after Illegal Placement of Imported Fill: A permittee who stockpiles or grades imported fill at the site without Department review and acceptance of the source statement required by subsections L4c and L4d of this Section or who stockpiles or grades fill at the site that does not meet the fill quality standards of subsections L4a and L4b of this Section is subject to measures specified by the Department to reduce risk of contamination of the site due to illegal placement of fill. Such measures may include, but are not limited to, any or all of the following and shall be implemented at the permittee’s expense: i.Provide the Department with the source statement defined in RMC 4-8-120D19 within a time-period specified by the Department; ii.Immediately cover fill with a waterproof cover; iii.Immediately remove fill; iv. Installation of monitoring wells and monitoring of ground water quality; v.Remediation of contamination of the site caused by the illegal placement of fill according to a schedule specified by the Department and in accordance with cleanup standards for soil and groundwater described in the Model Toxics Control Act Cleanup Regulation, chapter 173-340 WAC. 7 H/CED/Data/Forms-Templates/Self Help Handouts/Pubic Works/Fill Source Statement.doc Rev: 2/1/2018 j.Department Authority to Conduct Independent Sampling and Analysis: The Department shall have the authority to enter on to private property to conduct independent sampling and analysis of fill. If the Department determines that fill does not meet fill quality standards of subsections L4a and L4b of this Section, then it may require the permittee to accomplish any or all of the measures listed in subsection L4i of this Section at his or her own expense. k.Department Authority to Implement Removal and Remediation Measures: The Department or its authorized agents shall have the authority to implement measures listed in subsection L4i of this Section if the permittee fails to accomplish such measures in a timely manner. The permittee shall be responsible for any costs incurred by the Department or its authorized agents in the conduct of such activities. (Amd. Ord. 4740, 7- 19-1999; Ord. 4992, 12-9-2002) 5.Minimum Compaction: All fills shall be compacted to a minimum of ninety five percent (95%) of maximum density as determined by American Public Works Association (APWA) specifications. Field density shall be determined in accordance with APWA standards. 6.Maximum Slope: The slope of fill surfaces shall be no steeper than is safe for the intended use. Except in conjunction with a modification granted per RMC 4-9-250D1 for one of the circumstances listed in RMC 4-3-050N2a(ii) (Geologic Hazards – Modifications), fill operations associated with a plat, short plat, subdivision or dedication, or other permitted land development activity which would result in the creation of permanent slopes forty percent (40%) or greater which are fifteen feet (15') in height, i.e., protected slopes, shall not be approved. (Amd. Ord. 4835, 3-27-2000) 7.Drainage and Terracing: Drainage and terracing shall be provided and the area above fill slopes and the surfaces of terraces shall be as required by subsection N of this Section. (Ord. 5526, 2-1-2010)