HomeMy WebLinkAbout2130 BASSWOOD AVE; ; CBR2021-3289; Recycle(city of
Carlsbad
CONSTRUCTION WASTE
MANAGEMENT PLAN
8-59
o,11.elopmet1t ~e,yices
Building 'D(vision
1635 Forada. y1.Ajvenue
760jlwJ.~-2719
www.carlsbad¢a.gov
Many of the materials generated from your project can be recycled. You are required to list materials that' till be
re~sed, recycled or disposed from your project. If you !,ave questions about the recycling requirement or 901'1:l leting
tl,1s form, please contact Waste Management at (760) 929-9400, a certified C&D recycler, or the Carlsbad 8 ilding
Division at (760) 602-2700. Please note: Unless you are self-hauling, Waste Management or approved haulers r\i~st be
used for all construction projects within the City of carlsbad. ' I
, I
' I
PART 1 Complete and submit this form when applying for a Building Permit. Note: Permits will not be issued ,
without a completed Construction Waste Management Plan. , l
C~~c::.. l-.. { (.,_ 9~oO'l _____ ·, _
o1v$~)~,:_ e ~->"-t'\1 r_~ .0
. '
Applicant Mailing Address
(if different than project address)
__ S="~~=~<'-~--~-••" .. ----~----·------------'---•~---
1
Project Type Residential Commercial PubUc Building I~ :I
(check a/I that apply}: l£SI fj \ I\ □ □ LJ
Brief Description ~A~..il~J.--~~f!IJ__.__ .. ~~-. ~_f_t_ ~~~{2g~l>~t'/ ~' 05J_ ~L-t--
Project Size 1 1.;,} S' d. Estimated Cost of Project$_ ~£? _Q,...O.....P_.,_ _____ i ..... _L __
-,::;;;;re footage]
Please check the appropriate box:
I, 0 I plan on using WASTE MANAGEMENT roll-off bin(s) for all materials and will provide all receipts after construction.
[rj I plan on self-hauling to a certified recycling facility and will provide all receipts after construction. i
0 This is a proposed LEED certified project and I plan on separating materials on site in conjunction with WASiTE ;
MANAGEMENT. • \
!
Acknowledgement: I certify under penalty of perjury under the laws of the State of California that the infonmatl'?n
provided in and with this form pertains to construction and demolition debris generated only from the project list'~d
in PART 1, that I have reviewed the accuracy of the information, and that the information is true and correct to the
best of my knowledge and belief. , • ---Z-'·
PrintName <;\" .,_I< ft 1 '\1L,ll_, _Signature_ .__) ~ ___ Date s-1'7~-•~.~
I
STORM_WATER_POLLUTIDN PREVENTION NOTES
1, ALL NECESSARY EQUIPMENT ANO MATERIALS SHAil BE
AVAILABlE ON SITE TO fAaLITATE RAPID INSTAll.ATION
Of EROSION AND SEDIMENT CONTROL 8MPs \IAfEN RAIN IS EMINENT,
2. THE 01\NER/CONTRACTOR SHAil RESTORE ALL EROSION
CONTROl DE~CES TO WORKING ORDER TO THE SATTSfACTTON
Of THE CJTY INSPECTOR AFTER EACH RUN-Off PROOUCING RAJNFAIL.
l. THE OIIIJER/CONTRACTOR SHALL INSTAil ADDITIONAL EROSION
CONTROL MEASURES AS MAY BE REQUIRED BY THE ClTY
INSPECTOR DUE TO INCOMPLETE GRADING OPERATIONS OR
UNFORESEEN CIRCUMSTANCES \IHICH MAY ARISE.
All REMOVABLE PROTECTIVE orncEs SHALL BE IN PLACE
AT THE END Of EACH WORKING DAY \\HEN THE FIVE (5)
DAY RAIN PROBABlUTY FORECAST EXCEEDS FORTY PEi:!'NT
( 40;), SllT AND OTHER DEBRIS SHALL BE REMOVED AFTER
EACH RAINF All.
All GRAVEL BAGS SHALL CONTAIN 3/4 INCH MINIMUM
AGGREGATE.
ADEOIJA TE EROSION AND SEDIMENT CONTROL ANO PERIMETER
PROTECTION BEST MANAGEMENT PRACTICE MEASURES MUST
BE INSTALLED AND MAINTAINED.
THE OTY INSPECTOR SHALL HAVE !HE AUTHORITY TO ALTER
!HIS PLAN DURING OR BEFORE CONSTRUCTION AS NEEDED
TO ENSURE COMPLIANCE l'll!H CITY STORM WATER QUALITY REGULATIONS.
OWNER'S C:ERl]FICATE:
UNDERSTAND AN> ACKNO'M..EDGE lHAT f MUST: (1) IMPLEMENT
EST MANAGEMENT PRACTICES (BMPS) IJORING CONSTRUCTION
CTIVffES TO THE MAXIMUM EXTENT PRACTICABt.E TO A\QO
<£ MOOIUZATION Of POUIJTANTS SI/CH AS SEflWENT ANO TO
~D THE OPOSI/RE OF STORM WATER TO CONS1RUCTIOI-I
lA1EO POLWTANTS; AND (2) ADHERE TO, ANO AT ALL 111,ifS,
lllPI.Y 111TH THIS CITY APPRO'iEO TIER 1 COI-/S1RUCTION S'/,l'PP
IROUGHOUT THE DURA llON OF lH[ CONSTRUCTION Acn'ATIES
ITIL TiiE CONSTRUCllON 'NORK IS COMPLETE -ANO APPRO\ffi
' TI£ CITY Of CARI..S8AO. ~
STORM WATER COMPLIANCE FORM
TIER 1 CONSTRUCTION SWPPP
BEST MANAGEMENT PRACTICES (BMP)SElECTION TABLE
Bes! Msnegernent Pracuce·
(BMP) Description ➔
""'°"-➔
""
Q
.!kID . ---------Concr,te]Atpha!t Sowasttrna
Conctete Aolwork
PaVn'lq
Conduit e lndallatlon
stucco ortar Work
Wuaie~~ S1oq{no5;y Down Arw
Egulpm-,t Molnlat!anee and FuGfrla
Hozordotii Subitan~ lL_se/S~l
Q_ewate-'·
Sile AcceN Aetoss Dirt Olher{111t): ---
Instructions:
.,,
Emsiontoruol ''"'
;j "1] u
.. .r -~~.
~ :::i o"' C = 1 11/l_ ·e
!1 l~J
~1ro1~1"° frl ~ ~ frl
Sedin8ntCcnlrol BMPs
~ C 0
e 1 i~ 1 ilj11 "'.5 f ~.li'l!ci! ii r;i i O i ls In>
-~ T ~ ~ ~ m ~ tt: i1 J ill ill "' "'
'"' I .., ,.., I 11\._1.i
L ... I"
I .. eg
it "'"" 0 ~
T-""'"°'"""'
~ I .s s j! s
)5 )J ~. :;i. ~E ~&
iri
NoM!t>rm Water Mimagtntenl 8MPa
j -
1
11 ~~i ~ .R ~ 't'.; ,Q. l;; '>-l
c: JlmiJ
8~ _::.:§ II 11 j'I .,;'ll ... ] :;; s Jl &. tf. i_U
J; 11 1:;;1 % :z z z z
§
waste ~tlllld Melnk Poltrtlon Conlra BMPt
iii;~ g 6 .8
0 § • j ••"' -iL -~ :i. i ~5 g~ i li1~wi ~:11_ !l il~
5 _ii-,,~ ~ 8 -s. ig§ ~(J ga
::!!VJ ::r V, ~<1 tn:E :r:_:. (.J~
r
; •Ill l J I I -.
t Check the box to lht left of oU oppRoobfe coostrucUon octlvlty (first column) expected to occur during coostructlon.
2. Located glong the t~ of the BMP Tobie II o fiat of BMP's with it's corresponding Collfomio storrnwater Quciity Association (CASQA) designalfDn number. Choose one or more SM!Ts )OU Jnlend lo use during construction from lht 11st. Check th& box whCfe the chosen octMty row lntenects with the BMP column.
J. Refer to the CASQA construction handbook for lnformotlon ond detolls of the chosen BMPs ond how to opply them lo the proj!ct.
PROJECT!NFORMATION ,. 7
SIie Addreuc-;\~'3 V ~}'JOtJ'f-
A...,soi, """" N_,r. f 6 J-13 i'.)-• • J b
Emergency Contact: /
Name, £r .. -kl'1111q /,
24 H.,, Pho,,e:76o '$',!:, S-<fbq 'lJ €a<' "'-~k ,/VI' f'Pl ,II' •ERl7i\WJm's AGENT NAME (PRINT)
~ -::;:::::::,,. 1~ t{; -2 ·c Construction Threat to Storm Woler QuoJ1ty (C'1,ck Bo,)
NERt:::iJ/' S}/ffimER's AGENT NAME {SIGNATURE} -=
E'c29 --=---~-----· / Page 1 of 1
c;j~ J/Ju,w
___ REY Jl/17
PART 1 Complete, obtain signature, and submit this form when applying for a Building Permit. Note: Perm~~ will
(cont'd) n"' be Issued without a completed Construction Waste Manaaement Plan. • .
DEBRIS RECYCLING ESTIMATE:
'>I ( IIUN I\
,, 1 ~I!!,•• estlmal!ld w..ae~nnq11 to~,~fl'llted by yQur p~ .
. illei.nagement. cfian~s can.b~ 111ii1cl!:! ~n theflnal reey~e rep~t·
•liilie.ll,all l!t! f$,.;byw1111~J•fJlli!!l"••. ; :
Material Type
Complete this Hne of t/u/ table only If
only using WASTE MANAGEMENT
roll-o/1 bins.
Mixed C&D Dabrls
Estimated
Waste Quantity
(tons)
A
Place a (OJ check
next to items to be
reused or salvaaed
a
Place a (u) check next
to items to be
recycled
i-::As:::ph=•lt=&..::C;:;on:::cr:.::et:;:e:__ __ -4 ____ _j_ ---·-_ · -t----□= _ __ _ __ 0 _____ _
i.::B:::ri<::;k"-/.;.:Mo:as:::0:::n:..,rvccl.:Tcile::__ __ --1-_ .A~ 5 _____ □
Ml•ed Inert Debris _ ___ 0 _ ___ _ ___ 0 ___ ----'---'g _
cabinets, Doors, Fixtures,
l--"W:::ln~dow=•'-'(,=:cl'--'rccclec:•:::.11.::.th:=.at::.:a:i:p:;;;Pl,.,v)_+---__ Q_. ____ ·-·-· . _ O _____ _
c.
Place a (OJ c~eck, next
to Items to be
disposed •~ Ian' II
ea,pet ----i---o''-------· _____ D _____ .__ __ _.i. ___ ...j_ __ _.o4-_,_~
L.::ca:::r-"pet=P;c;•d:.::dc:cln.._g,_/ F;..;oc=amc:..... __ _,__ __ 0= ------+-_ _ _ 0 __ ----1---J..L----l---_.,""-l--~
Cardboard • d,. ':) ----i,-..-__ _tJ_ ___ -1-__ ___:i;;u._ __ -l ___ ..1,,,11.4-_;._-1
Ceilln&Tlle (acoustic) ----+--___ o____ ---D -
L.::Dryw=:::•lc..l (:.cuc.:se"'d'-'-, n"'e-'-w'-', •cccr..c•.,Pl ___ ~-"'"'-'--$_-_ ____ _ _____ Q ______ 1---_g"'-------1----==4-..;._~
~~:.::;:.::::,:;:.c:pe:::;•t:::c~"-t No:::br::clsd:::j~:::~c..us_h_, i_••_•_••-+--: ~ -_ Q _ ---
U!.'_palnted Wood & Pallets , 5"" m:._ __ _
Roofing Materials ____ vr_, _ .0 ._,-~-__ ~-L ___ .....!,j,L ___ -1-----"""-1--__.....--I
ScrapMetal ,. ~ s-::::_ _________ □..,,.___ __ Ja ---·
:J... s-----_JJ_ _...__ ___ _Il_ __ _ Stucco
□ : ____ ___;._ -+ ---
__ _ w_ ___ ··--
Other: __ □
TOTAL =
\llll()N(
To meet 65% Diversion Requirement (estimate) ___ 6 ___ x 0.65 =• ____ :3_, 'f-1--___ tons
Total Estimated Waste from above Minimum Required Diversion
Contractor/Owner S11nature, __ <_ .. _. -==·={=--__ =m> ________ Date 1-J~ 22 _
Page 2 of4
DEBRIS RECYCLIN REPORT (ACTUAL):
SECTION A Acknowledgement
I certify under penalt of perjury under the laws of the State of California that the information provided in and with
this form pertains to onstruction and demolition debris generated only from the project listed in PART 1, that I have
reviewed the accurac of the information, and that the information is true and correct to the best of my knowledge
and belief.
Permit No. ____ .. _________ _ Print Name £, -<_le //\ 1 ri, 1 , / / ·
Address __cl-4..LJLL_---1.....L<-"-"<;'---'~'--v"'--'"'-'"'"-fl--'=-l--'-/_.(-__ _____ Date _ 2-, _::-_±:}_~ ~ J'._
SECTION B Use this Final Log below to track loads of materials as they leave the job site.
@®SAVE RECEIPTS®®
Indicate FINAL quantit es in tons for each material and save receipts and documents from facilities where material is taken.
Additional ProJ ct Log pages are available if necessary. Use City Conversion Table to convert volume to tons.
Date
Example:
01/01/2020
M terial Type
Co rete (broken)
®TOT l
Diversion Rate Achie ed
A
Actual Amt
Reused or
Salvaged
-
Total of columns A+ 8
8 C
Actual Amt Actual Amt
Recycled Disposed In
Landfill
5 tons
. --·------
i-4 ,s
s---
, s
~
-s
• d, s.~
-s
C
Total of columns A+ B + C
Contractor/Owner Si nature __ 3~ ______ :::::::. _______ Date
Attach the following ocumentatlon to this Report:
Original recycling wel ht tickets, landfill weight tickets
Original donation rec ipts with photos and/or itemized descriptions
• Any other relevant In ormation to support Recycling Report
Page 3 of4
Destination Facility
(Name, Address, Phone)
Palomar Transfer Station~ 5960 £1
Camino Real
-760 603-0153
P<--l(1 rS:--f .. 1l"
S 7 c...c ~.,c c l~~C.:/
R'..R
ZRR
.: 65%
Rev. 2110/21
z
<
0
L I:
:
'
.
~
p-
l
Escondido Resource Recpvery
10~1 W Mission Ave i
Fscondido. CA 9?0?~
( 760) 745-3203
Customer: 0000
FRANK M.
Commodity
11 SELFHAUL REFUSE
[Gross(ln): 11,080.
I tricket:
' Dale.
Units
I .54
I C,S Sc l#ti
.. -/
I
68733
12/06/22
Rate
[NVO[Cr
[n: 7:48 Truck 0000
Oul. 7.~G Cont.dirier.
Route. 03011
98.00 per TON
Extended
Charye
62.00
lbsJ rare lU,UOO. lbs Scl#b Net: 1,080.
PA:D CREDIT CARD 62.00
r1vP.r
I /
I 1,,.\ 1 Ji) /
Escondido Resource Re~overy / ~ S__) \.JJCO c:!,
1021 W Mission Ave r --
Escondido. CA 92025 I / (f I c. O --r r
(760) 745-3203 / Jl I (C>!(' l 6 I I }\ (1
r. t 0000 ficket: 41126 In: R·?? _us omer: Truck: Date. 10/17/22 Out· 8:36 Container:
Route STEADY BUILDER
:
i
I NVOI Cf:
0000
08611
Exterded Corrrnod i ly
)
Units
1.68
.bs Scl#5
[la ·c Charge
11 SELFHAUL REFUSE
I Gross(lnl: 13,300.
VINCE
98.0C per TON lM.64
Tare 9.940 11.Js Scl#S Net. 3.360. lbs]
r,,u CHCCKt b43~
Driver
lz
-PA:,OMAR TRANSF:':?
::,960 EL CAMINO ?:':;:._:_
CARLSBAD, CA S2::, I
000999 -CASH
AUDRESS
carlsbad, CA
AND CH~CK C--llSTOMER
9200s I
ContracL: RE.SI
GROSS
TARE
NET
Tracking QLy:
Qty
0.88
Unit
TN
I
CAT~ Yr. ?
ill,380
i j,62C
f • --, ,, 0 i 1 I I 0\.
I 0.00
Des1:L ~-!..!Li:,n
MSW/
!
.Scale Jn
Gut; December OY,
Vehicle:
. •"-~ .. ,.,. -.,:Jv~ •'•-
Rd te Extension
GP.C:1
'
\~~<::Sr-v 0 l)
•
Signature:
20::2
Tax
SO.OJ
To::al
am
·Tot;:-ii
$77.04
$CJ.no
EsconrJido Resource Recovery
1021 W Mission Ave
Escondido. CA 9?025
( 7G0l 745.3?03
Cus Lo"Tier·: ODDO
FRANK M.
Commodity
11 S[Lf HAUi REFUSE
[l;ross(ln) 12.380.
Tir.krt.
IJatP
tJn i t.s
l 15
lbs Scl#S
~--J_ ✓7
IJz dl3o G,1s--,.J
1/ 2 I 25/ 'i P ~ .. f ~ :, .,
ngsg ln: 11 08 Truck:
17/16/22 Out: I I : IS Canta iner:
Rou'..e:
INVOJCF
0000
01611
Extended
fid te Chd r·ge
c;R 00 per TON 112. 70
Tare 10.080. lb, Scl#5 Net: 2,300. lbs' //
PAID r,rn r 1 r>RD f ~ / L_,
~ 5 b s i·-,
'. sc;,i'ld I de ~Ps;iurce Recovery
O.d,; M,ss1on Ave
i srn'ld i do. CA 92025
(760 l / 4:, -3203
Cust.omPr: noon I 1ckrt · H?O'll
lla'..P 01103/?3
rnANK M
·onrrn11 ty Un its kat0
In 11 11
Out· 11 : ?.7
1 Si I 111/\UI RffUS[ ? . ?5 08. 00 per fON
INVOIC
Truck: 0000
Container:
ilout c 03011
Gross(ln). H.S60. lb: Scl#S ld1~ 10.060. lbs Scl#5 Nel:
~ ,'< t.p,,~or;
Chu r:;c
??C. !)0
11.SDO. ~bsl
GRfG
>scondido Resource kecovery
1071 W Missinn Ave
[scondido. CA q707s
( 7(,ll l / 4S 3203
0000 Ticket: 8218'.i
Date. 91/ll:!/?3
I ,,ANK M
Corm7odi Ly Rate
;,1 n 79
Cul 13 3:i
PAiil CR~Olr CARil
IN
T,uck: uuuu
Container·
Route: 084 ! l
11 Sllr HAUL REF-USE
L(ir•oss(lnl 10.980.
L!~it:
.47
1:1s Scl#5
98. 00 OCI' TON
T d r·t• l O. 040 lbs Sc\ #S Net: 91\0 l t
l'AliJ l,RlDl r CARD
=n4161
DISCO~
Total: $
011Q3123
lnvU:~
~vd: Onlint
Oi1t0Vfl' Cr,cht
AID: !M152l!li
]~: 00 00 00 i,i ~
!SI: E8 00
. ~-:-.::::.:: :..r
:_· :~-.:.: ~ : .: :=:. :' 2_:"~:.
.,
C
\ '
L' C
r
' I
ESD1ILO R!:..""SCl.fln i;
l&H I k'Stll..:iT!.t4 AVE &OOI►l, CA. 92t2:i-1fl'l ~ii(: 7,i5 .32113
iForce
m~l
011:n'f.R ~ntrv ~tbx: ffiili:v
Tc,tal: $ E,9.5,9
01' :1123
Inv I: NllS
l'llPw: lhltf>!
Di, Mr
!ID Mli23ll!
Tl'I II il &1 fllit m ti
Ci:li ll (!lfii-(oo,aJlrJl
Cu,tc_, CoP•
·t,~lt( YOll'
llAF.ID
2' :J() 1
'love~y 13<>~ W (l~ d.
I· ccet 10432
D3te 01/31/23
i(cJ Le
I 1:
0,Jt:
98.0U per !ON
7:14
7:31
U·1 I l"
, /1
Its S:1#5 Tare 9,940 lbs Scl#5
INVOICE
Truck: 0000
::ontamer:
Route: 08611
--
lxtc:rded
Charge
6')_ 58
Net: l.420 lbs]
PAID CREDI! CARD 69.58
1r1 ver
A 9"
'/2 I
Ot1~P
e
l/2"1