Fillable Form 12095: Fultotit' County REDUCE RECYCLE l~i I. (County of Fulton)

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Form 12095: Fultotit' County REDUCE RECYCLE l~i I. (County of Fulton)

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BROWSE COUNTY OF FULTON (NY) FORMS

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TO: FULTON COUNTY LANDFILL PERMIT APPLICANTS
FROM: DAVID B. RHODES, DIRECTOR
SUBJECT: FULTON COUNTY LANDFILL USE PERMIT
Please read all of the enclosed information carefully. Your privilege to use the Fulton County
Sanitary Landfill is based on the rules and regulations specified in this application packet.
Fulton County has implemented a permit system for the Fulton County Sanitary Landfill. All
necessary application forms, as well as instructions for completing the forms, are enclosed.
The Fulton County Board of Supervisors adopted a local law, which is known as the “Fulton
County Solid Waste Management Law”. This local law establishes the framework for the
Department of Solid Waste to administer the permit process.
Upon approval, the permit will be valid until December 31
st
of each year. Renewal applications
must be filed a minimum of thirty (30) days prior to the expiration date. If you desire to amend
your permit (i.e. adding a new truck) you must notify the Department of Solid Waste a minimum of
five (5) days in advance of use.
The permit application fee must be submitted with your completed application. Make checks
payable to the Fulton County Treasurer. Send completed forms and check to the Department of
Solid Waste, P.O. Box 28, Johnstown, NY, 12095.
Please note that the Solid Waste Management Law provides Fulton County with a mechanism to
revoke landfill privileges of users violating said local law.
If you have any questions concerning the above, contact the Department of Solid Waste, at the
above telephone number.
DBR:pm
Enclosures
Fultotit' County
REDUCE ·
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♦
RECYCLE
FULTON COUNTY
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DEPARTMENT
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PO
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JOHNSTOWN,
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518-736-5501
FAX: 518-762-2859
David B. Rhodes, Director
H:\Landfill Permits\2019 Terms of Use.docx Page 1 of 2
Fulton County Department of Solid Waste
Landfill Terms of Use
Permit applications can be obtained at the Fulton County Department of Solid Waste or downloaded at
http://www.fultoncountyny.gov/dsw/
. These applications DO NOT apply to Transfer Station users.
1. INSURANCE REQUIREMENT:
Each account holder must provide proof of CURRENT coverage for Workers Compensation AND
Automobile Liability insurance certificate (Accord) with the Department of Solid Waste listed as a
Certificate Holder and have the following minimum limits:
a. Combined Single Limit of $500,000 OR
b. Bodily Injury per person $250,000, Bodily Injury per accident $500,000 and Property damage
$100,000
2. NYS PART 364 TRANSPORTER REQUIREMENT:
All permit holders must comply with the NYS Department of Conservation Part 364 Haulers
requirements if required. (see http://www.dec.ny.gov/chemical/8483.html
for information)
3. GENERAL USE REQUIREMENTS:
a. No Hazardous waste will be accepted at the Fulton County Landfill
b. All loads MUST be properly covered/contained during transport (NYS DOT Section 380-a)
Violators will be charged $150 per ton for an uncovered load.
c. All trucks utilizing the landfill are requested to be equipped with a CB radio, and front & rear tow
hooks.
d. Stop signs and Speed limits MUST be followed on the access roadway.
e. ALL trucks should come to a stop before getting on the weigh scale.
f. All 55-gallon drums must have tops/bottoms removed.
g. NO tires, Freon Units, Electronics or Appliances can be mixed in the load; violators will be
charged the appropriate removal/disposal fee.
h. Tires and Freon units must be disclosed to the scale attendant when weighing in.
i. All Industrial waste must be laboratory tested prior to acceptance.
j. Recyclables must be separated from refuse per preparation guidelines.
k. NO out of county waste/debris without an approved Out of County Contract.
l. NO Private Cars or Station Wagons will be allowed to utilize the Landfill.
4. LANDFILL OPERATING HOURS:
a. 7:15 AM – 3:00 PM Monday – Friday (except Holidays); 7:15 AM – 11:30 AM Saturdays.
b. NO hand unloading or Industrial waste after 2:00 PM daily or after 10:30 AM on Saturdays.
c. NO commercial recycling on Mondays or Saturdays.
d. ALL haulers must be scaled out by closing time.
e. Holiday Notices will be posted at Scale House.
5. PERMIT FEES:
a. ANNUAL PERMIT RENEWAL – Renewals are mailed to all current customers by November 1
st
and must be returned by December 1
st
.
b. Renewal Permit Fees are Invoiced on or about the 1
st
of the renewal year; base fee $50 plus $25
per vehicle permitted.
c. Permit fees are NOT prorated for partial year use.
H:\Landfill Permits\2019 Terms of Use.docx Page 2 of 2
d. Additions or changes to permitted trucks must be reported to the Landfill Office PRIOR to
utilizing the scale and must have required insurance coverage. Truck fee of $25 each may apply.
6. LANDFILL USE/BILLING:
a. CASH Accounts – Payment is required when weighing out. We can accept cash, check (NO 3
rd
party checks), or Credit/Debit. We accept MasterCard, VISA, or Discover, however, there is a
convenience fee charged by the processing company of 2.39% or $1.95 minimum for all
Credit/Debit transactions.
b. BILLING Accounts – Must be pre-approved.
i. 15 Day Accounts will be billed bi-monthly as of the close of business on the 15
th
and 30
th
of each month.
ii. 30 Day Accounts (Municipalities) will be billed at the close of business on the last day of
the month.
iii. PAYMENTS DUE – Per Fulton County Policy, all payments are due 15 Days from
Invoice date. Delinquent accounts (past 30 days) will be assessed 2% interest and
scale privileges will be revoked.
c. PAYMENTS – Should be made Payable to FULTON COUNTY TREASURER and mailed to
Fulton County Department of Solid Waste, PO Box 28, Johnstown, NY 12095.
7. TIPPING FEES AT SCALE FOR ALL USERS:
a. ALL Tipping Fees are set by the Fulton County Board of Supervisors (BOS) annually in Nov/Dec.
b. $150 per ton for any uncovered load crossing over the scale.
c. $5 service charge for each appliance brought into the landfill.
d. $5 minimum per load fee.
e. PRIOR APPROVAL Required for Contaminated Soil, Asbestos, Out-Of-County or other waste
f. Commercial recycling is currently accepted at our Materials Recovery Facility (MRF) (commercial
landfill or recycling permit required).
g. Dig Out fee, as set by the BOS, will be accessed on loads requiring DSW assistance to unload.
h. Out-of-County (OOC) waste will not be accepted without prior approval or signed standing
agreement/contract.
8. FULTON COUNTY FLOW CONTROL Legislation:
a. Any waste generated within Fulton County must be disposed of in Fulton County Landfill Facility.
b. No waste can be delivered to our facility that is generated from within the boundaries of any
county that has Flow Control Legislation, such as Madison, Oneida or Herkimer Counties.
9. CERTIFICATION:
I agree to indemnify and hold harmless the County of Fulton from any liability arising from the disposal of
inappropriate waste delivered by my business or my vehicle(s). I am aware that there are significant
penalties for submitting false information, including the possibility of fines, imprisonment and the
revocation of facility use.
I certify that I will abide by the rules and regulations, as outlined in the Fulton County Solid Waste Terms
of Use and Management Law.
Fulton County Department of Solid Waste Email: pmarkes@fultoncountyny.gov
PO Box 28, 847 Mud Rd. Phone #: 518-736-5501
Johnstown, NY 12095 Fax #: 518-762-2859
For County Use Only:
Date Issued Account No. Account Approval
Billing Account Type: 15 Day Acct. 30 Day Acct
Cash Only Credit : Monthly Billing Limit: _________ Billing/Credit Approval: __________
OOC Agreement Yes OCC Approval: _____________
No
[ ] LF DB [ ] QB [ ] Scale Permit Stickers: Mailed Scale Files: [ ] AR [ ] LF
LANDFILL APPLICATION
Part A: Applicant Information
1. Applicant Business Name: ____________________________________________________
DBA if applicable: _________________________________________________________
2. Business Address: __________________________________________________________
____________________________________________________________
3. Business Contact: ______________________________ Title: _______________________
Phone: ________________ Fax: ___________________E-mail: ______________________
4. Billing Address: ____________________________________________________________
____________________________________________________________
5. Billing Contact: ______________________________ Title: __________________________
Phone: _______________ Fax: _____________________ E-mail: ____________________
6. Legal Character of Business (check one):
Corporation _____ Partnership _____ Individual _____ Other (explain)
7. Annual Permit Fee:
a. Base Fee: $50.00
b. No. of Vehicles:________ at $25.00 per vehicle: $ __________
Total Fee Attached: $____________ (5a + 5b) (attach check here)
8. NYS Sales Tax ID No. (if available)
FULTON COUNTY
DEPARTMENT OF SOLID WASTE
PO BOX 28, 847 MUD ROAD
JOHNSTOWN, NY 12095
♦
RECYCLE
518-736-5501
FAX: 518-762-2859
David B. Rhodes, Director
ONLY applicants that desire a Department of Solid Waste Billing account must complete Part B.
NOTE: This will allow daily tipping fees to be applied to your customer account. Bi-Monthly Invoices
will be sent. Fulton County Code Article VII 260.28 requires payment be received within 15 days of the date of
the invoice.
Part B: Credit Check Authorization Form
I hereby authorize the Fulton County Department of Solid Waste to verify my credit history, bank
accounts, holdings and any other asset balances that are needed to process my landfill permit
application. I further authorize the Fulton County Department of Solid Waste to order a credit
report and verify other credit information. It is understood that a photocopy of this form will also
serve as authorization.
The information the Fulton County Department of Solid Waste obtains is only to be used in
processing my landfill permit application for the purpose of creation of a billing account for
Department of Solid Waste services.
Applicant Business Name:
Contact Person: (print)
Signature:
Date:
Requested Monthly Billing Limit $
Provide two business credit references (at least one bank, financial institution):
Name Contact:
Address
Telephone # Fax #:
Acct. No.
Name Contact:
Address
Telephone # Fax #:
Acct. No.
Part C: Vehicle Information
Applicant Business Name:
Number of vehicles listed: __________at $25/unit = $__________
NOTE: Denote "N/A" if not applicable. See Part H if sub-contracting Hauler)
Please see Part G: Insurance Certificate for insurance requirements for vehicles listed below.
VEHICLE A
Year & Make
Vehicle Type
State of Issue
License Plate No
Company assigned
number (if applicable)
Capacity (C.Y.)
NYS Part 364 Permit #
Vehicle LF Acct #:
(Official Use Only)
Date permit Issued
(Official use only)
Part D: Insurance Certificate
(Automobile Liability)
An insurance certificate (Accord) must be provided, per the requirements of the Fulton County
Solid Waste Management Law. The insurance certificate must name the Fulton County
Department of Solid Waste as Certificate Holder, list scheduled autos (if applicable), and must
have the following minimum automotive liability limits:
Combined Single Limit: $500,000 -or- Bodily Injury Per Person: $250,000
Bodily Injury Per Accident: $500,000
Property Damage: $100,000
Proof of NYS Workers Compensation coverage also required per the requirements of Fulton
County Solid Waste Management Law.
Part E: Waste Identification
Waste Description: Provide detailed estimate of quantities of each component of the waste
stream; i.e. tons of sludge, asbestos, contaminated soil, construction and demolition, commercial
waste, industrial waste, commercial recycling, etc. that you expect to be depositing annually at
the Fulton County Sanitary Landfill or Recycling Facility, itemized by type and origin:
Waste Description
Approx. Tons/Year
Village/Town/City
County
Unless an Out-of-County Agreement or Contract has been executed, all waste disposed of
at the Fulton County Landfill must be from within the boundaries of Fulton County.
NO Recycling from Out-of-County.
Part F: Toxicity Data
A Department of Environmental Conservation/Department of Health approved laboratory for
toxicity must test any and all waste material that is subject to NYS Part 364 Transporter
Regulations. The tests must be conducted with the TCLP method. Also, solids content
information must be provided.
Laboratory results must be received a minimum of two weeks prior to the transportation of refuse
to the Fulton County Landfill by each waste generator; tests must be conducted on each
component of the waste stream; tests must be performed on random samples for TCLP
parameters.
All laboratory data must be current; i.e. conducted within three months of permit application. A
retest is needed if the generator implements a process change.
If applicable, attach laboratory results to application.
Part G: Certification
I certify under penalty of law that I have personally examined and am familiar with the information
submitted in this application package and all attached documents; I affirm that the submitted
information is true, accurate and complete. I certify that no hazardous wastes (as defined by New
York State and Environmental Protection Agency regulations), explosives, infectious wastes or
radioactive wastes will be delivered by my business or in my vehicle(s) to the Fulton County
Sanitary Landfill. I agree to indemnify and hold harmless the County of Fulton from any liability
arising from the disposal of such wastes delivered by my business or my vehicle(s). I am aware
that there are significant penalties for submitting false information, including the possibility of
fines, imprisonment and the revocation of facility permit.
I also certify that I will abide by the rules and regulations, as outlined in the Fulton County Solid
Waste Management Law and Terms of Use.
I also certify that all the information provided on this application is true and that I agree to pay all
tipping fee billings within fifteen (15) days and understand that for any unpaid balance, a finance
charge may be assessed.
I also certify that all refuse delivered by my business or in my vehicle(s) originates in the County
of Fulton unless an Out-of-County Agreement or Contract has been executed.
BUSINESS NAME:
ADDRESS:
PRINTED NAME:
SIGNATURE:
DATE:
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H:\Landfill Permits\PERMIT APPLICATION\Authorization to bill customer - Part H -REVISED.docx
Fulton County Department of Solid Waste
Part H: 2019 AUTHORIZATION for HAULER to BILL CUSTOMER
A Customer that sub-contracts all or some hauling to another Hauler and desires landfill user charges
billed directly to their account, must complete and sign this form.
Yearly Blanket
This Job/Date only
Job Desc: ________________________________ Date Covered:______________________
CUSTOMER BILLING CERTIFICATION:
I, ________________________________________, hereby certify that the hauler listed below
(Customer contact person)
REFUSE HAULER: DSW Acct #
is authorized to dispose of waste generated by my business, and as such, is authorized to instruct
Department of Solid Waste staff that said tipping fees should be assessed to said Undersigned
Customer account, and the Undersigned Customer hereby agrees to promptly pay all invoices, per the
requirements of the Fulton County Solid Waste Management Law.
CUSTOMER : DSW Acct #
Authorized Representative:
(Type or print)
Signature:
Return this form to:
Fulton County Dept. of Solid Waste
POB 28, Mud Rd
Johnstown, NY 12095
Or
Fax: 518-762-2859
Email: pmarkes@fultoncountyny.gov
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Form 12095: Fultotit' County REDUCE RECYCLE li I. (County of Fulton)

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Completed 17 July 2020

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