For Office Use Only:
NEW HAAUSTIRE WMD Lag #:
|S DEPARTMENT OF Date Rec’d.:
“ Environmental No. of Copies:
ee =
Waste Management Division
Check #
APPLICATION FORM FOR
TYPE | MODIFICATION
TO SOLID WASTE MANAGEMENT
FACILITY PERMIT
pursuant to
RSA 149-M and New Hampshire Administrative Sotid Waste Rule Env-Sw 345
SECTION i. FACILITY IDENTIFICATION
4 F: hame:
classification: collections landfill
address: cfo Kimco Park Suite 100
: DES-SW-TO-95-004
street address : Center. Nashua
SECTION H. PERMITTEE IDENTIFICATION
1 name: Kimco
: 3333 New Park Suite 100 P NY 11042
Ti 4 7266
{4) | lf different than the associated with and designated by the to be the contact individual
for cation:
a Name: ons &
. Same
T number. same E-Mail:
SECTION Ii. DESCRIPTION OF PROPOSED MODIFICATION
Describe the proposed modification by answering each of the following questions. Use additional paper as necessary.
(1) | Provide a BRIEF description of the proposed modification, [Check box if response is provided on separate paper {Jt
Geotechnial underpinning to stabilize the building foundation at the Guitar Center corner of the complex via drilling of new piles
through the buried debris and disturbance of landfill cap for construction of new pile caps. Caps to berestored to existing condition.
(2) | Identify whether the proposed modification is a “type I-A" or “type |-B” modification. (If uncertain, use the worksheet provided with
the instructions for this form): [_] Type LA Type I-B
{3} | Identify, either below or on separate paper, each written permit condition that will require amendment to effect the proposed
modification and provide draft language for the same. [Check box if response is provided on separate paper {1}
Condition 3. Maintainence in accordance with Env-vWim 2507.4 (now (Env-SW 807.4}. No change, restore to existing conditions.
(4) | identify, below, each "last approved plan of record” identified in the permit which will be affected by the proposed modification and
will therefore require amendment/revision:
WMD LOG #
Check here if (Find this number on your copy of
affected TYPE OF PLAN DES APPROVAL DATE the approval}
Facility desiqn plans/specifications
Lj Facility operating plan
x Facility closure plan January 25, 1995 199500035
i] Facility financial assurance plan
i] Other plan (specify):
Page 1 of 4 Application Form for Type | Permit Modification Rev. 10/09
