ODOT Beneficial Reuse Form
This form is required for Clean Hard Fill; reinforced or non-reinforced concrete, asphalt concrete, brick, block, tile or stone that is free of all steel as per 703.16, to be managed in one or more of the following ways; recycled, beneficially reused as construction material, or used in legitimate fill operations on a site other than the site of generation. This form must be signed by the Recipient and Contractor and kept on file by the Project Engineer of the project generating the material.
Material Description:
__ Concrete - describe size (Slab, Broken, Crushed, Fines): .
__ Asphalt - describe size (Slab, Broken, Crushed, Fines): .
__ Mixed - describe size (Slab, Broken, Crushed, Fines): .
If Mixed, describe the ratio Concrete / Asphalt / other material: .
Estimated amount of material to be beneficially reused: . (tons / CY)
Where was the material generated?
Project Name: . PID / Work Order: .
CRS: . ODOT Project Engineer: .
Activity generating the material: .
Where will the material be beneficially reused, recycled or used in fill operation?
Recipient Name: .
Address/location: .
Description of the intended use: .
.
Note: Reclaimed asphalt cannot be placed within 1000 feet of a federal or state scenic river.)
Dates material is to be removed from project:
Beginning Date: / / . Ending Date: / / .
By signing below, I acknowledge that I understand Ohio’s laws associated with reusing Clean Hard Fill (OAC 3745-400-05). To my knowledge, the material described above will only be used as stated and be in compliance with Ohio’s Clean Hard Fill rules. The facility/location receiving this material is in compliance with all federal, state and local environmental laws.
Recipient Signature: . Date: .
Recipient Organization: .
Contractor Rep: Signature: .
Contractor Company: Date: .
Instructions:
This form was developed for use with the 2013 C&MS and associated SS800 for the beneficial reuse of Clean Hard Fill as defined in C&MS 703.16. The situation where this form may be utilized is identified in SS800 changes to 2013 C&MS 107.10.
Clean Hard Fill generated on an ODOT project may be reused in accordance with one of the seven situations below, each requiring varying degrees of documentation and approval:
1. Use on a different ODOT approved project.
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. File a Notice to Fill with regulatory agency if used as legitimate fill.
c. Provide executed copy of this form.
2. Use on a Federal, ODNR or OEPA owned location.
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. File a Notice to Fill when using this material in a legitimate fill operation.
c. Provide executed copy of this form.
3. Recycled into a usable construction material. {This includes transferring the material at a batch plant or recycling facility. This may also include private retailers of concrete/asphalt materials processed prior to transfer. Retail and recycling facilities are considered industrial uses and are required to obtain OEPA NPDES and occasionally Air permits. Material may not be transferred to facilities that do not have all appropriate permits.}
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. Provide executed copy of this form. {By signing this form, the recipient and contractor acknowledge understanding of all necessary permits required for the facility}
4. Temporary stockpile at a private or publicly owned location for intent of reusing as construction material. {This includes ODOT, county/municipal facilities or private property. Public facilities are typically subject to OEPA’s NPDES program and are required to be covered under a general or individual stormwater permit. Private property shall be covered by the project Construction General Permit or its own NPDES stormwater permit. Temporary stockpile must be limited to a period less than two years.}
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. Provide executed copy of this form.
c. Provide environmental clearance per C&MS 107.10 for temporary stockpile areas and intended fill areas on private property. {Environmental clearance is not required for temporary stockpile areas limited to existing driveways, parking lots or roadways}
5. Taken to a public or privately owned facility for reusing material on an existing driveway, parking lot or roadway. {This includes use on an existing private or public driveway, parking lot or roadway that would not constitute disposal or fill. Material will not be used to expand the existing driveway, parking lot or roadway boundary. Temporary stockpile locations shall also occur within the limits of an existing driveway, parking lot or roadway surface.}
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. Provide executed copy of this form.
c. Provide environmental clearance per C&MS 107.10 for all areas impacted beyond the limits of the existing driveway, parking lot or roadway.
6. Used in legitimate fill operations on a site other than the site of generation to bring a site up to grade. {This would require that the location receiving the fill be covered under the project’s Construction General Permit or have its own NPDES permit. Notice to fill shall be filed with the appropriate agency regulating the material disposal. This usually consists of the local Board of Health or Ohio EPA.}
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. Provide executed copy of this form.
c. File a Notice to Fill.
d. Provide environmental clearance per C&MS 107.10.
7. Any other reuse.
a. Notify ODOT Engineer of material use, provide transfer slips as required.
b. Provide executed copy of this form.
c. Provide environmental clearance per C&MS 107.10.
d. Any other documentation as required ensuring all environmental laws/rules are adhered to
This form would be completed for each prospective reuse application and material recipient and should properly describe the material and the estimated quantity involved.
A recipient is the person / agency / company that is the owner of the project or property where the material is to be beneficially used, and is not the contractor performing the work.
This completed form should be filed with the project records..
Form CA-EW-20, ODOT Beneficial Reuse Form 7/18/2014