SAFE CLOSURE AND REHABILITATION OF DISPOSAL FACILITIES

(Shall serve as an application for an Authority to Close)

To be prepared by the authorized representative of the LGU. Please fill up the information on the space provided and put a () on the appropriate items.

Name of LGU

Location of Dumpsite (Brgy./Sitio/City/Municipality/Province):

Mode of Ownership [ [ [ ] TCT/ OCT ____________ ] Contract of Lease with ________________________________________ ] Others (please specify): ______________________________

Type of disposal facility operation prior to closure: [ ] open dumpsite (active) [ ] controlled dump facility (with NTP) [ ] sanitary landfill Brief description of the disposal facility: [ ] open dumpsite (abandoned) [ ] controlled dump facility (without NTP)

Period of operation of disposal facility: From (mm/dd/yy)

to (mm/dd/yy)

Figure 1: Picture of dumpsite prior to rehabilitation as of (mm/dd/yy)

PHYSICAL CHARACTERIZATION OF THE DISPOSAL FACILITY Area covered by dumpsite: Estimated volume prior to rehabilitation: Estimated carrying capacity: m2 m3 as of (mm/dd/yy) m3

Estimated height (or thickness) of dump wastes prior to rehabilitation: m as of (mm/dd/yy) Estimated slope prior to rehabilitation (in ratio or percentage):

Figure 2: Schematic Layout of disposal Facility

Figure 3: Cross section of dumpsite showing height or thickness

Type of waste dumped in the disposal facility (provide percentage of each waste if determinable): [ ] Biodegradable ____% [ ] Non-biodegradable _____%

[ ] Bulky waste (i.e., home appliances, [ ] Hazardous waste / Biohazardous Waste furniture, etc.) _____% ______% [ ] Others (please specify) ____________________________________________ Daily volume of disposed waste: tons and m3

ENVIRONMENTAL CHARACTERIZATION OF THE AREA Site condition prior to use as disposal site: [ ] flat land [ ] hilly [ ] others, please specify Surrounding dominant land use condition (approximately 1km radius) [ ] agricultural [ ] residential [ ] industrial [ ] quarry/mines [ ] swampy area

[ ] others, please specify

Figure 4: Map showing dominant land use within 1km. radius (Please use color codes for identification) Existing nearby surface and ground water body [ ] Surface water (Creek, Rivers, Sea) Type of current use _______________________ Distance from dumpsite ______________

[ ] Groundwater [ ] Deep well [ ] Shallow well Distance from dumpsite ______________ [ ] Other (please specify and describe use briefly) _____________________________________________ Existing Drainage System [ ] present and operational (Please discuss briefly type and use) ______________________________________________________ [ ] none Ambient air condition (Please briefly discuss the current quality of air in the area)

ISSUES AND CONCERNS DURING OPERATION OF THE DISPOSAL FACILITY Adverse Impact to surrounding environment [ ] Pollution in nearby water body [ ] Contamination of nearby potable water source [ ] Adverse effect on nearby agricultural land [ ] Increase Mortality/ Morbidity on nearby residential areas [ ] Others, please specify

Occurrence of open burning/ spontaneous combustion [ ] Yes, if yes, discuss briefly the cause of incidence

[ ] No Occurrence of Hazardous waste dumping (i.e., household hazardous waste, hospital waste) [ ] Yes, if yes, discuss briefly the cause of incidence

[ ] No Presence of waste pickers [ ] Yes, if yes, discuss briefly the number of scavengers and frequency of visit:

[ ] No Presence of Squatters within or at the peripheries of the dumpsite [ ] Yes, if yes, discuss briefly the number of households or occupants:

[ ] No Other issues and concerns, please specify (use additional sheet if needed):

Is waste covering practiced?

[ ] Yes

[ ] No

If yes, what type and source of cover material is used? Frequency of waste covering [ ] daily [ ] weekly [ ] monthly [ ] others, please specify ________________________

SAFE CLOSURE AND REHABILITATION (SCR) PLAN COMPONENT

(The closure management program extended to particular disposal sites to address significant physical and environmental impacts and these are the activities that will be scheduled in the Gantt Chart. The sub-activities in every major activity may apply depending on the situation at the dumpsite).

SCR Plan managed or operated by: [ ] local government [ ] private sector, pls. specify __________________________ [ ] others, pls. specify __________________________

Cost / Budget allotment for Rehabilitation: Site clearing shall include:

[ ] stoppage of waste picking [ ] removal of squatters [ ] stripping off of top waste layer [ ] others, please specify _____________________________ Please discuss process/ mode of site clearing: __________________

Site Grading and Stabilization of Critical Slope [ ] compaction of exposed wastes [ ] benching [ ] modified present slope [ ] side slope at 1 vertical to 3 horizontal or gentler [ ] steep slope, specify estimates __________________ [ ] provision of retaining wall [ ] provision of embankment [ ] others, please specify _____________________________ Please discuss process/ mode of site grading and stabilization of slopes:

Application and maintenance of soil cover What type and source of cover material will be used?

Drainage Control System [ ] construction of canals/ditches [ ] modification/ improvements on existing drainage Leachate Management (follow the guidebook on safe closure and rehabilitation of disposal facilities)

[ ] installation of leachate collection pipes [ ] installation of collection pond [ ] leachate treatment [ ] evaporation [ ] re-circulation [ ] others, please specify and discuss method

[ ] surface water discharge [ ] natural attenuation Gas Management (follow the guidebook on safe closure and rehabilitation of disposal facilities) [ ] installation of gas vents number of gas vents to be installed _____________________ type of gas vent to be installed _________________________ Fencing and Security [ ] fence shall be provided [ ] checkpoints Signage Strategic locations: _____________________________ Proposed quotes or announcements to put in: [ ] guards shall be assigned [ ] other form of security measures ______________________

Other Component of SCR Plan (use additional sheets if needed):

Operating hours:

[ ] daytime

[ ] nighttime

Attached is a GANTT CHART OF IMPLEMENTATION of SCR Plan as Annex 1

Figure 5: Perspective of rehabilitated disposal facility (external view)

Figure 6: Perspective of the cross- section of rehabilitated disposal facility with the required amenities (gas vents, leachate pipes, etc.) POST CLOSURE LAND USE (PCLU)
(The closure management of the open dumpsite or the controlled dumpsite should be returned to some form of productive use.)

Site Maintenance [ ] Maintenance of rehabilitated disposal facility

[ ] Soil cover maintenance and monitoring [ ] Leachate treatment [ ] Gas management maintenance and monitoring [ ] Others, please specify [ ] Integrated Waste Management Facility, pls. specify details ___________________________________________ [ ] Public open space [ ] Park [ ] Parking Area or Roads [ ] Recreational Use [ ] Golf Course [ ] Grazing Area or Agriculture [ ] Building/Housing Units [ ] Commercial/Industrial Facility [ ] Others, pls. specify ____________________________________________ Attached is a GANTT CHART OF POST CLOSURE ACTIVITIES of SCR Plan as Annex 2 PROPOSED SOLID WASTE MANAGEMENT
(The proposed solid waste management plan shall be the alternative approach upon closure of disposal facility)

Biodegradable Waste [ ] Centralized composting [ ] barangay composting [ ] cluster (barangay) composting [ ] Household composting Please indicate target barangays of the above approach for bio-waste management

Recyclable Waste

Please discuss briefly the method of handling and management (attach extra sheets for additional information]:

Residual Waste [ ] Sanitary landfilling Estimated volume to be disposed/ schedule of disposal _______________________________________________ Please discuss briefly the operation of disposal (attach extra sheets for additional information):

] Residual waste processing technology Estimated volume to process daily: _____m3 Please briefly discuss technology to adopt

Special Waste (I.e., household hazardous waste, hospital waste) Please discuss briefly the method of handling and management (attach extra sheets for additional information)

Attached is a GANTT CHART OF ESWM ACTIVITIES INCLUDING IEC SCHEDULE IN PREPARATION FOR THE CLOSURE OF EXISTING DISPOSAL FACILITY,Annex 3 Prepared by: Designation: LGU/Office:

10

Reviewed and Approved by:

Mayor

11

Annex 1

GANTT CHART OF IMPLEMENTATION of SAFE CLOSURE & REHABILITATION PLAN INCLUDING ITS POST CLOSURE ACTIVITIES RESPONSIBLE ENTITY/ OFFICE D COST REMARKS

ACTIVITIES

TIME FRAME OF IMPLEMENTATION CY 2008

Prepared by: 1

Annex 2

GANTT CHART OF PROPOSED ESWM ACTIVITES RESPONSIBLE ENTITY/ OFFICE

ACTIVITIES

TIME FRAME OF IMPLEMENTATION 2008 J F M A M J J A S O N D

COST

REMARKS

Prepared by: 2

ACCOUNTABILITY STATEMENT This is to certify that the prepared SAFE CLOSURE AND REHABILITATION PLAN (SCRP) for the existing disposal facility of the LGU of _________________ is reviewed and approved by the undersigned. Should I/we learn of any information, which would make the SCRP inaccurate, I/we shall bring the said information to the attention of the concerned EMB Regional Office. In witness whereof, I/we hereby set our hands this __________ day of _______________ at ___________________________________. ______________________________ Printed Name & Signature ______________________________ Title or Designation

ACKNOWLEDGMENT BEFORE Community Tax ME this ______ No. day of ________________, 20_____ issued at on

___________________, personally appeared __________________________ (name) with Certificate _____________________________ _______________ (date) at ____________________ (place), in his/her capacity as _______________________ (position) of ___________________________ (company) and acknowledged to me that this SAFE CLOSURE AND REHABILITATION PLAN (SCRP) is a requirement of the DENR per DAO No. 9, Series of 2006 with the subject General Guidelines in the Closure and Rehabilitation of Open and Controlled Waste Disposal Facilities. This document, which consists of ______________ pages, including the page on which this acknowledgement is written, is a SCRP. Witness my hand and seal on the place and date above written. ______________________________ Notary Public Doc. No. Page No. Book No. Series of _______ _______ _______ _______