The purpose of this form is to ensure that nonresidential buildings and site designs provide space for collection of refuse and recycling generated at the location. This form must be completed as part of all nonresidential site plan applications, pursuant to Chapter 109.1 of the Code of the County of Fairfax, VA and to Chapter 10 of the Public Facilities Manual. Please review the manual for additional guidance regarding the design of trash and recycling facilities. If you have questions regarding solid waste management, please call 703-324-5230, TTY 711. County Plan Name County Plan Number Owner Developer Tax Map Identifier Property location (e.g., Burke, Herndon) Reason for Submittal New Occupancy Site Plan Amendment Part 1: Waste Stream Calculation This calculation will estimate the quantity of trash and recycling that will be generated from this property. Once the waste quantity is estimated, the information can be used to design trash and recycling collection areas that will provide adequate storage capacity and truck access. Directions: Determine the square footage and uses of all interior areas from this property. You will need to do a separate calculation for each area that has a different use. Floor Area (sq ft) this use x Annual Waste Gen. Rate for this use (from chart) = Annual Tons Generated this use. Annual Waste Gen. Rate by Building Use Building Use Tons Per Square Foot Office or Mixed Use 0.0013 tons/sq ft Industrial 0.0016 tons/sq ft Food/Retail 0.0057 tons/sq ft Public Facility 0.00105 tons/sq ft Institution/School 0.00105 tons/sq ft Warehouse 0.00155 tons/sq ft Next, add together all of the Annual Tons Generated. The sum is the Combined Annual Waste Stream. Enter your Combined Annual Waste Stream here: If the Combined Annual Waste Stream Quantity is greater than 100 tons, recycling of one Principal Recyclable Material may be required in addition to recycling of mixed paper and cardboard. Check one of the following options: Combined Annual Waste Stream The Combined Annual Waste Stream Quantity for this property is less than 100 tons. Therefore, a system for recycling mixed paper and cardboard is the only requirement. The Combined Annual Waste Stream Quantity for this property is greater than 100 tons. Therefore, recycling a Principal Recyclable Material in addition to mixed paper and cardboard may be required. For properties with a Combined Annual Waste Stream Quantity greater than 100 tons, indicate if substantial generation of any of the following waste items is anticipated at this property (check all that apply): Waste Items: ferrous OR nonferrous scrap metal container glass (includes bottles) cloth aluminum or tin cans plastic (containers OR scrap, rigid or film) used motor oil (from fleet maintenance OR retail services) automobile bodies clean wood (includes pallets, scrap, and waste wood) brush, leaves, grass, etc. Part 2: Description of Solid Waste and Recycling System ALL NONRESIDENTIAL FACILITIES MUST RECYCLE MIXED PAPER AND CARDBOARD (CHAPTER 109.1 OF THE CODE OF THE COUNTY OF FAIRFAX, VA). SPACE FOR COLLECTING THESE MATERIALS SEPARATELY FROM OTHER TRASH MUST BE INCORPORATED INTO THE DESIGN PROCESS (CHAPTER 10, PUBLIC FACILITIES MANUAL). The plan design must include elements that will provide for the proper, legal, and safe storage and collection of all solid waste. Include the following information: how the plan design elements will facilitate the separation of recyclable materials from the waste stream; how and where solid waste and recyclable materials will be stored; and, how solid waste and recyclables will be collected. Be sure to include descriptions of internal and/or external storage, compactors, balers, chutes, etc. Use this pattern to help design trash and recycling areas, based on your calculations in Part 1: Enter a written description of your solid waste and recycling system below. Part 3: Certification of Accuracy and Completeness I hereby certify that the above information is accurate and complete to the best of my knowledge. I certify that I have read the requirements for incorporating recycling systems into the design process described in Chapter 10 of the Public Facilities Manual. I understand that any amendments to the plan involving a use or ownership change will require resubmission of this plan statement. Applicant Name Date Email IMPORTANT: Please print this page before selecting the Submit button and retain for your records.