Disposal at sea permit application form for dredged material
Dredged Material
Proposed Activity
Permits are issued in accordance with Division 3 of Part 7 of the Canadian Environmental Protection Act, 1999 (the “Act”). “Disposal” has the same meaning as in subsection 122(1) of the Act. Information provided on this form will be used to evaluate the application for a permit.
Applicants should consult their nearest regional Disposal at Sea Program office of Environment Canada before preparing or submitting an emergency permit application under section 128 of the Act.
The following activities are covered by this application. Indicate those activities that apply to you:
Loading for the purpose of disposal
Disposal of waste or other matter
Disposal on ice
Other: __________________________________________
Identification and Applicant Information
| Name of Applicant |
Telephone No. | Email Address/Fax No. | |||
| Address |
Type of Business | ||||
Permit History - List the permit numbers and expiry dates of any previous permits (to a maximum of five), including renewals, that are relevant to this application.
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| Name of Individual(s) Responsible for Proposed Activity |
Telephone No. | Fax No./Email Address | |||
| Name of Technical Contact(s) for Proposed Activity |
Telephone No. | Fax No./Email Address | |||
Information on the Proposed Activity and General Information
Despcription of Activity - Give a general description of the proposed activity and its purpose.
Number of pages attached ____
Substance to be Disposed of at Sea - Indicate the substance to be disposed of at sea. Indicate the relative presence of the components listed below. The Applicant’s Guide - Chapter 3: The Disposal at Sea Permitting Process for Dredged Material is intended to help you meet the minimum information requirements associated with this form. For soil or sediment, indicate the relative presence of
For rock, indicate the relative presence of
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Total Quantity (m3): Term of Permit Requested(maximum one year):
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Renewals
Do you want the requested permit to be considered for renewal? Yes ____ No ____ Number of potential renewals required - Indicate how many times renewal may be required (maximum four renewals). ___________________________ |
Renewal Quantity (cubic metres): Estimate the maximum quantity for disposal under each expected renewal. For dredged material, the quantity must be calculated in cubic metres using place measurement. First Renewal _______________ Second Renewal _______________ Third Renewal _______________ Fourth Renewal _______________ |
Load Site(s) - Provide a detailed drawing showing the boundaries of each site to be dredged.
| Name and address of site(s) (if any) | Latitute (decimal degrees to five decimal places, referencing NAD83) |
Longitude (decimal degrees to five decimal places, referencing NAD83) | Quantity to be loaded(m3) |
Disposal Site(s) - Provide a detailed drawing showing the boundaries of each disposal site or release zone.
| Disposal site name(if any) | Latitude (decimal degrees to five decimal places, referencing NAD83) |
Longitude (decimal degrees to five decimal places, referencing NAD83) | Depth (metres) | Quantity to be disposed of(m3) |
Provide an estimate of the movement and dispersion in the water column and on the sea floor of the substance disposed of at sea. In the case of disposal at a new disposal site or disposal on ice, see the Applicant’s Guide - Appendix C.2: Guidance for Disposal Site Selection or contact the nearest Disposal at Sea regional office for details of additional information that must be included in your application.
Number of pages attached ____
Route from Load Site to Disposal Site - Attach a map, chart or good reproducible set of drawings that shows the location of each load site and each disposal site. If the route is not direct, explain why and show the intended route on the map, chart or drawings.
Number of documents attached ____
Equipment and Methods - Describe the equipment and methods to be used at each load site and disposal site. Check the appropriate boxes below or provide a description under other if applicable.
Loading (dredging) equipment/method:
Disposal equipment/method:
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Number of pages attached ____
Methods of Packaging and Containment
Number of pages attached ____
Disposal Specifications
| Maximum quantity per disposal(m3) |
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| Rate (if applicable) (m3/hour or m3/day) |
Frequency (disposals per day, week or month) |
| Speed during disposal | Time required for discharge (minutes) |
| Track to be followed during disposal |
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Number of pages attached ____
Carrier Information - If unknown, this may be provided at a later date but prior to start of operations.
| Name and address of carrier |
Telephone No./Fax No./Email address |
| Name, title and address of owner of ship, aircraft, platform or structure used to carry out disposal |
Telephone No./Fax No./Email address |
| Name of individuals responsible for loading or disposal on behalf of applicant (including the master) |
Telephone No./Fax No./Email address |
| Name or number of ship, aircraft, platform or structure used to carry out disposal |
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Approvals - List all permits, licences and reviews, including environmental impact assessments, that are required by any federal, provincial, territorial, municipal or local agency for the carrying out of the activity described in this application.
| Issuing agency | Type of approval | ID no. | Date of application (year/month/day) |
Date of approval (year/month/day) |
Date of refusal (year/month/day) |
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Notice of Application - Attach evidence that a notice was published under paragraph 127(2)(d) of the Act.
| Clipping attached___ | ||
| Name of publication | Place of publication (city, province) | Date of publication(year/month/day) |
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Loading Site Profile (Historical Data, Current Uses and Proximity to Sensitive Areas)
Factors Influencing Load Site Material Quality- Indicate how each load (dredging) site was used during the last 10 years. Provide a map and show, by means of the symbols indicated below, the location of the major operating and historical facilities in the vicinity of the site. Indicate your sources of information and attach a copy of the information where possible. Where the source is a person, provide the person’s name, address and telephone number.
| Symbol | |||
| Facilities | Operating | Historical | Sources of information |
| (a) oil refineries; | (O) | (O*) | |
| (b) mills (specify type); | (M) | (M*) | |
| (c) mines (specify type); | (N) | (N*) | |
| (d) sewage outfalls; | (S) | (S*) | |
| (e) storm drains/pipes; | (P) | (P*) | |
| (f) shipping docks; | (D) | (D*) | |
| (g) other industries (specify); and | (I) | (I*) | |
| (h) other source of pollution and contamination (specify) | (C) | (C*) | |
Number of pages attached ____
Proximity to Sensitive Areas - For a new disposal site, provide a map that shows, by means of the symbols set out below, the location of all sensitive areas in the disposal site’s vicinity. Indicate your sources of information and attach a copy of the information if possible. If the source is a person, provide the person’s name, address and telephone number.
| Sensitive areas | Symbol | Sources of information |
| (a) recreational areas; | (RA) | |
| (b) spawning and nursery areas; | (SN) | |
| (c) known migration routes of living marine resources; | (MR) | |
| (d) sport and commercial fishing areas; | (FA) | |
| (e) areas of natural beauty or cultural or historical importance; | (BH) | |
| (f) areas of special scientific or biological importance; | (IS) | |
| (g) aquaculture; | (AC) | |
| (h) shipping lanes; | (SL) | |
| (i) areas of the seafloor having engineering uses (mining, cables, desalination or energy conversion sites); | (EU) | |
| (j) marine protected areas, ecological reserves and bird sanctuaries; | (PA) | |
| (k) critical habitat for species at risk; and | (CH) | |
| (l) other areas (describe use e.g. water intakes). | (XZ) |
Number of pages attached ____
Detailed Characterization of Material to be Dredged (Chemical, Biological and Physical Information)
Chemical Information - Provide a chemical characterization of the substance. If possible, attach detailed data and methods and the quality assurance and control data and methods. If no data are provided, explain why. See the Applicant’s Guide - Chapter 3: The Disposal at Sea Permitting Process for Dredged Material for details of additional information that must be included in your application.
Identify the presence of the following in any soil, sediment and pore water being disposed of:
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Number of pages attached ____
Biological Information - Provide an assessment of the potential effects of the substance, including toxicity, on living marine resources. If possible, attach detailed bioassessment data and methods and the quality assurance and control data and methods. If no data are provided, explain why. See the Applicant’s Guide - Chapter 3: The Disposal at Sea Permitting Process for Dredged Materials for details of additional information that must be included in your application.
Number of pages attached ____
Physical Information - Provide an assessment of the potential of the substance, once disposed of at sea, to cause long-term physical effects. If possible, attach detailed physical data and methods and the quality assurance and control data and methods. If no data are provided, explain why. See the Applicant’s Guide - Chapter 3: The Disposal at Sea Permitting Process for Dredged Materials for details of additional information that must be included in your application.
Provide the following information in respect of the waste to be disposed of:
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Number of pages attached ____
Information on Alternatives to Disposal at Sea
Waste Assessment - See Schedule 6 to the Act or contact the nearest Disposal at Sea regional office.
Number of pages attached ____
Alternatives - Provide a comparative assessment of disposal at sea and other practicable alternatives that indicates the following:
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Number of pages attached ____
Previous Disposal Methods - Describe the methods, if any, other than disposal at sea, that you have previously used to dispose of the same type of substance. Indicate dates and locations.
Number of pages attached ____
Mitigation - Indicate measures intended to minimize the environmental, health, navigational and aesthetic impacts during loading, transport and disposal. Check on the form the following mitigation measures that apply to the loading and disposal activity.
General mitigation measures for project activities:
Mitigation measures for dredging:
Mitigation measures for transit to the disposal site:
Mitigation measures for disposal at sea activities:
Other (if applicable):
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Number of pages attached ____
Time Restrictions - If the load site or disposal site is to be in the vicinity of spawning areas, migration routes or fishing areas, list the major species involved and the periods during which they are the most sensitive (active time of year).
Number of pages attached ____
If this application is to be submitted by an agent of the Applicant, the Applicant must complete the following authorization: I authorize _____________________________________(print name) to act on my behalf as my agent in the processing of this application and to furnish, on request, supplemental information in support of this application. |
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| Date |
Name (print) | Signature |
| This application is made for a permit authorizing the activity described in this application. I certify that I have reviewed the information provided in this application and that, to the best of my knowledge and belief, the information is true, complete and accurate. I further certify that I am authorized to undertake the proposed activity or am acting as the Applicant’s duly authorized agent. | ||
| Date |
Name (print) | Signature |
| Telephone No. |
Fax No. | |
Send the completed permit application, the application fee and all supporting documentation to your nearest regional Disposal at Sea Program office of Environment Canada.
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