PFAS Statement Form

PFAS Statement Form - ASA

PFAS contamination in soil is present at Alice Springs Airport (ASA) at varying concentrations throughout the precinct. Source areas include historic landfills, fire training grounds and areas where fire-fighting foam has been released.

Construction activities, including new developments, infrastructure, facilities and maintenance projects, where soil excavation takes place, are required to obtain a PFAS Statement as part of the Airport Building Control (ABC) approval process.

The purpose of the PFAS Statement is to undertake a risk assessment to establish the likelihood of encountering PFAS-contaminated soil during excavations and outline the controls to be put in place to mitigate the risk to both personal health and the environment.

Step 1:

Complete and submit this form.

Step 2:

Once this form is submitted the Airport’s Environment and Sustainability Manager will assess the risks and outline any further environmental controls required. The signed form will then be returned to the applicant. A copy of this signed form must then be submitted as part of the ABC application.

Note: Checks will be undertaken at random to ensure all risk control measures outlined are being complied with.

To be completed by Applicant

Name of Project *Per- and poly- fluoroalkyl substances (PFAS) Statement

Project Scope

The purpose of the work is *

The proposed work will involve the excavation of soils: *

Please include the Name of Site, Address, and Grid Reference *

Will a hydrovac be utilised? *

YesNo

Will excavation be opened and closed on same shift? *

YesNo

What is the quantity (if any) of temporary stockpiling required at the site? *

Timing of Works

Commencement Date

Duration

Site Project Manager

Name *

Email *

Signature *

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Date

Additional documents

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Design drawings, historic contamination assessments etc.

To be completed by the Environment and Sustainability Manager

Potential PFAS risks

In referencing ASA’s grid map against ASA’s Contaminated Sites Register, we highlight known potential sources of soil contamination for PFAS related to this site are:

Main Fire Station and Surrounding Area (IS04) - Grid Reference J5Air Rescue Fire Fighting Training Ground and adjacent Soil Farm (CS06) - Grid Reference O8 Roadway adjacent Air Traffic Control Tower (IS01) - Grid Reference K5Unlined drain south of main firefighting station (IS02) - Grid Reference J6

Do known historical site uses of the proposed construction area suggest activities/ incidents potentially associated with PFAS use? *

YesNo

Has PFAS concentration sampling been undertaken in the construction/work areas?

In considering the PFAS National Environmental Management Plan and the the National Environment Protection (Assessment of Site Contamination) Measure 1999 (the ASC NEPM), ASA considers the risk of PFAS in these areas to be *

LowMediumHigh

Additional comments

PFAS Risk Controls

Soil

Further environmental testing required to determine if soil permitted to leave project site and/or determine stockpile management requirements.Temporary stockpiling will occur at each individual excavation site where appropriate.Plastic sheeting required under any temporary stockpiles.All excavations are to be backfilled on the same day.Excavations to be covered and protected from rain and/or wind.Fill or hydrovac slurry that is a surplus to refill needs, that has not come into direct contact with groundwater, must be relocated to an area designated by the ADG Environment and Sustainability Manager.

Additional controls

Work Health and Safety

Dermal contact with excavated material and inhalation of dust must be avoided using appropriate PPE.

Trigger for further assessment works

The proposed scope of works for this project should be acknowledged by the Department to be low risk with regards to potential PFAS contamination risks.At this point no further investigation and/or assessment is warranted based on the works being conducted.

Additional comments

Additional documents

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Limitations

In preparing this report, Alice Springs Airport (ASA) has relied upon data, surveys, analyses, designs, plans and other information provided to ASA by other individuals and organisations. Except as otherwise stated, ASA has not verified the accuracy or completeness of the data. To the extent that the statements, opinions, facts, information and/or recommendations in this report are based in whole or part on the data, they are contingent upon the accuracy and completeness of the data. ASA will not be liable in relation to incorrect conclusions should any data, information or condition be incorrect or have been concealed, withheld, misrepresented or otherwise not fully disclosed to ASA.

This statement is intended for the sole use of Airport Building Controller (ABC) and only for the purpose for which it was prepared, to assist in the assessment of Building Approval Applications as required under the Airport (Building Control) Regulations 1997.

Environment and Sustainability Manager

Is this PFAS Application Approved? *

YesNoRequires more information

Detail request for more information *

Detail reason for Applicaiton Refusal *

Name *

Date

Signature *

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CAPTCHA *

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