Form FDACS-04002 "Notice of Intent to Implement Water Quality/Quantity Bmps" - Florida

What Is Form FDACS-04002?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FDACS-04002 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-04002 "Notice of Intent to Implement Water Quality/Quantity Bmps" - Florida

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Florida Department of Agriculture and Consumer Services
Office of Agricultural Water Policy
FDACS-OAWP
Mayo Building
NOTICE OF INTENT TO IMPLEMENT
407 S. Calhoun St. MS-E1
WATER QUALITY/QUANTITY BMPS
Tallahassee, FL 32399
ADAM H. PUTNAM
COMMISSIONER
Rule 5M-9.004, F.A.C.
Before beginning, fill in the BMP manual that you are enrolling under: ______________________________
Check the box below if it applies to your operation:
I have an existing National Pollutant Discharge Elimination Permit (NPDES). If so, you will not be required to
complete a BMP Checklist for this enrollment. All other information provided in this form is still required. The
status of your implementation of best management practices will be evaluated based on compliance with your
permit as determined by the issuing agency. Permit Number: ________________________
I have an existing South Florida Water Management District Rule Chapter 40E-63, F.A.C. Permit. If so, you will not
be required to complete a BMP Checklist for this enrollment. All other information provided in this form is still
required. The status of your implementation of best management practices will be evaluated based on
compliance with your permit as determined by the issuing agency. Permit Number: ____________
In consultation with Florida Department of Agriculture and Consumer Services (FDACS) field staff or contractors, complete
this Notice of Intent (NOI), and each applicable BMP Checklist (in the BMP manuals), selecting the BMPs applicable to your
property. The NOI may list multiple parcels only if all of the following apply: the parcels are contiguous, they are within the
same county, they are owned or leased by the same person or entity, the same type of operation is conducted on each
included parcel, and the same BMPs identified on the checklist are applicable to each parcel.
Complete the NOI and the BMP Checklist in cooperation with FDACS field staff or FDACS contractors.
Keep a copy of the NOI and the BMP Checklist in your files as part of your BMP record keeping.
P
I
RODUCER
NFORMATION
Name:
Business Relationship to Landowner:
_______________________
Mailing Address:
________
City:
__
State: __ ___ Zip Code:
________
Telephone:
_____
FAX:
___
_______
Email: _________________________________________________________________________________________
L
I
ANDOWNER
NFORMATION
NOTE: If the Landowner is the same as the Producer Information listed above, please check:
 Same as above. If not, complete the information below for each landowner if leased properties are involved.
Name:
________
______
Mailing Address:
______
City:
__
State:
Zip Code:
______
Telephone:
FAX:
______
Email: __________________________________________________________________________________ _____
C
I
ONTACT
NFORMATION
NOTE: If the Contact is the same as the Producer or Landowner Information listed above, please check:
 Same as above. If not, complete the information below.
Name:
________
_____
Mailing Address:
_____
City:
__
State:
Zip Code:
_____
Telephone:
FAX:
_____
Email: _______________________________________________________________________________________
FDACS-04002 12/17
Page 1 of 3
Florida Department of Agriculture and Consumer Services
Office of Agricultural Water Policy
FDACS-OAWP
Mayo Building
NOTICE OF INTENT TO IMPLEMENT
407 S. Calhoun St. MS-E1
WATER QUALITY/QUANTITY BMPS
Tallahassee, FL 32399
ADAM H. PUTNAM
COMMISSIONER
Rule 5M-9.004, F.A.C.
Before beginning, fill in the BMP manual that you are enrolling under: ______________________________
Check the box below if it applies to your operation:
I have an existing National Pollutant Discharge Elimination Permit (NPDES). If so, you will not be required to
complete a BMP Checklist for this enrollment. All other information provided in this form is still required. The
status of your implementation of best management practices will be evaluated based on compliance with your
permit as determined by the issuing agency. Permit Number: ________________________
I have an existing South Florida Water Management District Rule Chapter 40E-63, F.A.C. Permit. If so, you will not
be required to complete a BMP Checklist for this enrollment. All other information provided in this form is still
required. The status of your implementation of best management practices will be evaluated based on
compliance with your permit as determined by the issuing agency. Permit Number: ____________
In consultation with Florida Department of Agriculture and Consumer Services (FDACS) field staff or contractors, complete
this Notice of Intent (NOI), and each applicable BMP Checklist (in the BMP manuals), selecting the BMPs applicable to your
property. The NOI may list multiple parcels only if all of the following apply: the parcels are contiguous, they are within the
same county, they are owned or leased by the same person or entity, the same type of operation is conducted on each
included parcel, and the same BMPs identified on the checklist are applicable to each parcel.
Complete the NOI and the BMP Checklist in cooperation with FDACS field staff or FDACS contractors.
Keep a copy of the NOI and the BMP Checklist in your files as part of your BMP record keeping.
P
I
RODUCER
NFORMATION
Name:
Business Relationship to Landowner:
_______________________
Mailing Address:
________
City:
__
State: __ ___ Zip Code:
________
Telephone:
_____
FAX:
___
_______
Email: _________________________________________________________________________________________
L
I
ANDOWNER
NFORMATION
NOTE: If the Landowner is the same as the Producer Information listed above, please check:
 Same as above. If not, complete the information below for each landowner if leased properties are involved.
Name:
________
______
Mailing Address:
______
City:
__
State:
Zip Code:
______
Telephone:
FAX:
______
Email: __________________________________________________________________________________ _____
C
I
ONTACT
NFORMATION
NOTE: If the Contact is the same as the Producer or Landowner Information listed above, please check:
 Same as above. If not, complete the information below.
Name:
________
_____
Mailing Address:
_____
City:
__
State:
Zip Code:
_____
Telephone:
FAX:
_____
Email: _______________________________________________________________________________________
FDACS-04002 12/17
Page 1 of 3
Complete the following information for the property on which BMPs will be implemented under this
NOI. You may list multiple parcels if they are located within the same county, are owned or leased by
the same person or entity, and are applying the same BMPs on them.
Farm/Site/Operation Name:
County:
Tax Parcel Identification Number(s) from county property appraiser: Please submit a copy of your
county tax bill(s) or the property information sheet from the county property appraiser for each enrolled
parcel, with owner name, mailing address, and the parcel ID number(s) clearly visible. Include each
owner’s phone number and email address if not already listed on the NOI. Attach a separate sheet if
necessary (see form provided).
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
 Additional parcels are listed on separate sheet. (check if applicable)
Total # of acres of all parcels listed (as shown on property tax records):
Total # of acres on which BMPs will be implemented under this NOI:
_____________
I
403.067(7)(
)2, F
S
, I
BMP
N ACCORDANCE WITH SECTION
C
LORIDA
TATUTES
SUBMIT THE FOREGOING INFORMATION AND THE
C
BMP
(
)
N
HECKLIST AS PROOF OF MY INTENT TO IMPLEMENT THE
S APPLICABLE TO THE PARCEL
S
ENROLLED UNDER THIS
OTICE OF
I
. B
, I
1)
; 2)
I
NTENT
Y THE SIGNATURE BELOW
CERTIFY THAT
ALL THE INFORMATION ENTERED IS CORRECT
THAT
HAVE ALL
NOI
;
3)
I
NECESSARY AUTHORITY TO SUBMIT THIS
FOR ALL THE PARCELS LISTED
AND
THAT
HAVE ALL NECESSARY AUTHORITY TO
NOI
BMP C
.
MAKE ANY COMMITMENTS MADE TO ACTIONS DESCRIBED IN THE
OR
HECKLIST
P
N
:
RINT
AME
(check all that apply)
 P
 L
 A
Agent (see below)
RODUCER
ANDOWNER
UTHORIZED
S
:
D
:
IGNATURE
ATE
:
____________
N
FDACS S
C
A
NOI
AME OF
TAFF OR
ONTRACTOR
SSISTING WITH
N
:
OTES
1. You must keep records of BMP implementation, as specified in the BMP manual. All BMP records are
subject to inspection, and include the verification of fertilization rates.
2. Notify FDACS if there is a full or partial change in ownership with regard to any of the parcel(s) enrolled
under this NOI.
3. Remember that it is your responsibility to stay current with future updates of this manual. Visit the
following website periodically to check for manual updates:
http://www.freshfromflorida.com/Divisions-
Offices/Agricultural-Water-Policy
FDACS-04002 12/17
Page 2 of 3
A
T
P
L
DDITIONAL
AX
ARCEL
ISTINGS
Operation Name:
County:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
Parcel No.:
Parcel Owner:
FDACS-04002 12/17
Page 1 of 3
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