Form MO780-0725 (F) "Application for Approval or Permit for Concentrated Animal Feeding Operation (Cafo)" - Missouri

What Is Form MO780-0725 (F)?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2013;
  • The latest edition provided by the Missouri Department of Natural Resources;
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FOR OFFICE USE ONLY
MISSOURI DEPARTMENT OF NATURAL RESOURCES
CHECK NUMBER:
WATER PROTECTION PROGRAM
FORM F- APPLICATION FOR CONSTRUCTION PERMIT FOR
DATE RECEIVED
FEE SUBMITTED
CONCENTRATED ANIMAL FEEDING OPERATION (CAFO)
FOR OFFICE USE ONLY
PERMIT NUMBER
APPLICATION NUMBER
TRACKING NUMBER
PART 1 – PERMIT ACTION
1.1 PERMIT ACTION
NEW OPERATION
SYSTEM MODIFICATION
IRRIGATION PIPELINE
OTHER
2.0 REQUIRED INFORMATION
(If any questions below are answered NO, this application may be considered incomplete and returned)
2.1
Is the appropriate fee included with the application?
YES
NO
2.2
Facility layout drawings on aerial and topographic maps?
YES
NO
2.3
Construction plan drawings?
YES
NO
2.4
Technical Specifications?
YES
NO
2.5
Engineering report includes:
2.5.1
Narrative project summary?
YES
NO
2.5.2
Project location map?
YES
NO
2.5.3
Operation and Maintenance Plan?
YES
NO
2.5.4
Soils Report for production area?
YES
NO
NA
2.5.5
Technical information and design data and calculations?
YES
NO
2.6
Geohydrological Evaluation by the Division of Geology and Land Survey (Earthen Manure Storage Basin)?
YES
NO
NA
2.7
Neighbor notice documentation?
YES
NO
NA
2.8
Emergency response plan?
YES
NO
NA
2.9
Nutrient Management Plan that meets the requirements of 10 CSR 20-6.300 (5)?
YES
NO
NA
2.10
Has an engineer sealed the engineering documents?
YES
NO
2.11
Has a Form W – CAFO Operating Permit Application with fee been included in the submittal?
YES
NO
NA
PART 3.0 – APPLICANT INFORMATION
3.1 OPERATION NAME
OPERATING PERMIT NUMBER IF
EXPIRATION DATE
CURRENTLY PERMIITED
MO-
PHYSICAL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE
ZIP CODE
LOCATION
COUNTY
¼,
¼, Sec.
, TWP
, RGE
3.2 OWNER (PROVIDE LEGAL NAME)
E-MAIL ADDRESS
MAILING ADDRESS
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE
ZIP CODE
3.3 CONTINUING AUTHORITY (IF DIFFERENT THAN THE OWNER)
MAILING ADDRESS
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE
ZIP CODE
PART 4.0 – OPERATIONAL INFORMATION
4.1 BRIEF DESCRIPTION OF OPERATION
Yes
No
4.2.1 IF CURRENTLY PERMITTED, HAVE THERE BEEN ANY CHANGES TO THE SYSTEM SINCE THE CURRENT PERMIT?
4.2.2 ATTACH PERTINENT INFORMATION (SEE INSTRUCTIONS)
4.3OPERATIONAL INFORMATION (SEE INSTRUCTIONS)
SIC Code(s)
Class Size
Yes
No
4.4 WILL THIS BE OR IS THIS AN “EXPORT ONLY” OPERATION?
PART 5.0 – SIGNATURE
NAME
TITLE
SIGNATURE
DATE
780-0725 (02-13)
FOR OFFICE USE ONLY
MISSOURI DEPARTMENT OF NATURAL RESOURCES
CHECK NUMBER:
WATER PROTECTION PROGRAM
FORM F- APPLICATION FOR CONSTRUCTION PERMIT FOR
DATE RECEIVED
FEE SUBMITTED
CONCENTRATED ANIMAL FEEDING OPERATION (CAFO)
FOR OFFICE USE ONLY
PERMIT NUMBER
APPLICATION NUMBER
TRACKING NUMBER
PART 1 – PERMIT ACTION
1.1 PERMIT ACTION
NEW OPERATION
SYSTEM MODIFICATION
IRRIGATION PIPELINE
OTHER
2.0 REQUIRED INFORMATION
(If any questions below are answered NO, this application may be considered incomplete and returned)
2.1
Is the appropriate fee included with the application?
YES
NO
2.2
Facility layout drawings on aerial and topographic maps?
YES
NO
2.3
Construction plan drawings?
YES
NO
2.4
Technical Specifications?
YES
NO
2.5
Engineering report includes:
2.5.1
Narrative project summary?
YES
NO
2.5.2
Project location map?
YES
NO
2.5.3
Operation and Maintenance Plan?
YES
NO
2.5.4
Soils Report for production area?
YES
NO
NA
2.5.5
Technical information and design data and calculations?
YES
NO
2.6
Geohydrological Evaluation by the Division of Geology and Land Survey (Earthen Manure Storage Basin)?
YES
NO
NA
2.7
Neighbor notice documentation?
YES
NO
NA
2.8
Emergency response plan?
YES
NO
NA
2.9
Nutrient Management Plan that meets the requirements of 10 CSR 20-6.300 (5)?
YES
NO
NA
2.10
Has an engineer sealed the engineering documents?
YES
NO
2.11
Has a Form W – CAFO Operating Permit Application with fee been included in the submittal?
YES
NO
NA
PART 3.0 – APPLICANT INFORMATION
3.1 OPERATION NAME
OPERATING PERMIT NUMBER IF
EXPIRATION DATE
CURRENTLY PERMIITED
MO-
PHYSICAL ADDRESS
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE
ZIP CODE
LOCATION
COUNTY
¼,
¼, Sec.
, TWP
, RGE
3.2 OWNER (PROVIDE LEGAL NAME)
E-MAIL ADDRESS
MAILING ADDRESS
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE
ZIP CODE
3.3 CONTINUING AUTHORITY (IF DIFFERENT THAN THE OWNER)
MAILING ADDRESS
TELEPHONE NUMBER WITH AREA CODE
CITY
STATE
ZIP CODE
PART 4.0 – OPERATIONAL INFORMATION
4.1 BRIEF DESCRIPTION OF OPERATION
Yes
No
4.2.1 IF CURRENTLY PERMITTED, HAVE THERE BEEN ANY CHANGES TO THE SYSTEM SINCE THE CURRENT PERMIT?
4.2.2 ATTACH PERTINENT INFORMATION (SEE INSTRUCTIONS)
4.3OPERATIONAL INFORMATION (SEE INSTRUCTIONS)
SIC Code(s)
Class Size
Yes
No
4.4 WILL THIS BE OR IS THIS AN “EXPORT ONLY” OPERATION?
PART 5.0 – SIGNATURE
NAME
TITLE
SIGNATURE
DATE
780-0725 (02-13)
Required Information for Construction Permit
Refer to 10 CSR 20-6.300 and 10 CSR 20-8.300.
INSTRUCTIONS
PART 1.0 – PERMIT TYPE AND ACTION
Complete PARTS 1-5 for permit applications.
1.1
Check which type of construction permit is required.
PART 2.0 – APPLICATION INFORMATION – This information required for a complete application. Regulatory citations are listed
below for each item. Check the appropriate box for each item as requested.
2.1
10 CSR 20-6.011 Appendix A.
2.2
10 CSR 20-8.300(3)(A)2.
2.3
10 CSR 20-8.300(3)(A)3.
2.4
10 CSR 20-8.300(3)(A)4.
2.5
10 CSR 20-8.300(3)(A)1.
2.5.1
10 CSR 20-8.300(3)(A)1.E.
2.5.2
10 CSR 20-8.300(3)(A)1.C.
2.5.3
10 CSR 20-8.300(3)(A)1.H.
2.5.4
10 CSR 20-8.300(3)(A)1.G, 8.300(7)(B), (8)(A), and (9).
2.5.5
10 CSR 20-8.300(3)(A)1.F.
2.6
10 CSR 20-8.300(3)(B)2. and (7)(A).
2.7
10 CSR 20-6.300(3)(C) and 8.300(3)(B)1.
2.8
10 CSR 20-8.300(3)(B)3.
2.9
10 CSR 20-8.300(3)(C).
2.10
10 CSR 20-6.300(2)(F)3. and 8.300(3)(A).
2.11
10 CSR 20-6.300(2)(F)1.
PART 3.0 - PERMIT OWNERSHIP AND CONTACT INFORMATION
3.1
General location and contact information for the operation. Operation name is name you wish to have the operation permitted
listed as or as it is listed on the current operating permit. Do not use P.O Box or RR for physical address of the operation.
3.2
Provide the name of the legal entity that owns or operates the CAFO facility.
3.3
List the Continuing Authority, if it is the same as the Owner enter “Same as above”. The Continuing Authority is the
permanent organization or party, responsible for operation and maintenance of the CAFO. All corporate entities are to be
registered with the Secretary of State’s office.
PART 4.0 – OPERATIONAL INFORMATION
4.1
Provide a brief description of the operation, including the total number of animals, buildings, and the manure and mortality
management systems. If the operation currently is permitted, describe the changes that are to be implemented during the
new construction.
4.2.1
If the operation is currently permitted and changes been made that are not covered in the new application, check yes;
otherwise check no.
4.2.2
If you answered yes to 4.2.1, provide details about the changes.
4.3
Enter SIC codes in decreasing order by animal units, for each animal type in confinement.
Animal Type
SIC Code
Animal Type
SIC Code
Animal Type
SIC Code
Beef cattle feedlots
0211
Dairy cows
0241
Turkey/turkey layers
0253
Hogs
0213
Broilers
0251
Poultry hatcheries
0254
Sheep/goats
0214
Chicken layers/pullets
0252
Horses
0272
CAFO Class Size. Enter CAFO Class Size based on AU. Class IB 3000-6999, Class IC 1000-2999, Class II 300-999.
(NOTE: To meet the definition of a Class I operation you must have 1000 Animal Units of one animal category. Once an
operation is Class I, animal units from all animal categories are added together to determine Class IA, IB or IC),
4.4
Indicate whether “all” the manure, litter, and process wastewater at this CAFO is “exported” off the farm (exported means sold
or transferred to another party). If any amount of manure litter, and process wastewater is land applied on land owned, leased
or controlled by the CAFO’s owner, then it is not an “export only” operation.
PART 5.0 - SIGNATURE
Sign and date the application.
Mail complete application to:
Missouri Department of Natural Resources
Water Protection Program
P.O. Box 176
Jefferson City, MO 65102
If there are any questions concerning this form, please contact the Department of Natural Resources, Water Protection Program at
573-751-1300 or by email at waterag@dnr.mo.gov.
780-0725 (02-13)
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