Form IL 406-1624 Non-lagoon Livestock Waste Handling Facility Certification of Construction - Illinois

Form IL406-1624 or the "Non-lagoon Livestock Waste Handling Facility Certification Of Construction" is a form issued by the Illinois Department of Agriculture.

Download a PDF version of the Form IL406-1624 down below or find it on the Illinois Department of Agriculture Forms website.

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AGOON
IVESTOCK
ASTE
ANDLING
ACILITY
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ERTIFICATION
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ONSTRUCTION
A. General Location Information:
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
Name:
____________________________________________________________________
Mailing Address:
____________________________________________________________________
____________________________________________________________________
Phone Number:
____________________________________________________________________
Facility ID #:
____________________________
C. Owner or Operator Information:
Name:
____________________________________________________________________
Company:
____________________________________________________________________
Mailing Address:
____________________________________________________________________
____________________________________________________________________
Phone Number:
_____________________________
D. Supporting Justification and Verification Documents:
Pursuant to 8 Ill. Adm. Code 900.506 (a), the owner or operator of a livestock management facility or
livestock waste handling facility shall provide the Department with copies of verification documents upon
completion of construction. Such verification documents shall include:
Photographic records of excavation and site preparation including any soil compaction,
footing preparation and construction, concrete forming including steel reinforcement,
construction joints during construction, walls and floors after form removal, installation of
perimeter drains if needed, and any other items deemed necessary by the owner or operator,
engineer, or construction personnel.
--For structures constructed of concrete, a signed statement from the concrete supplier
indicating the quality of the concrete.
Failure to provide such information may delay or impede the Department’s final issuance of a certification
of construction completeness.
N
-L
L
W
H
F
ON
AGOON
IVESTOCK
ASTE
ANDLING
ACILITY
C
O
C
ERTIFICATION
F
ONSTRUCTION
A. General Location Information:
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
Name:
____________________________________________________________________
Mailing Address:
____________________________________________________________________
____________________________________________________________________
Phone Number:
____________________________________________________________________
Facility ID #:
____________________________
C. Owner or Operator Information:
Name:
____________________________________________________________________
Company:
____________________________________________________________________
Mailing Address:
____________________________________________________________________
____________________________________________________________________
Phone Number:
_____________________________
D. Supporting Justification and Verification Documents:
Pursuant to 8 Ill. Adm. Code 900.506 (a), the owner or operator of a livestock management facility or
livestock waste handling facility shall provide the Department with copies of verification documents upon
completion of construction. Such verification documents shall include:
Photographic records of excavation and site preparation including any soil compaction,
footing preparation and construction, concrete forming including steel reinforcement,
construction joints during construction, walls and floors after form removal, installation of
perimeter drains if needed, and any other items deemed necessary by the owner or operator,
engineer, or construction personnel.
--For structures constructed of concrete, a signed statement from the concrete supplier
indicating the quality of the concrete.
Failure to provide such information may delay or impede the Department’s final issuance of a certification
of construction completeness.
E. Structures Constructed with Design Standards used by the Natural Resources Conservation
Service of the United States Department of Agriculture:
In the case of structures constructed with the design standards used by the Natural Resources Conservation
Service of the United States Department of Agriculture, copies of the design standards used and a statement
of verification signed by a representative of the United States Department of Agriculture must accompany
the owner’s or operator’s certification of compliance.
F. Filing Fee:
Pursuant to 510 ILCS 77/13 (f), a $250 filing fee must accompany this certification of compliance.
G. Inspection:
The Department will inspect the construction site within 10 business days following receipt of this
certification of compliance to determine compliance with the construction standards of the Livestock
Management Facilities Act. Within 5 business days of the date of inspection, the Department will send an
official written notice to the owner or operator of the livestock waste handling facility indicating that the
facility meets the standards or identifying the remedial measures necessary to enable the facility to meet the
standards.
H. Certification Statement:
“I hereby certify that the information provided on this form is correct and that the livestock waste
handling facility has been constructed to meet or exceed the standards as required by the Livestock
Management Facilities Act (510 ILCS 77/1 et seq.). Furthermore, I certify that the information
included on the originally submitted registration form, any subsequently submitted amendments,
and any information attached to this form is correct.”
Signature of the Owner or Operator
Submit to:
Illinois Department of Agriculture
Livestock Management Facilities Program
P.O. Box 19281 -- State Fairgrounds
Springfield, IL 62794-9281
217/785-2427
217/524-4882 (fax)
IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as
outlined under the Livestock Management Facilities Act (510 ILCS 77/1 et seq.). Failure to provide this information shall prevent this form from
being processed. This form has been approved by the State Forms Management Center.
IL 406-1624 (1-01)

Download Form IL 406-1624 Non-lagoon Livestock Waste Handling Facility Certification of Construction - Illinois

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