Form IL 406-1623 Non-lagoon Livestock Waste Handling Facility Application - Illinois

Form IL406-1623 is a Illinois Department of Agriculture form also known as the "Non-lagoon Livestock Waste Handling Facility Application". The latest edition of the form was released in January 1, 2002 and is available for digital filing.

Download an up-to-date Form IL406-1623 in PDF-format down below or look it up on the Illinois Department of Agriculture Forms website.

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N
-L
L
W
H
F
ON
AGOON
IVESTOCK
ASTE
ANDLING
ACILITY
A
PPLICATION
A. General Location Information:
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
(Please check the box if correspondence is to be sent to this address.)
Facility Name:
__________________________________________________________________
Facility Mailing Address: __________________________________________________________________
__________________________________________________________________
(Specify the actual facility address, if one exists.)
Phone N umber:
__________________________________________________________________
Facility ID :
____________________________
C. Owner or Operator Information:
(Please check the box if correspondence is to be sent to this address.)
Name:
____________________________________________________________________
Company:
____________________________________________________________________
Mailing A ddress:
____________________________________________________________________
____________________________________________________________________
Phone Number:
_____________________________
D. General Description of the Proposed Livestock Waste Handling Structure:
PROPOSED LIVESTOCK WASTE HANDLING FACILITY TYPE (CHECK ALL THAT APPLY):
Under building waste storage structure(pit storage structure)
Abov e-ground waste storage structure
In-ground w aste storage structure
Earthen
Runoff holding pond
Other:
Page 1
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 406-1623 (1-02)
N
-L
L
W
H
F
ON
AGOON
IVESTOCK
ASTE
ANDLING
ACILITY
A
PPLICATION
A. General Location Information:
__________________
__________
__________
____________
County Name
Township #
Range #
Prin. Meridian
_________
____________
____________
Section #
1/4 Section
1/4-1/4 Section
B. Facility Information:
(Please check the box if correspondence is to be sent to this address.)
Facility Name:
__________________________________________________________________
Facility Mailing Address: __________________________________________________________________
__________________________________________________________________
(Specify the actual facility address, if one exists.)
Phone N umber:
__________________________________________________________________
Facility ID :
____________________________
C. Owner or Operator Information:
(Please check the box if correspondence is to be sent to this address.)
Name:
____________________________________________________________________
Company:
____________________________________________________________________
Mailing A ddress:
____________________________________________________________________
____________________________________________________________________
Phone Number:
_____________________________
D. General Description of the Proposed Livestock Waste Handling Structure:
PROPOSED LIVESTOCK WASTE HANDLING FACILITY TYPE (CHECK ALL THAT APPLY):
Under building waste storage structure(pit storage structure)
Abov e-ground waste storage structure
In-ground w aste storage structure
Earthen
Runoff holding pond
Other:
Page 1
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 406-1623 (1-02)
E. Type and Number of Animal Units:
List the species of livestock along with the maximum number of animal units that the livestock waste
handling facility will serve. (Existing and proposed)
# of Head
x
Animal Unit Factor
=
# of An imal Units
Beef
x
1.0
=
Dairy (adults)
x
1.4
=
Dairy (young)
x
0.6
=
Laying hen s and b roilers
x
0.005
=
Laying hens and broilers (w/ continuous overflow watering)
x
0.01
=
Laying hen s and b roilers (w/ liquid m anure hand ling system s)
x
0.03
=
Sheep
x
0.1
=
Swine (>55 lbs)
x
0.4
=
Swine (<55 lbs)
x
0.03
=
Turkeys
x
0.02
=
Horses
x
2.0
=
Ducks
x
0.02
=
Other:
x
=
Total N umb er of Anim al Units
=
F. Specific Location Requirements:
Please provide a facility site map or livestock waste handling facility plot plan which depicts the location and
the distance to the following:
Nearest private or public potable well(s)
__________ ft.
Nearest stream
__________ ft.
Nearest abandoned or plugged well, drainage
_____ _____ ft.
well, or injection well located within 1,000 feet
of the proposed facility
Subsurface drainage lines within 100 feet of the
__________ ft.
livestock waste handling facility
G. Anticipated Dates of Construction:
Start ____/____/____
Finish ____/____/____
Page 2
Non-Lagoo n Livestock Waste
Handling Facility Registration Application
H. Site Investigation Certification:
(Site investigations are only required for facilities which meet the
definition of a “new facility” pursuant to 510 ILCS 77/10.45)
This registration form must be accompanied by the results from a site investigation conducted in accordance
with 8 Illinois Administrative Code 900.504(b)(8), as well as a “Certification of Site Investigation” form,
which may be obtained from the Departm ent.
I. Perimeter Drainage Tubing:
(Perimeter foundation drainage tubing is required for facilities where the
seasonal high water table m ay en croach upon the bottom of the facility.)
Pursuan t to 35 Illinois A dm inistrative Code 506 .304 (c), perimeter found ation drain age tubin g is
requ ired and w ill be incorporated into the design and construction of the w aste storage facility. A
sam pling port mu st be incorp orated and m ust be sam pled in accordance with 8 Illinois
Administrative Code 900.511.
Perimeter foundation drainage tubing is not required for this facility. Documentation must be
submitted to verify this claim.
J. Construction Plan :
The construction plan of the waste handling structure must include design specifications of the structure noted
as prepared by or for the owner or operator in accordance with the requirements contained in 8 Illinois
Administrative Code 900.504(b)(9). The plan should, at a minimum, include the following:
General Items for all Facilities:
Plot plan:
indicating the location of existing and proposed livestock m anagement and livestock waste
handling facilities, on-site wells, groundwater monitoring wells (if required), and any
subsurface drainage lines relative to the location of the proposed waste handling facility. Depict
surface water flow across the facility using contour lines or notation and arrows.
Plan view drawings
Cross section drawings
Elevations
Dimensions
Construction materials
Backfill type
Loading conditions
Drainage systems
Additional items for structures designed w ith reinforced concrete :
Maxim um com pressive strength
Steel tension yield strength
Steel size
Steel Spacing
Cover
Development lengths
Waterstop location, type and details
Slab support
Additional items for structures designed w ith synthetic materials:
Manufacturer compatibility statement
Construction material properties
Quality control/Quality Assurance
Installation details
Testing details, Post construction
Base preparation
Additional items for structures designed with steel:
Corrosion Resistance
Page 3
Non-Lagoo n Livestock Waste
Handling Facility Registration Application
Additional items for structures designed w ith earthen materials :
Maxim um proctor density test results
Shelby tube locations (if applicable)
Permeability results (if applicable)
Lift thickness
Installation Details
Quality Control/Quality Assurance
Erosion Control D etails
K. Certification of Compliance / Filing Fee:
Pursuant to 510 ILCS 77/13 (f), the owner or operator of a the proposed livestock waste handling facility
must send, by certified mail or in person, to the Department a certification of com pliance form together with
copies of verification documents upon completion of construction. A $250 filing fee must accompany the
certification of compliance.
L. 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 do cuments 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.
M. 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 shall accompany the
owner’s or operator’s certification of compliance.
N. Inspections:
The Department will inspect the construction site prior to construction, during construction and within 10
business days following receipt of the certification of compliance to determine compliance with the
construction standards. No livestock waste handling facility may be placed into service until the Department
has acknowledged compliance with the Livestock Management Facilities A ct.
O. Application Signature:
______________________________________
_______________
Authorized Agent (Printed)
Date
______________________________________
Signature of Authorized Agent
______________________________________
Title
Page 4
Non-Lagoo n Livestock Waste
Handling Facility Registration Application

Download Form IL 406-1623 Non-lagoon Livestock Waste Handling Facility Application - Illinois

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