"Non-lagoon Livestock Waste Handling Facility Certification of Site Investigation" - Illinois

Non-lagoon Livestock Waste Handling Facility Certification of Site Investigation is a legal document that was released by the Illinois Department of Agriculture - a government authority operating within Illinois.

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Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Illinois Department of Agriculture.

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Download "Non-lagoon Livestock Waste Handling Facility Certification of Site Investigation" - Illinois

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-L
L
W
H
F
ON
AGOON
IVESTOCK
ASTE
ANDLING
ACILITY
C
S
I
ERTIFICATION OF
ITE
NVESTIGATION
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. Site Investigation Results:
The site investigation has resulted in a finding that: (Please answer YES or NO to each question)
_____
Aquifer Material is present within 5 feet of the planned bottom of the livestock waste handling
facility.
_____
The proposed facility is located in the floodway of a 100 year floodplain. (If yes, construction is
prohibited)
_____
The proposed facility is located in the flood fringe of a 100 year floodplain.
_____
The proposed facility is located in a karst area.
_____
The proposed facility is located within 400’ of a natural depression in a karst area. (If yes,
construction is prohibited)
E. Supporting Justification and Verification Documents:
Pursuant to 8 Ill. Adm. Code 900.503(c) or 8 Ill. Adm. Code 900.504(b)(8), supporting justification and
N
-L
L
W
H
F
ON
AGOON
IVESTOCK
ASTE
ANDLING
ACILITY
C
S
I
ERTIFICATION OF
ITE
NVESTIGATION
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. Site Investigation Results:
The site investigation has resulted in a finding that: (Please answer YES or NO to each question)
_____
Aquifer Material is present within 5 feet of the planned bottom of the livestock waste handling
facility.
_____
The proposed facility is located in the floodway of a 100 year floodplain. (If yes, construction is
prohibited)
_____
The proposed facility is located in the flood fringe of a 100 year floodplain.
_____
The proposed facility is located in a karst area.
_____
The proposed facility is located within 400’ of a natural depression in a karst area. (If yes,
construction is prohibited)
E. Supporting Justification and Verification Documents:
Pursuant to 8 Ill. Adm. Code 900.503(c) or 8 Ill. Adm. Code 900.504(b)(8), supporting justification and
data from a Licensed Professional Engineer, Licensed Professional Geologist or a representative of the
Natural Resources Conservation Service of the United States Department of Agriculture designated to
perform such functions relative to the site investigation results is required as part of this certification.
F. Certification Statement:
“I hereby certify that the information provided on this form is correct and that the site investigation
which produced this information was performed in accordance with all applicable requirements of
8 Ill. Adm. Code 900.503(a) or 8 Ill. Adm. Code 504(b)(7).”
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Signature of the Owner or Operator
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