Form AR-CAFO "Annual Report Form General Permit for Concentrated Annual Feeding Operations (Cafo Gp)" - Montana

What Is Form AR-CAFO?

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

Form Details:

  • Released on October 1, 2018;
  • The latest edition provided by the Montana Department of Environmental Quality;
  • 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 AR-CAFO by clicking the link below or browse more documents and templates provided by the Montana Department of Environmental Quality.

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Download Form AR-CAFO "Annual Report Form General Permit for Concentrated Annual Feeding Operations (Cafo Gp)" - Montana

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Agency Use
Permit No.:
Date Rec’d
Amount Rec’d
Check No.
Rec’d By
Annual Report Form
FORM
General Permit for Concentrated Annual Feeding Operations (CAFO GP)
AR-CAFO
MTG010000
This form is to be completed by all Concentrated Animal Feeding Operations (CAFO) authorization under a Montana
Pollutant Discharge Elimination System (MPDES) permit. This form must be completed, signed, and submitted to the
Montana Department of Environmental Quality (DEQ) by the 28
th
day of January following each year in which a CAFO had
MPDES discharge coverage. Please read the attached instructions before completing this form. You must print of type legibly;
forms that are not legible or are not complete will be rejected. Do not leave blank spaces; if a question is not applicable put
and ‘NA’ in the space provided. If additional space is needed, the permittee may attach additional pages with specific reference
to the section of the form being elaborated on. A CAFO must maintain a copy of the completed annual report form in its
records.
Section A - Facility or Operation Information
Permit Authorization Number: MTG01 __ __ __ __
Facility or Operation Name ___________________________________________________________________________
Physical Location, Mailing address, or directions to location
___________________________________________________________________________________________________
Nearest City or Town __________________ Zip Code_______________________County________________________
Latitude ______________________________ Longitude ____________________________________________
Township/Range /Section (optional)____________________________________________________________________
Operation Contact Person/Position
Name and Title, or Position Title_______________________________________________________________________
Company Name (if different than the facility or operation _________________________________________________
Mailing Address ____________________________________________________________________________________
City, State, and Zip Code _____________________________________________________________________________
Phone Number (
)
E-mail ___________________________________________________
Authorized Representative
Same as facility contact
Name and Title
Company Name (if different than the applicant)
Mailing Address
City, State, and Zip Code __________________________________________________________________________
Phone Number (
E-mail _______________________________________________
)
October 2018
Agency Use
Permit No.:
Date Rec’d
Amount Rec’d
Check No.
Rec’d By
Annual Report Form
FORM
General Permit for Concentrated Annual Feeding Operations (CAFO GP)
AR-CAFO
MTG010000
This form is to be completed by all Concentrated Animal Feeding Operations (CAFO) authorization under a Montana
Pollutant Discharge Elimination System (MPDES) permit. This form must be completed, signed, and submitted to the
Montana Department of Environmental Quality (DEQ) by the 28
th
day of January following each year in which a CAFO had
MPDES discharge coverage. Please read the attached instructions before completing this form. You must print of type legibly;
forms that are not legible or are not complete will be rejected. Do not leave blank spaces; if a question is not applicable put
and ‘NA’ in the space provided. If additional space is needed, the permittee may attach additional pages with specific reference
to the section of the form being elaborated on. A CAFO must maintain a copy of the completed annual report form in its
records.
Section A - Facility or Operation Information
Permit Authorization Number: MTG01 __ __ __ __
Facility or Operation Name ___________________________________________________________________________
Physical Location, Mailing address, or directions to location
___________________________________________________________________________________________________
Nearest City or Town __________________ Zip Code_______________________County________________________
Latitude ______________________________ Longitude ____________________________________________
Township/Range /Section (optional)____________________________________________________________________
Operation Contact Person/Position
Name and Title, or Position Title_______________________________________________________________________
Company Name (if different than the facility or operation _________________________________________________
Mailing Address ____________________________________________________________________________________
City, State, and Zip Code _____________________________________________________________________________
Phone Number (
)
E-mail ___________________________________________________
Authorized Representative
Same as facility contact
Name and Title
Company Name (if different than the applicant)
Mailing Address
City, State, and Zip Code __________________________________________________________________________
Phone Number (
E-mail _______________________________________________
)
October 2018
Section B – Summary of Findings
Type and Number or Animals:
Report the maximum number of each type of animal confined at this facility at any one time during the 12 month
reporting period.
NUMBER IN OPEN
NUMBER HOUSED UNDER
TYPE
CONFINEMENT
ROOF
Mature Dairy Cows
Veal Calves
Cattle including dairy Heifers
Swine (55 lb. or over)
Swine (55 lb. or under)
Horses
Sheep or Lambs
Turkeys
Chicken broilers -includes
juveniles
Chickens layers – includes
juveniles
Ducks
Other (specify)
Other (specify)
Manure, Litter and Process Wastewater
Waste Production:
Estimate the amount of manure, litter and process wastewater generated by your facility during the last calendar
year
a. Liquid/Slurry manure, litter and process wastewater ___________________Gallons.
b. Dry manure and litter _____________________________Tons.
Waste Transfer
Estimate the amount of manure, litter and process wastewater transferred from your facility, to other persons,
during the last calendar year.
a. Liquid/Slurry manure, litter and process wastewater ___________________Gallons.
b. Dry manure and litter ____________________________Tons.
Land Application
a. Report the total number of acres of land that are covered by this facility’s Nutrient Management Plan
(NMP), developed in accordance with the applicable technical standards. Include all land application
acres covered by the NMP, whether or not they were used for land application during the calendar year
covered by this report. ______________Acres.
b. Report the total number of acres, under the control of the CAFO, that were actually used for land
application of manure, litter, or process wastewater in the past calendar year covered by this report.
_________________Acres
October 2018
Discharge Summary
Summary of Manure, Litter, and Process Wastewater Discharges from the Production Area
Provide a summary of each discharge of manure, litter, and/or process wastewater from the production area that
occurred in the past year covered by this report. Attach additional sheets, if needed.
Date
Time
Volume
Land Application Summary
A. Report the nitrogen (N) and phosphorus (P) content of manure, litter, and process wastewater using the results
of the most recent representative manure, litter and process wastewater tests for N and P. Report the form of N
and P used for nutrient management plan used for nutrient management planning purposes in the Nutrient form
column
Note: Large CAFO using the linear approach and all CAFOs using the narrative rate approach must present
results taken within 12 months of the date of land application of the manure, liter and processes wastewater.
Nutrient form
Manure N Content
_________________lbs/ton
as_________________
Manure P Content
_________________lbs/ton
as_________________
Litter N Content
_________________lbs/ton
as_________________
Litter P Content
_________________lbs/ton
as_________________
Process Wastewater N Content _________________lbs/1,000 gal. as_________________
Process Wastewater P Content _________________lbs/1,000 gal. as_________________
B. For each field, report the actual crop(s) planted, the season (for multiple crops planted in one field), the actual
crop yield, and the amount of manure, litter, process wastewater, and supplemental fertilizer applied to each
field during the previous 12-month period. Attach additional sheets if necessary.
Field ID
Season
Crop Planted
Crop Yield (specify units)
Amount to be applied as calculated according to the NMP methodology
Manure (tons)
Litter (tons)
Process wastewater (gallons)
Actual amount supplied
Manure (tons)
Litter (tons)
Process wastewater (gallons)
C. Comments (Eg., “Actual amounts of manure applied are greater than the planned amounts due to a drop in the
amount of N analyzed in the manure test”)
October 2018
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
D. CAFOs with NMPs developed using the narrative rate approach only: For each field used for land application,
report the results of the most recent soil nutrient analyses for any soil test taken in the last 12 months.
Most recent soil test results
Supplemental
fertilizer (lbs/acre)
nitrogen
Phosphorus
Field ID
N
P
applied
applied
ppm
N form
ppm
p form
method
as
as
as
as
as
as
as
as
as
as
as
as
as
as
Section C - Certification
Authorized Signatories: This form must be completed, signed, and certified as follows:
For a corporation, by a principal officer of at least the level of vice president;
For a partnership or sole proprietorship, by a general partner or the proprietor, respectively; or
For a municipality, state, federal, or other public facility, by either a principal executive officer or ranking
elected official.
All Applicants Must Complete the Following Certification:
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted.
Based on my inquiry of the persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware
that there are significant penalties for submitting false information; including the possibility of a fine and imprisonment for
knowing violations.
Name (Type or Print)
Title (Type or Print)
Phone Number
Signature
Date Signed
October 2018
INSTRUCTION FOR Form AR2-CAFO – Annual Report Form for
General Permit for Concentrated Animal Feeding Operations.
You may need the following items in order to complete this form:
• A copy of your most recently submitted NOI and NMP-CAFO:
• Results of you most recent manure test and if doing narrative rate approach;
• If doing narrative rate approach, the results of your most recent soil test for nitrogen and
phosphorus.
Please type or print legibly; forms that are not legible will be considered incomplete.
SPECIFIC ITEM INSTRUCTIONS
Section A – Facility or Operation Information.
Enter your permit Authorization number. Enter the most current information about the facility. Please
note this is not the place where a permit transfer would be completed. If permit transfer please refer to the
2018 CAFO General Permit. Enter the current Operation Contact Person and/or the current Authorized
Representative.
Section B – Summary of Findings
Type and number of Animals.
Enter the maximum number of animals confined at this facility. Please note this is not the total number
of animals but the one-day max held in the facility in the past year.
Manure, Litter and Process Wastewater
Estimate the amount of manure, liter and process wastewater generated at your facility in the last year.
This value is not based on what is transferred and/or what was spread on fields but what the facility
generated as a whole.
Waste Transfer
Estimate the amount of liquid and dry manure that you transferred to others from the facility.
Land Application
If the facility does not land apply then you can skip the section. For “a” you will need to add up all of the
area that you have submitted in your NMP as location in which you plan on submitting manure for the
permit cycle. For “b” enter the number of acres in which you apply manure, litter or process wastewater in
the past year.
Discharge Summary
This is where you enter any discharges that you had in the previous year. These discharges should
already be documented using the CAFO Area Discharge Event Form.
Land Application Summary
For “A” take the information directly from the sampling results of your most recent manure, litter and/or
process wastewater. For “B” you may need several pages because you applied to more than one field in
the past year. Use the field id that you reported in your most recent NMP. If the crop has not be
harvested like winter wheat you still need to fill out a table you will just enter Fall in the “Season” row
and enter “not yet harvested” in the “Crop Yield” row. If the crop is planted in the fall please make sure
to keep a record of the harvest from the following year.
October 2018
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