"Application for Bulk Pesticide Storage Facility Permit" - South Dakota

Application for Bulk Pesticide Storage Facility Permit is a legal document that was released by the South Dakota Department of Agriculture - a government authority operating within South Dakota.

Form Details:

  • Released on January 1, 2019;
  • The latest edition currently provided by the South Dakota Department of Agriculture;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

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

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Download "Application for Bulk Pesticide Storage Facility Permit" - South Dakota

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SOUTH DAKOTA DEPARTMENT OF AGRICULTURE
AGRICULTURAL SERVICES DIVISION
523 East Capitol Avenue
Pierre, SD 57501
Phone: 605.773.4432 Fax: 605.773.3481
sdda.sd.gov
APPLICATION FOR BULK PESTICIDE STORAGE FACILITY PERMIT
Firm making application
Name: ______________________________________ Address: _______________________________________
City: ________________________ State: ________ Zip: ______________ Phone: ________________________
Firm who will operate the facility
Name: ______________________________________ Address: _______________________________________
City: ________________________ State: ________ Zip: ______________ Phone: ________________________
Firm who will construct, install, or modify site
Name: ______________________________________ Address: _______________________________________
City: ________________________ State: ________ Zip: ______________ Phone: ________________________
New facility
Existing facility
Substantially altering existing facility
Location of site
County: ___________________________ City: ___________________________
Legal description or GPS coordinates of facility location
(Q4): ___________ ¼ of the (Q3) ___________ ¼ of the (Q2) ___________ ¼ of the (Q1) ___________
¼ section # ___________ of Township # ___________ of Range # ___________ GPS_________________
Does the construction require a local permit? If yes, please submit a copy.
Yes
No
Size of lot owned or leased: ___________________________________________________________________
Nature of terrain (check one):
Level area
Hillside or steep slope
Natural depression with no outlet
Valley
Hilltop
Slight slope
Type of primary storage containers (steel, poly, etc.): ________________________________________________
Number and capacity of primary storage containers:
New ____________________ Existing ____________________ Substantially Altering ____________________
Identify the name and approx. distance to nearby surface water (i.e. lake, stream, drainage ditch, or storm drain) into which liquid could flow:
___________________________________________________________________________________________
Identify the general soil type at the site (i.e. clay, gravel, sand, loam) and type, depth, and proximity of wells and aquifers on or near site:
___________________________________________________________________________________________
With this application, please submit two scale drawings of plans and specifications for the facility, along with the location of other storage
containers and buildings. Include length, width, and wall height (inside dimensions) of the containment area. Additionally, state the diameter
and height of each storage tank to be contained. Additionally, please submit two copies of a plumbing diagram for facility showing location
and type of pumps and valves used to control all transferring.
I, __________________________, certify that the information submitted is true and correct.
Signature: ______________________________________ Title: ___________________________ Date: _________________
OFFICE USE ONLY
Revised 1/19
Reviewed by: ______________________________________
Date: ___________________
SOUTH DAKOTA DEPARTMENT OF AGRICULTURE
AGRICULTURAL SERVICES DIVISION
523 East Capitol Avenue
Pierre, SD 57501
Phone: 605.773.4432 Fax: 605.773.3481
sdda.sd.gov
APPLICATION FOR BULK PESTICIDE STORAGE FACILITY PERMIT
Firm making application
Name: ______________________________________ Address: _______________________________________
City: ________________________ State: ________ Zip: ______________ Phone: ________________________
Firm who will operate the facility
Name: ______________________________________ Address: _______________________________________
City: ________________________ State: ________ Zip: ______________ Phone: ________________________
Firm who will construct, install, or modify site
Name: ______________________________________ Address: _______________________________________
City: ________________________ State: ________ Zip: ______________ Phone: ________________________
New facility
Existing facility
Substantially altering existing facility
Location of site
County: ___________________________ City: ___________________________
Legal description or GPS coordinates of facility location
(Q4): ___________ ¼ of the (Q3) ___________ ¼ of the (Q2) ___________ ¼ of the (Q1) ___________
¼ section # ___________ of Township # ___________ of Range # ___________ GPS_________________
Does the construction require a local permit? If yes, please submit a copy.
Yes
No
Size of lot owned or leased: ___________________________________________________________________
Nature of terrain (check one):
Level area
Hillside or steep slope
Natural depression with no outlet
Valley
Hilltop
Slight slope
Type of primary storage containers (steel, poly, etc.): ________________________________________________
Number and capacity of primary storage containers:
New ____________________ Existing ____________________ Substantially Altering ____________________
Identify the name and approx. distance to nearby surface water (i.e. lake, stream, drainage ditch, or storm drain) into which liquid could flow:
___________________________________________________________________________________________
Identify the general soil type at the site (i.e. clay, gravel, sand, loam) and type, depth, and proximity of wells and aquifers on or near site:
___________________________________________________________________________________________
With this application, please submit two scale drawings of plans and specifications for the facility, along with the location of other storage
containers and buildings. Include length, width, and wall height (inside dimensions) of the containment area. Additionally, state the diameter
and height of each storage tank to be contained. Additionally, please submit two copies of a plumbing diagram for facility showing location
and type of pumps and valves used to control all transferring.
I, __________________________, certify that the information submitted is true and correct.
Signature: ______________________________________ Title: ___________________________ Date: _________________
OFFICE USE ONLY
Revised 1/19
Reviewed by: ______________________________________
Date: ___________________