"Concentrated Animal Feeding Operation (Cafo) Application" - West Virginia

Concentrated Animal Feeding Operation (Cafo) Application is a legal document that was released by the West Virginia Department of Environmental Protection - a government authority operating within West Virginia.

Form Details:

  • Released on July 1, 2012;
  • The latest edition currently provided by the West Virginia Department of Environmental Protection;
  • 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 West Virginia Department of Environmental Protection.

ADVERTISEMENT
ADVERTISEMENT

Download "Concentrated Animal Feeding Operation (Cafo) Application" - West Virginia

Download PDF

Fill PDF online

Rate (4.7 / 5) 11 votes
Page background image
07-2012
Please print or type.
Permit Application No. WV___________(For WVDEP use only)
WV DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF WATER AND WASTE MANAGEMENT
CONCENTRATED ANIMAL FEEDING OPERATION (CAFO) APPLICATION
1.
Operation Status (Check One)
Existing Operation
Proposed Operation
2.
Name of Operation __________________________________________________________
3.
Physical Location
Street, Road, or Highway
City
County
4.
Owner
Owner Telephone Number
(
)
5.
Operator (if different from Owner)
Operator Telephone Number
(
)
6.
Operation Mailing Address
Street or Box Number
City
State
Zip Code
7.
Contact Person
Title
Contact E-mail Address
_________________________________
Contact Phone Number
(
)
Contact Fax Number
(
)
8.
Coordinate Data for the Production Area
Latitude
______
Longitude
______
9.
Receiving Stream(s) for the Production Area
***
10.
Attach a topographic map, or a copy of a portion of the topographic map, showing the specific
location of the Production Area*** (Attach map to application)
(Please continue on page two)
07-2012
Please print or type.
Permit Application No. WV___________(For WVDEP use only)
WV DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION OF WATER AND WASTE MANAGEMENT
CONCENTRATED ANIMAL FEEDING OPERATION (CAFO) APPLICATION
1.
Operation Status (Check One)
Existing Operation
Proposed Operation
2.
Name of Operation __________________________________________________________
3.
Physical Location
Street, Road, or Highway
City
County
4.
Owner
Owner Telephone Number
(
)
5.
Operator (if different from Owner)
Operator Telephone Number
(
)
6.
Operation Mailing Address
Street or Box Number
City
State
Zip Code
7.
Contact Person
Title
Contact E-mail Address
_________________________________
Contact Phone Number
(
)
Contact Fax Number
(
)
8.
Coordinate Data for the Production Area
Latitude
______
Longitude
______
9.
Receiving Stream(s) for the Production Area
***
10.
Attach a topographic map, or a copy of a portion of the topographic map, showing the specific
location of the Production Area*** (Attach map to application)
(Please continue on page two)
CAFO Application
07-2012
Page 2
11.
Types and Number of Animals
Number of Animals in
Number of Animals
Animal Type
Confinement
Housed Under Roof
Mature Dairy Cows
Dairy Heifers
Veal Calves
Cattle (not dairy or veal)
Swine (55 lbs. or over)
Swine (under 55 lbs.)
Horses
Sheep or lambs
Turkeys
Chickens (Broilers)
Chickens (Layers)
Ducks
Other - Specify:
TOTAL ANIMALS
12.
Manure, Litter, and/or Wastewater Production and Use
a)
How much manure, litter, and process wastewater are generated annually by the operation?
Tons or Gallons (Circle the appropriate unit)
b)
If land applied, how many acres of land under the control of the applicant are available for applying the
CAFO operation’s manure, litter and/or process wastewater?
Acres
c)
How many tons of manure or litter, or gallons of process wastewater produced by the CAFO operation will
be transferred annually to other persons?
Tons or Gallons (Circle the appropriate unit)
(Please continue on page three)
CAFO Application
07-2012
Page 3
13.
Type of Containment, Storage, and Capacity
Total Capacity
Type of Containment
(in gallons)
Lagoon
Holding Pond
Evaporation Pond
Other: (Specify)
Provide the total number of drainage acres contributing runoff:
acres
Total Number of
Total Storage Capacity
Type of Storage
Storage Days
(gallons or tons)
Anaerobic Lagoon
Storage Lagoon
Evaporation Pond
Aboveground Storage Tanks
Below Ground Storage Tanks
Under-floor Pits
Roofed Storage Shed
Concrete Pad
Impervious Soil Pad
Other: (Specify)
14.
CAFO Nutrient Management Plan (NMP) Information
***
***
Applicant must attach a copy of the operation’s approved NMP to this CAFO Application
a)
Was the CAFO NMP developed and/or approved by a certified Nutrient Management Planner?
_____Yes
_____No
b)
Please provide the name, title, and/or agency of the person who developed and/or approved the NMP:
____________________________________________________________________________________
c)
Is the CAFO Nutrient Management Plan being fully implemented for this facility? _____ Yes ______ No
d)
Please provide the date that the CAFO’s NMP was last approved or revised? (Date)______________
e)
If the facility is not land applying, please describe all alternative use(s) of the manure, litter, and /or
process wastewater from the operation.
_____
__________________________________________________
(Please continue on page four)
CAFO Application
07-2012
Page 4
15.
Land Application Best Management Practices
If applicable, please check any of the following best management practices that are being implemented at the
operation to control runoff and protect water quality.
____Buffers
_____Setbacks
_____Conservation Tillage
____Constructed Wetlands
_____Infiltration Field
_____Grass Filter
____Terrace
_____Other: (Specify) _____________________________________
16.
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 upon my inquiry of the person or 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 fine and imprisonment for knowing violations.
A. Name and official title (Print or type)
B. Phone No.
C. Signature
D. Date Signed
We will process your personal information (email address, mailing address and/or telephone number) in accordance
with the State of West Virginia’s Privacy Policy for appropriate and customary business purposes. Your personal
information may be disclosed to other State agencies or third parties in the normal course of business or as needed to
comply with statutory or regulatory requirements, including Freedom of Information Act requests. The Division of
Water and Waste Management will appropriately secure your personal information. If you have any questions about
our use of your personal information, please contact the DEP’s Chief Privacy officer at depprivacyofficer@wv.gov.
Page of 4