Closure Of Manure Litter Process Wastewater Storage Structures {51913}

CONCENTRATED ANIMAL FEEDING OPERATION CLOSURE OF MANURE, LITTER, OR PROCESS WASTEWATER STORAGE STRUCTURES State Form 51913 (R / 6-12) National Pollutant Discharge Elimination System Concentrated Animal Feeding Operation (NPDES CAFO) INSTRUCTIONS: INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Confined Feeding Section Office of Land Quality 100 North Senate Avenue MC 65-45, IGCN 1101 Indianapolis, Indiana 46204 (800) 451-6027 extension 2-4473 In accordance with 327 IAC 15-16-12, to close or discontinue the use of a manure, litter, or process wastewater storage structure, this form must be completed, signed, dated, and returned to the above address. I. GENERAL INFORMATION A. PERMIT INFORMATION NPDES CAFO Permit Number: B. FACILITY INFORMATION Facility Name: Location Address: City: County: Telephone: C. CONTACT INFORMATION Owner Name: Address: City: State: Telephone: Facsimile: ZIP Code: II. STRUCTURE CLOSURE INFORMATION Answer the following questions by checking your response, then follow the directions based on your response. 1. 2. 3. Do you plan to completely close the facility? If yes, go to option A below. If no go to question 2. Do you plan to completely close a structure? If yes, go to question 3. If no, go to option B below. Is the structure independent of other storage structures? If yes, go to option A below. If no, go to option B below. Yes Yes Yes No No No Options A. Remove all manure, litter, or process wastewater from the storage structure(s). Land apply and manage all manure, litter, and process wastewater removed from the structure(s) in accordance with your NPDES CAFO permit. Remove all associated appurtenances and conveyance structures from uncovered liquid manure or process wastewater storage structure(s). Submit this form to IDEM within thirty (30) days of completion. In the notes field below detail what at the facility was closed Prior to demolishing or converting the use of any manure, litter, or process wastewater storage structure(s), submit this form to IDEM reporting the recalculated storage capacity for the facility, and specify the intended future use of the manure, litter, or process wastewater storage structure(s) if the structure is to be converted. Adequate storage must be maintained to avoid land application when soil or weather conditions are unsuitable for land application or when the land is occupied with crops. New Combined Storage Capacity at the Facility (after closure): Future Intended Use of Closed Structure: days B. Notes I affirm that the information on this form is, to the best of my knowledge and belief, true, complete and accurate and I am aware of the penalties for knowingly submitting false information under IC 13-30-10-1.5 and IC 35-44-2-1. Signature Date (month, day, year) American LegalNet, Inc. www.FormsWorkFlow.com