DNR DATCP Cost Share for Notice of Wisconsin Department of by alicejenny


									State of Wisconsin                                                        DNR & DATCP Cost-Share Grant Application for
Department of Natural Resources
Bureau of Watershed Management (dnr.wi.gov)                          Notice of Intent/Discharge (NOI/NOD) Project Funding
Department of Agriculture, Trade & Consumer Protection           Form 8700-334 (R 1/12)
Bureau of Land & Water Resources (datcp.wi.gov)                                                                                             Page 1 of ___

Notice: This application form template was drafted by the Wisconsin Department of Natural Resources (DNR) and the Wisconsin Department of
Agriculture, Trade and Consumer Protection (DATCP). Applications are hereby made to the DNR’s Bureau of Watershed Management and to
DATCP’s Bureau of Land and Water Resources for grant assistance consistent with and under the authority of s. 92.14, Wis. Stats., and ch. ATCP
50, Wis. Adm. Code and the authority of s. 281.65(4e), Wis. Stats., and chs. NR 153 and 154, Wis. Adm. Code. Collection of this information is
authorized under the authority of ss. 281.65 and 92.14, Wis. Stats. Personal information collected will be used for administrative purposes and may
be provided to requesters to the extent required by Wisconsin’s Open Records Law [ss. 19.31 – 19.39, Wis. Stats.]. Unless otherwise noted, all
citations refer to Wisconsin Administrative Code.

Caution: Notice of Discharge Grants may not be used to cost share best management practices to address discharges for which the landowner or
operator has been referred to the Wisconsin Department of Justice for prosecution.

Part 1: Applicant Information
Project/Landowner Name

Governmental Unit Applying (Name and Type) (Example: Dane County Land & Water Resources Department)

Name of Responsible Municipal Representative (First Last)                     Name of Governmental Contact Person (First Last) (if different)

Title                                                                         Title

Area Code + Telephone Number                                                  Area Code + Telephone Number

Area Code + Fax Number                                                        Area Code + Fax Number

E-Mail Address                                                                E-mail Address

Mailing Address – Street or Route                                             Mailing Address – Street or Route

City, State, Zip Code                                                         City, State, Zip Code

Part 2: Project Location
A. Map and Photograph Submittal Requirement: This application must be accompanied by maps and photographs of the project site.
    Mapping requirements are:
        1. The base map should be an air photo clearly showing:
                  The livestock facilities, conveyance channels, and overland flow paths.
                  All affected surface waters including intermittent and perennial receiving waters.
                  Any point of suspected groundwater susceptibility.
        2. The map shall delineate and label the pollution source area and clearly mark the flow path and point of discharge to groundwater or
            the nearest surface water.
        3. If the nearest surface water is not navigable, the map shall show the flow path continued to a point where the receiving water network
            becomes navigable.
        4. Roads, section lines, and other features customarily used to orient the reviewer to the site should be included and labeled.

        Submit 3 to 6 photographs in total showing the site, the conveyance path, and the discharge point. Include brief descriptions of what each
          photograph is depicting.

B. Location Information                                            State Senate District #:
County:                                                            State Assembly District #:
Minor Civil Division Name         Township                                                      Quarter-          Latitude               Longitude
(city, village, town, etc)                     Range    E or W      Section           Quarter                 (North, degrees,      (West, degrees, minutes
                                    (N)                                                         Quarter    minutes, seconds only)       seconds only)
                                                                                                     DNR & DATCP Cost-Share Grant Application for
                                                                                                 Notice of Intent/Notice of Discharge Project Funding
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Method for Determining Latitude & Longitude (check one)
         GPS            DNR Surface Water Data Viewer       Other (specify):
C. Watershed Identified from DNR Surface Water Data Viewer (http://dnr.wi.gov/org/water/data_viewer.htm)
Watershed Name                                            Watershed Code

Name of Waterbody at Discharge Point                                Name of Nearest Navigable Water Receiving Pollutants

12-digit Hydrologic Unit Code (HUC):
D. Additional Receiving Water Information: Check all that apply.

Identify if either the waterbody located at the discharge point or the nearest navigable water receiving pollutants:

         Has any special designations (e.g. Exceptional Resource Water [ERW], Outstanding Resource Water [ORW], Area of Special Natural
          Resource Interest [ANSRI], Impaired Water [303-d listed]).
         Has other unique features such as being an area of high recreational use.
         Having enhanced public access (e.g. DNR fish easement).
         Is an important element of other publicly held natural resource areas not included above (e.g. Stewardship projects).

Provide a brief description regarding the responses marked above:

E. Section 319 Funding Eligibility: If applicable, check the appropriate box for DNR review to determine project eligibility under Section 319

         Check this box if the project site drains to an impaired water on the State 303(d) list. Otherwise, skip to Part 3.
         Check this box if the project is in an area covered by a TMDL and will reduce the pollutant for which the water is listed, or
         Check this box if the project is not in an area covered by a TMDL, but the area is covered by a 9 key element plan and the project will
         reduce the pollutant for which the water is listed (See instructions for eligible areas).

Part 3: Livestock Facility and Discharge Information
A. Size of Livestock Operation: Attach animal unit calculation worksheet form 3400-25A.
    Note: Livestock operations of 1,000 or more animal units are ineligible for NOI/NOD grants.

         Number of animal units included in this livestock operation (From form 3400-25A):
         Number of animal units contributing to the discharge for which this notice is being considered (if different):

B. Basic Discharge Characteristics: Check all that apply.

         Direct discharge to navigable waters from the production area via pipe, ditch, or other man-made conveyance.
         Direct discharge to navigable waters that pass over, across or through the production area.
         Discharge to navigable waters via overland flow (i.e. not via a pipe, ditch, or other man-made conveyance).
         Discharge to non-navigable surface waters.
         Discharge to groundwater.
         Discharge is from over-application of manure but not necessarily from rainfall or snow-melt runoff.
         Discharge is from land application of manure but mainly during periods of rainfall or snow melt.
         Land application area from which discharges occur are covered by a nutrient management plan that meets NRCS 590.
         Discharge marked above is caused by failure to meet one or more NR 151 agricultural performance standards or prohibitions.

C. Method of Problem Determination: Check all that apply. At least one is required.

         On-site investigation conducted by:     Federal     State          Local       Other:
            Last site visit was made (month/year):
         Information provided as part of a WPDES permit application.
            Application received (month/year):
                                                                                                DNR & DATCP Cost-Share Grant Application for
                                                                                            Notice of Intent/Notice of Discharge Project Funding
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Part 4: Receiving Water Impacts
Check all that apply:

         The discharge is known or strongly suspected of causing fecal contamination of a water supply well.
         The discharge is known or strongly suspected of causing fish kills.
         Documentation exists of observed or monitored impacts to physical, chemical, bacteriological or biological impacts to water quality or
         Significant discharges (based on amount of discharge and sensitivity of receiving waters) occur every spring or several times per year.
         Significant discharges (based on amount of discharge and sensitivity of receiving waters) occur only during large rain events.
         This site should be considered an emergency because a catastrophic discharge is imminent within the next year if not fixed.

Part 5: Discharge Summary & Site History
A. Discharge Summary: Briefly summarize in a narrative the current site conditions and discharge.

B. Site History: Briefly describe any previous work or communication with the landowner/operator by federal, state, or local conservation staff
    concerning this problem. Include such things as past site visits (prior to the one listed above), discussions about the problem and potential
    solutions, farmer’s previous attempts to fix the problem, ongoing or past cost-share offers, complaints, and enforcement activity such as

Part 6: Proposed Project
A. Proposed Solution: Describe the proposed solution to resolve the discharge. Include general approach, best management practices that will
    be used, and where they will be located. Identify which best management practices will be cost shared through this grant and other funding
    sources that may be used. Include nutrient management or other soft practices only if needed to resolve the discharge.

B. Proposed Practices: Check all that apply.

         Manure storage systems                                                      Riparian buffers
         Manure storage system closure                                               Roofs
         Barnyard runoff control systems                                             Roof runoff systems
         Access roads & cattle crossings                                             Sediment basins
         Animal trails & walkways                                                    Sinkhole treatment
         Critical area stabilization                                                 Subsurface drains
         Diversions                                                                  Terrace systems
         Field windbreaks                                                            Underground outlets
         Filter strips                                                               Waste transfer systems
         Grade stabilization                                                         Wastewater treatment strips
         Heavy use area protection                                                   Water and sediment control basins
         Livestock fencing                                                           Waterway systems
         Livestock watering facilities                                               Well decommissioning
         Prescribed grazing                                                          Wetland development or restoration
         Relocating or abandoning animal feeding operations
                                                                                 Streambank and shoreline protection (includes associated fencing)
     Process wastewater handling (NR 154.04(29) & NRCS 629)                           Stream crossing
          Milking center waste control                                                Streambank/shoreline rip-rapping
          Feed storage leachate                                                       Streambank/shoreline shaping & seeding
          Other wastewater:                                                           Streambank/shoreline fencing
                                                                                      Other streambank/shoreline protection (including bio-

         Other (specify):
                                                                                                  DNR & DATCP Cost-Share Grant Application for
                                                                                              Notice of Intent/Notice of Discharge Project Funding
                                                                                                                                   Page ___ of ___

C. Project Costs

      Practice Type                Total Cost                State Share 70%          Hardship Option 90%                   Local Share
Structural Practices
Cropping Practices
Sum for All Practices
          The landowner/operator is likely to seek economic hardship.        The landowner/operator is not likely to seek economic hardship.

Describe the level of site planning and design work already completed relating to the proposed solution. Indicate if anyone with necessary design
approval authority has been involved with the planning and preliminary design work.

Part 7: Landowner & Applicant Commitment
A. General Information: Check all that apply.

         The landowner is willing to sign a cost-share agreement for the required practices.
         The landowner has the management capacity to maintain the proposed best management practices.
         The County can perform all engineering and other services to design and install required practices.
         The applicant requires assistance from         for the following engineering assistance:

B. Project Completion: This project is expected to be completed within:          six months     one year       18 months
C. Timeline: Identify any special considerations in estimating the timeline.

Part 8: Request for Cost-Share Grant
       is applying for a cost-share grant from DNR or DATCP to resolve the requirements of a NOI or NOD issued by DNR pursuant to s. NR
243.24(3). The applicant understands that funding eligibility requires a project to meet the award criteria and grantee management requirements of
the state agency providing the grant fund, including the requirement that grant funds may only be awarded for projects issued a NOI or NOD from
DNR. I certify that, to the best of my knowledge, the information contained in this application and attachments is correct and true.
Name & Title of Authorized Representative:                                   Date:

Part 9: DNR District Review (office use only)
A. NOI/NOD Status: Check all that apply.

         There is inadequate information to determine if a NOI/NOD is warranted.
         A NOI/NOD is not warranted or should not be issued for this site at this time.
         A NOI/NOD is warranted for this site and a current NOI/NOD has already been issued.
            Name of Issuer:
            Date Issued:
         A NOI/NOD is warranted for this site and a new NOI/NOD would be needed.

B. Project Resolution: Check all that apply.

         The proposed project can reasonably be expected to reduce or eliminate the discharge adequately to meet the conditions of a NOI/NOD.
         The proposed project can not reasonably be expected to reduce or eliminate the discharge adequately to meet the conditions of a
         This project should be discussed further with DNR and DATCP before determining the adequacy of the project.

Name of DNR District Staff Contact:                                            Date Forwarded to DNR & DATCP Grants Managers:

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