Goodhue County Feedlot Registration Form

 

All blanks in bold print are required information.  Your form will not be complete without this information.

 

I.        Name of Applicant ___________________________________  Title:Owner / Operator (Circle one or both)

Phone: _____________  Address: _______________________________ City: ___________ Zip: ______

Name of Owner (if different from above) ______________________________________________________

Name and Address of others that should be listed with this feedlot (specify Owner or Operator)

________________________________________________________________________________________

________________________________________________________________________________________

Farm Name: ___________________________________

Location of Feedlot facility:

Township: _________________ Section: _____ Qtr Section: _____ Qtr of Qtr Section: _____

Township T_____ N  Range R_____ W

Feedlot Permit #:  If you have an existing permit or certificate number: _________________

Parcel I.D. # _____________________(Same as your county tax ID number)

Unique Well Number: ______________ Are there any other wells on the property used or unused: (Y or N)

Shortest Distance from any Well to Feedlot or Manure Storage is: _____________ feet.

 

II.     Listed below are common components of livestock operations, please check all that apply: 

_____1. Feedlot is total confinement.

_____2. Feedlot has open lots (dirt, concrete, other) that are designed as animal holding areas.

_____3. Feedlot has buildings that are designed for animal confinement or as animal holding areas.

_____4. Animals are on pasture for at least part of the year.

_____5. Feedlot has a liquid manure storage basin or pit. 

_____6. Part or all of the manure storage basin or pit is underground.

_____7. Feedlot has a manure (solids) stockpile.

_____8. Feedlot is within 1000 feet of the following surface waters: _____________________Distance_______

                                                                                                     _____________________Distance_______

              (Includes lakes, rivers, streams, drainage ditches, tile intakes, floodplains, and wetlands)

_____9. Sinkholes are located on or near your property. (Location: Qtr/Qtr ________)

 

III.       Animal Units ____________(Transferred from worksheet on back of this form)  Worksheet must be completed.

 

By completing, signing, and submitting this form to the entity listed below you have completed the Minnesota feedlot registration requirements.

 

To the best of my knowledge, the information submitted on this Registration form is complete and accurate.

 

_______________________________________                  _____________________

Text Box: FOR OFFICE USE ONLY RECEIVED ON___________ COPY SENT TO APPLICANT ON______________________                         Signature                                                             Date

 

Return to: Goodhue SWCD, 104 E. 3rd Ave., P O Box 335, Goodhue, MN  55027

                Phone: (651) 923-5286 ext.4