Fillable Special Or Experimental Lawn Care Containment Permit printable pdf download

SCHEDULE SE: SPECIAL OR EXPERIMENTAL LAWN CARE CONTAINMENT PERMIT

_____ Special Lawn Care Permit

_____ Experimental Lawn Care Permit

Facility Name ______________________________________________________________________________________________

Project Location _____________________________________________________________________________________________

Street Address

City

County

This information is required for each Special or Experimental Lawncare Containment Permit Application. Completion of specific parts of

this information is required on the back of this form.

1. LOCATION AREA MAP - Provide a location map of the area surrounding the facility. Identify the relative locations of the following

on the map, or by notations, the distance and direction: a) All community wells within 1,000 feet and all water- supply wells within 200

feet of the facility boundary; b) Surface water flow path to area lakes, streams, or storm water drains; c) Residences, institutions,

commercial businesses, and nearest city boundary; d) Notation of soil type and approximate groundwater depth at facility location.

Preferably, this location map should be done on a copy from the U.S. Geological Survey Quadrangle Map, or a County Plat Book Map

with adequate scale to show required details. NOTE: Setback requirements can be found in Section 14.2 of the Illinois Environmental

Protection Act (415 ILCS 5/1 et seq.).

2. PLOT PLAN - Provide a plot plan which clearly illustrates the relative locations of all facility structures, recovery tanks, facility wells,

off-site wells, connections to public water supply systems, storm sewers and drainage tile within property boundaries and use of adjacent

property. Identify all wash water containment area structures, pesticide storage areas, and operational areas, including loading, mixing,

and equipment washing. Topography of property can be shown by contour lines or notation and arrows depicting surface water flow

across and from facility. The plot plan should be drawn to a reasonable scale or adequately dimensioned.

3. WATER SUPPLY/WELL PROTECTION - Provide, in the spaces on the reverse side of this sheet, the required information describing

all water distribution points (filling and washing) and the required backflow protection provided as indicated on the form. Backflow

protection is required for all water distribution points at the wash water containment structure pursuant to 8 Illinois Administrative Code

256.90. Provide a schematic flow diagram of the facility water distribution system between facility well(s) and/or public water system

connection and all process or operational use points. Identify backflow protection (break-tank, fixed air gap, reduced pressure principle

backflow valves) on the diagram. Please identify if the well is potable (for human consumption) or not. If a fixed air gap is utilized,

please provide a diagram or drawing of such.

4. OPERATIONAL AND MANAGEMENT PRACTICES PLAN - Please provide a narrative description of the practices that will be

employed at the facility for handling recovered materials, accumulated precipitation, and to minimize the volume of recovered materials

generated. Please include the following:

a) List types and amounts of agrichemicals handled and stored at facility.

b) Please provide the methods of storage, reuse, or disposal and estimated quantity of solutions and solids recovered in the containment

structure. Please provide a schematic flow diagram of the collection and recovery system from the containment collection sump to

recovery storage tanks and to final reuse through the loading or mixing operation and indicate any provisions for storm water by-

pass. Please show and label all components indicating pertinent features, sizes, capacities, and flow rates of the tanks, pumps, and

piping.

c) Please submit the methods employed for handling storm water collected in the containment structure. This may include practices to

keep containment systems clean, to prevent storm water contamination, and any special precautions taken to ensure contaminated

storm water is not discharged as surface runoff. Please define differences in operational practices employed in the off-season such as

by-pass of wash water collection systems.

d) If an automatic recovery system is submitted to meet the proposed capacity requirements for the containment structure, please

describe the operation of each component of the system and indicate if the system is activated by a pump or a gravity drain system.

e) Please submit a narrative description of the inspection and maintenance practices to be employed by the facility for monitoring all

underground structures (i.e. pits, piping, etc.) used for the storage or transport of rinsates, wash water, or recycled liquid to ensure the

structural integrity of these structures.

5. ENGINEERING PLANS AND SPECIFICATIONS - Please submit plan and elevation drawings of the containment structure and the

collection and recovery system with overall and component dimensions and elevations referenced to a single facility benchmark. Cross-

sections must indicate construction details, elevations, and dimensions of the containment structure floor ramps, curbs, sumps, catchment

basins, and all transfer structures and piping. Please identify all construction materials and specifications.

6. EXPERIMENTAL PERMITS - Please provide the proof (i.e. quality control, quality assurance) and supporting analytical data to

indicate that the proposed structure or method has a reasonably substantial chance for success. Please include all pertinent drawings,

testimony, and verification to support the proposal.

IMPORTANT NOTICE: This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under the Illinois Compiled

Statutes, Chapter 415, Act 65. Failure to provide this information shall prevent this form from being processed. This form has been approved by the State Forms Management

Center.

IL406-1515(rev. 1/03)

Special Or Experimental Lawn Care Containment Permit

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