December 2003 Nutrient Management Protocol for Ontario Regulation 267/03 Made under the Nutrient Management Act, 2002

Part 15 – Forms

Table of Contents

15.1a Farm Unit Declaration Form When NMAN Software is Used

A: General Information

___ A Farm Unit as defined by the Nutrient Management Act, 2002 Ontario Regulation 267/03 is the basis for a Nutrient Management Strategy and/or Nutrient Management Plan.

___ For each Farm Unit there is only one Nutrient Management Strategy and one Nutrient Management Plan.

___ The Farm Unit must include all land on the property where the nutrients are generated.

___ The Farm Unit can include other properties.

B: Contact Information

Displayed in Page 1 or 2 of the Nutrient Management Approval generated by NMAN and dated _________________.

Operation Identifier (if previously assigned by Ministry):_________________________.

C: Location of all the Generating and Storage Facilities that are part of this Farm Unit

Displayed in Page 1 or 2 of the MSTOR Printout generated by NMAN and dated_____________________.

D: Location and Identification of Land that is part of this Farm Unit.

Displayed in Page 1, 2 and/or 3 of the NMAN Application for Nutrient Management Approval generated by NMAN and dated_________________________.

E: Declaration

I, _________________________________________ (farm unit operator or authorized agent) declare that the facilities and property referred to on this form comprise the entirety of this Farm Unit.  I acknowledge the requirement to complete a nutrient management plan and/or strategy, and that such nutrient management strategy and/or plan shall include all of the lands identified on this form.

I hereby warrant that the information contained on this form is true, and that I have authority to complete this document.

Indicate whether the operation that this farm unit is in, is either

___ Corporation, Name:

___ Division of a Corporation, Name:

___ Partnership, Names and addresses of Partners:

___ Sole Proprietorship, Name and address of owner:

Farm Unit Operator/ Authorized Agent (print):

Signature:

Date:

Witness (print):

Signature:

Date:


15.1b Farm Unit Declaration Form When NMAN Workbook is Used

A: General Information

___ A Farm Unit as defined by the Nutrient Management Act, 2002 Ontario Regulation 267/03  is the basis for a Nutrient Management Strategy and/or Nutrient Management Plan.

___ For each Farm Unit there is only one Nutrient Management Strategy and one Nutrient Management Plan.

___ The Farm Unit must include all land on the property where the nutrients are generated.

___ The Farm Unit can include other properties.

B: Contact Information

Operation Identifier (if previously assigned by Ministry):

Farm Unit Operator:

Legal Farm Name:

Mailing Address:

Telephone:

Category of Farm:

___ New Operation, > 5 NU and < 150 NU

___ New Operation, 3 150 NU

___ Expanding Operation, 3 300 NU

___ Existing Operation, 3 300 NU

___ Other

C: Location of all the Generating and Storage Facilities that are Part of this farm unit

Type of facility Lot Concession Township County
         
         
         
         
         

D: Location and Identification of Land that is Part of this Farm Unit

Give each farm or field a unique name that will also be used the nutrient management plan for this farm unit.

Farm or Field Name:

Lot, Concession:

Township, County:

Former Township:

Roll Number:

911 Location (if applicable):

Tillable Acreage:

___ Not owned or rented, application agreement attached.

Farm or Field Name:

Lot, Concession:

Township, County:

Former Township:

Roll Number:

911 Location (if applicable):

Tillable Acreage:

___ Not owned or rented, application agreement attached.

Farm or Field Name:

Lot, Concession:

Township, County:

Former Township:

Roll Number:

911 Location (if applicable):

Tillable Acreage:

___ Not owned or rented, application agreement attached.

___ More facilities listed on the back of this form.

___ More land listed on the back of this form.

E: Declaration

I, ________________________________ (farm unit operator or authorized agent) declare that the facilities and property referred to on this form comprise the entirety of this Farm Unit. I acknowledge the requirement to complete a nutrient management plan and/or strategy, and that such nutrient management strategy and/or plan shall include all of the lands identified on this form.

I hereby warrant that the information contained on this form is true, and that I have authority to complete this document.

Indicate whether the operation that this farm unit is in, is either

___ Corporation, Name:

___ Division of a Corporation, Name:

___ Partnership, Names and addresses of Partners:

___ Sole Proprietorship, Name and address of owner:

Farm Unit Operator/ Authorized Agent (print):

Signature:

Date:

Witness (print):

Signature:

Date:


15.2 Nutrient Management Strategy or Plan Sign-off form

Contact Information:

Name of Operator:

Address:

Telephone:

Operation Identifier (if previously assigned by Ministry):

Notice of Collection: Personal information provided in the application is collected under the authority of the Nutrient Management Act, 2002, Ontario Regulation 267/03 s. 4.1(1). It will be used for the review, approval, enforcement and audit of the strategy or plan, as the case may be. The information may be made available to external experts contracted by OMAF for advice during review and approval or to Ministry of the Environment for advice during review and approval or for enforcement purposes. A public record of approved plans may be made available to the public by publication in print or over the World Wide Web. Data from plans and strategies may be aggregated without personal identifiers and made available to researchers for evaluation of the program and other matters related to nutrient and environmental management that may be in the public interest. Questions about this collection should be directed to:

Manager, Approvals,
Nutrient Management Branch,
Ministry of Agriculture and Food,
1 Stone Road West
Guelph, ON N1G 3S4.
Phone: 519-826-6368

Provision of False Information in this Application: Any false or misleading information submitted by the applicant in this document may result in the invalidation of any approvals or permits granted, and prosecution in accordance to the provisions of the Nutrient Management Act, 2002.

Declaration:
Applicant declaration

I, _______________________________[the applicant (farm unit operator or authorized agent)], certify

(a) To the best of my knowledge, excluding unforeseen or uncontrollable circumstances, the information contained in this application dated ______________ provides an accurate description of the existing and proposed operation over the time period covered by this plan or strategy,

(b) that I understand that in the course of the administration of the Act, the ministry may provide the information contained in this application to external agents for review and analysis, and authorize the ministry to provide this information to its external agents, and authorize its external agents to collect this information from the ministry

and

I, _______________________________, authorize or do not authorize _________________________to act as my agent for the purposes of obtaining approval for this application, and may provide the ministry, or its agents, any information required in the review of this application.

Name (print):

Signature:

Date:

Declaration of Individual who prepared the plan

I, ____________________________, hereby certify that based on relevant information provided in good faith and excluding unforeseen or uncontrollable circumstances, the recommendations contained in this application dated ____________________will, if implemented, result in acceptable management practices in accordance to the regulation and protocols under the Nutrient Management Act, 2002.

Name (print):

Signature:

Date:


15.3 Application Agreement

An application agreement must be completed by operations required to have a Nutrient Management Plan and/or Nutrient Management Strategy as defined by Ontario Regulation 267/03, where nutrients are applied to land that is not owned or rented by the generator of the nutrients and the generator intends to manage the application of nutrients to the land.

Generator Information:

Name of Generator of manure/prescribed materials to be land applied:

Legal Name of the owner of the generating operation:

Address:

Telephone:

Operation Identifier (if previously assigned by Ministry):

Land Owner/Receiver Information:

Owner/manager of land on which manure/prescribed materials will be applied:

Legal name of the owner of the receiving operation:

Address:

Legal name of the land owner (if different from above):

Address:

Operation Identifier (if previously assigned by Ministry):

Agreement Information:

Term of Agreement (no less than one year):

Agreement commences on:

Agreement ceases on:

This agreement, between the parties named above, allows for the following fields to be included in the farm unit operator's Farm Unit Declaration and for application of manure to these fields under the farm unit's nutrient management plan.

List each field/section under this agreement:

Field/ Section Lot Concession Township County Tillable Acres Roll Number
             
             
             
             

___ There are more fields listed on the back of this form.

I,_________________________ (landowner) give permission to  __________________________(generator of manure/prescribed materials) to declare the above lands as part of the farm unit covered by the nutrient management strategy for the time period covered by this agreement.

I also give permission to the farm unit operator/authorized agent to do soil sampling on the properties listed to determine the condition of the soil. I also agree that the land identified in this agreement will not be used for the application of any other prescribed material, originating from any other operation, including my own (if I have any) during the term of this agreement.

I also agree that the prescribed materials covered by this agreement will be applied in accordance to the nutrient management plan that applies to the farm unit into which these lands are incorporated.

A spill contingency plan was developed and fully reviewed by both parties.

Land Owner (print):

Signature:

Date:

Farm Unit Operator/ Authorized Agent (print):

Signature:

Date:

Witness (print):

Signature:

Date:

Note: Permission to use these lands is required from all property owners listed on the title to the land. For properties owned by more than one person, permission may be given by additional owners in the form of a signature on this form or a signed letter accompanying this form.


15.4 Broker Agreement with Generator

Broker

Name and Certification Number:

and

Generator

Name and Operation Identifier (if previously assigned by Ministry):

This agreement, between the parties named above, is for the transfer of the prescribed material identified as:

___ Farm Animal Manure

___ Washwaters from Agricultural Operations

___ Runoff from Livestock Yards or Manure Storage Factilities

___ Organic Materials Produced by Intermediate Generators (ie Compost)

___ Biosolids (ie municipal sewage, pulp and paper sludge)

Description of operation where materials were generated:

Proposed date(s) of transfer:

Quantity transferred:

Days of Storage available by broker:

The Parties to this Agreement Agree as Follows:

This agreement shall be in force for a minimum period of one (1) year commencing

__________________________  and ending ___________________________ .

The terms of this agreement shall strictly apply to the present Broker. Should the Broker use the nutrient in a manner, which is demonstrated to cause environmental harm, the agreement ceases to apply.

Generator Name (print):

Signature:

Date:

Broker Name (print):

Signature:

Date:

Witness Name (print):

Signature:

Date:


15.5 Broker Agreement with Receiver

Broker

Name and Certification Number:

and

Receiver

Location of where prescribed materials to be applied to land:

Area of land available for spreading of prescribed materials:

Name and Operation Identifier (if previously assigned by Ministry):

This agreement, between the parties named above, is for the transfer of the prescribed material identified as:

___ Farm Animal Manure

___ Washwaters from Agricultural Operations

___ Runoff from Livestock Yards or Manure Storage Facilities

___ Organic Materials Produced by Intermediate Generators (ie Compost)

___ Biosolids (ie municipal sewage, pulp and paper sludge)

Description of operation where materials were generated:

Proposed date(s) of transfer:

Quantity transferred:

The Parties to this Agreement Agree as Follows:

This agreement shall be in force for a minimum period of one (1) year commencing

__________________________  and ending ___________________________ .

The terms of this agreement shall strictly apply to the present Broker. Should the Broker use the nutrient in a manner, which is demonstrated to cause environmental harm, the agreement ceases to apply.

Receiver Name (print):

Signature:

Date:

Broker Name (print):

Signature:

Date:

Witness Name (print):

Signature:

Date:


15.6 Nutrient Trasnfer Agreement

Generator

Name and Operation Identifier (if previously assigned by Ministry):

and

Receiver

Name and Operation Identifier (if previously assigned by Ministry):

Location of where prescribed materials are to be applied to land:

Area of land available for spreading:

This agreement, between the parties named above, is for the transfer of the prescribed material identified as:

___ Farm Animal Manure

___ Washwaters from Agricultural Operations

___ Runoff from Livestock Yards or Manure Storage Facilities

___ Organic Materials Produced by Intermediate Generators (ie Compost)

___ Biosolids (i.e. municipal sewage, pulp and paper sludge)

Proposed date(s) of transfer:

Quantity transferred:

The Parties to this Agreement Agree as Follows:

  • Both Parties will meet the requirements of the Nutrient Management Act, 2002 Ontario Regulation 267/03. 
  • The Generator and the Receiver warrant that between them there is adequate storage for these prescribed materials that meets the requirements for construction and siting in Part VIII of the Regulation, if required by the Nutrient Management Act, 2002 Ontario Regulation 267/03
  • The terms of this agreement shall strictly apply to the present Receiver. Should the Receiver use the nutrient in a manner, which is demonstrated to cause environmental harm, the agreement ceases to apply.

This agreement shall be in force for a minimum period of one (1) year commencing

__________________________  and ending ___________________________ .

Generator Name (print):

Signature:

Date:

Receiver Name (print):

Signature:

Date:

Witness Name (print):

Siganture:

Date:


15.7 Nutrient Management Strategy for Non-Agricultural Operations

Generating Non-Agricultural Source Material Form 

If you are a nutrient generator of material intended for land application, you must submit a Nutrient Management Strategy to the Ministry of Agriculture and Food, the Nutrient Management Branch, for approval every five years. In addition you are responsible for a documented annual update that must be retained on site.

Generator Responsibilities
  • Nutrient Management Strategy: Prepare and submit Part I through Part V.
  • Annual Strategy: Complete Part VI annually. This is a planned strategy of activities for the year. Submit Year One with Nutrient Management Strategy. Prepare Year Two through Year Five annually and retain on site with Nutrient Management Strategy.
  • Annual Report: Complete Part VII and Part VIII within 60 days of each year end and retain on site with Nutrient Management Strategy. These reports include the actual annual activities that were carried out, reported at year end.
Part I: Facility Description and Approval Information

Facility Name:

Facility Address (physical location - street number, name, city/town):

Telephone Number (including area code):

Facility's Contact Name (i.e. person responsible for NMS):

Total Volume of Materials Produced at Facility (imperial gallons/day or m3/day or wet tonnes/year):

Description of Operations:

I, the undersigned hereby certify that, based on relevant information provided in good faith and excluding unforeseen or uncontrollable circumstances, the recommendations contained in the attached strategy are compliant with the Nutrient Management Act, 2002.

Officer Name (please print) :

Officer Title:

Officer Signature:

Date (dd/mm/yy):

Date Submission Received (dd/mm/yy):

Date of Approval(dd/mm/yy):

Identifier Number:

Terms and Conditions of the Approval of this Nutrient Management Strategy:

This Strategy expires on __________________________________ (dd/mm/yy)

In accordance with Section 9 of the Nutrient Management Act, R.S.O. 2001, Part 3, you may by written notice served upon me and the Environmental Review Tribunal within 15 days after receipt of this Notice, require a hearing by the Tribunal. Subsection 9(6)  of the Nutrient Management Act, provides that the Notice requiring the hearing states:

  1. The portions of the certificate, licence, approval or order in respect of which the hearing is required; and
  2. The grounds on which the applicant for the hearing intends to rely at the hearing. 2002, c.4, s. 9(6).

The Notice should also include:

  1. The name of the appellant;
  2. The address of the appellant;
  3. The Nutrient Management Strategy unique identifier number;
  4. The date of the Nutrient Management Strategy approval;
  5. The name of the Director;
  6. The municipality within which the works are located.

And the Notice should be signed and dated by the appellant.

This Notice must be served upon:

The Secretary*
2300 Yonge Street, 12th Floor
P.O. Box 2382
Toronto, Ontario M4P 1E4

and

The Director
Environmental Review Tribunal
Nutrient Management Branch
Ministry of  Agriculture and Food
1 Stone Rd., 3rd Floor
Guelph, Ontario N1G 4Y2

Further Information on the Environmental Review Tribunal's requirements for an appeal can be obtained directly from the Tribunal at: Tel: (416) 314-4600, Fax: (416) 314-4506 or www.ert.gov.on.ca.

I, the undersigned, have reviewed the Nutrient Management Strategy and approve that it meets the nutrient management review criteria of the Ontario Ministry Agriculture and Food.

Director Name (please print):

Director Signature:

Date (dd/mm/yy):

Part II: Material Description and Storage Information
Type(s) of Material Produced (e.g. sewage biosolids, pulp and paper biosolids, Biosolids Utilization Committee recommended material) Description of Material(e.g. solid, liquid) Average Annual Volume for Period of Plan (imp. gal., m3, wet tonnes) Storage
On-Site P  Off-SiteP Off-Site, list physical address of each permanent storage facility (transfer station) Storage Capacity (imp. gal., m3, wet tonnes)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part III: Projected Five-Year Strategy for Non-Agricultural Source Material Generated
Destination of Material Volume (imp. gal., m3, wet tonnes)
Year 1 Year 2 Year 3 Year 4 Year 5
Land Application

 

 

 

 

 

Landfill Disposal

 

 

 

 

 

Incineration

 

 

 

 

 

Processing(e.g. composting, pellets, etc.)

 

 

 

 

 

Other (e.g. new technology)

 

 

 

 

 

Total

 

 

 

 

 

If volumes are projected to change by 20% or more between years, describe why this may occur:

Part IV: Nutrient Analysis of Material

 Provide a strategy for the analysis of materials that includes:

  • sampling of materials for metals and pathogens;
  • monitoring and analysis of results and record keeping; and
  • providing required data to haulers.
The sampling strategies must meet or exceed the standards established in the Regulations and Protocols. (Analysis results are to be retained on site.)
Part V: Contingency Plan

A written contingency plan is required that outlines alternative actions in the event that the strategy cannot be followed. For spills, non-agricultural facilities are subject to Regulation 347 and Part IX of the Environmental Protection Act.

Alternative Storage Contingency Plan:

Alternative Disposal Contingency Plan:

Part VI: Destination of Material

Land Application (Annual)

One sheet for each Hauler. Add more of required.

Name of Hauler Company:

Year of Strategy(e.g. 2003, Year 1):

Broker/Hauler Agreement (Yes or No):

System C of A Number or Licence Number:

Site Site C of A Number ORNMP Number, if available Area for Application (acres/hectares) Application Rate (imp. gal., m3, wet tonnes  per acre/hectare) Total Volume to be Applied (imp. gal., m3, wet tonnes)
1        
2        
3        
4        
5        
6        
7        
8        

Landfill Disposal (Annual)

Year of Strategy (e.g. 2003, Year 1):

Total Volume to be sent to Landfill (imp. gal., m3, wet tonnes):

Landfill Site (name and address):

Incineration (Annual)

Year of Strategy (e.g. 2003, Year 1):

Total Volume to be Disposed (imp. gal., m3, wet tonnes):

On-Site (please P):

Off-Site Address:

Processing Material (Annual)

Year of Strategy (e.g. 2003, Year 1):

Total Volume to be Disposed (imp. gal., m3, wet tonnes):

Describe Type of Process (e.g. composting, pellets, etc.):

On-Site (please P):

Off-Site Address:

Other Management Methods (Annual)

Year of Strategy (e.g. 2003, Year 1):

Total Volume to be Disposed (imp. gal., m3, wet tonnes):

Describe Method (e.g. new technology):

On-Site (please P):

Off-Site Address:

Part VII: Annual Report of Management of Material

Land Application Report (Annual)

One sheet for each Hauler. Add more of required.

Year End for Strategy Year (e.g. 2003, Year 1):

Name of Hauler Company:

Broker/ Hauler Agreement (Yes or No):

System C of A Number or Licence Number:

Site Site C of A Number or NMP Number, if available Total Area Applied (acres/hectares) Actual Application Rate (imp. gal., m3, wet tonnes  per acre/hectare) Total Volume Applied (imp. gal., m3, wet tonnes)
1        
2        
3        
4        
5        
6        
7        
8        

Landfill Disposal Report (Annual)

Year End for Strategy Year (e.g. 2003, Year 1):

Total Volume to Landfill (imp. gal., m3, wet tonnes):

Landfill Site (name and address):

Incineration Report (Annual)

Year End for Strategy Year (e.g. 2003, Year 1):

Total Volume Disposed (imp. gal., m3, wet tonnes):

On-Site (please P):

Off-Site Address:

Processing Material  Report (Annual)

Year End for Strategy Year (e.g. 2003, Year 1):

Total Volume Disposed (imp. gal., m3, wet tonnes):

Describe Type of Process (e.g. composting, pellets, etc.):

On-Site (please P):

Off-Site Address:

Other Management Methods Report (Annual)

Year End for Strategy Year (e.g. 2003, Year 1):

Total Volume Disposed (imp. gal., m3, wet tonnes):

Describe Method (e.g. new technology):

On-Site (please P):

Off-Site Address:

Part VIII: Report on Five Year Strategy for Non-Agricultural Material Generated
Destination of Material Volume (imp. gal., m3, wet tonnes) 
Year 1 Year 2 Year 3 Year 4 Year 5
Land Application          
Landfill Disposal          
Incineration          
Processing (e.g. composting, pellets, etc.)          
Other (e.g. new technology)          
Total          


If volumes changed by more than 20% between years, describe why this has occurred:

 


For more information:
Toll Free: 1-877-424-1300
E-mail: ag.info.omafra@ontario.ca
Author: OMAFRA Staff
Creation Date: 10 December 2003
Last Reviewed: 10 December 2003