Pennsylvania Clean WaterFarm Award Program
Nomination Form
County Conservation District: ______
Name of Farm Operator/Farm (Please enter the name(s) exactly as it should appear on the award certificate):
______
Farm Mailing Address: ______
Which Watershed is the Farm Located in (check one)?
____ Chesapeake Bay/Susquehanna ____ Ohio ____ Delaware ____ Potomac
____ Erie _____ Genessee
Telephone # (include area code): ______
Number of Acres Farmed:
cropland ______pasture ______
Livestock (check one): ___ yes ___ no
If yes, state number of each:
Beef______Dairy______
Poultry______Hogs______
Veal:______Other(Specify):______
Attach narrative about the farm's nutrient management, soil, water, and other conservation practices, and include any labeled photos.
Nomination materials must be received by PACD on or beforeApril 30.
Pennsylvania Clean WaterFarm Awards Program
Criteria Checklist
Check off the following criteria where applicable:
______Have recent soil test information for cropland
comments:
______Have manure management plan
comments:
______Have recent soil test information for pastureland
comments:
______Have manure test information for cropland
comments:
______Practice Nutrient Mgmt. Techniques
comments:
______Have a Farm Conservation Plan
comments:
______Practice Pesticide Mgmt. Techniques
comments:
______Belong to a Crop Management Association or retain the services of a Private
Farm Managerial Service
comments:
______Uses crop rotation – how many years of what crop? Please describe:
______Apply fertilizer\manure according to soil test recommendations
______Have soil tested on all crop fields in last three years
______Credit nutrient value of manure applied to fields toward total nutrient need of the
Crop
______Apply manure/commercial fertilizer to crop fields at rates recommended to meet
plant needs
______Adequate barnyard mgmt. techniques
______Practice split application/sidedress fertilize
______Does not apply manure on frozen ground
______Apply manure to best utilize its nutrient value (time/method of application)
______Incorporate manure to best utilize its nutrient value
______Have a storage facility
______Date of last nutrient management plan review or update: ______
can you produce it? Y___N___
comments: (Is the plan an approved Act 38 or NRCS 590 nutrient management
plan?)
______An up-to-date, complete, conservation plan
______Implement soil and water conservation practices on farm as recommended in
farm conservation plan
______Practice some form of reduced tillage (what percentage?)
______Practice no-till (what percentage?)
______Use cover crops ___ harvested ___ burnt-down
Is residue removed? _____
______Confined livestock operations are managed to minimize animal waste polluting
streams
______Limit access to streams by animals to minimize erosion
______Manage pastureland to minimize erosion
______Provide watering facilities for livestock
______Stabilize streambanks from erosion
______Have a restricted use pesticide license by state of Pennsylvania
______Pesticides/herbicides are applied according to label instructions
______Spray application equipment is properly calibrated
______Empty pesticide/herbicide containers are properly disposed
______IPM techniques used during farming operation
______Conduct farm tours of conservation practices or other education or outreach efforts
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