Clean Water Program Application Form:

Milkhouse / Milk Parlour Washwater Treatment and Disposal

Please complete the following application, and forward to:

Upper Thames River Conservation Authority

1424 Clarke Road, London, ON N5V 5B9

E-mail:

Fax: 519-451-1188

Personal Information

Name:
Address:
Town/City, Postal Code:
Telephone:
Fax:
911 Number:
E-Mail:
Do you have a Farm Business Number (FBN) (write Yes or No)

Project Location

Municipality/Township: / County:
Lot: / Concession:
Workable Acres Farmed - Own: / Rent: / TOTAL:
Number of cows milked:
Average daily volume of washwater: / Litres / Gallons
Calculated by: / Water meter / Sink volume / Guess
Volume measurements include:
Presanitary / Acid rinse / Bulk tank / Floor wash / Wash / Rinse / Other
Describe the project, including the present situation and how it impacts on water quality:

To be completed by CWP staff

Coordinates: X / Y
Conservation Authority: Upper Thames River / Long Point Region / Grand River

Please put an “X” beside the section(s) that you are applying for.

Storage within an existing or proposed manure storage system
Pump for transfer of milkhouse washwater for manure storage / Yes/No / Estimated cost
Add pipe connection for transfer of washwater / Yes/No / Estimated cost
Other project items / Yes/No / Estimated cost
Treatment Trench System
Soil Type:
Depth to subsurface water: / In feet: / Unknown
If unknown, do you use tile drainage/sump pumps in the vicinity to keep the ground/basement dry? / Yes / No
Will the septic tank and treatment trench be located at least 150 ft (50 m) from any dug well, watercourse or open catchbasin, and 50 ft (15 m) from any drilled, adequately cased well? / Yes / No
Volume of washwater per day:
Total trench length needed (in metres, minimum 96 m):
Number of trench lines (maximum length 30 m):
Distance between trench lines (in metres, minimum 2 m):
2 compartment septic tank size (minimum 3600 litres):
Length of smooth walled pipe from milkhouse to septic tank (in metres):
Length of smooth walled pipe from tank to trench (in metres):
Install tank and treatment trench: / Yes / No / Estimated cost
Add pipe connection for transfer of washwater: / Yes / No / Estimated cost
Other project items: / Yes / No / Estimated cost
Water Conservation Fixtures in the Milkhouse

Other Information

Estimated cost of projects:
Estimated project completion date:
Please provide any additional information or comments.
I acknowledge that the Clean Water Program representative can verify that I have an Environmental Farm Plan that is deemed appropriate.
I had my EFP peer reviewed in the County of:
Signature:
Date:


Site Plan

Provide a sketch showing existing site features and proposed best management practices. Include farm buildings, existing milkhouse and proposed treatment/ containment system, as well as the distance to and location of drain tiles, catchbasins, wetlands, watercourses and wells. Include other information that you feel is important.

Milkhouse / Milk Parlour Washwater Treatment and Disposal 1