ࡱ> { Abjbjzz 7  ``$PH|dnmmmmmmm$prVmi0o@00m``n"""0j`Rm"0m""]@"wcb`6{m4n0dnM`*s$ Tslwcwcsc k"l]mmx!~dn0000s &:   COUNTY___________________________________ TOWNSHIP_________________________________ APPLICANT LAST NAME____________________ APPLICANT FIRST NAME____________________ ENERGY GENERATION SYSTEM TYPE: Mounted on Rooftop(s) or Other Structure(s) % Ground-Mounted % o Farmland Preservation Program Application for Solar Energy Generation Facilities on Preserved Farmland N.J.S.A. 4:1C-32.4 Please be sure to provide all requested information and documentation in this application form. Completed applications should be submitted to the State Agriculture Development Committee, P.O. Box 330, Trenton, NJ 08625-0330. a. APPLICANT INFORMATION Duplicate this sheet as necessary to INDICATE ALL APPLICATION PARTICIPANTS. Please number each DUPLICATED page for THIS SECTION (e.g., Page 2A, 2B, etc.). Enter information for each related party applying for approval of energy generation (landowner of record and/or installer). ________________________________________________________________________ Applicant Name and Affiliation (if not Landowner of Record) ________________________________________________________________________ Address ________________________________________________________________________ City: _______________________ State:______________ Zip Code: _____________ Contact Person: _________________________________________________________ Phone (business/home/cell): _______________________________________________ Fax:_________________________ Email:_____________________________________ Landowner of Record _______________________________________________________________________ Address: _______________________________________________________________________ City: ___________________________ State: ____________ Zip Code: __________ Phone (business/home/cell): ________________________________________________ Fax _________________________ Email:_____________________________________ -2- B. BLOCK, LOT & ACREAGE OF FARM NOTE: For the purposes of this application, farm refers to all land under the Farmland Preservation Program Deed of Easement (Easement) and all exception areas not covered by the Easement. Duplicate this sheet as necessary to INDICATE each lot and its acreage separately. Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ Municipality:_________________ Block: _______ Lot: _________ Acres: ______ TOTAL ACRES: ______________________ ACREAGE BASED ON: Tax map acres o % Survey acres %n -3- C. LOCATION WHERE ENERGY FACILITY WILL BE CONSTRUCTED. Check appropriate box(es) to indicate whether the facility will be located on the preserved land or an exception area): Block: _____ Lot: ______ Acres: ______ Preserved land %o Exception Area: Severable % Non-Severable %o Block: _____ Lot: ______ Acres: ______ Preserved land %o Exception Area: Severable % Non-Severable % o Block: _____ Lot: ______ Acres: ______ Preserved land %o Exception Area: Severable % o Non-Severable % o Block: _____ Lot: ______ Acres: ______ Preserved land %o Exception Area: Severable % Non-Severable % D. TYPE OF ENERGY SYSTEM TO BE INSTALLED AND RATED CAPACITY Solar Photovoltaic o % Photothermal o % Energy generation capacity of system  in kilowatts (AC  alternating current) for systems generating power, or BTUs and kilowatt-equivalent for systems producing heat ________________________________________ -4- E. FARMS ENERGY DEMAND FOR THE PREVIOUS CALENDAR YEAR (Note: For purposes of this application, demand means the total amount of power or heat consumed by fixed structures on the farm in kilowatt hours or kilowatt-hour equivalent.) ____________________ F. GENERAL APPLICATION INFORMATION 1. Please provide the following information: a. Copy of current recorded deed of ownership (ATTACH AS SCHEDULE A), and copy of farmland preservation deed of easement (ATTACH AS SCHEDULE A1) b. Copy of site plan that includes the following. ATTACH AS SCHEDULE B Property lines and physical dimensions of the farm, including block(s) and lot(s) designations. Location, configuration and size of the occupied area of the solar energy facilities and any other solar, wind or biomass facilities existing on the farm, as defined in N.J.A.C. 2:76-24.3, measured in square feet or acres. Facility specifications including manufacturer, model, industry technical bulletin describing the solar energy equipment, method of mounting, system height, rated capacity and expected annual energy generation/production (in alternating current if power will be generated or BTUs and kilowatt-hour equivalent if heat will be produced). Location of pipes, wires and any other improvements or infrastructure to accommodate the solar energy facilities, including depths for below-ground improvements and infrastructure. For projects that will be net metered, the location of electric meters and sources of energy demand that will be serviced by the solar energy facilities. Location of proposed new roads or existing roads that will be used to access the solar energy facilities. Setback distances from property lines and roads. Location and calculated areas of concrete, asphalt, gravel, geotextile fabrics or other land treatments necessary for the solar energy facilities. -5- Nature, location and calculated areas of site disturbance on the preserved land, measured in square feet or acres. Site disturbance includes but is not limited to grading, topsoil and subsoil removal, excavation and soil compaction associated with the solar energy facilities and any existing solar, wind or biomass energy facilities on the farm. Location, rated capacity, installation date, and annual energy generation/production of any existing solar, wind or biomass energy equipment or structures on any portion of the farm, including exception areas (in alternating current kilowatt hours if power is generated or kilowatt-hour equivalent if heat is produced). Location of all existing structures and improvements on the farm. For a farm with an occupied area of more than one acre on the preserved land, a copy of the conservation plan that was approved by the soil conservation district. A copy of the farmland assessment form for the farm, approved by the local tax assessor, for the most recent tax year. c. Digital photographs showing the proposed installation site taken from various angles and distances to show the installation site and immediate surroundings (hard copy and digital files). ATTACH AS SCHEDULE C d. For facilities requiring a permanent ground mounting, written justification from the licensed professional engineer responsible for the installation explaining why a permanent ground mounting, including footings, concrete or other permanent methods, is necessary. ATTACH AS SCHEDULE D1 2. For facilities that will be mounted on buildings or other structures, describe the use of the buildings or structures and the date they were constructed. ATTACH AS SCHEDULE D2 3. Explain how the solar energy facilities, structures or equipment will affect the use of the preserved land for agricultural or horticultural production. Explain whether the occupied area on the preserved land will continue to be used for agricultural or horticultural purposes and/or how that area will be maintained. ATTACH AS SCHEDULE E 4. Explain who will own the energy facilities, structures or equipment. If the property owner will not own them upon installation, provide a copy of a lease or purchase agreement demonstrating how the property owner will acquire ownership of the facilities, structures or equipment over time. Describe any other agreement in which either the land under the solar energy facilities or the facilities will be leased to another party. ATTACH AS SCHEDULE F -6- 5. Explain how the energy generated from the facilities, structures or equipment will be used to provide power or heat to the farm, either directly or indirectly, or will reduce, through net metering or similar programs and systems, energy costs on the farm. ATTACH AS SCHEDULE G 6. For solar energy facilities that will provide power, provide an approved Part One Interconnection/Application Agreement Form approved by the Electric Distribution Company including a Part 1 and Part 2, for facilities that will be net metered; documentation showing that the facilities will provide power or heat directly to the farm outside of the meter; or an approved PJM Interconnection Service Agreement or an approved Part One Interconnection/Application Agreement Form completed and signed by the Electric Distribution Company for facilities that will provide energy directly to the electric distribution system. ATTACH AS SCHEDULE H 7. Provide copies of 12 months of utility bills for previous calendar year (or copy of most recent bill if it contains the previous 12-month usage information, in which case only this one bill is required) or copies of other bills, receipts or other documentation demonstrating the amount of electricity or fuel used to power or heat fixed structures on the farm (in kilowatt hours or kilowatt hour equivalent). ATTACH AS SCHEDULE I 8. Explain if the solar energy facilities are for the purpose of providing power or heat to service a nonagricultural use on the farm. If so, describe the nonagricultural use and where it is located (including block/lot), and provide evidence of the energy demand of the non-agricultural use. ATTACH AS SCHEDULE J 9. Explain whether solar energy facilities located on the preserved land will service any energy demand on an exception area, or whether solar energy facilities located on an exception area will service any energy demand on the preserved land. If so, describe all the energy demand(s) the solar energy facilities will serve. ATTACH AS SCHEDULE K 10. Explain how the amount of acreage devoted to the proposed energy facility meets the 1:5 acre requirement for farmland assessment, i.e., the 1:5 ratio for acreage in energy generation vs. acreage in agricultural/horticultural operations. ATTACH AS SCHEDULE L 11. Explain whether the installation and operation of the energy facilities, structures or equipment will require the conveyance of an easement or other interest in -7- the premises. If such an easement or other interest is required, provide copies of the proposed conveyance document(s), a location map and/or a survey. ATTACH AS SCHEDULE M 12. Explain in detail the nature and calculated area of any new impervious cover associated with the solar energy facilities and any existing solar, wind or biomass energy facilities on the preserved land. Impervious cover means any structure or surface that prevents the infiltration of precipitation into the land, including but not limited to the inverter, pilings, poles, concrete, asphalt, machine-compacted soil, compacted stone areas, plastic or other impermeable ground cover. Impervious cover does not include the area of the solar panels or USDA-Natural Resources Conservation Service conservation practices listed in the N.J. Field Office Technical Guide (NJ-FOTG). ATTACH AS SCHEDULE N 13. For a farm located in the Pinelands, provide written confirmation from the Pinelands Commission that the solar energy facilities as proposed comply with the Pinelands Protection Act and the Pinelands Area comprehensive management plan, or a copy of written correspondence to the Pinelands Commission requesting such confirmation. ATTACH AS SCHEDULE O G. CERTIFICATIONS The undersigned warrants, certifies and represents that: The information provided in this application package has been personally examined, and is true, accurate, complete and correct to the best of the undersigneds knowledge, based on personal knowledge or on inquiry of individuals with such knowledge; and The system proposed in the application will be constructed, installed and operated as described in the application and in accordance with N.J.S.A. 4:1C-32.4 and all applicable SADC regulations; and All signing parties realize that certain information in this application may be subject to disclosure under the Open Public Records Act; and All signing parties acknowledge that the submission of false information may be grounds for denial of this application and, if any of the foregoing statements are willfully false, the signers are subject to punishment. -8- ^ & ( , . 0 2 4 6 8 v x z û~sh]R]h5CJ(\aJ(h&5CJ(\aJ(h\(O5CJ(\aJ(h!b5CJ(\aJ(hq5CJ(\aJ(hv5CJ(\aJ(h?5CJ(\aJ(hsMh?5\ h?5\h5hCJaJhLnCJaJhLnCJ aJ hLnCJ$aJ$hWDhLnCJ$aJ$hRrhLnhcYhjh?UmHnHuh? bd ^ ` , 2 6 8 |`|gd? 0^`0gd5 L^L`gdLn`gdLnL^Lgd?`gd?L`Lgd?gd?  !gd?8 : < x z   8 : < > @ B D F H J ^`gd?gd SsgdU. $ ] a$gd $ ] a$gd!b $ ] a$gd\(O $ ] a$gd? ] gd?   4 6 8 D F H J  귬~vnbZRNChH)h8CJaJhH)h?CJaJh?CJaJhjRh?5CJ(aJ(hjRh'15hjRh()5hjRh?5hU.h?CJ(aJ(hU.CJaJhU.CJ(aJ(hU.hU.CJ(aJ(hU.5CJ(\aJ(jh?UmHnHuh)<h?5>*CJ(\aJ(hH5CJ(\aJ(h?5CJ(\aJ(hv5CJ(\aJ(h\(O5CJ(\aJ( WXDE+,-KLgdHgdgd&1zgd?gd0`0gdQ"' ^`gdH) " H I J K L Q ] a ǿxqh`ULhtH5CJaJh&1zh&1zCJaJh&1zCJaJh&1z5CJaJ h}hkiv h}hr] h}h h}hK h}>*h}h?>* h}h?hh$Gh,hC: hf>* h?>*?<h?>*h?5:CJ\aJh?5:>*CJ\aJhQ"'hQ"'5:CJ\aJhQ"'hQ"'5:CJ \aJ  'FLVWX6CD*,-@KLǿ|ǏthؗLJh%oPh5CJaJh\V~CJaJhhCJaJh?CJaJhCJaJhCJaJh<CJaJhbCJaJhZ,CJaJh=dCJaJh&1zCJaJhtHCJaJh&1z5CJaJh%oPhH5CJaJh$G5CJaJhtH5CJaJhZ,5CJaJ(;< ,gd&1z $|`|a$gdY|`|gdN 0`0gdQ"'  gd?gd?0:;<KLPU^pznbhM{5>*䴳a?5>*䴳a"'5Ca"'"'5Ca5Ca5Ca%&15Ca()5>*䴳a䴳䴳䴳ٱ䴳䴳<CJaJh?CJaJ%CQ  (+,4øti[Lih6h.J5>*CJ\aJh6h65CJ\aJh65CJ\aJht5CJ\aJh?5;CJ\aJh?5;>*CJ\aJh?5>*CJ\aJh?5CJ\aJh?CJaJh}h?CJaJh}h?CJ\aJh5h&1z5>*\ h&1z5\h*CJ\aJ478X6:=\ ;?@Cb8b|~Ͻĵh}hWDhWDCJ$aJ$h8h?5CJaJh8h?CJaJ h}h?h$GCJaJh?CJaJ h6h?h?5CJ\aJh6CJaJh?CJaJhsCJaJh6h?CJaJh6h?5CJ\aJ2,8;<=@ABC  gd?gd?:<`b(*24Tz|  gdJ ^`gdgdJ ^`gdN00`0gd%^0`0gdQ"' $|`|a$gdYgdgd?gd?48DZ\bj"&(*Dĸuuuj\TLhZ,CJaJhJCJaJh()h?5>*䴳.5>*䴳'<5>*CJaJhn5>*CJaJhZ,5>*CJaJhz)5>*CJaJh()h25>*CJaJhQ"'5CJaJhQ"'hH)5CJaJhj;5CJaJhNh%hH)5CJaJh8h?5CJaJhWDhWDCJ$aJ$hWD h}h?DPb ,.024Nfl8JLTnŽŏń{r{fhhCJ\aJhWDCJ\aJhCJ\aJhN0hJCJ aJ h%^CJaJhWDhWDCJ$aJ$hWDCJaJhCJaJhhCJaJh%^CJ aJ hCJ aJ h SsCJaJhsCJ aJ hWDh%^CJ$aJ$hsCJaJhZ,CJaJhJCJaJ(nprvxz~ 2DFJLN\^`|~"$&(:>HJLļωځڴρhCJaJhWDCJaJh SsCJaJhsCJ aJ hWDh%^CJ$aJ$hsCJaJhJCJaJhZ,CJaJhJ5CJ\aJhhCJaJhCJ aJ hCJ\aJhWDhWDCJ$aJ$hWDCJ\aJ2|~ N(\  "Ltvef  8gd8  gd\(O  gd8  gd  0gdQ"' 00`0gdQ"'gd ^`gdgdJ  gdJLN "BDFHJLlnprtvȿ{skc{skcXMh h CJaJh\(Oh\(OCJaJhWDCJ aJ h8CJ aJ h8CJaJh"hWCJaJhYCJaJh CJ aJ h CJaJhQ"'5>*CJaJhY5>*CJaJh()h"hW5>*CJaJhQ"'5CJaJhQ"'hQ"'5CJaJh?5CJaJhXCJ$aJ$hWDCJaJhCJaJhWDhWDCJ$aJ$  &'defx跮zozcXh-zhMCJaJhqLhM5CJaJhQ"'5>*CJaJh()h?5>*CJaJhQ"'5CJaJhQ"'hQ"'5CJaJhNh%h%5CJaJhN5CJaJhH)5CJaJhCJaJhXCJaJhC,NCJaJh,%4CJaJhN0CJaJh CJaJh(eCJaJhrCJaJ!f ^gd@gd?0^0gd5D  8gdF  8gd"hW $|`|a$gdY 80`0gd5 80`0gdQ"'  8gd8"   ºymbVKyCyhQ#CJaJh"h?CJaJh"h"CJ\aJh"5CJ\aJhSh"CJ\aJh?CJaJh?5>*CJ\aJh5D5CJ\aJh5Dh5D5CJ\aJhN5CJ\aJhC,NCJ\aJhgCJ aJ hl.CJ aJ h ZCJ aJ hC,NCJaJhMCJaJhMhMCJaJhqLCJaJh-zhqLCJaJ 7 9 O ^ !! 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