400065_Owner (Name Change)_20191016

Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
In accordance with the requirements of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is offip*l notific'
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Management ('*ility. Tlik
form must be submitted to DWR no later than 60 days following the transfer of ownership. Baas;-, f& `p<
General Information: oys rye O,
Previous Name of Farm:Ka D `_,l� Facility No: ' o
Previous Owner(s) Name:��,p�1 1 1��'�112 Phone No:
New Owner(s) Name: N, w i t , \0 Cj nt N b e, pa me b SonpS C& i s Phone No: �S a► S ��°\- S S d 3
SIP
New Farm Name (if applicable):
Mailing Addres
Farm Location: Latitude and Longitude: / County:
Please attach a copy of a county road map with location identified, and provide//the loc tion address and driving directions �,.,1
below (Be specific: road names, directions, milepost, etc.): �qa2 HQ e'dy /Ul F S.l'W"i � / n c QY t a 6
Oneration Description:
Type of Swine No. of Animals Type of Swine
❑ Wean to Feeder ❑ Gilts
❑ Wean to Finish ❑ Boars
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other Type of Livestock:
No. of Animals Type of Cattle
4 ❑ Dairy
❑ Beef
Number of Animals:
Acreage Available for Application: Required Acreage:
No. ofAnimals
Type of Poultry No. of Animals
❑ Layer (g
❑ Pullets
Number of Lagoons / Storage Ponds: Total Capacity: Cubic Feet (ft3)
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Owner / Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. I (we) understand the operation and
maintenance procedures established in the Certified Animal Waste Management Plan (CAWMP) for the farm named above
and will implement these procedures. I (we) know that any modification or expansion to the existing design capacity of the
waste treatment and storage system or construction of new facilities will require a permit modification before the new
animals are stocked. I (we) understand that there must be no discharge of animal waste from the storage or application
system to surface waters of the state either directly through a man-made conveyance or from a storm event less severe than
the 25-year, 24-hour storm and there must not be run-off from the application of animal waste. I (we) understand that this
facility may be covered by a State Non -Discharge Permit or a NPDES Permit and completion of this form authorizes the
Division of Water Resources to issue thefin`
required permit to the new land owner.
Name of Previous Land Owner: �hayr' 1 @
Signature: n Date:
Name of New Land Owner. �v, w�c uc ��n ne I �ve_ Pa rnt6_ &n %, 0 "%A I n �0u t
Name of Manager (if different from owner):
Signature: Date:
Please sign and return this form to:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699-1636
June 12, 2015