410001_Application_20220324

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Animal Feeding Operations Permit Application Form
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
State Individual Permit - Existing Animal Waste Operations
1. GENERAL INFORMATION:
1.1 Facility name: Robert Dale Holt Swine Farm
1.2 Print Land Owner's name: Robert Dale Holt
1.3 Mailing address: 6531 Dusty Rd
City, State: Liberty, NC Zip: 27298
Telephone number (include area code): (336 ) 263 - 2470
1.4 Physical address: same
City, State: Zip:
Telephone number (include area code): ( )
1.5 County where facility is located: GUILFORD
1.6 Facility location (directions from nearest major highway, using SR numbers for state roads): From I-40-85 at Gibsonville,
take NC 61 South, merge right onto NC 62 E, TL on Alarnance Church Rd, TR on Kimesville Rd, in a very short distance
TL on Dusty Rd: farm is at the end of Dusty Rd
1.7 Farm Manager's name (if different from Land Owner): NA
1.8 Lessee's / Integrator's name (if applicable; circle which type is listed):
1.9 Facility's original start-up date: 1994 Date(s) of facility expansion(s) (if applicable): NA
2. OPERATION INFORMATION:
2.1 Facility number: 41-01
2.2 Operation Description: This farm was a Wean to Feeder Operation when it was in business. It no longer has any animals.
Please enter the Design Capacity of the system. The "No. of Animals" should be the maximum number for which the waste
management structures were designed.
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
® Wean to Feeder 5000 ['Layer ['Beef Brood Cow
D Feeder to Finish ['Non -Layer ❑ Beef Feeder
❑ Farrow to Wean (# sow) ❑ Turkey ❑ Beef Stocker Calf
❑ Farrow to Feeder (# sow) ❑ Turkey Poults ❑ Dairy Calf
['Farrow to Finish (# sow) ['Dairy Heifer
❑ Wean to Finish (# sow) ❑ Thy Cow
❑ Gilts ❑ Milk Cow
❑ Boar/Stud
❑ Other Type of Livestock on the farm: No. of Animals: 0
FORM: AWO-STATE-I-E 1/10/06 Page 1 of 5

2.3 Acreage cleared and available for application (excluding all required buffers and areas not covered by the application
system): 9.5 Required Acreage (as listed in the CAWMP): 8.8
2.4 Number of lagoons: 1 Total Capacity (cubic feet): 295,333 Required Capacity (cubic feet): 228,101
Number of Storage Ponds: 0 Total Capacity (cubic feet):
Required Capacity (cubic feet):
2.5 Are subsurface drains present within 100' of any of the application fields?
2.6 Are subsurface drains present in the vicinity or under the waste management system?
2.7 Does this facility meet all applicable siting requirements?
2.8
YES or
YES or
(circle one)
(circle one)
or NO (circle one)
Brief description of treatment process: At this time, the only inputs are the rain that falls on the Lagoon. Only residual waste is in
this lagoon as there are NO ANIMALS on site.
3. REQUIRED ITEMS CHECKLIST:
Please indicate that you have included the following required items by signing your initials in the space provided next to each
item.
3.1 One completed and signed original and two copies of the application for State Individual Permit
Animal Waste Operations;
3.2 Three copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is land applied and a county road map with the location of the
facility indicated;
3.3 Three copies of the entire Certified Animal Waste Management Plan (CAWMP). If the facility
does not have a CAWMP, it must be completed prior to submittal of a permit application for
animal waste operations.
Applicants Initials
111o Ch (41\se In
Exl5 tij CAWMP
The CAWMP must include the following components. Some of these components may not have been required at the time
the facility was certified but should be added to the CAWMP for permitting purposes:
3.3.1 The Waste Utilization Plan (WUP) must include the amount of Plant Available Nitrogen (PAN) produced and
utilized by the facility
3.3.2 The method by which waste is applied to the disposal fields (e,g. irrigation, injection, etc.)
3.3.3 A map of every field used for land application
3.3.4 The soil series present on every land application field
3.3.5 The crops grown on every land application field
3.3.6 The Realistic Yield Expectation (RYE) for every crop shown in the WUP
3.3.7 The PAN applied to every land application field
3.3.8 The waste application windows for every crop utilized in the WUP
3.3.9 The required NRCS Standard specifications
3.3.10 A site schematic
3.3.11 Emergency Action Plan
3.3.12 Insect Control Checklist with chosen best management practices noted
3.3.13 Odor Control Checklist with chosen best management practices noted
3.3.14 Mortality Control Checklist with the selected method noted
3.3.15 Lagoon/storage pond capacity documentation (design, calculations, etc.); please be sure to include any site
evaluations, wetland determinations, or hazard classifications that may be applicable to your facility
3.3.16 Operation and Maintenance Plan
If your CAWMP includes any components not shown on this list, please include the additional components with your
submittal. (Composting, waste transfers, etc.)
FORM: AWO-STATE-I-E 1/10/06 Page 2 of 5

4, APPLICANT'S CERTIFICATION:
koborf" D4 i C
�" 1 (Land Owner's name listed in question 1.2), attest that
this application for ratCi �t',yy `Q abertble Hbt awn.,F4rw1 (Facility name listed in question 1.1)
has been reviewed by me and is akecurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as inc mplete.
g ) �i J/ Date 3- 5 Z
Signature � i, o _ ti _ �„
5. MANAGER'S CERTIFICATION: (complete only if different from the Land Owner)
1, (Manager's name listed in question 1.6), attest that this
application for (Facility name listed in question 1.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application package
will be returned as incomplete.
Signature Date
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER RESOURCES
WATER QUALITY REGIONAL OPERATIONS SECTION
ANIMAL FEEDING OPERATIONS PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
FORM: AWO-STATE-I-E 1/10/06 Page 3 of 5

6. SURFACE WATER CLASSIFICATION:
This form must be completed by the appropriate DWR regional office and included as a part of the
project submittal information.
INSTRUCTIONS TO NC PROFESSIONALS:
The classification of the downslope surface waters (the surface waters that any overflow from the facility would flow toward) in
which this animal waste management system will be operated must be determined by the appropriate DWR regional office.
Therefore, you are required, prior to submittal of the application package, to submit this form, with items 1 through 6
completed, to the appropriate Division of Water Resources, Water Quality Regional Operations Supervisor (see page 6 of 10).
At a minimum, you must include an 8.5" by 1 1" copy of the portion of a 7.5 minute USGS Topographic Map which shows the
location of this animal waste application system and the downslope surface waters in which they will be located. Identify the
closest downslope surface waters on the attached map copy. Once the regional office has completed the classification,
reincorporate this completed page and the topographic map into the complete application form and submit the
application package.
6.1 Farm Name: Robert Dale Holt Swine Farm
6.2 Name & complete address of engineering firm: Technical Specialist, Millie Langley Guilford SWCD,
Telephone number: ( 336 ) 641 - 2442
6.3 Name of closest downslope surface waters: Stinking Quarter Creek
6.4 County(ies) where the animal waste management system and surface waters are located: GUILFORD
6.5 Map name and date: Kimesville, 1970 rev. 1982
6.6 NC Professional's Seal (If appropriate), Signature, and Date:
TO: WQROS SUPERVISOR
Please provide me with the classification of the watershed where this animal waste management facility will be or has been
constructed or field located, as identified on the attached map segment(s):
Name of surface waters:
Classification (as established by the Environmental Management Commission):
Proposed classification, if applicable:
Signature of regional office personnel: Date:
(All attachments must be signed)
FORM: AWO-STATE-I-E 1/10/06 Page 4 of 5

DIVISION OF WATER RESOURCES REGIONAL OFFICES (9/05)
Asheville Regional WQROS Supervisor
2090 U.S. Highway 70
Swannanoa, NC 28778
[phone]
Fax [phone]
Avery Macon
Buncombe Madison
Burke McDowell
Caldwell Mitchell
Cherokee Polk
Clay Rutherford
Graham Swain
Haywood Transylvania
Henderson Yancey
Jackson
Washington Regional WQROS Supervisor
943 Washington Square Mall
Washington, NC 27889
[phone]
Fax [phone]
Beaufort Jones
Bertie Lenoir
Camden Martin
Chowan Pamlico
Craven Pasquotank
Currituck Perquimans
Dare Pitt
Gates Tyrell
Greene Washington
Hertford Wayne
Hyde
Fayetteville Regional WQROS Supervisor Mooresville Regional WQROS Supervisor
225 Green Street, Suite 714 610 East Center Avenue
Fayetteville, NC 28301-5094 Mooresville, NC 28115
[phone] [phone]
Fax [phone] Fax [phone]
Anson Moore
Bladen Richmond
Cumberland Robeson
Harnett Sampson
Hoke Scotland
Montgomery
Alexander Lincoln
Cabarrus Mecklenburg
Catawba Rowan
Cleveland Stanly
Gaston Union
Iredell
Winston-Salem Regional WQROS Supervisor
450 Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Phone [phone]
Fax [phone]
Alamance Rockingham
Alleghany Randolph
Ashe Stokes
Caswell Surry
Davidson Watauga
Davie Wilkes
Forsyth Yadkin
Guilford
Raleigh Regional WQROS Supervisor
1628 Mail Service Center
Raleigh, NC 27699-1628
[phone]
Fax [phone]
Chatham Nash
Durham Northampton
Edgecombe Orange
Franklin Person
Granville Vance
Halifax Wake
Johnston Warren
Lee Wilson
Wilmington Region WQROS Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
[phone]
Fax [phone]
Brunswick
Carteret
Columbus
Duplin
New Hanover
Onslow
Pender
FORM: AWO-STATE-I-E I/10/06
Page 5 of 5

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