310431_Application_20230216

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 1SA NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official notification
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Management Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership,
General information: Previous Name of Farm: -1`Y Y9 � 1
Previous Owner(s) Name: ROniL Wt � E rDbi e-\
New Owner(s) Name:Tt'_ - BroLs.::n Ct4ut
New Farm Name (if applicable):
Facility No: 3 i - D"l 1
Phone No: q 10 o j D o 4 j
Phone No: ll fl?k. q )0 .1 130-C
I f- 91(' , '7 I �5 y
Mailing Address: 3b . e.001 S�ri,n6s RA, fltioul16t (.?g'3
Farm Location: Latitude and Longitude: 3`{ 5,1 0? r 11 55 5s County: --1u 0 t '"
Please attach a copy of a county road map with location identified, and provide the location address and driving directions
below (Be specific: road names, directions, milepost, etc.): crot,ti +1,-N& ►tAr 4 t3C Hw,i 403 1-C) ehLissck 4
1icr►yn1,r;Ile 1 co tvortk Affirok -I Afu_lr� en itNi y 4D3 . l�l.P a r i f ai Ji;ce road t Vuwrn s
400 `tara5 c'rQe, 116,1.9
a{i8ftox
Operation Description:
Tvp of Swine No. ofAnimals Type of Swine No. ofAnimals Tvpe of Cattle No. of Animals
Jean to Feeder 1 17 i C ❑ Gilts I] Dairy
❑ Wean to Finish 0 Boars 0 Beef
❑ Feeder to Finish
❑ Farrow to Wean Tvpe of Poultry No. of Animals
❑ Farrow to Feeder 0 Layer
❑ Farrow to Finish 0 Pullets
Other Type of Livestock: Number of Animals:
Acreage Available for Application: Required Acreage:
Number of Lagoons / Storage Ponds: 1 Total Capacity: 'el 'DO Cubic Feet (fi3)
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. 1 (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 roan -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 torm authorizes the
Division of Water Resources to issue the required permit
to the new land owner.
Name of Previous Land Owner: KOrV.t1 ct G BtoAv
Signature: tc
Name of New Land Owner: p -3 re
Signature: t
Name of Manager Of different front whim):
Signature:
Please sign and return tins form to;
Date: Si - 3
ate: 2 - I ;
Date:
Animal Feeding Operoffins
N. C. Division of Waal' J.M
Water Quality R IU &don
1636 Maui Service Center
Raidgb, NC 27699-1636
.Tune 12. 2015

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