640067_Closure form_20231108

APPENDIX 3.1
Animal Waste Storage Pond and Lagoon Closure Report Form
(Please type or print all inforniation that does not require a signature)
General Information:
Name of farm: Swi k 90q FeyAA Facility No: 6y 67
Owncr(s) Namc: C ,0m;E >Jr&c. _ - Mailing Address: Soo .Tadcson sf- _ Phone No:_s51-T55-4889
Col County: Nosh
Operation Description (Tema-ininp. animals onlv):
0 Please check this box if there will be no animals on this farm after lagoon closure, if ilicre will still be aninials on the site
after lagoon closnrc, please provide the following infonnation on the animals that will remain
Oneration Description:
Tape of Swine No. ofAniuuals
o Wean to Feeder
o Feeder to Finish
o Farrow to Wean
o Farrow to Feeder
o Farrow to Finish
o Gilts
o ©oars
Tipe gf Poidity No of Aninuds"
o Layer
o Non -Layer
11 pe ofBeef No. of Auinirrls•
o Brood
o Feeders
o Stockers
Other- Tvff of Livestock:
Will the farm maintain a number of animals greater than the 2H .0217 threshold'?
Will other lagoons be in operation at this farm after [his one closes?
How many lagoons are ICR in use on this farm'?: 0
Tipegj'D(diy No. ofAnunals
o Milking
o Dry
o Heifers
o Calves
Nuinher of Aafaials
Ycs o No a
Yes o No a
(Nrrnie) T� Oe�nard) __ of the Water Quality Section's staff in the Division of
Water Quality's Raic.'g , Regional Office (see soap on back) was contacted on R3-2y - ZG zl(elale)
for notification of the pending closure of this pond or lagoon. This notification was at least 24 hours prior to the
start ofclosurc, which began on 01-10-1073 (dare).
I verify that the above information is correct and complete. I have followed a closure plan, which nheets all NRCS
specifications and criteria. I realize that I will be subject to enforcement action per Article 21 of the North
Carolina General Statutes if I fail to properly close out the lagoon.
Name of Lan O%s ier (Please Print):^ Cu no tY11 n ,) In C
Signature: —V Date:_ (1104 100 Z 3
The facility has followed a closure plats which meets all requirements set forth in the NRCS Technical Guide
Standard 360. The following items were completed by the owner and verified by me; all waste liquids and
sludges have been removed and land applied at agronomic rate, all input pipes have been removed, all slopes have
been stabilized as necessary, and vegetation established on all disturbed areas.
Name of Technical Specialist (Please Print): J,
Affiliation: N&SLL.,S0J.. 'e D� ;
Address (
Signature
ie No.:_z�1-y5�r-y�{ 6.._
1..1oe/ 2 o z3 _
Return within 15 days following completion of animal water storage pond or lagoon closure to:
N. C. Division Of Water Quality
Animal Feeding Operations Emit
1636 Mail Service Center
Raleigh, NC 27699-1636
PLC - 1 March 18, 2002