110011_ChangeOwnership Request_20200811

RECEIVED
Notification of Change of Ownership
AUG 112020 Animal Waste Management Facility
(Please type or print all information that does not require a signature)
In accordarWm% ments of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official notification
to the Divisgt esources (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: rr� Facility Nof N - I 1 dnt 1
Previous Owner(s) Name: Phone No W(Duo- &-4'T
New Owner(s) Name: L-Li r-iM l fir. ncti Phone No:T+50-rnwr
New Farm Name (if applicable):
Mailing Address:_ QD G.j6,cLM Z A IArl-n n C AIVA
Farm Location: Latitude and Longitude:CWQLO�5Z' / oZe35L O3,Z7" CountY:-GUne-=rtjj=,
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.): 9TO As!` enAj jg =- 2„C G.M . ja> e-u;4 3-1
Operation Description:
Type of Swine No. ofAnimals
❑ Wean to Feeder
❑ .Wean to Finish
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other Type of Livestock:
Type of Swine No. ofAnimals Type of Cattle No. ofAnimals
❑ Gilts ErDairy c �
❑ Boars ❑ Beef
Number ofAnimals:
Tvpe of Poultry
❑ Layer
❑ Pullets
Acreage Available for Application: I n7 - (o Required Acreage: 3q
Number of Lagoons / Storage Ponds:1 ba n, Total Capacity: t o-1. '1 2.5 Cubic Feet (ft3)
No. ofAnimals
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 the required permit to the new land owner. . ,1
Name of Previous Land Owner:
Signature: —Date:
Name of New�And Owner: L% g=jn 2 or,� rr-ti
Signature
Name of Manager (if different
Please sign and return this form to:
Date: IR) -LA - Q! D j D
owner): 14nr7p7lo r kll-'�
Date: C�,
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Donal Operations Section
1636 Mail Servk tenter
Raleigh, NC 276"-1636
LM
June 12, 2015