310654_OIC Designation Form_20240306

Department orEoviranmem al Quality
Division or Water Resources
Animal R'aste hianu((cmcnt Systcuts
Request for Certification of Cnterage
Facility Currentiv covered by an 1; pinng Sale Nnn-17ischargc Gencral Permit
On September 30. 2024. the \null ('arolina -State Nun -Discharge (icneral 1'emtils in :\IIinrd XV.MC \lunaeement Se,.tems trill
Non- . As required by these pumlits, 11 clhties that bate been issued Certificates of Coverage to nperale under these State
Non -Discharge Gcncril Permits must ;iPplc Im rcnc%%al at 4asl 190 days prior m tbcir espirnnm date. Therelim•. all appbeatiun>
taut be neuited b) the Dit isiou uf1\wer Resoureci by no later than :ipril 3, 2024.
P/case die nru Ira:r curt• queatinn mran-WerraL Please rwifv all inforntarian and make anCr neressam rnrrerlianr "Arlan•. APplicmtian must he signed and dared by the Permitter.
I- Ceruticale Of Coverage Number. AWS.i10ri9.{
2. Facility Name: \\i,ll'Brancb Farm
3. Pemlittci s Name (same as uu tits 1\Sste ivtanagnnent Plan 1: Whitehall Far It, LL('
4. Pemliltee a Mailing Address: PO Box 219
City: Faimm State: NV l•'-
Telephone Number. ':�-=%e• ,*„---' Entail:
i. Facility's Physical Address: 1770 Dmnuners% ille_ Rd
Orr; Seen Spines State: NC 'lip: 2Nirg
6. Cuumv witcre Facility rs loc:led: Duolut
7. Fnmi \•lancers Name Ofdilferent from Landnu'nerl: 4i r ¢M:.,. Q�(er 1?r51 66/'
R. Ftmn Managers telephone number (include area code): l l 'L LL 7 G p
0. Imegminrs Namc (il tberc is not an httegralor. trite "\�me^): %Vdn "e--�,� YLy 7 �6(�
I0. Openuor Nanie (OICI: =_t.•• o_.. h I n'✓ 'Sr` Phmu Nu.: 0 1 C
11. 101 3776
12, Indicate animal operation type and number:
Current Permit: Operaiions fripc Alluuable Count
Swine - Farrow In Feeder - 240
Swine - Feeder to Finish
Oncrxtion "Amer.
saint•
Cattle
Kean to FmWi
Dane Call,
15a n to feeder
Drain flutter
F:num to Finish
\lilk C'un
Fader u, Finish
Dry Cuw
f:nruw to Acan
Reel'Stucker Cali
runnn to Feeder
Ilccl'I4rdcr
Bear Stud
Meer Ilnxid Con
Coln
Other
Other
LOW
Din Paultr%
Other Teuce
Son Layln_('luekcns
Ilorsti- Iinr.ci
Latine C7ricken,
horse,-Chhcr
Taffeta •
Slurp - Sleep
'lurkevs
Sheep - Other
Turk r Pullet
1t et Puulln'
\tin l a%ing Pullet
La) en

Make a:. necessary corrections ant, pi'u\'Idc inking dala.)
Siniclure
\,ImC
simcau<'lyln
(Lap ... it Digester
U'$h)
lelnn.,icd
Date
n11111
Imter'1")pe
[Chly. S"112.11C.
t'nk... 1.m
CUIXIClt)
1("dlhlc l'eelI
L'Onlmed
Surface Area
(Sgn.nc l'eell
❑eelpn freehuard
"Itcdllod"
lalelle'l
\\'1t=1
Lag,wil
d IJ NIX
IT1.71'_.Ilil
t4"4I19 1N)
Hill
WB=2
laguoa
a i fukh
'$iJl'_b IHI
i11.INNl (HI
1+1.SU
Submit one (1) copy of the Certified Animal R'aste >ionagentent Plan (C•AWMP) with this completed and signed
application as required b% \C Cencrat Statutes 143-215.I0C(d). either In mailing to the address below or sending it aia
email to the email address below.
The CANNAIP must iuciucic the following cunlPonenl.:
I. The most reccut vlasic Culiz;tion Plan OVUPI. sieved hs the owner and a certified technical specialist. containing:
a. The method b} which waste is applied to the ih%posal fields (e.g. irrilpillon. infection. eic.l
b. A neap of even field used for land application Oor cx. nnple: irrigation map)
c. The soil series present (in corn land application field
d. The crops frown on even land application field
c. The Realistic field hxpecl:mon (RYLI fix every crop shown in the \%UP
F. The maxinunn PAN to lw applml to even land application field
g. The waslc application windows for cs ci% crop utiiired in the WUP
It. The required NRCS Standard specifications
2. A site map schematic
3. rnercencv.Action Plan
A. Insect Control Checkiisi with chosen best manaccmcnt practices noted
i. Odor Control Checklist w'th chosen hest management practices noted
G. rlortality Control Checklist with selected method noted- Use the enclosed updated Mortality Control C'heeklist
7. Lai; oIDstoragc Pond capacity dt cumcntalnn (design, l'all'tllalltlllti, etc.) Pieasc be FUfC file i1hU\Y tahle is
accurate and complete. Also provide any site c+alualnlns, wetland detennnnations. or hazard eiassif Killion] that may be
applicable to your facility.
N. Operation and Maintenance Plan
I f vour CAWMP includes any a+mponents not shown on this list. please include the additional components w id) your submmal.
(e.g. composting. digestcn, solids separaors, sludge drying syslctn. waste Iran, -fur,. c1c.)
I attest that this application has been revicwcti by me and is accurate and complete to the best or my knowledge. I undcnculd that.
if all required pans of this application are not completed and that Wall required supposing information and attachments are not
included. this application package will be returned to me as incinnpictc.

Note; In accordance it jib NC' cieneml titalulcs I41_215,6A aeul 143 215.613. anc perwn who knmcinglc' makes anv ralw
statement, rcprescnounrn. or ccnilicmlon tit any application may Ix subject to civil penalties up Io S25.INI0 per nolauun. 08
U.S.C. Seclion f 001 prm ides a puni.hmon h% a fine ol'nnt more
lbr a similar ollcnse.l than S I(I,(Nn1 or my+risomuem olluit more Thant 5 years. or 6mh
Print the Nans of the Penaiflce Landoac w,- Nignmg t )Ilicial ;uul %ign hclnu. (11 multiple Lando%rners ecisi, all lundmcnm
should sign. IrL u: nddmcner is a colpormon..igi :nurc should he by a principal eseculne ullicer nr ilia• corporanon 1'
Namc(Print): 10.L//0 ✓ 3 'Y _ Title:
Sig'7
nature: / Dole: J„/-j 7- ..
Namr (Print): Tills:
. Signature: Daly
Name (Prino: _- _ _ _ . _ Tale:
Signature: Date: - - -
Fill: COMPLL•TEI)APPLICATION SIIOL'LD BU SI:Ni-To [ tit. fuL131\\'INIi Af3131i1-.SS
E-mail: animal.operations(a deq.nc.Roc
NCDF.Q-D%l'R
Animal Feeding Operations Program
1636 >lail Service Center
Raleigh, .North Carolina 27699-1636