440058_Cattle Renewal (Application) Request_20190226

ROY COOPER
Governor
MICHAEL S. P-ECA14
sec"rary
LINDA CULPEPPER
Dfmaor
NORTH CAROLINA
Enyironmenta( Quaky
February 26, 2019
Peggy H Medford
Medford Dairy
247 Charlie Medforf Farm
Waynesville, NC 28786
Subject: Application for Renewal of Coverage for Expiring State General Permit
Dear Permittee:
Your facility is currently approved for operation under one of the Animal Waste Operation State Non -Discharge General Permits,
which expire on September 30, 2019. Copies of the new animal waste operation State Non -Discharge General Permits are available
at https:Hdeg.nc.gov/about/divisions/water-resources/water-quality-regional-operations/afo or by writing or calling:
NCDEQ-DWR
Animal Feeding Operations Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
In order to assure your continued coverage under the State Non -Discharge General Permits, you must submit an application for
permit coverage to the Division. Enclosed you will find a "Request for Certificate of Coverage Facility Currently Covered by an
Expiring State Non -Discharge General Permit." The application form must be completed, signed and returned by April 3, 2019.
Please note that you must include one (1) copy of the Certified Animal Waste Management Plan (CAWMP) with the
completed and signed application form. A list of items included in the CAWMP can be found on page 2 of the renewal
application form.
Failure to request renewal of your coverage under a general permit within the time period specified may result in a civil penalty.
Operation of your facility without coverage under a valid general permit would constitute a violation of NCGS 143-215.1 and could
result in assessments of civil penalties of up to $25,000 per day.
If you have any questions about the State Non -Discharge General Permits, the enclosed application, or any related matter please feel
free to contact the Animal Feeding Operations Branch staff at 919-707-9100.
Sincerely,
Jon Risgaard, Section Chief
Animal Feeding Operations and Groundwater Section
Enclosures
cc (w/o enclosures): Asheville Regional Office, Water Quality Regional Operations Section
Haywood County Soil and Water Conservation District
AFOG Section Central Files - AWC440058
igawNorth Carolina department of Environmental Quality I D AsionofWaterResources
512 N. Salisbury St. 1 1536 Mail Semite Center I Ra legh, North Carolina 27699-1636
919.7071040

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Animal Waste Management Systems
Request for Certification of Coverage
Facility Currently covered by an Expiring Sate Non -Discharge General Permit
On September 30, 2019, the North Carolina State Non -Discharge General Permits for Animal Waste Management Systems will
expire. As required by these permits, facilities that have been issued Certificates of Coverage to operate under these State
Non -Discharge General Permits must apply for renewal at least 180 days prior to their expiration date. Therefore, all applications
must be received by the Division of Water Resources by no later than April 3, 2019.
Please do not leave any question unanswered. Please verify all information and make any necessary corrections below.
Application must be signed and dated by the Permittee.
1. Farm Number: 44-0058
2. Facility Name: Medford Dairy
3. Landowner's Name (same as on the Waste Management Plan):
4. Landowner's Mailing Address: 247 Charlie Medforf Farm
City: Waynesville State: NC
Telephone Number: 828-627-6766 Ext. E-mail:
5. Facility's Physical Address: 254 Joe Medford Rd
City: Waynesville State: NC
6. County where Facility is located: Haywood
7. Farm Manager's Name (if different from Landowner): Charles F Medford
8. Farm Manager's telephone number (include area code): 828-627-6766 Ext.
9. Integrator's Name (if there is not an Integrator, write "None"):
10. Operator Name (OIC): Charles F. Medford Phone No.: 828-593-9230
11. Lessee's Name (if there is not a Lessee, write "None"):
Certificate Of Coverage Number:
Peggy H Medford
12. Indicate animal operation type and number:
Current Permit: Operations Type Allowable Count
Cattle - Milk Cow 130
Operation Types:
Swine
Cattle
Dry Poultry
Wean to Finish
Dairy Calf
Non Laying Chickens
Wean to Feeder
Dairy Heifer
Laying Chickens
Farrow to Finish
Milk Cow
Pullets
Feeder to Finish
Dry Cow
Turkeys
Farrow to Wean
Beef Stocker Calf
Turkey Pullet
Farrow to Feeder
Beef Feeder
Boar/Stud
Beef Broad Cow
Wet Poultry
Gilts
Other
Non Laying Pullet
Other
Layers
AWC440058
Zip: 28786
Zip: 28785
OIC #: 21353
Other Types
Horses - Horses
Horses - Other
Sheep- Sheep
Sheep - Other

13. Waste Treatment and Storage Lagoons (Verify the following information is accurate and complete. Make all necessary
corrections and provide missing data.)
Structure
Name
Estimated
Date
Built
Liner Type
(Clay, Synthetic,
Unknown)
Capacity
(Cubic Feet)
Estimated
Surface Area
(Square Feet)
Design
Freeboard
"Redline"
(Inches)
WET STACK
WSP
30.00
Mail one (1) copy of the Certified Animal Waste Management Plan (CAWMP) with this completed and signed application
as required by NC General Statutes 143-215.1OC(d) to the address below.
The CAWMP must include the following components:
1. The most recent Waste Utilization Plan (WUP), signed by the owner and a certified technical specialist, containing:
a. The method by which waste is applied to the disposal fields (e.g. irrigation, injection, etc.)
b. A map of every field used for land application (for example: irrigation map)
c. The soil series present on every land application field
d. The crops grown on every land application field
e. The Realistic Yield Expectation (RYE) for every crop shown in the WUP
f. The maximum PAN to be applied to every land application field
g. The waste application windows for every crop utilized in the WUP
h. The required NRCS Standard specifications
2. A site map/schematic
3. Emergency Action Plan
4. Insect Control Checklist with chosen best management practices noted
5. Odor Control Checklist with chosen best management practices noted
6. Mortality Control Checklist with selected method noted - Use the enclosed updated Mortality Control Checklist
7. Lagoon/storage pond capacity documentation (design, calculations, etc.) Please be sure the above table is accurate and
complete. Also provide any site evaluations, wetland determinations, or hazard classifications that may be applicable to
your facility.
8. Operation and Maintenance Plan
If your CAWMP includes any components not shown on this list, please include the additional components with your submittal.
(e.g. composting, digesters, waste transfers, etc.)
As a second option to mailing paper copies of the application package, you can scan and email one signed copy of the
application and all the CAWMP items above to: [e-mail]

I attest that this application 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 to me as incomplete.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false statement,
representation, or certification in any application may be subject to civil penalties up to $25,000 per violation. (18 U.S.C.
Section 1001 provides a punishment by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both for
a similar offense.)
Printed Name of Signing Official (Landowner, or if multiple Landowners all landowners should sign. If Landowner is a
corporation, signature should be by a principal executive officer of the corporation):
Name:
Signature:
Name:
Signature:
Name:
Signature:
Title:
Date:
Title:
Date:
Title:
Date:
THE COMPLETED APPLICATION SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NCDEQ-DWR
Animal Feeding Operations Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
E-mail: [e-mail]
FORM: RENEWAL -STATE GENERAL 02/2019