250017_Change of Ownership form_20200609

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 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official notification
to the Division of Water Quality (DWQ) of the transfer of ownership of an Animal Waste Management Facility. This form
must be submitted to DWQ no later than 60 days following the transfer of ownership.
General Information:
Name of Farm: " Rn Facility No: -
Previous Owner(s) Name:_ (; t I R �<- Phone No: Z �J! }q ) Z,
New Owner(s) Name: t� Lf~• J nn Qrra LLL Phone No: 252- 52 121 DO
Mailing Address: lei 0?0--4 48S MQ D 2 0
Farm Location: Latitude and Longitude:, / !M_.AoL7_County _m t!�
Please attach a copy of a county road map with location identified and describe below (Be specific: road names, directions,
milepost, etc.): 2.� CraV-C� rc" , Van bo-0 t-) CJ
Operation Description:
Tye of Swine No. of Animals
Wean to Feeder qq 00
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Type of Poultry No. of Animals
❑ Layer
❑ Pullets
Other Type of Livestock.
Type of Cattle No. of Animals
❑ Dairy
❑ Beef
Number of Animals:
Acreage Available for Application: 2 Required Acreage: I to
Number of Lagoons / Storage Ponds : Total Capacity:825 LhOl Cubic Feet (ft3)
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 Quality to issue the required permit to the new land owner.
Name of Previous Land)Owner:
Signature: 1/"'.
Name of New Land Owner:
Signature
Name of Manager(ifdifferent frc
Signature:
Please sign and return this form to:
N. C. Division of Water Quality
Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
May 2, 2007
Date: ('0 115 ,/ I�
Date:
03