230013_Lagoon Closure_20170829

APPENDIX 3,1
Animal Waste Storage Pond and Lagootl Closut•e Report Form
(Please type or pr(itt all information that does not require a signature)
General Information:
Nflme of Fm•m: I�arn r � e % (� ro•�'�erS Facility No:�- o I '
Owuer(s) Name:
Ivlfliling Addt•ess
Phone No: '�v y' G/7 Z •- 2 3 7 J
C��3� i= �rtr,as.i�IC County:, C'/tour%rvl�
O teration Descri thou reutainiu animals onl ;
Please check this bos if there will be no animals on this farm flfter lagoon closure. If there will still be animals on the site
a er lagoon closure, please provide the following infantation on the animals that will remain.
Oncration Descrintimt:
Type afSwine No, of�Ieinrnls
o Wean to Feeder
o Feeder to Finish
o Farrow to Wean •
o T'arrow to Feeder
o Farrow to Finish
o Gilts
o Boars
Type ofPauiny No. ofihriurnls
o Layer
o Non-Layor
7)y�e oflieef No, afAninrn(s
a Brood
o Feeders
o Stockers
Other 7}yte of Lireslock:
\Vitt the farm maintain fl nambor of animals greater than the 2H .0217 threshold?
\Vila other lagoons be in operation at this farm after this one closes?
How many lagoons are left in use on this farm?: �
Type ojDnir}+ No. ofAniurnls
o Milking
o bry
o Heifers
o Calves
NmvberofAnpnnls: �
Yes o Noza'
Yes o No,b,
(Nmue) �nY�eS r5c;c�e(G of the \Vater Quality Section's staff in the Divisiat of
\Vatcr Qaaliry's Moo 0.cSv�(,l P Rcgionfll Office (see malt on Gack) wflS C011t1eted OIt B — lU � 17 (date)
for notification of the pending closure of this fond or lagoon. This notification was at loflst 2A hours prior to the
start of closure, which began on $ - i (�'• l � (date).
I verify that the above inforntatiou is correct mtd complete. I have followed a closure plan, which meets all NRCS
specifications and criteria. I realize that I will be subject to enforcement action per Article 21 of the North
Carolina General Stahrtes iFI fail to properly close out the lagoon, �
Name of Land Owner (Please
r ��
The facility has followed a closure plan which meets all requirements set forth in the NltCS Technical Guide
Standard 360. The following items wore completed by the owner and verified by me: all waste Iiquicls and
sludges have been removed and land applied at agronomic rate, all input pipes have been removed, all slopes have
been stabilized fls necessary, and vegetation established on all disturbed areas.
Name of Technical Specialist (Please Print):_ �•>I�� �' f"' � � s l v ✓�
Affiliation:
L
Cc � e/�
ti t�
S r-� r
f�
Adch•ess (AQency):
i3`f�i
C✓«
�/sir• e
G � �� e
Return within 15 days following completion of animal water sta•age pmui or lagoon closure to;
N• C, Aivisiou Of 1Vater Quality
Animal P'cechhtg Operntioits Unit
163611Iai1 Set7�ice Ccutcr
Raleigh, NC 27699-1636 •
PLC - 1 Meech 18, 2002