230013_Closure Report_20210122

APPENDIX 3.1
Animal Waste Storage Pond and Lagoon Closure Report Form
(Please type or print all information that does not require a signature)
General Lnformation: Name of Farm: •44wir,ele 6rok-Ie6-S Facility No: 2.3 - cc(-)c'�
Owner(s) Name: /v\ X 1.-tcx,•vnr i f, . �
r�
Mailing Address: / 2 Q., H b ad Phone No: lay- y7 Z -- z S 7/
ao, l,na Scri•in...3 ) lC County: C'/evt/,v,D
O eration Description (remaining animals only):
:Please check this box if there will be no animals on this farm after lagoon closure. If there will still be animals on the site
a er lagoon closure, please provide the following information on the animals that will remain.
Operation Description:
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Dairy No. of Aninsals
o Wean to Feeder o Layer o Milking
o Feeder to Finish o Non -Layer o Dry
o Farrow to Wean Type of Beef No. of Animals o Heifers
o Farrow to Feeder o Brood o Calves
o Farrow to Finish o Feeders
o Gilts o Stockers Q
o Boars Other Type of Livestock: Number of Animals:
Will the farm maintain .a number of animals greater than the 2H .0217 threshold? Yes o No,z(
Will other lagoons be in operation at this farm after this one closes? Yes o No,e4
How many lagoons are left in use on this farm?: 0
(Name) )c r're 5 t:Se(ALLc of the Water Quality Section's staff in the Division of
Water Quality's Moo ttcSv Regional Office (see snap on back) was contacted on '8 - l0 17 (dale)
for notification of the pending closure of this pond or lagoon. This notification was at least 24 hours prior to the
start of closure, which began on $ -ICI • i / (date).
I verify that the above information is correct and 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 Statutes if I fail to properly close out the lagoon.
Name of Land Owner (Please Print): ��4,�,d _ �`�'t ••
Signature: /7/Liwrki l oo7 Nc hy f S . r 7 So Date: ' "' ? " 1 2
The facility has followed a closure plan which meets all requirements set forth in the NRCS Technical Guide
Standard 360. The following items were completed by the owner and verified by me: all waste liquids and
sludges have been removed and land applied at agronomic rate, all input pipes have been removed, all slopes have
been stabilized as necessary, and vegetation established on all disturbed areas.
Name of Technical Specialist (Please Print):
S; i c c 6r r--.- r3 , s 1, <: y"
Affiliation: C-. I c v e N i-7 S (—) c
Address (Agency): 6,-/ 4-/ //a r t°
Signature: ( Z- /` �--
Gz
0— Phone No.:7o`-/-z-/7/-oz rS
Date: �z
Return within 15 days following completion of animal water storage pond or lagoon closure to:
N, C, Division Of Water Quality
Animal Feeding Operations Unit O
1636 Mail Service Center
Raleigh, NC 27699-1636
PLC - 1 March 18, 2002