310288_Owner (Name Change)_20210210

RECEIVED
'21
JAN 2 9 2021
{�1G PLO ica -NNotification of Change of Ownership
tc Animal Waste Management Facility
(Please type or print all information that does not require a signatane)
In accordance with the requirements of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) tbis 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 than60 days following the transfer of ownership.
General Information:
Name ofFarm:, � ; 1 I r. 1/2 to Sze\yacality No: 3 I - D., 2 -Z
Previous Owners) Name:.70 1. vt.f' ).t y r/ + (((ye Phone No: 2 Z 5"1
New Ownez(s) Name:`) (r �,.,, �. 4 I m ! 1: k Phone No: t i ° _ �. 1- I 3
MailingAddiess: L D. ENLA Ll a.3 5
Farm Location: Latitude and Longitvde:34° 56' N Ines 4 igN County i i ; !A
Please attach a copy of a county road map with location identified and describe below (Be specific: mad names, directions,
milepost, etc.):
a C= %V' t.aLi IA w , 8cvI4c::11, Pic .1.25 I?
NC DEG)/DWR
Central Office
Operation Description:
Type ofSwine 1(o.(A iimals 7»e ofPoulby No. ofAnimals Type of Cattle No. of Animals
. Wean to Feeder -A Q Layer Q Dairy
❑ Feeder to Finish 0 Pullets 0 Beef
D Fallow to Wean
❑ Fanow to Feeder
0 Fanow to Finish Other Type ofLivestock: Number ofAnimals:
D Gilts
❑ Boars
Acreage Available for Application: O Required Acreage: / O
Number of Lagoons / Storer Ponds : I Total Capacity LI 3 5 t h i Cubic Feet ($3)
***********************ss*s*s*********s*****************************s******s********
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 pmcedores. I (we) know that any modification or expansion to the existing design capacity of the
waste tint and storage sysa-m 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 complelion of this from authorizes the
Division of Water Quality to issue the required permit to the new land owner.
Name ofP �OS1I.. AA+{l.n m•tj,2
Signature:.
Name of
Signature
Owner:\er
Date: C, / %217 ,;
Date: tit f -Z o as)
Name of Manager(if different from owner):
Signature: -- - - Date:
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

RECEIVED I
JO 2 2021'
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