310288_Application_20210129

1
RECEWO
JAN ` JAN. 2 9 2021
{�1G I)EO�,ce -Notification of Change of Ownership NC DEQ/DWR
tca1 Animal Waste Management Facility Central Office
(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 than60 days following the transfer of ownership.
Oral I�¢rrnatioa�
Name ofFarm:., ✓z to )V s s=yacimyNo- 3-
Previous Ownet(s) Name: Z—* --j � n f' k �.2 y ril + 1 (c P—
New Ownei(s) Name: ` 1 i r
No.0((0 - 2 $ I' 051
No: c(, o _ ), 7 i — L 31-5
Mailing Address: -R LO� 0 E N Q A y ! w I A'- A I,. i?
Farm Location Latitude and Longitude 3 / $ ° County
Please attach a copy of a county road map with location identified and describe below (Be specific: mad names, directions,
milepost, etc.):
�ZL( w l7cv 14 C 0'1:�� 1�
tin mdan Descripdw-,
,4V ofsWine gfAnimals
A Wean to Feeder
❑ Feeder to Finish
D Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
0 Gnus
❑ Boars
73W of Poultry
0 Layer
0 Pullets
No. ofAnimals
Type of Cattle
13 Dairy
0 Beef
No. ofAnimals
Other Type ofDvestock Number ofAnimals:
Acreage Available for Appliudon: O — -- Required Acreage: % O
Number of Lagoons / Storage Ponds : � Total Capacity q 3 -1 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 (CAW -MP) 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 regmw- a permit modification before the new
animals are stocked I (we) understand that there must be Do 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 rim -Whom. the application of animal waste. I (we) understand that thus
facility may be covered by a State Non -Discharge Permit or a NPDES Permit and complyion of this form authorizes the
Division of Water Quality to issue the, required permit tothe new land owner
l.
Name of Previnu Awd U -b .(
L )� I i tl ,n y M• I ljA
Name of
Name of Msnager(if different fronm owner)-
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
Date:
Z// /

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