830018_lagoon clouser_20160413

Name of Land Owner (Please Print):
Signature:
Animal Wa Storage Pond and Lagoon Closui eport Form
(Please type or print all information that does not require a signature)
General Information:
Name of Farm: Caafn: GhA . 1 ew katrtA SC 5 Iu C Facility No: S 3 - 0 ! $
Owner(s) Name: Edw ALA'1 ea r ffi t c k A et
Mailing Address: l 2''1'4 a S p L4J 4 3 04 MC/1 It e • Phone Nei in. 2 it 0• I D y f
LdwrNbuRy I NIC z4 352. County: 6c.c.4 .Jd
Operation Description (remaining animals only):
o 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
after 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. ofAnimals Type of Dairy No. of Animals
o Wean to Feeder 3)5 t 0 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
o Boars Other Type of Livestock: Number ofAnimals:
63
0°
Will the farm maintain a number of animals greater than the G.S. § 143-215.1 OB threshold? Yes o
Will other lagoons be in operation at this farm after this one closes? Yes o
How many lagoons are left in use on this farm?: none
(Name) & 6e t iii of the Water Quality Regional Operations Section staff in
the Division of Water Resources' f A Regional Office (see map an back) was
contacted on (date) 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 i / Q'/ L (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.
6,„/,‘...1
Date: Yi/ i g
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): , rue/lam. bteitifiZ'/7
Affiliation: A/61i-4-c 5
Address (Agency): )t Q/IB c 4'/c der 2753i' Phone No.: 9/0 - '7z _I 7o t
Signature: Date: "54--/3-1r1
Return within 15 days following completion of animal water storage pond or lagoon closure to:
N. C. Division of Water Resources
Animal Feeding Operations Branch
1636 Mail Service Center
Raleigh, NC 27699-1636
PLC - 1 Mar 23, 2016