310146_Owner (Name Change)_20210707

7/3/2021
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Notification of Change of Ownership
Animal Waste Management Facility
(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 than 60 days following the transfer of ownership.
General Information:
Name of Farm: Gander's Fork
Facility No: 31-146
Previous Owner(s) Name: Je Sim son
Phone No:910-375-0377
New Owner(s) Name: Noah Sim son
Mailing Address: 627 uinn Store R Beulaville NC 28518 Phone No:910-375-2632
Farm Location: Latitude and Longitude: 34.883610 / 77.747475
Please attach a copy of a county road map with location identified and describe below e specific: Duplm
milepost, etc.): Take NC 24 east of Beulaville to Old Chinquapin Rd. Turn right travel (Be2.4 miles to Quinn Store Rd. Turn left,
travel 1 mile to farm on right.
Operation Description:
Type of Swine No. of Animals Type of Poultry No. o
❑ Wean to Feeder f Animals Type of Cattle No. of Animals
❑ Layer 0 Dairy
'Feeder to Finish 7344 0 Pullets
Farrow to Wean ❑Beef
❑ Farrow to Feeder
❑ Farrow to Finish Other Type of Livestock:
❑ Gilts yp Number of Animals:
❑ Boars
Acreage Available for Application: 64.48 Required Acreage: 64.48
Number of Lagoons / Storage Ponds :3 Total Capacity: t S t 1109 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 (CAWMP) 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 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 completion of this form authorizes the
Division of Water Quality to issue the required permit to the new land owner.
Name of Previgtis Land Owner: Jer Sim son
Signature:
Name of Ne1y✓Land Own : Noah nn son
Signature: ' �
s
Name of Manager(if different from wner):
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
https://mail.google.com/mail/u!0/#inbox/FMfcgzGkZGfRLFCXdRbgzxbDQNdJfTDq?projector=1 &messagePartld=0.2
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