740041_Permit (Modification)_20201215

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 Resources (DWR) of the transfer of ownership of an Animal Waste Management Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership.
General Information:
Previous Name of Farm: k. a (wLA cN Facility No: if - 0°
Previous Owner(s) Name: Lea— j 14 o r dr t Phone No:
New Owner(s) Name: T J L L C. Phone No: 20,- )/ y - / O Ste.
New Farm Name (if applicable):
Mailing Address: i D 3 Ricoult. P.) Imo; . vl 1�ru. [)� / ilk_ cc
Farm Location: Latitude and Longitude: I County Pi /1
Please attach a copy of a county mad map with location identified, and provide the location address and driving directions
below (Be specific: road namll-r ,;� names, directions, milepost, etc.): Ur. *4s'r j -Tu,.. o-. S Grr �,e j Anl jr it),I 1 P1, d• L{i
Operation Description:
Type of Swine No. ofAnimals Type of Swine No. of Animals Type of Cattle No. ofAnimals
❑ Wean to Feeder CI Gilts 0 Dairy
CI Wean to Finish ❑ Boars ❑ Beef
❑ Feeder to Finish
® Farrow to Wean 1-V11 Type of Poultry No. of Animals
❑ Farrow to Feeder 0 Layer
❑ Farrow to Finish ❑ Pullets
Other Type ofLivestock- Number of Animals:
Acreage Available for Application: Required Acreage:
Number of Lagoons / Storage Ponds: 1 Total Capacity 3 2. s-11 ZZt 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 Resources to issue the required permit to the new land owner.
Name of Previous and Owner: A i")0, r d t t
Signature: Nit 7 ,CLe Date:
Name of New Land Owner: TY I LLL
Signature: Date: 12 1
Name of Manager (if different from owner):
Signature: Date:
Please sign and return rm to: Animal Feeding Operations
N. C. Division of Water Resources
�O�Q Water Quality Regional Operations Section
1636 Mail Service Center
OC-C %lea �� Raleigh, NC 27699-1636
DEQice June 12, 2015
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