640021_Application_20210925

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 I5A NCAC 2T , I304(c) and 15A NCAC 2T .1305(d) this form is official notifi cation
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: t r j' , 1
Previous Name of Farm: WFiq.TA rc,tS - 1 al( 1'1A't04 eomeAvy �1 hi x acility No: �Q (-) - 0 0 2
Previous Owncr(s) Name._KQorl�E�l�_� ►Z,MS 11 1 Phone No: 252 ' p I' jgg3
New Owner(s) Name: Dp S 'UteN1+&S) LL
New Farm Name (if -applicable):
Mailing Address: R p K 1.21 7 A/ at 6v l le. N L 2 7 g'5' 61
I,IJL {'GAMY► lb, bus 4,1002/
Phone No: .Z.SI 2 4.(1 767 a Sr -
Farm Location: Latitude and Longitude: 34, I39 £1 / 77, 7,59 soy County:
Please attach a copy of a county road map with location identified,, and provide the location adc •ess and driving directio�n;1
below (Be specific: road names, directions, milepost, etc.): I789S MOnm"C vat.A1, U T.-4..ecls aC 2789/
�(�'A1K I-4 5 N_ ray., uS%-f . TAKE.. (yDr [503f�{C: t!kir 33 E. 2',v �.9 n.,„,„
Tvn..nl t zr--- oN W A, s • o S.t�v .fPi�v+2 Rra . 14 1. 9 l t- s rung t err o -I/
Iv? cowrel J�A4-^i RAO,
Typ� of Swine No. o/•Ani,nals J T}p� v of Swine No. ofilnimals
Wean to Feeder 5SI lid'Cints _ / 7
❑ Wean to Finish 0 Roars
Operation Description:
o Feder to Finish
®'Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
etc 79
Type of Cattle No. of Animals
❑ Dairy
❑ Beef
Type of Poultiy No. of Animals
0 Layer
❑ Pullets
Other Type of Livestock•
Acreage Available for Application:
Number of Lagoons / Storage Ponds:
Number of Animals:
Zg D. 3 Required Acreage: e e. O O
Total Capacity: 3192I 140) Cubic Feet (ft3)
****** ************ ****** *********** ***** ****************** ****art**************
Owner / Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. 1 (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
wastc treatment and storage system or construction of new facilities will require a permit modification before the new
animals arc 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 Statc 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 Land Owner: KRaros LAC 'Z 1-,�r /
Signature: 711-egla Date: 9/7/2021
Name of New Land Owner: Do r G a /% r o +vt
Signature: 74,,,,,,/P,eZ
Name of Manager (if different from owner):
Signature:
Please sign and return this form to:
Date:
, f��/o2e °21
Date:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Centcr
Raleigh, NC 27699-1636
June 12, 2015