310482_Change of Ownership_20211208

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
to the Division of Water Quality (DWQ) of the transfer of ownership of an Animal Waste Management
must be submitted to DWQ no later than 60 days following the transfer of ownership.
General Information:
Name of Farm: niara i i'�rrK�� �nc_ Facility No:
31-4(62,
Previous Owner(s) Name: ['!i ..� /� c:�•. c.. �-� Phone No:
New (hvner(s) Name: 1 /r►1 D fk. 7 Lee PI& mok.
Phone No: q/o -02 —1166
Mailing Address: 605 Gyp feSS Cre Q k !del vvd / Lc-e /1/L
Farm Location: Latitude and Longitude: 3 ,13 6 $ / " 17 . 3 (I 7 County (3t,q 1 a ir%
Please attach a copy of a county road map with location identified and describe below (Be specific: road names, directions,
milepost, etc.): Lg l I Q reS S Cve eE R o . LJ Gt;1(a (.e ! ('1 L.
RECEIVEL
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act
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NC DEQ/DWR
Central Office
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Operation Description:
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Wean to Feeder 0 Layer 0 Dairy
El-reeder to Finish l rQ 7 5 0 Pullets 0 Beef
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish Other Type of Livestock: Number of Animals: FIECEIVE=L
❑ Gilts
❑ Boars
DEC 08 2021
Acreage Available for Application: It , to/ Required Acreage: — / 8 • (o 7
Number of Lagoons / Storage Ponds : f'7S Total Capacity: 'HI / 2,0 _ Cubic Feet (ft3)
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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 farmnamed 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. l
Name of Previous Land Owner: G�'�► ��w�r v"�/ 9�%2'� s'`� k*.-
Signature: 6,G.+, (l' tl Date:
Name of New Land Owner: pp• 1 1�►1Q 71.� L- e r i co 0.64
Signature: rJl.:eV-ffL o+.01 2.07 "s Date:
Name of Manager(ifdifferent from owner):
Signature: Date:
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
May 2, 2007
NC DEQ/DWR
Central Office

. Mctc.k Lbcn ier
BEFORE BEGINNING EXCAVATIC�
LANDOWNER IS ADVISED TO •1 " 935- Red/F1.12;sA
CONTACT ULOCO TO ASSURE THAT /�
UNDERGROUND UTILITIES ARE NOT Prer to E Farm j pt.
�STROYED I-800-632-4949
9 —lei -q1
SCS DOES NOT CERTIFY THAT
EXCAVATION AND FILL
VOLUMES ARE CORRECT
DEC 08 2021
\ NC DEQ/DWR
Central Office
51
Mink wa:
bearers, bi
long-haired
The color
dark and
are raised
They are 13
short legs
night, most
They nest it
der stumps