960010_Application_20220203

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 font)
must be submitted to DWQ no 1 an 60 days following the transfer of ownership.
General Information: z r. L�
Name of Faun: 3�
Previous Owner(s) Name: Nations Swine, LLC.
New Owner(s) Name: Michael B. Grav/36 arm, /
Mailing Address: 619 Parkstown Road LaGrange, NC 28551
Farm Location: Latitude and Longitude: _35_ _17 18_ / _77__ _50_ 20_ County: Wayne
Please attach a copy of a county road map with location identified and describe below (Be specific: road names. directions,
milepost. etc.): From GMC take Millers chapel road south to Hwy 70. Then take left on Hwy 70 to Deacon Jones Chevrolet
turn right. 1.3 miles later left on Conover Road(SRI732). Farm path is .4 mile on
right
- Old Farm Nations Swine,LLC.
Facility No: 96 - 10
Phone No: 919-222-3070
Phone No: 919-222-7809
Operation Description:
Type gf'Swine No. of Animals 7r pe of Poultry No. o/.Animals 'ripe of Cattle No. of Animals
Wean to Feeder 0 Layer ❑ Dairy
4. Feeder to Finish 5760 0 Pullets 0 Beef
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish Other Type of'Livesiock: Numher of Animals:
❑ Gilts
❑ Boars
Acreage Available for Application: +-55 Required Acreage:+-43.27
Numher of Lagoons / Storage Ponds : 1 Total Capacity: 1,1 12,927 Cubic Feet (113)
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. 1 (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 stone event less severe than
the 25-year, 24-hour storm and there must not be run-off from the application of animal waste. 1 (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 th required permil to the new land owner.
Name of Previous Land Owner: ttL� Nation Farm, LLC.
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Date: I ' 3' -
Signature: •. �(-✓w�v--� Date:11.4011.,
'
Michael B. Grav-3G **rot Farm, LLC.
Name of New
Signature:
and Owner:
ikaR
Name of Manager(if different from owner):
Date:
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
May 2, 2007

Change Of Swine Integrator Registration Form
Farm Name: 3G Swine Farm, LLC. Facility Number: 96 - 10
Physical Location of the Swine Farm: From Goldsboro Milling south on Millers
Chapel road to hwy 70. East on 70 hwy to Deacon Jones. Take right at light. 1.3
miles take left on Conover Road. Farm .4 mile on right
Owner(s) Name: Michael B. Gray/3G Swine Farm, LLC.
Mailing Address: 619 Parkstown Road
City, State, Zip Code: LaGrange, NC 28551
Grower(s) Name if different than owner:_ Michael B. Gray
Mailing Address: 619 Parkstown Road
City, State, Zip Code:LaGrange, NC 28551_
Current Integrator: Smithfield Foods
Integrator Contact: Robert Brent Mitchell Jr. / Enviro-One
Mailing Address: 104 Adler Lane
City, State, Zip Code: Goldsboro, NC 27530
I -3I -c2oaa
OJvner's Signature Date
We appreciate your cooperation. This information is required in accordance with
G.S. 143-215.10H. If you have any questions contact the AFO Unit at (919) 733-
3221, otherwise please return this form to:
NC Division of Water Quality
Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
CISIR 12-15-05