310458_Application_20220509

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: Farm #96847 Facility No: 31 - 458
Previous Owner(s) Name: Tony Cruse Phone No: 252-560-4594
New Owner(s) Name: Justin Murphy Phone No: 252-286-8083
New Farm Name (if applicable): Tuckahoe Farm
Mailing Address: 476 Guy Sanderson Road, Albertson, NC 28508
Farm Location: Latitude and Longitude: 35 os' 51186" / 77 05. 22.31" County: Duplin
Please attach a copy of a county road map with location identified, and provide the location address and driving directions
below (Be specific: road names, directions, milepost, etc.):
554 Bryce Hardison Road, Deep Run, NC 28525
Operation Description:
Type of Swine No. of Animals Type of Swine No. of Animals Type of Cattle No. of Animals
❑ Wean to Feeder 0 Gilts 0 Dairy
❑ Wean to Finish 0 Boars 0 Beef
El Feeder to Finish 1,440
❑ Farrow to Wean Type of Poultry No. of Animals
❑ Farrow to Feeder 0 Layer
❑ Farrow to Finish 0 Pullets
Other Type of Livestock: Number of Animals:
Acreage Available for Application: 16.5 Required Acreage: <16.5
Number of Lagoons / Storage Ponds: 1 Total Capacity: 362.666 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.
Tony Cruse
Name of Previous Izand Owner:
Signature:
Name of New and Owner:
Signature: :;; .ituz,e.
Name of Man A.r (if different m owner):
Signature:
Please sign and return this form to:
Justin Murphy
Date: l/ O� g i
Date: f 1 /Lf./?_J
Date:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699-1636
June 12, 2015

Facility/Farm Name:
Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
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Permit #: - 2 / Olen' Facility ID#: 31 ¥S County: tDe/9/..-/ /v
Operator In Charge (OIC)
Name: J0547/A1 414dt/
/141109Hr
First Middle
Cert Type / Number:
Signature.'
Last
AAvrt 945ri7
Jr, Sr, etc.
Work Phone: (023.7%2
aed -Sa83
Date:
"I certify that I'gree to my designation as the Operator in Charge for the facility noted. I understand and will abide by the rules and regulations
pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the Water
Pollution Control System Operators Certification Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
Name:
First Middle Last Jr, Sr, etc.
Cert Type / Number: Work Phone: (
Signature: Date:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the rules and
regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the
Water Pollution Control System Operators Certification Commission."
)
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Owner/Permittee Name: jL151%ki Jtta,hiv
Phone #: ay, a e6 - g083 Fax#: ( )
Signature:
er or authorized agen
Date: /I ( /
Mail, fax or email the
original to:
Mail or fax a copy to the
appropriate Regional Office:
WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618
Email: certadmin(a ncdenr.aov
Asheville
2090 US Hwy 70
Swannanoa 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq Mall
Washington 27889
Fax: [phone]
Phone: [phone]
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: [phone]
Phoen: 910.433.3300
Wilmington
127 Cardinal Dr
Wilmington 28405-2845
Fax: [phone]
Phone: [phone]
Fax: [phone]
Mooresville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
450 W. Hanes Mall Rd
Winston-Salem 27105
Fax: [phone]
Phone: [phone]
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]
Revised 05-2015
(Retain a copy of this form for your records)