680017_Application_20220520

RECEIVED
MAY 2 0 2022
NC DEQ/DWR
In ac a btaIOffi 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: ln{ t pie V j I/ Fa rr J f n C C. Facility No: 68 r�- 11
NIA 7 fanY16j it .Cr-fn re. i;file
-D i e Pho QI"1" /?3 .3 I5
Previous Owner(s) Name: � +� lifr - �.�.z _?Tr .�d Phone No: I
New Owner(s) Name: 1J iiY°1f _ j 1- is ( 69t f �d
New Farm Name (if applicable): hi 6 v irM
Mailing Address: ?1'-f �`'�D 1 -0� C'""‘'r'`t 1'�') {�
Farm Location: Latitude and Longitude: ,3 .5. 9 b-6�) / 79,1115 G�13 County: `� (rime
Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
Please attach a copy of a county road map with location identified,
below (Be specific: road names, directions, milepost, etc.):
y a:'/►
Operation Description:
Type of Swine No. of Animals
❑ Wean to Feeder
❑ Wean to Finish
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other Type of Livestock:
Type of Swine
❑ Gilts
❑ Boars
Phone No: G% 2z Y--
and provide the location address and driving directions
3�11 IJL�trVlGnc Rv�r� )- )i prpi6)-J/Y6
Tocl (ryE-,rUr,r1, 5 1 �2 l7 , ), c
No. ofAnimals
Type of Cattle No. ofAnimals
qt Dairy (�
0 Beef
Type of Poultry No. ofAnimals
❑ Layer
❑ Pullets
Number ofAnimals: 0 !-n iria.t Per n-• 1'4-
Acreage Available for Application: Required Acreage:
Number of Lagoons / Storage Ponds: Total Capacity: tt' �4 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 t required pit
Name of Previ
Signature:
Name of New Land Owner: _ d/r7" / '` t yrn
Signature:
Name of Mana
Signature:7,I/
Please sign and return this form to:
0! C: "Obnnie, 3+rowd
owner):
6.1444
Date: 6 ,2va�
Date:
Date:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699-1636
051 424.2-
June 12, 2015

E- Back
3111 Dairyland Rd
Hillsborough 1 NC 27278-8390
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Directions
Arthur Mlnnis Rd
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Arthur Minnis Rd
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oaty`ard Rd
Dairyland Rd.
Print
RECEIVED
MAY 2 0.2022
NC DEQ/DWR
Central Office
(;)
3111 Dairyland
Rd
https://www.mapguest.com/us/nc/hillsborough/27278-8390/3111-dairyland-rd-35.977934,-79.144226?zoom=0 5/16/22, 6:50 PM
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