820035_Application_20220429

RECSVED
Signature:
Name of New Land
Signature:
Name of Mana
Signature:
APR 2 9 2022
*:-y=:' the requirements of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official notification
to'lft- 1► .f 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: e rr 80y 1'arisoi .�i~G .S = 7' Facility No:
Previous Owner(s) Name / OL'rt 5 rr / Phone No: 9/0) 3 9(-2Y�$'
New Owner(s) Name: L r F l a- 5 , 5e55 5 t ��+� SC-1horie`N : it d)
New Farm Name (if applica
ble): & )115 (,LT''lern St:ll i n e L.LG
Mailing Address: i S (mil t- La -re— 1 ose -r , Af tJ • a33K
Farm Location: Latitude ktid Longitude: / County: t2P t i7
Please attach a copy of a county road map with location identified, and Ajrovide the location address and driving directs ns
below (Be specific: road names, directions, milepost, etc.): T'lrt 1V1 h bbN) ` fl� 1ou i (1 �a` % 5
�D[lv W L( Ired-1).-Jf S;rr moh S f� 1/446-e CLlF'an 6Djir► -)erlc{ e 'att�/
*ten +fc�� tea) bR �Nl" iei RcL . 3 yri r. -47,an Ca CArrkarJYi d')(1"
Operation Description:
Type of Swine No. ofAnimals Type of (Swine No. ofAnimals Type of Cattle No. ofAnimals
Wean to Feeder t'i) 0 0 Gilts 0 Dairy
❑ Wean to Finish 0 Boars ❑ Beef
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farmw to Feeder
❑ Farrow to Finish
Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
Type ofPoultry No. ofAnimals
❑ Layer
❑ Pullets
Other Type of Livestock: Number ofAnimals:
Acreage Available for Application: a lP Required Acreage:
Number of Lagoons / Storage Ponds: 1 Total Capacity: 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 tl a new land owner.
Name of Prev' s Land Ow er: Ei e —t5-G v'r (. e -v' Rol 1:70%- -s
7 Date: qi/3/2 ?-
aer:
Lll�
5�,ssan5
r (if different from owner):
Date:
Please sign and return this form to:
/eim of Alm'
()7o7_37e'2_
r61/40te .rab4f(&e r atn.r,Gov
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