310589_Application_20220624

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: Rooty Branch Farm - A&B Facility No: 31 - 589
Previous Owner(s) Name: Stephen Matthew Whitfield Phone No: 919-658-0544
New Owner(s) Name: Gordon R Ivey Phone No: 919-658-4860
New Farm Name (if applicable): Rooty Branch Farm - A&B
Mailing Address: 370 Ivey Rd. Mount Olive, NC 28365
Farm Location: Latitude and Longitude: 35° 84' 5t_ / 77° 58' 16° 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.):
Fatm A - 277 8eautancus Rd. Mount Olive, NC 28365
Farm B - 230 Daniel Chestnut Rd. Mount Olive, NC 28365
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
O Feeder to Finish 4.823
❑ 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:
j"sac+ Required Acreage: 43
Number of Lagoons / Storage Ponds: 2 Total Capacity: 969.767 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.
Name of Previous Land Owner: Stephen Matthew Whitfield
Signature)e /46. ,s} tikc WA? Date: ‘f/s/z2
Name of New Land Owner: Gordon R Ivey
Signature:
A. ,1
Date: (/J�1d L
Name of Manager (if different from owner):
Signature: Date:
Please sign and return this form to: 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

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
Facility/Farm Name:
Rooty Branch Farm
Permit #: AWS310589 Facility ID#: 31 - 589 County: Duplin
Operator In Charge (OIC)
Name: Gordon R
Ivey
First Middle Last Jr, Sr, etc.
Cert Type / Number: AWA 17228 Work Phone: ( 919 ) 658-4860
Signature:i )404$`) R` J
Date:
10512.2-
"1 certify that 1 agree 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 I5A 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)
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. 1 understand and will abide by the
rules and regulations pertaining to the responsibilities set forth in I5A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Owner/Permittee Name:
Gordon R Ivey
Phone #: [phone]
Fax#: ( )
Signature: X ��-1 � R . Date: fiSIZ
(Owner or authorized agent)
Mail or fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
(Retain a copy of this form for your records)
Revised 8/2007