490048_Application_20220802

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Animal Feeding Operations Permit Application Form
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
State Individual Permit - Existing Animal Waste Operations
1. GENERAL INFORMATION: RECEIVED
1.1 Facility name:SA • r_j �^S
1.2 Print Land Owner's name: \, SNCL.re-` AUG 01 2022
1.3 Mailing address: r
City, State: %7%me aL NC DEQ/DWR
y �� zip: ��10�1 Central Office
Telephone number(include area code):(-I
1.4 Physical address:am _CZkC_ e_1 fir.
City, State: se\�\, NL- zip: �TSloll
Telephone number(include area code):(-1 ,� ) �2 -'1`1 c�l-
1.5 County where facility is located:'ZECeJe\1
1.6 Facility location(directions from nearest majorhighway,using SR numbers for state roads):
1.7 Farm Manager's name(if different from Land Owner):
1.8 Lessee's/Integrator's name(if applicable;circle which type is listed):
1.9 Facility's original start-up date:c�slc> Date(s) of facility expansion(s)(if applicable):
2. OPERATION INFORMATION:
2.1 Facility number: _y�6
2.2 Operation Description:
Please enter the Design Capacity of the system. The"No. of Animals" should be the maximum numberforwhich the
waste management structures were designed.
Type of Swine No. of Animals. Type ofPoultry No. of Animals Type of Cattle No. of Animals
❑ Wean to Feeder ❑ Layer ❑ Beef Brood Cow
❑ Feeder to Finish ❑ Non-Layer ❑ Beef Feeder
❑ Farrow to Wean(#sow) ❑ Turkey ❑ Beef Stocker Calf
❑ Farrow to Feeder(# sow) ❑ Turkey Poults EY'Dairy Calf _
❑ Farrow to Finish (# sow) D Dairy Heifer
❑ Wean to Finish (#sow) ( Dry Cow ��
❑ Gilts c Milk Cow 13t>
❑ Boar/Stud
❑ Other Type of Livestock on the farm: No. of Animals:
FORM: AWO-STATE-I-E 1/10/06 Page 1 of 5

2.3 Acreage cleared and available forapplication(excluding all required buffers and areas not covered by the application
system)-! •S Required Acreage (as listed in the CAWMP): —\S-%
2.4 Number of lagoons: Total Capacity(cubic feet): Required Capacity(cubic feet):
C F
Number of Storage Ponds: TotalCapacity(cubic feet : Required Capacity(cubic feet):
0Q11 C�
2.5 Are subsu ace dralis present within 100'of any of the app cation fields? YES or (circle one)
2.6 Are subsurface drains present in the vicinity or under the wa ste management system? YES or (circle one)
2.7 Does this facility meet all applicable siting requirements? ES or NO (circle one)
2.8 Brief description of treatment process:
3. REQUIRED ITEMS CHECKLIST:
Please indicate thatyouhave includedthe following required items by signing yourinitials in the spaceprovided nextto each
item.
AnDlicants Initials
3.1 One completed and signed original and two copies of the application for State IndividualPermit
-Animal Waste Operations;
3.2 Three copies of a general location map indicating the location of the animalwaste facilities and
field locations where animalwasteis land applied and a county road map with the location of
the facility indicated;
3.3 Three copies of the entire Certified Animal Waste Management Plan(CAWMP). Ifthe facility
does nothave a CAWMP, it mustbe completedprior to submittalof a permit application for
anima l waste operations.
The CAWMP must include the following components. Some of these components may nothave been required at the time
the facility was certified but should be added to the CAWMP forpermittingpurposes:
3.3.1 The Waste Utilization Plan(WUP) must include the amount of Plant Available Nitrogen (PAN) produced and
utilized by the facility
3.3.2 The method by which waste is applied to the disposal fields (e.g. irrigation, injection, etc.)
3.3.3 A map of every field used for land application
3.3.4 The soil series present on every land application field
3.3.5 The crops grown on every land application field
3.3.6 The Realistic Yield Expectation(RYE)for every crop shown in the WUP
3.3.7 The PAN applied to every land application field
3.3.8 The waste application windows for every crop utilized in the WUP
3.3.9 The required NRCS Standard specifications
3.3.10 A site schematic
3.3.11 Emergency Action Plan
3.3.12 Insect Control Checklist with chosen best management practices noted
3.3.13 Odor Control Checklist with chosen best management practices noted
3.3.14 Mortality Control Checklist with the selected method noted
3.3.15 Lagoon/storage pond capacity documentation(design, calculations,etc.);please be sure to include any site
evaluations,wetland determinations,or hazard classifications that may be applicable to your facility
3.3.16 Operation and Maintenance Plan
If your CAWMP includes any components not shown on this list, please include the additional components with your
submittal.(Composting,waste transfers,etc.)
FORM: AWO-STATE-I-E 1/10/06 Page 2 of 5

4. APPLICANT'S CERTIFICATION:
I, 1 -„ ... , (Land Owner's name listed in question 1.2), attest that
this hasbe nhreviewedcation rbymea - 1 (Facilitynamelisted in question l.l)
®..
nd is accurate<i nd complete to the best of my knowledge. I understand that if all required parts of this
pp � eted and that if all required supporting information and attachments are not included,this applicat ion
application aprp
package r me as in
complete.
omplete
._ . .. ..Date Signature ... .. ..� .
- �
5. MANAGER'S CERTIFICATION: (complete only if different from the Land Owner)
I, (Manager's name listed in question 1.6), attest that this
applicationfor �„ (Facility name listed in question 1.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included,this applicat ion
package will be returned as incomplete.
Signature Da to
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER QUALITY
AQUIFER PROTECTION SECTION
ANIMAL FEEDING OPERATIONS UNIT
1636 MAIL SERVICE CENTER
RALEIGH,NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
6. SURFACE WATER CLASSIFICATION:
FORM: AWO-STATE-I-E 1/10/06 Page 3 of 5

This form must be completed by the appropriate DWQ regional office and included as a part of the
project submittal information.
INSTRUCTIONS TO NC PROFESSIONALS:
The classification of the downslope surface waters(the surface waters that any overflowfrom the facility would flow toward) in
which this animal waste management system will be operated must be determined by the appropriate DWQ regional office.
Therefore,you are required, prior to submittal of the application package,to submit this form,with items 1 through 6
completed,to the appropriate Division of Water Quality Regional Aquifer Protection Supervisor(see page 6 of 10). At a
minimum,you must include an 8.5"by I I"copy of the portion of a 7.5 minute USGS Topographic Map which shows the
location of this animalwaste application system and the downslope surface waters in which they will be located. Identify the
closest downslope surface waters on the attached map copy. Once the regional office has completed the classification,
reincorporate this completed page and the topographic map into the complete application form and submit the
application package.
6.1 Farm Name:
6.2 Name&complete address of engineering firm:
Telephone number:( ) -
6.3 Name of closest downslope surface waters:
6.4 County(ies)where the animalwaste management system and surface waters are located
6.5 Map name and date:
6.6 NC Professionars Seal(If appropriate),Signature,and Date:
TO: REGIONAL AQUIFER PROTECTION SUPERVISOR
Please provide me with the classification of the watershed where this animalwaste management facility will be or has been
constructed or field located,as identified on the attached map segment(s):
Name of surface waters:
Classification(as established by the EnvironmentalManagement Commission):
Proposed classification,if applicable:
Signature of regional office personnel _ ..................................... Date:
(All attachments must be signed)
FORM: AWO-STATE-I-E 1/10/06 Page 4 of 5

DIVISION OF WATER QUALITY REGIONAL OFFICES(9/05)
Asheville Regional APS Supervisor Washington Regional APS Supervisor Raleigh Regional APS Supervisor
2090 U.S. Highway 70 943 Washington Square Mall 1628 Mail Service Center
Swannanoa,NC 28778 Washington,NC 27889 Raleigh,NC 27699-1628
(828)2964500 [phone] [phone]
Fax[phone] Fax[phone] Fax[phone]
Avery Macon Beaufort Jones Chatham Nash
Buncombe Madison Bertie Lenoir Durham Northampton
Burke McDowell Camden Martin Edgecombe Orange
Caldwell Mitchell Chowan Pamlico Franklin Person
Cherokee Polk Craven Pasquotank Granville Vance
Clay Rutherford Currituck Perquimans Halifax Wake
Graham Swain Dare Pitt Johnston Warren
Haywood Transylvania Gates Tyrell Lee Wilson
Henderson Yancey Greene Washington
Jackson Hertford Wayne
Hyde
Fayetteville Regional APS Supervisor Mooresville Regional APS Supervisor Wilmington Region APS Supervisor
225 Green Street, Suite 714 610 East Center Avenue 127 Cardinal Drive Extension
Fayetteville,NC 28301-5094 Mooresville, NC 28115 Wilmington, NC 28405-3845
[phone] [phone] [phone]
Fax[phone] Fax[phone] Fax[phone]
Anson Moore Alexander Lincoln Brunswick New Hanover
Bladen Richmond Cabarrus Mecklenburg Carteret Onslow
Cumberland Robeson Catawba Rowan Columbus Pender
Harnett Sampson Cleveland Stanly Duplin
Hoke Scotland Gaston Union
Montgomery Iredell
Winston-Salem Regional APS Supervisor
585 Waughtown Street
Winston-Salem,NC 27107
[phone]
Fax[phone]
Alamance Rockingham
Alleghany Randolph
Ashe Stokes
Caswell Surry
Davidson Watauga
Davie Wilkes
Forsyth Yadkin
Guilford
FORM: AWO-STATE-I-E 1/10/06 Page 5 of 5