840001_Application_20220906

AECEtVED
2022 Notification of Change of Ownership
:animal Waste Management Facility
sPeease type or print all information that does not require a signature)
In acdepe'requirements of 15A NCAC 2T.1304(c)and 15A NCAC 2T.1305(d)this form is official notification
to that%er 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:
ti
Previous Name of Farm: r Facility No:
Previous Owners)Name: Le ... ............ ►" i � i.. Phone No:. L�
New Owner(s)Name:..— "...ri d ... .. ..l.i.h ..........___...Phone No:70q- 91
New Farm Name(if applicable):.
Mailing Address: .. f __. - -
E-mail Ad'aresa.. fp„
/Farm Location: Latitude and Longitude:, -
� n
Please attach a copy of a county road map with location identified,and provide the location address and drivViwg directions
below(Be specific:road names,directions,milepost,eta): i...i 4tf-..... _. --i c : ., , �. ....
O eration Descriiition:
Type of Swine N YP f f YP ❑Dairc
yP _ f o. D Beep
❑Wean to Feeder o o Ant � ❑Gilts
mals Type o Swine N o lnima s e o Cattle Nor male
❑Wean to Fmisb ❑Boars
11 Feeder to Finish
D Farrow to Wean Type of Poultry No. o Animals
El Farrow to Feeder - - 6 ayer. - --_— ___—
❑Farrow to Finish 0 Pullets .
Other T e o Livestock. .. .. .,,Number of Animals:...,,,
Acreage Available for.Application _Required Acreage w
Number of Lagoons/Storage Ponds:__..... Total Capacity: ',Cubic Fect(jl3)
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:
F ,
l Date:
Signature: °. r /' ..i
' e
Name of New,.l,and Owt r:
Z
a. n
Signature: �^•�„� � � ,°�..� Date:
Name of Man,ger(if different from owner):
Signature: Date,
Please sign and return this form to: Animal Feeding Operations
N.C.Division of Water Resources
Water Quality Permitting Section
1636 Mail Service Center
Raleigh,NC 27699-1636
March 25,2022

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Go gle Maps `24 & US-52, Albemarle, NC 28001 to 30123 Sides Drive 5.4 miles, 7 min
Rd, Albemarle, NC 28001
NC-24&US- 2
Albemarle,NC 28001
1. Head south on Aquadale Rd toward Eben St
0.7 mi
2. Continue onto U.S. 52 Hwy S
0.1 mi
r+ 3. Turn right onto NC-138
276 ft
4. Continue onto State Hwy 138
0.2 mi
5. Continue onto NC-138 S/State Hwy 138 S
0.2 mi
r+ 6. Turn right onto Old Aquadale Rd
3.7 mi
r* 7. Turn right onto Sides Rd
Destination will be on the left
0.4 mi
30123 Sides Rd
Albemarle, NC 28001
These directions are for planning purposes
only.You may find that construction projects,
traffic,weather,or other events may cause
conditions to differ from the map results,and
you should plan your route accordingly.You
must obey all signs or notices regarding your
route.