330002_Owner (Name Change)_20210429 (2)

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 requinaments 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 bc s-ubmitted to DWR no later than 60 days following the transfer of ownership,
'Genera! Information: {' r
Previous Name of Farm: J4tAItdamIt. 1~11,a.m. _Facility No: 33 - 015dZ.
Previous Owner(s) Name: Ka oft/s sp&q ,a ,,., Photos No: S$O 519 4300
New Owner(s) Name: Z AI T c% $ PL❑ EST Vitcy, EA r f C5{UCPhone No: 252 (S i I
New Farm Name (if applicable): J�
Mailing Address: `fL (DO 1 S] rl vl, e 8 A- t.yn Iv L. 02-7 8O j
Farm Location: Latitude and Longitude:15. JJ f' 7 J Z4441 County: +_ Co..veL
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.):
Operation Descrietion: C V a 2 E.r,t"i
Type ofSwum No. of Anfmois Type of Swine No. of Animals Type of Cattle No. ofAnimaLf
2''Wean to Feeder S. 5 I &milts _1331_ O Dairy
❑ Wean to Finish 0 Boars 0 Beef
0 Feeder to Finish
IleFarrow to Wean If 0 74-- Type of Poultry No. of Animals
O Farrow to Feeder 0 Layer
O Farrow to Finish O Pullets
Other Type of Livestock Number of Animals:
Acreage Available for Application: Required Acreage:
Nwnbcr of Lagoons / Storage Ponds: 5 Total Capacity: at 041$1 TZ0 Cubic Feet (tt3)
Owner / Manager Agreement
1 (we) verify that all the above information is correct and will bc updated upon changing. I (wc) understand the operation and
maintenance procedures established in the Certified Animal Waste Management Plan (CA WMP) for the farm named Above
and will implement these pmcedurca. I (wc) 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. 1 (we) understand that there must be no discharge of animal waste from the storage or application
system to surface waters of the state cithcr 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. f (wc) 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 .and Owner: 1<il.owtttotE42. F
Name of New La
Signature:
Nam
Slgnatuurr
Plea :dsfgo end return this form to:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mall Service Center
Raleigh, NC 27699-1636
June 12, 2015