820039_Application_20221221

RECEIVED
Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
DEC 21 2022
In accordance with the requirements of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is o . UWE
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Managemen a S• s
form must be submitted to DWR no later than 60 days following the transfer of ownership.
General Information:
Previous Name of Farm: Bill Warren 1-9
Previous Owner(s) Name: William M. Warren
New Owner(s) Name: Tyler Bass
New Farm Name (if applicable): 3 wild Hogs
Mailing Address: 1989 Taylors Bridge Highway Clinton, N.C. 28328
Farm Location: Latitude and Longitude: 34 57' 15" / 78 14' 30" County: Sampson
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.): From Clinton take US 421 South, approximately 6 miles turn left on
Beaman Woods Road. Go to intersection and proceed straight. Farm entrance is 0.4 miles on the right.
Facility No: 82 - 39
Phone No: 910-385-8813
Phone No: 910-385-7816
Operation Description:
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. ofAnimals
❑ Wean to Feeder 0 Layer 0 Dairy
® Feeder to Finish 6040 ❑ Pullets 0 Beef
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish Other Type of Livestock: Number of Animals:
❑ Gilts
❑ Boars
Acreage Available for Application: 32.02 Required Acreage: 32.02
Number of Lagoons / Storage Ponds: 2 Total Capacity: 1,185270 Cubic Feet (f13)
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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 Previot Owtfer:y William M. Warren
.14Signature: jjV�� i
Name of New nd caner• T ler Bass
Signature:
Date: r01 -1 yyitr
Date: 2/2^ 7-2—
Name of Manager (if different from owner):
Signature: Date:
Please sign and return this form to: N. C. Division of Water Resources
Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
April 23, 2012