310207_Application_20230207

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: Old Farm
Previous Owner(s) Name: , / Jimmy Williamsll�
New Owner(s) Name: 4Ofri y l if 6446 .. rG
Old Farm
New Farm Name (if applicable):
watiaxt
Mailing Address: 841 Old Chinquapin Road
Farm Location: Latitude and Longitude: 34° 53' 8.64. / n°
Facility No: 31 - 207
Phone No: f - ;98 1719
Phone No: 00'-62f4 033$°—
Beulaville, NC 28518
45' 55.06' 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.): 845 Old Chinquapin Rd. Beulaville, NC 28518
Operation Description:
Type of Swine No. of Animals Type of Swine No. of Animals
❑ Wean to Feeder 0 Gilts
❑ Wean to Finish 0 Boars
Feeder to Finish
❑ Farrow to Wean Type of Poultry No. of Animals
Cl Farrow to Feeder 0 Layer
❑ Farrow to Finish 0 Pullets
Type of Cattle No. of Animals
❑ Dairy
❑ Beef
1,880
Other Type of Livestock: Number of Animals:
Acreage Available for Application: 23.1 Required Acreage: 15
Number of Lagoons / Storage Ponds: 1 Total Capacity: 485,373 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: Jimmy Williams / J
Signature � 4 ki:ft. * ►, Date: ,91 7 2-o;:3
Name of New Land Owner: 44-7410yi, IAA' I/lam& 14 &C but'C//ai <
Signature')'.-
ignature & w cCrl y,_ L✓ - Date: 2/7(d�'-3
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: Old Farm
Permit #: AWS31 0207 Facility ID#: 31 - 207 County: Duplin
Operator In Charge (OIC)
Name: 1474412/
First
Middle
Wri/fins
Last
Cert Type / Number: / M- t dCJ 6 e-4 8
Signature:
Jr. Sr, etc.
Work Phone: (910 ) a 9 0 0 335
Date: al7IPe-9-3
"I 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 15A 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)
%tG 111/ th^S
First
Middle
Last
Cert Type / Number: /4-iX /9 7! 6'
Signature' Sl r 04 ut
Jr, Sr. etc.
Work Phone: ('V d ) ?q18- 4110
Date: 00/.'�3
"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 15A 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:
F5« !,t✓crttcu�S
Phone #: ( ) yy�%%�/% Fax#: ( ) /
Signature: c ttj�� / t h/��cGM' Date: 4R / 1 202-3
(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