HomeMy WebLinkAbout330002_Application_20221007DocuSign Envelope ID: 21C54FA3-AEAl-4E37-A570-AAA8474DSAlC
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 rNuiruments of I SA NCAC 2T .1344(c) and 15A NCAC 21-.1305(d) this form isofficial notification
to the Division of Water Resources (DWR) of the transfer of owricrahip of an Animal Waste Management Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership.
Genarml Information:
Previous Name of Farm: J 41 Qltda#*IG 1~11, a Facility No: 33 - o o d z
Previous Owner(s)Norm: 04SKDG V:A..ir•, Fhat:tiNo: 5$0' 599 4300
New Owner(s) Namc A'f T c% AZ ❑ S i _ 2al�ts� �� f �S Phone No: 252 164 (5 f 1
New Farm Name (if applicable):_
Farm Location: Latitude and Longitude:4.�YI•77, County:
et.+s�£
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 Description: C U 2 tz r,r
Type af.-rWirra No. o /fnimRLr
1;r Wean to Feeder SAI
❑ Wean to Finish
O Feeder to Finish
iieFarrow to Wean QZ�
13 Farrow to Feeder
13 Farrow to Finish
Other Type of Livestock -
of Slain No. of Animals Type of Cattle No. ofAnimals
Cs
4ts �13 __.. O Dairy
O Boars 13 Beef
Type of Poultry No. of Animals
0 Layer
O Pullets
_ Number of Animals:
Acreage Available for Application:_., Required Acrcmge:
Number of Lagoons / Storage Ponds: S Total Capacity: Oq TL❑ Cubic Feet (R3)
♦rr40�baaeafab�tq..pptr�►erabrar��o��bb�4 rta�����reae►rrrdtsa rt��i o ZLOO. Cubic eel (ft
Owner / Manager Agreement
1 (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 (CA WMP) far the farm named Above
and will implement these procedures. I (we) know that any modificalion ar cxpansi0n 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
signature:�
Name of New
r: fy tLe7wr56CrC�i 1^ 4�t
14 GLL
from owner)* Joe 40"
end return this form to:
Date: T~
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