830014_Application_20230510

Notillmdon of Change of Ownership
Animal Waste Management Facitity
(please type or print all information that does not require a signature)
of 15A NCAC 2T.1304(c)and ISA NCAC 2T.1305(d)this ii=is oWfW�goea°n
In accaa'+Division
with a er Re anenta WR of the transfha'of ownership of an Anmial Waste Management Facility 'This
�.. to the Division of Water Rosouc+ces(D ) •
form must be submitted to DWR no later than 60 days fallowing the transfer of ownership
Previous Name ofFarm'_ / • b- G, io-so+ L1 V es L Yoft No: 1 `f
c )
Prevoua owner(s)Name• 1 .6 - �, ���. , Pirona No: o q 3-o?b��9�
New Owners)Name: c rY. i ct.� << .. _ -, --Yam No:D Di - -A 013— 2 a9`1
Now Farm Native Of applicable): kcvrn t air.; ��r�•
Address: :as ' r ug;r�; t sf:• Ro�.�t/IV-\ )ge, Y. - c;W r
Farm Location: Latitude sad I,ongihrde: 3y. 1SV'I(o9D/ - 79,(o V3 9 4u County; Se-6+t,-c4
Please attach a copy of a county road snap with location identified,and provide the location address and driving directions
below(Be specific:road names,directions,milepost,etc.):
Oneratian Descrlotion:
Type of%Vhw No.ofAnimals Type OfMvine No. gfAnimals Type of CaNe No.ofAnimals
0 Wean to Feeder _ _ 0(hits -_ 0 Day
gWean to Finisho 0 Boars C3 Beef
'Feeder t Finish �_ 3 v
U Farrow to wean �a - T,�pe gf'Poultry No.gfAnbnals
0 Farrow to Feeder . — _ -- 0 Layer.
0 Farrow to Finish - 0 pall _
Other T)W ofLivest00k._ -- - Number afAnimals:
Acreage Available for Application: 3 3 •t{' Required Acreage: --
Number of Lagoons/Storage Ponds: Total Capacity:_ y 14 -L , Cubic Feet(0)
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
maidenenoe procedures established in the Cardfled Animal Waste Management Plan(CAWW)for the farm named above
and will implement time proceduuas. I(we)know that any modification or expansion to the existing design capacity of the
waste treatment and storage system, or construction of new ftft as 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 direct►through a man-made conveyance or from a storm event I=severe than
the 255-year,24-hour storm and dm must not be run-off fibm the application of animal waste. I(we)understand that this
Ir7ri'y 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: 1 C•_ I ip 5 0'
Signatare: ZA 1TL _ Date• 5 I q a�
Name of No, --._.. Owner: 1?4 r.- U 4 n ( },4 o s
Date: /11 a 3
Name of Manager(if different fig owner): _
SI@natare:_ 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 `� MVO j
Raleigh,NC 27699-1636
June 12,2015