670080_Rescission Request_20230518

APPENDIX 3.1
Animal Waste Storage Pond and Lagoon Closure Report Form
(Please type or print all information that does not require a signature)
General Information:Name of Ferm: 'T-.Y V"y 13 e l Y7 S an, Pecs wt Facility No: / I7
- C7
Owner(s)Name:_ `�'frn4 13rt nSOYI
Mailing Address: $Z f�Lt-[ow)1 tc 4tluy Phone No:
l Cjk10Lrlds N e2 T 51-1`f County: Dn n{b -y
Operation Description(remaining animals only):
o Please check this box if there will be no animals on this farm after lagoon closure. if there will still be animals on the site
after lagoon closure,please provide the following information on the animals that will remain.
Operation Description:
Type ofSwine No.ofAnimals Type of Poultry No.ofAnimals Type of Dahy No. ofAnimals
o Wean to Feeder o Layer o Mil
king
o Feeder to Finish � - o Non-Layer - o Dry
o Farrow to Wean Type ofBeef No.ofAnimals o Heifers
o Farrow to Feeder — o Brood o Calves _
o Farrow to Finish _ o Feeders - - -
o Gilts o Stockers -
o Boars Other Type ofLivestock: - - Number ofAnimals:
Will the farm maintain a number of animals greater than the 2H.0217 threshold? Yes o
Will other lagoons be in operation at this farm after this one closes?
Yes 17i> >
How many lagoons are left in use on this farm?: �
qvame)---->4 Lo-e- of the Water Quality Section's staff in the Division of
Water Quality's A.tat(Pri Regional Office(see map on back) was contacted on *:- -2U2�(date)
for notification of the pending closure of this pond or lagoon. This notification was at least 24 hours prior to the
start of closure,which began on�/-i/'atv�3 . (date).
I verify that the above information is correct and complete. I have followed a closure plan,which meets all MRCS
specifications and criteria. I realize that 1 will be subject to enforcement action per Article 2l of the North
Carolina General Statutes if I fail to properly close out the lagoon.
Name o d�vner(P nt): - -T-,-- ''f y `;7ri n-5m
Signature:
Date:
The facility has followed a closure plan which meets all requirements set forth in the NRCS Technical Guide
Standard 360. The following items were completed by the owner and verified by me: all waste liquids and
sludges have been removed and land applied at agronomic rate,all input pipes have been removed,all slopes have
been stabilized as necessary,and vegetation established on all disturbed areas.n
Name of Technical Specialist(Please Print): !. &,y7 r m ("6i ( ac e
Affiliation: �I V 151 r) -
Address(Age cy); 1�v {5f -I YI a l Y 1 c.-e_. C r — -
- r V �'`e�. Phone No.:
Signature: t-X wJ, L j a Lt _Date:_" O
Return within 15 days following completion of animal water storage pond or la sure to:
N.C.Division Of Water Quality ��� j
Animal Feeding Operations Unit 3
1636 Mail Service Center �� 202
Raleigh,NC 27699-1636
NG °d
PLC- 1 March 1 S,2002 ZEDvll