640011_Rescission Request_20230609

NC Division of Water Quality
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
I have completed the closure of the waste treatment lagoon on farm 64-11 according to a plan approved
by MRCS. The closure report form has been submitted. Therefore, I would like the permit to be
rescinded for this farm.
Respectfully,

APPENDIX 3 1
Animal Waste Storage Pond and Lagoon Closure Report Form
(Please type or print all inforniation that does not require: a signature}
General Information: 1 Gv%A ..R. k,V Name ofFaitn:
FeT fn racility f\ra:_lp '. I I� —
Owner(s) Na n ie:.�S(,', mi_
Mailing Address:1 %15-) W01- R6,, Ws 0*t'o- rid °II Phone Nu: 25 2— 510� 4L
County: __N41: j
OIreration Descri2r� rtion .remaininanimals on]y
a Please check this box if there �vrll be no aninrals on this farm after iaaoon closure. If there: tivill still be annnals on the site
af2ar laaoori tlasLiro. please provide the following information oit tilt aninrals that will ttuiain
Operation Deseriiition:
Tree ofStrine No ofkiinrals 7ipe of Poidli v No ul'Aninialr Tvpe of Dab y ko oj.9frinutl;
o Wenn to FQ.:d:r v Layer _-.- - u Milking
u Fecdcr to F,nish o Non -Latter o Dr%
n Finn o — to Wean Ti pe ujeeef No. gj.flrrrurrls o Heifers
a Farrovt- to Feeder _ o Brood _ a Calves
o Fa[row to finish o Fet:der�
o Gilts u stockers
o Boars 011tcr Tty�c ai'1 ii csto�k: __ .. _ � �'rrrrrl.rr uj.4rrirrtrrh. _
Will the: farm maintain a nuniber of aniuuols greater than the 211 .0217 threshold? Yes o ^No a
Will ether lagoons he in operation at this faun afer this one closes? Yes o No 0
How many lagOtis are fell In UsB on this farrn?:
(?1rCrnttJ S(fiil.i�_. VCYlOuYQ of the Water 01.1ality Sections staff in the Division of
Water Qualitvs . glk.(16 - Regional Office (see strap wi back) was contacted on' z t C _• � t.(cdale)
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 oil '1 - 2G 2022 (elwe)
I verify that the abote information is correct and co;npiete. I have followcd a closure Plan, which meets all MRCS
specifications and criteria. I realize that I will b subject to enforcement action per Article 2 l of the North
Carolina General Statutes if I fail to properly close aut the lagoon.
Name of Lan Owner (Please Print):\j e f1 t?
Signature.-� _ � Date.
The facility has followed a closure plan which inects all requirements set forth in the NRCS Technical Ouide
Standard 360. The following items 4,Nlere completed by the owner and verified by me: all waste liquids and
sludges have been removed and land applied at agronornic rate, all input pipes have beers removed, all slopes have
been stabilized as necessary; and vegetatioa establislicd on all disturbed areas.
frame of Technical
��Specialist
++(Please Print)- . 1 ._
Af6liatioii:_. !'. -
Address A .(i_ Q Q �p
( gy):._ ,.. (/&� � (�X ��� ��CJ�7 Phone No.-
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Signature: CIa` i� `v'c Date:
Return within 115 days following completion of animal water storage pond or lagoon closure to:
N. C. Division Of Water Quality
Animal feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
PLC - I March 18, 2002