680017_Rescission Request_20230620

APPENDIX 3.1
Animal Waste Storage Pond and Lagoon Closure Report Form
JUN 2 0 2023 (Please type or print all information that does not require a signature)
ation•
1 �owp. O A:e.n c ro i f- Farms Facility No: 4 % - 1-7
Owner(s) Name: GAnA:k f:&frn5 111 LLC
Mailing Address: 3111 Pd
Perm;+ * , Aw x- bgoo 11
Phone No: J i- 8 2 q- (o 8 DO
NC, Z7Z?8 County: brangf,
I
O aeration Description remainin animals only):
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.
Oneration Description:
Type of Swine No. of Animals
o Wean to Feeder
o Feeder to Finish
o Farrow to Wean
o Farrow to Feeder
• Farrow to Finish
• Gilts
o Boars
Type of Poultry No. of Animals
o Layer
o Non -Layer
Type of Beef No. of Animals
o Brood
o Feeders
o Stockers
Other Type of Livestock:
Will the farm maintain a number of animals greater than the 2H .0217 threshold?
Will other lagoons be in operation at this farm after this one closes?
How many lagoons are left in use on this farm?: 0
Type of Dairy
o Milking
•Dry
• Heifers
o Calves
No. of Animals
Number of Animals:
Yes o Nox
Yes o No)(
(Name) lume_ gern a.rd of the Water Quality Section's staff in the Division of
Water Quality's h aLie-;, k Regional Office (see map on back) was contacted on Zc Z-1 (date)
for notification of the pending closure of this pond or lagoon. This notification was at least 14 h urs prior to the
start of closure, which began on Aprj 7-1. 2-oZ3 (date).
I verify that the above information is correct and complete. I have followed a closure plan, which meets all NRCS
specifications and criteria. I realize that I will be subject to enforcement action per Article 21 of the North
Carolina General Statutes if I fail to properly close out the lagoon.
Name of Land Owner
Signature:
Date: 6 -(-Z
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.
Name of Technical Specialist (Please Print): Ff7l"'d ., .rr.� l� •�Q �
Affiliation: LiSAi� //�/�� i
Address (Agency): 2Z.) ® .h � M'G 222-7k Phone No.:
Signature: % c Date: /.2 -.2 O2�3
Return within 15 days following completion of animal water storage pond or lagoon cl EftD
N. C. Division Of Water Quality
Animal Feeding Operations Unit 2�23
1636 Mail Service Center JUN 2 0
Raleigh, NC 27699-1636
NC DEQIDWR
Central Office
PLC - 1 March 18, 2002