310082_Application_20230131

Date
Signature
Engineer's Seal
FARM
(Owner/Permittee name listed in question 1.2), attest
that this application for (Facility name listed in question 1.1) has
been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature
Date
6. MANAG_ER' S CERTI IC T � N: (complete only if different from the Farm Owner)
1 J U� h L IC 7 (Manager's name listed in question 1.7), attest that this
application for �4M 1, E J �� (Facility name listed in question 1.1) has
been reviewed by me and is accurate and complete to the best of my knowledge. 1 understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as mcom ere. �J
r Date
Signature
THE COMPLETED (CATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
ANIMAL FEEDING OPERATIONS PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
ELECTRONIC SUBMISSION IS ENCOURAGED. EMAIL TO: [e-mail]
SURFACE WATER CLASSIFICATION:
This form must be completed by the appropriate DWR regional office and included as a
part of the project submittal information.
INSTRUCTIONS TO NC PROFESSIONALS:
The classification of the downslope surface waters (the surface waters that any overflow from the facility would flow toward) in
which this animal waste management system will be operated must be determined by the appropriate DWR regional office.
Therefore, you are required, prior to submittal of the application package, to submit this form, with items 1 through 6
completed, to the appropriate Division of Water Resources Regional Operations Supervisor (see page 6 of 6). At a minimum,
you must include an 85' by I1" copy of the portion of a 7.5-minute USGS Topographic Map which shows the location of this
animal waste application system and the downslope surface waters in which they will be located. Identify the closest
FORM: AWO-STATE-G-DIGESTER-7/1512022 6Page