820122_Application_20230601

Notification of Change of Ownership °
Animal Waste Management Facility �iECEIVE®
(Please type or print all information that does not require a signature)
In accordance with the requirements of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official 0 IRAIn
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Managers t ]Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership.
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Genci al Information: J
Previous Name of Farm: (17 i
CITE 1--3
No: 70 C1 9
Previous Owner(s) Name: ,Av j 1V e S j CIA. d GL Phone No:
New Owner(s) Name:_ & L �4 +(, c R. Oda &t _ Phone No: q 10 — J� ' �2013Q
New Farm Name (if applicable): Mailing Address: W71'D Rps,e bDY to . , fD jv4.Q
Fann Location: Latitude and Longitude: / County: q MD IV
Please attach a copy of a county road map with location identified, and provide the location address and driviniduections I
below (Be specific: road names, directions, milepost, etc.)• 130 9 a g % 55 /5
�-.s�!3to9. 34&S-RaS.s k4K,0 d . I'l; N-�hN IV/ �2f4-t?Q'
Oneration Description:
Type of Swine No. ofAnimals 7)pe ofSipine
❑ Wean to Feeder ❑ Gilts
❑ Wean to Finish ❑ Boars
❑ Feeder to Finish
❑ Farrow to Wean
Cf Farrow to Feeder
❑ Farrow to Finish
Other Type of Livestock:
Acreage Available for Application:
Co.
No. ofAnirnals
Number ofAnimals:
Required Acreage:
7),pe of Cattle
❑ Dairy
❑ Beef
Type ofPoulby
13 Layer
❑ Pullets
Number of Lagoons / Storage Ponds: Total Capacity:_ _ _ Cubic Feet (ft3)
No. ofAnimals
No. ofAnhnals
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
maintenance procedures established in the Certified Animal Waste Management Plan (CAWMP) for the farm named above
and will implement these procedures. I (we) know that any modification or expansion to the existing design capacity of the
waste treatment and storage system or construction of new facilities 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 directly through a man-made conveyance or from a storm event less severe than
the 25-year, 24-hour storm and there must not be run-off fi•orn the application of animal waste. I (we) understand that this
facility 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: t= h tV e. 5 T [It. CJ cl u ►kL- —^
d_
Date:
Name of New Lan Owner: (S �" r4 e e. !� ©�.__ w_ _
Signature: t� ) Date:
Name of Manager (if different from owner): 5 12
Signature:
Please sign and return this form to:
Date
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699-1636
,Tune 12, 2015