960141_Application_20230626

8011101aaluaO RECEIVED
UMC11030 ON
£ZOZ 9 9 N(V JUN 2 6 2OZ3 APPENDIX 2.2A
Notification of Change of Ownership
NC DE0JDVfflhima1 Waste Management Facility
(33A1303bi 1 W C*r print all information that does not require a signature)
In accordance with the requirements of 15A NCAC 2H .0217(a)(1)(H)(xii) this form is official notification to the Division of
Water Quality (DWQ) of the transfer of ownership of an Animal Waste Management Facility. This form must be submitted
to DWQ no later than 60 days following the transfer of ownership.
General Information:
Name of Farm: Oq ir f, I (t Facility No: Lg -ILI)
Previous Owner(s) Name: -742 k& 41 Phone No:
New Owner(s) Name: 11 ,14as. J 1= : a Phone No: 920 (y10
Mailing Address: 44L-t O lexk U W d c� s 6O F.o
o / t/ a
Farm Location: Latitude and Longitude: 3!S ,(� Xr l 7 In or County: - GJagma
Please attach a copy of a county road map with location identified and describe below (Be specific: road names, directions,
milepost, etc.): —
Overation Description:
Type of Swine No. of Animals
El Wean to Feeder
❑ Feeder to Finish
MTarrow to Wean Igo O
❑ Farrow to Feeder
• Farrow to Finish
❑ Gilts
El Boars — —
Type of Poultry No. of Animals
❑ Layer—
❑ Pullets
Other Type of Livestock.
Acreage Available for Application:__ S/. I Required Acreage:`_491. 3—
Type of Cattle No. of Animals
Dairy
❑ Beef
Number of Animals:
Number of Lagoons / Storage Ponds : Total Capacity: 7619 41_2 Cubic Feet (0)
Owner I 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 from 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
Quality to issue the required permit to the new land owner. _
Name of Previous Land Owner: - ro'40
Signature: r A« Date: 6' / -o? _
Name of New Land
Signature:
Name of b lanager(if different from owner) s C tt 9E, o < <
Signature
1
Please sign and return this form to:
N. C. Division of Water Quality
Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Date: 6 - 1 - 2 3
Date:
November 1, 2004

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