240069_Owner (Name Change)_20230807

Nonnentlon of change of Ownership
Animal Waste Management Facility
(Please type or print ell information that does not require a signature)
In accordance with !hc requirement, of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official nollfieation
to The Division of Water Rcsourt:cs (DWR) of the Trnnaft:r ofownership of an Animal Waste Management Facility. This
form mtw be submittal to DW R no Into them MI days following the transfer of ownerahip.
General Information:
Previous Name of Farm: _ hacility No:
Previous Owners) Namc: �BY1 hone No' MA
New Owncr(s) Name: hone No:gl Oi Gam• �6'�
New Farrn Name (it'oppficable): V fee
Mailing Address: P0 A G11
Fames L(canon Latitude need Longitude: Y 27 `J `� I
Please attach n copy of a county rund map with location iden!}od, and provide the location
below IHe itic: _road names, directions, milapseetc-11,
l��i tit%
( ,
�j fv� lL 1 �D1�h1 t S r V1v GCS 00 ✓ 4 �"tw t- •�'
Opention Desedution:
7PC of swine No. of Rnintals Type ofSivine No. of Animals
VWean to Feeder 044Ci) ❑ Gilts
❑ Wean to Finish ❑ Boars
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other 7)i pe of Livestock: Wj j* Number of Aniatals: M 14
directions
z 5to
;�5fi
TjpeofCattle No. of4nimalr
❑ Dairy
❑ Beef
Tipe of Poullry No. ofAirinwA
❑ Layer
❑ Pullets
Acreage Available for Application: Required Acreage:
Number of lagoons 1 Storage Ponds: _ Total Capacity: Cubic Fort (0)
Owner I Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. 1 (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. 1 (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. l (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. 1 (we) understand that this
facility may be covered by a State Non -Discharge Permit or a NPDGS Permit and completion of this form authorizes the
Division of Water Resources to issue the r quired permit to the new land owner.
Name of Previous land Owner:
Signature: 4JCCG_
Name of Ner4J aced Own
Name of Manager (if differgnl from
J
ski
rVI
gate: to Z2.t 2 3
Signature' l-a-#V Date:,
Please sign and return this form to: Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 2769946-16
June12,2015