240069_Owner (Name Change)_20230804

RECEIVED
AUG 0 4 223 Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all Information that does not require a signature)
NO DEQ0W,,9
--In acco%m ate 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: �] t�.1rY,e g eY-Le.r.�, �o�rc�►
Previous Owner(s) Name:
New Owner(s) Name:
Mailing Address:
Facility No: Q4- ion
Phone No:
Phone No: Cm- Is Q - g(0%S*
Farm Location: ` 1110' 33, " 11i° 59" Ict" County: - C o k k rv,�j t,►.S
Please attach a copy of a county road map with location identified and described below (Be speck: road names,
directions, milepost, etc.): a 1356
tR n rtc Q Otrn
Cxe ss r ".5 \
Oaeration Descrit3tion:
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
Wean to Feeder 10400 Q Layer
Feeder to Finish ® Pullets
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wean to Finish
Gilts
Boars
Acreage Available for Application:
Number of Lagoons / Storage Ponds:
Owner / Manager Agreement
Other Type of Livestock:
Required Acreage:
Total Capacity:
C] Dairy
® Beef
Number of Animals
Cubic Feet (ft3)
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. 1 (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:
Signature: 1�c,-�c� L. Date:
Name of New Lan Owner: c
Signature:
Name of Manager (if d ffered rom
Signature: �
or
Date:
Date:
73
Please sign and return this form to: N.C. Division of Water Quality
Aquifer Protection Section
Animal Feeding Operations Unit
1630 Mail Service Center
Raleigh, NC 278WI638
November 1, 2004