520018_Rescission Request_20220531

Animal Waste Storage Pond and Lagoon Closure Report Form
(Please type or print all information that does not require a signature)
General Information:
Name of Farm: Potters Hill Nursery # I and # 2 Facility No: 52-18
Owner(s) Name: NC Real Estate Properties LLC
Mailing Address1627 Stoneaate N. Sanford NC 27332 Phone No: 910-303-9423
34.989086 / 77.685410 County: Jones
O eration Descri tion (remainine animals only):
Please check this box if there will be no animals on this farm after lagoon closure. If there will still be animals on the site after
lagoon closure, please provide the following information on the animals that will remain.
Oneration Descrintion:
Type of Swine No. of Animals
Type of Poultry No. of Animals
Type of Dairy No. of Animals
jib Wean to Feeder 6400 . -
❑ Layer
0 Milking
0 Feeder to Finish
❑ Non -Layer
O Dry
O Farrow to Wean
Type of Beef No. of Animals
O Heifers
O Farrow to Feeder
0 Brood
O Calves
❑ Farrow to Finish
0 Feeders
0 Gilts
O Stockers
❑ Boars
Other Type of Livestock:
Number of Animals:
Will the farm maintain a number of animals greater than the G.S. § 143-215.1 OB threshold? Yes U No
Will other lagoons be in operation at this farm after this one closes? Yes ❑ No
How many lagoons are left in use on this farm?:_
(Name)Chad Coburn of the Water Quality Regional Operations Section staff in the Division of Water Resources'
WIRO Regional Office (see map on back) was contacted on I0/1/21 (date) for notification of the
pending closure of this pond or lagoon. This notification was at least 24 hours prior to the start of closure, which began
(in 10/4/2021 (date).
I verify that the above information is correct and complete. I have followed a closure plan, which meets all NRCS
specifications and criteria. I realize that I will be subject to enforcement action per Article 21 of the North Carolina
General Statutes if I fail to properly close out the lagoon.
Name of Land Owner (Please Print): NC Real Estate Properties LLC
Signature: �[ (//% —�i �---- NG A -CA I Esq 'cf F J Date:
The facility has followed a closure plan which meets all requirements set forth in the NRCS Technical Guide Standard
360. The following items were completed by the owner and verified by me: all waste liquids and sludges have been
removed and land applied at agronomic rate, all input pipes have been removed, all slopes have been stabilized as
necessary, and vegetation established on all disturbed are
,::�
Name of Technical Specialist (Please Print):c�' �?.s
Address (Agency):
3-6 v -,7-6 y �_.
Return within 15 days following completion of animal water storage pond or lagoon closure to:
N. C. Division of Water Resources
Animal Feeding Operations Branch
1636 Mail Service Center
Raleigh, NC 27699-1636
PLC - 1 Nov 19, 2013