820715_Change Ownership Application_20191014

Notification of Change of Ownership
Animal Waste Management Facility
(Please type or 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: Marcus Daniels III Farm Facility No: 82-715
Previous Owner(s) Name Murphy Brown, LLC Phone No: 910-293.3434
New Owner(s) Name: Southern Harvest, LLC Phone No:
Mailing Address: 3900 Dunn Rd Roseboro, NC 28382
Farm Location: County: Sampson
Please attach a copy of a county road map with location identified and described below (Be speck: road names,
directions, milepost, etc.): 1148 Haynes Stretch Road Autryviile
Operation D�Mcriptiom
Type of Swine No. of Animals
❑ can to Feeder
Feeder to Finish 14060
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Wean to Finish
❑ Gifts
❑ Boars
Acreage Available for Application:
Number of Lagoons / Storage Ponds: _
Type o1 Poultry No. of Animals
❑ Layer
❑ Pullets
Other Type of Livestock:
212.07 Required Acreage:
Type of Cattle No. of Animals
❑ Dairy
❑ Beef
Number of Animals
212.07
108 Cubic Feet (ft3)
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 Cerfified Animal Waste Management Plan (CAWMP) for the farm named above and wlll 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
bysa State Non -Discharge Permit orar. 24 - hour Storm and here must not be run-off from the a NPDES Permit and completion of this form authorplication of izeal s he Divsb^)of WatataQualiry tond that ltssuelthye ray b ec permit
to the new land owner.
Name of Previous Land Otprngr: _.4 Murphy Brown
Name of New Lan � ,r
Signature:
Name of Manag r (limroint from owner):
Date: ►A — Q _
Date: /G—f 3 -/ i
Signature:
Date:
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
November 1, 2004

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F.0201
Facility/FarmName:- MO.rCt_S VdC ivy
Permit#: 1QV31S"ItO IS- FacilitylD#: -::6?-q_l_r"County: aq=b"1 ty
Operator In Charge (OIC)/�
Fin, ------- -
Middle /fir/ Intr /r, Sr, err..
Con Type / Number: .41'J / D s��f Work Phone: (910
Signature: /
Date: l0
"I certify, that I agree to my designation as the Operator in Charge for the facility noted I understand and will abide by the mien
and regulations pertaining to the responsibilities set forth in ISA NCAC 08F .0203 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission"
Back-up Operator In Charge (Back-up OIC) (Optional)
Cent Type/Number: UJ ii (/ Work Phone: (jZQ ) 6,. �i- 941
"Icerafytha C/_--- Date:_ ��i-i l Cl
"I certify that 1 a ea m m designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the
mica and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission"
OWner/PermitteeName: !fao r air. V\a,Cvq
Phone #: '6 e, Cl A Fax#: 33 6 3'
Signature; _ s/t — } C
(O ror am ed agent)— Date: "/ l
Mall or fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
(Retain a copy of this form for your records)
RCVUtd &3007