250007_Application_20240320

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Animal Feeding Operations Permit Application Form
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
State General Permit - Existing Animal Waste Operations
1. GENERAL INFORMATION:
1.1 Facility name:,L "T Farm
1.2 Print Land Owner's name:l iLey Far rlg LL G
1.3 Mailing address:2 (p e ray 'Tt JQ)h C,,_ CL � QP
City,State: ]gip;-gyp N C 7 q Zip: 5 O
Telephone number include area code): ( ) ligg-�4
1.4 Physical address: I p1/e.V �- (�jGt,t'tr1(/ l �C�
City,State:_Qg vier' (v C, Zip:?�6 2 to
Telephone number(include area code): 1 5 Lf
1.5 County where facility is located:S'r-wVer,
1.6 Facility location(directions from nearest major highway, using SR numbers for state roads):
1.7 Farm Manager's name(if different from Land Owner):
1.8 Lessee's/Integrator's name(if applicable;circle which type is listed): �"L(d
1.9 Facility's original start-up date: Date(s)of facility expansion(s)(if applicable):
2. OPERATION INFORMATION:
2.1 Facility number:—26.7
2.2 Operation Description:
Please enter the Design Capacity of the system. The"No.of Animals" should be the maximum number for which the
waste management structures were designed.
Type of Swine No.of Animals Type of Poultry No.of Animals Type of Cattle No.of Animals
❑Wean to Feeder ❑Layer ❑Beef Brood Cow
❑Feeder to Finish ❑Non-Layer ❑Beef Feeder
❑Farrow to Wean(#sow) ❑Turkey ❑Beef Stocker Calf
❑Farrow to Feeder(#sow) ❑Turkey Poults ❑Dairy Calf
❑Farrow to Finish(#sow) ❑Dairy Heifer
TXWean to Finish(#sow) ❑Dry Cow
❑Gilts ❑Milk Cow
❑Boar/Stud
❑Other Type of Livestock on the farm: No.of Animals:
FORM: AWO-STATE-G-E 1/10/06
Page 1 of 5

2.3 Acreage cleared and available for application(excluding all required buffers and areas not covered by the application
system): Required Acreage(as listed in the CAWMP): W S 10
2.4 Number of lagoons:I Total Capacity(cubic feet): Requirre�Oapacity(cubic feet):
Number of Storage Ponds: Total Capacity(cubic feet): Required Capacity(cubic feet):
2.5 Are subsurface drains present within 100'of any of the application fields? YES or circle one)
2.6 Are subsurface drains present in the vicinity or under the waste management system? Vi4 or (circle one)
2.7 Does this facility meet all applicable siting requirements? �9s
or NO (circle one)
3. REQUIRED ITEMS CHECKLIST:
Please indicate that you have included the following required items by signing your initials in the space provided next to each
item.
Applicants Initials
3.1 One completed and signed original and two copies of the application for State General Permit-
Animal Waste Operations; I
V Vv
3.2 Three copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is land applied and a county road map with the location of
the facility indicated;
3.3 Three copies of the entire Certified Animal Waste Management Plan(CAWMP). If the facility
does not have a CAWMP, it must be completed prior to submittal of a permit application for
animal waste operations. r
The CAWMP must include the following components. Some of these components may not have been required at the time
the facility was certified but should be added to the CAWMP for permitting purposes:
3.3.1 The Waste Utilization Plan(WUP)must include the amount of Plant Available Nitrogen(PAN)produced and
utilized by the facility
3.3.2 The method by which waste is applied to the disposal fields(e.g. irrigation,injection,etc.)
3.3.3 A map of every field used for land application
3.3.4 The soil series present on every land application field
3.3.5 The crops grown on every land application field
3.3.6 The Realistic Yield Expectation(RYE)for every crop shown in the WUP
3.3.7 The PAN applied to every land application field
3.3.8 The waste application windows for every crop utilized in the WUP
3.3.9 The required NRCS Standard specifications
3.3.10 A site schematic
3.3.11 Emergency Action Plan
3.3.12 Insect Control Checklist with chosen best management practices noted
3.3.13 Odor Control Checklist with chosen best management practices noted
3.3.14 Mortality Control Checklist with the selected method noted
3.3.15 Lagoon/storage pond capacity documentation(design,calculations,etc.);please be sure to include any site
evaluations, wetland determinations,or hazard classifications that may be applicable to your facility
3.3.16 Operation and Maintenance Plan
FORM: AWO-STATE-G-E 1/10/06 Page 2 of 5

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If your CAWMP includes any components not shown on this list,please include the additional components with your
submittal. (Composting,waste transfers,etc.)
4. APP ICANT'S CERTIFICATI N•
I, � f ry LL C (Land Owner's name listed in question 1.2),attest that
this application for it 2 (Facility name listed in question 1.1)
has been reviewed by me and is accurate aiA complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included,this application package
will be returned t e incom ete.
Signature Date 3 1 M911
5. MANAGER'S CERTIFICATION: (complete only if different from the Land Owner)
I, (Manager's name listed in question 1.6),attest that this
application for (Facility name listed in question 1.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included,this application package
will be returned as incomplete.
Signature Date
THE COMPLETED APPLICATION PACI{AGE,INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER RESOURCES
WATER QUALITY REGIONAL OPERATIONS SECTION
ANIMAL FEEDING OPERATIONS PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH,NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
FORM: AWO-STATE-G-E 1/10/06 Page 3 of 5

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6. SURFACE WATER CLASSIFICATION:
This form must be completed by the appropriate DWR regional office and included as a part of the
project submittal information.
INSTRUCTIONS TO NC PROFESSIONALS:
The classification of the downslope surface waters(the surface waters that any overflow from the facility would flow toward)ill
which this animal waste management system will be operated must be determined by the appropriate DWR regional office.
Therefore,you are required,prior to submittal of the application package,to submit this form,with items I through 6
completed,to the appropriate Division of Water Resources Regional Aquifer Protection Supervisor(see page 6 of 10). At a
minimum,you must include an 8.5"by 11"copy of the portion of a 7.5 minute USGS Topographic Map which shows the
location of this animal waste application system and the downslope surface waters in which they will be located. Identify the
closest downslope surface waters on the attached map copy. Once the regional office has completed the classification,
reincorporate this completed page and the topographic map into the complete application form and submit the
application package.
6.1 Farm Name:
6.2 Name&complete address of engineering firm:
Telephone number:( )
6.3 Name of closest downslope surface waters:
6.4 County(ies)where the animal waste management system and surface waters are located
6.5 Map name and date:
6.6 NC Professional's Seal(If appropriate),Signature,and Date:
TO:REGIONAL WQROS SUPERVISOR
Please provide me with the classification of the watershed where this animal waste management facility will be or has been
constructed or field located,as identified on the attached map segment(s):
Name of surface waters:
Classification(as established by the Environmental Management Commission):
Proposed classification,if applicable:
Signature of regional office personnel: Date:
(All attachments must be signed)
FORM: AWO-STATE-G-E 1/10/06 Page 4 of 5

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DIVISION OF V1-A1'ER RESOURCES REGIONAL OFFICES (9/05)
Asheville Regional WQROS Supervisor Washington Regional WQROS Supervisor Raleigh Regional WQROS Supervisor
2090 U.S.Highway 70 943 Washington Square Mall 1628 Mail Service Center
Swannanoa,NC 28778 Washington,NC 27889 Raleigh,NC 27699-1628
[phone] [phone] [phone]
Fax[phone] Fax[phone] Fax[phone]
Avery Macon Beaufort Jones Chatham Nash
Buncombe Madison Bertie Lenoir Durham Northampton
Burke McDowell Camden Martin Edgecombe Orange
Caldwell Mitchell Chowan Pamlico Franklin Person
Cherokee Polk Craven Pasquotank Granville Vance
Clay Rutherford Currituck Perquimans Halifax Wake
Graham Swain Dare Pitt Johnston Warren
Haywood Transylvania Gates Tyrell Lee Wilson
Henderson Yancey Greene Washington
Jackson Hertford Wayne
Hyde
Fayetteville Regional WQROS Supervisor Mooresville Regional WQROS Supervisor Wilmington Region WQROS Supervisor
225 Green Street,Suite 714 610 Bast Center Avenue 127 Cardinal Drive Extension
Fayetteville,NC 28301-5094 Mooresville,NC 28115 Wilmington,NC 28405-3845
[phone] [phone] [phone]
Fax[phone] Fax[phone] Fax[phone]
Anson Moore Alexander Lincoln Brunswick New Hanover
Bladen Richmond Cabarrus Mecklenburg Carteret Onslow
Cumberland Robeson Catawba Rowan Columbus Pender
Harnett Sampson Cleveland Stanly Duplin
Hoke Scotland Gaston Union
Montgomery lredell
Winston-Salem Regional WQROS Supervisor
450 Hanes Mill Road,Suite 300
Winston-Salem,NC 27105
Phone[phone]
Fax[phone]
Alamance Rockingham
Alleghany Randolph
Ashe Stokes
Caswell Surcy
Davidson Watauga
Davie Wilkes
Forsyth Yadkin
Guilford
FORM: AWO-STATE-G-E 1/10/06 Page 5 of 5

Animal Waste Management Plan Certification
(Please type or print all information that does not require a signature)
xisting or New or Expanded (please circle one)
General Information: Permit No: _l
Name of Farm: 1_l+IP_1 FCLV(n 2 Facility No: 25
Owner(s)Name: t I Fir nns I G Phone No:CI Iq • L-ci CI• 2JI 8t'
Mailing Address: 2 1 RL�-� Q�au2i 42 �, 4r1, NC. ZS60 1
Farm Location: J County Farm is located in:
Latitude and Longitude: 3s • Z / •1Z3(o27 5 3 Integrator: G)CI
Please attach a copy of a county road map with location identified and describe below (Be specific: road
names, directions, milepost, etc.): ah!g 1 DOW*- E rnw'el I Qc� t Dover NC,
Operation Description:
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Dairy No. of Animals
❑Wean to Feeder t I Layer ❑Milking
❑Feeder to Finish I Non-Layer f]Dry
❑Farrow to Wean Type of Beef No. of Animals P Heifers
u Farrow to Feeder ❑Brood t7 Calves
❑Farrow to Finish tl Feeders
u Gilts u Stockers
❑Boars Other Type of Livestock: Number of Animals:
(1'
[Expanding Operation Only
Previous Design Capacity: Additional Design Capacity: Total Design Capacity:
Acreage Available for Application: Required Acreage:
Number of waste structures: I Total Capacity: I I Cubic Feet(113)
Are subsurface drains present on the farm: YES or NO (please circle one)
If YES: are subsurface drains present in the area of the waste structures(please circle one or both as applicable)
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 approved animal waste management plan for the farm named above and wilt
implement these procedures. I (we) know that any expansion to the existing design capacity of the waste treatment and
storage system or construction of new facilities will require a permit application and a new certification to be submitted to the
Division of Water Quality (DWQ) and permit approval received before the new animals are stocked. I (we) understand that
there must be no discharge of animal waste from the storage system to surface waters of the state unless specifically allowed
under a permit from DWQ and there must not be run-off from the application of animal waste. I(we)understand that run-off
of pollutants from lounging and heavy use areas must be minimized using technical standards developed by the USDA-Natural
Resources Conservation Service(NRCS). The approved plan will be filed at the farm and at the DWQ Regional Office and the
office of the local Soil and Water Conservation District (SWCD). I (we) know that any modification must be approved by a
technical specialist and submitted to the DWQ Regional Office and local SWCD and required approvals received from DWQ
prior to implementation. A change in farm ownership requires a permit application to be sent to DWQ along with a new
certification(if the approved plan is changed).
Name of Lan Owner• l
Signature: Date: I`t 2
Name of Manager (if differenehom own r):
Signature: Date:
AWC-September 18, 2006

Technical Specialist Certification
LAs a technical specialist designated by the North Carolina Soil and Water Conservation Commission pursuant to 15A
NCAC 6H .0104, I certify that the animal waste management system for the farm named above has an animal waste
management plan that meets or exceeds standards and specifications of the Division of Water Quality as specified in 15A
NCAC 2T .1300 (formerly 2H .0217) and the USDANatural Resources Conservation Service and/or the North Carolina Soil
and Water Conservation Commission pursuant to 15A NCAC 2T.1300(formerly 2H.0217)and 15A NCAC 6F.0101-.0105.
The following elements are included in the plan as applicable. While each category designates a technical specialist who may
sign each certification (SD, SI, WUP, RC, 1), the technical specialist should only certify parts for which they are technically
competent.
IL Certification of Design
A) Collection, Storage, Treatment System
Check the appropriate boa:
Existing facility without retrofit (SD or WUP)
Storage volume is adequate for operation capacity; storage capability consistent with waste utilization
requirements.
LI New, expanded or retrofitted facility (SD)
Animal waste storage and treatment structures, such as but not limited to collection systems, lagoons and ponds,
have been designed to meet or exceed the minimum standards and specifications.
Name of Technical Specialist (Please Print): JA -
Affiliation a Date Work Completed: 18 1 z4
Address (Agen ): C Phone No.: 2 '2 2 I 1 -1C(o
Signature: Date: 3 & 24
B) Land Application Site (WUP)
The plan provides for minimum separations(buffers);adequate amount of land for waste utilization;chosen crop is suitable
for waste management;and the hydraulic and nutrient loading rates are appropriate for the site and receiving crop.
Naive of Technical Specialist(Please Print): F—Ve I( A-tnCEu t j�
Affiliation V Date Work Completed: 91%e )2q
Address (Age Phone No.: 21 1 7 0(o
Signature: Date: 3 1812+f
C) Runoff Controls from Exterior Lots
Check the appropriate boa:
Facility without exterior lots (SD or WUP or RC)
This facility does not contain any exterior lots.
Facility with exterior lots (RC)
Methods to minimize the run off of pollutants from lounging and heavy use areas have been designed in
accordance with technical standards developed by NRCS.
Name of Technical Specialist (Please Print):
Affiliation Date Work Completed:��8'
Address (Agen ! Phone N .: 2 5�21 110b
Signature: Date: 3
AWC-September 18, 2006

D). Application and Handling Equipment
Check the appropriate box
Existing or expanding facility with existing waste application equipment (WUP or I)
Animal waste application equipment specified in the plan has been either field calibrated or evaluated in accordance
with existing design charts and tables and is able to apply waste as necessary to accommodate the waste
management plan: (existing application equipment can cover the area required by the plan at rates not to exceed
either the specified hydraulic or nutrient loading rates, a schedule for timing of applications has been established;
required buffers can be maintained and calibration and adjustment guidance are contained as part of the plan).
rl New expanded or existing facility without existing waste application equipment for spray irrigation. (I)
Animal waste application equipment specified in the plan has been designed to apply waste as necessary to
accommodate the waste management plan;(proposed application equipment can cover the area required by the plan
at rates not to exceed either the specified hydraulic or nutrient loading rates; a schedule for timing of applications
has been established; required buffers can be maintained;calibration and adjustment guidance are contained as part
of the plan).
LI New. expanded_or existing facility without existing waste application equipment for land spreading not using spray
irrigation. (WUP or I)
Animal waste application equipment specified in the plan has been selected to apply waste as necessary to
accommodate the waste management plan;(proposed application equipment can cover the area required by the plan
at rates not to exceed either the specified hydraulic or nutrient loading rates; a schedule for timing of applications
has been established; required buffers can be maintained;calibration and adjustment guidance are contained as part
of the plan).
Name of Technical Specialist (Please Print): R/f ng�d Gt1
Affiliation OdVa le Date Work Completed: ct�118' 2+
Address (A (' x): Phone No.: -262621170to
Signature, Date: 2*
E) Odor Control, Msect Control, Mortality Management and Emergency Action Plan (SD,
SI, WUP,RC or I)
The waste management plan for this facility includes a Waste Management Odor Control Checklist,an Insect Control
Checklist,a Mortality Management Checklist and an Emergency Action Plan. Sources of both odors and insects have
been evaluated with respect to this site and Best Management Practices to Minimize Odors and Best Management
Practices to Control Insects have been selected and included in the waste management plan. Both the Mortality
Management Plan and the Emergency Action Plan are complete and can be implemented by this facility.
Name of Technical Specialist(Please Print): r2
Affiliation ' Date Work Completed: 8 L�
Address (Agenc S176W ki/ Phone No 521 n o b
Signature: Date:
F)Written Notice of New or Expanding Swine Farm
The following signature block is only to be used for new or expanding swine farms that begin construction after June
2 1996. If the facility was built before June 21,1996,when was it constructed or last expanded
t I we certify that I(we)have attempted to contact by certified mail all adjoining property owners and all property owners who
own property located across a public road,street,or highway from this new or expanding swine farm. The notice was in
compliance with the requirements of NCGS 106-805. A copy of the notice and a list of the property owners notified are
attached.
Name of Land Owner:
Signature: Date:
Name of Manager (if different from owner):
Signature: Date:
AWC-September 18,2006

III. Certification of Installation
A) Collection, Storage, ll-eatment Installation
New, expanded or retrofitted facility (SI)
Animal waste storage and treatment structures,such as but not limited to lagoons and ponds,have been installed in
r accordance with the approved plan to meet or exceed the minimum standards and specifications.
For existing facilities without retrofits, no certification is necessary.
Name of Technical Specialist (Please Print):
Affiliation Date Work Completed:
Address (Agency): Phone No.:
Signature: Date:
B) Land Application Site (WUP)
The cropping system is in place on all land as specified in the animal waste management plan.
Name of Technical Specialist (Please Print): EVE H-Q!OW/'4iW
Affiliation Priynk Date Work Completed: N18 2�
Address (Age nc Phone No.: 252 52) 1-70 fD
Signature: Date:_
Q Runoff Controls from Exterior Lots (RC)
Facility with exterior lots
Methods to minimize the run off of pollutants from lounging and heavy use areas have been installed as specified in
n I o the plan.
! For facilities without exterior lots, no certification is necessary.
Name of Technical Specialist(Please Print):
Affiliation Date Work Completed:
Address (Agency): Phone No.:
Signature: Date:
D) Application and Handling Equipment Installation (WUP or I)
)4 Animal waste application and handling equipment specified in the plan is on site and ready for use;calibration
and adjustment materials have been provided to the owners and are contained as part of the plan.
I 1 Animal waste application and handling equipment specified in the plan has not been installed but the owner
has proposed leasing or third party application and has provided a signed contract;equipment specified in the
contract agrees with the requirements of the plan; required buffers can be maintained; calibration and
adjustment guidance have been provided to the owners and are contained part of the plan.
Name of Technical Specialist (Please Print): a.l
Affiliation X Date Work Completed: c3/Ig�2�
Address (Agency) Phone No.:ZS2 ,�52) 1-job
Signature: Date: 3/I /2+
AWC-September 18,2006

E) Odor Control, Insect Control and Mortality Management (SD, SI, WUP, RC or I)
Methods to control odors and insects as specified in the Plan have been installed and are operational. The
mortality management system as specified in the Plan has also been installed and is operational.
Name of Technical Specialist (Please Print): EDVP "
Affiliation-Ri VOL Date Work Completed: 3 I Ig 1 ZN'
Address (Agen ): Phone No.: 252 �52 117U h
Signature: Date: 3 ji 12*
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Please return the completed form to the Division of Water Quality at the following address:
Department of Environment and Natural Resources
Division of Water Quality
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh,NC 27699-1636
Please also remember to submit a copy of this form along with the complete Animal Waste
Management Plan to the DWQ Regional Office and the local Soil and Water Conservation
District Office and to beep a copy in your files with your Animal Waste Management Plan.
AWC-September 18,2006