540087_Application_20240312

RECEIVED
Notification of Change of Ownership MAR 12 2024
Animal Waste Management Facility
(Please type or print all information that does not require a signature) NC DEQ/DWR
In accordance with the requirements of 15A NCAC 2T.1304(c)and 15A NCAC 2T.1305(d)this form i9g E 1Qno iI cation
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Management Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership.
General Information:
Previous Name of Farm: •ens I,r S1.0
?>>-ko- ARre ;olS ham. Facility No4 j'J5�ee:)$;*>
Previous Owner(s)Name:
�1Q. 5 G•� /b1 y_C,��r��til�L• t 1hone No: rX^.L� ���--19Y�
New Owner(s)Name: �&� C fPI /1 �/JO k:�_4 0 •4!1DAffne No:
New Farm Name(if applicable): ,L,Q-!'L !/Y" '50rn0— FA4- —
Mailing Address: a3e9 l A / // A ]] ,LLA- lVe- 9.f 5,40
E-mail Address:_ ► rylA9� D �SltDfA'EJyI�GC Ae_7 _
Farm Location: Latitude and Longitude:35 I L._% / 141 31 County:��-�Lm J H
Please attach a copy of a county road map with location identified,and provide the locationaddress
Jand�driving
�directions
below(Be specific:road names,directions,milepost,etc.): /4 / �Q,t1.!!L. h1s�! Rol. 1�-
PC
Oi)eration Description:
Type of Swine No.of Animals Type of Swine No. of Animals Type of Cattle No. ofAnimals
❑Wean to Feeder ❑Gilts ❑Dairy
❑Wean to Finish ❑Boars ❑Beef
❑Feder to Finish
Rf rrow to Wean 37345 Type of Poultry No. of Animals
❑Farrow to Feeder ❑Layer
❑Farrow to Finish ❑Pullets
Other Tape of Livestock: Number of Animals:
Acreage Available for Application: I. 4ef' Required Acreage: f 49, D
Number of Lagoons/Storage Ponds: Total Capacity: O Cubic Feet(0)
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 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. 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
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 Resources to issue the required permit to the new land owner.
A.Irpl 1 J
Name of Previous Land Owner: -0.S en A,fO �/� G /--�7PdT•�,,hh Yt
Signature: Date:�3 /�d+
Name of Land Owner: _ D �a,r�-x 1
Signature: Date: a
Name of N anager(if different from owner):
Signature: Date:
Please sign and return this form to: Animal Feeding Operations
N.C.Division of Water Resources
Water Quality Permitting Section
1636 Mail Service Center
Raleigh,NC 27699-1636
March 25,2022