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HomeMy WebLinkAbout820114_OIC Designation Form_20240311State of North Carolina Department of Environmental Quality Division of Water Resources Animal Waste Management Systems Request for Certification of Coverage Facility Currently covered by an Expiring Sate Non -Discharge General Permit On September 30, 2024, the North Carolina State Non -Discharge General Permits for Animal Waste Management Systems will expire. As required by these permits, facilities that have been issued Certificates of Coverage to operate under these State Non -Discharge General Permits must apply for renewal at least 180 days prior to their expiration date. Therefore, all applications must be received by the Division of Water Resources by no later than April 3, 2024. Please do not leave any question unanswered. Please verify all information and make any necessary corrections below. Application must be signed and dated by the Permittee. 1. Certificate Of Coverage Number: AWS820114 2. - Facility NNamme:- Williamson Swine Farm 3. Permittee's Name (same as on the Waste Management Plan): Linda Williamson 4. Permittee's Mailing Address: 17 Pond Ln City: Clinton State: NC Zip: 28328 Telephone Number: 910-590-5044 Ext. E-mail: 5. Facility's Physical Address: 5700 Mosley Ave City: Clinton State: NC Zip: 28328 6. County where Facility is located: Sam son 7. Farm Manager's Name (if different from Landowner): 8. Farm Manager's telephone number (include area code): 9. Integrator's Name (if there is not an Integrator, write "None"): 10. Operator Name (OIC): en Norris Phone No.: 910-52-9� OIC #: 11. Lessee's Name (if there is not a Lessee, write "None°) F .,. nth Aflk-j-- / � 12. Indicate animal operation type and number: Current Permit: Operations Type Swine - Feeder to Finish Operation Types: Swine Wean to Finish Wean to Feeder Farrow to Finish Feeder to Finish Farrow to Wean Farrow to Feeder Boar/Stud Gilts Other Cattle Dairy Calf Dairy Heifer Milk Cow Dry Cow Beef Stocker Calf Beef Feeder Beef Broad Cow Other Allowable Count 7,320 Dry Poultry Non Laying Chickens Laying Chickens Pullets Turkeys Turkey Pullet Wet Poultry Non Laying Pullet Layers Other Types Horses - Horses Horses - Other Sheep- Sheep Sheep - Other 13. Waste Treatment Lagoons, Digesters and Waste Storage Ponds (WSP): (Fill/Verify the following information. Make all necessary corrections and provide missing data.) Structure Name Structure Type (Lagoon/Digester/ WSP) Estimated Date Built Liner Type (Clay, Synthetic, Unknown) Capacity (Cubic Feet) Estimated Surface Area (Square Feet) Design Freeboard 'Redline" (Inches) n NEW #2 Lagoon 1/l/1994 Full, clay 739,908.00 102,000.00 19.00 OLD #1 Lagoon 1/1/1991 Full, clay 474,448.00 53,460.00 19.00 n Submit one (1) copy of the Certified Animal Waste Management Plan (CAWMP) with this completed and signed application as required by NC General Statutes 143-215.10C(d), either by mailing to the address below or sending it via email to the email address below, The CAWMP must include the following components: 1. The most recent Waste Utilization Plan (WUP), signed by the owner and a certified technical specialist, containing: a. The method by which waste is applied to the disposal fields (e.g. irrigation, injection, etc.) b. A map of every field used for land application (for example: irrigation map) c. The soil series present on every land application field d. The crops grown on every land application field e. The Realistic Yield Expectation (RYE) for every crop shown in the WUP f. The maximum PAN to be applied to every land application field g. The waste application windows for every crop utilized in the WUP h. The required NRCS Standard specifications 2. A site map/schematic 3. Emergency Action Plan 4. Insect Control Checklist with chosen best management practices noted 5. Odor Control Checklist with chosen best management practices noted 6. Mortality Control Checklist with selected method noted - Use the enclosed updated Mortality Control Checklist 7. Lagoon/storage pond capacity documentation (design, calculations, etc.) Please be sure the above table is accurate and complete. Also provide any site evaluations, wetland determinations, or hazard classifications that may be applicable to your facility. 8. Operation and Maintenance Plan If your CAWMP includes any components not shown on this list, please include the additional components with your submittal. (e.g. composting, digesters, solids separators, sludge drying system, waste transfers, etc.) I attest that this application 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 to me as incomplete. Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application may be subject to civil penalties up to $25,000 per violation. (is U.S.C. Section 1001 provides a punishment by a fine of not more than $10,000 or imprisonment of not more than 5 years, or both for a similar offense.) Print the Name of the Permittee/Landowner/Signing Official and Sign below. (If multiple Landowners exist, all landowners should sign. If Landowner is a corporation(, signature should be by a principal executive officer of the corporation): Name (Print): i P 1 I� l a C7 Title: --0 (41r) pjK Signature: a/1 G1� Date: 14 Name (Print): Signature: Name (Print): Signature: Title: Date: Title: - Date: THE COMPLETED APPLICATION SHOULD BE SENT TO THE FOLLOWING ADDRESS: E-mail: animal.operations@deq.nc.gov NCDEQ-DWR Animal Feeding Operations Program 1636 Mail Service Center Raleigh, North Carolina 27699-1636