630001_OIC Designation Form_20240306

On September
expire. As regr
Non -Discharge
must be receive
Please do not
Application mu
1. Certificate
2. Facility Na
3. Permitlee's
4. Permittee's
City: Rc
5. Facility's
City:
6. County w
7. Farm Ma'.
g, Farm Ma
9. Integrator
10. Operator
11. Lessee's 1
12. Indicate a
Current F
State 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
I, 2024, the North Carolina State Non -Discharge General Permits for Animal Waste Management Systems will
red by these permits, facilities that have been issued Certificates of Coverage to operate under these State
general Permits must apply for renewal at least 180 days prior to their expiration date. Therefore, all applications
by the Division of Water Resources by no later than April 3, 2024.
,are any question unanswered. Please verify all information and make any necessary corrections below
be signed and dated by the Permittee.
£Coverage Number: AWS630001
Wet Creek Farm
(same as on the Waste Management Plan): N G Purvis Farms Inc
ig Address: 2504 Spies Rd
State: NC Zip: 27325-7213
910-948-2297 Ext. E-mail: y+"nyay oa^P 767r�fru
Address: 10470 NC Hwy 705
nm State: NC Zip: 27242
Facility is located: Moore
's Name (if different from Landowner): Anthony Ray Moore
's telephone number (include area mile): 910-948-2297 Ext.
are (ifthere is not an Integrator, write "None"): N G Purvis Farms Inc
'jhe (OIC): Anre//�rCN[%Ir'� Phone No.: 979-948-2297
e (if there is not a Lessee, write "None"):/
it operation type and number:
t Operations Type Allowable Count
Swine - Farrow to Wean 3,272
Swi
Weans Finish
Weans Feeder
Fartow to Finish
Fccdcr oFinish
Fartow to Wcan
Parmw m Feeder
Gills
Other
Cattle
Dry Pou Itry
Dairy Calf
Non Laying Chickens
Dairy Hcifer
Laying Chickens
Milk Cow
Pullets
Dry Cow
Turkeys
Beef Stocker Calf
Turkey Pullet
Becf Feeder
Beef Broad Cow
Wet Poullry
Other
Non Laying Pullet
Layers
Oicn: >6ac f970&il
OtherTypes
Horses - Horses
Horses - Other
Sheep - Sheep
Sheep - Other

13. Waste Treat nnent Lagoons, Digesters and Waste Storage Ponds (WSP): (Fill/Verify the following information.
Make all ne�cssary corrections and provide missing data.)
Structure
are
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)
I
Lagoon
9/26/1996
Full, clay
272,766.00
51,319.00
18.00
2
Lagoon
Full, clay
738,204.00
94,871.00
18.00
3R¢STAGE
Lagooa
Full, clay
1,045,188.00
120,616.00
28.00
Submit one ( copy of the Certified Animal Waste Management Plan (CAWMP) with this completed and signed
application as required by NC General Statutes 143-215.1OC(d), either by mailing to the address below or sending it via
email to the eff ail address below.
The CAWMP a ust include the following components:
I. The most recent Waste Utilization Plan (WUP), signed by the owner and a certified technical specialist, containing:
a. The t iethod by which waste is applied to the disposal fields (e.g. irrigation, injection, etc.)
It. A ma of every field used for land application (for example: irrigation map)
c. The s oil 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 t imitation PAN to be applied to every land application field
g. The waste application windows for every crop utilized in the WUP
h. The t quired MRCS Standard specifications
2. A site in
3. Emergency Action Plan
4. Insect C nlrol Checklist with chosen best management practices noted
5. Odor C abut Checklist with chosen best management practices noted
6. Mortali Control Checklist with selected method noted - Use the enclosed updated Mortality Control Checklist
7. Lagoon forage 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.
S. Opertak n and Maintenance Plan
If your CAWM P includes any components not shown on this list, please include the additional components with your submittal.
(e.g. compostin , digesters, solids separators, sludge drying system, waste transfers, etc.)
I attest that thiJa
application has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that,
if all requiredrts ofthis application are not completed and that if all required supporting information and attachments are not
included, this plication package will be retuned to me as incomplete.

Note:, In
statement,
U.S.C. Seci
for a simila
Print the M
should sign
Name (Prin
Signature:
Name(Prin
Signature:
Name (Prin
Signature:
acco,
dance with NC General Statutes 143-215.6A am
'epre
ion 101
entation, or certification in any application may t
provides a punishment by a fine of not more th
r offe
se.)
,me o
the Perminee/Landowner/Signing Official and Sil
HL
undowner is a corporation, signature should be by
THE COMPLETED APPLICATION SHOULD B:
E-mail: animal.operai
NCDEQ-I
Animal Feeding Ope'.
1636 Mail Sery
Raleigh, North Caro
1 143-215.613, any person who knowingly makes any false
e subject to civil penalties up to $25,000 per violation. (18
an S 10,000 or Imprisonment of not more than 5 years, or both
in below. (If multiple Landowners exist, all landowners
t principal executive officer
/of the corporation):
Title: -Z7 , 4�57/�+yf
Date: 7 —� �/
Title:
Date:
Title:
Date:
E SENT TO THE FOLLOWING ADDRESS:
[ions®deq.nc.gov
)WR
rations Program
ice Center
Tina 27699-1636