670048_OIC Designation Form_20240213

State of North ( arolina
Department of Ensfronmenlaf Quality
Disision of haler Resources
Animal Nasle Management Systems
Request for Cenifitation of C of erlgc
Facilio Currently covered Its an kpiring Sale Nun -Discharge l,ener.d Pemnl
Oil September W. 2024. the Nonh Carolina Statc 'son-Di,charec General pernuts for %Itllnal \\a,te Management Sy aem, wdl
expire \, required by these peratim facifitics that hasc been issued Ccnificate, of Cu.cmec h• operate under thc,c state
\on-lhxharct General Pernm, must apply tin trnewal at lead 180 Jays prey to Their expiration date Therefore all irphcauon,
must he recciscd bs the Uhision of \later Resourecs by no later than A f,613.2112J
Please do not Iron umque,lion ummiurred. Phase verift all inlnrnratunl and male unr nereswn• tarretrinns IMlolr.
7pplu arrant most In- signed and dated In, the Permitter.
I Ccndicalc Of Cowrace \umber. A\%SWIM1118
2 l4olih\amc Moms lfrinsou l ann'i
I Pe•mlitiei , \amc (same as in the \kulc ManaBcnlrnl Ilan I \Norris Rnmon
q. Peratuces Mailing Address' 51 t A 1 Pas Tor RJ
Cm Richlands State. \C Tip: 2857q
telephone \umber 910.189-9954 Psi I:,mad
5. Faciliy\ phssicalAddress:
C fly: State: Zip:
6. County where Facility is located. Onsloss
7. Fann \tanager's Same lif dillercnt from Landuwnerl: /
g I arm Manager's telephone number l induJe area code) 1� rh"\LA.f
9 haegramrs \amc lit there I, not an hacerator. "rile "Sohn"). \11-pnnrni-hF�l Tom/
III. Operator \ante Off) +�r.'s.I. Phone V, Atuf- 30Afrtlo� OTC - 16215
nreroJt, ryrA ;T! y9Iv
11. Lessees \amc of Ihae is not a I. esscc. ,sntc "N,mdl: /I A 9D
12 InJlcne uninml operahlnuy pr and nundx•r.
Currant Fenno Operation, hpc \Ilowahlc Count
Somme - I ceder to I ini.li I.'_}I
Marat n Is
mine
LIM
N c:m b. I wall
Ilan, 1 all
N c;m In L.Jcr
D'Ir, 11okl
I an" I"Iln,h
Mid luu
I LCIkl II- I Inl,h
DI. co„
Lurow Tu Ncan
NO suh8cr(III
I anua to I «du
Ikcl I ccll,'1
❑Iwr stud
Ikd linaJt ua
(nit,
Isom
I Ilhwr
Dr, 1'uulln
00r r hric,
\nn I.o mg( hldcn,
Iform,- Ilnrm,
141111g l 111LUr,
Ilnl v,-In1"
fuller,
sheep - sheep
lulk„
sheep-umcr
I udc, Pnikl
NCI Poulin
\on I nl arg NIL I
I ncr,

is \1nac lnabnvutl�
I'nnds (%%sp) If dl\citl\ the bdlow mg mhrrnmuon
lof Ik•tgn l rccNI.ud
t_. .. Iincr his,
bu'gcJhna-
,nr!aae
Sni„I,m il�r.,.,n lnpcaa� IUt. tl t y)noI Vic..
"rus,1.cctl IInoIM.i
l\sl'I ILuh Lnt.
loon
x
ton n4
�ubmil one 111 raps of the (rnifieA Animal \lade %ismagement Plan (( AN'tl Pl "ith This completed and signtil
application a, required It,\C General Stalutes lqd-21 ,.To( (d). either by mailing In the address belo" or semlm% n sia
email to the email address brio".
the l%\% kill most include the following component,
I. The most recent Waste L lilhauon Plan (Nl Ill. si ned hs the owner and a certified technic al ,Ira talNl. a .nidlnni-
a The method bT which "rite ,applied to the disposal fields (c.g. !mgat!on, mlaoon. cts I
b. \ map of esery field used for land application ;far example: Irrigation map)
c The soil series present on escrs land application field
d The crops gru"n on esers land application field
c The Realistic N uld E\peclatlon IRYE) for eseD crop shoscn in the N L P
f The mammon IC4\ to be applied to escn land application field
e. The wa,te application "indo"s for evcp crop utibicd in the \kL 1'
h. The required SRC'S Standard specifications
2 \ site map schematic
?. Emergenq Action Plan
A Insect Control Checklist "ith chosen best management practices noted
j Odor Control Checklist %ith chosen hest management practices nolcd
6 \lonafit\ Control Checklist "ilh selected method noted . Use the enclosed updated \hit]alit) Control Checklist
7 lagoct storage pond capaciq documentation (design, calculations, etc Please be sure the abo%c table Is
accurate and complete \Iso pro%idc an) site evaluations, wetland determination,. or hartrd classifications that may be
applicable to psur facllll)
g. Operation and %humenalue Plan
11 your c %\%.MP include, am components not +ho"n on this list. please include the additional componcnG x nh )our suhmnlil
Ie g uanpcainc, Jicestrn. "did, separators, sludge drying sy stint. ssaste transfers, etc I
I attc,t that this application has been res is"cd hl ore and is accurate and complete to the best of mT kit."sledge. I understand that.
of all required parts of this applralion arc not completed and that if all required supporting information and attachments arc not
invluded. this application padwge w ill be returned to net as Ittcontplete

Note In accordance udh \( (icnend Sta611cs I41-2156A and I1 i.21' 68any pernml ssho Anossmgly males any lalw
>Lucmentrcrrewmauon. or cendicalion in any apphcanon may he subl«t to cwl penahles up to S_�AOf) per sndau,.n I la
I � ( Section 1001 pnaIda a punishment by a Zinc of not more than S10.000 or impmnnment al not tm rc than S )can. or N4
fora millar ollrme I
Pnnl the Name of the Pammittce 1 : downer Signing Otlicial and Sign belo"Aff maluple I. andossncrn et Pt. all land.nsntn
should sign I(Iandnwner lc a corporation, signalurc should be hs a principal cse.uusc olli«rut as corrontion),
Name (Print) _G/'/"f 5 'sI w'� ear✓ Idle 7W/'('/�
�� [ �-
Slenanlre _ .<✓e?,; ✓. Ge�w�'�- — - — Dale
\amc 1Pnitt) Title
Slcnaturc Date
\amc IPnnt)- Title
Slcnaturc Date.
IIIL: COMPLLI F D APPLIC 11I(V SIIO( 11) BE SLN1 10 1111 1(11 1 t N11W %DDRI-W
E-mail: animal.operations a detime.gm
�CUk:Q-UN R
:Urinal Feeding Operations Program
1636 Mail Senice (.-enter
Raltieh. North Carolina 2'699-1636