820035_OIC Designation Form_20220418

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
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,
ase o not leave any quest on unanswered P ease veiVy- X Tn7o_rmadon`­a_n_d mail any necessary corrections below.
Appitcatlon must be signed and dated by the Permittee.
1. Certificate Of Coverage Number; AWS820035
2. Facility Name: Sessoms Southern Swine, LLC - ���Vhr5 Rp^
- 3. 'Permittee'§ Name'(same ag on he -Waste Management Plan)'— J6 ferVDean Sesgoms
4. Permittee's Mailing Address: 15 Cigar Ln
City: Roseboro. State: NC
0goo _
Telephone Number: 910-305-NA4,Ext. E-mail: [e-mail]
5. Facility's Physical Address: 1992 McDaniels Rd
City: Clinton State: NC
6. County where Facility is located: Sampson
7. Farm Manager's Name (if different from Landowner): Lariy S Ammons
8, Farm Manager's telephone number (include area code): 910-564-6765 Ext.
9. Integrator's Name (if there is not an Integrator, write "None"): Prestage Farms Inc
10, Operator Name (OIC): Larry S. Ammons, Phone No.: 910-564-6765
11. Lessee's Name (if there is not aLessee, write "None"):
12. Indicate animal operation type and number:
-_ C-urrerrt-Permit:, t9paratimrs Tyke Atluwable-C-oufTr --
Swine - Wean to Feeder 6,080
Operation Tunes:
Swine
Cattle
Wean to Finish.._
Dairy Calms -----
Wean to Feeder
Dairy Heifer
Farrow to Finish
Milk Cow
Feeder to Finish
Dry Cow
- -Farrow-to Wean
—Beef Stocker Calf
Farrow to Feeder
Beef Feeder
Boar/Stud
Beef Broad Cow
_..__�._. Gilts _...
Other
- -----Other-- ---- ..... ----
- -- --- ---
Dry Poultry
Non Laying Chickens_
Laying Chickens
Pullets
Turkeys
Turkey Pullet
Zip: 28382
Zip: 28328
OIC #: 18342
Other Tunes
_--Horses-Horses_
Horses - Other
Sheep- Sheep
Sheep - Other
Wet Poultry
No 4Y_LU9.?U ll�_ ...-.. �--_.. __ I ...-
Layers

13. Waste Treatment Lagoons, Digesters and waste Storage Ponds (WSP): (Fill/verify the following information.
Make all necessary corrections and provide missing data.)
Structure11 pe Estimated Liner Type Estimated Design Freeboard
Structure (Lagoon/Digester/ Date (Clay, Synthetic, Capacity Surface Area "Redline"
Name WSP) Built Unknown) (Cubic Feet) (Square Feet) (Inches)
1 Lagoon 11/16/1993 Fall, clay 2739834.00 393,000.00 19.00
Lagoon 20.40
%bmit:-01the ertif AnnUn age - anagemen(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 roust 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-byRwhichrwaste �is-appiW-W t wd�i�l #lolds *(e-g iirngationinredtion, etc .)' --- ....-.. _.__..... -. _ . __. .
b. A map of every field used for land application (for example: irrigation neap)
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 MRCS 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
_ � `WMP inc u es any componen no s own on U1s Est, please iinclude 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. (18
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): ): Title. OVWJ"*
Signature: tsi Date: (, �� OALf
-Name rent • ._ _ .-- -- --- Title:
Signature; Date:
..Title; -
Signature: Date:
THE COMPLETED APPLICATION SHOULD BE SENT TO THE FOLLOWING ADDRESS:
E-mail: [e-mail]
NCDEQ.-DWR
Animal Feeding Operations Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636

Animal Waste Management System Operator Designation Form
Facility/Farm Name:
WKSOCC
NCAC 15A 8F .0201
Sessorns Southern Swine, LLC (Grandson's Farm)
Permit #: AWS820035
Operator In Charge (OIC)
Facility ID#: 82 - 35 County: Sampson
Name: Glen Allen Norris
First Middle Last Jr, Sr, etc.
Cert Type Number: 2 7 4 4 6 Work Phone:
yp C �
Signature: Date: Vla
VV
" I certify that I agree to my designation as the Operator in Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
First Middle Last Jr, Sr, etc.
Cert Type / Number:
Signature:
Work Phone: (
Date:
" I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Owner/Permittee Name: Jeffery D. Sessoms on behalf of Sessoms Southern Swine, LLC
Phone #: [phone] Fax#:
Signature: Date: r�1 44-
(Ow r utho agent)
Mail or fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
(Retain a copy of this form for your records)
Revised 8/2007