900077_Application - Cattle Gen Permit_20240916

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Animal Feeding Operations Permit Application Form
(TIIIS FORiI.iL4YBE PHOTOCOPIED FOR USE AS AA- ORIGI_VAL)
State General Permit — New or Expanding Animal Waste Operations
1. GENERAL INFORMATION
i ;-
1.1 F'acilityname: �d l i n cl d d -y..;: i.r j
1.2 Print Land Owner's name:
1.3 Mailing address: LUI I III VH't
1
City. Stater Vlr'if:•C, iVL Zip: -Z ry I; t ,
n
Telephone number (include area code): (� ` 6
1.4 Physical address: �6 LA -ill Q11 Vi I it
City. State: "Qw lft, C iL L Zip:
Telephone number (include area code): 2,oi _ �j w L
1.5 County where facility is located: U111 s i
1.6 Facility location (directions from nearest major highway, using SR numbers for state roads): 2jS &- -&4- 1 1 liF'i i 1 h j �Qli�
1.7 Farm Manager's name (if different from Land Owner): V'
mac. 2 Milta ; �'► Lttr vltu
1.8 Lessee's I Integrator's name (if applicable: circle which type is listed): �tnikalvi IUr fii i1`Y j23cL l �i�iGi i i J
1.9 Facility*s original start-up date: L�..� °-j Date(s) of facility expansion(s) (if applicable):
2. OPERATION INFORMATION:
2.1 Facility number: 1
2.2 Operation Description:
Please enter the Design Capacity- of the system. 'I'he "No. of Animals" should be the maximum number for which the
waste management structures were designed.
Type of Swine No. of Animals Tv of Poultry. No. of Animals Type of
Cattle No. of Animals
Wean to Feeder Layer Beef Brood Cow
Feeder to Finish
Non -Laver Beef Feeder
Farrow to Wean (4 sow)
Turkey" Beef Stocker Calf
Farrow to Feeder (9 sow)
Turkey Poults Dairy Calf
Farrow to Finish (# sow)
Dairy Heifer
Wean to Finish (# sow)
Dry Cow
Gilts
Milk Co-
Boar/Stud
Other Type of Livestock on the farm: No. of Animals:
2.3 Acreage cleared and available for application ;,excluding all required buffers and areas not covered be the
application .S;r f
system): Required Acreage (as listed in the CAWMP):
2.4 Number of lagoons: Total Capacin (cubic feet): Required Capacity (cubic feet): _
Number of Storage Ponds: Total Capacity" (cubic feet): Required Capacin (cubic feet):

2.5 Are subsurface drains present within 100' of am of the application fields? YES o `� NTO,� (circle one)
2.6 Are subsurface drains present in the vicinity or under the waste management system? YES or'yN0
(circle one)
2.7 Does this facility meet all applicable siting requirements? t YES%or NO (circle one)
3. REQUIRED ITEMS CHECKLIST:
Please indicate that you have included the following required items by
item. signing your initials in the space provided next to each
Applicants Initials
3.1 One completed and signed original and two copies of the application for State General
Permit - Animal Waste Operations:
3 2 J jf� Three copies of a general location map indicating the location of the animal waste
facilities and field locations where animal waste is land applied and a county road map with the
location of the facility indicated:
3.3 / 0 Three copies of the entire Certified Animal Waste Management Plan (CAWMP). If the
facility does not have a CAWMP, it must be completed prior to submittal of a permit application
for animal waste operations.
The CAWMP must include the following components. Some of these components may not have been required at the rime
the facility was certified but should be added to the C AW.VP for permitting ptttposes:
3.3.1 e- 11NRCS Site Evaluation Form NC-CPA-17 or equivalent
3.3.2 A hazard classification of the proposed lagoons, if required
3.3.3 Documentation that proposed swine facilities meet the Swine Farm Siting Act, including a site map
prepared by a Registered Land Surveyor. The scale of this map shall not exceed 1 inch = 400 feet. At a
minimum, the site map shall show the distance from the proposed houses and lagoons to occupied residences
within 1500 feet, schools, hospitals, churches. outdoor recreational facilities, national parks, state parks,
historic properties, or child care centers within 2500 feet, property boundaries within 500 feet, water supply
wells within 500 feet. The map shall also show the location of any property boundaries and perennial streams
or rivers located within 75 feet of waste application areas.
3.3.4 Documentation showing that all adjoining property owners, all property owners who own property
located across a public road, street, or highway from the facility, the local health department, and the county
manager or chair of the county board of commissioners if there is no county manager, have been notified by
certified mail of your intent to construct or expand a swine farm at this location.
3.3.5 A wetlands determination
3.3.6 The lagoon/storage facility design
3.3.7 Proposed runoff control measures, if required
3.3.8 Irrigation or other land application method design
3.3.9 fi, The Waste Utilization Plan (WUP) must include the amount of Plant Available Nitrogen (PAN) produced
and utilized by the facility
3.3.10 L The soil series present on even waste disposal field
3.3.11 The crops grown on every waste disposal field
3.3.12The Realistic Yield Expectation (RYE) for every crop shown in the WUP
3.3.13 4� Itt The PAN applied to every waste disposal field
3.3.14 L J/ The waste application windows for every crop utilized in the WUP
3.3.15 t? { The required MRCS Standard specifications
3.3.16 P Emergency Action Plan
3.3.17 1? j Insect Control Checklist with options noted
3.3.18 C. r1t Odor Control Checklist with options noted
3.3.19 �1 1 f Mortality Control Checklist with options noted
3.3.20 Documentation proving this facility is exempt from the Moritoria on
Construction or Expansion of Swine Farms, if the application is for a swine facility

3.3 21 L /- A map showing the tTpographN of the proposed facility location showing
features that affect facility design, the dimensions and elevations of any existing
facilities, the fields used for waste application, and areas where surface runoff is to
be controlled
If your CAWMP includes any components not shown on this list, please include the additional components with your
submittal. (Composting, waste transfers, etc.)
4. APPLICIt--
T'Sp,C,E,RTIFICATION:
A! f _ _ __ (Land Owner's name listed in question 1.2), attest that
this application for �.e` t } a j _(Facility name listed in question 1.1)
has been reviewed by me and is ccurate 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 e eturned to mg �s in omplete. _
Signature _YI t7� Date
5. MANAGER'S CERTIFICATION: (complete only if ditTerent from the Land Owner)
___ _ (Manager's name listed in question 1.6), attest that this
application for (Facility name listed in question 1.1)
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 as incomplete.
Signature — Date
PLEASE SUBMIT THE COMPLETED APPLICATION PACKAGE, ALL SUPPORTING INFORMATION AND MATERIALS,
AND ANY PLANS AND SPECIFICATIONS TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
ANIMAL FEEDING OPERATIONS PROGRAM
1636 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
ELECTRONIC SUBMISSION IS ENCOURAGED. EMAIL TO RAMESHAAVELLA^a,NCDENR.GOV
=6. SURFACE WATER CLASSIFICATION:
This form must be completed by the appropriate DWR regional office and included as a part of the
project submittal information.
INSTRUCTIONS TO NC PROFESSIONALS:
The classification of the downslope surface waters (the surface waters that any overflow from the facility would flow toward) in
which this animal waste management system will be operated must be determined by the appropriate DWR regional office.
Therefore, you are required, prior to submittal of the application package, to submit this form, with items 1 through 6
completed, to the appropriate Division of Water Resources Regional Aquifer Protection Supervisor (see page 6 of 10). At a
minimum, you must include an 8.5" by 11" copy ofthe portion of a 7.5 minute USGS Topographic Map which shows the
location of this animal waste application system and the downslope surface waters in which they will be located. Identify the
closest downslope surface waters on the attached map copy. Once the regional office has completed the classification,
reincorporate this completed page and the topographic map into the complete application form and submit the
application package.
6.1 Farm Name:
6.2 Name & complete address of engineering firm:
Telephone number: ( ) -
6.3 Name of closest downslope surface waters:
6.4 County(ies) where the animal waste management system and surface waters are located
6.5 Map name and date:
6.6 NC Professional's Seal (If appropriate), Signature. and Date:

TO: REGIONAL WQROS SLTERVISOR
Please provide me with the classification of the watershed where this animal waste management facility will be or has been
constructed or field located, as identified on the attached map segment(s):
Name of surface waters:
Classification (as established by the Environmental Management
Commission):
Proposed classification, if applicable:
Signature of regional office personnel:
(All attachments must be signed)
L-DIVISION OF WATER RESOURCES REGIONAL OFFICES (4/2020)
Asheville Regional WQROS Supervisor Washington Regional WQROS Supervisor Raleigh Regional WQROS
Supervisor v
2090 U.S. Highway 70 943 Washington Square Mall 1628 Mail Service Center
Swannanoa, NC 28778 Washington, NC 27889 Raleigh, NC 27699-1628
[phone] [phone] [phone]
Fax [phone] Fax [phone] Fax [phone]
Avery Macon Beaufort Jones Chatham Nash
Buncombe Madison Bertie Lenoir Durham Northampton
Burke McDowell Camden Martin Edgecombe Orange
Caldwell Mitchell Chowan Pamlico Franklin Person
Cherokee Polk Craven Pasquotank Granville Vance
Clay Rutherford Currituck Perquimans Halifax Wake
Graham Swain Dare Pitt Johnston Warren
Haywood Transylvania Gates Tyrell Lee Wilson
Henderson Yancey Greene Washington
Jackson Hertford Wayne
Hyde
Fayetteville Regional WQROS Supervisor Mooresville Regional WQROS Supervisor Wilmington Region WQROS
Supervisor
225 Green Street, Suite 714 610 East Center Avenue 127 Cardinal Drive Extension
Fayetteville, NC 28301-5094 Mooresville, NC 28115 Wilmington, NC 28405-3845
[phone] [phone] [phone]
Fax [phone] Fax [phone] Fax [phone]
Anson Moore Alexander Lincoln Brunswick New Hanover
Bladen Richmond Cabarrus Mecklenburg Carteret Onslow
Cumberland Robeson Catawba Rowan Columbus Pender

Harnett Sampson Cleveland Stanly Duplin
Hoke Scotland Gaston Union
Montgomery Iredell
Winston-Salem Regional WQROS Supervisor
450 Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Phone [phone]
Fax [phone]
Alamance
Rockingham
Alleghany
Randolph
Ashe
Stokes
Caswell
Surry
Davidson
Watauga
Davie
Wilkes
Forsyth
Yadkin
Guilford
FORM: AWO-STATE-G-1V/E 4/17/2020 Page 1 of 5