310522_Owner (Name Change)_20180427

Notification of Change of Ownership
Animal Waste Management Facility
(Please type or print all information that does not require a signature)
In accordance with the requirements of 15A NCAC 2T .1304(c) and 15A NCAC 2T .1305(d) this form is official notification
to the Division of Water Resources (DWR) of the transfer of ownership of an Animal Waste Management Facility. This
form must be submitted to DWR no later than 60 days following the transfer of ownership,
General Information:
Previous' ame ofFerm: acklity No:& - Z�
Previous Owne Phone N /O
NewOwner(s)Name: _ - Phone Notl��dZ�Y F�ld'7
New Farm Name (if applicable): -7 & W Afir
Mailing Address:_
It zaatw__
Farm Location: Latitude and Longitude{��� t/ L9_ " a
County:
Please attach a copy of a county road map with location identified, and provide the location address and driving directions
below (Be specific: road names, directions, milepost, eto.):
Operation Description:
Type Of&LW No ofAnimafs Type ofNine No. ofAnimals
❑ Wean to Feeder ❑ Gilts
❑ Wean to Finish ❑ Boars
l�eedertoFbdsh
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other Type ofLivestocic Number ofAnimals:
Acreage Available
Number ofIaaoon
Required
Total Cat
Type ofCattle No, ofArdmafs
❑ Dairy
❑ Beef
Type of Poultry No. ofArrtmals
❑ Layer
❑ Pullets
Cubic Feet
Owner / Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing, 1(we) understand the operation and
maintenance promdures.established in the Certified Animal Waste Management Plan (CAWMP) for the firm named above
and will Implement these procedures, I (we) know that any modification or expansion to the existing design capacity of the
waste treatment and storage system or conatrucdon of new facifit es will require a permit modification before the new
animals are stacked. I (we) understand that there must be no discharge of animal waste from the storage or application
system to surface waters of the state either directly through a man-made conveyance or from a storm event less severe than
the 25-year, 24-hour storm and there must not be nun -off from the application of animal waste, I (we) understand that this
facility may be covered by a State Non -Discharge Permit or a NPDFS Permit and completion of this farm authorizes the
Division of Water Resources to issue the required permit to the new landowner.
Name of New
Name of Manager (if different from owner): I P
Please sign and return this form to:
Date:
Animal Feeding Operations
N. C. Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699-1636
June 12,2015