970002_INSPECTIONS_20171231

Type of Visit: XCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C\4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: o Departure Time: 3D County: W Region: WS R a
Farm Name: A -, 5 -S oAt$ Fa I`m Owner Email:
�- /� , ` v 4z'
Owner Name: S I`P >O CL 1S Phone:, F -I T+ � � 7 p g / —3-7 $­S_
Mailing Address:
Physical Address:
Facility Contact: ern h n or LU Title: Phone:
Onsite Representative: U il� V Integrator:~�
Certified Operator: / Certification Number -
Back -up Operator:
Location of Farm:
Certification Number:
p I�
Latitude: 3 & & a $ i � 11 Longitude: 1910d � q ` ® 9
U5 qa1 N fo 1-5 P6LrM— a.- -v+-h L
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish jj ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Ca gci.
C►urrent
Dry Cow
Farrow to Feeder
D , i quitr,
I Layers
P
Non -Dairy
Farrow to Finish
13eef Stocker
Gilts
Non -Layer
Beef Feeder Q
Boars
Pullets
Beef Brood Cow
Ot
Other
Turke s
ey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes PNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes t No
❑ Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 9-7- • JDate of inspection: oZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u V P-rP4 P r f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 03No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes �No ❑❑ NA ❑ NE
❑ DN 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No I A ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ���---"'/
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s): r
Lli�-�itJ
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes
J� "o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[] No
NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
�;�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ZYcs
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
K No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
COINo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement?
❑ Yes
XNo
❑ NA
❑ NE
Application Weekly Waste Analysis Soil Analysis
[—}*este-q'�rarrsfers
Weather Code
Rante
ainfall 1 f Stocking *rop Yield ❑ 120 Minute Inspections Monthly and V Rainfall Inspections
r
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[:] No
XNA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Z . Date of inspection: —7QZ 4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [(No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes !S o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes oNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Nar4o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
tRKo
❑ NA
❑ NE
❑ Yes
Y No
❑ NA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
❑ Yes
X<O
❑ NA
❑ NE
❑ Yes XNo ❑ NA
❑ Yes f�No ❑ NA
❑ Yes C�-<o ❑ NA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments.'
Use drpons of facility to better explain situations (use additional pages as necessary).
,;t b 13 016L I 't ra n NO 0_� l ra_ o h FEZ 70 u u�
ISP[�40-l� -SIG ►rt b��T waSf�. �lan
U MA� _LM4_r_j
boo
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
❑ NE
❑ NE
C&L41 6,0 kL'� I ined
,,* ? laj te, P_.. Fe) P-rut
5e� r
Phone:
Date:
214,12011

(Type of Visit: ?ZC9mpliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit: ��(! Routine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access 1
8
Date of Visit: Arrival Time: Departure Time: County: KA!S Region:
Farm Name: A 5 S (fit' Fc rrn Owner Email:
Owner Name: 5��� Q Phone: F RS'�- 3390 N -37 s'S
Mailing Address: S our r IZ71 Ue-r
Physical Address:
Facility Contact: To V, n a r U u V- e- Title:
n� `y1 -0
Onsite Representative: LU V. fl NkbQ 1%'l
Certified Operator:
Back-up Operator:
Phone:
L G - 98 Z7 - s3]
Integrator: --� _T C S .2
Certification Number: T O— q g 4— a w )
Certification Number:
Location of Farm: Latitude:_s_j ( ()g SK Longitude: Iqjo 5—q Q L
U 5 +a 1 N 1 tkaAvls Farm- M • e-y, t+.) fcXr rn, i rnl IL om le*F+
Design Current
Swine Capacity Pop.
Wean to Finish
RNon-La
Design Current
Wet Poultry Capacity Pop.
La cr
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
er
Dairy Calf
Feeder to Finish
Design Current
Dr> P.ouit . Ca aei P.o ,:Non
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
-Dairy
Beef Stocker 7
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 56 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 91<0
❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - . Date of Inspection: Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes YNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes �No ❑ NA ❑ NE
maintenance or improvement? X(No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): YJ QQJf .LAj
13. Soil Type(s): !]`
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
f4NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [] Design ❑ Maps [:]Lease Agreements ❑Other:
W21. oes record keeping need improvement?. ❑ Yes No [] NA ❑ NE
Waste Application �Fie Waste Analysis Soil Analysis [Weather Code
Rainfall /Stocking Crop Yield 20 Minute Inspections Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: ­- • Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [*No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes XNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes NTo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Xo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes ❑ No
❑ NA ❑ NE
�] Application Field ❑ Lagoon/Storage Pond ❑ Other:
T�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [16o
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use,dxglyings of facility to better explain situations (use additional pages as necessary).
�
;?JM�
a� ..
t4L)
j
I �
Reviewer/Inspector Name:
V�viewer/Inspector Signature;
uge 3 of 3
3 ;t AM N((OwI n,4 bp * 0u+ bqpro duc+ on *416r
Phone:
Date:�J�o�
2141011
t&nd C PC) U1i ry

Type of Visit: Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance . I
Reason for Visi : Routine O Complaint O Follow-up O Referral () Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: I X I,• $ Q County: W I t l[�° S Region: Lk-6 Q
Farm Name: �� q I,S' ��rm Owner Email:
Owner Name: S'�PJ�I �. �T �,�s Phone: F '1$4- 3 nO q q -3 ?9,5`
Mailing Address: s __0CL*.5 ar Roo_X-Nl�yVey— NC-
Physical Address:
Facility Contact: ltt O f LJ kLe Title:
Onsite Representative: _L) I (L\W's
Certified Operator: L L) t`"'�
Back-up Operator:
Integrator:
Phone: �-
T6) QS7-017-10;L
Certification Number: _ q is- d
Certification Number:
Location of Farm: Latitude: t ol;� 5� I Longitude: <�o q-9 0,5?
Swine
Design Current Design Current Design Curreut
Capacity Pop. Wet Poultry CapaNO-acit-VINPap.
La er Dairy Cow
Wean to Finish
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, P.oultr,
Design
C•_a acr
Dairy Heifer
Current Dry Cow
P,o Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes pQ No ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - • Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [}, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes [] No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2 Structure 3
Covered
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
[:]Yes ❑ No
WA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes
XNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes jbg<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
[] Application Outside of Approved Area
12. Crop Type(s): r '
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No TA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Wo
� N'❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records & Documents '
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes�1�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [,] Yes �fXrNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. es record keeping need improvement? I€jca Yes ❑ No �Xeather
❑ NE
4=2Waste Applicat' n Waste AnalysisYonthly
il Analysis aste Transfers Code
[+Rainfall tocking Crop Yield 6�20 Minute Inspections and L" Rainfall Inspections ,B.g.4WV_%rvep--
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JNrs4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No .;R,'�A ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste appilion equipment as required by the permit?
❑ Yes XNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [:]No
NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
.01
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31 D subsurface the drains exist at the facility? If yes, check the appropriate box below.
�Ycs ❑ No
❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.77Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..),,':
Use drawings of facility to better explain situations (use additional pages as necessary).
Ace. i;zo1 gd
3 a. Trox+ III F 4 1- ` y _-7 Re c e i v e d no
i
S � n e �. Ic�S-t-- i � s ��cg4'c on • 4V o S � r �
'�
cry �a Sf� Sam* 1e
�uu i T� v l re �� JZ F9�R �,7 FId
5
/P-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r (�
Date: 1 x
21412011

I
Type of Visit ACompliance Inspection ' 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: •f kG Region: W5 R 0
Farm Name: AS T Ma ,s Farm Owner Email: q
Owner Name: �S'f-eV�. A' "� �S Phone: N 1q ,f�-" ��S (N4 /Y — -37, --
Mailing Address: _1 Gagrfia K fl/1Gi N G ��irrCi
Physical Address: L k ICt;
Facility Contact: ✓ ✓IMq 1 f f Title: Phone No: Lj�) 95-7 O Z o Z
Onsite Representative: i^L4 lVLa 1rf Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
11Wy 11�24 Al.,
Operator Certification Number:
Back-up Certification Number:
Latitude: ®° OS E
Mq Pj �M Rm�1 ,PrJ h', F,rM ., Z mJIe,
Longitude: ® ° [a' M
0,t Le -A,
�esignuur rrent Design Crent Design C►urrent
Swine C►►apacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish 10 Layer I 1 ❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer 1
❑ Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
Non-Dai C0
❑ Layers
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
IF Turkey Poults
10 Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Jib No ❑ NA ❑ NE
❑Yes ❑No
❑NA
❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑Yes ❑No
❑NA
ONE
❑ Yes ANo
❑ NA
❑ NE
❑ Yes )1�o
❑ NA
❑ NE
12128104
Continued

t Facility Number: - Q Z 1 • Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: d i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threa s to the integrity of any of the structures observed?
❑ Yes J�`No ❑.NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes k No []NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes J�[I No ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes f❑ No XNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Ar mlication
10. Arc there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes k No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) Kerfi J;. 1 / f lrar,4 d-SM�t�� gl�Jn Cdd%fWOp,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NOX NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (rcfer to question . #)i .Explain -any YES answers and/or any recommendations or any other comm.'entsrr :, W
Use drawings of facility to better explain situations. (use additional pages as necessary):` i
Reviewer/inspector Name ��
i,'s�;`� �1 ;�`° Phone:
r ,ti
Reviewer/Inspector Signature:
Date: Z3 Zor D
Page 2 of 3 12129104 Continued

•Facility Number: 7 — d 1�of Inspection 0 L3 0
Required_ Records & Documents Xyes
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑YesXNo ❑ NA ❑ NE
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does keeping need improvement? if yes, check the appropriate
belo[
ElYesNo
[INA
[INE
�record ;box
Waste Application asteAnalysisoil Analysis
Rainfall 0 Staddug- 1kCrop Yield onthly and 1"
Rain Inspections B<eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
WNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes k,
[I NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes)�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes *o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes WNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes WNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes )No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes rNo
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYeso
❑ NA
❑ NE
Additional Comments and/or Drawings:;,
L
��G /�CA7�1�/t itlp/�G►'�' CLV�/�1�i0Y1 VLF DG
�JIv� Cp ZOlDI
US
aI�✓
J ee_,j h 9 CS,5, A— l�rle,
or ✓ f�-� �i1 f tl e
1
u �j
nS,
Page 3 of 3 12128104

Division of Water Quality
Facility Number Division of Soil and Water Conservation
O Other Agency
Type of Visit I
Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit (Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
�--�Date of'Visit: Uisit: ! Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: tit
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator: _
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: N—IQ e
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
01E6
Longitude: 0] ° ®i ®11
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
Non -Dairy
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes %No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes KNo ❑ NA ❑ NE
❑ Yes �eNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stru ture 1 _+ Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: PL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � No ❑ NA ❑ NE
& Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 03No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;No ❑ NA ❑ NE
maintenance/improvement?
It. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,� f
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
NA
❑X
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Yes
El Yes
No
NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
ElYes
*o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
9No
❑ NA
❑ NE
Comments (refer to question #): Explain any. YES answers and/or any recommendations or anygothercomments` ,j ie'
Use drawings of facility to 6ettei'explam'situations. {useadditional pagEsas necessary } _Ai1�
k
t!,
i1� o 1 1 1 ✓
�+ � 3 r
a
U4 4XU-1—
.
Ce X�_,s 6z4d_�
W—L)P
o
Re iewerllnspector Name
Phone: $
Reviewer/Inspector Signatur
Date: a1 6
12128104 Continued

• Facility Number: e of Inspection
�9
Required Records & Documents ,,,,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Ipl Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes fi�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El maps El Other
M,
21. Does record keeping need improvement?ifyos, rlz@Gk ❑ Yes *o ❑ NA ❑ NE
tRaiaste Application Waste Analysis Soil Analysis , f
nfall ❑4toek+rrg Crop Yield Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ?No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes ❑No CTA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
Ibl No
El NA
❑ NE
El Yes
/❑ No
*A
❑ NE
❑ Yes
D No
ElNA
❑ NE
❑ Yes
XNo
❑ NA
ElNE
PAA_
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes [,,No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �To
El NA
El NE
and report the mortality rates that were higher than normal?
I \
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
'kNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
tNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
h :F
y^�
! f
I I
l
03
L
!
// 12128104

Facility Number
0
Division of Water Quality
Division of Soil and Water
O Other Agency
nservation qw
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit {Routine 0 Complaint 0 Follow up 0 Referral ()Emergency 0 Other ❑ Denied Access
Date of Visit: 3 a Arrival Time: w) Departure Time: ': QQ County: _r6a I t Ke5 Region: WS Ao
Farm Name: 115 in l t 5 - _ Owner mail: 1 , I
Owner Name: T2V PhZ) s $b �4l 84I " $S
T�
Mailing Address: &ari ne?FQC. a t7 9
Physical Address: Q } e-
0 qgq- D-LOO—
Facility Contact: aT�h n 5 Title: Phone No:
•
Onsite Representative: ti,E hn l_5 �,i, t5 1ntegrator:
0 S C mAq'115 & cZ 1 I a L IS
Certified Operator: ,,.,_ pator Certification Number:
Back-up Operator: _
Location of Farm:
05 WWI qaf
lei'+.
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: ® Longitude: ® ICI
11
to Ma 15 Farm Pd . 2X_1q- Y furn ITT¢. arm 1 mi I e on
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys,
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
Non -Dairy
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: U
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potentials dverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
El NA
El NE
❑ Yes No ❑ NA ❑ NE
�s El No El NA El NE
12128104 Continued

Facility Number: 0 Date of Inspection
Waste Collection & Treatment KNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
I! , c a. If yes, is waste level into the structural freeboard? [I Yes ❑ No El NA El NE
405 Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
(p Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): lo-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q<No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ) No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No XNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes '' `` �No ❑ NA ❑ NE
maintenance or improvement?
Waste AADlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload [IFrozen Ground [IHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 1bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
a
12. Crop type(s)�6m S 1 /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElrNoYes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
XNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
%No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
*No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
3 4 onfLn ue- ePt`o
. asste �Sc� le �Q d. S Of 0PP1 i c(Z-hL) n
Reviewer/Inspector Name e,h Phone: M.
Reviewer/Inspector Signature Date: A I X
12128104 Continued

Facility Number: q I — t7a Wate of Inspection o� •
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA El NE
the appropirate box, ElWUP ❑ Checklists ❑ Design ❑ Maps [I Other // �'
21.
Does record keeping need improvement?
❑ YesXO
❑ NA
❑ NE
rite Application Waste Analysis oil Analysis Waste Transfers
w
❑ Rainfall 0 Stocking Crop Yield ;�K20 Minute InspectionsKonthly and 1"
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes krNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
WNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
I<NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes KN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
A Yes
❑ No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NrNo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�?�o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
X
ElNA ❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9'No
❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA ❑ NE
Additional Comments and/or Drawings:
I al
,e�.Iil�.a �
AL
4e5 f ? Talmo flat- S h l w a r+. 6k zc Ae__ new f- v 154 .
I
0& ibf-a*'0r1 due OclGbe✓ aoa%Sma d r`ain eove.,radrded io wrn.P No+ Ye: .. DPP i e-a-ko�
IT
0),
S~koct� h �j 1r s r u4 red un4n l you haue-
Fe�dS i n w5p 4!'6�t� Poo 40- Mow u
`�or�
C 1� rso --

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
O' Other Agency 3
Type of Visit Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit (YRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t Arrival Time: =Departure Time: l i ' a Z l l County:
Farm Name: Owner E aiL•
Owner Name: Phone. F/ }4%
Mailing Address: _[,o �__—�Q>� �ln ! �'� O4r t i �� L
Region:
;Lo I I IS es . rw-*.
--37ZS-
a 11,66 q
Physical Address: L M e- I,./
Facility Contact: �. ohvl �� Title; Phone No: V
On site Representative: 6 hV, NIO i• Integrator:
Certified Operator: to y I n `" LQ V Operator Certification Number: 19`t0z'_�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: [Mo ®' [�46 Longitude: ® o
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
Non-LayerEl
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
urkcx Poults
❑
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
j
❑ Dairy Heifei
E]Dry Cow
Non-Dai
tj
El
Beef Stocker 7
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: QJ
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [[� No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Yo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: gocQ — nn \oj.LYYIeA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X&o ❑ NA ❑ NE,
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �lo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ e,
7. Do any of the structures need maintenance or improvement? ❑ Yes 1A No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No
maintenance/improvement?
L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (NNo
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
El NA
El NE
O<NA
❑ NE
❑ NA
❑ NEB
El NA
❑NE
❑ NA
❑ NE
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) A44 _
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Comments
Use
❑ Yes
4No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
XNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19(N0
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
%No
El NA
❑ NE
(refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
drawings of facility to better explain srtuatrons. (use additional
pages as necessary}.
Reviewer/Inspector Name
p Phone:
Reviewer/Inspector Signatur
Date: a� 0
t12128104 Continued

Facility Number: — d Z, te of Inspection ( D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WuP ❑ Checklists
❑ Design El Maps El Other
21. Does r ord keeping need improvement?
Waste
❑ Yes
�No
❑ NA
❑ NE
ante Applicationsll L"f Analysis Soil Analysis Waste Transfers
Rainfa Stocking Crop Yield Lyitlu Minute Inspections Monthly and 1"Rain Inspection eather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0,N o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ No
[XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
VNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Nt"'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[(No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes '%No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
❑ NE
m and report the mortality rates that were higher than noral?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
%No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1, No
❑ NA
❑ NE
M,,ional Commentsi Drawings:
Pay 3�
ED IT,
�- / ' J
a
WIN
�I ' 1

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 970002 Facility Status: Active Permit: AWC970002 ❑ Denied Access
Inspection Type; Compliance Inspection _ Inactive or Closed Date:
Reason for Visit: Routine County: Wickes Region: Winston-Salem
Date of Visit: 1010412006_ Entry Time:12:10 PM Exit Time: 02:15 PM Incident #:
Farm Name: ASJ Mathis Fjrm Owner Email:
Owner: Steve Mathis Phone: [phone]
Mailing Address; 615 Mathis Farm Rd Roaring River -NC 28669
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant
Location of Farm:
Integrator:
Latitude:36°08'58" Longitude:80"59'08"
Farm Location: 421 north to Mathis Farm Road exit and turn left. Go 1 mile to Farm on left.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment Waste Application
Records and Documents Other Issues
Certified Operator: John M Mathis Operator Certificatlon Number: 21423
Secondary OIC(s):
On -Site Representative(s): Name
On -site representative John Mathis
Title
Phone:
24 hour contact name John Mathis Phone:
Primary Inspector: Melissa Rosebrock Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
21. 2005 soil test reslts ok, some fields need lime.
21. Need to bring rainfall records to inspection.
21. No beef manure applied this year. Poultry litter applied in April and May 2006.
21. Must use highest N value from waste sample, not an average since sample isn't taken from dry stack.
28. Must still have fields available and listed for beef waste. Combine waste plans?
Phone
Page: 1

i •
jI
Permit: AWC970002 Owner - Facility: Steve Mathis Facility Number : 970002
Inspection Date; 10/04/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
O Cattle - Beef Feeder 300 0
Total Design Capacity: 300
Total SSLW: 240,000
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
taste Pit PIT UNDER ROOF 96.0(
Page: 2

Permit: AWC970002 Owner - Facility: Steve Mathis Facility Number: 970002
Inspection Date: 10104/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes No NA NE
1, Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify'DWQ) ❑ ■ ❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
■ ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
■ ❑
❑
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a
❑
■ ❑
Cl
discharge?
Waste Collection, Storage & Treatment
Yes
No NA
NE
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5, Are there any immediate threats to the integrity of any of the structures observed (I.e./ large trees, severe ❑ ■ ❑ ❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑ ■ ❑ ❑
or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
■
❑
Cl
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits,
❑
❑
■
❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
■
❑
❑
improvement?
Waste Application
Yes
No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑
❑
improvement?
11. Is there evidence of incorrect application?
❑
■
Cl
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground? ❑
Heavy metals (Cu, Zn, etc)? ❑
Page: 3

•
Permit: AVVC970002 Owner - Facility: Steve Mathis Facility Number: 970002
Inspection Date: 10/04/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No NA NE
PAN? ❑
Is PAN > 10%/10 lbs.?
❑
Total P205?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1 Corn (Silage)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑
■
❑
❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■
Cl
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑
❑
■
❑
17. Does the facility lack adequate acreage for land application?
❑
■
❑
❑
18. Is there a lack of properly operating waste application equipment?
Cl
■
❑
❑
Records and Documents
Yes
No
NA
NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■
Cl
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■
❑
❑
If yes, check the appropriate box below.
WUP?
❑
Page: 4

• •
Permit: AWC970002 Owner - Facility: Steve Mathis
Facility Number: 970002
Inspection Date: 10/04/2006 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Records and Documents
Yes
No NA NE
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑
■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■ ❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)? ❑
❑ ■ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■ ❑ ❑
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑
❑ ■ ❑
26, Did the facility fail to have an actively certified operator in charge?
❑
■ ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ ■ ❑
Other Issues
Yes
No NA NE
28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
■
❑ ❑ ❑
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air ❑ ■ ❑ ❑
Quality representative immediately.
Page: 5

•
•
Permit: AWC970002
Inspection Date: 10/0412006
Owner • Facility; Steve Mathis
Inspection Type: Compliance Inspection
Other Issues
31. Did the facility fail to notify regional DVvQ of emergency situations as required by Permit?
32. Did Reviewerlinspector fail to discuss reviewlinspection with on -site representative?
33. Does facility require a follow-up visit by same agency?
Facility Number: 970002
Reason for Visit: Routine
Yes No NA NE
❑ ■ ❑ ❑
❑ ■ ❑ ❑
❑ ■ ❑ ❑
Page: 6

Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:
T�
Arrival Time: a parture Time:
County:
Farm Name:
A 5�
Qj 15 Far
Owner Email:
Region: LL—�
Owner Name: vie- 1 1f 1 , 5r ,{ Phone: �; 3 ?6 A V$ T 3 7 3. ��
Mailing Address: 1S ! V OMN 5 I a.r PA �C1� r ` i V� g 2 I vLr . I `yam 2&h 7
Physical Address: --I', Facility Contact: 1T0 � Y 6L l , t 1S /� Title: Phone No: T — °� 4 v
�S7-Dao�
Onsite Representative: Je)44- n V1 M CI /lI Integrator:
ACertified Operator: Z-4 �l I f I '.5 Operator Certification Number:
Sack -up Operator:
Location of Farm:
U5 491 no
on k'6k.
Hack -up Certification Number:
Latitude: ©i ®ii Longitude: ® o ®' Wig
45 0_ rM `i' +u y- Pi fa vrA -I S 2 iln
000=rrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ we to Feeder
❑Non -La Non -Layer
El Calf
❑ Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ La ers
Cow
on -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑Non -La Non -Layers
Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Be ef Brood Cowi
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes O(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
12128104 Continued

Facility Number:l— Q a • Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural Freeboard?
� U r� l�Structure 2 Structure 3 Structure 4
Identifier: Tf
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes W No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Cg�<o ❑ NA ❑ NE
❑ Yes WIo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes WTo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No P< A ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��..,, //
9. Does any part of the waste management system other than the waste structures require Yes �,No ❑ NA El NE
maintenance or improvement? ,, ``
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes K
o ❑ NA ❑ NE
maintenance/improvement? XNo
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ElNA ElNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Co r n S r
I f ao -Q,
t3.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No [%NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to .question #): Explain any YES answers and/or any recommendations or:any.,other, comments.
Use drawings of facility to better explain situations. (use:additional pages:as necessary):'
Reviewer/Inspector Name Phone: —
Reviewer/inspector Signatur Date:
Page 2 of 3 - ' ' `- 1 12128104 Continued

w
Facility Number: -- 6 1 date of Inspection
,Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. DoZsccord keeping need improvement?�£ es; -epee ia�e.be�c-1�ow. _/❑ Yes No❑ NA ❑NE Application and aste Analysis Soil Analysis DPO aste Transfers
❑ StI+e,{;❑ Crop Yield aliens ❑ Mt4gnd I" Rain Inspections ❑ Weather Cod PA
{T r u {r far po>s 6
0 goo ► �, po L �j
22. Did the facility fail to instI and maintain a rain gauge? ❑Yes No ❑ NA ❑ NE r
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No D�NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? "r0 t� ❑ Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No 0 NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No X NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal? /,,(~
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ICI No [I NA ❑ NE
If yes, contact a regional Air Quality representative immediately I .
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
1 y ►nl 1 Crop i C� 2, r 1 I Y1S ��G`ho ' P n
a I WL us -I•- vse_ 1 herd j�l VAIu�.rovY`�le no-k- c� U
I Po I �r !r 5P reaj I I'YLcll 1 boob.
Plus+ fe4d 4e) r be�
3 Q'1,✓ -- DwQ
e
Page 3 of 3

Division of Water Quality
Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 970002 _ Facility Status: Active Permit: AWC970002 ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Routine , _ County: Wilkes Region: Winston-Salem
Date of Visit: 04/12/2006 Entry Time:10:00 AM Exit Time: 12:30 PM Incident #:-200601324
Farm Name: ASJ Mathis Farm Owner Email:
Owner: Steve Mathis
Phone- 336-984-3380 Sieve,
LMBZI�111=i1ii - IIA r - . 1 ! U - ►1.eY�I�:�
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 36°08'58" _ Longitude: "
Farm Location; 421 north to Mathis Farm Road exit and turn left. Go 1 mile to Farm on left.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment Waste Application
© Other Issues
Certified Operator: John M Mathis Operator Certification Number: 21423
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative John Mathis Phone:
24 hour contact name John Mathis Phone:
Primary Inspector: MeLkssa R sebrock Phone:
Inspector Slgnature:t.4 Al (�N tyr'Date: Q
Secondary Inspector(s):
Inspection Summary:
2. and 3. Evidence of previous discharge of silage leachate (no animal waste) into an UT to the Yadkin River. Discolored soil and
sludge worms were observed below the silo.
9.and 10. Poultry litter was stockpiled in a field off Clingman Rd. Win 100 feet of the Yadkin River. Operator was ask to move or
land -apply it within a week.
RAIN IN > too r -a, (�t v->✓,r. -To be-, c0t) e"re 1
QRd- n-U-J XT- Y--V le s .
Page: 1

i 0,
Permft: AWC970002 Owner - Facility: Steve Mathis Facility Number; 970002
Inspection Date: 13411212006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
❑ Cattle - Beef Feeder 300
Total Design Capacity: 300
Total SSLW: 240,000
Waste Structures
Type Identifier Closed Data Start Date Designed Freeboard Observed Freeboard
k1ste Pit PIT UNDER ROOF
Page: 2

• •
Permit: AWC970002 Owner - Facility: Steve Mathis Facility Number. 970002
Inspection Date: 0411212006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges_& Stream Impacts Yes No NA NE
1. Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ ■ ❑ ❑
c, Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ ■ ❑ ❑
2. Is there evidence of a past discharge from any part of the operation?
■
❑
❑ ❑
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a'
■
❑
❑ ❑
discharge?
Waste Collection, Storage & Treatment
Yes
No
NA NE
4. Is storage capacity less than adequate?
❑
❑
❑ ■
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.eJ large trees, severe
❑
❑
❑ ■
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑
01111
or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0110
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits,
❑
❑
■ ❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
■
❑
❑ ❑
improvement?
Waste Application
Yes
No
NA NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
■
❑
❑ ❑
improvement?
11. Is there evidence of incorrect application? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding? ❑
Hydraulic Overload? ❑
Frozen Ground? ❑
Heavy metals (Cu, Zn, etc)? ❑
Page: 3

Permit: AWC970002 Owner- Facility: Steve Mathis
Facility Number: 970002
Inspection Date: 04/12/2006 Inspection Type: Compliance Inspection
Reason forvislt: Routine
Waste Application
Yes No NA NE
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total P2O5?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Corn (Silage)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑
■
❑ ❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■
❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
Cl
❑
0 ❑
17. Does the facility lack adequate acreage for land application?
❑
■
❑ ❑
18. is there a lack of properly operating waste application equipment?
❑
■
❑ ❑
tither Issues
Yes
No
NA NE
28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
❑
❑
❑ E
29. Did the facility fail to properly dispose of dead animals within 24 hours andlor document and report those ❑ ■ ❑ ❑
mortality rates that exceed normal rates? 1
30. At the time of the inspection did the facility pose an air quality conc:em? If yes, contact a regional Air ❑ ■ ❑ ❑
Quality representative immediately.
Page: 4

• •
Permit: AWC970002 Owner- Facility: Steve Mathis Facility Number: 970002
Inspection Date: 04/12/2006 Inspection Type: Compliance inspection Reason for Visit: Routine
Other Issues Yes No NA NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? ❑ ■ ❑ ❑
32. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ ■ ❑ ❑
33. Does facility require a follow-up visit by same agency?
Page: 5

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a

Road access
9
Subject: Road access
From: [e-mail]
Date: Fri, 17 Feb 2006 11:51:32 EST
To: [e-mail]
CC: [e-mail]
Mike,
Yesterday afternoon my brother and I drove to the black mailbox ("Berry
1173") and small house at the end of Dr. Beale Farm Road. Beyond that is private
property, including the large warehouse and manure field to the north. Most of
the area is marked by cornfields and livestick ponds.
Apparently this farming operation straddles the west bank of the river across
from Gentry's Island.
If you need anything, call Chris at 835-6396. Also I will be back on March
29. Thanks again for you help!
Sincerely,
Rick
Foris refugium spirare
Terra Folia, S.A.
Apartado 15-3015
Costa Rica
[phone]
[e-mail]
[e-mail]
www.terrafolia.com
Nature, to be commanded, must be obeyed.
--Francis Bacon, Novum Organum (1620)
IIii-trnnnc "I.111 n%X

Re: Yadkirl R - Wilkes
Subject: Re: Yadkin-R - Wilkes
From: [e-mail]
Date: Tue, 14 Feb 2006 14:46:43 EST
To: [e-mail]
Mi ke,
Actually the site is located on the back side of a fairly large island
(Fishers Island?) in the middle of the river. By boat you cannot miss it, just
paddle around the island to your right. Also hold your nose, as the stench is
pretty strong, and indeed there is abundant brown algae in full flower all along
the stream and river bottom, as well as white foam on the surface of the water.
By land I can only make.a guess how to get there. On Beale Road probably you
should head northeast until the break in surface quality (solid to dotted line
on map), and then make your way due east towards the river.
From the July 2005 paddler report, some plastic bags may include seeping
rotted chicken carcasses (50-100 reported) and/or waste from the farm above the
ridge where all this is happening. Enclosed is a digital that describes the
precarious nature of things.
Please note the landowners are close neighbors to my brother Chris at'
Roundabout Farm. Even if those guys are making a real stink of things, I suggest we
measure our steps very carefully. Really it's not pointing fingers but the
long-term health of our watershed that is at stake, and as you know, that kind of
thing requires the maximum level of cooperation between neighboring landowners.
Please advise what you think!
Thanks,
Rick
P. 0. Box 566
Elkin, NC 28621
336-835-5101
[e-mail]
www.terrafolia.com
WARNING: This e-mail has been altered by MIMEDefang. Following this
paragraph are indications of the actual changes made. For more
information about your site's MIMEDefang policy, contact
MIMEDefang Administrator <[e-mail]>. For more information about
MIMEDefang, see:
http://www.roaringpenguin.com/mimedefang/enduser.php3
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2/14/2006 3:24 PM

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Division of Water Quality
Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 970002 Facility Status: Active Permit: AWC970002 ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date:
Reason for Visit: Routine _ County: Wilkes Region: Winston-Salem
Date of Visit: 10118/2005 __ Entry Time:09:35 AM Exit Time: 11015 AM
Farm Name: ASJ MathisEarm
Owner:
Incident #:
Owner Email:
Phone: [phone]OR37 ,,,-_-
Mailing Address: 615 Mathis Farm Rd Soaring River NC_28669__
Physical Address:
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 36°08'58" Longitude: 80'59'Q&"
Farm Location: 421 north to Mathis Farm Road exit and turn left. Go 1 mile to Farm on left.
Question Areas:
Discharggs & Stream Impacts
Records and Documents
Certified Operator: John M Mathis
Secondary OIC(s):
Waste Collection & Treatment Waste Application
Otherlssues
Operator Certification Number: 21423
On -Site Representative(s): Name 1 Title Phone
On -site representative John Mathis Phone:
24 hour contact name John Mathis Phone:
Primary Inspector: `M li sa Rosebrock Phone: [phone]
Ext.383
Inspector Signature: 011, Date: d
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
21. 2004 soils ok. Don't forget to obtain 2005 samples for 2006 use.
21. Record daily rainfall and crop yields.
21. Use highest waste analysis for completion of PAN balance. May have averaged?
21. No cattle on site within the last year. No beef waste applied.
28. Could not locate months of application in the WUP. Need to add range?
Page: 1

• •
Permit: AWC970002 Owner - Facility: Steve Mathis Facility Number. 970002
Inspection Date: 10/1812005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
Cattle - Beef Feeder 300 0
Total Design Capacity: 300
Total SSLW: 240,000
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
aste Pit PIT UNDER ROOF 108.00
Page: 2

•
0
Permit: AWC970002 Owner - Facility: Steve Mathis
Facility Number: 970002
Inspection Date: 10/18/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes No NA NE
1. is any discharge observed from any part of the operation? ❑ m ❑ ❑
Discharge originated at:
Structure ❑
Application Field
❑
Other
❑
a, Was conveyance man-made?
❑
m
❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
m
❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
■
❑ ❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M
❑ Cl
3. Were there any adverse impacts or potential adverse Impacts to Waters of the State other than from a discharge?
❑
M
❑ Cl
Waste Collection, Storage & Treatment
Yes
No
NA NE
4. Is storage capacity less than adequate?
❑
■
❑ ❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Led large trees, severe erosion,
❑
Cl ❑
seepage, etc.)?
8. Are there structures on -site that are not properly addressed and/or managed through a waste management or
❑
❑ ❑
closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M
❑ ❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry
❑
0
❑ ❑
stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
M
❑ ❑
Improvement?
Waste Application
Yes
No
NA NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or Improvement?
❑
■
❑ ❑ `
11, Is there evidence of incorrect application?
❑
0
❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu. Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total P2O5?
Cl
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Corn
(Silage)
Crop Type 2
Crop Type 3
Crop Type 4
Page: 3

Permit: AWC970002 Owner- Facility. Steve Mathis
Facility Number :
970002
Inspection Date: 10118/2005 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Application
Yes No
NA NE
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving craps differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑ ■
❑ ❑
IS. Does the receiving crop and/or land application site need improvement?
❑ ■
❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
Cl ■
❑ ❑
17. Does the facility lack adequate acreage for land application?
❑ ■
❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑ ■
❑ ❑
Records and Documents
Yes No
NA NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■
❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■
❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
■
❑
❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
■
Inspections after > 1 inch rainfall 8 monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
■
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑
■
❑ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■
❑
25, Did the facility fail to conduct a sludge survey as required by the permit?
❑
■
❑ ❑
26. Did the facility fail to have an actively certified operator in charge?
❑
■
❑ Cl
Page: 4

•
•
Permit: AWC970002 Owner- Facility: Steve Mathis
Inspection Date: 10/18/2005 Inspection Type: Compliance Inspection
Facility Number: 970002
Reason for Visit: Routine
Records and Documents
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air Quality
representative immediately.
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
32. Did Reviewerlinspector fall to discuss review/inspection with on -site representative?
33. Does facility require a follow-up visit by same agency?
1101111
Yes No NA NE
❑ ■ ❑ ❑
❑ ■ ❑ ❑
❑ ■ ❑ ❑
Page: 5

Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: o ,� County: �LV l� Region:L�y
Farm Name: I T Faf Owner Email:
Owner Name: Phone: -I,9 338
,•„ r �J7O�
r- no V
g M T 01,5 Fig ey- � Gy
Mailing Address: ,
Physical Address: (�
Facility Contact: Title: Phone No:
Onsite Representative: Sd n 1 0 I�� EntegratorI
Certified Operator: LTA h" 1' t 0a+hl n Operator Certification Number: 914
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Me Zf Longitude: Mo
Design
Currents
Design Current
t
Design
Current
Swine 0
Capacity
Popullate on
Wet Pou try Capacity Population
Cattle
eap ity
Population
❑ Wean to Finish
Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non-Layet
❑ Dairy Calf
❑ Feeder to Finish
❑ DaLry Fieifej
❑ Farrow to Wean
Dry Poultry
Dry Cow
❑ Farrow to Feeder
Non-Dai
O
❑ La ers
❑ Farrow to Finish
❑Non -La ers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
--
ot!er
❑ Other
El Turkey Poults
JE1 Other
INumber
of Structures:
Discharees & Stream Impacts
. Is any discharge observed from any part of the operation? ❑ Yes *o ❑ NA ❑ NE
Discharge originated at: El Structure ❑ Application Field El Other
!!!rr
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes ( No ❑ NA ❑ NE
other than from a discharge?
12128104 Continued ,

Date of Inspection I lolls A
Facility Number: q=0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[yNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Stru tur I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
` Identifier: ,
q1$�
Spillway?: jN0
i0
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
iNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
X No ❑ NA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
❑No PNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No [INA [INE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
A ,
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination: ❑ Yes
❑ No
tXNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
*0
❑ NA
❑ NE
x,, � a r"'� - � R. �.aj � li
Comments (refer to question#.} Explain any�,YESransw,ersa and/or any�recommendativns or any other comments.
Use drawingsiof,facility: toFbetter explain "situations {usieslas{ necessaryy()R� i
,sNt1�'�9.��i.. i... 1, -.5 t ..�a { ..R.�pi�a 5?qe., ."_+lFu•�.h5L�;4• �s1R.YRft
&bt4v
M.'_) tlteop4t 00JM4
A
Reviewer/inspector Name
a �' —
Phone: �(--
Reviewer/Inspector Signatur
Date: lol
►'0
1• ' . - 12128104 . Continued

Facility Number: — Q Dor Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'XN'o ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does rec rd keeping need improvement? If yes, check 7thepropriatc box beio Yes ❑ No ❑ NA ❑ NE
Ap�Zg'
❑ nalysis ❑ So Analysis ❑ e Transfers
Rainfa Crop Yield s ❑ Weather Code
�.
22. Did the facility kil to install and maintain a rain gauge? ❑Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
24. Did the facility fail to calibrate waste application equipment as required by the permit? xlzo)e O0❑ Yes
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
)�No
❑ No
No
No
1�Io
1�4.No
No
No
No
�No
❑ NA ❑ NE
NA ❑ NE
El NA El NE
[(NA ❑ NE
❑NA El NE
�KNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104 pr1� ij4
�)P 49
12128104 pr1� ij4
�)P 49

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 97 2 Date of Visit: 7/14/20fl4 Time: 040fl
rO Not Operational Q Below Threshold
Permitted ® Certified [3 Conditionally Certified 0 Registered pate Last Operated or Above Threshold: ...........
Farm Name: AW.Na�0.1x>xiS.�a�...................................................................................... . County. Wilk!~s................................................ MR10 ........
Owner Name: S.tieyp......................................:. MOLM5 ........................................................ Phone No: ( G1.9.#4.- 13Q.Q1.��.4, 7. 5..............................
Mailing Address: 615..11��f�klis�.karm.,d......................................................................... RQAjr.jPzRiycr..N.0 .............................................. M.69 .............
Facility Contact: hb.tt.MAtbia...................................................Title:................................................................ Phone No: 336,9.#.4i24 Q........................
Onsite Representative:10A.1,!'taRiM................................................................ Integrator:..
................
Certified Operator:,lojlla.M.................................. MAlbla .............................................. Operator Certification Number.U.4,23 .............................
Location of Farm:
Farm Location: 421 north to Mathis Farm Road exit and turn left. Go 1 mile to Farm on left. #
[I Swine []Poultry ®Cattle []Horse Latitude 36 • 08 SS Longitude 80 ' 59 , 08
Deli n Curr g ent Design Current Design Current
Swine Cap icity Population...,;,Poultry Ca acit Population:. Cattle capacity Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer IqNon-Dairyj 300 0
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish
Total Design;Capacity 300
❑ Gilts
❑ Boars Totafs W 240,000
Number of Lagoons
0
Ho
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®No
Discharge originated at: []Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ Yes [:]No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....P..iunder.roa£...................................... .................................... .............................. :.... ......................................................................
Freeboard (inches): 96
12112103 Continued

Facility Number: 97-2 Date of Inspection 7114/201}4
* .
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ® No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste A P.11cation
M. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ® No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes % No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ® No
Air Quality representative immediately.
Comments refer to uestion # : Explain an YES answers and/or an recommendations any other comments.
p y, y
.. ,3 ., : ::. 'I P ,or
Ilse drawrngs of facility to better explain situations. (use additional pages as necessary) �] Feld Copy ® Final Notes
F
2. Could not locate WUR Operator thought it might be in the SWCD office since they were working on PLAT for his facility.
7
3. Per 2003 soil results, the highest copper is on a field above Jim Mathis' house (1939 units). Don't forget to obtain your soil samples
for 2004.
3. June 2004 poultry litter applications need a waste sample now to be within the 60-day window.
Reviewer/Inspector Name ;Mel ssa Rosebrock , � ! �'� ;;
Reviewer/Inspector Signatur . Date:
12112103 l' V t r Continued

Facility Number: 97-2 *f Inspection 7/14/2004 0
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
® Yes
❑ No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
® No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
[:]Stocking Form []Crop Yield Form [:]Rainfall [:]Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

!Type of Visit aCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0,Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tune:
10 Not Operational C Below Threshold
Permitted ❑ Certified © Conditionally Certtiifi�erdrV 3 Registered Date Last Operated or Above Threshold: ....... ..... ...�
Farm, Name: ...� ��...._ ��.»»��t1....t.a• t................................. County: __.L11 al.11465 ......... .....» __.»..._.
Owner Name: _u�[Q.._ Qn ._..... Phone No: �r
Address:Ymt ... "`._'A koa_rl. kz­
Mailing too, ,.. 2 �
j� ry} m
Facility Contact: 61..1 ..» 1.I..1, ___ _... Title:.. ..._....._ ...._. _._._. Phone No: 1 t4 _ ---- ;.�.
Onsite Representative:.._. ^� . i ..iA��� .. ............ »»» ............ Integrator: _»»__..........»...» ----- _.__._...._. _ ..».
Certified Operator:. _ . �0 1�1....,> ` `,;»».�a! ..... . _» »....».» Operator Certification Number:
Location of Farm:
ts EVW*i 5 F04-m lid bt- +urn Pe++. Form b n l 't, .1 m.'t jea,
❑ Swine ❑ Poultry 16Cattle ❑ Horse Latitude ' At Longitude ®' ®4 64
Sine
El Wean to Feeder
Feeder to Finish
Farrow to wean
Farrow to Feeder
Farrow to Finish
4171 Gilts
Discbm-y—es - Stream Ininacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
^•pry . � +.,
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 91No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
tructurl 1 S cture 2 Structure 3 Structure 4 Structure 5 Structure b
` �•� Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
'S. Are there any immediate threats to the 91grity of any of the structures observed? (ie/ treessevere erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Ponding PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes [No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes '�` o
Odor Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El Yes E9
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 4No
o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yeso
Air Quality representative immediately.
Reviewer/Inspector Name
Reviewer/luspector Signer
Field Covv ❑ Final Notes
Date:
l!r/iL/VJ [.vru�skru

Facility Number: — D e of inspection
0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNO
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) Yes o
23. DETaste
rd keeping need improvement? If es, check the appropriate box below. ❑ Yes No
Application ❑ Feeboard astc Analysis ❑ oil Sampling
V
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes//To
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes eNco
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes KNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Wcu4
P.PN am3 �Nf',-tetl� ��p
d-P��Rw MaLka�wuw_
�4 �e:F ffi (1 Pltcw a�� Sm+J�.
Al e:�D
M
12112103

Tiachnicall Assistance Site Visit Repo 1101
• Di n of Soil and Water Conservation
O Natural Resources Conservation Service
O Soil and Water Conservation District
O Other...
Facility Number 97 - l L Date: 3/24I04 Time: 1 10:18 Time On Farm: 75 WSRO
Farm Name ASJ Mathis Farm County Wilkes Phone
Mailing Address 615 Mathis Farm Rd
[phone]
Roaring River NC 28669
Onsite
Representative John Mathis Integrator
Type Of Visit Purpose Of Visit
® Operation Review
❑ Compliance Inspection (pilot only)
❑ Technical Assistance
❑ Confirmation for Removal
U No Animals-uate Last uperatea:
❑ Operating below threshold
❑ Swine ❑ Poultry ® Cattle ❑ Horse
Design Current
Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
O Routine
O Response to DWQ/DENR referral
O Response to DSWCISWCD referral
O Response to complaint/local referral
O Requested by producer/integrator
O Follow-up
Q Emergency
O Other...
Design Current
Capacity Population
❑ Layer
❑ Non -Layer
❑ Dairy
® Non -Dairy soo 0
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier Pit under roof
Level (Inches) 55
CROP TYPES Icorn, Silage I Ismail grain silage
SPRAYFIELD
SOIL TYPES -
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03
O Routine
O Response to DWQ/DENR referral
O Response to DSWCISWCD referral
O Response to complaint/local referral
O Requested by producer/integrator
O Follow-up
Q Emergency
O Other...
Design Current
Capacity Population
❑ Layer
❑ Non -Layer
❑ Dairy
® Non -Dairy soo 0
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier Pit under roof
Level (Inches) 55
CROP TYPES Icorn, Silage I Ismail grain silage
SPRAYFIELD
SOIL TYPES -
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03
❑ Dairy
® Non -Dairy soo 0
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5. Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structurel Structure 2 Structure 3 Structure 4 Structure 5
Identifier Pit under roof
Level (Inches) 55
CROP TYPES Icorn, Silage I Ismail grain silage
SPRAYFIELD
SOIL TYPES -
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/10/03

Facility Number 97 - 2 Date.
3/24104
PARAMETER
© No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
25. Waste Plan Revision or Amendment
El
El
10. Level in structural freeboard
Conditional
❑
❑
[111. Level in storm storage
26. Waste Plan Amendment
27. Review or Evaluate Waste Plan wlproducer
❑
❑
❑ 12. Waste structure integrity compromised
28. Forms Need (list in comment section)
❑
❑
❑ 13. Waste structure needs maintenance
29. Missing Components (list in comments)
❑
❑
❑ 14. Over application >= 10% & 10 lbs.
❑
❑
[115, Over application < 10% or < 10 lbs.
30. 2H.0200 re -certification
❑ 16. Hydraulic overloading
31. Five a Thirty day Plans of Action (PoA)
❑
❑
32. Irrigation record keeping assistance
❑
❑
[117. Deficient irrigation records
❑ 18. Late/missing waste analysis
33.Organizelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
❑ 21. Crop needs improvement
35. Sludge or Closure Plan
❑
❑
❑ 22. Crop inconsistent with waste plan
36. Sludge removallclosure procedures
❑
❑
37. Waste Structure Evaluation
❑
❑
[123. Irrigation maintenance deficiency
❑ 24. Deficient sprayfield conditions
38. Structure Needs Improvement
❑
❑
39. Operation & Maintenance Improvements
❑
❑
40. Marker checklcalibration
❑
❑
Reaulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
43.
❑
El
[I Other...
Irrigation system designlinstailation
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc.)
❑
❑
MADE BY OPERATION
46. Wettable Acre Determination
❑
❑
1
47. Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluationlrecommen dations
❑
❑
2.
49. Drainage work/evaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
❑
❑
❑
13.
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4.
54. Mortality BMPs
❑
❑
55. Waste operator education (NPDES)
❑
❑
5'
56. Operation & maintenance education
❑
❑
67. Record keeping education
❑
❑
B.
58. Croplforage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

Facility Number 97 - �.J Date: 3124104
COMMENTS:
Waste analysis: 3-04-04 SLB (MF1) 21.2 Ibs.Nlton B, SLB (MF2) 20.1 Ibs.N/ton B,
SLB (MF3) 32.4 Ibs.Nlton
B, SLB (MF4) 11.7 "
SLB (MF5) 16.6 "
", SLB (MF6) 3.6 "
SLB (MF7) 7.5 "
", SLB (MF8) 5.8 "
SLB (MF9) 18.4 "
", SLB (MF10) 7.4
SLB (MF11) 12.0 "
", SLB (MF12) 12.8
Mr. Mathis has application records, waste analysis and soil test for the Poultry waste applications.
No cattle or cattle waste application since the last operation review. Good farm.
TECHNICAL SPECIALIST lRocky Durham
SIGNATURE
Date Entered: 3/26/04
Entered By: LRocky Durham
3 03/10/03

(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit O Rouline O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access jl
F[)ntc of Visit: ObCL6/2003 Time.
Facility Number 97 2
O Not Operational Below Threshold
® Permitted M Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: 11191/.9991„
Farm Name: ASJ..IYIAWs.k:Arm......................................... :............................................... County: 1'.lrill gS............................................... W.SRQ........
OwnerName: 54ex.e........................................ Mathis ......................................................... Phone No: .............................
Mailing Address: 6J,5.Mathjs.1#rm.Rd...............................:..............
Facility Contact:.j9b.I1.MAWA..................... .........Title:
Onsite Representative:John.M9his.....................................................
Certified Operator:Jobit.11'l(.................................. malkia ...................
Location of Farm:
liaaAntg.liixl rAc.............................................. ZM9 .............
PhoneNo: .............................................
Integrator: ....................
... Operator Certification Number:Z)i,42.3.........
?arm Location: 421 north to Mathis Farm Road exit and turn left. Go 1 mile to Farm on left. A
❑ Swine []Poultry ® Cattle []Horse Latitude 36 • 08 f 58 64 Longitude 80 • 59 1 08 64
�{ ;� 4 -i 1 r min - �-—['JPL.iflt� .'y .. fy g5 -.,- 1
; a # D'estgn, `, Current +��� Design`, Currentp - , R: a Design Cutrrent;.`;
r W.
Swine Ca acit 9Po elation
Point rY` r�d�416[ iCB Po tit ttona Cattle
,Ca sett Tb ulatio'
w
i
i
W. FT4 i
Numbere of j,agoons R ©UFO
,0
Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area ,.,
---
HoIdl g Ponds /'Solid Traps
'
❑ No Liquid Waste Management System
s ► .
.�
.,..._......�.,.�..�.®ram
c
�
�
dam..
❑ Wean to Feeder
Layer
airy
❑ Feeder to Finish
Non -Layer on -Dairy 300 0
Other ';
�� Total Design Capacityn 300
Y9c M1..
240,000
❑ Farrow to Wean
❑ Farrow to Feeder
�
❑ Farrow to Finish
Gilts
❑ BoarsSSLW,�
Dischryt'L'�� Stream Ire c
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b.. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..Slatted.fltaoc.pit .............................................................................................................................................. .......
Freeboard (inches): 60
osio3rol
��3/�
❑ Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
Structure 6
Continued

Facility Number: 97-2 Date of Inspection 06l26/2003
0:
5. Are there any immediate threats to the flegrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
W- t • Appligation
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
y
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•o ents fer to do # : Explain any ES a and/or any ecommentiatlons or any other comments.
V . wings of facil• o etter explain situations. u additional pa es as necessary): ❑ Field Copy ®Final Notes
Questions left blank are not applicable to this facility at this time.
_
attle numbers have not been above 100 since 1991. Facility has not applied any cattle waste in the last year. No application records or
wastelsoil analyses required.
Poultry
Waste analyses dated 3/19/03 were : 23.6, 15.8, 39.3, 13.3, 41.2, 34.9, 27.5, 29.3, 7.5, 4.7, and 34.4 (lbs. Nlton) for litter. Lower
umbers are for the stockpiled litter while the lhigher numbers are for dry stack litter. Operator used state ave. of 33 to perform his
calculations for broilers and 14 for hens/layers.
H.,
__
ReviewerMspectorhame �Mei' Rosebro
Reviewer/Inspector Signatu Date:
05103101 r 1 V Continued

Facility'Number: 97-2 D9f Inspection 06/26/2003
_Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
rXdditlonal'-• mmentslan or raw nigs:
Poultry WUP needs to be revised to include acreages, PAN, and application windows.
*2002 soil analyses for poultry litter and sludge application fields: Cu and Zn was less than 2000 for all fields. Many fields report P
> 600.
05103101

•
so[Fand Water Cone
x
A ,.
gyp,
Type of Visit A Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 0 Time:
of O erati nal Belo , Thre hold
Permitted /C�errtifieed /�� �C4�5
onally Certified ©12egistered Date Last Operated or Above Threshold:1
Farm Name;
1��•-7�1 1 V 1 r Q rM County: W ges
T
Owner Name: T
Mailing Address:
Facility Contact:
Onsite Representative: `
Certified Operator: t
Location of Farm:
Ph neNo: 3�' o ` 33E6 VN - 37ds
0(�-rajr r V r a 8
Title: D PJhone No: - ` 4? ` ' .2� i
Integrator: T4 sw
Operator Certification Number:
al N . t=&rm 8d. men on e- m i le * Fairm or) l e
19
❑ Swine ❑ Poultry Cattle ❑ Horse Latitude Longitude° ®M
Destgii y Ct;rrent ;Design r Current y 'Design Current
pi -A I
= :Swtne lE'' Ca acitv'E: Po 'alatton , 9 Pout€ ,, . , y.;. .Ca achy ,.Po ulatidn:. ,Cattle ;,,,,,.; k,?Ca "acf[vt Po ttlation
Wean to Feeder I ❑ La er (: ❑ Da' t
❑Feeder to Finish I Non -La er i Non-Dai
!. J 19 3
� ❑Farrow t0 Wean ❑ Other � Ik �� !�l '
Farrow to Feeder
Farrow to Finish`i
Total DestgnlCapaclri a
ly i hl 3 y.
❑ Gilts
[ ❑ BOais I !! ! ! Total -SSE E
k ❑ ❑ ❑ Spray Field Area i Number of Lagoons y, ;! , j i!3 } 11 Subsurface Drains Present Lagoon Area
!lih....
t :Huldtng`Ponds I Solid`Traps :.TI
❑ No Liquid Waste Mana ement Svstern ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes !�J No
Discharge originated at: ElLaeoon [I Spray Field El Other
``
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection &c Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X
No
tru tore 1r S c e 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I` QOi'
Freeboard (inches):
05103101 Continued
l�

Facility Number: — �, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
)(NO
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
W aste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type 11Aex_-- Porn
13. Do the receiving crops diff r with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
14. a) Does the facility lack adequate acreage for land application?
❑ Ye
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
NYo
Required Rec rids& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
/
o
X
18.
Does the facility fail to have all components of the Certif ed Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) / �
[I Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reO ports)
❑ Yes
No
20.
Is facility not incompliance with any applicable setback criteria in effect at the time of design?
❑Yes
1
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Vo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_ w Y 9. F r....w. ..yr, r r- v ,.•;
Comments refer,to uestiofi #) Explain man YES answers and/or an recommendations or, any a ere mmenEs.
(' .'.
,Y 1 .,. ?... •.,hV !
.. i q ..,_ w A...;.,...a
,Use drawings 6' f 61ity to bcttcr expiarnksi#uahons„(use"additional as necessary) £ FpE � ❑ Field Cory ❑ Final Notes
'" ".y
"pages
�. s 1, k
Pout�rL -- 3�[ R d3 23. F -Or 4,5+aGV, �. $ 5+ocj!�p' le_
1
2t p'%o I e--`>1- 3
YOLA V-1 V1 1) rV SA -eel! -- 11 e Z S a,,- S 3tt. Sp i it wcLj 7.
z 9• 417 Jim.7
e - _� .
.
1� 3 .. •fir EE i 3 .'�, ! } �i �^ 5"sei i E` E � 3.:i EP 13N C 97 it it. €'n. i�`,
Reviewer/Inspector Name'"
Reviewer/Inspector Signature: 1A. Date:
05103101
' i

Facility Number. — �, Date of Inspection
or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ',qo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt; ❑Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? �E3 '''e5,E;lNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) E3 its B so
31. Do the animals feed storage bins fail to have appropriate cover? ❑ YesxNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?-iie5--E5 I5
AdditiohaGCommentsandlar"Drawings.' �3, a ir;:
f
flfJ� PO
u 07
l/� U 114
C fro lowed •
�V�Z11 4 ZOOS Po- 20Q2.
OS/03101

JAW.,
iDri°ofliWatei<,.' ualit€.a'1:,.�1, ll�rlfi.l,, .. I €I t",i:. I'II '{131;I,n I!l 1''j!r'IIIi�'
I a,. ' ,, {, 11 I :',,.. !, , I .::•,I; I O" Q Y f r, , „,`� !,1,1. { Il+l :,,.P I.. 1, rl .. I ,
11! 3€�€r• ,.. a¢eun�, a ..: R€�d:1. ^,11, � ! ,I � a s ' I�^,€ i, , I.,I iia 1:. !� ,
Ill, .!lJ;Itlt1 . �... I r�:�a P+i{.N'.LI.€�ft( Ilr .IVJ11it€ li'. , : i I i'.I j $
i, J I€},l �I� �Ii it iltl dill .,:i �llf liili I i;',,J I+.Ifi . jii'il•, ! �l
I,!li,l�!•,tlrStupfjSotand(W,ater,Consecvat�ont lrl •','I,.I.,i,riit, ,`IlfIIItb{,I, ,
? ,.� r, 1,!! as iil f r r.,.11 `l,r a I ! I !"
11 - ,k O 1 i.' r , ! L. JjI ,i I fib 1 o - -u I
O„ he ge , eY , �iilisl, a IIr'il�hal ...!I +JI ,rli{
} r t r n I I
IJ.�ir.I:',..
,..':i
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason far Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 9"1 2 Date of Visit; 6/25/2002 'rime: 0945
0 Not Operational 0 Below Threshold
® Permitted'® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: J.11.1.1.I991.....
Farm Name: AS,I.MAT.b1AY.A►RM.............................................................................. . County: W. jj ks............................................... 1'.l'BRA........
Owner Name: S. Y>................................... MATHIS.................................................... Phone No: (��.C1.9>�4.-���Q.Q�.�S.4.�.7..�5.........
Mailing Address: 64.5.M,A TH1S.FAIT,M.RQAD........................................................ Ii.S)AFUNGAIVER. A. C............ I....................... U6.0.9 .............
Facility Contact:191v.MAIbis................................................... Title:................................................................ Phone No: 334,984,24.40 .......................
Onsite Representative: jAbia.Mi.this................................................................................ Integrator:....... ...........................................
Certified Operator: J.Qb x.M.................................. raaiwa .............................................. Operator Certification Number:2.1,4.23 .............................
Location of Farm:
Farm Location: 421 north to Mathis Farm Road then 1 mile to Farm on left. +
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude 36 • 08 1 58 f{ Longitude 80 ' 1 59 , FITT,
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow_ to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity,Population
❑ Layer ❑ Dairy
❑ Non -Layer ®Non -Dairy 300 0
❑ Other
Total Design Capacity 300
Total SSLW 240,000
Number of Lagoons ` 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdtn .Ponds 1, Solid,Traps, 1 ❑ No Liquid Waste Management System rj
Discharees & Stream Ininacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..S.latted.floor.pit............................................................................................................................................... .......
Freeboard (inches): 22
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure G
05103101 t#C/6P p, Continued

Facility Number: 97-2 Date of Inspection 6/25/2002 '
5. Are there any immediate threats to the I grity of any of the structures observed? (ie/ treeevere erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
It'
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments"(refer to question #): Explain any YES ansivers and/or any recommendations or any other comrrierits.
Use drawings of facility to better explain situations..(use additional pages as necessary): f❑MF�eld Copy ® Final Notes�i i r
The following comments pertain to the poultry operation:
19. Poultry waste sample results are highly variable and some are unusually low in nitrogen. Poultry records use the State average for
roilers (33 lbs. N) and hens (14 lbs.) for determining a PAN balance.
25. CAWMP needs to specify months for waste application. I could not locate these in the plan.
27. Facility is composting dead poultry, Need to add "composting" to mortality checklist.
For questions about certification and hours, contact Beth Buffington at 919.733.0026 ext. 313
01...,. ... ..,y .,�. �., ...'. .. ....... �.. _ _,�I�.v. ......__..y�..r ....-.....��r ..:�r.l �r..� li....�.. .,,..�._. �,.....,...,s 1 .i., 44h0f�I
Reviewer/Inspector Name Melis Rosettrock f;
Reviewer/Inspector Signature. Date: 02 C'�J
05103101
I
Continued

Facility Number: 97-2 Da0Inspection 6/25/2002 •
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
is there any evidence of wind drift during land application? (ix, residue on neighboring vegetation, asphalt,
❑ Yes
®No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
05103101

9: 30110 : oo n ry)
Type of Visit 0 Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 4Q Routine 0 Complaint Q Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility #Certifiedumber Date of Visit:
NPermitted [3 Conditionally Certified [3 Registered
Farm Name: _MQ 1 S Ea rn�)
Owner Name:
Mailing Address: I/2 d,-Z 1=1LA1 r Il l,) t U ► + r i I� 1-
Facility Contact: b6 M 1 Title:
Onsite Representative:'' '�J r ' r Q `"i --5 C
Certified Operator: ► ! Q i5
Location of Farm:
W/gK V Time: IV t ,T M I
10 Not Operational SEBelow Threshold
Date Last Operated or Above Threshold: I ! 21
County: ILI i i Ke.S
Phone No: .3.3 6 • 98 V - 3 3 ?b o2. 3 7R-5-
ar-1 n)ejye r, lU - �g cl
Phone No: 3 .3 �P ' ! 8 : T 0
Integrator:
Operator Certification Number:
US 4,2or -o i5 Farm • Farm iS6he. mi e co k44. •
❑ Swine ❑ Poultry
cattle
❑ Horse Latitude ®' ®4
®u Longitude ®0
Design
Current Design
Current
Design Current
Swine
Capacity
Population P ultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dair
❑ Feeder to Finish
1
10 Non -Layer I
I Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
p Q
❑ Gilts
❑ Boars
Total SSLW
.710163 C
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes KN 0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N<o
WaLte Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes xNo
$tn tur I St ti�aF, r� Structure 3 Structure 4 Structure 5 Structure 6
Identifier -
Freeboard (inches):
05103101 Continued

Facility Number: 7— Date of Inspection [�O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
XNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
o
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
—{Yee--B-PFa
Waste Agglication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
K No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
X
12. Crop type
13. Do the receiving crops differ with thos designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
too
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
" No
b) Does the facility need a wettable acre determination?
❑ Yes
Z No
c) This facility is pended for a wettable acre determination?
❑ Yes
O�No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
X No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) /
❑ Yes
dry
VNo
19. Does record keeping need improvement? (ie/ mi 1pti" freeboard, waste analysis & soil sample reports)
❑ Yes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
ElYes
XNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
X No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Wo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer to question Explain any YES answers anany recommeudations:orkany�other comments.
t
Use drawings of facillty to=be ter�expI in situations (use additional pages as necessary). Field Co Final
❑
Notes
�-
§tea;`
Reviewer/Inspector Name I ,
Reviewer/Inspector Signature:
05103101
3 IJ
'XAJ 4
Date:
Continued

0
Facility Number: -7 —
Date of Inspections d
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El ves o
❑ Yes ko
❑ Yes N No
GF :
❑ Yes ;� No
-des—B-No
es o
Additional Comments and/or Drawings:
y
05103101

of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 97 2 pate of Visit: 1318/20t11 'rime: 9:10
0 Not Operational Q Below Threshold
® Permitted ® Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
FarmName: Elba..lkUTM.FAHX ............................................................................. . County: WiDws .............................. .................... R..........
Owner Name: S. E.0................................... 1!'Ili,TAUS................................................... Phone No: { .9,�4- 8.Q..ax. 2 S......................................
Mailing Address: 615.MATUMEABUROAD........................................................ i.OARr NGRIYE iAC................................... U0.9..............
Facility Contact: .........................................
Onsite Representative: ,IQ)l;tx.l!'> a.(his......
Certified Operator:,]Qlim.M.....................
Location of Farm:
Title:
................
Phone No:
......... ........... ................ I... Integrator:......................................................................................
KUM.............................................. Operator Certification Number:�X���....
Farm Location: 421 north to Mathis Farm Road then 1 mile to Farm on left. A
❑ Swine ❑ Poultry ®Cattle ❑Horse Latitude 36 ' 08 ' 58 a Longitude 80 ' S9 i 08 16
Design Current De sign Current Design Current
Swine PoultrCapacity y
Ca Po ulation' CattIe Capacity Population
❑ Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ® Non -Dairy 300 0
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 300
❑ Gilts
❑ Boars Total'SSLW , 240,000
Number of Lagoons _❑ Subsurface Drains Present i ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps I j ❑ No Liquid Waste Management System
r.
DischarEes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b..If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Stnicture 6
Identifier: ...................................................................................................................................................................................................................
Freeboard (inches):
05103101 Continued

Facility Number: 97-2 Date of Inspection 11113/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ treeovere erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Corn (Silage & Grain) Small Grain (Wheat, Barley,
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
®No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management PIan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes [--]No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicablc setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
fer to uestion ) plain an YES:;answers and/or any recommendations[or'an other comments ,
Comments (re„ q # Ex y y
� . .�....,�..�.I.�... a ...�,,.. I
Use drawings of facility to better explain situations., additional pages as necessary) I
4' 1S . II , "k Field Copy ❑ Final Notes
i !!
L�::€. _ ir{.6i,c._ , I E i:�.. hl...i..i-�1 t I. _ • � t z ,.�".....�� i -'nnl"'"��';1"""`+'1"•».,.."t",.t_"'n 1'f"Y'ly-pf I. ,
Facility has not had any cattle since March of `92.
o application records or waste samples required on the beef operation.
Mr. Mathis had his poultry waste plan and application records on site.
,
w
Reviewer/Inspector Name Rocky Durham
Reviewer/Inspector Signature: Date:
O5103101
Continued

f Facility Number: 97-2 D W f Inspection l I/8/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes []No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
Additional Comments and/or rawmgs ���� : I , , �' i �,� i{{ �> ���
�.� i I �I' r .�i. i l�f ��. �, Li
'I I ICI `" iff I!8'`' ` ,� tf€ ,,r� I , f� i l 11
�.�.��{r-ilii'iiiJ� u��ilalit.,ari�i� i ��b1 Li a.i , „u I L, .,:I
��I Ir+, r l f 3
4.1 {e .d,1._
T
05103101

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date offish-. 6/20/2001 'time: 0919 Printed on: 6/21/2001
97 02
tD Not Operational 0 Below Threshold
Permitted M Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: 111111M....
Farm Name: ASJ.N9►TBUYARIY.I.................................................. .... County:WAka ............................................... 1' .SRQ........
Owner Name: S.T.E E................................... MAT:k W.......................................---.---..... Phone No: (.3 ft�.9 4.-3 �Q.ctx. 7. ......................................
Mailing Address: 615.1YIAU1U11,1M..t OAD........................................................ ROtt.M. QJUVEX.N.0 ................................... U6,69 .............
Facility Contact: J0.1..N1At11iA................................................... Title:................................................................ Phone No: 33.6,98.4,24.40 .......................
Onsite Representative: dukta.11'I"his...................... .................... Integrator:......................................................................................
Certified Operator.johil........................................ MULI is.............................................. Operator Certification Number: Z1.423 .............................
Location of Farm:
Farm Location: 421 north to Mathis Farm Road then 1 mile to Farm on left.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude F 36 ' Longitude 80 ' S9 OS
4: � ,�� ., , Destga Cu rent Point . R. �' Desifgn , C„ur�rent Cattle ,S Design
'Ca aclf�P,o uhition 1Y Ca actt Po ulation r Ca actt�Po ulation
❑ Wean to Feeder ❑ Layer [] Dairy
❑Feeder to Finish ❑Non -Layer ® Non -Dairy 300 0
❑ Farrow to Wean F,;
❑Other
El Farrow to Feeder
❑ Farrow to Finish
�wA, Tbtal�gn Cap if 300
El Gilts
f.
Boars � ��a � " �' '", � otal��,StSLW .:: 240,000
Number of Lagoons © ❑ Subsurface Drains Present ❑ I,agmn Area ❑ Spray Field Area
Holding Ponds /Solid Traps �l ❑ No Liquid Waste Management System
Dischart'es _& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
a5ig collection _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..... Cawctc.P.i t.....................................................................................................................................................................................
Freeboard (inches): 22
05103101 Continued
-� 9 3 ur-/

Facility Number: 97-02 Date of Inspection 6/20/2001 • Printed rrn: 6/21/2001
5. Are there any immediate threats to the ione8rity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ® Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn (Silage & Grain) Rye
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the (.'ertified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
[]Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations, as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ent
❑yo
®eFFinal Notes Field Copy
o cattle here since March 1992. Structure built in Dec. 1976.
9. No need for gauged marker. Structure is concrete pit with concrete walls and slatted floor.
Poultry:
Operator also raises poultry and had WUP onsite and records up to date. All dead birds are composted.
19. Could not locate specific months of application in WUP, though. May want to revise tract/field labels in recordkeeping book to
assist in locating records for each application field. Need to have checklists added to poultry WUP.
Reviewer/Inspector Name �Meli sa Rosebrock
Reviewer/lnspector Signature. AM Date:
05103101 L ! v Continued

Facility Number: 97_02 1), -f inspection 6/20/2001 Printed on; 6/21/2001
0
do r lissucs
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IS No
❑ Yes ® No
[]Yes []No
rteona •ommen an o ,awing
05103101
05103101

Type of Visit A Compliance Inspection p Operation Review O Lagoon Evaluation
Reason for Visit koutine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: ZO Time:
FFacility Number i�
Q Not O erational Below Threshold
j Permitted Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .....�.�.�..�...�Q
(Farm Name: .... L. 5Z .........M.A5........ F�!.rm........................................... County: ....la.) ... 1.y—!: ....... .-7d
V
eAOwner Name:.....S.J.......1.:..1.............................................................. Phone No:......:.,..!..�.�.....` Q L
Facility Contact:
Mailing Address:
Onsite Representative:., vv.q t ���,u [��.1`?....................
........ ..............................
Certified Operator:... TEn........ PA ........... M.A.6 .......
Location of Farm:
❑ Swine ❑ Poultry
.............. Phone No., �.....!. u.... i:0
��..��......�. !..v.�.�......1.......... a �6..L.....
Integrator: ............ ....................................................................
Operator Certification Number: ....... 0,,,,1, , ..; -3.....
Q 15 dot v m 'then o hw m i +d Fair-wt o n _.
Cattle ❑ Horse Latitude • 1 v L3' �66 Longitude ®* ! ` ®64
Design Current Design Current Design Current
('nnae�ty"Fnmslatinn' PoultrvF ;C?anecitv.,Pa Isitinn Cattle [ mmirity. !;Pnnntn$nni11
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number' of Lagoons : ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
6 Holding' Ponds /�Solid,Traps❑ No Liquid Waste Management System {
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
C. II' discharge is observed, what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I ° Structure 2 Structure 3 Structure 4 Structure 5
Iden ti fier: 12efp:'..I'..11 .................................................
Freeboard (inches): a
S/00
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes it No
❑ Yes XNo
❑ Yes kfNo
Structure 6
Continued on back

Facility Number: Z, Date of Inspection �a 0
5. Are there any immediate threats to the At Pgrity of any of the structures observed? (ie/ trees; severe erosion, Yes No
seepage, etc.) ❑ -
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes � No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level �[
elevation markings? ® Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidenc of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes No
12. Crop type A) A_0 f4ntgj) &,d4
13. Do the receiving crops differ with th se designated A the Certified Animal Wa to Management Plan (CAWMP)? ❑ Yes No
14. a} Does the facility lack adequate acreage for land application? ❑ Yes �'j No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes o
15. Does the receiving crop need improvement? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents J J
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes [ No
18. Does the facility fail to have all components of the Certified Animal Waste anagement Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) / El Yes XN 0
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sam le reports) NYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )�No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes*,Rgo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
24. Does facility require a follow-up visit by same agency? ❑ Yes J�[Ro
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yesly: o
N4 •Y.01jaiti0s;ot. 0014e00e WVre )io e#• 00rift t)tjs;vjsit; • 'Y;oo jij-tee�iye ijo i' rj�
6 iesnorit#ence: about this :visit: ...........::::::.::::............: .
UsWdrawuigs of facllity.to better` expiaft situations (use` addiitidaal pages�as necessary): ' '' y'' r=,i t� 'C EY y`;+i <a

Facility Number: j — of 111spection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Iiquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Jb(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �'1�To
roads, building structure, and/or public property) P
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes *o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) y ❑Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes * No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ^-� No
AdditionaMomments an or ra ngs:'' i
:. ' }� H. �,V i ;fir
max
i
f � //� �� /ram, �,, � , i /� r ,• r�,�s
'� f

Facility Number 97 02 Date or visit.. 12/Z7/2000 'Time: 9:45
Not Operational O Below Threshold
Permitted a Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:... ......................
FarmName: ASIN A'TMEAR................................................................................ County: WAO ............................................... WNR.0........
Owner Name: 5. UY.................................... MATH .
Phone No:
FacilityContact: JAAI.MAWA................................................... Title:................................................................ Phone No:.....-----.........................................
Mailing Address: 615,MA,THIS.k:A,Iil AO&3........................................................ ROAM. G.DIYERAC................................... 20.6.6.9 .............
Onsite Representative:10PA.M111his.............................................
Certified Operator: JQha..
Location of Farm:
Integrator: ...........
MatWa.............................................. Operator Certification Number:,Z].423... ...............
Farm Location: 421 north to Mathis Farm Road then 1 mile to Farm on left.
❑ Swine ❑Poultry ®Cattle ❑Horse Latitude Longitude 80 • 59 0866
,,$gY4?SDI
L �r - "" q r ei frc 1'.. V'
5� wine €� . a'
I '�
Design t'Current
, . +.i
Ca actt Po ulation
-_. ..
y = i Des n :Currents t I)esa n Current "
-:,� Y a-.��g_::- pd:,.'`.r1r >' k - n',
'Poultry ;+✓C`a acit Po uldtioni> Cattle Ca actt ulation
.-Xii
WeanEtoFeeder
❑�Layer ❑Dairy
❑ Feednish
❑ Farrow to Wean
❑ Non -Layer ®Non Dairy 300 p
4 ❑ Farrow to Feeder
,.
❑ Farrow to Finish1
total De�stgn CaQactt'y 300
Gilts'
❑ Boars
i'� yr �Tota1SSLW, 240,000
:4cr'
Number of Lagoons 10 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps �.J ❑ No Liquid Waste Management System
i ' h g Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State?(If yes, notify.DWQ) 0 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection X Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:..........bWlding........................ ...................................................
❑ Spillway ❑ Yes ® No
Structure 4 Structure 5 Structure b
.. .................................... .................................... ......................... I ..........
Freeboard (inches): 22
5100
Continued on back

Facilit Number: 97-02 Date of Inspection 12/27/2000
5. Are there any immediate threats to theagrity of any of the structures observed? (ie/ tr0severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: No yW atitiris:or &fleiencies ivere:rlbted during this: �isif::You:will recewe.no further
�corresnondenee' about this.visit. ............... .
have had no animals in the last year.
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
1W
Reviewer/Inspector Name ?Daphne Cartner
Reviewer/Inspector Signature: Date: 5100

-Facility Number: 97-02 Dl$f Inspection 12/27/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Facility Number 97 02 Date of Visit: 7/2S/2000 Time: 09Qo Printed on- 7/26/2000
Q Not O erational 0 Below Threshold
Permitted 0 Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .VV2.0#.5.......
Farm Name: A►SJ.MA:tJEARU............................................................................... County: Wj&o ............................................... WSRQ........
Owner Name: 5T.E.YZ ...................................MIMS ................................................... Phone No: Q3.61.9A4.-3.1$.Q..Qr37.85 ......................................
FacilityContact: J.QbX..11'JAWki...................................................Title:................................................................ Phone No:...................................................
Mailing Address: 6J,5.MA1H1S.FARM.RQAD........................................................ ROAM. G..RIVFR.NC ................................... 20.66 ..............
Onsite Representative: 1t?jAn.Math6................................................................................ Integrator: TyS.wlp.Wlry).....................................................
Certified Operator:J.Qbja.M ............................... M.41 ia.............................................. Operator Certification Number: 2,1.4,23.............................
Location of Farm:
Farm Location: 421 north to Mathis Farm Road then 1 mile to Farm on left.
❑ Swine ❑ Poultry ® Cattle ❑ Horse Latitude F 58 « Longitude 80 • 59 08
Design
e Ca acit
Current Design Current
Po uiation Poultry Ca acit P,o uiation Cattle
Design Current
Ca acit Po ulation
ean to Feeder
❑Layer ❑Dairy
❑ Non -Layer ®Non -Dairy
Total Design Opacity
Total SS L W
300 0arrow
300
240,000
rFeederto Finish
to Wean
arrow to FeederOther
arrow to Finish
ilts
❑ Boars
111111 Number of Lagoons
Holding Ponds /Solid Traps
1t ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field W
I ❑ No Liquid Waste Management System
Discharges & Stream its
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: [)Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection K Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: ...... Coucrete..F.it...... ....................................
Freeboard (inches): 84
5100
❑ Spillway ❑ Yes ® No
Structure 4 Structure 5 Structure 6
..............................................................................................................
Continued an back

Facility Number: 97-02 • Dale of Inspection 7/25/2000 Printed on: 7/26/2000
5. Are there an immediate threats to the* rit of an of the structures observed? ie/ treLT, severe erosion,
Y g Y Y ( ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ® Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12, Crop type Corn (Silage & Grain)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes IN No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: o yiolatiotis:or iiefciencies were:nbted during ttiis visit::You*Will :rece ve-hO fi rthefr.. •.
' . correspondence about this :visit:
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
® Yes ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
�. Facility has concrete pit below slatted floor. Will start checking weekly freeboard with measuring/fuel stick.
17. and 18. Wilkes County SWCD currently has the poultry and beef WUP and records. They are assisting farmer in putting records
an computer for the farmer.
27. Composting/drystack of dead poultry. Dead cattle are buried.
Soil test results are showing almost 1000 for copper in several fields where poultry litter is applied. May want to consider alternate
fields at some point. Farmer has notified Wilkes SWCD.
Reviewer/Inspector Name imelissa Rosebrock
Reviewer/Inspector Signature: "T ly Date: % 5100
1>•

1 F� acility Number: 97--02 D0f Inspection 7/25/2000 . Printed on: 7/26/2000
OJkr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
' 0 ►om�rten an or a ngs:
w
5100

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Ale
rmitted ertified [3Conditionally Certified [3 Registered JE3 Not Operational I Date Last Operated:
Farm Name: .....i^�.151T ........ M .1.15...........m.................................... County,:�..1�/.A.K..V� p ......
Owner Name:...�...1..�?YI.I'1. �.LlC�.1......�Qrl%..... j.. Phone No g7 3 O ....f� ................ ............. �............
p�, 3.9. 3
Facility Contact: ......���,.Y.�...... •••a..r.•tc.�.�............Title:........................................................ .Phone No:..........................................7.15
Mailing Address:.�.1 ........ ..tzl .f.C.l 1. ........�if�..rm . ��. �...�...., t 1�1ti.......���..ie�.. �.!...' ......... .............. p
S1_a G
Onsite Representative:..... ....... mci. . �............................................. Integrator: ....... ,[.1[blur. .......... 6.i~.5.QV.`..P-o.V1;-r-1)
Certified Operator: ..11nil'n......... M. ;........ ....f................................... Operator Certification Number:.9.1,ca3...............---.
Location ofrarm: _
1
f T r, r' n ., n r— w►—TA 01n tl kl p_ M 1 ! tl Y!
Latitude E.� IDS 1 ��[.7 ' ' �i Eff
Design ;Current Destgio` 'Current a .:., �� �a�l�t� $ Desrgn �2Current ,
$wme� Ca act Po ialation
, Poultiry Ca aci ;Po Mahon., Cattle �Ca act "'y:Po ulation
❑ Wean to Feeder
❑ Layer Dairy
❑ Feeder to Finish
; ❑ Non -Layer Nan -Dairy
❑ Farrow to Wean
3,, ❑ Farrow to Feeder
❑Other 4,i ,` ,
Farrow to Finish
a' g'
• Total Deslgn CapacltyM� b
.'
z ❑ Gilts
o,"
❑ Boars
e
Total SSE ! 000
�•
# ' " '
Number of Lagoons,
;
❑ Subsurface Drains Present
❑ Lagoon oon Area
k
❑ 5 ra Field Area
P Y
t! >'.s �� <<., P� �j�.
Hold�ngPond5l Soltd•'Traps
❑ No Liquid Waste Management SystemE
DischaEM & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 6lHWY,
Freeboard (inches): ............... ................ ....... )/
[j Yes
No
Continued on back
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
t'�
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,�o
❑ Yes ok<
❑ Yes P<o
Structure 6

of Inspection Facility Number: a
6. Are there structures on -site which are 10properly addressed and/or managed through a waste management or
closure plan? ❑Yes *o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? >�es ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes X No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes 19 No
12. Crop type Corn 5"
13. Do the receiving crops differ wiathose designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there'a lack of adequate waste application equipment?
Rectuired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ✓ `
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20: Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
YMh fioos'o�- iigflcle d"' i4r@ ]n4tg4�• O(WiOg #his'vlsit; • Y;oo wiil•tee0iye ijd full
• comes• oricieike. about this visit: •
❑ Yes o
❑ YesXZO
❑ Yes )io
❑ Yes 4o
❑ Yes No
❑ Yes No
Yes ❑ No
9Yes ❑ No
Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes �6
No
❑ Yes 10
❑ Yes
❑ Yes XNo
i' ,. I. U . ..�. �.; r s g�. _r 3a . PI " # I a •-f f�t � `. �t
Use i-kWings of facilityto lietter4explatri situations (4selidditidhal pageslas necessary) r r; ty 4 a r:,
�> ��° 1�� Inas c,an �,r�,aL-� •1 loeh 5�k. �66r- W I
1q elm �+-�Gioa,�rd �►.���v � -trig `-true
(611145 cit. 5ua"b KaLs P0Ul4-r-I U3Up� ���n� i `i-do
Oke,t- Vi)r -Gaq-m, 415c) ha:5 bee:� R,
,• C, •: -r ''`` ' T''_-"G''" { n—Y o�ir Fr p ��A,} Ci•1�: ham''i-r r t , �• �� 3 r
Reviewer/inspector Name
Reviewer/Inspector Signatur e Jl xJ� l ��, �q f� Date: � �r d�

' Facility Number: — Q of Ijispection QQ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation? Om I 1r
j
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )kNO
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property) TTTT
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? rn IT ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Q� ❑ Yes ❑ No
k' C E{ 7 k. ! 0 P 1 y[;i(if L 3 �i 7E °i 1�'p¢�S� dig€-. 3$ { {y;- F
dna nmmen an OC ra ngs oI , r cs _ I t o E3 ::..3? � 4 :. 4 _ .; ' $ & _ ! E
1

0 Division of Sixd Water Conservation Uther ticy
EMvision of Water Quality
.,
,tap '' t , 'm4f�"" "`K'" .r�`£.."•..:. � m. .p,, q *�«. � _-. K.....,.'�3*39t^3Y'.9� e r , 4 ', � �<�� � $<�Y
0 Routine O Complaint O Follow-up of DWO inspection O Follow-up cif DSWC review O Other
Date of Inspection�
Facility Number D
Time of Inspection 24 hr. (hh:mm)
_�e OKI'
0 Registered MrCertified 13 Applied for Permit Permitted IMot Operational I Date Last Operated:
Farm Name: .......... .T.....1.:r....... ''>i�........................................... County:........1Y...............................................IIS.!Q.O.
Owner Name: i
PhoneNo•... 3.�`/`30 � 37�'S
m ,
Facility Contact: .... MR ..... ...RjA.j'r...... ?),ATkfj5.............. Title: .......O.Y E-1k....................................
Phone No:..........?� ��?�t�........................
2
Mailing Address:..... ... ,?r—.... ......".0............................. ......Q! � �......� �'+t`...!!............................ ................. ..
n
OnsiteRepresentative:........................................................................................................... Integrator:.............................................................. ...........
Certified Operator;..........., ........ ....... Operator Certification Number;........ �,Z.,3..
..........
Location of Farm:
.......... ...z.... ....,tt.:4.,rrl........ ,, �^ 5........., rlYtir......... .....................
r
Latitude Longitude ®• ©� i0 �°
1
Design Current
Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Poultry Capacity Population Cattle ; Cap.acyty -Population,
❑ Layer ❑ Dairy
❑ Non -Layer I I M Non-Dairyl /p00
❑ Other
Total Design Capacity,-' app
Total SSLW , 1?00, 000
Q Nuimber oMag000s / Holding Ponds ID Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
;r ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 031Vo
2. Is any discharge observed from any part of the operation? ❑ Yes 04<0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®K
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 041c,
c. If discharge is observed, what is the estimated flow in gaUmin? Al
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 03'N'o
3. Is there evidence of past discharge from any part of the operation? ❑ Yes �Wo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 1[J'<0
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 11,d'1Vo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the timc of design? ❑ Yes ! o
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [eo
7/25/97 / r 3'�

Facility Number: — p
' 8. Are there lagoons or storage ponds *te which need to be properly closed?
❑ Yes
ff o
Structures (Lagoons.Holding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
❑K
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ....PAR Df ........... ............................................................................................................................................
...... ...........................
Freeboard(ft): .....I lmPIr'...............................................................................................................................................................................................
10: Is seepage observed from any of the structures?
❑ Yes
93,lQo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
E o
12. Do any of the structures need maintenance/improvement?
❑ Yes
Q5<0
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ETo
Wastg Application
14. Is there physical evidence of over application?
❑ Yes
Milo"
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..... C.L?leZV......... ...........................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
QXo
18. Does the receiving crop need improvement?
❑ Yes
ED.Wo
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted -Facilities Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Ndvitilations•or deficiencies: were noted-dtiring this:visit.- You:will receive,nti-further• : -
comes:p )0delnce dl%oui
[1D-Y'es ❑ No
❑ Yes [U o
❑ Yes �o
04'es ❑ No
[�Kcs [I No
❑ Yes 2<0
❑ Yes El-Ivo
7/25197
Reviewer/Inspector Name a .?�' i'►7 1 "1" 1f :f
Reviewer/Inspector Signature: �, Date:

Facility Number: q7 — OZ of Inspection F �{
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [U.WO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? [:)Yes EX
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes QJ-Wo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JZWo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,) ❑ Yes
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P<O
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes
awtngs: ' , . 3 ,
0, _ .. �. ., .. 3 ... i fir. A", J1 �'. _iF �..A
.. 1
3/23/99

Facility Number 97 02 Date of Inspection 8-18-99
Time of Inspection 10:10 24 hr. (hh:mm)
0 Permitted ® Certified 13 Conditionally Certified 0 Registered 10 Not Operational 1 Date Last Operated:
.. County: Wilkes .............................
Farm Name: ASJ.Ikl.P1��.1..�'.A�RIY.t............................................................................ ................... WSJitA........
Owner Name: S.TEYE................................... 1.!'tAJ S..........
Facility Contact: ARC,EMMUM...................................
Mailing Address: 615„iyaATHIS.FA,BUROAD....
Onsite Representative: ....................................................
............................. Phone No: L3 b).954- SQ..ctt. 2 5......................
.. Title: O..W..NE R............................................. Phone No:...................................................
......................................... ROAWNGALVE AIC................................... Z06,69 .............
Integrator:............................................................................... ...
Certified Operator: jokin.).!'1.................................. KaLW5 .............................................. Operator Certification Number: 2l423.............................
Location of Farm:
Latitude 36 • 08 6 53 64 Longitude 81 ' S9 { 10 64
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ps
Dairy
❑ Non -Layer Non -Dairy 300 0
❑ Other
Total Design Capacity 300
Total SSLW 240,000
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid'Traps` ❑ No Liquid Waste Management System
D.ischaraes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: PARLOR
Freeboard(inches): .............. AQO.............. ....... ................................................................ ................................... ....... ............................ ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 97-02 of Inspection
6. Are there structures on -site which are Aproperly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Corn, Soybeans, Wheat
S-1$-99
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? [:]Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio vialatiorisI .del. . .. i. I w.... . . :. . g•this: Visit::Yoti:will' receive nti further,
cor'res�oridence: about this .visit.
[]Yes ® No
® Yes ❑ No
® Yes ❑ No
® Yes ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
16) FACILITY WAS NEVER USED.
17, 18, 19) OPERATOR IS ALWAYS WORKING ON OTHER PROFECTS. THEY MOSTLY HAVE CHICKENS. NO COWS
PRESENT ON THE SITE.
Reviewer/]nspector Name George Smith
Reviewer/Inspector Signature: Date:
3/23/99

�❑ DSWC Ani 1 Feedlot Operation RevieAdEk
kr= f rn
f3'DWQ Animal Feedlot Operation Site Inspection ; ,,
0 Routine O Complaint O Follow-u of MVQ inspection O Follow-up of DSWC review Q Other
Date of Inspection
Facility Number O
Time of Inspection Oq :.ia 24 hr. (hh:mm)
Et t7tRb a 4
© Registered dl/certified © Applied for Permit [] Permitted JQNot Operational I Date Last Operated:
Farm Name: .......ns.� ��- ./!`. �^'f.................... Counlv:......V, .. . ..... ............................ .Ac�
Owner Name:....,... ............................. .........,.................................. Phone No: ... 3.3.6..-..q.P.113..,3.,.i.Q...v'L..
/ q
Facility Contact: le_�.......7t,� ... ........................ Title '4 i.,...... Phone No:..........kr........S..q. `..Z � ....N.,....... .................. 3 3
Mailing Address: ......... ...1✓. ...... ..... !- Lr......A" .............. ......�.;..... .......................... .21?6 .q....
OnsiteRepresentative :.................................. ............ ............`......................... Integrator:....,.................................................................................
Certified Operator;... ........ ....... ......... .............................................. Operator.Certification Number.... . ....�j............
Location of Farm:
Latitude �' �` �" Longitude
G
Design Current Design Current s Design:::: Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity. Population
❑ Wean to Feeder ❑ Layer I 7 1[] Dairy
❑ Feeder to Finish ❑ Non -Layer 1 10 Non -Dairy d
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity f OOD
❑ Gilts
❑ Boars I Total SSLW 900 ooD
Number of Lagoons / Holding Ponds 0 ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
❑ No liquid Waste Management System
General
1. Are there any buffers that need maintenancelinip rove ment?
2. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. 11'disehargc is observed, did it reach Surface Water? (Yves, nobly DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any -applicable setback criteria in effect at the time of design?
❑ Yes [Ko
❑ Yes U340
❑ Yes alf�o
❑ Yes j 21<0
❑ Yes M<o
❑ Yes OKo
❑ Yes 931�o
❑ Yes KKO
❑ Yes I I
❑ Yes [Po
Continued on back
7. Did the facility fail to have a certified operator in responsible charge`!
7/25/97

F9cility Number: '?%— �O IS •
8. Are there lagoons or storage ponds on site which need to be properly closed?
'tructures (Lap oons Holdin Fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
ldentifier.
.............................................................................................................. ......
Freeboard(ft): ... . ..........................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ Yes
UK
Structure 5 Structure 6
..............................................................
...........,,....,..�..
❑ Yes
❑ Yes
Dfgo
12. Do any of the structures need maintenance/improvement?
(Ir any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...............................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Dlt o
MCes
❑ No
❑ Yes
"o
❑ Yes
Olgo
❑ Yes
U-No
D"No.vi6latio'n's,'or'd6ficie'nciis'w'e'ri-'no't'ed-d'ur'in-g'this: visit.- You.yvill receiv'm, &further-
' eofrespkidehce. aliout this'visit: :
13) 6e4,�� 4(,� 4,,t, ­1�
❑ Yes 21qo
❑ Yes M-I<o
❑ Yes Q'Ko
❑ Yes 11Ko
❑ Yes 04010
❑ Yes ILd'N0
❑ Yes Pio
❑ Yes
7/25/97
Reviewer/Inspector NameiM °a17g!7 ME
Reviewer/Inspector Signature: �_,,, �(,� Date: S'—

10 Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Date of Inspection D-- I 3M
Facility Number D
Time of Inspection ir2 t 2. 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: t@ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel and rocessin
❑ Not Operational Date Last Operated : ................................... ................ .............................................................. ...................................
Farm Name: .... RA ......... 0416 .6f.......rel.. m.................................................. County:......... •1.4iCz......... .... ................. ..WAA ,...
Land Owner Namc:...7Y......... ....
.....TIh(S...................................
p......... Phone No:....[.1 �..�..Y.....� 3�0....37p�.......
Facility Conctact:....N9WSON........... 1� ..�!'........................ Title:. Ff etR...................... Phone No: ........ .... ............... ........ ....I.............
MailingAddress:.....(0.it4 ....... 1..!1. zk.s... plika.... &.......................................... ................. ........ ................... ................ ......... ............ I ..........................
OnsiteRepresentative: ..j?R04V!P......... M..6T.k#1f..................................................... Integrator:.......................................................................................
CertifiedOperator: ............. . ................................... .............................................................. Operator Certification Number:.........................................
j,ocanon of rarm:
....................... +............ .............L :'!....... .............................. ......... .................................. ...... 4
................................................................................................................................................................................................................................... .... 4D
Latitude Longitude ®• ®` 0"
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
2. Is any discharge observed from any part of the operation? ❑ Yes CkNo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes CR No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes UqNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes OU No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes So No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes �No
4/30/97 maintenance/improvement?
Continued on back

Facility Number:..... ..... _.J0.1...
S. Is facility in *cable in
❑ Yes
51 No
- not compliance with any setback criteria effect at the time of gn?
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ONO
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
U,No
Structures (Lagoons and/or Holding on"
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Q No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
............................ ............................ ............................ ............................ ............................
10. Is seepage observed from any of the structures?
............................
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
r
9-No
12. Do any of the structures need maintenance/improvement?
❑ Yes
R No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid Ievel markers?
❑ Yes
No
3yaste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoof_f�entering waters of the State, notify DWQ)
15. Crop type4vY1�......eP''....tr.................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
$ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
EZNo
19. Is there a lack of available waste application equipment?
❑ Yes
M No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
2 L Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
For Certified Facilitles Qnly
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes .
❑ No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No .
24. Does record keeping need improvement?
❑ Yes
❑ No
Reviewer/Inspector Name �:'
�•y:� �. :`. {7
� .�:,� ,.� ��;�, E20sMt?:.MO
N.
Reviewer/Inspector Signature:
��
T ,L
i ��rr ��rirr�i ■u�rrr�i
Date:
� ���u��un��i i��w�
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

v
a........ .... - ��
Division of So d Water Conservation Other A �I
J
l l ° Division of Wa .., Quality p�;l ig i €Gl
4aw f �3 Ua i t ` E?t¢ i ° 1 �� €� � } i �'� ii E �� 1 €lr �N MI
`�..""�("."�pi i� V r :e'�N
p Routine p Complaint p Follow-up of DWQ inspection p c
Facility Number
0 Registered p Certified p Applied for Permit p Permitted
Farm Name: AS.,I..Mathis.Farm....
Owner Name: Sterne ....................................... Mathis...
Facility Contact: ..............................................
up or DSWC review p Other
Date of Inspection
Time of Inspection r 24 hr. (hh:mm)
in Not Operational 1 Date Last Operated:
County: Willies WSRO
...... Phone No: 9111-9.M.-3a8ft.o.r..3.7.85.........................................
Title: ............................................................... Phone No:
.........................
Mailing Address: fi15.Ma:axis.Farm..Rd......................................................................... Raari.ng.Riven.11[C............................................... 28.669 ..............
OnsiteRepresentative: A,.Mathis..................................................................................... Integrator:.......................................................................................
Certified Operator: .................................................. .............................................................. Operator Certification Number:.........................................
Location of Farm:
Latitude ®• ®' ©" Longitude ®• ®� ®��
eslg n Current,,Design urren �` Catty eslgu, urren
Capacity' Population Poultry , Capacity Population Po , a Ciapacrty pulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to can
❑ Farrow to Feeder
❑ Farrow to Ftnts
❑ Gilts
❑ Boars
❑ Layer' ❑ Dairy
p Non -Layer ® on airy
p Other
Total`Design Capacity.;
' = Total SSLW i
-,
3 t 3 i € � g' ❑ qManagement� Y_g 0': I � y'.'„� a ` "'
Number of!Lagoons,:,, /Holtlm Ponds iSubsurface rams Present a oon rea �r� ie re
u
!€irrlli is D Liquid aS astem trF
4 �3 iii E - , i -
,.:t,6� .L,.�PI€ ri g. '€ r tri? € g'ri lu �, ?: 6 it ❑
..:_
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discliarge originated at: ❑ Lagoon p Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
all No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
0 Yes
®No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (11'yes, notify DWQ)
17 Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
®No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
®No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97

J
-Facility Number'. 97_2�
8. Are there lagoons or storage ponds on picewhich need to be properly closed?
Structures (Lagoons,H.olding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):.............................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
'(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Annlication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
p Yes
® No
p Yes
® No
Structure 5 Structure
6
............................. ............ I ........
0 Yes
I.............
® No
p Yes
® No
p Yes
N No
p Yes
® No
p Yes
N No
15. Crop type ....... C.orn4SidagF..&..Grain.)....... ............................................................
Milo, Qats)
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Q... o,via iaons.or ar-ren�cies:were.no a .. aiing rs visi :. You wY .receive no, ur er ., .
CorrespojnOMcO �W' t�iisviis��::.:....::....:.............:.:.:.:..... .
p Yes N No
p Yes ® No
p Yes ®No
p Yes N No
p Yes ®No
p Yes ®No
p Yes p No
p Yes p No
0 Yes I] No
p Yes p No
Reviewer/Inspector Name
`Reviewer/Inspector Signature:
Date: