710001_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

IType of Visit 0 Compliance Inspection Oc ration Review O Structure Evaluation O Tefnical Assistance I
Reason for Visit O Routine O Complaint eFollow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: Departure Time: County:
Facility Contact: Title:
Onsite Representative: .���_ 9r,A-_)A_x
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
��. Region: ZZI-ZZOS
Phone No.
Integrator: / '11eq
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = n = = « Longitude: = ° = 1 = {1
Design Currcnt
Design Current Design
Current
Swine
Capacity .Population Wet Foultry
Capacity Popul�n Cattle Capacity
Population
❑ Wean to Finish
113 Layer I
I❑
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Pouhs
Number of Structures:
❑ Other 10Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field Other
a. Was the conveyance man-made?
❑ Yes ONo
❑ 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)
ZYes
❑ No
Cl NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
lNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
//!
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection 2 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?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
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 X No ❑ NA ElNE
[]Yes J2'No []NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes 'P'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
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '_ `"o ❑ 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 Plo ❑ 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? ,� /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes �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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑Ao ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes No ElNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 1 3 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes O No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
'Comments (refer�toaquestion. �#) 'Ezplain,uny YES answers andfor any recommendationslor;any�other
m :.� m
Use drawings of facility tobetter,explain'situations. (useadditional pages as necessary):
.All
(,tJ �s
l.S S�l/ C�vr�«�.��°
CUPIt/ Gf���•
Reviewer/Inspector Name �- 1 ,. t�:�,.rtfixT. w._ m Phone:
Reviewer/Inspector Signature:
Date: p
Page 2 of 3 12128104 ' Continued

Facility'Numbe�r��� ��
Type of Visit QCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral 3Amergency O Other ❑ Denied Access' � n
DAIC of 1'iiii: :1rri al "Time: "� Departure'Time: County: Region: GU!/CA
Form Name: j &Z Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Represental'ive: jov:11m
Certified Operator:
Back-up Operator:
Locatiuu cif Farm:
Swine
Wean to Feeder
Feeder to Finish
LI Farrow to Feeder
In Farrow to Finish
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑o ❑` ❑u Longitude: =0=1 ❑"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I I ❑ Non -Layer
Dry Poultry
Pullets
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ DairySalf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
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?
Xyes ❑ No ❑ NA ❑ NE
El Yes ?1 ElNA [INE
❑ Yes [VNo ❑ NA ❑ NE
0Yes ❑ No ❑ NA ❑ NE
[--]Yes glNo ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
12128104 Continued

Facility Number:.7� -00 l Date of Inspection aZ4111-9Waste 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?
tructure I Structure 2 Structure 3� Structure 4Identifier: s��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes F No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2-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 E140 ElNA [INE
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 E;,No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes [7No ❑ 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste —Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenancelimprovem ent?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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 �fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes INo
❑ 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 VVo
❑ 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 Signature: Date: y
12128104 Continued

Facility Number: Elate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ZINE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ZZ
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 01 E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA' 2f'NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA O�TE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA VNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA 1LI NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA �fNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document Q Yes ❑ No ❑ NA Omand 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 ❑ No ❑ NA VNE
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
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 ❑ No ❑ NA [ NE
Additional Comments and/or Drawings:
,, g O&� 47 1U01V
We c fi/v- 441jr�l 0' r',s
A � c/1 7 c G. an 7 �,-rn . i��e �i h ma's �e&kq
AOaj1A
7f
—��n
12128104

Type of Visit QrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arriwnl Time: eparture Time: I� County: wt Region: 4/4ep
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
� Integrator: _LU
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c = = Longitude: 0 ° = ` 0 "
Design@�—u
Frenti
esign
Current
llesign Current
Swine Capacity
Population
Wet Poultry
Capacity
Population
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cowl
I
❑ Turkeys
❑Turke Pouets
❑ Other
Other
Number of Structures:
❑ 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)
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ,ONo
❑ Yes J?No
❑ NA
❑ NE
❑ Yes 12Ko
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: -71-4011 Date of Inspection a-
AVaste 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes Z'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes JZ'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 P7No
❑ NA ❑ NE
8. 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 ,ENo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P%
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Po
ElNA ❑ NE
❑ Excessive Ponding ElHydraulic Overload ElFrozen Ground [IHeavy 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 ZTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes j2fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes PT No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
.Comments (refer to question #) R Explain any YES, answers and/or any recomiricndatinns or any others comments
.
Use drawingslof facility to better explain "situations: (use additional pages:as:nece"ary):
�fe s a r�� ob 2/1-loU� 6j �- ,/ I
ll
h6ve. �-Pe� /r2lnau�e ,,L Gc back
P�
�d
r1n � �c �� �1 e��r e o� >A
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 1
Page 2 of 3 I2128f04 Continued

r
Type of Visit (p Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 9(Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access /�
Date of Visit: I % Arrival Time: l Departure Time: ounty: �/�� Region:'�" F
Farm Name: �A�Li�i �'lGti .lGr/ /.�2%1Owner Email:
Owner Name: �1ir27 �� L _ _ __ _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
�5I-)xaek-/�
Onsite Representative: ? ,� integrator: R �` —
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: = c = 0 Longitude: = o =, = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
— 1, ❑ Layer
i❑Non -La er
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Puliets
❑
Turkeys
❑
Turkey Poults
❑
Other
DischarZes & 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
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 WrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
12128104 Continued

� t
Facility Number: 7 —
Date of Inspection d5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, iwaste lev l�n�he s uctur l freeboard? ❑ Yes ❑ No [I NA El NE
Structure i Structure 2 Structure 3
t rtructure 4 Structure 5 Structure 6
Identifier: - ?f 1 �2
Spillway?: Na NO O
Designed Freeboard (in): fa 2�
Observed Freeboard (in): og
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes o 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 1VNo ❑ NA ❑ NE
8. 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) 0
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 No ❑ NA ❑ NE
maintenance/improvement?
11. 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 Acce
ptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
M. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
} RA �5 Copt-n 1� 1'4e-0r1j5- ' A�_forju l v U//K/% PAP /•s;�,,�asy�,�c- %ss
eA) rW6 ,f cr , w �=<
,5 n� rig zdl s .
n�p 6,,G� n nn
CURRfia ARKF,►�5 ��7 RFQI zlL�� Rk t�A�O I♦`� �NCr! Esf mA4
LJ4-p -t -D Cr1 A,d, rL � 2a -;rp10 tm�,,
Reviewer/Inspector Name r I =r' Phone: y'
Reviewer/Inspector Signature: Date: /
12128104 Continued

Facility Number: — Date of inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R(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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other ,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IVNo
La No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
)2j NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
LINE
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
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
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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:,'
�0) LJllo 6/3 /0i{ 'J /
%D !(/%`rl�} /Oi��5/!;��
G'L'®,e F= �-
12128104

Type of Visit QJCo 20iance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 16 Time:
10 Not Operational C Below Threshold
Permitted �ertified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
FarmName:/........ �? P...E.....�........�..................................................................... County: .............................................................. .......................
Owner Name:
Phone No:
MailingAddress:...............................................................................................................................................................................................................................
FacilityContact: ........................... ............ ...................... ...�...n...�.... Title:................................................................ Phone No:...................................................
Onsite Representative:.......M r p!. ....�1. 1�-[.................................... Integrator:......................................................................................
Cerfiied Operator: ..................... ............................. . . ......................... . .............................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 1 «
Discbarges & Stream Impacts J
1. Is any discharge observed from any part of the operation? ❑ Yes LCd(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ 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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;79
N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 } Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..1')J SEk V............. It .......................... ..........',�................... ................................... ......................................................................
Freeboard (inches): s4 z3 33
12112103 Continued

Facility Number: ' .1 -- Date of Inspection
5. Ai e_ there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes /Ng,7No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 yes
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? /Ye❑ N
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�Vxo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes :No
Nl1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Gs W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ElYes 0
b) Does the facility need a wettable acre determination? ❑ Yes 9No
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes
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 o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �Q N�
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes L
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.
Field Copy ❑ Final Notes
3 e fLy,A 5 z:1J Fr_c_- c.D W ZT � 6PAsS COVER. To R e-P F-&" nn ?rZvr.05
;"' GaTes CaL OMLAU-S P-T np GooD vRvcg,
St;EaILO WAT6a_tA4Aqs AND GRAvP'Ct1 ra•
fJiF1s `�A (,�t,,,10ouCG3 w-os WaiI.IC ANb WattSl-oPE MAY +JcE.a Stq,M dA�E
LN s7',1`TCt OS Sa M
�
F� wa��RasA'� �Ntzutlf Gr...Ass Gav(2 QF.c,�'c Rant G>! E E sr')o
D3CkL'.GJAt.tr ,JU()S sow'c "04C o,J G•R.ASS &UE&'
(pNTt1�JVE �fO�K 6� ]�ffZLk-w� ATZG ('�R-aSI.o,J WAS.
�Ennova` oL-p P•3PE W D-1XIA FZEUfb 3 oR CAP.
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Date: 5/ ?
12112103 Gonnnued

Facility Number: ' — Date of Inspection
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?
(iel WUP, checklists, design, maps, etc.) ❑ Yes er zo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ 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
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 01VWo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
28. Does facility require a follow-up visit by same agency? ❑ Yes Qfqgl
29. Were anadditional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
y P P
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) O<es �;/Q/
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Yes N
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit J0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification
Facility Number Date of Visit:
toPermitted C/er�tified D Conditionally Certified 0 Registered
'Farm Name:
Owner Name:
Mailing Address:
fU Other ❑ Denied Access
Time:
Date Last Operated r Above
Threshold: _
County:
Phone No:
Facility Contact: Title: 4 1 Phone No:
Onsite Representative: 7A/1']f u1N_ GfiL Ivok
ntegrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Rf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 Longitude r-�a �
Design Current Design Current Design Current
Swine Capacity Population P ultry cHpacitv Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I ILI Non -Dairy
... .........................
Farrow to Wean
Farrow to Feeder Qp ❑Other
Farrow to Finish Total Design Capacity
❑ Gilts Boars Total SSLW
❑
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
.,,Holding Porids 1 Solid Traps ❑ No Liquid Waste Management System
Discharges 8� 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 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?
Wg§teCollectigg & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
St r cture l Structure 2 S ructure 3 Structure 4 Structure 5
Identifier: 11
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
xYes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number; — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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? 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
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 Certified 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?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
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.
E ., a. .�, 'tIs` '6•d'A°.;.5 ".', TM r... -..�,. _. i'.y�' ...
Comments "referuestl n# Explain any YES.answers undlor:any recommendations ar any other comments
`` . c .:
p..ba..,: 1 �. ...
Use tlrawings of facility,to,Ebetter,explain situatious :(use additlonai pagesas accessary); a ❑
't � Field Copy Final Notes
�vS,Pfic-rzo� 01VDUC-rf40 6,Ce4U6, �� �Nafj� �tJFp iPprr� u4n►_
ON &12.31b3
�y z9wQ
Gt%45�E %,E�2E0 /o l�r¢✓F �iV�i� sO�Gsfi�� r4v� ���
ReviewerlInspector Name /f 46A_N
Reviewer/Inspector Signature: Date: p
05103101 Continued

Facility Number: — Date of Inspection ,� Q
or es
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 hours7 ❑ 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? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(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
AtlditioniilCo_mrnentsandloirTDrawings:t
- A4,R l ,10 664-;d A64e7cr OG� F �f,�QlYt
y� 68 /��L+O
A.
�O�FYCF'r•I� ���. r
- �,FR r.9K 49"- e &4 .)I)
Dr- i VV ZA,�7- 1CC(Y�✓✓
41
Av o�i� �'�'�✓F��
A &/OvI0/4
r
05103101 r ���5 w.ro ,�.v�..����.--z,.✓��i�
C
wFO

�l.
Type of Visit 91 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: I Time:
10 Not Operational 0 Below Threshold
Permitted © Cert' led [3Condit' nally Certified[3 istered Date Last Operatedq Above Threshold:
Farm Name: ►2 �J� County:
Owner Name: Ag ,1w9 Phone No:
Mailing Address:
Facility Contact: _ ",
Onsite Representative:
Certified Operator:
Location of Farm:
Pho No:�
Integrator
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude
Longitude
'Design
Current =
'Design
Current
Design Cu�nent
Swine ('
a o u a ion
FM__Wean to Feeder
LJ Farrow to can
Farrow to Feeder
Farrow to Finish
❑ Gilts
er of Lagoons
ids I Solid Traps .�
❑ Other
Total Des j
❑ Subsurface Drains Present
❑ NgLiquid Waste Managen
CapacftyE C
t�
ftal SSLW
❑ Lagoon Area ❑ S
at System
Discharims & 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 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
Str cture cture 2 Stru ture 3 Structure 4 Structure 5
Identifier; OL.J OWL ;'
Freeboard (inches): Z A0
yy
05103101
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
ElYes ANo
❑ YesNo
❑ Yes VNo
Structure 6
Continued

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? ❑ Yes )ONo
(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 VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence over applicatio►�? ❑ E>essive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type
13. Do the receiving crops di er with those de ignated 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?
Reauired 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 certifled operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ 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?
CL
El Yes � No
El Yes 9No
No
El Yes
❑ Yes El No
El Yes �No
El Yes VNo
El Yes �No
❑ Yes VNo
❑ Yes No
El Yes No
❑ Yes No
❑ Yes No
ElYes No
ElYes No
ElYes fNo
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 andloi any recommendatiansfo any other comments
Use da"pwings of facility to better explain situations. (use additional pages asrecespYsy1ai- ry, " •� Field Copy ❑Final Notes
r"72C
�F�o��,E•✓o � '640 11)41os S�a� ,.� ��5 1� � /t/o
Reviewer/Ins ector Name i 7!
p �r
Reviewer/Inspector Signature: Date:W.(a49
05103101 v' — v Continued

1
Facility Number: — Date of Inspection
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 PNo
❑ Yes ❑ No
Additeonril;Gomments aiidlor DirhWings,
05103101
05103101

Type of Visk Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for VleltRoutine O Complaint. O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
to Not Operational tD Below Threshold
13 Permitted 0 Certified [I Condit
ionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name. .........%' t...�e....1. �l sDc.✓ ••'^ County: vQ..Y?8,1r.........................................................
OwnerName: ...........Lj.. rt'r Qf......L '.L... . ....4. s.................................... Phone No:....................................................................................:.
FacilityContact, ............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress:........................................................................................................................................................................................................ ..........................
Vo
Onsite Representative:. `'p..:�. �.............'..Z ��........................ ZJ�i ..... Integrator: L � f�:. .
.........................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 49 Longitude • 4 «
Design . Current Design Current Design + Ctiriiret `
`'Svine Ca aci . Po ulation Poultry . ,Ca sill ' Po ulation Cattle Ca acit' . Po "uliijtioa' '
❑ Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
' ❑ Farrow to Wean
arrow to Feeder Ie (j ❑Other
rE]Barrow to Finish Total Design Capacity
ilts
oars Tota1;SSLW
t
Nlmbe'rof Lagoons' j ❑ Subsurface Drains Present ❑ ❑ Lagoon Area . Spray Field Area'
1' - �F ` E
;Holding Poiids'1 SolidETraps ❑ No Liquid Waste Management System
Dischars & Stream Im»acts
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? ❑ YesoNo
b. if discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes wo
c. If discharge is observed. what is the estimated flow in gal/min? Y1 d A
d..Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes'P.110
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E�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_oNo
Struc re I ,Stf re 2 Struct re 3 Structure 4 Structure 5 Structure 6
Identifier: 14 f I' 1Z.
..............................................................................................................
Freeboard (inches): 2 Z 31
5/00 Continued on back '

Facility Nu&ober: I — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? `(i`e'/"trees, severe erosion, ❑ Yes ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ff 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 ZrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ YesE!rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes E!fNo
Waste AURlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ff No
12. Crop type Coe `1 t %,i 3'l e4
13. Do the receiving crops differ with those 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?
Reuuired 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 Rcviewer/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:. 4Yi n14ns.or- d fciexim •wore inofed• 00 og Ois'visit; • Y:o0 will t eoiye ne ���her • .
corresnoiidence' ahotif this visit: ................................... .
❑ Yes ZNo
❑ Yes ❑ No
'El'Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes ,ffNo
❑ Yes d No
❑ YesA!fNo
❑ Yes gNo
❑ Yes No
❑ Yes No
❑ Yes ,?fNo
❑ Yes J2�No
❑ Yes 0$4o
❑ Yes dNo
:araauucnu �acaca-w yuca,, bCt ei ex 18in's�tuatiflns J ,d, .r: a, wul � .fl.f. - - :. P {uSe•additifl, s va�
ua ! ca wiuucuu
F7Y.
actytofe8l ege4'ag G� du i
f(il F
l q .J . ---L, e -il eW 41 Wile e h,Pj A o ctses (cv reaG, e ewned) n eetf -ho false
+4 ; .r Jneee(s k ie ukd Air'
n �fl �'✓ F14 H q ptL 4n -,e _741r Z lS .
-rbe 4AC,/;4r� )� rlM41y h��. -T7,e eeeoote clror-,a t zed-
Tj c r e I s G GJ 110A G D-An
I.gg
Reviewer/Inspector Name ?'„f f t
ReviewerlInspector Signature: Date: 5/00

Facility, ftmber: Date of Inspection
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 91,10
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P 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 'RNo
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 /J!fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:. �
5/00

Longitude �' �• �'
Design Current;'' Design Current
Poultry Capacity Population Cattle L,.Capacity➢°Populaon
I ^ ' Di si6n.of Soi I and, W ate `Conservatton °'Operation Review` ' ?'
3'Divtsion of Soif and: Water Conservation CompLaiace Inspection ,
a. ky
c IRDivNion of Water.Quality - Compliance inspect on .
,Otherl�igency =� O� ratloiii ,11 lew 3 0 � 1F3�? �' a i a' �.. n' E'� 3
E;..Fa ! E a.. L .� 9
14PRoutine OComplaint O Follow-u of DW ins ection O Follow-u of DSWC review O Other
Facility Number 7 j j Date of Inspection '7 nQ
Time of Inspection Z ?A hr. (hh:mm)
0 Permitted © Certified © Conditionally Certifiedj.� 0 Registered 10 Not O erational Date Last Operated: ..........................
...........,yq� ..:.......................... � County....R.I.d .?rile ......................
Farm Name:
Owner Name :......... "l..Y.......!1 epr !'� !'!'k s� ..... Phone No:.......................................................... 1...................................
Facility Contact: .............. ........ Title: Phone No:
........................................................ ................ .................. .......................................................................
MailingAddress:.................................................................................................................................................................... ..........................
Onsite Representative: + CfL e "u �f r 7>� 6 ✓rdwh Integrator• (( �'
a.....�............... .
Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
.......................................................................................................................................................................................................................................................................
.......................................................................................................................................................... ......... :.....................
Latitude �� �' �•°
Design oCurrent'
Swine Ca aci ' i`Po ulation
❑ Wean to Feeder
`
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
5` SDO
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Imttacts
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 J; No
c. If discharge is observed, what is the estimated Flow in gal/min? !t A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ffNo
2. Is there evidence of past discharge from any part of the operation? ffYes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O No
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A/ ee7 /s�":;4 , z� �e
Freeboard (inches): 31 Z..% 30 .. .................................... ................ I ..................
...........................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes :0 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
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 stbetures 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 tr, o r n d9 `ram b c4qs 6 e r-m udci Graz e rye rGe!e �'✓'qz.�
13. Do the receiving crops differ with those dAignated 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?
Reg wired 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?
(icl 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?
' �'Va •yigla>�iQris'o�• d�ficaertcies •vt��re i�Qte�• o; IFurt��r
• cor'res�oridence. about. this vesit:: • • • • • • •
❑ Yes 19 No
❑ Yes 05No
❑ Yes allo
❑ Yes J2 No
❑ Yes 9 No
2.Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
19 Yes ❑ No
❑ Yes C9 No
❑ Yes ff No
Yes ❑ No
Yes ❑ No
❑ Yes Jallo
❑ Yes Of No
❑ Yes ES No
❑ Yes �9 No
❑ Yes ;gNo
❑ Yes [E�No
-2, /r%,plly �'q✓s+h tv ,^csa-1W'✓e pgz,/�e-d 42u I ��e ���{ ✓Yield Gt�1�'+'r'►�}
Tl�l q•��'Ja� q n®( J¢,a et� vas � B 6 v � Lea s� e la � S Co•rllq?V1 eel , C/e" h „P J
�; God '1►'1 ��t 0(u 1 ""j
I� • �Y,�rct�i� j� �� apt ®n e �� 11 6
Is. ,3��'•�-�d� crazy Field and �'�sGv� �'�1d Le 10 1 ]1 Com,aN ?
lt.t�s-fly ►��t ►^-tvd�i �%n4tj'feseUG grASi5¢1' re-.5paG �rQ]t�. Iva -,k ?4
remave e s a e,4,?ot;,�5e-f /,dvc.sPeG/f- GfoP.
Reviewer/Inspector Name1
J€
Reviewer/Inspector Signature: ^ Date: /9 /f0

Faciflity Number: — 1 Date of nspection
Odor Issue's
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 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 ZNo
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes O 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 XrNo
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 f9.No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? fS Yes ❑ No
ihona . omments'an . ,or ruwtngst.:° ..., .` a
l�. Obi -, I en hJJ6O-I d.Cs,ly, Z k-Qe tiv /% k
use Wa S �e qua ly.; r -ror �lI�GG�t`ans aGa��r y h.� 1� ��n b4 dk�f
o-t'da4e- jx.q sus ,�v]l� }3 ; s in Plti>� as Gdrh bv� iS ;/C, P
ill f i e i �) Oerl ��j Sfr Gh i"t q? 17 /q n t� �i G �!� p `� G T C� Gj� r e- eWv-
-
I 1 lI
e./e �a1/1it�i�,��c O-F L,nC{S � }7jgh StL�j lbga //�Ih ;-r/' 'raPIf 9
I\JA ,v- F/l Z0Z911 4uc� JPletn Ls I����� r /Z/9 7, When
rvteafl��;�� ?Drl� /pre r,,k44,e 44? 1✓4f-lali14h,o`�,nee �-�eGb•
4' d4�4e�'10�►^�,'�a�i�a�ls-
vQ�G /wa yS A4Ake .SU/Ir Itee Gnaf�S to �'le7 IIt J')?

i
i },
I 13iDivision of Soil and Water Conservation-Operation Review'
[3 Davision aif Soil and.Water Conservation : Compliance Isspectroffn
- - ui 1111` K ` IRS M S 4 li f [ li yE
' ..
Other• n of Water „ualrty.` Compliianee InspeetlOn
`Agency-OperationReview
Routine Q Com taint Q Follow-up of DWQ inspection 0 Follow -tip of DSWC review Q Other
Facility Number Date of Inspection 3
hinic of Inspection 24 hr. (hh:mm)
Permitted 0 Certified C] Conditionally Certified [] Registered 1E3 Not Operational Date Last Operated:
County: .............. V......................—........................
Farm Name:
_[ 5"
Owner Name: Phone No:
FacilityContact................................................................................l'itle:................................................................ Phone No:........................................
MailingAddress: ................................�... ......................................................... ........I..................... ........ ...... I...........
Onsitc Representative:-/t^A`� `►- Integrator��.!......................
........ ((( ..
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
,q catiot of Farm:
�.
::....
C.. .. .. ..S. .................:-s,........................................................................................................................................................
Latitude Longitude � • ��°
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Laycr ❑ Dairy
❑ Feeder to Finish JE3 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder G 0 ❑Other
Farrow to Finish Total Design Opacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons J❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray l;ield Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharge & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. II'discharge is observed. did it reach: ❑Surface Waters ❑ Waters of the State
c. 11 discharge is observed. what is the estimated flow in anal/min'!
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2 Structur:• 3
Identifier: s-1¢y7 4,6,V+ 111, sw �-d
r� I►
Freeboard (inchcs)�...............1................. .........................., ....... 1
Structure 4 Structure S
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes 0 No
❑ Yes [9No
,WYes ❑ No
Structure 6
1 /6/99
Continued on back

Facility Number: — Date of Inspection 0 .
n
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] yes ONa
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 n No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings'? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 1W No
11. Is there eviden of over application? ❑ Ponding ❑Nitrogen ❑ Yes �No
1- r /I12.
Croptype���...''1. L..1... �!lC(.............................................................. t..:. �.. t.. �.... <. �...... ........................
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. Does the facility lack wettahle acreage for land application? (footprint) ElYes KNo
15. Does the receiving crop need improvement? ❑ Yes KrNo
16. Is there a lack of adequate waste application equipment'? ❑ Yes ff No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes M 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 pdNo
19. Does record keeping need improvement? (ic/ 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 X No
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ttav( No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) XYes ❑ No
23, Did Reviewcr/lnspector fail to discuss review/inspection with on -site representative? ❑ Yes �d No
24. Does facility require afollow-up visit by same agency?Rryes. [-]'No
:: WviolatioRs:or. dehci ienc'jes .were no.ked. duiring A' is. visit:. You w' il[.rekceive no further .: .
• cderesporidence' botat'this visit: ::: ' ' ' " ' ' ' ' ..... .....
Comments (refe'r., to question #): Explain any YES answers and/or'any recommendations or any other comments J, ti ,
Use drawings of facility: to.bettevexplain 'situations. (use additional page`s as necessary)::
i.
A'
.Py�\ r i-1 , ( � vjeC cs
�yt-�tr<-23 v� 1[�r-,� r�l-mil ��*d
h\ CV Is
Reviewer/Inspector Name�,�
Reviewer/Inspector Signature: Date: 3 � i 11/6/99

rFacility Number: Date of Inspection: TM
,-AdditionO.Co'mments and/&DraWings:
L6
4/30/9'

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number {
Farm Name: v. -,
On -Site Representative: �L-UI�,
inspector/Reviewer's Name:
Date of site visit: 3 I <�ci
Date of most recent WUP:
Operation is flagged for a wettable
acre determination due to failure of
/ Part 11 eligibility item(s) F9 F2 F3 F4
V Operation not required to secure WA
determination at this time based on
exemption E1 E2g
E4
Annual farm PAN deficit: pounds
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D,,/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part If. Complete eligibility
checklist, Part 11- F1 F2 F3, before, completing computational table in Part III).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) chi spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
-- of 75% of the respective field's total acreage as noted in table in Part III.

Revised January 22, 1999
Facility Number. -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD I COMMENTSa
NUMBER NUMBERIRRIGATION ACRES ACRES %
SYSTEM
11 IAll�t•171 L..J...{ �..11 ��_� �— ��.�{ ....�L.w—w ....... 4......w.-..d :.•. r.l.. w.....i lwl.l ... .....L �—� J��_�J:_� _� 11 Al�II.Iri
u.y r+un, iV1IV, v. " . J ...+ .....-.+ ... r........ ... ......0 ..a.... �...v�.a VVFJ4111.,- v.l —1111 —
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption 9 possible; otherwise operation will be subject to WA
determination.
FIELD NUMBEW - must be clearly delineated on map.
COMMENTS3 - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

[] Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
Routine
Facility Number
of
13 Registered Certified © Applied for Permit —*Permitted
Farm Name:..........--...D.4,!................... ......................
Owner Name: "'�
Facility Contact: �S?, / uahou✓ ...... Title:
............................................ ............
Follow-up of DSWC review O Other
Date of Inspection -.30-4
Time of Inspection E= 24 hr. (hh:mm)
10 Not Operational I Date Last Operated:.........
................
.............. County:........... td ......................
.............. Phone NO:.......J, 1. U.....z. �...1... �..7.:�Sb................
................... Phone No:...................................................
MailingAddress: ..................................................................................................................... ..............,...................................................................... ..........................
Onsite Representative: .D.... .. 1. ht7Lu ............................ .........,.....
�p � �... �.. 'r..................................... Integrator:...L. �.L.cJ..Y..��.{� � �
Certified Operator;........... .t�. .....?'Io.4.1�.......................................................... Operator Certification Number ;....�..� 1� 51�
..........................
Location of Farm:
Latitude 0' ° 0"
❑ Wean to Feeder
❑ Feeder to Finish
F-Ijiarrow to Wean
Eg,Farrow to Feeder
00
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude =• 0' ="
Desigr4 Current' '
! Poultry' Capacity Population Cattle
❑ Layer Fon-Dairyl
airy
❑ Nan -Layer
❑ Other
Total S:
c
Neimbei• of Lagoons°/ Holding Ponds
ID Subsurface Drains Present
10 Lagoon Area
❑ Spray Field Area
❑ No Liquid Waste Management System
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
Discharge originated at: ❑ Lagoon ❑ Spray Field Other
a. If discharge is observed, was the conveyance man-made?
Yes10
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes VNo
c. If discharge is observed, what is the estimated flow in gal/min?
Z
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes x No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes )dNo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
Xyes ❑ No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes JK[No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes XNO
7/25/97

'�acllity Number: �- —
J� 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes �(No
Structures (Lagoonsjjoldingy Ponds Flush Pits te.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ YesXNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ...S.rLO?.L:... t-'% .... N �4jq...............
Freeboard(ft): ... ..II ............................ Z.. L.......... ................................... .................................... .................... ................ ....................................
10. Is seepage observed from any of the structures? ❑ Yes 9No
11. Is erosion, or any other threats to the integrity of any of the structures observed? )dyes ❑ No
12. Do any of the structures need maintenance/improvement? Yes ❑ 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 level markers?
❑ Yes �(o
3yastg Application
14. Is there physical evidence of over application?' �4��j/� LDS )eyes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....��!� G..��r`..1... 12� ��� .............:.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes gNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes XNO
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 reviewlinspection 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?
No:vidla'tioinsor. deficiencies:were-rtoteid-duri igthis:visit:-.You:willrecei've'noItirther,:
correspuitde O albout -this',vtsit.• :
'ryes ❑ No
❑ Yes
El Yes �XNo
❑ Yes &No
❑ Yes WN0
❑ Yes VNo
❑ Yes
�No
❑ Yes y No
2 A+ J OL.SL-V. T-o,4 r{y Uir IrcIYGId
i1/1z , - !: ros;0h ,CLJ5 on pCi-s" k•'i( a_� SOL- I4sooil gec15 +b der
�p - rosio� C,+ oq L,-If( C¢Lnvr6Q*-y �kee15 -64j1e_e- 6UkP:l[e�w;�(,,Gk�,4���
(7ve,-appl�`cr,4io j h,f,-e oh•4ie.r�i iI2 . T�-.7 ;-2 d,e_ fv CowAf-T' �►'rjy%
1y Cohn ..e 4- i t- Pro -e- Ca mGr Gyroe
j; $%o"I'4 +Vo-'4pp,y'--"y c_+ra coma.�✓vps r.l,�u� Q�L i k o��,^H,
7�.'(� 1I�r� lt5 �e1�c7G�� �Cln w:i� Govalcrsp. 7/25/97 H
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: it-5O

.. . . . ............. ..
J3 D Review SWC A
1: aN
. .
4NDWQAnimal TeedlotQpera on SlfeJasmtfic
... ........
2_.K.
I
.!40 Routine 0 Com2laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number f
- I .
Time of Inspection it, , 00 _j Use 24 hr. time
Farm Status: .... Total Time (in hours) Spent onRe%iew
I or Inspection (includes travel and processing)
Farm Name: .... . .... County:. ..... . .......
j-e
Owner Name: Phone No:..---ZS
Mailing Address:.—L3-3-5:--Jlt—�.aLb- L"_ LLA., a
Onsite Representative: Integrator: . .....
Certified Operator-.-'-'%?
..... . . ... Operator Certification Number: . ....................
Location of Farm:
Latitude Longitude
JE3 Not Operational Date Last Operated:
Type of Operation and Design Capacity
'Swine
urn b er
-A, Cattle :-;Number` ,:­,.%M.'11'�W1,:,.
❑Wean to Feeder
10 Laver
Dairy
0 Feeder to Finish
10 Non -Laver I
Beef I
j,"..
Farrow to Wean
Farrow
p
-A
to Feeder
Farrow to Finish
ro Other Type of Livestock
Subsurface' Drains Present
�aggounAr�ea�J_4510 Spray Fiel-d—A—rea-:
Iiazl,
General
1. Are there any buffers that need maintenance/improvement?
2, Is any discharge observed from any part of the operation.?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (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)
Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
D'Yes G-No
El Yes [31To
El Yes allo
El Yes [allo
0 Yes D-No
D Yes [9�"o
0 Yes 0,90
C3 Yes [2,<'o
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenanceAmprovcmcnt"

6. Is facility not In compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after i/l/97)?
❑ Yes Gi z,6
❑ Yes allo ,
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holdina Ponds)
9. Is structural freeboard less than adequate?
Freeboard (ft): L-2rmon 1 Lagoon 2 La_oon 3
2• _ ._.__ le 7 ..._._ . _ _...... _
10. Is seepage observed from any of the structures?
I I. 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 adquate markers to identify start and stop pumping levels?
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 active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a Iack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/inspector fail to discuss review/inspection with owner or operator in charge?
F.
❑ Yes 9No
❑ Yes
9No
Lagoon 4_..._
❑ Yeses
Blgo
E2 r es
Cl No
Effes
❑No
❑ Yes QrNo
❑ Yes [ No
❑ Yes
CR`j�,70
❑ Yes
C9-4%
❑ Yes
P14
❑ Yes
(�o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes i] No
❑ Yes [}'1Qo
❑ Yes G-KO
iIYY► � l�rGl� I !/7-� rm (� �itiG�cJ I+' � ,eG�vi/�°GS �'p�pp r�P, �AG�%`1 ,ram. �i"� N£f.�
�Q 3� v►n�i•D -a c� IQew�� ,V ►nre�� i � bit �f� ����r�-�.1 j 5��-�
A
T i 5 ri "ryn--p 1CA NV r I 1'c.1 v 1" ,
V, LA 1-0 .
Reviewer/InspectorName —� max.
Reviwer/Inspector Signature:
Date:
��)21
Division of Water Quality, Water Quality Section, Facility Assessment Unit
11/1.1/96

Facility Number:
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record /UDU
Date: /0�- ,7_9 4, W P
Time: -
General Information:
Farm Name:�A,/1 tJ _ County: d
Owner Name: 7 Phone No: zS 7 S' IP
On Site Representative: Za 44crr-Q Integrator: _ _jM 1/,g f. F, Z35 -
ww2 �vJ�
Mailing Address: jam _
Physical Address/Location: Ake 2" s0 _
Latitude: I I Longitude: I 1
O erati n Descri tion: (based on design characteristics)
T pe of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
ow ❑ Layer ' C] Dairy
Nursery ❑ Non -Layer ❑ Beef
Feeder Zz
OtherType of Livestock Number of Animals:
Number of Lagoons: 7-- (include is the Drawings and Observations the freeboard of each lagoon)
Facilitv Inspection:
Lagoon
Is lagoon(s) freeboard less than 1foot + 25 year 24 hour storm storage?:
Is seepage observed from the. lagoon?:
Is erosion observed?:
Is any discharge observed?
O Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need improvement)
Crop type:_ : a i __ Acreage:r ''2.a7
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOi -- January 17,1996
YesAL
No ❑ y
Yes ❑
No M
Yes &
No ❑
Yes ❑
No ❑
Yes ❑ No CR
Yes ❑ No IN
Yes ❑
No Bi
Yes ❑
No 0
Yes ❑
No 3
Yes ❑
No 0

I
Maintenance
Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Yes ❑
Noll
Yes ❑
NoAa
Yes ❑
No V
Yes Q
Now
I r
i
Signature: Date:
cc: Facility Assessment Unit Use Attachments if Needed
Drawiny-s or Observations: I " Z 9 07Ta C,l/.•
�Ipy'i0�Sa'f�� R='4
A,OI — January 17,1996

Environmental Chemists, Inc.
® MAILING ADDRESS: TELEPHONE: SHIPPING ADDRESS:
CONSULTING P.O. Box 1037 [phone] (Office) 6602 Windmill Way
CHEMISTS Wrightsville Beach, [phone] (Lab) Wilmington,
North Carolina 28480 [phone] (Fax) North Carolina 28405
REPORT OF ANAL Y.S'1 .S
Customer: NCDEHNR-DWQ
127 N.-CARDINAL DRIVE EXT.
WILMINGTON, NC 28405
Date Sampled: 10-17-96 Date of Report:
Sampled By: DAVID HOLSINGER P.O.#:
Report To: RICK SHIVER Report #:
WASTEWATER: M & H Farm
10-31-96
4443
PARAMETER
#lA&B
(#6915A&B)
#50A&B
(#6916A&B)
Total Kjeldahl Nitrogen, (TKN) mg/L
24.1
3.08
Ammonia Nitrogen, NH3-N mg/L
13.4
3.08
Nitrate+Nitrite, NO3+NO2-N mg/L
0.86
0.96
Fecal Coliform, Col./100ml
29,000
46
Total Phosphorus, P mg/L
2.72
0.31
NOV 0 6 1996

Irenivirochelm
Environmental Chemists, Inc.
MAILING ADDRESS:
TELEPHONE:
SHIPPING ADDRESS:
P.O. Box 1037
[phone] (Office)
6602 Windmill Way
CONSULTING Wrightsville Beach,
(910) 392-= (Cab)
Wilmington,
CHEMISTS North Carolina 28480
[phone] (Fax)
North Carolina 28405
CHAIN OF CUSTODY FOR SAMPLE COLLECTION
Client: Report # :
Collected By (signature & print) ---
Sample Type: Influent, Effluent. Well, trea Soil, Other
Collection: For composite Indicate Date & Time for Start & Finish
Location &
Identification
Sample
Type
Collection
Date Time
Bottle
ID
Lab
ID
Analysis
Requested
`3
10 -1 7-1 6
l ri -1 -��
r2 : y S
J:S
-0
jIGA
cra L
Lr
Transfei Relinquished By
Date/Time
Received By
Date/Time
1
2
Proper Preservative Used: Acid , Base Other
Received On Ice or Chilled to 4*C: Yes 'r No
Accepted ✓ Rej.ected By Comment
Comments
Delivered By `�il�r�a _3i S�n1�r=� Received By
Date 0 Time _ O�

PHY-
UNNAMED TRIB
<:ANGOLA CREEK
f' M & H FARM
PENDER COUNTY
_ 1 - - MAP. NOT -TO SCALE
LAGOON
I
HOUSES
OUT BUILDIN
SPRAY
FIELD
DAMAGED RISER
SPRAY
FIELD
r
0
HOU
L--i L--Jll"
LAGOON

4�1
a
,4Z
's 4.
e S.
........ . . . . . . . .

,
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UP
1 .. •�.r:- .. � ! s� it �

Site Requires Immediate Attention:
3
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: —a' 3 a
Farm Name/Owner: _ _ K *- I'1 T�. ► nS
Mailing Address: ! 7 H kA a ktay%act r_ _IC VOCC, ,il P .0 e
County:
Integrator: VY-ktA JQA4eA M Phone:
On Site Representative: Phond-'�?lJ) 2356
Physical Address/Location:
Type of Operation: Swine Poultry
Cattle
Design Capacity: 14, S� u� Number of Animals on Site: tl
DEM Certification N46ber: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes(No Actual Freeboard: �/ Ft. �� Inches
Was any seepage observed from the lagoon s)? Yes or No Was any erosion ob erved? Ye�gIYPo� (�4
Is adequate land available for spray? Yes or No Is the cover crop adegtiatees or No uLG�
Crop(s) being utilized:
Does the facility meet SCS minimum setback, criteria? 200 Feet from Dwellings?or No
100 Feet.from Wells. e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes q0N
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes Oro
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o(3K- If Yes, Please Explain.
Does the facility maintain adequate waste management rec ds (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? e or No wa
Additional Comments: (0 �� 6'' "� _
' cc 6RAA
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediat-e Attention
0
Facility Number. � ' (
SrM VISITATION RECORD
DATE: 7uty ig. -- -• 1.995
Owner: Pate MIrpby . Farm Name:
County: _Pander
Agent Visiting Site: tender M Phone: , (910) 2„-4305 .�.
Operator. Rnh u rinr , .. _.._ - Phone: (s1 259-73s-- - - -
On Site Representative: Bob Honour Phone: same {
Physical Address: 3 miles NW of the intersection of NC 50 and NC 53. Turn right
on Murphy Honour Rd. off NC 50.
MaDing Address: 1735 Murphy Honour Rd.
Maple Hill, N:C.
2845T-
Type of Operation: `:Swine x Poultry Cattle
Design Capacity: unknown Number of Animals on' Site: 5,500 Soars Farrow - Wean
Y.atirude: �-o Longitude: � ,400 can - feeder
Type of Inspection: Crround X Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or Actual Freeboard: Feet 10 Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for laud application? Yes or No Is the cover crap adequate? Yes or No
Additional Comments: inspection of west dike was completed. Vegetation did not
pamit assa a for remainin three iM2undment structures. Liquid level is within
10 inches of top 9f dike. Waste ponded an top of west dike in area of irrigation
PUM•This site r2.cM res inpediate attention.
Fax to [phone] Signattife of Agent