510035_PERMIT FILE_20171231

V B IRS Zrls CN011)
Type of Visit: ($fCompliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 1WRoutine Q Complaint Q Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: c F11011 { Arrival Time:
J Departure Time: County:
Farm Name: She & kelp V-acksch 'I—�l(iY1_ Owner Email:
Owner Name: �� �Q'G �S Q� - Phone:
Mailing Address:
Region: R-0
Physical Address: 71),T- L)ew 42 r�»1 QQ�s
Facility Contact: She �6 �-oCkf1h Title: Owl-, Phone:
Onsite Representative: � 'Qcks� _ Integrator: I —B
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current Design CurFe n 11
t
Swine
Capacity
Pop. Wet Poultry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, P,oult . Ca aei P■o
Non -Dairy
Farrow to Finish
Layers
I 113eef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke 1'oults
Other
I
10ther
Discharees and Stream Imnacts
I. 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
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ 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 DWR)
❑ 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilit 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
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C' No
❑ 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
D Yes
CR 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Eg No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
0 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
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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�R 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 Approved Area
12. Crop Typc(s): '50V b o4h S Small 41m)Ih
13. Soil Type(s): --A %11
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
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
to No
❑ NA
❑ NE
acres determination?
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
[oci 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:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: al - 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 ❑ No ❑ NA [RNE
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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
CZ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
EZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ff No
❑ NA
❑ NE
Comments (refer to question #):. Explain anyYES answers and/or any additional recommendations or any, other comments.
Use-drawin s of facility to better explain situ�adons use additional: -'pages as `necessa
g Y p ( �"Y)
4-Sher, has s vffi ieit C&fi1(%v►h eot hoar1 4/ya h 4"he e4 e aD ( 9',
Ud)w14'e J 4-9 Y6.
1
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ay ! � � O ,9�
�01 Cali01� S[aye
saf v? by HaR UVIltf
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Thll� '0001a0y spy[` �gp��or 3 ylQa�
37111111 W007030
All VAji ► do�Q+� summer .
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Reviewer/Inspector Name:
Phone:
V Reviewer/Inspecttor-S`ignature: TOGM schA-ey/ _ Date: t & caor)
c
Page 3 of 3 t.fit jo s�) 4&'j4q Icyhfk &i iozv LJ 21412014

M bin
' -Divi"sign of Water Resources
F"Cility Number - ,J� 0 Division of Soil and Water Conservation
O Other AgLnnCy
Type of Visit: 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ZrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: QQ;S County: D Region:
Farm Name: s'Adio
Owner Name:
Mailing Address:
Owner Email:
Phone:
Physical Address: _70r Ni wth (ofove Rd- T`vrr oaks
Facility Contact: shel �--dc cry, Title: Phone:
Onsite Representative: s w6 Integrator: M-P
Certified Operator: S Ae 6 IV&SaaCertification Number: 1-T76,5—
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent`® Des g Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Wean to Feeder Non -La er
Design Current
Cattle C►►opacity Pop.
DairyCow
DairyCalf
Feeder to Finish Q
Design
Dr: P■pult Ca acit
La era
Current
P.o P.
DairyHeifer
Farrow to Wean
Farrow to Feeder
Dr Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and 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
[] No
❑ NA
❑ NE
b. Did the discharge reach waters ofthe State? (If yes, notify DWR)
❑ 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 DWR)
❑ 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
21 No
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 21412015 Continued

Facility Number: - 357- jDate of Inspection: Q
Wastc-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
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): _ q
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes [M No ❑ NA ❑ NE
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
5 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
$j] No
❑ NA
❑ NE
S. Do any of the structures 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
® 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?
I I . Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): Car) ) WbeO '. S(5,1. ft#o) --
13. Soil Type(s): N,9 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? O Yes ®No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes CZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage.& Permit readily available?
❑ Yes
C' No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
❑ Yes
R7 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes "No 0 NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [ZNA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: .IT I - Date of Inspection: PJj-
24., Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [5j No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [�g 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 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 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 No
❑ 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
CZ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were 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
15D No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2 No
❑ NA ❑ NE
Comments (refer to question #):, Explain,any YES answers, and/or any additional recommendations or any other comments..
Usedrawings of facility to better'explaiin�'sltuations (use additional pages as necessary)";
aG, Sher wfl) ah�s Cp�`hnUjn' ek befae.
�1 e_ check gj1311� Nay kAowvl6 1,S"p) Co Ed)
-P+J ��,TrVo 3,Sf1'� }bpi o
, Cal i b ai o„ y j l,31(� ,11 o pl , a 6r'Pf -a ko � 'Max kne►-lY1 i 6a4d-Cor aye&-
way NA ysts
91111N w006$-7y l Bvh yeas— soybe&6 Mere s payed, *H'h a- fewwfe��
itl 10115 Yv 00 � *U a'D I I
p1e4,�'h, avvg�_-5 qnj lv-- wh e,\ yov 1),ex1f sP n;,
Sefl ifSt sLpa983� j 911al Jf , Qmeneede� 0—o,3-Jt,SIaue--too-Wall aznovAi- `fe(y
C-o p 4 ZNncr 01(e_ 11110 . Good -N,, 3 y,Ws,
600dtfab &f fold%spray Eve-l*�-o)��s'ii►�, a�P�acre.,
>�ori o� ash Cold no�-�1�d✓ a� �ss1 Ld a fye -)V00VV6(e art D-P_ffC�eAC ;-f +iis wo.r
W da)t✓ chd wi M l 4 ai c heck x -er11V0�`t- e.s �a� ��uk, �4pn wf) C' ftkwild i- X'
Add �h'o1� nde. al jowcb a15s v, cl AecapinvM� al
►111 is e�d'�e �e a[a a [ 1 s.',� 36
1 u�. V, vol, J. "F, y8 °lo
Reviewer/[nspector Name: ^30 24 'Q f Cc Phone: 91 1 ql- l4: l
Reviewer/Inspector Signature: %Date: AvaaQ
Page 3 of 3 /4/201S

ype of visit: u Lompuance inspecrton u c.uperanon tceview 14y arrucrure r.vaivanon u i ecnmcai Assisrance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' 00 County: Region:
Farm Name: fir(-pth jock , t2 Jr Owner Email:
Owner Name: lhPhone:
Mailing Address:
Physical Address:
Facility Contact:
Shp '�&SQ1 Title:
Onsite Representative: IQCkl
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: H"g
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Popap -it—VIEPop.
Wean to Finish La er
Cattle
Dairy Cow
Design
Capacity
Current
I.
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design C*urrent
Dt, P.oultr. Ca aci P,o ,
La ers
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�R No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ 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 DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

lFacility N ynber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[R No
❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:)Yes
fa No
❑ 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
P 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 DWR
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
❑ 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
❑ No
❑ NA
[.VNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
W NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[,V 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):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
IqE
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
❑ NA
CZ NE
acres determination?
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
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:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail 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 ❑ No
❑ NA ® NE
❑ Weather Code
❑ Sludge Survey
❑ NA ® NE
❑ NA [Z NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA J;a NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NJ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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)
❑ Yes
❑ No
❑ NA
U NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
No
[] NA
❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewcr/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
CRNo
❑NA
❑NE
No
❑ NA
❑ NE
�No
❑NA
❑NE
No
❑ NA
❑ NE
Comments (refer to question #): Explain: any: YES answers and/or, any additional recommendations or any other comments:'
Use drawings offacility to better explainsituatlons (use additional pages:a's,necessarv)
5�1p6wre. tvgl�ai�'a �y
Reviewer/Inspector Name: c l n 1�r h -P I P r Phone: 9R—_ 1H33a
Reviewer/Inspector Signature: - Date: F p 01
Page 3 of 3 U 21412014

1oral15-
Type of Visit: (WCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: SMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ]]��` Arrival Time: Departure Time: Q; Q County:
Farm Name: Shy l� K�el � n ��'ack s6i A, Owner Email:
Owner Name: S t e- �`� K. V ack Sib Phone:
Mailing Address:
Region: ►�
Physical Address: 76r K&Iet-a , Nbvio, C910ve_
Facility Contact: ShAAM 7TO JIA, , Title: owoel Phone:
Onsite Representative: ShQt'�(iY1 ��C�ISI /1 Integrator: H_R
Certified Operator: Sk h6iL k, Certification Number: 177,61-
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Design
Current
Design Current
Swine Capacity Pnp.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I lNon-Layer
1
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C►urrent
D Cow
Farrow to Feeder
iff. P,Mult .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
NJ Other JS
Other
T ----
M
Discharges and Stream _Impacts
1. Is any discharge observed from any part of the operation? [:]Yes RNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ 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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes f 5 'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Nr No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
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
Structure 1 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 Co No
❑ 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
[3 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 DWR
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
❑ 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 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C;2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
"Yes []No
❑ NA
❑ NE
❑ Excessive Ponding C&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): Cal) -VVhAA_S0U , L' Qrff0n
13. Soil Type(s): MIN IV A 1� [Q fDic) A-
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 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�R No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E�eNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
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
ER�NA
❑ NE
Page 2 of 3
21412014 Continued

Facili 14umber: 51 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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:
❑NA ❑NE
❑NA ❑NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
P NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes Off No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [Z 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 a follow-up visit by the same agency? ❑ Yes g 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).
altlr Shelia, hu r- svfP r'e4wf� Avj� ed_h.&.s -hloyi, -rhea o� ma's farbvt W ill rw��'
+his,
@3-(QiV S I)f v I I I I Ir � b y Mux kn0".l,, (saw Co 0-0O Of � , Sly � 3r� 1 .10
I /'? f1' Mt-
I+v l� aL vd
�n d"
yeers ye,
c'a,e_ gaall �oo� -Poi a ,A�� . rJo m� a6A7,V1 Ff
}, YI1as�e�[G�n �S t� l`l�t7rmLZK141�n� a 1i1c1 �P� ac1eqe'' ��e��'��Pri
lv"re'Same.Wh
����.to s u reel a bl`�-►�n s�,>Q. f�'��d� .
pal i -�i� Chn r
1 M -her/Pull W104Ch►�) _._1 t � _� 7)aul 9
!-y %30 ;ao g y$o f $G00) '51101ly-- a,)Iwo
a`y 3 0 ka
e) 30) 9-1 ayo N'ix Soi1�nfle- SL6aq,
dap q_3 „lhi9PPJ1'404
5- 3
s1( -3,30
y3 � , 11 � 1 r eV CO��a� 'le Sa-�1 lY1
7�! Mad-D)MC hrl' h1A�SP_ ,SF1i s erP_ l�l/!r� /� Nry7l�
Reviewer/Inspector Name: �Qn n�p��/ Phone: 1q1Q q1_q D V
Reviewer/Inspector Signature: r Date:.
Page 3 of 3 21412014

(Type of Visit: -0 Compliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance I
Reason for Visit: G Routine Q Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:E,]5j;E�16aunty: Region: RRQ -
Farm Name: ShP� kf � IM501 Owner Email:
Owner Name: Sj}_Q1121 �Y_QCk SOI Phone:
Mailing Address:
Physical Address: -70T Rohn" 1'& , f i j� ty& 6f0 "P _
Facility Contact: She l iTitle: Phone: q�-S l6,pa O
Onsite _
Representative: J Integrator: 1 --B
Certified Operator: N GkSa Certification Number: 1-77�pr
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine Capacity Pap.
W&PouUey Capacity
Pop.
Cattle C•apaeity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , P,oult`. Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPuuets
Other
Other
Discharges and Stream ImnaCtS
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
❑ 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 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
NJ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

" Facil' Number: - 3" Date of Ins ection:$
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
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 43
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ 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
L No
❑ NA
❑ NE
8. Do any of the structures 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
M 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[R No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
0 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
❑ NA
❑ NE
acres determination?
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
2] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR 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:
21. Does record keeping need improvement? If yes, check the appropriate box below. aYes []No
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail 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 ❑ No
Page 2 of 3
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey,,
❑NA ❑NE
NA ❑ NE
tQj
21412011 Continued

IFacility Number: 3 ,S Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CK No ❑ NA ❑ NE
to
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ;K 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 [�4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (3 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3 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
ERNo
❑ 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
[51 No
❑ 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
P No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were 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
r" No
❑ NA
❑ NE
34. Does the facility require a follow-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).
ate, O ra1,� wj d 1 n � & ho�.� coiO Ll,� ediea—h , bye- I )311 a?41'S,
CaIiJvra'4 dfi llog�m by Nokn bb�y 5 613`1P'11 ►4IV cal'
SIUzs urv� "c(q� �Iad I I3 � Y n d 0 w; 1
`9 2r 4 �e bb a f4 ear, RQr 0 is a`� ye �o , 1
heed. d0 k cAe&io t W►~-�i� a
raj Cr rdo re
Qc% j-� t&A'1 M 70
�
a L hl &�e ana yS s covs& pd+" sera7 eye, Q,,de,?Pj �o at lln� recoor,
Z 1ar f i y 1,03 1v000q Rj
0113 I, 9> >N000 q91
Noe vr— Cal Pavia _ ra*-of 110 M d) "J+-retolds, PAYWo-t not �QXCeol 4
Sol ajaS-1f9 SL©a4a-77 r t* iMewasafflied
Oj*d in book. (,j'%
0 hurrl Y1�ds9roNn i� a013 �Th;.s kraf ndJ-1f) YVOJ �/41,There as noane r,er�Col e'f
r�e "Ark does Adl ry 'I` i more. ,1� you Gh�, e cro ,
s 9y
d .Boa o � -hl�'%
`1 �o' !�� b��, �` needs Sole mae work.
o�e. 9 �� y
BdIm 's v io ova , M1 ma,�-�Q�L` 1A
Reviewer/Inspector Name: 1,0144. 010 PE Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 V V 21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: LIB Departure Time: County: Reg o
i n
Farm Name: h n (+?T n b( .n E A- h f l /i e jV ',M �Kl4&.Bwner Email:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
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?
Phone:
Integrator: M G ILL,-,
_
Certification Number:
Certification Number:
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?
Longitude:
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes o
❑ Yes ET'No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesNo ❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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 XNo ❑ 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 ON' o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I ( No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ 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 ZNo ❑ 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). 3 (2 G le I_ a
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesJPTI�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 21"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes /XNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
�/
ElYes l/(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes%o
❑ 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 T2<0
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
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

r
LFOlity Number: Date of Inspection:
24
Dide�facility fail to calibrate waste application equipment as required by thc ❑YesNo ❑ NA ❑ NE
2�. Is the face out o perrnii conditions related ge? It�yes, i`&V_ ❑ Yes & o ❑ NA ❑ NE
the appropriate box(es) below, aLd l "3 )
❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes ZNo ❑ 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 ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. ;2"N*o
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 o
❑ Yes' o
❑ Yes '2"N0
❑ Yes No
❑ Yes (� C3/No
❑NA ❑NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #t): 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). l'
c��oaa9til
A 3 < i evrd 3j � Nam Kco �I�
c,Q �.�.�m 5- a 0 9 y41M 1(,3 M hA_�
OLpPe'6U CcbApx_a� mo ���
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Z-4-3
21412011

type of visit: A Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 2:" outine O Complaint O Follow-up O Referral O Emergency O Other () Denied Access
Date of Visit: Arrival Time: Departure Time:
Farm Name: - 1, Vin im
ail:
County: Region:��
Owner Name: Phone: q 1—— 1093
10- 6089- Sl6(
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: MjjArjhA
Certified Operator: s �j (� (�iJ `('c K Certification Number:
Q
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Curren
1111Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
CaDesign
Cattle pacity op.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
e
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr,
Ca aci.
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
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 ZNo ❑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 g o ❑ 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 J2!rNo ❑ 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 elNo ❑ NA ❑ NE
8. Do any of the structures 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes EfrNo
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes JZ'No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EfrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily availablc? If 1111 es, check ❑ Yes ; No ❑ NA ❑ NE
the appropriate box. ��
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements Other: t 0q
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 0 Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes E:fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ��o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: ZZ
-
24. Did tth f f,, iIi(t�_faij tocaliibbrat �wasaste application equipment as required by the permit? ❑ Yes � No
25. Is the facility�t o`l comp Alice with permit conditions related to sludge? If yes, check ❑ Yes P3No
the appropriate box(es) below. a Q I O BELL°(-�-* s-Z.-V {YX_G fcl I I
❑ 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 provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ,En"No ❑ NA ❑ NE
❑ Yes FeNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes JZNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �' o
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ 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).'.c
�0 ( e- a0 f C4-pp^ a' J44'VV� f 41WU
a 0 l a. - 6 - a9 - I
kN � 4,0 �nw,� e-n 09 k
11,5) 1. 4 7**/i/ 5-6 -1 l n/s/,1
y % 5 a . Co (a 3 js� ► 5 - 4 - / �), 7/9 a1
C.O�1\ pjiy_� U 7 went i 31 d J
_ Tr a l\ h nn, I -a ^ Ll Arh-mr-, nil) 1 C L n /e . )ate. 1 / f ", 1 b..
Reviewer/inspector Name: � (� � •(� � C {�(�`
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q fC%7C]I t/�a
Date: 6
21412011

Type of Visit: goutine
[lance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visi : O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I= Departure Time: County: Z�C) Region: 6 (ka
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator:
Back-up Operator: ]\] Z10P_ L50 j\) /j, I per
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►►urrent
Design Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry Capacity Fop. C*attle
C•apac[ty Pop.
Wean to Finish
La er Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
. Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder.
Dry P,oultr, Ca aci P,o Non -Dairy
Farrow to Finish
La ers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
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?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
e. 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 ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes )21"No ❑ NA ❑ NE
of the State other than from a discharge?
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
VNo
❑ 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
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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
VNo
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 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
[;YNo
❑ 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
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 Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VfNo
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P31,140
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ff No
❑ 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:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
12rNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
nj No
T
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

*A ..
Facility Number: 51 - 3 Date of Inspection:
24. ',d the fhccility fa�l tOo cglibra,Ie waste ap hcation equipment as required by the permit? ❑ Yes
25. Is the utility out of compliaa nce`drith permit outio s related to sludge? If yes, check ❑ Yes
the appropriate box(es) below. rj I d0I10 LT 7- ��, 1
❑ 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:
ZNo ❑ NA ❑ NE
R1 No ❑ NA ❑ NE
26, Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VrNo
❑ 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
2rNo
❑ 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
9No
❑ 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ 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 WrNo ❑ NA ❑ NE
Comments (refer, to question #): Explain any YES answers and/or any additional recommendations or any other comments', "g
Use'diawin s of'facility to better explain situations (use addition as necessar)} Ni*6 ,* �: ;
S Sarnple. 3- a5-10 14 3'!a S 1 1'W L&yw Ar Lcrvt r-c CL r 5ctm� le
ao I ?
Iti7Qs }c lA nn 1N/s,'S U)0 $ i j 1 txih,�
�o ,i ec oc�s
a o i a-
UJ a IT'& wed on %.I ,n a C, n d 0-0 "' poLc e d
Lx q zb&
P oe_f31
ac-uw oZ.O 1 l T V1�4 k_&4�
fi
Reviewer/Inspector Name: �� Q e '�)Q C X—\O, 1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Q/ 1 L/P3�
Date: /
14/2011

Type of Visit O'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �� Arrival Time: Departure Time: County: SW U
Farm Name:TT��_ innOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ` pp.'
Certified Operator: ��`� 71-M- n
Back-up Operator:
Location of Farm:
Title:
Region a-!RQ
Phone No:
Integrator: I
Operator CertiDcumber: + 9 (0 ]
Back-up Certification Number:
Latitude: =' =' =" Longitude: = ° =
I ?.
Design Current
Design Current
Design Current
Swine Capacity Papulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ Dait Calf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dray Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish
❑ Beef Stocker
El Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
lother I
❑Turke Points
❑ Other
Number ofI, ructures:
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 gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
I No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: s — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes „2No ❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0No ❑ 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 eNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ElYes ZNo El NA El 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 ZNo ❑ 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 ZNo ❑ 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 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
O'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2f No
❑ NA
❑ 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
eNo
❑ NA
❑ NE
. • 4 -. §S#�
Comments (refer tp qu, tion #E).i�:Exp•�lain.apy YESp'answsers and./6r anytirecoinrnendati6§n or any�other comments
w
Use drawings of facility to better explain situations. (use additions! pages as,nec'essary};;n
,_. g
7
Reviewer/Ins ectorName"�
P
Phone: �9 J -y aQ�
Reviewer/Inspector Signature:
Date: q
Page 2 of 3 / 12/28/04 Continued

Facilify Number: s — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Xo ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ 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 j2of o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IC�_lo
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
El Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z_No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
El 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
S% 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
ZNo
❑ 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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Additional Comments and/or Drawings; v`
To,gack r. AAA ts47(, _LNVL10
�[10I04 0= 3, 9 a= L1,9 Q�- ao 10
31310 4 S -I rw JLv,.c.Q -- W f 91 I a rt.o nFv�e ei a G.� n 3T
Wa.at� 31301 10 a, 1 31301oq = ao 7 l a la og - a ,1-1
5 r 4 ` 62. D,, t.c-lCd.O 4e.
rn�,
h" -" tV � COY -IN
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vlit 3,26ROutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I Departure Time: County. Region
Farm Name: Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E=] c ❑ ' ❑ « Longitude: ED ° ❑ I = N
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Po pulation
ElWean to Finish
Dairy Cow
❑ Wean to Feeder
❑Non -La er
0 Dairy Calf
❑ Feeder to Finish
El Dairy Heifer
❑ Farrow to Wean
Dry Pouhtry
❑ D Cow
❑ Farrow to Feeder
❑Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non-Lacrs
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
ENo
❑ 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
N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
, o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
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
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 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 [Vo
ElNA
[I 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 ,KNo ❑ 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 �No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDUCatlon
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 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
XTo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is lack
❑ Yes
o
❑ NA
❑ NE
there a 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 lolr6f 1o2 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 6No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
;ZNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
GNo
❑ NA
❑ NE
❑ 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
XTo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[PKNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L2"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P &o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
eNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ 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
eNo
❑ 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?
El Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
F ,, j' f f• I
� ����► sir � c � �
Page 3 of 3 12128104

Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 510035 Facility Status: Active Permit: AWS510035 ❑ Denied Access
Inspection Type: Compliance Inspection _ Inactive or Closed Date:
Reason for Visit: Routine County: Johnston Region: Raleigh
Date of Viisit: 04/24/2008 Entry Time:10*00 AM Exit Time: 11:00 AM Incident #:
Farm Name: Shelton Keith Jackson Farm Owner Email:
Owner: Shelton K Jackson Phone: [phone]_
Mailing Address: 1480 Alex Benton Rd Newton Grove NC 28366
Physical Address:
Facility Status: N Compliant ❑ Not Compliant Integrator: Prestaae Farms Inc
Location of Farm: Latitude: 35°17'30" Longitude: 7§ 18'§T'
Hwy. 701 north to Newton Grove, right on SR 1700 on into Johnston Co. (SR 1192). Go 3 miles farm on right.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment Waste Application
Records and Documents
Certified Operator: Shelton K Jackson Operator Certification Number: 17765
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
Primary Inspector: Jane Bernard Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Page: 1

Permit: AWS510035 Owner - Facility: Shelton K Jackson Facility Number : 510035
Inspection Date: 04/24/2008 Inspection Type: Compliance Inspection Reason for Visit: Routine
Inspection Summary:
Please keep three years in farm "BOOK"
Soil Sample 01/23/08
Calibrations 4/20/06 Due this year
Sludge Survey 12/7/07 LZ-5.42
Waste sample missing for 6/27107;7/7107;7/8107
WASTE SAMPLES WITHIN 60 DAYS (BEFORE OR AFTER) -Attached III. MONITORING AND REPORTING REQUIREMENTS #6
Attached Operator Designation form to add Justin.
AWMS CERTIFICATION RENEWAL as of 1/29108
Shelton Jackson 6 hrs needed before 12/31/09
Justin Jackson 6 hrs needed before 12/31/09
Page: 2

Permit: AWS510035 Owner - Facility: Shelton K Jackson
inspection Date: 04/24/2008 Inspection Type: Compliance Inspection
Facility Number : 510035
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Swine
Swine - Feeder to Finish 2,480 2,700
Total Design Capacity: 2,480
Total SSLW: 334,800
Waste Structures
TYDe ' Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
agoon 1 27,00
Page: 3

Permit: AWS510035 Owner - Facility: Shelton K Jackson Facility Number: 510035
Inspection Date: 04/24/2008 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)
001111
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.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?
❑
■
❑
❑
8. 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
❑
woo,
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: 4

Permit: AWS510035 Owner - Facility: Shelton K Jackson Facility Number : 510035
Inspection Date: 04/24/2008 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
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? ❑ ■ ❑ ❑
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? ❑
Page: 5

Permit: AWS510035 Owner - Facility: Shelton K Jackson
Inspection Date: 04/24/2008 Inspection Type: Compliance Inspection
Records and Documents
Facility Number: 510035
Reason for Visit: Routine
Yes No NA NE
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
■ 0110
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after a 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?
❑ ■
❑ ❑
Page: 6

FARM 51-35 WHO Shelton Jackson
(� �6/25/2007
W08701 41261 007 3.6
2/25/2007
2/24/2007
11 /28/2006
11 /27/2006
W02451 9/28/2006 1.8
7/30/2006
,off �►
L' n
n
q

Type of Visit 0Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: rrival Time: Departure Time: County::'o H NSTOA) Regional
Farm Name: h-enl -Loyxj � e t'+h -- �� o c � S ©w �' WO rMee Email:
Owner Name: x k Q Phone:
Mailing Address:
Physical Address:
7
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: Integrator:
Certified Operator: V hoo Q'T etc Lem C' Operator Certification Number:
Back-up Operator: n 3runNQ Back-up Certification Number:
Location of Farm: Latitude: = o = = Longitude: = o = 1 =
Design Current
x Design Current
Design Current
In Ca
et Poltry Capacity Population
Cattle C*apacity Population
❑ Wean to Finish
❑ La er
❑ DaiEX Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish S
`.
❑ Dairy Heifer
❑ Farrow to Wean
pry PoultR,ry
❑ Dry Cow
❑ Farrow to Feeder
"
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
El Non-Layers
❑ Beef Feeder
❑
El Pullets
❑Beef Brood Caw
ElBoars
Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
'N.
1. Is any discharge observed from any part of the operation?
❑ Yes
0
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
J
E No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ErNo
❑ 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
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
2 No
❑ NA
❑ NE
other than from a discharge?
page 1 of 3
12128104
Continued

Facility Number: S —3 S Date of Inspection
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?
El NA [I NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5' Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
IV —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes oNo ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ 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 El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JZ`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 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;2fNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes do
❑ Yes No
❑ 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
I
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
a
❑ Yes .91 N� ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,L_,No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes rYJ No
17. Does the facility lack adequate acreage for land application? ❑ YesNo
18. Is there a lack of properly operating waste application equipment? ❑ Yes �No
❑NA El NE
❑ NA ❑ NE
❑NA ❑NE
❑ 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 Narr►e Phone: 9 `
Reviewer/Inspector Signature: Date: f�
12128104 Continued

47
Facility Number: 5 1 — S Date of Inspection
Required Records & Documents
19. Did he facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo
Jo o�/av- l0/0/10 9
20. Doles the facility fail to have all c mponents of the CAWMP readily available? If yes, check ❑ Yes FfNo
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need impr vement? If yes, check the appropriate box below. ❑ Yes ; No ❑ NA [I NE
a`1(o I
❑ Waste Al lication Weekly Freeboard ❑Waste Analysis Vd �aste Transfers El Annual Certification
ainfall191) Crop Yield ❑ 120 Minute Inspections .�oil Analysis thly and V Rain Inspections pWather 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 ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VjNo ❑ NA ❑ NE
25. Did the facility fair to conduct a sludge survey as required by the permit? ❑ Yes dN o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ONo ❑ 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
EfNo
❑ 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
[ffNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
1
31. Did the facility fail to notify the regional office of emergency situations as required by
ElYes
JNo
❑ 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
ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[No
❑ NA
❑ NE
Additional Comments and/or Drawings:
7 1 '(5- 3 0 $'
NUWi)% l n 30
6, w a, 1
CPA &,,4- e)'_�
0
12128104

Facility Number �-
.'e-tivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
3
Type of Visit-4a3'_rbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�utine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: p� Q Arrival Time: ® Departure Time: County: O 1 titJ M Region
Farm Name: {_l ��UTEM_ Q L-t h �1,�_�s <,rs1n) Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: C�_ Operator Certification Number:
Back-up Operator: :S tt a&@ Back-up Certification Number:
Location of Farm: Latitude: o Longitude: ❑ o
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
_ . _ I I ❑ Non -La et
Discharges & Stream impacts
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
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:
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No
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
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ No
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes ❑ No ❑VlA ❑ NE
other than from a discharge?
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
S u re 1 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 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
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E I No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E j 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 Drift ❑ Application Outside of Area
12.
Crop type(s) C' -Uj MAN-1 t T-0 mQ
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
No El NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
El
No ❑ NA
El 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: Ma Date:
F . 12128104 -Continued

Facility Number: 5 — Date of Inspection
Required 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 appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. ecord keeping ne;;Z6
ement? If yes, check the appropriate box below. [I Yes No El NA El NE
DoeTaste Application ly 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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 11
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
(a 10 010 (0 CZANQt0d
J �7 I I 1 0(0 5142
LI) a I Ja") 03 , V -- 4* to a $ -7q I
a I 5od7—
— 12128104

'W_...
Off, A
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 7 Arrival Time: Departure Time: County: a z,4 Region:
Farm Name: �, [.�-ram..! . 1 A car—Sgs I Owner Email:
Owner Name: Phone: c) Z 6 3 Z 7�
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 57�1 CL—­Q4
Certified Operator:
Back-up Operator:
Phone No:
Integrator: I S V—
Operator Certification Number: 17 7-(- S
Back-up Certification Number:
Location of Farm: Latitude: = o = = Longitude: = o a 1 =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C►'attle Capacity Population
❑ Wean to Finish
❑ La er
❑ Daia Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish -z+f$a Zbbti-
sa-.a out` 3/G
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
El Beef Stocker
El Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
i The
IM Turkey Poults
❑ Other 1
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
j9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
7NA
❑ 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
;Z No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
ElNA
ElNE
other than from a discharge?
Page 1 of 3
12128104
Continued
4

Facility Number: s — Date of Inspection 3 oG
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V] No
❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
XNo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J6 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
OrNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P 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
No
❑ NA.
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JZNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 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) �~ ��-5 R
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PrNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes VfNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes gNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 No ❑ NA ❑ NE
F 7 q I zZ:1 a
ReviewerlInspector Name u,,l :; w Phone: "7 7 ZC) O
Reviewer/Inspector Signature: Date: 3
12128104 Continued

Facility Number: j — 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [' Vo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box. ❑ WDp ❑ Checklists ❑ Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. [I Yes Z] No ❑ NA ❑ NE
s$1'Iz 3.S
Elp an Waste Apon ❑ Weekly �eeboard ❑Wastete An Analysis ❑Soil alysis ❑Waste Transfers El Annual Certification
❑ Rai�f°a11 ElStocking [ICrop`Yield El120 Minute Inspections ElMonthly and 1" Rain Inspections ElWeather Vlode
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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?
Additional Comments and/or Drawings:
j 90 0V c_VA- AwAga- 'TtkA r st.c&b(,r. i. •u �.y
a y o c.Tr _ zoo C.
-1-11
"'C4 L: o .'r D�q ga)c
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
❑ Yes
2(No
❑ NA
❑ NE
❑ Yes
JZNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
El Yes ❑No ❑NA ❑NE
❑ Yes HNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
Ef No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
A IV �J¢Q: G . CA U 62A`Ti"o.-f D VF_
Page 3 of 3 12128104

Type of Visit Qj Compliance Inspection 0 Operation Review 0 Structure Evaluation . 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 8 o S Arrival Time: Departure Time: County: Vo' d �f`a� Region:
Farm Name: -SI+£ LTor1 AC-r-S6 Owner Email: }
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone: _� .�_ .� 3— Z'4 i1
v►� R� t{q a � ^+L d
Phone No:
Integrator: �PR9.M _, J�SIR - 'ft'LI�S
Operator Certification Number: _177 6
Back-up Certification Number:
Location of Farm: Latitude: =e =' = Longitude: =.0 =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish Z4 $ a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La ec
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turke s
❑
Turkey 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?
Design Current .
Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Reef 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 No ❑ NA ❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
F� No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 51 -- 3 Date of Inspection 3 g
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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3
❑ Yes PC 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? Cl Yes �No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /E� 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 4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PI 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 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 Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
I ryy 1qV 1 or �y� �Cb ILt'G
12. Crop types} Goc+� � r' IS$ Ccs-t�.'d G 1 W (5
13. Soil type(s) jJ o k u C=s , rr
14. 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
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations[]
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
Reviewer/Inspector Name ` ` �j ;s�' sk ,� Phone: -�s
Reviewer/Inspector Signature: Date: -3 B n'S
12128104 Continued

Facility Number: fjE — 3 S Date of Inspection 3 6 a
Required 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 ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP
❑ Checklists ❑Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the ap ropriate box below. El Yes VNo El NA [I NE
'4 7
•6 7��`P /
El Waste Appeication El Weekly Fy6eboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ 1>4all ❑ Stoc�ing ❑ 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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
❑ No
P NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
O'No
❑ NA
❑ NE
❑ Yes
[2f No
❑ NA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Addit�onalComments?and/orDrawings br �
z�) v rSv..St D mArr.-rr.l
P.Gi�•n1�K.+ Cc�L,L.`t JC—�+11 �ttaC�ot1 - �-i"[`r ��cocLaS
.2-ms nt° '1-�.Q�►?�ES� `� 2 �0� �c-cPi.J(d.
i� Ly Pi3�x�S�
12128104

Type of Visit 47 Compliance 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 3 [fate of Visit:E.N.t
Time: t
Operational Q Below Threshold
PlIermitted �ertified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ..........St Tar.B......`-�+ 5^1.......................................... County:.......`".�1.s3..S.r�...........................................
Owner Name:
Mailing Address:
Phone No:
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Onsite Representative:...... ..... ....................................... Integrator:... !.z�� Qn+" S,T2
...................... .
......................... .................
Certified Operator:....................................................................................I..... .. Operator Certification Number:.......
..................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C 66 Longitude ' 6 "
Discharges & 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes [2rNo
❑ Yes �Vo
❑ Yes �No
❑ Yes ONO
❑ Yes ONo
❑ Yes 0No
❑ Yes .O-No
Structure 6
Identifier: .............................................................................................................................................
Freeboard (inches):
12112103
Continued

Facility Number: 5 I — '3 ,5 Date of Inspection I tiz
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 thin waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ;2 No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 12'No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes P10
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
c-zq m q I Z S
12. Crop type C. ! ..J S C ot"'-1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �YNo
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 attor below ;2rfes ❑ 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 o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes WNo
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 90
Air Quality representative immediately. I1V
$•� S.rQ� 'N r-PtMiL.iA��'C.� y�J��-S�t_�F
Reviewer/Inspector Name �
Reviewer/Inspector Signature:
❑ Final Notes
Date: i l / 1 Z
12/l2MI
Cnntinuvd

Facilitt Number: 5 r — 3 5 Date of Inspection
Reauired 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/ WIT, checklists, design, maps, etc.)
❑ Yes
No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Waste lication ❑ FrAoard ❑.7WUste Apalysis Woil Sampling .r--f
jj
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?
discharge, freeboard
❑ Yes
No
(ie/ problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
7No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 00 No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
NX No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
t
PfP\EgD �J
12112103

r ..
W
Type of Visit Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit Routine ( Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: I 11 <33 Time: FfIQ Not Operational 0 Below Threshold
)Permitted P Certified 0 Conditionally Certified Li Registered Date Last Operated or Above Threshold: _
Farm Name: S)4L-- =Wj r— A County: _ .�l-A'A 1 'N •J s o 5
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: ate) ,4 r/ A -s1ntegrator: Uf Aa_F— PJ SLj ; ---I
Certified Operator: Operator Certification Number: 1 $
Location of Farm:
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude
6
46 Longitude
' 1 G6
Design
Current
Design
Current
Design Current
Swine Cnnncity
Pnnnlatinn Poultry
Capacity
Population Cattle
Ca'`eci Po ulation
❑ Wean to Feeder
Feeder to Finish
Z 0-
1 Zcfm>
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I ❑ Dairy
❑ Non -Layer I IF Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holdi>Ponds ItSolid Traps ❑ No Liquid Waste Manaeement Svstem
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laeoon ❑ 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:
Freeboard (inches):
05103101
❑ Yes ;3'N"o
❑ Yes 2<
❑ Yes No
El Yes �No
❑Ycs L1N
❑ Yes No
❑ Yes f No
Structure b
Continued

Facility Number: c5J —35 Date of Inspection t 7 t a3
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ONO
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
XNo
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
EI No
9. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
PINK
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
;a<o
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN 4 Hydraulic Overload
�
❑Yes
No
1 i t ►tl� toS
12. Crop type C��+ us �r / 5,'9
Sr
13. Do the receiving crops differ with those designated in je 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
VNo
16. Is there a lack of adequate waste application equipment'?
❑ Yes
ONO
Required Retards &_ Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
pmo
a�
6�
18. Does the facility fail to have all components of the Certified Animal V)a1e anagement Plan readily available?
❑ Yes
FfNo
(ie/ WUP, checklists, design, maps, etc.) /�J���}},�y Ste�. a
19. Does record keeping need improvement? (ie/ irr�on, frmoard,`WasTe and ' 3 & soil s;attple reports) �/7
Yes
Ayes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
;ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�k%
(ic/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2rN.
24, Does facility require a follow-up visit by same agency?
❑ Yes
[;Wo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Z No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ka
Comments'(refer3to,questlon #): Explainany YES,answers and/or anyrecommendations ar.any other comments.,:i'' t`}e
Use drawings of facility talictter explain s tuatlons (use addrtional pages as necessary. []_Field Copy ❑ Final Notes
41 ,ers .:
►�► -�- c; � �..,�. �,,� � �,� r,,Ia �� c, A-,'JS 'S can e► I 54-C - � 41040
/ 44S aszlo c,jDm.li;, lf•'Gv AiL IGaQ C Tro4 17LI-.-4Tom4 5 �-
� ♦
D+t< —tC C� :1`I.DS C� of nl [ 1 AL)
SA' r,em.��Q�
¢� Cssa4 La 6 A sus f 1"a - t�3 �tia a P a-¢.J b&r' E _ k P 1'' eJ04-V-11
rv. o o +r s 7 £ Pt�.� .
Hy
eviewerllnspector Name ' X 4^ _ 4 eJArJ,
Reviewer/Inspector Signature: Date: 1 f
0510310I 1 Continued

` Facility Number: wrl — 3 Date of Inspection I! ! o
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?
Additional Comments and/or Drawings:
❑ Yes JFZNo
❑ Yes (d No
❑ Yes �xo
❑ Yes VNo
❑ Yes W16 a
El Yes
El Yes 7rNo
05103101

r
Type of Visit Q-,6ompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit S2KRoutlne 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: I 0 Time: I O 16 `
'r �
Not Operational Below Threshold
Permitted Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: SP),;— � K, J PfC 1::-5 County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: [[ Phone No:
Onsite Representative.- 1 ::z— S� !2, Integrator: cV*0-&- qA
Certified Operator: Operator Certification Number: r7 T'b�:
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 06 " Longitude 0• 4 «
Discharges 8. f 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
ElYes No
❑ Yes No
❑ Yes PWO
❑ Yes P,
No
❑ Yes o
❑ Yes m No
❑ Yes ;R'No
Structure b
Continued

Facility Number: St — 3 } Date of Inspection 1 '
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(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 maintenancelimprovement?
11. Is there evidence of over a4 cation? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
I I a. i4s
12. Crop type C, -9 hLt WD,J
13. Do the receiving crops differ with those d signated 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?
Required Records & Documents 9j.0 1 y
17. Fail to have Certificate of Coverage n ra Permit r-other Permit readily available?
11 / as-
18. Does the facility fail to have all components of the Ce ified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
G s.'� 2,4
19. Does record keeping need improvement? (ie/ irr�on, fr�goard, whte analysis & soil sample r�orts) .l
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?
(iel 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 Rl'No
❑ Yes ,❑ No
❑ Yes No
❑ Yes P'lo
❑ Yes P'No
❑ Yes t1.9INo
❑ Yes P'No
❑ Yes p No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes .Ej N
❑ Y e I No
❑ Yes .0 "0
❑ Yes ;3 No
❑ Yes ❑ No
❑ Yes "P'No
❑ Yes [?No
i
❑Yes plI,
❑ Yes )21190
❑ Yes /2No
❑ Yes ! ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (referao question #}:`''Explain any YES answers and/any recommendations or ny other' com nts. � '.,
* r❑
Use�drawings of facility to b_ ettt�er explain situations. (use addrtionslpages�aii�necessary}: •Field Copy Final Notes �"
l 90 Cpv`,D ,sow (� m_,n 2Aoa. r a tt E c sus "S.J FA--%, ' 9 rC,e:.1t-%o_ e4 i 1. L
,��;' �-y � `A ntc•.�4 � �� �, mac^ �} z az
Pb t'tUQ '�a� L?s r� Pk— I've—�AcN C�.ie-
rtFvao.S e0 +��
tiF �►� -q"- 9C,11uihtl r�41 r 'ice--E(4! , ! Ak V'S I— a� • ��tK t 5�
_
Reviewerllnspector Name'
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — 2 Date of Inspection /I
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?
Additional��Commen_tszandlor,Drawings:
❑ Yes Ca No
❑ Yes �
El Yes jVNo
❑ Yes �No
❑ Yes �No
❑ Yes �o
0 Yes ❑ No
05103101

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0"C"Omplaint Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: VNo!tOnerational
Time:
Below Threshold
op"e'rmitted Certified [3 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: S�jCL_r-'j JA!Gfr - County: J00 /z%o
Owner Name: Phone No:
Mailing Address:
Facility Contact: / Title: Phone No:
Onsite Representative: Integrator: 4& A i-e..F—j S va i r•�
Certified Operator: Operator Certification Number:
Location of Farm:
/t� Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 � �66 Longitude 0 6 �u
_ Design Current Design Current D;esig :Current :
Swine 'Capacit_ . Population oultry Ca aci Population Cattle CiPlkcitV Po 6 uiation
.; ❑Wean to Feeder ❑ Layer ❑Dai;
❑ Feeder to Finish 10 Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean Lfi -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 1
❑ (i►lts
❑ Boars �. Total SSLW
/ Solid
W
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'FeKo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 2Ko
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes �o
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 4ETI o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q']Qo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ED-Ko
Waste Collection & Treatment f
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway El�
Yes �rv0
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: S -- Date of InspectionI or
b ! a
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(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 [2<0
❑ Yes P o
❑ Yes M No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes K 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 J `vu
12, Crop type r'Q -.t
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 & Do,c!jments
IT
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?
(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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
06
+Comments'{refer?to question'#)"Ezplain+agYESe ers andlq;joanyareconm ndationsFor.any, other comments.;:
Use drawings of�facility to betteriexplam sittiatlons:usaddiionl (e additional pages asgnecessary)
, . � ❑Final Notes a=�
C. roo ,,,,:,JvA- a,,.r,/
Foc�r�.y Ta..t Tr,P cmtr�"T r ,TI ic,ri 01k`t
So l Lec�T`a� ri3J� TNE6�E., ; S ev �m�J
A$ltrac�.� RrCrz
�_ sTAe_T-tW� Aa- T+�gll� I
�•1E SAS /10'? A �Io.FGoM Qom] q Press 'tea . Q��J GIZQ Dot:r� S.l� PE tea`"
T.1A4' IFS I��GfI�•a� EQt1iP/��1T y1Ry 1�1��. $'t.5r.,.t `iAM�r:�l� c,ult�'�—
�
Reviewer/Inspector Name V:,d� : J. az ,, ` ' `
ReviewertInspector Signature: Date: .6 Z
05103101 Confinued

Type of Visit ',0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 01Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: $ 5t Time:
Facility Number
Q Not O erational Q Below Threshold
OPermitted) Certified Q Conditionally Certified 13 Registered Date Last Operated or Above Threshold: � YV. c'
Farm Name: ... s. o .3 c.�-S� r1< County: .. A-S �
-4.rT�............................................................................................................. .
OwnerName:........................................................................................................................... Phone No:.......
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative :.......
sAA&';a r►j Integrator ...
/`�,........................................................:
�. g
Certified Operator:..................................................._ ........................................................... Operator Certification Number:.... ........
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��
i n rrDesi Current >
Swne Capacity Population Poultry Capacity Population-, Catte ..CDa
e` saicgi
❑ Layer ❑ Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
Total.:SsLw
Number, of Lagoons Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area 3 9
Haling Ponds l Sollyd Traps ❑ No Liquid Waste Management System
E
❑ Wean to Feeder
❑ Feeder to Finish
Zq t3-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Inter
1. Is any discharge observed from any part of the operation? ❑ Yes
o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes J3<o
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 Ef No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑,�o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [--]Yes WNo
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: ........ ..............................................................
...................................................................................................................................
Freeboard (inches):
5100 Continued on back

} Facih`ty Number: Date of Inspection Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management of
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?
1/9/2001
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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 (_Q e44 i W k--AV' / S. V lI E_"
❑ Yes &No
❑ Yes ?fNo
❑ Yes W'&o
❑ Yes ( No
❑ Yes 2To
❑ Yes R<O
❑ Yes ERNo
13. Do the receiving crops difiEer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
;2.fqo
14. a) Does thefacility 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
RrNo
15. Does the receiving crop need improvement?
❑ Yes
f2rNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
LB<o
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available') ❑ Yes 2'No
rag
18, Does the facility fail to have all components of the Certified Alni al Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONO
i8'a / 1IvJtom) ZiIsis &soil sample Sol
19. Does record keeping need improvement? (ie/ irr' lion, fr ard, w stea ai � ports} ❑Yes fa'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes PrNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes O'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 01�10
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 'Prio
Yi�;�4ipl s'o d�fe�en aI i4fir laot:ed1 O(Wiog, sy sit;-eeiyei)o
.. ctir'resnoridence: about this visit: • .. • : • : • : • ::.....:......... : :... • ........ .
Z-6""i 5!}c.� L i Ti tAf &auv
si)Aet' tbi`,s
J
G0 '1 P L €_`
i
Reviewer/Inspector Name
Reviewer/Inspector Signature -A..A7 Date: s/� `.

Facility Number: g) — 3,571 Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes WNo
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 PeNo
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 2(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 dNo
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
1
VOO
1

—. a
Facility Number 51 3b Date of Visit: SI31/200t1 Time: 10:30 Printed on: 6/20/2000
Q Not Operational 0 Below Threshold
® Permitted ® Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...................
Farm Name: Best..Y.9 as±bload..t?airm............................................................................. County: Mutslom ........................................... BRO............
OwnerName: Bgq........................................... YounblooA ............................................. Phone No: 934-2,3f7.......................................................
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
Mailing Address: �11.i�ee..Xstulagb]Qud.tiRmd................................ ...SJmtjtMd..SIC...................................................... 2.7.5.7.7 .............
Onsite Representative: ��tt.lf►lute.. e> .XQIaIt lAt1�1.............................................. Integrator: SAJrxAMMeadaHc.FA.t:na,.t'is,,............................
Certified Operator: D.wj hj.B..................... Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 ' 33 1 16 " Longitude 78 • 20 54 '
Desi�'n
to
Ca aci
Cu'r'rent
Poelation
����' nt Dest n Currentwine
i t�aeaeR Po�ula .g• ' u����,i%�
Poult E� fioq Cattle IGa ace a .Po elation
a
❑ Wean to Feeder
Layer
❑ Dairy
® Feeder to Finish
❑ Farrow to Wean
3900
3900
i� ❑ Non -La er Non -Dairy
pntt
❑ Other si i4�
l" {�li�
�� � � Total Design Capacity
I§§„�, 'Total SSLW
4 1 11 1szlAlllc. 4i
• i � f1,1
1 � F
3,900
k '
❑ Farrow to Feeder
Farrow to Finish
Gilts
526,500
..
S.,......................,.........�.,.,
Boars
.....:................_._._�_.a�_�.�-.......-.....-......�.
Numqo
ber of Lagoons 3
41��;1@ljp I�Nll��wffl 111f
Hooding fonds 1 Soli�T raps
❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area ill
""'"
❑ No Liquid Waste Management S stem
--iftom"
Discharges.& 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 IN 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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...S2y.tnil Qky..pipp... ................. ...jxge............. .....................................................................................................................................
Freeboard (inches):.... ...1.2.. ..... 332. 34....

Continued on back
Facility Number: 51-36 Date of Inspection 513112000 Printed on: 6/20/2000
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 ® 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 Annlication
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, Soybeans, Wheat Coastal Bermuda (Hay) Small Grain Overseed
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?
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?
u:'Nti•vio Atiolls :or deficiencies •were noted during•this: visit.• :You've' ill- receive-i1616'rthet•- : • :
cor.resvondence about this visit. : :
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
2) Improve area around hydrant at corner of large lagoon (beside farm path). Evidence of some flow from Al. pipe once disconnected -JL
ind flowed down path apparently toward surface waters. Recommended a berm or diversion to contain future releases.
i) One tulip poplar in corner should be removed from lower lagoon. Some holes (rodents) but not threatening.
19) Permitted farms must maintain a copy of a weekly freeboard log. Keep irrigation records by crop growing cycle; not necessarily
sy calendar year. Over applied N by 30.7 lb/ac. on field 6A for overseed after the Hurricane. (over applied by 20 1bN/ac, on field 6A
'or C.Bermuda in 1998).
t is not clear from design information available as to whether storm storage for both small lagoons is contained in #2.
.. .. �
ReVieWerllnspector Name JohE 1 �n

�Permitted 9.Certified E3 Conditionally Certified [3 Registered 0 Not O erational Date Last Operated:
Farm Name: .............. — A .......................
S. £,YN �Sa ,1 County: ^..�n�'.!S .✓
Owner NameQS � Phone No
FacilityContact:..............................................................................Title:.........................---..--------.--....................... Phone No:
Mailing Address:. ........................................ .............
Onsite Representative; .... .... i �{� J Q � S o �• Integrator U;:�. Q" #'► r".........................................
Certified Operator: Operator Certification Number: 17765
p P.................................
Location of Farm:
A
................................. .. ......
Latitudes �'" Longitude ®* ®' ®"
ne, ; 'i
❑ Wean to Feeder
kkFeeder to Finish
Z r3
Z�j 8a
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Ponit r' I :r!
CaAacity.: �Populati'on. ;,..
�❑ Non -Layer Non -Dairy
❑ Other
d j
p i f, i
�,�iTotal Desl n Capacity,([,
„11
aTota� W °�,#
Z
SSL
b ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
;3a EE 1i i .. ................... ........_ ..... ... ................... r; ale
❑ No Liquid Waste Management System 9 $
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
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 7No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
E
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): •„..... J'?
.......................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes &No
seepage, etc.)
3123/99 Continued on back

Facility Number: Date of Inspection 8
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? .
❑ Yes
;!fNo
(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
;E�No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
RJ'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
00
Waste Al2Rlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONa
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
?(No
12. Crop type z_rj$*4 %.j j4e— S4hggAAS
1,
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
VTo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑Zo
15. Does the receiving crop need improvement?
❑ Yes
16. Is there'a lack of adequate waste application equipment?
❑ Yes
7fNo
Required Records & Documents
17.. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
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
{G No
19. Does record keeping need improvement? (ie/ irrigat on, fre6oard, waste a alysis & soil saFtiple reports)
❑ Yes
C;Wo
20: Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
❑ Yes
g No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
;Z'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
CXNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
eNNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
�'�1Q YiQla�igtjs:flF d� ciertcie5 •ware pOte#- dofig phis;visit! • Y;o> 'Will. eeoiye ij fu4-tit�r
Torres o deuce.' about: this visit:
"ra grAy hr' L`Q_A9 r [bp' Frot^ vwLL. askA AtP_Yi.J(r c, AsrF_S I�
?, t Ep UI��DS Do 1r 1' o a t f4 ' QE, W ACl-, s T�6AA r' pb r''6S IAA+DF— JJ`'
;n g� g, 3e'j{ t..P.. '° �'• I ;q 4 P� , nne-�; ��E! ii�-,,>. ,� {,�, i c� .N3 �- t .},¢ d i asp 311
�Reviewer/Inspector Name
Reviewer/Inspector Signature: G�(,�,.,_ ��,,.� Date: .9- $1

Facility Number: — 3 S Date of Inspection B
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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?
❑ Yes 640
❑ Yes A No
❑ Yes J2fNo
❑ Yes Rf4o
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 '01�1 o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNo

E3 d Water Conservation = Operation Review
0 Division of Soil an
'.
d Water Conservation - Compliance Inspection
�--Dwrsion of Water Quality —Compliance Inspection
�'OtheC.:Agency,'-'Operation Review,.�i li jai 36 €
LO Routine Q Com laint 0 l olioiv-ri or D1V iris cctio,r 0 follow-u of DSWC review Q Other
Facility Number, Bate. off nspedion G /i 7
Time of inspection 24 hr. (hh:mm)
'Permitted
Certified [3 Conditionally Certified [3
Registered
JE3 Not Opera Date Last Operated:
Farm Name:
.....SJ E'.4.r'-:qt.+Y..............................J.!4�-t....
...F14f�X�
.....................
(:panty:........1.�Q. /!�5 •fY.................
. .
Owner Name: Phone No:
..................................................................................................................................................................................................................
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
LMailing Address:
Onsite Represcntative:..S1JeL-T-Q.-I Integrator:......p. ,...................... .................
CertifiedOperator: .................... .............. .... ............................................................. Operator Certification Number:....,.,..................................,
Location of Farm:
Latitude ' 4 '4 Longitude • 4 "
Design Current
Swine CaDacity Population
❑ Wean to Feeder
FrFeeder to Finish
Z
Z 8a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lai;oon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & 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 nian-made'!
b. II'clischarge is observed, did it reach: ❑ Surface Waters []Waters of the State
c. I1 discharge is observed, what is the estimated flow in gaUtnin'?
d. Docs discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impaets to the waters of the State other than from a discharge?
Waste Collection h Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
ldcnI.IfIC['; c.
Frechoard(inches): ......................................................................................................................................
❑ Yes &No
❑ Yes )j!(No
❑ Yes RfNo
❑ Yes ;j�No
❑ Yes ZNo
❑ Yes P4140
❑ Yes ONO
Structure 5 Structure 6
1/6/99 Continued on back

Facility Number: 5 j — 3 S Date of Inspection �6
.' 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes O 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 ONO
8. Does any part of the waste management system other than waste structures require maintena6ce/improvement?
[]Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes E!(No
elevation markings?
❑
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes IN 0
12, Crop type C.X o f w' A'r Z Sri EA4
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 readily available?
[-]Yes VNo
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 j"lo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 4No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Q' Io
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 XNo
N,6- 61atidAs'or dfflcie;ndH •mere a0ed• 00tirig �his'visit.' • Y;oa'will i:e 6*6 Rio, 1p�thsrr '
corres' onc�ence' abatif this :visit.. ..... .
Comments (referto question #):''Explatn:anyiYES ransiver2. s and/or any`recommendations or,any ot}ier comiments.p, a a h{ ;
Usc drawings of faerhty to better. explain sttuattons (use.additionalEpaues,as necessary) . :� l a` f P, F ! 1 !
r+
Reviewer/Inspector Name i,�
Reviewer/Inspector Signature:
Date:
3/23199

Facility Number: S' — 3 Date of Inspection
'Odor ['sues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
OINO
liquid level of lagoon or storage pond with no agitation?.
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VIo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
(Plo
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
ONo
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
OINO
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[:]Yes
"No
tttona omtnents an or+ rawtngs.:." I F , 4;. + „, y '
.: .: ::...: �.. .. ..'::...: x -:.: .. :. . �H : .. .1!:➢ l5" .. 4 i .. I. Y4-li.�� � .r 11 '�'�ii��. 1 .rl �I, � I .-�A.. -.♦ H. ei .! 1 Ai .:. ;y dnAk'«
AL1
3/23/99

A,
Routine O Complain
Facility Number
[rDivision of Soil and Water Conservation - Operation Review
(] Division of Soil and Water Conservation - Compliance Inspection
E3 Division of Water Quality - Compliance Inspection
Other Agency - Operation Review
tin, Q Follow-up of DSWC review
0 Permitted 13 Certified ❑ Conditionally Certified ❑ Registered
Farm Name:
Owner Name:
Facility Contact:
"ride:
Dote of Inspection
Time of Inspection
24 hr. (hh:mm)
I Operational I Date Last Operated: ...
County: ..... Via.. r.n..t., 4.) ...............
Phone No:
Mailing Address: ..................................................................................................................... ..
........................
Onsitc Representative. .../,/............. r1G.. 5 ei Integrator:
>r .+ t .... w........l 1................
Certified Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Latitude =• =' =" Longitude =- 01 ="
3wme
to f
io
J to
to
J to
Poultry _ Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste 'Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes 9No
Discharge originated al: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made! ❑ Yes P�No
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes yJ No
c. If discharge is ohserved. what is the estimated Ilow in gal/hnin'?
d. Docs dischtu'ge bypass a lagoon system! ❑ Yes 14 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Po
Waste Collection & Treatment ������,,,,,, ,,,,,,//////
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
.........
2.L''. ....................................................................................................................................................................................................
1/6/99 Continried on back

Facility Number: 61 -- t Date of inspection
5. Are there any immediate t rcats to the integrity of any of the su'uctures observed? (ie/ 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?
(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 top of dike, maximum and minimum
liquid level elevation markings?
El 'Yes No
❑ Yes /No
❑ Yes ONo
❑ Yes X
0
❑ Yes /NO
Waste Application
10. Are there any buffers that need maintenance/improvement'? []Yes INO
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen ❑ Yes
12. Crop type ,.(,. �.... i�..i4.%`�........!.. .................................................. I ........ I ....................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ( �10
14. Does the facility lack wettable acreage for land application? (footprint) ❑ YesXo
15. Does the receiving crop need improvement'? El Yes
/. 1V
16. Is there a lack of adequate waste application equipment'? El Yes ]
Required Records & Documents
17. Fail to have Certificate of Coverage, & General Permit readily available? ❑ Yesfo
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 Rrf 10
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) es 00
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes r� 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 J No
24. Does facility require afollow-up visit by same a,ecy? O�❑
A:vialations-or deficiencies ,were noted: during .this:visit:: Y:oa farill'recceive nog further -" /
eorresboRideitce; about: this visit.: :::.:.:::: ::: ::: ::::: :.. • : • :...: • : .
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).
i/ �
lh t:� t- S4P0 ?le vw, f�� ;,J 1 �-Gt/S �[� iye- 3 K wiz cat ki s q O'kr� [" 5 r S l� ��(�zv bt kcr y /,
LAJL
PTM T-4M11) I�AAVIL-16_1_'7 je
Reviewer/Inspector Name 6 l( cm -E c- �=.
Reviewer/Inspector Signaturt1Z9_A� 1 Date: q All" y _ 1 1/6/9S

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number -� Operation is'flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative: 54LILT Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name -A 0 xz
Date of site
kf—operation not required to secure WA
determination at this time based on
exemption El E2 E3 E4
Date of most recent WUP: 3 �r� 1 Annual farm PAN deficit: h1 ; pounds
Irrigation System(s) - circlehard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkier system w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part 1 exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
U/ 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 Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part I11).
PART II. 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) on 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 Ill.

0 Divis' Soil and Water Conservation ❑ Other Agency
E31TBvision of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Registered Certified © Applied for Permit © Permitted rNot Operational Date bast Operated:
..........................
Farm Name: 1 e �/ AGl�t�` IZw County:...` J.................................................
...................................................................................................................
Owner Name: ..5'..?..?:.`................ �2 0 �'`G—S0 .... ..... Phone No: l V SF,3
Facility Contact: ...�`'" ......'�.......:'�.................................................... Title: ........................ ...................... .................. Phone No:
Mailing Address:... R........f........ ¢ v.�
L..........................................................................................................
OnsiteRepresentative:. '1. ., ............................................................ I ... Integratrsr:,,,V,,,,�e
Certified Operator: .................................. .............^.............................................. Operator Certification Number........................
Location of Farm: S' �Z �/ 9 L-
i....................•....................:......:.........................• .....I....•I..._...•'...'.•."...........-............................................................................................••.... I., ............................................... T
['
Latitude • ' " Longitude =• =' ="
f,F `�
Design ;N ,,Current Design tri rent` Designurtrent
Swine f�»'Capacity .Populationoultiy F Capacity .Papulatyan CatEle GpcityP.,opulaton
_ r _ .._ re
❑ n to Feeder I0 Layer I ❑ Dairy
Feeder to Finish �j�,a ❑ Non -Layer 1 ❑ Non -Dairy
`
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other °ems
M �
El Farrow to Finish n Tt)tal DeSlgn CapaClty
❑ Gilts
T Dial SSE
❑ Boars :.„ : W
. _
�;. ,x
N mem0.
ber f Lagoo hHoldmg P nds ❑Subsurface Drains Present ❑ hagoon Area ❑Spray Field Area
£ `3' ❑ No Liquid Waste Management System
�`e ; sse
..
.. f . 3a�k
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? El Yes l�4
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a Iagoon system? (If yes, notify DWQ) ❑ Yes
3. Is there evidence of past discharge from any part of the operation? ❑ Yes N
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes N
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes N
maintenance/improvement? 11
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes /o/
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

lFallity—Number: .57
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11ol ding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
0 Yes
:0
❑ Yes
,
No
Structure I Structure 2 Structure 3 Structure 4 SMICUIre 5 Structure 6
Identifier:
........................ I .......... ................................... .................................... .................... ....... ... ......... I ...........
Freeboard(ft): ....... . ........................ .............................. I ..... ...................... I ............ ................. .............. ...... ............. ........... .................
10. Is seepage observed from any of the structures? U Yes N
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12. Do any of the structures need maintenance/improvement? EJ 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? El Yes 0
1-4r
Waste Application
14. Is there physical evidence of over application? El Yes :N o
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type " .,�- ................................... ...................................................................................................................
........... V
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 0
17. Does the facility have a lack of adequate acreage for land application? C1 Yes 0
18. Does the receiving crop need improvement? 0 Yes
19. Is there a lack of available waste application equipment? ❑ Yes N
20. Does facility require a follow-up visit by same agency? ❑ Yes N
21. Did Revieiver/Inspector fail to discuss reviewlinspection with on -site representative? 0 Yes
22. Does record keeping need improvement? 0 Yes No
No
For -Certified or Permitted Facilities Only
23. Does, the faci i y fail to have a copy of the Animal Waste Management Plan readily available? El Yes N
24. Were y additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
25. ere any additional problems noted which cause noncompliance of the Permit'? C1 Yes No
No.vio'laitions'-or de'ri , eienc'ie's.were'-no'tedAur'ing this.'visiL -you4ill receive no ftirther
coensp6hdekO about this visit'.'
tomtnefi6(refer to question Explain 'any' VES­ answers-"&ri&i'�y iecommenkations.ot:!any otherZJU"e �
Uie- dira"wings,o u6fitiv'"toi<bette I . ....... �exp.:�jn si ua ioms., (use pages n&essatv)-..:: 1�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature-, 11'y�, Date:

C1 Division of Soil and Water Conservation ❑ Other Agency
❑ Division of Water Quality
SO Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other �
Date of Inspection aU
Facility Number -5 . Time of Inspection 24 hr. (hh:mm)
Registered 13 Certified © Applied for Permit 13 Permitted 113 Not O erational Date Last
......................... Operated:.....
Farm Name:....:�_TE.K......... lUF...... .A • ,..County:...0..
. ,sr..............I....", .............
OwnerName: ....................................... . .......... •...........................................•........................•.. Phone No:.......................................................................................
Facility Contact: ...............................•.......•.•........................... . Title: ... Phone No:
MailingAddress:........................................•.........•......•.•.......•...................................................................................................................................... ..........................
Onsite Representative:.................................... � ,5/ _..................................
.�.1....Integrator: ..................................................
Certified Operator ................................................... ............................................................. Operator Certification Number ..........................................
Location of Farm:
C
C
Latitude ' 1 16 Longitude • 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes] No
2. Is any discharge observed from any part of the operation? ❑ Yes [ZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P� No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes to No
c. if discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (I€yes, notify DWQ) ❑ Yes (zNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes dNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? Cl Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Cl Yes E
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 7No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes l No
7/25/97
Cnnrirrrrecfnn hack

f,. Facility Number: 7
8. Are there lagoons or storage ponds on site which need to be properly closed''
Structures (La oons.Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ko
Structure 1 tructure 2 Structure 3 Structure 4 Structure 5
Identifier!
/..1. e ..Pv................ 5........°.'� ............................................................................................................
. .........
Freeboard (ft) ..~ ` �l
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 maintenancelimprovement?
(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 Application
14, Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type r.{..C.c'?..t..............................................................................................................................
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?
No.violations-or'deficiencies.were-noted-during this:visit.,, You:will receive-no-ftirther
;•:•correspbncienceab"outtliis:visit.-:� �:���: :�.�:�.:.::...::....... ,:,.. .. .'`..: .,....;
❑ Yes VNo
Structure 6
.................I .............
Cl Yes j/No
❑ Yes j� No
❑ Yes P(No
❑ Yes 1�4o
❑ Yes VNo
❑ Yes d No
❑ Yes eNo
❑ Yes ONO
❑ Yes ONO
Cl Yes ONO
❑ Yes No
❑ Yes No
❑ Yes lxNo
❑ Yes 2fNo
❑ Yes �Ko
4 N 13 r PO 1 ti U,,V O e tt (r'eal-v IJ
U3 F o l - J�O L) %tA)
OUA) Ai<a- 5/'r1 /3 b v I IVl) e'AG'Sia-fV •f%014Z
Reviewer/Inspector Name
7/25/97
Reviewer/Inspector Signature:
Date:

-.w'Sg'2'.
tt isibn o Soil andwWdter onservattan -Operation Review r � ''s*�y w M
��aa1ra=mom z -
_ Divtstnn of Soil and Water Gonservatron 'compliance �nspectiotxg a.r
0 Dn i4ton of «titer Quality Compliance inspection M r� « ,
�"` ���„ � �� � � a Other A►gencV =Operation Review` �� �-��^ � a�"' .`�,°``�" � ax`�r 9� f�
outine a Complaint a Follow-up of DWO inspection
Facility Number I
® Registered ® Certified E3 Applied for Permit E3 Permitted
Farm Name: .................................................
Follow-up ol" DS'vVC review Q Other �
Date of Insptclion /i.• , ; Y
Tinic of inspection �24 hr. (hh:mm)
0 Not Operational I Date Last Operated:
County: 1 . k'. .lZ!.Y:......................................
OwnerName: ....... ........................................................................ Phone No: ............... ................................................... "I ......... .........
Faciiit%, Contact: ....................................... .............. Title: Phone No:
Mailin<( Address: ......... ............................................................................................. ..........................
Onsite Representative'._:...�..:r ..-....:. �:: � � -c . .......................................
Certified Operator...................................................... . Operator Certification Number;...................
Location of Farm:
. . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . L . . . . . . . . . . . . . . . . . . L . . . . . . . . . . . . . . . . . . I L I . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
. . .
..........................................................'..............:.....................................................................................................:..........................................
. .
. .
. .
. . .
Latitude �• r— Longitude �• �� �'�
Swine
E - -
Design Current
CapacityPopulation
❑ We to Feeder
,
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
{
Design Current w. Design Current;
Poultry Capacity Population Cattle Capacity` Pdpulation;i.k,
❑ Layer Dair ,
❑ Dion -Laver ❑ Nan -Dairy
❑ Other
Total.Design Capacity
Total SSLW
Ntimber of:Lagoons I Holding Ponds
10Subsurface Drains Present
❑ Lagoon Area
I0 Spray Field Area
❑ No Liquid Waste Management System
General
ZNo
L Are there any buffers that need maintenance/improvement?
❑ Yes
2. is any discharge observed from any part of the operation?
❑ Yes
r
El No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If dischar€e is observed, was the conveyance man-made?
❑ Yes
No
b, If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
El Yes
No
c. If discharge is observed, what is the estimated flow in -al/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
El Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
m No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ErNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
9Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No

Facility Number. —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0N0
Structures (Lagoons.Holding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1
,10
Structure 1 Structure. 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):..`�I... ................ .......................... ....
........................................................................................................................................... ......
10. Is seepage observed from any of the structures? ❑ Yes iJ No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes dNo
12. Do any of the structures need maintenance/improvement? E 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
dNo
Waste Application
`
14.
Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess or runoff entering waters of the State, notify DWQ)
15.
/o�f`WMP,
Crop type c ..%. .7.......w . L�-}..........................................I.................
............................................................................................................................
16.
Do the receiving crops differ with those designated'in the Animal Waste Management Plan (AWMP)?
ElYes
❑,Ko
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Ld No
18.
Does the receiving crop need improvement?
❑ Yes
('No
19.
is there a lack of available waste application equipment?
❑ Yes
O No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
6] No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
[YNo
For Certified or Permitted Facilities I y
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
U�O
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 No.vlolations or. deficiencies.were n' 6ted,du' Hng this:visit.; You.will receive ' o'-fu.rther.::
eorrespbiidenee ghoul this.visit:.:.
Sa- ; a . C 5 7-AA /-I S 1� -/—A`-/4-4, 5 o.v 9-2 r
r n On-) �_ y CaN s r & v (, rz-,o 12-4 l�t,� T— rc
t Cey_,/9-5 s,'
fiy/ 101_i5 d,.v )- IT-6- aG.iv
,t) /I/L--, 6 la-,v, F1,1-7z *1 E­4 S
�-1 m �---S T7)-I-� Y E_197�, h tl 7
Reviewer/Utspector Name
7/25/97

State of North Carolina
Department of Environment,
Health and Natural Resources
Raleigh Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Shelton Keith Jackson
1480 Alex Benton Rd.
Newton Grove, NC 28366
A��
[DEHNR
Division of Soil and Water Conservation
August 1, 1997
SUBJECT: Operation Review Summary and Corrective Action Recommendation
Shelton Keith Jackson Farm
Facility No. 51-35
Johnson County
Dear Mr. Jackson,
On July 28, an Operation Review was conducted of Shelton Keith Jackson Farm, facility no. 51-35.
This Review, undertaken in accordance with G.S. 143-215.10D, is one of two visits scheduled for all
registered livestock operations during the 1997 calendar year. The Division of Water Quality will conduct a
second site inspection.
During the Review, it was determined that waste was not being discharged to the waters of the State,
and the animal waste collection, treatment, storage and disposal systems were properly maintained and
operated under the responsible charge of a certified operator. A copy of the completed review form is
enclosed for your information. The following observances were discovered and noted for corrective action or
response:
1. There are slight channels present in the bare areas on your lagoon. Vegetation needs to be
established to avoid problems caused by erosion. Please take care of this as soon as possible.
The Division of Soil and Water Conservation appreciates your cooperation with this Operation Review.
Please do not hesitate to call me at 919/571-4700 ext. 208 if you have any questions, concerns or need
additional information.
Sincerely,
4m
Margar t O'Keefe
Environmental Engineer I
cc: Johnson Soil and Water Conservation District
Judy Garrett, Water Quality Regional Supervisor
DSWC Regional Files
3800 Barrett Drive, Suite 101, i
FAX [phone]
Raleigh, North Carolina 27609 N� An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50°,6 recycled/10% post -consumer paper

---=�- ❑DSWC Animal Feedlot Operation Review
•- WQ Anunal Feedlot Operation Site Inspection
Routine Wcompliint [3 State employee call 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review
Date of Inspection _ Zp- `� 7
Facility Number ' J'. Time of inspection o Use 24 hr. time
Farm Stator. _ Total Time (in hours) Spent onReiiew
or Inspection (includes travel and processing)
Farm Name: 5'A.e." j�`%GS�a' I i�r� / ` el County: '70 �h �
Owner Name: �'�`T�.��s Phone No: 9io - 5-9di— r, YS
Mailing Address: /�v A%�- � �• � �y. h� i�t�-� G� �e--ee r�/e� -243 GL
Onsite representative: 24c-XS_21' Integrator. PVer
Certified Operator Name: _,. 5'x1 r►. .. .., _
Location of Farm:
Latitude �•�0"
Longitude • 6
113 Not Operational j Date Last Operated:
Type of Operation and Design Capacity
Swine Number
❑ W Ferder
ceder to Finish
=—Umw to Wean
11 w to Feedu
ElFarrow to Finish
Number o Lagoons Bolding Ponds'' 0 Subsurface Drains Present
0 Lagoon Area KSorav Field Area
Genera
I. Are there any bufrm that need maintenanceltmprovement?
2. Is any discharge observed from any part of the operation?
i If discharge is observed, was the conveyance man -trade?
b, If discharge is observed, did it reach Surface Water? Of yes, notify DWQ)
c, If discharge is observed., what is the estimated flow in pVmin? tax �=�row'r
d. Does discharge bypass a lagoon system? 0f yes, notify DWQ)S'jr 4r Grn -
3. Is cheat: evidence of past discharge from any pan of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
5. Does &nv part of the waste management system (other than lagoonsiholding ponds) require
maintenanceimprovernent?
❑ Yes 0 No
ff'Yes ❑ Now
❑ Yes 0'No
❑ Yes No
❑ Yes 13 No
❑ Yes 2<0
❑ Yes No
❑ Yes No
Continued on back /
I

.. w-&A the iazility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
8. A: a sere lagoons or storage ponds on site which need to be properly closed?
Strictures ,a oons and/or Holding Ponds
9. Is structural freeboard less than adequate?
Freeboard (fi): Lagoon 1 r Lagoon 2 Lagoon 3
14. 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 adquate markers to identify start and stop pumping levels?
NVaste Apoticstion
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
1S. Crop type C(1r_W4 -
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 lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management PIan 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?
❑ Yes 9•1Vo
❑ Yes j2.N6--.._
❑ Yes O No
Lagoon 4
[:]Yes 0'No
❑ Yes 1 'o
❑ Yes i o
❑ Yes i o
❑ Yes l�No
❑ Yes 0 o
❑ Yes
❑ Yes Imo r
❑ Yes L�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Gotnmerits (refer` o question #}= Explain any YES answers aiid/or any recommeudahons or aayother corrimennts
iise dra Jw�a¢s.of facrLty to better"explgrn srtnaaans (use ad'ditidiW pages as necessaryry)$ + _ ; ; ,�; A
�CC,t�P.+�+'��� rP-�i/� l?� Z `r �IrG l�`G�'li 7~iS�„� �1ra{ OCiCGclrer� ►f" cj h4_la� 1�.�+c-. �1L' �73ck.�P�-, 4
arc 7 �f �Jro6/g,*- e O-1 t'eNctexr y r��9Jn Falb a�ly�,.,5�m.
G"hJ
wW,,- G� ,� d r � �L-� ✓ - d r
— Z j / Gt n Yj D T �01�.. d t� T (� �j G �'�t)r C C r �r n� N� D v'i S G �i`
Ho
Re--iewen"Inspector Name
......
_
.... .
"--r
Reviwer1nspector Signature:
�pL,,.l�1�1
Date. S ;�o—
cc: Division of Warer nua/im. Water O+tulin, Section. Faciliti- Assessment Unit l ;'14,96
l
-�

JUL-14-1995 15: 26 ERC1M DEM WATER QUALITY SECT I C IN TO RRO P.02�02
Site Requires Immediate A rten dor.
Facility No. S' - 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
- ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: D o_llqs,1995
Time:
Farm Name/Owner_' C i5c p fAa K 2It 14 od a7
Mailing Address: s �
County:.-
_ Integrator. 1 n.. _J-iarmcw
-
- Phone:
On Site'Renresentative: _ _non
bI
1'�-e - _ Phone:
S 9 4t
_ Yhysicai� Address&oeation: a kt 4 xt. a
�r l e 0s SAM xlel _„fSs
a s /? /C,o 3.- 1.4g MI16
Type of Operation: Swine
1`
Poultry Cattle
Design Capacity: sl!;o '
Number of.Animals on Site. 4
• DEM C&6 cation Number:.
ACE
DEM Certification Number: ACNEW
Latitude: Longitude: Elevation:`�Feet
Circle Yes or No
..Does the Animal Waste Lagoon have'Sufficient. freeboird of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) orNn Actual Freeboard.-�` 3 Ft. Inches
'Was any seepage'observed from the lagoon(s)? Yes or& Was any erosion observed? Yes or&
Is adequate land available for.spray? or No Is the cover crop adequate? car No = .
Crop(s) being utilized:
Does the facility meet SCS minirnuni setback criteria'? 200 Feet from Dwellings? )e or No
100 Feet from Wells? 29
or No /wrl� .�, �&y'F'tVed
.W�N1R I�r7. -
!J,e animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�
a,d a l waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line'? Yes or�
ani.B- al waste discharged into waters of the state by man-made ditch, flushing system, or other
iiMilar man=made devices? Yes or - ' i If Yes.'Please Explain.
. )(,C4 Iflc facility ruaintain adequate waste managerncrit records (volumes of nsanuxe, land applied.
spray irrigated on specific acreage with cover crop)'' Yes o'r No_ Uh/rhawn -
Additional Comments: • _7'�i Lz C ��. 1 &1 lhJr'tlj^.�gr. 21--,cY.fi_atzr.l_
r lv Z S B 5-i oa :17
all �� e c� _ ' GyatSl T �r 1'tr j 97+v �` �i e - 2 K d%g�c��7
c! dui �} .S•f!� �teoN- _ --
Si acure
cc: Faciliry Assessment Unit
Use Attachments if Needed.
TOTAL P.02

k4e,timo 001,E `{,�Drt NQX nrflwl�J
Appendix 1. Lagoon Sludge Survey Form . Revised August 2008
A. Farm Permit or DWQ Identification Number Shelton Jackson
B. Lagoon Identification 51-35
C. Person(s) Taking Measurements Max Knowles
D. Date of Measurement / 3122115
E. Methods/Devices Used for Measurement of:
a. Distance from the lagoon liquid surface to the top of the sludge layer.
PVC/Boat
b. Distance from the lagoon liquid surface to the bottom (soil) of the lagoon.
Design
c, Thickness of the'sludge layer if making a direct measurement with "core sampler".
NIA
F. Lagoon Surface Area (using dimensions at inside top of bank): 1.874 (acres)
(Draw a sketch of the lagoon on a separate sheet, list dimensions, and calculate surface area. The lagoon
may have been built different than designed, so measurements should be made.)
G. Estimate number of sampling points:
a. Less than 1.33 acres: Use 8 points
b. If more than 1.33 ac. 1.9 acres x 6 = 12 , with maximum of 24.
(Using sketch and dimensions, develop a uniform grid that has the same number of intersections as the
estimated number of sampling points needed. Number the Intersection points on the lagoon grid so that data
recorded at each can be easily matched.)
H. Conduct sludge survey and record data on "Sludge Survey Data Sheet" (Appendix 2). Also, at the
location of the pump intake, take measurements of distance from liquid surface to top of sludge
layer and record it on the Data Sheet (last row); this must be at least 2.5 ft. when irrigating.
I. At the time of the survey, also measure the distance from the Maximum Liquid Level to the Present Liquid
Level (measure at the lagoon gauge pole):
J, Determine the distance from the top of bank to the Maximum Liquid Level
(use lagoon management plan or other lagoon records)
K. Determine the distance from the Maximum Liquid to the Minimum Liquid level:
(use lagoon management plan or other lagoon records)
L. Calculate the distance from the present liquid surface level to the Minimum Liquid Level
(Item K Minus Item I, assuming the present liquid level is below the Maximum Liquid Level)
M. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level to the
lagoon bottom (average for all the measurement points)
N. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level to the top
of the sludge layer (average for all the measurement points):
O. Record from the Sludge Survey Data Sheet the average thickness of the sludge layer:
P. Calculate the thickness of the existing Liquid Treatment Zone (Item N minus Item t_):
1.0
2.4
1.7
0.7
7.5
4.1
3.6
3.4
Q. If Item O Is greater than Item P, proceed to the Worksheet for Sludge Volume and Treatment Volume.
If Item O is equal to or less than Alt m P, you don t have to determine volumes.
Completed by: ��� Date: 3A 0/ 5
Print NamelSignature

The average thickness of the sludge layer and the thickness of the existing liquid (sludge -free) treatment zone are determined
from the information on the Lagoon Sludge Survey Form ( Items 0 and P, respectively). In this example, the average sludge
layer thickness is 2.5 feet and the existing liquid treatment zone is 3.5 feet. If the lagoon has a designed sludge storage volume,
see notes at end of the worksheet. The dimensions of the lagoon as measured and the side slope are needed
for calculations of sludge volume and of total treatment volume. If the lagoon is a standard geometric shape, the sludge
volume and the treatment volume in the lagoon can be estimated by using standard equations. For approximate volumes
of rectangular lagoons with constant side slope, calculate length and width at the midpoint of the layer, and multiply by layer
thickness to calculate layer volume; as"shown in the example. For irregular shapes, convert the total surface area to a square
or rectangular shape. For exact volumes for lagoons with constant side slope, the "Prismoldal Equations" may be used.
Example
Your Lagoon
1. Average sludge Layer Thickness (T)
2.5
fL
3.6
2. Depth of the lagoon from top of bank to bottom soil surface (D)
11
ft.
10.9
3. Slope = Horizontall vertical side slope (S)
3
2.5
4. Length at the top of Inside bank (L)
457
ft.
355.0
5, Width at top inside slope (W)
229
fl.
230.0
6. Length at midpoint of sludge layer L, = L-2S(D-(T12))
398,5
ft,
309.6
7. Width at midpoint of sludge layer Wm W-2S(D-(T12))
170.5
ft.
184.5
8. Volume of sludge (Vs) Vs=L�, Wr, T
169,860
ft'
205,570
9. Volume in gallons: V%--V"7.5 gal.lft3,
1,273,950
gal:
1,541,774
10. Thickness of existing liquid tmt. zone (Y)
3.5
ft
3.4
11. Thickness of total treatment zone (Z) Z= T+Y
6
ft
7.0
12. Length at midpoint of total tmt. zone L== L-2(S)(D-(Z/2)
409
ft.
318.0
13. Width at midpoint of total tmt. Zone WZ = W-2(S)(D-(Z12)
181
ft.
193.0
14, Volume of -total treatment zone (Vz) Vz = Lr. WZZ
444,174
ft3
429,618 -
15. Ratio( R ) of sludge layer volume to total Treatment Volume
R = Vs/Vz
0.38
0.48
If the ratio R exceeds 0.50, than a sludge Plan of Action may be required. Check with DWQ for Information
on filing the Plan of Action.
Note: If the lagoon has a designed sludge storage volume (DSSV), subtract that volume from both the volume
of sludge (Vs) (item 8) and from the volume of total treatment zone (Vz) (Item 14), and take the ratio.
Then, R = (Vs-DSSV) t (Vz - DSSV)
Example: If DSSV = 85,000 ft3, then R = (169,860 - 85,000) I (444,174 - 85,000) = 84,860 1359,174 = 0.24.
16. Design sludge storage volume (DSSV) 85,000 0
17. Ratio (R) of sludge layer volume to treatment volume adjusted
for designed sludge storage volume 0.24 0.48
I
I

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
Facility/Farm Name:
Permit #: B: W 5 C�_( & d � Facility [D#: �- 3 S
Operator In Charge (OIC)
Name: 1 �t� ✓ f { 1 `C 7'Ef J-14'C le `> �ac�
First Middle Last Jr, Sr, etc.
Cert Type 1 Number: Work Phone: (q
Signature: _ -- Date: _ �' 17
" I certify that I agree to my designation as the Operator in Charge for the facility noted. 1 understand and will abide by the rules
and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
First Middle Last Jr, Sr, etc.
Cert Type / Number:
Signature:
Work Phone: {
Date:
I certify that 1 agree to my designation as Back-up Operator in Charge for the facility noted. 1 understand and will abide by the
rules and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission,"
Owner/Permittee Name: S KLf LXbf--` TA C.KSv ---'
Phone #: ( `rl t) 1, erW ` ( o 4- Fax#:
Signature: Date: 7 , 7
(Owner or auth(fdzed agent)
Mail or fax to: WPCSOCC e/
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone] J
(Retain a copy of this form for your records)
Revised 8ROn7 `

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and -Natural Resources
Alan W. Klimek, P. E., Director
Division of Water Quality
October 1, 2004
Shelton Keith Jackson
Shelton Keith Jackson Farm
1480 Alex Benton Road
Newton Grove NC 28366
Subject: Certificate of Coverage No. AWS510035
Shelton Keith Jackson Farm
Swine Waste Collection, Treatment,
Storage and Application System
Johnston County
Dear Shelton Keith Jackson:
On June 11, 2004, the North Carolina Division of Water Quality (Division) issued a revised State General
Permit for swine facilities. The General Permit was issued in accordance with the directive of Senate Bill
733 (Session Law 2003-28).
In accordance with your application received on January 17, 2003 and in accordance with the directive of
Senate Bill 733, we are hereby forwarding to you this Certificate of Coverage (COC) issued to Shelton
Keith Jackson, authorizing the operation of the subject animal waste collection, treatment, storage and
land application system in accordance with General Permit AWG100000. The issuance of this COC
supercedes and terminates your previous COC Number AWS510035 which expires October 1,-2004.
This approval shall consist of the operation of this system including, but not limited to, the management
of animal waste from the Shelton Keith Jackson Farm, located in Johnston County, with an animal
capacity of no greater than an annual average of 2480 Feeder to Finish swine and the application to land
as specified in the facility's Certified Animal Waste Management Plan (CAWMP). If this is a Farrow to
Wean or Farrow to Feeder operation, there may also be one boar for each 15 sows. Where boars are
unneccessary, they may be replaced by an equivalent number of sows. Any of the sows may be replaced
by gilts at a rate of 4 gilts for every 3 sows
The COC shall be effective from the date of issuance until September 30, 2009. Pursuant to this COC,
you are authorized and required to operate the system in conformity with the conditions and limitations as
specified in the General Permit, the facility's CAWMP, and this COC. An adequate system for collecting
and maintaining the required monitoring data and operational information must be established for this
facility. Any increase in waste production greater than the certified design capacity or increase in number
of animals authorized by this COC (as provided above) will require a modification to the CAWMP and
this COC and must be completed prior to actual increase in either wastewater flow or number of animals.
Please carefully read this COC and the enclosed State General Permit. Since this is a revised State
General Permit, it contains new requirements in addition to most of the conditions contained in the
previous State General Permit. Enclosed for your convenience is a package containing the new and
revised forms used for record keeping and reporting. Please pay careful attention to the record keeping
and monitoring conditions in this permit.
Aquifer Protection Section —Animal Feeding Operations Unit
1636 Mail Service Center, Raleigh, North Carolina 27699-1638
Phone: [phone] FAX: [phone] Internet: h2o.enr.state.nc,us
An Equal Opponunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
Nne
oithCarolina
,Vaturally

If your Waste Utilization Plan has been developed based on site specific information, careful evaluation
of future samples is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have a new Waste Utilization Plan developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility.
Per 15A NCAC 2H .0225(c) a compliance boundary is provided for the facility and no new water supply
wells shall be constructed within the compliance boundary. Per MRCS standards a 100 foot separation
shall be maintained between water supply wells and any lagoon, storage pond, or any wetted area of a
spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at Ieast 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or Iimitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the staff member listed below for information on this
process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Raleigh Regional Office. The Regional Office, Water
Quality Staff may be reached at [phone]. If you need additional information concerning this COC
or the General Permit, please contact Duane Leith at [phone].
Sincerely,
J
for Alan W. Klimek, P.E.
Enclosures (General Permit AWG100000)
cc: (Certificate of Coverage only for all cc's)
Raleigh Regional Office, Aquifer Protection Section
Johnston County Health Department
Johnston County Soil and Water Conservation District
Permit File AWS510035
APS Central Files

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W_ Klimek, P. E., Director
Division of Water Quality
May 1, 2003
Shelton Keith Jackson
Shelton Keith Jackson Farm
1480 Alex Benton Road
Newton Grove NC 28366
Subject: Certificate of Coverage No. AWS510035
Shelton Keith Jackson Farm
Swine Waste Collection, Treatment,
Storage and Application System
Johnston County
Dear Shelton Keith Jackson:
On April 28, 2003, .the North Carolina General Assembly ratified Senate Bill 733 which directs the
Division of Water Quality (Division) to extend the expiration date -of the -Swine Waste -Operation General
Permit AWG100000. Therefore, the General Permit has been re -issued by the Division to extend the
expiration date to October 1, 2004. During the period of this extension the Division will be working with
all interested parties on the development of a new version of the Non -Discharge General Permit.
In accordance with your application received on January 17, 2003 and in accordance with the directive of
Senate Bill 733, we are hereby forwarding to you this Certificate of Coverage (COC) issued to Shelton
Keith Jackson, authorizing the operation of the subject animal waste collection, treatment, storage and
land application system in accordance with General Permit AWG100000. The issuance of this COC
supercedes and terminates your previous COC Number AWS510035 which expired on April 30, 2003.
This approval shall consist of the operation of this system including, but not Iimited to, the management
of animal waste from the Shelton Keith Jackson Farm, located in Johnston County, with an animal
capacity of no greater than an annual average of 2480 Feeder to Finish swine and the application to land
as specified in the facility's Certified Animal Waste Management Plan (CAWMP). If this is a Farrow to
Wean or Farrow to Feeder operation, there may also be one boar for each 15 sows. Where boars are
unneccessary, they may be replaced by an equivalent number of sows. Any of the sows may be replaced
by gilts at a rate of 4 gilts for every 3 sows
The COC shall be effective from the date of issuance until October 1, 2004. Pursuant to this COC, you
are authorized and required to operate the system in conformity with the conditions and limitations as
specified in the General Permit, the facility's CAWMP, and this COC. An adequate system for collecting
and maintaining the required monitoring data and operational information must be established for this
facility. Any increase in waste production greater than the certified design capacity or increase in number
of animals authorized by this COC (as provided above) will require a modification to the CAWMP and
this COC and must be completed prior to actual increase in either wastewater flow or number of animals.
If your Waste Utilization Plan has been developed based on site specific information, careful evaluation
of future samples is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have.a new Waste Utilization Plan developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
N�
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Customer Service Center
An Equal Opportunity Action Employer
Internet http:/m2o.enr.state.nc.us/ndpu
Telephone [phone] Fax [phone]
Telephone [phone]
50% recycled/10% post -consumer paper

Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility.
Per NRCS standards a 100 foot separation shall be maintained between water supply wells and any
lagoon or any wetted area of a spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COG or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the staff member listed below for information on this
process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Raleigh Regional Office. The Regional Office Water
Quality Staff may be reached at (919) 5714700. -If you need -additional -information concerning this COC
or the General Permit, please contact Michelle Barnett at [phone] ext. 544.
Sincerely,
for Alan W. Klimek, P.E.
Enclosures (General Permit AWG100000)
cc: (Certificate of Coverage only for all cc's)
Raleigh Regional Office, Water Quality Section
Johnston County Health Department
Johnston County Soil and Water Conservation District
Permit File AWS510035
NDPU Files

-._.:v '-W
ANIMAL WASTE UTILIZATION PLAN
Producer: SHELTON REITH JACKSON
Location: 1480 ALEX HENTON RD.
NEWTON GROVE NC 28366
Telephone: [phone]
Type Operation: Existing Feeder to Finish Swine
Number of Animals: 2480.00 hogs
(Design capacity)
STORAGE STRUCTURE: Anaerobic Waste Treatment Lagoon
APPLICATION METHOD: Irrigation
The waste from your animal facility must be land applied at a
specified rate to prevent pollution of surface water and/or
groundwater. The plant nutrients in the animal waste should be used
to reduce -the amount of commercial fertilizer required for the crops
in the fields where the waste is to be applied.
This waste utilization plan uses nitrogen as the limiting nutrient.
Waste should be analyzed before each application cycle. Annual soil
tests are strongly encouraged so that all plant nutrients can be
balanced for realistic yields of the crop to be grown.
Several factors are important in implementing your waste utilization
plan in order to maximize the fertilizer value of the waste and to
ensure that it is applied in an environmentally safe manner:
1. Always apply waste based on the needs of the crop to be
grown and the nutrient content of the waste. Do not apply
more nitrogen than the crop can utilize,
2. Soil types are important as they have different infiltration
rates, leaching potentials, cation exchange capacities, and
available water holding capacities.
3. Normally waste shall be applied to land eroding at less than
5 tons.per acre per year. Waste may be applied to land
eroding at 5 or more tons per acre annually, but less than
10 tons per acre per year providing that adequate filter
strips are established.
4. Do not apply waste on saturated soils, when it is raining,
or when the surface is frozen. Either of these conditions
may result in runoff to surface waters which is not allowed
under DWQ regulations.
Page: 2

ANIMAL WASTE UTILIZATION PLAN
5. Wind conditions should also be considered to avoid drift and
downwind odor problems.
6. To maximize the value of the nutrients for crop production
and to reduce the potential for pollution, the waste should
be applied to a growing crop or applied not more than 30
days prior to planting a crop or forages breaking dormancy.
Injecting the waste or disking will conserve nutrients and
reduce odor problems.
This plan is based on the waste application method shown above. If
you choose to change methods in the future, you need to revise this
plan. Nutrient,levels for different application methods are not the
same.
The estimated acres needed to apply the animal waste is based on
typical nutrient content for this type of facility. Acreage
requirements should be based on the waste analysis report from your
waste management facility. In some cases you may want to have plant
analysis made, which could allow additional waste to be applied.
Provisions shall be made for the area receiving waste to be flexible
so as to accommodate changing waste analysis content and crop type.
Lime must be applied to maintain pH in the optimum range for specific
crop production.
This waste utilization plan, if carried out, meets the requirements
for compliance with 15A NCAC 2H .0217 adopted by the Environmental
Management Commission.
AMOUNT OF WASTE PRODUCED PER YEAR (gallons, ft3, tons, etc.)
2480 hogs x 1.9 tons waste/hogs/year = 4712 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
2480 hogs x 2.3 lbs PAN/hogs/year = 5704 lbs. PAN/year
Applying the above amount of waste is a big job. You should plan
time and have appropriate equipment to apply the waste in a timely
manner.
The following acreage will be needed for waste application based on
the crop to be grown, soil type and surface application.
Page: 2

ANIMAL WASTE UTILIZATION PLAN
TABLE 1: ACRES OWNED BY PRODUCER
TRACT
FIELD
SOIL TYPE & CLASS-
CROP
YIELD
LBS
COMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N
PER AC
AC
USED
-----
or
-------
APPLY
RESID.
APPLIC
METH
N
TIME
11328
1
NoA
C
115
123.75
20
7.79
964.012
I
MAR-JUN
r
11328
NOA
W
0
1-1
I
160
1144
17.79
11121.76
SEP.--
APR.
133 )
11328
SB
35
140
0
1090.E
1-1
INOA
I
17.79
APR.-
SEP.15
11328
^1
NoA
CO
875
d
811.95
I
1105
17.19
APR.-
AUG.
11328
3
NoA
10.49
1298.13
IC
I
1115
1123.75120
1
MAR-JUN
I
11328
0
10.49
1510.56
1-3
JNOA
JW
I
�60
1144
ISEP-APR
u,
11328
SB
35
140
0
1-3
INOA
I
110.4911468.6
APR-
SEP.15
11328
CO
875
0
1-3
INOA
I
1105
110.4911101-45
APR-
AUG.
11328
UN4
GoA
C
142.5
5.73
I
1130
120
1816.525
MAR-JUN
11328
-UN4
5.73
893.88
lGoA
JW
I
165
1156 1
ISEP-App
v
1Q-
11328
-UN4
SB
38
152
0
5.73
jGoA
T
1870.96
APR-
SEP.15
11328
-UN4
IGOA
ICO
1925
1111 10
15.73
1636.03
JA iltl 4
Page: 3

ANIMAL WASTE UTILIZATION PLAN
W
f
�I
APR-
AUG.
10130
1
NOA
C
10.04
1242.45
1
I I
1115
1123.75120
1
MAR-JUN
Pdl `I
10130
W
1-1
jNoA
I
160
1144
JO
110.0411445.76
SEP-
APR.
�)
V /
t
' OD
10130
SB
35
140
0
1-1
INOA
I
110.0411405.6
APR-
SEP.15
10130
CO
875
0
1-1
INOA
I
1105
110.0411054.2
APR--
AUG.
10130
2
NoA
1.95
IC
I
111.5
1123.75120
I
1241.312
MAR-JUN
10130
0
1.95
1-2
INOA
JW
I
160
1144
1280.8
SEP-
APR.
10130
SB
35
0
1.95
1-2
INOA
I
1140
1273
APR-
SEP.15
10130
CO
875
0
1.95
1-2
INOA
I
1105
1204.75
APR-
AUG.
END II
TOTAL118738.3
- Indicates that this field is being overseeded (i.e.
interplanted) or winter annuals follow summer annuals.
y r r / J
NOTE: The applicator is cautioned that P and K may be over applied
while meeting the N requirements. In the future, regulations
may require farmers in some parts of North Carolina to have a
nutrient management plan that addresses all nutrients. This
plan only addresses nitrogen.
Page: 4

ANIMAL WASTE UTILIZATION PLAN
Y
TABLE 2: ACRES WITH NOTARIZED AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowners must be attached.)
(Required only if operator does not own adequate land.
See required specification 2.)
TRACT
FIELD
SOIL TYPE & CLASS-
CROP
YIELD
LBS
COMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N
PER AC
AC
USED
-----
or
-----
APPLY
RESID.
APPLIC
METH
N
TIME
END
Indicates that
winter annuals
0-roP RO�4, lo,7
TOTAL 10
this field is being overseeded (i.e. interplanted) or
follow summe annuals. /� �
A-IJ AVC/ eo//asp
** Acreage figures may exceed total acreage in fields due to
overseeding.
* lbs AW N (animal waste nitrogen) equals total required nitrogen
less any commercial nitrogen (COMM N) supplied.
The following legend explains the crop codes used in tables 1 and 2 above:
CROP CODE
CROP
UNITS
PER UNIT
C
CORN
BUSHELS
1.25
CO
COTTON
POUNDS
.12
SB
SOYBEANS
BUSHELS
4
W
WHEAT
BUSHELS
2.4
TOTALS FROM TABLES 1 AND 2
ACRES I LBS AW N USED
Page: 5

ANIMAL WASTE UTILIZATION PLAN
Y
TABLE 1
TABLE 2
TOTAL
36
0
36
*** BALANCE
Jy-,, Al, 69#4!L/Z
vrips. /41;1?fr°�q �
yo RuX 41 A
*** This number must be less than or equal to 0 in order to
fully utilize `the animal waste N produced.
i r s i n e rC /9 )r y � Ate' e' CY e,4
lqp) J S4 d,4J)ee ei,6ple/
rP s 1 c1u,y /�• %ro c Pry 74�0 m 5v h��w� e �,�/f !
/
`c y r yak �u s /-e �,a i�•'%�r6 P� 7` i le 1 7}`a //(/h
I/c/
,VelI
7
/ /�/
4 ge
� c
f
� Y
0 k-k) �/! %�? / /i r S U C4 f ,e) U �9 �0 !91/l i�
// 1
C � �� /Qc p��- leT-`% W,_ T7 �/�CC(> �G �/,f //0 Q h f/9
a Xew j,
r
/v �1Z c �� fin/ � F r�, h r s � kuil % n l ie �Jls k. i C�u e- �b
e alo5e ro}c;m/-I U4
C r4 � C 19��v � �; r� Iy CaAe- X e j-,
�
el �vn A',,
P,- Ilk- 4 7-',"
0 71- 7'X5 / e-
�2c9/aooU page: 6

ANIMAL WASTE UTILIZATION PLAN
*** This number must be less than or equal to 0 in order to fully
utilize the animal waste N produced.
Acres shown in each of the preceding tables are considered to be the
usable acres excluding required buffers, filter strips along ditches,
odd areas unable to be irrigated, and perimeter areas not receiving
full application rates due to equipment limitations. Actual total
acres in the fields listed may, and most likely will be, more than
the acres shown in the tables.
See attached map showing the fields to be used for the utilization of
animal waste.
SLUDGE APPLICATION:
The waste utilization plan must contain provisions for periodic land
application of sludge at agronomic rates. The sludge will be nutrient
rich and will require precautionary measures to prevent over application
of nutrients or other elements. Your production facility will produce
approximately 917.6 pounds of plant available nitrogen per year in the
sludge.
If you remove the sludge every 5 years, you will have approximately 4588
pounds of PAN to utilize. Assuming you apply this PAN to hybrid
bermudagrass hayland.at the rate of 300 pounds of nitrogen per acre, you
will need 15.2933333333 acres of land. If you apply the sludge to corn at
the rate of 125 pounds of nitrogen per acre, you will need 36.704 acres
of land. Please be aware that these are only estimates of the PAN and
land needed. Actual requirements could vary by 25% depending on your
sludge waste analysis, soil types, realistic yields, and application
methods.
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of the
soil at the time of irrigation such that runoff or ponding occurs. This
rate is limited by initial soil moisture content, soil structure, soil
texture, water droplet size, and organic solids. The application amount
should not exceed the available water holding capacity of the soil at the
time of irrigation nor should the plant available nitrogen applied exceed
the nitrogen needs of the crop.
If surface irrigation is the method of land application for this plan,
it is the responsibility of the producer and irrigation designer to ensure
that an irrigation system is installed to properly irrigate the acres
shown in Tables 1 and 2. Failure to apply the recommended rates and
Page: 7

ANIMAL WASTE UTILIZATION PLAN
11
amounts of nitrogen shown in the tables may make this plan invalid.
The following table is provided as a guide for establishing application
rates and amounts.
I
I
(Application
RatelApplic. Amount
Tract
l Field I
Soil Type
I Crop
I (in/hr)
I (inches)
10130
l 1 l
NoA
l C
.40
l *.50
10130
I I
l 2 l
NoA
I
I C
I
l .40
I *.50
I
10130 l
I
-1 I
NoA
I
l CO
!
l .40
, *.50
10130 l
-1 l
NoA
l SB
.40
l *.50
I
10130 l
I
-1 l
NoA
I
l W
I
l .40
I *.50
I
10130 I
I
-2 I
NoA
I
I CO
I
!
I .40
j *.50
1
10130 l
I
--2 I
NoA
l SB
I
l .40
I
l *.50
10130 l
-2 l
NoA
l W
l -.40
, *.50
11328 11
I
NoA
I C
I .40
I *.5
!
11328 l
I
3 l
NoA
l
l C
I
l .40
l *.50
Page: 8

ANIMAL WASTE UTILIZATION PLAN
e
11328
I
I UN4
I
I GOA
I
I C
I
I .40
I *.50
111328
I -1
I
I NOA
I
I Co
i
I .40
i
I *.50
11328
I
I -1
I
I NoA
I
i SB
I
I .40
I *.50
11328
I
--1
I
I NoA
I
W
I
I .40
I *.50
11328
I
I --3
I
I NoA
I
I CO
i
I .40
i
I *.50
11328
I
I -3
i
I NaA
I
I SB
I
.40
I
I *.50
11328
I -3
I NoA
I W
.40
*.50
11328 I
I
-UN4
I
I GOA
I
CO
I
I .40
I
I *.50
11328 I
-UN4
I GOA
I
I SB
I
I .40
I
I *.50
i
11328 I
I
-UN4
I GOA
I
I W
I
I .40
I
I *.50
* This is the maximum application amount allowed for the soil
assuming the amount of nitrogen allowed for the crop is not over
applied. In many situations, the application amount shown cannot
be applied because of the nitrogen limitation. The maximum
application amount shown can be applied under optimum soil
conditions.
Page: 9

ANIMAL WASTE UTILIZATION PLAN
V
Your facility is designed for 180.00 days of temporary storage and
the temporary storage must be removed on the average of once every
6.00 months. In no instance should the volume of the waste be stored
in your structure be within the 25 year 24 hour storm storage or one
foot of freeboard except in the event of the 25 year 24 hour storm.
It is the responsibility of the producer and waste applicator to
ensure that the spreader equipment is operated properly to apply the
correct rates to the acres shown in Tables 1 and 2. Failure to apply
the recommended rates and amounts of nitrogen shown in the tables may
make this.plan invalid.
Call your technical specialist after you receive the waste analysis
report for assistance in determining the amount of waste per acre and
the proper application rate prior to applying the waste.
NARRATIVE OF OPERATION
Page: 10

WASTE UTILIZATION PLAN
' REQUIRED SPECIFICATIONS
1. Animal waste shall not reach surface waters of the state by
runoff, drift, manmade conveyances, direct application, or
direct discharge during operation or land application. Any
discharge of waste which reaches surface water is prohibited.
2. There must be documentation in the design folder that the
producer either owns or has an agreement for use of adequate
land on which to properly apply the waste. If the producer does
not own adequate land to properly dispose of waste, he/she shall
provide a copy of an agreement with a landowner who is within a
reasonable proximity, allowing him/her the use of the land for
waste application. It is the responsibility of the owner of the
facility to secure an update of the Waste Utilization Plan when
there is a change in the operation, increase in the number of
animals, method of utilization, or available land.
3. Animal waste shall be applied to meet, but not exceed, the
nitrogen needs for realistic crop yields based on soil type,
available moisture, historical data, climatic conditions, and
level of management, unless there are regulations that restrict
the rate of application for other nutrients.
4. Animal waste shall be applied to land eroding less than 5 tons
per acre per year. Waste may be applied to land that is eroding
at 5 or more tons, but less than 10 tons per acre per year
providing grass filter strips are installed where runoff leaves
the field. (See FOTG Standard 393 -Filter Strip)
5. odors can be reduced by injecting the waste or disking after
waste application. Waste should not be applied when there is
danger of drift from the irrigation field.
6. When animal waste is to be applied on acres subject to
flooding, it will be soil incorporated on conventionally tilled
cropland. When applied to conservation tilled crops or
grassland, the waste may be broadcast provided the application
does not occur during a season prone to flooding. (See "Weather
and Climate in North Carolina" for guidance.)
7. Liquid waste shall be applied at rates not to exceed the soil
infiltration rate such that runoff does not occur offsite or to
surface waters and in a method which does not cause drift from
the site during application. No ponding should occur in order
to control odor or flies.
8. Animal waste shall not be applied to saturated soils, during
rainfall events, or when the surface is frozen.
9. Animal waste shall be applied on actively growing crops in such
a manner that the crop is not covered with waste to a depth that
would inhibit growth. The potential for salt damage from animal
waste should also be considered.
Page: 11

WASTE UTILIZATION PLAN
REQUIRED SPECIFICATIONS
10. Waste nutrients shall not be applied in fall or winter for
spring planted crops on soils with a high potential for
leaching. Waste nutrient loading rates on these soils should be
held to a minimum and a suitable winter cover crop planted to
take up released nutrients. Waste shall not be applied more
than 30 days prior to planting of the crop or forages breaking
dormancy.
11. Any new swine facility sited on or after October 1, 1995 shall
comply with the following: The outer perimeter of the land area
onto which waste is applied from'a lagoon that is a component of
a swine farm shall be at least 50 feet from any residential
property boundary and from any perennial stream or river (other
than an irrigation ditch or canal. Animal waste other than
swine waste from facilities sited on or after October 1, 1995),
shall not be applied closer than 25 feet to perennial waters.
(See Standard 393 - Filter Strips).
12. Animal waste shall not be applied closer than 100 feet to
wells.
13. Animal waste shall not be applied closer than 200 feet of
dwellings other than those owned by the landowner.
14. Waste shall be applied in a manner not to reach other property
and public right-of-ways.
15. Animal waste shall not be discharged into surface waters,
drainageways, or wetlands by a discharge or by over -spraying.
Animal waste may be applied to prior converted cropland provided
they have been approved as a land application site by a
"technical specialist". Animal waste shall not be applied on
grassed waterways that discharges directly into water courses,
and on other grassed waterways, waste shall be applied at
agronomic rates in a manner that causes no runoff or drift from
the site.
16. Domestic and industrial waste from washdown facilities,
showers, toilets, sinks, etc., shall not be discharged into the
animal waste management system.
17. A protective cover of appropriate vegetation will be
established on all disturbed areas (lagoon embankments, berms,
pipe runs, etc.). Areas shall be fenced, as necessary, to
protect the vegetation. Vegetation such as trees, shrubs, and
other woody species, etc., are limited to areas where considered
appropriate. Lagoon areas should be kept mowed and accessible.
Berms and structures should be inspected regularly for evidence
of erosion, leakage or discharge.
Page: 12

WASTE UTILIZATION PLAN
REQUIRED SPECIFICATIONS
18. If animal production at the facility is to be suspended or
terminated, the owner is responsible for obtaining and
implementing a "closure plan" which will eliminate the
possibility of an illegal discharge, pollution and erosion.
19. Waste handling structures, piping, pumps, reels, etc., should
be inspected on a regular basis to prevent breakdowns, leaks,
and spills. A regular maintenance checklist should be kept on
site.
20. Animal waste can be used in a rotation that includes vegetables
and other crops for direct human consumption. However, if
animal waste is used on crops for direct human consumption it
should only be applied preplant with no further applications of
animal waste during the crop season.
21. Highly visible markers shall be installed to mark the top and
bottom elevations of the temporary storage (pumping volume) of
all waste treatment lagoons. Pumping shall be managed to
maintain the liquid level between the markers. A marker will
be required to mark the maximum storage volume for waste
storage ponds.
22. Waste shall be tested within 60 days of utilization and soil
shall be tested at least annually at crop sites where waste
products are applied. Nitrogen shall be the rate -- determining
element. Zinc and copper levels in the soils shall be
monitored and alternative crop sites shall be used when these
metals approach excessive levels. pH shall be adjusted for
optimum crop production and maintained. Soil and waste
analysis records shall be kept for five years. Poultry dry
waste application records shall be maintained for three (3)
years. Waste application records for all other waste shall be
maintained for five (5) years.
23. Dead animals will be disposed of in a manner that meets North
Carolina regulations.
Page: 13

o
ANIMAL WASTE UTILIZATION PLAN
Y
WASTE UTILIZATION PLAN AGREEMENT
Name of Farm:SHELTON JACKSON
Owner/Manager Agreement
I (we) understand and will follow and implement the specifications
and the operation and maintenance procedures established in the
approved animal waste utilization plan for the farm named above. I
(we) know that any expansion to the existing design capacity of the
waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the
North Carolina Division of Water Quality (NCDWQ) before the new
animals are stocked. I (we) also understand that there must be no
discharge of animal waste from this system to surface waters of the
state from a storm event less severe than the 25-year, 24-hour
storm. The approved plan will be filed on -site at the farm office
and at the office of the local Soil and Water Conservation District
and will be available for review by NCDWQ upon request.
Name of Facility Owner: SHELTON KEITH JACKSON
(Please print)
Signature: Date: D
Name of Manager(If different from owner):
Signature: Date:
Name of Person Preparing Plan: (Please print)Chris W. Smith
Affiliation:NRCS Phone No. 919-989-5381
Address (Agency): 806 North Street
Smithfield NC 27577
Signature: 10, -1 Date:
Page: 14

ANIMAL WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
I, , hereby give
permission to apply animal waste from his Waste Utilization System
on acres of my land for the duration of time shown below.
The field(s) on which waste can be applied are shown on the
attached map.
I understand that this waste contains nitrogen, phosphorous,
potassium, and other trace elements and when properly applied
should not harm my land or crops. I also understand that the use
of waste will reduce my need for commercial fertilizer.
Adjacent Landowner:
Waste Producer:
Technical Representative:
SWCD Representative:
Date:
Date:
Date:
Date:
Term of Agreement: _ _ _ ,19_ to
(Minimum of Ten Years on Cost Shared Items)
(See Required Specification No. 2.)
Page: 15

ANIMAL WASTE UTILIZATION PLAN
STATE OF NORTH CAROLINA
COUNTY OF
I, , a Notary
Public of said County, do hereby certify that
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument.
WITNESS my hand and official seal this day 'of
19
My commission expires
Notary Public.
(SEAL)
Page: 16

ANIMAL WASTE UTILIZATION PLAN
Waste Utilization - Third Party Receiver Agreement
I, hereby agree to apply waste
generated by in a manner that meets the
Waste Utilization Standard (633), or use an alternative waste
utilization system that has been accepted in writing by the
Division of Water Quality.
Third Party Receiver:
Date:
Term of Agreement: to
(Minimum Ten Years on Cost -Shared Items)
STATE OF NORTH CAROLINA
COUNTY OF
,'a Notary
Public of said County, do hereby certify that
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument.
WITNESS my hand and official seal this day of
19
My commission expires
( SEAL)
Notary Public.
Page: 17

JAN 06 ' 00 03 t 50PM JOHNSTON CO. COOP CX �-�f7��STOr✓ G U P . 2/5
r � PR��6E !�'io8►st..5
Plant Amendment to Include S&WCC Cb Stan dard,F.through March 311, 2000
1. If this facility can comply with its exist — -- -..__ .. SO. - _ --
2. Temporary Addition of New Sprayhclds (Yj (Check appropriate boxes.)
[) A. acres of cropland. List crop types used-.
j] B. acres of hardwood woodland @ 100 lbs PAN ! acre added.
Q C. acres of pine woodland added @ 60 lbs PAN / acre added.
3. Summer Perennial Grass (Check appropriate box.)
j] A. Application window extended for acres of perennial grass until first killing frost.
n B. An additional 50 lbs of PAN applied to acres of perennial grass prior to killing frost.
4. P Application increased for Small Grains & Winter Gras to be harvested_ (Check appropriate box.)
PAN application increased up to 200 lbs per acre for acres of small gains or winter grasses to be harvested.
0 B. PAN application increased up to I50 lbs per acre for acres of overseeded summer perennial included in 3. B:
5. Waste Analysis (Check appropriate box.)
0 A. Prior to December 1'.1999 the calculation of PAN will be based on a 35% reduction of the last analysis taken
ppor to the first 25 year 24 hour storm event. (Current Waste analysis must be used after Oec. Ia .)
". Use current waste analysis to determine PAN.
6. Reyulmd - Mwdrnum Nitrogen Utilization Measures for Small Grains and Winter Grasses.
A. Use of higher seeding rates,
B. Timely harvest of forage to increase yield, and
C. Irrigating during periods of warmer weather.
7. Reouired - Irrigation Management Techniques to Reduce Runoff and Pending Potential.
A. Making frequent, light irrigation applications. and
B. Not irrigating immediately before predicted rainfall_
8. The owner / manager is required to manage the movement of animals to and from the facility to minimize environmental
impacts, ensure compliance with the facility's permit and amended CAWMP, and avoid discharge to surface waters.
9. Authorization to use the additional practices included in this amendment expires if facility discharges to surface waters_
Any discharge is a violation and may result in an enforc=ent action_
10. The owner / operator is required to keep records of all waste applications.
11. This revision must 'include a map or sketch of new land application areas.
Facility Number �_� _(_() S F�7o.J KC*17-W JAC+CSeri f kP- iu
Facility Name
Facility Owner / Manager Name (PRINT) Technical Specialist Name (PRINT)
Manager Signature
Date 1 i-
Technical Speci st Signature
Date ItU-199 -_
This document must be filed at the SWCD office and be attached to the facilities CAWMP
and be available for inspection at the facility.
({) New temporary sprayflelds must meet applicable buffer and setback requirements. Waste must not be: applied to wetlands.

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Shelton Keith Jackson
Shelton Keith Jackson Farm
1480 Alex Benton Road
Newton Grove NC 28366
Dear Shelton Keith Jackson:
1 M.?OW'A •
NCDENR
NORTH CAROLINA DEJ�ARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
11!
December 30, 1999
OpFlce
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number,5:L=35=7
Johnston --County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. iPRl, IRR2, DRYI, DRY2, DRYS, SLUR], SLUR2,
SLDI, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely,
Kerr T. Stevens, Director
Division of Water Quality
cc: Raleigh Regional Office
Johnston County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

FACILITY NUMBER _S I -
FARM NAME: sK£c-�rW►J -JACY-sue►
REVIEWER: r '-
DATE:
---ram— w
TYPE
NUMBER
# ANIMALS
LAGOON - PAN
POND - PAN
Farrow/Wean
sow
2.5=
5.4=
19=
Farrow/Feeder
sow
4=
6.5=
22=
Farrow/Finish
sow
10=
26=,
91=,
Wean/Feeder
head
1=
0.48=
1.6=
Feeder/Finish
head
1=
2.3=
7.9= .
Gilt Developer
head
1=
2.5=
Boar Stud
head
1=
3.7=
DESIGNlVOLUME CALCULATIONS:
Top of dike elevation.-
Elev. below structural & storm storage:
Normal operating water level elevation
(top of permanent storage):
Bottom elevation:
Permanent storage volume ft3
Temporary storage volume ft3
IRRIGATION:
Operating Pressure (psi):
Flow (gpm):
Application Rate (in/hr):
Nozzle/Ring Size(s):
Design
Recorded
Design
Recorded
Design.
Design
Design
Design �\
WUP - Days of temporary storage:
Caics - Days of temporary storage:.
ft. 15t 25 yr.124 hr. storm in.
ft. 2"d 25 yr./24 hr. storm in.
ft, Structural freeboard in.
ft.
Exceeds required volume?
Exceeds required volume?
Actual
Actual
Actual
Actual
Actual
Actual
FREEBOARD CK.
1
2
3 4
5
Water level reading
y
Top of dike reading
Difference
Marker reading
'

CAWMP Components
Permitted Facility; Date;.3 L �(
Completed Certification orm; Date:
Waste Utilization Plan;. Date: /97
Amount of plant available nitrogen produced/used annually ( S7D Ibs)
Dominant soil series:
Crops to be grown: C�R�1r„s�Eaa��sG)
Field Maps
Based on usable (Total= Usable= )
Present day format w/RYES or actual records; application windows 2/1193;
Standard #633 required specifications
Emergency Action Plan
Odor Control Checklists (effective 1/97)
Insect Control Checklist (effective 1/97)
W—� Mortality Checklist (effective 1/97)
Type of irrigation: rave ' un Solid -Set Small Gun Center Pivot Linear Move
Other (description):
NRCS irrigation parameters usable field size, max. application rate, max. application
rate per cycle (effective 9/1/96) or
Calibration information or
Land application system design information (after 9/1196) including parameters,
equipment type, system layout and settings
Show design needs (storage & treatment calculations)
Operation & Maintenance Plan
Site schematic
Site evaluation, after 2/96 (NRCS NC-CPA-17) includes wetlands determination
Hazard classification
Construction inspection notes, including liner inspection & observation trench (after
911 /96)
Consideration for emergency spillway (after 6/21/96)
REQU ED RECORDS effective 911/96 PERMIT FACILITIES
,Waste application records (1RR 1 &2) eneral Permit & COC on site
Annual soil sample reports for 1999 . weekly lagoon level records
(Cu index: )
index: )
Waste analysis - date last taken
PAN Ibs11000 gals. for struciurb#1
PAN Ibs/1000 gals. for structure #2

State of North -Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
March 26, 1999
Shelton Keith Jackson
Shelton Keith Jackson Farm
1480 Alex Benton Road
Newton Grove NC 28366
A 117?0
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCE5
Subject: Certificate of Coverage No. AWS510035
Shelton Keith Jackson Farm
Swine Waste Collection, Treatment,
Storage and Application System
Johnston County
Dear Shelton Jackson:
In accordance with your application received on September 9, 1998, we are forwarding this Certificate
of Coverage (COC) issued to Shelton Keith Jackson, authorizing the operation of the subject animal
waste collection, treatment, storage and land application system in accordance with General Permit
AWG100000. This approval shall consist of the operation of this system including, but not limited to,
the.; management of animal waste from the Shelton Keith Jackson Farm, located in Johnston County,
with an animal capacity of no greater than 2480 Feeder to Finish and the application to land as specified
in the Certified Animal Waste Management Plan (CAWMP).
The COC shall: be effective from the date of issuance until April 30, 2003. Pursuant to this COC, you
are authorized and required to operate the system in conformity with the conditions and limitations as
specified in the General Permit, the facility's CAWMP, and this COC, with no discharge of wastes to
surface waters. An adequate system for collecting and maintaining the required monitoring data and
operational information must be established for this farm. Any increase in waste production greater than
the certified design capacity or increase in number of stocked animals above the number authorized by
this COC will require a modification to the CAWMP and this COC and shall be completed prior to
actual increase in either wastewater flow or number of animals.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
Upon notification by the Division of this COC's expiration, you shall apply for its renewal. This request
shall be made within 30 days of notification by the Division.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the DWQ prior to a name change or change in ownership.
P.O. Box 29535, Raleigh, north Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Certificate of Coverage AWS510035
Shelton Keith Jackson Farm
Page 2
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual non -discharge permit by contacting the engineer listed below for information on
this process. Unless such a request is made within 30 days, this COC shall be final and binding.
The subject farm is located in the Raleigh Regional Office. The Regional Office Water Quality Staff
may be reached at [phone]. If you need additional information concerning this COC or the
General Permit, please contact Sue Homewood at [phone] ext. 502.
Since
r
r
I
r
/- Kerr T. Stevens
cc: (Certificate of Coverage only for all cc's)
Johnston County Health Department
Raleigh Regional_Office Water=Quality--Section-=-a
Johnston County Soil and Water Conservation District
Permit File
NDPU Files

State of North Carolina
Department of Environment
and Natural Resources
•
Division of Water Qualitymom
_
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
CDENR
A. Preston Howard, Jr., P.E., Director
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NAruRAL RESOURCES
August 2I, 3998
CERTIFIED MAIL
1
"
RETURNRE UQ ESTED
Shelton ith Jackson
L N EI
Shelton Keith Jackson Farm
f
1480 Alex Benton Road
Newton Grove NC 28366
+b-HNIR RALEi6d R..G1v14nL u, i is Ef
Farm Number: 51 - 35
Dear Shelton Keith Jackson:
You are hereby notified that Shelton Keith Jackson Farm, in accordance with G.S. 143-215.1 OC,
must apply for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter,
your farm has six 60 da s to submit the attached application and all supporting documentation. In
accordance with apter 676 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any
owner or operator who fails to submit an application by the date specified by the Department
SHALL NOT OPERATE the animal waste system after the specified date. Your application must
be returned within sixty (60) days of receipt of this letter. Failure to submit the application as required
may also subject your facility to a civil penalty and other enforcement actions for each day the facility is
operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
f
If you have any questions concerning this letter, please call at [phone] extension or
Charles Alvarez with the Raleigh Regional Office at (919) 5714700.
cerely,
for A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Raleigh Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

ANIMAL WASTE UTILIZATION PLAN SEP 0 919A
----------------------------------------------------------------------
Producer: SHELTON KEITH JACKSON
Location: 1480 ALEX BENTON RD.
NEWTON GROVE NC 28366
Telephone: [phone]
Type Operation: Existing Feeder to Finish Swine
Number of Animals: 2480.00 hogs
(Design Capacity)
STORAGE STRUCTURE: Anaerobic Waste Treatment Lagoon
APPLICATION METHOD: Irrigation
The waste from your animal facility must be land applied at a
specified rate to prevent pollution of surface water and/or
groundwater. The plant nutrients in the animal waste should be used
to reduce the amount of commercial fertilizer required for the crops
in the fields where the waste is to be applied.
This waste utilization plan uses nitrogen as the limiting nutrient.
Waste should be analyzed before each application cycle. Annual soil
tests are strongly encouraged so that all plant nutrients can be
balanced for realistic yields of the crop to be grown.
Several factors are important in implementing your waste utilization
plan in order to maximize the fertilizer value of the waste and to
ensure that it is applied in an environmentally safe manner:
1. Always apply waste based on the needs of the crop to be
grown and the nutrient content of the waste. Do not apply
more nitrogen than the crop can utilize.
2. soil types are important as they have different infiltration
rates, leaching potentials, cation exchange capacities, and
available water holding capacities.
3. Normally waste shall be applied to land eroding at less than
5 tons per acre per year. Waste may be applied to land
eroding at 5 or more tons per acre annually, but less than
10 tons per acre per year providing that adequate filter
strips are established.
4. Do not apply waste on saturated soils, when it is raining,
or when the surface is frozen. Either of these conditions
may result in runoff to surface waters which is not allowed
under DEM regulations.
----------------------------------------------------------------------
Page: 1

ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
5. Wind conditions should also be considered to avoid drift and
downwind odor problems.
b. To maximize the value of the nutrients for crop production
and to reduce the potential for pollution, the waste should
be applied to a growing crop or applied not more than 30
days prior to planting a crop or forages breaking dormancy.
In3ecting the waste or disking will conserve nutrients and
reduce odor problems.
This plan is based on the waste application method shown above. If
you choose to change methods in the future, you need to revise this
plan. Nutrient levels for different application methods are not the
same.
The estimated acres needed to apply the animal waste is based on
typical nutrient content for this type of facility. Acreage
requirements should be based on the waste analysis report from your
waste management facility. In some cases you may want to have plant
analysis made, which could allow additional waste to be applied.
Provisions shall be made for the area receiving waste to be flexible
so as to accommodate changing waste analysis content and crop type.
Lime must be applied to maintain pH in the optimum range for specific
crop production.
r
This waste utilization plan, if carried out, meets the requirements
for compliance with 15A NCAC 2H .0217 adopted by the Environmental
Management Commission.
AMOUNT OF WASTE PRODUCED PER YEAR (gallons, ft3, tons, etc.)
2480 hogs x 1.9 tons waste/hogs/year = 4712 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
2480 hogs x 2.3 lbs PAN/hogs/year = 5704 lbs. PAN/year
Applying the above amount of waste is a big job. You should plan time and
have appropriate equipment to apply the waste in a timely manner.
The following acreage will be needed for waste application based ❑n the
crop to be grown, soil type and surface application.
----------------------------------------------------------------------
Page: 2

ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
TABLE 1: ACRES OWNED BY PRODUCER
TRACTFI
LD
SOIL TYPE & CLASS-
CROP
TELD
LBS
ICOMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N
PER AC
AC
USED
-----
or
------
APPLY
RESID.
APPLIC
METH
N
TIME
1 3328
1�6
1��
915.325
NoA
C
20
I
MAR-JUN
67T/
FA
I
S
I
FEB-MAR
iAPR.-AUG
�C 128 3 NoAJ160 1120 10-- �10.4911258.8
I FEB-MAR
11328
INoA
133
132
13
ISB
10
1-10—.4-11384.68-AUG
11328
UN4
GoA
C
I
I I
1125.01136.25120
1-5-
1780.712
MAR-JUN
11328
687.6
UN4
0
lGoAJ160.0
I
�120
15.73
FEB-MAR
u, d2j. 0
11328
UN4
Go
B
39
156
0
I
1
1
1893.88
APR.-AUG
10130
1179.7
1
C
r070"4-
�NoA
I
1110
1117.5
120
MAR-JUN
10130
1
0
lNoA
JW
I
160 1120
�10.0411204.8
FEB-MAR
10130
j
1485.92
1
SB
37
148
0
lNoA
ii
I
I
APR. -AUG
10130
229. 125
2
oA
C
110
g5--
I
1117.5
120
iMAR-JUN
Ay, .3?,s6
,101.30
2
NoA
JW
160
1120
0
1..95
1 234
1
1
FEB-MAR
Page: 3

ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
10134 2 1 NoA SS 37 148 0 1 288.6
I 1 1 APR.-AUG
END
T
.38
TOTAL 3 3a3 8Y 7
- Indicates that this field is being overseeded (i.e. interplanted) or
winter annuals follow summer annuals.
NOTE: The applicator is cautioned that P and K may be over applied while
meeting the N requirements. In the future, regulations may require
farmers in some parts of North Carolina to have a nutrient management
plan that addresses all nutrients. This plan only addresses nitrogen.
J 1 r.0
r hC1iC.aTes GL I Wo UFa r f D c /0rj --- eorrJ a C L SvaeWs
rou n C' pu.mploq �ou�c� ,6E 6esT` ]� g�lvvi
Corn -, o�ye �I ra /f 5o feA�s. y�. h pis
Uor� Shou/ a/SO horve c� �rD!Ci�Ia�E/r/ C fAcref a, c�
TaaUCCo 1'o;iCLlr`%Jyl 0'7 Oae 07f �h�s 7wv0 ruc.�s.
Page:

I
ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
TABLE 2: ACRES WITH NOTARIZED AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowners must be attached.)
(Required only if operator does not own adequate land.
See required specification 2.)
TRACT
FIELD
SOIL TYPE & CLASS-
CROP
YIELD
LBS
COMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N
PER AC
AC
USED
-----
or
-------
APPLY
RESID.
APPLIC
METH
N
TIME
END
TOTAL 10
- Indicates that this field is being overseeded (i.e. interplanted) or w
annuals follow summer annuals.
** Acreage figures may exceed total acreage in fields due to overseeding.
* lbs AW N (animal waste nitrogen) equals total required nitrogen less
any commercial nitrogen (COMM N) supplied.
The following legend explains the crop codes used in tables 1 and 2 above:
CROP CODE
CROP
UNITS
PER UNIT
C
CORN
BUSHELS
1.25
SB
SOYBEANS
BUSHELS
4
W
WHEAT
BUSHELS
2
TOTALS FROM TABLES 1 AND 2
ACRES LBS AW N USED
TABLE 1 i7Blr5-9
t' 36A` 0!� Sb 9.3 1�
----------------------------------------------------------------------
Page: 5

ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
TABLE 2 0 0
TOTAL a-0.8-- 1'3��9
864.39
*** BALANCE ------Mt 5----
*** This number must be less than or equal to 0 in order to
fully utilize the animal waste N produced.
----------------------------------------------------------------------
Page: 6

ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
*** This number must be less than or equal to 0 in order to fully utilize
the animal waste N produced.
Acres shown in each of the preceding tables are considered to be the usable
acres excluding required buffers, filter strips along ditches, odd areas
unable to be irrigated, and perimeter areas not receiving full application
rates due to equipment limitations. Actual total acres in the fields
listed may, and most likely will be, more than the acres shown in the
tables.
See attached map showing the fields to be used for the utilization of
animal waste.
SLUDGE APPLICATION:
The waste utilization plan must contain provisions for periodic land
application of sludge at agronomic rates. The sludge will be nutrient
rich and will require precautionary measures to prevent over application
of nutrients or other elements. Your production facility will produce
approximately 917.6 pounds of plant available nitrogen per year in the
sludge.
If you remove the sludge every 5 years, you will have approximately 458A
pounds of PAN to utilize. Assuming you apply this PAN to hybrid
bermudagrass hayland at the rate of 300 pounds of nitrogen per acre, you
will need 15.2933333333 acres of land. If you apply the sludge to corn at
the rate of 125 pounds of nitrogen per acre, you will need 36.704 acres
of land. Please be aware that these are only estimates of the PAN and
land needed. Actual requirements could vary by 25% depending on your
sludge waste analysis, soil types, realistic yields, and application
methods.
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of the
soil at the time of irrigation such that runoff or ponding occurs. This
rate is limited by initial soil moisture content, soil structure, soil
texture, water droplet size, and organic solids. The application amount
should not exceed the available water holding capacity of the soil at the
time of irrigation nor should the plant available nitrogen applied exceed
the nitrogen needs of the crop.
If surface irrigation is the method.of land application for this plan,
it is the responsibility of the producer and irrigation designer to ensure
that an irrigation system is installed to properly irrigate the acres
shown in Tables 1 and 2. Failure to apply the recommended rates and
----------------------------------------------------------------------
Page: 7

ANIMAL WASTE UTILIZATION PLAN
-------------------------------------------------------------------------
amounts of nitrogen shown in the tables may make this plan invalid.
The following table is provided as a guide for establishing application
rates and amounts.
Tract
Field
Soil Type
Crop
Application Rate
(in/hr)
App ic. Amount
(inches)
36136-
1
NoA
C
.4
*1
10130
1
NoA
SB
.4
*.1
10130
UOT30-
10 30
1
NoA
W
.4
*1
27-
NoA
C
.4
*1
2
NoA
SB
*1
10130
2
NoA
W
.4
*1
�'12 S
11328
1
NoA
C
.4
* 1
1
NoA
SB
.4
*1
11328
1T3-28
1
NoA
W
.4
*1
3
NoA
C
.4
*1
11328
1-1328
1T-3-28
3
NoA
SB
.4
*1
3
UU-F�
NoA
W
.4
*1
GoA
C
.4
* 1
11328
UN4
GoA
SB
.4
*1
11328
UN4
GoA
W
.4
*1
* This is the maximum application amount allowed for the soil
assuming the amount of nitrogen allowed for the crop is not over
applied. In many situations, the application amount shown cannot
be applied because of the nitrogen limitation. The maximum
application amount shown can be applied under optimum soil
conditions.
------------------------------------------------------_----------------
Page: 8

ANIMAL WASTE UTILIZATION PLAN
----------------------------------------------------------------------
Your facility is designed for 180.00 days of temporary storage and the
temporary storage must be removed on the average of once every 6.00 months.
In no instance should the volume of the waste be stored in your structure
be within the 25 year 24 hour storm storage or one foot of freeboard except
in the event of the 25 year 24 hour storm.
It is the responsibility of the producer and waste applicator to ensure
that the spreader equipment is operated properly to apply the correct rates
to the acres shown in Tables 1 and 2. Failure to apply the recommended
rates and amounts of nitrogen shown in the tables may make this plan
invalid.
Call your technical specialist after you receive the waste analysis report
for assistance in determining the amount of waste per acre and the proper
application rate prior to applying the waste.
NARRATIVE OF OPERATION
Page: 9

WASTE UTILIZATION PLAN
--------------------------------------------------------------------
REQUIRED SPECIFICATIONS
I. Animal waste shall not reach surface waters of the state by
runoff, drift, manmade conveyances, direct application, or
direct discharge during operation or land application. Any
discharge of waste which reaches surface water is prohibited.
2. There must be documentation in the design folder that the
producer either owns or has an agreement for use of adequate
land on which to properly apply the waste. If the producer does
not own adequate land to properly dispose of waste, he/she shall
provide a copy of an agreement with a landowner who is within a
reasonable proximity, allowing him/her the use of the land for
waste application. It is the responsibility of the owner of the
facility to secure an update of the Waste Utilization Plan when
there is a change in the operation, increase in the number of
animals, method of utilization, or available land.
3. Animal waste shall be applied to meet, but not exceed, the
nitrogen needs for realistic crop yields based on soil type,
available moisture, historical data, climatic conditions, and
level of management, unless there are regulations that restrict
the rate of application for other nutrients.
f 4. Animal waste shall be applied to land eroding less than 5 tons
per acre per year. Waste may be applied to land that is eroding
at 5 or more tons, but less than 10 tons per acre per year
providing grass filter strips are installed where runoff leaves
the field. (See FOTG Standard 393 -Filter Strip)
5. Odors can be reduced by injecting the waste or disking after
waste application. Waste should not be applied when there is
danger -of drift from the irrigation field.
6. When animal waste is to be applied on acres subject to
flooding, it will be soil incorporated on conventionally tilled
cropland. When applied to conservation tilled crops or
grassland, the waste may be broadcast provided the application
does not occur during a season prone to flooding. (See "Weather
and Climate in North Carolina" for guidance.)
7. Liquid waste shall be applied at rates not to exceed the soil
infiltration rate such that runoff does not occur offsite or to
surface waters and in a method which does not cause drift from
the site during application. No ponding should occur in order
to control odor or flies.
r
8. Animal waste shall not be applied to saturated soils, during
rainfall events, or when the surface is frozen.
9. Animal waste shall be applied on actively growing crops in such
a manner that the crop is not covered with waste to a depth that
would inhibit growth. The potential for salt damage from animal
waste should also be considered.
Page: 10

WASTE UTILIZATION PLAN
REQUIRED SPECIFICATIONS
10. Waste nutrients shall not be applied in fall or winter for
spring planted crops on soils with a high potential for
leaching. Waste nutrient loading rates on these soils should be
held to a minimum and a suitable winter cover crop planted to
take up released nutrients. Waste shall not be applied more
than 30 days prior to planting of the crop or forages breaking
dormancy.
11. Any new swine facility sited on -or after October 1, 1995 shall
comply with the followincl: The outer perimeter of the land area
onto which waste is applied from a lagoon that is a component of
a swine farm shall be at least 50 feet from any residential
property boundary and from any perennial stream or river (other
than an irrigation ditch or canal. Animal waste other than
swine waste from facilities sited on or after October 1, 1995),
shall not be applied closer than 25 feet to perennial waters.
(See Standard 393 - Filter Strips).
12. Animal waste shall not be applied closer than 100 feet to
wells.
13. Animal waste shall not be applied closer than 200 feet of
dwellings other than those owned by the landowner.
14. Waste shall be applied in a manner not to reach other property
and public right-of-ways.
15. Animal waste shall not be discharged into surface waters,
drainageways, or wetlands by a discharge or by over -spraying.
Animal waste may be applied to prior converted cropland provided
they have been approved as a land application site by a
"technical specialist". Animal waste shall not be applied on
grassed waterways that discharges directly into water courses,
and on other grassed waterways, waste shall be applied at
agronomic rates in a manner that causes no runoff or drift from
the site.
16. Domestic and industrial waste from washdown facilities,
showers, toilets, sinks, etc., shall not be discharged into the
animal waste management system.
17. A protective cover of appropriate vegetation will be
established on all disturbed areas (lagoon embankments, berms,
pipe runs, etc.). Areas shall be fenced, as necessary, to
protect the vegetation. Vegetation such as trees, shrubs, and
other woody species, etc., are limited to areas where considered
appropriate. Lagoon areas should be kept mowed and accessible.
Berms and structures. should be inspected regularly for evidence
of erosion, leakage or discharge.
Page: 11

WASTE UTILIZATION PLAN
REQUIRED SPECIFICATIONS
18. If animal production at the facility is to be suspended or
terminated, the owner is responsible for obtaining and
implementing a "closure plan" which will eliminate the
possibility of an illegal discharge,'pollution and erosion.
19. Waste handling structures, piping, pumps, reels, etc., should
be inspected on a regular basis to prevent breakdowns, leaks,
and spills. A regular maintenance checklist should be kept on
site.
20. Animal waste can be used in a rotation that includes vegetables
and other crops for direct human consumption. However, if
animal waste is used on crops for direct human consumption it
should only be applied preplant with no further applications of
animal waste during the crop season.
21. Highly visible markers shall be installed to mark the top and
bottom elevations of the temporary storage (pumping volume) of
all waste treatment lagoons. Pumping shall be managed to
maintain the liquid level between the markers. A marker will
be required to mark the maximum storage volume for waste
storage ponds.
22. Waste shall be tested within 50 days of utilization and soil
shall be tested at least annually at crop sites where waste
products are applied. Nitrogen shall be the rate - determining
element. Zinc and copper levels in the soils shall be
monitored and alternative crop sites shall be used when these
metals approach excessive levels. pH shall be adjusted for
optimum crop production and maintained. Soil and waste
analysis records shall be kept for five years. Poultry dry
waste application records shall be maintained for three (3)
years. Waste application records for all other waste shall be
maintained for five (5) years.
23. Dead animals will be disposed of in a manner that meets North
Carolina regulations.
Page: 12

ANIMAL WASTE UTILIZATION PLAN
--------------------------------------------------------------------
WASTE UTILIZATION PLAN AGREEMENT
Name of Farm:SHELTON KEITH JACKSON
Owner/Manager Agreement
I (we) understand and will follow and implement the specifications
and the operation and maintenance procedures established in the
approved animal waste utilization plan for the farm named above. I
(we) know that any expansion to the existing design capacity of the
waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the
North Carolina Division of Environmental Management (NCDEM) before
the new animals are stocked. I (we) also understand that there
must be no discharge of animal waste from this system to surface
wasters of the state from a storm event less severe than the 25-
year, 24-hour storm. The approved plan will be filed on -site at
the farm office and at the office of the local Soil and Water
Conservation District and will be available for review by NCDEM
upon request.
Name of Facility Owner: SHELTON KEITH JACKSON
(Please print)
Signature:_1"Z' Date:
Name of Manager(If d`fferent from owner):
Signature:
Date:
Name of Person Preparing Plan: (PleaseTprint)Chris W. Smith
Affiliation:NRCS Phone No. 919-989-5381
Address (Agency): 806 North Street
Smithfield NC 27577
Signature:
Date:
Page: 13

ANIMAL WASTE UTILIZATION PLAN
---------------------------------------------------------------------
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
I, /r/,/� , hereby give
permission to apply animal waste from his Waste Utilization System
on acres of my land for the duration of time shown below.
The field(s) on which waste can be applied are shown on the
attached map.
I understand that this waste contains nitrogen, phosphorous,
potassium, and other trace elements and when properly applied
should not harm my land or crops. I also understand that the use
of waste will reduce my need for commercial fertilizer.
Adjacent Landowner:
Waste Producer:
Technical Representative:
SWCD Representative:
Date:
Date:
Date:
Date:
Term of Agreement: ,19 to
Minimum of Ten Years on Cost Shared Hems)
See Require Speci ication No. 2.)
Notary
--------------------------------------------------------------------
Page: 14

( ANIMAL WASTE UTILIZATION PLAN
--------------------------------------------------------------------
I
Waste Utilization - Third Party Receiver Agreement
I,� hereby agree to apply waste
generated by in a manner that meets the
Waste Utilization Standard (633), or use an alternative waste
utilization system that has been accepted in writing by the
Division of Environmental Management.
Third Party Receiver:
Date:
Term of Agreement: to
(Minimum Ten Years on Cost -Shared I ems
Notary
--------------------------------------------------------------------
Page: 15

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Non -Discharge Permit Application Form R E= C. = f
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN
General Permit - Existing Liquid Animal Waste 0perations
8FP 0 9 1998
The following questions have been completed utilizing information on file with the Division. Please
review the information for completeness and make any correctionsN' vhich:`are, appropriate. If a
question has not been completed by the Division, please complete as best as possible. Do not leave
any question unanswered.
1. GENERAL INFORMATION:
1.1 FacilityName: Shelton Keith Jackson Farm
L2 Print Land Owner's name: Shelton Keith Jackson
1.3 Mailing address: 1480 Alex Benton Road
City, State: Newton Grove NC Zip: 28366
Telephone Number (include area code): 910-594-1043
1.4 County where facility is located: Johnston
1.5 Facility Location (Directions from nearest major highway. Please include SR numbers for state roads. Please include a
copy of a county road map with the location of the farm identified): Hwy. 701 north to Newton Grove, right on SR 1700
on into Johnston Co. (SR 1192). Go 3 miles farm on right.
1.6 Print Farm Manager's name (if different from Land Owner):
1.7 Lessee's / Integrator's name (if applicable; please circle which type is listed): _ Prestage Farms
1.8 Date Facility Originally Began Operation: 01/01/91
1.9 Date(s) of Facility Expansion(s) (if applicable): Pj� T
2. OPERATION INFORMATION:
2.1 Facility No.: 51 T (county number); 35 (facility number).
2.2 Operation Description: Swine operation
Fee e-r to Finish
2480- Certified Design Capacity
Is the above information correct? toyes; no. If no, correct below using the design capacity of the facility
The "No. of Animals" should be the maximum num er or which the waste management structures were designed.
Type of Swine No. of Animals Type of Poultry No. of Animals -Type of Cattle No. of Animals
0 Wean to Feeder 0 Layer 0 Dairy
0 Feeder to Finish 0 Non -Layer 0 Beef
0 Farrow to Wean (# sow) 0 Turkey
0 Farrow to Feeder (# sow)
0 Farrow to Finish (# sow)
Other Type of Livestock on the farm: No. of Animals:
FORM: AWO-G-E 5/28/98
�t
Page 1 of 4 51 - 35

2.3 Acreage cleared and available for application (excluding all required buffers and areas not covered by the application
system): 36 ; Required Acreage (as listed in the AWMP): 30
2.4 Number of lagoons/ storage ponds (circle which is applicable): 1_
2.5 Are subsurface drains present within I00' of any of the application fields? YES or O (please circle one)
2.6 Are subsurface drains present in the vicinity or under the lagoon(s)? YES or O (please circle one)
2.7 Does this facility meet all applicable siting requirements? (Swine Farm Siting Act, NRCS Standards, etc.) (Swine Only)
ES or NO (please circle one)
What was the date that this facility's swine houses and lagoon were sited?
What was the date that this facility's land application areas were sited?
3. REQUIRED ITEMS CHECKLIST
Please indicate that you have included the following required items by signing your initials in the space provided next to each
item.
Applicants Initials
3.1 One completed and signed original and one copy of the application for General Permit - Animal
Waste Operations;
3.2 Two copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is land applied;
3.3 Two copies of the entire Certified Animal Waste Management Plan (CAWMP). If the facility
does not have a CAWMP, it must be completed prior to submittal of a general permit
application for animal waste operations.
The CAWMP must include the following components:
3.3.1 The Waste Utilization Plan (WUP) must include the amount of Plant Available
Nitrogen (PAN) produced and utilized by the facility.
3.3.2 The method by which waste is applied to the disposal fields (e.g. irrigation,
injection, etc.)
3.3.3 A map of every field used for land application.
3.3.4 The soil series present on every Iand application field.
3.3.5 The crops grown on every land application field.
3.3.6 The Realistic Yield Expectation (RYE) for every crop shown in the WUP.
3.3.7 The PAN applied to every land application field.
3.3.8 The waste application windows for every crop utilized in the WUP.
3.3.9 The required NRCS Standard specifications.
3.3.10 A site schematic.
3.3.11 Emergency Action Plan,
3.3.12 Insect Control Checklist with chosen best management practices noted.
3.3.13 Odor Control Checklist with chosen best management practices noted.
3.3.14 Mortality Control Checklist with the selected method noted.
3.3.15 Lagoon/storage pond capacity documentation (design, calculations, etc.). PIease be
sure to include any site evaluations, wetland determinations, or hazard classifications
that may be applicable to your facility.
3.3.16 Operation and Maintenance Plan.
If your CAWMP includes any components not shown on this list, please include the
additional components with your submittal.
FORM. AWO-G-E 5/28/98 Page 2 of 4 51 - 35

Facility Number: 51 - 35
Facility Name: Shelton Keith Jackson Farm
4. APPLICANT'S CERTIFICATION:
(Land Owner's name listed in question 1.2), attest that
this application for (Facility name listed in question 1.1)
has been reviewed by me and is accurate and Complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.. -
Signature
Date F� — Z 3 '9 Sr
5. . MANAGER'S CERTIFICATION: (complete only if different from the Land Owner)
I, (Manager's name listed in question 1.6), attest that this
application for (Facility name listed in question 1.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature
Date
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER QUALITY
WATER QUALITY SECTION
NON -DISCHARGE PERMITTING UNIT
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
FORM: AWO-G-E 5/28/98 Page 3 of 4 5I - 35

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DENNR-RALEIGM ,,a,,4: ''
REGIONAL OFFIC
- -- - ---

State of North Carolina
Department of Environment,
Health and Natural Resources 1 • • •
Raleigh Regional Office a
James B. Hunt, Jr., Governor Amdn��p E H N
Jonathan B. Howes, Secretary ;Z
Division of Water Quality
June 2, 1997
Mr. Shelton Jackson
1480 Alex Benton Road
Newton Grove, North Carolina 28366
Subject: Notice of Deficiency
Shelton Jackson Farm 1-4
Facility # 51-35
Johnston County
Dear Mr. Jackson:
On May 20, 1997, Mr. Buster Towell from the Raleigh Regional Office
conducted a complaint inspection of the subject animal operation.
The complaint stated that animal waste had been discharged into an
adjacent ditch which is a conveyance to waters of the State.
Mr. Towell's site visit determined that wastewater from your
facility was not actively discharging to the surface waters of the
State, nor were any manmade pipes, ditches, or other prohibited
conveyances (for the purpose of willfully discharging wastewater)
observed. However, as a result of the inspection, the following
deficiency was observed:
An accidental break of a two inch pvc pipe designed to carry
water to a flush tank caused an unknown amount of wastewater to run
overland and into an adjacent ditch located behind your lagoon.
This waste did flow into the ditch and dried up approximately 25
feet down gradient in the ditch. No flow was noted in this ditch
at the time of investigation and the proper repairs had been
affected.
The Raleigh Regional Office will require a response to this Notice
summarizing the above referenced event. Please respond in writing
within 30 days of the receipt of this Notice and include in your
response the actions that you will take to address this deficiency,
3800 Barrett Drive, Suite 101, !' FAX [phone]
Raleigh, North Carolina 27609 Ni # C An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50% recycled/10% post -consumer paper

Mr. Shelton Jackson
Page 2
This office would like to remind you that you are required to
submit an approved animal waste management plan by December 31,
1997, or you may choose to submit a closure plan for this facility.
These plans must be Certified by a Designated Technical Specialist
or a licensed Professional Engineer. For a listing of certified
technical specialists or assistance with your waste management plan
you should contact your local,Soil and Water Conservation District
Office.
The Raleigh Regional Office appreciates your cooperation in this
matter. If you have any questions regarding this inspection please
call Buster Towell at [phone].
Sincerely,
Kenneth c uster, P.E.
Regional Supervisor
cc: Johnston County Health Department
Mr. Ken York, Johnston Soil and Water
Conservation District
Ms. Margaret O'Keefe, DSWC--RRO
DWQ Compliance Group
RRO Files
NOD\51-35

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Shelton Keith Jackson
Shelton Keith Jackson Farm
1480 Alex Benton Road
Newton Grove NC 28366
SUBJECT: Operator In Charge Designation
Facility: Shelton Keith Jackson Farm
Facility ID#: 51-35
Johnston County
Dear Mr. Jackson:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Raleigh Regional Office
Water Quality Files
P.O, Box 27687, �o��
Raleigh, North Carolina 27611-7687 N)Wf An Equal Opportunity/Affirmotive Action Employer
Voice 919-715-4100 &71 m7a 50% recycled/1M. post -consumer paper

I
M 1 - f I
EMERGENCY ACTION PLAN
PHONE NUMBERS
DWQ 919- 571-4700
EMERGENCY MANAGEMENT SYSTEM 919-989-5050
SWCD 919- 989-5381
NRCS 919- 989-5381
This plan will'be implemented in the event that wastes from
your operation are leaking, overflowing, or running off
site. You should not wait until wastes reach surface walzers
or leave your property to consider that you have a problem.,
You should make every effort to ensure that this does not
happen. Thi_splan_should be -posted in an accessible
location for all employees at the facility. The folowing
are some action items you should take.
1. Stop the release of wastes. Depending on the
situation, this may or may not be possible. Suggested
responses to some possible problems are listed below.
A. Lagoon overflow -possible solutions are:
a. Add soil to berm to increase elevation of dam.
b. Pump wastes to fields at an acceptable rage.
C. Stop all flows to the lagoon immediately.
d. Call a pumping contractor.
e. Make sure no surface water is entering lagoon.
B: Runoff from waste application field -actions
include:
a. Immediately stop -paste application.
b. Create a temporary diversion to contain -.vasta.
C. Incorporate waste to reduce runoff.
d. Evaluate and eliminate the reason(s) t::az
caused the runoff.
e. Evaluate the application rates for the Lields
where runoff occurred.
C: Leakage from the waste pipes and sprinklers -action
include.
a. Stop recyc-le pump.
b. Stop irrigation pump.
C. Close valves to eliminate ruroher discnarge.

RU
d. Repair all leaks prior to restarting t;)umps.
D: Leakage from flush systems, houses, solid
separators --action include:
a. Stop recycle pump.
b. Stop irrigation pump.
C. Make sure no siphon occurs.
d. Step all flows in the house, flush systems, or
solid separators.
e. Repair all leaks prior to restarting pumps.
E: Leakage from base or sidewall of lagoon. Often
this is seepage as opposed to flowing leaks -
possible action:
a. Dig a small well or ditch to catch all, seepage,
put in a submersible pump, and pump back to
lagoon.
b. if holes are caused by burrowing animals, trap
or remove animals and fill holes and compact
with a clay type sail.
C. Have a professional evaluate the condition of
the side walls and lagoon bottom as soon as
possible.
2. Assess the extent of the spill and note any obvious
damages.
a. Did the waste reach any surface waters?
b. Approximately how much was released and for :ghat
duration?
C. Any damage noted, such as employee injury, fish
kills, or property damage?
d. Did the spill leave the property.
e. Does the spill have the potential to reach surface
waters?
f. Could a future rain event cause the s_p:il tc reach
surface waters?
g. Are potable water wells in danger (either on or ofF
or the property)?
h. How much reached surface waters?
3: Contact appropriate agencies.
a. During ncr:nal business hours, call -;cQr C6v
(Division or ,eater Qualit•. ) regional Of iCe = h lie
919- - ?Tter hours, emergenc✓ number:-
733-3942. Your phone call should include: vcur
name, facility, telephone number, the details cr

the incident from item 2 above, the exact location
of the facility, the location or direction of
movement of the spill, weather and 'Hind conditions.
The corrective measures that have been under.- taken,
and the seriousness of the situation.
b. If spill leaves property or enters surface wavers,
call local EMS Phone number 919-989- 5050.
C. Instruct EMS to contact local Health Department.
d. Contact CES, phone number 919--989-5380, local SWCD
office phone number 919-989--5381, and .Local ARCS
office for advice/technical assistance phone number
919- 989- 5381.
4: If none of the above works call 911 or the Sheriff's
Department and explain your problem to them and ask
that person to contact the proper agencies for you.
5: Contact the contractor of your choice to begin repair
of problem to minimize off -site damage.
a. Contractors Name:Al
b. Contractors addre s.
C. Contractors ocg_^ LOY- yam_
6_6 N-/' fI
6: Contact the technical specialist who certified the
lagoon (MRCS, Consulting Engineer, etc.)
a. Name: Chris Smith
b. Phone: [phone]
7: Implement procedures as advised by DWQ and technical
assistance agencies to rectify the damage, repair the
system, and reassess the waste management plan to keep
problems with release of wastes from happening again.
.1 aUn0InEAnt W O/UI!YnQx[alan. a cm
[emt 12319

Emergency Action Plan
This plan will be implemented in the event that wastes from your operations are leaking, overflowing, or
running off the site. You should NOT wait until wastes reach surface waters or leave your property to
consider that you have a problem. You should make every effort to ensure that this does not happen. This
plan should be available to all employees at the facility, as accidents, leaks, and breaks can happen at any
time.
1) Stop the release of wastes. Depending on the situation, this may or may not be possible. Suggested
responses to problems are listed below:
a) Lagoon overflow: ;i: •.�:�
• add soil to the berm to increase the elevation of the dam
• pump wastes to fields at an acceptable rate
• stop all additional flow to the lagoon (waterers)
• call a pumping contractor
• make sure no surface water is entering the lagoon
Note: These activities should be started when your lagoon level has exceeded the temporary storage level.
b) Runoff from waste application field:
• immediately stop waste application
• create a temporary diversion or berm to contain the waste on the field
• incorporate waste to reduce further runoff
c) Leaking from the waste distribution system:
• pipes and sprinklers:
O stop recycle (flushing system) pump
® stop irrigation pump
close valves to eliminate further discharge
® separate pipes to create an air gap and stop flow
• flush system, houses, solids separators:
(D stop recycle (flushing system) pump
® stop irrigation pump
Os make sure no siphon effect has been created
® separate pipes to create an air gap and stop flow
d) Leakage from base or sidewall of the lagoon. Often these are seepage as opposed to flowing
leaks:
• dig a small well or ditch to catch all seepage, put in a submersible pump, and pump back
into the lagoon

i
• if holes are caused by burrowing animals, trap or remove animals
and fill holes and compact with a clay type soil.
• other holes may be likewise temporarily plugged with clay soil.
Note: For permanent repair measures, lagoon problems require the
consultation of an individual experienced in their design and installation.
2) Assess the extent of the spill and note any obvious damages.
a) Did the waste reach any surface waters?
b) Approximately how much was released and for what duration?
c) Any damage noted, such as employee injury, fish kills, or property damage?
3) Contact appropriate agencies.
a) During normal business hours, call your DWQ regional office: [phone] ; after
hours, emergency number: 1-800-858-0368. Your phone call should include: your
name, facility, telephone number, the details of the incident, the exact location of the
facility, and the location or direction of movement of the spill, weather and wind
conditions, what corrective measures have been taken, and the seriousness of the situation.
b) If the spill leaves the property or enters surface waters, call the local EMS:
989-5050.
c) Instruct EMS to contact the local Health Department: 989-5200.
d) Contact CES: 989-5380
local NRCS office: 989-5381
and your integrator:
4) Implement procedures as advised by DWQ and technical assistance agencies to rectify the
damage, repair the system, and reassess the waste management plan to keep problems with
release of wastes from happening again.
5) Contact contract pumping and/or irrigation equipment companies:
a)
b)
c)

6) Contact dirt moving and/or heavy equipment companies:
a) , V 6
b)
c)

,.
-r - -
3 .ii0N
ANIMAL WASTE UTILIZATION PLAN
-- l------------------------------------------------------------fifit�
i/ N01--ismargo �'�d7nitting
TABLE 1: ACRES OWNED BY PRODUCER
TRACT
FIELD
SOIL TYPE & CLASS-
CROP
YIELD
LBS
COMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N
PER AC
AC
USED
-----
or
-------
APPLY
RESID.
APPLIC
METH
N
-7779-
TIME
915.325
11328
1
NoA
C
110
117.5
20
I
MAR-JUN
11328
1
NoA
W
20
0
7.79
934.8
1
I I
160
FEB-MAR
_Av,
1li3't;i,)
11328
1
NoA
SB
132
0
-7--7-9-
1028.28
1
1
I
133
1 APR.-AUG
11328
3
NoA
C
10-.49
1232.57
_� 5
I 1
1110
1117.5
120
1
MAR-JUN
a
.1328
3
NoA
W
120
0
10.49
1258.8
1
I I
160
FEB-MAR
y,�.c%
11328
3
NoA
SB
33
132
0
10-:49
1384.68
1
I
1
APR. --AUG
11328
UN4
GoA
C
136.25
20
5:73-
780.712
I I
1125.0
MAR-JUN
11328
UN4
GoA
W
60.
120
0
5.73
I
/
1687.6
FEB-MAR
A v. fh3 !, G,
11328
UN4
GoA
SB
39
156
0
5=73-
893.68
I
1
APR.-AUG
10130
1
NoA
C
117.5
10704'
1179.7
1
I I
1110
120
MAR-JUN
10130
1
NoA
W
120
0
I
160
110.0411204.8
FEB-MAR
10130
1
NoA
SB
37
148
0
-1-0,04-
1485.92
I
1
1
APR.-AUG
10130
2
NoA
117.5
20
i-w-95­7
229. 225
IC
1110
1
j
MAR--JUH
10130
2
NOA
W
60
0
234
I
1120
11.95
FEB-MAR
----------------------------------------------------------------------
Page: 3

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INI.LJAAgrUUUMICLVIVISIOR��"UU,AeCGYL,reCKKoaa-
.-Z . � 1. .. 1. - . .1 --'. Keporl IN 0: -1 just:P1
wer: Jackson, Shelton Copies to: Tyndall, Marl
1480 Alex Benton Rd.
00 Nemon Grove, NC 28366
v.Cw %
C)SOU Test Report Farm:
Cu
til
C5,
12/16. 9 SERVING N.C. CITIZENS FOR OVER 50 YEARS Wavne County
Agronomist Comments: c' 3. S
z
field-Infot'mi1ioft0ii6d,Liine'i-,REcemniendations-
Sample No.. Last Crop Mo Yr T/A Crop or Year Lime N M 5 KO Mg Cu Zn B Mn See Note
HHI Cnrn, Grain 1st Crop: Corn, Grain 0 120-160 0 0-20 0 0 0 0 3
2nd Crop:
Test Results
Soil Class ILV% W/V CEC
ES%
Ac pH P-1 K-1
Ca% Mg%
Mn-1 Mn-AI (1)Mn-AI (2) Zn-I
Zn-Al
Cu-1 S-I
SS -I NQ3-N AW-N Na
MIN 1.02 1.54 5.8
76.0
IA 6.1 102 84
54.0 15.0
45 42 109
109
37 36
0.1
Field
Aoplied
Lime
t6c&m ri ndatiohi-----K
Sample No. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N M 5 M
Mg Cu
Zn B
Mn See Note
HH2 Tobacco,FC
1st Crop: Corn, Grain
0
120-160 0 0-20
0 0
0
0 3
2nd Crop:
Test Results
Soil Class Aw% W/V
CEC
BS%
Ac pH P-1
K-1
Ca%
Mg,*6
Mn-1Mn-AI (1)Mn-Al(2) Zn-I
Zn-AI
Cu-I
S-1
SS-1
NQ3-NA2fj-N
Na
MIN 0.46 1-30
3.5
74.0
0.9 6.0 74
76
49.0
14.0
48 46 97
97
43
35
0A
Field
Noolied
Ulotto
me
;Recommen asT
'j. . -'. .
Sample No. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N M 5 Xt0
Mg Cu
Zn
B
Mn
See Note
HH3 Corn, Grain
1st Crop: Corn, Grain
.K
120-160 0-20 40-60
$ 0
0
0
3
2nd Crop:
Test Results
Soil Class HM% W/V
CEC
BS%
Ac pH P-1
K-1
Ca%
Mr%
Mx4 Mn-Al(I)Mn-Al(2) Zn-1
Zn-Al
Cu-1
S-I
SS-1
NC3-NA7*-N
Na
MIN 0.32 1.24
2.4
50.0
1.2 5.0 65
43
33-0
10.0
42 42 64
64
38
39
0.0
Field Informatioh'
A02fied
Lim'
C
rm s-
R&,b endation
Sample ,N-o. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N P-,O 5 K-0
Mg Cu
Zn
B
Mn
See Note
HH4 Corn, Grain
1st Crop: Corn. Grain
-5T
120-160 0 20-40
0
0
0
3
2nd C roo:
Test Results
Soil Class H41% W/V CEC BS,06 Ac PH P-1 K-1 Ca% Mg% Mn-1 Mn-A] (1) An -Al (2) -Zn-I Zn-AI - Cu-1 S-1 SS-1 NQ3-N A7&N Na
MIN, 0.36 1.35 2.8 61.0 1.' 5.5 216 60 44.0 6.0 81 66 12S 128 67 33 0.0

r
,&NCDkAO-"-'4hie,DMsi6W 30WzR6FdV--Uie-kR6a&, RAeigh-NCx2,7607-"6 (9 19)-?,7 3 3 2 6 5 5, G r'o w-'e -:'� I dic R s i ifi'- 9 b e I i o r i R r 170'
I 1 8
q
Sample No. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N P-105 KO
Mg Cu
Zn
B
Mn
See Note
HH5 Corn, Grain
1st Crop; Small Grains
-5T
80-100 0 0
$ 0
0
0
3
2nd Crop: Corn, Grain
0
120-160 0 0
9 0
0
0
3
Test Results
;Soil Class HM% W/V
CEC
BS%
Ac pH P-1 K-1
Ca% Xg%
Mn-IMn-AI (1)Mn-AI (2) Zn-I
Zn-Al
Cu-1
S-1
SS -I A'Q8-NAZ&N Na
MIN 0.56 1.30
2.8
57.0
1.2 5.6 143 103
34.0 6.0
59 45 52 92
92
60
30
0.1
Field info 6-n`�M�
W NN
A00fied1iiiii[Ai
ns
Sample No. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N ho 5 M
Mg Cu
Zn
B
Mn
See Note
HH6 Corn, Grain
1st Crop: Small Grains
.5T
80-100 0 0
$ 0
0
0
3
2nd Crop: Corn. Grain
0
120-160 0 0
$ 0
0
0
3
Test Results
Soil Class HM% W/V
CEC
BS%
Ac pH P-1 K-1
Ca% Mg%
Mn-I Mn-Al (1) Mn-Al (2) Zn-1
Zn-Al
Cu-1
S-1
SS-1
A-03-N 1vB-N Na
MIN 0.6 1.27
3.1
0.0
1.2 5.6 139 110
37.0 7.0
63 48 55 100
100
61
31
0.1
Field infor&ation'
Lithe
Uc67&uiindafiyu
Sample No. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N P-10 5 K?O
Mg Cu
Zn
B
Mn
See Note
HH7 Corn, Grain
1st Crop: Corn, Grain
1AT
120-160 0-20 110-130
$ 0
6
10
3
2nd Crop:
Test Results
Soil Class HM% W/V
CEC
BS%
Ac pH P-1 K-1
Ca% Mg%
Mn-I Mn-Al (1) Mn-AI (2) Zn-I
Zn-Al
Cu-1
S-1
SS-1
NQ-N AB-N Na
MIN 0.32 1.34
2.2
9.0
2.0 4.6 65 13
6.0 2-0
12 24 19
19
45
44
0.0
Field lnfohnati6d-
Sample No. Last Crop
Mo
Yr TIA
Crop or Year
Lime
N
Mg Cu
Zn
B
Mn
See Note
Sj I Corn, Grain
1st Crop: Cotton
.9T
50-70 0 20-40
0 0
0
1.0
0
3
2nd Crop:_
Test Results
Soil Class HM% W/V
CEC
BS%
Ac pH P-1 K-1
Ca% Mg%
Mn-1Mn-A1(1)Mn-A1(2) Zn-1
Zn-Al
Cu-1
S-I
SS-1
NC8-NAB-N Na
MIN 0.76 1.25
3.4
59.0
1.4 5.4 289 66
18.0 11.0
36 36 106
106
114
32
0.0
Field hff6rrtiktiod-j�
Aopfi
lied
ihie
Rebjfiindatiofis �j-
x
Sample No. Last Crop
Ho
Yr TIA
Crop or Year
Lime
N M5 K-0
Mg Cu
Zn
B
Mn
See Note
SJ2 Corn, Grain
1st Crop: Cotton
I -3T
50-70 0 0-20
0 0
0
1.0
0
3
2nd Crop --
Test Results
Soil Class HM% W/V
CEC
BS%
Ac pH P-1 K-1
Ca% Mg,%
Mn-I Mn-Al (1) Mn-Al (2) Zn-1
Zn-Al
Cu-1
S-I
SS-1
A-Cs-N AB-N Na
MIN 0.76 1.22
4.4
55.0
2,0 5.4 177 79
34.0 11.0
29 31 90
90
80
47
0.0

P;�,es
`ram. 5 .5
1 800
o txs r. s d wt
he re 4-1%
j me .
r_- 1
i
J,.
ST i
1 gvo
w'v^

hCDA' ano*- Division,', 4300 ReedyCreek:Roam _Raleigh; NC' 27607-6465L1 "` 733-2655
ReportNo: Vi" ` `122 =V _,
•
Grower: Jackson, Shelton
Copies To: County E_\tei,�.on Director
'
1480 Me_v Benton Rd.
USDA -MRCS -Sampson
hen -ton Grove, NC 28366
rite nalys is e ort Fann,'
5/19/98
Sampson County
Sam le IIA6 ;`:..
.: "
-Laboratofv Results arts kr mullion unless otherwise noted • >:
Sample ID:
N
P 1[ Ca mg S Fe Mn Zn
Cu B Mo CI C
0001 '=
W
Total 588 M
63.6 713 95.7 28.7 1&2 5.21 0.36 0.51
0.99 0.77
IN -N
M H M M M M M M
M ,if
Waste Code:
-NH4
1LS
-NO3
Ala Ni Cd A AI Se Li pH
SS C.-N DAM CCE% ALE(K all
170 7.59
Description:
OR-N
Swine Lagoon Li .
Urea
M
Recommendations
a Nutrients for First Cro rvsnoa0 auo
Other`:Elements rbs/x000 arrow T
, ," _.:._ .. ._u..w -_ . ,.. �. W
;_ .
_ 4 _..
7rcativn<MetEtod'
`I fip.
,, <P203F `R20 v Ca �`
Mg S Fe " =Mri = "Zn « =Cu B `Mo
_
5
0:01 lrione .7
y,a<.AFa
I.T

-.
as ii'NCDA Aicisl6 60,W6dOieek Roa"dgNC 27606465�9-7
06j '�
wo
ower.- Jackson, Shelton
Copies To: County Emensk -.-irector
1480 Alex Benton Rd.
USDAMRCS-Sanipson
Newton Grove, NC 28366
Waste
-
nalysis GYort
1 12/29/97
Sampson County
!Sinplilik
IoratoryResults :•Parts 1peialiofi.'U�16 s MI
d
Sample ID.-
N
P K Ca M S Fe Mn Zn
Cu
E MO Cl C
OoE F�
Total 385 M
67.6 984 106 29.1 26.2 5.11 0.29. 0.60
1.03
1.19
IN -N
M H M M M M M M
M
H
Waste Code:
-NH4
ALS
-NO3
Na Ni Cd A Al Se U PH
SS
C.-N DAN CCE% ALE(Kgal)
239 7.41
Description:
OR-N
Swine Lagoon Lig,
Urea
H
i
Read. i1i60di
(ftVii-Ilihiiiii 6
'g sl't600
litb 2�"`T>,P205tA� r
5��-AO3 Mi:
0 0 62 5r 01
'21-
IMO

tower., Jackson, Shelton
Copies To: County Extensir -Nreclor
1480 Alex Benton Rd.
USDA-NRCS-Sa...,.,�on
Nemon Grove, NC 28366
WasteAnaiysisRp
I—IP ort Fann:
7/21/97
Sampson County
10� Mill
waste code.-
-AW4
caffim
WOE

V
RECEIVED
WATER QUALITY SEC
-998
Moil-Dscharp 1311itItfing
Vi
tk
67
� ..}, -i�,S � yQ I r"�±,y:i� tr JCit .w `lll�,,,. t.•. -
i,
� r f
'a�� t.. .,r•w ,�i„Y��'��:+f ��� �e e < # c�.ii� ', �fi ��1 � j j1 ��
. �`.11t� '! ��".�t-k.:MF :!G-';y..•r i. ��` -Y Mtn � '%: \_, -
{�J��(' J 1 '%� �'1�; . •� 'y+;r+�^. r• ' j D"'J OI r I i- �, 0 -iJ �� ��i
Cr � 6' rj�{��,F�� of • ,�'•' .'s� ;� '�
• <v it � !� ,f '�'�i��� •�� - � ,
71
af
f ' *•, � , �' d"`s` '� t .t..��rr � �4,►� Yx�' - � � ali i '�' ?''�t'.r, ,
IL '41
'•��3t :�Y"`'r'i r .-1'''. ��'a 'fir`, .•T• .'i `_

�GIS-=�T:2N =GRIM --R A-NL I:�!AL - :C CT C?EF.%T?CNS
Decartment of Environment, Health and Natuwal Resources
Division of E.vi-onmental Management
Water Quality Section
__ t::e animal waste management system for
your feedlot on_ erar:icn
is
designed to serve more than or
eeual to
100 :.ead
of cattle,
75
horses, 250 swine, _, 000 sl eec, or 30,000
bids c. iac
are served
by
a ? _-u 4i 1 waste s ✓seem, ::e.^. c _s
f::rm must
be f _ iec
eut and :tailed
by Cecember 3-, _9?3 pu_suant _ .
' SA NCAC
2�:.02_7 (c1
in Qyde_ to
be
deemed permitted by OEM. ?_ease
print clearly.
a, rt Name ��fr .,�' BUTr�^:-?
Address { 1
Cou: t 1l f j ?:one
Owners) Name.,��c�..� t'�Trllt�9CJrS�..} -• ---
Manace= (s) Name
Lessee Name:
Farm Location (Be as sneci=_c as possihle: road names, direction,
milepost., ecc.) , % '1 )
_40h, .7,01--
Lati-ude/Loncitude if known -
Desicn capacity of animal waste management system /(Number and type
c_ con_n e d an_.:jai (sJ)
Average animal population, on tfte farm (Number and type of animal (s)
.raised)
Year Production segan : "1 9 �/ ASCS Tract. No.: K - ��3%j -
Type of Waste Management System Used:
Acres Available for Land Application of Waster �S
Owner (s) Signat�we (s) _ u / DATA' •
DATE:

'r�ivit�l �':...1 ar��:• - _ram'''' J:: :{.'.'',
= }.. f T J .� •..jam 4''.:1ZM
n
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i

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t ;� �iii►4 a ; f1 t r 1 �- r
t
�.r,� � � '�•y _ram ft; �� `_ � .r,P� }�. i !: � s ii;r f-.,..,- �� _, � '_ _ _ la.
-
�_:~ A _ • i y '�,.x �` "�_ -,tt i S 9 - c��Y�c ,to .�,:� i Y P�Yy J�gy't[� -
i y !. r'b, F� � d' ��7 ':-may.. �"'k�h`i�-"� �,��3.``��.y �1-��' -�i L.,+���.. e ��,�•e t.:! _
y`Yy"-': i t•:i�!..•.a�"f�li- 4 As �.`Ti..,- � 1' �;?;�y'3.,ti 'r f • n'..._.:.. �i4T'• _ y�
3f
� r� �i � i� # w#' �Pr ,�� � � Jim � r �� _ -. --• - .
. a �•. � �
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F
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'6000011

r;77
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- � - i •fin- �� ��><, � Zit f+•'� �rr� , �-• .t `�.! - 1 i
,:;�ir ;ti �� �'�ia •' •a1rY _ -, � ., F� '�J, �,� .:i,. -? �•5�;.'•�j(i:1iiL�•. :� *r,•�,,,�1.J'�
�. F , �j .fit yy�` �' .. _ `t � • y1 � �"`
yq �t•i� � ;+'�' „�� ,T ���� ` �� ti��! i-i � •'�'�,aj'r''. j'`� .=ti•'� �„ •�" ,��. ,*tom �-..``�{..-r f
;;'.�isw/ll ��-*r s:a •r.s Y `� r �:-.:-K`�RZx 1}: _•i�• -• � 4 •�
•� +� • { `"k+ ti :�� s 's..F �ti r ,J ST i � Nd +- ,^ �y..,�:�,:' �'�•- r'.'r � •v � � a'. .
`� ` j..r � � r1 r- f: y ,t r � ...= o� *•. }'y y. 4 � x 1 'V,� � ��j - ~v Y". � .-. 9- v
•w - :...: .. : r 7'. w.'Ia s;,�1 �L � '%� d •:.•*i'. �,jr ti -.: * "`d- ' I� !* ;=.FIr, .��.: f- ". .tS�,hr�`�
�,�. ; it Y .i' `ti +-�k4? 1�''Q7. �,yr�'�.: ,��, :��r n '• +
G 4 �`P) < < +r•:n 'ip� � 4'�' '� ' l•�jr y' r'R ���'���7�',�r '_: �,� "i, •+�
w� ..'} l_ - -•. ..��}i_ _ -���,. �•� - ' `4 r ,, 4f �'1I lam: -. {.�"• • .•!•L•� •4' _ ,�S-�
.: r' a`" _+1_c �". a�1 ' r _ a Y F C� s'r'� * i•S'= .. �i s�. _

L L
FORM IRRA
c
Qm Owner
d-
Irtigalion:Operator
Lagoon Liquid Irrigation Fields Record
For Recording Irrigation Events on Different Fields
vfti*r Facility Number
Tract #;
r,i-FieId # F a
Dale
mm/ddl r
Crop Type
Field Size
acres
Irrigation Time
Number of
S irinklers O eratin
3W
4 ^l —
C
3,
aT
37C
G
�
-)
71
3,
Y• �'
6'z3_y�
W
�,_'�
Jiro _
7;�a
� —�
/
- -

r,
FORM IRR-7
Farm Owner
Irrigation Operator
7
6_
7
Lagoon Liquid Irrigation Fields Record
For Recording Irrigation Events on Different Fields
-3
? Facility Number -
Tract #
Field #
Date
mm dd r
Crop Type
Field Size
(acres)Sprinklers
Irrigation Time
Number of
O eratin
i
�w-r
LW_
TAT
r o
f r !
� �
' ✓
It% sr
7,
`t` r '7
41-
Fill
c/J�
}ems -
C- -!3 -YS'
-
,�.I�-
3
6
7
! V
f 1 //
/,a
er
D 1) CCrr
4 �r -
v
C l e 7
�itl Y
l
;90
C. r�
3 � O �
� � �:�
r r 2-:l
3'Zi
dr 3L7
.24 -if
.✓
7 sd
ry;r"�7
7Z
/

l �
FORM IRR-2
LV1^C,;,C-
d"u U-16i
Tract #
Field Size (acres) = (A)
Farm Owner
O%vner's Address
O%--ner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Facility Number t — 3
Irrigation Operator
Irrigation Operator's I
Address
Operator's Phone # Yt F 6C
From Waste Utilization Plan
Crop Type Recommended PAN Loading
(lb/acre) = (B) yV
ft5 17t 111 141 fM f51 l71 fRt 101 rim litt
Field #_ E
��- NAG LS3C�
e rh — I,-' +{—;l
Date
mmlddlyr
Irrigation
Waste Analysis PAN'
(Ibll Goo gal)
PAN Applied
lacIb
(lb x re)
(lb
1000
Nitrogen Balance 2
(lb
(lb _ { t 0)
Start Time
Eno Time
Total
Minutes
(3) - (2)
✓; of sprinklers
Operating
Flow Rate
(gal/min)
Total Volume
(gallonsl
(6) x (5) Y {4)
Volume
per Acre
(gallacre)
f71
(A)
- %L
.d •:ret
G toy
G
I��
4 o c,
1 Y—
�:42r,
y�.
- C
g.'J�
�; �v
�;
�y�
�6.9w
1 ��
J
L ,
I
Crop Cycle Totals
Own � -'s Signature Operator's Signature
Certified Ope- =.tor (Print) � Jr f r ��c Ste_.✓ Operator's Certification No. ' 7 7 e
NCl3A Waste Ar aylysis or Equivalent or NRCS Estimate, Technical Guide Section 633,
Enter the value r-ceived by subtracting column (10) from (B). Continue subtracting column (10) from column (1 t) following each irrigation event.

FORM (RR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Facility Number
Irrigation Operator
Irrigation Operator's
Address Lam- �.--�-•� r-� �- Us 3 <
Operator's Phone # r a _ a— -- f u-
From Waste Utilization Plan
Crop Type f Recommended PAN Loading
�! (Iblacre) - (5)
fit (21 rat rat l5s rs) r,t lat (Al not rill
( 3 v/ Field # /', t-
t�t(.
Date
mm,dd'yr
Irrigation
Waste Analysis PAN'
[Ibn000 gal)
PAN Applied
(lb/acre)
(S) x
S000
Nitrogen Balance '
(lblacre)
(B) - (10)
5+ar1 Time
End Time
Total
Minutes
(3} _ (Z)
N of Sprinklers
Operating
Flow Rate
(gal/min)
Total Volume
(gWons)
(6) x (5) % (4)
Volume
per Acre
(gallacre)
�_
(A)
Crop Cycle Totals !
Owner's Signature Operator's Signature ! /
Certified Operator (Print) Ssue.✓ Operator's Certification No. j 7 :7
NCDA Waste Anaylysis or Equivalent or MRCS Estimate, Technical Guide Section 633.
Enter the value received by subtracting coiumn (10) from (B). Continue subtracting column (10) from column (1 1) following each irrigation event.

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owners Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Field a
Facility Number 1r
Irrigation Operatorc�
Irrigation Operator's
Address
Operator's Phone # `
From Waste Utilization Plan
Crop Tyne , Recommended PAN Loading
C c� (Iblacre) _ (B)
,t% ro% (5i (61 (7) flit 191 (101 rill
Date
mmldtVyr
In igation
Waste Analysis PAN `
(IU!]000 gar)
PAN Applied
�) • (9)
1000
Nitrogen Balance'
(Vacne)
(H) - (10)
Start Time
End Time
Total
Mfinutes
0 of Sprinklers
operating
Flow Rate
Flow
(gaBmin)
Total volume
(gallons )
Voiurne
per Acre
(galfarre )
(A)
1 1r � • 7 y
�,' Lam=
'? '
y �' 4
! Y ��
.? c :�
r
f . ,F, "t-
��
y-
0 cj
2,
�
5
Crop Cycle Totals
i
Owner's Signature
Certified Operator (Print) r7,w/
Operator's Signaltre
Operator's Ceilification 140. -7 7 G a
t NCDA Waste Anaylysis or Equivalent or NRCS Estimate. Technical Guide Section 633.
Enter the value received by subtracting column (10) frorn (B). Continue subtracting column (10) from column (11) following each i(rigalion event.

FORM iRR-2 Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Oviner's Phone #
p I v 1 Field #
Facility Number
Irrigation Operator uv��
Irrigation Operator's
Address
Operator's Phone #
From Waste Utilization Plan
Crap Type vl� 1! J Recommended PAN Loading
![ (lblacre) = (8)
(1) (2) 131 141 (5)
(6) (7) iBl
y�
(9) (10) 111)
Date
mm/dd/ Y r
Irrigation
waste Analysis PAN
{Ib11000 gall
PAN Applied
(lb/acre)
J-8 �x --Ll—
1000
Nitrogen Balance'
(Iblacre)
(B) - (10)
Stan Time
End Time
Total
Minutes
(3} (2)
to of Spnnklers
Operatin g
Flow Rate
(gallmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gal/acre)
(7)
° (A)
i 3a -- •y'
i� ;���
; �'�v
�qv
/
, �
�' � ��
;-ice �
I.
6 -f s-
, o;:}
y: o 7
rr2
f
tr 7 rr/
3 L
2—
�7 G Crop Cycle Totals
Owns s Signature Operator's Signature
Certified Ope'_=,[or (Print) j y � , J�� � rt r �:'� Operator's Certification No. j 7
NCDA Waste Ar _ylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
Enter the valuer _ --eived by subtracting column (10) from (8). Continue subtracting column (10) from column (11) following each irrigation event.

1
FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Field #
�Y� v
i
[c� — Fel ror
Facility Number I T1-r73
Irrigation Operator
Irrigation Operator's
Address
Operator's Phone #
From Waste Utilization Plan
Crop Type Recommended PAN Loading I ' J-
(Vacre) = (8) fw
III 1,;.5 1.11 !A1 MI. Oct M Opt IM 41n1 Jill
Dale
mmfddlyr
Irrigation
Waste Analysis PAN'
(Ib/1000 gal)
PAN Applied
(lb/acre)
(g} x f9}
1tl0tl
Nitrogen Balance z
(lb/acre)
(B) - {10i
Start Time
End Time
Total
Minutes
{3) - (2)
p of Sprinklers
Operating
Flow Rate
(gallmEn)
Total Volume I
(gallons)
(6) z (5) x (4)
Volume
per Acre
(gallacre}
- (7)
' (A)
— r —':
i' ! 7
y- 1 J
1 y v
G r-s'v
6 c• y
r� p c�
Crop Cycle Totals I _ I /
Owner's Signature,�.f �� _ Operator's Signature , r_��
Certified Operator (Print) 1 r? r�,�� Y1 �.,; 54�,' Operator's Certification No. 7
NCDA haste Anaylysis or Equivalent or MRCS Estimate, Technical Guide Section 633.
Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.

FORM IRR-2
Facility Number 1 3 J
Irrigation Operator
Irrigation Operator's
Address
Operator's Phone #
From Waste Utilization Plan
Crop Type / Recommended PAN Loading / C,
r�, , {Iblacre) = (8)
f11 1?1 (31 W f&1 031 (71 (8) f91 f101 1`11)
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
%C a Field #
Date
mm/ddlyr
Irrigation
Waste Analysis PAN'
(IblI qq0 gal)
PAN Applied
(lb/acre)
8f ! x (9)
1000
Nitrogen Balance'
(lb/acre)
(13) - 00}
Start Time
End Time
Total
Minutes
(3) - (2)
# of Sprinklers
Operating
Flow Rate
(gallmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallacre)
M
n (A
35�
-3 65
f L
r-,- '9-
i °n
7ir
71;—
e.
471C
Crap Cycle Totals I, 1
Owner's Signature ,/� L � �•'�"r' Operator's Signature
Certified Operator (Print) t ,.,� a 6 PCs Operator's Certification No.
-7 7
I NCDA Waste A,--aylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
Enter the value , aceived by subtracting column (10) from (13). Continue subtracting column (10) from column (1 t) following each irrigation event.

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Facility Number / .3 J
Irrigation Operator
Irrigation Operator's
Address
Operator's Phone #
From Waste Utilization Plan
Crop Type ��y Recommended PAN Loading 1
�� (Iblacre) _ (B)
(1) 42l 131 (4) (51 f61 M fal f91 (101 fill
/ v o Field # CL-L-Z_ ) y
Date
mmfddlyr
Irrigation
Waste Analysis PAN'
(lbl1000 gal)
PAN Applied
(lb/acre)
(g) x 19)
1000
Nitrogen Balance =
pblaere)
(B) - 110)
Stara Time
End Time
Total
Minutes
(3) - (2)
#of Sprinklers
Operating
Flow Rate
{gallmin}
Total Volume
(gallons)
(6) x (5) x (4)
volume
per Acre
(gallacre)
71
" (A)
Crop Cycle Totals
0%vner's Signature 611; . ;� Operator's Signature
Certified Operator (Print) C ((d Operator's Certification No.
I NCDA Waste Anaylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
2 Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) fallowing each irrigation event.
e

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
,L-
1 1 3 Field # �-
03 .
i cr S -z� ca.2yc.. il.�.�• �i<�'
S9�—ro3
Facility Number
Irrigation Operator :eat'—
Irrigation Operator's rr
Address
Operator's Phone # 7 L.�, / 0 'y
From Waste Utilization Plan
Crop Type /n _ / Recommended PAN Loading
r L" (lb/acre) = (B)
f11 12) Ml 141 f51 (R1 f71 (A) 19) 11M fiI1
Date
rnmldd'yr
Irrigation
Waste Analysis PAN'
pb11000 gal)
PAN Applied
tlblacre)
8 x 9)
1000
Nitrogen Balance z
(lb/acre)
(B) (10)
Start Time
End Time
Total
Minutes
(3) - (2)
# of Sprinklers
Operating
Flow Rate
(gallmin)
Total
(gallMons)ons)
(6) x (5) x (4)
Volume
per Acre
(9a11acre)
- (7)
°(A)
—�-o
3 k-
ric 71
2-
7 0
c
3 S-4-00
ryl 7
�
G �
,y— Crop Cycle Totals I I I
Owner's Signature ('11 � Operator's Signature
Certified Operator (Print) T-cam -77� `;c 5 C Operator's Certification No. j -7 7 G
I NCDA Waste Anaylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
2 Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Farm for Each Field per Crop Cycle
11 3 a- y Field # 3 ::
S
Facility Number
Irrigation Operator
lrrigalion Operator's S�-err f
Address
Operator's Phone #
From Waste Utilization Plan
Crop Type �.� % Reconu»ended PAN Loading
tlblacre) _ (B)
III t2) (3) (4) (5) (6) (7) (8) f4) (10) fill
Date
mmlddlyr
Inigalron
Wasle Analysis PAN'
¢W1000 gal)
PAN Applied
oblaue)
B) ' (9)
1000
Nitrogen Balance'
(Vacre)
(a).00)
Start Time
End Time
3'h-,
Tdal
Minules
(3) 12)
"37�
8 d Sprinklers
Operating
I
Flow Rale
(gallmin)
�-�
Tola! Volume
(gallons)
(6) ` (5) " (4)
SGo0
Volume
per Aue
(gallacre)
(7)
(A)
IyIS
z,
o =
6
- Crop Cycle Totals
Owner's Signature
Certified Operator (Print) yy�-
Operator's Signature
Operator's Cerliflcalion No. 17 7 6
1 NCDA Waste Anaylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
E,;.ter the value received by subtracting column (10) from (8), Continue subtracting column (10) from column (11) following each irrigalion event.

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Irrigation Fields Record
One Farm for Each Field per Crop Cycle
( y5,
Field # 13y [ .
/ r
f '-t`S
Facility Number / — 3 S� -
Irrigation Operator:�—
Irrigation Operator's S
Address
Operator's Phone #
From Waste Utilization Plan
Crop Type r Recommended PAN Loading >
C l� tJ pUracre) a (8) 1
(11 (2) (3) (4) (5) (6) (7) (e) {9) (10) (t1)
Dale
mDate yr
litigation
Waste Analysts PAN '
(I6r1000 gal)
PAN Applied
1g}
1000
Nitrogen Balance
Star! Time
End Time
Total
Minutes
(31 (2}
Operating
Flow Rate
(gaumin)
Total Volume
(gallons)
(6) . (5) , (4)
Volume
per Acre
(galtacte)
_jam
(A)
1 v35-2
3, V
C—s%�!
jIC
7G0
F
A Crop Cycle Totals
Owner's Signature L� ��� -t
Certified Operator (Print) 5 t-tc.r—
Operator's Signature
Operator's Cellification No. -7 7
I NCDA Waste Anaylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
2 Enter the value received by subtracting column (10) frorn (6). Continue subtracting column (10) from column (i 1) following each irrigation event.

Mortality Management Methods
(check which method(s) are being implemented)
Burial three feet beneath the surface of the ground within 2—' hours ar'ter
knowledge of the death. The burial mast be at least S00 feet from anv flowing
stream or public bodv of water.
Rendering at a.render= plant licensed tinder G.S. 106-I 68.7
Comolete incineration
In the case of dead poultry only. placing in a disposal pit of a size and desicn
approved by the Department of .agriculture
:i Anv method which in the professional opinion of the State ti e;erinarian would
make possible the salvage of part of a dead animal's value without e^dange:inQ
human or animai health. (Written aeprovai of tine State `'eterina.rian nust �e
attached)
L:

V'IIilk l�,l/i •
Auulh.,l 11u.1, 1(u I-i1(-a:5
- Flool atll f,I,
Swine Farm Waste Management Oclor Control Checklist
Cause:
]IN11's lu Minilllicc 011or
Swilkc plodlictioll - - (Kvegctalivc of wooded buft� rs;
Reco11 menLie 1 best lllanagellicill placticcS;
(Inc} jildgnlenl and colllnlnll sense
• Dilly lllalllIlC-00VCf1;d allilklikiS :ry 11001s
• WO rllanorc-Lovcl-cil flouts — V/%
lolled floors; ~
$ Witicfcrs 10CMe(I ovcf slnitc(i flours;
ff1 feeders at high chit of solid ilonlS;
[ Scrape manure: buil(lu[I (11ont floors;
n tln(1ef11oor VC111ilillirlo fur illying
to 1.111411C Lill -1 I14111 1111 • 111 i11C; ---� Fic(luclll lilatlllic rCnloval by ih lSll, [lit fcclull-gu,
• l'altlill 1111Cr(Shl:ll 11CC+SYnll:l5kll(ll1 M SCfilllc; -
V.:IIIILIII,uI . ,lLul:,1 I,uI� - � ----Vol:llill: (•asc5;
I �
11RI1Illl ' II5 - [ ILA '
I-II1:.11 l,u,l. - 1;ililtiull of rCLy( ul lal;nun
;'hll+ti(I lvllilc t:ulks ar(: lillinl,
I lu;h .II1..; _ -
• - Aailikii,ill dill ilia w;iA(:lvalcr
CnklvcyiulL'c .
till I1.11Lo, {„ l(ll,
lgiliYlion+Ifr,cyclC+l lsgoo(l
lilitlill while flits ale lilliug
l il1 Illl,s
Agitiltioll (luting 51lllhll l:llll
lllllllh i1RIl lll}hVlh3Wli
1�1+1�IllC 111 .Ili 1 UIII,, hllllh
:11;(lalllllt timing %Vi lc%ViIICf
of Inll(.1111., 11,,h C!,
t.,ll{V(:ylII1Le
Cl iln(lcfl]nul vetlltlali+�n
--
lir l:lll�lGll all ❑ ovimic l
V W:tsll(lown haa(VCCl1 gliltl l of anili)MS,
i-1 1'ccil all+litivu:i;
f1 I'ce(Icr (:+lvcf s;
f-1 I't:cll (IC:IiVCly fillIMullnul cLl(au11:1s to ICCtI,:f
C(IV(If!i
11 I'hlsh lank cnvels; —�---
1-1 I:xlcild till lilies to ncaf ho11r11n of tanks with
-.y .till-sillilnu VCIIIS _
1a lI'II&Ill+lof Iltlslt,villl n1111ct11i1(It VLntlliItioll
n EXIC1111 ICAM11,(: lillc% 14) nlcu hullunt of Ilils
tvillt anli-5illh(lll vcnl"
C] Suns[) tuff}; LovClti _-_-- ---.--.----.---
Sltc �[ICCI(-lC �'I�:YCIICI'S
At,l( it v1 nIl 1:l 11, 111 In I'.+l c 1

--SIUII I',: Cuusc RMPs It) Nlillilnicc (Mor
- Fild nl Il,ainliill,:� at - _ Agilation (luring 1vilS1C%ViI1Cr n Extend discharge point of plpus mulcincalll
l.olrvcyanec — !1,4ruoll licplicl level `
1 i,t.u,l,l .uI I.0 VulalllC �i1S cnllsslfllls, Iltllper lagoon liquid capachy;
• Iliuloglcisk nlixing; QK�Lorrcel lagoon slarinp proccdttres;
• ALirlliult n Miuinulnl surface area-lo-voluutc rlliom
Il l IUntI,ul �11F Inl.l.a •
nuul::, •
l+udl,c I,,r,t. ul klI.Iil
SI II
(� �liuinunn agilalinn wllcn Ilunlping;
A;/11rfqIvL:Il
Icchanical aclalioo;
biological ildtlilivcs
I ligh pleTsll[C ilgitalion-, `'I igillC (III (lry daIli) with lillle ur wif1d;
Wind Ill II(��7WW///�illllll1111I1 reC11111111Cnfle(I Oherallil(; Ill'I:SSIIIC;
[g' I'unlp illlal a new- kagoon liqui(I surface;
n I'nnlp froul second -stage lagoon
—l'iuliu! miclolkiil! dccnnlpo�iu[lFl; n 1louonl or nlidlevet loading;
• N.lixing while 1111ing; n Talil: covers;
• A1jimion when cmpiying
f=) Ihlsul sill f;lCl.' mill oi-Solids;
n Proven biological ilddilives nr oxidants
•—N,ulial Iui.:rullial Ilecolopusililal; Pf Exlcocl drainpillc models underneath litplid
[Mixing while Idling; vcl;
law-
MWI
• A1511allun when CIL1111ying IitillOve SClllcd soliclS regularly
t�fauule, lulry ,Ic ;Icicll;I: Agitation when spreading; n Soil in.jeclion nl shulyl,lu+lgcs;
spce.I,l,a ,,,III,:1' VOhIIill >'ts enllssln Is
aulty ,u ,luJl,c „�I Ir,:l,l
..t1�,I�1 a,lukLll�.
1141.,11 ,:1 •11,n:.
Wadi residual luiulure 110111 sllrcildcr idle, use;
rl
Plovc,l hillhlgical alldilivus Ill oxidilllls
VIIIiltih: leas clllisSions while
n
Soil injccliolt {li'::Iluly/shldj,c,.. .. ...._.-. _..�._
,hying
n
Soil illcorporalion wilhirl AH Ills.;
n
Spiead in Illill Illlir011I1 hlycls fur Iallill Illying;
n
[`coven lliological adllilivcs III oxillallls
('aICitsS llccunlposilioll
l`rope1. (1isposition n1•cal'eas.SCS ---
{ •.o, :lt's d,:I:uu11lo:J1P)It -
I1
Cnulpll (e cnv,ainl; ut r.ale;l:::la iu llurial Mils;
n
I'rtlpel' ln1:alllln/eI111]{lklellnll UI Ili5pnSitl Ilils
i 111:,,1I4�li�:IC la llllk,l15111111---------�`n
iCCllnlial yVilla. blll llCl5 ----------T'-.-
:fir-it u ! I„t. uIl ,:l I I, 1'rrn, I',ll,c •I
Slit; SlwcIfiC Praclices

S(.luJillg w,,ict ;n,nuul inlpruper ilrautage;
Lu.11ukc:, pki,auhiul ciccnlupc3siliuki ol�
ulgJnlc UYalltil
away (tolls faciliftes
I JAII IC h111..cll until • l oolly Iilallllaklled acccss roitih Farill access road InainiclialicC
pubis.: Iu,uls Iiuul I�.uul '
aLCL:SS
Addilltmal Illt,llnlillinu : Availabiv From :
Swim: I,l;lnknc I�Ien,lLcntcnl ; Q00 IWILAIN4P Packk:l
Swim: i'I,iilui lieu 1,;ulik NutclkIinl 011ur SMIICCS alit Itclllcklics ; Ii1IAli FitLI Slkec(
Swim! i'k,lklu.-dull l;lcilily N1,11Mlc NiJlrilgiMirnt: ['it itecllalge- Lagunn Ticalinaail ; IillAI: 128-88
Swiuc ('10411ILliun 1 ilCilily N1,0111Ie tvlauauenfelll: Unilcrllonr Filisll - Lagoon Trealumil ; iillAF 129-88
1 at;nnn 1)ctIigu ;uk,l 1.1;IIIALtulcrtl lur Llvcatn& N-lanklrc'I'rea1111ew anti Storage; ; FBAF 103-87
( ,111ill.uiun of 111,11uuc an,I W;tSICLYLICr Application Ftlktipkucia ; I_BAli I:ilcl Sllcka
('nikirnlling ( I,IuI!, Ilnfll Swine Iluililings ; 1'111-33
1-nvir,11IML t A AS,011411CC I'lugrinl ; NI'I1C ti9auual
(kluu,iu till N1;III.i1;1ul; O,lur ; it Icpult lions 1111: Stvikic Ocio; Task force
11111.,1n..0 t ul 111611i;i1 t-1,llnnl: R-1;ulagcutcol: (h1n1S Ants flits ; NU)107, 095 ("IMIClcrn:c l';uccccltllgs
NCSII, Onttlily Fx1ension Ccnlci
NCSII - I1AF
NCSI1 - 11AF
NCSI1 - HAI:
NCSI1 - 11Ai.
NC511 - I1AF
NCSI1 - Swil%C I:XICIlsillll
NC folk Producers Assoc
NCSI1 Agri CI1t11111till icatiotl5
I-ln;ith CnnpCralivc 1-xlcnsintl
rl f• 1+ 11 ' 1 I �.. u.l., , I I . 1'1'ir,, E'.,I;.c �

i
(5
Fes•
G17
s i
r
N
Tw
1'11h11 G1 ILIA, 5
I.aglluus ant fits
Insect Control Checklist for Animal Operations
Cause
ACCL31llniatillll of solids
• ('rusted Solids
Fxctss,i t U l;Lliltivc T• lhct
liluu•Eh
�11,Lt,1k:I
BMPs to coull-ol 1115Cl:ls
Liquid Systems
Flush syslem is designed and operalell
sufticienlly to remove accunlldillcd solids from
butters as designed.
( Remove bridging of accumulated solids ill
discharge
n Mainttlin lagoons, settling basins and pits where
pest breeding is apparent to minimize Ilse
crusting of solids to a depth of no more than b -
8 inches over more lhan 30u D of surface.
Milintaill WgUtalivl: control along haul's of
lagoolls atld other impoundments to prevent
accutuulalion of decaying vegetative matter
along watcr'S CdgC on impollnllnlelrl's perimeter.
�T -- - l)l'y SySlculs
• Fue(t Spitlagc iEf Design, operale will maintain feed syslems
11It11�Crs'�t�d tionglls) Ill minimise lhl:
ilccumiltill lull Ill 11Ccaying waslilge.
Clean up spillage un a routine h;ISiS (e.g., 7 - 10
slay inlel vas ctllrint; sunulltl ; I S-30 day inlcrvill
All ilig win(er).
-- AC[Wnlll16011S elf ftcd residues HCdklcc nlnislurt acclnnulatinn within anti
around imllwdiillc pcl imcler of l"Lell slol;1ge
areas lly irtsuliol; dlaiucll;c away frosts situ
and/or lrroviding adetluate CM1I;1iim1C11( (e.g.,
covered hill for hrcwcl's gruiu crud sinlilal high
%tlnislllre grain prullucts)-
tR Inspect hir iuul rcnlnve or hrcA. up accunullaled
snlills in 111Ecr strips around ICCII sHiragt as
Site 5oeci0c Vraclices
Ahll(' - ClnvclWbL:L I i, I`190, I'aUc I

Sl 111 f l' C Cause
Animal Holding Atcas Accumulations of animal wastes f3
and feels wastage
n
DI y Nl:ulm c I landling • Accun►Illations of amoral waslcs fi
SyStuns
n
n
111►ilrs io CoitiroI Iitsec Is - -- - Site specific Practices
Eliminate low areas that Iran moisture along
Fences and other locations where waste
accumulates and disturbance by animals is
minimal.
Maintain fence rows and filter strips around
animal holding areas to minimize
accumulalions of wastes (i.e., inspect for and
remove or break up accumulated solids as
needed).
Remove spillage on a routine basis (e.g., 7 - 10
clay interval during summer; 15-30 day interval
during winter) where manure is loaded for land
applicalion or disposal.
Provide for adequate drainage around manure
stockpiles.
Inspect for and remove or break up accumolaled
waslcs ill FLIICr strips around stockpiles mull
manure handling areas as deeded.
For Inure inlurnruiun contact the Cooperative Extension Service, Department of Entomology, 13ox 7613, Norlh Carolina Slate tlniversily,
Raleigh. NC.27695.7013.
ARlic: - N+wcmim 11. 1996, Pa�c2

Precipi-tition Record
Location: 0 411,04 lr14 it t."It S
County: State:
Time of Observation: Year:
MEN M
411, M�
Total Annual:

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
November 20, 1998
Shelton Keith Jackson
Shelton Keith Jackson Farm
1480 Alex Benton Road
Newton Grove NC 28366
Now
NCDENR
NORTH CAROB -DNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. AWS510035
Additional Information Request
Shelton Keith Jackson Farm
Animal Waste Operation
Johnston County
Dear Shelton Jackson:
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject
application. Additional information is required before we can continue our review. Please address the
following by December 20, 1998:
i . Please submit lagoon capacity documentation (design, as -built calculations, etc.).
2. Please submit an Operation and Maintenance Plan.
Please note that all WUP revisions must be signed and dated by both the owner and the technical
specialist. Please reference the subject permit application number when providing the requested
information. All information should be signed, sealed, and submitted in duplicate to my attention at the
address below. The information requested by this letter, must be submitted on or before December 20,
1998 or the Division will return your application as incomplete in accordance with 15A N.C.A.C. 2H .
.0200 and your facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit
is a violation of North Carolina General Statute 143-215.1 and will subject you to the enforcement
authority of the Environmental Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 502.
Sincerely,
e Homewood
Environmental Engineer
Non -Discharge Permitting Unit
cc: Raleigh Regional Office, Water Quality
Permit File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

scs ca
T= SECTION
s�c���n .�a�kSo� . � R ooh -cihU Lliasl�CNos��7d'�i' e�
4cca_'
U:;Q`'/����. ..1�
SVGA C� �,) �r 1 T� �'%� �ah i1;Gr �.,. JXea laced
;, k f E
k' r
The Fad dimensions and grades -are the test estimate. The
builder or contractor is responsible for final layout and
design of the pads. SCS personnel will assist in a limited
capacity, as i is major concern is the proper- design and
construction of the waste treatment lagoon.
The 'actual amount of material required for pads and darn may
vary from the estimates. The design wi i I attempt to loaf anct
cuts and fills as close as possible. If additional material is
required after- construct i „r, is complete on th:e lagoon, the
contractor- anal owner wi l l negotiate on the price and location
of the borrow area.

LAGOON
Firstance from nearest residence
900
Solis 00 0
,)k Number of Animal Units or Total lbs.
Type LagoonKind of anima A S, Tu -15
Volume Units X ft. /.6, ed 0 cu. yds.
27 .1
HOLDING VOLUME (waste + rain + 25-year storm)
Period /83 Watershed -acres
Waste :P�179 cu. yds., rain,2012 _.!cu. yds.
25-yr. storm 190?
Total cu. yds.
LAND DISPOSAL /0-3, .0 total acres
FERTILIZATION & SEEDING acres
Lime Fertilizer _,/C>C))6_5 10-10:ft-)
Seed__,3.6)L Fejj,,e Mulch 2
z5pf-c.
As A.dA
AV.
h-7) t v -
appja W
end 7 P; dJ
Av. as5-
.173-7
+ -so
Is
Length ,56- 1
Width - .2 Top Width
Top of fill ---- - - - -
- - - elev. 2
+ S74
Top of holding volume -
- - - elev. 12
Top of lagoon volume
elev; 5'2,
4 q, s Z.
Bottom of 1 * agoon - - - -
- - elev.__!!�
Interior side -slopes
)Top 0cflej e1j cjvv.T
I C, 111h t
of Jam 6,,4
1,�10
000.
/V0,1,1 rj( �a,,l Fri e
,Y 1-
��;Me , IV0,41 s.-C18 6-p<�i7l'e, U. S. DEPARTMENTOFAGRICULTURE
Wx C q, 17 / go SOIL CONSEVAnON-SERVICE, 41
Da rn 4 Z
.......
. . ................
.................. .........
4, C 4 / e-k 10 Le MOV4
ch"'ed ............ I .. . ..... . ... . .... ..... 140
S t f,
/;4 SCS-ENG-313A. REVS-7S

Animal Waste System
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Sketch
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Sheet 2 of 2

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MINIMUMell► u14
�1l4fLR �� MAX1314UM
TRE4TED
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31 MINIMUM prAnlTiER
VY
PA $ uRE
tt)ASfE WATE2 P►PE

SPECIFICATIONS FOR CONSTRUCTION OF WASTE TREATMENT LAGOONS
AND/OR HOLDING PONDS
Clearin : All trees and brush shall be removed from the
construction area before any excavation or fill is started.
Stumps shall be removed within the area of the foundation of
the embankment and all excavated areas. Satisfactory
disposition will be made of all debris.
Construction: Construction will consist of excavation to
the neat lines and grades as planned. In areas of the
lagoon bottom and side slopes where sandy material is
encountered, the area shall be overexcavated by 1 foot and
backfi'lled with clayey material. Excavation shall be by
pan, drag Iine and/or backhoe. A bulldozer or other
equipment will be used to dress the slopes. Fill material
placed in the embankment shall be free of sod; roots, stones
over 6 inches in diameter, and other objectionable
materials. The fill material. -shall be placed and spread
over the entire fill area in layers not to exceed 8 inches
in thickness. Construction of the fill shall be undertaken
only at such times that the moisture content of the fill
material wi'ii permit a reasonable degree of compaction.
Compaction of all fill material shall be accomplished with a
sheep --foot roller or heavy rubber tired equipment <such as a
loaded pan) passing several times over the entire surface of
each.•S inch lift. To protect against leakage, the entire
lagoon bottom and all excavated side slopes shall be
compacted in the same manner as the fill material
compaction.
Vegetation: All exposed embankment and emergency spillway
areas shall be seeded to the planned type of vegetation
immediately following construction.

GENERAL
These specifications are to be made a part of: detailed engineering plans of the pro-
posed embankment, spillway(s), and reservoir.
No changes nor deviations from these plans and specifications shall be allowed without a
written amendment, in advance of change, from the responsible technician of the Soil Conser-
vation Service.
All facilities for impounding water shall comply strictly with all state and local laws
regulating such activity.
The Soil Conservation Service makes no warranty, expressed or implied, of the impounding
structure or the water holding ability of the structure.
RESPONSIBILITIES OF:
A. Landowners:
The landowner will acquaint himself with the provisions of these plans and specifications
to determine that the completed structure will fulfill his present and future needs. Inspection
during construction will be the responsibility of the landowner.
He may request inspection by SCS employees during construction and upon completion of work.
Where benefits are to be received from Government agencies, or when the dam falls under the
Dam Safety Law of 1967, inspection and approval by SCS employees are mandatory.
B. Contractors:
The,contractur will acquaint himself with the provisions of these plans and specifications,
conditions at the site that may affect his schedule of operation, and the location and meaning
of all stakes on the site. Failure to do so will not relieve him of the difficulties and cost .
pursuant to satisfactorily completing the work in compliance with these plans and specifications
and any written or verbal contract with the landowner. Ali bench marks, grade, and line stakes
will be left undisturbed and protected by the contractor to facilitate construction and in-
spection.
The contractor, weather permitting, will schedule his work so that he will start on the
agreed date and work will be a continuous operation until satisfactorily completed. All
damages occurring to completed work or materials, by the elements or otherwise, during con-
struction, will be the responsibility of the contractor. Partial or damaged work and/or re-
placed materials damaged from any cause will be paid for by the contractor. Absence of in-
spections during construction will not relieve the contractor from completing the work in
strict compliance with these plans'and specifications.
Upon completion of the work, before moving his equipment, the contractor will request a
final inspection by the landowner and an employee of the SCS. The contractor will then receive
approval that all work has been completed satisfactorily and/or he may complete those items that
vary from the plans and specifications in order that a final inspection will result in approval.
C. U. S.-Department of Agriculture - Soil Conservation Service:
The United States and its employees are in no manner a party to any verbal or written
contract between the landowner and the contractor. SCS employees, within limit of personnel
available, will inspect and advise on techniques during construction to assure satisfactory
compliance with the plans and specifications.
SCS employees will, upon reasonable notice, cunduct a final inspection for strict compli-
ance with all plans and specifications concerning this structure. Inspection will determine
the satisfactory completion of work so that (a) approval may be given for the eligibility of
the landowner to re.:eive benefits from anv Government agency concerned with this structure,
(b) final payment may he made to Ehe contractor, and (c) the pool may be filled under the
provisions of the Dam Safety, taw' f- 196-7.
-2-

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p.��pN. S ... a. ��.> i k .y �. s 1-.y �L�. ,; 4-' �'9 s' � �r�w -i�• t yr �t5' •� � t 'L } C� ,-..r ! t• n-� '.
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Py_t�4yYti� r OPERATION ,AND MA I NTENANC�'PLAN
7.
— .� .�. — �-- ¢%C nit 4 yr t srl j � r r� 4ht..�•H �;'4}.�,-s �' �� {, ; 4 Y T' �
��. d�Si "r't ��?� r t i s r C(k ��• �?v '� � r : •7 j 7. 'e'Tt � ,
�eF u As Neff �' •"s C i.�, .s" x .r r r ! t S P k .'t< 1� r+ ,�T' +^- _t �'�, 5 i�. tri -t `"- r-
--r .<<1� ti,.
•This -lagoon. is designeda> 'for'.•wa5te:-treatment with.:minimu•m r'odor� ,
control. The 'time -requ1red .for the :"planned fluid `level ,to
reached may '•vary'". due to :,So l; corid i t ions; f lush i ng operas and
•'4l."�': . j: S yf Ly4 C 5 x
the amounts"af fraesh water: added'.to,--the system
- l'• _ t��r } �..+f-h �.}i - - _1,k r f +��,} k i�Jr d� ��jr'CC �;r- v4.
•.:Y �, -p .'Y. � .- 7 }„-} .. `. 1 ^ - .r'rpc ] ..° -'' •. f ri`Xly j�` r
Land applicatian°of tt,
waste'water isrecognized "as ,an acceptable
method of'"disposa1 :Me'thods of application „include solidse:.
center pivot,- guns, -'and traveling gun, -:irrigation.';. -Care shou,be�,
taken -when applying waste -,to prevent runoff•from'the field cr damage
to -crops.
The following 'items are'.to+be car'i-i d -out: "
ri.
1. It is strongly' recommended that the' -treatment lagoon be pre-
charged to•1/2 its capacity to prevent excessive odors during,:;
start-up. Pre -charging 'reduces the concentration of the initial
waste entering the lagoon thereby -reducing odors. Solids should be'-1.
covered with effluent at all times.
2. The attached waste utilization plan•shall be followed. This
plan recommends sampling and testing of waste (see Attachment B)
before land application.
3. Begin pump -out of the lagoon when fluid level reaches eleva-
tion .'SA{- as marked by permanent markers. Stop pump -out when
the fluid level reaches elevation_ or before fluid depth is
less than 6 feet deep (this prevents the loss of favorable
bacteria) .
4. The recommended maximum amount to apply per irrigation is
one (1) inch and the recommended maximum application rate is 0.4
inch per hour.
5. Keep vegetation on the embankment and areas adjacent to the
lagoon mowed annually. Vegetation should be fertilized as needed
to maintain a vigorous stand.
6. Repair any eroded areas or areas damaged by rodents and
establish in•vegetation.
7. -All surface•runoff is to be diverted from the lagoon to stable
outlets.
B. The Clean Water Act of 1977 prohibits the discharge of
pollutants into waters of the united States. The Department of
Environment, Health, and Natural Resources, Division of Environ-
mental Management, has the responsibility for enforcing this law.

... 'OPERATION PLAN
This plan includes sufficient land for proper use or disposal of waste
at _locations, ,times, .rates, and volumes that ,maintain desirable water
soil plant ,.conditions
ter: ..e• �,e.�r:i
There will=be .approXimately BYvd lbs.' of :nitrogen produced-0::each year. .
This is the dominate nutrient along with phosphorus:and.-potassium that:. s:
you will be involved with. The nitrogen in the fresh waste will be
reduced by approximately 70Z with the use ofvirrigation or liquid
spreading. This would -yield lbs. of nitrogen-to'.be'used.'�•-Tests-of
nitrogen content in .`lagoons should be`'checked`i.:t-"prior .to land 'application.
'.J Le <. ._. •3 :)1: ..: ... . _ _. �. is
Waste -will-.be (spread by."use of ; r QQ �h 'r u,tj:�r} s.°r : -_r� ,:, _ •,t ;
The holding volume of. -this basin is for months.
Crops on'the rm available for nitrogen -use: _-
ac. x lbs. rate per c.
x lbs. rate p r ac.
ac. lbs.'._rat per ac. .
ac. x lbs. to per ac.
Total
Other farms (Nave
ac.
ac.
ac.
ac.
x lbs. r e per ac.
x lbs. rate p ac.
lbs. rate per a
lbs. rate per ac.
Total
The basin is composed of two volumes. The lower feet of depth in
the basin is the lagoon volume. The remaining, depth of the basin to the
emergency spillway level is holding volume. The lagoon volume is a
permanent volume whereas the holding volume is fluctuating. When
construction is completed, the lagoon level and the top of the pumping
volume is marked with permanent markers.
Effluent should be pumped when (1) it will be most beneficial to the crops
and (2) when the soil can readily absorb the effluent and have no runoff.
This may be several times within the month holding time.

OPERATION PLAN (Cont'd)
The routine maintflnance of this lagoon involves the
following:
1. .Maintenance of a vegetative cover on the
embankment and in the emergency spillway: Fescue
is being established on these areas. Beginning in
:1988 and each year thereafter, the embankment and
emergency spillway should be fertilized with 1,000
pounds of 10--10--10 per acre to maintain a vigorous'
stand.
2. :Control of weeds, brush, and trees on the
embankment and,In the emergency spillway: This
shall be done by mowing, spraying, or chopping, or
a combination of all three. This will need to be
done at least once each year and possibly twice In
years favorable to heavy growth•of vegetation.
You may check with the local Extension Agent or-
. SCS office for .the latest information on spray
material and the best time to apply them.
Maintenance inspections of this lagoon should be made during
the, initial filling, at 1'east annually, and after every
major storm. Items to be checked should include, as a
minimum, the 'fo'I lowing: ,
1. Emergency Spillway
a. erasion
b.; sedimentation
c. weeds, small trees, logs, fences, or other
obstruction that reduce channel capacity or
may block flow.
2. Embankment-
a.'
settlement, cracking or "jug" holes
b. side slope stability— slumps or bulges
c. erosion
d, rodent damage
e . seepage or .other I e-akage
f. condition and typelof vegetative cover

ra } sta td'y ,Fah
e r ATTACHMENT A „ ..
�+ - roc% {yi { } t� µ.erF .Y r�.1 ,�-'t,e2.i✓Y 'i :.r_. F..-_ ..., +.G - r• Pa 1..11 -.y-. S?! �l, t'. hY �i i3 'L a Y.� !V b f (•�.J .l _ '.:Y l ra, f e5 j M7-
J-
• � }F .•: Tr. •,�, x,2�.�..r WASTE- UTILIZATION PLAN . � - � +' •� _
. _�.r 6 -�riw4 t7.+!�"a' a'd�'a b� w ti .. � r � R!y - .k• � x�.,N r � Y:,if. �`rv,a�?,.,r' F# .`; r bh. +.. , !� - �sr i •
C.^cI `C p
�Prodiicer oc e+r. ounty .Y
r
- - rJ -. �ri�'F ���'�'�r-�}k�.yJ:• 01-s- �m _- ,,,,•"�1` L � G x 4 f.�>a -_. J f �.:. r+t... , ._. ...u- .. , � ••-
Address h ": e a "44 .: Kind of O erat on
mob; n Type of Waste Facility nee rQ-
�'•fi� , y "t t - / ti4 --rs.x YC a':a i -. v'A -n _ '- ^^
• - ':j -. r Al,
t -.S Y74i�13.FrM-t•F rii.-i Et'i.. ?tirri S►r �A j KNy 4-arl _
iY_+- '" ! T.�ii-4 ii`.-.4.7 �i^..eb�.•.. ,. 13•fy., ....i:'AM = ': �++` ~ •fw'.y..�r.y K.gt.r,.. r• • 'a xN'I r•
Your`anima`1 waste mani4ement,facility.has'<been'designed'for a.''.
.,.
�-given'!storage:capaciy,,::+;When"the ..waste -reaches .the designed
level;' it `"must``be''land -'applied atx'A`.'s`pecified ;rate ' to'prevent
;Rpollution`:' of',"surface 'and/or�ground'water. The plant nutrients ,
animal•-waste•.should -'be :.used'<to . reduce the ;amount .,of ,
comme`rcial:4ertilizer-'-requiired :far :the °-crops ;on :the;.`fields
,wherd'°the`: waste is to -be •appliedThis 'waste -:utilization plan
ruses' nitrogen `as the ..limiting nutrient: :.. Waste .should .be " -
:.-> analyzed -before -'each'-application cycle 'and 'annual -soil, -tests
:'_:.:.are i encourag6d-1so ;that'=all •plant nutrients -can :-be -balanced for
,._....realistic ..yieldsrof the crop to be grown. -- ;
Several factors -axe important in implementing your waste
.-utilization plan`:in`orderto maximize the fertilizer value of
the waste' and -to ensure- that'lt is .applied in an
environmentally safe manner. Always apply waste based on the
needs of the crop to be grown and the nutrient content"of the
.:waste. -Do not-apply.•more-nitrogen than the -crop can utilize.
a -,Soil types =are- important 1as ..they..•have .different.-.infi.itration
ratesp'and :leaching potental -• Waste shall -not =be -applied to
land eroding at greater than 5 tons per -acre per year. Do not
apply waste on -saturated soils or on land when the surface is
_-Either. of -these-conditions may -result -in runoff to
.-.surface waters.'..,.Wind conditions should also be considered to
avoid drift anddownwindodor problems.- To maximize the value
of ,nutrients .for .crop ..production and to -reduce -the -potential
for -pollution, -the •waste should be applied to -a growing crop or
.._not more .than 1"30 days.prior to planting. --Injecting the waste
_ dr.disking will - conserve nutrients and reduce odor . problems .
-''The acres "needed to apply`the'animal'waste is based on -typical
nutrientcontent`for this type�of facility. 'Acreage:
requirements may be more or less based -on the waste analysis
report from your waste management facility.
The design of your waste management facility is based on the
following:...
Amount of Waste 'Produced Per Year:
11�1�/00 animals x q waste /animal/yr = �) total waste
produced.

ATTACHMENT A
Page 2
Amount of Nitrogein Prc� i ged- Per Year: �5 '* - � ^., .k 7 } � wiz _ ,; � 'r�'•+_ ��f -ice Tyr � r: � w - .' - � i
�=`£ OC animalsyx '+ ,3'lbs `N/animal/yr-��1� ;total ,N
,
rT45 `� o y "" q,r a<7 �r':q �f. .. rf[.3.[•.�-J'-. .b r r. liz
s• �` 1( i'�lx-� 5.: �•: W.� �ra.�,: �F,, -... a s .w::J�..•n S�{r;,y .i -..t :�•�-,.. � .r "
Applying .,the above ,amount, of waste is "a'°big " job You should
---,-plan •time-•and.�have appropriate,,equipment-to--apply th�1eg waste,in
a timely, manner.=,'''Your�-rfacility`•is designed for''. �3 F days `of
storage: The're'f =e, =it'``willneed 'toy be'pumped :every
r months. „�:, .��;::r�'t� ,,���' ,•;
The fo_ Bowing acreage 'for •waste +application will ybe needed `
based `on =the .crop to 'be -,'grown .and ,surface .application:
F F"f' e, 4 ;e, tt r a _ 1 .:°,r, ,.f •j + f - . • }tip
Field
A Soil Crop , �;,Aaalistic =�; tba M NKr Acres _; Lbs M Nonth of
I.� +i f..�". )t3 .1. it •b �. a.' i 1.`,♦ wi iti 1• 3 . x .F
Type a fY,;. " Tield Ac. }• .,Utilized ; Applicatlan
A.
y ' - :.
T Ssa 2
7-
EPA=
• i .
< mrComMM
WRE ro=
• t
WX"A
MOM
MM.
�WRW�
t►MMUFM
TOTAL
of N
SUrptUS or rci
■
' '
Narrative of operationI's / J1
./V fa' i ;„7r.. � � lJ1+,t CI Udad�,t7- ���.•- Crop
11 1 � I
l Y er 1 ifN Aisr a il. aTi ✓,, V ' ! ii• -1-3
T 4;,Id 5 �s � iSl f�iAl, .4,Q.I6- X 601hs -AlSSc# IA e -
Call the.Soil and Water -Conservation District Office after you
receive waste analysis report.to obtain the amount_ to
apply'and'the irrigation application rate prior.to applying
waste. j
Prepared by �,�, f/Z/•z.. - vC G a f • l
e Title Date
concurred in by ���1 7-1 �l
Produ Date
(Copy to producer and copy to case file)

i
ATTACMaNT B
1 of 3
w a r Nori!1 Ca!'olina Aj'':�li�i.1''.tI4
01
-7 q' [. ri .'�' a r" :♦ i.
_ _ • �-�a . elm aria irem.ent�=�
�` •S 1-1.br..1!}�� .} a ((/}}J�4'�J�.�r IS- Sri= i 4;�• t'.L' ? S `I.L -9 r .l.la. nfa- :t'. -� r i•. "1.- �?„- iA 'sr:'rr s :•rs� � �r
. k. an„�:. 2. +ro. � �8� r-i,"„au. s,. o-,h r .. .Sr -. J.', .'` -. �`i" "rt yr ��•' � M.• r
;? Zrt. iG 1 •[.`-•. v- ,`!''l`•a`-�'i'{i��*j:r.`n � �� `� r- �� rrr...- Crr •YL� r��{;ti•^. , r kt
Biological and -Agncultural�Engiheenng 5 ; w Nortli'CaroIina"State Uniuers:ty
.. M'. il.+i�.Y•S_ a..Y .� ; .r_z. 7 - :t r f r, '• i. �=f .:'4 ., e!"r l" � 4 �1.• _a""• - � - .- :a
- .. +•'? t, 4 f yam_= , J!; r r`i. F - -
4 ! ....ci'
LIVESTOCK WASTE SAIiPLIHG�'l1HALYSIS AND CALCULATION
.OF LAND 'APPLICATION RATES
yr.YJ, ,.M;i �3S ,{. + i ' r Ya.l;f v • =?
I1. }-.
James C. Barker*
' � '�J � k.?+,ra`er - �°• ux�'�„.:-.�• *.. �'%`�, JYSt- : t.�"Jra• . ✓ - - -
t,
I SAMPLE COLLECTION
A.' Semi=Solid'Lot-
Manurn1:'';
" S S " i+;i 7 iti ti 7_'iE, 7 .F fir. ���r.,, i¢ � ; .�.'X ' � - � i.i�• =-:: GS ...� -• %.'�' -
i.`PScraped.di,rectly from lot into spreader
a. From loaded spreader, collect about 2 lbs of manure from
different locations using nonmetallic colle-ctors..
ii.'.From storage'
a. Collect about 2 lbs of manure from under the surface crust
avoiding bedding materials and using nonmetallic collectors.
B. Liquid .Manure Slurry a.
_ i '.ail. -� r- -F o, x{' •'' ,.. i, -`. L. Under -slotted -floor pit '
a. Extend a 1/2" nonmetallic conduit open on both ends into
manure to pit,. floor.
'b.'Sealrupper endof conduit (e.g., by placing a thumb over and .
of conduit) trapping manure that has entered lower end, remove
and empty slurry into plastic bucket or nonmetallic container.
c. Take subsamples from 5 or more locations or at least 1 quart.
d.'Mix and add about 3/4 pint to nonmetallic sample container.
Li. -Exterior 'storage basin or tank
a. Make sure manure has been well mixed with a liquid manure
chopper• agitator pump. or propeller agitator.
b. Take subsar.,ples from about 5 pit locations, from agitator pump
or from manure spreader and place in a plastic bucket.
* Professor and Extension Specialist, Biological and Agricultural Engineering
Department, North Carolina State University, Raleigh, NC.

7 < ATTACiiMENT B .'
7
2 of
w,.•
�c Mix and add 3/4 pint Ito a nonmetallic sample container
i, 1
.is,:'?r a i hey z s i fx 4 t. „� •+• ~+ s �r"x s t� .
. C "iLagoon�Liquid 7` as�.t�,*4 .{�, 7*.� � w _ � Y` ;�� •�.� '��. �, �;:� f :�. � :�, ..
�- �� .r; w .. � �,•' r-a r-i r+,� „ s .+� �- r 'ni• ,. ..L 4 � - ,r . ej � w.-: ,� � ;+' .a � _• K. <+:.r.... i4.,.:i, s
:Dram'rrw,rorv�c;.aar,.�•suuc,xs-c.-.�asar r.<ccbauti..r.
_ � 'P'y'-.YhJ 1 HIyO.W WlRYK!.'.F.k� 4Yf _ram+
^•{c'�• z i ;Collect :about 3%4 pint of--recycled„lagoon liquid, -from inflow pipe -
...�f'•'s,.C* .. r .•j .r 0k+". rr--- eY."iS;pS r s
to flush tanks in a nonmetallic sample container._:'
J�- .. .�.. .,. b
- -Y �;� -;., w� � }� .� -� a :-_:-•�. � is - -w rJ„ F -�„r �y ."s�r.�,. s.•rt'� ":,r' .
ii. From'"lagoon <' .
a PZaee a smallbottle1/2 pint or{less) oa,end of 10 15' pole F
�L v yy S vY ,G +} } y, .� y� ♦f'-pf M� y.ly
l'LdZ <-i'�.lk'1#�1 'J. PFS• �' `� ."S•
b 'Extend bottle' '10-15'-away from bank edge 4
c :Brush away floating scum or debris. -
d ':Subsierge bottle within A of liquid surface • -z j —e% Y n=
Y c" r;'
e Empty;into a plastic bucket,'--repeat;about-5',times'Mar6und
v lagoon. ,mix, .and add 3/4 pint to nonme tall ic 'sample container.
D. -Broiler ,or 'Turkey Litter '
i. -House litter
a. Visually inspect litter for areas of varying quality, e.g.;
areas around feeders and waterers, and estimate percent of
:. floor ' surface 'ia each area. _
b. Take about 5 litter subsamples at locations proportionate cc
item a. E.g., if 20% of litter of similar visual quality is
-, around feeders and waterers,:take 1 subsample:there.and the
other 4 subsamplas from remainder of -floor surface.
,c. At each location, collect litter from a 6" by 6" area down to
earth floor and place in a plastic bucket.-,. ,
­d.-After.5 subsamples have been added to the bucket.,mix, and add
about-2-3 lbs•litter to &'nonmetallic sample container such as
.:;a 1-galloa freezer bag and seal.
ii. From-dtockpile
a. Take subsamples from about 5-locations at least 16" into pile.
b. Mix, add 2-3 lbs cc nonmetallic sample container and seal.

��. :ATTACHMENT B
' 3 of 3
SAMPLE PREPARATION AND TRANSFER
3 A."'Plaee sample ,into an expandable container that .can be sealed.`, -Rinse
.
residues from container with clean water but do :not use disinfectants,
soaps, or 'treat 'in any other way.
B.",,,Pack sample.,in ice, refrigerate, freeze. or transfer to'lab quickly.
'• ' C.-: Hand-delivery,is most reliable way of sample transfer." ? "
ID If meiled,` protect sample container with packing material such as '
-''newspaper, box or package with wrapping paper, and tape.
E. Commercial sample containers and mailers'are also available. Contacts:
i.­ A&L'Eastern Agricultural Lab. Inc. iii. Polyfoam Packers Corp.
;..7621 Whitepine Road 2320 S. Foster .Avenue
Richmond, VA- 23237 Wheeling, IL .60090
Ph: [phone] Ph: [phone]
ii. Fisher Scientific Co. iv. NASCO
3315 Winton Road 901 Janesville Avenue
Raleigh, -,NC 27604 Fort Atkinson, WI 53538
Ph: [phone] Ph: [phone]
F. Private analytical labs are available, but sample analyses are costly.
C. The NCDA provides this service for North Carolina residents.
i. Address: North Carolina Department of Agriculture
.,Agronomic Division
Plant/Waste/Solution Advisory Section
Blue Ridge Road Center
P.O. Box 27647
Raleigh, NC 27611
'Ph: [phone]
Attn: Dr: Ray Campbell
ii. Forward $4 along with the sample.
iii. Include the following identification information with sample:
a. Livestock species (dairy, swine, turkey, etc,)
b. Livestock usage (swine -nursery. finishing: turkey -breeders,
brooderhouse, grower, number flocks grown on litter; etc.)
c. Waste type (dairy -lot scraped manure. liquid slurry; swine -pit
slurry, lagoon liquid, sludge; broiler -house litter, stockpile
iv. Routine analyses performed on all samples: N, P, K, Ca, Mg, Na,
S, Fe, Mn, Zn, Cu, B
v. Additional analyses performed upon request: DM. Mo, Cd, Ni, Pb
Prc

SCS-ENG-538 U. S. DEPARTMENT OF AGRICULTURE
Rev. 5-70 SOIL CONSERVATION SERVICE
SOIL INVESTIGATION TO DETERMINE SUITABUTY OF PROPOSED POND SITE
a top
ot�
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_—_.__WATERSHED AREA MEASUREMENTS', i ••
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SKETCH 07 PROPOSED POND SHOWING WHERE BORINGS WERE MAJ)E -4cale V=' feet.)'
L4xa fe'refircipce point 'm - conler line of darii and Identify on sketch.
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SOMMINNEENNEEMEMN
•13ORING
NUMBER AND PROFILE
Nake and 11-91 dapri-sile andspillway borings first- th4m ponded arm and borrow''pit barings -sevarate with wwdcal red line.
.(Ccritinuedon back where necessary) �'Show water table elcuations an dam -site borings.
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A:.NGS MADE BY

-- - - -.-TYPES OF MATERIAL ENCOUNTERED IN BORINGS M _• _,
-(Use one of sysier6s below) '••,
UNIFIED CLASSIFICATION
..._USDA CLASSIFICATION
'GW-.We11 graded gravels; gravel, sand _mix _ w;_
_g-gravel• .
.GP _Poorly graded gravels',: - .... c�
GM -Silty gravels; gravel -sand -silt mix .' -'
-s'-sand . 1': .. -• -
vfs-very fine sand
GC='Clayey gravels;'gravel-sand-clay "mix'
sl=sandyloam _
SW.-Well.graded sands; sand -gravel mix,_,.. ;_ ' ..,
fsI-.fine sandy loam
-SP - Poorly graded sands:
I - loam
SM - Silty' sand .. _.it._ �_.- - ,� _ .a-�, .. _.. -
-gl -gravelly loam
SC -Clayey sands; sand -clay mixtures
ML'=Silts; silty, v. fine iiids; sandy or clayey silt
si-silt_'
sil-silt loam ,
CL _Clays of low to -medium plasticity._
cl - clay loam.
CH. -Inorganic clays of high plasticity
sicl -silty clay loam '
MH - Elastic silts --` - _
scl -sandy clay loam ' - -
OL-Organic silts and silty clays, low plasticity
sic - silty clay _.
JOH - Organic clays, medium' to high plasticity
c -clay
L: Suitable material for embankment is available O Yee No yndlcale where localea on I& sketch on
- rea " side)
. REMARKS: • - - . . — .. - .
2 Explain haurds requiring. apecial attention, is design {Seepave, vrino..mch tee.)
GENERAL REMARKS:,.
24
25
261
27
281129
130
Ij 31
1321133
34
35
1361137
381139
401141P42II43
44
45
46
47
' 48
491150
51

U. S. Department of Agriculture
Soil Conservation Service
NC-ENG-34
September 1980
4 HAZARD.CLASSIFICATION DATA SHEET FOR DAMS.
Landowner County
Community or Group No.' Conservation_Plan'No."
Estimated Depth of Water to Top of Dam__�' Ft. Length'of F1ood.Pool s��� Ft.
Date of Field Hazard Investigation --3 -/5- 91
Evaluation by reach_of,flood plain_. downstream to the point of estimated minor effect
from sudden dam failure. `
st.: ev. :Est. -Elevation
._ Kind of :Improvements: "of Breach
Reach: Length: Width_: Slope:'Land Use ; Improvements : Above :Floodwater Above
: Flood Plain:'',Flood Plain
Ft. Ft. Pa C;-Ft. -_Ft.
2
3
Describe potential for loss of life and damage to existing or probable future downstream
improvements from a sudden breach iYon�
Hazard Classification of Dam a b, c) (see NEM-Part 520.21)
Dam Classification CI II�j II, IV, V)
By (,611- W,, j1W1_"- J !(Z Date 3 /SS-2/
—'name) (title
Concurred By
name title
NOTE: 1. Instructions on reverse side.
2. Attach additional sheets as needed.
Date

INSTRUCTIONS
All dams built with technical -assistance from the'SailJ'Conservation Service
must have a hazard classification assigned by the person responsible for
-approving -the-design. 'Nlos't farm ponds; -except -in borderline cases, can
be classified after..a•complete.field investigation- without assuming failure ;
and making -breach" studies:''This'data sheet is to be used -for -recording
the information.obtained.through field studies and for documenting the
hazard classification. Where there is a possibility for loss of life or
major property damage from a dam failure, an approved breach routing
procedure is to be used . '---(Consul t -with' the area -engineer .) - `
Hazard classifications of dams °are'made-by evaluating the possibility
for loss of life and the extent of damage that would result if the dam
-
-.should-suddenly.breach--that -is--a -section of -the dam be -suddenly and - -
'''�.completely'washed out." It is to be assumed that a wall of water will be
released equal to hei
ght ight of the dam. This flood wave will be reduced
inrheight as it moves down the flood plain. The wave height (depth of
'=-flooding)•should be -evaluated for a sufficient distance downstream until
the estimated flood level will not cause significant damage to improvements,
- -such-as--homes, buildings, roads, utilities, reservoirs,.etc. The breach
flood level will be reduced depending on the valley storage, slope, and
- - openess of the flood plain; however, in a narrow steep valley slopes
steeper than 10% should be given special consideration. One method of
• •evaluation is to compare available valley storage (under flood conditions)
to impoundment storage (figured to the top of the dam) for each reach
evaluated with a judgment estimate made of the flood wave height at all
critical points downstream.
Should there be any questions about the hazard classification for a dam,
the area engineer should be consulted before making design commitments.

USPA-SCS
r,.aleigh, N. C.
• -Rev. 2/82 .-SWINE
ANIMAL WASTE MANAGEMENT SYSTEM
Engineering Design.Work Sheet
Field Office S.�,f'�`d►7 '��Cl ` Design by (�7�r�. �,�� Date --9�
Owner's Jlame 5Ae Ton Jsei, - A '
Location -in J,. , 11,r'L
Y — (attach watershed location''sketch)
'Population (est) within 1/4 mi. 3 No. of inhabited hauses'witin
Distance to nearest inhabited house other than
-operator's :.
Type of livestock c«�r,P ^� Type of operation (check one)`
Farrow to finish Farrow to feeder pig FinishWOther
Type of confinement facility (flush, pit, number of houses, dimension.of
houses ,' etc.')
Type of waste treatment: Anaerobic lagoon & holding pond Anaerobic
lagoon'with holding volume holding pond , pit or tank
other
Method of handling waste when design capacity is reached (i . e. , Pump & irri gation_,
honeywagon, etc.)
Lagoon & Storage Design Data
Type, number, and sizes of livestock:
Total No. for design
sows z lbs = lbs
boars x lbs - lbs
pigs x Z5S—lbs = Tbs
pigs x albs = lbs
or: Total 1 bs' for design �� G'Os� �' lbs.

-2-
Desiqn Capacity_ for Anaerobic Lagoon -Treatment and Odor Control
Use — cu. ft./lb: or cu. ft./animal
1. (lbs) or (animals) x, .{cu.ft./Ib)'or {cu.ftanimal).
'. DOO cu. ft. ` 066 Cu U
2. Estimate size of lagoon: .'3 x 3,Z x
S
t lengthw ae t
..:.. cu. ft.
%y00M (CI ylgerabTCI)- a).) 3
Design forr-Holdin Pond
Design period days. {Longest anticipated period--before'purnpout)'
25-year storm _-G.2 inches. Normal precipitation less evaporation
for design period �_ inches.
Waste production lbs/day/.lb, live wt.
? 3. Volume -of waste ,3)ab�. live'wt• x R#n 1 b ..w
c�d5s e� r t •b cu t'r':.
x days = SD.Z cu.
4. Volume of waste wate,7Fj al da animal x .an:im'als::_,:.
.5 ga cU: t.
x days - cu, ft.
5.. Normal precipitation less evaporation on lagoon surface for,design,period
in . x� 0� f t . x 'f t . a - � Q-1 7
12 in/ft - el ngth with- C1
5. Normal precipitation less evaporation on -holding and turf ace..:for,de
o! u rre tERO
inches x ft. x ft. cu : ft. r SfackdSys�e
12 in/ft engt width
I. Storage required for 25-year storm on lagoon surface =
6, i n . x _3, t<n f t , x .Z�L_ f t ". _ �� r� % -ctt�t ,
engt width C� Cs .
12 in ft y
8. Storage required for 25-year storm on holding pond surface'
in. x ft. x ft.
12 in/ft - cu, ft`"1°��, R�
length width . Y�sferrti -
,` F1US17ryw i+� W4-+e J .-ejLAMS aboLC" �-3�.� I5O
---
:� his de-Ei9,h sheef-ammts anc4 0 ..uM
morn ot.+- de drpina aks
a, a e wa ee, lV,

v �Z /
.. i
69. Total capacity needed -for holding pond (add Cs 3, 4; 5, 6, 7, & 8)
cu. ft.
10. Total capacity needed far treatment lagoon (add Cs 1 & 9 when treatment.
lagoon & holding pond are one component) _ �-eCG,
Set 5IQ e, , lao 036 5" eef,3
Planned Capacity for Treatment ��a�oon
ft. x ft. ft. w/ ss =
avg. length avg. widt5 avg. ept
{r�'' Q cu. ft. 11
M I i�i rn u m .. `T� /� L 9 `i� Net l h l h
6 D f viaer�brc � ooP, e�.:�' i�r:-4 Trn.es
Planned Capacity for Holding Pond
ft. x ft. x ft. w/ ss .._
avg, length avg. width avg. 2eptF
Cu. ft.. V61 Y e Is
Design for Disposal 'Area
Annual nitrogen production in -fresh waste =
lbs. N/lb/day x � lbs live wt. x 365 days = lbs. N
Assume7D % N loss during anaerobic lagoon treatment, storage & land application.
Estimated N available for crop =
1bs x3 % =
Type of vegetation or crop to be grown at the disposal site
Timing and rate of application
A,mouvi+ caf AppI ca+ oPi
X�XEstimated acres needed for ef7
cent disposal
lbs.
-XX F-rorn of Tom,, Guide (Sprrrk)e.r =rr q4�T " Gu+de)
**X Averu e Eaits of Aephceon
aCA-C C,ati,,U
zoo
4{o o 22 0 Ar N�o -

o
pay,0�4,1V Z�Cesz EVI
4.!,Z)- / �
1w 12
.3.2
4,5
--
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0 1)
000
C/'%
c

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u: o. uepari:i,,e t. of Agriculture's 5�
Soil Conservat ..b:1 Service
�Y' 7
` • +,
VOLUME ESTIMATE FOR EARTH EMBANKMENT
NC- LNG- L2(JS) Z7, ,20 /�
3/72 1 '-jr70 � l
Name
Address
Embankment: Top Width Side Slopes ?,S"/ _
STATION
•FILL
HEIGHT
( Feet)
END AREA
(Sq. Ft.)
SUM OF
END AREAS
(Sq. Ft.)
DISTANCE
( Feet)
DOUBLE
VOLUME
(Cu. Ft. )
O4n U
y
9
tea.'
/no Rr)
0c
a fD5
2. S
3
500
y y -
121
.�s3
7 744,41
3.9
7 7
.r
I. Double Volume of Fill 2= �t-' Cu. Ft.
2. -Volume of embankment fill (1ine-1 = 27)= , Cu. Yds.
3. Allowance for settlement (5 or 10% of line 2) _ - Cu. Yds.
'4. Total cubic yards ( line 2 + line 31 = `! �' Cu. Yds.
Computed by Date "

v: 'j. u_1Pi1V1.1,'0 L 0I AgrICulture
Soil Conservar:.0:1 Service !1
4VOLUME ESTIMATE FOR EARTH EMBANKMENT
NC -EEG- 12(JS)
3/72
Name
Address
Embankment: Top Width
Side'Slopes
STATION
•FILL
HEIGHT
( Feet)
END AREA
(Sq. Ft.)
SUM OF
END AREAS
(Sq. Ft.)
DISTANCE
( Feet)
DOUBLE
VOLUME
(Cu. Ft. )
U
92.
10
9 DO
:1 o J2
:') %J rJF
?4-n n
p lam; L/
1., Double Volume of Fill - 2- ► Cu. Ft.
2. Volume of embankment fill (-line 1 27)m / Cu. Yds.
3. Allowance for settlement (5 or 10% of line 2) _ � Cu. Yds.
4. Total cubic yards (line 2 + line 3)= Cu. Yds.
Computed by Date

Soi). Conservac'.o:i Service �,�/ S/72
VOLUME ESTIMATE FOR EARTH EMBANKMENT
Name
Address
Embankment: Top Width Side Slopes
STATION
FILL
HEIGHT
( Feet)
END AREA
(Sq. Ft.)
SUM OF
END AREAS
(SCL. Ft.)
DISTANCE
( Feet)
DOUBLE
VOLUME
(Cu. Ft. )
AD=.�
r
r .•-
r'
r F
a
r
.y
1.
2.
3.
4.
Double Volume of F111 2=` Cu. Ft.
Volume of embankment fill (•line 1 1.27)= %.l Cu. Yds.
Allowance for settlement (5 or 10% of line 2) = Cu. Yds.
Total cubic yards (line 2 + line 3)= Cu. Yds.
r
Computed by Date ~�
tiJ

01
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Ili
5z. z
53,3
0
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D