640002_PERMIT FILE_20171231

Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
I _ u
Date of Visit: Arrival Time: Departure Time: County: Napjy Region:
Farm Name: jt�QL ��1T'��"� i.fa�1rt� Owner Email:
Owner Name:�t?rr� l�1Lu ,U�y ,� i Phone:
Cr —P'
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: 'a}'r1'hr'6& " N royN .__
Back-up Operator:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
I'll-HIN111
N11gli11111GlH 1
Current
ul
111'age
IIIII[ i
Desl n
�llflllllfL4s,:+ {
1131 hn
Currenta
N 11 ,
Capatcyyi��ty
Pop.
W♦��Mecttn Poultryty
Pmyo�eyp.
}C1apaf.
P��y�,po�i5K13
liBiew�R1 ���iid'l
IIl
���Ih1ill�
�
ii��GI 1111fl_alk Ei
'£Htl al
Wean to Finish
Layer
Wo
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Poult .
Ca acit
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turke Poults
Other
Other
wllu..iwlnlww.4iu .wwalcw
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )?:PNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes EfTNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [XNo ❑ NA ❑ NE
c. What is the estimated volume that reached waters orthe State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes 6 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ETNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes Vf No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilit Number: C& q- 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 9No ❑ 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 0 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 [4 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 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 APUIleation
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 0No ❑ 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?
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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 16 No ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes E4No
❑ 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 ❑NE
Page 2 of 3 21412015 Continued

Wazility Number: - Q Date of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes'0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f:],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 IffrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ..E�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J'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 PrNo ❑ 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
Q'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
[2r-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
O No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2TNo
❑ 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.;
ilse"drawings of facility to'bef"ter explain situations (use additional pages as necessary). "
a lI -q// 7
�aQ ty\4 p4t-v 1
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: IF/? 7 9/ ya, 34
Date:
21412015

' ' 1 ivision of Water Resources
Facility Number ®- ® 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection Operation Review p Structure Evaluation p Technical Assistance
Reason for it:
Argoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: jj)ALJ),h Region: Jwo
Farm Name: 20TAQ 470 i 7 i t CM�r -Q21 f, m Owner Email:
Owner Name: ��U �- - (, y {` YY) -TVIC' Phone:
Mailing Address:
Physical Address:
Facility Contact: Bd'6, AeiO n Title:
Onsite Representative: Bib Y 6y) m D otY
Certified Operator:
Back-up Operator:
Location of Farm:
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: lq W � 9 )q f q
Certification Number:
Certification Number:
Longitude:
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
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)
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 frog a discharge'?
❑ Yes jno ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes [ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I qf'3 21412015 Continued

Facilit Number: - QoL Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z�No ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? ❑ Yes 2rNo ❑ 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 [;J�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 WfNo ❑ 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 E,_2 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 Z No ❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P� No ❑ NA 0 NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/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): so';j sn,�M) o o f s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement`? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �f No ❑ NA ❑ NE
acres determination? ,T
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
to
;2rNo
❑ 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? I f yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
r
❑ 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 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: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes jon No
kP ^.GIZL1b
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes No
the appropriate box(es) below. c;2 011'7 CL, A-Q
❑ 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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes C?fNo ❑ NA ❑ NE
❑ Yes
16 No
❑ NA
❑ NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes [� No
❑ Yes [r] No
❑ Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Coininents (refer'to question ft Explain any YES`answers and/or any additional recommendation's or°any other comments..
Vse drawings of facility to,better explain situations (use additional pages as necessary):
woo(0 IS
V,o IN
= o RO 3a5 rk-7 l,kete
WOO a%i to
1r- 9-1(o
�R,01101
N)-ot-73
1)00 I tcQS
q- ate.- it
RO �S3
N_0ta(0 'go 9 la
waa ri i 159
kzc_t�
Ll -aq_ 16
ap+a&--e_
R PL4til
Cej��
N 9X14 IL
�M U,)e_
c +-c -%+
Reviewer/Inspector Name
Reviewer/Inspector Signat
Page 3 of 3
'elA - ^ ri / . , r.
Phone: 71 Y V `lot
Date: 6 to t
21412015

Type of Visit: OTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ORoutine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: L Departure Time: ( County:
Farm Names (sp Pint, � IN- Eazinoc, Owner Email:
Owner Name: ! ► JzJ1,C Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region:
Onsite Representative: Integrator:
Certified Operator: (� mj p�� (j�j'ZyQ Certification Number: C� f
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
9.'2iQ (, 'Tayl afi5 54(710- 2&A l�orb�x l� po !VG
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity P,p.
I Layer r a
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
11
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Q—ry
IP,oultr, Ca aci P,o
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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)
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 2 Ro ❑ NA ❑ NE
❑ Yes RfNo
❑ Yes ONO
❑ Yes ,fNo
❑ Yes, ,No
❑ Yes/�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

RWP 10q 09,
Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes�No
a. If yes, is waste level into the structural freeboard'? ❑ YesL)2T'No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i,e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan'?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
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 g' No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes gfNo ❑ 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 6No ❑ 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 E ❑ 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): Js y r Lj 3 Q C.1PL�
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes m No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes,,�fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes )2no ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes EfrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes,,ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes .2�"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes J�'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? Il'yes, check the appropriate box below. ❑ Yes �o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

- cup
Facili Number: 1,0 Ll-6L7 Date of Inspection:
24didd tl}e f-cility fail to calibrate waste a plip cation equipment as required by the permit?
❑ Yes
0No
eN
❑ NA ❑ NE
25. Is the facility out of comp fiance with permit conditions related to sludge? If yes, check
❑ Yes
o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�rNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
FrN o
❑ 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
JNo
❑ 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
ZNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
V I No
i!
❑ NA ❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FeNo
❑ 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).
,-,b,6J a01 D i (o aR pip)
c000?I$1 4 -aq - I Io 2.,A N
W605aoI a-11-IS I, a
W 314I 11-10-1b e, Io7
t o o a 1 y V) -,;t 15 I, la
W00$4SL3 (a-a3 5 1,055�3(0.��oi
5��
ReviewerlInspector Name: ���1� rV\Pk_A
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

type of Visit: Q Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: i Departure Time: County:
Farm Name:- p _-az Pay 14 cN Owner Email:
Owner Name: QkbSIZ Cr-t _ Lv .�' c`i-1._nr,A N e . Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: iRM r (, 6 n)
Certified Operator: jmy\6p tN _ m np [—e_
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Region:
Certification Number: a ( q I q
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
.Pop.
Cattle Capacity Pop.
Finish
La er
If cf
Dai Cow
Feeder
Non -La cr
Dai Calf
o Finish
Dai Heifer
o Wean
Design
Current
D Cow
to Feeder
De, Pkoult.
C►a aci
P,o
Non -Dairy
to Finish
t
La ers
Beef Stocker
Non -La ers
Beef Feeder
PBeef
Brood Cow
urke surke
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes_,2'1lo ❑ NA ❑ NE
❑ Yes ff�o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ,0No [:]NA ONE
❑ Yes iT No ❑ NA ❑ NE
❑ Yes �(No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Pacility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes E�J`No
❑ NA
❑ NE
Structt 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes,,Ef_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/6No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[] Yes �/ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes`,E�r_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 ZJ�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Pl1 o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes WNo
❑ 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): 5 Li t Lj 3
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �`--' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes,,ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 2 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2-,Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /TNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes C;J'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E 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 E No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 4� o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes O'No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 0Date of Inspection: fj
24,,Did`tthUoii,
facilityfailfail jto calibrate wastes aplication equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the d it ofcpo� oav w th permit conditions related to sludge`? If yes, check El Yes ZNo ❑ NA ❑ NE
the appropriate box(es) below. t C) 1 $ 11 L( ©- - y 5 P= 3, 9 -9 y 0010
❑ 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 01IN-0 ❑ NA ❑ NE
❑ --
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes �No ❑ NA ❑ NE
Other Issues
2& 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 eNo
❑ 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.c., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ala
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ID"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
No
❑ NA
❑ NE
Comments (refer to question tt): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings, of facility W better explain situations (use additional pages as necessary).
a O 1.1\e_e ed o rto re_. t 31 is
U�o o�oa3
C� (a3 1S
1105
W005-a-j3
313011s
113i
W00377-zr
1 I 115...
©`�7.1
w oO 1U(oa
Ct ( 1QI(S
1.
U)0003 so
'
n�aalls.
b E,c T
a1�� 5, 3 G 5r� 9. 014
kc-eA&-) oj\,. e,� clwd-c.t'e.Q gym.
R0a VC1, 1 , 6j2_0.Q
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: a I q I q I L{
Date: 9 7
21412011

Type of Visit: �2rCompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regio .
1A�J#�
Farm Name: 05,9- PO uJU6\AA TiaNY-"- Owner Email:
Owner Name: }�� ��7 j) IZ D�WX, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: BC[XS� 66 6J JAM —
Back -up Operator:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
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)
❑ Yes ;2'No ❑ NA ❑ NE
❑ Yes�o ❑ NA ❑ NE
❑ Yes 9410 ❑ 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 PNo (DNA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes PXNo ❑ 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 21412011 Continued

Facility Number: - 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?
Struct re I
Identifier; �
Structure 2
Structure 3 Structure 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes,,E]'1Qo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
Structure 5 Structure 6
❑ Yes E�!r�o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �o
❑ 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 dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 4!jNo
❑ 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 (2-flo
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes F,;rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JZNo ❑ 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): ('I , L-1 3
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the 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
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑ Yes ;3'No
❑ Yes No
❑ Yes No
❑ Yes _12r�o
❑ NA
❑ NE
❑ NA
❑ NE
NA
❑ NE
❑ NA
❑ NE
❑ YesJZNo
❑ NA
❑ NE
❑ Yes ff No
❑ NA
❑ NE
❑ Yes,,❑/ <o
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box PSo�i'Aqnysis
❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste 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 _ONo ❑ 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

Facifi Number: to IDate of Inspection.
24, 12id the facility fail to calibrate waste application equipment as required by the permit? ❑ YesEfrNo
ati �--
25. Is the facility out of comp is c�ezith permit conditions related to sludge? If yes, check ❑ Yes ;:kNo
the appropriate box(es) below. a Q 13 CLE CR__
❑ 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:
2$. 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:
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-,EfrNo ❑ NA ❑ NE
❑ Yes _L;-No ❑ NA [] NE
❑ Yes "�o ❑ NA ❑ NE
❑ Yes FIT -No ❑ NA ❑ NE
❑ Yes 2-No ❑ NA [] NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
E'No
❑ NA
❑ NE
❑ Yes
E2*No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other,comments.
Use drawings'of facility,to better explain situations (use additional pa F9 as necessary).
to 06 a - r7 - P_( 1, ti 7
too() n as -/ L( �, q
WOO W6,P0
(ZGbS� °?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonc:
Date: l
1412LOI

Type of Visit: / C mpliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visa: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: ,
Farm Name: Owner Email:
Owner Name: 1 (nC f /I A -� /�(�(� _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region:(q9,-D
Onsite Representative: Integrator:
Certified Operator: &&Iadm M ene__, .__- Certification Number: g,
Back-up Operator:
Location of Farm:
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?
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)?
Certification Number:
Longitude:
ElYes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
[] NA ❑ NE
Page I of 3 21412011 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 FTNo ❑ 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): ,3�3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z 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? e
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 "El No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2�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 2fNo ❑ 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 ONo ❑ 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): + L,j 13
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VfNo ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Zj'No
❑ NA
❑ NE
❑ 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 gNo ❑ 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 Vj 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 21
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 21412011 Continued

Facility Number: ro Date of inspection:
2 Did the
j facility fail to calibrate waste applica�tio eguiuipme t as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. l�)L\i i ou o commpl once with pperrmit c�Cin lbns Te d to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. J). U' 1 �4, Ck,tkQ-
❑ 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 JC2'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes )ErNo ❑ 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 '4No
❑ 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 JZ yo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [Z No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations, or any other comments r
z.. " 'tm
Use`d'rawings'offocility to
Better explain situations(use additional
pages"as'necessary) d ='tf4Vi,
LO0© 1 `.7 r7 D—
— - 0 k eo>b C 4 5 j
G 5 - I
t_0n ©a 3 (0 S -,
- - I i 1 o c gq)
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0. $q(0� )
W©cD93i0!K,
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Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: gig I
Date: I U13
21412011

E Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 640002 Facility Status. Active Permit: ❑ Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Bate:
Reason for Visit: Routine County: Nash Region: Raleigh
Date of Visit: 11/27/2012 Entry Time: 10:30 AM Exit Time: 11:30 AM
Farm Name: Rose Poultry Farm
Owner: Rose Poultry Farm Inc
Incident #:
Owner Email:
Mailing Address: 2687 Old Bailey Hwy Nashville NC 27856
Irlt'm4--yet.
Physical Address: 3326 Taylors Store Rd Nashville NC 2785g _
Facility Status: 0 Compliant ❑ Not Compliant Integrator: Braswell Milling Company
Location of Farm:
Latitude:36°01'22" Longitude: 77°58'40"
Hwy. 58 north out of Nashville 1 mile turn left on State Road 1004. Go 3 miles sign on left of road reading Rose Poultry Farm.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Brandon G Moore
Secondary OIC(s):
Operator Certification Number: 21919
On -Site Representative(s): Name Title Phone
24 hour contact name Brandon Moore Phone:
Primary Inspector: Jane Bernard Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Page: 1

Permit: AWP640002 Owner - Facility: Rose Poultry Farm Inc Facility Number: 640002
Inspection Data: 11/27/2012 Inspection Type: Compliance Inspection Reason for Visit: Routine
Inspection Summary:
Labs are under Rose Poultry
Recommend the waste analysis pulled from the same area of the lagoon that the pump is drawing from. This will give the most
accurate PAN value applied.
Soil Analysis 11-28-11 SLO18483 ZINC 1537
1-6-11 SL026050 ZINC 2315
Next soil sample due in lab on or before 12-31-12.
Sludge survey 12-1-11 0=2.19 and P=3.61
Next sludge survey due on or before 12-31-12.
2011 Calibration based on manufacturers chart and design.
Next calibration due on or before 12-31-13.
2700 tons of calcium dried and removed from A & D farm and Rose Poultry- for soil amendment.
Started removal of calcium on 3-26-12.
Records were complete and organized.
Page: 2

Permit: AWP640002 Owner - Facility: Rose Poultry Farm Inc
Inspection Date: 11127/2012 Inspection Type: Compliance Inspection
Facility Number: 640002
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Wet Poultry
Wet Poultry - Layers 175,000 98,598
Total Design Capacity: 175,000
Total SSLW: 700,000
Waste Structures
Designed Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
agoon 1 33.00
Page: 3

Permit: AWP640002 Owner - Facility: Rose Poultry Farm Inc Facility Number: 640002
Inspection Date: 11127/2012 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. 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 observable 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
U
■
U U
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)
g. Does any part of the waste management system other than the waste structures require maintenance or
❑
■
❑ ❑
improvement?
Waste Application Yes
No
NA NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑ ❑
improvement?
11. Is there evidence of incorrect application? ❑ ■ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding? ❑
Hydraulic Overload? ❑
Frozen Ground? ❑
Heavy metals (Cu, Zn, etc)? ❑
Page: 4

Permit: AWP640002 Owner -Facility: Rose Poultry Farm Inc
Facility Number: 640002
Inspection Date: 1112712012 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Waste Application
Yes No NA NE
PAN?
❑
Is PAN n 10%/10 lbs.?
-
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge 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?
❑
E
❑ ❑
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?
1100
❑
If yes, check the appropriate box below.
WUP?
❑
Page: 5

Permit: AWP640002 Owner - Facility: Rose Poultry Farm Inc
Inspection Date: 11/27/2012 Inspection Type: Compliance Inspection
Records and Documents
Facility Number: 640002
Reason for Visit: Routine
Yes No NA NE
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
■ ❑ ❑
If yes, check the appropriate box below,
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
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?
❑
0013
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 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?
❑
■ ❑ ❑
Page: 6

Ui�i"siiinof Water Quality
Faeili#y Number ©- Q ; Divissioon of SoiF3n d Water Conservation
® Ottiler Agc,�cy
Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Q Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: _fyA5.LL Region:
Farm Name: ��o a�Q 79-A Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: 6M (\ d,dv'_) mcr,- �, Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Sim my 5 Lri TJ a.S F v F I I e a
Design Current
y�
Design
Current
Design Current
Swine Capacity Fop.
Wet Poultry
Capacity
Pop.
C►attle Capacity Pop.
Wean to Finish
La er
ibovid
Cl &S
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr.
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
keys
Othe
key Poults
Other JELLOther
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 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?
❑ Yeses a-Mo ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [—]No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
JDNo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

!Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J�J`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 ONo ❑ 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 1Vo ❑ 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 L2rNo ❑ 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 ❑ No ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes 0No ❑ 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?
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
acres determination'?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment'?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes
�o
[] NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes E2rNo
❑ 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 E;no
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F3*No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facilit Number: -0 Date of inspection. /
24, id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
$-Id>r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Fero ❑ NA ❑ NE
the appropriate box(es) below. , I - I I T
❑ 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:
❑ Yes
LZNo
❑ NA
❑ NE
❑ Yes
9rNo
❑ NA
❑ NE
❑ Yes
�no
❑ NA
❑ NE
[:]Yes VNo ❑ NA ❑ NE
❑ Yes No
[:]Yes P'No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
ONo
❑ 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 ZNo ❑ NA ❑ NE
Comments (r`efer.to question #): Explain any YES answers and/or any,additional recommendations-or:any. other coinmentk:y * g
Use<drawings of facility to better explain situations (use 'additional ages'its necessary).:
tuo0a(G1)q 10-
t' ott CC aa
15 o
5 ��r a-
01
do
Reviewer/Inspector Name: _7 G� >� e \'� _ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Permit: AWP640002 Owner - Facility: Rose Poultry Farm Inc
Inspection Date: 11/27/2012 Inspection Type: Compliance Inspection
Records and Documents
Facility Number: 640002
Reason for Visit: Routine
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification? ❑ ■ ❑ ❑
Other issues Yes
No
NA
NE
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report
❑
■
❑
❑
mortality rates that exceed normal rates?
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 regional DWQ of emergency situations as required by 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 1 Storage Pond
Other
If Other, please specify
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 on -site representative?
34. Does the facility require a follow-up visit by same agency?
Page: 7

- Division of Water Quality
Magin.mber - 0 Division of Soil and Water Conservation
© Other Age to
Type of Visit: of Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: SZ(Routine 0 Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: L %L Arrival Time: FIT-7 T7 Departure Time: /' County:
Farm Name: �c}(� PC, It y I l-eOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design murrent
Design Current
Design G*urrent
Swine Gapacity Pop.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
keys
Other
key Poults
Other
Othcr
Farrow to Wean
Farrow to Feeder
Dr, P.oultr.
Design Current
C•_a alit P,o
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gills
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation'?
❑Yes
Z No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other:
a. Was the conveyance man-made'?
❑Yes
E!fNo
❑ NA
❑ N$
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
❑Yes
ZNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? ([f yes, notify DWQ)
❑Yes
VTNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
PT -No
❑ NA
❑ NE,
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
La"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/20I1 Continued

Faciliti y Number: - L jDate of Inspection: 11112,117
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
.2]'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E�`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
Z 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
2rNo
❑ 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
EjNo
❑ NA
❑ 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
[7 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
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
allo
❑ 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
❑ Yes
J'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
Fe�o
❑ 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
�;_IrNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes 12�rNo
❑ 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 tail to install and maintain a rain gauge? ❑ Yes ZNo
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

jFacilfty Number: jDate 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 provide documentation of an actively certified operator in charge?
❑ Yes
Fe T o
❑ NA ❑ NE
2T 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
�2 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
12'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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;a No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ER'No
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency'?
❑ Yes
PNo
❑ NA
0 NE
Comments (refer to,question #) Explain any YESanswersand/or anyfadditionalFrecor�i$imendatitihs oriany
o'thcr commeuts
Use drawings of facilit to better eat lath.situatlois" use additional a es'ris-necessar �
f —C- I I
�--i7 rl
—
err=/l
I G-
?c-lI
Reviewer/Inspector Name
Reviewer/Inspector Signature
Page 3 of 3
Phone: ?/7 722/,- 5°Z Co
Date: /2 IZ / /
21412011

Division of Water Quality
rlim Ker r Y Z Division of Soil and Water Conservation
� Other Agency
Type of Visit �Compiiance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %— / Y/ Arrival
Time: Departure Time: County:
Farm Name: GyiQ _. �/�N�✓ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator:
Alil l
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 0 6 Longitude: = ° = 1 = 1{
Design Current Design Current Design Current
Swine t►opacity Population Wet Poultry Capacity Population Cattle Cap itzy Population
❑ an to Finish
❑ Layer I
1
❑ Dairy Cow
❑ an to Feeder
❑Nan -La Non -Layer
❑Dai Calf
❑ Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ La ers �� U ❑ Beef Stocker
❑ Gilts ❑Non -La ers ❑ Beef Feeder
❑ Boars ❑Pullets
❑Beef Brood Cow
❑ Turke s
Outer ❑ Turkey Poults
❑ Other JO Other INumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ZNo
❑ Yes
�eNo
❑ NA
❑ NE
❑ Yes
d No
❑ NA
❑ NE
12128104 Continued

Facility Number: Z Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZrNo
❑ 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): 3' 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Zf 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
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,_,{oNo
LI 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
ONo
❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;;`No
❑ NA ❑ NE
maintenance/improvement'?
It. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
[:1 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
g]"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
eKNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2(No
❑ NA
❑ NE
Commen7ts(r�}efer�,to��questto�n,#)��Explain�any`YES�ans�wrers�andlor anyrecnmmendatlons orany other comments' � �,
Use drawingffacility�tobetter,�explatn situations. {ase;addttional pages�as necessary,):
Reviewer/Inspector Name ��,,;;,,o,.f '� Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

r
iF'acility Number: ry— Z Date of Inspection T-7rr ,
77
Required Records &D_ocuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P'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 PNo ❑ 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?
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
ZNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
)ZNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
;2rNo
❑ NA
❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ['No ❑ NA ❑ NE
❑ Yes
rP No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
it o al Comrt'ents andlor Dra_win s•WIN
�a�r/r✓� 1� ��
�
��aP f, scary 7d /p
Page 3 of 3 12128104

•
�"bivision of Water Quality
%WC111ty Number 1 _ ` Z O Division of Soil and Water Conservation
Other AgSncyffl
Type of Visit Q-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CYRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: i"� —/G Arrival Time: Departure Time: %? C County: ka
Farm Name: IIaIP Owner Email:
Owner Name:
Mailing Address:
Physical Address: Facility Contact: KJ- /r4r0 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 107e
�Longitude: =0=6
Design C►urrent
Design Current
Design C*urrent
Swine C►apacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
G
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
ElNon-Layers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
El Pullets
El Beef Brood Cow
❑ Turkeys
Other.
❑ Other
❑ Turkey Poults
ther
Number of Structures:
Discharees & 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 ,3 No ❑ NA ❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Z[No
❑ Yes
RfNo
❑ NA
❑ NE
❑ Yes
m No
❑ NA
❑ NE
12128104 Continued

,l Facility Dumber: Y —�
Date of Inspection - /G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes )21'N o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �TNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2 2 �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes �2r`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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O'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 ;Er -No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'FTNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S� , �}
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 2"`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 ,�fNo ❑ NA ❑ NE
:Comments (refer to quesflon #) Explain any YESSanswees and/or an'y reeommendation! hlhy other commentsffi a ,,.,
?Use drawings ofrfaul ty to'tie``tter a rplain situatjons:'(use.additional pages as necessary):' g s q `Cg 5 ,
TReK ",d,ii .•1_s; � t... `',� �:�ra-> i _7 .1<=e�.,'�'e ?k r,_k:"> ' "2 .1�� :m �ii S �' i144t5�
Reviewer/Inspector Name S�f�Q��e �ij '�E� Phone: /1l' 79/` P2C�
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Fe:�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes j2NNo ❑ 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
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Fe_ -No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JET -No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E:rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
ONo
❑ 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? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[!No
❑ NA
Cl NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
bNo
❑ NA
❑ NE
A�ildili nal Conrtiuents andl�or Dings:
12128104
12128104

Facility Number
BDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
3`l11 i q?
(Type of Visit (5 Co lance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance j
Reason for Visit Routine 0 Complaint O Follow up O Referral o Emergency Q Other ❑ Denied Access I
Date of Visit: 94�m Arrival Time: 1112, n I Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: & rT�y C~ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = 6 = Longitude: = ° 0 g ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ .Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ utts
:Other :.
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
BDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
3`l11 i q?
(Type of Visit (5 Co lance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance j
Reason for Visit Routine 0 Complaint O Follow up O Referral o Emergency Q Other ❑ Denied Access I
Date of Visit: 94�m Arrival Time: 1112, n I Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: & rT�y C~ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = 6 = Longitude: = ° 0 g ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ .Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ utts
:Other :.
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ 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
Cattle CapacityPopulation'l.
❑
Daia Cow.
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes <O ❑ NA ❑ NE
❑ Yes ��o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
12128104 Continued

Fac'slky 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? ElYes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No NA ❑ NE
(ic/ 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 thr , notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes No NA El 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 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) 4'`4,
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
El Yes
NA
rNo
❑ NE
18.
Is there a lack of properly operating waste application equipment'?
❑ Yes
NA
❑ NE
Comments (refer to question fl: 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 4, e Phone- 7�J'/- 4(2-0,D
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — p Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No "NA El
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ eather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA El NE
24, Did the facility fail to calibrate waste application equipment as required by the permit'? El Yes � ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes V NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes rNo
NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

t
Division of Water Quality
Facility Number _ 0 Division of Soil and Water Conservation
0 Other Agency
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 ❑ Denied Access
Date of Visit: Arrival "rime: I Departure Time: County:
Farm Name: Jam" S-e ro I. 110 -t _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _6" A 11 cit��i✓t d L'i,�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Integrator:
Region:
Phone No:
Operator Certification Number:
Back-up Certification Number:
0
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
La er ' e r
Y
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ 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?
Longitude:
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes L2'No ❑ NA ❑ NE
❑ Yes .2 No •❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑,NA ElNE
z
[:]Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

'1
Facility Number: "f"I — ''L 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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNo NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElYes 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 thre , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 statics 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 El 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)
5
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes pl� ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
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? El Yes ❑ NA ❑ NE
A
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft 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):
ReviewerAnspector Name Phone:
ReviewerAnspector Signature: . Date:
12128104 Continued

Facility Number: & — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 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 appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �-'<NNEINA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7NQ,'[:]
❑ NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes
NA El NE
26. Did the facility fail to have an actively certified operator in charge? El YesNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[]No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

46
0
L
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ZT Arrival Time: Departure Time: County:
Farm Name: ��t _P104 / 17le Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:--6/AhJrj"
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = I = 11 Longitude: = ° = � a
Design CUT. e n t
Design Current DesiIffilswine
urrent Capacity Population Wet Poultry Capacity Population Cattle Capapulation
❑ Wean to Finish
10 Layer
ai Cow
❑ Wean to Feeder
❑ Non -Layer
ai Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -La ers
❑ Pullets
❑ Boars u
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
ED ai hleifer
Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Number ofiiii ructures:
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA
❑ NE
❑ Yes NA
El
El Yes:�o ❑ NA
❑ NE
❑ Yes NA
ElNE
Yes;Z?Nj
❑NA
❑NE
❑ Yes ❑ No ❑ NA
❑ NE
12128104 Continued

Facility Number: — '-- Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
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): l/
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes NWo
❑ NA ❑ NE
El Yes❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental thre , notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes NoO 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 El Yes NA [IN I,
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 E2 <oONA ❑ 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 ❑rlo/❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
�N ❑ NA ❑ NE
VN9��No
V ❑ NA [INE
❑NA El
❑ NA ❑ NE
.Comments (refer to question #): Explain any, YES „answers and/or -any recommendations oraany other, comments
Use drawings of facility to better explain situations.. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number:&'4/ Date of Inspection i' 7
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 appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ g Other
p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain InspectioZNNNNEl
eather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
��NEEJNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency'?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/2"4

A
E2
(Type of Visit nce 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: �r Arrival Time. �t/ it U Departure Time: � County:
Farm Name: d'�Owner Entail:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Certified Operator: i/ '1 M 'e"'
Q
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No. -
Integrator:
operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 O Ell
= {1 Longitude: ❑ o = , =
Design Current Design Current
Capacity Population We sultry Capacity Population
Layer __F
�sDac
J JEI Non -Layer
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
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf'
❑
Dairy Heifci
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system? (I f 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 0<0 ❑ NA ❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
NA
❑NE
❑Yes
❑ Yes
ZoElNA
[INE
Yes
;No ❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection r 17!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
O 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): 3 D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej`No []NA
❑ NE
(ic/ 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 thre -,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes:N>o
NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ 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
12. Crop type(s) �� r Le ��. d�"�l f'ni ✓3 t f
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ef?❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&N/O-/
❑ NA
❑ NE
Reviewer/Inspector Name "`¢, f�':� Phone:
Reviewer/Inspector Signature: j t'� .e Date: DS^
12128104 Continued

r . . k
Facility Number: Date of Inspection o�
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes Zf 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 ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
No • ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L�J N ❑ NA
El
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
❑ NA
�No
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP7
❑ Yes
dNo ❑ 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
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Addrtio'ua1 CoinmentsandlorDrawitigs , S .
k ter°
_ ONO
12128104

of Visit A Comt;lWhice Inspection O Operation Review O Lagoon Evaluation
Reason for Visit '0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
F t ity Number Hate of Visit: .30 0 Time: C� a
Q Not Operational Q Below Threshold
Permitted [3 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName: ............`.r...1.`1............................................................ County:...................................................................................
Owner Name: ............ .� �... .........r?� .&-e ........................................................... Phone No:.......................
Mailing Address:
Facility Contact:
Title:
Onsite Representative; ,.....................................................................
Certified Operator:,,,1�,,,,?"'9 h ` -0 � -C'
.................................... /� �
.............................
Location of Farm:
,,,, Phone No:
Integrator:........A9..................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Ladtude • d 64 Longitude • 4 44
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 gaUmin?
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
❑ Yes No
El Yes No
❑ Yes ZNo
❑ Yes o
❑ Yes o
❑ Yes0 o
Structure
Identifier:
Freeboard (inches)
12/I2103
Continued

[]Facility dumber: & - Date of Inspection 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
J2. o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
ZNo
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
Waste Application
r'
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
rPAN
12. Crop type 1 e 'g Y f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�No
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
.Comments {refer,.to uesttoa,#).Explaua airy YES; answers and/or any recommendattoas ar any other comments31
�'" e5.;k.§-IES°r,3a:x:i;f,p,;EaS'r�l.,[s,ety�i�e68.�ti!'.�44"�N{5�- s� ��.•rel.�:.i� {G ."!s.°�ifVFvE a{ii�,{'Jl.<$a ztk�„sJ,FYi"k #ili W.4 i!���.,,$i .DES§.Iiv:?i.i El.,'1r ti.i,.,&.E .M.. r.t,::i�.:.: .. �.tti ,,wSLr.-F sk::illisEaG,si-ha �i i��
;,Use drawtngs'of facility totbetter$rezplarn'sitiiat,oans (nse'addihonal'pages'as necessary?• ! ❑Field Copy ❑ Final Notes „4 .
: t !; s-!, "p..S. E..., ..i3s.:f edBr. •�1'f "vi:E Eif �- 4 �.il: ast r-i.:! j'.t 't "��;s4 3 SE
€' � _ _.', , ?�:�'°�s! e ,,3,�3 .,, ,-s$, ;, .;t9 R' ¢....E, �,ry e ;r3S._o$ r ;i�1 r�<„ §a.sr§ a ,�§€e : €,€ s slEE it..3..,> >,,,. S i� .t• . �t'i s .€, ,� E, ,,. �s ,.,,:..,�;�:... . .....:.. . ..........
�! ,,, . >$.€. s ���$ �r�,i� s r�,..t+, �..?t3�i s; �� ,s �;t t r s � .€?}� ,� ;., B � , ¢j, s gI .:�i[ { t �E a i ,!s a,(_s.a=ta€<. E.[.,s lo�.c<€ > �; xS i � � p € , i
a=r,,,.!",,.,.rxi.,,,..�,.,,..iT._99,.zsE»�.�.,..E.,��..�5..�.,.,3�.�6�.tip,�_3.,P61€�u,,._'9..�¢,€.a;tiai�,�4a�s�.'x§:r-�,.l�ii;«;a:�ct.,.�si,.t.�:a.._iiiE,....�la[.,. ,_..s.,,�.t..,a;�,1�`6z,u. .a:�,.36_n€,�ai,..,,..
7
vm r i)NPT § s�IT al } T' E
Reviewer/InspectorName�i
Reviewer/Inspector Signature: Date:
12112103 Continued

FacilityVumber: (y — p `
Date of Inspection `D&07/ �or
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPI)ES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes o
❑ Yes
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes N
❑ Yes N
❑ Yes No
❑ Yes o
�YesEj No
El Yes N
❑ Yes�No�,�
❑ Yes
❑ Yes
❑ Yes No
12112103

f � �
Type of Visit O Co iance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Number Date of Visit: Time:rO
"
Not Orierational 0 Below Threshold
Permitted 0 Certified D Condditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: PO j®1Je�J�T� �. County:
V Owner Name: a ✓r� �+ J201—'— Phone No:
Mailing Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: 19r.9 n
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude 0 4 14
77
Ir
Swine Ca aci
.Po 'Mahon-;
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
""Design Current
Cinacity Pnnulation�"�Ci
s, Number"of rLagoon5 j ❑Subsurface Drains Present ❑ La oan Area ❑ S ra Field Area
Holdrng;PondslSolid:Traps ❑ No Liquid Waste Management S stem
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? (Ifyes, 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 ollection & 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): n�
05103101
❑ Yes No
El Yes U<
El Yes IQN0 ,-
❑ Yes
❑ Yes
❑ Yes
❑ Yev"❑ No
Structure b
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc,)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 01 �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? ❑ YesVNo
8. Does an art of the waste management system other than waste structures require maintenance/im rovement? ❑ Yes
YP g Y q P
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes�XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 7No
"
11. Is there evidence of over application? El Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes
12. Crop type Aerli Gto1.!;L , .%h'79 z7g,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
4
14. a) Does the facility lack adequate acreage for land application?
ElYes
N
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
,
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
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?
❑ Yes
NN
(ie/ discharge, freeboard problems, over application)
23. Did Revicwcr/lns ector fail to discuss review/ins cction with on -site representative?
P P P
El Yes
LdN
24. Does facility require a follow-up visit by same agency?
❑ Yes
N
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 visi .
..r • }
�CmmeniNrefer to question #) E plaii an YES answers�and/or.any recommendatijns:or,any other:camments..
U_ se:drawings of facility to better explain- situations.,(use additional pages.as neces` = Y ❑ Field Copy Final Notes
' s..x�..., �� 9ary
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: i
05103101
Continued

Type of Visit aCom ' nce Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit jerRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
ility Number bate of Visit: [
0 Permit/te_d [3 Certified 0 Conditionally Certified [3 Registered
Farm Name: t) u I t
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: may,
Certified Operator:
Location of Farm:
rime:
rO Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County:
Phone No:
Phone No:
Integrator: __3'-] 5-yc J
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 16 Longitude 0 G 11
Design Current ,Design Current Design Current.
Swine Capacity. Population"' Pou t y Ca aci Population Cattle tip acity Population '
❑ Wean to Feeder I La er -7 o D ❑ Dairy
❑ Feeder to Finish JLJNon-Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity I
❑ Gilts
❑ Boars "Total SSLW"
Number oflaagootis ❑ Subsurface Drains Present ❑ Lagoon oon Area ❑ Spray Field Are r
- ---- -
Holdtn " Pondsi7'Soltd Tra ��
g p ❑ No Liquid Waste Management System
Discharges 8z tream Impacts
I. 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): Ih ti
05103101
❑ Yes
❑ Yes �No
❑ Yes No
❑ Yes VNo
❑ Yes
El Yes o
❑ Yes No
Structure 6
Continued

Facility Number: — b -T Date of Inspection 3 ► 0
5. 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? El Yes a
(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? Cl Yes o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes r No
Waste Aunlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes TNo
12. Crop type d ec — --4 4, Sm �, ✓r�r �'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Re wired Records & Documents
17 Fail to have Certificate of C r & G I P 't th P 't d'I '1 bl
❑ Yes
❑ Yes v3el-I
❑ Yes
❑ Yes
❑ YesVNo
❑ Yes
ove age cnera ermE or o er ermt rea i y avat a e. ❑Yes N
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) El;N_',�
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 o
21. Did the facility fail to have a actively certified operator in charge? ElYes o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ElYes No
24. Does facility require a follow-up visit by same agency? ❑ Yes §No
o
p
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments ("refer to giyestion #) Explain any 7�ESia'n.swers and/or, anyrecommendations or any,ather caw eats.
Use tirawin s.of facility Eo be a�� El Field Cop
� g y fitter explain situations. (use additionalpuges as.necr nary)�
Copy
❑ Final Notes
f�
ReviewerlInspector Name .e,..
Reviewer/Inspector Signature:
05103101
Date: 3 P z_
Continued

Facility Number: (0 2— Date of Inspection Z
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 hlade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes jErNo
❑ Yes No
❑ Yes 2 No
❑ Yes o
❑ Yes
❑ Yes N
❑ Yes No
05103101

+� I �_,4Sa 1 °, 7t.: � .; �tj,Ct„1 1 i �r y:rr h 11 h -,�
to $fvislo�ioWiltplr-(Ilaffty�Stuff �> h
t: 1� T `S �` , '� 1
lAslon gf %i and Water, Lf� atlon
rr
Qr ay'.
f,t
a. '" 7 ct. , ! � a. E � `� �-:a k �I �� � a 1, y��'4. � F E ��°' ��3 �i °� r, i`ty�.. `e{ ke yf -';•9 tF C �?� E .1
x,.a,.:r•' ». _ �� �• •. r�.;�E. �� .%asr, �'..•��. +,�.� F �_.,,- t• m. irq•.€•.'[ ..z �x..,:o �r-;§_'_-. ,�! r ik. ���,N� i?i. u�?'�t�. a:... y-x_..,� ...
Type o�Visit ocomplia Inspection O Operation Review Q Lagoon Evaluation
�V.1 l
Reason for Visit O utine O Complaint O Fallow up Q Emergency Notification O Other ❑ Denied Access
Facility Number t Date of Visit: Time:
Q Not Operational Q Below Threshold
Permitted [3 Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold:
FarmName: .... .�(rr'.... a. k..I .................................................................. County:.....................................................................................
OwnerName:.... anv..,..4?t............+.4............................................................. Phone No:.......................................................................................
FacilityContact: .................................. ............................................Title:................................................................ Phone No:...................................................
MailingAddress: ...............rr........................1................................................................................................................................................................... ..........................
Onsite Representative:. i..... ea- t ..:9^.......... ^SC��1�.'C� ... Integrator:......................................................................................
Certified Operator:,,,,,,'✓ tr, "Q' ...... Operator Certification Number: .........................................
...............`-�,011-N ..........!^...............................................
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �+� Longitude • ���«
Swine
Design Current
Cannrity Ponulation
We
❑ an to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
a Numberr of Lagoons
. Holdin ?finds / Sohd'Traps
'Design Current Destgn ur
Poultry ` C
-------Capacity Population CattleCaacPo ule yer p ❑ Dairy
TO Non -Layer ❑ Non -Dairy
❑ Other ,F
3 � 1[•.
Total D 'S' jgfi"Capaclty
Total SkW'
❑ Subsurface Drains Present
❑ No Liquid Waste Managen
Dischliraes & 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?
Area Ill Spray Field Area
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)
N
❑ Yes o
❑ Yes o
❑ Yes o /
❑ Yes
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? [I Yes o
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ N
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier..............................................................................................................................................
Freeboard (inches):
5/00
Continued on back
a Numberr of Lagoons
. Holdin ?finds / Sohd'Traps
'Design Current Destgn ur
Poultry ` C
-------Capacity Population CattleCaacPo ule yer p ❑ Dairy
TO Non -Layer ❑ Non -Dairy
❑ Other ,F
3 � 1[•.
Total D 'S' jgfi"Capaclty
Total SkW'
❑ Subsurface Drains Present
❑ No Liquid Waste Managen
Dischliraes & 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?
Area Ill Spray Field Area
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)
N
❑ Yes o
❑ Yes o
❑ Yes o /
❑ Yes
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? [I Yes o
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ N
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier..............................................................................................................................................
Freeboard (inches):
5/00
Continued on back

)f~acility44umber: ! — Date of Inspection Printed on: 1/9/2001
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 maintenance/improvement?
11. Is there evidence of over application? . ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Document.,
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?
�'YiQlg i(jI145.0�' dtfi£k»ctes ftre �i ed- ¢>srr'iog 00s'v}sjt; • Yoo jll •teboiVo 46 illI'tho .
coriesootidence. about: this :visit: .....::.....::.....:......:........ .
❑ Yes.. wo
❑ Yes 041O
_�
ZYes NoN
❑ Yes
❑ Yes o
❑ Yes No
❑ Yes
❑ Yes
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes � o
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes N
❑ Yes No
❑ Yes o
ElYes ❑

acilit? Number: — a 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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'?
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover'?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
❑ Yes ,2-110 -
❑ Yes
❑ Yes o
❑ Yes No
❑ Yes 7,
❑Yes ❑N0�/
1;�Luamonai commentsancuor prawings:, �F" .' ` � , ;'�3° E `''�` �.'. '.�j�:
5/00

tfon �Operation�rReview � "t��*'
1,077 =yCompGgnce*Inspection
c,�t;.✓r Jt;'r .T"r.u` ,,. -..- a..,x,
�OtherrAgency Operation Renew
121outine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Faci ' umber Z Date of Inspection
Time of Inspection 0 3 a 24 hr. (hh:mm)
'r pitted Q Certified Q[3 Conditionally Certified r] Registered Not O erational Date Last Operated:
Farm Name: .... ��... i! r?�t1?1e.` ...... ...... County:..���............................................................
............. .. .................. .............................. ...........
Owner Name......... I v.r... ........ -............................................................. PhoneNo:..Z�Iz....-.... _5 ... ..�60.Q.......................
FacilityContact: ....... �A...:' . .e .................................................... Title:................................................................ Phone No:...................................................
Mailing Address: 4.(e'o... h .... v.....
'I�C.. ,>............................................................ ..........................
Onsite Representative: ...............Integrator:..I.��..��5'�/ 1 ............................................................................................ ............................................................
Certified Operator:....Dez�...... .......................... I............................ Operator Certification Number:..........................................
Location of Farm:
I&
....... .... .. .......................................................... ,r.
Latitude =-=, ='[ Longitude =• =_ «
Di stgn ` Carrent r
Dersig't► , , I R; DeBgn ,; Current
$wtne Ca Y Po
.
Pou
PCurrent
E
Ca 3„ o Cattle fit. E C "Po",ulat<on ''r.
act ulahon, ;
U4,61 n;
aci e:jp
❑ Dairy
�° '
❑Non -Dairy
Total=De'sign{Capacity, ;
li
..Total SSLW ik
Subsurface Drains Present
Lagoon Area
❑Spray Field Areat€„
P t{- S k� f i�oldtn PondsJSohd Tra s
El�
❑ No
Liquid Waste Management System
•'� i;, d , _ 'fW. r+ 1°�
�,,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑Boars
Layer
❑ Non -Layer
❑ Other
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 ycs, 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): .......161.1.................................................. ............. I......................
.........................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes
❑ Yes
-
❑ Yes
❑ Yes No
❑ Yes
❑ Yes �
❑ Yes No
Structure 6
................................
❑ Yes o
Continued on back

Facility Number: � — Z Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes o
❑ Yes N
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes No
12. Crop type S'
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N
b) Does the facility need a wettable acre determination? ❑ Yes N
c) This facility is pended for a wettable acre determination? ❑ Yes N
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes <Noo
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 N
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 N
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
23. Did Reviewer/Inspe r fail [o discuss review/inspection with on -site representative? ❑YesPNo
24. Does facili equire a follow-up visit by same agency? ❑Yes
25. We r any additional problems noted which cause noncompliance of the Certified AWMP? El Yes
��1o�yiula�iQris o� d�fcie'ncie� �rv�re pQt:e�i• il�l'ir�g ���s:v�sit; • :Y:o�x wi��•>ree�iye t#o #'uj-t�l�r.
. • coriesporicieRce: about this visit: •.......:.:.:.................:.... .

Facility Number: S —p Z Date of Inspection S 2
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes N
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent temporary cover? ❑Yes o
,&1
119-? �/6i

t € 03Drvts' '' of Soil auil Water` C
0onservation O ►eration Review E `
':. ►sign of Soil and Water Conservation - Compliance Inspection
DiAsion.of Water Quality - Compliance Inspection t
13 Other Agency - Operation Review
outine O Com laint O Follow-u) of 1)\V ins )ection O hollow-u p of I)SWC review O Other
facility Numbe►, Date of Inspection
•I•inre of inspection 0 24 hr. (hh:mm)
ermitted [3 Certified [3Conditionally Certified [3 Registered p Not Opera Date Last Operated: •••„•.....•••.•••.
FarmName: ....0 ....rrl�lrh� /7.� �-............................................................. County :.!.5......... :........................... ..... ..................
OwnerName:... t�•Lv.••••• D6.V.....5:..--..............................................I..................... Phone No:.• ....~..Y.s.....-7..4�6..0 ..........................
Facility Contact:?................... ........................'l�itle:............................. Phone No:...................................................
Mailing; Address: Z •�Y r e`� ........... `),/J ,f........ �70`)
Win. .....(.... . ins:...... .... ................................I......................
Onsite Kcpresentatiye: .... integrator: { ,(:. we ll...y'.!r............
Certified Operator: ...... V..gf r.................................. Operator Certification Num}per:..........................................
Location of Farm:
.......................................................................................................................................................................................................................................................................I -
......................................................................................................................................................................................................................................................................... .
Latitude Longitude �• �� °�
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
12'rayer Z` t7D OF,
❑ Non -Lay r ❑ Nun -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Suhsurface Drains Present ❑ Lagoon Area 10 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 ycs, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ruin-niade?
h. I1 discharge is observed. did it reach: ❑ Surface Waters [:]Waters of the State
c, If discharge is observed. what is the estimated flow in aal/min?
d. Docs discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part ofthe operation?
3. Were there any adverse impacts to the waters of the State other than from it discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate'?
❑ Ycs E o
❑ Yes PNo�
❑ Yes
❑ Yes No
[] Yes ��No
❑ Yes
❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........ ;
1/6/99 1 Continued on back

Facility Nunifler: / — p Datc of Inspection ,
5. Are there any immediate threats to the integrity of any of the structures observed'? (ic/ trees, severe erosion, /El Yes 0 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
8, Does any pail of the waste management system other than waste structures require maintenance/improvement? ❑ Yes rXN,
9. Do any stuctures lack adequate, gauged markers with required top ol'dike, maximum and rninintum
liquid level elevation markings? ❑ Yes , /No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen eOO' bie SGC G �e-4s []Yes No
12. Croptype J �f!r.!Q!!!.S. rBsltt- ......................... ......................................*..............
..................
........
................
....
......
................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Managcment Plan (CAWMP)? El Yes o
14. Does the facility lack wettable acreage for land application? (footprint) es ❑ No
15. Does the receiving crop need improvement`? El Yes No
16. Is there a lack of adequate waste application equipment'? ❑ Yes
Required Records & Docuinents /
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes (d�'N/o
18. Does the facility fail to have all componcnls of the Certified Animal Waste Management Plan readily available?�
(ie/ WUP, checklists, design, maps, etc.) ❑Yes o
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
21. Did the facility fail to have a certified operator- in responsible charge? ❑ Yes 0
22. Fail to notify regional DWQ of emergency situations as required by General Permit? /
(ie4 discharge, freeboard problems, over application) El Yes 211O
23. Did Reviewer/Inspector rail to discuss review/inspection with on -site representative? ❑ Yes No/
24. Does facility require a follow-up visit by same agency? ❑ Yes
113- lVo:vialattons.or: der..... .were noted: during,this.visii . Y_ou wi7l.re�ceive no further .:.
eorresporideiiee: t;:bout: this :visit.; • ; • : • : :: .. :::
Comments'(refer to question #): Explain any YES answers and/or any recommendations on any other cominents.
Use dra'wingsgof facility to:better explain situations. (use additional pages as necessary):
�1 41 wis Io 6e. r-Iigel r-v, bras,
4 re c 10 y 6V'j't" ' d j a 5: ' PI C�c.�-{.
T'Ie,-c t hn rcGo��.r s�ac,1 finhd 1�1 (_�c.,�.�►-
Ipp
Y
r CCCrr'jJ✓ G
f ('t_ k"n1le CV../j /Irfs.file' rerr..lT -7r
1 /6/99

JUSTIFICATION & DOCUMENTATION
Facility Number- D 2--
Farm Name: ,t
On -Site Representative: 7
Inspector/Reviewer's Name:���
Date of site visit:��1
Date of most recent WUP:
Revised January 22, 1999
FOR MANDATORY WA DETERMINATION
<- g9►
Operation is'fla ed for a wettable
acre determination due to failure of
Part11 eligibility items) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Annual farm PAN deficit: -3.2 7 'z- pounds
Irrigation System(s) - circle - . hard -hose traveler; . center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part l exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D21D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part ill).
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 111.

Revised January 22, 1999
Facility Number
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER' z
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
3 �"7 �
�
<< l �
a• -3 b
1- a
7
3
7 2
�
J5
S -3
39)?7
r
`' ''
���7
'20.9
9
2-
rr,
�0 it f
7.7
7 6
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER' - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

State of North Carolina
Department of Environment,
Health and Natural Resources •
Raleigh Regional Office Aa
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary [DaHNF;Z
DIVISION OF WATER QUALITY
February 28, 1997
Mr. David Rose
2640 Old Bailey Road
Nashville, North Carolina 27856
Subject: Compliance Evaluation Inspection
Facility # 64-02
Rose Poultry Farm
Nash County
Dear Mr. Rose:
On February 19, 1997, Mr. Buster Towell from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. This inspection is part of the Division's efforts to
determine compliance with the State's animal waste nondischarge
rules.
The inspection determined that the poultry operation was not
discharging wastewater into waters of the State and that the waste
lagoon had the required amount of freeboard. As a result of'the
inspection, the facility was found to be in compliance with the
State's animal nondischarge regulations.
Effective wastewater treatment and facility maintenance are an
important responsibility of all animal waste producers. The
Division of Water Quality has the responsibility to enforce water
quality regulations in order to protect the natural resources of
the State. Accordingly, illegal discharges of wastewater to
surface waters of the State are subject to the assessment of civil
penalties and may also result in the loss of deemed permitted
status, requiring immediate submission of a waste management plan.
This office would also like to take this opportunity to remind you
that,you are required to have an approved animal waste management
plan by December 31, 1997. This plan must be certified by a
designated technical specialist or a 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.
3800 Barrett Drive, Suite 101, �� FAX [phone]
Raleigh, North Carolina 27609 �
Nif Equal An E Opportunity Affirmative Action Employer
Voice 919-571-4700 50% recycled/10% post -consumer paper

David Rose
page 2
The General Assembly recently passed Senate Bill 1217 which will
require all animal waste management systems to designate an
"Operator in Charge". It shall be the responsibility 'of this
individual to oversee the operation and maintenance of the animal
waste management system and to have control over waste application
activities. Currently classes are being held for operators of
swine facilities and training is being developed specifically to
address dairy and liquid poultry operations. For more information
please contact either your local Soil and Water Conservation
District of Cooperative Extension Service Office.
The Raleigh Regional Office appreciates your cooperation in this
matter. If you have any questions regarding this inspection please
call Mr. Buster Towels at [phone].
Sincerely, `�— I-
1:
tLett
A W,:oJ
Water Quality Section Supervisor
cc: Nash County Health Department
Mr. Terry Best, Nash Soil and Water Conservation District
Mr. Steve Bennett, Regional Coordinator, DSWC-RRO
DWQ Compliance Group
RRO Files

aclUTnot in compliance with any applicable setback criteria?
Jid the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
�. Are there lagoons or storage ponds on site which need to be properly closed?
SMUctures a oohs and/or Holdin Ponds
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon i Lagoon 2 Lagoon3- .
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?.p,A_ f
Waste ApRUcation U`" sf►abi�J� ��� �yr�erlf�,-.f
14. Is there physical evidence of over application? ~
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes i] No
❑ Yes Ll \ u
❑ Yes No
❑ Yes OlNo
Lagoon 4
❑ Yes dNO
❑ Yes No
❑ Yes 21N
15. Crop type �� s�.�� _ _..._.....r » .. _. ,M..r...... B
16. Do the active crops differ with those designated in the Animal Waste Management Plan?,1 o 14/4,., y e
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 Onlv
24. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
2I. 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 ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes <0
❑ Yes p'No .
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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 additio'iW'Fages as necessary) u "
Reviewer/Inspector
Name G� :. z �'� •�
Reviwer/Inspector Signature: Date: Z — -- Jn
ee. r w ,.. !1„nlih. W l.. rlunliwo C.rrina Fnriiiry Atte[SAlent Unit 11/14/96
Reviewer/Inspector
Name G� :. z �'� •�
Reviwer/Inspector Signature: Date: Z — -- Jn
ee. r w ,.. !1„nlih. W l.. rlunliwo C.rrina Fnriiiry Atte[SAlent Unit 11/14/96

Date of Inspection
Facility Number �--- Time of Inspection Use 24 hr. time
Farm Status:
Total Time,(in hours) Spent onRoiex
or Inspectioo,.(inclddes travel and processing)
Farm Name: -D�CC r9'" ff�`'_ County:
Owner Name: 1 I �! _ Phone No: -j
2��k0 f
Mailing Address: d �► �� ����,��,.� C� 2- 4�.,,._ ..
Onsite representative: QQ Integrator: ..� .._
, Certified Operator Name:
Location of Farm:
Latitude Longitude
[� Not Operational Date Last Operated: _ �._...,—,_
Type of Operation and Design Capacity
Swine. # Nuaeberf'} Poul :.: Number `:" Cattle Number
.._
❑ Wean to Feeder er (oo d Da•
s::'
❑ Feeder to Finish h Non -Layer (] Beef
Farrow to Wean ,
Farrow to Feeder
'laFarrow to Finish 1 ❑ Other Type of Livestock
Number o1<Lagoons /Halding Ponds,. Subsurface Drains Presen
`� �t � x✓�, t r4Y� °�a-`5. ate~ �' y, *"� "�' �� X .„x;• ° {a � � -_'"^ ✓ �
©La OOa Area S rav Field Area
c�
Gtaeral
1. Are there any buffers that need maintenaace/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes l�o
a. If discharge is observed, was the conveyance man-made? ❑ Yes IG nQ
b. If discharge is observed, did it reach Surface Water? Of yes, notify DWQ) ❑ Yes � 0
c. If discharge is observed, what is the estimated flow in gai/min?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ}
[J yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes o
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes o
maintenance/improvement?
Continued on back

Facility Number
❑ Applied for Permit
❑ Permitted
❑ Not Operational Date Last Operated: ........................................................................................................................
Farm Name:.,P'k<_ ®off: I ]jo1....................
_.........................
_........................
. County:......hIAS �' .....................
pal ..
Land Owner Nante:......... � t.......�.............................................................................. Phone No:..........................................................
Facility Conctact:....... _li!!.!.. ........5...................... Title:................................................ Phone No: .
Mailing Address: ..1�..112... v_Ld.!���a.�J�........(4.wr�l..................:v�pO.......2-7._SS6/..........................................
Onsite Representative:.. t!..'._ ...../".!.ST .............................................................. Integrator: ... l,1. ... k e.l............................................
Certified Operator:........ �?....�P......... `.'..7..rP�................................................. Operator Certification Number: ..................................... _..,
Location of Farm:
Latitude =• =' =" Longitude =• =' =R
cenerai
1. Are there any buffers that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97
maintenance/improvement?
❑ Yes NO
❑ Yes 0
❑ Yes No
❑ Yes o
❑ Yes ErN
❑ Yes
❑ Yes
❑ Yes o
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes , 'o
Structures (Lagoons,llolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes �11)
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): L? '
10. Is seepage observed from any of the strictures? ❑ Yes ,'o
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes hn
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximun) liquid level markers?
Waste .application
t4. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...6WWM,!^.. ! r. eu^ lr. .f ........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
I7. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
1.9. 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 oa-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 AW,MP?
25. We'any additional problems noted which cause noncompliance of the Permit'?
❑ Yes Ni)
❑ Yes INO
...................................................
❑ Yes No
❑ Yes 2 I O
❑ Yes No
❑ Yes o
❑ Yes l�'N
❑ Yes N
❑ Yes \o
❑ Yes N
El Yes
❑ Yes No
No.violations or deficiencies were noted during this. visit.- You will receive no further
correspondence about this visit.
IComments"(teferjto question #). Explatn'any l'ES answers andlor any recommendations of any other comments: >
Use drawings of faeility'to better exptain;situatittns.'(useodditional piig'es'as neccssary). u" a
7/25/97

l State of North Carolina
Department of Environment,
Health and Natural Resources •
71
Raleigh Regional Office
James B. Hunt, Jr., Governor p E H N F1
Jonathan B. Howes,, Secretary
tsa
Boyce A. Hudson, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT �
September 18, 1995
Mr. David Rose
Rose Poultry Farm
Route 3, Box 48-A
Nashville, North Carolina 27856
Subject: Compliance Evaluation Inspection
Poultry Operation
SR 1004
Nash County
Dear Mr. Rose:
On August 23, 1995, Mr. Danny Smith from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. This inspection is part of the Division's efforts to
determine potential problems associated with liquid waste disposal
systems.
Mr. Smith's site visit determined that wastewater from your
facility was not discharging to the surface waters of the state. In
addition, no manmade pipes, ditches, or other prohibited
conveyances (for the purpose of willfully discharging wastewater)
were observed. As a result, your facility was found to be in
compliance during this visit.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facilities. The Division of
Environmental Management is required to enforce water quality
regulations in order to protect the natural resources of the State.
Accordingly, illegal discharges of wastewater to surface waters of
the State are subject to the assessment of civil penalties and may
also result in the loss of deemed permitted status, requiring
immediate submission of a waste management plan.
This office would also like to take this opportunity to remind
you that you are required to have an approved animal waste
management plan by December 1997. This plan must be Certified by a
designated technical specialist or a professional engineer.
3800 Barrett Drive, Suite 101, Raleigh, North Carolina 27609 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 5M recycled/ 10% post -consumer paper

David Rose
Compliance Evaluation Inspection
Page 2
For a listing of certified technical specialists or assistance with
your waste management plan you should contact your local Soil and
Water Conservation District.
The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions regarding your inspection
please call Danny Smith at [phone].
Sincerely,
f
J
4 _LAA
Ju y E. Garrett
Water Quality Supervisor
/ds
H:\animdn
cc: Nash County Health Department
Nash County Soil and Water Conservation District
Steve Bennett - Regional Coordinator, Division of Soil and
Water Conservation

DWQ Animal Feedlot Operation Site inspection
a1koutine O Complaint O Follow-up of I)WQ inspection O Follow-up of l)S«VC review O Other
Date of Itspection
Facility Number 57— Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
-,arm Status: kirRegistered ❑ Applied for Permit (ex:l 25 for"I hr IS ntin,i) Spent on Review C
Cj Certified ❑ Permitted -or Inspection (ittcludes travel and processing)
[3 Not Operational Date Last Operated:.............................................................................................................
Farm Name :............ U�.�. l�'V.f-,. "I. County:..............................................................................
.................................................
Owner Name: ....................... P.r l.'�.� ................ ..... Phone Nu:......../j ....................................
FacilityContuct:..............................................................................Title:................................................................ Phone No:............................................
MailingAddress: :.......................................................................................................................%/.%......r...................................................................... ...........,.......
Onsite Representative.....+.&............ ..!�....,JN�ic7.. Inrator:................................................................................
Certified Operator: .................................................. .................................................... Operator Certification Number:.....
Location of harm:
.............................. ............. ..................... ............. ............ .......................... .......................... ................. ................... ....... ........... .................. ..................... ............... I................
Latitude Longittide �• �` �:�
Ntitnber of hagoons 14Holding Ponds ` ❑ Subsurface Drains Present ❑Lagoon Area 10SFray t field Are.
General
f. Are there any buffers that need maintenance/improvement? ❑ Yes . ❑ N�
2. Is any discitarge observed from any part of the operation? Yes I ❑ N,
1)ischaree ork,inated at: ❑ Lagoon ❑ Spray Field Other
a. If discharge is observed, was the conveyance than -made? ❑Yes P'N
b. If discharge is observed. slid it reach Surface WatcO (If yes, notify DWQ) ❑ Yes N
tr
c. if disch u,c is observed, what i the estitnu(ed flow in gal/nlin?
d. Does discharge bypass a lagoon system'! (If ye:, notify I)WQ) El Yes ❑ N
3. Is there evidence of past dischargge 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 EeN

Y
Is facility not In compliance wlIli any appiicawc �;l IWL'l.i Iu L� �.,... �.............. ... ....
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
XNO
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
� No
ructures (Lagoons andlor Holding Ponds)
Is storage capacity (freeboard plus storm storage) less than adequate? .
❑ Yes
J
VNo
Freeboard (ft): Structure 1 Structure �cture 3 Structure 4 Structure 5
Structure
:........�-..L1..�....I....:
......... ............. .... ......... ...........t.Y............................................... ......................................
...........................
.
}. is seepage observed from any of the structures?
❑ Yes
[ No
r�(N0
1. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
2. Do any of the structures need maintenance/improvement?
pllYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
3. Do any of the structures lack adequate minimum or maximum liquid level markers?
;2/�es
❑ No
Naste Application
.4. Is there physical evidence of over application'?
❑ Yes
XNO
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type %... nn
�.` . .. il:'..................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
INo
5 17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
ZrNo
18. Does the receiving crop need improvement?
❑ Yes
V No
19. Is there a lack of available waste application equipment?
❑ Yes
["No
20. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
21. Did Reviewer[lnspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
0c
fi For Certier] Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ Nc
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ Nc
24. Does record keeping need improvement?
❑ Yes
❑ Nc
Paw416aer- �6 ol 6 e�EVIlld-L Pt/ G,0!?CVX)00 Aid
E P_EmUJ St-�ht711-�rtiG
_4x)Te
►� t 7Y <-AU cxr vS �d,U�v� c `� v� l9
_U5
Reviewer/Inspector Name !°

n-d 0(n,
�7 7

NUH TH CAROLI NA
Department of Environmental Qua

Af
T3g7 2
j
Lj
T34
1 F -
r!y

r
f
f•
.fi
/ s�
;+
�, °; ._ _ t 1r r
`s
r �.-

5.i

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: 6 Y - O z
Facility Name: Rose. PoLL4,,d Fa.r,K
County: -hl"4L
Certified Operator Name: jar&w,dom Mogre- Operator # z 1717
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Lagoon NamelIdentifier (ID): moo•%
Spillway (Yes or No): No
Level (inches): 18
11
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures. Five
and 30 day Plans of Action are attached. Hydraulic and agronomic balances are within
acceptable ranges.
✓ Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A 30 day
Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste to
pumped and hauled is reflected in section III tables. Included within this plan is a list of the
proposed sites with related facility number(s), number acres and receiving crop information.
Contact and secure approval from the Division of Water Resources prior to transfer of
waste to a site not covered in the facility's certified animal waste management plan.
Operation will be partially or fully depopulated.
- attach a complete schedule with corresponding animal units and dates for depopulation
- if animals are to be moved to another permitted facility, provide facility number; lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: .'-- S - / Y
I hereby certify that I have reviewed the information listed above and included within the attached Plan
of Action, and to the best of my knowledge and ability, the information is accurate and correct.
Ddf L. Rose _ ._ Phone: zSz- V57- 7608
Facility Owner/Manager (pant)
Facility Owner/Manager (signature)
PoA Cover Page 2/21100
(} ti
Date:

a
PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
THIRTY (30) DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Name/ldentifier (ID): La_aoo i
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker
b. designed 25 yrJ24 hr. storm & structural freeboard
c. line b - line a (inches in red zone) =
d. top of dike surface area according to design
(area at below structural freeboard elevation)
e. line c x line d x 7.48 oallons —
12 ft
18" inches
19" inches
1 If
inches
315 000,0 ft2
3. Projected volume of waste liquid produced during draw down period
j683. z gallons
f. temporary storage period according to structural design 180 days
g. volume of waste produced according to structural design _ 13y-, 7,5,1. q ft3
h. actual waste produced = current herd # x line g =
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i +i) x 7.48 x 30 days =
line f
4. Total PAN to be land applied during draw down period
1. current waste analysis dated 3 115 / 1 q
m. (lines e + ki x line I _
1000
95, 399.9 ft3
0.0 ft3
a6S-SYl.7 ft3
366,6q4,5 gallons
1. 3 5 Ib/1000 gal.
771.3 lb PAN
REPEAT SECTION 1 FOR EACH WASTE STRUCTURE ON SITE
ll. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YRJ24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
PoA (30 Day) 2/21/00 1

L
1.
structure ID: Lagoon
line m = 791,
3 lb PAN
2.
structure ID:
line m =
lb PAN
3.
structure ID:
line m =
lb PAN
4.
structure ID:
line m =
lb PAN
5.
structure ID:
line m =
lb PAN
6.
structure ID:
line m =
lb PAN
n.
lines 1 +2+3+4+5+6 =
791.3
IbPAN
Ill. TOTAL
PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAYDRAW DOWN
PERIOD.
DO NOT LIST FIELDS TO WHICH PAN CAN
NOT BE APPLIES DURING THIS 30 DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining
IRR-2 PAN
balance
(lb/acre)
t. TOTAL PAN
BALANCE
FOR FIELD
(Ibs.)
column r x s
u.
application
window'
5 q
z I&.OZ
IZ86,3
31
3 8 2
H Y- 2
O
z 20.0
880.0
Au 3
-3787
14
O r - H
, 8
3 05 0
5'i . 0-5C44,
30
3187
Hie- K
ei 0. - H
5. 5,
30S.0
16775
30
398-2
N N--S
e,
q.gj
30510
1308,q6
S 0
3
-6
Arx da-
q.
305%0
13 2,S
S
3yzl
r -H
3, 7y
315.0
119 0.5
S
3Y21
-8
0k da.- H
3.5
3A5.0
1 3 ,S
Se 4. 30
35 2
-
-
210
3.25.0
L90,0
S 30
3572
-10
.k -
R.2
3z5.0
1 ,O
30
'State current crop ending application date or next crop application beginning date for available receiving
crops during 30 day drawn down period
v. Total PAN available for all fields (sum of column t) _ to, 856,7S lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
PoA (30 Day) 2121/00 2

w. Total PAN to be land applied (line n from section II) = '2 yr, 3 lb. PAN
x. Crop's remaining PAN balance (line v from section III) = _ 104 856. 75 lb. PAN
y. Overall PAN balance (w - x) =-10406s. ys lb. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here
including pump and haul, depopulation, herd reduction, etc. For pump & haul and herd
reduction options, recalculate new PAN based on new information. If new fields are to be
included as an option for lowering lagoon level, add these fields to the PAN balance table and
recalculate the overall PAN balance. If animal waste is to be hauled to another permitted
facility provide information regarding the herd population and lagoon freeboard levels at the
receiving facility.
NARRATIVE:
PoA (30 Day) 2121/00 3

,k,,G a d 13 0 r& 5P-,
PLAN OF ACTION (PoA) FOR HIGH
Facility Number: 6 Y - 0,2.
FREEBOARD AT ANIMAL FACILITIES
Count: NusA.
Facility Name: ►pose. P.,,,j4, . Far.n i JUL 16 2013
Certified Operator Name: Operator # ;L1911
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Lagoon Name/Identifier (ID): J ftocn
Spillway (Yes or No)
Level (inches):
2. Check all applicable items
A/o
16 " --
Liquid level is within the designed structural freeboard elevations of one or more structures. Five
and 30 day Plans of Action are attached. Hydraulic and agronomic balances are within
acceptable ranges.
✓ Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A 30 day
Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste to
pumped and hauled is reflected in section III tables. Included within this plan is a list of the
proposed sites with related facility number(s), number acres and receiving crop information.
Contact and secure approval from the Division of Water Quality prior to transfer of waste
to a site not covered in the facility's certified animal waste management plan.
Operation will be partially or fully depopulated.
- attach a complete schedule with corresponding animal units and dates for depopulation
- if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: ;�—. /(2 r /3
I hereby certify that I have reviewed the information listed above and included within the attached Plan
of Action, and to the best of my knowledge and ability, the information is accurate and correct.
Phone:.2S5- -271S9` 7(D0
Facility Owner/Manager (print)
Date: ` /s
Facility Owner/Manager (signature)
PoA Cover Page 2/21100

A
PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
THIRTY (30) DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Name/Identifier (ID): L_
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker
b. designed 25 yr./24 hr. storm & structural freeboard
c. line b - line a (inches in red zone) =
d. top of dike surface area according to design
(area at below structural freeboard elevation)
e. line c x line d x 7.48 a_g Ilons _
12 ft
inches
1 q it inches
Inches
32 S 000, O ft2
647 710 p gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 18p days
g. volume of waste produced according to structural design I3Y, 759, q ft3
h. actual waste produced = current herd # x line g =g, 7. q 3. 9 ft3
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i +i) x 7.48 x 30 days =
line f
4. Total PAN to be land applied during draw down period
I. current waste analysis dated o3//V/z o t 3
m. (lines e + k) x line I =
1000
o. Q ft3
10e.3g►.7 ft3
3650006.0 gallons
z q6 lb/1000 gal.
219a,0 Ib PAN
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE
11. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YR./24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
PoA (30 Day) 2/21100 1

1.
structure ID: La ae,
line m = 2.3g 2! 0_ Ib PAN
2.
structure ID:
line m = lb PAN
3.
structure ID:
fine m = lb PAN
4.
structure ID:
line m = lb PAN
5.
structure ID:
line m = lb PAN
6.
structure ID:
line m = lb PAN
n.
lines 1 +2+3+4+5+6 =
234310 lb PAN
Ill. TOTAL
PAN BALANCE REMAINING FOR AVAILABLE
CROPS DURING 30 DAYDRAW DOWN
PERIOD.
DO
NOT LIST FIELDS TO WHICH PAN CAN
NOT BE APPLIES DURING THIS 30 DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining
IRR-2 PAN
balance
(lb/acre)
t. TOTAL PAN
BALANCE
FOR FIELD
(lbs.)
column r x s
u,
application
window'
338
14Y-
a 9019
1123
3
33 8
r
.OD
180.91
723.56
At- , 3
87
Y-
A -1
1180
305,00
Y q 00
sc.af. 30
987
Y- Y
13 er -H
550
2.53. Y 2
13911.09
smi, 30
39
HY-S
Cr,►.
. 23
ag6.51
105 .53
0
87
Y-6
l
50
257, VY
1169,qB
Seof. 3o
3qz
9y-7
ro%
3,4y
30 .27
91.8
.5 ew f. 3 a
8
S ei,„mdg--
50
313, 61
9 -2. 6
S 30
3
r - H
2100
32.5 00
01 DO
Scol. 30
3572-
Hy-10
2,20
,00
715.00
Se 4. 30
'State current crop ending application date or next crop application beginning date for available receiving
crops during 30 day drawn down period
v. Total PAN available for all fields (sum of column t) = g0tf. 3 Y lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
PoA (30 Day) 2121/00 2

w. Total PAN to be land applied (line n from section I I) = z 3 93, o Ib. PAN
x. Crop's remaining PAN balance (line v from section III) = 267y.3y lb. PAN
y. Overall PAN balance (w - x) = - 7 2 81.3Y lb. PAN
Line y must show as a deficit. If line y does not show as a deficit, list course of action here
including pump and haul, depopulation, herd reduction, etc. For pump & haul and herd
reduction options, recalculate new PAN based on new information. If new fields are to be
included as an option for lowering lagoon level, add these fields to the PAN balance table and
recalculate the overall PAN balance. if animal waste is to be hauled to another permitted
facility provide information regarding the herd population and lagoon freeboard levels at the
receiving facility.
NARRATIVE:
PoA (30 Day) 2121/00 3

NCDENR
North Carolina Department of Environment and Natural
Jl1! Division of Water Quality
Beverly Eaves Perdue 6 ? Coleen H. Sullins
Governor Director
July 2, 2009
Rose Poultry Farm, Inc
Rose Poultry Farm
2687 Old Bailey Hwy
Nashville, NC 27856
Resources
Subject: Additional Information Request
Application No. AWP640002
Rose Poultry Farm
Nash County
Dear Rose Poultry Farm, Inc:
Dee Freeman
Secretary
The Animal Feeding Operation Unit of Division of Water Quality's Aquifer Protection Section has
completed a preliminary review of your renewal permit application package. Additional information is
required before we may continue our review. Please address the following items within 30 (thirty) days
of receipt of this letter:
1. Missine Waste Utilization Plan:
You were requested submit two copies of your facility's waste utilization plan (WUP or, nutrient
management plan, NMP). Our records show both copies of the waste plan are missing in your permit
application. Please submit missing copies of your current WUP or NMP to my attention at the
address given on at the bottom of the first page of this letter.
Please be aware that you are responsible for meeting all requirements set forth in North Carolina rules and
regulations. Any oversights that occurred in the review of the subject application package are still the
responsibility of the applicant. In addition, any omissions made in responding to the above items shall
result in future requests for additional information.
Please reference the subject application number when providing the requested information. All revised
and/or additional documentation shall be signed, sealed and dated, with two (2) copies submitted to my
attention at the address below. Please note that failure to provide this additional information on or before
the above requested date may result in your application being returned as incomplete.
Failure to request renewal of your coverage under a general permit within the time period specified may
result in a civil penalty. Operation of your facility without coverage under a valid general permit would
constitute a violation of NCGS 143-215.1 and could result in assessments of civil penalties of up to
$25,000 per day.
Aquifer Protection Section 1636 Mail Service Center
Internet: www.ncwatergyality org Location: 2728 Capital Boulevard
An Equal Opportunity/Affirmative Action Empioyer— 50% Recycled110% Post Consumer Paper
Nortc
PM Carolina
dvatura!!g
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

If you have any questions regarding this letter, please feel free to contact me at [phone].
Sincerely,
one D. Blanton
Animal Feeding Operations Unit
cc: Raleigh Regional Office, Aquifer Protection Section
Nash County Soil and Water Conservation District
APS Files- AWP640002

a
RoS� Pouf��b
ANIMAL WASTE UTILIZATION
69-z
Producer:
Location:
Telephone:
Type Operation:
Number of Animals:
(Design Capacity)
STORAGE STRUCTURE:
APPLICATION METHOD:
DAVID L ROSE
2640 OLD BAILEY HWY
NASHVILLE NC 27856
252-459-7608
Existing Layer
175000.00 bird
JUL 2428
n r`JL
Anaerobic Waste Treatment Lagoon
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. RECEIVEDIDENRIDWQ
AQUlFFR'PRnTFr..T1r)N RFCTION
JUL 2 2 Z009
Page: 1

ANIMAL WASTE UTILIZATION PLAN
5. Wind conditions should also be considered to avoid drift and
downwind odor problems.
G. 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.)
175000 bird x 25.373 tons waste/bird/year = 4440275 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
175000 bird x 0.084 lbs PAN/bird/year = 14700 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
1280.5
3421
1-7
GoA
BH
6.5
325
0.00
3.94
I
APR-SEPT
3421
1-7
G
50.0
1GoA
�I
�50
�0.00 13.94
1197
SEPT-MAR
3421
1-8
BH
6.5
�GOA
I
�325
�0.00 �3.50
11137.5
APR-SEPT
3421
'1-8
SG
50.0
IGOA
I
�50
I
�0.00 13.50
�175
SEPT-MAR
3421
1
BH
6.5
0.00 2.90
942.5
jGoA
I
�32_5
I
APR-SEPT
3421
SG
50.0
1-1 IGOA
I
150
10-00 �2.90
1145
SEPT-MAR
END
I
TOTALI3877.5
- 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.
Page: 3

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
3572
1-9
GoA
BH
6.5
325
0.00
2.00
650
APR-SEPT
3572
I'1-9
IGoA
SG
50.0
If
f
150
�0-00
I2.00
�100
SEPT-MAR
3572
1
BH
6.5
JGoA
�325
10.00
�0.90
�292.5
APR-SEPT
3572
SG
50.0
1-1
JGoA
150
10.00
10.90
�45
SEPT-MAR
3572
2-10
BH
6.5
JGoA
�325
10.00
�2.20
�715
APR-SEPT
3572
"2-10
GoA
SG
50.0
�50
10-00
�2.20
1110
SEPT-MAR
3572
2
BH
6.5
0.00
�GOA
1325
12.80
1910
APR--SEPT
3572
SG
50.0
�-2
�GOA
150
10.00
�2.80
�140
SEPT-MAR
3987
1-3
NOB
BH
6.1
�305
�0.00
�1.80
�549
APR-SEPT
3987
1-3
NOB
SG
50.0
50
0.00
1
�1.BO
�90
SEPT-MAR
3987
1-4
NOB
BH
6.1
0.00
1677.5
1305
15.50
1 APR-SEPT
3987
1-4
NOB
SG
50.0
0.00
150
�5.50
1275
SEPT-MAR
3987
1-5
NOB
BH
6.1
�305
10.00
�4.29
�1308.45
APR-SEPT
Page: 4

ANIMAL WASTE UTILIZATION PLAN
3987
1-5
SG
50.0
214.5�SEPTMAR
F
�NoB
150
jo.bo
14.29
3987
1-6
NOB
BH
6.1
�305
10.00
�4.50
11372.5
APR-SEPT
3987
1-6
NOB
SG
50.0
150
�0,00
14.50
1225
SEPT-MAR
3987
1
NoB
BH
6.1
0.00
4.30
1305
1
�1311.5
APR-SEPT
3987
NOB
SG
50.0
50
0.00
�_l
�4.30
�215
SEPT-MAR
3382
1-1
NOB
4.0
ISA
�220
�o.ob
15.90
11298
MAY-AUG
3382
1-1
50.0
F
�NoB
IWA
�50
�0.00
15.9
1295
SEPT-MAR
3382
1-2
NOB
SA
4.0
1220
�0.00
14.00
�880
MAY-AUG
3382
"i-2
NoB
WA
50.0
200
�50
�0.00
�4.00
SEPT MAR
3382
1
NOB
SA
4.0
�220
�0.00
15.90
�1298
MAY -- AUG
3382
NOB
WA
50.0
1-1
150
10.00
�5.90
�295
SEPT-MAR
END
TOTAL114466.9
Indicates that this field is being overseeded (i.e. interplanted) or
winter annuals follow summer annuals.
In interplanted fields (i.e. small grain, etc, interseeded
in bermudag.rass), forage must be removed through grazing,
hay and/or silage. Where grazing, plants should be grazed
when they reach a height of six to nine inches. Cattle
should be removed when plants are grazed to a height of four
inches. In fields where small grain, etc, is to be removed
for hay or silage, care should be exercised not to let small
grain to reach maturity, especially late in the season (i.e.
Page: 5

ANIMAL WASTE UTILIZATION PLAN
April or May). Shading may result if small grain gets too
high and this will definitely interfere with stand of
bermudagrass. This loss of stand will result in reduced
yields and less nitrogen being utilized. Rather than
cutting small grain for hay or silage just before heading as
is the normal situation, you are encouraged to cut the small
grain earlier. You may want to consider harvesting hay or
silage two to three times during the season, depending on
time small grain is planted in the fall.
The ideal time to interplant small grain, etc, is late
September or early October. Drilling is recommended over
broadcasting. Bermudagrass should be grazed or mowed to a
height of about two inches before drilling for best results.
Caution must be exercised in grazing or haying summer
annuals under stressed conditions. Nitrate poisoning
may occur in livestock. Sampling forage or hay for
nitrate levels is recommended.
** 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
BH
SA
SG
WA
CROP
BERMUDAGRASS - HAY
SUMMER ANNUAL
SMALL GRAIN OVERSEEDED
WINTER ANNUALS
TOTALS FROM TABLES 1 AND 2
ACRES
TABLE 1 1 10.34
LBS AW N USED
3877.5
TABLE 2 1 44.09 1 14466.95
UNITS
PER UNIT
TONS
50
LBS
55
BU
1.0
1.00
Page: 6

ANIMAL WASTE UTILIZATION PLAN
TOTAL 1 54.43 1 18344.45
*** BALANCE-3644.45 1
-------------------
*** This number must be less than or equal to 0 in order to
fully utilize the animal waste N produced.
Page: 7

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 9100 pounds of plant available nitrogen per year in the
sludge.
If you remove the sludge every 5 years, you will have approximately 45500
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 151.666666667 acres of land. If you apply the sludge to corn at
the rate of 125 pounds of nitrogen per acre, you will need 364 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: 8

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)
Applic. Amount
(inches)
3382
1
NoB
SA
0.40
*1.00
3382
1-1
NoB
SA
0.40
*1.00
3382
1-2
NoB
SA
0.40
*1.00
3382
"1
NoB
WA
0.40
*1.00
3382
'1-1
NoB
WA
0.40
*1.00
3382
NoB
WA
0.40
*1.00
3421
1
GoA
BH
0.50
*1.00
3421
1-7
GoA
BH
0.50
*1.00
3421
1-8
GoA
BH
0.50
*1.00
3421
GoA
SG
0.50
*1.00
3421
GoA
SG
0.50
*1.00
3421
GoA
SG
0.50
*1.00
3572
1
GoA
BH
0.50
*1.00
3572
1-9
GoA
BH
0.50
*1.00
3572
2
GoA
BH
0.50
*1.00
3572
2-10
GoA
BH
0.50
*1.00
3572
1
GoA
SG
0.50
*1.00
3572
GoA
SG
0.50
*1.00
3572
"2
GoA
SG
0.50
*1.00
3572
GoA
SG
0.50
*1.00
3987
1
NoB
BH
0.50
*1.00
Page: 9

ANIMAL WASTE UTILIZATION PLAN
13987
1-3
NoB
BH
0.50
3987
1-4
NoB
BH
0.50
3987
1-5
NoB
BH
0.50
3987
1-6
NoB
BH
0.50
3987
NoB
SG
0.50
3987
NoB
SG
0.50
3987
NoB
SG
0.50
3987
"1-5
NoB
SG
0.50
3987
'1-6
NoB
SG
0.50
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
* 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.
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
Tract 3382 Field 1 and Tract 3556 Field 1 are added to the waste utilization
plan.
The crops grown on these fields will consist of small grain and summer annuals,
i.e.
Page: 10

ANIMAL WASTE UTILIZATION PLAN
millet, sorgham, etc. The summer annuals may be substituted with Tobacco, Sweet
Potatoes, Cotton, etc. as needed.
Mr. Rose will also be using a honey wagon to apply waste to areas not wetted by
the
irrigation system.
Page: 11

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: 12

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.
15. 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: 13

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: 14

ANIMAL WASTE UTILIZATION PLAN
WASTE UTILIZATION PLAN AGREEMENT
Name of Farm:ROSE POULTRY
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: DAVID L ROSE
(Please print)
c:7r
Signature: Date:
Name of Manager(If different from owner):
Signature:
Date:
Name of Person Preparing Plan: (Please print)J. Edward Long
Affiliation:Nash Soil and Water Conservation District Phone
No. 919-459-4115
Address (Agency): Room 107 Ag. Center Drive
Nashville NC 27856
Signature: a Date: 77
Page: 15

WASTE UTILIZATION FLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
I, Caroiy,. U). hereby give
D0.vrGl L, Rose_
permission to apply animal waste from his Waste Utilization System
on 8.0 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. Tracf �S �2 F trd !� 2
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 Landowners Date : r%
Waste Producer: ��'i�!�,�, Date:
Technical Representative: p � , Date: 3-/6--9 9
SWCD Representative. Date
Term of Agreement: i�, , 19 ` to1��_i`�
(Minimum of Ten Years on Cost Shared Items)
(See Required Specification No. 2.)
Page: 11

WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, ec:..)
I, SfgnIcy Robhirt.5 , hereby give Dau,'d Ro,Sc
permission to apply animal waste from his Waste Utilization System
on z/ 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. ira,-t 39 8 7 F'G r�
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 41111:{. , '•=`��`�, Date
Waste Producer:. Date.. -A�j'
Technical Representative: Date:
SWCD Representative :— ! �---7 Date:
Term of Agreement: 4�-2�% %< -- , 19� to
(Minimum of Ten Years on Coat Shared Items)
(See Required Specification No. 2.)
Page: 11

ANIMAL WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
IA.,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. Tracf 33$ F�elci
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, Date:
a
Waste Producer:- 7f ��'/` �i1- _. Date : �4
Technical Representative: Date:
SWCD Representative: Date:
Term of Agreement: 19 to C. / G
(Mi imum of Ten Years on Cost Shared items)
(See Required Specification No. 2.)
Page: 12

0
WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
I, R i d T 9 s a , hereby give
D",c,( Ras c-
permission to apply animal waste from his Waste Utilization System
on .G acres of my land for the duration of time shown below.
The fields? on which waste can be applied are shown on the
attached map. T,0.cf'3356 F;G(J (
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 Landowne
Waste Producer:
Technical Representative;
SWCD Representative:
Term of Agreement:
Date: —
Date: 7 - /C�'__
Date:-3 -/ 6 -95
Date: 3 -16`yf
fig
to
(minimum of Ten Years on Cost Shared Items)
(See Required Specification No. 2.)
Page: 11

U.S. DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE
SOIL MAP LEGEND
Legend
Map Soil name
symbol
i
AaA jAltavista sandy loam, 0 to 3 percent slopes
AbA jAltavista-Urban Land complex, 0 to 3 percent slopes
AuB lAutryville loamy sand, 0 to 6 percent slopes
Bb (Bibb loam, frequently flooded
BnB (Blanton loamy sand, 0 to 6 percent slopes
130B �Bonneau loamy sand, 0 to k percent slopes
Co lCongaree fine sandy loam, frequently flooded
DOA IDothan loamy sand, 0 to 3 percent slopes
FaB IFaceville loamy sand, 1 to 6 percent slopes
GeB jCeorgeville loam, 2 to 6 percent slopes
GeC lGeorgeville loam, 6 to 10 percent slopes
GeE lGeorgeville loam, 10 to 25 percent slopes
GgB IGeorgeville gravelly loam, 2 to 6 percent slopes
GgC IGeorgeville gravelly loam, 6 to 10 percent slopes
GgE IGeorgeville gravelly loam, 10 to 25 percent slopes
GOA IGoldsboro fine sandy loam, 0 to 2 percent slopes
GrB jGritney sandy loam, 2 to 6 percent slopes
OTC 10ritney sandy loam, 6 to 10 percent slopes
Gun IGeorgeville-Urban Land complex, 0 to 6 percent slopes
HeB jHelena coarse sandy loam, 2 to 6 percent slopes
Me IMeggett loam, frequently flooded
NaC (Nankin sandy loam, 2 to 10 percent slopes
NnB INason loam, 2 to 6 percent slopes
NnC INason loam, 6 to 10 percent slopes
NoA lNorfolk loamy sand, 0 to 2 percent slopes
NoB INorfalk loamy sand, 2 to 6 percent slopes
NPB �Ncrfolk-Wedowee complex, 2 to 6 percent slopes
NrB Norfolk, Georgeville, and Faceville soils, 2 to B percent slopes
NUB Norfolk -Urban Land complex, D to 6 percent slopes
Ra IRains fine sandy loam
Rb Rains -Urban Land complex
To ITOmotley fine sandy loam
Ud jUdorthents, loamy
Ur jUrban Land
W lWater
WeB lWedowee coarse sandy loam, 2 to 6 percent slopes
WeC 1wedowee coarse sandy loam, 6 to 10 percent slopes
Wh fWehadkee loam, frequently flooded
WkA JWickham fine sandy loam, 0 to 3 percent slopes
WoA lWorsham loam, 0 to 2 percent slopes
I
PAGE 1 OF 1
03/15/99

• a, i
Attachment B
Page I of 3
North Carolina Agricultural Lztension Service
Agri -Waste Management
.Fi• I rmid • ♦ • • NO?Ift •• • •r r.•• - •rr
LTPFSZOC= tra= SAXM=C , ■x & ors Alm raTrnt =024
OF LM AP9'*.,,:U=ON R&=
James C. Barker*
1. SAM CC==Off
L. Semi -Solid Lot 'e
L. Scraped directly from lot into spreader
a. From Leaded spreader, collect about 2 lbs of mm a from
d!&rent locations using no=masa14 is collec:.ors .
ii. From storage
a. Collect about 2 lbs of means :roar under :he surface crust
avoiding bedding matarials and using nonmeallic collecr.ors .
B . Liquid Ma:vure Slur=+
i. Under -slotted -floor pit
a. Extend a 1/2' nonmetallic conduit open on both ends into
manure to pit floor.
b. Seal upper and of conduit (a.g.• by placing a throb over end
of conduit) �aaping manure that has entered lower and, remove
and empty slums-7 into plastic bucket or nonmetallic container.
c. Take subsamples !=om 5 or more locations or at laser 1 quart.
d. Nix and add about 3/4 pint to nonmetallic sample container.
Li. Exterior storage basin or caak
a. !Sake sure manure has been wall mixed with a liquid manure
chopper -agitator pump or propeller agitator.
b. Take subsamplas from about 5 pit locations, :!--= agitator pump
or from manure spreader and place in a plastic bucket.
* Professor and Zx=ewicm Specialist, Biological and Agricultural Engineering
Denar=emt, Nor-h Caroling Stazt University, Raleigh, NC.

,y
.attachment B
Page 2 of 3
c. Mix and add 3/4 pint to a nonmetallic sample container.
C. Lagoon Liquid
L. Collect about 3/4 pint of recycled lagoon liquid from inflow pipe
to flush tanks in a nonmetallic sample container.
U . From lagoon
a. Place a small bottle (1/2 pint or less) on end of 10-15' pole,
b. Extend bottle 10-15' away from bank edge.
c. Brush away floating scum or debris.
d. Submerge bottle within 1' of liquid surface.
e. Empty into a plastic bucket, repeat about 5 times around
lagoon, mix, and add 3/4 pint to nonmetallic sample container.
D. Broiler or Turkey Litter
L. mouse Litter
a. Visually inspect litter for areas of varying quality, e.g.,
areas around feeders and waterers, and estimate percent of
floor surface in each area.
b. Take about 5 litter subsamples at locations proportionate to
Item a. E.g., if 20% of litter of similar visual qualitrr is
around feeders and waterers, take 1 subsample there and the
other 4 subsamples from remainder of floor surface.
c. At each location, collect litter from a 6" by fi" 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 liner to a nonmetallic sample container such as
a 1-gallon freezer bag and seal.
U. From stockpile
a. Take subsamples from about 5 locations at least 18" into pile.
b. Mix, add 2-3 lbs to nonmetallic sample container and seal.

Attachment B
Page 3 of 3
- II. SAISM PREPARATION AND TRANSFER
A. Place 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 ocher way.
B. Pack sample in ice, refrigerate, freeze, or transfer_to lab quickly.
C. Hand -delivery is most reliable way of sample transfer.
D. If mailed, 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. AFL Eastern Agricultural Lab, Inc. iii. Polyfoam Packers Corp.
7621 Whitepine Road 2320 S. Foster Avenue
Richmond, VA 23237 iiheeling, IL 60090
Ph: [phone] Ph: [phone]
U. Fisher Scientific Co, iv. NASCO
3315 Winton Road 901 Janesville Avenue
Raleigh, NC 27604 Fort Atkinson, `1 53538
Ph: [phone] Ph: [phone]
F. Private analytical labs are available, but sample analyses are costly.
G. The NCDA provides this service for North Carolina residents.
i. Address: North Carolina Department of Agriculture
Agronomic Division
Plant/Raste/Solution Advisory Section
Slue Ridge goad Center
P.O. Sox 27647
Raleigh, NC 27611
Ph: [phone]
At= 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: 1. P. R, Ca. Ng, Na,
S, Fe, Mn. Zn. Ca, S
v. Additional analyses performed upon request: DN' No, Cd. Ni, Pb

k
ANIMAL WASTE UTILIZATION PLAN �L�'�
x:as�_ Ae..14.
Producer:
Location:
Telephone:
Type Operation:
Number of Animals:
(Design Capacity)
STORAGE STRUCTURE:
APPLICATION METHOD:
DAVID L ROSE
2640 OLD BAILEY HWY
NASHVILLE NC 27856
252-459-7608
Existing Layer
175000.00 bard
JAN 2 4 2001
� MNR RALEIGH REGIONAL OFFICF
Anaerobic Waste Treatment Lagoon
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: 1

4
ANIMAL WASTE UTILIZATION PLAN
S. 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.)
175000 bird x 25.373 tons waste/bird/year = 4440275 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
175000 bird x 0.084 lbs PAN/bird/year = 14700 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

r �l
ANIMAL WASTE UTILIZATION PLAN
TABLE l: 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
1280.5
3421
1-7
GoA
BH
6.5
325
0.00
3.94
I
APR-SEPT
3421
IGoA
ISG
�"1-7
I50.0
150
3421
1-8
GOP,
BH
6.5
325
I
3421
"1-8
SG
50.0
�GOA
I
�50
3421
1
BH
6.5
IGOA
1325
3421
�-1
�GoA
SG
50.0
150
I
END
I
0.00
13.94
�197
SEPT-MAR
0.00
�3.50
11137.5
APR-SEPT
0.00
�3.50
�175
SEPT-MAR
0.00
12.90
1942.5
APR-SEPT
�145
0.00
12.90
SEPT-MAR
TOTALI3877.5
- 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.
Page: 3

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
3572
1-9
GoA
BH
6.5
325
0.00
2.00
650
APR-SEPT
3572
1-9
SG
50.-a
2.00
100
�GOA
�50
I0.00
SEPT-MAR
3572
1
BH
6.5
11�
JGoA
�325
�0.00
10.90
�292.5
APR-SEPT
3572
SG
50.0
�-1
�GOA
�5o
�o.bo
�0.90
145
SEPT-MAR
3572
2-10
BH
6.5
�GoA
1325
�o.ob
12.20
�715
APR-SEPT
3572
'2-10
GOA
SG
50.0
150
10-00
12.20
�110
SEPT-MAR
3572
2
BH
6.5
0.00
v'
JGOA
1325
12.80
1910
APR-SEPT
3572
SG
50.0
�_2
�GoA
�50
�0.00
�2.80
�140
SEPT-MAR
3987
1-3
NOB
BH
6.1
�305
�0.00
�1.80
1549
APR-SEPT
3987
1-3
SG
50.0
�NoB
�5o
�o.bo
�1.8o
�qo
SEPT-MAR
3987
1-4
BH
6.1
�NoB
�305
10-00
�5.50
�1677.5
APR-SEPT
3987
NOB
SG
50.0
�-1-4
150
�0.00
15.50 1275
SEPT-MAR
3987
1-5
NoB
BH
6.1
3fl5
0.00
4.29
�1308.45
APR-SEPT
Page: 4

ANIMAL WASTE UTILIZATION PLAN
3987
1-5
NOB
SG
50.0
F
�50
�0.00
�4.29
�214-5
SEPT-MAR
3987
1-6
NOB
BH
6.1
305
0.00
�4.50
�1372.5
APR-SEPT
3987
1-6
NOB
SG
50.0
�50
�0.00
14.50
�225
SEPT-MAR
3987
1
NoB
BH
6.1
0.00
1311.5.
�305
�4.30
APR-SEPT
3987
NUB
SG
50.0
0.00
�_l
150
1
14.30
�215
SEPT--MAR
3382
1-1
NOB
SA
4.0
0.00
5.90
1298
�220
MAY-AUG
3382
1-1
NOB
WA
50.0
F
150
�0.00
�5.9
�295
SEPT-MAR
3382
1-2
NOB
SA
4.0
1220
10-00
14.00
1880
MAY-AUG
3382
�l-2
NOB
�WA
�50.0
�50
�0.00
�4.00
�200
SEPT MAR
3382
1
SA
4.0
220
0.00
jNoB
15.90
11298
MAY-AUG
,3382
WA
50.0
�_l
(�
jNoB
150
�0-00
�5.90
�295
SEPT-MAR
END
TOTAL114466.9
- Indicates that this field is being overseeded (i.e. interplanted) or
winter annuals follow summer annuals.
In interplanted fields (i.e. small grain, etc, interseeded
in bermudagrass), forage must be removed through grazing,
hay and/or silage. Where grazing, plants should be grazed
when they reach a height of six to nine inches. Cattle
should be removed when plants are grazed to a height of four
inches. In fields where small grain, etc, is to be removed
for hay or silage, care should be exercised not to let small
grain to reach maturity, especially late in the season (i.e.
Page: 5

ANIMAL WASTE UTILIZATION PLAN
April or May). Shading may result if small grain gets too
high and this will definitely interfere with stand of
bermudagrass. This loss of stand will result in reduced
yields and less nitrogen being utilized. Rather than
cutting small grain for hay or silage just before heading as
is the normal situation, you are encouraged to cut the small
grain earlier. You may want to consider harvesting hay or
silage two to three times during the season, depending on
time small grain is planted in the fall.
The ideal time to interplant small grain, etc, is late
September or early October. Drilling is recommended over
broadcasting. Bermudagrass should be grazed or mowed to a
height of about two inches before drilling for best results.
Caution must be exercised in grazing or haying summer
annuals under stressed conditions. Nitrate poisoning
may occur in livestock. Sampling forage or hay for
nitrate levels is recommended.
** 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 I and 2 above:
CROP CODE
CROP
UNITS
PER UNIT
BH
BERMUDAGRASS - HAY
TONS
50
SA
SUMMER ANNUAL
LBS
55
SG
SMALL GRAIN OVERSEEDED
BU
1.0
WA
WINTER ANNUALS
1.00
TOTALS FROM TABLES I AND 2
ACRES I LBS AW N USED
TABLE 1. 1 10.34 ! 3877.5
TABLE 2 1 44.09 1 1.4466.95
Page: 6

ANIMAL WASTE UTILIZATION PLAN
TOTAL 1 54.43 1 18344.45
*** BALANCE I-3644.45
-------------------
*** This number must be less than or equal to 0 in order to
fully utilize the animal waste N produced.
Page: 7

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 9100 pounds of plant available nitrogen per year in the
sludge.
If you remove the sludge every 5 years, you will have approximately 45500
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 151.666666667 acres of land. If you apply the sludge to corn at
the rate of 125 pounds of nitrogen per acre, you will need 364 acres
of land. Please be aware that these are only estimates of the PAN and
land needed. Actual requirements could vary by 259,; 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: 8

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)
Applic. Amount
(inches)
3382
1
NoB
SA
0.40
*1.00
3382
1-1
NoB
SA
0.40
*1.00
3382
1-2
NoB
SA
0.40
*1.00
3382
NoB
WA
0.40
*1.00
3382
NoB
WA
0.40
*1.00
3382
�1-2
NoB
WA
0.40
*1.00
3421
1
GoA
BH
0.50
*1.00
3421
1-7
GoA
SH
0.50
*1.00
3421
1-8
GoA
BH
0.50
*1.00
3421
1
GoA
SG
0.50
*1.00
3421
GoA
SG
0.50
*1.00
3421
1-8
GoA
SG
0.50
*1.00
3572
1
GoA
BH
0.50
*1..00
3572
1-9
GoA
BH
0.50
*1.00
3572
2
GoA
BH
0.50
*1.00
3572
2-10
GoA
BH
0.50
*1.00
3572
1
GoA
SG
0.50
*1.00
3572
"1-9
GoA
SG
0.50
*1.00
3572
GoA
SG
0.50
*1.00
3572
GoA
SG
0.50
*1.00
3987
1
NoB
BH
0.50
*1.00
Page: 9

ANIMAL WASTE UTILIZATION PLAN
3987
3987
3987
3987
3987
3987
3987
3987
NoB
NoB
NoB
NoB
NoB
NoB
BH
BH
BH
SG
SG
so
SG
SG
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
0.50
* 1 . 0 0
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
*1.00
* 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.
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
Tract 3382 Field 1 and Tract 3556 Field 1 are added to the waste utilization
plan.
The crops grown on these fields will consist of small grain and summer annuals,
i.e.
Page: 10

ANIMAL WASTE UTILIZATION PLAN
millet, sorgham, etc. The summer annuals may be substituted with Tobacco, Sweet
Potatoes, Cotton, etc. as needed.
Mr. Rose will also be using a honey wagon to apply waste to areas not wetted by
the
irrigation system.
Page: 11

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: 12

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: 13

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: 14

• r
ANIMAL WASTE UTILIZATION PLAN
WASTE UTILIZATION PLAN AGREEMENT
Name of Farm:ROSE POULTRY
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: DAVID L ROSE
(Please print)
�q
Signature: Date:
Name of Manager(If different from owner):
Signature:
Date:
Name of Person Preparing Plan: (Please print)J. Edward Long
Affiliation:Nash Soil and Water Conservation District Phone
No. 919-459-4115
Address (Agency): Room 107 Ag. Center Drive
Nashville NC 27855
Signature : Date: 3 /6 ` 77
Page: 15

WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be'leased, etc.)
I, car6n W. Raeo(, hereby give Da,y;d L, Pose.
permission to apply animal waste from his Waste Utilization System
on 8.0 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. Trae.+ 3,52X F'-'-Id 1"
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: � Date:
Waste Producer: _ yL� Date: 7- Y
Technical Representative'�� Date: 3
SWCD Representative: Date:
Term of Agreement: IL , 19_y� to IYe,,,,.. � 660
(Minimum of Ten Years on Cost Shared Items)
(See Required Specification No. 2.)
Page: 11

WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, eta.)
I, RoWA-5 , hereby give Dccu,d Rose_
permission to apply animal waste from his Waste Utilization System
on ;L/ 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. %ro; c;'f• 9R 8 ? F,'c fnfr 1
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.
Adj acent Landowner: ;r Date:
Waste Producer : � 2 Z-e' Date
Technical Representative: _� Date
SWCD Representative: Date
Term of Agreement: /!_, 19Z to
(minimum of Ten Years on Cost Shared Items)
(See Required Specification No. 2.)
Page: 11

ANIMAL WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
;-Z4Whereby give
permission to apply animal waste from his Waste Utilization System
on N 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. 7-,w,.f 3382. F<<)
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 Date:
Waste Producer: Date:
Technical. Representative : Date.
SWCD Representative: Date:
v
Term of Agreement- , 1-9 8 to
(Min1mum of Ten Years on Cost Shared Items)
(See Required Specification No. 2.)
Page: 12

WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
I, rc�a�aQ /yso.� hereby give D«. ;d R05C-
permission'to apply animal waste from his Waste Utilization System
on acres of my land for the duration of time shown below.
The fields) on which waste can be applied are shown on the
attached map. Tact 335G Fktld (
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 Landowne Date :
,� a
Waste Producer: Date: i4
Technical Representative: Date: 3 _�6rgy
SWCD Representative; Date:
Term of Agreement; 19-2 to
(Minimum of Ten Years on Coat Shared Items)
(See Required Specification No. 2.)
Page: 11

U.S. DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE
SOIL MAP LEGEND
Legend
Map Soil name
symbol
AaA jAltavista sandy loam, ❑ to 3 percent slopes
AbA lAltavista-Urban Land complex, 0 to 3 percent slopes
AuB lAutryville loamy sand, 0 to 6 percent slopes
Bb 13ibb loam, frequently flooded
BnB jBianton loamy sand, 0 to 6 percent slopes
BOB lBonneau loamy sand, 0 to 9 percent slopes
Cc Congaree fine sandy loam, frequently flooded
DcA IDothan loamy sand, 0 to 3 percent slopes
FaB IFaceville loamy sand, 1 to 6 percent slopes
GeB lGeorgeville loam, 2 to 6 percent slopes
GeC IGeorgeville loam, 6 to 10 percent slopes
GeE lGeorgeville loam, 10 to 25 percent slopes
G9B lGeorgeville gravelly loam, 2 to 6 percent slopes
GgC IGeorgeville gravelly loam, 6 to 10 percent slopes
GgE IGeorgeville gravelly loam, 10 to 25 percent. slopes
GOA Goldsboro fine sandy loam, 0 to 2 percent slopes
GrB IGritney sandy loam, 2 to 6 percent slopes
GrC IGritney sandy loam, 6 to 10 percent slopes
GuB IGeorgeville-Urban Land complex, 0 to 6 percent slopes
HeB jHelena coarse sandy loam, 2 to 6 percent slopes
Me IMeggett loam, frequently flooded
NaC (Nankin sandy loam, 2 to 10 percent slopes
NnB INason loam, 2 to 6 percent slopes
NnC INason loam, 6 to 10 percent slopes
NoA (Norfolk loamy sand, o to 2 percent slopes
NoB JNorfolk loamy sand, 2 to 6 percent slopes
NpB Norfolk -Wedowee complex, 2 to 6 percent slopes
NrB INorfolk, Georgeville, and Faceville soils, 2 to 6 percent slopes
NuB Norfolk -Urban Land complex, 0 to 6 percent slopes
Ra lRains fine sandy loam
Rb Rains -Urban Land complex
To fTomotley fine sandy loam
Ud jUdorthents, loamy
Ur Urban hand
W jWater
WeB jWedowee coarse sandy loam, 2 to 6 percent slopes
weC 1wedowee coarse sandy loam, 6 to 10 percent Slopes
Wh jWehadkee loam, frequently flooded
wkA lWickham fine sandy loam, 0 to 3 percent slopes
WoA lWorsham loam, 0 to 2 percent slopes
PAGE 1 OF 1
03/15/99

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
David Rose
Rose Poultry Farm
2687 Old Bailey Highway
Nashville NC 27856
Dear David Rose:
L79�'A
NCDENR
NORTH CAROLINA DEPARTMENT OF
EN V I RO N M ENT-ANATURAL- RE:sou RC Es
It It, _ra
December 30, 1999
4
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 6_42�
,Nassh-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. IRR1, 1RR2, DRYI, DRY2, DRY3, SLUR1, SLUR2,
SLD1, 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
Nash 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

Uhl
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RE30URCES
DlvlsION OF WATER QUALITY
Division of Water Quality
March 10, 1999
CERTIFIED MAIL
RED TEN RECEIPT REQUESTED
Mr. David Rose
Rose Poultry Farm
2687 Old Bailey Hwy.
Nashville, North Carolina 27856
Subject: Notice of Violation
Rose Poultry
Permit No. AWP640002
Nash County
Dear Mr. Rose:
On March 2, 1999, Mr. Buster Towel] of the Raleigh Regional Office conducted
an annual compliance inspection at the subject poultry laying facility.
The following permit violation was noted during the inspection:
During the site visit you stated to Mr. Towell that you had used a honey wagon
on this facility to land apply waste. Your OIC, Ms. Dale Harper, was unable to
produce any land application records utilizing a honey wagon.
The above referenced violation is a violation of your General Permit which requires
that accurate land application record be kept on site for a period of five (5) years.
Violations of your Animal Waste General Permit are subject to civil penalties of up
to $ 10,000.00 per day, per violation.
Please respond to this Notice in writing within fourteen days of your receipt. If data
is available from the land application in question please include this information
with your response. The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions please call Mr. Buster Towell at (919) 571-
4700.
4enSincere
neth Schuster, E.
Regional Water Quality Supervisor
cc: Nash Health Department
Mr. Terry Best, Nash Soil and Water Conservation District
DWQ Non -Discharge Compliance Group
Ms. Margaret O'Keefe, RRO-DSWC
P.O. BOX 29535, RALEIGH, NORTH CAROLINA 27626-0535
PHONE [phone] FA% 91 9-733-2496
AN EQUAL. OPPORTUNITY / APPIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POST -CONSUMER PAPER

ROSE POULTRY FARM, INC. f -
��4�-
2640 OLD BAILEY HWY
NASHVILLE, NORTH CAROLINA 27856
Phone ZDZ-4D9-!1j
Fax [phone]
March 19, 1999
Mr. Kenneth Schuster, P. E.
Regional Water Quality Supervisory
N. C. Dept. of Environment and Natural Resources
Raleigh Regional Office j
3800 Barrett Drive, Suite 101
Raleigh, NC 27609
Dear Mr. Schuster,
This letter is concerning the notice of violation that I received by letter dated March 10,1999.
As I was leaving Rose Poultry Farm on the day of inspection, I met Mr. Buster Towell entering the farm.Quring
our brief conversation Mr. Towell informed me that the acreage of wettable area would have to be reduced due to
irregular field shape and borders that could not be wet by traveler irrigation.
At this time I told Mr. Towell that we had modified our plan to include a honey wagon for hard to reach areas. I
also told him that we had used a honey wagon briefly last year.
The honey wagon application in question was actually a demonstration by Mr. Lee Brock of Brock Equipment
Co. of Bailey, N. C. After about two loads we found out that the air agitation system would not work with poultry
manure due to high calcium concentration settling to the bottom of the tank. To correct this problem we are
purchasing a honey wagon with a liquid pump agitation system.
I appreciate you taking the time to meet with me on March 18 to discuss this matter. I am requesting that you
consider removing this violation since it was only a demonstration by an equipment dealer to help us make an
informed decision on what equipment to buy.
Sincerely,
David L. Rose

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
June 2, 1998
David Rose
Rose Poultry Farm
2687 Old Bailey Hwy
Nashville NC 27856
Subject: Application No. 64-0002
Additional Information Request
Rose Poultry Farm
Animal Waste Operation
Nash County
Dear David Rose:
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 July 2, 1998:
In order to complete the various components of the certified animal waste management
plan, please submit two copies each of the following documents that may be applicable to your farm:
1. Page 3 of the permit application (attached) with proper signatures and dates
2. Operation and Maintenance PIan for your lagoons
3. Number of lagoons and calculations to show required storage volumes in each of these
lagoons
4. Senate Bill 1217 checklists that include emergency action plan, insect control, odor control,
and mortality management methods
5. Dates poultry houses, lagoons, and spray fields were sited
Please consult your technical specialist for further assistance in determining and obtaining
documents required for your farm. Please include an explanation if any of the above requirements do not
apply to your farm.
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 by the date specified above 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.
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

Application No. 64-0002
David Rose
Page 2
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 363.
cc: Raleigh Regional Office, Water Quality
Permit File
Sincerely,
6e t'—
J R Joshi
Soil Scientist
Non -Discharge Permitting Unit
OFFICE
----_ --_ ��w ,r ,

State of North Carolina IMMM
Department of Environment, VWA
Health and Natural Resources ; •
A 21
James B. Hunt, Jr., Governor IDEF.HNF;Z
Jonathan B. Howes, Secretary
Steve W. Tedder, Chairman December 5,1996
David Rose
Rose Poultry Farm
2687 Old Bailey Hwy
Nashville NC 27856
Subject: Operator In Charge Designation
Facility: Rose Poultry Farm
Facility ID #: 64-2
Nash County
Dear Mr. Rose:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge by January 1, 1997, for each animal
waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more horses,
1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management system. Our
records indicate that your facility is registered with the Division of Water Quality and meets the requirements
for designating an OIC.
A training and certification program is not yet available for animal waste management systems involving
cattle, horses, sheep, or poultry. Owners and operators of these systems will be issued temporary animal waste
management certificates by the Water Pollution Control System Operators Certification Commission
(WPCSOCC). The temporary certificates will expire December 31, 1997, and will not be renewed. To obtain
a permanent certification, you will be required to complete ten hours of training and pass an examination by
December 31, 1997. A training and certification program for operators of animal waste management systems
involving cattle, sheep, horses, and poultry is now being developed and should be available by the spring of
1997. The type of training and certification required for the operator of each system will be based on the torture
of the wastes to be treated and the treatment process(es) primarily used to treat the animal waste.
As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not intend to
operate your animal waste management system yourself, you must designate an employee or engage a contract
operator to be the Operator in Charge. The person designated as the Operator in Charge, whether yourself or
another person, must complete the enclosed application form for temporary certification as an animal waste
management system operator. Both the designation form and the application form must be completed and
returned by December 31, 1996,
If you have questions about the new requirements for animal waste management system operators, please call
Beth Buffington or Barry Huneycutt at 91gn33-0026.
Sincerely,
FOR
Steve W. Tedder
Enclosures
cc: Raleigh Regional Office
Water Quality Files
Water Pollution Control System �!"A Voice 919-733-0026 FAX [phone]
Operators Certification Commission �� An Equal Opportunity/Affirmative Action Employer
P.O. Box 29535 Raleigh, NC 27626-0535 FIT FPS 50% recycled/10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources •
Raleigh Regional Office rI
A
1
James B. Hunt, w , Secrnoretary � F F1
Jonathan B. Howes, Secretary C
Boyce A. Hudson, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
September 18, 1995
Mr. David Rose
Rose Poultry Farm
Route 3, Box 48-A
Nashville, North Carolina 27856
Subject: Compliance Evaluation Inspection
Poultry Operation
SR 1004
Nash County
Dear Mr. Rose:
On August 23, 1995, Mr. Danny Smith from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. This inspection is part of the Division's efforts to
determine potential problems associated with liquid waste disposal
systems.
Mr. Smith's site visit determined that wastewater from your
facility was not discharging to the surface waters of the state. In
addition, no manmade pipes, ditches, or other prohibited
conveyances (for the purpose of willfully discharging wastewater)
were observed. As a result, your facility, was found to be in
compliance during this visit.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facilities. The Division of
Environmental Management is required to enforce water quality
regulations in order to protect the natural resources of the State.
Accordingly, illegal discharges of wastewater to surface waters of
the State are subject to the assessment of civil penalties and may
also result in the loss of deemed permitted status, requiring
immediate submission of a waste management plan.
This office would also like to take this opportunity to remind
you that you are required to have an approved animal waste
management plan by December 1997. This plan must be Certified by a
designated technical specialist or a professional engineer.
3800 Barrett Drive, Suite 101, Raleigh. North Carolina 27609 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

V
David Rose
Compliance Evaluation Inspection
Page 2
For a listing of certified technical specialists or assistance with
your waste management plan you should contact your local Soil and
Water Conservation District.
The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions regarding your inspection
please call Danny Smith at [phone].
Sincerely,
Judy E. Garrett
Water Quality Supervisor
/ds
H:\animdn
cc: Nash County Health Department
Nash County Soil and Water Conservation District
Steve Bennett - Regional Coordinator, Division of Soil and
Water Conservation

s
ZUL_14-1995 15 26 FROM 17EM WATER DUALITY SECTION TO
PRO P.02i02
Site Requires .Immediate Artendor,-
Facility No..2
DIVISION OF ENVIRONMENTAL MANAGEMENT'
ANE AL FEEDLOT OPERATIONS S= VISITATION RECORD
DATE: �- , 1995 . Cy
, line:
Farm Name/Owner >1
Mailing Address:
County:
Integrator: Phone:
OnSite Re -presentative: Phone- u�
Physical Addressfl-xx ation: �• J . Sc Ski l Z� C al �/'� /G'�`G/
Type of Operation: Swine Poultry Cattle
Design Capacity: ��U Number of Animals on Site.
DENT Certification Number: ACE- DEM Cemfication Number: ACNEW
Latitude: Longitude: ` _ �'$ Elevation: / jZ) _Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficienr freeboard of I Foot + 25 year 24 hour storm event
(approxiriaately 1 Foot + 7 inches) 6D or No Actual Freeboard: �t.)- 6? ,Inches
Was any seepage observed from the lagoou(s)? Yes or49 Was any erosion observed? Yes or
Is adequate land available for spray? "e or No Is the cover crop adequate? oeor No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet fion 'Dwl ellings? or No
100 Feet from Wells?_ o"�
r�No
_sir animal waste stockpiled within 100 Feet of USGS Blue Line Sfreatn? ' Yes or r;
arumal waste land applied or spray irrigated within 25 Feet of a USGS' Map Blue Line? Yes or
animal waste discharged into waters of the stare by rna.n-made ditch, flushing. system, or other CO1
-;irnila!' man-made devices? Yes or'lJ if Yes, Please Explain.
tnr facility maintain adequate waste matiagernent Tecards (volumes of ruanure, land applied;
spray irrigated on specific acreage with cover crop)'? Yes oil .
Additional Comments:
Ise
cc: Facility Assessment Unit
Signature
Use Artachiments if Needed.
TOTAL P.02

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
April 17, 1998
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
David Rose
Rose Poultry Farm
2687 Old Bailey Hwy
Nashville NC 27856
Farm Number: 64 - 2
Dear David Rose:
You are hereby notified that Rose Poultry Farm, in accordance with G.S. 143-215.10C, must apply for
coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has six 60
days to submit the attached application and all supporting documentation. In accordance with Chapter 626 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
If you have any questions concerning this letter, please call Mike Lewandowski at [phone]
extension 362 or Charles Alvarez with the Raleigh Regional Office at [phone],
Sincerely/reCstonHoward,
11Z'
_f,,
r A. 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

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
11.E"'�-_.
July 20, 1998If�
ilij
David Rose ? JUL 7 z 19% f '
Rose Poultry Farm
2687 Old Bailey Hwy
Nashville. NC 27856?�cir`;t orr�c
SubjecT. Certificate of Coverage No. AWP640002
Rose Poultry Farm
Poultry Waste Collection, Treatment,
Storage and Application System
Nash County
Dear David Rose:
In accordance with your application received on May 22, 1998, we are forwarding this
Certificate of Coverage (COC) issued to David Rose, authorizing the operation of the subject animal
waste collection, treatment, storage and land application system in accordance with State General Permit
AWG300000. This approval shall consist of the operation of this system including, but not limited to,
the management of animal waste from the Rose Poultry Farm, located in Nash County, with an animal
capacity of no greater than 175000 Layer 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 143-2I5.6C 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.
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
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 AWP640002
Rose Poultry Farm
Page 2
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 J R Joshi at [phone] ext. 363.
Sincerely,
.� A. Preston Howard, Jr., P.E.
cc: (Certificate of Coverage only for all cc's)
Nash County Health Department
Raleigh Regional Office, Water Quality Section
Nash County Soil and Water Conservation District
Permit File

State of North Carolina (Vowzf
Department of Environment and Natural Resources 124e0
Division of Water Quality
Non -Discharge Permit Application Form
(THIS FORM MAYBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
General Permit - Existing Liquid Animal Waste Operations
The following questions have been completed utilizing information on file with the Division. Please
review the information for completeness and make any corrections which 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:
RECEIVED
1.1 Facility Name. Rose Poultry Farm WAiPR sllal I1YCGr`Tiat l
1.2 Print Land Owner's name: David Rose
1.3 Mailing address: 2687 Old Bailey Hwy
City, State: Nashville NC Zip: 27856 Non -Discharge panmittinn
Telephone Number (include area code): 919-459-7608
1.4 County where facility is located: Nash
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. 58 north out of Nashville 1 mile turn left on
State Road 1004. Go 3 miles sign on left of road readin;; Rose Poultry Farm.
1.6 Print Farm Manager's name (if different from Land Owner):,[ 't_- I&& K U L- &4'
1.7 Lessee's I Integrator's name (if applicable; please circle which type is listed): EWOJE-1,L M I L L I1NG Gd .
1.8 Date Facility Originally Began Operation: 01/01/78
1.9 Datc(s) of Facility Expansion(s) (if applicable): 9
2. OPERATION INFORMATION:
2.1 Facility No.: _64 (county number); 2 (facility number),
2.2 Operation Description: Poultry operation
Layer
175000- Certified Design Capacity
Is the above information correct? yes; F7 no. If no, correct below using the design capacity of the facility
The "No. of Animals" should be the maximum number For 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
Wean to Feeder Layer Dairy
Feeder to Finish Non -Layer Beef
Farrow to Wean (# sow) Turkey
Farrow to Feeder (# sow)
Farrow to Finish (# sow)
Other Type of Livestock on the farm: No. of Animals:
FORM: AWO-G-E 1/28/98
i\
Page 1 of 4 64 - 2

2.3 Acreage cleared and available for application (excluding all required buffers and areas not covered by the application
system): 58 ; Required Acreage (as listed in the AWMP): 40.8
2.4 Are subsurface drains present within 100' of any of the application fields? YES or NO (please circle one)
2.5 Are subsurface drains present in the vicinity or under the lagoon(s)? YES o O (please circle one)
2.6 Does this facility meet all applicable siting requirements? (Swine Farm SiqiwAst, NRCS Standards, etc.) (Swine Only)
�ES or NO (please circle one) rrA�
What was the date that this facility' swine ouses 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.
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 land 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.
3.39 The required NRCS Standard specifications.
3.3.10 A site schematic.
3.3.11 Emergency Action Plan.
3.3. l2 Insect Control Checklist with chosen best management practices noted.
3.3. l3 Odor Control Checklist with chosen best management practices noted.
3.3.14 Mortality Control Checklist with the selected method noted.
3.3.1 ` Lagoon/storage pond capacity documentation (design, calculations, etc.)
If your CAWMP includes components not shown on this list, such as an irrigation design,
or site evaluation, please include the additional components with your submittal.
Applicants Initials
FORM: AWO-G-E 1/28/98
Page 2 of 4 64 - 2

♦ ANIMAL WASTE UTILIZATION PLAN
r
Producer: DAVID L. ROSE
RECEIVED
Location: 2640 OLD BAILEY HWY WATER QUALITY SEC110N
NASHVILLE NC 27856
Telephone: [phone]
Type Operation: Existing Layer Non -Discharge Permitting
Number of Animals: 175000.00 bird
(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: 1

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.)
175000 bird x 25.373 tons waste/bird/year = 4440275 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
175000 bird x 0.084 lbs PAN/bird/year = 14700 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
3421
1
GoA
BH
6.5
325
0.0
10.5
3412.5
I
APR-SEPT
3421
�-1
IGOA
3578
1 1
Ra
3572
1
jGoA
END
SG 50.0 �50
ISEPT-MAR
10..0 10.5 525
FH 4.5
�225
I
10.0 �1.0 �225
SEPT-NOV
BH 6.5
1325
I I
�0.0 13.1 11007.5
APR-SEPT
TOTAL15170
- 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.
Page: 3

ANIMAL WASTE UTILIZATION PLAN
4
w
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
3572
GoA
SG
50.0
50
0.0
3.1
155
SEPT-MAR
3572
BH
6.5
12
JGoA
1325
�0.0
15.3
11722.5
3572
SG
50.0
1-2
�GoA
150
�0.0
�5.3
1265
SEPT-MAR
3987
1
BH
6.1
JNoB
1305
10.0
�20.9
16374.5
APR-SEPT
3987
NOB
SG
50.0
�_l
�50
10.0
120.9
�1045
SEPT-MAR
3382
1
NOB
SA
4.0
1220
10.0
�7.7
11694
MAY-AUG
3382
NOB
WA
50.0
1-1
150
�0.0
17.7
1385
SEPT-MAR
3556
1
SA
4.0
�NoB
1220
�0.0
�4.3
1.946
MAY-AUG
3556
50.0
1-1 JNoB
�WA
�50
�0.0
�4.3
1215
SEPT-MAR
END
TOTAL112802
Indicates that this field is being overseeded (i.e. interplanted) or
winter annuals follow summer annuals.
In interplanted fields (i.e. small grain, etc, interseeded
in bermudagrass), forage must be removed through grazing,
Page: 4

` ANIMAL WASTE UTILIZATION PLAN
hay and/or silage. Where grazing, plants should be grazed
when they reach a height of six to nine inches. Cattle
should be removed when plants are grazed to a height of four
inches. In fields where small grain, etc, is to be removed
for hay or silage, care should be exercised not to let small
grain to reach maturity, especially late in the season (i.e.
April or May). Shading may result if small grain gets too
high and this will definitely interfere with stand of
bermudagrass. This loss of stand will result in reduced
yields and less nitrogen being utilized. Rather than
cutting small grain for hay or silage just before heading as
is the normal situation, you are encouraged to cut the small
grain earlier. You may want to consider harvesting hay or
silage two to three times during the season, depending on
time small grain is planted in the fall.
The ideal time to interplant small grain, etc, is late
September or early October. Drilling is recommended over
broadcasting. Bermudagrass should be grazed or mowed to a
height of about two inches before drilling for best results.
Caution must be exercised in grazing or haying summer
annuals under stressed conditions. Nitrate poisoning
may occur in livestock. Sampling forage or hay for
nitrate levels is recommended.
** 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
BH
BERMUDAGRASS - HAY
TONS
50
PH
FESCUE - HAY
TONS
50
SA
SUMMER ANNUAL
LBS
55
SG
SMALL GRAIN OVERSEEDED
BU
1.0
WA
WINTER ANNUALS
1.0
TOTALS FROM TABLES 1 AND 2
Page: 5

ANIMAL WASTE UTILIZATION PLAN
TABLE 1
TABLE 2
TOTAL
ACRES
LBS AW N USED
14.6
5170
38.2
12802
52.8
17972
* BALANCE
-3272
*** 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 9100 pounds of plant available nitrogen per year in the
sludge.
If you remove the sludge every 5 years, you will have approximately 45500
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 151.666666667 acres of land. If you apply the sludge to corn at
the rate of 125 pounds of nitrogen per acre, you will need 364 acres
of land. Please be aware that these are only estimates of the PAN and
land needed. Actual requirements could vary by 251c 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)
Applic. Amount
(inches)
3382
1
NoB
SA
0.40
*1.00
3382
"1
NoB
WA
0.40
*1.00
3421
1
GoA
BH
0.50
*1.00
3421
"1
GoA
SG
0.50
*1.00
3556
1
NoB
SA
0.40
*1.00
3556
"1
NoB
WA
0.40
*1.00
3572
1
GoA
BH
0.50
*1.00
3572
2
GoA
BH
0.50
*1.00
3572
"1
GoA
SG
0.50
*1.00
3572
GoA
SG
0.50
*1.00
3578
1
Ra
FH
0.40
*1.00
3987
1
NoB
BH
0.50
*1.00
3987
Y1
NoB
SG
0.50
*1.00
* 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.
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.
Page: 8

ANIMAL WASTE UTILIZATION PLAN
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
Tract 3382 Field 1 and Tract 3556 Field 1 are being added to the waste utilization plan to
supplement the existing waste utilization plan. The crops grown on these two tracts will
consist of small grain and summer annuals, i.e. millet, sorgham, etc. Every third year a
conventional row crop such as tobacco and sweet potatoes.
Page: 9

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: 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 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: 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 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: 12

ANIMAL WASTE UTILIZATION PLAN
WASTE UTILIZATION PLAN AGREEMENT
Name of Farm:ROSE POULTRY
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: DAVID L. ROSE
(please print)
Signature: k 0
4_ Date :
Name of Manager (If different from owner) :
Signature: Date:
Name of Person Preparing Plan: (please print)J. Edward Long
Affiliation:Nash Soil and Water Conservation District Phone
No. 919-459-4115
Address (Agency): Room 107 Ag. Center Drive
Nashville NC 27856
Signature: Date:
i
Page: 13

l
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 /D 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. 7iac.# 3572 Feld /i 2.
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: 7 Date:/
Waste Producer:A Date 1,7
Technical Representative Date: l 212-3(11%
SWCD Representative: r Date:
Term of Agreement: ,19W to / 9
(Xinimttrm of Ten Years on Cost Shared items)
(See Required Specification No. 2.)
Page: 13

ANIMAL WASTE UTILIZATION PLAN
STATE OF NORTH CAROLINA
COUNTY OF 22
I, I,WP�_ _ _ ! 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
, h , el '1L - . 19 9� .
My commission expires
(SEAL)
Y
Notary Public.
Page: 14

lei '
ANIMAL WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only If additional land has to be leased, etc.)
hereby giveLZ446�1
4
X�L
permission
to apply animal
waste from
his Waste Utilization System
on .Z:L 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. _Te-Qt 3R 87 F� c ld 1
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:
L. Date:
Date
—� Date: /2/Z,3 / V
Date:. /Z1z3/?7
Term of Agreement: ;1gyy ASh
( nimum of Ten Years on Cosred items)
(see Required Specification No. 2.)
Page: 13

ANIMAL WASTE UTILIZATION PLAN
STATE OF NORTH CAROLINA
COUNTY OF I,Q
I ,t /1J��Grr� /��,CJ 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 ,�,/3�9�%l1,?fl[l� /C • Yl
Notary Public.
(SEAL)
Page: 14

ANIMAL WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
1, �A? .�cni2�'-- , hereby give 5��- n Go
permission to apply animal waste from his Waste Utilization System
on 1/ 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. Tracf 33 8 Z F'efo- "
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 : Date:
Waste Producer: Date:
Technical Representative: Date:
SWCD Representative: Date
Term of Agreement: ,19 8 to -.O / b .110-Z
(KInImum of Tea Years on Coat Shared Items)
(see Required specification No. 2.)
•1-
Page: 12

ANIMAL WASTE UTILIZATION PLAN
ANIMAL WASTE UTILIZATION AGREEMENT
(Needed only if additional land has to be leased, etc.)
I, hereby give 4gC2
permission to apply animal waste from his Waste Utilization System
on ID 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. 7,-0.et 3.359 F"(:6 2
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.
6Date:
Adjacent Landowner:
Waste Producer:-
Date:
Technical Representative: -a,
�-�
Date:
SWCD ..Representative :
c
Date:
Term of.Agreement:
,1921yr- toQO
S
(M nimum
of Ten Years on Cost Shared
Items)
(See Required Specification No. 2.)
Page: 12

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000 4000 3000 2000 1000
This soil survey map was compiled by the U.S. Department of Agriculture.
Soil Conservation Service, and cooperating agencies. Base maps are S
orthophotogranhs prepared by the U.S. Department of the Interior, Geological
Survey, from 1975 1980 aerial photography. Coordinate grid ticks and
land division corners. if shown. are approximately positioned.

� 06/16/98 07:27 V9194596189
F w0itp Numb=. 64 - 2
f sty NMM Rose Panitry Fnm
002
(Land Ownsr'a namc listed in quadoa 1.2X Guest that
t ds applica uoa for Adjky on= listed in question 1.1)
t as been reviewed by ins and is Mamd o template to *9 best of my lmvwlodgo. I understand that if all n qutrad parts of this
a )placation am not camplc W and that if ellrequited suppm-fitg informadon and ettecbments are not included, this applicatsoa paclop
F fl) be rcudmdAO-ft as intomnlaw
i . MANAGER'S CERTMICATION: (completa valy if dillmwt liom the Lard owner)
(Maoaga% oaw listed in qumdoa 1-6), attoet tbnt this
e splicstloa iar (Fec Wty name listed in question 1.I)
t :s been reviewed by me and i9 accurmw andcmvlata to the best of my knowledge. I undwstwd that if all mgaised pasta of this
a �plimon are not completed and that if ell u quimd aoppordng infer u4c m mW anaahmgs are not included. this 49licatian package
o .1] be rammed as izcomplet&
Dam — L -5 - 9 ?
THE COMPLSIED APPLICATION PACKAGE, INCLUDING ALL SUIFORMNO DMORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLL owiNG ADDIt &
NORTH CAROLINA DIVISION OF WATER QUALITY
WATER QUALITY SECTION
NON -DISCHARGE PERNWrMGr UNIT
POST OFFICE BOX 2953E
RALEIGH, NORTH CAROLIN'A 2762&0535
TELEPHONE NUMBER: [phone]
FAX NUMBER: (919) 73 4M
I OR1VI: AWO-G-E 5fM8 page 3 of 4 64 - 2

00i16/98 07:29 V9194896189 R 007
C of ffx1s' f"3 (.d�oo�- .Stem
THIS DESIGN IS FOR A SINGLE STAGE LAGOON (LAYER)
CLIENTS NAME -------••.•_•---- ••---_> ROSE POULTRY
COUM osesneaa==e=Qa=aGSGassaa=GiaisgQPasaaa} NASH COUNTY, NORTH CAROL
TODAYS DATE =anmCiaavaamRaaaaeenae====asn} FEBRVARY 12, 1997
DISTANCE TO NEAREST NONFARM RESIDENCE =7 1500t . FEET
NUMBER OF LAYERS == ,•-- ' 175000 '
DEGREE OF ODOR CONTROL 2.5
(minimum 2.5 cu. ft. per lb SSLW)
(maximum 4.0 cu. '.ft. per lb SSLW)
NEDMER OF YEARS OF SLUDGE ACCUMULATION > 0.0 YRAR.S
TOP LENGTH AT NORMAL WATER LEVEL ==bapa>
636.5
FEET
TOP WIDTH AT NORMAL WATER LEVEL,----
486.5
FEET
NORMAL WATER LEVEL ELEVATION a===a=a=a=>
45.8
FEET i
SEASONAL HIGH WATER TABLE ELEVATION =ae>
38.0
FEET
LAGOON BOTTOM ELEVATION=a=====__=====g>
39.8
FEET
Depth of Permanent Water 6.0
(minimum depth without sludge - 6 feet)
(minimum depth with sludge = 8 feet)
SIDE SLOPES-aase
2.5:1
Permanent Volume Required 1750000.0
cubic feat
Permanent Volume Provided 1758673.5
cubic feet
I
ADDITICHAL DRAINAGE AREA IN SQUARE FEET> 0 SQUARE FEET
(i.e. pumpout pond & other outside area)
LENGTH OF PUMPING CYCLE _--===ace==aaa=y 180 DAYS
GALLONS OF FRESH WATER ADDED DAILY 0 GALLONS
EXCESS R VENFALL ABOVE EVAPORATION -____> 7.7 INCHES
25YR/24M STORM RAINFALL 6.6 INCHES
FREEBOARD 1.0 FEET
Temporary Storage Volume 522051.0 cubic feet
Top of Dam Elevation W 48.5 feet
Inside Dimensions Of Lagoon at Top of'Dam
Length - 650.0 feet Width - 500.0 feet-sAsa.orr;i>�x,f+�.r�r'�-�
Begin Pumping Elevation a
Stop Pumping Elevation =
46.9 feet
45.8 feet
i
f

06/16/98 07:29 09194596189 IM008
1. STEADY STATE LIVE WEIGHT,
175000 LAYERS X 4 POMMS 700000I1bs
TOTAL STEADY STATE LIVE WEIGHT (SSLW) 700000 lbs
2. SLUr)GE ACCUMULAT109
Sludge accumulates at the rate of 0.160 cu. ft. per year
per pound of STEADY STATE LIVE WEIGHT in layers.
Years of sludge accumulation in design? 0.0
Sludge Volume a 0.0 cubic feet
3, REQUIRED LIQUID VOLUME OF LAGOON
Design for 2.5 cu. ft. per pound SSLW
Total Volume (SSLW * Design factor) + Sludge Volume
Total Volume 1150000.0 cubic feet f
4. NORMAL LAGOON LIQUID LMML
Maintain normal lagoon liquid level at elevation 45.8 feet
Construct lagoon bottom elevation 39.8 feet
Lagoon size for normal lagoon liquid volume using prismodial formula
SS/END1 SS/END2 SS/SIDE1 SS/SIDE2 DEPTH
2.5 2.5 2.6 2.5 6.0
AREA OF TOP
LENGTH * WIDTH =
636.5 486.5 309657.2 (AREA OF TOP)
AREA OF BOTTOM
Lb * Wb
606.E 455.5 276867.2 (AREA OP BOTTOM) ,
AREA OF MIDSECTION
(Lm * wm) m
621.5 471-S 293037.2 (AREA OF MIDSECTION)
CU. YD. . [AM TOP + (4*AR.EA MIDSECTION) + ARRA. BOTTOM] *'DEPTH/6
309657.2 1172149.0 276667.2 1.000
VOLUME OF LAGOON AT NORMAL LAGOON LIQUID LEVEL = 1755673.5!CU. FT.
VOLUME NEEDED 1750000.0 CU. FT.
THE SURFACE DIMENSIONS OF THE LAGOON AT NORMAL LIQUID LEVEL
ARE 636.5 FEET LONG BY 486.5 FEET wiDE

06/16/98 07:29 129194396189 [a 009
5. DIKE
P1dCe spoil as a continuous dike to elevation 48.5 feet.
6. TEMPORARY STOP -AGE REQUIRED
DRAINAGE AREA
Lagoon (top of dike)
Length * Width
650.0 500.0 325000 square feet I
Additional Drainage Area
0 square feet
TOTAL DA 325000 square feet
Pumping cycle to be 180 days.
6A. Volume of watee produced i
Volume - 700000 SSLW * 0.008 gallon/lb. S5LW/day * 180�daya
in the pumping cycle / 7.48 gallons per cu. ft.
Volume m 1347S9.4 cubic feet
I
6B. Volume of excess water.
This is the amount of excess water usage (see tech_ guide 633-83)
I
Volume a 0 gallons/day * 180 days i-a the 'Pumping
cycle divided'by 7.48 gallons per cu. ft.
volume - 0.0 cubic feet
5C. Volume of rainfall in excess of evaporation
Use period of time when rainfall exceeds evaporation by largest
amount.
Excess rainfall (difference) II 7.7 inches
Volume - 7.7 inches * DA / 12 inches per foot
Volume o 208541.7 cubic feet
6D. Volume of 25 year - 24 hour storm
volume s 6.6 inches * DA / 12 inches per foot
Volume - 1787So.0 cubic feet
TOTAL REQUIRED TEMPORARY STORAGE
GA. 134759.4 cubic feet
6B . 0.0 cubic feet
GC. 208541.7 cubic feet
610. 178750.0 cubic feet
TOTAL TEMPORARY STORAGE 522051.0 cubic feet
0

06/10/98 07:30 " "0
7. DEPTH OF STORAGE REQUIRED (ABOVE NORMAL LIQUID ELEVATION OF LkGOON)
Depth required = Volume of temporary storage divided by surface
area of lagoon.
Depth required - 522051 cu. ft. / 309657 sq. ft.
Depth required a 1.7 feet
Normal lagoon liquid elevation - 45.8 feet
Depth required 1.7 feet
Freeboard 1.0 feet
Top of Dam 48.5 feet
THE DIMMSIONS OF THE INSIDE EDGE OF THE DAM AT RLEVATION 46.5
ARE' ' 650.0 FEET BY 500.0 FEET i
e. SET BEGIN PUMPING ELEVATION
PUMPED STORAGE VOLUME
6A. 134759.4 cubic feet
53. 0.0 cubic feet
6C. 206541.7 cubic feet
i
TOTAL PUMPED VOLUME - 343301.0 cubic feet
Depth required G Volume of pumped storage divided by surf& e
area of lagoon at normal water level.
Depth required - 343301.0 cu. ft. / 109657.25 sq. ft.
Death required - 1.1 feat
DESIGNED BY: APPROVED BY:
DATE: DATE:

.
• 06/10/98 07:27 09194598189
iM 003
EMERGENCY ACTION PLAN
PHONE NUMBERS
DWQ 919-571- 4700
E)MCENCY NANAGEMENT SYSTEM 919-459- 7376
swcD s i9-- 45 9- 4115
VRcs 9Z9- 459-4115
This plan will be implemanted in the event that wastes from
your operation are leaking, overflowing, or running off
site. You should not wait until Wastes reach surface waters
or leaven your property to consider that you have a problem,
You should make every effort to ensure that this does not
"happen. This plan ahoga!j be nantad J an accessible
Iona iez _fog ajj-jWloXeea at_the� _fagility. The following
are some action items you should take.
I. stop the release of wastes. Depending on the
situation, this may or may not be possible. Suggested
responsea 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 rate.
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. I m$diately stop waste application.
b. Create a temporary diversion to contaih waste.
c. Incorporate waste to raduca runoff.
d. Evaluate and eli,minata the roason(s) that
caused the runoff.
e. Evaluate the application rates for the fields
where runoff occurred.
cs teakage from the waste pipes and sprinklers -action
includes
a. stop recycle pump.
b. Stop irrigation pump.
o. Chose valved tv eliminate further disoharga.

08/16/98 07:28 _ 4005
d. Repair all leaks prior to restarting pumps.
Ds Leakage from flush systems, houses, solid
separators -action include:
a: Stop recycle pump.
b. stop irrigation pump.
c. Make sure no siphon occurs.
d. stop all flowa.in the house, flush systems, or
solid separators.
e. Repair a12 leaks prior to restarting pumps.
L: Leakagge from base or sidevall of lagoon. often
T. this is seepage as opposed to gloving leaks-
-.- possible actions
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 soil.
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 what
duration?
C. Any damage noted, such as employee injury, fish
kills, or property damage?
d. Did the spill leave the property?
a. DQBs the spill have the potential to reach surface
waters?
f. could a future rain event causes the apill to reach
# scuface: waters?
g. Are potable Water wells in danger (either on or off
of they property)7
h. How much reached surface water$?
3: Contact apprepriata ageaeie:s.
a. During normal business hours, call your DWQ
(Division of water Quality) regional office; Phone
g1g�71 - 4700. After hours, emergency number: 919-
733-3942. Your phone call should include: your
name, facility, telephone mbar, the details of

06/10/98 07:28 09195698189 Q 008
the incident fron► item i above, the exact location
Of the facility, the location or direction of
movement of the spill, weather and wind Conditions.
The corrective measures that have been under taken,
and the seriousnass of the situation.
b. If spill leaves proparty or enter* surface waters,
0411 local ENS Phone number 91.9-459-7375.
c. Instr}Act US to contact local Health Department.
d. Contact CES, phone number 919-459 -0810 , local SWCD
office phone number 919-459- 4114 and local MRCS
office for advice/technical assistance phone number
919- 459. 4115.
a: =f nose of the above warks call oil or the Sheriff's
Department and explain your problem to them and ask
_ _.. -....that parson to contact the proper agencies for you.
51 Contact the contractor of your choice to begin repair
of problem to minimise off -site damage.
a. Contractors Name:
b. Contractors Address.
c. Contractors Phone:
61 contact the technical specialist who certified the
lagoon (MRCS, Consulting Engineer, eta.)
a. Name; NRC D
b. Phone., (919) 459- i
7: Iuaplement procedures as advised by =9 and teOhniCal
assistance agencies to rectify the damage, repair the
system, and reassess the waste management plan to keep
problems witb release or wastes from happening again.

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06/10/98 07:31 V9194598189
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snllieiMly to negsm►s neattmtt6ticdsaitde warn
gpllem as MEd.
Remo" haddthg of a=muhftd sdids N
disrttaage
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stay ialtml duftwsttntatcr.15 30day iotcr,rul
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D6/18/9$ 07:32 �'918468618D �01B
Martanty Manzgmwt Method
(check which methods) are bring impienLent
M Burial three feet beneath the surfaca of the ground Witbin 24 hours after
Jmowledge of the death. The burial Must be at least 300 feet from any flowing
stream orpublie body of water.
Ca Rendering at azendaring plant li=nd underG.5.'1D6.168.7
a • Complete, inchamtian
IQ In the case of dead poultry only. placing in a disposal pit of a size and deaign
approved by the Department of Agricukurr.
_.0.... _Any method which in the professional opinion of the State Veterinarian would
make possible the salvage of part of a dead animal's value without tndaugariug
human or animal health. (Written approval of the State Veterinarian must be
attached)
December 18, 1996
11

ni
4.
OPERATION AND MAINTENANCE PLAN
------------------------------
This lagoon is designed for waste treatment (permanent storage) with
min. odor control. The time required for the planned fluid level to be
-reached (permanent + temporary storage) may vary due to soil conditions
flushing operations, and the amount of fresh water added to the system.
'''The designed 6 months temporary storage is an estimated volume
based on: 1) waste from animals; 2) excess rainfall after evaporation;
:.and 3) the largest 24 hour (one day) rainfall that occurs on the
average -.of once every 25 years. The volume of waste generated from
a given number of animals will be fairly constant throughout the year
and from year to year. This estimate is based on 7 inches of excess
rainfall which is equal to or exceeds the highest 6 months excess in
a year. The average annual excess rainfall is approximately S inches.
Therefore, an average of 8 inches of excess rainfall will need to be
pumped each year. The 25 year rainfall will not be a factor to consider
in an annual pumping cycle, but this storage volume must always be
available. -'A maximum elevation is determined in each design to begin
pumping and this is usually the outlet invert of pipe(s) from
building(s). If the outlet pipe is not installed on the elevation to
begin' -pumping, a permanent marker must be installed on this elevation
to indicate when pumping should begin. An elevation must be established
to stop pumping to maintain minimum treatment depth (6 feet).
Pumping. -can be started or stopped at any time between these two
elevations for operating convenience as site conditions permit, such as
weather,soils, crop, and equipment in order to apply waste without
runoff or leaching.
Land application of waste water is recognized as an acceptable
method,;of disposal. Methods of application include solid set,
center..pivot, guns, and traveling gun irrigation. Care should be
taken when applying waste to prevent damage to crops.
The.following items are to be carried out:
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
covered with effluent at all times. When precharging is complete,
flush -'buildings with recycled lagoon liquid. Fresh water should not
be used 'for flushing after initial filling.
2. The attached waste utilization plan shall be followed. This
plan recommends sampling and testing of waste (see attachment)
before land application.
3. Begin pump -out of the lagoon when fluid level reaches eleva-
tion 45.Z as marked by permanent marker. Stop pump -out when

tr e.u.z iuia ieveiL reacnes e ieva aX.u..
1ess6 feet deep (this prevents the loss of favoinu,Lc
bacteri.than _aY. The design temporary storage, less 25 year storm
isF?'''-:178473 cubic feet or 1334977 gallons. As stated before, this
`volume`;will vary considerably from year to year.
fir.; .' .
,.._.4. The.recommended maximum amount to apply per irrigation is
one (1) inch and the recommended maximum application rate is 0.3
inch per. hour.
5. Keep vegetation on the embankment and areas adjacent to the
lagoonJmowed 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.
'z 7. All' surface runoff is to be diverted from the lagoon to stable
outlets.
B. Keep.a minimum of 25 feet of grass vegetated buffer around
waste utilization fields adjacent to perennial streams. Waste will
' not be -applied in open ditches. Do not pump within 200 feet of a
residence or within 1.00 feet of a well.
9. '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.

Animal Waste Management Plan Certification
Please type or print all information that does not reauire a signature
General Information:
Name of Farm:_ Rose_ PoJfir y Fa.,,,,, Facility No: 6 `I -- 0 2
Owner(s) Name: Dmu;ci Rose Phone No: 91?459-„2608
Mailing Address: 268i Old- &;lesi Nw,y. N4.sk.allle AIC 2.28,56
Farm Location: County Farm is located in: /Uas A
Latitude and Longitude: J 6 01 1,5 I 7.7 -13_ /5 Integrator:
Please attach a copy of a county road map with location identified and describe below (Be specific: road
names, directions, milepost, etc.): On Sit looj ,y r}k of NC.18.
Operation Descrintion:
Type of Swine No. of Animals
❑ Wean to Feeder
Q Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
0 Boars
Type of Poultry No. of Animals Type of Cattle No. of Animals
® Layer 121000 ❑ Dahiy
* Pullets RECP-14.
Other Type of Livestock: I Mr�b�,4fkAals:
WATER C►JAJTY SECT{ -IN
Acreage Available for Application: _ _ 6Eo _ Required Acreage: y0- 8
Number of Lagoons / Storage Ponds: ! Total Capacity: 2, z80,, 72`lCubic Feet (ft3)
Are subsurface drains present on the farm: YES or NO (please circle one)
If YES: are subsurface drains present in the area of the LAGOON or SPRAY FIELD (please circle one)
Owner 1 Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. I (we) understand the operation
and maintenance procedures established in the approved animal waste management plan for the farm named above and will
implement these procedures. 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 Division of
Environmental Management before the new animals are stocked. I (we) understand that there must be no discharge of
animal waste from the storage or application system to surface waters of the state either directly through a man-made .
conveyance or from a storm event less severe than the 25-year, 24-hour storm and there must not be run-off from the
application of animal waste. I (we) understand that run-off of pollutants from lounging and heavy use areas must be
minimized using technical standards developed by the Natural Resources Conservation Service. The approved plan will be
filed at the farm and at the office of the local Soil and Water Conservation District. I (we) know that any modification
must be approved by a technical specialist and submitted to the Soil and 'Water Conservation District prior to
implementation. A change in land ownership requires written notification to DEM or a new certification (if the approved
plan is changed) within 60 days of a title transfer.
Name of Lan er : Da�� Ras er
Signature: X
Name of Manager(if different from owner):
Signature: Date:
AWC -- August 1, 1997

Technical Specialist Certification
L As a technical specialist designated by the North Carolina Soil and Water Conservation Commission pursuant to 15A
NCAC 6F .0005, I certify that the animal waste management system for the farm named above has an animal waste
management plan that meets or exceeds standards and specifications of the Division of Environmental Management
(DEM) as specified in 15A NCAC 211.0217 and the USDA -Natural Resources Conservation Service (NRCS) and/or the
North Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 2H.0217 and 15A NCAC 6F .0001-
.0005. The following elements are included in the plan as applicable. While each category designates a technical specialist
who may sign each certification (SD, SI, WUP, RC, I), the technical specialist should only certify parts for which they are
technically competent.
II. Certification of Design
A) Collection, Storage, Treatment System
Check the appropriate box
M Existinz facility without retrofit (SD or WUP)
Storage volume is adequate for operation capacity; storage capability consistent with waste utilization
requirements.
❑ ew_e;Spanded or retrofitted facility (SD)
Animal waste storage and treatment structures, such as but not Iimited to collection systems, lagoons and ponds,
have been designed to meet or exceed the minimum standards and specifications.
Name of Technical Specialist (Please Print): T e rru aes
Affiliation MRCS Date Work Completed: //- a -? 7
Address (Agency): Rm l07 Ag ce. +er De. .4_5l.0:/le- X/C &-2r3e Phone No.: 9/` _(,f5- y//5
B) Land Application Site (WUP)
The plan provides for minimum separations (buffers); adequate amount of land for waste utilization; chosen crop is
suitable for waste management; hydraulic and nutrient Ioading rates.
Name of Technical Specialist (Please Print): S.-Ed-w-x I_ona
Affiliation'No-i k So,! ¢ Cuter Date Work Completed: //- 03 -9 2 -�
Address (Agency): RMl07 A� Ce.•�}cr Dr:�� N kv:lle -(✓c z Y5 Phone No.: 9/9- y37-y//S
Silsnature:.�. �. -�� Z, Date:
C) Runoff Controls from Exterior Lots
Check the appropriate box
Q Fadlily without exterior lots (SD or WUP or RC)
This facility does not contain any exterior lots.
❑ FaciIitY with exterior lots (RC)
Methods to minimize the run off of pollutants from lounging and heavy use areas have been designed in
accordance with technical standards developed by MRCS.
Name of Technical Specialist (Please Print): :7. Ed,�;ardl Lo^3
Affiliation -ash Sg,'I o a. a tc.- D sf r , d Date Work Completed: 11- 03 - 97
Address (Agency): R*.3,n /07 4 Cenier Dr:ae looay,l/e Al .z7"L4 -Phone No.: 9/9-y39- WIS
Signature: Date: !/-03 -
AWC -- A ust 1, 1997 2

D): Application and Handling Equipment
Check the appropriate box
ZI Existing or expanding facility with existing waste application -equipment (WUP or 1).
Animal waste application equipment specified in the plan has been either field calibrated or evaluated in
accordance with existing design charts and tables and is able to apply waste as necessary to accommodate the
waste management plan: (existing application equipment can cover the area required by the plan at rates not to
exceed either the specified hydraulic or nutrient loading rates, a schedule for timing of applications has been
` established; required buffers can be maintained and calibration and adjustment guidance are contained as part of
the plan).
❑ New. expanded. or existing facility without existing waste application equipment for spray irrigation. (1)
Animal waste application equipment specified in the plan has been designed to apply waste as necessary to
accommodate the waste management plan; (proposed application equipment can cover the area required by the
plan at rates not to exceed either the specified hydraulic or nutrient loading rates; a schedule for timing of
applications has been established; required buffers can be maintained; calibration and adjustment guidance are
contained as part of the plan).
9 New, expanded, or existingfacility without existing waste application equipment for land spreading not using
spay irrigation. (WUP or 1)
Animal waste application equipment specified in the plan has been selected to apply waste as necessary to
accommodate the waste management plan; (proposed application equipment can cover the area required by the
plan at rates not to exceed either the specified hydraulic or nutrient loading rates; a schedule for timing of
applications has been established; required buffers can be maintained; calibration and adjustment guidance are
contained as part of the plan).
Name of Technical Specialist (Please Print): 7. Ed(.►ar L ^
Affiliation Nai k so: l 4 ul-#e r Date Work Completed:
Address (Agepsy): RM. /Q2 Ai G ,,tom. Dn�t N--JkV //C .✓c z7r-919 Phone No.: 9/9-yS9-yi/5
Si
/Z-//-9?
E) Odor Control, Insect Control, Mortality Management and Emergency Action Plan (SD
SI, WUP, RC or D
The waste management plan for this facility includes a Waste Management Odor Control Checklist, an Insect
Control Checklist, a Mortality Management Checklist and an Emergency Action Plan. Sources of both odors and
insects have been evaluated with respect to this site and Best Management Practices to Minimize Odors and Best
Management Practices to Control Insects have been selected and included in the waste management plan. Both the
Mortality Management Plan and the Emergency Action Plan are complete and can be implemented by this facility.
Name of Technical Specialist (Please Print): T. Edwo-,4 L.a.tea
14
Affiliation ALsk Se; 1 4- "fie,, Cae Le Date Work Completed: /I-03-9� _
Address (Agency): Rot 102,E cede, Drivf- A1a4k r!e- ,vC z7t5s Phone No.: 919-y59-y//.S
Signature: C Date: // �4 ~ `� %
F) Written Notice of New or Expanding Swine Farm
The following signature block is only to be used for new or expanding swine farms that begin construction after June
21, 1996. If the facility was built before June 21, 1996, when was it constructed'or last
expanded
I (we) certify that I (we) have attempted to contact by certified mail all adjoining property owners and ail property owners
who own property located across a public road, street. or highway from this new or expanding swine farm. The notice was
in compliance with the requirements of NCGS 106-805. A copy of the notice and a list of the property owners notified is
attached.
Name of Land Owner:
Signature: Date:
Name of Manager (if different from owner):
Signature: Date:
AWC -- August 1, 1997 3

f
III. Certification of Installation
A) Collection, Storage, Treatment Installation
New, expanded or retrofitted facility (SI)
Animal waste storage and treatment structures, such as but not limited to lagoons and ponds, have been installed
in accordance with the approved plan to meet or exceed the minimum standards and specifications.
For existing facilities without retrofits, no certification is necessary.
Name of Technical Specialist (Please Print):
Affiliation Date Work Completed:
Address (Agency): Phone No.:
Signature: Date:
B) Land Application Site (WUP)
Check the appropriate box
0 The cropping system is in place on all land as specified in the animal waste management plan.
Cl Conditional Approval: all required land as specified in the plan is cleared for planting; the cropping system
as specified in the waste utilization plan has not been established and the owner has committed to establish the
vegetation as specified in the plan by (month/day/year); the proposed cover crop is
appropriate for compliance with the wasteutilization plan.
❑ Also check this box if appropriate
if the cropping system as specified in the plan can not be established on newly cleared land within 30 days
of this certification, the owner has committed to establish an interim crop for erosion control;
Name of Technical Specialist (Please Print): T,
AffiliationNo4k Sa;l4_WaJe• ,_Date Work Completed: 11-03-77
Address (Agency): Rwn, io? 4_g ce,.fer &,•ue. Am- z-7 85 b Phone No.: `119 - `! 59 - y 115
Signature:
11-03 -97
This following signature block is only to be used when the box for conditional approval in M. B
above has been checked.
I (we) certify that I (we) have committed to establish the cropping system as specified in my (our) waste utilization plan,
and if appropriate to establish the interim crop for erosion control, and will submit to DEM a verification of completion
from a Technical Specialist within 15 calendar days following the date specified in the conditional certification. I (we)
realize that failure to submit this verification is a violation of the waste management plan and will subject me (us) to an
enforcement action from DEM.
Name of Land Owner:
Signature: Date:
Name of Manager (if different from owner):
Signature: Date:
AWC. -- August 1, 1997 4

C) Runoff Controls from Exterior Lots (RC)
Facility with exterior lots
Methods to minimize the run off of pollutants from lounging and heavy use areas have been installed as specified
in the plan.
For facilities without exterior lots, no certification is necessary.
Name of Technical Specialist (Please Print):
Affiliation Date Work Completed:
Address (Agency): Phone No.:
Signature: Date:
D) Application and Handling Ealuinment Installation (WUP or I)
Check the appropriate block
Animal waste application and handling equipment specified in the plan is on site and ready for use;
calibration and adjustment materials have been provided to the owners and are contained as part of the plan.
❑ Animal waste application and handling equipment specified in the plan has not been installed but the owner
has proposed leasing or third party application and has provided a signed contract; equipment specified in
the contract agrees with the requirements of the plan; required buffers can be maintained; calibration and
adjustment guidance have been provided to the owners and are contained as part of the plan.
❑ Conditional approval: Animal waste application and handling equipment specified in the plan has
been purchased and will be on site and installed by (month/day/year); there is adequate,
storage to hold the waste until the equipment is installed and until the waste can be land applied in
accordance with the cropping system contained in the plan; and calibration and adjustment guidance have
been provided to the owners and are contained as part of the plan.
Name of Technical Specialist (Please Print): Loti
Affiliation /c/4s k 5o,' I f Date Work Completed: 12-11—V
Address (Agency�:_R•.• (07 4., ce.Je- yc z7e§6- Phone No.: 919-y..S9-y11s
Signature: U __. Date: /z - %/ -
The following signature block is only to be used when the box for conditional approval in III D
above has been checked.
I (we) certify that I (we) have committed to purchase the animal waste application and handling equipment as
specified in my (our) waste management plan and will submit to DEM a verification of delivery and installation
from a Technical Specialist within 15 calendar days following the date specified in the conditional certification. I
(we) realize that failure to submit this verification is a violation of the waste management plan and will subject me
(us) to an enforcement action from DEM.
Name of Land Owner:
Signature: Date:
Name of Manager (if different from owner):
Signature:
Date:
E) Odor Control, Insect Control and Mortality Management ISM SI, WUP, RC or I)
Methods to control odors and insects as specified in the Plan have been installed and are operational. The
mortality management system as specified in the Plan has also been installed and is operational.
Name of Technical Specialist (Please Print): J. Lo
Affiliation 8LaAk .so;t f w0.fc, D,,xf,r-t Date Work Completed: 1 -a3- :7
Address (Agency): Rrn lo) ,2s center D,..-.,*-N,� rll� ,✓r- -L7Fs.sG Phone No.: 9l7- Y9-Ylls
S
-9d
AWC. -- August 1, 1997 5

Please return the completed form to the Division of Water Quality at the following address:
Department of Environment, Health, and Natural Resources
Division Of Water Quality
Non -Discharge Branch, Compliance Unit
i P.O. Box 29535
Raleigh, NC 27626-0535
Please also remember to submit a copy of this form along with the complete Animal Waste
Management Plan to the local Soil and Water Conservation District Office and to keep a copy
in your files with your Animal Waste Management Plan.
AWC -- August 1, 1997 6

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