760030_INSPECTIONS_20171231

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Richard Dale Hollingsworth
Hollingsworth Dairy
PO Box 116
Sophia, NC 27350
Dear Mr. Hollingsworth:
Division of Water Quaiity
Coleen H. Sullins
Director
October 2, 2009
Dee Freeman
Secretary
' RECEIVED
N.C. Dept. oT E.NR
PC 0 ti 20
WimmnSatnm i
Revanal QN9W
Subject: Erroneous Issuance of General Permit, and
Confirmation of Permit Rescission
Certificate of Coverage No. AWC760030
Hollingsworth Dairy
Randolph County
Reference is made to the General Permit mailed to you on October 1, 2009. That permit was
mailed in,error, and is not valid. This letter is to confirm that the permit rescission mailed to you
on July 15, 2009 is still valid. We apologize for any confusion that this may have caused.
Please contact the Animal Feeding Operations Unit at [phone] if it would be
helpful to discuss this matter further.
Sincerely,
Keith Larick
Animal Feeding Operations Unit
cc: Winston-Salen Regional Office
Permit File AWC760030
A00IFER PROTECTION SECTION
16,M Mail Service Center, Raleigh, North Carolina 27599.16Y
Location: 2728 Capital Boulevard, Ra4gh, North Carolina 27604
Phone: [phone] FAX 1: 919.715-0588; F,AY. 2: 919-715-5048 l Customer Service: 1-877-623-6"48
lntmet: www.ncwaterguality.org
(i11�
l� oil tro in'
F'r. FGual Opporiunity %AilirmativeAsiion Employer

NCDETIR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director 7RECEIVED Secretary
of ENR
l 20
July 15, 2009 Winston-Salem
Reglana! Qistlnv i
Mr. Richard D. Hollingsworth
Hollingsworth Brothers Dairy
P. 0. Box 116
Sophia, NC 27350
Subject: Rescission of Animal Waste Permit
Certificate of Coverage No. AWC760030
Hollingsworth Brothers Dairy
Randolph County'
Dear Mr. Hollingsworth:
Reference is made to your request for rescission of the subject animal waste permit Certificate of
Coverage with the submission of a completed Animal Waste Storage Pond and Lagoon Closure
Report Form on July 8, 2009. Staff from the Winston-Salem Regional Office has confirmed that
this Coverage is no longer required. Therefore, in accordance with your request, Certificate of
Coverage No. AWC760030 is rescinded, effective immediately.
If, in the future, you wish again to operate an animal waste management system you must first
apply for and receive a new animal waste permit Certificate of Coverage. Operating an animal
waste management system without a valid animal waste permit Certificate of Coverage will
subject the responsible party to a civil penalty of up to $25,000 per day.
Please contact the Winston-Salem Regional Office at (336)-771-5000 if it would be helpful to
discuss this matter further.
Sincerely,
Coleen H. Sullins
cc: Winston-Salem Regional Office
Technical Assistance and Certification Unit
Randolph County Soil & Water Conservation District
Fran McPherson, DWQ Budget Office
Permit File AWC760030
AQUIFER PROTECTION SECTION One
1636 Mail Service Center, Ralegh, North Carolina 27699-1636 NorthCarolina
Location: 2728 Capital Boulevard, Raleigh, North Carolina 27604 Naturally
Phone: [phone] FAX 1: 919-715-0588: FAX 2: 919-715-60481 Customer Service: 1-877-623-6748
lntemet: www.ncanratercuality.om
An Equal Opportunity 1 Affirmative Action Employer

Animal Waste Storage Pond and Lagoon Closure Report .Form
(Please type or print all information that does not require a signature)
Ge eralInformation:
-Name: of Farm: Facility No;�-
) 'Dwner(s)' Name:
Mailing Address:- _ f D- Z, K /lP ham,-- V( 3, [5-- -- — -- -- -- Phone No: 3 06- .J1, r7)
.County: A0416111
O erati n D cri Lion remaiuin nilaals only):
please check this box if there will be -no animi0s-on this farm after lagoon closure. if there will.still be animals on the site
a er lagoon closure, please provide the following information on the animals that will remain.
Operation Descrintion:
Type afSwine AV of Animals
o Waan to-Fceder
n Feeder-to;Finish
o Farrow to -Wean
a Farrow to Feeder
o Farrow to Finish
o Gilts
o Boars
Type of Poultry No. ofAnimals
o Layer
o Non -Layer
} 7pe of Beef No, of Animals
o Brood
o Feeders
a Stockers
Other .7} pe af,Livestock:
7j pe of Dairy No. of Animals
o Milking .
o, Dry
' o ileifeis
o Calves
Number of Animals:
Will the farm`maintain a number of animals greater than the G.S. §-143-215.1013 threshold? Yes o NOX
Will other Ingoons be in operation at this'farni after this one closes? Yes o No,-'
How many lagoons are -left in use: on this, farm?:
(Narne)— 4 . ..cs' of the Water Quality'Section's staff in the=Division of
Water Quality's W =S RegionalC1fFice (see m4ji on back) was contacted'on (date)
for notification -of th4eriding closureo is pond or. lagoon: This not&ation,was at least h ours.priorto the
start of Closure, which began on' (dale).
I verify�that the above information is correct and complete. l have>foIlowed a.closureplan, which meets all NRCS
specifications and criteria. 1°realize that I will be subject to enforcement action per Article 21 of the North
Carolina General Statutes.if l fail to properly closeout the -lagoon.
I'Narne of Land Owner (Please Print}: .
signature: Date:
The facility has followed a closure plan which meets all requirements set forth in the NRCS 7'echnical:Guide
Standard 360. The.following itemswere completed by the owner and verified by me: all waste liquids and
sludges have been removed and land applied -at agronomic rate, all input pipes have been removed, all slopes have
been stabilized asnecessary, and;vegetation established on alt disturbe& areas,
Name of Technical Specialist'(Please Print): Lq U&POM29_
one No.: -3 1;- ` LO cr7-3
Retarnwithin 15'days %Iiowiig completionlof aoiinai water.storage poad,or:'lagooir elosure to:
N. C: D"Ioii! Of Water Quality
Animal Feeding Operations'Unit
1636-Mail Service Center
:Raleigh, NC27699-1636.

'To All it May Concern:
My farm located at 1927 Hollingsworth Farm Trail, Sophia, North Carolina, which
was permitted and rented by the Cashatt's-beginning in July of 2005 will no longer
be used as a dairy facility. The manure storage pit has been closed out and
approved the USDA Natural Resources Conservation Service of Randolph County
and the North Carolina Division of Water Quality. I respectfully request foamy
name to be removed from the permitted list in North Carolina. Thank you for
your time.
Sincerely,
Richard Dale Hollingsworth
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Animal WasteMorAgeYond and Lagoon Closure Report Vorm
(.Please type or print.all.infoi-mation,,tha't does, not require a signature)
GeneralInformation
Name of Farm,(r r"� " ircJ ' Facility;No: .
MailingAddress: ' 0_ &K 11(�,' ���� NC 2%�:�C3: phone No:3&� ���- :3�(Gr]
ear county: my_ez
to ert4tioii>l)escri tion: remain n anihiarls onl
Please check this box if'thzre will be no animals'on this�farm aver lagoon closure. If there will still be anirnals'on the site
atter lagoon closure, pl6ase provide the following information on the animals that will remain.
Operation''Descrintion:
7; pe of Swine No. of -Animals T37)e of Poullry No. of Animals Tyne of Dairy No. of Animals
o Wean to "Feeder o Layer 1o,Milkinb
o feeder to Finish o Non -Layer o dry
o ftTow to Wean 7, pe of Beef No. ofAnimaly 'o Heifers
o Farrow to Feeder. o [good o Calves
o Farrow to Finish,t> Feeders
o Gilts -_ o Stockers
o Boars Other, 7 ,pe e f Litte-vtoclr: _ Number of Animals: -
Will the farm maintain a number of Animals greaterthanthe G.S. § I h3-215.1013 threshold? Yes o Nox
Will other lagoons be in operation at this farm after this one closes? Yes•o "Nn
How malty lagoons are lefi-in use on thisifarm?.-
(1Vamc�j� " S '.•T•nX/_____ of the Water Quality Section's staff in. -the Division of
Water (: tk lity's. It S Regional Office (see mal) on back] was contacted on
for notification ofthe.pending closure o this pond.or lagoon. This notificatiotiVas:at least 4 tours:pd6r to the,
start of ctosurc, which,began on . � (ci00).
I verify. that Elie ab6ve information is correct and complete. I have followed a closure plan, which. me' dis,alINRCS
specific' a ions.and criteria; l•realire'tliat•l. will lie siibjeot to enforcement=action per Article 2I,° 6f'the!North.
Carolina General Statutes if I fail to properly closeout the lagoon.
sine of :Land Owner (Please Print).)L ,�` ,�,�'� RUC � /" ,e S ��
5�inaturc. Datc3:00,
The facility has followed a closure plan which meets all requirements set forth in the NRCS Technicat Guide
Standard 360. The. following. items were completed by the owner and verified by ine: all waste liquids. and
sludges°hiave.bepn removed and=land applied at#gronomic rate,.all input pipes have been,removed; all slopes have'„
been stabilized as necessary, and vegetation established on all disturbed areas.
Name of Technical`Specialist (Please Print): f/ll' .,612
Affiliation: N _.)
az��iu�u�c.� nrLri.,�.�,fr Ir�L i �•�a�� u�s��: �/,��/�'�.?�.:..,, ,.. �
Return within 15 days following completion of animal waterstoragc�pond or lagoon,clasurelo:
N. C. Division Of Water Quality
Animal Feeding Qpemtions Unit.
1636 Mail Service.Ce'rriter
Raleigh, NC 2'76994636
2.2ZnS_

0
Type of Visit R �C/ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (iR Routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name•
Mailing Address:
Physical Address:
TArrival Time: V' Departure Time: County: a Region:C'11-NIAn -A trw
fo Owner Email:te- I YIQS �ffi n /zI
Phone: `? � i to 6y
)O 4C 11 h ,A�C✓ a
Facility Contact: A,2L U I [ _11Z r�j__ Title:
Onsite Representative: Qxi �� e,CtS
Certified Operator: 1-.5—
Back-up Operator:
Location of Farm:
u S 311
Latitude: MTO
on to Becke-ri
RA'z AUC. R )3Sa
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
t fe,
Longitude: o
Design Current Design Current
Swine C*apacity Population Wet Poultry Capacity Population
Design Current
Cattle C►acity Popylatien
ap
❑ Wean to Finish ❑ Layer
Dairy Cow
❑ Weto Feeder Non -Layer
DairyCalf
❑ —Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
FoGilts ElNon-La ersEl Pullets
Boars
❑ Turke s
Other ❑ Tu rkex Points
❑ Other ❑ Other
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
rn
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
El NE
Discharge originated at: ❑ Structure [I Application Field [I Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,❑
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
II ''No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

C'
Facility Number: 1 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes A 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes j9'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 0 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 l0 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes ❑ Nox NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes VNo ❑ NA ❑ NE.
18. Is there a lack of properly operating waste application equipment? ❑ Yes ANo ❑ NA ❑ NE
x v ;Y+FeC..
Comments (refer to question #)• Explain any YES'answers and/or anyrecomrriendattons or any other comments.
j
better
Use drawings of facility to explain situahoris: (uscradd�honal pagesaas,necessary,}:
547 Ile- e lion on 4- --g l
P Lt,� �J d a
Reviewer/inspector Name i AT , 3' : � s T Phone:
Reviewer/Inspector Signature: Date: �Q
I 12128104 Continued

Facility Number: —7 ,30Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have 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 El Other
El Yes c ❑ NA El NE
❑ Yes �(No ❑ NA ❑ NE
21. Doe record keeping need im ovement? e-appreprme 1- Yes ❑ No ❑ NA ❑ NE
aste Application Weekly Freeboard Waste Analysis Soil Analysis
Rainfall Stocking Crop Yield 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 JXNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
9NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
'WNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesKo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Ycs
)?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
,�;<o
❑ 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
yVNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
§ a :z.:� y.v� fit, s k Y gip: 'L K ''.S
Additional Comments and./iir Drawings '..i .x �1�1�,
Urack
l S
jots uW-1
12/2R/fid

Division of Water Qa'ali
Facility Number Division of Soil and Water Conservation
0 Other Agency
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 OR ther ❑ Denied Access QJ(
Date of Visit: Arrival Time: Departure Time: County: b Region:+�'�
Farm Name:Ili Q`I I^ 4 Owner Email: J {� 2 /
Owner Name: Phone: . _ T U.R �1 1fo bW
Mailing Address: �O Ua� i0 e��= 1 s� 7 3��Q
Physical Address: AA/h' C c2
Facility Contact: �la� IS �'Qsha Title: Phone No: �98 4/
Onsite Representative: aAi' s OL Integrator:
Certified Operator: O�/J l 4 Operator Certification Number:
Back-up Operator:
Location of Farm:
�6 3 [ I
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
0
B r)
Latitude:
rye
Back-up Certification Number:
Design Current Design. Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
II ❑ Non -Layer.. - - - - ---
Dry Poultry
❑ La ers
❑ 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 Capacity Population
Dairy Cow
Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:.FT
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes -ANo ❑ NA El NE
El Yes �No
____ ❑ NA ❑ NE
12128104 Continued

Facility Number: — 3 • Date of Inspection 13,
. 40
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(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?
P Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L Vo
❑ 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? r
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 Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes 1 o ❑ NA ❑ NE
aj(
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
I, 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
KNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages. as necessary):
Reviewer/Inspector Name f Phone:
Reviewer/Inspector Signature: 4W Date: _!/.2/60 j
Page 2 of-3 ' r L 1 1
12128104 Continued

l
Facility Number: — 36 110 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Nc ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes To ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Doe record keeping need i ovement? ❑ Yes /No ❑ NA ❑ NE
Waste A lic ion Wee Freeboard Waste Anal sis Soil An sis Waste Transfers
PP Y Y
Eainfall 5 Stocking Crop Yield onthly and l" Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
A No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
'IdNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
)(NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
jNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] 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
El NA
[I 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
ElrJ Yes
,��I��h,"```�
I 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
)dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
qNo
❑ NA
❑ NE
AlKonal Comments and/or Drawings:
01,
� aes�-via
Page 3 of 3 12128104

0 Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760030 Facility Status: Active Permit: AWC7QQ030 ❑ Denied Access
Inspection Type: Inactive or Closed Date:
Reason for Visit: Routine County: Randolph Region:Winston-Salem
Date of Visit: 05111/200Z Entry Time:09:25 AM Exit Time: 11:00 AM Incident #:
Farm Name: Hollingsworth Dairy Owner Email:
Mailing Address: PO Box 116 _ $oohia NC 2735Q
Physical Address: 1927 Hollinosworth Farm Rd
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35°49'24" Longitude:
Farm Location: 311 to Sophia, Turn on Beckerdile Rd., farm 114 mile on right,
Question Areas:
Discharges & Stream impacts Waste Collection & Treatment Waste Application
Records and Documents Other Issues
Certified Operator: Sidney D Cashatt Operator Certification Number: 2131 D
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative Davis Cashatt Phone: [phone]
24 hour contact name Davis Cashatt Phone; 336-498-4814
Primary Inspector: li sa 4osebrock Phone:
Inspector Signature: Date:
st If
Secondary Inspector(s):
Inspection Summary:
5. & 7. Leaks have been repaired on structure. Continue backfilling and then seed with grass.
9. Continue efforts on gutter repairs. Looks much better.
9. Suggest installing curbing to exclude rainwater from lot.
9. Repair leak at speedbump on feedlot to contain waste. Not a water quality concern at this time.
10. Freshwater ditch not fenced out but cattle have not been grazing in this pasture. Fence prior to grazing.
21, 2007 soil samples to be obtained this Fall.
21, Don't forget to record commercial nitrogen.
21. 4-18-07 waste analysis=2.6 lbs. N11000 gal.
24. Calibration completed July 2006.
28, T-2159 F-9 needs to be split up to match how operator is farming the land.
Page: 1

• 0
Permit: AWC760030 Owner- Facility: Richard Dale Hollingsworth Facility Number: 760030
Inspection Data. 05/1112007 Inspection Type: Compliance Inspection Reason for.Vislt: Routine
Regulated Operations Design Capacity Current Population
Cattle
Q Cattle - Milk Cow 150 120
Total Design Capacity: 150
Total SSLW: 210,000
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
k1sle Pond WASTE STORAGE POND 24.00
Page: 2

•
Permit: AWC760030 Owner - Facility: Richard Dale Hollingsworth Facility Number: 760030
Inspection Date: 0511112007 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yes No NA NE
1. Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ ■ ❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ ■ ❑ ❑
2. Is there evidence of a past discharge from any part of the operation? ❑ ■ ❑ ❑
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a ❑ ■ ❑ ❑
discharge?
Waste Collection, Storage & Treatment
Yes
No
NA NE
4. Is storage capacity less than adequate?
❑
■
❑ ❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large trees, severe
❑
■
❑ ❑
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑
■
❑ ❑
or closure plan?
7. Do any of the structures need maintenance or improvement?
■
Cl
❑ ❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits,
❑
■
❑ ❑
dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
■
000
improvement?
Waste Application
Yea
No
NA NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑
■
❑ ❑
improvement?
11. Is there evidence of incorrect application?
❑
■
❑ ❑
If yes, check the appropriate box below
Excessive Ponding? ❑
Hydraulic Overload? ❑
Frozen Ground? ❑
Heavy metals (Cu, Zn, etc)? ❑
Page: 3

Permit: AWC760030 Owner- Facility: Richard Dale Hollingsworth
Inspection Date: 05/11/2007 Inspection Type: Compliance Inspection
Facility Number: 760030
Reason for Visit: Routine
Waste Application
Yes
No NA NE
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total P205?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Fescue (Hay)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Sail Type 4
Sail Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management
❑
■ ❑ ❑
Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
■ ❑ ❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑
❑ ■ ❑
17. Does the facility lack adequate acreage for land application?
❑
■ ❑ ❑
18. Is there a lack of properly operating waste application equipment?
❑
■ ❑ ❑
Records and Documents
Yes
No NA NE
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Page: 4

Permit: AWC76003D Owner - Facility: Richard Dale Hollingsworth
Facility Number: 760030
Inspection Date: 05/11/2007 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Records and Documents
Yes No
NA NE
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21. Does record keeping need improvement?
❑ MOO
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑ ■
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES
only)? ❑ ❑
■ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ ■
❑ ❑
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ ❑
■ ❑
26. Did the facility fail to have an actively certified operator in charge?
Cl ■
❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑ ■
❑ ❑ ,
Other Issues
Yes No
NA NE
28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
■ ❑
❑ ❑
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air ❑ ■ ❑ ❑
Quality representative immediately.
Page: 5

•
Permit: AWC760030 Owner- Facility: Richard Dale Hollingsworth
Facility Number: 760030
Inspection Date: 05/1112007 Inspection Type: Compliance Inspection
Reason for Visit. Routine
Other Issues
Yea
No NA
NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
■ ❑
❑
32. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑
■ ❑
❑
33. Does facility require a follow-up visit by same agency?
❑
■ ❑
❑
Page: 6

Division of Water. Quali 4
[Lie
ility Number 3b Division of Soil and Water 'onservation `I : ,3
Other Agency
Type of Visit 7°s Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ' r—J County: G Region: -L-15-RO
Farm Name:
Owner Email:
Owner Name: U 4 �-11 kias LUO r 4— Phone:
Mailing Address: 0 . K)C- oR 7 3 _cE 0
Physical Address:
Ar7 r Farm 'Pi•, S�hia� , ?73Sb
Facility Contact: Q Title: Phone No:
Onsite Representative:Integrator:
Certified Operator: _IQ -\h _ �45 h Operator Certification Number:
Back-up Operator:
Location of Farm:
u S Hu..) y 3 l I
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: u l 57 " Longitude:
h onto �i +
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La y er
❑ Non -Layer
Dry Poultry
❑ La ens
❑ Non -La ers
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c S aa-
o r7 r- i ah+
Design Current
Cattle Capacity Population
Dairy Cow
rf,$~O
o�
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood CoyA
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ET11
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 3KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: r� — Date of Inspection
Waste Collection & Treatment f
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
i
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure Structure 2 Structure 3 Structure 4 Structure 5
Identifier: e_ �J _
Spillway?: N r>
Designed Freeboard (in): _
Observed Freeboard (in): p� _
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �dNo ❑ 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? 0Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X 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
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes "flo ❑ 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)
13.
Soil type(s) V
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
P�NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
1XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�+.
S 1. S�RaC`�-ire i PAYS re Q4-I r'e ? �S . Co Ai V 10 0 Ccx T I� h G ,�
`1
`tie-ri
q S�� v
-S r"p", reA ? C-d rok h u e e-r-fotr+S — M uCr1r1 be
SFr e- h i�xtt (�, ��r�+ —a u-t ? Nod e-t f �raav� t►.ov,�,�a�e. �e�
Reviewer/Inspector ame
Phone:
Reviewer/Inspector Signature:
Date:
— 12/28/04 rrtrnued
g� �n�th c�rbkn� �-° ��C Uae rain - lob
9 01,

Facility Number: — *ate of Inspection 7
i
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9,No ❑ NA ❑ NE
the appropirate box. t 1~ ;EgEhecklists QBest • .Maps ❑ Other
21. Does record keeping need improvement? ❑ Yes 1�i No ❑ NA ❑ NE
,Waste Application Kweekly Freeboard EWaste Analysis RQ Soil Analysis [ Waste Tim—f s4; _ Annuai El• n
Rainfall Stocking KCrop Yield Monthly and 1" Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �KNo
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
24.
Did the facility fail to calibrate waste application equipment as required by the permit? SU14 M ❑ Yes
Oio
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ANo
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ErYes
❑ No
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
kfNo
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
KNO
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
MTo
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
�(No
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
XNA
❑ NE
❑ NA
NE
jX NA
❑ E
❑ NA
❑ NE
[%NA
❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
El NA ❑NE
A ionai Comments and/or Drawings:
AL
acbl� sb�t ( -esf rvsL)Ifs
a P rv;�� was r)oj sued 4�1I '7/141oS. Calibra4an dome-
1e j -1j 14 j o-1. Co UJ�Nohsa abo to
r,,)NdL4�C A-1 me
�q T- a l s9 - `j n e.�ds -� b� s ply+ to +nn a-��►�
Z t • `�-15-0 - cz N
J2.2►-0(� � 3,9 N
�d Z�on� 4e �z re- ccrd Com K-u- 6 a L N
J

{7�f A s• .�� r s� � fi�'t �+
ff b}� ,�Llf �tsr Jl 1�y b ppW,yj�5 j (L�(
,rC' �y1� .r {' Y^7;R C"� ���.+-• J [ ����{`,����i T '� W4lY��+ � `E �S.y '+
nz.
., i, rrt to • a;a Y 4,R , "� w ++............��
NR
Type of Visit 0 Compliance Inspection jV Operation Review 0 Structure Evaluation 0 Technical Assistance 0 � 101
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access,n-Se em
Date of Visit: i Arrival Time: : 3 Q Departure Time: /b; v County: - .-�!!t -__ Region:.._ ..
Farm Name: _ _DScJrtt7�j Owner Email:
Owner Name:_ /C:_ �,�-;.__��_.__�------------�--_--
. ._+���Phone:
Mailing Address:
Physical Address: ___Zf1 _ .C.s�43P►fi...-r"1�.y _,�lr �%.a �..__._w--.. _...._m...._- _^_ ._ _
Facility Contact: �� ._ -- Title:._ L1:L4_V,4j;t �.. Phone No: --
a �t
Onsite Representative: -
Certified Operator: _",
A
Integrator: _ ._- _..... •..-..._ .__..._ _... ...... r.._.�.. _.
Operator Certification Number:.V3!Lc?__
Back-up Operator: _ - Back-up Certification Number:
Location of Farm: Latitude: l S e I o I' 5 7 l Longitude: FIT 0 I S •J 6 I Z I
31C so#//Z4 *,jorvv lzal af?fse FARat f,} fke4g oN �Ua—j
Design Cprrent beSigil L'grrent r DeSign r CuT rent
Swine !tea aci Po ulatiou Wet Poultry Capacit `Po ,ulaEron Cattle Ca acr Pa ulation
y P p #y P.
3 ❑ Layer -"
❑ Non -Layer
Y-
4 T
Dry Poultry
4'.
❑ La ers
' El Non -La ers
❑ Pullets
i
' ti} J Y h Y ❑ Turke S
�"Q#he' ,�rp{�. 4� '°`i5 4,l rr�r?Y ffn . t'.r S r+ ❑ Turke PoultS ." CLl r u
❑ Other Other '4 Number of Structures
Wean
to Finish
„'
a;
Discharges
❑Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
' El
El Boars
Dai Caw
C)
Z
❑
Dai Calf
❑
Dairy Heifer
El
Dry Cow
El
Non -Dairy
❑
Beef Stocker
Beef Feeder
❑
Beef Brood Co
&Stream Impacts '
1. is any discharge observed from any part of the operation? El Yes � No El NA El NE
Discharge originated at: El Structure ❑Application Field ❑Other
Li n
-
a. Was the conveyance Wien -made?
❑Yes
El No
[I NA
[I NE
h. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑Yes
El No
❑ NA
[I NE
c. What is the estimated volume that reached waters of the State (gallons)?
d: Does discharge bypass the waste management system? (If yes, notify DWQ)
❑Yes
El No
❑ NA
❑ NE
2., Is there evidence of a past discharge from any part of the operation?
El Yes
' �] No
❑ NA
El NE
3:"Wefe-t#�e e-�ffd�er���#r�53�--ar-p�i terttfatativerscimpa�-ta,Cte'Wnter
12/28/04 Continued

A
.f
Facility Number: (, - • Date of Inspection IZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the, structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: fit% Sf�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '
5. Are there any immediate threats to the integrity of any of the structures observed?
[I Yes
P 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
1 ] 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?
M,,Ycs
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[I 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 JRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El 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 Area
12. Crop type(s) T4 :1GtiG �i4�14RC: ti�l
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes, 0 No DQ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 5Q No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No NA . ❑ NE
P1.
4w;r R.-sw &J/t ram¢ b tfL4 '10 A.!5'T�2i
Reviewer/Inspector Signature: Date:
1212VO4 Continued

r
Facility Number: — Inspection •
ate of
Required Records & Documents
19.. Did the facility fail to have Certificate of Coverage & Permit readilyavailable?
❑ 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 approprrate box. ❑ WUp ❑ Checklists ❑ Desi n g ❑Maps ❑.Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
. ❑ NA
❑ NE
❑ Waste Application ❑ WeekIy 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
j No
❑ NA
. ❑ NE
23. If selected, did the facility fail to install and.maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
PNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR No
❑ NA
Cl NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
URNA .
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
00 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
kNo
❑ 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
DQ 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
❑ Ves
J� 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
9 ] No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
TRYes
❑ No
❑ NA
❑ NE
j2_12_ 04

,•-
0
Facility Number: --
Date of Inspection
Technical Assistance
Need2d
Provided
34, Waste Plan Revision or Amendment
❑
❑
35. Waste Plan Conditional Amendment
❑
❑
36. Review or Evaluate Waste Plan w/producer
❑
❑
37. Forms Need (list in comment section),
❑
❑
38. Missing Components (list in comments)
❑
❑
39.2H.0200 re -certification
❑
❑
40. Five & Thirty day Plans of Action (PoA)
❑
❑
41. Irrigation record keeping assistance
❑
❑
42. Organize/computerization of records
❑
❑
43. Sludge Evaluation
❑
❑
44. Sludge or Closure Plan
❑
❑
45. Sludge removal/closure procedures
❑
❑
46. Waste Structure Evaluation
❑
❑
47. Structure Needs Improvement
❑
❑
48.Operation & Maintenance Improvements
❑
❑
49. Marker check/calibration
❑
❑
50, Site evaluation
❑
❑
51. Irrigation Calibration
❑
❑
52. Irrigation system design/installation
❑
❑
53. Secure irrigation information (maps, etc.)
❑
❑
54.Operating improvements (pull signs, etc.)
❑
❑
55. Wettable Acre Determination
❑
❑
56. Evaluate WAD certification/rechecks
❑
❑
57. Crop evaluation recommendations
❑
❑
58. Drainage work/evaluation
Cl
Cl
59. Land shaping, subsoiling, aeration, etc.
❑
❑
60. Runoff control, stormwater diversion, etc.
❑
❑
61. Buffer improvements
❑
❑
62. Field measurements(GPS, surveying, etc.)
❑
❑
63. Mortality BMPs
❑
❑
64. Waste operator education
❑
❑
65, Operation & maintenance education
❑
❑
66. Record keeping education.
❑
❑ .
67. Crop/forage management education
❑
❑
68. Soil and/or waste sampling education
❑
❑
69. PLAT
❑
❑
70.Other
❑
❑
List ImRrovements Made by Operation:
..... _....... __.... _ -- -
1. 4.
2. 5.

0 - •
Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 76QQ50 Facility Status: ActiyP Permit: AWC760030 ❑ Denied Access
Inspection Type: Comnlianc-Insnectlon _ Inactive or Closed Date:
Reason for Visit: Routine_ _ County: Randolph Region: Winston-Salem _
Date of Visit: 07/25/2006 . Entry Time:09:35 AM Exit Time: 11:45 AM Incident #:
Farm Name: Hollingsworth Dairy_ Owner Email:
Owner: Richard Dale Hollingsworth Phone: [phone]
Mailing Address: PO Box 116 Sophia NC 27350
Physical Address: 1927 Hollingsworth Farm Rd
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: 35°49'24" Longitude: 79°52'00"
Farm Location: 311 to Sophia, Turn on Beckerdite Rd., farm 114 mile on right.
Question Areas:
Discharges & Stream Impacts Waste Collection & Treatment Waste Application
Records and Documents Other Issues
Certified Operator: Sidney D Cashatt Operator Certification Number: 21310
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On -site representative Davis Cashatt . Phone: [phone]
24 hour contact name Davis Cashatt Phone: [phone]
Primary Inspector: M a Rosebrock Phone: J
Inspector Signature: Date: r S
Secondary Inspector(s):
Inspection Summary:
5. and 7. Need to repair wall of WSP ASAP. Getting some leaks but is not a WQ problem at this time.
6113/06 waste analysis=5.31 lbs. N/1000 gal.
9. Need to repair gutters to exclude freshwater from pond.
14. Per operator, WUP is being revised at this time.
15, H4 and H5 are to be pastures. Need to take these out of WUP as application fields since operator says he can't apply waste here.
Fields are high in Zinc,
21, Don't forget to obtain soil samples this Fall for 2006 permit requirement.
28. Take H4 and H5 out of WUP and add "Dodson" and "Hollingsworth" fields as grass hay.
Page: 1

Permit: AWC760030 Owner- Facility: Richard Dale Hollingsworth Facility Number: 760030
Inspection Data: 07/25/2006 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
O Cattle - Milk Cow 150 132
Total Design Capacity: 150
Total SSLW: 210,000
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
�aste Pond WASTE STORAGE POND 15.00
Page: 2

0
Permit: AWC760D30 Owner - Faclllty: Richard Dale Hollingsworth Facility Number: 760030
Inspection Date: 07/25/2006 Inspection Type: Compliance Inspection Reason for Vlstt: 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) ❑ ■ ❑ ❑
e Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
Cl
■ ❑ ❑
2. is there evidence of a past discharge from any part of the operation?
■
Cl ❑
Cl
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a
❑
■ ❑
❑
discharge?
Waste Collection, Storage & Treatment
Yes
No NA
NE
4. is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large trees, severe 00011
erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed andlor managed through a waste management ❑ ■ ❑ ❑
or closure plan?
7. Do any of the structures need maintenance or improvement?
■ ❑ ❑
❑
B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits,
❑ ■
❑
❑
dry stacks and/or wet slacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
■ ❑
❑
❑
improvement?
Waste Application
Yes No
NA
NE
10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or
❑ ■
❑
❑
improvement?
11. Is there evidence of incorrect application?
❑ ■
❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
Page: 3

Permit: AVVC760030 Owner- Facility: Richard Dale Hollingsworth
Inspection Date: 07/25/2006 Inspection Typo: Compliance inspection
Facility Number: 760030
Reason for Vialt: Routine
Waste Ap Ifcp ation
Yes No NA NE
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total P2O57
Cl
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type 1
Corn (Silage)
Crop Type 2
Corn (Grain)
Crop Type 3
Natural Vegetation
Crop Type 4
Timothy, Orchard, &
Rye Grass
Crop Type 5
Fescue (Hay, Pasture)
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 fall to secure and/or operate per the irrigation design or wettable acre determination? ❑ ■ ❑ ❑
17. Does the facility lack adequate acreage for land application?
❑ ■ ❑ ❑
1 B. 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?
Cl ■ ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ ■ ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Page: 4

Permit: AWC760030 owner- Facility: Richard Dale Hollingsworth
Inspection Date: 07MI2006 Inspection Type: Compliance Inspection
Records and Documents
Checklists?
Design?
Maps?
Other?
21. Does record keeping need improvement?
Facility Number: 760030
Reason for Visit: Routine
Yes No NA NE
❑ ■ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soil analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
■
Cl ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment (NPDES only)?
❑
❑
■ ❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■
❑ ❑
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑
❑
■ ❑
26. Did the facility fail to have an actively certified operator in charge?
❑
■
❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑
■ ❑
Other Issues
Yes
No
NA NE
28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP?
❑
■
❑ ❑
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those ❑ ■ ❑ ❑
mortality rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air ❑ ■ ❑ ❑
Quality representative immediately.
Page: 5

•
0
Permit: AWC760030 Owner- Facility: Richard Dale Hollingsworth
Facility Number: 760030
Inspection Date: 07/25/2006 Inspection Type: Compliance Inspection
Reason for Visit: Routine
Other Issues
Yes
No
NA
NE
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
■
❑
❑
❑
32. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑
❑
❑
33. Does facility require a follow-up visit by same agency?
❑
■
❑
❑
Page: 6

Division of Water Quality
(Facility Number = 3 Q Q Division of Soil and Water Conservation
Q Other Agency
1111
Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit iRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ri S7016A rrival Time: ® Departure Time: County: of P6 Region: 1A35 RD
Farm Name: < Owner Email: � CAS Q W rAO
G 11
Owner Name: Q- l r Phone: o 6 Q
Mailing Address: ! (3 thy- � �, � ,�:?10. 1 N C :2 -1 3s 0 `
Physical Address: 1 T1 °� r� F_ s d p h t a- j N L' aL-7 3
Facility Contact: C t C OZ Title: Phone No: `T 9q ! q 8 I
Onsite Representative: Lag,--,
Lg5 &'e Integrator• 11
Certified Operator: Y1PAl1� `mid Operator Certification Number: a I 1
Back-up Operator: htd:E Back-up Certification Number:
Location of Farm:
Latitude:
VS 1 y 311 Soot+n onto b.e
o n r�glrt�
Longitude: 5$ ° [� t ® "
i f-e_ is , farm Is V4 In ,
Design Current
Design C*urrent
Design C►►urrent
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er I
I
Dairy Cow Q
❑ Wean to Feeder
1 10 Non -Layer
Daia Calf
❑ Feeder to Finish I
I
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ DEX Cow
❑ Farrow to Feeder
❑ La ers
ElNon-Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowi
❑ Turkeys
Other
❑ Turkey Poults
[_1 Other
❑ Other
Number of Structures: D]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ikes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: i -- Date of Inspection .
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
❑ No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
o ❑ 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
enviro mental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
)(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
)i(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 El Application Outside of Area
t2. Crop type(s) L.Oril liA 5 U re— 612AA
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 9No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 1%*No 0 NA ❑ NE
17, Does the facility lack adequate acreage for land application? ❑ Yes ANo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes IkNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
IN a
Ur � j �♦ �I � i ! � - �
f �
Reviewer/inspector Name 1&41 ' I Phone: ' — S
Reviewer/Inspector Signatur Date:
Page 2 of 3 I2/28/04 Continued
j 3O S. 3 ! !ss Nl I ow 0aQ

Facility Number: i= — 3 4ate of Inspection P 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )?"No
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Doe record keeping need i rovement? If yes chec e aPP p ro riate box low. ElYes M4
❑ NA ❑ NE
El NA [I NE
❑ NA ❑ NE
X
ste Applic ion Wee y Freeboard Waste Analysis S2Monthly
nalysis Waste Transfers
Rainfall Stocking Crop Yield and I" Rain Inspections [}'Weather Code
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?
El Yes
No
24.
A, 4 nn//
Did the facility fail to calibrate waste application equipment as required by the permit? l dk- 0O❑ Yes
XNo
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,❑.,,/No
L(No
L❑_No
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
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)
❑ NA ❑ NE
19NA ❑ NE
El NA El NE
�(NA ❑ NE
❑ NA ❑ NE
YNA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes I!fNo ❑ NA ❑ NE
❑ Yes >lo ❑ NA ❑ NE
Di�yes ❑ No ❑ NA ❑ NE
32. Did Reviewerdrispector fail to discuss review/inspection with an on -site representative? ❑ Yes YNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes )(No ❑ NA ❑ NE
Additional Comments and/or Drawings:caw
03
r Y
Lic
to
to up is *Ale
a
H4+HIS C
WWTX
12128104
1 ! a

0 Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 760030 _ _ Facility Status: Active Permit: 6WC760030 ❑ Denied Access
Inspection Type: Compliance Inspection . Inactive or Closed Date:
Reason for Visit: Routine County: Randolph Region: Winston-Salem
Date of Visit: 07/22/2005 Entry Time* 11:15 AM Exit Time. 01:30 PM Incident #:
Farm Name: Hollingsworth Dgjnr Owner Email:
Owner: Richard Dale Hollingsworth
Phone: [phone]§0 _
Mailing Address: PO Box 116 Sophia NC 27350
Physical Address: 192Z UollingsWorth
Facility Status: ❑ Compliant ❑ Not Compliant
Location of Farm:
Integrator:
Latitude: 35.49'24" Longitude: 79.52-00"
Farm Location: 311 to Sophia, Turn on Beckerdite Rd., farm 114 mile on right.
Questlon Areas:
0 Discharges & Stream Impacts
Records and Documents
0 Waste Coliectiori & Treatment Waste Application
Other Issues
Certified Operator: Sidney D Cashatt Operator Certification Number: 21310
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Davis Cashatt Phone: [phone]
On -site representative Davis Cashatt Phone: [phone]
Primary Inspector: meijissp M Rogebrock Phone: [phone]
Ext.383
Inspector Signature: Date: 7�a a�OS
Secondary Inspector(s):
Phone:
Phone:
Inspection Summary:
8. Need to install marker within 30 days.
18. operator borrows honey wagon.
21. Went over new permit requirements with operator.
22, Computer weather station has been purchased but is not installed yet.
Page: 1

• r
Permit: AWC760030 Owner - Facility: Richard Dale Hollingsworth
Inspection Date: 07/22/2005 Inspection Type: Compliance Inspection
Facility Number: 760030
Reason for Visit: Routine
Regulated Operations Design Capacity Current Population
Cattle
Cattle -Milk Cow 150 155
Total Design Capacity: 150
Total SSLW: 210,000
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
Waste Pond WASTE STORAGE POND 72.00
Page: 2

•
Permit: AWC760030 Owner • Facility: Richard Dale Hollingsworth
Facility Number: 760030
Inspection Date. 07/2212005 Inspection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts Yea No NA NF
1. Is any discharge observed from any part of the operation? ❑ M ❑ ❑
Discharge originated at:
Structure ❑
Application Field ❑
Other ❑
a. Was conveyance man-made? ❑ ■ ❑ ❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ 0 ❑ ❑
c. Estimated volume reaching surface waters?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑
0 ❑ ❑
2. Is there evidence of a past discharge from any part of the operation?
❑
0 ❑ ❑
3. Were there any adverse impacts or potential adverse impacts to Waters of the State other than from a discharge?
❑
Yes
M ❑ ❑
Nn NA NE
Waste Collection, Storage & Treatment
4. Is storage capacity less than adequate?
❑
0 ❑ ❑
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.1 large trees, severe erosion,
❑
0 ❑ ❑
seepage, etc,)?
6. Are there structures on -site that are not properly addressed and/or managed through a waste management or
❑
0 ❑ ❑
closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑ ❑
8, Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry stacks
M
❑ ❑ ❑
and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require maintenance or
❑
0 ❑ ❑
improvement?
Yes
No blA NF_
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives 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)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total P2057
❑
Failure to Incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
Crop Type t
Fescue (Pasture)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Page: 3

Permit: AWC760030 Owner- Facility: Richard Dale Hollingsworth
Inspection Date: 07/22/2006 Inspection Type: Compliance Inspection
Facility Number : 760030
Reason for Visit: Routine
Warta Appllratinn
Crop Type 6
YAs
Nn NA
NE
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑
■ ❑
❑
15. Does the receiving crop and/or land application site need Improvement?
❑
■ ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑
■ ❑
❑
17. Does the facility lack adequate acreage for land application?
❑
■ ❑
❑
18, Is there a lack of property operating waste applicaton equipment?
❑
Yes
■ ❑
No NA
❑
NE
Hoods and Ogwaicals
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
■ ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
■ ❑
❑
If yes, check the appropriate box below,
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Other?
❑
21, Does record keeping need improvement?
❑
0130
If yes, check the appropriate box below,
Waste Application?
❑
120 Minute inspections?
❑
Weather code?
❑
Weekly Freeboard?
❑
Transfers?
❑
Rainfall?
❑
Inspections after > 1 inch rainfall & monthly?
❑
Waste Analysis?
❑
Annual soll analysis?
❑
Crop yields?
❑
Stocking?
❑
Annual Certification Form (NPDES only)?
❑
22. Did the facility fait to install and maintain a rain gauge?
■
❑ ❑
❑
23. If selected, did the facility fail to install and maintain a rainbroaker on irrigation equipment (NPDES only)?
❑
■ ❑
❑
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■ ❑
❑
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑
■ ❑
❑
26, Did the facility fall to have an actively certified operator in charge?
❑
■ ❑
❑
27, Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
■ ❑
❑
Page: 4

•
0
Penult: AWC760030 Owner - Facility: Richard Dale Hollingsworth Facility Number: 760030
Inspection Date: 07/22/2005 Inspection Type: Compliance Inspection Reason for Visit: Routine
26, Were any additional problems noted which cause non-compliance of the Permit or CAWMP7 13 M ❑ ❑
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those mortality ❑ M ❑ ❑
rates that exceed normal rates?
30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air Quality ❑ ❑
representative immediately,
31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? ❑ ❑ ❑
32. Did Reviewerllnspector fail to discuss reviewlinspection with on -site representative? 0000
33. Does facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
Page: 5

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
t '
Farm Name:{ Owner Email:, i Q�
Owner Namk [A Phone: LOT 314 0
Mailing Address: o~f tD �� t )a \ 1 t� i .C� C u jn�T+ t l,1�
Physical Address: 5 \ b
Facility Contact: `L 5 tie: Phone N 3
Onsite Representative: �1 )� s C g��C� Integrator:
Certified Operator: �� �S L �5 Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: r Longitude: ® I.]_a�
° " 0 (A
MPlr
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
De" gn Current Design Current
`Capacity Population Wet Poultry Capacity Population
❑ Layer `
11 ❑Non -Layer
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 Capacity Population
Dairy Cow
10 Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: 4
J
56 ! b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �jNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: TO— • of Inspection •
Waste Collection & Treatment X
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes 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`?: N >
Designed Freeboard (in):
Observed Freeboard (in): 12.,
�No
5. Are there any immediate threats to the integrity of any of the structures observed? ElYes [INA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes ❑ No ❑ NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 19
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 4No ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) FeC-P 1 I4P_ ( g,rQ.2Ze_,
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? ElYes JNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes ❑ No �q(NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
6co�ic.�S �ov�� 0
Reviewer/inspector Name r
I Phone:
Reviewer/inspector Signature. AV Date:
12128104 dentinued

Facility Number:-1 — DOIns6on [ Q�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
9*
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists El Design El Maps ❑Other
❑ Yes No
❑ Yes p[I No
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need im vement? if yes, check the appropriate box b low. ❑ Yes No ❑ NA ❑ NE
L1� W ste Application V i�reeboard ante Anal sis Soii Anal sis "'� - ion
Y YRainfall p Stockingp Yield Vonthly and I" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? Xyes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
24. Did the facility fail to calibrate waste application equipment as required by the permit? c�)-1tr ❑ Yes No
25. Did the facility fail to conduct a sludge survey as required by the permit? 'Tut
4 0'7 El Yes ❑ No
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
3 1 . Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes l�(I.No
❑ Yes �V No
❑ Yes A No
❑ Yes A No
❑ Yes *0
[I NA ❑NE
(NA ElN E
❑NA El NE
KNA ❑ NE
❑NA El NE
El NA ❑NE
[I NA ❑NE
❑ NA ❑ NE
El NA El NE
❑NA ❑NE
El NA ❑NE
❑ NA ❑ NE
Addi 'oval Comments and/or Drawings:
Ve r
a� � mj A,��
F
12128104