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MapQuest: Maps: map wysiwyga/92/http://www.mapquest.com/mal$wEkPwRmhlc2h3Hyjfg8elW44ho)rM38Q%3d%3d
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DOOR TO DOOR DRIVING DIRECTION
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y* 300m=IIAAPgV*sf#� u Sml
afgd 900ft 4T II�5KM
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41999 Mapquest.cam, Ina.; 01999 Navgaticr 01999 MapQuest.00m, Inc.: 01999 Navgatbr
585 Waughtown 2265 n Lomax Road
Winston-Salem, NC Traphill, NC
Direction Distance
There are 0.01 miles (0.02 km) between the start of the directions
and 585 Waughtown.
Use the map above to get to WAUGHTOWN ST.
1: Start out going Southeast on WAUGHTOWN
ST towards OLD LEXINGTON RD by turning 0.0 miles (0.1 km)
left.
2: Turn RIGHT onto OLD LEXINGTON RD. 0.1 miles (0.2 km)
3: Turn RIGHT onto NC-150. 0.1 miles (0.2 km)
4: Turn LEFT to take the US-52 SOUTH/NC-8
0.2 miles (0.3 km)
SOUTH ramp towards (US-311 SOUTH).
5: Merge onto NC-8 S/US-52 S.
0.1 miles (0.1 km)
6: Take the I-40 WEST exit, exit number
0.3 miles (0.5 km)
107B, towards STATESVILLE.
7: Merge onto I-40 W.
4.8 miles (7.7 km)
8: Take the I-40 EAST/US-421 exit, exit
number 188, towards
0.2 miles (0.3 km)
WIN STON-SALE M/YADKINVILLE/WILKESBORO.
9: Keep LEFT at the fork in the ramp.
0.6 miles (1.0 km)
10:. Merge onto US-421 N.
27.5 miles (44.3 km)
11: Take the I-77 NORTH exit.
0.4 miles (0.6 km)
12: Merge onto I-77 N.
7.8 miles (12.6 km)
13: Take the NC_67 exit, exit number 82, 0.2 miles (0.3 km)
of 2 1/26/2000 11;09 AMi

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Anywho - Driving Directions wysiwyg://14/http://www.anywho.conVcgi-bin/mgtripplus
towards tLK1N/JUNt5V1LLt/bUUIVV1LLt.
14: Turn LEFT onto NC-67.
15: Turn SLIGHT RIGHT onto SECONDARY
ROAD 1402.
1.6 miles (2.7 km)
0.1 miles (0.1 km)
16: Turn LEFT onto ELM ST. 0.2 miles (0.3 km)
17: Turn RIGHT onto US-21 BR. 0.4 miles (0.6 km)
18: US-21 BR becomes US-21 BR/NC-268. 0.2 miles (0.3 km)
19: Turn LEFT onto NC-268. 1.5 miles (2.5 km)
20: Turn SLIGHT RIGHT onto SWARINGEN RD. 10.2 miles (16.5 km)
There are 1.74 miles (2.80 km) between the end of the directions
and 2265 n Lomax Road.
Use the map above to get to 2265 n Lomax Road.
Total Distance 56.5 miles (91.0 km)
Estimated Time 1 hour, 31 minutes
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Narrative for Payne Dairy
■ The waste management plan includes waste from one (1) waste storage pond oil your
dairy.
■ Your waste management plan is written with nitrogen as the limiting nutrient.
Because of this, applications for other nutrients may be in excess of the nornial rate.
You should monitor any build-up of these nutrients and adjust your waste
management as necessary.
■ When applying nitrogen, caution should be exercised to prevent excess accumulations
in the plant causing nitrate poisoning.
■ Use caution in applying waste to prevent runoff or drift. Observe all setback
requirements.
■ Some of the fields in your waste management plan may receive irrigated waste,
broadcast or both.
Enclosed is a revision of your waste management plan that now accounts for wettable
acres as part of the irrigation system. ]'[case review it for errors or omissions. This is a
complete rewrite of the waste management plan. Please follow the plan as closely as
possible to ensure compliance with laws affecting your operation. If you need to deviate
from the plan, or change any components, please contact the Wilkes Soil and Water
Conservation District field office before land application of litter, or as soon as you have
knowledge of any deviations.
This plan is written with nitrogen as the limiting nutrient. You will note many of the
fields do not receive the maximum allowable Plant Available Nitrogen (PAN) using
waste from your facility alone.. In these instances, it is permissible to supplement the
fields with other sources of nitrogen. Some of these may include, but are not limited to,
commercial fertilizer, poultry waste, industrial or municipal sludge, or other animal
wastes. Remember that records are to be kept for all fields receiving animal waste for a
minimum of three (3) years. You should also maintain records for any other sources of
fertilizers applied to these fields.

•
•
rm
ANNUAL DAIRY MAN
Owner Jason Payne Phone # [phone]
Address 2296 N. Lomax Road Facility # 97-26
Traphill, NC. 28685 Date: 5/10/02 Update
A) Number and type of Cattle
Dairy Milk Cows
Dairy Replacement Heifers
Dairy Dry Cows
B) Manure produced per year
8118.0 Gallons per head per Year
Gallons per head per Year
Gallons per head per Year
C) Average Total Plant Available Nutrients
Broadcast Application
PRODUCTION WORKSHEET
3rd Party User:
Address:
Phone #
Waste Received: Gallons
200 Head X 8,118.0 gallons/head =
PAN ,,, 9<µ%> Lbs. per 00 gal M bs
P205: 5.5 Lbs. per 1000 gal lbs.
K20: 9.6 Lbs. per 1000 gal lbs.
Soil Infected Application (SS)
PAN. Lbs. per 1000 al Mlbs.***
P205: 11 Lbs. per 1000 gal lbs.
K20: 17 Lbs. per 1000 gal lbs.
Use actual waste analysis from your own operation once available
Shaded areas with *, ' , or *** will carry over to Form Wet-2
* Total Gallons per year
Soil Incorporated Application (Sl}
PAN: <'<»° r 1000 lbs.
m. Lbs. per gal
P205: 10 Lbs. per 1000 gal 16,236 lbs.
K20: 16 Lbs. per 1000 gal 25,978 lbs.
Irrigation Application (!
z':
PAN: :'����>_�n�..; Lbs. per 1000 gal=<�:,.. lbs.
P205: 5.3 Lbs. per 1000 gal 8,605 lbs.
K20: 9.4 Lbs. per 1000 gal 1b,262 lbs.

0
Form Wet 2 Dairy Manure Application Worksheet
Owner/Mgr: Jason Pavne Third Partv User:
Address: 2295 N. Lomax road Address:
Tramill, NC. 28585
Phone #: [phone] Phone:
Facility #: I97-25 •Crioinatin_ Fad ty :
1 2 3! 4 5 6 ; ! 9T 10
Soil Applied Lbs. PAN Lbs. PAN
Tract Applied Field Type Method nYE rate per ac Applied per fld
No. irate No. Optional Croom s.sl•ss.s Table 2 Acres (Table 2) { 8 x 9 )
Gallons / Waste I
11 1 12
Gal. To apply Gal.
Per Acre Field
:- PAN11000 salt-- (8 x 11
13
14
PAN
Applied
Balance
Gallon Bal.
13-10)'"
(14-12r
r i I
00 8 0
� 1 3/ � 5- rl1 2i � 2 torn a�lg I 18 ton 4 4 2 8 0 25 000 110.000.D
E51 i B I
...:.... ::.:. _
2 1851 3112b ; 5 7/1 i Pc62 Corn/acaoe ! S 18 ton , 1.5 200 300,0 21,978 32,957.0
3 1851 I 3/15-7/1 4i PcB2 Corn/Shape i 1 18 ton I 1.6 j 200 I 320.0 25,000 40,00,10
4 1851 ' 1 3/15-7/1 1 4b PcB2 CornlSiiape I 118 ton I 0.5 200 j 100,0 j 21,978 10,989.0
5 1 1851 I 3115-7/1 j 6i PcB2 Corn/Silazle I I i IS ton I 21.1 • t 20D - I 4,224.0 I 25,000 527,500.0
5 I 1851 1 3/15-7/1 j 6b PcB2 Corn/Silage j B 1 18 ton ! 7.0 I 200 I 1,400.0 I 21,978 153,845.2
7 1851 } 3115 7/1 8i PcC2 Gorn/Silage I I 118 ton j 3.7 I 2D0 I 740.0 I 25,000 92,500-0
.....:::::. ::......................
8 1851 { 3/1�7! i 1 8b PcG2 CorNSiiagp I ? 18 ton I 1.2 I 200 24D.0 21,978 26,373.6
v-..-.................. .......--.-....-....:.......... ..... _... ....-......................... ,v,+}?;}�:ust_tii�.}iit�: v. �.,t'.: ,Y.:ti��.::::::: l:.vs tk:v
...........n... .......:..v:................ v..,..vv.:..... •-.__--............, v: .-..,..�::.:..-::. �::.-:::::::::..:.v::::.-::::.v::::::::::::::.v:.v:.v::.v::: }.v.::::::. ry..... x•.w:::......,w.:..,.,v.......::..:.:..:.::.,..
9 i 1852 3/15-7/1 I 1 PcB2 CornlSiiape I B 118 ton I 30.0 j 200 6,000.0 I 21,978 659,340.7
................. ,.:......:...
101 1852 12/20-5/20 2 PcC2 Fescue/Past j B ! 5 ton i .5 150 1,125.0 16,484 - 123,626}.4
I
11 1 - Small Gra 1 40 bu 4.4 I 80 352.0 10 000.0
851 9113/1 2i PcB2 �n ODO 44
.. .-- . .., ... .. ........v.. ...v...............,, .,.:,.:.vv::.v-�-�vw:.w::::::.,..:v:.,-•::::.v:.v::1::...... ti..n.,rn......,... ...................:::.;:.;.:.r-............. ..... ,mrvrvv,-nv ,.v-0:.v-•;,:B.:7..:;91.v �:.1..:;3.,1iv8::.5.v8.v......
151 9/1_311 2b PcB2 Small Gain B 40 bu 1.5I80 .120.
• .............. ...---:.:.........................
..n..:.:::::.:,.v::::::;. v:::: nv: . ::.................r- v ..t..:.v....,.::::.::}.v: w.v �,:.::.............................:.,. �. ......,+w.,.:.w.v.,v. ... s }: t
:?^:.'::.}Kr :}.,::..::v•.\,v.v:.v:.v:,vv.:v:.-: v+l: senh:; t:.vv:: n,v': S}Y. ..,, ...v.--...-.....,sr.
.......,.......x ... ,-£..:. }�.�,. ......,..-...:...uti:....................-.....-.,-..,.,...................,...........,,.,.-........ ..,.. ..,...,...v ...-... l 'tic.:\v.i`Y.-:v},^..:,n}': :4:
13 I 1851 � 911-3/1 j 41 PcB2 Small Grain � I 140 bu � 1:6 �. BO L t.� 128:0 � ••-•,• .•-••. • 10 000 i 16 000 0
,�: rv::... ...x:: r.•}::.Jii:J:i4 ....::•::-}i}::::i::i�ri�:i�i}ii:4t^`:":'_::: }:-::i-:ti^}}}}.}:-::: _:^:::':::'::::::._:.v::.v::: . ..:::::::.... •:ry.
14 1 1851 � •r�9/1-311 {� �4b ! PcB2 � Small gain 1 B i..,4o �tl I 0.5 � 80 I 40.0 � 8,791 4,395.E
BB0
110 Q00
30D
32,957
320
40,000
100
10,989
4,220
527,500
.........::
1,400
153,846
740
92,500
N.
240
26,374
6,000
659,341
1,125
123,626
352
44 000
.:.w:_:::.
120
13,187
'}:3:t.::::r :.: is :. .;
-- - �-�?:.�A'.-...::'
128
16,000
......
........., .,--.... ......,:
40
4,39E
Refer to Form Wet-1 to get total gallons (shaded box') produced from your facility and/or bought from another facility
" Refer to Form Wet-1 to get PAN11000 cal, according to dairy type and application method (shaded area ")
"' Carry Total PAN from Form Wet-1 (shaded box---)

•
0
Form Wet 2
Owner-/Mor-
Address:
Phone t"7:1
acil ity #:
1 j 2
3 1 4 1 E
l'
Tract A.o.c)[ied
�
Field � Type
No. Dale
No, Ootional Crop
15: 1851
9,11-3/1
51
PcB2
Small Grain
X. .......
. .....
.....
........ . .
I B51
9PI -311
6b
PcB2
Small Grain
17 t 1851
9/1-3/1 I
.........
8i
PcC2
Small Grain
18 1851
91 �i-'3"/I i
X.
8b
.........
PcC2
................
Grain
V�
19 I 1852
911-3/1 I
1
PcB2
Small Grain
20 1851
2/20-5/20
1i
PcC2
Fescue /Past
21 1 1851
2/20-5120 1
lb
PcC2
Fescue /Past
221 1851
2/20-51201
31
PcB2
Fescue Ipast
V
23 iry
1851
2/20-5/20
3b
PcB2
Fescue /Past
fi
24 18511
2/20-5/201
5i
PcC2
Fescue /Past
2
2&�E'i'/'2 0
5�
cC2
Fescue /Past
_
.
... ......
... ......... .
2
P
Pa©
Fescue /Past
..... ....
27
-PaD
Fescue /Past
28
1851
1 2120-5/20
9i i»
PcC2
Fescue /Past
on
Third 7-arty User:
Address:
Phone#-.
Oriainatin- Faciljty#:
I Tons received :1
6
7
8
9
- 10
Applied
Lbs. PAN
Lbs. PAN
Method
RYA
rate per ac Applied per fl d
t5orsit
Table
Acres
Table 2)
x 9
1
11 40 bu
21.1
. ....
80
...
1 ".638.0
E
ND bu j
7-6
80
2.
1 550.0
I
1 40 bu l
3 f
80
2-05.0
:4 %x
B1
40 bu J-1.2
1
80
95.0
B
40 bu
30.0 1
80
1400.0
1
5 ton
17.9
150
...... ...............
2,685.0
B
1 5 ton
5.9 I
150
j 835,10
1 5 ton ZO 1 5 0
3066
�XM
B
5 ton
n
0.7
150
105�O
.. . .......
1
...
5 ton 10.4
», , w:
160 1.55D.0
...... I. ..
B 5 ton 50
B
5 ton
1.6
150
240.0
T_ 5 ton -1 11 1 150 T-'iYC6
Refer to Form Wet-1 to get total gallons (shaded box') produced from your facility and/or bought from another
Refer to Form Wet-1 to get PAN/1 000 gal. according to dairy type and application method (shaded area
Carry Total PAN from Form Wet-1 (shaded box—)
I 1 1 12
13
14
ons Applied Tons per
Per -Acre Field
PAN/ton—) (8 x 11)
PAN
Balance
(13 - 10)***
Applied
Tons Bal.
(14 - 112)*
10,000 211,000.0
........ .
. ........ .... . . ..
8J91- 61,538-5
i
MEMEME
10,000 37,000.0
............. . ..... . ......
............... .
. .... ...... .........
. ........
8Y6i­­'i`6,54q.5
_r` 2
. . . ... ...... ..... ..
8.791 263,73c 3
18,750 335,625.0
16,484, 97,252.7
18,750 37,500.0
.......... -.2
16,484 11,536.5
18,750 195,000.0
16,484 57,692.3
18,750 i 93,750.0
16,48.4 j 26,373.6
18,750 :1 22,500.0
1.688
211.000
550
61.538
-14
296
37,000
21.
96
10,549
2,400
263,736
6S, 0.1
2,685
335.625
885
97,253
300
37,500
105
11,538
1,560
195,000
525
57,692
J.,
750
93,750
240
26,374
180
22,500

•
•
Form Wet 2 Dairy Manure Application Worksheet
Owner/Mgr: Third Party User:
Address: Address:
Phone r: Phone #:
Facility #: Originating Facility #:
1
2
3
4
5
6
7
8
9
10
Soil
Applied
Lbs. PAN
Lbs. PAN
Tract
Applied
Field
Type
Method
RYE
rate per ac
Applied per fld
No.
Date
No-
O tional
Crop
(B or sq
Table 2
Acres
Table 2
8 x 9
29 1 / c/ 0 9
185 2 2a 2 B
� 1
P cC2 Fescue (Past
B
5 ton
0.4 1a0 60.0
I 1.
_ :.
.......... ..................... .A..rv.....:.., .:.
30
31
32
133
34
35
36
Sl }
tt37
139
140
41
42
Tons received
11 12
ons Applied Tons per
Per Acre Field
-:- PAN/ton** 8 x 11
16 484 6,593.4
EMS
:fizz
-'.:.$:.\:{+js\'•� thnw.-vyytiJ:.txu� v ; ��viiij xi 2�W
* Refer to Form Wet-1 to get total gallons (shaded box *) produced from your facility and/or bought from another facility
*' Refer to Form Wet-1 to get PAN/1000 gal. according to dairy type and application method (shaded area **)
**' Carry Total PAN from Form Wet-1 (shaded bo)('**)
hued...
13
14
PAN
Applied
Balance
Tons Bal.
13-10***
14-12*
2
60
6,593

RECEIVED
N.C. Dept. of EHNR
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA H&RTI fJIVNtTION
USER NOTES - Revised April 20, 1999
Winston-Salem
Objective: to confirm proper acreage is credited in an animal operation's Re onM 't � p p gff
e u i iza Eon plan thus
allowing the operation to comply with its overall nitrogen balance projection. Proper acreage is
defined as those acres receiving waste. Acreage not receiving waste cannot be credited in the waste
utilization plan.
Acronyms: CAWMP - Certified Animal Waste Management Plan
D, - Field Specifications (exhibit D-1)INRCS Irrigation System Design Parameters
Dz - Travel Irrigation Gun Settings (exhibit 0-2)INiRCS IrriyaLian System Design Parameters
D, -Solid Set Irrigation Gun Settings (exhibit D-3)INRCS Irrigation System Design Parameters
D, -'Irrigation System Specifications & Thrust Block Specifications (exhibit D-4)INRCS Irrigation
System Design Pararrr(Aers
D5 - irrigation System Designer (exhibit D-5)INRCS Irrigation System Design Parameters
Ds - Narrative of Irrigation System Operation (exhibit D-6)INRCS Irrigation System Design
` Parameters
Flagged - operation marked for a mandatory WA Determination
i 1 - technical specialist designated in irrigation design and installation
Irrigation Design - complete package including D, through D. forms/inforn-lation
PAN - plant available nitrogen
PE - Professional Engineer
WA - wettable acres
WUP - waste utilization plan or technical specialist designated in waste utilization
deneral Guidelines;
•- Technical specialists available- toter fake WA Determinations are very limited, Reviewer should use
good judgement and flexibility, when possible and allowable, when making justifications. Examples
include:
(1) An operation with a weak map backed by good design with calculations may be exempt if field
inspection reveals no problems with the irrigation system.
(2) When an operation is. subject to flagging under F2 due to some lacking/unclear information but
Reviewer feels farm should be exempt due to quality of other information, high PAN deficit, accuracy of
irrigation records, etc.; the Reviewer may peed the operation to allow producer additional time to
provide missing information. WA determination is not required if new information meets requirements.
(3) When an operation is subject to flagging under F4 because it failed the 75% rule based on small
percentage of farm's total available acreage (1-2 fields) and the operation has a high PAN deficit, other
available fields, etc.; the Reviewer may Pend the operation to allow producer additional time to have
WUP amended by technical specialist to reduce field acreage to below 75% of total acreage. If after
the amendmeht the overall PAN balance remains in a deficit, a WA determination is not required.
• If an operation is lacking an irrigation layout map or does not meet the E1, E2 or E3 exemptions,
,the 75% rule must be used as a last option to avoid: a mandatory WA determination.
Operations utilizing pump & haul (ielhoneywagons) exclusively will not be subject to a WA
Page 1 of 2

r fi. iV130 "SS •
determinaticW dt this timed For operations utilizing an irrigation system/pump & haul combination for
total field coverage and the system operator is unable to differentiate acres under irrigation versus
honeywagoiiif6_Jr1- record' Keeping purposes (IRR-1&2 vs. SLUR-1&2), operation is to be flagged.
• The only required D, information is the identification of the specific area receiving irrigation. Listing
of pulls for travelers and zones for stationary sprinklers/guns are usually needed. This information
included in the WUP or other format is acceptable.
- Irrigation layout maps for E1, E2 and E3 must show the area receiving irrigation and provide the
basis for calculations of areas. For travelers, the location, length and width of pulls are needed, as
are sprinkler/gun location, spacing and type of throw (ielfull versus partial circle) for stationary
sprinklerslguns. In other words, basic dimensions are to be noted (or scaled) so that a third party
could calculate the acreage covered by the system or confirm the system's layout through field
inspections or measurements. Acceptable maps include a layout on aerial photography or a
schematic to be used in conjunction with aerial photography or land survey map.
• Documentation of basis for wetted diameter is not usually required for E3. Details such as
pressure, nozzle size, etc. are not necessary unless some obvious problem is evident.
• Some situations exist'where for E4 (75% analysis), complete sprayfield acreage is not available.
Common examples include 1) newly cleared land for which aerial photo is not available and 2) part of
a sprayfield has been displaced by a lagoon, swine buildings, etc. Acceptable documentation
includes measurement by FSA or a land survey. Under some situations the operation
reviewer/inspector may make the necessary acreage estimation. Acreage estimation can be based
upon scaled dimensions from a photograph or some other means available to the operation
reviewer/inspector.
If operation has adequate information on irrigation system includinci �,!-tted acres however the
acreage in the WUP exceeds the wetted acre amount, the WUP will need to be amended by a
technical specialist. A WA determination is not required. Example: producer keeping IRR-2 records
by pull according to irrigation design. Sum of pulls in acres < WUP acres = plan needs to be
amended.
• Back-up field status noted in table's footnote 3 may change if primary fields are taken out of use
due to field upgrades, crop failure, etc. or operation expands increasing PAN requirements. Operator
should be made aware of this since a WA determination may be required at a future date due to field
status change.
' - For flagged operations, a copy of the completed Justification & Documentation form is to be sent to
DWQ Database Coordinator (Sonya Avant) with original to go to regional files. A courtesy copy may
be left with the producer upon request.
• To retract a Justification & Documentation form for a flagged operation which has already been
submitted to DWQ, the Reviewer must notify DWQ Database Coordinator by e-mail or phone as soon
as possible to stop the producer notification process, and a revised Justification & Documentation
form must be mailed to the DWQ Database Coordinator. DWQ has ultimate authority at this point ir,
the process to determine whether retraction will be granted.
Page 2 of 2

Wettable Acres Determination Certification
Name of Facility:
LOCUST K
N 0 6 _' -_A R IYI
_ —Facility Number: `�7 - ' 2-Co
Owners) Name:
�j_A Sorel
PA �,I-Nt=
— Phone No: 33c-- 115-7- g 20
Mailing Address:
Z2-1(o N.
LomA
c NC. Lg(-SS
By signing this form, the facility owner and Tecluucal Specialist acknowledge the completion of the
Wettable Acres Determination. All necessary Wettable Acre Determination Field Data Sheets and
calculations were completed to conduct a Wettable Acre Deterrnination. The facility's Waste
Utilization Plan has been amended as necessary to reflect actual wetted acreage. A copy of all
worksheets, calculations, and other Wettable Acres Delerrrunation documents, along with the
applicable Waste Utilization Plan and Wettable Acre Determination Certification will be filed with
the local Soil and Water Conservation District. A copy will also be kept on site with the Certified
Animal Waste Management Plan. Any future modifications must be approved by a technical
specialist and filed with the Soil and Water Conservation District prior to implementation. If any
modifications to the existing irrigation system or any new irrigation equipment was required to
adequately address the waste management needs of this facility, rur Irrigation Specialist or
Professional Engineer has certified the design and lnsu lation below.
Owner N
Owner
Date'
:.h/6-003
v n ' ' I /�
Technical Specialist Name: ! " n t t t 1AA E L W . PI-IIZ _� v _ —
"'Technical Specialist Signature: L Vdik � � ..Date:��-- —
If assisted by an irrigation Specialist or Professional Engineer please read and sign below:
Animal wasteapplication equipment has been designed or modified to apply waste as necessary to
accommodate the waste management plan and according to NRCS Standards. Animal waste
application equipment has been installed according to NIZCS Standards and is ready for use.
Irrigation Specialist/PE Name:
Irrigation Specialist/PE Signature: Date:
Subrtxit this form to: „
Attn: -Sonya-Avant
Non -Discharge Compliance Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
WAD - 7/99

0
•
Revised April 18, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 97 _ 2G
Farm Name: Lccusr lrNol3 C1990
On -Site Representative:
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP: 510oz
Annual farm PAN deficit: ' 145 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part It eligibility item(s) F1 F2 F3 F4
✓ Operation not required to secure WA
determination at this time bnsed on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
` Irrigation System(s) - circle #: 1. hard -hose traveler;. 2. center -pivot system; 3. linear -move system;
;.4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportable pipe;
:'6.1 stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2ID3 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
i checklist, Part 11 - F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements.' WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which. resulted. in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of informationlmap.
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.

€4 .
}
Revised April 18, 1999
Facility Number 9 ? 7_6o
Part Ill. l=ield by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER''
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
j g s r
Z yL
5T
l, 0
:3 0. 5'
r gs�
3 S
5o4ip SC-
'19.6
3o.5
75 Ulo
711E
Rr Nivu6
151&e_ S 1!,
rfl
VVVkec(fiuc
Lrz r 6, r
.lj .
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, 1nspeclorlrev!ewer will have to combine fields to
calculate 76% field by field determination for exemption; 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 4s 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.
Part IV. Pending WA Determinations due to adequate wetted acreage but unable to complete
evaluation due to the following reason(s):
P1
P2
P3
Plan lacks following information:.
Plan revision may satisfy 75% rule based on adequate overall PAN deficit and by
adjusting all field acreage to below 75% use rate
Other:

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