740021_Annual Report_20200312

ATTACHMENT A
ANIMAL FACILITY ANNUAL REPORT FORM
Report for (previous) Calendar Year: 20-&-- Today's Date: 3` 3 —10)0
Certificate of Coverage or Permit Number A�y5r7q Q o a 1 County P;-��
Facility Name (as shown on Certificate of Coverage or Permit) �p}�tCi> C/�SYYI 1 �Af ry�.
rr ��
Operator in Charge for this Facility FSf, 1, fi 3'i Operator Certification # 29 2 15$
Facility's Integrator, if applicable:
Part I: Facility Information (As of December 311 of reporting year unless otherwise specified):
Land application of animal waste as allowed by the above permit occurred during the past calendar year
YES NO. If NO, skip Part I and proceed to Part II and Part III. Also, if animal waste was
generated but not land applied, attach an explanation on how the animal waste was managed/disposed.
CAWMP SUMMARY
Total number of application Fields or Pulls in the Certified Animal Waste
Management Plan (CAWMP):
5
Fields or
Pulls/zones
Total Useable Acres approved in the CAWMP
r • 1
Acres
Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied
annually by the CAWMP and thepermit:
*tv- 1 nv i 3q
au- Z Jj 7 f
Lbs. PAN
LAGOON SUMMARY
Number of Permitted Lagoons
# Lagoons
Number of Permitted Lagoons with a sludge removal or management plan
per Permit Condition III-22
v
# Lagoons
ANNUAL OPERATIONS SUMMARY
for all crops with windows that ended during the previous calendar year
Total number of Fields or Pulls on which land application occurred during
the year:
5
Fields or
Pulls/zones
Total Acres on which animal waste was applied
Acres
Total pounds of Plant Available
Nitrogen (PAN) applied during
the year for all application sites:
Permitted Animal Waste
lei
] 5-3
Lbs. Lbs. PAN
Other Nutrient Sources (incl Dry Litter)
Lbs. PAN
SOIL SAMPLE SUMMARY
Total number of Fields or Pulls for which the most recent soils evaluation
indicated a Soil P (P-index) greater than 400
0
Fields or
(0
Pulls/zones
Total usable acres of Fields or Pulls for which the most recent soils
evaluation indicated a Soil P(P-index) eater than 400
0
Acres
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h
ATTACHMENT A
BENIFICAL USE SUMMARY
Estimated amount of total manure, litter and process wastewater sold or
given to other persons and taken off site during the year
Tons
0
Gallons
PRODUCTION SUMMARY
Annual average number of animals by type at this facility during the previous year
Operation Type
Number of Animal
j
Swine
Wean to Finish
Wean to Feeder
Farrow to Finish
ee er toEm—i—sth
Farrow to Wean
Farrow to Feeder
Boar/Stud
Gilts
Other
Cattle
Dairy Calf
Dairy Heifer
Milk Cow
Dry Cow
Beef Stocker Calf
Beef Feeder
Beef Broad Cow
Other
Dry Poultry
Non -Laying Chickens
Laying Chickens
Pullets
Turkeys
Turkey Pullet
Wet Poultry
Non -Laying Pullet
Layers
Other Tunes
Horses — Horses
Horses — Other
Sheep — Sheep
Sheep - Other
Part II: Facility Status (Respond for activity within the Calendar year of reporting year unless
otherwise specified):
Directions: Check box next to the appropriate answer, for each statement were the answer is "No", provide a
written description of any action take taken or pending to address the requirements and return the facility to
compliance
1. All "major changes," "revisions," and "amendments" to the CAWMP were made LL ❑ No
according to requirements of Condition I.4.
2. There were no freeboard exceedances in any lagoons or storage ponds. ❑ Yes L�No
3. There was no PAN application to any fields or crops at this facility greater than the G�'es ❑ No
levels specified in this facility's CAWMP. /
4. Sludge Surveys as required in Condition III.22 have been completed. P Yes ❑ No
5. For any temporary lagoon lowering event, drawn down restrictions and record I�'es ❑ No
keeping requirements in Condition 11.29 have been met.
6. Soils analysis were performed within the last three years on each field receiving animal FYes ❑ No
waste.
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ATTACHMENT A
7. All required monitoring and reporting were performed in accordance with the facility's VYes ❑ No
permit during the past calendar year. /
8. Crops as specified in the CAWMP were maintained during the past calendar year on all ❑ Yes M No
sites receiving animal waste and the crops grown were harvested and removed in
accordance with the facility's permit.
Part III: Affirmation Statement
"I affirm by my signature that this document and all attachments were prepared under my direction or
supervision. The information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the
possibility of civil and criminal penalties."
(-5.42 )111, 6L4 XL::2� >L
ignature Permittee Date
Si4ture of Operator in Charge
(if different from Permittee)
ME
- l 3 - 1 )-0
Date
AFOAR 4-12-2019