820645_Annual Report_20200417

RECEMM
APR 17 2020
ATTACTWENT A
[}MDwR ANIMAL FACILITY ANNUAL REPORT FORM
Uiiice
Repor�'i`�'�pxevxous) Calendar Year: 20- ? Today's Date:
Certificate of Coverage or Permit Numbed fl/ $ o s-- County
Facility Name (as shown on Certificate of Coverage or Permit)
Operator in Charge for this Facility ��,o jam„ � � Operator Certification #_ 44 17999
Facility's Integrator, if applicable:
Part h . Facili Information i As of December 3ls' of reao 'nu _ ear unless otherwise specified]:
Land application of animal waste as allowed by the above permit occurred during the past calendar year
l/ YES NO. If NO, skip Part I and proceed to Part Hand 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):
Total Useable Acres .Moved in the CAWN2 _
Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied
annuall :b :the CAWMP and. the camit:
Number of Permitted La
Number of Permitted Lagoons with a sludge removal or management plan
er Permit Condition III 22
ANNUAL OPERATIONS SUMMARY —
for:all crops with wfndows that ended durin the revious calendar
Total number of Fields or Pulls on which land application occurred during
die year:
on which animal waste was applied
Total pounds Of Plant Available Permitted Animal waste
Nitrogen (PAN) applied during
the year for all application sites: Other Nutrient Sources (inel Dry Litter)
Total number of Fields or Pulls for which the most recent soils evaluation
indicated a Soil P (P-index) greater than 400
Total usable acres of Fields or Pulls for which the most recent soils
evaluation indicated a Soil P =index .' ' ter than 400
fo _ Fields or
Pulls/zones
.2Acres
Lbs. PAN
# oohs
# Lagoons
! Fields ',or
Pulls/zones
�G. Acmes
�ys�! Lbs. PAN
Lbs. PAN -�
Fields or
Pulls/Zones
;Acres
I
MAR 2 3 2020 AFOAR 4-12-2019
Ti
WV.e FD n ON
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OPERATOR CERTiFICAiiON PROGM'0

ATTACHMENT A
CBBN CAL USE SUMMARY
Estimated amount of total manure, litter and process wastewater sold or Tons
given to other persons and taken off site during the year ® Gallons
PRODUCTION SUMMARY
Annual average number of animals b e at this fac!#ty duriM the orevioas Year
Operation Type Number of Animal
F.ti a _ /sr / 96
ftine
Cattle
Dry Poaltry
Other Tomes
Wean to Finish
Dairy Calf
Non -Laying Chickens
Horses — Horses
Wean to Feeder
Dairy Heifer
Laying Chickens
Horses — Other
Farrow to Finish
Milk Cow
Pullets
Sheep — Sheep
Feeder to Finish
Dry Cow
Turkeys
Sheep - Other
Farrow to Wean
Beef Stocker Calf
Turkey Pullet
Farrow to Feeder
Beef Feeder
Boar/Stud
Beef Broad Cow
Wet Poulm
Gilts
Other
Non -Laying Pullet
Other
Layers
Part II: Facility Stains ,Res and for acttvi within the Calendar ;ear of repolik& 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 Yes No
according to requirements of Condition 1.4.
2. There were no freeboard exceedances in any lagoons or storage ponds. (Ye No
3. There was no PAN application to any fields or crops at this facility greater than the No
levels specified in this facility's CAWMP.
4. Sludge Surveys as required in Condition H1.22 have been completed. Yes No
5. For any temporary lagoon lowering event, drawn down restrictions and record Y No
keeping requirements in Condition H.29 have been met.
6. Soils analysis were performed within the last three years on each field receiving animal Yes No
waste.
2 AFOAR 4-12-2019

ATTACHMENT A
7. .All required monitoring and reporting were performed in accordance with the facility's (9.No
permit during the past calendar year.
8. Crops as specified in the CAVIW were maintained during the past calendar year on all Yes 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."
Peimittee Name and Title (type or print)
Signature of Permittee Date
Signature of Operator in Charge
(if different from Permittee)
RECEIVE®
APR 11 2420
NC DF-Q1DWR
Date
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