670076_Annual Report_20210305

to 4,--;1 1 *
Report forf w F t Year: 20
Certificate of a or Permit Number 7 " 7
Facility Name (as shown on Certificate of Coverage or Permit)
A TACHMENT A
tiva 06 ANIMAL FACILITY ANNUAL REPORT FORM
Today's : 1/7 A i
County
Operalor in Charge for this Facility : , V Operator Certification # /r
Facility's Integrator, if applicable:
Part I: FacditvInformation (As of December 31d ofrepar_tmg year unless otherwise:specif°aed):
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 Cued Animal Waste
Management Plan (CAWMP):
Fields, or
Pulls/zones
Total Useable Acres ao.roved in the. CAWMP
Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied
annually by the CAWMP and the permit;.
LAGOON SUMMARY.
Number of Permitted Lagoons_
Number of Permitted Lagoons with a sludge removal or -management plan
Permit Condition 31l-22
ANNUAL OPERATIONS SUMMARY
(forali crops with windows that ended during the reviions calendar.year
Acres
S2
Lbs. PAN
# Lagoons
# Lagoons
Total number of Fields or Palls on which land application occurred during
the year,:
Total Acres on which animal waste was. applied
Fields or
Pulls/zones
A
Total pounds of Plant Available Permitted Animal Waste / (7 5 Lbs. PAN
Nitrogen (PAN) applied during
the year for all application sites: Other Nutrient Sources (irel Dry Litter)
SOIL SAMPLE SUMMARY
Lbs. PAN
Total number of Fields or Pulls for which the mostrecent soils evaluation
indicated a Sod P (P-index) greater #ban 400
Total usable acres of Fields or Pulls for which the most recent soils.
evaluation indicated a Soil P F-index ` • - than 400
Fields or
Pulls/zones
1 AFOAR 4-12-2019

ATTACHMENT A
BENIFICAL USE SUMMARY
To
Estimated amount of total manure, litter and process wastewater sold or
given to other persons and taken offsite dming the year
®
Gallons
PRODUCTION SUMMARY
Annual average number of swim�als by type at this facility during the previous year
Operation Type
Neer of Animal
VC- a ft` -WC"--
35E S
1
Swine Cattle Dry Poultry Other Ttpes
Wean to Finish Dairy Calf Non -Laying Chickens Horses - Hoses
Wean to Feeder Dairy Heifer Laying Chickens Horses — Other
Farrow to Finish Milk Cow Pallets 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 Pour
Gilts Other Non -Laying Pullet
Other Layers
Part II:.. Facility Status ;(Res;,.and.for activiF within.the Calendar ear of re ortim ,gear 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 rhanges," "revisions," and "amendments" to the CAWMP were made Yes No
according to requirements of Condition I.4.
2. There were no freeboard exceedances in any lagoons or storage ponds. ( Yes No
3. There was no PAN application to any fields or crops at this facility greater than the Yes No
levels specified in this facility's CAWMP.
4. Sludge Surveys as required in Condition 111.22 have been completed. ( Yes No
5. For any temporary lagoon lowering event, drawn down restrictions and record No
keeping requirements in Condition I129 have been met
6. Soils analysis were performed within the last three years on each field receiving animal No
waste.
2 AFOAR 4-12-2019

ATTACHMENT A
7. All required monitoring and reporting were performed in accordance with the facility's No
permit during the past calendar year.
8. Crops as specified in the CAWMP 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 afrtmi 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."
Cie Arz'
Permitted -Name and Title (type or print)
Signature of Operator in Charge
(if different from Permittee)
Date
3 AFOAR 412-2019