040009_Annual Report_20210329

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ATTACHMENT A
NC p�o�oW ANIMAL FACILITY ANNUAL REPORT FORM
Report for ( 14sraiendar Year: 20 gt, Today's Date: S' 7 2 1
Certificate of Coverage or Permit Number /4/.0r 9 County . �s
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Facility Name (as shown on Certificate of Coverage or Permit)/��liS' 6-
L,e el Lift)
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Operator in Charge for this Facility �I Operator Certification # � g
Facility's Integrator, if applicable:
Part 1: Facility Information (As of December 31st 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
ated 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):
Fields or
Pulls/zones
Total Useable Acres approved 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
er Permit Condition 111-22
ANNUAL OPERATIONS SUMMARY
for all cro s with windows that ended during the previous calendar Year
Total number of Fields or Pulls on which land application occurred during
the year
Total Acres on which animal waste was ap7lied
Total pounds of Plant Available
Nitrogen (PAN) applied during
the year for all application sites:
Permitted Animal Waste
Acres
Lbs. PAN
# Lagoons
# Lagoons
Fields or
Pulls/zones
Other Nutrient Sources (incl Dry Litter)
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
Total usable acres of Fields or Pulls for which the most recent soils
_evaluation indicated a Soil P -index) greater than 400
Acres
Lbs. PAN
Lbs. PAN
0
Fields or
Pulls/zones
Acres
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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
PRODUCTION SUMMARY
Annual average number of animals by type at this facility during the previous year
Operation Type Number of Animal
S 1V _ Wean -40 Fehr
So,
Swine Cattle Dry Poultry Other Types
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 Poultl _-
Gilts Other Non -Laying Pullet
Other Layers
Part II: Facility Status (Respond for activity within the Calendar v ear of reeorting 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 I.4.
2. There were no freeboard exceedances in any lagoons or storage ponds. 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 111.22 have been completed...0.-No
5. For any temporary lagoon lowering event, drawn down restrictions and record rii
No
keeping requirements in Condition II.29 have been met.
b. Soils analysis were performed within the last three years on each field receiving animal No
waste.
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ATTA - NT 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 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."
Gz I iet7/ -Or-
Permittee Name and Title (type or print)
Signature of Pennitt
Date
Signature of Operator in Charge Date
(if different from Pernnittee)
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