040031_Annual Report_20210329

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lc D .01 ANIMAL FACILITY ANNUAL REPORT FORM
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Ce ottlee
R port for (previous) Calendar Year: 20 2't? Today's Date: 3 7 61r
Certificate of Coverage or Permit Number 14Ws0g003f County /7-51,-y-.7
Facility Name (as shown on Certificate of Coverage or Permit) G-e_ 44.&iI s *ti
Operator in Charge for this Facility 71,1S /i v4L /,V Operator Certification # 67V.5 7
Facility's integrator, if applicable:
ATTACHMENT A
Part I: Facility Information (As of December 315t of reporting year unless otherwise siiecified;:
Land application of animal waste as allowed by the above permit occurred during the past calendar year
)c 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):
Total Useable Acres approved in the CAWMP
Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied
annuallv by the CAWMP and the permit:
LAGOON SUMMARY
Number of Permitted Lagoons
Fields or
Pulls/zones
Number of Permitted Lagoons with a sludge removal or management plan
er Permit Condition III-22
ANNUAL OPERATIONS SUMMARY
for all cro . s with windows that ended durin ! the
/t
9-1't5
1
I
Acres
Lbs. PAN
# Lagoons
# Lagoons
revlous calendar year)
Total number of Fields or Pulls on which land application occurred during
the year:
Total Acres on which animal waste was applied
Total pounds of Plant Available
Nitrogen (PAN) applied during
the year for all application sites:
Permitted Animal Waste
Fields or
7 Jl�
Pulls/zones
Acres
i313.3 5
Other Nutrient Sources (inci Dry Litter)
0
SOIL SAMPLE SUALMARY
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 (P-index) greater than 400
Lbs. PAN
Lbs. PAN
Fields or
Pulls/zones
Acres
1 AFOAR 4-12-2019

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 faciliq during the previous year
Operation Type
Sr�e�ia� W,%mr. 1 di -
Number of Animal
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 Poultry.
Gilts Other Non -Laying Pullet
Other Layers
Part II: Facility Status (Respond for activity within the Calendar .ear of reporti' i v ear 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 III.22 have been completed. Yes No
5. For any temporary lagoon lowering event, drawn down restrictions and record No
keeping requirements in Condition II.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

ATTA
7. All required monitoring and reporting were performed in accordance with the facility's
permit during the past calendar year.
8. Crops as specified in the CAWMP were maintained during the past calendar year on all
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."
'17;ir
Permittee Name and Title (type or print
Signature of Permittee
Signature of Operator in Charge
(if different from Permittee)
7 /
Date
Date
3 AFOAR 4-12-2019