820423_Annual Report_20200408

0515
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ANIMAL FACILITY ANNUAL REPORT FORM
Gec°
Report for (previous) Calendar Year: 20
ATTACHMENT A
Today's Date: 3 - 3 o._- g_C7,
Certificate of Coverage or Permit Number . bt/ S. .0 a a. _ county
Facility Name (as shown an Certificate of Coverage or Permit) S GLt, ,S
Operator in Charge for this Facility .: G = t Operator Certification # - • ° a 3
Facility's Integrator, if applicable:
Part.I: Facility Information ;;As of December 3.1d of re ore ear unless otherwise si
Land application of animal waste as allowed by the above permit occurred during the past calendar year
17 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.
L.CAWMP,SUMMARY
Total number of application Fields
Management Plan (CAWMP):
or Pulls in the Certified Animal Waste
..
Fields_ , or...
Pulls/zones ..
Total Useable Acres approved in the.CAWMP
12, '7 3
Acres
Total pounds of Plant Available Nitrogen (PAN) allowed to be land applied
annually > . the _CAMP and ..the.pen .it:
& J 0 4
Lbs. PAN
LAGOON_ SUMMARY .
Number of Permitted. Lagoons
f ...
#Lagoons
Number of Permitted Lagoons with
per Permit Condition III-22
a sludge removal or management plan
# Lagoons
ANNUAL OPERATIONS SUMMARY
(for all crops with windows that ended duringthe . revious calendar_ .ear
Total number of Fields or Pulls on which land application occurred during
the year:
Fields or
9
Pulls/zones
Total Acres on which animal. waste was applied
J 2 2.
..:
Acres.
Total pounds of Plant Available
Nitrogen (PAN) applied during
the year for all application sites:
Permitted Animal Waste
_"I
r
Lit
�
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
Fields _ or
Pulls/zones
Total usable acres of Fields or Pulls for which the most recent soils
evaluation indicated a Soil P (P-index).greater than 400
0
Acres
1
AFOAR 4-12-2019

ATTACHM
BENIFICAL USE SUMMARY
Estimated amount of total manure, litter and process wastewater sold or
Q
Tons
...........
given to other persons and taken off site during the year
Q
Gallons
PRODUCTION SUMMARY
Annual average number of animals by type at this facility: during the previous year
Operation Type
Number
of Animal
F er o ra_ To F r-i 275
,
Swine
Wean to Finish
Wean to Feeder
Farrow to Finish
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Boar/Stud
Gilts
Other
Cattle
Dairy Calf
Dairy Heifer
Milk Cow
Dry Cow
Beef Stocker Calf
Beef Feeder
Dry Poultry Other Tes
Non -Laying Chickens Horses - Horses
Laying Chickens Horses — Other
Pullets Sheep — Sheep
Turkeys Sheep - Other
Turkey Pullet
Beef Broad Cow Wet Poultry
Other Non -Laying Pullet
Layers
NT A
Part 11: Facility Status (Respond for activi r within the Calendar ear 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 / 'e No
according to requirements of Condition I.4.
2. There were no freeboard exceedances in any lagoons or storage ponds. es 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 I1I.22 have been completed. es No
5. For any temporary lagoon lowering event, drawn down restrictions and record es 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

ATTACHMENT A
7. All required monitoring and reporting were performed in accordance with the facility's i'es 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 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."
b,/ 1 Yi'/.:= e
irJ
Permittee Name and Title (type or print)
y
Signature of Permittee Date
L
Signature of Operator in Charge
(if different from Permittee)
RECEIVED
APR 0 8 2020
NC DEQ/DWR
Central Office
3-30 -gyp
Date
3 AFOAR 4-12-2019

Permit No.:
CD
Owner Signature:
INSTRUCTIONS FOR USE
irement of the CAWMP
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Permit No.:
Swine Farm Waste Management — Odor Control Checklist
Site Specific Practices
Comments
BMP Option to Minimize Odor
Cause/Source
HOUSE / BARN — VENTILATION
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Permit No.:
Swine Farm Waste Management — Odor Control Checklist
Site Specific Practices
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:WOa3 318V1IVAV

DEVICES TO AUTOMATICALLY STOP IRRIGATION EVENTS
STATE GENERAL PERMITS
The State of North Carolina has issued State General Permits for animal facilities to operate in North Carolina. These
Permits meet both State and EPA requirements and provide coverage for the following types of facilities.
• AWG100000 - Swine Facilities
• AWG200000 - Cattle Facilities
• AWG300000 - Poultry Facilities with a liquid waste management system
You have recently been issued a Certificate of Coverage (COC) to operate your animal facility under one of these General
Permits.
Condition 1124 of each of these Permits reads as follows:
The Permittee shall:
a. install, operate, and maintain devices on all irrigation pumps/equipment designed to automatically stop irrigation
activities during precipitation; or
b. commit to provide for the presence of the OIC, a designated backup OIC, or a person under the supervision of an
OIC or designated backup OIC at all times during the land application of waste so that in case of a precipitation
event, the irrigation activities will be stopped immediately. This commitment must be submitted in writing to the
Division on a form supplied by, or approved by, the Division. [G.S. § 90A-47]
Installation of devices or submission of alternate documentation shall be completed within 12 months of the
issuance of the COC for this General Permit. The Permittee shall maintain such devices according to the
manufacturer's instructions and warranties. This Condition does not apply to manure spreaders or other equipment
pulled by manned vehicles. [15A NCAC 02T .0108(b)]
Please check the box below that indicates your commitment to do one of the following.
O Within twelve (12) months of the effective date of a COC issued under this permit, I shall install, operate and maintain
devices on all irrigation pumps/equipment designed to automatically stop irrigation activities during precipitation.
This condition does not apply to manure spreaders or other equipment pulled by manned vehicles.
O I will commit to provide for the presence of the Operator in Charge (OIC), the designated backup OIC, or a person
under the supervision of an OIC or backup OIC at all times during the land application of waste.
"I certify under penalty of law that this document was prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information,
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 fines and imprisonment for knowing
violations."
24-4-k S 4' ‘, /J & r o `1.23
Permit Number
Facility Name
Owner/Permittee Name and Title (type or print)
G/ F �/" Jr �r .Lr. Sf t ftV iP+
Signature of Owner/Permittee
Signature of Operator in Charge (if different from Pezni ee)
FI EII/eD
Mail to: Animal Feeding Operations
1636 Mail Service Center
Raleigh, NC 27699-1636
DTASIE 1-22-2020
APR 0 8 2020
NC, DEQ/DVR
Center office
Date
Eo
Date