820423_Annual Report_20200408 (2)

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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
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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