670076_Annual Report_20220214

RECEIVED
'Ate 4inqi*
FEB 1 4 2022 ATTACHMENT A
• NC DEQ/DOMAL FACILITY ANNUAL IMPORT FORM
Report for cixeciallealaar year: 20 itRi
Today's Date: aisha
county On JO is,
Certificate &Coverage or Permit Number / 7 47
FacilityName (as shown on Certificate of Coverage or Pamit)
n
Operator M Charge for this Facility (17,..E9 fejar5 Operator Certification #
Facility's Integrator, if applicable: /wine
Part 1: FacilitV Information (As of December 31st of renordni *eau- mins otherwise sneciried):
Land application ofanimal waste as allowed by the above permit occurred during the past calendar year
YES NO NM, skip Part I and proceed to Part li 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 intbe Certified AniTTIRI Waste
Management Pim (CAWMI) :
Fields or
Pas/zones
Total Useable Acres Itn ;-oved in the CAWMP
Total pounds of Plant Available ITMogen (PAN) allowed to be land applied
ammally by the CAWIte and the perm; t-
LAGOON SUMMARY
Number ofPennitted Lagoons_
Number of Peimitted Lagoons with a sludge removal or management plan
Permit Condition 111-22
Acres
ANNUAL OPERATIONS SUMMARY
(far all crops with windows that ended during the p revions calendar year)
Total number of Fields or Pulls on whichland application occurred during
the year::
•
37
Lbs. PAN
1 # Lagoons
# Lagoons
Melds
,Pulls/zones
Total Acres onWllich2lthwd waste was applied
Total pounds ofPlant Available
lerogen (PAN) applied during
the year for all application sites:
Acres
Pemlitted Animal Waste
Other Nutrient Sources (incl Dry Litter)
SOIL SAMPLE Su..
Total number ofFields or Pulls for which the most recent soils evaluation
indicated a &HP (P-index) greater than 400
Total -usable acres of Fields or Pulls for which the most recent soils
evaluation indicated a Soil P (P-indos) than 400
0
Lbs. PAN
Lbs. PAN
0
Fields or
Pulls/zones
Acres
1 AFOAR 4-12-2019

ATTACHMENT MENT A
BENIFICALIISE SUMMARY
Estimated amount of total tee, fitter and process wastewater sold or
Igiven to otherpersons and taken off site the year
PRODUCTION SUMMARY
Annual average number of animab6 type at Ads fad i!y dwing the previous yea r
OPe atton Type
✓Can fn TrzIr
Number of Animal
Swine Cattle Dry Poultry Other 'nixes
Wean to Finish Dairy Calf lion -Laying Chickens Hoses -Horses
Wean to Feeder Dairy BAT 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 2 oul€ry
Gilts Other Non -Laying Pullet
Other Layers
Part ii:.Facility Status (Respond for activity within the Calendar;vear of renortina
otherevise sue:
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. "amp" to the CAWMP were made No
acing to requirements of Condition L4.
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 es No
levels specified in this facility's CAWMP.
4. Sludge Surveys as required in Condition 11127 have been completed. es No
5. For any temporary lagoon lowering event, drawn down is ttic ions and record • No
keeping requirements in Condition 11.29 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. s All required monitoring and reportin,g were permed in accordance with the facility's No
permit rimingthe past calendar year.
8. Crops as specified in the CAWMP was maintained during the past calendar year on all
sites receiving animal waste and the mops grown were harvested and removed in
accordance with the facility's permit.
No
Part Affirmation Statement
"I affirm by my signature that this document and all attachments were prepared under my direction or
supervision. The information saber is, to the best ofmy 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."
(7rcn. fC2r-�Mu r�
Permiuee Name and Title {type or print)
S ignatde o Pennine D: to
Signature of Ovaiator in Charge
(if di#%entfrom Peamitteel
AFOAR 4-12-2019