390002_Inspection_20221115

Facil ti y Number
139
00_
QrDivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Id Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Arrival Time:
F B 1Cu..r.,iil
IS; is
Departure Time:
Mailing Address:
Physical Address:
Facility Contact:
10 - s
Owner Email:
Phone:
County: C7,jy441t Region: ag6
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
f a5 c
1/3D
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dr v Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
_
Turkey Poults
Other
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [No ❑NA ❑NE
El Yes El No ❑NA LINE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes rii9 ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3
5/12/2020 Continued

Facility Number: 5 Q - Q ,�- I [Date of Inspection: (1 /15/ O� p4-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IZI-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and./or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ID/No ❑ NA ❑ NE
❑ Yes
❑ Yes
�Vo ❑ NA ❑ NE
❑ITO ❑NA ❑NE
❑ Yes Er o ❑ NA ❑ NE
❑ Yes ffr-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ['Checklists ❑ Design ❑ Maps D Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
El Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Ra
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page2of3
❑ Yes 21-No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes [r]'No ❑ NA ❑ NE
❑ Yes ET -No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Other:
❑ Yes ❑-No ❑ NA ❑ NE
❑ Waste Transfers ❑ Weather Code
infall Inspections ❑ Sludge Survey
❑ Yes
❑ Yes
[/]''No ❑ NA ❑ NE
Io ❑ NA ❑ NE
5/12/2020 Continued

'Date of Inspection:
Facility Number: 3 y -0 .
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
❑ Failure to complete annual sludge survey
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
['Failure to develop a POA for sludge
❑ Yes ,V.No D NA
❑ Yes IZ(No D NA
levels
❑ NE
❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus Toss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ziNo ❑ NA
❑ Yes No ❑ NA
❑ Yes eNo ❑ NA
❑ Yes No ❑ NA
❑ Yes arNo ❑ NA
❑ Yes 6 No ❑ NA
❑ Yes e No ❑ NA
❑ Yes iz No ❑ NA
❑ Yes liNo ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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a-ft da ee� r ao9 �70 da, .�
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+0... $-a2- I f i4
g` ' 'If 'a (3 U O Ic4 7
Lt.902,6/\ Wcua--fr-k ° 6-tcA 1941\12- 11'
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
WiNNooc--
aA-g_
I `f i 0 •)3-7
Phone:
Date:
cog 19/ Liaa
5/12/2020

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 390002 Facility Status: Active Permit: AWS390002 0 Denied Access
Inspection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine County: Granville Region: Raleigh
Date of Visit: 10/22/2021 Entry Time: 08:00 am Exit Time: 10:00 am Incident #:
Farm Name: C. F. Blackwell Company Owner Email:
Owner: C Forest Blackwell Phone: [phone]
Mailing Address: 8114 Dick Blackwell Rd Oxford NC 27565
Physical Address: 2081 Mtn Creek Rd Oxford NC 27565
Facility Status: Compliant ❑ Not Compliant Integrator: Murphy -Brown LLC
Locatfon of Farm: Latitude: 36,, 26' 45" Longitude: 78° 41' 01"
Mountain Creek Rd. between Sam Blackw^" - id Dick Blackwell Rd.
Question Area. 3w N 363
▪ Dischrge 8t t 9 r q, (P O
▪ Records and II Issues
Certified Operator • 3 fl
Secondary OIC(s): ` 4
to Col, Stor, & Treat Waste Application
Operator Certification Number: 18339
On -Site Representative(s): Name Title Phone
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Jane Bernard
Phone: [phone]
Date:
Inspection Summary:
Page 1 of 5

Permit: AWS390002
Owner: C Forest Blackwell
Inspection Date: 10/22/21 Inspection Type: Compliance Inspection
Facility Number: 390002
Reason for Visit: Routine
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:
Structure
Application Field
Other
a. Was conveyance man-made?
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
State other than from a discharge?
Waste Collection, Storage & Treatment
4. Is storage capacity less than adequate?
If yes, is waste level into structural freeboard?
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ /arc
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect application?
If yes, check the appropriate box below.
Excessive Ponding?
Hydraulic Overload?
Frozen Ground?
Heavy metals (Cu, Zn, etc)?
PAN?
Is PAN > 10%/10 lbs.?
Total Phosphorus?
Failure to incorporate manure/sludge into bare soil?
Outside of acceptable crop window?
Evidence of wind drift?
Application outside of application area?
Crop Type 1
Yes No NA NE
O 000
❑ ❑❑❑
0000
O 000
O 000
O 000
Yes No NA NE
O 000
0
O 000
O 000
DODO
O 000
DODO
Yes No NA NE
O 000
❑ ❑❑❑
❑❑❑❑❑❑❑❑❑❑❑
Page 3 of 5

Permit: AWS390002
Inspection Date: 10/22/21
Owner: C Forest Blackwell
Facility Number: 390002
Inspection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
120 Minute inspections?
Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipmen
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
appropriate box(es) below:
Failure to complete annual sludge survey
Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
If yes, check the appropriate box below.
Application Field
Lagoon / Storage Pond
Other
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
34. Does the facility require a follow-up visit by same agency?
Yes No NA NE
O 000
❑ ❑❑❑
❑ ❑❑❑
O 000
❑ ❑ ❑ ❑
❑ ❑❑❑
Yes No NA NE
❑ ❑❑❑
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑
❑ ❑❑❑
o
o
❑ ❑❑❑
O 000
❑ ❑❑❑
Page 5 of 5