520073_Annual Report_20230303

ANIMAL FACILITY ANNUAL CERTIFICATION FORM
Certificate of Coverage or Permit Number County - Year 2QR-1-3
Facility Name(as shown on Certificate of Coverage or Permit) l
Operator in Charge for this Facility )L M I ' L : Certification #
Land application of animal waste as allowed by the above permit occurred during the past calendar year
YES NO. If NO, skip Part I and Part II and proceed to the certification. Also, if animal waste
was generated but not land applied,please attach an explanation on how the animal waste was handled.
Part I : Facility Information:
1. Total number of application Fields❑or Pulls V(please check the appropriate box)in the Certified Animal
Waste Management Plan(CAWMP): tj Total Useable Acres approved in the CAWMP
g!3 IL4,1-r
2. Total number of Fields ❑ or Pulls X(please check the appropriate box) on which land application
occurred during the year: 1 - Total Acres on which waste was applied ` b.
3. Total pounds of Plant Available Nitrogen(PAN)applied during the year for all application sites:
­7 L. 511
4. Total pounds of Plant Available Nitrogen(PAN)allowed to be land applied annually by the CAWMP and
the permit: O 110
5. Estimated amount of total manure, litter and process wastewater sold or given to other persons and taken
off site during the year tons ❑ or gallons ❑ (please check the appropriate box)
6. Annual average number of animals by type at this facility during the previous year:
5a
7. Largest and s allest number of animals by type at this facility at any one time during the previous year:
Largest
Smallest
(These numbers are for informational purposes only since the only permit limit on the number of animals
at the facility is the annual average numbers)
8. Facility's Integrator if applicable: sm l� Ll A
Part II: Facilih, Status:
IF THE ANSWER TO ANY STATEMENT BELOW IS"NO", PLEASE PROVIDE A WRITTEN
DESCRIPTION AS TO WHY THE FACILITY WAS NOT COMPLIANT, THE DATES OF ANY NON
COMPLIANCE,AND EXPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKEN TO
BRING THIS FACILITY BACK INTO COMPLIANCE.
1. Only animal waste generated at this facility was applied to the permitted sites during C-Yes ❑ No
the past calendar year. RECEIVED
AFACF 3-14-03 1
MAR 0 3 2023
�rallOffvice

2. The facility was operated in such a way that there was no direct runoff of waste from N Yes ❑ No
the facility(including the houses, lagoons/storage ponds and the application sites)during
the past calendar year.
3. There was no discharge of waste to surface water from this facility during the past Cf Yes ❑ No
calendar year.
4. There was no freeboard violation in any lagoons or storage ponds at this facility during 14 Yes ❑ No
the past calendar year.
5. There was no PAN application to any fields or crops at this facility greater than the Yes ❑ No
levels specified in this facility's CAWMP during the past calendar year.
6. All land application equipment was calibrated at least once during the past calendar year. [ (Yes ❑ No
7. Sludge accumulation in all lagoons did not exceed the volume for which the lagoon L' Yes ❑ No
was designed or reduce the lagoon's minimum treatment volume to less than the volume
for which the lagoon was designed.
8. A copy of the Annual Sludge Survey Form for this facility is attached to this Certification. Yes ❑ No
9. Annual soils analysis were performed on each field receiving animal waste during the C (Yes ❑ No
past calendar year.
10. Soil pH was maintained as specified in the permit during the past calendar Year? NJ Yes ❑ No
11.All required monitoring and reporting was performed in accordance with the facility's Yes ❑ No
permit during the past calendar year.
12.All operations and maintenance requirements in the permit were complied with during FJ Yes ❑ No
the past calendar year or, in the case of a deviation,prior authorization was received
from the Division of Water Quality.
13. Crops as specified in the CAWMP were maintained during the past calendar year on all F4 Yes ❑ No
sites receiving animal waste and the crops grown were removed in accordance with
the facility's permit.
14.All buffer requirements as specified on the permit and the CAWMP for this facility were qYes ElNo
maintained during each application of animal waste during the past calendar year.
"I certify under penalty of law that this document and all attachments were 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."
"A r --�A\s -ytv, n M I 115
Permittee Name and Title(type or print)
D
Signature of fermittee Date
Signature of Operator in Charge bate RECEIVED
(if different from Permittee)
MAR 0 3 2023
NC DEQ/DWR
AFACF 3-14-03 2 Central Office

Appendix 1.Lagoon Sludge Survey Form Revised August 2008
A.Farm Permit or DWQ Identification Number —La t�7
B.Lagoon Identification
C.Person(s)Taking Measurements
D.Date of Measurements
E.Methods/Devices Used for Measurement of-
a.Distance from the lagoon liquid surface to the top of the sludge layer:
b.Distance from the lagoon liquid surface to the bottom(soil)of the lagoon:
i
c.Thickness of the sludge layer if making a direct measurement with"core sampler":
F.Lagoon Surface Area(using dimensions at inside top of bank): (acres)
(Draw a sketch of the lagoon on a separate sheet,list dimensions,and calculate surface area. The lagoon may
have been built different than designed,so measurements should be made.)
G. Estimate number of sampling points:`
a.Less than 1.33 acres:Use 8 points
b.If more than 1.33 acres,-�,/ W- acres x 6= / .';) ,with maximum of 24.
(Using sketch and dimensions,develop a uniform grid that has the same number of intersections as the
estimated number of sampling points needed Number the intersection points on the lagoon grid so that
data recorded at each can be easily matched)
H. Conduct sludge survey and record data on"Sludge Survey Data Sheet"(Appendix 2).Also,at the location of
the pump intake,take measurement of distance from liquid surface to top of sludge layer and record it
on the Data Sheet(last row);this must be at least 25 ft.when Irrigating.
I. At the time of the sludge survey,also measure the distance from the Maximum Liquid Level to the Present
Liquid Level(measure at the lagoon gauge pole):
J. Determine the distance from the top of bank to the Maximum Liquid Level _
(use lagoon management plan or other lagoon records)
K. Determine the distance from the Maximum Liquid Level to the Minimum Liquid Level
(use lagoon management plan or other lagoon records)
L. Calculate the distance from the present liquid surface level to the Minimum Liquid Level /
(Item K minus Item I,assuming the present liquid level is below the Maximum Liquid Level):
M. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level to the lagoon
bottom(average for all the measurement points): //• 2-
N. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level to the top of the
sludge layer(average for all the measurement poii ): ,K
O. Record from the Sludge Survey Data Sheet the average thickness of the sludge layer. r
P. Calculate the thickness of the existing Liquid Treatment Zone(Item N minus Item L): /,#,
Q. if Item O is greater than Item P,proceed to the Worksheet for Sludge Volume and Treatment Volume.
UItem O is e than
equal to or less an Item P,you drt have to determine vohimeess.
Completed by: IC la S Date: der
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