440064_Inspection_20231113

Division of Water Resources
Facility Number ` EVI tl O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit-. O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:—'-r'—r Arrival Time f, Departure Time: 1 County: 1 Region:
Farm Name: tA�-���CTC- ILOow i[7Na..� 4-f�i. lt+u+'-Owner Email:
Owner Name:
Mailing Address: I _
Physical Address: ^� , I�e.t� y/��1�yoy7s.I INN NL 316-71t(7
Facility Contact: (U��s Title: Phone:
Onsite Representative:
Integrator:
Certified Operator: W?j lah3s0 Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
I6D It �ae661
„ l.�G
Latitude: c"T3 33 Longitude: dam'
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 5LNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
C&No
❑ NA
❑ NE
❑ Yes
QeNo
❑ NA
❑ NE
Page 1 of 511212020 Continued

Facili Number: IDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
YYY❑���
❑ NA
❑ NE
a. If [e level into the structural freeboard?
❑Yes
No
❑ NA
❑ NE
eeI 2 Structure 3 Structure 4
V-SA
Structure 5
Structure 6
Identifier:tN
pStructure
--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15�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
❑ Yes
C No
''�
❑ NA
❑ NE
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?
❑ Yes
([� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
IQ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
i
9. Does any part of the waste management system other than the waste structures require
❑ Yes QN0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E�No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes S�No
❑ NA
❑ NE
❑ Excessive funding ❑ 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 ❑ E�vid�eencce of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): rt��iC.4_L2. jdI/`-ef/PtF-l�' �'i dl/C'r%L, /
/Gd72,A/
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [P�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Eg-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes [2�3Jo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
allo
❑ NA
❑. NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EjLNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
*.
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Z No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
$,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑Waste Analysis ❑Soil Analysis
❑Waste Transfers
❑Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'kNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�gNo
❑ NA
❑ NE
Page 2 of
511212020 Continued

]Facility Number: jDate of Ins ection: �.,(
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eb No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes liNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) and data of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
CNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑Yes
No
❑ NA
❑ NE
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?
❑ Yes
No
❑ NA
❑ NE
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
❑ Yes
EO_No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ENo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause noncompliance of the permit or CAWMP?
❑ Yes
159No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�_No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
kNo
❑ NA
❑ NE
Comments (referto question N): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better explain situations (use additional oases as necessarv).
at fX, &oft, p6'�), ?emuD, ?tsd P l((e-
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1. ��fJt �evtYti x :'e7Vve/ l��v� YL�SS�t�� aA D"t3_
av Lu a fad resau i� j l e ins 0 ..
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a?� �e,c�.C�•h�c �lv+,�,•� `(�2-ems �1
( ( Te-e i;M Onovancrists
tCri3(o t�iQ t r7e.
Reviewer/inspector Name: hone:
Reviewer/Inspector Signature: t Dale:
Page 3 of 3 51122020

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A SF .0201
Facility/Farm Name:
Permit #:
Operator In Charge (OIC)
Name:
Facility ID#: - County:
Last Jr, SY, arc.
Cerl Type / Number: Work Phone:
"I certify that I agree to my designation as the Operator in Charge for the facility noted. I understand and will abide by the roles and regulations
pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the Water
Pollution Control System Operators Centralism Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
Name:
Cert Type / Number: Work Phone:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the rules and
regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the
Water Pollution Control System Operm re Certification Commission."
Owner/Permittee Name:
Phone #:( ) Fax#:
Date.
(Owner or aallodzed agent)
Mail, fax or eaudl the
WPCSOCC 1618 Mail Service Center, Raleigh, NC 27699-1618
Fax: [phone]
original to:
Mail or fax a copy to the
Asheville
Fayetteville
Mooresville
Raleigh
appropriate Regional Office:
2090 US Hwy 70
225 Green St
610 E Center Ave
3800 Barrett Dr
Swannanoa 28778
Suite 714
Suite 301
Raleigh 27609
Fax: [phone]
Fayetteville 29301-5043
Mooresville28115
Fax: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone].
Phonc:919.791.4200
Phoem 910.433.3300
Phone: [phone]
Washington
Wilmington
Winston-Salem
943 Washington Sq Mall
127 Cardinal Dr
450 W. Hanes Malt Rd
Washington 27889
Wilmington 29405-2845
Winston-Salem27105
Fax: [phone]
Fax: [phone]
Fax: [phone]
Phone: [phone]
Phone: [phone]
Phone: [phone]
(Retain a copy ofthis form for your records)
Revised oS-2015