090211_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual
II

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`.N We I, i �� ili, / I" ", li Q� Divlsian of Soll'and .Water Ganservation . '
tt13. i 4 IrE,� aj l' I r
'��i I L
D� Other.'Age11Cy�
Type of visit: EMompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: EY11fo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: —J— Arrival Time: p'p Departure Time: County: o11- Region:
Farm Name: �� /`%%rt,ro y--�it,^� f,� I Owner Email:
Owner Name: i Phone:
Mailing Address:
Physical Address:
Facility Contact: ^ff lip•-v jn,1��,. Title: e)LU Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
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II I�}ilr(r
Iris k��Fyy �ppilI
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irR
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I�,� ;.. � IDesni
�,r: ' i � I I
Swine
F: ,, ,; �� l --t ,,,.,,. •.!tu �:� k; -t ul ni za �i,
1lislj�j� 1j11f1f II:i.l Ca aclt br1YPo
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La er
Non-LI
k l l;
ril p �� �� I i ' 4r 11 rl
11i',
�' „,:,�:_���f��D MN
�` r' La ers
Non-LI
;,.. Pullets
Wean to Finish
I`I
Wean to Feeder
(
Feeder to FinishII's1,'f�'Ljj^°
Farrow to Wean
Farrow to Feeder
i
���,
Farrow to Finish
Gilts
�ilY�
Boars
Other
Other
Latitude:
Integrator: 4�jyyi ,iz%�
Certification Number:
Certification Number:
Longitude:
Desigp Current, I'' ;I `I E i Design Current
altry' Ki ;Capacity, I Pops { ', Cattle l Cap.aeityr Pap
is
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? ([fyes, 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
—Dry
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes D No ❑ NA f,NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
RLNE
❑ Yes
❑ No
❑ NA
1,21NE
Page I of 3 21412015 Continued

1
Facility Number: - Date of Ims ection:
S-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo
❑ NA
J21-NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
[Z 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
[] No
❑ NA
S 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? 1
❑ Yes
❑ No
❑ NA
Z[ NE
(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
❑ Yes
❑ No
❑ NA
[0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
❑ No
❑ NA
ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[aNE
❑ 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?
[] Yes
❑ No
[] NA
§& NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
U1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
21 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ELNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ELNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
® NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ 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
❑ No
❑ NA
® NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ONE
Page 2 of 3
21412015 Continued

4
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes ❑ No
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
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 provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No
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
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 ❑ No
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 ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes S No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? 0 Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No
❑ NA [&NE
❑ NA ® NE
❑ NA E@ NE
❑ NA ZI NE
❑ NA L NE
❑ NA 5'NE
❑ NA aNE
❑ NA ® NE
❑ NA
1 E
[] NA
❑ NE
❑NA
❑NE
Coirim'e'tits rc`fc"r to, uii do"u`0 Ex lain an=YES-answers'and/ar.an`aildidonaFrecommcndations'or:an other comments
„vlilii i 's9811!?SitN'Fs(liii t S.I.s, _, �.[![( .): ! �. r, ic`=31"4$t.t= r° y,l!.115: 3 P! yt!.i i. !, ! I,
UsedrawinksioFfacility!Eto;better e�ePlain;situations':!(use, addit>Ivnal pales As•necessary) ,-.'- . ,
Reviewer/Inspector Name:
Reviewer/Inspector Signatue
Page 3 of 3
Phone: 2lp
Date: �5 I
21412015

S - 9-S
ivision of Water Resources
Facility Number [� `� - OLI 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: cr —�`--� =•� Arrival Time: 10,00 Departure Time:=J County: Region:
Farm Name: '7'j 1749Pr rD-r- Owner Email:
Owner Name: _t" 1. V-_ M p r, /b Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone: I
Onsite Representative: _ 5Integrator: 7ld'
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dry Poultry CanaeitV Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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? (Ifyes, 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA JRNE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑Yes [:]No
DNA ❑NE
DNA ❑NE
❑NA ❑NE
❑ NA aNE
❑ NA R[NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
[!I NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
[KNE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
' Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
M 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
❑ No
❑ NA
[5,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
Z NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
[&NE
(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
❑ Yes
❑ No
❑ NA
CNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
[XNE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
D5,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?
❑ Yes
❑ No
❑ NA
CE�NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
�,NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
KNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
&NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
❑ No
❑ NA
[R NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA [ZNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes
❑ No
❑ NA 21 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 qNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:1 Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
E] Yes
[] No
❑.NA [R NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No ❑ NA [&NE
Page 2 of 3 21412015 Continued

e
Facill Number: - Ail Date of Inspection; 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E] No ❑ NA EZNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA LEI -NE
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 provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss 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
❑ No
❑ NA
2�NE
❑ Yes
[]No
❑ NA
rNE
❑ Yes
❑ No
❑ NA
CNE
[]Yes []No ❑ NA [&NE
❑ Yes
[]No
❑ NA
ONE
[]Yes
[]No
❑ NA
RNE
[:]Yes [:]No
❑ Yes [&No
❑ Yes E�No
❑ NA �NE
❑ NA ❑ NE
❑ NA ❑ NE
Comnieri AU 'refer tof uestlom# ,Fx [ainlan 'YESaanswers`and,/ r-- an additicina_I recommendations or any`.other comments.
► ��,` ta��i�.3 �� �i� �.kp 3 6� ��b� cn ..Ra .,, i ��Y s; a � i
Us'e drawings,ofifacilltv�tblbetteiMei6lainisituations:{us_e, ddltion'al vaEestas necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: `1%p_r_�P 3`/
Date: r- —Q'�, / -]
21412015

it
(Type of Visit: (EMompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — f Arrivai Time: Departure Time: / . Q!7 County: Region:
Farm Name:
;� .-� �J�%prL 1*0 r
�ut rJ+'t f
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: .Wp,,1j-0r Title: aWnef-
Integrator:
Certification Number:
Onsite Representative: S`zAA.1f -
Certified Operator: S ��
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
j 7[)—
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oultr. Ca aei P.o
Lavers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkc s
Turkey Poults
Other
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
❑ Yes ❑ No
�] Yes ❑ No
[:]Yes ❑ No
[]Yes [:]No
[:]Yes [:]No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA NNE
❑ NA 02 NE
Page 1 of 3 - 21412014 Continued

Facilit Number: el - J Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
R71 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ 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
❑ 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
PNE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
❑ No
❑ NA
NE
(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
❑ Yes
❑ No
❑ NA
NE
maintenance or improvement?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
51NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ No
❑ NA
MNE
❑ 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?
❑ Yes
❑ No
[3 NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
® NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
©NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
NA ® NE
❑ Weather Code
❑ Sludge Survey
❑ NA ERNE
❑ NA [0 NE
Page 2 of 3
21412014 Continued

Facility Number: -Ll Date of Ins ection:
t.y 24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes [:]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
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? ❑ Yes [] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No
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?
❑ NA [Z NE
❑ NA E.NE
❑ NA YMw � NE
❑ NA R NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA ®, NE
❑ Yes ❑ No ❑ NA 4Z NE
❑ Yes ❑ No ❑ NA ELNE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ NA
R,NE
❑NA
❑NE
❑ NA
❑ 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 gas. necessary).
��;r✓rrc �'�3 /W � �'� oar.- .� u i�f"'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/O'33 33ya
Date:
21412014

.1
W Division of Water quality
Facility Number u -'� O Division of Soil and Water Conservation
Q Other Agency
Type of Visit; Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: &froutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: — / Arrival Time: Departure Time: County:
Form Name: rf "ort 6f l Owner Email:
Owner Name: AV rO -•— 100-e %' j7, ,, " -e Phone:
Mailing Address:
Physical Address:
Facility Contact: ei/-Dz Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: ��� Certification Number:
Back-up Operator:
Location of Farm:
Swine
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Wean to Finish
Wean to Feeder
Feeder to Finish
—
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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 DWQ)
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 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 the waters
of the State other than from a discharge?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA M NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
®.NE
❑ Yes
❑ No
❑ NA
[0 NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection: 3— /-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA 2S-NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ❑ No ❑ NA [3 NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
I NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
RNE
(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 ❑ Yes ❑ No
❑ NA
[3 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
® NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes []No
❑ 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?
❑ Yes
❑ No
❑ NA
(2 NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[R NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
UNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[gNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
;gNo
❑ NA
OgTE7
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 14 No ❑ NA RTE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? []Yes ❑ No ❑ NA rZNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA aNE
Page 2 of 3 21412011 Continued

' Facility Number; Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ® NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ® NE
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? ❑ Yes ❑ No ❑ NA ® NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA CKNE
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 [] No ❑ NA Q NE
❑ Yes ❑ No ❑ NA NINE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA [g NE
❑ Yes ❑ No
❑ Yes [] No
❑ Yes ❑ No
❑ NA NE
❑ NA ® NE
❑ NA NE
Comments (refer to question ft 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /Z�"y.33t--S 3Df-
Date:
21412011

/ / vision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation�� r 13
0 Other Agency
Type of Visit: (D,C-ompliance Inspection 0 Operation Review 0 Structure Evaluation ( Technical Assistance
Reason for Visit: 011routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: / ; DD County: Region: 11RO
Farm Name: /nj.4nq e �txr/!? / Owner Email:
Owner Name: ; LfipY._ Phone:
Mailing Address:
Physical Address:
Facility Contact: _�ilr•— A%D.-tAbx-_ Title: Phone:
Onsite Representative: �ai+.�_ Integrator: '
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I =�L
ayer I I F�
Discharaes and Stream Impacts
Non-L
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
I . Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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 DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
[R NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
Z[NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

- Facili Number: - /El jDate of Inspection:
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
Lam, NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]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
❑ No
NA
[g 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 DWQ
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
❑ No
❑ NA
® NE
(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
❑ Yes
❑ No
❑ NA
® NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[]No
❑ NA
NE
[� Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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?
[] Yes
[:]No
❑ NA
® NE
15. Does the receiving crop and/or land application site need improvement?
C] Yes
❑ No
❑ NA
® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
® NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
® NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
CRNE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA [U NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA CRNE
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 Z NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking [] Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA ® NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [:]No ❑ NA NNE
Page 2 of 3 21412011 Continued

Faciiit Number: / Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 18 NA [3NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
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 phosphorus loss 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?
❑ Yes
❑ No
❑ NA
JX NE
❑ Yes
❑ No
❑ NA
faNE
❑ Yes
❑ No
❑ NA
gNE
❑ Yes ❑ No ❑ NA R NE
[:)Yes ❑ No ❑ NA [21,NE
❑ Yes ❑ No ❑ NA ,® NE
❑ Yes
❑ No
❑ NA
®, NE
[:]Yes
® No
❑ NA
WE
Reviewer/Inspector Name: Phone: 9, %D 33Z D
Reviewer/Inspector Signature:
Page 3 of 3
Date:
214,0011

ivision of Wafter Quality
Facility Nttmer ®- /j O Division of Soil and Water Conservation
DQ Other Agency
Type of Visit: Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Ergoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: d
Departure Time: t) County:
Farm Name:
�� 1 �oz--
%%fpn/-per �Ltl_
% Owner Email:
Owner Name: 4,7 4:n p Phone:
Mailing Address:
Physical Address:
Facility Contact: #TJ— ,,7 � 1 p3. Title: '� �J/pr-/� Phone:
Region:
Onsite Representative: Integrator:'i9�/r�/%y
Certified Operator: sue_ Certification Number: 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop,
DairyCow
DairyCalf
ceder to Finish
f 6Q
�
DairyHeifer
Farrow to Wean
Farrow to Feeder
Dr, P,�uItr�
Design
C_a aci
Current
POP.
D Cow
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
Turkey Poults
1 10ther
Beef Brood Cow
i
i �M_
I
Discharees 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 DWQ)
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 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 the waters
of the State other than from a discharge?
❑ Yes [3 No ❑ NA � NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
X NE
❑ Yes
❑ No
❑ NA
J.NE
Page 1 of 3 21412011 Continued

Facility Number: / Date of inspection: I —b /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA MNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identificr:
Spillway?:
49A—
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []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 ❑ No
❑ NA
JK 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
PS NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [] No
❑ NA
�! NE
(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 ❑ Yes ❑ No
❑ NA
[KNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
E
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
;4_NE
❑ Excessive Ponding ❑ Hydraulic Overload E] 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? ❑ Yes ❑ No ❑ NA NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ® NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA M NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA ® NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP, readily available? If yes, check
❑ Yes
❑ No
❑ NA E 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 [P NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:]No
❑ NA ® NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ® NE
Page 2 of 3 21412011 Continued

lFacilt Number: jDate of Ins ection: " /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA E� NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No [DNA NE
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 provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA r NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA [ANE
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
5� NE
f 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
❑ 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
❑ No
❑ NA
[K NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No [] NA NE
33. Did the Reviewer/[nspector 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 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES nnswers and/or any additional recommendations or;any ot.hervomments;'
-.
Use drawings of facility to better explain situations (use additional pages as necessary): ,.
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Phone: 9110-'�� - V 0
Date: _6 f ` /�-
2/4/2011
Page 3 of 3

(vision of Water Quality
Facility Number Q.Division of Soil and Water Conservation f�
0 Other Agency
Type of Visit CoCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q46utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: Departure Time: County: {— Region: I / z o
Farm Name: ,/ fL 'i 31— /Yld`i 1-6 Iff 1 9ean ___ f __ _- Owner Email:
Owner Name: ff ��'j "� L�-�-e_ z2lp �-�_t~ Phone:
Mailing Address:
Physical Address:
Facility Contact: % ' __h,�^�.Yr Title: Phone No:
Onsite Representative: ��1�-�-�-- Integrator:
Certified Operator: Operator Certification Number:
Sack -up Operator:
Location of Farm:
Swine
Back-up Certification Number:
�o
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
weeder to Finish
4-0
—a —
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Longitude: ❑ o a ` 0
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: DJ
b. Did the 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 adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA [0 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
q NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
KNE
❑ Yes
❑ No
❑ NA
ZLNE
Page 1 of 3 12128104 Continued

` Facility Number: — J Date of Inspection
Waste Collection & Treatment
` 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA BNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA ®,NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA 2 NE
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA NE
(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 ❑ Yes
❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA kNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA kNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) R e, d`tU2
A,o1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
®,NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
RNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
g NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
R NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
5Z-NE
.I&-/- �eeti 6x, If
Reviewer/Inspector Name -- , - - I Phone:
Reviewer/Inspector Signature: Date: 4;t/
Page 2 of 3 12128104 Continued

Facility Number: — pate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA KNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ® NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [INE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA &NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[KNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
'jj& NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
[:]Yes
[:]No
❑ NA
,X NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
;O NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
®.NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
® NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
® NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
❑ No
❑ NA
aNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
E-NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
[Z NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
[SNE
Additional_Comrrienfsoand/or Drawings:
Page 3 of 3 12128104

Type of Visit DTompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (TKoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: �d eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: 14 , I 1 D o"*�-,a� He M 4o1 v" d's Phone:
Mailing Address:
Physical Address:
Facility Contact: IF, L-ro r-Z?—%A M-r— Title: 4QC"Xv ,- i' Phone No:
Onsite Representative: Integrator: mz"9h0 _
Certified Operator:Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
n°
Back-up Certification Number:
❑" Longitude: ❑ ° = ' = ,
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cettic Capacity Popu[atnt
❑ Wean to Finish
JCI Layer
I
I ❑ Dairy Cow
❑ Wean to Feeder
I JE1 Non -Layer I 1 ❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry ❑ kryCow
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non-DaiEy
❑ ers El Beef Stocker
El Farrow to Finish
❑ Gilts
N
❑on -La on -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Pou Its!
❑ Other Number o 5tructures:
Discharges & 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 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 adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [:]No ❑ NA �3 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
n-I
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
�SNE
❑ Yes
❑ No
❑ NA
jg�NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
Q,NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
[9NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
[RNE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
®,NE
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA MNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA R1NE
(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 ❑ Yes ❑ No ❑ NA WNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ®.NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [,ENE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
® NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
®NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
0 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[S�NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
51.NE
r
pz,- , hay
Reviewer/inspector Name r s .y' ' z ws <» s 'ag 7a.#.. Phone: 53 33VO
Reviewer/inspector Signature Date:
11)1110An11

Facility Number: Date of Inspection r� a
Required Records & Documents
k 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t"No ❑ NA 6tNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA E,NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ENE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
®.NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Z,NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
CRNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
®.NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
59,NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
CR'NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
® NE
and report the mortality rates that were higher than normal?
30.
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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
2 NE
General Permit? (ic/ discharge, fecboard problems, over application)
L-
32.
33.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
eE
❑ Yes
[0 No
❑ NA
EKE
12128104

I
Division of Water Quail ty S'{�s,
Facility Number _� �1__ Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �/� Arrival Time: r' Departure Time: : goCounty:
Farm Name: #)1+10' art 1" 171!�_ ")'� Owner Email:
Owner Name: At-; L TEr— Phone:
Mailing Address:
Physical Address:
Facility Contact: _1!' ,ojh2n Ldi— Title:
Onsite Representative: d,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o= I Longitude: = 6= i 0
it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
kk ❑ Layer ❑Non -Layer T
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
I . 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 DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy -Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: TO
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 adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ®,NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA ❑ NE
❑ NA [q�'NE
❑ Yes
❑ No
❑ Yes
[]No
❑ NA ;4 NE
❑ Yes
❑ No
❑ NA ❑`NE
12128104 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA MIKE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ®.NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E.NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
MNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
aNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
0 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
9NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
RLNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
KNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
XNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
®-NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
51NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
fL NE
12128104

y Facility Number: C� — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No ❑ NA
iA NE
a. If yes, is waste_ level into the structural freeboard?
❑ Yes
❑ No ❑ NA
E.NE
Structured Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No ❑ NA
XNE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA
9NE
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
DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ No ❑ NA
RNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA
RNE
(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
❑ Yes
❑ No ❑ NA
.KNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA
XNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
.14 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
9NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
KNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
MNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
5� NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
WE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�ar,r- n 0103 Af
L
er/inspector Name �+^� Phone:er/Inspector Signature: Date:
If IW VY l.V►11J/iHGIf

Type of Visit QfCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q1 outine O Complaint 0 Fallow up O Referral O Emergency Q Other ❑ Denied Access
22 Date of Visit; lf_h�ne Arrival Time. 1130 1 Departure Time: �a.�3Q County; Region:
Farm Name: _61 L 9''_= e2&C-12-C _ EiLt '` _ Owner Email:
Owner Name: &; Lro P%- / on-f,y a Phone:
Mailing Address:
Physical Address:
Facility Contact: /J�i ��D �'L. PU d CD le Title:
Onsite Representative: 4��L
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= n = i = Longitude: ❑ o ❑ 1 = "
Design Current Design
Swine Capacity Population Wet Poultry Capacity
Current Desim N 0gn Current
Population Cattle Capacity Population
❑Dairy Cow
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -La er
ai!j Calf
❑ Feeder to Finish
117&0
1
pry Poultry
❑ Layers
❑ Non -Layers
❑Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Cow
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Pullets
❑ Turkeys
El Turkey Poulis
El Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
E,NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (I f yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is (here evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
JkNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
2 NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Dumber: — Date of Inspection U
Waste Collection & Treatment ;
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ELNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA KNE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No
❑ NA 5Q NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No
❑ NA Z] NE
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No
❑ NA q NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes
❑ No
❑ NA NNE
(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 ❑ Yes
❑ No
❑ NA RNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA q NE
maintenance/improvement?
It. Is there evidence of incorrect application? 1f yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA UqNE
❑ 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
� NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA 0 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
(KNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
,INE
Comments (refer to question #): Explain'dny YES�answers andh r anyoreco'mmendations or a'ny`other comments
Use drawings of faci[ity to:better explain situations. (use a`ddititMal pales as necessary):
rm xa.3 rrn 1k, L)�
Reviewer/inspector Namse
el Phone:
Reviewer/inspector Signature:
rage t aj 1 12128104 Continnea

Facility Number: — Date of Inspection
Required Recnrds & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C-No ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA I$�NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA GkNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
4NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an activeiy certified operator in charge?
❑ Yes
❑ No
❑ NA
NE
27.
Did the facility,fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
ENE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
2�NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
PqNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
Additional Comments and/or Drawings..,�.�„ .� ;... x.
Page 3 of 3 12128104

A�a
NCDENR
FAX TRANSMISSION
DENR
FAYETTEVILLE REGIONAL OFFICE
FAYETTEVILLE, NORTH CAROLINA 28301-5043
VOICE: 910-433.3300
Fax: [phone]
To: roo AivW7
Fax #: g1 °1 '7/5 0'5 *6
From: '��r 4%ftAJAa-
Subject:
rX00
%[Y
COMMENTS:
Date: 'Ir" - Z ( , 0 9
Pages (including cover):

k.
Type of Visit ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time: ©V Departure Time: 3� County: /L Region:
Farm Name: d% to'n 'Olpu2e z Arm- Owner Email:
Owner Name: /�:L"�'p"�'�%J� 1V r Phone:
Mailing Address:
Physical Address: Facility Contact: _1�►1PO" A9n-tor_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o =' ❑ Longitude: = o ❑ ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i
❑ La er
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
(P
" 0-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: Q I
b. Did the 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? i
3. Were there any adverse impacts or potential,adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA CB -NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
5 1NE
❑ Yes
❑ No
❑ NA
S-NE
12128104 Continued

Facility Number: — Date of Inspection 7
Waste Collection & Treatment
v ❑ No El NA ® NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA M NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA f2j"NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ONE
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA MNE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes ❑ No ❑ NA RNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA RNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA SNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA RNE
❑ 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[9NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
9NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
Q NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
RNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
;�NE
Comments (refer to question ft Explain any YES answers. and/or any recommendations or any other=comments , r
Use drawings of facility to better: explain situations :(use, additional pages: as necessary): u
;
A
G' Q G 6,,-�t�� J�1 a-,Zf--,L Fes,-.
Reviewer/Inspector Name S Phone: DO a
Reviewer/InspectorSignature: Date:
Page 2 of-3 IZ/28/04 Continued
19

r
Facility Number: Ct— Date of Inspection
'• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA �5NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA T[NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA EINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA PINE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
5�NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
W NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
&I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
RLNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
R NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
53'NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
$2 NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
f@ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
C4 NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
51NE
Additional Comments and/or Drawings::
Page 3 of 3 12128104

Type of Visit O'Com liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other El Denied Access
�IJ
Date of Visit: .p Arrival Time: Departure Time: County: Region:
Farm Name: & L IV wL /yIDr, r t2f dt✓v'k-- Owner Email:
Owner Name: ; le n D h r-D `C Phone: �1
Mailing Address: v ^ r, � e ` Clglkto —
Physical Address:
Facility Contact: f-�rL�'a~' N1 D rlVgitle:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] o ='
= „ Longitude: ❑ ° ❑ ' =
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Population
Cattle
Design Current
Capacity P opulation
❑ Wean to Finish
Layer
FEI Non -Layer
El Cow
❑Wean to Feeder
El Dairy Calf
Feeder to Finish
r0 "'
ischarges &Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
❑ No
❑ NA
ANE
Discharge originated at: El Structure El Application Field [I Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
ONE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑Yes
❑ No
❑ NA
JR NE
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)
❑Yes
❑ No
❑ NA
JKNE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ No
❑ NA
RNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
❑ No
❑ NA
other than from a discharge?
JaNE
Page I of 3
12/28/04
Continued

y
Facility Number: Date of Inspection
t
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 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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?
❑ Yes ❑ No ❑ NA ®.NE
❑ Yes ❑ No ❑ NA KNE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA 9NE
❑ Yes ❑ No ❑ NA ®.NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA RZNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA RNE
(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 ❑ yes ❑ No ❑ NA J NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA KNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA kNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[8 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
[Z NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
® NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
QNE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other".comments. p
Use drawings of facility to better explain situations. (use additional pagd as gecessary):
Nei Inowl e- &;P47 Xa-f
A4.-e E7r4�rL
Reviewer/Inspector Name ;� g-sti-
I Phone:
Reviewer/Inspector Signature:
Date: jp--,g-
Page 2 oj'3 12128104 Continued

Facility Number: — Date of Inspection
:j
Required Records & Documents
19. Did the facility fail to have 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 ❑ Other
[]Yes tgNo ❑ NA MNEde
[]Yes [:]No ❑ NA S N E
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 19 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
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?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. 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
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes ❑ No ❑ NA ONE
❑ Yes
❑ No
❑ NA
% ;NE
❑ Yes
❑ No
❑ NA
KNE
❑ Yes
❑ No
❑ NA
®.NE
❑ Yes
❑ No
❑ NA
9 NE
[I Yes
❑No
El NA
ONE
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA NE
[I Yes ❑No El NA ®NE
❑ Yes ❑ No ❑ NA R' NE
❑ Yes
❑ No
❑ NA
9 NE
❑ Yes
❑ No
❑ NA
�&NE
Page 3 of 3 12128104

{ Division of Soil ar�d Water`Conse`rvatlon - Operation Review F f
_ ,s. rv«. ,, i _ 1� T . kr
Division of Soiland Wster'Conservahon Comj�liance inspection 1 t u
"`V �° _ ih Division of Water Quality -,Compliance Inspection 4 F t� �'4 •L. {�. �x i ' `R 1 'p. kx ' as r . ` ',�n
13Other Agency = Operation Review_'.., `, �, �•i i?. '€fir + , +w r r " �+
Imoutine O Complaint Q Follo%v-ue of Dinspection Q Follow-np of DSWC review O Other
Facility Number Date of Inspection
--- — Time of Inspection 24 hr. (hh:mm)
13 Permitted © Cer((•lllied [3 Conditionally Certified 0 Registered KNot O cration d D to Last Operated:
Farm Name: .........11...../....:. �...!— :...................... County:.... rlf..tr��.......................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
Facility ....................................... Contact: ....................................... Title:................................................................ Phone No:..................................
.
MailingAddress: .......................................................................................................................................................................................................... ..................I.....„
OnsiteRepresentative:...............................:........................................................................... Integrator:......................................................................................
Certified Operator:,,,,,,,
Location of Farm:
............. Operator Certification Number:..........................................
.. ................................................... ..... .. .. ..... ...
Latitude ' ' i4 Longitude • =_ =41 -
Design Current Design. Current, Design Current
Swine • Capacity Po elation Poultry Ca acit Po elation Cattle Capacity Population -.
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer I❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
,r.. Total Design Cap acitY
Total SSLW
(Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldingPonds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im_ pacts
1. Is any discharge observed from any part of the operation?
Discharge originated ,w ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, I5 storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ❑ No '---
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ................................... ............. ................................................................................................................................ .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

R
Facility Number: — Date of Inspection
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 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the'structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do'any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not iri compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the -Certified AWMP?�= �—_"'--"­ "
*'04`�it?, dtrf c�e>;cies ....... p .. iita......... .. wiil.tee�iyo Oo; fufthoe ,
.. corres�6r deuce. about. this visit:
Comments (refer to question ##): ' Explain any YES answers and/or any recommendations or any' other comment:
Use drawings of facility to h'etter.explain situations. (use additional pages as necessary)
0
Reviewer/Inspector Name
a
Reviewer/Inspector Signature.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
�- Date: _ZD —
3/23/99

ANIMAL WASTE UTILIZATION PLAN
Producer: HILgTON MONROE
rco--FAYEi1E LLERE&110ALONE
i
Location: 919,CHARLIE MONROE RD.
CLARRTON NC 28433
Telephone:
'Type Operation:
1omber of Animals:
,.,.(Design Capacity)
STORAGE STRUCTURE:
APPLICATION METHOD:
910-645--4281
Existing Feeder to Finish swine
1760.00 hogs
Anaerobic waste Treatment Lagoon
irrigation
The waste from your animal facility must be land applied at a
specified rate to prevent pollution of surface water and/or w
groundwater. The plant nutrients in the animal waste should be used
to reduce the amount of commercial fertilizer required for the props
in the fields where the waste is to be applied.
This waste utilization plan uses nitrogen as the limiting nutrient.
Waste should be analyzed before each application cycle. Annual soil
tests are strongly encouraged so that all plant nutrients can be
balanced for realistic yields of the crop to be grown.
Several factors are important in implementing your waste utilization
plan in order to maximize the fertilizer value of the waste and t
ensure that it is applied in an environmentally safe manner:
1. Always apply waste based on -the needs of the crop to be grown
and the nutrient content of the waste. Do not apply more
nitrogen than the crop can utilize.
2. Soil types are important as they have different infiltration
rates, leaching potentials, cation exchange capacities, and
available water holding capacities.
3. Normally waste shall be applied to land eroding at less than
5 tons per acre per year. Waste may be applied to land
eroding at 5 or more tons per acre annually, but less than
10 tons per acre per year providing that adequate filter
strips are established.
4. Do not apply waste on saturated soils,- when it is raining, or
when the surface is frozen. Either of these conditions may
result in runoff to surface waters which is not allowed
under DWQ regulations. RECEIVED IDENRIDWQ
Aquifer protection Section
MAR 13 2909
r
Page: 1

L '
ANIMAL WASTE: -,.UTILIZATION PLAN
S. Wind conditions should also be considered to avoid drift and
downwind odor problems.
6. To maximize the value of the nutrients for crop production
and to reduce the potential for pollution, the waste should
be applied to a growing crop or applied not more than 30
days prior to planting a crop or forages breaking dormancy.
Injecting the waste or disking will conserve nutrients and
reduce odor problems.
This plan is based on the waste application method shown above. If
you choose to change methods in the future, you need to revise -this
plan. Nutrient levels for different application methods are not the
same.
The estimated acres needed to apply the animal waste is based on
typical nutrient content for this type of facility. Acreage
requirements should be based on the waste analysis report from your
waste management facility. In some cases you may want to have plant
analysis made, which could allow additional waste to be applied.
Provisions shall be made for the area receiving waste to be flexible
so as to accommodate changing waste analysis content and crop type.
Lime must be applied to maintain pH in the optimum range for specific
crop production.
This waste utilization plan, if carried out, meets the requirements
for -compliance with 15A NCAC 2H .0217 adopted by the Environmental
Management Commission.
AMOUNT OF WASTE PRODUCED PER YEAR (gallons, ft3, tons,- etc.)
1760 hogs x 1.9 tons waste/hogs/year = 3344 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
1760 hogs x 2.3 lbs PAN/hogs/year = 4048 lbs. PAN/year
Applying the above amount of waste is a big job. You should plan
time and have appropriate equipment to apply the waste in a timely
manner.
The following acreage will be needed for waste application based on
the crop to be grown, soil type and surface application..
Page: 2

ti l�. ..
ANIMAL` WASTtUTILIZATION PLAN
I
TABLE 1: ACRES O'WgED BY PRODUCER
TRACT
FIELD
SOIL TYPE & CLASS-
CROP
YIELD
LBS
COMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N
PER AC
AC
USED
----
or
----- - --
APPLY
RESID.
APPLIC
-1 ----
METH
N
TIME
462� 8
IA,C
GBA
BH
7
I
350
0
4.3
1505
T
MAR-OCT
4628
SG
1
MAC
JALL
II
I
150
10
14.3
1215
MAR
4628
1B
LN
BC
6
0
-
I
1300
[3.2
1960
MAR-OCT
4628
�1B
SG
1
0
JALL
I
150
13.2
1160
OCT-MAR
4628
2
BC
6
0
IL11
II
1300
11.7
1510
MAR-OCT
4628
SG
1
0
1-2
JALL
T
150
11.7
185
OCT-MAR
4628
3
ILN
BC
6
300
0
*
Z" 2aIf
I
0.7
MAR-OCT
4628
--3
ALL
SG
1
0
45 3 7.•S
I
1.90
OCT-MAR
dye
It
494r J-401kkk1r A A1041M. s•fp,.:Mkwi x C.- 040041.
TOTAL I
3697.5
- - Indicates that this field is being overseeded (i.e.
interplanted) or winter annuals follow summer annuals.
NOTE: The applicator is cautioned that P and K may be over applied while
meeting the N requirements::. In the future, regulations may
require farmers in some parts of North Carolina to have a
nutrient management plan that addresses all -nutrients. This
plan'only addresses nitrogen-
Page:3 ` )

ANIMAL WASTB,UTILIBATION PLAN
TABLE.2: ACRES WITH NOTARIZED ILGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowners must be attached.)
(Required only if operator does not own adequate land.
See required specification 2.)
TRACT
FIELD
SOIL TYPE & CLASS-
CROP
YIELD
LBS
COMM N
**
* LBS
DETERMINING PHASE
CODE
AW N
PER
ACRES
AW N''
PER AC
AC
USED
----
or,
-------
APPLY
RESID.
APPLIC
METH
N
TIME
6
3 q•
4591
1
GBA
BC
300
0
,.3
%A
MAR-OCT
4591 1 --1 1 ALL SG 1 1 150 0
OCT-MAR
END
+r �i le,y Sc�'. TOTAL
Indicates that this field is being overseeded (i.e. interplanted) or
winter annuals follow summer annuals.
In interplanted fields (i.e., small grain, etc, interseeded
in bermudagrass), forage must be removed- through grazing,
hay and/or silage. Where grazing, plants should be grazed
when they reach a' height of six to nine inches. Cattle
should be removed when.plants are grazed to a height of four
inches. In fields where small grain, etc, is to be removed
for hay or silage, care should be exercised not to let small
grain to reach maturity, especially 1-ate in the season (i.e.
April or May). Shading may result if small grain gets too
high and this will definitely interfere with stand of
bermudagrass. This loss of stand will result in reduced
yields and less nitrogen being utilized. Rather than
cutting small grain for hay or silage just before heading as
is the normal situation, you are encouraged to -cut the small
grain earlier. You may want to consider harvesting hay or
silage two to three times during the season, depending on
time small grain is planted in the fall.
The ideal time to interplant small grain, etc, is late
September or early October. Drilling is recommended over
broadcasting. Bermudagrass should be grazed or mowed to a
height of about two inches before drilling for best results.
Page: 4

ANIMAL WASTE UTILIZATION PLAN
e
** Acreage figures may exceed total acreage in fields due to
overseeding.
* lbs AW N (animal waste nitrogen) equals total required nitrogen
less any commercial nitrogen (COMM N) supplied.
The following legend explains the crop codes used in tables 1 and 2 above: `
CROP CODE
CROP
UNITS
PER UNIT
BC
HYBRID BERMUDAGRASS-CONTROLLED GRAZED
TONS
50
BH
HYBRID BERMUDAGRASS-HAY
TONS
50
SG
SMALL GRAIN OVERSEEDED
AC'
50
TABLE 1
TABLE 2
TOTAL
**
TOTALS FROM TABLES 1 AND 2
ACRES
1 995
.
LBS AW N USED
9697.s
l
4100
* BALANCE
- ley. 5' -
yO'ie r0rad,4r4
> qls-a-5-
C V4
*** This number must be less than or equal to 0 in order to
fully utilize the animal waste N produced.
Page: 5

ANIMAL WASTE.UTILIZATION PLAN
1,
L
*** This number must be less than or.equal to 0 in order to fully
utilize the animal waste N produced.
Acres shown in each of the preceding tables are considered to be the
usable acres excluding required buffers, filter strips along ditches,
odd areas unable to be irrigated, and perimeter areas not receiving
full application rates due to equipment limitations. Actual total
acres in the fields listed may, and most likely will be, more than
the acres shown in the tables.
see attached map showing the fields to be used for the utilization of
animal waste.
SLUDGE APPLICATION:
The waste utilization plan must contain provisions for periodic land
application of sludge at agronomic rates. The sludge will be -nutrient
rich and will require precautionary measures to prevent over application
of nutrients or other elements. Your production facility will produce
approximately 651.2 pounds of plant available nitrogen per year in the
sludge.
If you remove the sludge every 5 years, you will have approximately 3256
pounds of PAN to utilize. Assuming you apply this PAN to hybrid
bermudagrass hayland at the rate of 300,pounds of nitrogen per acre, you
will need 10.8533333333 acres of land. If you apply the sludge to corn at
the rate of 125 pounds of nitrogen per acre, you will need 26.048 acres
of land. Please be aware that these are only estimates of the PAN and
land needed. Actual requirements could vary by 25% depending on your
sludge waste analysis, soil types, realistic yields, and application
methods.
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of the
soil at the time of irrigation such that runoff or ponding occurs. This
rate is limited by initial soil moisture content, soil, structure, soil
texture, water droplet size, and organic solids. The application amount
should not exceed the available water holding capacity of the soil at the
time of irrigation nor should the plant available nitrogen applied exceed
the nitrogen needs of the crop.
If surface irrigation is the method of land application for this plan,
it is the responsibility of the producer and irrigation designer to ensure
that an irrigation system is installed to properly irrigate the acres
shown in Tables 1 and 2. Failure to apply the recommended rates and
Page: 6

ANIMAL WASTB UTILiBATION PLAN
.amounts of nitrogen shown in the tablgs may make this plan invalid.
The following table is provided as a guide for establishing application
rates and amounts.
I
I
I
(Application
RatelApplic. Amount
Tract
j Field l
Soil Type
i Crop
(in/hr)
l (.inches)
4591
l 1 l
GBA
l BC
l 0.5
l *0.75
4591
I I
I --1 l
ALL
I
l SG
I
l 0.5
I
l *0.75
}
4628
I I
l 1A,C I
GBA
I
l BH
I
l 0.5
I
l *0.75
4628
I I
l 1B l
LN
I
I BC
I
l 0.5
I
l *0.75
4628 1
2 I
LN
l BC
l 0.5
l *0.75
4628 l
3 I
LN
i BC
l 0.5
l *0.75
i
4628 l
I
-1AC I
ALL
I
I. SG
i
l 0.5
I
I *0.75
4628 l
-1B l
ALL
l SG
l 0.5
l *0.75
4628 l
--2 l
ALL
i SG
0.5
l *0.75
I
4628 l
I
--3 I
ALL
I
l SG
I
l 0.5
I
l *0.75
Page: 7

ANIMAL WA 'UT Q 'ILISATI0N;. PLAN
* This is the maximum application amount allowed for the soil
assuming the amount of nitrogen allowed for the crop is not over
applied. In many situations, the application amount shown cannot
be applied because of the nitrogen limitation. The -maximum
application amount shown can be applied under optimum soil
conditions.
Your facility is designed for 180.00 days of temporary storage and
the temporary storage must be removed on the average of once every
6.00 months. In no instance should the volume of the waste be stored
in your structure be within the 25 year 24 hour storm storage or one
foot of freeboard except in the event of the 25 year 24 hour storm.
4
It is the responsibility of the producer and waste applicator to
ensure that the spreader equipment is operated properly to apply the
correct rates to the acres shown in Tables 1 and 2. Failure to apply
the recommended rates and amounts of nitrogen shown in the tables may
make this plan invalid.
Call your technical specialist after you receive the waste analysis
report for assistance in determining the amount of waste per acre and
the proper application rate prior to applying the waste.
NARRATIVE OF OPERATION
Vri.�u�-� 5 '� v►
S-13-�3
C.,JL+ r-eq LU ► fL�.
\,4� up 6-A—C.. &��k
a u� � "44UA.c.
*6
4"6WNL&-
,n L4 � a-(*
Vt_ CA W-t4 0 A, ,Q
of
I yco irv" �"^$.O�H fJ�'1 r4CW u.`rs L l' I+ I f4,%e4 ,A .. f _, WT --� _- V .._
O r s t3 •--,
f

WASTE. UTILIZATION' PLAN
" REQUIRID SPECI ICATIONS
1. Animal waste shall not reach surface waters of the state by
runoff, drift, manmade conveyances, direct application, or
direct discharge during operation or land application. Any
discharge of waste which reaches surface water is prohibited.
2. There must be documentation in the design folder that the
producer either owns or has -an agreement for use of adequate
land on which to properly apply the waste. If the producer does
not own adequate land to properly dispose of waste, he/she shall
provide a copy of an agreement with a landowner who is within a
reasonable proximity, allowing him/her the use of the land for
waste application. It is the responsibility of the owner of the
facility to secure an update of the Waste Utilization Plan when
there is a change in the operation, increase in the number of
animals, method of utilization, or available land.
3. Animal waste shall be applied to meet,- but not exceed, the
nitrogen needs for realistic crop yields based on soil type,
available moisture, historical data, climatic condition&, and
level of management, unless there are regulations that restrict
the rate of application for other nutrients,
4. Animal waste shall be applied to land eroding less than 5 tons
per acre per year. Waste may be applied to land that is eroding
at 5 or more tons, but less than to tons per acre per year
providing grass filter strips are installed where runoff leaves
the field. (See FOTG Standard 393 --Filter Strip)
5. Odors can be reduced by injecting the waste or disking after
waste application. Waste should not be applied when there is
danger of drift from the irrigation field.
6. When animal waste is to be applied on acres subject to
flooding, it will be soil incorporated on conventionally tilled
cropland. When applied to conservation tilled crops or
grassland, the waste may be broadcast provided the application
does not occur during a season prone to flooding. (See "Weather
and Climate in North Carolina" for guidance.)
7. Liquid waste shall be applied at rates not to exceed the soil
infiltration rate such that runoff does not occur offsite or to
surface waters and in a method which does not cause drift from
the site during application. No ponding should occur in order
to control odor or flies.
8. Animal waste shall not be applied to saturated soils, during
rainfall events, or when the surface -is frozen.
9• Animal waste shall be applied on actively growing crops in such
a manner that.the crop is not covered with waste to a depth that
would inhibit growth. The potential for salt damage from animal
waste should also be considered.
Page: 9

:U
;i•j;.
WASTE UTILISATION PLAN
RE UIRED` p CIF CATIONS
10. Waste nutrients shall riot be applied in
spring planted crops on.soils with a high
leaching. Waste nutrient loading rates o
held to a minimum and a suitable winter c
take up released nutrients. Waste shall
than 30 days prior to planting of the cro
dormancy.
fall or winter for
potential for
n these soils should be'
over crop planted to :
not be applied more
p or forages breaking
11. Any new swine facility sited on or after October 1, 1995 shall
comply with the following: The outer perimeter of the land area
onto which waste is applied from a lagoon that is a component of
a swine farm shall be at least 50 feet from any residential
property boundary and from any perennial stream or river (other
than an irrigation ditch or canal. Animal waste other than
swine waste from facilities sited on or after October 1, 1995),
shall not be applied closer than 25 feet to perennial waters.
(See Standard 393 - Filter Strips).
12. Animal waste shall not be applied closer than 100 feet -to
wells.
13. Animal waste shall not be applied closer than 200 feet of
dwellings other than those owned by the landowner.
14. Waste shall be applied in a manner not to reach other property
and public right -of --ways.
15. Animal waste shall not be discharged into surface waters,
drainageways, or wetlands by a discharge or by over -spraying.
Animal waste may be applied to prior converted cropland provided
they have been approved as a land application site by a
"technical specialist". Animal waste shall not be applied on
grassed waterways that discharges directly into water courses,
and on other grassed waterways, waste shall be applied at
agronomic rates in a manner that causes no runoff or drift from
the site.
16. Domestic and industrial waste from washdown facilities,
showers, toilets, sinks, etc., shall not be discharged into the
animal waste management system..
17. A protective cover of appropriate vegetation will be
established on all disturbed areas (lagoon embankments, berms,
pipe runs, etc,). Areas shall be fenced, as necessary, to
protect the vegetation. Vegetation such as trees, shrubs, and
other woody species, etc., are limited to areas where considered
appropriate. Lagoon areas should be kept mowed and accessible.
Berms and structures should be inspected regularly for evidence
of erosion, leakage or discharge.
Page: 10'

18. If animal production at the fagility is to be suspended or
terminated, the owner is responsible for obtaining and
implementing a "closure plan" which will -eliminate the,
possibility of an illegal discharge, pollution and erosion.
19. Waste handling structures, piping, pumps, reels, etc., should
be inspected on a regular basis to prevent breakdowns, leaks,
and spills. A regular:.maintenance checklist should be kept on
site.
20. Animal waste can be used in a rotation that includes vegetables
and other crops for direct human consumption. However, if
ahimal'waste is used on crops for direct human consumption it
should only be applied preplant with no further applications of
animal waste during the crop season.
21. Highly visible markers shall be installed to mark the top and
bottom elevations of the temporary storage (pumping volume) of
all waste treatment lagoons. Pumping shall be managed~to
maintain the liquid level between the markers. A marker will
be required to mark the maximum storage volume for waste
storage ponds.
22. Waste shall be tested within 60 days of utilization and soil
shall be tested at least annually at crop sites where waste
products are applied. Nitrogen shall be the rate - determining
element. Zinc and copper levels in the soils shall be
monitored and alternative crop sites shall be used when these
metals approach excessive levels. pH shall be adjusted for
optimum crop production and maintained. Soil and waste
analysis records shall be kept for five years. Poultry dry
waste application records shall be maintained for three (3)
years. Waste application records for all other waste shall be
maintained for five (5) years.
23. Dead animals will be disposed of in a manner that meets North
Carolina regulations.
Page: 11

ANIMAL WASTS-UTILIZATION PLAN
nOTE UT LI MON PW AGREEMENT
Name of Farm:HILTON MONROE
owner/Manager Agreement
I (we) understand and will follow and implement the -specifications
and the operation and maintenance procedures established in the
approved animal waste utilization plan for the farm named above. I
(we) know that any expansion to the existing design capacity of the
waste treatment and storage system or construction of new
facilities will require a new certification to be submitted to the
North Carolina Division of Water Quality (NCDWQ) before the new
animals are stocked. I (we) also understand that there must be no
discharge of animal waste from this system to surface waters of the
state from a storm event less severe than the 25--year, 24--hour
storm. The approved plan will be filed on --site at the farm office
and at the office of the local Soil and Water Conservation District
and will be available for review by NCDWQ upon request.
Name of Facility Owner: HILTON MONROE
(Please print)
Signature:A.d&.Date: IL/L LZ
Name of Manager(If different from owner):
Signature: Date:
Name of Person Preparing Plan: (please print) Samuel G. Warren
Affiliation:UBDA- MRCS Phone No. 910-862-6936
Address (Agency): 122 Ag. service. ctr.
Elizabethtown NC 28337
Signature: LV 73:)_r". Date: /01-9 47
Page: 12

-ryb ZP
,r
7 Hsgi
'1-4bz.B
IRRIGATIO�N,r SYSTEM DESIGN PARAMETERS
Landowner/Operator Name:
Address:
Telephone:
TABLE I - Field Specifications'
County:
Date: ?-,a -mod 7
Field
Number2
Approximate
Maximum
useable Size
of FIeId3
(acres)
Soil Type
slope
crop(s) .
Maximum
Application
Hate 4
(Inlhr)
Maximum
Application
per Irrigation
cycle4
(inches)'
Comments
R
6bA
;
c
D
6b �+-
� •
(00Vs A e—
. J"`
4. ?.J�
cue r1� ..� ►•►
n
r
t U.
4. LF
-2-1
f jee it -owe a2
'Table to be completed in its entirety by Field Office personnel and forwarded to the irrigatiorp system designer.
2See attached map provided by the Field Office for field location(s).
'Total field acreage minus required buffer areas.
4Refer to N. C. Irrigation Guide, Field Office Technical Guide, Section 11 G. Annual application must not exceed the agronomic rates for the soil and crop used.
Irrigation parameters
October 1995
page-1
USDA -MRCS
North Carolina
AM

TABLE 2 - Traveling irrigation Gun Settings
Make, Model and Type of Equipment: c�
L.J �I{t X Ille-4;eh/tea 6c�
Field Nol
and
Hydrant Noz
Travel
$ttospeed
0-in} i
Application
Rate
(tnlhr)
TRAVEL LANE
Effective Effective
width (ft) Length (ft)
wetted
Diameter
(reel)
EQUIPNIM SETTINGS
Nozzle Operating Operating
Diameter Pressure - Pressure Arc
(inches) Gun (psi} @ Reel (psi) Pattem3
Comments
928-
L4 Zo
A4
7o
3ap
� - 8
Z--
63
30
600
H
- c
ZZ
O.
Z3/D
oc>
�.
N 3Za°
f.
�1
f S
ilI
..
{
32,a0e-
-,Sim oF „
* 4-flA161 PW11. ken*ie = 5", = 1. 3te-
'See atta a map provided b}rttField Office for field iocation(s).
2Show separate entries for each hydrant location in each field.
3Use the following abbreviations for various arc patterns: F (full circle), TQ (three quarters), TT (two thirds), H (half circle), T (one third), Q (one quarter).
May also use degree of arc in degrees.
Irrigation Parameters USDA -MRCS
October 1996 page-2 North Carolina

I
TABLE 3 - Solid Set Irrigation Gun Settings
Make, Model and Type of Equipment;
Field Not
and
Line Noe
Number of
Hydrants
Wetted Hydrant Spacing (ft) Application
Diameter Along Between Rate
(feet) Pipeline Pipelines (infhr)
OPERATING PARAMETERS
Nozzle Operating Operating
Diameter Pressure Time
(inches) Gun (psi) @ Hydrant (hr)
Comments
4I32-
e�ti..-s
v.�o� er
rji S
O 5 � urN
'See attached map provided by the Field Office for field location(s).
2Show separate entries for each piperine with hydrants in each field.
Irrigation Parameters
October 1995
paged
USDA.NRCS
North Carolina

T)4
LGn���75 �
0)51t Pg �oo ` IcI14
LAW 1. il�o � tof
-7lLt►V t.'4�1
TABLE 4 - Irrigation System Specifications
Traveling
Irrigation Gun
Solid Set
Irrigation
FIow Rate of Sprinkler (gpm)
9
/ 0
Operating Pressure at Pump (psi)
..
co 8
Design Precipitation Rate (kdhr)
p, 33
0.28
Hose Length (feet)
400
xxxxxxxx
Type of Speed Compensation
.! R
XXXXXXXX
Pump Type (PTO, Engine, Electric)
rr�Y�
Cn f�7 CiELM�M
Pump Power Requirement (hp)
a S
G u �.-
c r w,— a ` b
TABLE 5 - Thrust Block Specifications'
Desioner may provide thrust block details on senarate sheet.
LOCATION
THRUST BLOCK
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Irrigation Parameters USDA-NRCS
October 1995 paged North Carolina

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IRRIGATION SYSTEM DESIGNER
Name:
Company: a-� a F+ - A)/Z cS
Address:
Phone:
REQUIRED DOCUMENTATION
The following details of design and materials must accompany all irrigation designs:
1. A scale drawing of the proposed irrigation system which includes hydrant locations, travel lanes, pipeline routes, thrust block
locations and buffer areas where applicable.
2. Assumptions and computations for determining total dynamic head and horsepower requirements.
3. Computations used to determine all mainline and lateral pipe sizes.
4. Sources and/or calculations used for determining application rates.
5. Computations used to determine the size of thrust blocks and illustrations of all thrust block configurations required in the system.
6. Manufacturer's specifications for the irrigation pump, traveler and sprinkler(s).
7. Manufacturer's specifications for the irrigation pipe and/or USDA -MRCS standard for Irrigation Water Conveyance,
N.C. Field Office Technical Guide, Section IV, Practice Code 430 DD.
8. The information required by this form are the minimum requirements. It is the responsibility of the
designer to consider all relevant factors at a particular site and address them as appropriate.
9. Irrigation pipes should not be installed in lagoon or storage pond embankments without the approval
of the designer.
NOTE: A buffer strip_ feet wide or wider must be maintained between the limits of the irrigation system and all perennial
streams and surface waters per DEHNR DEM Code Section `15A�NCAC 2B .0200 - WasteNotDischarged to Surface
Waters. - 1Slr w ;11 b L ttSc_ 0. c �-�ts ,o h-4ti�s s. i er [r�o., _ �j e►rc w;l
Irrigation Parameters
October 1995
page-5
USDA -MRCS
North Carolina

Narrative of Irrigation System Operation
Describe the operation of the system in the space provided below or on a similar sheet most convinient to the designer/supplier.
Include procedures such as start-up, shut -down, winterization and regular maintenance of all equipment.
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Irrigation Parameters USDA -MRCS
October 199S gage-6 North CaroUna

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8x8x16 STANDARD
CONCRETE BLOCK
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FILL BLOCK CAVITIES
WITH GRAVEL- EXTEND
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CONCRETE BLOCK
QUICK -COUPLING RISER
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BELOW TOP OF
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PVC PIPE
LATERAL LINE
CLASS *9 PVC PIPE --
GROUND SURFACE------r
Figure 1. Swing Joint for Quick -Coupling Riser Valve
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