670008_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

IF
Type of Visit: Q rRoutine
fiance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: 'ID6U &I-j 5 "_�0'e-j9p"i Integrator:
Certified Operator: Certification Number: i P R 4 a
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent
C+apacity Pap.
Design Current Design C►urren#
Wet Pqultry Capacity Pop. Cattle Capacity Pqp.
Layer Dajg Cow
Wean to Feeder
er Non -La
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Dry Cow
i P,o , Non-Dan
Farrow to Finish
ILavers
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Wither
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Im acts
1. 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 DWR)
❑ 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 DWR)
❑ Yes
❑110
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LJ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

k]F'acili Number: - Date of Inspection:
1�
Waste Collection & Treatment
ZJ110
41. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ 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): 13
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
d-11
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:)Yes WNo ❑ 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 0 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 C3 0
❑ 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 6"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
W
oes record keeping need improvement? If yes, check t appropriate box below. ❑ Yes ❑No ❑ NA ❑ NE
aste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Trans2
fers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ElMonthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F
Lhcility Number:. ���' I (Date of Inspection: yr a dT t,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dN
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 04140 ❑ 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 ON ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes to ❑ 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 C3 No ❑ NA
❑ 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/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA
gNo
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA
❑ NE
Comments (refer to question ft. Explain any YES answers and/or any additional recommendations or anyaother comments.
Use drawings of facility to better explain situations'(use additional pages`as necessary).
E2 � -Te2 Z Rcu r,,95 Fop- FES GUC , sEPY0 i Xs VkOtn
IILJUv`T" --
JJ-V L�, W N s 7( HAI&r4j Iq'9D ' &/j FOP-Awz'
_Z,0 i S` m R G TO t E �F j fl !� AAT L el. r( CT- :1TRe Z
Scpp St-vO6(- cn t6�sz6?J Fin- KgrTo- ;F 17/
-D)q ,
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phon� /o
Date: ' 1
11 -�Ul
0
F'7llf I%

Type of Visit: t) Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: ,Q/ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 101tS Departure Time: County: OhkAVJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: - Title:
� ll
Onsite Representative: aA ") rt.d�.S ��o(Lop' J
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ((o 2ZL -
Certification Number:
Longitude:
Design
Swine C+apacity
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
$1{
3
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Design Dry Cow
D , P,ou1 Ca aci P,o Non-Da'iry
ILayers I Beef Stocker
Non-Laye Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
I Beef Brood Cow
101 Qther
Other
Turke s
Turkey Poults
Other
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?
❑ Yes No ❑ NA ❑ NE
❑ 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
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
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 ❑ NE
Structure 1
Identifier: Lhewj
Spillway?:
Structure 2 Structure 3 Structure 4
Designed Freeboard (in):
Observed Freeboard (in):b
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 Ua/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 2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
D Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0o
❑ 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
d No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Frill o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
U�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
VNo
❑ 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 d)� o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes [�J o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 611- Date of Inspection: I I
24. Did the facility fail to calibrate waste application equipment as required by the permit? JYes ZNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 EiNo, ❑ NA ❑ NE
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 ❑ NE
❑ Yes E/ No ❑ NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes Ffj� ❑ NA ❑ NE
C] Yes � No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or_any ptber comments. F
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: "j U
Reviewer/Inspector Signature:
Page 3 of 3
Phone:('11 b 19 6 — J
Date: k to S
l A12014

Type bf Visit: Q Co�pliance Inspection V Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Arrival Time: �jf� Departure Time: County: ,6a Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: �py(��1rz45Eai integrator:
Phone:
Certified Operator: Certification Number: 161,15
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
Design
D . P,oult . C_a aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113eef Brood Cow
Qther
Other
Turke 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?
❑ Yes 0NNo ❑ NA ❑ NE
[:]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 ❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 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 ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: UR
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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
- ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
� ❑ 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 EY<01
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes fi VNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
wl�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FZ/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El�❑
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�j`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 [�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti;NA
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑YesN ❑ ❑ 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

Facility Number: --71 Date of Inspection: /
24. Did th,e. 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 �io ❑ 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 to ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Io ❑ NA ❑ NE
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:
❑ Yes
L.d" o
C ] NA
❑ NE
❑ Yes
to
❑ NA
❑ NE
❑ Yes
016C
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3 1`10 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Q,��❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑'NO ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 5
A11011

Type of Visit: 0 Com Hance Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p 3 Arrival Time: C% Departure Time: County: OA)$Z60 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: DdcJG
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: k(0 2—S Z—
Certification Number: Zn-6�
Longitude:
Design Current
Swine C►apacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Current
C►attle Capacity Pop.
DairyCow
>(
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , PTu-It ,
Layers
DesiEE3
gn Current
C•_a aci_ P,o
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113cef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
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 2f No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes lyo
❑ Yes /�1 o
❑ Yes No
[]NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility, Number: 677 - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2(No ❑ NA ❑ 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: 'A 64003
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35
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 o ❑ 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 environments threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes V ❑ 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 Ea<❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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 X ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑Yes ON ❑NA ❑NE
❑ Yes 'VU ❑ NA ❑ NE
❑ Yes [� ❑ NA ❑ NE
❑ Yes (No ❑ NA ❑ NE
❑ Yes Ld l`' ❑ NA ❑ NE
[:]Yes fo ❑ NA ❑ NE
❑ 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 V Rainfall InspectionsF
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [[J❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
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 VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes dNo ❑ 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 C, No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 1__I No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes XlNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of faeility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
3-0 Hij F - L. Phone qlaaz�:u 3�
Date: G 119/11
21412011

Type of Visit: &Com Hance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
,Reason for Visit: Routine 0 Complaint Q Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: R j Arrival Time: Departure Time: County: J, C6w„ J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: � bU ,. J d flIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 to 2��2/
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er Dairy Cow
Wean to Feeder
I INon-Lffer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Dr, P,oultr, Ca aci P,o Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

FaciliNumber: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
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 I__I 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 reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes VNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes[DNA
❑ 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 To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo,❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Fjl<o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
, ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
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 V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No [DNA ❑ 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

Facility Number: - Date of Inspection: 611
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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 CAWW?
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?
�lv ❑NA ❑NE
zTo` ❑ NA ❑ NE
❑ Yes F-1 o
❑ Yes E2410
❑NA ❑NE
❑ NA ❑ NE
[-]Yes 2'�10 ❑ NA ❑ NE
[:]Yes u No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [aXo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
�Io ❑ NA ❑ NE
�0) ❑ NA ❑ NE
z7o ❑ NA ❑ NE
oil
Reviewer/]nspector Signature: Date: 1-k- /11-- -
Page 3 of 3 2 4,061

Division of Water Quality
FaCtitty :NumbeC=� G� 0 Division of Soil and'Water Conservation Z
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint O Foilow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
Owner Email:
Phone:
Facility Contact: J Title: Phone No:
Onsite Representative: 1✓ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =' ❑ ' ❑ Longitude: = ° ❑ ' =
Design Current'DesIgnry Cur
Swine CapaciP ty opulation Wet Po`uliev Capacity Popul
W- �>
❑ Wean to Finish �� ❑ Layer
Wean to Feeder JO Non -Layer
`. ❑ Feeder to Finish
❑ Farrow to Wean „ M
ElDry Poultry
Farrow to Feeder
❑ Farrow to Finish ❑ Layers
-r
Gilts
-
❑ Non-L�
Boars
"
❑ Pullets
PTurke
Turke
Other
Other
Doti Cattle ce;�,� =.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Poults
IVui
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El Yes
❑No El NA
[I NE
❑ yEl NA
❑ NE
❑ Yes
❑ Yes
El NA
[I NE
❑ Yes❑
VNo NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection t
Wr ante 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?
,p Structure 1 Structure 2 Structure 3 Structure 4
identifier: —61XN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ 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 ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ado ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental lh;reaf, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �,/o [I NA El NE
E
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 dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes U401
❑ 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 Area
12, Crop type(s)
l3. Soil type(s)
l4. 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
ff�'io ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
J El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
��70
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U<o ❑ NA
❑ NE
Comments (refer to question #)..Ezplain any YES:answers_andlor any recommendations or any other comments r.
,Use drawings of facility to better explain situations. (use additional pages',as necessary) m k '
Reviewer/Inspector Name Oafw' ] Phone: 0 6
Reviewer/Inspector Signature: Date:
Page 2 of 3
r 71121nd rn"f;mtmod

Facility Number: — Date of Inspection ►
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EJ o ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LIN/.
❑ NA
❑ NE
❑ Waste Application [I 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
E] No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
h2�2 No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
ldNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
❑ NE -
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑'Ko
❑ 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 duality concern?
El Yes
//
Q o
❑ 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
El Yes
Cj 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
ffNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a
E
Page 3 of 3 12128104

I
Type of Visit (Compliance 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:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: ® Departure Time: County: Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: D) C_LIDf-
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] c = i = Longitude: = ° = I = «
ED Current Design Current Design
Current
Swine C«apacity Population Wet Poultry Capacity Population Cattle C*apacity
Population
Finish
❑ La er
❑Dai Cow
F]t]o Feeder
3 D
V
❑ Non -Layer
El Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
❑Turke Poults El Other
Number of Structures:
=Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
EJ 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 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
[I NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Zo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

.Facility Number: 6 — g Date of Inspection
,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?
��St�ructur�e 1 Structure 2 Structure 3 Structure 4
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): P-7
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ 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 2/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes WNo ❑ NA ❑ NE
❑ Yes LI 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 E(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L] 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 VNo ❑ NA ❑ NE
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 L No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
M. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
91No
El NA
❑NE
VNo
❑ NA
❑ NE
d i�"No
El NA
El NE
❑NA
❑NE
WONo
No
El NA
El NE
Comments refer to question # • Ex lain an YES answers and/or an recommendatio "A ( q ). p y y ns,or any;othercomments� m'
Use drawings of facility !wbetter explain situations. (use additional pages as neeessary)
Reviewer/Inspector Name JO&V fjw[_,k, I Phonek%)) 17L ' %SY1
Reviewer/Inspector Signature: Date: f/�
12128104 Continued

1
Facility Number: -- Date of Inspection a 5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�Xo ❑ NA ❑ NE
the appropriate box.
❑ WUP [I Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3 No
❑ NA
❑ 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
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
21 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[T N ,
❑ NA
❑ 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?
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?
❑ Yes
f! No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
Ld No
❑ NA
❑ NE
❑ Yes
(o
El NA
[I NE
❑ Yes
;7No
❑ NA
❑ NE
12129104

Type of Visit 6 C pliance 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: 57LF Arrival Time: © Departure Time: County: D�I/S� OInZ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ] Title:
(}� 6jfy
Onsite Representative: _ yoa
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = ( Longitude: = ° = , ❑
Swine
Design Current Design
C•apaty PopulatiogtAItUYAWynacift—Y
10 Layer I
54 po 10 ❑ Non -La er
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
KI Wean to Feeder
❑ Dairy Cow
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
El La ers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Non -Layers
El Pullets
❑ Turke s
❑ Turkey Poults
110 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?
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 [3/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[;I 'No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 6? —
Date of Inspection D
* aste Collection & Treatment
2No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '3b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ef 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
JNo
❑ 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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ 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
,.,/
L� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[31<o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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?
ElYes
D'1vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
L7 No
❑ NA
❑ 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
❑ NA
❑ NE
Comments (refer -to queshbnr#} .Explain any YES suswers and/or any recommendations or any other comments.
'Use dr�awingszof�facitity to�betteregplaip situations. (useaadditiunal pages as necessary):
Reviewer/Inspector Name Phone: C Q _7 a
Reviewer/Inspector Signature: Date:
n___ _Ir f 7'7/1Q/a4

`Facility Number: — Date of Inspection a o
lr
e uired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No
NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Elyes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
El o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
d�qo
❑ NA
❑ NE
fail
��No
23.
If selected, did the facility to install and maintain rainbreakers on irrigation equipment?
❑ es
[I NA
El NE
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
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Did the facility fail to dispose of dead animals within 24 hours and/or document
❑ Yes
�No
wt
❑ NA
❑ NE
properly
❑ Yes
o
❑ 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?
ElYes
No
ElNA
❑ 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
El Yes
,�
L✓J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:; ro
Page 3 of 3 12128104

Type of Visit 0 Co pliance 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:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: Departure Time: County: _ Q1V5 LO Al Region:
Owner Email:
Physical Address:
Facility Contact: Title:
Onsite Representative: Dor/CrA n`
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = ' E Longitude:
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
�( Wean to Feeder 2�
ln1
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Layers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Broad Co
❑ Turkeys
Her
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
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?
Page I of 3
❑ Yes /No❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes ❑l
❑ Yes
❑ NA
El NE
❑ Yes VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection v
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?
Structure1I Structure 2 Structure 3 Structure 4
Identifier: Cr�G�✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1W
dNo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
❑ Yes ❑/ ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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 environmentalWeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA El N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ N
(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 ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LQ N ❑ NA ❑ N
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ N
❑ 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
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Eo
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? E] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
gage 2 of s LLIL61U4 uonnnuea

r
Facility Number: 7 — Date of Inspection L5
R4uired 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 ❑ Desi n g ❑ Ma p s ❑Other
❑Yes �No
�o ❑NA ❑NE
[--]Yes ❑ NA ❑ NE
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
[:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain InspectioZEINA
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
7
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
rJ No
❑ NA
❑ 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
d o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
CNo
❑ 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
dNo
❑ 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2No
❑ NA
❑ NE
Additional Comments and/or Drawings: �
Page 3 of 3 12128104

Division of Water Quality /
Facility Number Q Division of Soil and Water Conservation
V
-- 0 Other Agency
Type of Visit JCo Hance 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: 2 V d Arrival Time: Departure Time: County: 01VR.611Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: COWA ,J) P6J(-,(A r
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = Longitude: = ° = =
:Design' Carrent Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity. Population
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
j
Other
❑ Other _
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
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?
Page I of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
El NE
El Yes
El Yes
VNo❑ NA
❑ NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: (� 7 — T Date of Inspection
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?
Structured Structure 2 Structure 3 Structure 4
Identifier: (jQ 600 r
Spillway?:
Designed Freeboard (in): 'La
Observed Freeboard (in): �✓ Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ 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 2J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E,_K ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 10% or l0 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
fNo ❑ NA ❑ NE
;7No
❑ NA El NE
❑ NA ❑ NE
[�o El NA ❑NE
�?No ❑ NA ❑ NE
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):
T
ReviewerlInspector Name Phoneel f/0
Reviewer/Inspector Signature: Date: 2 1 bb7
Page 2 of 3 / 12128104 Continued

Faeili /
ty Number: Date of Inspection Z ► 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EJ No ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
[/ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ef No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;3*No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'I'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
Pj 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
WfNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EX/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- -- - - O Other Agency
Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
ZRoutine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: Departure Time: County: dN L10Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: fJ6 ") l'l
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 ❑ . ❑ « Longitude: ❑ ° 0 , 0
Design .- Cgrrent-. ,Design Current "° Design Current
Swine. Capacity Population Wet Poultry �:{
p ty p try. Capacity 'Population Cattle Capacity,E Populahon
❑ Wean to Finish
91 Wean to Feeder 3 f qo a()
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other - — — — -
❑ Layer
❑ Non -Layer `
F=A
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharizes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
El Non -Dairy
ElBeef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Numberof Structures _[
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?
Page 1 of 3
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LdNo
❑ NA
❑ NE
❑ Yes LiNo ❑ NA ❑ NE
1212"4 Continuer)

Facility Number: 47 — g Date of inspection s 1 D(r
if
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?
Structur i Structure 2 Structure 3 Structure 4
Identifier: Gee
Spillway?:
Designed Freeboard (in): ZO
Observed Freeboard (in): �$
E No ❑ NA ❑ NE
EI No ❑ NA ❑ NE
Cl Yes L_'J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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 2-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes -1 No ❑ NA ❑ NE
(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 El Yes ❑kilo ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes FJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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) Fg,g ,F t rll5En>N04 (6) S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ yes
L✓J No
❑ NA
❑ NE
❑ NA
❑ NE
�2'N'o
L� No
❑ NA
❑ NE
LIB
❑NA
El NE
CJ No
❑ NA
❑ NE
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):
06 "1 Sao.
�9
/�
s '/V f��C, �17 4 (114,614 e
T
C
Reviewer/Inspector Name �� o� 1,I. Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 t 12128104 Continued

Facility Number: 'f — Date of Inspection r
Required Records & Documents
19. Did the facility fail to have 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 ENo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ENo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspectionss
Weather
Code
�❑
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
l�'N0
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L_f No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ErNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�}o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,U
I� 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
EXo
❑ 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
El Yes
�,�
L"J 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
E�l,Ko
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
ET o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number--� 0 Division of Soil and Water Conservation
--- — 0 Other Agency
Type of Visit �C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit L'J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: %o Arrival Time: 5 Departure Time: County: eMSLAiN Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Cr 4.581ZD1q1
1
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: _,.Zi1T.0 L9'9Ad Sack -up Certification Number:
Location of Farm:
Latitude: = o = ' Longitude: = ° = ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
ILKWean to Finish 38 �$ 0
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Nan -La ei L T= I
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges 8z 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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 ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes LdNo ❑ NA ❑ NE
❑ Yes 4o ❑ NA ❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: paA.)
•
Spillway?: till
Designed Freeboard (in):
Observed Freeboard (in): 3S
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ 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 WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ 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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R�T ❑ 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 Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No
/o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
(:]PAN ❑ PAN > 10% or ] 0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift ❑ Application Outside of Area
pt
12. Croptype(s) 1'E5(,ye (-G) 1&_,_,yDA (r.) ZS
13. Soil type(s) Cj 0L,psa4y�'� ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� o
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
Yes
YNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7No
❑ NA
❑ NE
(,jip N cen S -75 (4 j . 5 G O R.AS& ou 4� rd CG{aA-z�6 , S-4 CAo to Poqw__ ,
Reviewer/Inspector Name v� �. hkat)t '� Phone:{ 1�U TF J� t l3
Reviewer/Inspector Signature: Date: 31Zv 5,
12128104 Continued

Facility Number: — Date of Inspection p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;No
N El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA LINE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Ld No
❑ NA
❑ 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 El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EX'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
u No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[[3'NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
ELJ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,❑l
Ld No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[�A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
//No
2No
❑ 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
o
❑ 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
L✓J 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
No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
� o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other [] Denied Access
Facility Number Date of Visit:
V+ Permitted 13 Certified © ConditionaP5 Certified [3 Registered
. I N.Fars Name: ...........................
Owner Name: •---�_... �....�..p'JQ
�Q4 Time:
Not Operational O Below
Date Last Operated or Above Threshold: _ ..... .
Phone No:
MailingAddress: _� .�..._............. ,...............�_ _ ... - ............ ............ ..... ........... ...............
Facility Contact: .. --11 pp ...... Title:.._ ._ ....... .... _ �.. Phone No: ._. _._.................... .......
Onsite Representative:.._ V W j, �,i` . . .............. .. .. Integrator: r• w .. ---- .------
Certified Operator: ....................... . .......... . ....... . ..... ............ ....................... Operator Certification
Location of Farm:
Swine ❑ Poultry ❑ Cattle © Horse Latitude �• �` �L° Longitude
Deign ; Current ; Design Currentw- `Desg in C
urrent
s `".'Po -Cattle Swine- Ca acr Po Wat.on ..= - --.tr3' _ _ „PCa ci Po Watioio. . - _W `-_Ca-"aci .`Pci nlation_ "<
Wean to Feeder x [] Layer ❑ Dairy
Feeder to Finish °Y`L Non -Layer rt ❑Non -Dairy
Farrow to Wean
❑ Farrow to Feeder Other
Farrow to Finish w TOtal Deli e3Glt E
Gilts - P
Boars �s _r Tot ,7�7LW
w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. 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 gallmin'?
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. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes
),No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
Ye �No
❑ Yes I -No
Structure 6
Identifier: _.._...._........... .................................. .... ..,. ....... ...I ........... .........
Freeboard (inches):
12112103
Continued

acility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 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 maintenancelimprovement?
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 maintenancerimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessii
12. Crop type
13. Do the receiving crops differ with those
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. 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.
❑ Yes XNo
❑ Yes IN 0
❑ Yes �No
❑ Yes ONO
❑ Yes J( No
❑ Yes A No
❑ Yes )eNo
❑ Yes
❑ Yes
Zj No
'gNa
❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes )Z(No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes XNO
Comments {referto question #)ExplaEanyYFS answesisr�anyrecommeadatsoas or any othei comment. x
'Use drawrags of fa�r9 to�better explarn srtuatx►as�{ase°addrtwnalrFa� � n�1T)• Field COPY 0 Final Notes � �
.�
�D
/vf405 �o 6e �h� nC�FO �0:7 /Z"
T
r-• 1 xr ^r --- -•• ,r'°
ReviewerAnspector Name i '-= µ, �`w • 6
ReviewerAhspector Signature: Date: 3
12112103 Continued

• Fa' ty Number: Date of Inspection qti�o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
TNIPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ONo
❑ Yes (VNo
❑ Yes YNo
❑ Yes tg� No
❑ Yes O No
❑ Yes J�No
❑ Yes ONo
❑ Yes V(No
IVYes ❑ No
❑ Yes,dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
12112103

r , - CY'44 c o ,'
Facility Number Date of Visit: S 1 % D Time: 1 �S
rO Not Operational 0 Below Threshold
O Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: a r d tt n Is ; rA r rt County: ►'l S �o' ✓
Edw'.r
12 Owner Name: G' J 3a el d �� Phone No:
Mailing Address:
Facility Contact: Title: Phone No: ,,11
On site Representative: EYWAI-d-De2ly4t45 _ O-d-lvl Integrator: Celle1,f'ci [7�+��ir�, %.L-G
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 a Longitude ' 0 6
Feeder to Finish
Farrow to Wean
Other
Farrow to Finish
Gilts
Boars
Dischartses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. 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. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: +
Freeboard (inches): 4
05103101
Field Area
❑ Yes ;2rNo
❑ Yes ❑ No
❑ Yes (--]No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ❑ No
❑ Yes,/dNo
Structure 6
Continued

Facility Number: _ '7 —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ieI trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 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 Aunlication
❑ Yes ONO
❑ Yes 2fNo
❑ Yes ONO
,Yes ❑ No
❑ Yes ❑ No
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type (`�e/'v"�v�i`, �q��v/� �wr�,l1/r�/�rih t�YcrSC � re.5 j7af1t!✓e
13. Do the receiving crops differ with those designated in the Certified Animal Was Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
S. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ff No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ieI WUP, checklists, design, maps, etc.) ❑ Yes 2No
19. Does record keeping need improvement? (ieI irrigation, freeboard, waste analysis & soil sample reports) JffYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ieI discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? Oyes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
S .s OterdationsofanotercntCommens (referto3 uestioi#) Ezplarits YEansweraad/oanyrecommens .
=,.
drawings
Use of facility to better explain situations .(use addihonal;pagesrasneeessary) ❑Fiend Copy El Notes
`tA, r.. --.. .
1�j. _�� .. /yI� • 7d�dgh ,'s i7o>� kee�oi 401'eebau�d.
oGG�►Sst'a+1411y � iecbaq✓Gib ICCov re 40 b-- be tve,e�l ,
Nee �U/be sys e -Ea �s,Ve W454e s4?,%1 1ef
p(c, y S 5yr A O 1; Ce4j ►'rvt e✓e P45 q -AA vSie G Wa S42 r-t�l �1 f�'r G��r-� �� 1.JA; ►-%
dot
(,a s 0 elp 1+cali evtnis 4a r� e app1>ec'i'Pin
11i2�Z f0��+%tsf !✓%r.�oYG�9►t p�G� .?O� L1c}vC q tn/c.f�e
L_ Laa S o F �/�- D 1 1 o r z DI 4 I0/13 a) e veris. 4n91 su wf Ad,,d alZb/a1 d� Z/►�%7
Reviewer/Inspector Name
Re viewer/Inspector Signature:
05103101 Continued

Facility Number: 6 7 — g Date of Inspection !(o
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ',�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,2No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 'o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AaaInonal comments anator urawings: j �1 /+
►7eed3 Td VSe 2 1 f'Dr lk7e Re�t
,V�QNGItlet,,,g Ice rtylvd4) cAt -111e ewo-qe FlgAq
17e iS (,v✓r ¢n 1 y �f� �r� 2qS. 411.. -�Fv{o(�� ✓I�e�1 - � use /9 SAS
''' � ac
PAV a 1�,14ore ire,-4est:ve on -44e �AC-zsae
8'. So...,e a-t Ae so1"d .Sc4 r►s��•s ler� wr.�.� /e v�o•� -14e
s ,r!,-I-ear 6 ;.-•� 4,/r&Aed 0er, ale cessc,,.� etc4 0 drt3 heed 4, be .4 to
4e r re ve m e J* y-N e 4 k :,,-5
Cv4 e4tc Vei1ve5 A4 neCeSSele fa ;o�t3 w�61/, COVr�Cl
Yo 5�oul1,4 co✓t4ac -��e D11S-;, G4 Ao✓ 051.-S5;S AP,6e .
S 1 r•1 ✓1 eG I o �Z e V a r ✓vl �5� rd !� , -1 �,� s y -�� of fie � Yt�-,��d
1S. S4 yrcrArs 41-g3 4 k e -tr;8Id dies►°�•-ta�Of far �r�vdG ,�q►J
�o have -�L,e 6e��vd� S�a►'�d s�',rrtt�,�GLti✓1-}r 1-%Y1Ove'Oi; r#
4L,,n A e �'e r S' q +^-t o► j r , -j v� a-f' o -f lie •� -�.� e S O ff" r otf'Sc r a � Ae-
�';�oald. T;tke Pie cessAa E-4 vtlfrove et&-d eY,syre
Ck Well eS, Ci6J;Jkedl-s�g+�c`� D�' t��,��I berv► v& orn 4he
e ) ; re-F O-r 4 he A r ld .
2S. ►''?r.��dates yAs�d n fo,4,oh or 41,xf' oveeseed rye.
7Lye t.-►as}e �tq,.t 9i��s a l�� 16�o►Lr� gljaw�r.ce oh ��e pvefs�
qhd lrei v,res AaI ►VIO . 1'?'je. Te dclYl w I'ACS -40 Gircja� - 4-Te r
!� ¢d 11O �LGa ff -{!, e o ve Y lead � ]tte I^ k7e h ea dS � e '0,14o r 4 -li e
DiS4r I- ? c4 t`rP. AR, neGeSSG✓ � q.�ehdr+�leY1`� ndde-d 4e Ae-
P14 P
17IS0M• . TordGtY1 Sa �J l.,e avCYSeed t A3 /ZM,9VCd -row
4ke 1'�' L° j 0i l eiS-1 week. Tt.e ew✓Seed :5-A oq 41 lin ve been
re Af % I r P r� r 4d heeld ; ►i w k; c he ve r Comes �;'•s� .
�i, �PGa�w.E►rded � q +�l��ko►- w��-�, iNGre�et�lS�and rlec�ssq��j
05103101 ma✓,�: s4� allot,,� -reee.bea,'d de4e.-.�l:�a-

c
Division of WaterQuality
Division of Soil and Water Conservation
.Other.Agency
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Woutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time: ® Printrd on: 10/26/2000
Facility Number t•
NNot O erational Q Below Threshold
Permitted Q Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
�U �c� County: �Gi� .........................
FarmName•° ................. c�..................... .....................................................................................
Owner Name: ................................................... .................... Phone No:
.................................................... .......................
FacilityContact: ...............................................................................l'itle:............................. .......... ..... Phone No:
MailingAddress:.....................................................................................................................
Onsite Representative: , IN.��Q;Y.................... ...I......_... ............... Integrator:.....1` t ...:.................
Certified Operator: ................................. .... Operator Certification Number:..........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0 4 .1 Longitude 0 4 64
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder Q a Q ❑ Layer ❑ Dairy
❑ Feeder to Finish JE03 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes V No
Discharge originated at: ❑ Lagoon [ISpray Field [3Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
['YNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
tkrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Suructure I Structure Z Structure 3 Structure 4 Structure 5
Structure 6
Freeboard (inches): d` -9
5100
Continued on back

Facility Number: — g
Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion,
❑ Yes
N<rqo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
kNo
(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?
❑ Yes
(<No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Pi�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
ONO
elevation markings?
❑
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
t<No
11. Is there evidence of over application? Overload
❑ Excessive Ponding ❑ PANJ ❑`
❑ Yes
9No
tHydraulic
1
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
ONO
15. Does the receiving crop need improvement?
❑ Yes
U'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
)<Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(� No
(ic/ WUP, checklists, design, maps, etc.)
❑
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
J�o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
gNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
allo
24. Does facility require a follow-up visit by same agency?
❑ Yes
§jTNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
yio1atigns;or deficiencies were note ditrtrig �his;visitt Youeeeiye Rio #'urt. ;
correspotideit><ee. a'b' f this visit` ; : :
Comments (refer to question #): Explain any YES answers and/or any recommendations br any other comments
Use drawings of facility to better explain situations. (use additional pages asnecessary):
ep— Orr
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

Facility Number: -- g Date of Inspection CIS Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below (Yes ❑ No
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Kj No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes fi�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes YNo
Additional-CornmenWand/orDrawings:
�.o-�-e_ , �i� ��.� � �c ►-- lei-�e�--� �� ,�-,�-�- � �,e.►-e�---
4\11\5 4-4 A- VV—�",A-
` l �
11\t��
J
5100

i
ti
Divisioin of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ARoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Tune: I 93-o Printed on: 10/26/2000
NNot O erational O Below Threshold
© Permitted kertified
[ © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name:�1.�'` `y-+�t"vy2 County: ... 1�........................................... .....................
................... .........
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
;Mailing Address:.............��✓............................................................................................................�......................... _.....................
Onsite Representative: ...........
...................... ........ .......................... ........................ ................
Integrator:..........Q_.........
Certified Operator:... .............................
Location of Farm:
:.................................. Operator Certification Number:............................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �+ ��� Longitude �• ��
Design Current
Swine Capacity Population
Wean to Feeder
13 $�-{o
`l:� ty4
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes E'M'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.................................................................................... .........
Freeboard (inches): 3�
5100 Continued on back

Faicih y Number: 6q — g Date of Inspection r_ Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management of
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?
10/26/2000
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 maintenance/improvement?
11. Is there evidenKof over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
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? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in 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 reviewlinspection 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?
10 •yii�a wfis.ok- di f ciendiaAg •were b6fea- during fhis;visit: • Y:oir wilt•reeeiye iio further
cor'res oricieike: about this .visit.
❑ Yes �INo
❑ Yes ,'o"jj No
[:]Yes �fNo
❑ Yes kdNo
❑ Yes JVNo
❑ Yes ONO
❑ Yes D�No
❑ Yes �TNo
❑ Yes allo
❑ Yes gNo
❑ Yes ErNo
❑ Yes [t(No
❑ Yes KNo
❑ Yes 9No
❑ Yes D<No
❑ Yes W'No
❑ Yes JUNo
❑ Yes ONo
❑ Yes Jp'No
❑ Yes No
❑ Yes No
❑ Yes krNo
Comments (refe'r to question #): Explain any YES answers and/or any recommendations or any, other conrunents..-
Use d•awisgs of facility to better explain situations. (use additional pages as necessary): -
Gi-���-�-�- Z�R � � �co�. G.I�C \1 � c��Q� ?�:-- h•�t,.� w��c����, � J
t�� �£.0 �✓ EGG►-�, . j
1'tCii�•- , �--,� cues, y..� !c-e.�-t`-,t\e� �+- a-1••,��+es C3�'��� ,�.,�- �.�� � �4 ��� __
Reviewer/Inspector Name �G,, �� 9Kj =39S 3 U Q ' x _4�
Reviewer/Inspector Signature: Date: is S `� a 5/00

Fieflity Number: 6 -- Date of Inspection 04 Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
gYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes O No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
ElYes No
roads, building structure, and/or public property)
1
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes b�No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes �Mo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes qNo
5100

0
Lagoon Dike Inspection Report
Name of Farm / Facility
_ Douglas Jordan (Jordan Pig Farm)
67 - 08
Location of Farm / Facility
SR 1434
Owner's Name, Address
Douglas Jordan,
2350 Belgrade Swansboro
Road,
and Telephone Number
Maysville,
NC 28555 910-743-8601
Date of Inspection
9 / 28/ 99
Names of Inspectors Zahid
Khan
Vincent
Lewis
Structural Height, Feet
5-6
Freeboard, Feet
20 Inches
Lagoon Surface Area, Sq. Ft.
29.900
Top Width, Feet
4-5
Upstream Slope, aH:1V
_ 2 to 1
Downstream Slope, aH:Iv
4 to 1 _!
Embankment Sliding?
Yes
X No
( Check One, Describe if Yes)
Seepage? Yes X No
( Check One, Describe if Yes)
Erosion? Yes X No
( Check One, Describe if Yes )
Condition of Q A grass cover
Vegetative Cover
( Grass, Trees )
Did Dike Overtop? Yes X_ No
i
Follow -Up Inspection Needed? Yes X- No
Engineering Study Needed? Yes X_ No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
Yes X No
a

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numb r 6� -
ame: Farm Na (A`� S c<—e
On -Site Representative:
Inspector/Reviewer's Name: sZ
Date of site visit: `0
Date of most recent WUP: �4-
Annual farm PAN deficit: `� pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
5. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by.an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE_
E3 Adequate D, irrigation operating parameter sheet, including map'depicting
wettable acres, is complete and signed by a WUP.
V E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fall the eligibility checklist in Part 11. Complete eligibility
checklist, Part it - F1 F2 F3, before completing computational table in Part III).
PART 11. 75% Rule .Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because. operation fails one of the eligibility
requirements listed -below:
F1 Lack ofacreage_whichTesultedin:over-applicationmfwastewater,(PAN) on:spray.
fields) according#ofarm'sdasttwoyears:of.irrigation-xecords.-.
F2 Unclear, -illegible,- or lack of information/map.
F3 Obvious -field limitations -(numerous flitches;failureio:deductTequired....
buffer/setback zcreage;-or25% ofiotal_acreageddentified:.in-CAWMP=inciudes
small; -irregularly -shaped .fields --fields -less-than-5mcresfor travelers -or.less-than
2 acres for.stationarysprinklers).
F4 WA determination required because CAWMP creditsfield(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number -
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS'
NUMBER
NUMBER'''
IRRIGATION
ACRES
ACRES
%
SYSTEM
a ao I s,sa 3.s Lc
1
FIELD NUMBER' - hvdrant, pull, zone, or.pointnumbers maybe used in place of field numbers depending on CAWMP
and type of irrigation system.- If pulls, etc. cross morethan one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated on map.'
COMMENTS' - back-up fields with CAWMP acieage�exceeding'75% of its total.acres and having received less than 50%
of its annual PAN as documented in the farm's previous -two years' (1997 & 1998) of irrigation Tecords, cannot serve -as the
sole basis -for requiring a WA Determination. ;Back-upfields -must•be noted in the -comment -section and must be accessible
by irrigation system_
Part IV. Pending WA Determinations -
P1 Plan. lacks. following -information:
P2 Plan revision may_satisfy75% rule based on adequate overall PAN deficit -and by
adjusting all field acreage -to below 75% use rate
P3 Other (ielin process of installing new irrigation system)_

[3 Division of Soil and_ Water Conservation , Operation Review -
0 Division of Soil afi Water Conservatior Compliance Inspection
_ 15Division of Water Quality _ ,Compliance.Inspection
O Other Agency R Operation eview
Routine O Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 3(j 24 hr. (hb:mm)
Q Permitted ACertified © Conditionally Certified © Registered [3'Not O erational Date Last Operated:
G��d,�� Count .-.
Farm Name: ............................45�_'-...........! ........!............................... y' ........ k�� G...........................-...- .......................
Owner Name: .............................................
Facility Contact:......................................................
MailingAddress: ...............................................................
Onsite Representative:..v Q
Certified Operator: ...................................................
Location of Farm:
......................................... Phone No:.............-.........
.. Title................................................................. Phone No....................
......................................................................................................... ..........................
Integrator :......e`~`Q
Operator Certification Number: ..........................................
.....................................................................................................................................................................................................................................•--.--...............................
Latitude �� �° ��� Longitude =0 4 =11
Design Current Design Current f Design Current =
Swine
;.. •-
- - Capacity Population Poity ." Capacity ty Po -elation• `Cattle Capacity Population
Wean -
to Feeder Q R� ❑Layer ❑ Dairy
[] Feeder to Finish ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish Total Design Capacity
Gilts(
❑Boars T..otal SS
LW
Number of Lagoons ❑Subsurface Drains Present I[] Lagoon Area JE1Spray Field Area '
Holdiiag Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the Suite? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gaVmin?
❑ Yes gNo
❑ Yes ❑ No
❑ Yes ❑ No
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes NNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CWNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): ...................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc-)
3/23/99 Continued on back

Facility Number: — Data of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
t53�No
(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?
❑ Yes
9No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
OdNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
OdNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
10 No
11. Is there evidence of over appli tion? ❑ Excessive Ponding ❑ PAN
El Yes
4No
I12_ Crop type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�TNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
X No
b) Does the facility need a wettable acre determination?
❑ Yes
O(No
c) This facility is pended for a wettable acre determination?
❑ Yes
b�No
15. Does the receiving crop need improvement?
❑ Yes
()(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[190
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes j<No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes .N No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes t4 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes La
"(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9WNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes WNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 14 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes NrNo
0: io•yiolatiotis:or de#icieucies •were noted• di ing 0.s.visit' • Y;oir wi I. ceive no; further . ; .
corres orinence. a�aut this visit .. - ... ..: _ .... .
Comments (refer:to uestiou # :-'E-tplain any, YES answers and/orrany recommendations:or any &ther. commeints. r
q ) = -
Use.drawings of facility to:betfir explain situati imfuseadditiunal pages.as-necessary} r
�Q{�,-
_ ._
Reviewet/Ins ector Signature: — i Date: 'Z
Reviewer/Inspector Name y���� ? .e,
-5
p g A . �4 !o 9`�
3/23/99

Facility Number: — S Date of Inspection -TT
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes %No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J( No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes N No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 4 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes NrNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes MNo
AAditional. .omihents an or _Dirawrngs;_ F .
5
3/23/99

L - - i
Division of Soil and Water Conservation ❑ Other Agency
:Division of Water Quality
10 Routine O Complaint O Follow-un of DWO inspection O Follow-un of DSWC review O Other
Date of Inspection {1 S
Facility Number
Time of Inspection 3 24 hr. (hh:rnm)
© Registered Pr Certified 0 Applied for Permit 13 Permitted 0 Not O erational 1 Date Last Operated:
Farm Name:..... 1 n County ....... ...... .......................
a ............... .............Pt.�......_r...-.. f .............. ..t.) ~� ............
Owner Name: ............. . , �.�?.D./jAn.).................................. Phone No: 7�%3.4:� 0.................................................
................. .
Facility Contact: Title: ......... LY!�.SfZ- ......................... .......� �,� ...... ......... Phone No:...................................................
.... S.
i n-� I'
Mailing Address:...... ....1 ..4..1. .% ..... ,�9f/!h....... r i:2.....1'ur. .......1 .... 5f(t./�k....................�.................... ..........................
OasiteRep resentative:..J.w..L�-� >sr:Cza.R%........... Integrator:......!`W1Tvi'1...........................................
r
Certified Operator,.....` .......7.,........ ,.�cr�.G.)AA............................................ Operator Certification \umber, .... �.....�s�...._.._.....
Location of Farm:
0
'c
Latitude 0 6 66 Longitude ° "
Design ...,.Current , ,_ Design Current Design Current
Swine
Capacity Population ",'
;Poultry Capacity Population Cattle Capacity. Population
Wean to Feeder
j%
❑Layer
❑ Dairy
r:
Feeder to Finish
❑ Non -Layer
I
JE1
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Desigi[I
❑ Gilts
.Capacity::3.
❑ Boars
Total SSLW'
Number of Lagoons
/ Holding .Pond5
❑ Subsurface Drains Present 110
Lagoon Area I0 Spray Field Area
f
P
❑ \To Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes J'No
2. Is any discharge observed from any part of the operation? ❑ Yes g No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes cbNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes N No
c. If discharge is observed, what is the estimated flow in ,aVmin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes &No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes J4 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ®`No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Pr No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes jo No
7/25/97
Continued on back

4 '
Facility Number:
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes C2�Wo
Structures fLagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KLNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................................................
............................................................................... .
...................................
Freeboard (ft): ..........t.....................................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
,1 No
Waste application
14.
Is there physical evidence of over application?
❑ Yes
9NO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
t 5.
Crop type .. ....................P �.. .................................................... �.
e
..................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
J;a No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
PNo
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
A No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
4 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Ryes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
AN'o
0° No.violatio'ns-or. deficiencies.we're-noted-during this:v_ isit'.- You;W'ill 're'eei'Ve•iro,ftirilier :
:: corresponde><lce. about :: : ;
Commettts(refer`to questot3 # k'Fxplfa any YES answer and/or anytimmendatronEs orany other cgmEncts 1
U�d�ra�r�ng� 1',faciWtya 1&e,�tter explaut sltua��ions (use addths�nal�pages as necessary} � ` a; ����„ ��.� �
,�i� •',
A.2ez ' atO-�cc...�. Cvrr►ti , I g r� S�•5 _ i
7/25/97
Reviewer/Inspector Name 6
WP W
Reviewer/Inspector Signature: Date: Z

Routine 0 Complaint 0 Follow-up of DWQ ins2ection 0 Follow-up of DSWC review 0 Other
Date of Inspection Z3
Facility Number 41
I I Time of Inspection Use 24 hr. time
Farm Status-' (f f P,7— —
Total Time (in hours) Spent onReiew
or Inspection (includes travel and processing)
Farm Name: . Ax) g_-t-m 167 County,
Owner Name:. :Da iZ &_&l
Phone No L
-73
Mailing Address: yV-'4-(4!5_iJ(4
Onsite Representative: DO-0 :fQ G>_ Integrator:
Certified Operator- __ �O_ — -?_r-v::% 6) Operator Certification Number:
Location of Farm:
Latitude Longitude
❑ Not 02crational Date Last Operated:
-pe of Operation and Design Capacity
'uerg
Wean Feeder
,Cattle
to
Laver v =Daii
0 Feeder to Finish
IQ Non -Laver 10 Beef
Farrow to Wean
2N,
'g�
Farrow to Feeder
Z -
Farrow to Finish
Other Type of L ivek
stoc
10 Subsurface Drains
M.—
U
Present
inamitm
FEI Lagoon _Area :
Spray Field
'�$
General
1. Are there any buffes that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Is there evidence of past discharge from any part of the operation?
4. Was there anv adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
n-mintenance—limprovemcrit'?
El Yes ErNo
0 Yes mlNo
0 Yes B/No
El Yes [B"No,
El Yes
01,10
D Yes
[3N0
[3 yes
[�To
El Yes
9No

6. Is facility not in compliance with imy applicable setback criteria?
❑ Yes
Qfb -
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
❑ Yes
[Rfq '
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
ERNo
Structures (Laeoons and/or Aoldina Ponds)
9. Is structural freeboard less than adequate?
El Yes
�
R o
Freeboard (ft): Lagoon 1 Lagoon 2 La_oon 3
Lagoon 4
z.3
10. Is seepage observed from any of the structures?
❑ Yes
["�to
11. Is erosion, or any other threats to the integrity of any of the structures observed?
BKes
E04o
12. Do any of the structures need maintenancelimprovement?
❑ Yes
@"TRo
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13'. Do any of the structuues lack adquate'markers to identify start and stop pumping levels?
❑ Yes
9-1�0
NVaste ASplication
14. Is there physical evidence of over application?
❑ Yes
EKo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15: Crop type �Z $G Gc 7E)_° %
16. Do the active crops differ with those designated in the Animal Waste Management PIan?
❑ Yes
Bl To
17. Does the facility have a Iack of adequate acreage for land application?.
❑ Yes
&NO
18. Does the cover crop need improvement?
❑ Yes
[moo
19. Is there a lack of available irrigation equipment?
❑ Yes
D�,Io
For Certified Facilities Onlv-
`-
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
El Yes
//
B o
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
Efiq o
22. Does record keeping need improvement?
❑ Yes
[O`o
23. Does facility require a follow-up visit by same agency?
❑ Yes
B<o
24. Did ReviewerfInspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes
B'<o
GoQiments (refer to question � 1;z�iIaui an.� YES answets:andforany recommeadaitons t>r. any Qtfier comments �:: �; -� r :
LisedraRuigseffacfitt�io�hettereaplam.:situations: useadm�tonal�agesasnecessa�), ,��, ,��.� ,��,,,� �.-.
fryytL /M .r10& Z?6'51i /1
a
Reviewer/Inspector Name"
Reviwer/Enspector Signature: 4 Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Douglas Jordan
Jordans Pig Farm
2350 Belgrade Swansboro Rd
Maysville NC 28555
SUBJECT: Operator In Charge Designation
Facility: Jordans Pig Farm
Facility ID#: 67-8
Onslow County
Dear Mr. Jordan:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919n33-0026.
Sincerely
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.Q. Box 27687, ��
Raleigh, North Carolina 2761 1-7687 C An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50°,6 recycled/10% post -consumer paper

DIVISION
AMMAL F EDI
Farm Name/Owner: cJDs?!>, 1,j
Mailing Address: r'- 3 54
County: d2NSLO& s
Integrator, NO u AL, r -- -
On Site Representative: oL n2
Physical AddressfLocation:�
Type of Operation: Swine _r
Design Capacity:'
DEM Certification Number: ACE,
Latitude: 3 � - 5c, ' 33• 30-
Does the Animal Waste Lagoon h;
(approximately 1 Foot + 7 inches)
Was any seepage observed from tt
• Is adequate land available for spra
Crop(s) being utilized::ex
Does the facility meet SCS minim
Is the animal waste stockpiled wid
Is animal wasteland applied or spi
Is animal waste discharged into w;
similar man-made devices? Y
Does the facility maintain ade
spray irrigated on specific
Additional Con=ents:
Inspector Name
cc: Facility Assessment Unit
900 ' 39UJ
/VCR
Site Requires Immediate Attention:
Facility No. %r
ENVIRONMENTAL MANAGEMENT
OPERATIONS SITE VISITATION RECORD
ATE: 1995
Time: l/r '7l
. rt'Vrn rr jw "n
Phone:
Phone: 9 r 0 7 3 y e(o of
r{ g a e"PP ro x- 1
1 rn r /,� '
a rv► ' / 4 310 Y1 i.r J5 rr ry r
Poultry — Cattle
�. Number of Animals on Site: /:7 z� C
DEM Certification Number: ACNEW
Longitude: 7.-7 ' / -Z ` 5Z " Elevation: 96 Feet
Circle Yes or No
e sufficient freeboard of I Foot + 25 year 24 hour storm event
5esr No Actual Freeboard: Ft. Inches
lagoon(s)? Yes or No Was any erosion observed? Yes or No
(�r No Is the cover crop adequate? 7i'es w No
n setback criteria"? 200 Fect from DwellinQs�Yeor _No
100 Feet from W010r No
n 100 Feet of USGS Blue Litre Stream? Yes or(�dD
y irrigated within 25 Feet of a USGS Map Blue Line? Yes o��
trs of the state by man-made ditch, flushing system, or other
oElp If Yes, Please Explain.
waste management records (volumes of manure, land applied,
ge with cover crop)? Yes
Signature
Use Attachments if Needed.
DN 31-1I0NOSADHr UH3 WO'J3 82:2I 96: C nLi

OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 '95 18:06 P.10/18
Site Requires Immediate Attention Ni
Facility Number: � 7` S
SITE VISITATION RECORD
DATE: 7�c !_�, 1995'~
Owner -
County: s , TG rc.(�.rt� _.. Farm Name: a r e -.41 /"r ..L d r n
1v5Cll W_
Agent Visiting Site: NkC -Phone: lU 91-55-ZL
-
Operator: Phone: A) 7� 3 -j ,,K
On Site Represen alive: _ Phone:
Physical Address: _ _ S # / � 3 41 _ 9_7 _...tea i A[ - 1r� V l =
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: {'C,�O _ Number of Animals on Site: �� / �e��.l�� _y'Tr-��
Latitude: a Longitude: Q it
Type of Inspection: Ground- Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot +$ inchesy:YiD or No Actual Freeboard: &_ Feet - y Inches
For facilities with marc than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes ogfDwas there erosion of the dam?: Yes orEO
Is adequate land available for land application? r No Is'the cover crop adequate? es r No
Additional Comments:
Fax to [phone]
Signafure of Agenf/