670014_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Or7Routine
iance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0Complaint O Follow-up O Referral O Emergency O Other Denied Access
Date of Visit: Arrival Time: SD Departure Time: 3A County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
I o
Onsite Representative: A 1 r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: j SS 4-2
Certification Number:
Longitude:
Design Current
Swore Capacity Pop. Wet Poultry
Wean to Finish Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
to Feeder
Non -La er
I
E]
Dairy Calf
eederto Finish G 7Z 13
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult .
Lavers
Design Gwent
Ca aci PLO
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Lavers
Boars
Pullets
Beef Brood Cow
Turkeys
tither Turkey Poults
Other 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
0 Yes._ Jo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No E] NA ❑ NE
❑ Yes [�]'Now❑ NA ❑ NE
❑Yes [�❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: - Date of Ins ection: QZ 1 32 1/1
Waste Collection & Treatment
4. Isf`torage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CkIo ❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
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 properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ETNo ❑ 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes El"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Zo
❑ 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 E] 1'�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E3No
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes fo
❑ 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 E3<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ' ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable El Yes No [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L!J "' 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 dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Io ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: -I L41Date of Inspection:
r
24, Did the'facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
nNo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ 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
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo 0 NA
❑ NE
ICornments (refer to;question' #; Explain aay. YES answers -and/or any additional recommendations ar.any othir commeiits.; 'r
's�of
tJsei rawin facil> to better,explain srtpations use, additional pa es as: necessa :
Reviewer/Inspector Name: � J ' r � A
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 710 7 ?,K 7 -boy
Date:
o /3 -117
214,12015

Type of Visit: (0 Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number: 2E�
T � A .3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Prop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry P,oultr,
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �/No
NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ectiom:& jr7
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ffNo
❑ NA
❑ NE
Y
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoD
❑ 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
E 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 environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F2<()
❑ 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
U40
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rio ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I No ❑ NA
IE-11o
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Q ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a] No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ 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 �o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection- 01/
24. Did the facility fail to calibrate waste application equipment as required by the perm ? ❑Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
2 No ❑ NA
❑ NE
, permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the faciiity? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ YesFNNo
❑ NA
❑ 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 any.otber comments..
Use drawings of f tcHity.to better explain situations (use.additionat pages as: necessary)-
Reviewerllnspector Name:
Reviewer/Inspector Signa
Page 3 of 3
dCW Phonq Ip
tore: Date: c
h -7&
2141201

Type of Visit: U Com ante Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: 1, Arrival Time: i r'J Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _ ('' a 4 ke " C Py Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle C►apacity Pop.t
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
(r 7 Z 3 b
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oultr,
Ca aci_
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream IMDaCts
1. Is any discharge observed from any part of the operation?
[] Yes
[2-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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
E—No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [5No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

1
dFaciWy Number: jDate of Ins ection: qr,O
/ jy
Waste Cotlection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ej'_N o
❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C:I'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
[/] N
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes EJ�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 ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EfNo
❑ 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
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E:rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ 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
❑rNo
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
ONE
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

�rFacili Number: ("1 - I t( Date of Ins ection:
3 4 r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
o
❑ 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
C] No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
❑ No
F1 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 the 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 ]�No ❑ NA ❑ NE
❑ Yes ["No ❑ NA ❑ WE
❑ Yes [nNo ❑ NA ❑ NE
❑ Yes [5'No [] NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes F3< ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: ✓(� (o
Reviewer/Inspector Signature: ��----��x✓'�
Page 3 of 3
Phone: 1 q ? r G 7 3Oy
Date: �/ 3 yzc-
214,2015

(Type of Visit: p Compliance Inspection V Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit:_ _fC„_J(R_o_u_tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access _
Date of Visit:y c Arrival Time: Departure Time: County: QA.i_,S(_p Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: MATrR&W (?,31L Integrator: p
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish a er
Design Current
Capacity Pop.
sign Current
Cattleacity Pap.
�Ma
DairyCow
Wean to FeederF
IlNon-Layer
DairyCalf
Feeder to Finish
61)1
3
Dai Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
Dry P,OnIt .
Layers
C►_a aci P,o ,
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
F—Fo—ther
Other
keys
Turkey Foults
Other
—
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
[—]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 E55No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?;�(No
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection: 3fit) I jig
Waste Cdllection & 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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U%brCj
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? ❑ YesVNo
o ❑ 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 To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No [DNA ❑ 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 l0 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
Io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q o
❑ NA
❑ NE
Required Records & Documents
N
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? 1f yes, check
❑ Yes
WNo
❑ 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 n No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E(No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Faci!q Number: - Date of Inspection: p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j(No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EJNo ❑ 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
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 UTo
❑ Yes EfNo
❑ Yes
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑NA ❑NE
❑NA ONE
�No
❑ NA
❑ NE
❑ No
❑ NA
❑ NE
No
❑ NA
❑ NE
N
g
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or, any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��
Date: j�-f
2/4 011

Type of Visit: (Z) Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: doutine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Z,S Arrival Time: $ S Departure Time: Q S County: �0 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �i A'Tf H lv--(j CQx— Integrator:
Certified Operator: Certification Number: 94 p J
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Desigu CurrentWN
Iiiiiiiiiiiiipitesign
Current
Swine
Capaclty
Pop.
Wet Poultry Capacity Pop.
Cattle
Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design C►urrent
Dry Cow
Farrow to Feeder
D P,oul Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
L
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes O/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes WNo
o ❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: Z;'129911
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: I AGCOO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3,R
Structure 2 Structure 3 Structure 4
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 properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
EYes 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 environmental threat, 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
❑ 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
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
U40
❑ 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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2<o
❑ 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
❑ YesgNo
❑ 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
[DNA
❑ 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
d
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412011 CondAued

acili Number: Date of Inspection: j Z4
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 040 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 2❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �7o❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations, or,any:other comments
Usedrawings of facility to better explain situations (use additional pages as,necessar3).4y.:'
❑ Yes
<o
❑ NA
❑ NE
[:]Yes
<o
❑ NA
❑ NE
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes [fNo ❑ NA ❑ NE
Reviewer/Inspector Name:
[]Yes C3"No ❑NA ❑NE
[—]Yes No ❑ NA ❑ NE
-79
101
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 . 214/2011

r!d
Type of Visit: (3 Co liance Inspection U Operation Review Q 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: Z Arrival Time: Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
OnsiteRepresentative: Imo] -IC-0 C4K_ Integrator:
Certified Operator:
Phone:
Certification Number: 12 55 F3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry C*apacity Pop.
Finish La er
Design Current
C*attle Capacity Pop.
DairyCow
Feeder
Non -Layer
Dai Calf
o Finish
Design C*urrept
D . P,ault . Ca aci P,o
La ers
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
o Wean
F,Farrowo Feeder
o Finish
Non -La ers
Pullets
Beef Feeder
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (galions)?
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 No ❑ NA ❑ NE
[:]Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes FNo
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

F I
Fecifi Number: - Date of Inspection:
7—
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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j1j7No ❑ 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 ❑ Yeso ❑ NA ❑ NE
waste management or closure plan? ...�JTTTTT"
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
❑ NA
TT
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
—j/QO
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
"I"9.
Does any part of the waste management system other than the waste structures require
[3 Yes
PIKO ❑ NA
❑ NE
maintenance or improvement?
7
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EjN/o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
54o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 �Zo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El 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 � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes - �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ONo ❑ 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
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 C1440
❑ Yes I_J No
❑ Yes O/NNo
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments .r,
Use drawings of -facility to better explain situations (use additional pages as necessary). "
�C-�t w4i� +�c QucS�'b� rv� z oll JLJLVR��C MKI 06Ak. Tj1W A _S.
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone:& ! 6 —2 J SQ
Date: _; 1'942-,
era orr

Type of Visit: 0 Co Hance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: #[E]
i Arrival Time: Departure Time: County: _dtiS�&j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: M ! 214GQ COX— _ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine C+apacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
.,4 o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , P.oult
Design Current
Ca acity P.o ,
Da Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
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?
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?
Page I of 3
Yes [�No NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N,❑ NA ❑ NE
❑ Yes ilJ o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412011 Continue

[Facility - Date of Ins ection: t
Waite 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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: lr
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in):C
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 0 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
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L 1 o ❑ 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 ApOication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes [;2/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box
below. [:]Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZIo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �Noo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes I rJ N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L,d l 0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ es IT ❑ NA ❑ NE
20. Does the facility fa to have all components of the CAWMP readily available? If yes, check . Yes [ No ❑ NA ❑ NE
the appropriate b
WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements do 'r:
21. Does record keeping need improvement? If yes, check the appropriate box bel . lJ '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 I" Rainfall Inspecti��Co
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili ': umber: Date of Inspection: 11
24 `Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
o [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
WNo ❑ 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
Eo 0 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
0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
f
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[2/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 I__I 11 ❑ 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 F3<o ❑ NA ❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.=_ -2r'-2.
Use drawings of facility to better explain situations (use additional pages as necessary). r `�
tj,) UV%ATG woe I,smi(4 OW dw�1r I-. GAT 6eY ti( CAAoC E 6wpCOS IW fkopn
tt P w Q , C AA►)c-6 n c dscr ?Apce�woax 06CM r gE &IJ6 ,
11) L,0 (,AT-C Z.o i o S 61,L AN ACAk6ZS .
Reviewer/Inspector Name:y N wJ
Reviewer/Inspector Signature:
Page 3 of 3
c op4l Ta
Phone: M D)-M —1
Date: LC4 1
21412011

11
0
Type of Visit (?fCoynpliance Inspection Operation Review Structure Evaluation 0 Technical Assistance I
Reason for Visit � 7ftutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: i_`.t_i t�J Arrival Time: b 3o Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 2=.,WAPLb 8 &9 W,J
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =]' =' =" Longitude: = ° =' = "
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream I_mpacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 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
2 N
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
tJ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

i' Facility Number: I ty _ {p'+? � � � Date of Inspection
1
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:LA&6esoJ _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4Z
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 ❑ No ❑ NA ❑ NE
❑ Yes 2f/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 Q No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 IJ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IJ 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
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
[!] No
❑ NA
❑ NE
NA
❑ NE
7❑
o
❑ NA
❑ NE
❑ NA
❑ NE
2'
❑ NA
❑ NE
Comments (refer to. question #E): Explain any YES answers and/or any rec`ammendations ar "any other comments
�.. _. . .
Use drawings offacility to better explain situations.,(use.additional�pages as:necessary)
AL
Reviewer/Inspector Name UPhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12128104 Continued

i
Facility Number: (01 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 No ❑ 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
EdNo
❑ 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
WN o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
dWN
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D o
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
o
❑ 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
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No ❑ 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
L✓J 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
ElYes
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
ffNo ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N�o ❑ NA
❑ NE
Additional' Comments and/or Drawings:
Page 3 of 3 12128104

iType of Visit Co�liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVisit (VRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: L4
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: Region: _
Facility Contact: q Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' [� Longitude: = ° =' = u
IN 111spi
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultr+}' Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish
(o 6D
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -La ers
El Beef Stocker
El Gilts
El Beef Feeder
El Boars
❑Pullets
El Beef Brood Co
-
❑ Turke s
Other
❑ Turkey Poults
❑ Other
I
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
U 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
NA
[INE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
rN
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Ld'No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

h
Facility Number: — Date of Inspection 'S o
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: LAkaz
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 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 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 Ll 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 Ci No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
d o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
WN o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C�l o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
1CJ No
❑ NA
❑ NE
a Comments (refer t ques'tton'#) Ems►lain anyYES answersancllor any �ecomtnenda ions oany other comments: '" i� �'
"Use�'drawuigs of facility to better explain s�tuahons: (use•addihonal pages as necessary)E: ��" "�` � � -,.. ''
Reviewer/Inspector Name Phone: - i3$6
Reviewer/Inspector Signature: Date: 3 3
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Cl Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E' No ❑ NA ❑ NE
the appropirate box. ❑ WGP ❑ Checklists ❑ Design
g ❑ 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 ❑ 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 in ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � o El NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes Zo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Wo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes PNNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElLd Yes
,0"No
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
U�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
ENo
❑ 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
C�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZ/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

n
IType of Visit Qf Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: r County: 0a.S1.4 ' Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 2 _ Title:
Onsite Representative: Rrt CAI AV-D _1J�-YA1� Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 0 Longitude: 0 ° = I = 11
Design
Current
Design
Current
Design Current
Swine Capacity
Population
Wet Poultry
Capacity
Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
El Calf
® Feeder to Finish '�
El Dairy Heifer
El Farrow to Wean
Dry Poultry
[ID Cow
El Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures
❑ Other
❑ Other
Discharges & 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 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Zo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

.F
F9cility 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 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Vrl
Structure 3 Structure 4
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 E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes O No ❑ NA ❑ NE
❑ Yes I d No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo
No [INA [3NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ 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/J 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/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 240 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
t6. 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
ONo ❑ NA ❑ NE
dNo ❑ NA ❑ NE
�No ❑ NA ❑ NE
7No
❑NA ❑NE
❑ NA ❑ NE
.e.a y. 5�.�t'Q.—+v-y.i
Comments,{refer toqueshon-1�#) �xla�n gny Ys�answei s aztd/or anyrecommendations or• ariy other comments.
.�i:
drawEngs of faciltty to better�ezplam situahons (use addiittonal pages"as necessary.).A
e) Coe of "L 0 a.£r'- -To OL.)
Reviewer/Inspector Name r— — J �^ LV\/
Phon VQ '7Q
Reviewer/Inspector Signature:
Date: (.7 - / q
Page 2 of 3 1 12128104 Continued

cility Number: (0— Date of Inspection l� u
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 dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑Ma s Design
g p El 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 ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
ElYes
3No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3"IN
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? 3'Yes ❑ 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
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
VNo
❑ 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑
El NA
[:3 NE
General Permit? (ie/ discharge, freeboard problems, over application)
W
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional.Com""meets. and/or Drawmgs _
Page 3 of 3 12128104

7 Division of Water Quality
Facility Number b'1 1y O Division of Soil and Water Conservation
- O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 750 Departure Time: County: JfQSUOPI� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: IZX(, R BOAd
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 0 ' 0 « Longitude: = ° = ' 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Lamer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Imoacts
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 Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: �' I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Ion❑
NA
El NE
El Yes
D-N`o ❑ NA
❑ NE
12128104 Condritted

Facility Number: 1l Date of inspection 3 1 a 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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: LAGooe,
Spillway?:
Designed Freeboard (in): 7-h
Observed Freeboard (in): Z 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ 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? El Yes
� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L9 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
Q'Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�.�
L�J No ❑ NA ❑ NE
maintenance/improvement?
H . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1 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 Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
E I Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
QXo
❑ 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
[;kNo
❑ 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):
P Gam/ L►JUP 000c, e A'6VX6US
Reviewer/Inspector Name �4 Fjk -QN L A-- _ Phone: — 3
Reviewer/Inspector Signature: Date: 31 1.5� d

Facility Number: Date of Inspection I!
r" Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
N
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El 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
❑ 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
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
0o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
12o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
d/io
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
❑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
2f/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
EJ'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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

CA Vacility Number
i
Division of Water Quality /
0 Division of Soil and Water Conservation ✓
0 Other Agency;
Type of Visit Cgmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1 S O Arrival Time: ® Departure Time: County: O1uSLA I- Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish ') ';i_
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -- ---
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = { Longitude: = ° ='
= "
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
Cattle =°` Capacity 'P
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures._, �y
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 dN, ❑ NA ❑ NE
❑ Yes ��No ❑ NA ❑ NE
12128104 Continued

Facility Number: J f — � �i Date of Inspection
- j-
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA[x-eFR'fj
Spillway?:
Designed Freeboard (in): 1110
Observed Freeboard (in): X19
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
VNo
❑ 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
ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
LI[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
do No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IQ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) A s► r�-�tvZ �.�s�6 jJ
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?
Oyes
El No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z No
[__1 NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2"No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L],l�o
❑ NA ❑ NE
Comments (refer to question ft 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):
IS•) �SEt.A $ K4-62Us2ES 2.5 T+Ns 6 r 1✓Ln4E . Pf& I-fbeJ T.�C2�ME�IIS
2,6,E a6eo To gl%,f4 WL*V UPOATED froe- AL4_'F4_kL,0j NarJ ZJ 13&tWtV0A LG�
2E sC�1+~ c..2�St Nd La Alt,-E2 vSED.
Pr4'%6Q,,.S jpo6=a, Re a v ( -r AL.L AAA -r (ANN►�4 L C6R� ; SwOt� Sr�Vc ; Ett �
Reviewer/Inspector Name }; Jr., � I Phone: (qJ 0) -7 i(o ]1(o J f
Reviewer/Inspector Signature: de., Date:
Page 2 of 3 12128104 Continued

FaFility Number: b-) — iLj Date of Inspection S
Required Records & Documents �
9. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes BN' o ❑ NA ❑ NE
20. Does the facility fail to have a components of the CAWMP readily available? If yes, check yes ❑ No ❑ NA ❑ NE
the appropriate box. L{ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
allo
❑ 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
dpo
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�YN o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LdNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
120�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
El2
,❑,,''No
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
0 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
E<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
2No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 7Routine
pliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S" S v S Arrival Time: Departure Time: County: _wvSLe jn/ Region:
Farm Name: _ Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: -_ C
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= 1 ❑ « Longitude: = ° = d
DegnW
Current
Design Current
VIVO
Design Current
Swtne Capacity
Popes on
Wi Poultry' '"Capacity` Population
Cattle
Capacity Population
❑ canto Finish
❑ Layer
❑ Dai ry Cow
❑ canto Feeder
❑ Non -Layer
❑ Dai Calf
® Feeder to Finish
0.
2.
❑ Daig Heifei
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VfNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
Cl 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
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E/No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection v 5
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 l Structure 2 Structure 3 Structure 4
Identifier: M 1D,) N l
Spillway?:
Designed Freeboard (in): 2.0
Observed Freeboard (in): 3)
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 GI/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dxo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltheat, notify DWQ
El7. 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
[�'&o
❑ 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
o
ElNA ❑ NE
maintenance or improvement?
91,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�,/
ld No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
O No
❑ NA ❑ NE
❑ 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 Windd Drift
[IApplication Outside of Area
12. Crop type(s) 13E(LVv%)()A SGO I�.(cjCUE
CaAksS
`CG')
13. Soil type(s) AA L%1, o6r\
t'1�ll l�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[!(No
.
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LrlKo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
El NA El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA ❑ NE
21.1 aECD T° (_tt , ovr ArJNUA L CC all (T GATS-or1 AQO sCNb XoJ Aw06- w:4A
�u)D&e WfL46 j ( kcLp coeY wrxg ZE.Gon-o.S) 5t4oL4D 14AdE gEEPJ 04n1£ 63y
MAaICIA Ise, 2oor% ConrT,tPU( To (ZC--core Kl�, fLkCgoA" GALA, VS
Reviewer/Inspector Name Phone: �9�D���jf��60��7.�
Reviewer/Inspector Signature: Date: Uy
i7n.eina 9!'n"finl od

Facility Number: -- j Date of Inspection S a S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes U"NNo ❑ NA ❑ NE
❑ Yes L2 o ❑ NA ❑ NE
21.
rovement? If yes, check the appropriate box below.
Does record keeping neeYweekly
Yes
Li No
Li NA
❑ NE
❑ Waste Application Freeboard ElWaste Analysis ❑ Soil Analysis ElWaste Transfers
B'Annual Certification
❑ Rainfall dstocking ❑ 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
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Zo
3
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
do
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
7o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LdNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
G? No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EK
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Xo
❑ 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
/
2 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
eNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,,_,/
L7No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
Addtioniil Comments and/or Drawings a_��
12128/04

r.
Dmmon of Water Quality - t
{
t � s _ O fh ision:of Soli and Water Conservation
O Other Agency _
x
q _ it
E
Visit Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit Routine O Complaint O Follow up O Emergency [Notification O Other ❑ Denied Access
Facility Number f Date of Visit: ime:
O Not O rationM O Below Threshold
Permitted © Certified © Condition�allyy Certified Q Registered Date Last Operate or Above Threshold: ........_. ..............
4. ................, �1 ✓ Conn
Farm Name: .. - . l� "` ...._ ............_................. County: ,1✓ -.......................................................
OwnerName: _ Phone No: ,
Mailing Address: .......... . ......................... ..
Facility Contact: Title:.._.... Phone No: _. ---......
Onsite Representative: •-'1>!Q-- .. �C1�L1....................... Integrator:.
Certified Operator: -- ................................. .............•-----............. ................ ...... ............ ..... Operator Certification Number:.....:....................................
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude
t Design Curi^ent °� Design Current
s
Swine : Ca' a -:Po Matron P,ouliry� Capacity ,Popalatioi
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
rJE1 N
+C
>�6m
Longitude • ' "
Design y r Current
the ,r -- 'Capacxtv.-:Population:
] Noi
.77
Discharges & Stream Imaacts
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 gaUmin?
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 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes RoNo
❑ Yes )zNo
[:]Yes JOINo
Structure 6
Identifier: _..-- ....................... .
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes P'No
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?
❑ Yes W(No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes ;�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
/
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ YesNo
❑ Excessive Ponding ❑ PAN Hydrauli Overload ❑ Frozen Ground Copper d/or Zinc
12. Crop type
13. Do the receiving crops differ with those designs in the Certified Animal Waste Managem nt Plan (CAWMP)?
❑ Yes JO 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
15. Does the receiving crop need improvement?
❑ Yes JWNO
I6. Is there a lack of adequate waste application equipment?
❑ Yes ZNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes JXNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 9No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes O No
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
❑ Yes eNo
Air Quality representative immediately.
Conxmeuts refer tv to uesteon # laea an AYES answers andlor an recomrseadatons or as other comments.
r pa:stuations�{Lpages as necessary):. ❑ ❑Final NotesUsedawuue Feld COPY
_
5a,z, leePok, 51A94v64 7Ar U-14s
n1,�6a'Cd F'f 5 ' �� li i lac
1.2 /PIC
--� Z, v : A
.35),IJ,rFa fir
49 11104We4 O ZXde-2 ✓E'
owe€2- 4
Reviewer/Inspector Name s - Z a 4
ReviewerAnspector Signature: Date: .
lL/11L/D3 W-ununaeu

Facility Number: — Date of Inspection
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?
Oe/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
NPDES Permitted Facilities
❑ Yes XNo
❑ Yes VNo
❑ Yes JKNo
❑ Yes A No
❑ Yes E�No
[:]Yes WNo
❑ Yes RrNo
❑ Yes fi!rNo
❑ Yes ❑ No
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ONo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ONo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Oyes ❑ No
Ottocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After l" Rain
01,120 Minute Inspections ❑ Annual Certification Form
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.:._
ddat�onal Comments;and/or Drawings > <' �.. �=- -� s �:
m�
� �U�-s�f if�✓.q� �szs,
�r/,�eyTi�ln /C 1N D�D�R�,�f}/f2s��,Os /��71�//�E2�`p
.�� �vo,p SN�gPf_, li(//g'yC� (�DK1 G�/vc-�5 r02 C.C�,gS� �"esV•aZ.�C
Zo
mac_ O /¢ff�-U $T �5 LOi✓��� �"0�� J7"�-Gat-c�5_
12112103

Type of Visit 'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Ja koutine 0 Complaint 0 Fallow up 0 Emergency hlotificaiion 0 Other ❑ Denied Access
Facility Number Date of Visit: A Time:rO 1 04
Not O erational Below Threshold
0 Permitted 0 Ce�rrttified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: r- ^ ' L` c v �` County: liorl-V I w
Owner Name: R �+-...,r k �'' `') �''� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: c t.zo-.iQ_ 13 hA ii
Certified Operator:
Location of Farm:
Phone No:
Integrator: GQ k °' - Ill' e
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 C " Longitude a <
Design Current
aci P,o uiation
Feeder
Design Current Design Current
Poultry Ca aci P.o ulation Cattle Ca acP.o ulation
❑ La er ❑ airy Io
Finish
❑Non -La er
❑ Non-Dairyto
Weanto
17-
Total Design CapaciTotal SS
Feederto Finish
Number of Lagoons
Holding Ponds / Solid Traps
❑Subsurface Drains Present
_10Ga
❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ,Ej'No
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) ❑ 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,,dNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes�No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3 Z-
05/03/01 Continued

Facility Number. 07 —
Date of Inspection B 3
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 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?
I I. Is there evidence of over application'??? El Excessive P�o+nding ❑ PAN ❑ Hydraulic Overload
12. Crop type —Ise � >'� ✓ /('i R ,;, vl , -Sy"*� / � (, r a s "t . Ile 5L u R ri ✓ Gi, 53 �a1 J� d r?
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?
Regyired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other 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?
❑ Yes"JONo
❑ Yes PNo
❑ Yes IdNo
❑ Yes J'No
❑ Yes gNo
❑ Yes No
ElYes �'No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes .No
❑ Yes VrNo
❑ Yes Po
❑ Yes P'No
❑ Yes ONo
ElYes Na
ElYes I
❑ Yes �FNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes X1No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 'PrNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _2'No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
!.S vJ e
%�ce j4 } • ��Q I Gt r� Oh S Well
✓�lA ; n o, a Yte a� 7"� �i'P C a R �G�
re v e t A n A 7�1< koksdea r� c� i� (,,, c1 l a ►1 c� Pd
A f 4I-te c ohs a �-.d� �; e (d ire L,/e 11�,�'.,
tJeaklj i'r¢G?6ca,-A recorA-P, JG oAr �atc -Ante Yo,4,'Q4
05103101 Continued

Faciliq, Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 .FrNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O'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 It—T�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 J20No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes .2TN0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
05103101

Type of Visit Ocompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine 0 ComplaintFollow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit:
❑ Permitted 0 Certified O Conditionally Certified ❑ Registered
Farm Name: �r ' 1 '1 ' S Eel co--)
Owner Name:
Mailing Address:
Time:
Date Last Operated or Above Threshold:
Countv:
Phone No:
Facility Contact: Title: yPhone No:
Onsite Representative: �� ClL rQ( 8✓ �T'1 Integrator: _)171.-!Z 1. 1
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • 0" Longitude 0` 0 0"
Design
'_Current : = = :.:Design.. -Current :Design ..Coireut _
Swine _. eCa aciri
: Po ulatioii Poultry 'Ga achy L Pd ulation - . Cattie m . �a achy Pa ulstioit
❑ Wean to Feeder
', '
❑ Layer
❑ Da'
4
❑ Feeder to Finish
❑Non -Laver
_
',.
❑Non -Dairy
+
❑ Farrow to Wean
_�. =
[] Farrow to Feeder
❑ Other I I-
-
❑ Farrow to Finish
Total Uesign Capacity
❑ Gilts
_
❑ Boars
= Total SSL _
.•Numbtrof Lagoons. - _
l�+ W. Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds;! Sohd=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 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): S
0510310.7
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

t!
Facility Number: 6 —
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 maintenance/improvement?
9. Do any smctures 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 evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
I4. 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
15. Does the receiving crop need improvement?
❑ Yes
❑ 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 or other Permit readily available?
❑ Yes
❑ No
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
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes _ONO
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?
❑ Yes
❑ No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) .Explatn anv YFS ansrcers and/vr.'sn)reconuttestdadons or auv:other_eomments. --
_.. _ _
Use; drawings of-facr tty to:better expiarn situations: (nse additional pages as necessary) Conn Final Notes ❑ Field
T -7-6e l®r�oo�, will 4c,s been mowed ana( g11,Psys
T$8. Mr. B �a"� 4'.15 -A plate �o r�''��4II F}11✓9 lks dq r -fe"S -��ct4
1601k 40 le,?k:'•. j . Th:.s .s2e ai 5- -,,AC' a wta y
p9 eets e e v41 u 4- 4 c -these wleA s v ref f d e nsvr4e 4L,e -y a r e
Reviewer/Inspector Name =� orleU/Gj )' : f S / CIS .S"t.-✓�
Reviewer/Inspector Signature: Date:
05103101 Continued

,I
Facility number: Date of lnspectinri
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30_ Were any major maintenance problems with the ventilation fan(s) noted? (Le, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31 _ Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Add itional.Corn ments.and/or Drawings:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:)No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Ins A m q�p Ores ,' 9 n ei.4 i hs A*e af.' Ere —e►14
Spp�� Zo►'��s q'tG` `��P,�- �'e,�eG�,'Le �c�'c�occ,�s • . S""I
,s "aW vs;y.9 �P ��jorO fv.�,'�¢e aceec� P �jo, eac1n
zO V} e OP? 7 4 e �2�� �S
►'n , F, y a , /-) a 5 6 e e" p "'mac G-l; ,.,P )-Al Y& svJ V ; �15 411
na�� ;n �l,e �1�.� may, zaoz �'�s�ec-}�Q�-,• the e�Fa�-f-�
a�Q a! ` rQGr•��,
05103101

Type of Visit ZCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit �O Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: S Z 02- Time: ) Z = 57
rO 1
Not Operational 0 Below Threshold
Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: LcG b County: rt 11" L...l
Owner Name: �' r� B rT� Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: �' G�C1� �`r �''� Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' ° OK Longitude 0' 06 0�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes _EYNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes Cl No
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 2
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes 9No
Structure 6
Continued

C\
Facility Number: 7 LtDate of Inspection Z 2
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes &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? ZYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ElNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 12'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type Ree," vd G S v+/G li Ove-seed,vG
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ZYes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ' "No
16. Is there a lack of adequate waste application equipment? ❑ Yes 'ONO
Required Regis&Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ",ffNo
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 ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) )�Kes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes J21N0
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 12mo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �No
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? -FeYes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
34b , Sa.N►e o -11,e sot;d50 S�r;nkkrs Afpeq_- 4o Imll wr,54e, peYh4Ps
4k:5 is OGGt✓rJ IIVA) ti✓l,evi s'I/s-�ey-, )*S no---r%,417 �✓L'SJ v✓; _P�
e �ricr 1
7R h� ClFfi3✓ �UI� �O!✓eJS v✓ �7�l�ior. OFS�/l�c�^� . ThP' Ej
rit/a3�e p+�DfG{f i grld �totirt.ti�f� f4445 o-� AeSe YK r7i eJ,'S.
s�V s hid -rta be �u�cPn o preveJ14 1e,?ka5 e )' per1,�I.� ;� s�u11�:•,9 6 ul
GAr tmt ves Ph .t}H el rtd o; %; z ►► q Ae)-7 tv ll bdp. H,
Reviewer/Inspector Name 'tet
P r 9 - .� q%;
Reviewer/Inspector Signature: Date: k Z e Z
05103101 Continued

Facility Number: iW — / i -
dor Issues
,0a5 e 3
Date of Inspection 2 OZ
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
ONO
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
PNo
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
JL2'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporaty cover?
❑ Yes
❑ No
Additional Comments and/or Drawings:
r7. A eed -Ae keep ve9e q dh oh to 9aon Lv/C 11 �z'/Cd a 1044c,rW
h�tdjiYi ��►�lt'd 40 aw AV t✓tSpC(��ia� dT 4),e lNq11-< i f
ensree;gll y d;eec4cof 46 ate back 4r,ef L;-'4e rvg1ls,
Yt-ec4s !� we4gble acres deaCY.►tivie,-lion .
,-1 Arfcifs a wrap was 6eeei4cd last �eq- e--yh,c4 Argos
yff,MkIe.- l0644;vtnl a�4� yracc s �j1e�-, i+rt40 Zoa'1e3. oc.�cvc-'1
41 c ✓e. is i7 O s vtpOr-/ :LtJ d p G v►-►"t,e rt �R) ,,oh A40W.+,A A e ae ✓r,5l t!
ie) eAA -Z-OkV , A-<OJ Mr. IF'74.M 3yf Ae
vscs r'k)el a, o� 1 �lt.►-.74yAs 'eCvvsr ✓Crl�l,
w.-)
W J1, one zayte i) C4C4 fA44 iJ less
j7 v. 6Y,y4Y1 deeds GfeCv#,- cm G' '!P47
1411)"%1 ryore,• lqe✓soV-�s�hpt,✓''✓
-JAe gLrCaye �n eaGl,-yv�C. �vr-7�te✓►'�pr�� rYjr, 1�r�gv� Y'PeA��a
afera1e EGrG Zone c'iGGOrd''`"� �o )4e Lv� y 1� 1t4S t eel G��s►rj'-�eo(�
far le .-Ogm,-e F ��,� Zane l j�s .��or;itk)c► J des)5 na4cd� fie need."
7Lo eV 5pv, k Icrs so /�.1n neeaf s -It, wse -�1,e
�,-0fe,1 crea�9c ors �4 7Y01C-Z's .a/ GaI /,v1G4e -kLe Ya1vwte jac e
ow f; cd L✓i� ;-� , l9IsQ1 �l,,e �,,,�s-gyp �1�� r, eels �0 fie ►ten
be,s cal e5n weN o�2e a,�res do eyrn ° t�; o+cq►.�1 Yyl ��'�an
c,?Qeds qe USQ - 1?e GOrec o4 Aev ea qe' On
l8 . Tee�Lticei1 seee)'4lisI "eells 7,o s; jN $ dale LVnl-ke
er �An j •?d ►? e, W rlg3� r'J v,• eh2�
wavked a� - I /
Need fa rt-je 3Z,j�Ibs php)14ere 4o- be9;Pn' 1 -717l7,lvg1l0t,�,QLtee00
Sl1 " Z' T CUy"e,14 I,-Vg34e pbv," �+?s-1 �rx 4r ZSQ LA; 61,
is crrYent bej.,j used �h �2,C-'Z `s, ✓-�-�; s J ahl -�a►- 4�,e 1,e.-�7 vd�
Dc�s ore r:",..)z1 r
Need 4e, We q (.ja54e RnQ1y-<is d4-4,�,d Lv;44i0 Lid])d� y-f 1-P 41Aey� p
aI �l V e4 evey14S 70 C.e, lG v1,r1C 6 /? y1 /C - . /'� 1� L�p►�
tv,s 4e g4ef s, S ADO? -fed sVAC;cieM4/ bu V�ee S d Vs2 i� oil -Ike �1��'Z�
r y

• Facility - p s2 Z eQ ye
Facili Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours?
to discharge at/or below
2$. Is there any evidence of wind drift dXandue
plication? {i.e. tdue on neighboring vegetation, asphalt,
roads, building structure, and/or publ29. is the land application spray system near the liquid surface of the lagoon?
30. Were any major maintenance probleentila * fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable31. Do the animals feed storage bins failropriate cover.
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Cl No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
9C4
-Z's� far h� ap'PliGG� 1 ohJ 61-1
r-lgkC5 d1:giGv0 �o �le�eyr,r',•�e i4A1,?4,-,
oC�Uf�ed . f Ali a 1� cot&nJ P., -IL�P
atq of ra/4 ievla-, zone need 4a to
4r�LA-1-`� t S 4,�
ZS . -TL, e
jV' � ✓�r 14rt
S StLyh qs -CVr
fL�,G
�d .5,-qef) l 9)/a io 0144-5; d e D ot.,r' . Pla�I ►•n a� Ie
cble, & be w +'-den L4/r'�b Seep �r''I�c� - iy14✓GLj bv� -nIVY4
doe 11mev,4ad 4,gpp►'DUeA� 6t, -�ez�nji 4% s,PBGiAIYS ;K
wci.s I I U
O5103101

F ° �' _ Ihvrsion of Water Qriality 't � _
Division of Soil and=W Conse>rvatron
_ ater.
r f'�:Other Agency _ a
of Visit gCompliance Inspection ()Operation Review Q Lagoon Evaluation
Reason for Visit PRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: Q Not O d BeloPrinted on: 7/21/2000
erational Q w Threshold
Permitted [j Certified 13 Conditionally Certified 13 Registered Date Last Operated or A ove Threshold:
Farm Name: ...... ............. �,............................ County:....... -'Ni.,l................
.................... .........................
Owner Name:
Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ...........................................................................................................................................................................................
Onsite Representative:. ........ . Integrator: ......
................ ......
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
T
❑ Swine ❑ Poultry []Cattle ❑ Horse Latitude 0Longitude �• ��«
Design Current
Swine Capacity Population
❑ Wean to Feeder
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 I I❑ Dairy
❑ Non -Layer I I HI IF1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lag .... n Area 10 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 b(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -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 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 f(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �'-C No
Waste Collection & Treatment �
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNo
Structure l Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: ..................................................................... ...-
Freeboard (inches):
5/00 Continued on back

Facility Number: 6= Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes qNo
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
(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
ER/No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
t9rNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
N(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
)R�No
12. Crop type v—� ►�G U2
13. Do the receiving crops differ witf4 those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
D(No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
[�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
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?
No
(ie/ WUP, checklists, design, maps, etc.)
KYes
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
]Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
bTNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
krNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNo
24. Does facility require a follow-up visit by same agency?
Yes
hfNoK4C'h, -
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
yiolatiQris o. deficiencies ire noted dint . this:v. ... it will . . . . e o fui•th r
rorresponcienC -about this .visit..: _ _ . ... . .. . . . . . . . . .
Comments°(refer to question #); Explain any YES answers and/or anyrecommendations:or.any other -comments '':
tise:drawings of facility to better explain situations. {use additional pages as necessary}
m..
1 C�
Reviewer/Inspector Name,
Reviewer/Inspector Signature: Date: 5100

Facility Number: — Date of Inspection ct Printed on: 1/9/2001
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 No
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 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
lAoditional Comments an ar. ra _.: _
W
sNr=� �•ee s w 4�e—
l 5 L,Q KCi
if
5100
J

Division of Water Quality
0 Division of Soil and Water Conservation9�v
Q Other Agency
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date or visit: -Time: �(� Printed on: 7/21/2000
rO Not Operational Q Below Threshold
*Permitted © Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: ..................
Farm Name: V Count<<:.-...�1S��i1^?.................................................
OwnerName: ................................................... ........................................................................ Phone No:......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:
MailingAddress: ......................................................................................................................................................................................................... .........................
Onsite Representative: ...5!`,r^e'r.................
Integrator:.......................................................
Certified Operator: ...................................... ............ Operator Certification Number:..................
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude �•�� �� Longitude �• C` Os
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish ❑ Non -Layer I I ❑ 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 ❑ Lag--nn Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ElSpray Field ❑ Other
a. II'discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. If discharge is observed, slid it reach Water of the State'? (If yes, notify DWQ) ❑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? El Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
SLMCturc I Su•uuturc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................................
Freeboard (inches): 3 1
5100 Continued on back

l
fttaciliiy'Number: / — kLj Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, El Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes tqNo
(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 maintenance/improvement?
❑ Yes
)� No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
9No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
PA No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
'9No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
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?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) El Yes )4No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo
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?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
yiolafroris:oc• deficiencies were h6fed• duithis, • Yoi� will-iceye do :ufrthi!fn
._Corres�oridence.ab' kthisvisit. .. ...•.•.•.•.•.-.•.•.-.-.•.•.•.•.•.•.•.•.•.•.
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):
� ' ►-� �►-c
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5100

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 9 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 ONO
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 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 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ((No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes O� Na
Additional Comments and/orDrawings:
A.
5100

Rtviscd January 22, 1995
JUSTIFICATION
& DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numbe
Farm Name: 4 --
On-Site Representative:
Inspector/Reviewer's Name:'
Date of site visit:
�L Operation is'flagged for a wettable
acre determination due to failure of
Part II eligibility items) F1 ® F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Date of most recent WUP: Annual farm PAN deficit: 10 pounds
k 1-aLl -95.
Irrigation System(s) - circle #: 1. hard -nose traveler, 2. center -pivot system; 3. linear -move system;
4�, stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6, 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 acresjs 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.
E4 75% rule exemption as verified in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II_- F1 F2 F3, before'completing computational table in Part 111).
PART IL 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 of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of informationtmap.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields -fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised January 22, I4(
Facility Number
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'-2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
L3,�
_`{
I�
i
f
I
I
I
1
i
I
E
FIELD NUMBER' - hvdrant_ Dull_ zone_ or point numbers may be used in place of field numbers
deoendino on CAWIA
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBERZ - must be clearly delineated on map_
COMtJIENTS3 - back-up fields with CAWMP acreage 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 & 1 998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

Division of Soil and Water Conservation -' Operation Review .
D Division of Soil and. Water Conservation - Compliance Inspection
Division 14
:of Water Quality -Compliance Inspection _
(]:Other Agency - Operation Review.'
LC�Routine O Corr: taint Q Follow-u of DW iizs ection O Follow-up of DSWC review Q Other
Facility Number Date of Inspection
hinre of Inspection r7770 124 hr. (hh:mm)'
Permitted Q Certified [3 Conditionally Certified ❑ Registered 10 Not operational] Date Last Operated:
..........................
Farm Name:-- ... -..� County: e t.
..... ......................... ........... .............................. -
OwnerNante:..._.....r.`.'a...................................................... Phone No:_.-........._...-......................................---............--....---........
FacilityContact:-.............................................................................Title: ................................................................ Phone No: .....................................
Mailing Address: ...........................................
Onsite Representative: l_J..�+`--.Ly � �!...� � , In t-1rat..... r.��............................................
.......... ....... ......
Certified Operator: .................................... Operator Certification Number:................. .
Locati?n of FVrmj\
... ls... !;�'
' - 0,............................................................. ........-..-._..........--....................................................
Latitude 4 ;a Longitude • 6 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish '3 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons i I I❑ Subsurface Drains Present IL1 Lagoon Area I❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If dischargc is observed, was the conveyance man-made?
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. ll'discharoe is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system?
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2
Identifier:
Freeboard (inches):
Structur; 3 Structure 4 Structure 5
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes MNo
❑ Yes D(No
❑ Yes VNo
Structure 6
1/6/99 Continued on back

1
Facili f Number: 6rl— 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 pact of the waste management system other than waste structures require main te nan celimprove ment?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
12. Crop type ��.17�r�.........+..:........................................................
0
❑ Yes KNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
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 sampld 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 certified operator in responsible charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes KNo
❑ Yes X No
❑ Yes ONo
❑ Yes KNo
❑ Yes O `No
❑ Yes IN No
❑ Yes C9 No
❑ Yes KNo
❑ Yes W No
❑ Yes PfNo
❑ Yes CYNo
❑ Yes b<No
❑ Yes PO No
❑ Yes LN
❑ Yes [kNo
❑ Yes 9No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JKNo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
0. NA.vialations or. deficiencies .were noted. during .this. visit:. You wriXl.ret eive no further . ;
etirr-esporidenee; about; this 'visit.; ....:.. ...: :... ... .... .. . .
Comments'(refei- to question #): Explain any YES answers arid/or any_`recommenda_tiions or any other. comments.-.
Use;drawings of,:facility._to:better explain situations. (use additional pages as.necessary) _
40) OkCt-e it t r (5 �l G Ica+--d s �^I t- •s f p�c�y .
��� GEC!-eS�- � $•' r1�t� �II.,Q..S G�.o� �.�. �� {� [I f
e s-�
Reviewer/Inspector Name ,,
Reviewer/Inspector Signature: _ , , _ Date: "r r f .S 1114 - 11/6199

Lagoon Dike Inspection Report
G
Name of Farm/Facility
Location of Farrn/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection �� Names of Inspectors �J� �{ �` P4 c
U% /7 Cie -
Structural Height, Feet Z Freeboard, Feet _
- �- - -
Lagoon Surface Area, Acres yS'� �C �� O Top Width, Feet _ A
Upstream Slope,xH:1 V Downstream Slope, xH: IV
Embankment Sliding? Yes K No _
(Check One, Describe if Yes)
Seepage? Yes K' No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
C00d
Yes_ No If Yes, Depth of Overtopping, Feet
Fallow -Up Inspection Needed? Yes -- �L No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

[3Division of Soil and Water Conservation Other Agency q
Division of Water Quality
Routine O Complaint 0 Follow-up of DWQ inspection O Follow-up of DMVC review O Other
Date of Inspection Z
Facility Number Time of Inspection 24 hr. (hh:mm)
© Registered [3 Certified © Applied for Permit )dyermitted 113 Not Operational I Date Last Operated:
Farm Name: x... a ............................... County:..............................................................................
a�. �........ J,
Owner Name:........a.c,,i�- ............... ...... 81'4rlc►. Phone No:.....3... .. .............................
Facility Contact: .............................................
Title:................................................................ Phone No:...................................................
MailingAddress: .... .�.��.. j........,...... :...�--.....���...............�F......................................................... ................
Onsite Representative: ..fr:.. .... ..... integrator:..... ............................. - ........ I......
Certified Operator;....... c.uCl ...................... .r h(fir._........................... Operator Certification Number;.................
1
Location of Farm:
C
ME
Latitude 006 44 Longitude 0• 4 064
Nutxther of I:agdons % HoidtiigxPonds'ri Suhsurface Drains Present Lagoon Area Spray Field Area
f2 q ❑ No Liquid Waste Management System'
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes Q No
2. Is any discharge observed from any part of the operation? [] Yes No
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 Surface Water? (If yes, notify DWQ) ❑ 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
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ,� No
5. Does any part of the waste management system (other than lagoons/holding ponds) require XYes ❑ No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Uf No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 4No
7/25/97 Continued on back

Facility Number• —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (L agoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes i1 No
❑ Yes gjLNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft.): .,35 ............ .................................... ................................... ...............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
O-No.vialatioi►s•or d6rkiencies4eire'noted during_this:visit.- Yu:will oreceive•,66 6rthe':
correspondence d otit this:visit.- :.. ::.:
❑ Yes XNo
49 Yes 0 No
Yes ❑ No
❑ Yes W1 No
❑ Yes qNo
fO Yes El No
❑ Yes &(No
❑ Yes ji No
❑ Yes JO No
❑ Yes JZ No
❑ Yes PI No
(Yes ❑ No
❑ Yes Ed No
❑ Yes jP No
❑ Yes P No
.S- c s�. fZ �-�A �.,c1 c. ;� .� _ �-% :�#- f tl�ylt ?�r�..,�,1 i 5 �, p �1 � 2r/►rli
r
Ot ! V O`R �. l� /c%7.1 tY1 visa v� 2 rL D� �f• 11� [. . LsdC7rr s f���c f �GPi4 i 2 stT
/lp �i�n9 2�Sv75id� �n� �Giv�Cv� ry�Aty� Sf4�1�1c� bv?� 2��.�s
Laps T� dJdJIW�
7/25197
I Reviewer/Inspector Name
fReviewer/Inspector Signature:
Date:

RECEIVED
NOV 3 0 1998
OBY:
NO e-�
s � s �, vAcz�
�Kj e.

Producer: Richard Bryan
Location:
Address:
Telephone:
Type Operation:
Number of Animals:
(Design Capacity)
Storage Structure:
Application Method:
1280 Gregory Fork Rd.
Richlands NC. 28524
910-324-4382
Feeder to Finish
3672 Existing
Anaerobic Waste Treatment Lagoon
Irrigation
The waste from your animal facility must be land applied at a specified rate to prevent
pollution of surface water and/or groundwater. The plant nutrients in the animal waste
should be used to reduce the amount of commercial fertilizer required for the crops in the
fields where the waste is to be applied. This waste utilization plan uses nitrogen as the
limiting nutrient. Waste should be analyzed before each application cycle and annual soil
tests are strongly encouraged so that all plant nutrients can be balanced for realistic yields
of the crops to be grown.
Several factors are important in implementing your waste utilization plan in order to
maximize the fertilizer value of the waste and to ensure that it is applied in an
environmentally safe manner:
1. Always apply waste based on the needs of the crop to be grown and the nutrient
content of the waste. Do not apply more nitrogen than the crop can utilize.
2. Soil types are important as they have different infiltration rates, leaching
potentials cation exchange capacities, and available water holding capacities.
3. Wind conditions should also be considered to avoid drift and downwind odor
problems.
This plan is based on the waste application method shown above. If you choose to change
methods in the future, you need to revise this plan. Nutrient levels for different application
methods are not the same.
The estimated acre needed to apply the animal waste is based on typical nutrient content
for this type of facility. Actual acreage requirements may be more or less and should be

based on the waste analysis report from your waste management facility. Attached you will
find information on proper sampling techniques, preparation, and transfer of waste samples
to the lab for analysis.
Provisions shall be made for the area receiving waste to be flexible so as to accommodate
changing waste analysis content and crop type. Lime must be applied to maintain pH in the
optimum range for specific crop production.
This waste utilization plan, if carried out, meets the requirements for compliance with 15A
NCAC 21-1.0217 adopted by the Environmental Management Commission.
AMOUNT OF WASTE PRODUCED PER YEAR (gallons* W, tons, etc.)
3672 animals x 1.9 tons wastelanimallyear = 6976.8 tons /year
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
3672 animals x 22.3 lb. PAN/animal/year = 8. 4444bs. PAN/year
Applying the above amount of waste is a big job. You should plan time and have
appropriate equipment to apply the waste in a timely manner.
See attached map(s) showing the field(s) to be used for the utilization of animal waste. The
following acreage will be needed for waste application based on the crop to be grown and
the method of application:
2

Table 1: ACRES OWNED BY PRODUCER
Tract
#
Field
#
Soil
Type
Crop
App Method
Real.
Yield
Lbs. N
Per Ac
Comm N
Per ac,
Acres
Lbs. AW
N
Utilized
Month Of
Application
3500
1
AuB
BP -I
6.5
325
0
10.7
3477.5
Mar -Oct
3500
-r1
SG -I
1
150
0
10.7
535
Sep -Nov
3497
3
AuB
BP-1
6,5
325
0
8.1
2632
Mar -Oct
3497
~3
SG -I
1
50
0
B.l
405
Se -Nov
3497 -
4-1
St
Mat
250
0
0.4iji
110
Sep -May
3497
4-2
St
Mat
375
0
0 , �41
165
Sep -May
3497
4-3
St
Mat
500
0
0, qq
220
Sep -May
3497
4-4
St
Mat
625
0
0.4ckk
275
Sep -May
3497
4-5
St
Mat
250
0
0 --7LA
185
Sep -May
3497
5
St
Mat
250
0
4 ., % a
1030
Sep -May
1 25.4 l 9036.65
Table 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
Tract
#
Field
#
Soil
Type
Cron Code
App Method
Real
Yield
Lbs. N
Per AC'-'
Comm N
Per acre
Acres
Lbs. AW N
Utilized
Month of
Application
Total in Table 2
Total in Table 1
Total 25.4 9036.65
Amount N Produced 8445.6 -
Surplus or Deficit �591.05
it This PAN Is from animal waste only. If nutrients from other sources such as commercial fertilizer are
applied, they must be accounted for. Total N must be Lased on the crop realistic yield expectation (RYE).
NOTE: The applicator is cautioned that P and K may be over applied whr7e meeting the N -
requirements. Beginning in 1995, the Coastal Zone Management Act ml require farmers in some
3

eastern cormiAes of North Camlfna to have a nutrient management plan that aftesses a!! m Ments.
This waste uh7fzation elan only addresses Nf mgen.
Acres shown in the preceding table(s) are considered to be the usable acres excluding
required buffers, filter strips along ditches, odd areas unable to be irrigated, and perimeter
areas not receiving full application rates due to equipment limitations. Actual total acres in
the fields listed may, and most likely will be, more than the acres shown in the tables.
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of the soil at the time of
irrigation such that runoff or ponding occurs. This rate is limited by initial soil moisture
content, soil structure, soil texture, water droplet size, and organic solids. The application
amount should not exceed the available water holding capacity of the soil at the time of
irrigation nor should the PAN applied exceed the nitrogen needs of the crop. The amounts
shown in the table below are maximums if the soil is dry and conditions are at the optimum
for soil intake.
It is the responsibility of the producer and the land application system designer to ensure
that the application system is designed, installed, and operated properly to avoid any runoff
of waste from the land applied to. Failure to observe the maximum recommended rates and
amounts of nitrogen shown in the tables may make this plan invalid.
Table 3: APPLICATION OF WASTE BY IRRIGATION PARAMETERS
Tract
#
Field
#
Soil
Type
Crop
Rate
Application
in/Hr.
Application
Amount In.
3500
1
AuB
.5
1
3500
--1
.5
1
3497
3
AuB
.5
1
3497
--3
.5
1
3497
4-1
St
.5
1
3497
4-2
St
.5
1
3497
4-3
St
.5
1
3497
4-4
St
.5
1
3497
4-5
St
.5
1
3497
5
St
.5
1
4

This is the maximum application amount allowed for the soil assuming the
amount of nitrogen allowed for the crop is not over applied. In many
situations, the application amount shown cannot be applied because of the
nitrogen limitation. The maximum application amount shown can only be
applied under optimum soil conditions.
Your facility is designed for 160 days of temporary storage and the temporary storage must
be removed on the average of once every 6 months_ In no instance should the volume of
the waste stored in your structure be within the 25-year - 24 hour storm storage or one foot
of freeboard except in the event of the 25 year - 24 hour storm.
It is the responsibility of the producer and waste applicator to ensure that the spreader
and/or irrigation equipment is operated properly to apply the correct rates to the acres
shown in Tables 1 and 2. Failure to apply the correct rates or nitrogen shown in the tables
may make this plan invalid.
If assistance is needed, call your technical specialist after you receive the waste analysis
report for assistance in determining the amount of waste per acre and the proper
application rate prior to applying waste.
SLUDGE APPLICATION:
The waste utilization plan must contain provisions for periodic land application of sludge at
agronomic rates. The sludge will be nutrient rich and will require precautionary measures
to prevent over application of nutrients or other elements. Your production facility will
produce approximately 1358.64 pounds of PAN per year in the sludge.
If you remove the sludge every 5 years, you will have approximately 6793.2 pounds of PAN
to utilize. Assuming you apply this PAN to corn at the rate of 125 pounds of nitrogen per
acre, you will need 54.3 acres of land. Please be aware that these are only estimates of
the PAN and land needed. Actual requirements could vary by 25% or more depending on
your sludge analysis, soil types, crops, realistic yields, and application methods.
5

REQUIRED SPECIFICATIONS
1. Animal waste shall not reach surface waters of the state by runoff, drift, manmade
conveyances, direct application, or direct discharge during operation or land
application. Any discharge of waste, which reaches surface water, is prohibited by
state law. Illegal discharges are subject to assessment of civil penalties of $10,000
per day by the Division of Water Quality for each day the discharge continues.
2. There must be documentation in the design folder that the producer either owns or
has an agreement for use of adequate land on which to properly apply the waste. If
the producer does not own adequate land to properly dispose of waste, he/she shall
provide a copy of an agreement with a landowner that is within a reasonable
proximity, allowing the producer the use of the land for waste application. It is the
responsibility of the owner of the facility to secure an update of the Waste Utilization
Plan when there is a change in the operation, increase in the number of animals,
method of utilization, or available land.
3. Animal waste shall be applied to meet, but not exceed, the nitrogen needs for realistic
crop yields based on soil type, available moisture, historical date, climatic conditions,
and level of management, unless there are regulations that restrict the rate of
application for other nutrients.
4. Animal waste shall be applied to land eroding less than 5 tons per acre per year.
Waste may be applied to land that is eroding at 5 or more tons, but less than 10 tons
per acre per year providing grass filter strips are installed where runoff leaves the
field. (See FOTG Standard 393 - Filter Strip and Standard 390 - Riparian Forest
Buffers.) These filter strips and forest buffers are in addition to "buffers" required by
DWQ.
5. Injecting the waste or disking after waste application can reduce odors. Waste
should not be applied when there is danger of drift from the irrigation field.
6. When animal waste is to be applied on acres subject to flooding, it will be soil
incorporated on conventionally tilled cropland. When applied to conservation -tilled
crops or grassland, the waste may be broadcast provided the application does not
occur during a season prone to flooding. (See "Weather and Climate in North
Carolina"for guidance.)
7. Liquid waste shall be applied at rates not to exceed the soil infiltration rate such that
runoff does not occur offsite or to surface waters and in a manner which does not
cause drift from the site during application. No ponding should occur in order to
control conditions conducive to odor and insects and provide uniformity of application.
C:

B. Animal waste shall not be applied to saturated soils, during rainfall events, or when
the soil surface is frozen.
9. Animal waste shall be applied on actively growing crops in such a manner that the
crop is not covered with waste to a depth that would inhibit growth. The potential for
salt damage from animal waste should also be considered.
10. Waste nutrients shall not be applied in fall or winter for spring planted crops on soils
with a high potential for leaching. Waste nutrient loading rates on these soils should
be held to a minimum and suitable winter cover crop planted to take up released
nutrients. Waste shall not be applied more than 30 days prior to planting of the crop
or forages breaking dormancy.
11. Any new swine facility sited on or after October 1, 1995 shall comply with the
following:
• The outer perimeter of the land area onto which waste is applied from a lagoon
that is a component of a swine farm shall beat least 50 feet from any residential
property boundary and from -any perennial stream or river (other than an irrigation
ditch or canal).
• Animal waste other than swine waste from facilities sited on or after October 1,
1995 shall not be applied closer than 25 feet to perennial waters. (See Standard
393 - Filter Strips.)
12. Animal waste shall not be applied closer than 100 feet to wells.
13. Animal waste shall not be applied closer than 200 feet of dwellings other than those
owned by the producer.
14. Animal waste shall be applied in a manner not to reach other property and public
right-of-ways.
15. Animal waste shall not be discharged into surface waters, drainageways, or
wetland(s) by a discharge or by over -spraying. Animal waste may be applied to prior
converted cropland provided it has been approved as a land application site by a
"technical.specialist". Animal waste shall not be applied on glassed waterways that
discharge directly into watercourses. On other grassed waterways, waste shall be
applied at agronomic rates in a manner that causes no runoff or drift from the site.
16. Domestic and industrial waste from truck or other washdown facilities, showers,
toilets, sinks, etc., shall not be discharged into the animal waste management system.
7

17. A protective cover of appropriate vegetation will be established on all disturbed areas
(lagoon embankments, berms, pipe runs, etc.). Areas shall be fenced as necessary,
to protect vegetation. Vegetation such as trees, shrubs, and other woody species,
etc., are limited to areas where considered appropriate. Lagoon areas should be kept
mowed and accessible. Berms and structures should be inspected regularly for
evidence of erosion, leakage, or discharge.
18. If animal production at the facility is to be suspended or terminated, the owner is
responsible for obtaining and implementing a "closure plan" which will eliminate the
possibility of an illegal discharge, pollution and erosion.
19. Waste handling structures, piping, pumps, reels, etc., should be inspected on a
regular basis to prevent breakdowns, leaks, and spills. A regular maintenance
checklist should be kept on site.
20. Animal waste can be used in a rotation that includes vegetables and other crops for
direct human consumption. However, if animal waste is used on crops for direct
human consumption it should only be applied preplant with no further applications of
animal waste during the crop growing season.
21. Highly visible markers shall be installed to mark the top and bottom elevations of the
temporary storage (pumping volume) of all waste treatment lagoons. Pumping shall
be managed to maintain the liquid level between the markers. A marker will be
required to mark the maximum storage volume for waste storage ponds.
22. Waste shall be tested within 60 days of utilization and soil shall be tested at least
annually at crop sites where waste products are applied. Nitrogen shall be the rate -
determining element. Zinc and copper levels in the soils shall be monitored and
alternative crop sites shall be used when the metals approach excessive levels.
Acidity levels (pH) shall be adjusted for optimum crop production and maintained.
Soil and waste analysis records shall be kept for five (5) years. Poultry dry waste
application records shall be maintained for three (3) years. Waste application records
for all other waste shall be maintained for five (5) years.
23. Dead animals will be disposed of in a manner that meets North Carolina regulations.
NARRATIVE OF OPERATION:
indicates that this field is being overseeded
Mat = Matua
This farm is participating in an experiment conducted by NCSU to determine Nitrogen
intake rates of Matua grass. Various amounts of N are to be applied (see Table 1 Lbs. N
Per acre and attached map). Groundwater wells have been installed (see map).
�u

WASTE UTILIZATION PLAN AGREEMENT
I (We) understand and will follow and implement the specifications and the operation and
maintenance procedures established in the approved animal -waste utilization plan for the
farm named above. I (we) know that any expansion to the existing design capacity of the
waste treatment and storage system or construction of new facilities will require a new
utilization plan and a new certification to be submitted to the North Carolina Division of
Water Quality (NCDWQ) before the new animals are stocked. I (We) also understand that
there must be no discharge of animal waste from this system to surface waters of the state
from a storm event less severe than the 25 year - 24 hour storm. The approved plan will be
filed on -site at the farm office and at the office of the local Soil and Water Conservation
District and will be available for review by DWQ upon request. Failure to comply with the
Waste Utilization Plan may require any cost share funds to be refunded to their source.
Name of Facility Owner (please print):
Signature: Date:
Name of Manager (if different from owner):
Signature: Date:
Where owners of animal operations do not have adequate amounts of land to apply the
waste, the producer must provide a written agreement whereby another landowner has
agreed to land apply or allow land application on his or her land. The attached agreement
may be used or some other documentation may be provided.
ADJACENT LANDOWNER AGREEMENT
1, , understand that Mr./Mrs.
does not have ample land to apply the animal waste produced from his/her animal
operation. I agree and give permission for Mr./Mrs. to
apply animal waste from his Waste System on acres of my land for the duration
of time shown below.
I further understand that this waste contains, nitrogen, phosphorous, potassium, and'other
nutrient elements and when properly applied should not harm may land or crops. I also
understand that the use of this animal waste will reduce my need for commercial fertilizer.
Term of Agreement: , 19 to , 20
(minimum of Ten yews on cost Shared Items)
(See Specification No. 2)
Recipient Landowner (please print):
0

Signature:
PLAN APPROVAL
Name of Technical Specialist (please print):
Affiliation (Agency):
Address:
Signature:
SWCD BOARD REVIEW
SWCD Representative (please print):
Signature:
file: C:1Wirdaw9%Per9oml1020(AWa9te Utillm1k)n Ptan.doe
A December, 1997
10
Date:
Date:
Date:

u
a
a.
a

David,
Now I know where your office building is! I was there on Thursday for the
field day portion of the On -site Wastewater Treatment Conf. Friday, Karen,
her intern, Richard Bryan, and I installed 10 --5' to 6'-deep groundwater
monitoring wells. There are two wells in each of the four application rate
areas, plus two in areas that don't receive irrigation water (one upslope, one
downslope). The wells were placed 25' from the hydrants, ho that they won't
(shouldn't) receive over -lap irrigation from adjacent hydrants. The top 1-2'
of the wells is solid 2" pvc, rather than well -screen. The area surrounding
the tops of the wells has hole -plug bentonite, to help prevent surface water.'
from entering the well area. To help keep the site from being vandalized, the
wells were placed flush with the ground level, and have caps plus cover boxes.
We reached water at each well site (@--4-51), so obtaining samples should not
be a problem.
Mike and I will be putting the finishing touches on the waste utilization plan
today. Karen is color -coding the Irr-2 forms, so Richard will have an easier
time keeping track of where everything goes. There will be an Irr-2 form for
each application rate. I will try to fax you a copy later today or tomorrow.
Please pass this message along to whichever Groundwater Section person you
think appropriate.
Thanks for your patience! Project start-ups are s0000 much fun.
Diana _
Diana M. C. Rashash, Ph.D.
NC Cooperative Extension Service
604 College St., room 8
Jacksonville NC 28540
Area Specialized Agent -Environmental Ed.
Internet: diana [e-mail]
http://onslow.ces.state.nc.us/staff/drashash/enved/index.html
Phone: [phone]
Fax: [phone]
S 0 U--J

❑ DSWC Animal Feedlot Operation Review
,l DWQ Animal Feedlot Operation Site Inspection
19Routine O Complaint O Followr-up of D'4i O inspection O Follow-up of i)MVC review O 0ther I
Date of Inspection /t?
Facility tiumUcr
l Time of Inspection 24 hr. (hh:mm)
registered U Certifiied 13 Applied for Permit 0 Permitted 113Notoperatiatul Date Last Operated: ....
2
Farm Name: ...1!t, +h..f�.............. S.—A. x7...�.--------- County:......,.. , .. ..................
Owner Name:.... .t..t . a.C.�f�. .7Z..fiVVn .......................................... Phone No: �z � ............................................................
Facility Contact: ...........................
.,FI!k1............. Title: +V � ....... Phone No:
Mailing Address:..A.b.9 .. . rr..ax..< ......U....... ........................ I ............. �`i157.........
Onsite Representative:... n. ti. .A.-t7..........apf.1 G�1!L..................................... In[enrat�tr:......�!L1�i�................................
I ..............
..
Certified Operator:.................................................................. ................... Operator Certification Number,..... .....................
Location of Farm.
Latitude I &C Longitude • ° :1
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish ❑ Non -Layer I I Irl Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds ❑Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. 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 obsen°ed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
J. Does discharge bypass a lagoon systetn? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5, Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/'improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design')
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
01-No
❑ Yes
2&o
❑ Yes
lI No
❑ Yes
gNo
❑ Yes
[. N0
Yes
2NO
Yes
Ulqo
❑ Yes
JEJ">vo
❑ Yes
[;�NO
❑ Yes
�. -o
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds. Flush Pits etc.i
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard ft) 3tr .
10. Is seepage observed from any of the structures?
❑ Yes lR'1'sio
Yes tit No
Structure 4 Structure 5 Structure 0
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes BIG-
0 Yes Ef"No
12.
Do any of the structures need maintenance/improve ment?
Q Yes
L3'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
EKo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
El"No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
@@'
15.
Crop type
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
O'No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
WNo
18.
Does the receiving crop need improvement?
❑ Yes
[;Ko
19.
Is there a lack of available waste application equipment?
❑ Yes
l 10
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ErNo
21.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ NO
22.
Does record keeping need improvement'?
❑ Yes
ENo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
D No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
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):
14 -A s 9-2 C IM, ; �s dl� Afa /�;�_ , T .fit tfG�a i s r
J A104,$) - " 't
cism el,
7125/97
Reviewer/Inspector Namf-_ i -
Reviewer/InspectorSignature:_ Date: /6//Z

Site Requires Immediate Attention:
' Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: '7 �-- � '_ , 1995
Time: r
Farm Name/Owner:y �' ` /uS �� CO
f��. d> art -�,
Mailing Address: �� r�C7 �,���.-� ,,—
,. Al - -
County: _ _ -/_fir
Integrator _ - -�r-�� - - - - - -- Phone:
On Site Representative: �� Phone:� - �-
Physical Address/Location:
Type of Operation. Swine Poultry Cattle
Design Capacity: 36 7 ��• Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: =- S JFeet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Xes r No Actual Freeboard: Ft. CD Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? ''Ye or No Is the cover crop adequate? aaor No
Crop(s) being utilized: _ _ r
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. es r No
100 Feet from Wells? fyR or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orr O If Yes, Please Explain..
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o' o
Additional Comments:
f
40 /
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed_

OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 ',,� 1 �.�� r. _i -.�
Site Requires Immediate Attention -t,1¢
Facility Number: d?- 1t
SITE VISITATION RECORD
LATE: y_k f 17 199
5
Owner: Farm Name: JUL ,•,t IcQ,
County: w
Agent 'Visiting Site: P a 4 INVa
Operator: ItrcN•a.CAT , y,�r Phone: _4 r,,D L .-7,r � W,rt
On Site Representative: /rcN.�x_ d yx� Phone:
Physical Address: 41a �_. � rw st �err.� c s ,per a.,.c i-f il�ayt.�...�rr, i-7-10, 1Ae4f&.0VA, rc.�
44e /�._ Pry /ylgw .O/Fww.rN lld, f%V.,, � /,. Rr+.- r�w�t �J
Mailing Address;
Type of Operation: Swine „ Poultry Cattle
Design Capacity: .7 6 7 1- Number of Animals on Site: .1c -7Z
Latitude: o Longitude: o "
Type of Inspection: Ground Aerial
0 Circle Yes or No
•
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(apprvximately 1 Foot +8 inches) (�e or No Actual Freeboard: A Feet c Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)7 Yes or l Nas there erosion of the darn?: Yes or
Is adequate Land available for land application? �Gor No Is the cover crop adequate? �r No
Additional Comments:
Fax to [phone] Signature of Aue, i

Site Requires Immediate Attention: 0
Facility No. - 1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO //SITE VISITATION RECORD
DATE: 76 .1995
Time:
Farm Name/Owner: AlewA"012
Mailing Address: y
County: I -ow
Integrator:
On Site Re
Physical A
/ Y�IsO
Type of Operation: Swine Poultry Cattle
Design Capacity: 36 12 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �O Longitude: �° 3�' i� " Elevation: Feet
Does the Animal Waste Lagoon have
(approximately 1 Foot + 7 inches Y+
SWas any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: ^ '
Circle Yes or No
icient freeboard of 1 Foot + 25 year 24 hour storm event
No Acgzai Freeboard! - Ft. Inches
n(s)? Yes r� as any erosion observed? Yes r N
�r No Is the cover crop adequate? Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings(Ye;,§r No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 2S Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec acreage with cover crop)? Yes or No J
Additional Comments: aeM
Inspector Name
Si
cc: Facility Assessment Unit Use Attachments if Needed.