310031_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Xitci[tty Number
Type of Visit: is Co ance Inspection V 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: 7 Arrival Time: Departure Time: O County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6rc"— LE (/ Integrator•
Certified.Operator:
Phone:
Certification Number: 1 7 1 73
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-- k Desygn Current nDesigns Current
wine =
tapackiy Pop �" �Wet;Poultry ,,a Capacity. Plop Cattle
-
Mro3;s
n to Finish
s.
s v. y'b+" ',«_.. ...,... ";X:.:";r7. •s'A ;w
La er
�.P"'..gaitgvS-.A...',1
DairyCow
can to Feeder
fR 't 90 f. ,
(f �f DD Non -La ye
Dairy Calf
?•
Feeder to Finish°»
^, .
Dairy Heifer
Farrow to Wean
%" ° D aghCurrent
Dry Cow
Farrow to Feeder
D ;Point
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
r=.
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
x Turkeys
Other
jTurkeyPoints
"
Other
Other
4
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? 0 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)
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 U N ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - ( Date of Inspection: A71
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: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 4k^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IiE 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 Q"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t, 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 ❑ 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 ZfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,E�]F`No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Na ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
Ek<o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ion❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
['1 o�❑ 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 M No r] 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 Ej No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: jDate of Inspection:
24- Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
�^❑ NA
❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
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
2rNo ❑ 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
�❑ 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
❑wo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� o ❑ 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
�No ❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
y
;lee e %f,9 _., /
WlaAf t Phone: 119 74 SJoy
Date: 7
2/4/20I5

® Division of Water Resources
Facility Number 0 Division of Soil and Water Conservation
(1
0 Other Agency
Type of Visit: Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /n� GG Title: Phone:
OnsiteRepresentative: lJ�ctL 910SE Integrator:
Certified Operator: Certification Number: 111113
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Laver
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [21 No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

1~'acili Number: jDate of Inspection: S
Waste Collection & Treatment
4. GIs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&06N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 16 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 CZ/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 environmentgl 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 F/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 ZNo ❑ 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? /No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VN9
❑ NA
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ 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 a
❑ 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 EX0
❑ 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 hl
❑ 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 21412015 Continued

Facili Number: 5X jDate 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 ❑ YesVNo ❑ 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 LCJ 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 C�/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [:J/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ENo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause 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?
❑ Yes rnl�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [o
❑ NA
❑ NE
Comments (refer�to question ft Explain, any YES .answers and/or, any:additional recommendations or any other comments:
Use drawn s offacilrt, additional, a esas necessar) y 6better aglainsitQations' use
(,s o ►� C- o� (,. AU, S HO w s Z M P" ,.S T
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone C�'
to
Date: .'�, ) at
21412015
9 0- ?

40 Division of Water Resources
i�=.Facitity Number - O Division of Soil and Water Conservation
O Other Agency zj
Type of Visit: r(OuRopliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: /6 County: .JI)RZ#J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Ce C=(, Q dSc integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Phone:
Certification Number: 1 1 1 ` 13
Certification Number:
Design. Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
6gop lsaDDRNon-Layer
jjry routtry
Layers
Non -Layers
Pullets
Turkeys _
Turkey Poults
Other
Design Current
Discharzes 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes / No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes ❑No ❑NA ❑NE
❑Yes �o ❑NA ❑NE
❑ Yes W] No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: f2i - Date of Inspection:`it I lb
Wi ste Collection & Treatment
oNNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA 6ozq,4 1 CAC-<x)t4 Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
1jZr7No
❑ 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
2!fNo
❑ 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 i nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures tack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C2fNo ❑ 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 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. D 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FJINo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ET�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E/No
❑ 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
To
❑ 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
['Io
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� o
❑ 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 21412015 Continued

Facility Number: jDate of Inspection: 0
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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
EfNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E3'No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
dNo
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
[allo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[�/No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ea"No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ 'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facilitv to better explain situations (use additional uaQes as necessarv).
(Ylo ru w O CCIC PE E ._0C_D 6�J F",U t- LlAGVVO I Ce W A L-�.
G"95 Cauca. :5 ?0 a 2
Reviewer/Inspector Name: d N A) N-&X_ LC
Reviewer/Inspector Signature:
Page 3 of 3
Phone(e?l0, 1 4 1 3 fJ
Date: I ,
2/4/265

Division of Water.Quahty -
t
Facility Number O Division of, Soil and WateraConservation
a: ().'Other Agency
�m
Type of Visit: Q'ZRoutine
Hance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
isit: Reason for VO Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ERV-1 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: C(�c,� 90 S c- Integrator:
Certified Operator:
Phone:
Certification Number: Mr73
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design 'Current _ Design Current Design `Cu
Swine x Capacity Po Wet Poultry Capacity 'op. Cattle Capacity )P
p:
v Wean to Finish Layer
Wean to Feeder Non -La er
Feeder to Finish
Farrow to Wean Design`: Current
Farrow to Feeder Dry Poultry, Ca aci Pop.
La ers
Non -Layer
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
-
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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?
1 Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes El"No
❑ Yes C31No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Focili Number: -51Date of Inspection:
Waste Collection & Treatment
4.,Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
,
Stddru/ct�u_re, 11 1Sttructure �% Structure 3 Structure 4 Structure 5
Identifier: LUZ J f III�,i16/ (/
Spillway?:
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): _b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IdNo ❑ 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 EKo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [(Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures 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
C] Yes
2"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes:�Noo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rVo
❑ NA
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
1�40
❑ 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 Inspecti�X(
s ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:)Yes ] ❑ NA [3 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . El Yes
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
/❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to 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 5<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
�jj o ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explaimany YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�I C NTU vE ' a wOI.IL 61J 96LASS CAle- — a�- DUT—( LV C=
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone �j 3
Date: 0
21 2olr

ti. Division of Water Quality
Facility Number ® ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 13 Arrival Time: Lj Departure Time: .5 County: dUPLXO Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ;� Title:
Onsite Representative: CCC-L i.,
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other '
Other
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity, Pop.
La er
Non -La er
Design Current .
LA Gl J
Non-L
Pullets
Other
Poults
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?
Daia Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection: S {
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: LAiStx>#.-'LAfy7J 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1�0 O�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [l 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 ZNo ❑ 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 envi oental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yesnm❑ No [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PNo [3 NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) h— /
9. Does any part of the waste management system other than the waste structures require ❑ Yes t ylVo ❑ NA ❑ NE
maintenance or improvement? 77
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 [2/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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VN
❑ NA
❑ NE
the appropriate box.
❑WUP El 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 [] 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Faciti Number: - Date of Inspection:
24.12id 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 [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [ No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes VNo
❑ 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 M/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 E?(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 O 1`o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ 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 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations.or any, other.comments.-
Usedrawings-of facility to better explain situations use additional a esaas necessa� =-�
h' p ( P g ry)
., LA Cstpo r--1 OE D 5 Y1v10 sty ck.E Aa;Z� Td TTh E
0T Kf- WALL,. qL90 s PaT Occ.) S G-&s5S WACLIC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-q ! 3
Date: J
21412011

Division of Water Quality
Facility Number - 3 0 Division of Soil and Water Conservation
$ 0 Other Agency
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ Arrival Time:® Departure Time: County: L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: CX-C--a_ 265 C-_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other -
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Other
Poults
Longitude:
Design Current -
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�
❑ NA
[3 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
r
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - k Date of Inspection:
Waste Collection & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: LACtmAJ I^ L&dwJ—L
Spillway?:
Designed Freeboard (in):
Structure 4
Observed Freeboard (in): � _ �_17
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 ❑ 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 environmen I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes dNo
❑ NA
❑ NE
maintenance 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 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rNp
❑ NA
❑ 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 Imo" 9q
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EyNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
❑ Yes [go
❑ 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 [3"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
21412011 Continued

[Facft Number: - Date of Inspection: L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O/XO ❑ NA ❑ NE
25. Is.the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ' No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA 0 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 Et 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 rNoC]
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 NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional°recommendations.or any other comments: :..
Use drawings. of facility to better explain situations (use additioiialVages as: necessary). ra a
Reviewer/Inspector Name: "_j A-' Phone(to) " 73G6
Reviewer/Inspector Signature: Date: $ L
Page 3 of 3 21412011

'I
Facifi Number ty ( i -
Gd Division of Water Quality
0 Division,ofSoil,apd Water, Conservation
Q.Other Agency. _
Type of Visit OrCoompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 3 Arrival Time: 9 C0 Departure Time: `� !" `I County: OUPL2-0 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: %C2ll_ "SC— _ _: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 ' Longitude:
0
Design Current Design Current �' Design Currenf_;Y_
Capacity Population 'Wet Poultry Capacity Population Cattle.' =Capacity Population
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry.
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 CT/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑Yes
El No ❑NA
❑NE
❑ ❑ NA
❑ NE
❑ Yes
El Yes
Zo
L7 ❑ NA
ElNE
❑ Yes
To ❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: - 3
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?
Structur 1 Structure 2 Structure 3 Structure 4
Identifier: Cry i + A&PpeJ Z
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 VNo
[I NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes ❑ 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 thh .eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L� N El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes kd 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 Z ❑ NA ❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L/I 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)
t 3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ o ❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ .yes
rNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
No ❑ NA
❑ NE
s
Comments (refer to,question #} &Explain any YES answers and/or any recommendations or any other comments
Use,drawings of facility to betterexplain- situations (use, additional pages as necessary) . p� u
Reviewer/inspector Nameo R-!ll ail:. i� >r `;� .:: Phone:
Reviewer/Inspector Signature: _ Date: .� 3
Page 2of3

Facility Number: Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑Yes LAN" El 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 /XO ❑ 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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Zo❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes❑
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes❑
NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes;eo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
/
/El
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
^L�,yNo
NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�
0�
❑ 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
❑ 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
Io
❑ NA
❑ NE
Additional Comments and/or Drawings:. e :: w : �` ; " e s
.� a .. G.. .��.' .�...� �� ,�..: P.....�.
w
Page 3 of 3 12/28104

Fa�ilaty Number; j � j. �i
a &�
)rv�sion of Water wQualety
)ivision of Soil and Water Conservation
Type of Visit 46 Co Hance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
4411( O
Date of Visit: Aanp Arrival Time: ® Departure Time: County: Ou9cuJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Ck_ 94!F-%C=
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0. 0 Ii Longitude: = O = L = fl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer t-iOr� ❑ Non -La er
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
El Pullets
ElTurkeys
❑ Turke Poults
❑ Other
Design Current
Cattle Capacity Population
ElDai Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes C14,0 ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
FINE
[--]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ONo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 I — 3 Date of Inspection �D
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: (AGC:EfA� � L. A CY2% 2—
Spitlway?:
Designed Freeboard (in):
Observed Freeboard (in): 35 2'-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes fNo . ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 yes ❑No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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?
I5. 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
[2/No
❑ NA
❑ NE
C:J'No
❑ NA
❑ NE
Ef"No
❑ NA
❑ NE
E No
❑ NA
❑ NE
�10
❑ NA
❑ NE
Comments (refer to question:#) Explain,any YES. answers and/or any recommendations or any other omments p ` y
Use drawings offadlity to better. explain aituatons. (nse addrtronal pages�as necessary)"
ReviewerlInspectorName
w� Phone: �a
.:=�J��1rtJ21F+Cr=� �796 — 7,3g
Reviewer/]nspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection f lD
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes �o ❑ NA El NE
I/
❑ Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EJ 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
ENo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,d(No
dNo
ElNA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EJ No
❑ NA
❑ NE
Other Issues ,—,!
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes 90 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Coo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��
L'7 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
nNo
❑ 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
P o
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El! Yes
4
❑ NA
❑ NE
C
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

iiOsion,of.
Facility Number,31
3]
ter -Quality
.. t
! and Water Conservation
Type of Visit (D Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: ����� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ �'-_ NSF
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: c = 6 Longitude: = o 0 ` =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑Layer
oa (cqGD ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
urkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
[3NA
ElNE
ElYes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 31 Date of Inspection Q 8 09
i
V4taste 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: LACE r) I LAGaeN 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 L �j
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
10yes No ❑ NA ❑ NE
❑ Yes YNo ❑ 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? dyes IJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [I/No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1)40 ❑ 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
J-71 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,allo
E7 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
dNo
❑ NA
❑ NE
^Comments,(refer to question #): Expla►r► any. YES answers and/or any*recomttiendations or any other comments
Y
Use drawings ©f facili to`betteir ex"lain,"s'ituahons: (use additional pages as�necessary): �.• � � *"
ty p
Cc tort- S an�� o rU E A 3 T I
Reviewer/Inspector Name �— a�-I� �n1�iU Phone:
Reviewer/Inspector Signature: Date: �
Page 2 of 3 1 12128104 Continued

Facility Number: 3 — 3 Date of Inspection
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 El Maps El Other
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain InspectionWo
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
[I Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
LJ No
❑ NA
❑ NE
'
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7NO
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,,��,,!/
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[]Yes
&o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
yNo
❑ NA
❑ NE
Additional Comments and/or Draw►ng"s:
a
Page 3 of 3 12128104

r Q Division of Water Quality
Facility Number ,S j 31' O Division of Soil and Water Conservation
.� - 0 Other Agency
Type of Visit Cq(npliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: _ Departure Time: C] County: 19t/PL u Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e-c-cIV SF
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = =is Longitude: = ° = g 0 «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
© Wean to Feeder 4►.lLx> Lj8
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
giurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dr
y Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
-
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Cf No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑rEl NA
El NE
❑ Yes
El Yes
[INA
' XNo
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: ' j — Date of Inspection a�
Waste Collection & Treatment
J%4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ 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: (44 &%FdA1 &V0'V Z'
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[2rNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
��,, //
E 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 improvement?
any of the structures need maintenance or U Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ye
ZNo ❑ 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
tdi No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
1'J No ❑ NA ❑ NE
maintenance/improvement?
l L 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L] Np ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
LJ No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo ❑ 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):
oN - re of 6orw cAcr 6w Fop- cwc-K. G4fiaS ocvc b,
Reviewer/Inspector Name p/R/J�/ jQ Phone:
Reviewer/Inspector Signature: Date: dd'
12128104 Continued

Facility Number: 31 — 3 1 Date of Inspection
,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
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 ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes No ❑ NA ❑ NE
❑ Yes CI No ❑ NA ❑ NE
❑ Yes
NNo
rrN
El NA
El NE
❑Yes
❑NA
❑NE
ElYes
o
❑ NA
❑ NE
❑ Yes
fNo
ElNA
❑ NE
ElYes
Q No
❑ NA
❑ NE
❑ Yes
❑ No
C�<A
❑ NE
❑ Yes Q'1<o- ElNA ElNE
ElYes D o ❑ NA ❑ NE
❑ Yes O'No ❑ NA ❑ NE
❑ Yes [?No' ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes �E] NA ❑ NE
12128104

0
` 0 Division of Water Quality
`) Facility Number Q Division of Soil and Water Conservation
O Other Agency
Type of Visit (21rCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �(J Routine O Complaint o Follow up O Referral ()Emergency 0 Other ❑ Denied Access
Date of Visit: 5 9 o Arrival Time: 2- G Departure Time: County: 1DL-'Pt--MIJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Cc c-a_ ZoSC
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = i 0 « Longitude: ❑ ° ❑ 4 ❑
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
® Wean to Feeder GLloo fj Ka
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — ? 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 I Structure 2 Structure 3 Structure 4
Identifier: CA Ga o N f LA &MA) 2—
❑ Yes &No ❑ NA ❑ NE
El Yes El No ❑NA ❑NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 11
Observed Freeboard (in): LJ ,_
No ❑ NA ❑ NE
Ll No ❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes�`No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes YJ 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
El
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/No
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?❑ Yes
�PrNo
L� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6o
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ 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):
Reviewer/InspectorName `J a}� l�j Phone: 7 go,
Reviewer/Inspector Signature: Date: 9 a
Jlr/L'V/VT L.VI�f{/iNGM

y� Facility Number: Date of Inspection
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 ❑ yes 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 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes N�o ❑ NA ❑ NE
❑ Yes LdNo ❑ NA ❑ NE
❑ Yes No ❑ N ❑ NE
❑ Yes
❑ No
lJ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
❑ Yes
E iVo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
ff -No
❑ NA
❑ NE
12128104

0 Division of Water Quality
Facility Number 3 3 0 Division of Soil and Water Conservation
- - — 0 Other Agency
Type of Visit Cornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G Routine O Complaint O hollow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 3' f± d(r Arrival Time: Departure Time: County: /)1$LZ&j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Swine
Other
❑ Other .� . —
CA emu,. JZas E
Title:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: E--] o ❑ Longitude: = 0 0 d ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ell
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 (gailons)?
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 LJ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
El Yes
❑ NA
❑ NE
❑ Yes
YNo ❑ NA
❑ NE
12128104 Continued

Faci itg Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JNo ❑ 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 600^1 1 LA &.ow 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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? ❑ Yes 0No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 El Yes �,No ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [l4 ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. El, Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 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) C"w .S
13. Soil type(s) A V G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 6. ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Z"No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes 0No ❑ 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):
'�7'AfLo., Ame, lut-AV5 L60It- G"D.
Reviewer/]nspector Name I � j o�FA��, I Phone: L`Il ) 'I ' j (, — -) V, j
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Gonffnued

i
Facility Number: 31 — Date of Inspection 3 L e G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ L�J Yes /No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[I/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 InspectionsEl
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[3 No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7No
[W'NA
El
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElE 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
LJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[J"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
Q 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
C?&o
❑ 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
,�/
IT No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P1No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

//I
Tom Rose
T&C Rose #1&2
877 Garners Chapel Road
Mount Olive, North Carolina 28365
Dear Mr. Rose:
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
June 6, 2006 nl�UE I VE D
JUN 0 8 200b
im
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. AWS310031
T&C Rose #1&2
Animal Waste Management System
Duplin County
The Division of Water Quality (Division) received your sludge survey information on May 31,
2006. With your results, you requested that a sludge survey for the lagoons at the T&C Rose
#1 &2 facility not be required until 2008. Due to the amounts of treatment volume available, the
Division agrees that a sludge survey is not needed until 2008. The results of the 2008 sludge
survey for the lagoons are to be submitted with the Annual Certification Form that will be due on
March 1, 2009. Thank you for your attention to this matter. if you have any questions, please
call me at [phone].
Sincerely,
Todd A. Bennett
Environmental Engineer
cc: Wilmington Regional Office, Aquifer Protection Section
APS Central Files
Aquifer Protection Section 1636 Mail Service Center
Internet: www.ncwate1guaii0 orR Location: 2728 Capital Boulevard
An Equal opportun4/Atfirmative Action Employer— 50% Retydedl10% Post Consumer Paper
No Carolina
Aatirrally
Raleigh, NC 27699-1636 Telephone: [phone]
Raleigh, NC 27604 Fax 1: [phone]
Fax 2: [phone]
Customer Service: [phone]

fa Division of Water -Quality ` #
Facility Ndmber O Division of Soil and Water, Conservation
0 bther.Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
,J
Date of Visit: rJ 3/ Q Arrival Time: .`Z® Departure Time: County: u0L-�A1 Region:
Farm Name: L: ©�✓F� / �� Owner mail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
' Title:
04 ��
No:
/Phone
T
Onsite Representative: c.�c-� `� f!5�
In�at�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other .— — -
Operator Certification Number:
Back-up Certification Number:
Latitude: = c F--T = Longitude: = c = 6 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
V00 ❑ Nan -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
l
❑ Beef Feeder
❑ Beef Brood Co
I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No. ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
PfNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V] 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
Identifier: A-1�
Structure 5
Structure 6
Spillway?: C1
Designed Freeboard (in): (�t�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
f3 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
INo
❑ 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
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
jP
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,_,(
I[� 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
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) 14,6w�-
13. Soil type(s) V46
4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V1 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
- YNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
A No
❑ NA ❑ NE
Comments {refer to question #lj: Explain anyY10ES answers and/or any recommendations or any other cumments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerllnspectorName r��-0s�� Phone:
Reviewer/inspector Signature: Date:
I21*2&04 Condmured

s
Facility Number: Date of Inspection 3/ O
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑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 ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ;�`No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes /No
ElNA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes � No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes )ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes { (No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes /❑ No
XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
/� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Addit,onai Comments''andh r,Drawings ; ; �� ' �" � ax dr.. AdMk
12128104
12128104

,_
Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X Routine O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number Date of Visit: i/ Tune:
O Not Operational O Below Threshold
0 Permitted [3 Certified [3 Conditionally Certified 13 Registered Date Last Operate r Above Threshold:
Farm Name: ........�_'!E1�4 _. Z......_.. _ ..._.._ County: _.f�,l�! ............ ...... ..... _ ..............
OwnerName: ........... ........................................ ... ............... Phone No: _.......... .. _ ..
MailingAddress: ...................... ............ ...................... .........................
_..,._ �.
Facility Contact: ........................... .............._........2..................... Title: • --• -------- �P hone No:_--
Onsite Represen#ahve:..��_._._----�LJfi� _�jj�4�'� Integrator:
- . /c . ..........� .� .7.
Certified Operator: ................ ................... 1-1 ..... ..................................................... Operator Certification Number: ..... ....... ..................
Location of Farm:
XSwine ❑ Poultry ❑ Cattte ❑ Horse Latitude ' 4 0« Longitude • 4 46
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Ye0
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 ;(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes�o
Stni -tore 1 Strp� 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ....... .............. - .... _............. ......... ............... ..............
Freeboard (inches):
12112103 Continued

F-
Facility Number: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelrmprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A hication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes I No
❑ Yes No
❑ Yes [P(No
❑ Yes W(No
❑ Yes ;dNo
❑ Yes XNo
❑ Yes �&o
❑ Yes 91 No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9(No
❑ Yes XNO
❑ Yes VNo
❑ Yes A No
❑ Yes /dNo
ElYes JdNo
;Comments (re%r to gnestron ) Explain any YES answers auwgr any recummnneudations orgaany other comments: z
iise drswrngs of facility to'better explaEn sitaanons. (use aslthhunal=pag s as necessary) ] field Co
i py [3 Final Notes
_e
+
Nf % ��f S�.�f LSF
" si 'c^s �"
Reviewer /In/Inspsl1ector Name -Z
�: DW4 �
Y �/.I✓ /. is x y� _c:?" Y� e.•,.
Reviewer/Inspector Signature: Date:
I2112103 Continued

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/ WIT, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
60--
/Yes 00
❑ Yes XNo
❑ Yes P(No
❑ Yes 2(No
❑ Yes P(No
❑ Yes 0 No
❑ Yes WfNo
❑ Yes &No
❑ Yes INO
❑ Yes J211
❑ Yes/❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 10 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: /p Time:
Facility Number
Not O -rational Below Threshold
0 Permitted [3 Certified 0 Con ' ionally Cegtifie 0 Registered Date Last Operated or Above Threshold:
Farm Name: F County: 061AGZ��
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: 422642&!�QRO
Phone No:
Onsite Representative:D�� Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 1 " Longitude • 4
Design Current
Design Current Design Current
Swine Capacity Population
Poultry Capacity Population Cattle Capacity Population
Wean to Feeder
❑ Layer
I
I
❑ Da'
❑ Feeder to Finish
10 Non -Layer
I
I
JE1 Non -Dairy
El Farrow to Wean
_ _ - -- - - - - - - - - --_------------
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boa
Total SSLW
Number of Lagoons ©
❑ Subsurface Drains Present ❑ Lagoon 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?
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
Stmeture 1 Structure 2 Structure 3 Structure 4
Identifier: 0 1 X 1
Freeboard (inches):
05103101
Structure S
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes i No
El Yes �No
❑ Yes YNO
Structure 6
Continued

F
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
lLJ No
seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(It any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
PAN ❑ Hydraulic Overload
it. Is there evidence over application? ❑ Excessive Pondin//gJJ�`
❑ Yes
)�❑
12. Crop type _ R `� _ _ \�V Y � jL[f.[T�
13. Do the receiving crops diffe(with those designated in th/Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
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?
ElYes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
ElYes
&NO
24. Does facility require a follow-up visit by same agency?
❑ Yes
[z o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
[3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Corn%me&nfs (refer�to queshoo #) EapEaEn any$YEb$ answr's,and//or�igny�recomTmeyndations'ar any o er coaaments, ; - .,y 1
`�• A S 3 i -& C� wB 4 ' -i 4,1 ✓ -`fin � z. +A' X *,* r .: -e s %R
Ilse dra ngs of iacility� to?better expla n- tua (useraddttidnalrpageT.s
i
ons nec%essary) Field Copy Final Notes ,
df9#1_
64a
#e,.411'1 OCft�DntS /D iP,, �5 /¢f►!O �54167W �- , Je,-
Reviewer/ins ector Name
P �T
Reviewer/Inspector Signature: Date:
05103101 1L.17 v v f 11 Continued

Facility Number: -- Date of Inspection 1 i
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fait to discharge actor 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? (i.e. 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?
❑ Yes o
❑ Yes /dNo
❑ Yes �INO
❑ Yes 10 No
❑ Yes 9No
❑ Yes �dNo
ElYes ❑ No
05103101

Type of Visit qkCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0,Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date. of Visit: Time- i Printed on: 10/26/2000
Q Not Operation. Below Threshold
dt Permitted 0 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: -.I !TaigCounty:........Dkf. l...'.�..-...............O'D. ^4....................
. ............ � ............................... 'fir'!-{
Owner Name:........L.P1 GJ....�3.—....1 Fi.�...1.... .. ►..4..�-:�..,�.. Phone No: 1.............
.................................................. ............
Facility Contact: ...i.a.�'^.... .�{L i..�.....'iS ` Title:...b�(1. ..... .... Phone No:.. r�.,.' f
...........
& r 1 4/4) l/i Sy
_Mailing Address:.................................................................. � S
..................... ................... .......................... ....................
I v
Onsite Representative:......8>!?!......G.1....... Sr4........ ill..... grator:............ ZQ. �A'�S.t7�...�*i..L......1.....
�j 1 �k 5f
lc*C .. ............... iT t+�,..t1.......... Intc
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
JA Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• ° •i Longitude • �' �66
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 ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Arer ❑ 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?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II'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. II" discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & "Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Stru •turc 2 Structure 3 Structure 4 Structure 5
^� i i
Identifier:.........-.�%.�..............
......... ...! ..
Freeboard (inches): �r,,,,�,k 1C _
5100
❑ Yes 04 No
❑ Yes ❑ No
❑Yes
]No
_ /Aj 4 -
❑ Yes'
❑ No
❑ Yes
❑ YesjNo
No
❑ Yes WNo
Structure 6
Continued on back

Facility Number: — �j Date of Inspection b2 4
f- ----;,
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: &-L-
..... ...... ........... .............
Freeboard(inches): 32...... ...... :............... ...................... ............. ........................ ............ .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes WNO
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 puhlic health or environmental threat, notify DWQ) ��//
7. Do any of the structures need maintenance/improvement? ❑ Yes RNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes K No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes JYNo
12. Crop type I`
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes11No
No
b) Does the facility need a wettable acre determination?
❑ YesNo
c) This facility is pended for a wettable acre determination?
El Yes
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
17.
Are rock outcrops present?
❑ Yes
❑ No
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Required
Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
[-]Yes
[(No
,
20,
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
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
040
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
$No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
�(o
__
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
0
r
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
'VNo
01/01/01
Continued

FaClllty,Number: _ .�� Date of Inspection L y
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover?
Printed on: 1/4/2001
❑ Yes ( No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes 1A No
❑ Yes JJNo
110 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name
Reviewer/Inspector Signature. 0 Date:
01/01/01

*Division of Water Qual
ity
ty
Q Division of Soil and Water Conservation '
Q Other Agency
of Visit OtCompliance Inspection O Operation Review Q Lagoon Evaluation
(Reason for Visit V Routine O Complaint O Follow up Q Emergency Notification O Other 0 Denied Access
Facility Number Date of Visit: - -10 Time: [�= Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted 0 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ........%.........
Farm Name: ...... �..Y........Y�^ .... . �....�.......... Count}=:..............ln�,���t........................L.:.........
Owner Name :........ ...lP.k''L. ......� ........�.. .. Phone No: ..To ................
Facility Contact: ..RA . ........ �...... ............. "Title:....... 1.1.V...%:........................................ Phone No: 5..�[f. �... � �q}.i1 ` .'..5e15'
MailingAddress:........................................................................................................................................................
. ........... ......
Onsite Representative:..... L.fT..w+......-5. -(' 1...?5�..... .... ............ .....m0-e"egrator:......... .�� ....�6Y�.......f Y...LJ.�.1tI................
Certified Operator:.....1..ble+n.-.....,--.....�[..!............ . .. ...5..... .............................. Operator Certification Number:.....................,...
Location of Farm:
b(Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude �• �� ��� Longitude �• �� «'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder U pv JE1 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
❑ FarroW to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ID Subsurface Drains Present 0 Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream impacts
I. 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 Watcr of the State'? (If yes, notifv DWQ)
c. If discharge is observed. what is the estimated flow in gallinin''
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
5 uciute I tlructE 2 Structure 3 Structure 4 Structure 5
Identifirr: .........�.-...31V1.................. .... .t
. .
Freeboard (inches): ��33
5/00
❑ Yes
❑ No
❑ No
❑ Yes
❑ Yes
o
❑ Yes
kNo
❑ Yes *0
Structure 6
Continued on back

Facility Number: 3 — 3 Date of Inspection t, Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs rved? (ie/ trees, severe erosion, ❑ Yes No
.r
r� seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Cl Yes k
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 VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNO
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes I o
11. Is there evident of over application? T❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �}fiio
12. Crop type La . 4- I D �L
13. Do the receiving crops diffel with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17_ Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record [seeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: 10.violatioris:or deficie tki •*ere hbted• d&itig tbis:visit.' Moir :will •receive rio further
....
roriesporidence. abouln this visit....... .
....
❑ Yes XNo
❑ Yes 1io
❑ Yes PNo
❑ Yes N No
❑ Yes jKNo
❑ Yes '0�`No
❑ Yes N(No
❑ Yes f <No
❑ Yes Wo
❑ Yes rl)
❑ Yes DNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes XNo
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):
W L P Te -fo vv,ki p, =vn�t�- ot1,5 i9� %VWtV _ r-Lk-ct 4D 6r6.r-
IQ. +.5 1i� i�S�h syaw yowlsOilu
by aS.
Y
-- ��.v,•,.� wr, i Ntat 3 � 31 �,�•
A,
lJ
Reviewer/Inspector Name j­ ff
Reviewer/Inspector Signature: !�
Date: 5 r 1 —
5100

Facility Number: ' —J? Date of Inspection MLLU219k 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 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 ro
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RfTo
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 WTo
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 D�'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 KNO
Additional Comments antiorDrawings:
AL
5/00

f l '
4V r--
[3`DEvision of Soil and Water Conservation = Operation•Rev�ew r
O Division of Soil and Water Conservation - Compliance Inspection
': V Division of Water Quality - Compliance'Inspection
0 Other.Agency - Operation Review
Routine O Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review Q Other
Facility Number Date of Inspection a
Time of inspection 24 hr. (hh:mm)
j3 Permitted Certified [] Conditionally Certified ©Registered IF3 Not Operational Date Last Operated:
��11
FarmName: ... C..............5........................................ County:.........r....._....1�.....
nrvnt-r N...,- aV`' A- Plump Nw.
Facility Contact: .................... .... Title:........................ ..................... Phone No............... .
MailingAddress: ..................................................................................................................... ................................................ ..........................
Onsite Representative:Ot!J''.'J'.................................... lntctirator......�... �...............................................
...........
Certified Operator: .............
Location of Farm:
........... ......... I ....... .................. Operator Certification Number:....
E............................ .........__......_.................................... 1
Latitude Longitude
Design Current Design Current Design Current
Swine Ca acity Population Poultry Capacity Population Cattle Capacity Population
54 Wean to Feeder co ❑ Layer ❑ Dairy
❑ Feeder to Finish 10 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify,DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance liltrn-made'?
h. II'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge 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 t
Identifier:
Freeboard (inches): .............
Structure 2 Structurc :3 Structure 4
.........._.19-9 .......................................................
0
❑ Yes �dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONO
❑ Yes
b6o
❑ Yes 9No
Structure 5 Structure 6
........................................................................
1/6/99 Continued on back

Facility Number: Date of Ltspection
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 maintenancelimprovement?
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 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 appli�ion❑ Ponding El Nitro-en
Crop type ....'........................t57 ......................
...........................
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 Covera-e & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) -
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a 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)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
q, No.viWaitioras ir. deficiencies .were noted during .this;visit:. You vvill.rerceive nt7 further . • .
• ; • cti- - - - ndeitce;about; this ;visit.:.:. ; • . • . • _ • . • . • . ..... .. •...........................
Comments (refer: to question#): Explain any YES answers and/or any.recommendaiions or any other. cominents
Use drawings of facility to better explain situations. (use additional pages as neciissary) & ° -
❑ Yes IgNo
❑ Yes )RfNo
❑ Yes k'No
❑ YesNo
❑ Yes YNo
❑ Yes '19fNo
❑ Yes DR�No
❑ Yes O�No
❑ Yes E� No
❑ Yes 0 No
❑ Yes ArNo
❑ Yes [6N No
❑ Yes MNo
❑ Yes � No
❑ Yes WNo
❑ Yes E'No
❑ Yes [�(No
❑ Yes gNo
❑ Yes NrNo
Vr
Reviewer/Inspector Name
Reviewer/Inspector Signature: ( _3L, 1���� _ _ _ __ Date: ',�d l f I i/6/99

X;c •..- r' _. _........ ......... _. .._._,,. ............._._,._.._.._.... ......... .._—..............—............ ......
0 Division of Soil and Water Conservation 0 Other Agency
F3 Division of Water Quality
ID Routine O Com taint O Follow-un of DWO ins ection O Follow-uu of DSWC review O Other 1
Facility Number
© Registered Wertified © Applied for Permit [3 Permitted
Farm Name:-........
Owner N'ame:... ..; , ---, ...........................................
Date of Inspection I fI a319 "
Time of Inspection ® 24 hr. (hh:mm)
0 Not O erational Date Last Operated:...........
..............
County:........^..........ff�.�'1pp...........................
Phone No:....:30. 4...........................
FacilityContact: ............................ Title:................................................................ Phone ......................................
Mailing Address: ......l....... ... et
.L.tlw�.....�............'..n.......a...........
�.......................
........................ ..........................
Onsite Re resentative•.Qt...-.2........................... .....-----............_.............Itegrtor:... .
Certified Operator:.............................................................................................................. Operator Certification Number ..........................................
Locatio of F
......
... ......
... ......... . . ... .. .... ...
^T�-�,.............IG1.:...:--',.....i...3..�..:..... ..-................................
Latitude • =' 46 Longitude =• & "
Design Cu rent
Design Current
Destgtr ,Current
v. ,
Swine R f Capacity; Population ;: Poultry Capacity Population Cattle „ ,
,.Capacity Popiilahon
Wean to Feeder
GU
�`
❑Layer
❑ Dairy
❑ Feeder to Finish
W'
❑ Non -Layer
I
I
1
10 Nan -Dairy
ai
[] Farrow to Wean
❑ Other I Is
x
❑ Farrow to Feeder'
❑ Farrow to Finish
Total Dtlsign Capacity
❑ Gilts
❑ Boars
e Total' SSLW
�NumbeC of Lagoons I Holding fonds
❑ Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
d
= ❑ No Liquid Waste Manageinent System
.
54
General
1.
Are there any buffers that need maintenancelimprovement?
❑ Yes
0 No
2.
Is any discharge observed from any part of the operation?
❑ Yes
[gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
d 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 gaUmin?
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
❑ Yes
qNo
maintenance/improvement?
5.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
IA No
7/25/97

I
Facility Number: 3 — 3 \
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
(4No
Structures (LagoonsMoldingPonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Ej No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier. L'
-----------------------------------................. .......................................................................
................................... ...................................
Freeboard (ft): .........� :� S
..........................................
10. Is seepage observed from any of the structures?
❑ Yes
(9 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
ff No
12. Do any of the structures need maintenance/improvement?
❑ Yes
NrNo
(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
5rNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
A No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...4`'' Z.�...54... ti`
�---�---- ................................................................ •--•.............................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 14;:f No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes O No
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?
0• No.viola onssor deficiencies-were'note_ci-during this:visit. You;w'ill i�&e' iv`iro,fdrth:err :
- O&Osp6ndek6 about this'visit:
❑ Yes [9 No
❑ Yes ffNo
❑ Yes (j'No
❑ Yes UNo
'Yes ❑ No
❑ Yes CdNo
❑ Yes J@ No
❑ Yes 0 No
a�� hem .�-�e+� ►�-� �� - ie� �=���•. h�,�e� t ,�� v� �.��s .rL.��. �,
7/25/97

DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
® Routine 0 Complaint 0 Follow-up cif DNVO inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 23 �
[ 11.1. ­­-., Facility Number 31 31
Time of Inspection � 24 hr. (hh:mm)
Registered 0 Certified E3 Applied for Permit [3 Permitted JE3 Not Operational Date Last Operated:
FarmName: *C °E- ................................................... Countv:...... DU In ......................... ....................
OwnerName:......... BZh ....... Se.................................................................................... Phone No: ..�. A) ... M.Ml.1..............................................
Facility Contact: .....�.t?rr....`�.... Jhp5Z.................... Title:.......... a(4!i]1.r.................. ....... Phone No:... `tl9�.w.S�.'.i�4.�...........
Xiailittg Address:...... ...... OICi S...... �1F.......,...W................................ .......i�!� .F....Q.��t�Ve.... MCA.................................. la ......
r
Onsite Representativer....?Q`ri►......
p4G-inL.i......................... [.�
Integrator: .........
Certified Operator;.....C�£C:.l-.-.--.-1�-......Ploy........•..................................................... Operator Certification Number,...-M.31 ......................
Location of Farm:
Yc:►�4�..........ID3....t�or......... �x�.... s,�C ..:...T�rn.... e......Qr�....GK.14.Q...:...Tl?rr...r........,nn....S.R..Ia�.a��...�"u�!....---.
�. ...-Qr..-.SR...ISAS a.,r. h....i.S..-....p.:.. ..haa�S..... t?!+....SQ.V.`� ...:50:f....... , ..lC �...........................•--------.-.-.........
..........................-.....
Latitude • D$ �"] Longitude '» • 5� '�
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 ❑ Dairy
❑ Non -Layer I I JE3 Nan -Dairy
❑ Other
Total Design Capacity . (oJtfpp
Total SSLW qz Ol,�p
Number of Lagoons / Holding Ponds J❑ Subsurface Drains Present ❑ lagoon Area ❑ 5prar Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes 54 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 g kUrnin? tj
d. Does discharge bypass a lagoon ysw n? (If yes, notify DVI-Q) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P] 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 ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 93 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 54 No
7/25/97 Continued on back

FaziWy Number: 31 — 31
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: # I ................ # Z ..
Freeboard(ft):.........,3....t...................................................................................................................
t0. Is seepage observed from any of the structures?
L Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
$J No
❑ Yes
No
Structure 5 Structure 6
❑ Yes
RNo
❑ Yes
& No
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
t4. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) t 5. Crop type ........ CP.Cti....................................................................................................J t l.....................
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?
® No.violations or deftciencies.were noted during this.visit. You_:will receive -no ftirther _
Oeres'poRdence about this:visit:-
❑ Yes ® No
❑ Yes ® No
❑ Yes $j No
❑ Yes allo
❑ Yes 0 No
❑ Yes K No
❑ Yes SNo
❑ Yes VL No
❑ Yes KNo
fY Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes C5 No
Comments [refer tirquestionft Explainany YES anstvers.and/or any rec6nunendattons or any other eotnment,
Use d..rawinggsofacWt .to,>better ex lain situations (use additional pages as neeessa " -.
ry)
2Z. SPrc,,,l
r'tcora% -skaJ�
h,Q.-
KLtt bl run rtomber a,--J PAJ rlunhc--. Alt Yt2n 60.4a,, w. for s�(r Q&
jkoul�
INCOd" Vhc�+ n.
�r✓i�a�icsi eVtp"J !%,QQG1R-ta''OnS SkOdO 6(! en Slit_
7/25/97
Reviewer/Inspector Name
ReviewerfInspector Signature: �,,,� _ /,, / /�,— Date:

Site Requires Immediate Attend
' Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: . , 1995
Time: Pi za'-00
65—
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: r 0 Lon tude:%7° 5-7 6:3 '" Elevation:- Feet
3 s o � 13 Circle 79 or 4_7
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)(9 or No Actual Freeboard: — Ft_ C �iI�es
iWas any seepage observed from the lagoon(s)? Yes or o' Was any erosion observed? des or�I
Is adequate land available for spray? es r No Is the cover crop adequate? ' use or No
Crop(s) being utilized: C F O
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. or No
100 Feet from Wells?&s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orb .
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oo 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)? (Y . o No
Additional Comments:
Inspector Name
z2zC_�1e_1_
Sigre natu
cc: Facility Assessment Unit Use Attachments if Needed.