310286_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

L Vv
Type of Visit: 0 ?6RLoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical AssistanceReason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: PuK �t T C i t_,o L--/ P S Integrator:
Certified Operator:
Certification Number: 17 Z , { �-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design C*urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
1 7 vg
INon-Layer I
Dairy Calf
Feeder to Finish
Design Current
D , P,oul Ca aci P,o ,
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Lavers
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: -❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
go
NA
❑ NE
Yes
❑ NA
❑ NE
Page I of 3 21412015 Continued
I�

Facili Number: 2 1 _ 1,2 L2 Date 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
Structure 1' Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
No ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 6
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IZNo NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmFNo
hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ef No ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 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
❑ NA
gz�,E]
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
No ❑ NA
�
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[-]Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [!J'No ❑ NA ❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

lFacility Niimber: jDate of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es to Q 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej No
❑ NA
❑ NE
Comments (refer to gdestioi. #): Explain any'YES answers and/or any additional recommendations or any other comments. g...: -...
Use drawings of facility to•better.explain situations (use additional pages as necessary).
is 11.E 4—
f
i 0 3 .SD ? oo y
Reviewer/Inspector Name: rt v l o<--� !/ Phone: 7 C 7
Reviewer/Inspector Signature: _ � { Date: / J
Page 3 of 3 21412015

Type of Visit: dance 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: ( Co ( Arrival Time: 2 Departure Time: 3 / County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: J Title:
Onsite Representative: _. ^(% C& L. n `-, { e S T
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1- 4 �
Certification Number:
Longitude:
Swine
can to Finish
Design Current
Capacity Pap.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
4 O
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Design
D . P,oult . C•.a acit P,o
ILavers
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR) .
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ Yes
['jNo
�No
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili •Number: ( - Date of Inspection: o Ire 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in): Z >
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E!f No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 E fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L__l No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ej No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U!rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
6 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfrNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q' o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection: 1 o r
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes N ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [3NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3 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 �o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [?fNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes (6 No
❑ Yes [ 1 o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3
n 1'
2/4 01

Type of Visit: a Co pliance Inspection U 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: J Arrival Time: Departure Time: County: Wpb�1 V Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: +Title:
Onsite Representative:{S
Certified Operator:
Phone:
Integrator:
Certification Number: 199
�1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer IDairy
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
INon-Layer I
a
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry P■oul_ Ca aci P,o P.
Layers
Non -Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[:]NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
F&o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
PINo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Condnued

Facili Number: - jDate of Inspection: JJVS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eve/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yesgo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes CNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 2 n, 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 �o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes rNo
❑ NA
❑ NE
acres determination?
2No
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 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 Wo
❑ 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 InspectiWl�'
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: j
s
24. Did'the facility fail to calibrate waste application equipment as required by the permit? [:]Yes o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 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 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
CZ/No
❑ NA
❑ NE
�No
NA
NE
❑
❑
No
❑ NA
❑ NE
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to better explain situations (use additional panes as necessary).
Reviewer/Inspector Name:
"13
Reviewer/Inspector Signature: Date:
Page 3 of 3
2141201

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
.F
Reason for Visit: Q'Rkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: , Arrival Time: I tf) jeparture Time: r_� County: , � �/ Region: ZIV
Farm Name: �('�fi 1 "(,j j , Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
letlipoultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Finish
o Feeder
er
Dai Heifer
to Finish
to Wean
Eo
to Feeder
Design Current
l Ca aciP,o
D Cow
Non -Doi
to Finish
jEN
Beef Stocker
ers
`.
Beef Feeder
Beef Brood Cow
JEWOther
Other
oults
�L
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [aNo ❑ NA ❑ NE
s�
:. Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes E No ❑ NA ❑ NE
z
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes JErNo ❑ NA ❑ NE
4'
1
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?
Page I of 3
❑ Yes ,[i No ❑ NA [] NE
❑ Yes -D No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑FNE
21412014 Continued
I

hSaJL =^1 'rl',i't +r ri�'; h -�( f -F ^r' _) ._ •,�7` 'FCC•' ...
��`-:'- ' , .�
£ .. -S
Facili Number: .3 - Date of Ins ection: <
y/ e/
Waste Collection & Treatment
P 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
�No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
' Spillway?:
±• Designed Freeboard (in):
Observed Freeboard (in):
r,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
' (i.e., large trees, severe erosion, seepage, etc.)
'4.
' 6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
0No
❑ NA
❑ NE
waste management or closure plan?
��``
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
° 7. Do any of the structures need maintenance or improvement?
❑ Yes
❑'No
❑ NA
❑ NE
' 8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'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 [;TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Anllllcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ; V(Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground Heavy Metals (Cu, Zn, etc.) -
l
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare S611 '
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 'Z No
❑ NA
❑ NE ;
w
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
[DNA
❑ NE
;....,
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[-]Yes PTNo
❑ NA
❑ NE
acres determination?
;.-
17. Does the facility lack adequate acreage for land application?
❑ Yes © No
❑ NA
D 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 ZfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes J�fNo
❑ 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 ONo
❑ NA
❑ NE
I�.
Waste Application Weekly Freeboard Waste Analysis Soil Ana! sis
❑ pp ❑ Y ❑ Y ❑ Y
❑ 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 Eff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes EjrNo
❑ NA
❑ NE
�`
Page 2 of 3
21412014 Continued

-�Vf�' '�' ? r -^�.' 1:.. f .. �. k"`'-�5 ^l^- ,. .!' •y.'.. "1' r-':i. [T 't'i ^I�n' v:ri.;� ��S�ht f.??'t., �-,w fin 1
Facili Number: - ,2- Date of Inspection: _ ti�/_2 71_1W
J
24: Did the facility fail to calibrate waste application equipment as required by the permit?
�❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related tJ 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 n NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
j2no
❑ 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
O 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
P]'N-o
❑ 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
FXNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[D"No
❑ NA ❑ NE-
31 Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
12 No
❑ NA ❑ NE
Comments (refer to question #): Explain any.YES answers and/or any additional recommendations°or.any: other:comments.
Use drawings of facility to better explain situations (use additional,, pages: as necessary.).
614CL2 Z,
,e S C
/Als tfeq
I
Reviewer/Inspector Name:
Reviewer/Inspector Signature: _
Page 3 of 3
Z-411 {eve t S
wq'- 0, PI
Phone:
Date:
21412014
W.,

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
310286
Facility Status: Active
Permit: AWS310286
Denied Acoess
Inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for visit:
Routine
County:
Duplin Region:
Wilmington
Date of Visit:
05/29/2014 Entry Time: 10:30 am Exit Time: 11:30 am Incident d
Farm Name:
Gerald's Nursery
Owner Email:
Owner.
Paulette Mills Knawles
Phone:
910-296-0995
Mailing Address:
384 Kirby Quinn Rd
Kenansville NC 283498804
Physical Address:
203 Gerald Knowles Ln
Warsaw NC 28398
Facility Status:
❑ Compliant ❑
Not Compliant Integrator.
Murphy -Brown LLC
Location of Farm:
Latitude:
35° 02' Longitude:
77" 57' 23"
West of Westbrook Crossroads.
On North side of SR 1300 approx. 0.5 mile West of SR 1004 on Knowles Farm Lane.
Question Areas:
Dischrge & Stream Impacts
Waste Col, Star, & Treat
Waste Application
Records and Documents
Other Issues
Certified Operator: Frances Knowles Operator Certification Number. 19947
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Frances Knowles Phone:
Primary Inspector. Kevin Rowland
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
REQUESTED SITE GRD2 BE RESAMPLED, ZN LEVELS EXCEED SOIL INDEX.
Phone:
Date:
page: i

Permit: AWS310286 Owner - Facility : Paulette Mills Knowles Facility Number: 310286
• Inspection Date: 05129/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Disignatsd ObservedType Identifier Closed bats Start Data Freeboard Freeboard
Lagoon 1 19.50
page: 2

'Permit: AWS310286 Owner - Facility : Paulette Mills Knowles Facility Number. 310286
Inspection Date: 05/29/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges S Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
[]M
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
01111
b. Did 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?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0 ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e.l large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
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 ❑
❑
maintenance or improvement?
Waste Application
Yeq_ No Na He
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ ■ ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
■ ❑ ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
[]
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
PAN?
❑
Is PAN > 10%/10 Ibs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑ .
page: 3

Permit: AWS310286 Owner - Facility : Paulette Mills Knowles Facility Number: 310286
Inspection Date: 05/29/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes
No Ne Ne
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
E ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
E ❑
❑
Records and Documents
Yes No No, No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
[]
N ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
[]
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310286 Owner - Facility: Paulette Mills Knowles Facility Number: 310286
Inspection Date: 06/29/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Surrey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
01111
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
M ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
■ ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check the
❑
0 ❑
❑
appropriate box(es) below.
Failure to complete annual sludge surrey
❑
Failure to develop a POA for sludge levels
❑
Nan -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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
M ❑
❑
Other Issues
Yes No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
M ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
1101111
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(.e., discharge, freeboard problems, over -application)
31. Do subsurface We drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/inspector fail to discuss reviewfinspection with on -site representative?
00011
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

Date of Visit: Arrival Time: Departure Time: County: ,(�[�,�//h Region:
Farah Name: �� &trdesc L Owner Email: �"�
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�s
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry C►apacity Pop.
Layer
Cattle
Dairy Cow
Dairy Calf
Dairy Heifer
Design Current
C►apacity Pop.
Wean to Feeder
I INon-Layer I
El
Feeder to Finish
Farrow to Wean
Design burrent
Dr, P.oultr Ca aei P.o .
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
F-To—ther
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)
❑ Yes ;Z�4o ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes }" No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

F*cility Njrmber: 13 1 _1141y jDate of Inspection: $ZZIZ43,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ["No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes E2'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes )2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .
❑ 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 2!f No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes -6No ❑ NA ❑ NE
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 Q No
[:] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes ,0 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 /6 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes WNo
[] NA
❑ NE
Page 2 of 3 21412011 Continued

F cili 'Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
DNA ❑ NE
❑ NA ❑ NE
❑ Yes [?�No ❑ NA ❑ NE
❑ Yes ,�No ❑ NA ❑ NE
❑ Yes J ' o ❑ NA ❑ NE
❑ YesjEj`No ❑ NA ❑ NE
❑ Yes,,ETNo ❑ NA 0 NE
❑ Yes ,❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ETNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 13' qo ❑ NA ❑ NE
Comments (refer to. question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pales as necessary).
fietd
O �7 �o'� Nvveilh�✓ � u /n�ln�
0t7�'
+21a-8�iz Q .7G
�3 /z 0, 5-3
G R 1 4- C RD 2��f Z,
l eve 6 e &,y 3 d
te, fe Soj­,_pte...-
Reviewer/Inspector Name: keowl. 047-'J Phone: �7V/
Reviewer/Inspector Signature: " Date: l 3
Page 3 of 3 /4/2 I

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 04outine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: /3 Arrival Time: Departure Time:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: %Title: Phone:
Onsite Representative: PIntegrator: 'Oft-t //3
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region: W //f&
Desfgn Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
I Layer
]Non -Layer
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Current
Pop.
Wean to Feeder
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , P,oul Ca aci P,o ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ?o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes o ❑ NA ❑ NE
2, Is there evidence of a past discharge from any part of the operation? ❑Yes/ N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faciti Number: - Date of Ins ection:
Waste Collection & Treatment
•4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 17rNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes,,[allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes O-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
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
_P�No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes jallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes L�JNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes - No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'L2-No
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 _12-No
❑ 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 _L2-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J:�'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes (TNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [-],No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o" No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,Eallo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes J:�Wo
❑ NA
❑ NE
❑ Yes [a No
❑ NA
❑ NE
❑ Yes ;3 No
❑ NA
❑ NE
❑ Yes E 'No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes )No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 4f No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or, any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
j5ir/Pi o�- recotes !A c5a'X-y drG
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: % /2
2 /2011

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:. Title:
Onsite Representative: //r r
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ❑" Longitude: ❑ o ❑ 6
Design Current
urrent Design Current
Designboct
Capacity Population
ItTROU ltry Capacityulation Cattle Capacity Population
o Finish
rn
❑ Laer
❑ Dai Cow
o Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑ DairyHeifer
Farrow to Wean
Dry Poultry ❑ D Cow
Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
Non -La ersPullets Beef Feeder
❑ Beef Brood Co
Farrow to Finish
Gilts
poBoars
❑ Turkeys
er
❑ TurkeyPoults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 12r ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
,ETNo
❑ Yes o El NA ❑ NE
[3 Yesjf�No ❑ NA ❑ NE
Page I of 3 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 ONo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes d-No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ! e
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 02A
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes/1 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/16No
❑ 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?
❑ YespNo
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes/0-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 ,E!(No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �'No
El NA ❑ NE
maintenance/improvement?
/
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 2rNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
t
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes Rr No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes /LJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J�],No
❑ NA
❑ NE
'Comments (refer to question.#) Explain any YES an and/or any"recommendattons or any othe�4comments �x "<
o Use..drawmgs of facility tbetter e_xplain,situations (usc,additional pages as necessary}
, , �...w
'p
Reviewer inspector Name Phone: -
Review
erllnspector Signature: Date: , �l
r I 12/2R 4 Cnnlinued
use Z. of i

Facility Number: — ' Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J, No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design 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 J[7No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �Ko ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes pNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ;2'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes pNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [P(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,UN o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes )3'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
❑ 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 FNo
❑ 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 4No
❑ NA
❑ NE
Page 3 of 3 12128104

3 _
�—? -- . - - _ ' .:a°•. �, s m.. ,;r! - � �°'rh. a m3 � � � w . '�7 ,y�^.,�y ,� `i ".�. .:..K j . .. <r
y0 Dtvt§ton of Water QuaLty
Facill Number„ Q Dtv�sion of,11
Sod and"Water" onservation
��`*�O,OtherAgency
Type of Visit Ql-eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 21woutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: Arrival Time: �� �r,�j Departure Time: County: k l� RegionW�t-y,�J
r
Farm Name: Gam, ��"e�;� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: d=j Title:
Onsite Representative: L?9.ke5
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: ,
Operator Certification Number:
Back-up Certification Number:
Latitude: n = , Longitude: [� ° = d = u
Design Current: �' Design Current"`4Design Cnrrent
Swute
Capacity Population �'et Poultry ryCapactty Populahon+"
Cattle,y •= Cap ty� Population
ram...
❑Dai Cow
Non-Layer
❑Dai Heifer
*°
,may 3 ..
Dry Potiltry, .
❑ D Cow
x
El
Farrow to Finish
❑ Layer
❑ Non -La er Dairy Calf
l Layers
E77
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Pouets
❑ Other
&Stream Impacts
1. Is any discharge observed from any part of the operation?
,,{'
❑Yes CJ INo
[I NA
❑ NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
❑Yes ❑ No
0; NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[I Yes [I No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes �No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes �
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑7No Yes
❑ NA
❑ NE
other than from a discharge?
72/28/04
Continued

Facility Number: — Date of Inspection (/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes_ '�lo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes OQNo
❑ NA ❑ NE
5tru pre 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
>
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes io
❑ NA ❑ NE
through a waste management or closure plan?
/
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes PIR
ElNA ElNE
(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
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes L21go
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesrL'r(o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P--No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ft 'Explain any YES an''swers:and/orany'recommendations or any other comments , w
Use drawings of facility to better explain situations (use;additional pages as necessary); , 2�
Fal-IY7 A�iCr 670F.
Reviewer/Inspector Name Phone: �,�p' — �
Reviewer/Inspector Signature: Date:
12128104 Continued

}
Facility Number: — Date of Inspection
if if
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 El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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?
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? (iel 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?
w19- '' � Us*�
NU
tf
r
❑ Yes /En No ❑ NA ❑ NE
❑ Yes A�No [I NA El NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes jdNo ❑ NA ❑ NE
A Yes ❑ No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
P3'No
❑ NA
❑ NE
❑ Yes
OKNo
❑ NA
❑ NE
El Yes
o
K
El NA
ONE
❑ Yes
❑ Yes
/ No
❑ NA
❑ NA
❑ NE
❑ NE
jab ci-G ek r-4 f V S L-S
spit s�',(,7/
L-) o C-C (C/ f xn e cr'f`
CcIrrec'r"e,
Sal vt;:�
/'�' 47 l
12128104

[F;;t�*y Number
-or"Bivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit t>dompllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit EfRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Time: Q Departure Time: County
Farm Name: CJ� Z_Vk' feP'c Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: _ Title: Phone No:
Onsite Representative: Integrator: �- _/
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
❑ Other
Back-up Certification Number:
Region:
Latitude: [= O = = Longitude: 0 0.= ,
Design Current Design Current
Capacity Population 'Vet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry'
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke Poults
❑ Other
Discharp,es & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: El
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 j'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
LR<o
❑ 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 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes -No ❑ NA ❑ NE
Struc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,'No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P'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 J 'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ElNE
(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 j2<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4 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 ZONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes C2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes _21 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [)fo
❑ 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):
l*oo-�i ,,, jjL& to r
0rfii(o 71 kex� IAAZL� a^Alyri s,
' Na SJ u r trr� �� �joG • �1�� e L�
u'-c j
'r ikt't 2dl-0-
z �7 lG 7 �� ` ge .5imr .dl�
Reviewer/Inspector Name Phone: l 7—
Reviewer/Inspector Signature: Date:
aj-r- A#. .12128104 Continued

facility Numbeir
61�rlvision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ��/'Q AlCee:�{ ✓ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: / %/Title: Phone No:
Onsite Representative: _Ce, W4 �(�1lO�t'Jl; Z et��S' Integrator: Azov
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: = o
Back-up Certification Number:
0" Longitude: = ° =' = "
Design Current
°,Design. Current..
ine Capacity Population
Wet Poultry. .Capacity Population
Wean to Finish
I
❑ La er
Wean to Feeder
D
❑ Non -Layer
Feeder to Finish
Farrow to Wean
Dry Poultry',
Farrow to Feeder
OtherT.
f ❑ Other
❑ La ers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ElOther
a. Was the conveyance man-made?
Design ...Current,,,.,,
Cattle Capacity Population -
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
El Non -Dairy
I
ElBeef Stocker
ElBeef Feeder I
❑ Beef Brood Cowl
T
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes (a'No ❑ NA ❑ NE
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ElOther
a. Was the conveyance man-made?
Design ...Current,,,.,,
Cattle Capacity Population -
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
El Non -Dairy
I
ElBeef Stocker
ElBeef Feeder I
❑ Beef Brood Cowl
T
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes (a'No ❑ NA ❑ NE
❑ Yes
T
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes (a'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
❑No
❑ Yes
8 No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

FASility Number: Date of Inspection
-� Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J27No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes P'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 ONo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�No El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) //
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/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 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JFNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[]Yes
�I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Peee 2 of 3
Phone: rfrL�_
Date: V/
12118104 Continued

}
Facility Number::31 7Z2.14 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;j"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,Y" "" ❑ 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. Oyes ❑ No ❑ NA ❑ NE
❑ Waste Application JZWeekty Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 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 E2'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes J'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes JZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
PONE
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 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
,0
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 2 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 XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes 6No
❑ NA
❑ NE
Additional Comments and/or Drawings:
or
,4 ov -le- , 15 V r' 4J a,
er
Page 3 of 3 12128104

rqGDivMEM)n of Soil anal WC
ater onseraO
ther Agency
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ,Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:'F Departure Time: � County: Region:
a
Farm Name: a Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: `^-'f.
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Num er:
Back-up Certification Number:
Location of Farm: Latitude: [=o Longitude: =° =,
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
` F
La erGo �.s0
`� Non -La er. - - - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =4
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 ,ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
j2r%
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
12128104 Continued

+ Facility Nuniber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %
❑ Yes � ❑ NA ❑ NE
❑Yes ❑No ❑NA ONE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �2 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 j 'Nio ❑ 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 E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes,,�o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Po El NA ❑ NE
maintenance or improvement? /
Waste Application
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 21�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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 2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes 0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,21'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E;VNo
❑ NA
❑ NE
Reviewer/Inspector Name J41`Venz rA Phone:
Reviewer/inspector Signature: Date: = Z , D
12128104 Continued

r �
Facility fumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O^No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;3'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 _O'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
ONA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
PNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 4Er No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [--]No
❑ NA _2NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes eE 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_]KNo
❑ 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?
❑ Ye9-1:TNo
❑ NA
❑ NE
ffs�f.I�i'l!I!

Type of Visit 0 Corn fiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number $ Date of Visit: (0 3o O Time:
0 Not O erational 0 Below Threshold
afre�tted EiCertified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold : .........................
Farm Name: E 2A L D'4 �% E County:... _ UP�........................................................
. ........................................................................................_...
OwnerName: ........... . ...................................... ..... .......................... . ...... ..... .... Phone No:............................................................... _._._ .........
Mailing Address: .......................................
Facility Contact: .. Title: ......... ................................. ......... ... __.. Phone No:..................................................
Onsite Representative: „ Integrator: _. (YW_aR '
Certified Operator: .. . ....... . .......... . .......................... ...... ...._..................... Operator Certification Number: ....... ............. ...... ..._ .. .
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Harse Latitude �• �' �" Longitude �• �' �"
- DestgA 6 Current` Design y'Cnrrent .a' Desrgn E Current
Svniae
Po ulah1on Ca `aci atioii Cattle Ca: acf=Pow ulattort^:
3 wCa ac><
W ^Poultrywar2,` {:Po
❑Ye1 ' ❑ Day
❑Non -Layer ❑ ' Non -Dairy
ri
r Other
,s
rs K
Total Des�lgn Capac><ty 1
'- -' 'TotaISSLW P.,
r-.
�aNnmber of Lagoons
x
,. �..
Wean to Feeder
p o
❑Feeder to Finish
Farrow to Wean
Discharges 8 Stream Impacts
C3
1. 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 Water of the State? (If yes, notify DWQ) ❑ Yes El No
c. If discharge is observed, what is the estimated flow in gal/nun'?
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
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ��o
Waste Coflection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ......... ..... I .... .............. ......................_.......... ---... ....................... ........ ...................
2-5Freeboard (inches): ✓
12112103 Continued

Facility Number: —2, Date of Inspection p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 24
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 12(Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancermprovement? ❑ Yes '-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2f No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 0410
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type _& E Lfll J A ( a) S6 d
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 [14o
❑ Yes ;�O�
❑ Yes 8<
❑ Yes o
❑ Yes o
❑ Yes to
❑ Yes EWo
❑ Yes Q-
❑ Yes [ o
❑ Yes L7No
Corarnents (rf#er�to qu'estron.#} Ezplauu ay'YESsansweis and/or any re mmenrlaiYons or anpotler comments.' ,
;Use draw�rgps of fac�{rty to better explain s�tuat.ons {use"sdda�txo�I pages as'necessary') Field Co Frnal Notes � ��.
.�,�;
• � �L� �. a A YZ* LA, 9 LA &c >j W A (_L.
1ZC-'coR-Js
T
Reviewer/luspector Name
Reviewer/Inspector Signature: Date: d
.121.12103 1 Continued

Facility Number: 9 —2gLj Date of Inspection a O
• Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ Yes [ No
❑ Yes /Vo
❑ Yes
❑ Yes /N
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes 7No
6
El Yes
❑ Yes [2r/No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit 0 Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit (2) Routine O Complaint Q Fallow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: E� Time: ih
Not O erational 0 Below Threshold
Permitted 0 Certified [3
CConditii000nnally Certified D Registered bate Last Operated or Above�hreshold;
Farm Name: v ^�'�`d`4 f`" '�`-V�%� County: /i_Zl
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
-�� Certified Operator:
3,,-'Location of Farm:
Phone No:
Phone No:
l
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude ' 4 �u
Design
Current
Design Current
Design Current
Swine Capacity
Population Poultry
capacitv Population Cattle Capacity Population <
Wean to Feeder I ZSV
10 Layer
❑ Dairy
El Feeder to Finish
JCI Non -Layer I
I Ed, ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
El Farrow to Finish
Total Design Capacity
❑ Gilts
❑Boars
Total SSLW
.
Number of Lagoons
f❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Holding;iPonds,l Solid Traps
17, ID No Liquid Waste Management System
:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier:
Freeboard (inches):
05103101
❑ Yes JZ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ZNo
❑ Yes
Ef No
❑ Yes VNo
Structure 5
Continued

i
r
Facility lumber: —Zod Date of Inspection
Odor lssuec
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 34 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. X ere anv 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 storaLye bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Additional
❑ Yes �Z No
❑ Yes (I No
❑ Yes 73 No
❑ Yes d No
❑ Yes ONO
❑ Yes No
❑ Yes No
05103101

t Facilih Number: f —2 Date of inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 maximum and minimum liquid level
elevation markings?
Waste Apnlication
❑ Yes tU No
❑ Yes Z No
❑ Yes 21 No
❑ Yes P� No
❑ Yes P No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
m No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAIN ❑ Hydraulic Overload
ElYes
ONO
12.
Crop type ��% G(/�tt��t� . is[Q Y74 � �.4// i ,,k A!/�c�eiC
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
5No
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
;Z No
15.
Does the receiving crop need improvement?
❑ Yes
}2fNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 1�3 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.) El No
19, Does record keeping need improvement? (ic/ irrigation. freeboard, waste analysis & soil sample reports) ❑ Yes O'No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes P No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes q No
22. Fail to notif}- regional DWQ of emergency situations as required by General Permit?
(ie. discharge, freeboard problems. over application) ❑ Yes 10 No
23. Did Reviewer/Inspector fail to discuss review inspection with on -site representative? ❑ Yes ONO
24_ Does facility require a follow-up visit by same agency? ❑ Yes E3 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
--,' a,,o'rp_i+ :_-, aw �- ".aim .i°..17[T"r-+-•" ''�
Comments:(refer to question#). ,Eiplaia.any YES aasweis andJor, apy recomniendatmns_ ar auy othee_r, comme>rts. =: `
Use drawings of fac s�tty to better explain si#nahous se addr (nbonal pages as necessary) W
. ' , Y; � ❑ Field Copv Final Notes
r � �
Reviewer/InspectorName"e l
�g�'a.
Reviewer/Inspector Signature: Date:
O5IV3101 v Q Continued

Facility Number Date of Visit: '--sr�-=-� Time:rO I �3
Not Operational 0 Below Threshold
0 Permitted 0 Ceerrttified /i %13 Conditioon�ally Certified [3Registered
Farm Name: t� er 4f Gt S IJ6-y
Owner Name: 1JjL4-gi Z&41 'o
Mailing Address:
Facility Contact: Title:
Onsite Representative: 06A G�
Certified Operator:
Location of Farm:
Date Last Operated or Above Threshold: _
County: kIf /_
Phone No:
Phone No:
Integrator* ._ 40.,r,04/
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 " Longitude 0 6 Du
Design
Current Design Current Design Current
$wine Ca aci
P,o ulation P,outil- Ca s LC. attl e Ca aci P,o ulation
to Feeder Q
❑ Layer ❑ Dai
rWean
❑ 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 0 ❑ Subsurface Drains Present ❑ La oon Area ❑ S ra Field Area
Holding Ponds 1 Sotid Traps
F ❑ No Liquid Waste Mana ement System
Discharges && Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: GDn lg .� D'4
Freeboard (inches): Zl 3'A?
05103101
❑ Yes a No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
A No
❑ Yes
allo
❑ Yes
29No
Structure 6
Continued

�i
r
t
Facility Number: 51 — 2VZ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excess ive�Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type psi (_k4w, `,(fIAew-f .:'WOW h-/VJ"L-
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?
Ree uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes No
❑ Yes No
❑ Yes JXNo
❑ Yes PNo
❑ Yes No
❑ Yes No
❑ Yes E4 No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
E3No
g] No
SM No
No
O No
V] No
❑ Yes g] No
❑ Yes P No
❑ Yes 69 No
❑ Yes ® No
❑ Yes V] No
(ie/ discharge, freeboard problems, over application) ❑ Yes ( No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes [59 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 90 No
INNo violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
11`„' ;
❑ Field Copv ❑ Final Notes
/rle: �Qel r�lp4Y 4e. 2��re f t �,, It
!e
/P ! J&d 5 e-- . �Jplts &d b4 �- ,j�ro 4e lf.G1►s J
Reviewer/Inspector Name
Reviewer/Inspector Signature: _
O5103101
=._.
Date:
Continued
1

%acuity V, umber: 3/ — / Date of Impection ] }Tinted 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 KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JRNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O-No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes MNo
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 Q} No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes t,No
Additional Comments and/orDrawings: -
J
5100

_7
Division of Witer Quality
07Divisio'f Soiln and Water Cofis6rvation
O:OthOr Agency
k_� M
Type of Visit -Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
I- Facility Number j Date urvisit:
El Permitted OCertified [3 Conditionally Certified 0 R . egistered
Farm Name: ............
Owner Name: C, rot )of
Facility Contact:
Title:
Et7arrirne- 1 la.,415 1 Printed on: 7/21t2000
Not Operational 0 Below Threshold i
Date Last Operated or Above Threshold: .........................
County: Vuov . ........ V"', ; . . ................................................
Phone No:
........I .................... Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: '�94464f- X"Okntegrator-JW rc. .............. I .............. .......................... ........... . . ........................................................
Certified Operator: ..................... ............................. ............................................................. Operator Certification Number:..........................................
Location of Farm:
-14 Swine 0 Poultry 0 Cattle 0 Horse Latitude 0 & 66 Longitude 0 4 9f
Design. Current
Wean to Feeder
2-b 00
F der t,
Feeder to Finish
Feeder
F ow I
Farrow to Wean
t
Farrow to Feeder
t
Farrow to Finish
Farrow
Gilts
s
Boars
Tot4l De&dgjrCapacity
Totaf$$LW
146niber of Lagoons FEI subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
_.
Holfdug
Pofi&I Solid Traps rO No Liquid Waste Management System :
DischaMU & Stream Impacts
1, Is any discharge observed from any part of the operation? 0 Yes 17NO
Discharge originated at: [I Lagoon El Spray Field E] Other
C,
a. If discharge is observed, was the conveyance man-made'! 0 Yes JRNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Y No
c. II'discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) 0 Yes 15f No
2. Is there evidence of past discharge from any part of the operation? El Yes PNo
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [] Yes IgNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? E] Spillway C1 Yes -0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... #Aj Wc44--,?,d 6W
�)­­ ...... ................ .............. ................................... ............ I ....................... .................... .... ........... I ....................................
Freeboard (inches)-
5100 Continued on back

F4cility Number: 3f — Z$( Date of Inspection Printed on.• 7/21/2000
5.' Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes] No
seepage, etc.) !�
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes lNo
(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 ;ErNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes Old No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 0 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes IoNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes yNo
12. Cra t o q
YP P I.f rl t � � � G a vti. f G L GO F-L' /' ►'�'V p� .t, fJ"'' [� /'eel � IPA/ , Tii� fJYI %1 t![+� L
13. Do the receiving crops differ with those designated in the Certified Animal Wast Management Plan (CAWMP)?
❑ Yes 9(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 40 No
b) Does the facility need a wettable acre determination?
❑ Yes FNo
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes 'ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes iNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes J�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes '0 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes FNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes :5Wo
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
❑ Yes J9No
24. Does facility require a follow-up visit by same agency?
❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
' Nd—'V• iolatidiis;ot. &fldeucies were notes dining t;his;visit'. - Y;ou will -receive iio tutther
correspondence. about this .visit.
Connments (refer to question #): Explain any YES answers and/or any recommendations or any: other comments
Use diva of facili to better explain sitaationsy(use adlditional pages.as necessary) - wiiags ty
/���^Oi �'�� �0; � ��-�a ��ao17-�ra►►1 11ou.5� . `
(,JeA1A,,x5 e'cc,+ looX..s oo4..
Reviewer/Inspector NameT,F
Reviewer/Inspector Signature: llp�� Date: ;F/ .L >/ V 1 S/pp

Facility Number: 31 Date of Inspection 3 Z 1 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 J31 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 J No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
9 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
C�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
P No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
IONo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
5100

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection --Q6
Time of Inspection � 24 hr. (hh:min)
❑ Permitted Certified 0 Conditionally Certified El Registered 0 Not O erational Date Last Operated:
FarmName: ........................................�................................................................. County: ....... ....Yl1.L.%............................... .......................
OwnerName:. ------------------------------------ Phone No: ......................................................
Facility Contact: ..... Title Phone No:
MailingAddress: ..................................................................................................................... ...........................................�........�................................... ..........................
Onsite Representative: � Itegrator:........ ................................1Y`................................................. Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude • ° 61 Longitude ' ' "
-Design Current Design Current `� Design Current
c. ; T
_ _Cat aci ':Population:- Poultry Ca iia i "" Cattle
1'o ulatiiin.� Ca` acr '"sPo` ulagon''
Wean to Feeder r446 6 ❑Layer ❑Dairy
❑ Feeder to FinishNon
'_' ❑Non -Dairy
❑ Farrow to Wean
1 ❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish Tdtai Design cii ii lty.
❑ Gilts
❑Boars Tata1SSLW
NuritberOf Lagoons :;� ❑Subsurface Drains Present ❑ Lagoon Area _ ❑ Spray Field Area
Holdmg:Pondsa Solid Traps'. ❑ No Liquid Waste Management System !'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes *o
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? (Ir yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than,from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ���ve—
Freeboard(inches): ...........................�°I ...........................................................................................................................
5. Are there any immediate"threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ yes ;TNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: '3( Date of Inspection
0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? .
❑ Yes
KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
W No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
9No
elevation markings?
❑ Yes
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
1' rNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
WNo
12. Crop type YjS4 S43\1 �w(a�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
tj�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
t 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
N(No
16. is there'a lack of adequate waste application equipment?
❑ Yes
'ONo
Reuuired Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18. 'Does the facility fail to have all. components of the Certified Animal Waste Management Plan readily available?
Yes
)g No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
( No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
kf No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24. Does facility require a follow-up visit by same agency?
❑ Yes
PdNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
o yiialal iOris;oe d rjcjerndes -*v re piftea ilortOg �his'visit; • YOO will •i'eeeiye iio further -
correspondence. ahouf thfs visit.
�2ep c�i�
CC*
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Facility Number:3 ( — Date of Inspection Q(J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes R(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes *o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes kNo
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 9No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ®11 No
AAditional-Comments: anor rawmgs "T e
3/23/99
3/23/99

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Geraldt Knowles
Gerald's Nursery
384 Kirby Quinn Rd
Kenansville NC 28349
Dear GeraldE Knowles:
A4 0 •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-286
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludgestresiduals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. IRRI, IRR2, DRY1, DRY2, DRY3, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely,
/// /Z7
l/
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
GeraldE Knowles
Gerald's Nursery
384 Kirby Quinn Rd
Kenansville NC 28349
Dear GeraldE Knowles:
A�14�
0 •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 8, 1999
Subject: Conditional Approval
Animal Waste Management System
Facility Number 31-286
Duplin County
Our records indicate that your facility was conditionally certified in order to fulfill the requirements of
completion of your Certified Animal Waste Management Plan Certification. This letter is to inform you of your
unresolved conditional approval status. Any facility receiving a conditional approval must notify Division of Water
Quality (DWQ) in writing within 15 days after the date that the work needed to resolve the conditional certification
has been completed. Any failure to notify DWQ as required, subjects the owner to an enforcement action. As of
December 7, 1999, we have no record of any information from you, advising us of the status of your conditional
approval. Therefore, please fill out the attached form and have your technical specialist and landowner sign the form
in the appropriate areas.
The completed form must be submitted to this office on or before 45 days of receipt of this letter. Please be
advised that nothing in this letter should be taken as removing from you the responsibility or liability for failure to
provide DWQ with proper notification of your conditional certification status or possible failure to comply with the
requirement to develop and implement a certified animal waste management plan by December 31, 1997.
If you have any questions regarding this letter, please do not hesitate to contact me at [phone]
extension 571.
Sincerely,
Sonya L. Avant
Environmental Engineer
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 MaiI Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

D ivisioh of $oii bii&Wateir Kz
_f i ; r vnivicion of Soil r nrrinliance Incnectinn. - r
D Other Agency; Operation Revrew
&Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection'?3
Time of Inspection []� 24 hr. (hh:mm)
Permitted © Certified 13 Conditionally Certified 0 Registered 10 Not O erational Date Last Operated:
Farm Name: �Y...... �^� �...... County:..............�11. ........
l.-�jG
Owner Name: ...............................-............. Phone No:
Facility Contact: ..... Title:.............. ............................... Phone No: ... ................................................
MailingAddress: ................................... ................................................................................ .................................. ........................................... .......... ..........................
Onsite Representative:..`.J�^ .'........................................................................... Integrator:.........1..!.` 'r..................
.1,.......................
-
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Itocatio�r ofrm ; l 1 1 f K t
................... ................ ............. ......................................................................................................................
Latitude a 6 •1 Longitude • & i°
;. Design Current ::; Design , `Current Design Cup rent
-Swine
Population-- _-, nCa achy ati.
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean - -
[] Farrow to Feeder ; ❑ Other - .
❑ Farrow to Finish
ti Total Design Capacity
Gilts,
❑ Boars _... Total`SSLW
Number of.Lagoons. ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdtng'Ponds / Soh&Traps : ❑ No Liquid Waste Management System r =
a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fNo
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. Dees 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 jg No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6
Identifier:
Freeboard (inches): ............... . ... /.......................................................................................................... ........ ........................ ...................................
b
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes D'No
seepage, etc.)
3123/99 Continued on back

V
Facility Number: 31 a�>� 4 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
10. Are there any buffers that need maintenance/improvement?
1 l . Is there evidence of over ap lica1b tion? ❑ Excessive Ponding ❑ PAN
12. Crop type �J�P_r- �SG� I , Wq
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?
9
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21 _ Did the facility fail to have a actively certified. operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss 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?
:: .lo yiq�afs:or defeie-ncies were nQfed-during'this:visit:- Yoit Will-te d*e iio further
:: corresnoride' abanitr this visit.: • :...::::....::::::: ...
❑ Yesel-
9Yes ❑ No
❑ Yes 1XNo
❑ Yes [XNo
❑ Yes e7f No
❑ Yes S No
❑ Yes ff No
❑ Yes VNo
❑ Yes W No
Yes ❑ No
❑ Yes D�No
❑ Yes XNo
❑ Yes j' X
❑ Yes S(No
❑ Yes Ed No
❑ Yes 09 No
❑ Yes � No
❑ Yes 0 No
❑ Yes 21 No
❑ Yes qNo
❑ Yes RNo
3/23/99

Facility Number: Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes (�(No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? [--]Yes j(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes gNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
3123/99

0 Division of Soil and Water Conservation ❑ Other Agency
®,Division of Water Quality
19 Routine O Complaint ® Follow-up of DWQ inspection O Follow-up of USWC review O Other _
Date of Number �i Inspection Z R
Facility
Time of Inspection � 24 hr. (hh:tnm)
©Registered M Certified © Applied for Permit ©Permitted [] Not Opera t oonal Date Last Operated:.........*....,
FarmName: S ,r County:........ Q t1.O..........................................................
C.�.v7r .................... 1,1. C... ....._.._............................................ 1
Owner Name,. 1.. Phone No:
Facility Contact: .......................................... .. Title Phone No:
1
Mailing Address: ..... zz.`.1........ I.Y ..SR `1--............R..j.............. ...�nes.s..a1..s...�.{.J2. Q.i`.,............
Onsite Representative:.M.'r...4.1 k.M: .....
Certified Operator_.A.%.AA .:r. .1( �f i. p .... �.......... ........... .. ..... ....................... Operator Certification Number:...3... ... . ...............
Location of Farm:
Latitude =• ®' ®" Longitude ®• ©, Elm]"
Design xCurrent Design Current h DestgnZ Currents
:�
wme Capacafy Pupulation Poultry Capacity Population: Cattleft puiahon
X
_
`r
Wean to Feeder z,�
Q� [] Layer ❑ Dairy
r[I Feeder to Finish
' ❑Nan Layer , ❑Non DaisyELI
to Wean
'!
_z :max �5 4- c:aw� �Farrow
u Other 1
❑
❑ Farrow to Feeder
J t . .:_
❑ Farrow to Finish{
Total Des�gn�Capat:�ty; 2 ° �
s ❑Gills
« �%
F
❑ Boars
� Total SSLW g o o
.._ ... _..... ,_.. __ ..-.-..
Number Of Loons ! Holdwg Ponds© ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field+�Area
nfg
❑ No Liquid Waste Management System
mt'
-y a5:4.a='.
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes JS No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes R No
c. If discharge is observed, what is the estimated fEow in gal/min? _� A
A. 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 allo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 'M No
5. Does any part of the waste management system (other than laaoons/holding ponds) require ❑ Yes 112[No
V maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? - ❑ Yes In No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes E9_No
7/25/97 Continued on back

S
Facility Number 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures (Lagoons.tJolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less th adequate? El Yes ®.No
(Se.a- Sf-jy) tr-iril �
Structure 1 Structure 2 tructure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._...�..,... �.. ........ ..............
Freeboard(ft):...................................................................
...... ................................. .................... ............... ................ ....... ........... ..... .............................
.......
10. is seepage observed from any of the structures? ❑ Yes �1No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 19 No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
'® Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
KNo
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .......................q..�-...............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
El No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
®'No
18.
Does the receiving crop need improvement?
IdYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
S No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
it No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
BNo
22.
Does record keeping need improvement?
RYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
E9 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
El No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
S No
[] No.violatians-ur deficiencies.wereanted during this" visit'.- You:win receive•n' 6 further-
OerespOhdettce Aboiit this: visit:- . • : ;
p' 9.�'Mr �t € - -- S 1 &---"^1F �` � 4�,-5� "i,�.� � raD�rr
Comments (refero question #) xExpla any YES ans4vers and/or anyrecommendaiinns ar any otierig
corntnents.,il
Use drayi�n s nfjfacthty tb b tter explain sttuahons [use addtt oral pages a necessary){ F � L
Zug O
Pke ,.,
i 3 • C4e ia� v o
[ o�.n { o.-.j VZ t,, 4 4 4, Tm �t 3734
, -t v►,- i i vZ, , ,.. 1, 0-" " t-, d h t , f
W o v tcl � a d-., .s a b Lp J_-O p 10- ,+ tw3 _ `� �•. fi V4
I t a 4-e �l n �-` e.r o 1J a p t a-K w S �j s t r•e c e,,.< <-('` -� 44 k
C rr o S i h `� t (0 uu p"ti, t�`v'e w- CR ✓ ti r 4�r o-c� p
Ca1cuLafie. v►, t-v. � toa1 tt, bat'Li`- tt� _j�_ti t� �;r�-s•- o� 19 47, Aiso,
C-0v+n k4 , Qdor iv3aCt-, y-4 VV-oe_Il �/1T�c,kIrC�, Fitodi c � it dui t
A` °^ p t aM . P l e a 3 e s mod- C4 V- 1 f.zOL r}$ to o v r @ V- a L s 079a507
r
10r- W w a ." rix -� r x
viewer/Inspector Name i, K r• " t .,.
FReviewer/Inspector
Signature: Date:
LOYva..ct: 74r W-orV. 0" t�a0�- WgAN 100-t , QOd-

............
® Division of Soil and Water Conservation ❑ Other
i Davis on of Water uali
❑ Q ty
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 11/10/97
E :
Ea
LyNmber 31 286
Time of Inspection 1600 24 hr. (hh:mm)
❑ Registered 0 Certified [3 Applied for Permit ❑ Permitted ❑ Not Operational Date Last Operated:
Farm Name: Cj.er d:&Xuxsexy ......................................................................................... County: Auplin................................................ W. .I .Q..---....
Owner Name: Gerald .................................... .KBO.W.IGs........................................................ ' Phone No: 9.10.-.29fi-_0995 ..........................................................
Facility Contact: ............................................ Title: .Co..Qkvnrx:......................................... Phone No:.....................
Mailing Address: JX4'.XjP:ht:.Q.uinn.Rd......................................................................... Kena,navalleKC................................................... 283.49 .............
Onsite Representative: G]C�Ld.K]ItPH:IG�......................................................................... Integrator: Muxltb3.�;tjWj:.1!:uxxW.....................................
Certified Operator:.N.aJ1cr.G............................... mowles........................................... Operator Certification Number: .1,9661.............................
Location of Farm: „ ....
?arxn lnsaxi�tt:..�f1.�ar�d.Bxirlg�iCl,.any.KnRies.l+arxr�Laxue..............................................................................................................................................
�n.Gaatsade.Qi>R 1.i12,sQ�uth.Rf.itaterscstl�n v►i�tlx.SlEi IAQ................................................................................................................................................. ,.
Latitude 3S ' O1 'E 38 K Longitude 77" 6 53 13
® Wean to Feeder
2600
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify D WQ)
❑ Yes
© No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
© Yes
©No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
N 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/holdirig ponds) require
[1 Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in et%ct.at,the time of design?
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible charge? -'
❑ Yes
® No
7/25197

Facility Number: 31--286
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes N No
Structures (LagoonsMoldin2 Ponds, Flush Pits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes N No
Structure I Structure 2 Structure 3' Structure 4 Structure 5 Structure 6
Identifier: M?1 ...............1 t1. .. gQc� ......................... ........ ....... ...............................................................................................................
Freeboard (ft): ................ ................ .......................
10. Is seepage observed from any of the structures? ❑ Yes N No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes N No
12. Do any of the structures need maintenance/improvement? ❑ Yes N No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? N Yes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes N No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................
M�jo, Oats)
16. Do the receiving crops di er with those designated in the Animal Waste Management Plan (AWMP)? N Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes N No
18. Does the receiving crop need improvement? ❑ Yes N No
19. Is there a lack of available waste application equipment? _ .. ❑Yes ®No
20. Does facility require a follow-up visit by same agency? ❑ Yes N No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes N No
22. Does record keeping need improvement? N Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes N No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes N No
� •No-V,iolattbtls' or'de deFides-Wi ee.n'oted.durlag t4ig-Nish.' Y-otf vili'reteiVe'n!) fort -her: •:
cor-respvudence aho' t fhis.v sit;: :
DR done with Mr. Knowles. Farm is part of NCSU wetland research project. +
13) Need to replace broken marker on wetland lagoon.
16) Although row crop fields are in narrative if you regularly irrigate on them you should have them added to plan to know the N
application rate.
22) Need to Balance N on records to show what is being put on crops. Need'wasie sample for farm (get from research project if
possible).
Fill out emergency action plan. Have Murphy or Duplin SWCD assist with filling out odor, insect, and mortality checklists. Remove
vegetation from lagoon as is possible.
7/25/97
T
Reviewei/Inspector Nameyhp lVX fzgefals
Reviewer/Inspector Signature: Date:

le Routine 0 Complaint 0 Follow-up of DWQ inspection OFollow-up of DSWC review 0 Other
Facility Number
Date of Inspection 16 R 1
Z 6
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: . ..... ......... ........... ......... ....... ....... _ _............ ._......... ..... ...................
Farm Name: �,r 4.esr�a,_�.�...N .. S.?:�I... ............ ........ _...._ ...-- ....... County:.. rr .Q-f..�s .n .... M.. _........_.... ( a.�.�
Land Owner Name:..... �u�.�.s .... _ .5..... _.... _..... ..... Phone No:._� .`t 10.� �- `�. R 9...TS.
Facility Conctact:
Title:.........._ ......................... ...... Phone No; ................._.
- t
Mailing Address: ---3— ..�......�... ................. ...�.��.----.._....
r:.....�YOnsiteRepresentative:s"rato'Ll.........
..................
�......s.�.....�.......q.[..
._
Certified Operator:.0.Qy,.......Operator Certification Number: ..
Location of Farm:
zx�.....g._,..,S..i:...S.�. ,5... ..� 5.2.... s�.� �a...... 7.rGt.��.S.3.. .l.t1..ra......1N :...... .....�Q .............................. 4
................................ .......... -........ ................. ......... ......................... ....... ...... .................. ................. ._..... ........................ ....... ..... .......... .....................
Latitude 0 O I s ®" Longitude • 53 4 i3 66
Type of Operation and Design Capacity
Design Curre t Design Current - Design Curreeet�
Swine tryx, :, Ca aci r,Po tilateon°`. .Ca ace P,o uiation E, Ca ace �Po ulation,x oul Cattle
Wean to Feeder O �j[] Layer ID Da'
❑ Feeder to Finish ❑ Non -Layer ❑ Non-DaiTy
Farrow to Wean
Farrow to Feeder = Total Design Capacity Do
IEIFarrow to Fin
ish g
T t o aISSW� '?
❑ 80c�
Other
02.
Number oift
f Lagoons l I3oldingPonds ❑Subsurface Drains Present
JU Lagoon Area JU Spray Field Area
f
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes allo
2. Is any discharge observed from any part of the operation? ❑ Yes [X No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IN No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in gal/inin? 0 1 A
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 MNo
4/30/9 7 maintenance/improvement?
Continued on back

Facility Number:. 1......—...i.�
6..Is facikty not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 9 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Stru!;tures (Lagoons and/or,Ilolding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
.�.�...._... .-9, 5 _ .... _....._....
10. 1s seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes 19[ No
❑ Yes [$ No
❑ Yes ® No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type kj 4!+ trrL........ ........
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?
JERr Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
No
E9 Yes
❑ No
fates
❑ No
❑ Yes
IN No
❑ Yes
KNo
❑ Yes
29 No
❑ Yes
1g No
❑ Yes
® No
❑ Yes
No
Yes
❑ No
❑ Yes
RNo
❑ Yes R No
❑ Yes ® No
Yes ❑ No
Comments {refer to`queshon Explain any: YE5 answers:and/or any recommendations of any other continents
Use drawings�of facility to better expiam situations {use addtional pages as necessary) h Ny...
l I ./ I Z. C ,tea s i 0 r% Lo t 0.,..d Q"r- .�. t o o �. w a L l t °'°� n e etl s
4?
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Reviewer/Inspector Name
ReviewerAnspectorSignature: _ r ,J� Q_ , _ f Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �" �� , 1995.
Time: aly
Type of Operation: Swine. f-'� Poultry Cattle LA 5", d-7
Design Capacity: i7 Number of Animals on Site: a ;gip d)_Q
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude.'3-5° D a 3 3 " Longitude: -7:2_" �Z2 (-" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) C9 or No Actual Freeboard: _2_Ft. i�_ Inches
• Was any seepage observed from the lagoon(s)? Yes 'or No, Was any erosion observed? Yes oo
Is adequate land available for spray? e or No Is the cover crop adequate? es or No
/ r .f n i n
Crop(s) being utilized: —C
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings, flas or No
- 100 Feet from Wells? _s'or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or eo-)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oio 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)? loor No
& 0" 01 C, 6__ - �
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.