310352_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

b
ivi`sion of Water Resources
Faeility Number ©- ® Division of Soil and Water Conservation
0 Uther Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: i o : 3J Departure Time: : 3-d County: Region:
Farm Name: _ /(,(J `-ir t d __ 2PfA r-ry'_' Owner Email:
Owner Name: y J;;en, _5 cL 4 ITt.4TL f rtc � Phone:
Mailing Address:
Physical Address:
Facility Contact: / rrd otyr­e- Title:
Onsite Representative: �x
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
•e_' Phone: /
Integrator:
Certification Number: 100A9_,7_ }
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
CatEle
Dairy Cow
Dairy Calf
Design •urrent
Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Feeder to Finish
3
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P,oul Ca acit P.o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Turkey Poults
Other
—=dm
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes 5Q No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes M No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
Page 1 of 3
21412015 Continued

Facili Number: - Date of Inspection: 40
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3,No ❑ NA ❑ NE
l
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes CjjNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®. No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 [Z No ❑ NA ❑ NE
❑ Yes L&No [DNA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
lComments (refer to question ft Explain any -YES answers and/or any, additional reco_mmendations;or any other.comments._
Use drawings of faci[ity_to better explain situahc►us=(use additional pages;as ne cessarx):=
A p f 'r_'- OW n'.' j ff, j
1� 'J-- kw Farm. ; S . �lou3 ��� u,; T"� 7`c cats ka&—_s,
a/�P4 )e r� 1j
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone:
Date: C/' Jp7r�/ 7
21412015
Page 3 of 3

Facili Number: JDate of Inspection:
Waste Collection & Treatment
<< 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IS 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: NrU Y Z�4_-'1A1
Spillway?: u tj e *~— //!''-`—
Designed Freeboard (in):�
Observed Freeboard (in): C3 f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F 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
JZJ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VC No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z_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 'm d, /, r/
13. Soil Type(s): r 1,6 1 D !D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2[ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [K No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[E No
❑ NA
❑ NE
❑ Yes
Z) No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E[ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZLNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

- Divi"sion of Water Resources
Facility Number 0 - 3 ' 0 Division of Soil and Water Canservatiou
Other Agency
Type ofVisit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
[season for Visit: outine Q Complaint C) Follow-up O Referral (:) Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 4 1_L__ Region:
Farm Name: &( (r - t (--)C? [4 j Owner Email:
P.
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: K��/'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: %%1,42
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C►urrent
Wet Poultry Capacity Pop.
I ILayer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design l
D P■oul Ga aci
.
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
—.Layers
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑" No ❑ NA ❑ NE
❑ Yes JffNo ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes EE] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes _eNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - 3 $1 Date of Inspection: (, —CC
��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes , FeVNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Q'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structured 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard 0 30
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J:�No
[DNA ❑ 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 JEJ'fqo
❑ 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 [2-No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 4ErNo
❑ 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 Jallo
[DNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes' _[2'jNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [ZNo
❑ 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 ..e'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes -0 No ❑ 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?
Required Records & Documents
❑ Yes _13'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes _E�rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes fj�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 L3'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 JD"Flo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 3 1 - S` Z 1 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes j2'No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [ErNo
❑ NA ❑ NE
the apr�opriate 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 ,0No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes EfrNo
❑ 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
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
_[:j'No
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 _Ej No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E2/No
❑ NA ❑ NE
recommendations or any other comments.
o �Oris
Use drawings of facilty beite e n an s tu> fuse $aa t;onal pannad�tronal
es as necessarvl.
.J
Z�g� 16J d ' � -yl,c 5 so � � �► � e. s � o �s
a re55e Soclvl
q pt'rjP 5 6�_-5 5
5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/Q 2�
Date:
21412015

I'ype of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: .(5 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �� 1�s Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: k lrl'1
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator: M 115
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish qVG O
Farrow to Wean
Farrow to Feeder
Farrow to Finish
MPKIgn
1) . P,oult ,
Layers
Ca aci
Current
Flo
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream lmuacts
1. Is any discharge observed from any part of the operation? ❑ Yes j�^No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: T
a. Was the conveyance man-made? ❑ Yes f] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes E No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes Vo
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

FactNty Number: - ,3 Z Date of Ins ection: py /
.,L-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes C2'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Sr
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 'P3'.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 E '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 4n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes LffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box
below. [:]Yes C2No
❑ 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 J:3'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes .0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes .❑/ "No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 12-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 QLNo ❑ 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 J�? No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes „[EINo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes"—
ff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
ZNo ❑ 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
[3"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o ❑ NA ❑ 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
XNo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
PNo ❑ 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
0 ❑ NA ❑ NE
gt
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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).
r. a O G f U 5 eon 0 c,. -. c,J G.s to ar l� 5 is
L Vv 4-Gvr (e_j , �J ho w [p� L4 j /y�Q,,, .
i, 6 log --= -� +-1&3
r
IV113
�
1 y� zz
Reviewer/Inspector Name: Phone:<v <
Rcviewer/Inspector Signature: Date: 1!
Page 3 of 3 34120d

I,
Type of visit: O Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Q Arrival Time: eparture Time: County: Region:IV
Farm Name: r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: Al /- j
1
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design1 Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Finish
La er
Da Cow
Feeder
on -Layer
DairyCalf
o Finish
rFarrow
DairyHeifer
o Wean
Design Current D Cow
D , P,oult . Ca aci Po Non-Daio
Layers Beef Stocker
o Feeder
Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Broad Cow
IMI Other
Other
Turke s
Turkey Poults
Other
0 1
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ,g 'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑Yes _2 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes j2-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 [�;rNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes Y❑'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes [3"Ko
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facility Number: - Date of Inspection: /3
W ste CoQection & 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 �o
❑ 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 ONo
❑ 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
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ErNo
❑ 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?
JZNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance or improvement?
JVNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes J'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 ElrNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes J tqo ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes E2,1�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,EffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �Vo
❑ 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
❑ 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 VNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - .. Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Ef No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
ZNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
;2 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
P No .
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
0 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EJOINo
❑ 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).
, IVeej PO4 rur J a k = 3 -Fd oe- L5—/uG4,� l ecle s
VV113 0.38
p.36
5/?//,) 119:3
/ // /�// -z-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�6cl •j'Cjfr► e retdrds
�J
3.6G /
,2.. /3 S3Zz
a,33Z
Phone:
Date:
141201r

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 0 Denied Access
Date of Visit: Z 7-1111 Arrival Time: p eparture Time: County
Farm Name://T?J' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Region:
Integrator: --77
Certification Number: / Z;
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C*urrent Design Current
Wet Poultry Capacity Pop. Cable Capacity Pop.
Layer Dairy Cow
11
Wean to Feeder
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D , P,oul C•_a aci $o , Non -Dairy
I I Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O
Other
Turke s
key Poults
Other
Discharges and Stream Discharges and Stream Imams
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes _ETNo ❑ NA ❑ NE
❑ Yes _j:jNo
❑ Yes _La^No
❑ Yes '12-7No
❑ Yes ,Eno
❑ Yes ,rNo
❑ NA ❑ NE
�] NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: y Z T
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,E�rNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E;jNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes IdNo ❑ 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 ;ZNo ❑ 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_,ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?5;.No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes );�rNo
❑ 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 Ea'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes C;K0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E ff Ro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J:D'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �fi o
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .E] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ 1(40
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes E!fNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ,E rNo-
❑ 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?
❑ Yesi� No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ETNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes�o
❑ 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.
T�
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 Q'IVo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes PNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 2no
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes gNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional -pages, as necessa) ,-
ry-.
.
/0 r C�Ck dqk
o l L w! (1-,
F131)?Z lt.-7
1X/7/11 /, 3
ar69
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
N
Phone: J "7Q6 %I
Date: 4_004�12
21412011

Type of Visit: IGTompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 101outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I /i/6//r I Arrival Time: eparture Time: County: /cGc�j//h Region:(ilf"
Farm Name: k17 d- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: cX (J f �rit f
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: -
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C>apacity Pup.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Dai Calf
Design C►urrent
Capacity Pop.
Wean to Feeder
Non -La er
Feeder to Finish
Design Current
Dr P,oult . C*_a aci P.o ,
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
o Wean
o Feeder
o Finish
Non -Layers
Beef Feeder
EBoars
Pullets
Beef Brood Cow
,I
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes )E No ❑ NA ❑ NE
[::]Yes [::]No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA [] NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes 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

Facility Number: Date of Ins ection:
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 Stru--r- Structure 5 Structure 6
Identifier: " 77
-T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ITC-)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 7 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ,0 No
❑ Yes PNo
❑ Yes 12 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 2] No ❑ NA ❑ NE
❑ Yes r�No ❑ NA ❑ NE
❑ Yes ;�rNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. C201yes 4VNo
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Contdnued

Facili Number: - Date of Inspection: �.
24. Did the facility fail to calibrate waste application equipment as required by the perm/ ❑ Yes ONo ❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PrNo ❑ 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 ,0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;2"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:______ _
❑ Yes No ❑ NA ❑ NE
❑ Yes �no ❑ NA [] NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EfNo ❑ NA ❑ NE
Comments; (refer to question #): Explain any YES answers andlor any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
N
G� � 3 7- Z.
�- 2 32s
° (.5Jt-d (,J a- o-v,,Q C� SL S 4n Gavel' ec43
Mares
d- A&cs�- pc'�Mp1r\n
* S3 e S L,(v 4'° 4r4Q (i-&u-6.1- cat (-, s�-c c 1 y S 1 S
' rtqf. r1 a--A't-e(cps Z 6 Q) k 4�j 6ec:�� -
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone: L /(/ ' � b '7Y4
Date: la %a //
4/1 ll

Cervatii
fa'dtityXm Nuber, 31
3�'� �, ( DeVlSiiin of Soil and Water ons
Other=Agent
Type of Visit pS Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit_ /Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: % Arrival Time: Departure Time: County: Region:
Farm Name: W 7 O Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
!G
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = , [ « Longitude: 0 ° = i
Design CurrenE irfDesign �Cirrentn Design Current
Swore CapactyPopulahon Wet Poultry CapacityPo illation Cattle �`' " Ca aei "`Po ulation
El Wean to Finish g ❑ Layer W613ai Cow
❑ Wean to Feeder ID Non -Layer ❑ Dairy Calf
❑ Feeder to Finish Q Dairy Heifer
❑ Farrow to Wean ❑
D Cow
El Farrow to Feeder
�. w
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers �• ❑ Beef Stocker
❑Gilts f El Non -Layers
El Beef Feeder
El Boars El Pullets ❑ Beef Brood Co
urkeys
Other; .. ❑ Turke PouIts �^
❑ Number of Structures:
K❑Other Other °.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
12128104 Continued
Type of Visit pS Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit_ /Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: % Arrival Time: Departure Time: County: Region:
Farm Name: W 7 O Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
!G
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = , [ « Longitude: 0 ° = i
Design CurrenE irfDesign �Cirrentn Design Current
Swore CapactyPopulahon Wet Poultry CapacityPo illation Cattle �`' " Ca aei "`Po ulation
El Wean to Finish g ❑ Layer W613ai Cow
❑ Wean to Feeder ID Non -Layer ❑ Dairy Calf
❑ Feeder to Finish Q Dairy Heifer
❑ Farrow to Wean ❑
D Cow
El Farrow to Feeder
�. w
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers �• ❑ Beef Stocker
❑Gilts f El Non -Layers
El Beef Feeder
El Boars El Pullets ❑ Beef Brood Co
urkeys
Other; .. ❑ Turke PouIts �^
❑ Number of Structures:
K❑Other Other °.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
12128104 Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
12128104 Continued
12128104 Continued

r.
Facility Number: Date of Inspection 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;�'No ❑ NA ❑ NE
a. 1f yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure St Lure 2 Struc e 3 Str ctu eA Structure 5 Structure 6
Identifier: 4✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Q (�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes 10 No ❑ NA El
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 PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Comments (refer -to question:#) Explain any YES answers andliir any Yecommendahons or any other co nments = „.
.. e , r • �?' »� :» .:,a.�- a> - r �"` ''.°za. Win'
Use drawings`of facility to better explain situations {use addtttonal pages as necessary)_
ReviewerlInspector Named
Reviewer/Inspector Signature:
, Phone:
Date:
ZZk
7
]
7
r
IYMOI
C antinaed

` Facility Number: 3 —jZF Date of Inspection
r
Required Records & Documents Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ;ZNo ❑ NA ❑ NE
the appropriate box. ❑ W-Up ❑ Checklists ❑ Design ❑Maps ❑Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
?No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VrNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0No "
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
[] NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document.
❑ Yes
ZNo
❑ 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
A No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O 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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VI No
❑ NA
❑ NE
Additional Comments and/or Drawings; `
a3 2z dw
��9�% . �• z - Flo
(�f 1) � 325
) 3 ZZ
2 3 zr
�Z/2� (�� /• 3 ��ZZ
�� � z-3 zt✓
Page 3 of 3 12129104

Type of Visit Anompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit OwRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: o Arrival Time: 1,&?�0 I Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Yi'1 1rn4n4 n Lj Ly
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: /" //,:;)
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 0 Longitude: 0 0 = =
Design Current
Design
Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity
Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
ElBeef Feeder
PE01 Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
umber of Structures:
❑ Other ❑ Other
I
Discharges & Stream I_mpacts
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 Oslo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
❑ NE
El Yes
VNo
❑ 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 WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes VNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `3 • l%
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 PfNo ❑ 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 1:kNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes VNo ❑ 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 ILJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 4o ❑ NA El
maintenance/improvement?
11. Is there evidence ofincorrect application? Ifyes, check the appropriate box below.
ZNo
ElYes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
N
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
1-1Yes(_]/
No
❑ NA
❑ NE
Reviewer/Inspector Name I I Phone: '- 29�j
Reviewer/Inspector Signature: Date: r— G
P.,uo 10 nF ? 12/2R/1%4 rantinued

haetlity Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes K No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ 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 V 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
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
[INA
❑NE
26.
Did the facility fail to have an actively certified operator in charge?
[IYes
Mo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R 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
0No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�,S�
LNo
❑ 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
dN o.
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dN o
❑ NA
❑ NE
Additional' and/or`Drawings
A.
off
U • �� y
Page 3 of 3 12128104

e
.�—AdIrvivision of. Water Quality
Facility Number Q Division of. Soil and Water Conservation
- - 0=0ther Agency
Type of Visit EloCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Te nical Assistance
•
Reason for Visit_01outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
IL I Boars
Other
❑ Other
Time: County:
Email:
Phone:
Phone No:
- 11,-2.1
Integrator:
catio Operator Certifin Number:
Back-up Certification Number:
Region: Yl"4;
Latitude: [=] o = ' ❑" Longitude: = ° = ' 0
❑ 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. Cuq"v'
Cattle. Capacity Population;:
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
f
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 EjNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
[I NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes, 2TNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

4Facili�y Number: Date of Inspection �r3 1L3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
/Yes jo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes' ❑ No ❑ NA ❑ NE
Structure 1 tructure�2g tructurre 3 Structure 4 Structure 5 Structure 6
Identifier: J 7'!� d" N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 ONo ❑ 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 [3No
❑ 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 2No
❑ NA ❑ NE
maintenance/improvement?
11. _Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .,0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 2rNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ETNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo ❑ 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):;', .
a
Ak
Reviewer/Inspector Name Phone: /vim
Reviewer/Inspector Signature: Date: / Ay O
Page 2 of-3 12128104 Continued

Facility Number: 31 -J61 Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j;1No ❑ 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes J2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
.0 No
❑ NA
❑ NI:
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
;311'es
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,;'No
❑ NA
❑ NE
26.^
Did the facility fail to have an actively certified operator in charge?
❑ Yes
j'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,Z No
❑ NA
❑ NE
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
f 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
RNo
❑ 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? (ieI discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1p No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O/ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�. b
a�J N
J.�'
'sq t go o C" _ 5L' ✓e- `10
os sIb��-
H
Page 3 of 3 12128104

Type of Visit DZEompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other /' Region:
El Denied Access
�
Date of Visit: l >'S d Arrival Time: %G Departure Time: County: '"��
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
JF
Facility Contact: Title:
Onsite Representative: 2,7 ,& 1 i?�c.1/�S_-
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = [=64 Longitude: =1 ° = I = if
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to FinishLj
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet j
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
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 [2'No ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
12No
❑ NA
❑ NE
[--]Yes
;2'No
❑ NA
❑ NE
12128104 Continued

S
Facility Number: 3 —�,f-�
Date of Inspection ! O
AVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure
Structure 5 Structure 6
Identifier: %•� /Z 3 �' 3�6 G� Q /�
Spillway?:
^
VC
Designed Freeboard (in):b
Observed Freeboard (in): 3 ,S 3 67
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 Ll'1<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
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes .fNo ❑ 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J(2'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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 0 Eviidde)nce of Wind Drift ❑/ApplliiccaJtion Outside of Area )
12. Crop type(s) 6 l ,�vi' J ,L ����ii�i L �1/ / �'l ��✓
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yesj'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 21No
❑ 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 ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L3"No
❑ NA
❑ NE
Reviewer/Inspector Name ) Phone:
Reviewer/Inspector Signature: L/ Date: 6
12128164 Continued

Facility Number: — cfd, Date of Inspection �l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ..ETNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Iallo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EFNo
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
[] Yes
ET -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
,ETNo
❑ 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
;2" To
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JZNo
. ❑ NA
❑ NE
12128104

Date of Visit: i Z f o 0 4 Tune: a o a
Facility Number 31 35�
Q Not Operational O Below Threshold
[Permitted Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: K Vf S 1 5+k Fpm!r s �` County:
Owner Name: _ ------ . _ .. SPhone No: (cr 10)-!j—S - 55-1. S-
VlIaihng Address:.
Facility Contact: Phone No:
Onsite Representative: v KNA W- -6S ,, , , ,� integrator. ,,,__pyI �&Tcl_Y
Certified Operator:
Location of Farm:
Operator Certification Number.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Iatitude ' 4 u Longitude a �u
Dsehmes & Stream Impcts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ yes E;rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes U2/No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ _ 1jc W I KvJ V _ K W 7 -4 S _. _ J+ k _ . _ _. - _ -
Freeboard (inches): 2-i 3 y
12112103 Continued

Facilityr,Tumber. 31 — 352-1 Date of Inspection lz 3 04
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
❑ Yes
0 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/unprovement?
['Yes
[:]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Le o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
21,10
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerrmprovement?
❑ Yes
[1No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Ld l/o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type MzvA ec-R.wiv� VC5 C'jc SG-o
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAV W)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[l o
b) Does the facility need a wettable acre determination?
❑ Yes
[No
c) This facility is pended for a wettable acre determination?
❑ Yes
[(No
Yes
15. Does the receiving crop need improvement?
Q
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
04,40
Odor issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
E;�M
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
TO
Air Quality representative immediately.
Ca {refer tv gaestfon) F 1a ariY YF.S;answcrs anEl/ara 0r attp oi6e oa
Use dra of _ .
�ta�ty &' arplaur S3t=fKMSf dibmal,pagep,asOD-- Field C Final Notes
23.) WASTE AAAL.`1'5s5 Coop Eon- Go NkYs P2TaQ. ANta-Arrert SA+wPLc_ oATc-, ApazL j6T
CyuEcLc_,o 3'-? WY.1Sr(= A�JAti•4's_s S.-r Z--�i.
�. �CEAIJ a-_tc_f_ �,jAuh
��.� LorST��- injGE.r> C.ctJi'i2olf
-�A,ssfC�L -zd�`� ;FFL��3-oAap (L�c..aGL�S To W6'�¢�/GO Fret-�'►�,
35�) vt3i�mr� CoP`t' a� �r✓lart�`7lat_� �itcr� S'jTrQ& Alb#., V— EP C'P `r' dF AAvNUgL. � •.
_ oA ^1 C(wfV16 IIIJ rJGW 96ZJwwof�,,
T
Renewer r Name�r, lJ U—--�-_
Reviewer/Inspector 4 1 � �
_ FMM:� r � �.;
Reviewerflnspector Signature: jiatjA Date: 1
12/12/03 Confinued

Facility Number: 31 Date of Inspection 43
Rectuired Records & Document.-
h. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
❑ Yes
ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
23_ Does record keeping need improvement? If es, check the appropriate box below.
efYes
ElNo
❑ Waste Application ❑ Freeboard Q aste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QYgo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[-No
26. Fail to notify regional DWQ of emergency situations as rewired by General Permit?
❑ Yes
ONo
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/lnspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
®No
2$_ Does facility require a follow-up visit by same agency?
❑ Yes
[]"No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
911<0
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35)
[Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ef No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
13"No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
ako
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
Q o
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
�es
❑ No
OStocking Form [Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections M-Knnual Certification Form
12112103

Type of Visit 'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint _,Qrpollow up OEmergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: 3 03 Time: T
ro 31 .�
Not Operational Q Below Threshold
0 Permitted Q %)Ce'i�
rtifif ed [3 CCondition lly Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: Af W 7 -� �1 ice- / County: _ y Ll n
Owner Name: Kq ey �'"L J r�`n'�� f� naGt� �J Phone No:
Mailing Address:
Facility Contact: �' Title:
�f
Onsite Representative: v ;WP"U now) 01
Certified Operator:
Location of Farm:
Phone No:
Integrator: rn v ^
Operator Certification Nulber,
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 u Longitude 0 1 0
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacitv Population Cattle Capacity Population
❑ Wean to Feeder
1
10 Layer
I
I
❑ Dairy
❑ Feeder to Finish
I
ILI Non -Layer
I
I
ILI Non-Dai
❑ Farrow to Wean
- _.. ._.._.
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Opacity
❑ Gilts
❑ Boars
Total SSLW
Numberof La oons JLJ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
g
Holding Ponds 1Solid Traps . ❑ No Liquid Waste Management System
Discharees & 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? ❑ Spillwav
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

.- .
` Facility Number: / 3t, Date of Inspection
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? El Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? /Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
N. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Rgquired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
" t;. �, � y - --.
�cl
omments {refer. to questibn #) Eaplam anv YES answers and/or any rei ommenf7se drawings•of�factitty to better e$platq"situations. (usegadthhonal pages.as neces'saDD - y s y o ❑ Field Copv ❑ Final Notes
c�a1'� SA S37G{+"d �n /nf�eC�ra� ark $113103 ; •,
a
des apse �a a1t �rd�-, �uY-�,� ��¢ kti?���
5 � i ne I Ga_ Gv �v �l l � �`'� l.V e re4 tv ;- k 1--m 1 kV C"
f'-�' �%V,,✓� !.r )1'Yj �, /� a�.l� S / e,74,' I Gt»'rsOvt_�
/� � Gd r�►1 rrte M O� 4 �' 1,���, jitA'�'C �'La./.t � .
yy� �
Reviewer/InspectorName ��,�sp�ayt/g 7.�..1.a! tS'
Reviewer/Inspector Signature: Date:
05103101 Condnued

S
Facility Number: —
Date of Inspection 3 Q
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or Drawings: """6`
T to OL S!J✓�� S� l!? �! ?Cb+'t �/� YSDc -� ,'v✓1 l✓ i'T �� ��� "� D
YV 1 v 1r ��L� C� y-e ►.i
en S V" red d e /a � Wq Oe� . `a l �r�
,Seer or; Jc �i -• 01-�� !� Gq YM -) 44e 11 �Gt G ,� �h �'S do W �
TA e ` 1 iqY► -Il44 i'f n.aGv be)'� ell) ") oli -
/'Yf 4 Jee v : L✓es�c,-, ��' Y�? v �� 1�-1�sat,✓h
w4-r twj Q r44 ]a do so ;l v4 ,' �.,9f , e i �h Ala �h e
40;� eebo,1fvl /eve) Sl, a 14W nG4 4e if 1'5 h q-< 14 hq-t bee Pi
gete�abl2.
05103101

Type of Visit tgCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 � Date of Visit: Time:
Not Operational 0 Below Threshold
Permitted 0 Certified `/D ConditiioJ�nally Certified 13Registered Date Last Operated or Above Threshold:
Farm Name: 7 r �� �v�+ &zf County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: /I Title: ��JPPAhone No:
Onsite Representative: �49401g t S _ _ Integrator: AIVI^1 /
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Currenu - rijent=1111111111111Design Current
Swine
Ca achy P,o ulation P.aultry Ca aci P,o utation Cattle Ga aci P,o ufat*on
El Wean to Feeder
❑ Layer ❑ Dalll
Feeder to Finish
❑ Non -Layer I JEJ Non-Dai
❑ Other
Total Design Capacity
❑
Farrow to Wean
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Total SSLWFM
- —
Number of Lagoons MEE
Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
No Li uid Waste Management System
Bolding Ponds / Solid Traps
Discharges & Stream Impacts
1. 'is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ER No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r WI AA4kL7t-B 5;-,C
Freeboard (inches): Z7
05103101 Continued

Facility Number: 31 — 55'Z Date of Inspection li ZC
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?
❑ Yes 0$ No
❑ Yes H No
❑ Yes ® No
❑ Yes ER No
JO Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes MNo
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes ®No
12. Crop type AAU J&460016 [ "I, 1114614A /W4 C /
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes O No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Q@ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Pa No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[RNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5d No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
NNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
RNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
0 Yes
JM No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;ffNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
. ,. r 1 t - T
Comments {refer to question #)., Expla na n�y*YES¢ans�rers.and/or any recommendations°or any other coiinment's.
Use drawings ofbfacihty to better explain sttuahons (use addthonal gages as necessary) Copy ❑ Final Notes
i �� ... � ❑Field
e � R
>'t k4l 7f4 ate' if c ne.v fa tfe leee
/f ` �4i! fl4hf�1�L 'Jr�d4!!` �C Li�'!G f1GG�
k A14e 1r' 14,01 6WA*�
Reviewer/Inspector Name!
Reviewer/Inspector Signature: Date: An-
05103101 v Continued

Facility Number: Date of Inspection
Odor Issues4
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes P�97No
liquid level of lagoon or storage pond with no agitation? %i
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IRNo
,e
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El 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 54No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or f,
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes lid No
3l. 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 M No
Additional Comments and/or Drawings: ,.", A;;, , _
A,
05103101

Facility Number 1 Z Date of Visit: td 2 DI Time: f3a A
16775perational 0 Below Threshold
0 Permitted 13 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....... v O L�4L County: ..... Rer".)-----.-....---.-••--••-------
. .
_ ......
Owner Name:..... L...kA V;h....^...".W.tCi� �+• IC'^v1..1 65......._.. Phone No :............. ..........
FacilityContact:........-•-----•.....:........................................................ Title:................................................................ Phone No:...................................................
Mailing Address :..............................
OnsiteRepresentative:'J �.✓+�� xJ•wi�-e�--..... .... Integrator: .................................... W..
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 46 Longitude • 4 !emu
Desig>sT; ` Current Design- . - Current Design Cnrrent
Swine capacity Po uiadon Cattle-
on.-
ulation PoultryCaci u lstiCa aciPo Po u
❑ Wean to Feeder ❑ Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
_.. ❑ Farrow to Feeder ❑Other
»' ❑ Farrow to Finish TOW Design Capadt
Y.
Gilts
❑ Boars Total SSLW
Nembee of i,agoon ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area F:
HoldingPonds / Solid-
'd Traps; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed_ what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 tructulre Struet+u 4 Structure 5
Identifier: �iWL,1 !j 1 `w� 9 �% t,�-..�7-!.........................................................................
Freeboard (inches): .31 36 53 5Z
5/00
❑ Yes J 10
❑ Yes _[ 0
❑ Yes No
nla
❑ Yes 1lo
❑ Yes /YNo
❑ Yes o
❑ Yesk(No
Structure 6
Continued on back

Facility umber: 3'1 —,3 Z Date of taspection l D
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 maintenancelmprovement?
9.. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes P'&o
❑ Yes O No
❑ Yes ,dNo
❑ Yes ONo
❑ Yes 'J6 No
❑ Yes ;2'No
❑ YesJZNo
12. Crop type I F 1<i-ivti M JIVIAf vCj 1jkCPSCC,4'6e,-r"'t✓dC Ha4 ;Seee'rM4"* G(it,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes dNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
[IYes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes J No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/P1
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ONo
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 2fNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes 0 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes JUNo
24. Does facility require a follow-up visit by same agency?
❑ Yes 0No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes [ No
To yiQla>iigt> s ;o d f cienfx" wire pQte�i dix°Eng th;s;vispt: Yoi� wii# >t ee�iye o u>rt��r - -
cories oridenc. . .
Comnments`(refer to.qu"on #) Ezplajn:any YES answers aadlor any:i ecommend8tions or=any other commence.
Use drarvngs of facility to better etpla�nsitaations (use add tionalpages as necessary)
T LAC-aCatG; J," y ) CraPS) e' ^4 ✓ ecv -4'r Ct�-e twe?-Illl kelll,
a
Reviewer/Inspector Name , = _ ,' vtf!;! - f
Reviewer/Inspector Signature: Date: 14 Z O 1 5/00

Facility Number: •-V) —3521 Date of Inspection 11 Q Z O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 'E�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �To
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 'PrNo
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 ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments andfor_ ravings:..... -
L3
5/00

k,F
t
_ J11 Division of Water Quality _
Q Division of Soil and Water Conservation
'Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit §Woutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: j it Z ! D 0 Time: ! 3: O Printed on: 7/21/2000
� � 35
Q Not Operational Q Below Threshold
Permitted 13 Certified © Conditionally Certified © Registered Date Last Operated or% Above Threshold: .........................
Farm Name K W? 4 I` W e County:..%D.iarL1-7.....................................
............................................................................................................................. ..... .....................
Owner Name:............................................................................. Phone No:............................................._.......................................
y✓, iV�k n0W1e.I'
Facility Contact: .............................................................................. Title: Phone No:
MailingAddress: .................................................. ..................................................................
Onsite Representative:.. s." `'\ ...................vvi'i w c
- 1 ...........r.......................................
Certified Operator:
Location'of Farm:
...................................................................................
Integrator: e v'rpk y f j
.... ..............................
Operator Certification Number:.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude �• �9 66
Design; Current
Design It Design current -.
Swine _ _ Capacity Population
Poultry Capacity Population Cattle. :Ca ci` `P60i"tion
Wean to Feeder Z4,10
❑ Layer ❑Dairy
Feeder to Finish
❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
❑Other
Farrow to Finish
Total NM& C#Pikdty
Gilts
Boars
Tolta.1 sww
Number of Lagoons❑
Subsurface Drains Present ❑ Cagan Area 10 Spray Field Area
Hollding Ponds /Solid Traps `
❑ No Liquid Waste Management System
Discharees & 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/ruin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Str cture 2 SttIcture Str c}urc 4 Structure 5
Identifier: �' w t"� r �. tJ � " `��lr ... ....
............................................................................?...���....................................... ..............
Freeboard (inches): z 1) 49 S-0
5/00
❑ Yes '�JNo
❑ Yes 0 No
❑ Yes )EfNo
V? q
❑ Yes ZTNo
❑ Yes jjdNo
❑ Yes ONO
❑ Yes ffl'No
Structure b
Continued on back

r '
Facility Number: 31 Es 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 .0 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 9 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
7"e
12. Crop type Sa U e 0417 , 13 rwrVo � Flay 5 - �,11 Grp r, F�esL'�
c ue Y�7-c �2rr
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
2I. 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?
Q yioiatioris:or- deficiencies -were noted- ding this:visit: • Y:oi} will-reeeive ti6 i'_urthO
' . ';correspondence. abaut. this .visit..
❑ Yes J5 No
❑ Yes 21 No
❑ Yes .0 No
❑ Yes ;5 No
❑/ Yes � No
V o[ A lQrG 7r
A Yes ❑ No
❑ Yes ❑ No
)irYcs ❑ No
❑ Yes []No
91'Yes ❑ No
❑ Yes ITNo
❑ Yes No
9Yes ❑ No
'Yes ❑ No
❑ Yes ,K No
❑ Yes 9No
❑ Yes 'S No
❑ Yes J�9 No
[:]Yes A No
❑ Yes 15 No
Gomments (wafer to question #}: Explain any-YE5 answers and/or any recommendations or any.othecomments.
Use dra of.fki: i to better ex lain situations. (use. additional a es:as necessary)
v�ngs: t3' _ . p p. g A
f3. F-; L�v,54-e Plan, bL4 is �0-0lS,s ih .`
►-►,ALc Sure wt', t Ziedd p,-Ar_4�ca �.•Ce.
Fa c e � i -� `f rt cad 1 a w e # 41 e q c res o(��r►^ t; .1 "an .
15 , =,•�Pro4re S�-r1► F ' 6 rwt, ✓�diice ih :t��4g, wes*� AervQe ;10% ✓%J,,'dd(C' dl
r't' e j di i.J o, k 46 e / ,`^� �` ,4e r-tev%be✓," vok t ef, elr� ef r d r, i[h- f ►' C� %Gf J�, f.�
1V_ lVe.,A �G tgave TAlrti ce,-f,*ficr-4ioK(s) �C,.�``}}Doh✓d`cst'!)n l+q'ry Jbn rec'61Wr
Ktc Se e-"A{e ZKIC—Z's f'dV- Ol,,r✓4znk Crap ;�, Sel�scr�S. ge sure to L-se
1 wa� ! yss c ire f t.j «. 60 dkY� ��-�l.c /l �G �QNp��CEL�te�, o+• Melt Z 1X 7
Reviewer/Inspector Name sfaV, C w a d l M 6i
Reviewer/Inspector Signature:
m
�i Date: % ZI bd 5/00

y
Facility Number: T Date of Inspection Ium eG 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 AL/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 *PfNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )f 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 (FNo
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 j No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
rec0Mr"Ct,dot -/;dnts.
i�io� ��, I t S 6C i'+ ��e✓q�C'a( D S `f ��� ra3q1cr -/o�7
-4to L-1-f ;4 a s weg �q fo le'eede, •- .
J
5100

� Fwd: 31-352 77'???'??'?'?? Knowles1 3 ! ` 3 S
Subject: lFwd: 31-352 ?????????? Knowlesj
Date: "hue, 07 Nov 2000 08:58:06 -0500
From: Dean Hunkelc <[e-mail]>
Organization: NC Division of Water Quality -- Wilmington Regional
To: Stonewall Mathis <Stonewall.Mathis rr ncmail.net>
Subject: 31-352 ??????????'Knowles
Date: Mon, 30 Oct 2000 14:32:02 -0500
From: Dean Hunkele <[e-mail]>
Organization: NC Division of Water Quality -- Wilmington Regional
To: Sue Homewood <[e-mail]>, Jaya Joshi <[e-mail]>,
Don Friday <[e-mail]>
CC: Elizabeth McVickcr <Elizabeth.McVicker a nemail.net>
Once you discover who is handling this permit package, then there are
several things that need to be addressed.
1. There are at least 3 sites with hogs here having at least 4
lagoons. They are supposedly under 1 waste plan. I take it that some
of this was lost when the other facility numbers were deleted from the
system according to comment section.
2. We have no idea what the combined certified size and type is, but
beiieve it to be two 600 Missouri house sites and one enclosed 2448 site
that are finishing.
3. As far as ownership and name of farm, we are at a total loss down
here. Involved are Marvin (the father) and his 2 sons (Larry and
James). James supposedly owns the 2448 site that was certified by Kraig
West-er.beek.' Larry and/or Marvin supposedly own the two older sites.
Who owns it for permitting -- I have no idea.
Let me know if and when you figure it out. If you have any lingering
questions that might be answered on the farm, then let Greer and I both
know. At least one of us will be doing a visit in the next couple of
weeks.
Dean
Dean Hunkelc <[e-mail]>
Environmental Specialist
Division of Water Quality
Environment &Natural Resources
I of 2 11/8/2000 9:16 Awl

ffunera >Tc
Facility Number 31 352
puplin
.Owner _ -
Marvin E. Knowles
Manager
Address
1 Cornwallis Road
eachy NC
Location
Certified
Farm Name
L KW7 & KW8
Phone Number
910-289-2318 (Marvin) 285-5565(Jimmy)
Lessee
Region
ARO 0 MRO O WARO Q W SRO
FRO C RRO W IRO S
est of Wallace. On Southwest side of SR 1101 approx. 0.2 miles Southeast of SR 1133.
Certified Operator in Charge
Backup Certified Operator
ames
originally registered as 3 separate facilities (31-538 (duplicate 31-539) and 31-541 deleted) per operation
review. Was previously listed as Larry Knowles owner, incorrect.
..........
---------------------------
[3 Inactive operation ELI Lagoon Closed Date inactivated or closed
Type of Operation
IM Swine [I Poultry [I Cattle ❑ Sheep [3 Horses [] Goats © None
Design Capacity
Non Layer '' r
..............:...................
Total
SSLW
3
Subsurface Drains Present Lagoon Area
No Liquid Waste Management System
i 2,400 Swine
72,000 Wean to Feeder
I
Lagoon Total Capacity ft 1 8799866
Y`
Spray Field Area

1e Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 31 352 Date of Inspection 7/22/1999
Time of Inspection 16:00 24 hr. (hh:mm)
Ej Permitted 2 Certified E3 Conditionally Certified E3 Registered 113 Not O erational Date (Last Operated: • . -
FarmName: K►WI N..8.................... ................. County: 11uRlia--------------------._..
Owner Name: harry_-• ---_---•- _-• _-. _.. _._ _.. _. Katowl�. _........ _........... _.. _--------_--_-• Phone No: (QXQ).7.134-344.. _.............. _.. _.. -•- _-. _........ _.. _
Facility Contact: ........................................................... Title: ............................................... Phone No:
Mailing Address: 1O�1.Gariaxvalbs.load..................................................... Tgacbuey.AC............................................ 28.�69..........
Onsite Rep resentative• Integrator:
Certified Operator: Jamea.A.......................... Knowlea................................ Operator Certification Number: 1.7241............---......
Location of Farm:
kestiAWallaGe._ On. SoutbwestAft of -SR 1101 gWrv.L 0.2 miles.Southe4stAt SR.11AL -- -- -- ---- -- -- -- --
Latitude 34 ' 46 :� 40 " Longitude C 78 • r_04 ' 1 44 -
® Wean to Feeder
2400
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
. El 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 ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........JK... _.. _.. - K17..... _....... _.. _..1T18_.. _.. _... _..... _........... _.. _..- - . _.. _.. _.. _.. _.. _........ .... _.. _.. - -
Freeboard (inches): -- -- -- --37 - - - -- -- --4 .- -- -- - - - --2$ - - - - - -- - -- -- -- -- -- - - -- -- -- -- -- -- - --
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on hark
-insonrvrnni

. Facffify Number: 31-352 1Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? 0 Excessive Ponding ❑ PAN
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Fescue_ (Hay)
I VIVVILVV
Printed on
7/22/1999
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
❑ Yes ONO
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14. a) Does the facility lack adequate acreage for land application?
D Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
0 Yes
® No
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss 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?
No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
- There is a new lagoon that recieves waste from the KW7 and KW8 lagoons. That lagoon's level is 33".
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
[)Yes N No
0 Yes N No
❑ Yes N No
.A►
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

A Routine Q Complaint Q Foll=-ug of DWQ inspection 0 Follow-up of DSWC review 0 Other
€ Date of Inspection 11-29-1999
Facility Number 31 352 p
Time of Inspection 1634 24 hr. (hh:mm)
❑ Permitted 11 Certified ❑ Conditionally Certified ® Registered JE3 Not O erational Date Last Operated:
... County: ]2lapajA---------------
Farm Name: I�Y.7..�c. ��............. - -- -- -- -• - -- --
........................................................
Owner Name: Larry_.. _.. ... _.. _.. _.. _. Knos�lRs. _._ _.. _.. _.. _.. _.. _.....-........ -.. _.. Phone No:
Facility Contact:........................................................... Title: ...................... Phone No:
Mailing Address: 12.4.8.-Co"R this.Road..................................................... Ron.HUM ........................................... 2845$..........
Onsite Representative:llfAA4J.�pd.7.ealClp �{AlQF1 ��s. _.. _.. _.. _.. _.. _. ... Integrator:yJly.k]y.ktlg _........ _.. _.. _.. _.. _.
Certified Operator: James.A........................ KA.akaeA................................ Operator Certification Number: 1714.1......................
Location of Farm:
QUA-01-wallace.- Dn So-utbwest-side of.SR I10)L approx.O.z miles.So>lheast-of--
:._ 4 c u g �r c t --
Latitude 34 46 40 longitude 78 04 44
.. Derrent Des_ ign Current , Destgn Current
Ga achy Po iilahon :PoWtry_ Ca aeit ..:P6' ula#idn Cat#le Ca'iacit . Po ik on
Swtne:..,_......... ......... ....
® Wean to Feeder
2400
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑Layer ❑ Dairy
❑Non -Layer ❑ Non -Dairy
........................ ......... ......... ......... - -
❑ Other
„ Totai Designapacty. 2,400
- T&W m.$SLW - 72,000
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: - --.JiYiK .......... _.. _.. _3=stage_.. _.. _.... _.. _.. _.. _.. _.. -•• -•• - - - - . -.. _......... _.. _..... _..... _.. _..... _..
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes ® No
❑ Yes 0 No
Structure 6
Freeboard (inches): _..- -- --35.- - -- - - - 24- - -- -- - -- -- - -- -- -- - -- -- -- -- - -- -- -- -- -- -- -- --
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
3/23/99 Continued on back
'qn19n Mnnf

acirty_Nudhber: 31-352 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 4fi was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type • Fescue (Hay) Coastal Bermuda (Hay) Small Grain Overseed
IV/YVI�vV
Printed on
11-29-1999
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ®No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. - Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss 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?
13 No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
8. Odor checklist needed in records. Lagoon designs needed in records.
9. Keep weekly freeboard records on site.
Westerbeek has amended additional PAN to plan if needed under Emergency Guidanceplan -- copy in records.
❑ Yes N No
N Yes ❑ No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
FIR
Reviewer/Ins ector Name
P IEreerMcixaciter
Reviewer/Inspector Signature: Date:

E3 Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
Routine O Com faint Q Follow-up of DWQ ins ection Q Follow-u of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection G4 24 hr. (hh:mm)
© Registered © Certified r[Appiied for Permit © Permitted 113 Not Operational Date Last Operated:
Farm Name: .1.1.......................................................... ........................... County:........ ..... ,).........................................
.... ..............
OwnerName: .(' �.�-G4................................................... ............................�'.`..`;.........................-........................-............... Phone No: �
Facility Contact: .............................................................................. Title:................ .......... Phone No:
Mailing Address ���
�`......... -.................. -..-- ................. .�..-.........................
Onsite Representative:.--c! ... Integrator:................��.......�.�.--.-�........................
.......................................... GG .-... ,C
Certified Operator:.................................................................................................. ............ Operator Certification Number;
Locati n of FarT: eN
xc.........................................--....-------....----....-----•---------•- -- 7-V
Latitude =0 L___ , 0" Longitude • 01 =11
Design Current ".
Design Current
Design Curirent
$wme
Capacity'Ir uiation7 Poultry
Capacity Population -,. Cattle
Capacity Populatrton
❑ Wean to Feeder
❑ Layer
❑ Dairy
.'
gFeeder to Finish
`JX$G
❑ Non -Layer
I ❑ Non -Dairy
❑ Farrow to WeanMT
❑ Other
w= {t
❑ Farrow to Feeder
Total Design Capacity
Farrow to Finish
❑ Gilts
r Total SAM
❑Boars
ram..
d
Number of Lagoons / Holding Ponds
❑ Subsurface
Drains Present
❑ Lagoon Area
❑ Spray Field Area
M
77
❑ No
Liquid Waste Management System
r
General
1.
Are there any buffers that need maintenancelimprovement?
❑ Yes
V(No
2.
Is any discharge observed from any part of the operation?
❑ Yes
Z[No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
P9 No
c. If discharge is observed, what is the estimated flow in gal/min?
l`
d- Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
Pq No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
O No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ONo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
ANo
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
4No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
6No
7/25/97

tlity Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons,Holdinu Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate'?
❑ Yes 0 No
❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 - Structure 6
Identifier:
Freeboard(ft): a-, .............. ........... ---........--------.....................................................
10. Is seepage observed from any of the structures? ❑ Yes 1 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ARplication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
yy
15. Crop type b LF.. s�...............................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0, No.vitilations•ar deficiencies: were, noted,dtii ing this:visit.-_ You:will i kei f ni 6ltirther . -
:�-.�correspfliadeinceatiou>�><.his:visit.�:�; :-:�:-:�:�..:�: ;:�:: .-. . ;::: :-.•.•:-: ..�::-:-:�:�
❑ Yes IgNo
Oyes ❑ No
❑ Yes DNo
❑ Yes
ff No
❑ Yes
ONO
❑ Yes
[%No
9Yes
❑ No
❑ Yes
A No
❑ Yes
ONO
❑ Yes
lK No
ISrYes
❑ No
❑ Yes
!dl No
❑ Yes
No
❑ Yes
ONO
�-b,� e �t , o� �y' e o.�,a•�, y�, �,es�e �� ec��lc►
.r.V V,�04� 1�7
�rw �17/25/97
Reviewer/Inspector Name ...R
Reviewer/Inspector Signature: Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
143�,Rijutine O Complaint O Follow-ug of DWQ inspection O Follow-up of .DSWC review O Other
Facility Number Z Date of Inspection
Time of Inspection = 24 hr. (hh:mm)
0Registered [3 Certified 0 Applied for Permit 13 Permitted JE3 Not O erational 1 Date Last Operated:
Farm Name:.........' ?...IlL�.7...'� .... �isi$.........inrr! 15.......................
Owner Name: .............. .................. .."1 Q.I 11XC.....................................
Facility Contact: ..........�.1�(1( V1.......y VOUIS............. j 1 ...... Title: ..............
Mailing Address :........... &A.....CQ ...c3tlx��a.SXlt,�n ...... . .....................
Onsite Representative: ................... s -�Vx"'.r y....VVwja ................................
CertifiedOperator;....................................................................................................
Location of Farm:
County: `
Phone No:....�`�.�-..SSf'v$� .....................
Phone No:
�1,�a,1�ctC t[1..................................... ...
... Integrator:.............................
.........................I.. . .
...... Operator Certification Number, ...........................
Latitude 0' 46 Longitude 0• 04 0"
General f
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes EYNo
❑ Yes P No
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes Co No
❑ Yes yu No
7/25/97

Facility Number: 31
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
12 No
Structures (Laeoens.11oldine Ponds„ Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
W No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: . t14.......... ............. ! .V........... ............. k? ........................!`31 .............
.................... I.............. ...................................
Freeboard(ft):•-----.....:.l............... ..............Zr%.............. ............. ; :.14............ .............L-5.... ..........
....... ............................. ....................................
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
'@I 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 ADDlication
14.
Is there physical evidence of over application?
❑ Yes
E] No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ................ 6_V- r�tl&.........Lau.. c ............. 5YI It....1........ ........ C-OXX....... aiaj..........U.Y ..................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
aYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
[AYes
❑ 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
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
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
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
(LNo
0- NO.viplatiohs'Ot; d6 ciencies4ere-noted during this.'visit.- You.rvill recei've-'&further :.
.•correspoude�ceatiouttl3is:visit:�:�:-:-::�:�:-:•��.:-:::-. .-�•:•.. ,�. :.: .�: _ .. .
U. cn t nruy-- a 0(& W&Alr ak 6 )eel's �i_k + 1,1W S " b a �- (W , z u( C,61
M..seezQ. a, oWcus er S`1 K mil- ,Lw Inva.s Shoild be MwSelo.".bewee+-
+vuses + V-wg i ao� s l�eOl,] tie c1 �o ��rbvu� �„�o-{-u- '�-,o CoI cc f-s�N
16- &,r, da- k&6 betr- s A)y 1�crr� pta�s ko sp t� iJuQ c�.�1 r
is. �cr5cu� t� t�ie�{� -i� ` sfna�lJ be Ch•Crovet �
z. "V-ct kv)^. dc.�s s61 lZ be. ohseK4 'm (csc.ue. ;JUP-1,tcU13 be. c ed it l�k b-rrnud
'�w�' G��xe�#' co�rrt.E�'� .p � re.c�� -� s ��t # 7/25 97
Reviewer/Inspector Name
Reviewer/Inspector Signature: /-- A Date:

[] DSWC Animal Feedlot Operation Review
. . . . . . . . . . . . . . . . . . . .
. . .
WQ Animal Feedlot Operation Site Inspection'
. . . . . . . . .
IG Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up 9of1D)SAVVkC review 0 Other
F 0
Date of Inspection c 41
Facility Number ti:mm) ne of Inspecon Qi , 3 t) 24 hr. (hh 2-
Tithe 1 'J
Farm Status: a Registered [3 Applied for Permit
[3 Certified [] Vermitted
Total Time (in fraction of hours -
(ex; L25 for I hr 15 rain)) Spent on Review
or Inspection f.inc(udes travel and processing)
NotOpe;ational Date Last Operated . ................................................................................ ................... ...........................................
county: ... ................................ Farm Name- . ..... ........................................................ ................
Owner Najne:_.37.R_ ..v.n . w.. kg� 4 ...................................... Phone No:..C,jj. jA ........................ ..... yn=,o 9.) .....................
FacilityContact:...........................................................I..... .. Title: ................................................................ Phone No: ...................................................
Mailin- Address: .....
cl ?AK....... ....................... _WAJA.&x_g_j .... M..0 ....................... 1. ......... ...
OrLsite Representative:j�~n.jj" 1ntegrator:..4.V..,f.f ...........................
... ­--- 7­­­­­ ......... I'll, 711, - 11 ................ I ....... I—— -
Certified Operator:................................................................................................................ Operator Certification Number: ..... jj.24(
............................
Location of Farm:
e
......... S.R.A.I.- 3.n_ ....................... ... ............................................................... I ........................................ .......................
Latitude 0 4 .4 Longitude 0 1 44 . I
Type of Operation c D
esign Current sign Current Design Current
Swine h Capacity, Population PoultryCapacity. Population apacttyI.Popu ation
0 Wean to Feeder
gLeeder to Finish
—TTR7
El Farrow to Wean
0 Farrow to Feeder
JEI Farrow to Finish
❑ Other
NiPonds I LagZn �Area D Spray Field Area
umi�e� Lagoons'/Hoidpgo ID Subsurface Drains Present
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge4-- 0
originated at: 0 Lagoon El Spray Field 0 Other
a. If dischan,e is observed, was the conveyance man-made'!
b. If discharge is observed, did it reach Surface Water! (If yes, notify DWQ)
c. li'dischar---c is observed, what is the estiniated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4130/97 maintenance/improvement?
El Yes 0 No
0 Yes 21 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
0 Yes RNo
E3 Yes �No
Continued on back

Facility Number: 31....-.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes MNo
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?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is 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?
❑ Yes 19 No
❑ Yes Q4 No
❑ Yes BNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste lication
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-= c v P-
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?
For Certified Fagilities QnLv
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?
immt�ntc lrPfe
❑ Yes JgNo
❑ Yes 9 No
R Yes ❑ No
❑ Yes 18 No
❑ Yes ® No
❑ Yes R No
❑ Yes ® No
10 Yes ❑ No
❑ Yes &No
❑ Yes ONO
❑ Yes ®.No
❑ Yes 19 No
❑ Yes ® No
El Yes ❑ No
1 Z • Gut � t,t�-..-f� a v, 4— 1 r �s-.r l o-o c .L wa 1 I . R-n � c �-w 4 10rn--t s Pe,
V �e,d t t: L w t c. A S S
17. V3 s< r 6 v� u J N C.c �i aye 5 v� .� � 044 •
x LA. C t LI-& ; t- �t..,. d- s ,�.. ac-s . U �,E u- 6A J-
Reviewer/Inspector Name
4 . r
Reviewer/Inspector Signature: IqLd,, A n Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

i__
ti
State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
James Knowles
J&K Farm
608 S Cumberland St
Wallace NC 28466
e��
1DEHNR
November 13, 1996
SUBJECT: Operator In Charge Designation
Facility: J&K Farm
Facility ID#: 31-352
DupB County
Dear Mr. Knowles:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
callBeth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
Sin;resoln
ely,
A. Howard, Jr., P ctor
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
AW P.O. Box 27687, W i
Raleigh, North Carolina 27611-7687 N'Wf An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 5001. recycled/10% post-consumerpaper