310358_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of visit: k:JrC:ompliance inspection V Vperation Review V Structure Lvaluation V Technical Assistance I
Reason for Visit: 0-9outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: h { Arrival Time: k Departure Time: I tLE' Y County:
Farm Name: 1403 er g iJ �k-t �N. Owner Email:
Owner Name: _ -C Phone:
co Region: ej,
RECEIVED/NCDENR/M
Mailing Address: AUG 17 2017
Physical Address: water Qualo � �_
Operations Section
Facility Contact: �u �. �tS �a `rGh Title: PIMnington Regional Office
r Onsite Representative: i � Integrator: ryV
Certified Operator: CLg, �,Ucivt,12 Certification Number: 17&,?- (N 2-
1
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design
Swiune Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design C rrent
Cattle Capacity Po�.\
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P.oui. Ca aci Po P.
La ers
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
FIBeef
Brood Cow
Other
F-TO—theT
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [cQ-t4V- ❑ NA [:]NE
❑ Yes ❑ No C]-N-A ❑ NE
[:]Yes [:]No [ A ❑ NE
[:]Yes [:]No
[:]Yes [r -No
[:]Yes [fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

lFacili Number: q$ Date of Inspection:
G [
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[5-NI
F] NA
❑ NE
a. If yes, is waste level into the structural freeboard?.
❑ Yes
❑ No
[A-N-A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D-PAS
❑ 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 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
E j 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
EJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�./
�.-���
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ET -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): G r utcL[x �, s6 0 cu_)6
13. Soil Type(s): t, Lct"-�en
14. Do the receiving crops differ from those designated in the CAWW?
❑ Yes
� ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I fiNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
I356❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ N6- ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;;J Qoo ❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes B 4-o
❑ 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 Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection:
` 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2-No ❑ NA
D NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
[]-No— ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
I�`!10 ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E ❑ 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 ga- o ❑ NA ❑ NE
❑ Yes g]'<o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2io ❑ NA ❑ NE
❑ Yes to
[:]Yes
[do
❑ Yes [2-iffo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Ciammenis (refeir It aquestion;#) Explain any YES,ansWeMnd/or any additional recommendations oc any other comments. iiPfl s
Me,dra ings ofFfacillty to better ezplain situatW (use additi6h4l pages as necessary):,..,. , , ., _< { ;; ., ;
CA -r3���
Reviewer/Inspector Name: y 1 vl Phone:
1i
Reviewer/Inspector Signature: 1 Date:
Page 3 of 3 21412015

V
}; O Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Folfow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: / Departure Time: County: Region: =�A
all or
Farm Name:
Owner Email:
Owner Name: Phone:
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
❑ barrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator: r�
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 1 Longitude: = ° = 1 ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑Non -Layer
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?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
VINo
❑ Yes
�?No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

' 1
Facility Number: — Date of Inspection =15K01
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 ONo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes qNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �TNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ,❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Y No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes [P'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 ;; o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes )No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Lt/PC C'r%/i7�/` G✓%�� �P. I-A7
y
AL
ki
12128104

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Ko
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):aw
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
PIN
El ElNA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P-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
PKo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[;k&o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[TNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ej'No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
[�'No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
INo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name lG Phone: r /—
Reviewer/Inspector Signatur : Date: 62-7
12128/ 4 Continued

(Type of Visit: ,Q Corn. ' nee Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: L o Departure Time: 1 ao County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
/*0,chase (No/1%S
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1 49/�?24F-9
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
D . P,oul C+_a ati P■o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 0-No' ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[I Tlo ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[]r17o_­D NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facili -Number: -3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑^No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 19 41 1 ( /5 /i4. 4 Z is�OVI c/3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P - ❑ 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 12<0 ❑ 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 Ej No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes T— ❑ 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?
❑ Yes Io
❑ Yes io
❑ Yes Vo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 <No ❑ NA ❑ NE
❑ YesFa-'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [/] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [3 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [DNA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Skj jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Fai a to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [31`'A ❑ 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? ❑ Yes [2'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ZrNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EJINo ❑ NA ❑ NE
Comments {refer.to question"#): Explain any YES answers and/or any additionat.recommenda.tions or any.other 6mments.
__.
Use drawings of facili Y to better explain situations use additional page's as necessary)'. e s
S 9 Nc (C c Q r cr1 L---e Pma t le ` _
2<--
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes FZ<o ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
l Z.00Y3 G /� y e �i,�ve f Sc9�e s S/u W� c
J Sic*- e /P . e /s
C µµ se pre,Gle MAvt
Y l
6As/v /4 slN�c s����
Reviewer/Inspector Name:
Reviewer/Inspector Signature:-- ��
Page 3 of 3
Phone:
Date: y� 7
21412015

tvision of Water Quality
facility Number . � ,3 0 Division of Soil and Water Conservation
,� n. Other Agency .
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 7;Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:�(� vUII�� S r Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 & = es Longitude: = o = 6
Design Current
Design Current
-":',Design '4Currentf.;i,"
Swine n
?` Capae�ty'"1?opulatio"
_
Wet Poult
Poultry
,
Capacity Population Cattle
,
Capacity Population::,:
r °
❑ Wean to Finish
❑ La er
�;
❑ Dairy Cow
❑ Wean to Feeder
110
Non -Layer I
I
Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry,
El Dry Cow
'
arrow to Fee er
v ❑ Farrow to Finish
`. ❑Gilts
❑ Boars
Other
y; ❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts i
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
on- airy
❑ Beef Stocker s
❑ Beef Feeder
❑ Beef Brood CowlG'
Z.
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

i
Facility Number: 37 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): +�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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?
U Yes
Ll No
LJ NA
U NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
/❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other_ comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
wee d/ Con -tea
vU
pea-, a- o c &
Reviewer/Inspector Name i K e U 1 01- I Phone: /Q .61 T—,?y 2-y
Reviewer/Inspector Signature: Date: 6 �.9c6
Page 2 of 3 12128104 Continued

t
Facility Number: — Date of Inspection
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ No
❑ 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
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit: 12rCompliance 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: Z Arrival Time: Departure Time: ounty: f Regiont/lJ A
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: � � �p � a i ll
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity'
Pop:
Cattle Capacity Pap.
Wean to Finish
Layer
DairyCow
Wean to Feeder
I"
-Ton -Layer
Da' Calf
Feeder to Finish
Da" Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P.oul r
C►.a aci
P,o ,
Non-Da'iry
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other101
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 0,V
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 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: ."z /
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 El No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes pWo
❑ 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 J:2-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 .Efr"No
0 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ffrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes fjNo
❑ 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 AEJ-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes .ff-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E]" No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes .E�rNo ❑ NA ❑ NE
❑ Yes -ETNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes _Ea -No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4D-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 ,Q -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 -E3-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes "[jNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 73 it
24, Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes/ No ❑ NA ❑ NE
25. Ic the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes pVNo
❑ 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
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 0No DNA ❑NE
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes 16 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VO No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any outer comments.
Use drawings of facility to better explain situations (use additional panes as necessary).
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: ?/.,)(//r{

FaL�tlity Number,�� i
ivision of Water
OzDivisbi of Soil an
WO
LLality
�''^>
WaterCanservation -
Type of Visit ­0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visite"outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: V eparture Time: ounty: �\ Region:
Farm Name: 2 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 4 Title: Phone No:
Onsite Representative: n�. ,�r�l%rl� Integrator: KK
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= u = 6 = Longitude: 0 0 = .
'Design =Current
Design Current Design Gurrenf
Swine - _. :
, Gapa..i#y .Population Wet Poultry
. 'Capacity. Population ;Cattle
Capacity Populat�vn
❑ Wean to Finish
= ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
I ❑Non -La er
❑Dai Calf
❑ Feeder to Finish
"0
Dairy Heifer
❑ Farrow to Wean
:=Dry Poultry
El D Cow
❑ Farrow to Feeder
Non -Dairy
�:_
❑ Farrow to Finish
El
Layers
❑Beef Stocker
Gilts ❑ Non-L
Boars ❑ Pullets
❑ Turke
ier' ❑ Turkey
L Other Other
ers
❑ Beef Feeder
< ❑ Beef Brood G
Poults 4
Number>of S1
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 gNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA
❑ NE
❑ Yes ❑ No ❑ NA
❑ NE
❑ Yes 6INo ❑ NA
❑ NE
❑ Yes B No ❑ NA
❑ NE
Cl Yes XNo []NA
❑ NE
12128104 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is heavy
storage capacity (structural plus storm storage plus rainfall) less than adequate?
❑ Yel o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: { 2— �3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G
5. Are there any immediate threats too 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 gNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-5 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 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 ,Rj No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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 6 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No
❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facifl Number: - Date of Inspection: sr
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes �1 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes y� No ❑ NA ❑ NE
the appropriate box(es) below. ✓�
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ 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 FfNo ❑ 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 V(No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
77``-''
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 VNo ❑ 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
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o ❑ 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 additionat recommendations or any other comments
.�
Use drawings of facility to better explain situations (use additional pages s necessary).
'
Reviewer/Inspector Name:
Phone: "J///1'
7,
Reviewer/Inspector Signature: Date: �cs,
Page 3 of 3 /1/4/

_ m
llivision of Water Quality -�
�'acd�ty Number / � [Zn-6t&r-,A2ency
Type of Visit o�mpiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visits Routine O Complaint O Follow up Q Referral O Emergency 0 Uther ❑ Denied Access
Date of Visit: Arrival Time: < a parture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = g =Ag Longitude: = ° ❑ 1 0
is
Design Current
Swine Capacety Populatto`it Wet Foul
❑ Wean to Finish ❑ Layer
Desig►i Current ;
rY .Capacity :Population�:a Cattle
❑ Wean to Feeder
❑Non -Layer
:'
❑ Feeder to Finish
Ii Poultry"
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
- El Layers
❑ Gilts
El Boars
Other
' ❑ Non -Layers
h ❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ OtherT
❑ Other
------------
Ll Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
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 1 of 3
❑ Yes LdNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No El NA ❑ NE
❑ Yes l[�No ❑ NA ❑ NE
❑ Yes 7No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑.No ❑ NA ❑ NE
Strac re I Structure 2 Struck 3 Structure 4 Structure 5// Structure 6
Identifier: s
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J"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 gNo ❑ 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9-1qo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes VINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZ"No ❑ 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 > i0% 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 j2rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes XNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes PKNo ❑ NA ❑ NE
17. -Does the facility lack adequate acreage for land application? ❑ Yes ZNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
Comments refer to uestton.# Ex laid an YES answers and/or an recommendations organ other comments°
(:�� q e_ _ . )•:._ P ,s _ y .. t y y
r . Nk .
Use`drawtnsof facili to better explain use additional a es as necessa k
g t5` P �� P g � rY)
Reviewer/Inspector Name
Phone:
�i=
Reviewer/Inspector Signature:
Date:
Page 2 of 3 lof/28104 Continued

Facility Number: 3 — S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J2<0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�Ko ❑ 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
,ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
/allo
❑ 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
P�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J2'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
eoNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P�4o
❑ 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
�YNo
❑ 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
?Qo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 05 Arrival Time: � 0 Departure Time: County:
,
Farm Name: J ,4 z }CJD F�� Owner Email:
Owner Name: _ !/I(f/IP�7 Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C`/�i��L A D"Z75-
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 6—A"'
Location of Farm: Latitude: = c = 4 = 4i Longitude: = o = 1 = !{
Design Current Design Onrreni
Design Current
Swine
Capac�i�tyP�opnl, action" ',' Wet P-�anl#r�ap�act�tyopulation
Cattlge�apacty
Population ,
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La et
❑ 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 -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Coyd
IG
❑ Turkeys
Other
❑ Turke Pou Its
Number of Structures:
❑ Other
❑Other
Discharges & 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
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Fhcility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes ONo
❑ Yes ❑ No
Stru tune Structure 2 Structure 3 Structure 4 Structure 5
Identifier: � `V> "G�
Spillway?: /fin NO AO
Designed Freeboard (in): 19, 5
Observed Freeboard (in): ZJW2
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
El NA El NE
El NA El NE
Structure 6
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes IVNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ix
❑ NA ❑ NE
(Not applicable to roofed pits d stacks and/or wet stacks)
, ry
9. Does any part of the waste management system other than the waste structures require ❑ Yes
improvement?
�No
❑ NA ❑ NE
maintenance or
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
P
El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/VfNo
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Window ❑ Eviddenc,lof Wind Drifl ❑ Application Outside of Area
,�lC�ro�p
12. Crop type(s) -.e U`�fil� r��f}y[�. (/��if-D Ut/
�`
13. Soil type(s) /✓Q, j .�4�4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[4No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
gNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
PrNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ONo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
XNo
❑ NA ❑ NE
Comments (efertopq soon �`Eplainany�"'`�YES nswers,(and/ar any recommendations or any other comments.
Use drawings of f cilitytobe�t�terY°` ref plain s�tuahan' ;ys.'�(us �at��ih; o al pages as necessary): .
20)
Reviewer/Inspector Name ' .� ; �* = Phone:
Reviewer/Inspector Signature: ? Date:
12128104 C,it Continued

4
Facility Number: Date of Inspection �8
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ 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
1p
2'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No '
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V1No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
12128104

a� �'iSiOD Df W$ter ty 'oc
_may
vision of Sod and Water4Conservatiau
Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 0 Tune:
Not O erational Q Below Threshold
,JdPermitted gCerfified 0 Conditionally Certified 0 Registered Date Last Operated or Above reshold•
Farm Name: 1�1D �p
........ ...._.......... -- --.................................. ......... County: ........,�!_.I .... ... ............. _ .._..........
Owner Name: _.........._ .... _..__._..... Phone No: ....................... ................................. ........ ...........
MailingAddress: ........................................................... ... . .. ........................ ..................... ....... ......................... ........................ .... ..................... ... ........ _.............
FacilitvContact: .............................................................................. Tide: .................... .................. -........ - Phone No:
Onsite Representative: ............. Integrator:.........._....._........... ........... -...
Certified Operator: .................. . .......................... _................ ..... Operator Certification Number: ............................. .... ....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 �C.9 Longitude • 6 "
Discharges & Stream impacts
I . Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure , Structure 4 Structure 5
�
Identifier:_.._Z2S -
.-_..-•--•-•-•............................................__ .._.__�_..............._......- ...................�........
Freeboard (inches): A�, `i 3Z'
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
12112103 Continued

Facility Number:{
Date of Inspection 0�1
�. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground
12. Crop type CSLJ (3E9fNVO C G 4 k
❑ Copper and/or Zinc
SC_b
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?
I6. Is there a lack of adequate waste application equipment?
Odor I.,sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes No
El Yes o
❑ Yes 12'No
❑ Yes o
❑ Yes L 0
❑ Yes /No
❑ Yes o
❑ Yes
❑ Yes o
ElYes 90
❑ Yes
❑ Yes FNo
❑ Yeso
❑ Yes No
ElYes o'
ElYes � o
El Yes a
Comrrteuts erato question #) laps airy YF.$ answers and/or arty recommendations or any_ oiher comments. � -
adnaaField Cop ❑Final Notesse abapea�
_U
L
W lZi�1Y4 �' z c u 5 �J IEC D S lm FROV Y1
tr NLZDOLE AM" .
ANNUAL C[R-TY LA1xotj Coe? x-d �EGoit-nS.
Reviewer/Inspector Name C�:;.- x
.... _ .
Reviewer/Inspector Signature: Date:51 a
12112103 1 1 Continued

Facility Number: 3 —3
Date of Inspection o
1fe uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ;N1
0
❑ Yes
❑ Yes No
❑ Yes N
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ Yes No
ZYes
❑
❑Z
Yes��9/
❑ Yes
El Yes
❑ Yes
❑ Yes
12112103

Type of Visit 9kompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:1116 Lis
Not O erational 0 Below Threshold
r Permitted 0 Certified
U Conditionally Certified
0 Registered
Date Last Opera�V4
r AAbove Threshold:Farm
/
Name: Z
�on� ap,
M
County: rG�/� _
Owner Name: _ li��fi'
1 lqm,
Phone No:
Mailing Address:
Facility Contact: A Title: Phone No.:/
Onsite Representative: 0 :T j4 F,1 _ o oRRz__�_ 5 Integrator: ���J��t/— RV,.d ✓
Certified Operator: Operator Certification Numher:
Location of Farm:
10 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 1 " Longitude 0 &
U Wean to Feeder I ILJ Layer
Feeder to Finish ❑ Non -Layer
Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish TotAI
❑ Gilts
❑ Boars _,:
Number of Lagoons I ' I ❑ Subsurface Drains Present IiLJ Lagoon Area
Holding Ponds /Solid Traps ❑ No Liquid Waste M:
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 S. cture 2 Structure 3 Structure 4 Structure S
Identifier:�Z
Freeboard (inches):
05103101
M
W
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes , /❑�No
❑ Yes ONo
Structure 6
Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
ONO
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
❑ Yes
ONO
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ 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 ARplic2tion
10. Are there any buffers that need maintenanceiimprovement?
❑ Yes
ONO
11. Is there evidence of over applicatio ? ❑ Excessive Pending ❑ PAN 14 Hydraulic Ov load
❑ Yes
No
12_ Crop type 6E M AZ 0✓ � C•��itl
� %
13. Do the receiving crops differ with those designate in the Certified Animal Vi'aste Management Plan (CAWMP)?
❑ Yes
[ZNo
14_ a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
(� No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Reguired Records &: Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
21 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wi iP, checklists, design, maps. etc.)
❑ Yes
2J No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
1;2�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
21 _ Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22. Fail to notifi- regional DV+ Q of emergency situations as required by General Permit?
❑ Yes
VNo
(ie.-` discharge. freeboard problems. over application)
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
0No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
S
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments:(reier to question l#}. 'Ezp n:airy YES answers andior,ay.recornmeadations yr asrv_offter:cammeuis.
W
Use drawings of facfitty in to better explasituations..(use additional pages as tecessaryj _ ❑Field Capv ❑Final Notes
�..
tx�
�N6PrCCr on1 DA/,Oc1CTE,p rr,�I On) of `P� ( �!-�4�lTig
fFFscE
l.5�•�Ae� ERm� �} �z,��O iV�FOs �%f-,o (�Oi�;�eoL,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility lumber: 3 — Date of Inspection O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fait to discharee actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there anv evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt.
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. NVere any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts. missing or
or broken fan blade(s). inoperable shutters_ etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
;� r)n the finch tnnkc tack s v hmProed till nine nr a nermsnenihemnnrnry crnvr•r) MCA
❑ Yes S-; nfa
❑ Yes .L 13 0
❑ Yes 12-No
❑ Yes Z No
❑ )'es ,� No
❑ )'es ZNO
n VF-z n Nn
05103101

r % '''
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number bate of Visit:
O Permitted ©Certified 0 Conditionally Certified 0 Registered
Farm Na n '� L
Owner Name:
Mailing Address:
Facility Contact: �} Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operated Above Threshold: _
County: , —
Phone No:
Woe No:
Integrator:
Operator Certification Number:
Vswine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0`' 0" Longitude 0 K
LJ Wean to Feeder LJ Layer I I I LJ Da'
Feeder to Finish 10 Non -Layer ❑ Non -Dairy
El Farrow to Wean"
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity
11E] Gilts _
Subsurface Drains Present
No Liquid Waste Manaeer
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?
n
U Spray Field Area
❑ Yes/No
❑ Yes ❑ No
❑ Yes ❑ No
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
,$trycture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: JO L
Freeboard (inches):
05103101
❑ Yes
El No
❑ Yes
I No
❑ Yes
VNo
El Yes
/No
Structure 6
Continued

i b
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�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
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
P No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
{[J 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? ❑ Exce sive Ponding ❑] PLAN ❑ Hydrauli Overload
❑ Yes
No
12. Crop type �+ D [TLIA
13. Do the receiving crops direr with those designated in the Certifid Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
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
ONo
16. 1s there a lack of adequate waste application equipment?
❑ Yes
�No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
CdNo
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
NI
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
I
X3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
r:.
iComments';(refer�to questions#) ExoMn at,y YES.answers and/or'any recommendations or auy of me er comnts:: 4
Us drawings of facilityto better explains tuations.:�(use additrona pages as necessary} : Field Covv ❑ Final Notes
��• ��[,j��zii�- r�i�t+�i425 �d �� �iP,O,E,P, �f.�/�-Tr�/� F��
6?4�iS / /J
an W�-
eo,Q,o5 d0 6 ,Vo�
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
El Yes
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
/11
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
ElYes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or;Drawings:_
O510310I

Type of Visit Comp iance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit _Z Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
.35�
Permitted 0 Certified [3 Conditionally Certified © Registered
Farm Name: K.� Z ' �'��
. .. ... ....... .. ... .... .. .. .. .. ... .. .... . . .-................ i.. ........................... [�. .......................... ... .
Owner Name:........ u r ! q -^'! 1 �j...1..`ti.` .....................................
Facility Contact:
Mailing Address:
Title:
q Time: �S
NNot O erational 0 Below Threshold
Date Last Operated or Above Threshold: ------
County: , V l...`.............................................................
PhoneNo:__.......................................................... _...... .........
Phone No:
Onsite Representative:.L..:.[.i.� !'L G� �att� J} , l az, 1146j6 Integrator• .�.�t _.............................. - -.. ---
Certified Operator: .............................. .................................................................................. Operator Certification Number:..........................................
Location of Farm:
r
❑ Swine ❑ Poultry ❑ Cattle ❑ Florae Latitude Longitude
_ Desiga = Current Design _ Current Design''; Current
„
Swine = . - Ca ci Po elation .::Poultry> Ga aci Po elation Cattle Ca aci Po ialatioa
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish El Non -Layer ❑Non -Dairy
[] Farrow to Wean —'
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total.Design Capacity__
Gilts =
❑Boars Total SSLW�
Niiinber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
W
_ .. Hoiduig Ponds / Solid Traps j[] No Liquid Waste Management System
Discharges & Stream Impacts
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 j2 No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes j2 No
c. If discharge is observed, what is the estimated flow in gal/min? W h?,
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes f'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'P=No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .8 No
Structure 1 Lructure 2 5trt.101.117c 3d Structure 4 Structure 5 Structure 6
Identifier: ....... o✓l� Oct I-
.......................... q ........................ j .................................................................---
Freeboard (inches): 3 Z j I
5/00 Continued on back

Facility Number: 3 f — 35g Date of Inspection t1 / d ,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JZfNo
seepage, etc.)
6. ' Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes-, No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes _ONo
8. Does any part of the waste management system other than waste structures require maintenancetimprovement? ❑ Yes _B'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes J21 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes _[3/No
11. Is there evidence of over application? ❑ Excessive/+Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes &No
12. Crop type �crr•vda �1�y,l�ei^d� C�-4-x.c,11 et � v°► /G _C ,�h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ff No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EfNo
b) Does the facility need a wettable acre determination? ❑ Yes _0"No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss 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?
YiQIg�iQ>;s'e� defciencie5 mere pg" dix`ing �hlS.v�s�tt Yo(t reeeiye 40 f. . .
6 resp Bence: abauf this visit
❑ Yes j'No
J'Yes ❑ No
❑ Yes A!SNo
❑ Yes _12rNo
❑ Yes _oNo
❑ Yes ONo
❑ Yes �No
❑ Yes �No
❑ Yes J3"No
❑ Yes 'PrNo
❑ Yes J2rNo
❑ Yes "No
Cnmments"(refer to gaeshon #) Explain any YES answers andlor anyurecommendaboas or;auy other comments: ,
Use drawings 9f facility toTbetter expla situations. (use addrbonal Pages as nece.4sarY) x - �' -� `=r ;
/-V% AjeeO( �o lave beNeres4cj61;j-k,Keq- o-' (lecei����
AL

Facility Number: J? Date of Inspection 10
Odor-I."*ues
rr
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_'PYNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesPINo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the Iagoon? ❑ YesXNo
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.) ❑ YesXNo
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
5100

on f W iial �,
I' .DIvis O ateC Q lty �- r,_ ssxfS -
t
- Q Division of Sorl anwwater Conservation
Q.OtherAgency
Type of Visit '0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit jW Routine O Complaint .Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: � Time: I t4 it Z 1 Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted © Certified (3 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
Farm Name: ��..... w ...f� County:.... {t (..tl ! i....................................................
Owner Name:.......... r " F rn . F e w...t Phone Na........................................................... ".�' ................ ....................._..
FacilityContact: ......... .........Title:................................................................ Phone No:...................................................
MailingAddress: ............. ....................................................................................................... .....................................................................................
Onsite Representative: ,v0,-,, a. , ., I G --,,, Integrator: ,-!,' [„U+f? t„�. - --^t S'
. ............................................................. 7 .................
Certified Operator: ................................................. Operator Certification Number:...............
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 4;
TI
Longitude �• ��"^
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ID Layer I I ❑ Dairy
eeder to Finish 1+,7 Af 353-Z ❑ Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Tota15SLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag--n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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 ilmv 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 t Structure Str cturc 3 Structure 4 Structure 5
Identifier: .... ei,✓ 1���� old z'° 'spa e Dh fs,. a. --
�1................................2 ..........-. 2 ��....--- .... ........... Jr.?
Frees c and (inches): 43 j
5100
❑ Yes -D"o
❑ Yes P'No
❑ Yes -KNo
n/,j
❑ Yes fWNO
❑ Yes N No
❑ Yes J9 No
❑ Yes gNo
Structure 6
Continued on back

Facility Number: ,3 — 3 j� Date of Irlspectiotl printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes $No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ff 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 ;K No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JZNo
Waste Npplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes iallo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes jjrNo
12. Crop type 6etrvt&A 6,ia ze , r7a- -vim, Q Ve trSee,d , �e •" �d ti /7�t y -�.S`rn� ll �a �^
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9 No
14. a) Does the facility lack adequate acreage for land application? El Yes LZ No
b) Does the facility need a wettable acre determination? ❑ Yes 9No
c) This facility is pended for a wettable acre determination? ❑ Yes feNo
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)
f
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?
.: Nd-yioiatidris:oc. deficiencies were noted• during tl�is'visit' - :Y:o(t will-t&6*e do #'urth. .
corres�oxidence: albvuf this :visit. :::: :: :
rComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
IUse drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes 8 No
❑ Yes J9 No
[-]Yes g No
❑ Yes �ffNo
Yes ❑ No
❑ Yes N No
❑ Yes XNo
❑ Yes ;g'No
❑ Yes ;S No
❑ Yes JgNo
❑ Yes 5?r No
—77h e✓ c- q r-e Somme d,` J'Gre fetvLo;er &e.-fweeh 4e d 4 e
�1 ` 2�5 rn or � joh �Qr f lac ZO�D ver�''t v � 5eoxoh, ge
,fv ► le 4o (use ev, ��i �� ��G� r-va e �►�7 �i ��
/1Jo4e;=�L,c Jr.^ �lie:-r r�esre
' h �j,,Ljs �.SS` c.cs �o� a' ,eid q
H yd_,jj ]/ jv�: le - �.� q sf� �Ig �t a � j ✓�!� 1,9 1G�i r A;p ,�'4 ;"v
1 • Z� gcr�Es.
Reviewer/Inspector Name 5�G n-C Lj A l] 4; S
Reviewer/Inspector Signature: -.0 Date: i0 2 T O 1 5100

Facility Number: 3/ —357Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge gt/or below OYes ❑ 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 19 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
JRNo
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?
�S Yes
❑ No
Additional Comments and/orDrawings:
5/00
5/00

_: ti v ., -. � .,F• Y • y..�r., :a. > ;��v=.-.v-6" .� :y+-.�.• �. .Y.:'ti s' e*a^' -. -.. , *�.:.�!.v <.• :c--..Lp••„^ir.;r,'r�+•,.. _�.rv�.-r-'vow," :-yLy`_ _ ,.:n i......^- _. rdF•'+�-.+
0

I
r
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection
Facility Number _
Time of Inspection
E3 Registered R,Certitied E3 Applied for Permit )3 Permitted Not Operational
Other
24 hr. (hh:mm)
Date Last Operated:
FarmName: .............$nnz.-....�7.�fx�t/........1AK�ynr..................................................... County: ....... ..NP)!h..................................... .......................
Owner Name :........ _....... 1:`!t7nJiC.Q .......A',vQj..... .1..aei,........................................ Phone No:...>! 5.1.4 �..-...ffRSq......................................
Facility Contact: [.�..............( �f?.t tl i ...... �cr.G.C.............. Title:..................................r......-............L............ Phone No:...................................................
MailingAddress: .6-:2.5..................................................................................................�vle._[d.....t..... lJC...................................
Onsite Representative: ............ k�61...... lfi'.Syl. i............................................. Integrator:...... j1................................_.......................
Certified Operator................................................................................................................ Operator Certification Number:..................:......................
Location of Farm:
Latitude =*=,=" Longitude =• 0' ="
Desrgn -- Current; �^ _Design =Current Design Current
Swore, s'." s , • Capacity'Population ,- Poultry Capacity,,Populahon, Cattle sCapacitp Population
�n ❑ Wean to Feeder F' ❑ Lay er = ❑Dairy `.
;?,,�, Feeder [o Finish ❑ Non -Layer I ❑ Non -Dairy I
❑ Farrow to Wean
❑ Farrow to Feeder P' ❑Other a _ ,, �., „ .,
',, ❑ Farrow to Finish " Total Des9gn`Capacii
❑ Gilts
❑ Boars Total SSLW
Niimbertof Lagoons /Holding Ponds © ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
— _
z;
- y �e� - ❑ No Liquid Waste Management System „*
�. u.
General
I. 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?
7/25/97
❑ Yes VNo
❑ Yes 151 No
❑ Yes [3 No
❑ Yes
No
❑ Yes
fo No
❑ Yes
UlNo
■ it
ERYes ❑ No
❑Yes qNo
❑ Yes [A No

ti
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
WYes
❑ No
Structures (Lagoons,Holdina Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Structure 1 Structure &J) Structure 3 Structure 4
Structure 5 Structure 6
Identifier: �JQt............gt`At...'........5��/nm.let?.................................
......
................................... ...................................
Freeboard(ft):................ 3A.......... .................. J.,71......... .............. 3.............. ....................................
.................................... ....................................
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?
121 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
0 No
Waste ADDlication
14.
Is there physical evidence of over application?
❑ Yes
19No
(If in excess of.WIM_ P, or runoff entering waters{ of the State, notify DWQ)
Is.
Crop type ........... :C.)elf.7!'1f10.I.....................511! ..1........�"IN...................... ..............................................................................
I................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17.
Does the facility have a lack of adequate acreage for land application?
Yes
❑ No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
7P 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?
-PYes
❑ No
0• No.vitilations-or. deficiencies.werenotedduring this: visit.- You.v�ill receiventi-ftirilier-
:: 'corres�ondei�ce about -this. visit.,', - -
aurco- h1 -ei� 3 Sha1L],tr�l % h1LtJ, �jiar�4 + resc�2ldi'e , •
o1c (a.Q cbr` 5 S kww@ _11 c 4+rV G�S�e� O u+ wil�k d,-�Pro�Y�� f{r�,zra)or
FleosOK GWt,c.1.1 0V1 oV4' l!ti L (,.),.l` r 6_� &.6 li�yoh (Wv)) 5koui� P�U V,
%'(,gee, � . LV S1OV\ are-D, S or, 7 V\ J
� -1t ! I� . �a�� d, �4 �, I � or
th1Z v� sluff �1�U� bc,
�= (W re�ee9��. 4rix�� �5 t o B NZ Z S e 5inn� U IDe �.)( A- t "kJ
il-ees 4 ��Y V�c%�ia\ 64. c�goo�S�la� Idz
Ink, ,�ve, t� v`e WVVej,1����— yeas or. 44.,., O- 7/25/97 _
Reviewer/Inspector Name
Reviewer/Inspector Signature: ^ _ _ /' , A Date: fa

M�
Facility Number: Date of Inspection: z
Additional Comments` and/or Drawings r yr
y'
{
s6UI6 L4P_,ft,,tr SjU....� bvil� 'T s,
4
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t-� r���{�is . �;e�� #Z 5 bey►. �+-�Zcc�. 00,
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7 tj Q �� Ca �},y,�„` Cx+� lr� ,l m ;,� r• fv c_ 7-Sq os,
11 4/30/97

Facility Number .� l Date of Inspection I 1 zb G
Time of Inspection F 1165 124 hr. (hh:mm)
[] Permitted [3 Certified © Conditionally Certified 0 Registered 113 Not Operational I Date Last Operated:
Farm Name: Z ` 19 1 a vt a( Fa V-.-N County:.. uy ) i.1
.............................................................................................................-•--•----................... .......... ................
.......
Owner Name: ......-....Y11 u,:rk........F,`'' rvots
1.' .......................... Phone No:........................
Facility Contact:
Mailing Address: ......... ...........................
Onsite Representative...�Ta ?!'!„ t C
.......................................
Title:....
................ Phone No:..............-..-..._.
Integrator: � vle fa"%"'/ r"1s
...............p...............................� ...................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude ���°�•� Longitude
Design Current _ -Desi Current;..
..... Design. Current „.
,.Swine : ,,..; ,.. Point ,
-' Cattle , ....
Capacity Po ulatton _ rye Capacity Population Capacity _-Populaton,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Non -Layer Non -Dairy
Other
Number of Lagoons - e ❑Subsurface Drains Present ❑-Lagoon Area 10Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gat/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? 14 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches):..................................................................... .............................................................................................................................................
.
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 Conarnued on back

Facility Number: Dale of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? El Yes El 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
❑ Yes
❑ No
12..
Crop type
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
❑ 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
Renuired Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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
JM 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
yioiaiicjns:or deleiencies,were notes during t.. . . s. You . . . . . . . . further
corres bii fie' ' e. A' f this visit. .... ... .. .. .
Comments (refer to question #) Explaiwany YES answers iktid&r.any- recommendations or:any,otho er emme-nts.
Use drawings of fhCilrty to' better:'expI situations (use'additionalpsges as iieeessaiy) s E
f Z c
�l , lsCc; 0
, s4� �-
q rcycle )Jiif �,tA rr,gc_keA AX4 �cce•"s4e or)4c), 71e- grativ,Gi.
UJAslnmwl •Oe 4S Wes ] }4 1 d 44'.q At c ar e,_+1�1 4ns�N F,< rcfyGW14q tve
'Z e, 7rVed 44,4 44,4 e�A A ac teL,
t../ to C ,(E 14
Le �� leAkt , ►'�, f e a d;hh, A'n A-r±t,�� in+o a ova ��.�co�r s� • /t'r�F rcPs
had iock:kG 44C , q&,d Puryed LJ, AA 4%a,-- L^)41s Gam+.*r�;nert in -i�
d i4d, 6ek �6 44e sPrR -r, e-fd, 11 Af CA -I of 1.va s4e t)eta( rAVN bacK
ecru. -r tc t-- A s+e. iniz> +1e r4^4e_-1CuUd9
Reviewer/Inspector Name •' -
Reviewer/Inspector Signature. Date: j L 3D gq
3123/99

Facility Number: 3 —3rjB Date of Inspection 2
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
Shona omments an or rawin n a ;
beyohd fhr re,iiA rA� wit; ck PmrF• re�rese��a-}���s
U r" art o -��e S� ra y �� e l d q s we'll.
4t c,} -Fite ed,_f a!' ��e geld �Q �.sceG( 4-e black -4vr' ,e.Y-
►^ Un d FF -rp--A e AIsa re-jues4ed 41,, 0 m e),ee � ose 6c o4a; n c-d
fo ey4evol -- L e- f1A,-e",,znJ q 4he waST�y��dr �tl /��ct ;rA, 4c —r'W i
�a A;A ;n Oer,cv1Oy74 n) -rutio1q. M]CF re,phad �Ivead�
d 4ke brpktn-Flt�sh I�r,e Etta itAd[ r,,tusm 4 4 e d-q
3/23/99

Facility Number 3 3S Date of Inspection f 29 4 1
Time of Inspection 137—24 hr. (hh:mm)
❑ Permitted Q Certified [] Conditionally Certified © Registered 113 Not O erational Date Last Operated:
Farm Name: �ia1><��r1 County:....��1........................................................
........................................................................................................
Owner Name: ,,,,,,,,,,,,01 •V t^� it �a►� 1+ �cy✓ eh t Phone No:
.....................................................................
FacilityContact:.......................................................................... -... Title :........................................ ...I.......... Phone No:...........-----...................................
Mailing Address:... .................................................
Onsite Representative:.. r� j'J .!...z € G. I ... Integrator: v r h r+., l Fe, /- r-x.S
g .... !� ....... ......
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
........................................................................................................................................................................................................................ ...............................
Latitude Longitude • �° �"
Design Current Design Current". Destgn. Current ".
SwineCPoultry Capacity Population Ca acit3_Po lation
Capacity Populatio nattle
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
;Number of.Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JC1 Spray Field Area -
Holdtn Ponds /Solid Traps ❑ No Liquid Waste Management System
i- p 0, q g-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ....................... •................................... ............--- ..---............................................
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 back

c: .�tr

Facility Number: ;j 1 —3516 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenarice/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
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired 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?
0_ o yiolatigiis :oi•• docle.ncm were ngfed dialing �bis:visit; • ;Y;oir WH1 •reeeiiye Rio further
correspondence. about. this .visit. ........:...:....... : .......:...:.:.....:...:... : ... . . .. . ... .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [A No
❑ Yes ❑ No
❑ Yes ❑ No
Comments {'refer to' question #): `Exp[atni;anyYES answers aind/or any recommendatEons or anyother.comtnents`
4% -i
Use°drawings of facility,to better exp[ain s>ituaiions._{use addrtional.'pages as necessary) =
-T-rt s-j9c0icK cc ►%d vc4c4 its a _fAte, ry -UP P-f 12IZe191 I►'t.frt4irK .
t'ht�v1°� >`am�1� F�r"•s rePrese�-i�-��vcs �td �L' ed was+e 41yc sj1+6",
�ctrk di-tfe �hc 519rly{ ;end _ s"o-,e w•,s4e �vgs
,iac>n d
i ,
sf;(( rejo��4Aa`+e,,e br 11'tfe�ou} em,o f',C+d, -rkere
tier 6V tdne 411f 0V.1 , jwa4e0- Jegv4ke sprR)r;e,14 a
� 6eh c:ced as �ct�s+ued r QAe- -A'cld'hA4 n6
Iz1villo 5spec4,'ro. A 15o, An q#e+r+M j.lqs mode +o l'vr,%,p w44e -1rcf" 4- ie bvA4e -cvt✓tfse
Reviewer/inspector Name w
Reviewer/Inspector Signature:
;A Date: f 2-/.36
3/23/99

Faciley Number: 3 _ 3S8 Date of Inspection r 2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Cl 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
'Additiona,.:. ommenfs an or _ rawings : ` --- � � -
yavtA -tt 1Lie da �Gck o,n+c-T� c 5-0fa'j-Fi1C'fd- Wasle GL�14� 4'(11 be
,Seen s'e 0{ � �C'� -e SBrl�Gt {' rc 4W 4
411,1° v �y ; n+4 kL w,,41A in -t -e 4AP bz Se4 d ; reG 41 y In 4 C I,✓q s �e +e
fr'er'Nowe '+ et 1n/j adv;seo( 41-,A!-'vr''}keY pvr►�t1O ino1 bt/,t-r needed
f.,, ct- f LIV A ). �t le Sa n1 b e•! f J
A.
3123/99

Facility Number 3 3 Date of Inspection 12.3d
Time of Inspection �24 hr. (hh:mm)
© Permitted © Certified (] Conditionally Certified (] Registered JE3 Not O erational Date Last Operated:
y� n �J
Farm Name: .......... q 1. ......J-5-n.4.......�ir�M............................................ County:.- -. ti✓� ......................
Owner Name: ......................�y..- t wt i Form -e Phone No:
/ .......... .........f..................................................
Facility Contact: t f .... Title: ................................................................ Phone No: ........................... .:......................
:Mailing Address :......................................................................................................................................................................................................... ..........................
Onsite Representative: Te�'J✓tg'L� [� �,r al LS4C44 pC... �efirTvr'�integrator:..........!.!�f -7- r !''�.!.! r • ✓ �L
Certified Operator: Operator Certification Number:
Location of Farm:
A
.................................................................................................................................................................................. •---- �
Latitude 0•6 .4 Longitude • 4 46
Swine - °-
Design Current
Capacity Population :Poultry .�
Capacity Population . Cattle
❑ Wean eeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer_ _ ❑ Dairy
` ❑ Non -Layer °° ❑Non -Dairy
❑ Other
Total.Design Capacity
TOtaISSLW
Design Current - -
.apacity Population -.
jNumber of Lagoons ; ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area e _
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the. conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ................................... ..........................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure b
❑ Yes ❑ No
Continued on back
3/23/99

a
P.

Ifaeility umber: 3 — � Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility, need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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
Ej No
2.4.
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. Vo yiolafioris:or defcieneie5 were noted• di'ing this:visit::Y:oil witl•teeeiye fio i'ukthg
correspondence about this visit.
{ to_question #) Explain any YES answers and/or aQy. recommendations or any other eommenits.,
Comments- refer
Use drawings of facility to'better explain situations {use additional pages :as necessa%y)
=nspe/.4 i6h do>ie As Ct ->�d rdt-✓" D� 1Z/21/," IvispcC4-'ctx,
41n44 Z� 5ao a ll ohs c n4•e� eef Avi t,n k7e,vv cd �� � lrv�-ur
�y weir C�'eeK, Adv;se?MvrQhy tirr.,m;ly rA,r&ir eyre reA4 1'yel_�V
t,1A^Vt Ale i't M;et as r�egv1eed b t^et',A4 1e9;sl�a ict-,. %tVa- 1'' FP r,eprr�eri} ;veJ
s,✓l�re4�'�"tF01'��iavlGj✓�GeftrJ:n� Tl1l S 1el�+Slct-�ian. Ady;>eA Y�vPF
repfese)144 iv" +o 0 WAs4�M �za gv'.�l To FakreF seari�,dvuT-►1r
1-0
` eys. TD vviove e &t4&4' tiose.001A 44 kr �ez reca V4i oil f •}a Prey e'l
Reviewer/Inspector Name ( -
Reviewer/Inspector Signature:
Date: 1_Z_/32)
3123/99

Faciliity umber: Date of Inspection %Z 3t1
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?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? • (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
A`difiona ., omments an or ravings -
rU►�0�� t-Jq-1�r 4vRl;4 sA,-Ir CS And �o>C4v+cS 1-jee,c �akeh.
M FT �� resent fa 4 - s 7sceG# e ed a F lee ; el mid lag ati
p 1 4A 5 d y
r
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3/23/99

D Division of Soil and Water Conservati6n -•Operation Review.
[] Division of Soil and Water Coinservation - ,Compliance Inspection
M vision of Water Quality - Compliance Inspection - Y
Other Agency Operation Review
-
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other t
Facility Number Date of Inspection
Time of Inspection Q 24 hr. (hh:mm)
Permitted © Certified Q Conditionally Certified I:] Registered Not O erational Date Last Operated:
�{ 11 .............. I ........
...
Farm Name: .........N, ��^v.- County: -.. ........ ......1................................
:................................................................... �...........---.........
OwnerName:•............................................................................
Facility Contact: .......................................................................
1lailinl; Address: ..........................................e.........................
VG
Onsite Representative:... ... ..... �,,,,,,,jZ\�„
............ ...........
Certified Operator: ................................................... ...............
Location of Farm:
Phone No: • ..........................................
Title: ................................................................ Phone No:..
Integrator:........ ``,..-;Y Vy
.�....................................................
Operator Certification Number;,,,,,,,,,,,,,,,,,,,,,
........................................................................................................................................................................................................................ .
......................................................................................................................................................................................................................................................................... q1+
Latitude �o � �•� Longitude
Design, Current Design Current Design- ''Current
Swine. Ca acity .Pd ulation Poultry Capacity Population Cattle ..",_Capacity 'Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish Ta. ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean .......
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons, ❑ Subsurface Drains Presen# ❑ Lagoon Area ❑ Spray Field Area
EiH
olding Ponds:/ SolidTraps e ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
k&o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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? (Il' yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�Oo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
VNo
Stufture I Str cture 2 Structure 3 Structure 4 Structure 5
Structure 6
identifier: Q�L]• Q
LLa
Freeboard(inches)_
-.................... ..._.......1�..g............................................................_......3.................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
V No
seepage, etc.)
3/23/99 Continued on back

Facility Number:31 —'�LJ� Date of lnspt�ction
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
N/No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? t
❑ Yes
MAO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11. Is there evidence of overapplication? []Excessive Ponding ❑ PAN
❑ Yes
XNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
&jNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
Ryes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
b5,No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NrNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ YesNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
CgNo
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 'IV No
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )E� No
violaticjns:ot• deficiencies vt� ... Ofed- dirr'ing �his:visit; • Y:oit} will-rebdir6 Rio; fni-th�r'
toeres ondeirtce about this Visit: .::..
Continents (irefet fo question #) Explain;any YE8 answers and/or aigy"recommendat ons i►r any other comments = i
al e drawings of facility to better eacplatn situattons {use adcLtitinpagesTas necess Usary)'
.. ?
n
_ `a- ��_ GSa�>� ��•t.-��e �+►-e�� _ i� .��- hey, � �_
A.
V.e LIP-
s��s �. �l^�Yh ���� s�e� �I �•�Y•2 ►� ����1 An^�W1
Reviewer/Inspector Name { z- - a'e
Reviewer/Inspector Signature: Date:4—
3/23/99

s

Date of ln:.pection
"F'acl ity Number: - 3SYI
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
LN,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
PNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
OiINo
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
A�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
broken fan bladc(s), inoperable
❑ Yes
WNo
or shutters, etc.)
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
RM
32.
Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover'?
❑ Yes
XNo
3123/99

3
DSWC Animal Feedlot Operation Review611
�i
w'
DWQ Animal Feedlot Operation Site Inspection`'
10 Routine O Complaint O follow-up of DWQ ins ection O Follow-up of DSNVC review O Other +
Date of Inspection
Facility Number 3
Time of Inspection MI24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: IN Registered ❑ Applied for Permit fex:1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑Permitted or Inspection (includes travel and processing)
10 Not O eratianal Date Last.Operated:............................................................... ........
Farm Name .......... ihind.... 1'.tn*....................1........... County':....... Du�ka ...................................... ................
Owner Name: ..... k,U.Y.p� .......�ral''j ........ rh.5................................................... I'hone Nw .1,11 �. i.-.u�.................................................
Facility Contact: 1 j `[
t Yu.......l .Ll� tl�tti�!.h .............. Title:....... �Q.1........................:......... Phone 1a:...� lo�zg�.-z �a.............
II .
Mailing Address: h ` ! ..
Q..��CM...- 11D.............................................................................C5.43G......4.[.1............................. Zg.......
Onsite Representative:.... cm:IZN.........�i�%W... .... Integrator:.,,.,
Certified Operator:................................................................................................................ Operator Certification Number:....�.l.�.�....•
...............
Location of Farm:
Latitude �• �� �:� Longitude
rp%i wb an '�,avWJ)-%T » o er t_t't tU
Type of Operation ` . Design Current Design Current Design ' - Currenf
Swine Capacity Population ' Pauitry Capacity_ . Population Cattle ., =~ Capacity Population
❑ Wean to Feeder
". [%Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
. ........... .1 . . ..... --
Nuntber.of Lagoons:/ Haldce Drains Present ID Lagoon Area 10 Spray Field Area '
General
1. Are there any buffers that need maintenancehmprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is.obse.rved, was the conveyance man-made?
b. lfdischarge is observed, did it reach Surface Water? (lf*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
4/30/97 mai ntenanceli in prove me nt?
❑ Yes 0 No
❑ Yes ® No
❑ Yes
(A No
❑ Yes
15d No
N14
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
[ No
Continued on back

0
Vqt
44-
SL ;s Ir dvESm' 3.s
r
+ � I

Facility Number: 31 —
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?
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 Il�Q Structure 2 L"�40 Structure 3 Uev Structure 4
3...............................3, 7..............-.-....-. �.j................. ....... ...............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 0 No
❑ Yes R1 No
EX Yes ❑ No
❑ Yes 10 No
Structure 7 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 Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
.. .....
15. Crop type ............... ......�.�........LRf�V.k..............................................................S_, lZUX'11.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 Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
T. o N d 1 u1titr1's 16V) 6 b e do -'A 4
14. �-61eorS11-# t *Z# bf- rootuej.
11, Sew tuJ.o are s6rl:n. 5, WS. 5c�c� to rp �S �7e+►tom
a0cVW A Nlsvk. Omurc i ac"t car` ( w ocd va` c _ _7
❑ Yes PNo
❑ Yes 12 No
0 Yes ❑ No
❑ Yes ® No
❑ Yes 6d No
................................................
❑ Yes W No
Yes ❑ No
❑ Yes 1A No
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ® No
ja_ a'a low 4"' J
I
cc: utvision of water duality, water Sluaury �ectton, hactttty Assessment Unit 4/JU1Y 1