310427_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental W4

lll�ision of Water Resources
i~ aciiit, Number ©- Division ot'Snil and Water Conservation
Q Other Agency
Type of Visit: GPCompliance Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: & Routine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Imo`" P LJ�YJ Region: j.L ,
Farm Name: Ct"' s i C ��'t � Owner EmTai-]-:
Owner Name: (.l? Phone:
Mailing Address:
Physical Address:
I S
Facility Contact: r � Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone: j
Integrator:
Certification Number:
Certification Number:
Longitude:
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Discharues and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Stn)cture ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Il'yes, notify DWR)
c. What is the estimated volume that reached waters ofthe 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 ' o ❑ NA [] NE
[] Yes ❑ No
[] Yes ❑ No
❑ Ycs ❑ No
❑ Yes 0 No
❑ Yes b] No
[PNA ❑ NE
1�NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

�acility-Number. - �7 Date of Inspection:
r
Mate Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ONo
❑ NA
[3 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
$2 NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Pllkstructure
6
Identifier:
Spillway?:
Designed Freeboard (in):
_
r�Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6, Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 'No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require [] Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement'?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of'Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP7
15. Does the receiving crop and/or land application site need improvement'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check
the appropriate box.
❑ Yes [P No ❑ NA [] NE
❑ Yes No ❑ NA ❑ NE
❑ Yes P
No ❑ NA ❑ NE
❑ Yes �9 No ❑ NA ❑ NE
[] Yes [P No ❑ NA ❑ NE
❑Yes
�No
[]NA
NE
❑ Yes
No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? if yes, check the appropriate box below, [] Yes ( - No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ RainfalI ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" RainfaII Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

taellit umber: - Date of Ins ection:
2: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i,e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box beiow
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ' No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance ol'the permit or CAWMP?
❑ Yes 1P
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 toy yu6tian.#):.Explain. nny.,VES answerw,nnd/oi• any additional.rceonimndations
oY r an
oths r contnientc
e:,.
' .
inggofacly daditionalpaUsedrnw.
.
."4.
Reviewer/Inspector Name:
ReviewerAnspector Signatui
Page 3 of 3
Phone: 99-g33 -31co
Date:
214I 015

type of Visit: compliance Inspection 0 Operation Review a Structure Evaluation 0 Technical Assistance
iteason for Visit: RTtoutine Q Complaint ❑ Follow-up n Referral ❑ Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: Lrt?,,.,
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: #1ze
Certlfication Number:
Certifieation Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Design Current D Cow
D . I'oult . Ca aci P,o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
$oars
Pullets
Beef Brood Caw
Outer
Other
Turke
Turkey Pouits
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ,;-Wo ❑ NA ❑ NE
❑ Yes 1� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
Q-No
❑ NA
❑ NE
[]Yes
E3173'
❑ NA
❑ NE
❑ Yes
❑-7o-
❑ NA
❑ NE
Page I of 21412015 Continued

Facifi Number: - Date of Inspection: T
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3Ro
❑ 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
J[2-No
❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Fe No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;2-No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
01�o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
;2110
❑ 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
P3'No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P-<o
❑ NA ❑ NE
33, Did the Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P310
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej/No
❑ NA ❑ NE
o� 5rs��j j�4,o
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
Phone:
Date:
21412015

►,e
Facility Number: Date oflns ection: 2
tr
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 E2tNo
[] NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;2-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 re�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ,� o
❑ NA
[3 NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 2TNo
[] 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 f::.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )2-No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes FINo
❑ 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 C.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Jallo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Z�J-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes .E!rNo
❑ 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 _E�+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 [�[10
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes $1+10
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes -f5-N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 2,1412015 Continued

[1 ype of visit: tnpliance tnspectton V Operation Review (.J Structure 1✓valuation V Technical Assistance
Reason for Visit: C6 tbutine O Complaint Q Follow-up ❑ Referral Q Emergency 0 Other D Denied Access
Date of Visit:OF� MI - 4L
Arrival Time: Departure Time: County:
Farm Name: r'Y'i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: S/&/-e
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region
Design Current
Swine Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Ail
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Nun -La er
I
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr I'vult . Ga acit Eo P.
Dry Cow
Nun-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Beef Brood Caw
Boars
Pullets
Other
Other
Turkeys
Turkey Puults
OtherI
M
Discherses and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: E] Structure 0 Application Field [] Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Yes ;30"No [] NA [] NE
[] Yes
Z No
❑ NA
❑ NE
[:]Yes
�TNo
❑ 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) C3 Yes o 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 L] NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: -V&4Ds ection: 11.
Waste qoIlectlon & Treatment
4, Is star ge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YesjZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ;2"No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes,,o No
❑ Yes .,E::fNo
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes �' 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 Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
j�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7�'''
VNo
❑ NA
❑ NE
Rewired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PIN
❑ 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
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EfN
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
. w
25. rts the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? {7
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector tail to discuss review/inspection with an on -site representative? ❑ Yes Q No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes DNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionaal: recommendations or any -other comments.,.
Use drawings of facility to better explain situations. (use additional pages as necessary). .
a rV / /7n
ol;vl A/d
Reviewer/inspector Name: Phone:
Reviewer/Inspector Signature: Date: d
Page 3 of 3 4I 014

Type of Visit: ompliance Inspection 0 Operation Review ❑ Structure Evaluation p Technical Assistance
Reason for Visit: ZFRoutine a Complaint Q Follow-up Q Referral Q Emergency_Q Other Q Denied Access
Date of Visit: Arrival Time: ■ 6d Departure Time: 0 County:
Farm Name: 6 �-=r � ,1�, f� P;,-1r' /Yl Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: J'YfI
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Current
Swine Eapaclty Pop.
Wet Poultry
Eapaclty
Pop.
Cattle Capacity Pala.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oul#n
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2'No ❑ NA ❑ NE
❑ Yes Ef No
❑ Yes [� No
❑ Yes /Ej No
❑ Yes V'No
[:]Yes eNo
❑ NA ❑ NE
(DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I oj3 21412011 Continued

H acillt Number: 131, - Date of Ins ection: �2i
J
Waste Collection & Treatment 1
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes,
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
["No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�no
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
PNo
❑ 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 r, No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ki 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste ADnlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[/�No
❑ NA
❑ NE
maintenance or improvement?
1"
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
XNu
❑ 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
4NO
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�qo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
effNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
FfN o
❑ NA
❑ NE
Re uired 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
ZNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;:�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis E] Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jEj No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
21412014 Continued
�e

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C2 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 'Rio ❑ 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 structurc(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 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT") certification? ❑ Yes U7No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J:no ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Ino ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 121�o E] NA ❑ NE
permit`? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ,EI'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ff No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or. any other comments.
Use drawings of facility to better explain situations (use additional eges as necessar ).
�� G,�ysear3II&IN 64-
Carp �S%r� S cee"Ve � le
i y
Reviewer/Inspector Name:
Reviewer/Inspector Signature: Ale -
Page 3 of 3
Phone: AK 7 .2-3
Date:
417 14

Division of Water Quality
Facility Number - Q Division of Soil and Water Conservation
r
❑ Other Agency
Type of Visit: mpliance inspection 0 Operation Review Q Structure Evaluation D Technical Assistance
Reason for Visit: ¢'Routine ❑ Complaint Q Follow-up 0 Referral Q Emergency Q Other Q Denied Access
Date of Visit: y 71 Arrival Time: Departure Time: O County:
Farm Name �F f f �� Owner Email:
Owner Name:
Mailing Address:
Physical. Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title:
t
Latitude:
Phone:
Integrator:
Certification N her:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Pouets
Design Current
Discharees and Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Region: ZAL�
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairyjlqifcr
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
P 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 [DNA ❑ NE
of the State other than from a discharge?
Page 1 of 3
I
21412011 Continued

Facility Number: - Date of Inspection: ,C
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
ONo ❑ NA ❑ NE
ZNo ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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
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
10 No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlieatioq
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? +�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�1] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
k] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ICJ 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
Re uired Records & D cuments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ETNo
❑ 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 00'N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z] N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �N
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA FINE
❑ ❑ NA [] NE
Page 2 of 3 21412011 Continued

Facill Number: - Date of I nsp ection: Z 43
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT") certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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.
34. 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ;3 No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes Z[ No ❑ NA ❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑Yes JZNo
❑NA
❑NE
❑ Yes 2f No
❑ NA
❑ NE
R
Reviewer/Inspector Signature: Date; Z
Page 3 of 3 .11412017
1

:=I ^o Division of Water Quality - -
Facility Number Q Division of Sail and Water Conservation
Q Other Agency
Type of Visi r,co��►►mpliance inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �J�Routine O Complaint ❑ Fallow up Q Referral Q Emergency d Other ❑ Denied Access
Date of Visit: YU/,
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: " ICE7 eparture Time: County: Region: 44L/f?b
Facility Cantact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = V =' = Longitude: = o = 6 =
ii
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
C5 �? ❑ Layer
❑ Non -La er
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beet' Brood Cow
Number of Structures: Eil
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 'WNo ❑ NA ❑ NE
❑ Yes RrNo
❑ NA
❑ NE
❑ Yes )a No
❑ NA
ON I,
❑ NA
❑ NE
❑ Yes /En No
❑ Yes EO No
❑ NA
❑ NE
❑ Yes 19
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: - Date of Ins ection: D
ate Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E f No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable.Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
I4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
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
Reaulred 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
[XNo
❑ 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 VNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes [A N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V N
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
21412011 Continued

Facili Number: - Date of Inspection: fd
24,Did the facility fail to calibrate waste application equipment as required by the pent?
❑Yes
ij No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
;] No
❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�] No
❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA [] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ 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,other cotnments:s
UseArawin s of facilit to better ex an'situations (itse;additional pages as necessary
�0/ram SU v� eo�00C/
y
az la
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�t�` �f
Bate: eld
l.;p Rzzl
2/4/2 dl

A:7Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
❑ Other Agency ,
Type of Visit: QMompllance Inspection a Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other �0 Denied Access
Date of Visit: Arrival Time: eparture Time: County: Reglon4.�
. . F"
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: d t't'
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop, Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design Current
Ury t•outtry Uapactty ro
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
--d--Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potcntial adverse impacts to the waters
of the State other than from a discharge?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes C2No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes %Io
❑ Yes �No
❑ Yes F!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: UL4 1 6 1 /
Waste'Collection & Treatment
"4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2rR0
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes P. No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): u
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ,E!fNo
❑ 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 �2rNo
❑ 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 LNo
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �' o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �► o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;;�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes 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 Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )2]'N❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes �o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ��o
❑ NA
❑ NE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18, is there a lack ofprop erly operating waste application equipment?
/"�No
❑Yes j2'No
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.��o
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciii Number: - jDate of Inspection:
24.•Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;?fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �' o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ;allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZrNo ❑ 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes a ❑ 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 o ❑ NA ❑ NE
Comments (refer to question 0): Explain any YES answers and/or any additional recommendations or auy:other comments;='.: 4 , .
..-F
use drawings of facility to better explain situations (use additional pages as necessary),
Gc� N
a II
❑ Yes Z No
❑ NA
❑ NE
❑ Yes WNo
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes 7No
❑ NA
❑ NE
o farms +- Irkr6ts LY-t- 5 asdZ o ram.
Reviewer/Inspector Name: ✓L e4•,� Phone: 9 G-%C
&6 r 2
Reviewer/inspector Signature: Date: 3 G X,
r
Page 3 of 3 2 4/10I

Facility Number
I
0-Division of Water Quality
Q Division of Sall and Water Conservation
0 Other Agency
E
of Visit Compliance Inspection ❑ Operation Review ❑ Structure Evaluation Q Technical Assistance
on for Visit je<Routine ❑ Complaint ❑ Follow up Q Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: V,2zaM Departure Time: County: Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
T tI'
Certified Operator:
Sack -up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number -
Back -up Certification Number:
Latitude: = = I Longitude: = ° = 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -La ers
❑
Pullets
❑
Turke s
El
Turkey Puults
❑
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
-Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: I +�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes J2'ro ❑NA ❑NE
❑Yes ❑No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes "O o ❑ NA ❑ NE
❑ Yes FNo ❑ NA ❑ NE
Page I of 3 I2/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
St cture 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
[?Vo
El NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
;ZVo
❑ 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
PNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E
El NA
El 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
[51510
❑ NA
❑ NE
maintenance or improvement?
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2rNo
❑ NA
❑ NE
main ten an ce/i m prove men t?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ 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 acre determination ?
❑ Yes
;Er No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Comments (refer to question 4): Explain any VES�answers and/or -any recn`mmenilatitrns;or any. .other, Coinrinents:
Use drawings of facility to better explain situations. (use:dddltintaal. pttgcs as: necessary):.::
Reviewer/Inspector Name
;� : 7 ¢ ° `' � Phone: L
Reviewer/Inspector Signature:
Date:
Page 2 of 3 JZIA104 ' Continued

Facility Number: — Date of lnspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ ether
21, Does record kecping need improvement'? If yes, check the appropriate box below. WYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis oil 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
P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit!
❑ Yes
;21No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P-R❑
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
qKo
El NA
ElNE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 90 ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PVo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
10No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
f�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V(No
❑ NA
❑ NE
Additional Comments and/or Drawings:
•-- o 4,ez r a .
A,,s year (jo/c,)
0/c1 /a t')
c 6a e d-o�
CG��S 5
T
Page 3 of 3 12,128104

Type of Visit Ort6mpliance Inspection ❑ Operation Review Q Structure Evaluation a Technical Assistance
Reason for Visg_O-Routine O Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: % 7rrivafl 1'imCe: d Departure Time: County: Region:
Farm Name: _____ 6ZZ2� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Phone:
Title: Phone No:
Integrator: 'et-41
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Resign Current
!winejjjjjjjjjjjjjjj Capacity. �l'�opulation
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: 0 0 = I = Longitude: = o = ' 0 1i
IIIDesign Current
11aw Poultry 'Capacity Population
❑ Layer
Non -Layer
Dry Poultry
El
Layers
❑ Non -Layers
Pullets
❑ Turke s
❑ Turkey Points
El Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
N rn er of Structures: l
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ANo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ElApplication Field ElOther
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
VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
zNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

i
Facility Number: Date of Inspection / 7
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes /No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
St7ure 1 Structure Z Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway7:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes�o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes ,0 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_121�o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes o
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes _E No
[]NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
,ter
❑ Yes ,�] No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ErNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 1:;FNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ;2-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes P�qb ❑ 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 iNo❑ NA ❑ NE
Comments refer to question q Explain any YES answers and/or any recommendation3 ar any other eommentg,
Llse drawings of facility to better explain situations. (use additional pages as necessary
Reviewer/Inspector Name ` ; ;. , : '� `` a•' Phone:
i/
Reviewer/Inspector Signature: Date: ' % (�T
Page 2 of 3 12128104 Continued

1
Facility Number: Date of inspectionLl
Reuuired Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ' No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes /Ko ❑ NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ;�'Ro ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes o ❑ NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ;o ❑ NA Cl NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard prablern s, over application)
32. Did ReviewerlIrispector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes,,�TNo
❑ NA ❑ NE
❑ Yes Na
❑ NA ❑ NE
❑ Yes O"No
❑ NA ❑ NE
❑ Yes [ < ❑ NA ❑ NE
❑ Yes 01No ❑ NA ❑ NE
❑ Yes J No ❑ NA ❑ NE
Xeditional?Cvmiiie its and/or Ora ng
UWE
Page 3 of 3 12,28104

Ir
r ..
a Facility Number
dDivision of Water Quality
Q Division of Soil and Water Conservation
0.Otber Agency . ..•
Type of Visit
Compliance Inspection
0 Operation Review ❑ Structure Evaluation
Q Technical Assistance
Reason for Visit
( Routine 0 Complaint
Q Follow up Q Referral 0 Emergency
Q Other ❑ denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` 0 " Longitude: 0 0 0 4 = ii
Design Current Design Current
Swine. Capacity Population Wet.Poultry Capacity Population
❑ La er
Ej Nan -La et
❑ Wean to Finish
❑ Wean to Feeder
21 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Pullets
Other
Design Current
Cattle Capacity Population' .
❑ Dairy Cow
❑ Dairy Calf
❑ Daig Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
�I
DIschargeS § Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑NA
❑NE
El Yes
❑No
❑ Yes
El NA
ElNE
El Yes
�Zo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 6 D
r
Waste Collection & Treatment ,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CJ 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: f _
Spillway?:
Designed Freeboard (in): LO
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes in ❑ 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
tiro ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by (lie permit?
❑ Yes
P40 ❑ 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
ElNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,_, j
L-�I<o ❑ NA
❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application`? If yes, check the appropriate box below.
El Yes
,.,
I I No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[Z No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LrNo
❑ 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):
6 . ZA7 ,0 G► 1 OBI G 14�Ga1'� D f •
Reviewer/Inspector Name r.-fw 44wkV Phone D 73
Reviewer/Inspector Signature: Date: Q p
1212,VO4 _antinued

r •
Facility ]Number: — Date of Inspection �
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA El
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check El Yes�No ❑ NA ❑ NE
the approprrate box. ❑ WUp 0 Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
L( Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ ly lireeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers
El Annual
Certification
XropYield
❑ Rainfall ❑ Stocking ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
NNoo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
I o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d'No
l6N"'o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ia
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
❑ No
VA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ltilo
❑ NA
❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
T
r
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
DOl 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
UXo-__"E:1 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
ICI El
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0Compliance inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 complaint Q Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: / O�G Arrival Time: Departure Time: only:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: lLh�61C _
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certificatinn Number:
Region: 6VIAV
Location of Farm: Latitude: ❑ e =1 =11 Longitude: = e 0 , ❑
Design Current
yPoatioutry
DesigTG urrent
Eapa=iopulation
Design Current
Cottle Eapa�ity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder I
JE:1 Non -Layer I I
Dairy Calf
A
Feeder to Finish I 110M I
El Dairy Heifer
Farrow to Wean
❑ry Poultry
❑ D Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
El Layers ers
El Beef Stacker
❑ Gilts
❑Non -La Non -Layers
Beef Feeder
❑ Boars
EI Pullets
❑ Beef broad Co
Turke s
Other
❑ Turkey Poults
❑ Other
Other
!Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
;/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
Cl 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
E3 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'!
❑ Yes
IQ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)ZNo
❑ NA
❑ NE
other than from a discharge?
Page I of
12128104
Continued

r
Facillty Number: 1 —
Date of Inspection O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 1ZNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
Structure 5 Structure 6
❑ NE
❑ Yes
Pff"No
❑ NA
❑ Yes
X.No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require []Yes )2fNo ❑ NA ❑ NE
maintenance or improvement?
Waste AtiWication
10. Are there any required butters, setbacks, or compliance alternatives that need ❑ Yes/ZfNo ❑ NA ❑ NE
maintenance/improvement?
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /JjNo
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 Q% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi
❑ Outside c
12. Crop type(s)
13. Soil type(s)
El NA El NE
14. Do the receiving crops di(fer from those designated in the CAWMP?
❑ Yes ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ 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);
rl) / ve P ro c
r-2l� 5 c� eK49P.15.
Reviewer/Ins ector Name
p � .._ - --- --- -- - � Phone• k�32 9L
Reviewerllnspector Signature: Date: !! ! �Xv
Page 2 of 3 12128104 Continued

Facility Number:, -- Date of Inspection lI !
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 9yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ;YNo ❑ NA [INE
the appropriate box. ElWUP ElChecklists ElDesign ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ACrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fait to install and maintain a rain gauge?
❑ Yes OoNo
{❑
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
XNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
VYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
XYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)zNo
[]NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
'gNo
XNo
❑ 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
XNo
❑ 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
ONo
❑ 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
X
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
f
j I A-F--p-69 7 Z t] ram•
Page 3 of 3 12128104

(Type of Visit ACompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit ORoutine 0 Complaint Q Follow up D Referral Q Emergency Q Other ❑ Denied Access
Date nFVisit: I Arri�alTime: Departure'i'ime: ' County: �/ �� Region:
Farm Name: —' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Cnntact: r� Title:
Onsite Representative: !�
4I,41f _
Certified Operator: _ CJ ICI 6_ &,--•-•-••---•
Back-up Operator:
Location of Farm:
Phone No:
Integrator: _I/ IIQ%trJ
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 ❑ ='
= Longitude: = U =' = "
Design
Current
Design Current
Design Current
Swine GO acity
Population
Wet Poultry Capacity Pvpulat_inn
Eattle..
Capaclty
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Nan -La ei
iry Calf
Feeder to Finish
❑ Dairy Heifei
Farrow to Wean
l)ry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La cn
❑ Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of, Structures:_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
Cl Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
)Z No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
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 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 VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes VNo ❑ 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 Drill ❑ Applicgtion Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
9No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
PINo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�yj'(No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,LI No
❑ NA
❑ NE
. � .�... ..�i`.x. is rq%S'._:�: '... F :4•.... - +..ems.«.-..�.:.a:'..
Ued"r:wing`s',a[f eility to,better esplain,s tun ons.ustLp onapages`as),neeesa•ary
:
u1t ��'/d �jFGp�rJ
�e
eES�C�r1 ��rJATad,�S� 2 r67. �►�r�o �
rq) o G ra��o � z� W:, rIl 4�V ea s,
_ 1.
Reviewerlinspector Name a "' ''`` �.�' Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

f
Facility Number: 31 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available`! .0Yes ❑ No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ///❑ Yes PNo ❑ NA ❑ NE
the appropirate box.
❑ WIJP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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
Vf No
Cl NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ 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
to
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
[I Yes
'rNo
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
;Z'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
ez
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
4 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
�fNo
❑ NA
❑ NE
.i irA; �.:
Adtlitinual Comments aridlor':Dr'a�vtri s: `
£ K. •»s:
hcow'05'
/Z)/-
I Z/Z8/U4

Aug 26 09 09:41a
MURPHY-BROWN
9102933138 P.1
MurphymBrownLL.
Murphy Brown LLC
PO Box 856
2822 Hwy 24 West
Warsaw, NC 28398
Phone (91 Q) 293-3434
Fax [phone]
Fax Transmittal Sheet
Fax: Pages:
Phone: Date:
Re: C_5t,,C�4 k`s- -e CC: --
❑Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle

-Rug 26 OS 09:41a MURPHY-BROWN 9102933138
5
p.2
urower: Vary usner uesignea tsy: JN I
Address: 1312 Brices Store Rd. Checked By: DSE
Rose Hill, NC 28458 Date; 04/13/02
County: flu lin Sheet 1 of 7
ANAEROBIC WASTE LAGOON DESIGN
FARM INFORMATION
• ui 97MMIM
Nursery: -------------------
Finishing: ------------ I ------
Fa rrow to wea nli ng : ------ ------------
Farrow to feeder: -------------------
Farrow to finish: -------------------
Boars: ----------- -------
Storage Period: -------------------
25 Yr. / 24 Hr Storm Event ...................
"Heavy Rain" Factor Not Applicable
Rainfall in Excess of Evaporation ------------------
Additional Water Usage: -------------------
Additional Drainage Area:-------------------
LAGOObl INE911MATION
Is Lagoon Designed as an Irregular Shape?
(Y/N)
Does Operator Want Emergency Spillway?
(Y/N)
Is This Design for an Existing Farm?
(Y/N)
Is Drain Tile Req'd to Lower SHWT?
(Y/N)
Seasonal High Water Table Elev: -----------=-------
Freeboard: ------------------
Emergency Spillway Flow Depth: Not Applicable
Side Slopes: -------------------
Top of Dike Elevation:
Finished Bottom Elevation:
Start Pump Elevation:
Stop Pump Elevation:
Press ALT-C to Download
contour areas see sheet 2 of 7...
-------------- Depth
-------------- 10.30 Ft.
-------------- 20.04In,
-------------- 51.6In.
y
N
y
y
0
1800 Hd,
0
0
0
0
180 Days
7,5 In.
7.5 In.
7.0 In.
0
0
93.00
Ft.
1,0
Ft.
0.3
Ft.
3
:1 (H.V)
0.0
0.0
97,70
Ft.
87.40
Ft.
96.03
Ft.
93.40
Ft.
LAGOON VOLUME
REQUIRED VOL.
DESIGN VOLUMES
NO R99'D.
Storm Star =
39041
(Cu.Ft.)
39,469
(Cu.Ft.)
101.10%
Temporary =
134765
(Cu.Ft.)
141,251
(Cu.Ft.)
104.81%
Permanent =
243000
(Cu.Ft.)
255,294
(Cu.Ft.)
105.06%
Total Volume =
416,806
(Cu.Ft.)
436,014
(Cu.Ft.)
104.61%
Min. Required Liner Thickness -------------------
Lagoon Surface Area: (Inside TOD)-------------------
1.5 Ft.
62,466 S. F.
Murphy -Brown, «C Engineering P.a. Box 856, Warsaw, NC 28398 (910) Z93.3434

-Aug es 05 09:41a
MURPHY-BROWN
9102933138
p.3
Grower: Gary Usher Designed By: JNT
Address: 1312 Brices Store Rd. Checked By: DSE
Rose H111, NC 28458 Date: 04/13/02
County: ❑u lin Sheet 2 of 7
ACIUAL 121ESIGbi VOLUMgCAL LAT QNS
.LAGOONSTAGE-AREA
VOLUMES
Contour
Elevatlon (.FT_)
Area 5Fj
Incr. Vol. (Cu. FTC
Culnul. Vol. [Cu. FD
87.40
35,243
88.00
36,618
21,558
21,558
89.00
38,969
37,794
59,352
90.00
41,392
40,181
99,532
91.00
43,886
42,639
142,171
92.00
46,454
45,170
187,341
93.00
49,093
47,774
235,115
94.00
51,805
50,449
285,564
95.00
54,589
531197
338,761
96.00
57,445
56,017
394,778
97.00
60,373
58,909
453,687
97.70
62,466
42,994
496,680
These volumes were calculated usina the vertical average end area method.
TOTAL RE D VOL
416,806
CF
CUMULATIVE VOL.
ZONE VOL,
104.61%
END PUMP = = =
93.40
FT
255,294 CF TRVT
255,294
105.06%
START PUMP = =
96.03
FT
396,545 CF TEMP
141,251
104.81%
MAX STORAGE =
96.70
FT
436,014 CF STORM
39,469
101,10%
Murphy -Brown, LLC Engineering P. 0. Box 856, Warsaw, NC 28398 [phone]

Rug 26 05 09: 4 1 a MURPHY-BROWN
9102933138
R.4
Grower: Gary Usher Designed By: ]NT
Address: 1312 Brices Store Rd. ,Checked By; DSE
Rose Hill, NC 28458 Date: 04/13/02
County: Duplin Sheet 3 of 7
]MINIMUM REQUIREQ V LUME CALCULATIONS
Permanent Storage:
Required Treatment Volume:
'Animal Type capacity ALW cu.ft./I - Tota
Nursery
0
30
1.00
0
Finishing
1,800
135
1.00
243,000
Farrow to weanling
0
433
1.00
0
Farrow to feeder
0
522
1.00
0
Farrow to finish
0
1,417
1.00
❑
Boars
❑
400
1.00
0
Total Required Treatment Volume (cu. ft.)= 243,000
Sludge Storage Volume:
Animal Type Capacity ALW * cu. . - Tot
Nursery
0
30
0.00
0
Finishing
1,800
135
0.00
0
Farrow to weanling
0
433
0.00
0
Farrow to feeder
0
522
0,00
0
Farrow to finish
0
1,417
0.00
0
Boars
0
400
0.000
0
Total Required Sludge Storage Volume (cu. ft.)=
Temporary Storage Volume:
Manure Production:
0
TnImal Type Capacity * Sto. Per a = Total
Nursery
0
180
0.30
0
Finishing
1,600
180
1.37
443,880
Farrow to weanlIng
0
180
4.39
0
Farrow to feeder
0
180
5.30
0
Farrow to finish
0
180
1 14.38
0
Boars 1
0
180
1 4.06
0
Total Manure Production (gals.)=
Total Manure Production (cu.ft.)=
Excess Fresh Water:
443,880
59,342
Animal Type capacity Sto. Period a = Total
Nursery
0
180
0.20
0
Finishing
1,800
180
0.90
291,600
Farrow to weanlIng
0
180
2.90
0
Farrow to feeder
0
180
3.50
0
Farrow to finish
0
180
9.50
0
Boars
0
180
2.70
0
Total Fresh Water Excess (gals.)=
Total Fresh Water Excess (cu.ft.)=
Murphy Family Farms Engineering P.O. Box 759, Rose Hill NC 28458
291,600
38,984
[phone]

'Rue 26 05 09:41a MURPHY-BROWN
Grower: Gary Usher
Address: 1312 Brices Store Rd.
Rose Hill, IBC 28458
Temporary Storagg Vo WeL(Cunt.)
9102333130
Designed By:
Checked By:
Date;
Sheet 4 of 7
Rainfall in Excess of Evaporation:
Vol.=(Lagoon Surface Area + Additional Drainage Area) * Rainfall j 121n,/ft
Val.= (62466 sq.ft. + ❑ sq.ft.) * 7 In. /12 in./ft.
Total Required Volume for Rainfall in Excess of Evap. (tuft.)=
Storm Storage:
Vol.=(Lagoon Surf, Area + Addt'I Drainage Area) * 2SYr./24Hr. Storm(in) / 12fn./ft.
Vol.= (62466 sq.ft + 0 sq.ft.) * 7.5 in. 112 in./ft.
Total Required Volume for 2SYr.-24Hr. Storm Event (cu.ft)=
"Heavy Raln" Storage:
Vol.=(Lagoon Surf. Area + Addt'1 Drainage Area) * "Heavy Rain" Factor (In) / 121n./ft.
Vol.= (62466 sq.ft + 0 sq.ft.) * 7.5 in. 112 In./ft.
Total Required Volume for "Heavy Rain" (cu.ft.)
(for Extended Periods of Chronic Rainfall)
Additional Water Storage:
No Additional Water Storage is Required
Total Required Storm Storage
(25 Yr. / 24 Hr, Storm + "Heavy Rain") _
Total Required Temporary Storage
(Manure Prod. + Excess Fr. Water + Rainfall Excess)
Total Required Permanent Storage
(Treatment + Sludge) _
TOTAL REQUIRED VOLUME = 416806 (CU.FT.)
p.5
INT
SSE
04/ 13/02
36,439
39,041
39,041 (CU.FT)
134,765 (CU.FT)
243,000 (CU.FT)
Murphy Family Farms Engineering P.O. Box 759, Rose Hill NC 28458 (910) 289-211
101

'AuC 26 05 09:42a
MURPHY-BROWN
9102533138
P.6
Grower: Gary Usher Designed By: }NT
Address: 1312 Brlces Store Rd. Checked By: DSE
Rose Hill, NC 28458 Date: 04/13/02
County: Duplin Sheet S of 7
1AGOON DESIGN SUMMARY
Top of Dike Elevation -------------------
97.70
FT.
Emergency Spillway Crest Elevation --------• --------
Not
Applicable
Top of 25 yr/24 hr Storm Storage -------------------
96.70
FP.
Top of "Heavy Rain" Storage -------------------
Not
Applicable
Start Pump Elevation -------------------
96.03
FT.
End Pump Elevation --- —----- --------
93.40
FF.
Top of Sludge Storage -------------------
Not
Applicable
Seasonal High Watertable Elev.---- ------- ------
93.00
FT.
Finished Bottom Elevation ----- -------- --- --
87.40
FT.
Inside Top Length -------------------
Not
Applicable
Inside Top Width — ------------
Not
Applicable
Side Slopes ----------- ------
3:1
H:V
Lagoon Surface Area ---------- --------
62,466
SF
Min. Liner Thickness {if required} -------------------
is
Ft-.
Freeboard Depth -------------------
1.00
FT.
Temporary Storage Period -------------------
180
Days
TOTAL DESIGN VOLUME = 436014 (CU.Fr.)
Zone Det -
Treatment / Sludge Storage Zone Depth ---- ------- 6.0 Fr.
Temporary Storage Zone Depth ----------- 2.6 FT.
Freeboard / Storm Storage Zone Depth ------ — — -„ 1.7 FT.
Total Lagoon Depth ----------- 10.3 FT.
Murphy Family Farms Engineering P.D. Box 759, Rose Hill NC
Z89-211 f

z
3
0.
of
Grower: Gary Usher Design INT
Address:. 1312 Brines Store Rd. Checke DSE
Rose Hill, NC 28458 Date: 04/13/02
County: Du fin Sheet 6 of 7
ZONE ELEVATIONS
TOP OF DIKE ELEV = 97.70 _
1 1 TOP OF STORM ELEV = 96.70 /
1 1
• 1 1
STRT PMP £L.= 96.03 1 TOP OF TEMP STORAGE ELEV = 96.03 1
1 1
END PMP EL. = 93.40 TOP OF TREAT ELEV = 93.40 SHVVT = 93.00
1 1
1 1
� 1
L_ J
FINISHED BOTTOM ELEV = 87.40
Murphy Family Farms'Engineering
P.O. Sox 759, Rose Hill NC 28458
[phone]

- Pluc eG 05 03: 428
MURPHY-BROWN
5102833138
P.8
Grower: Gary Usher Designed By: JNT
Address: 1312 Brices Store Rd. Checked By: DSE
Rose Hill, NC 284SS Date: 04/ 13/02
Countv; DUDlin Sheet 7 of 7
This livestock waste treatment lagoon Is designed in accordance with the North Carolina
Natural Resources Conservation Service PRACTICE STANDARD 359- WASTE TREATMENT
LAGOON, revised prior to June, 1995.
Emergency Spillway:
An Emergency Spillway is not required.
•��
Subsurface drain tile will be installed adjacent to the lagoon as shown on the site
drawing. The the is being installed to keep the seasonal high water table adjacent
to the lagoon at or below the stop pump elevation.
.�tt� " zrte
NOTE: See attached Wakle I€g loin.
DESIGNED: -EfLcyzg
DATE:
COMMENTS: The lagoon has been designed as an irregular shape.
Actual contour areas taken From the lagoon design are used to calculate
the surface area and storage volume characteristics of the lagoon.
This approach insures that rainfall capture on the lagoon is fully
accounted for and that storage volumes calculated represent actual
conditions regardless of the shape.
Murphy Family Farms Englneering P.O. Box 759, Rose H111 NC 28458 [phone]

IType of Visit Compliance Inspection 0 Operation Review D Lagoon Evaluation j
i for Visit outine O Complaint p Follow up O Emergency Notification Q Other
Facility Number
Date of Visit: ,� d Tune: •'3
❑ Denied Access
Permitted
ertified © Conditionally Certified 0 Registered
��
�"
Date' List Operat r Abar Threshold: »......» .. _
Farm Name:
. ».._ .!„�'"_+�...�.
�d Irk .._ . _ . __
County: _. _._ G..»..._ ..».».....» .....».... ..
Owner Name:
Mailing Address:
Phone No:
Facility Contact: . » ....» �.».»......_.r.'............................ Tithe:.. . ___ . _.. _ _ . __.._._...» _.. Phone No:
Onsite Representative:... ;r. �r_-» _r., . _ _ ___ .._,.. ».r._. Integrator: „•,�{,,�
Certified Operator: .........._-------- ..».....»...».»»....» ._w_ ........»...».»..»» » .».....».»... Operator Certification Num r:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 9 fi Longitude • 6 «
Dis' chi es & Stream m acts
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 1� 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
Struct l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection 4
.6. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 40
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes �No
closure plan?
{If any of questions 4-6 was answered yes, and the situation poses as
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ YesNo
elevation markings?
Waste Ati�lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes YNO
[I Excessive Ponding ❑ PAN ❑ H draulic Overload ❑ Frozen Ground [I Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those desiinated in the Certified Animal Waste
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?
(CAWMP)? ❑ Yes 1.No
El Yes i�No
❑ Yes 17.No
❑ Yes PfNo
❑ Yes zid No
❑ Yes XNo
Odor Iss_ nes
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A No
19. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative imaaediately. II
. �....-._.•._..�::._.�,s:=.•:;•7m�y.'...,;-._.^t.:�:r ,�a'�• � s^.� ..%max. spa.:•';s�_r���:.xrrx.�+�y:r-r!sr ry
GO is {rrfes eta questson #) Earplalla s y, YF..S amr+►ers Ox a xy�oL#tEr lmt>z ta. k' V
or an3' ;i; a;,
.... .M' 'I: r.':q P` °'3k '€d'.g" 'm'.?Ix.s?.a ?i YP d H7'YXj - 'i+}'YIE. u•NiYir-k'sxeNii!Sa-''ia:?S R]i1gL i:".?{^;¢;. 'd€.•crwWd.p•: �. 4
uQ i%uassit Line `tlli ot'fa to %ietltr, lain`aittloa. {use aal pageky ry }� (] Wield COPY ❑ Pinal Notrs "
Irleaft 7�h
i ,q-�. �..::� "�l,;s=:j a ;:t�";:s;�'';;,s:; '.•::l ��. ' ;� , : .l,�F:;P t+€� j#'w ,,:4� � ;;„ � !;. �. r �x;�..:,ss,,�:.� ; ��eu�i,i � s
.: „. ,. .. ..ia:=' �.. .. g...�...,.'•a�:. .., s-. r�. � .� �l�' � .i .a,<r_ >'9el,s� s�„a.y?s�,s:.:.. �:r,�.'$z:.d;::' s� :c.: .:a! srµ �- ..#,ai:�'•
ReviewerAkspector Name -
ReviewerMspector Signature:
Date:
'!A tvh Mil
A~4~w.

Facility Number: Date of Inspection
µRequired Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes A�wo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes Q'No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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? ❑ Yes 'ZNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,2No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,ONO
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative? ❑ Yes C�-No
28. Does facility require a follow-up visit by same agency? ❑ Yes 0,90
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes j2NNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 710
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Farm ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form

Facility Number bate of Visit:
Permitted © Certified 0 Conditionally Certified © Registered
Farm Name:
Owner Name:
Mailing Address:
Time•
t r Below Thresh2ld
Date Last OperateA or Above Threshold:
County: \ �/_1_/%) _
Phone No:
Facility Contact: T le: Phone /No:
Onsite Representative: IJ •s Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
[�swlne ❑ Poultry ❑ Cattle ❑Horse Latitude Longitude �' 0•
Design Current::.: Design current:.."' °: .....:.: ..: Desigh: ,..:Curreint
Swine Ca acih.: Population' . `Poultry Cn arit►;' Pv'ulution ' Cattle . Ca achy .+Pa ulation
Wean to Feeder Laver I ❑ Dai
Feeder to Finish ? U Non -Layer : ❑ Non -Dairy j
Farrow to Wean r . _......,. -. r ....
❑ Farrow to Feeder
❑ Other '
❑ Farrow to Finish Total Design! Capacity''
Gilts I j
Soars Total: SSLW
Number of LagoonsHSubsurface Drains Present ❑ l,a oon Area Spray Field Area j_ k
Holding Ponds 1 Solid Traps No Li vid Waste Mana ement System ; ;
Discharges & Strgam 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?
WasteCpfiatim & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identi Fier;
Frceboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
El Yes XNo
❑ Yes /11 No
Structure 5
Continued

1 •1
Facility Number: — Date of Inspection I D
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
VNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Cl Yes
No
Waste licati n
10. Are there any buffers that need maintenance/improvement?
❑ Yes
tO No
11. Is there evidence o aver application? ❑ Excessi a Ponding PAN ❑ ydraulic Overload
Yes
12. Crop type
�]o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNoa
b) Does the facility need a wettable acre determination?
❑ Yes
9,No
c) This facility is pended for a wettable acre determination?
El Yes
FfNo
15. Does the receiving crop need improvement?
❑ Yes
�qo
16. Is there a lack of adequate waste application equipment?
❑ Yes
)?I No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
9No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
)zr,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?
(iel 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?
ElYes
�'40
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
nt { t nsvrers�andlor an `
Comments refer o question #): Explain any 1' 5 a y .rcevat€tneuda6ns or.atiy o er cbminents
d• i�.r^.b.ti
,Use drawings of facility to better explain iltuations: (use additional pagirs es'necessary):,''`'`Field Copv ❑ Final Nntes
,GAF ,ET mzr��� r� AC,
1,4
Reviewer/Inspector Name , •..
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number; — Date of lnspeclion Tom'
Odor sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Iiquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals riot 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, andlor 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.c. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes XN 0
❑ Yes W �'N o
❑ Yes /1'
o
ElYes X
No
ElYes ❑ No
Additional Comments andlor Drawings:.
AL
41x
�59"5-
05103101

44
�QlUvisi6h of Water.,Quality
+'� d Div[§inn of Svil and,Water Conservation
Other Agency
u
.. ... .. . �,...:._: . _....+. • ._.,,., ; .,.. •:' ��. • _ .. � ' is }, i, �' i 's, s v
Type of Visit 112rcompliance Inspection O Operation Review p Lagoon Evaluation
Reason far Vlsit 0,,9outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: rf Q 3l� dl 'Hine: ® Printed on: 7/21/2000
1 Z
O Not O eratiunal O liciow Threshold
© Permitted 0 Certified E3Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .......................
Farm Name: ....... . �` �... V S � �...r al.Y .' `'�............................................ County:......... � �.,'............
................. ........... ............ ........
OwnerName: Cq q !lam i'1Q!�'............................. ................................... ... Phone No:....................................................................................
Facility Contact: .............................................................................. Title:............................ Phone No:
Mailing Address:
Onsite Representative: iJ• 1n... ��� .6o'.L"l USlc
'r Integrator
Certified Operator:................................................................................................................ Operator Certification Number: ............... I ........................
..
Loration'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • a « Longitude • 4 44
Design Current
i;��'.. � .'=C:w�sneit�i . Pornilgt3nn
?. Wean to Feeder
a
;;;; ❑ Feeder to Finish
Y' Farrow to Wean
Farrow to Feeder
s is Farrow to Finish
Gilts
Design Current Design Current
0
Poultry Ca aci Population Cattle Capacity.. . ' poptrlation
Layer 1 0 Dairy
❑ Non -Layer I I I0 Non-Dairy
p--�
❑ Other
Total Design Capacity
Total SSL W
{❑Subsurface Drains Present l.ag�nn Area Spray Field Area
:;i'iiutaler.niipgooug;:
%Holditug Potltls I, Solid Tl'iap ❑ 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 )Rr&o
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes eNo
c. II' discharge is observed. what is the cstirnalcd flow in gal/min'' ''i / 0.,
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 ZONU
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �!o
`Waste Collection & 'Treatment r
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes J00INa
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:................................................/................ ..........
�j�_'.I.................... .................................... .................................... ....................................
Frecboard (inches):
5100 Continued on back

Facility,Number: 31 -- 42-T? Date of Inspection 1� 30 al
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenancetimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
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
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
Ye t 118.0
enrresporideii a motif: this .islt_ ' .. .
Comments;(refer to question #): Explain any YES answers and/or any recommeiidations'or. any, outer, continents: -, iq
Use drawings of facility to better explain situations. (use addltional pages, as necessary):: ,' 'l, • : _ �� .;t; : , p q
Tp � ; s
-Fa f �., + r 6 e ►.,�
Q�e r'�t-�_�l f
v�Ql e�
�he s� w►e �k1f-� e � �c�� t,� ►'-� �.
3 — 0
F,
qV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
l,r. i .!' .. .. ! . ,I ��' 4 .I. �h iFF �.!` I iii .i ....��.i ..Se u.. [: �1 i1� . II 71'
Date: D 5100

•: :.Yi......-• .5�" ..�.'.I �ql�l.: - ": J., iJ .nl H.. - c•4':� .�I ��: 1:q'� ' - _,� 3!•.� : yr
;F..Y....[ -r" '... Fi�l: r'1' I„ i • ��' . M.i'lY' �] .i'fil�:' "i:... •. s,. -
. .. •.-...lit .i yy�t>�� f
Divisiori.X�Witer'Qualrty•��..,
�a._�_:� i':. i i-S�j., .7� �:ti : 4'• - _ 'id' g� k:. .CF�yC° . �Y.• . ,�'h•T'p:u.�
....',ti,�i a .71 •; --::�:.y..: ,r.i� .7
Division of5oil und'Water ConsecAtiori' ;;: h:;: ; ,.
q a_ :', i:.
ther
O, A enC •r1ol
4
yes . �. - . _.,:fir �;:�: 'F". "i'=k;��: ..s.i:�,"•� �.I�L
i
,
!.�''.. _.r•.a x,v�a"t3,.�' IF T:....!_ ..I. .. •. L.. _ _. ". _ � ., �. .a.. en. f.. _._. .. ,_ �.v. i , .dY .. .M "e;.[.. ,_ >• it d.E .. l.'] .. +I. G.Y. RY!t�7.. �Ygaa: .: knw.l. N_
Type of Visit Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit outine 0 Complaint ❑ Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number date. of Visit:
Ekermitted 0 C red © Conditionally Certified © Registered
Farm Name: ......... .................� .......... 7f� ,s................
OwnerName: ................................................... ...............
Facility Contact: „. ...... 'title:
Time: ari _�Printed on: 7/21/2000
Iperational 0 Below Threshold
Date Last Operate r ;1bovc Threshold:
.............. .a ..
County:
Phone No: .......�....................
Phone No: ;
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite RepresentativeL...l.7os/7 1........... Integrator:.... ,........................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
l_ I T..1
VSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude � • �� �Y. Longitude �• DY F—D«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy .
eeder to Finish 1. ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagolnn Area I0 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impactti
1. Is any discharge observed from any part of the operation?
❑ Yes
Discharge orivinated at: ❑ Lagoon ❑ Spray Field ❑ Other
it. If discharge is observed, was the conveyance m:m-made''
❑ Yes
[]No
h. If discharge is observed. did it reach Water of [lie State`( (If yes, notify DWQ)
❑ Yes
❑ No
c. if discharge is observed, what is the estimated flow in gallmiti?
:
—
d. Does discharge bypass a lagoon system:' (if yes, notify DWQ)
❑ Yes
❑ No
2. Is (here 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
ENo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
qN0
SITuctUr- I Structure: 2 Structure Structure 4 Structure 5
Structure b
Identifier: �:......., ........
Freeboard (inches):
5100 Continued
on back

acility-Number: — Date of hispeetion Printed on: 7/21/2000
5. Are there any im ediate threats to the integrity of -any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
b. 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 �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes E?'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 1�1 No
Waste Application
10. Are there any buffers that need maintenance/improvement? Cl Yes IqNo
11. Is there evidence of over application? Ex,ssive Ponding [I PAN ❑ Hydraulic Overload ❑ Yes {�No
12. Crop type 6 99.
13. Do the receiving crops diffell with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Pocurnent5
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 flan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & sail sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the tirne 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?
P. yION it�I>ls;vr- ii�fieieRCIPN "re hot 0. fttirlg #his;�is}t; • yoo �vflj f'r&c B Lv Iiti fui-tkr
. .,.,Caries otidehc'e. about this visit .. . • . .. -.
❑ Yes J!�No
❑ Yes No
❑ Yes o
❑ Yes &o
``Yes [INo
[:]Yes KNo
❑ Yes D(No
❑ Yes &No
R�:es ❑ No
❑ Yes 4No
❑ Yes o
❑ Yes
❑ Yes
❑ Yes '-0-6-o
Kyes ❑ No
Comments (refer to question 4): 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):
I9's� •inn. UI��s�L (� �f1iL�� �-�. to ?x.�.n .31- /IGf •
} ! rG►� � � 1-t's �� h�-' s-Je ► 1,3A bV-
(3/— 4'e17)
�k•v ►�.c �L,.,..� ct r. �,..L, a_ ��`Y ►7�t � �[� -i-r' ����. Gi�al-�- �,�•N S �GM
Reviewer/Inspector Name y, �� tr I
Reviewer/Inspector Signature: Date:
t -

Facility Number: Date of luspection } 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 htlor hplow 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 [io
28. Is there any evidence of wind drift during land application`? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
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 o
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover? )a�res ❑ No
AdditionaL Comments,and/orDrawings:
A.
Cam. T�w�-ems 1
. � s
CA/VL &-ii '7�A--
64
U
2� W6(
�
5100 `

r OA%
13 Division of Soil and•Water Conservation - Operation Revie''w
.: 13 Division of Soil and Water Conservation-:Corn4E liunce inspection. •;t'
(Division of Waiter Quality - Con! liance Inspection s.F � • x,� '
�'
{7ther Agency = Dperativni Re►+ieW ,
Ruutine O Com laint O Follow-up of DWQ inspection Follow-tt of I)SWC review 8 0ther
Facility Number Date ol. Inspection
-Q>-
Time of Inspccliun 24 hr. (hh:mm)
Permitted Certified 13 Conditi onally Certified ❑ Registered Not O erational Date Last operated:
Farm Name: .: .E....13 f.k c.�...41 r...... [G�...14-4- l.................... County: ...... ...L. & 1.te n ................ ........... Co ............
Owner Name :................................ Phone No:/�A.t,3.' ..
Facility Contact: ....75.0
1.!��S........... .a,.S.�. .a,.S.ht.r . Title:.........I1 ............................... Phone No:...................................................
Mailing Address: .....,!„ [.1.._AV. .../).. ....... 1........ 1 1 I,.f r....................................................................
r. I - F
❑nsite Representative: .�i............. k..!'�.I.r.......................................... Integrator:.......N.-Fr....................f...,..............................
r
Certified Operator:.]xk*.................................. .. 1� (':,(.................................. Operator. Certification Number:.,.1.. I % ...............,
Location of Farm:
A
............................ ....... qW
Latitude a 6 i Longitude • 9 69
Design Current i:, Design Current Design Current
Swine Capacity Population Poultry: Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish qJ1111 I[] Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons g ❑ Spray ❑ Subsurface Drains Present ❑ Lagoon Area S tra Fie Area
Holding Ponds 1 Solid Traps J❑ No Liquid Waste Management System sir.
Discharues & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 1�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance mast -made? ❑ Yes rVNo
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes QdNo
c. If discharge is observed. what is the cslimated flow in gal/spin'?
d. 17��as discharge bypass a lagoon system? (II'yes, notify DWQ) [IYe ;9No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo -
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes %No
Structure ] Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: 7 ' 1(Cf3i A'_1 �6W) 'V 3 (4 k. )
Freeboard (inches): .........31.............. ....... M.............................j .....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes PLNo
seepage, etc.)
3/23/99 Continued on hack

Facility Nuniber-.,31 hate of laspcction
6., Are �erc structures on•sitc which are not properly addressed and/or managed through a waste management or
A� 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 maintenancelimprovemcnt?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving ops differ with those designated in the Certified Animal Waste Man agemcnt Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel 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?
(icl 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?
�'Va yiQlaiitjt�s ojr drr cjewiim •wore �i�#ea il000g o1s,visit, • You will teegiye ijo futtw -
corres oridence: abauf this visit . .
❑ Yes No
❑ Yes Df No
❑ Yes ANo
❑ Yes XNO
❑ Yes Z10
❑ Yes 1X No
❑ Yes 0(1140
❑ Yes 9No
❑ Yes jNo
❑ Yes Q� No
XYes ❑ No
❑ Yes XNo
❑ Yes b(No
1$Yes ❑ No
❑'Yes JKNo
❑ Yes qNo
❑ Yes j 6o
❑ Yes �iNo
❑ Yes 9No
❑ Yes %No
❑ Yes No
Comments (refer to question #): Explain.a iy YES answers and/or any recommendations or any other'commerits `+ff
Use drawings of facility to better explain situations. (use additional pages as necessary):; ,n
',�• G h[cG '� XV4 d�? IW ttG� Cd,z rr�1. M "ii-e e-T, 14-,( ir�►��� �CCa►'�i w
�J
�u�a f m � � •� ,ACC `//S(we's,
Reviewer/Inspector Name :' ` 'i
! rt>rr c y ,t l „;; ' :r ,,w,, i ,,.
- < - - � -
Reviewer/Inspector Signature' Date: 12 —. .2Cf
3/23/99

Facility Number: — Date (of lrr.spertivn�_q�,
{7L'[►r Issires
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below rQ.Y&-.Lj.�Jo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNa
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 KNo
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 XNO
3/23/99

.......... �...... .
...
[] Division of Soil and Water Conservation [] Qther Agency e
Division of Water Quality =z
F:7:ik
i
Routine Q Complaint Q Follom-ue of DW2 inspection Q Follow-up of DSWC: review 8 Other
Date of inspection
Facility Number �,
Time of Inspcetion 24 hr. (hh:mm)
Registered Certified ©�A}pplied for Permit 13 Permitted 0 Not Operational I Date Last Operated:
Farm Name: ...............Gex..4........
��.�1.5�Lv....... F.i.,c.x.... ................. . ........ I ................. ...... C:ounty:.......rD.L, Jih.....,......,,.............................................,.
Owner Name:...... ........................ !`!.,, ,,......., �............................................... Phone No:.......... �t � i.. i : l.....5`•53...,.............................
FacilityContact: ............................•..,,,.....,,..................................... Title:......--.......,...,........................................... Phone No:
MailingAddress; .................(.L........ ........ .... ...... .............. ....... ,....,....... ,...!`: g:...��I.S.i.�..N.r........................ ..gq. .•....
Onsite Representative: ........... a� ....... ............................................................. Integrator:..................................................................
Certified Operator................................................................................................................ Operator Certification Number............................ ..............
Location of Farm:
Latitude ' 4 " Longitude ' 44
Swine
+::
Capacity Population..
F.,.. Subsurface Drams Present ❑ Lagoon Area ❑ Spray Field Area
Nub er of Lagoons-, Hnlding.Parids ❑ g F Y i-
.�. • 5...
Liquid Waste Management System
.... ........
e,;
N o 9 g Y
................
.: ...:..., ,:,::....:::.:..... .. •fie . ..:,:. ..F. .... ..e...e::....
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes !d No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal./min?
d. Does discharge Bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 1P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5, Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenanceli mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facility Number: 31 — Z�
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
5JU!gtures (Lagoon Aolding fonds, Flush Pits, et
9. is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ............ I .............. ........ ............................. ................ ,.....,,........... ................................. ,..,,.................................
...................................
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?
❑ Yes
CC No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste AnnlSatiol.
14• Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. :LLV c........................`Q [_uwz.........C-OC.Y.� .............................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
@ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
Q Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
i) No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
MI No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
22.
Does record keeping need improvement?
Yes
❑ No
Eor Certified or Permittgtl Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
[P No
0 No.violatioits o'r' defi.666es Were'- ntited-dtiring this;visit.:YodWill i e'M,Ve•no�ftirtlier
earrespyndettce dhoitt #his: visit:- :.::::
Gotttnok&i; re-k!r.to question :';E lain any';?YE answers andltiir'atx ''xecia r lotions fir:
.i...:,•..,:e... • . ��::: .. .....'� ..... -.�i: . ... .;.. IFk,FE''F�E»iii!!'ij.-:
' t :t�srstrvlin s.ofFactht tv.trettcr'ex ain:situaGntts..{useaddittonal es:asanccessury}i:SF4, ,'i,' -.,
::3.�.�..�.,:. �,,:. �:.:. ..s»t �..s�t::?..... �. Si.e....ee. :.' ::'.:Ii.n�....t.i+4:iiiilt".•:. .••ifFiF:�::�.F:e...3'.:53:.:�::..�::;i?»St:�;t,.,��..�,::�:::;»»;�.:.......�........�5`e`:";....;�;i%'
It. { sv.c �fs&vc- !% w-M es��tisku3 ► , ;%'A
L.Z. S ra,,i ►re�arUS sL.aUl� tine [C�t,`�f- �' SP �V I v�ur►.�+4+r `H [ U lttl�.iv■.Y� Ux►W `�-4�
��" !{ irrlAr,.�'lfll� �CsiGlll�j S�u(� � W� •`� r'�.�4rt frCC4rU1 . �p� 1 t'�i� 5�v{U �A�
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ��_ _ % I., I- � _. date:

rrg f S ... .........
13 {jig �4F�ediat UPYettiai Rei:viewDSWC Animal!
5 °.
5 Fi•
p:F
F -:3�t 3 ,
D nimal eedlot erati a" it S e,,
W A F Q o S e''Zn �tvnH` ��
...:: .. ::: .f,' .3,. .. •. ..... ... ...: si s.' .:: .�sl!Y..:.. .. .... .,..3.. .. .,e. ... .. ... .s ... ,..� .,, 3. :;•: i ff �i;ii': "ice �;�? ;'•: �.
# , e€ .. ....3........ .e .. .. .........s i....�3.€.F..iFF i .F. .. F.3s . � ...i...i.. .. ...�,,......,; ... x.58...:«•: c.:.;....?.. :e:3???.
0 Routine D Complaint Q Follow-up of DWQ Inspection Q Follow-up of DSWC review Q Other
FacilityNumber [ Z Date of Inspection 2�
Tithe of Inspection 24 hr. (hh;mm)
Total Time (in fraction of hours
Farm Status: Ed Registered ❑ Applied for Permit (ex:.1.25 for I hr .15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection Includes travel andprocessing)
❑ Not Operational Date Last Operated: ...... ....... -.............. .»......... ............._................................».»......................_-........................
Farm Name: »...t<�_- S. .. ............................... County:...i�r►....»....».................»....- _...]..1,1
Land Owner Name...,....... ..U.1,.��,c.�........._......».....»........._...... Phone No: �.g..�.,�.�.._��.�......y..�..
FacilityConctact:......»................................................................... Title:.......I.»........... ...... ........ ............ Phone No: ...................................... ..................
Mailing Address: ....,.��.12 ...... ...IL. S........ _$±. ..�c:�......---- 1............... z_r.t....... i4ni .l...1......UK.............
Onsite Representative: ..�!�f .i..% ... s . �t ::c-�7.a.�. �,...�`'� s�.. ^' ........... Integrator:... .u..x ;�a ,l . 7_...........................................
Certified Operator:........ ! ._.. . »...............! S.kpf............. ....................... .».. Operator Certification Number: $� ......................
.»,
Location of Farm:
Y1... +tx.oaC..-.-...,�.1. A..... ...II .. ... f....4�..�i..g 7C� ,t�La 74. ...... a .:..... ............. q.,I. t . A ....�.,n.. .......,..1�...........
.3,x.t li.k y'......
Y'b -
Latitude 1 *1
. ' Ll Z " Longitude ®a ®6 96
Type of Operation and Design Ca acity
" -:,;:. ........... .... .... .:;'i:::.:::::::........: a..; .. . s.. ..F ..viin Ii S -' i€•.� ,3 ••xs:4i
Desi n Ciiirrent ::« € :Desi n _? I, Current �F:,:: t
/ �:.:'.;:;;:... g..., F g. „,€: g "Oe§Ign';F ,Gurren...,.._...
;; t„ ^3 53. �? ...3€ .. eeFs;' %��3'
Ca'',acl Po' ulatioti. ,',,„ p° <Ca' aci u ulatioi' : Ca _ ��:s�;:s�'Ci aci ':;�,po:, lit On
-, g�1FIs ttlC `���}
Wean to Feeder �❑ Layer ❑ Dairy
Feeder to Finish o ❑Non -La Non -Layer Nan-17ai
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❑Subsurface Drains Present
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Genera!
1. Are there any buffers that need maintenance/improvement? ❑ Yes ENO
2. Is any discharge observed from any part of the operation? ❑ Yes Eg-No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gallmin? 0� -4
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes K No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 2-No
4130197 maintenance/improvement?
Continued on back

'arilitpNumbcr:. ........--..... 77
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 0,No
7. Did the facility fail to have a certified operator in responsible charge?
S. Are there lagoons or storage ponds on site which need to be properly closed?
StrucjmLc(Lal;oQns__ndlor_lioldin-g,Fonds}
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
.... ..._..... a ....... ............................ ....... ................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes KNo
❑ Yes 19 No
❑ Yes E-No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
W asteAnnlicat4oU
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .».............................. .......... .... ..... ...... .................. ..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss reviewlinspection with on -site representative?
For Cgrtfled Facilities —Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readilyavailable?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
®.No
® Yes
❑ No
[AYes
❑ No
❑ Yes
® No
❑ Yes
ELNo
❑ Yes
L&No
❑ Yes
13'No
®.Yes
❑ No
❑ Yes
O No
❑ Yes
E(No
❑ Yes
®-No
❑ Yes ® No
❑ Yes [9 No
&Yes ❑ No
Comments {iefer. to question # '; Ez iain`art ;YES,:swers andlor an recammendations'or:aix ' otliei comments:
Use win s o£ factlt to better.ex latn sttuations:
use addiriorial a es as necess
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ReviewerllnspectvrHame .. ...:.. ...:.. " `:e;:.._..,,k�;;: ::. � , ':.. _ .. s3... � � i�-�;i;.;�,:��. w::..'_::.:... ,.;.... �.«>iraF...�::f PE:Nf�f?f. !FSF S.: .e• .'-
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Reviewer/Inspector Signature: r� n_ _j<.. n ! a r _� ]4�t Date: -7 ZZ
rr_ Division at Water Oualitv. Water Oualitv .iertinn. Farility Assessntent rinit 4/10/97

Site Requires Immediate Attention: �jo
Facility No. 31 -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: fb� / , 1995
Time:.
Farm Name/Owner: U&J-LAL
Mailing Address: -3 1 _2 i C z _r Sion, `7�d . -05 r__ l n C_ a'6'� s
County: _ _ _.
Integrator
On i'
Physical Address/Location: *26&=a_7�
Egan
Type of Operation: Swine Poultry Cattle ouxt
Design Capacity: 1 D o D Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)Ye or No Actual Freeboard `�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or Was any erosion observed? I Oesr No
Is adequate land available for spray? Yes or No Is the cover crop adequate? es r No
Crop(s) being utilized: qi,4,g�r 1.tk 4 `-I 9 k
Does the facility meet SCS minimum setback criteria? 2b6 Feet from Dwellings? Y or No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Nime
Signat6re
cc: Facility Assessment Unit
f
Use Attachments if Needed.