310465_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Type of Visit: 0 Compliance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: ❑ Routine 0 Complaint 0 Follow-up 0 Referral ❑ Emergency 0 Other 0 Denied Access
Date of Visit: 1 71 7a T �] Arrival Timer Departure Time: County:
Farm Name:Owner Email:
Owner Name: r,�.,..� v Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Beek -up Operator:
Location of Farm:
Title;
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: _
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
a er
Deslgn
Capacity
Current
Pop.
Deslgn Current
Fettle Capacity Pop.
DairyCo
Wean to Feeder
[INon-Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
D . PouIt
Design
Ca aci
Current
P,o .
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
NJ
Boars
Pullets
Besf Brood Cow
Other
Dther
Turke s
TurkeyPouets
ether
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes [5 o ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [N
❑ Yes WNo
[] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 o, f 3 21412015 Continued

)Facili ,1Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
E]�<o DNA [D NE
[:]No ❑ 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 [Q N5 ❑ 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 Io ❑ 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
EN❑
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ea -No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
E� o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[No
❑ NA
❑ NE
matntenance or improvement.
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. [[] Yes M140 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN a 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
[31�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
QjNo
❑ 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
❑.t4o
D 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
�o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps D Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [E�'K10
❑ 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 5?14o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M)N❑
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection: `�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes g;.W ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q<A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [2-No D NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes G�J-Aio ❑ NA ❑ NE
❑Yes fl;IKo ❑NA ❑NE
❑ Yes [E Ro ❑ NA ❑ NE
❑Yes ❑NA ❑NE
❑ Yes VNo ❑ NA ❑ NE
Continents (refer4Wquestlon #}: ExplAin;any YFS answer .and/or„any.:additinns! recamrtiendations nraanylnther'.cunitne ts: � . rcr r
Use drawin s of facilit ;to b4te' lain sihiationsl[use additional 'ages�as neeessar }.
Reviewer/Inspector Name: Phone:
ReviewerlInspector Signature: Date:
Page 3 of 3 21412015

for Visit: -9'Routine Q Complaint Q Follow-up ❑ Referral ❑ Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: 4a:i A4z2= Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 71 LktSj;r0't'.-
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator: i7'1
Certification Number:
Certification Number:
Latitude: Longitude:
'
Design Current
Design Current Design Current
Swine
Ca lty Pap.
Wet Poultry Capacity Pop. Gattle Capaclty Pap.
I :4-Wean to Finish
La er Dai Cow
Wean to Feeder
-Layer
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D • P,ouit . Ca aci pop.
Layers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkex Poults
Other
Other
Discharges and Stream Imnacts
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 �- o ❑ NA ❑ NE
❑ Yes ff No
❑ Yes EI�No
❑ Yes J�rNo
❑ Yes P�'o
❑ Yes pl�o
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number: j I- Date of Ins ecdon:
Wast�Coll tion & Treatment
4. Is`storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ 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 ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
5. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes G2/No [DNA ❑ 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 JZNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [,_Jll�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 PNo ❑ NA ❑ NE
maintenance or improvement?
Waste A��lication
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes Z*"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 0-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff No ❑ NA ❑ NE
15. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JZ"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [] Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes AZ�No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ''No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l 20 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
ram--=a-the.facility fail to install and maintain a rain gauge? ❑ Yes '•f No ❑ NA ❑ NE
��'~�^�t•ta.install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
21412015 Continued

Facility Number: - Date of Inspection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
2�,:1s the Facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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 below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes
❑No
❑NA
❑NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No
33. Did the Reviewer/[nspector fail to discuss review/inspection with an on -site representative? r] Yes [] No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No
l 141,6 Grs-7- J 1�
1 f 3 (T
un�l If ,)-r)IF
War)( on CKO dLy arcs s Cl i�f lc
gcrr ) 16� 56r ,
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 o. f 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:'�('i . G -7-3
Date: / c ! 66
2411015

ivision of Water Resources
F,neility- Number ©- ❑ Division of Soil and Water Conservation
Q Other Agency
Type of Visit: �ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: .77
olioutine ❑ Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: O County:
Farm Name: d--�-�r1-Y� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �—Let h ) 0 y-,
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:
Latitude:
Phone:
Integrator: 1/•
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Pullets
Puults
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management systern? (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 frorn a discharge?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
5-airy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ,2 No ❑ NA ❑ NE
❑ Yes ZNo 0 NA ❑ NE
[] Yes Z'No ❑ NA ❑ NE
❑ Yes '❑ No
❑ Yes XNo
❑ Yes �Na
❑ NA ❑ NE
❑NA ❑NE
[]NA []NE
Page 1 oj'3 21412015 Continrred

Facility Number: jDate of Ins ecdon;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
�j2No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure
re I Struct 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats tot a integrity of any of the structures observed?
❑ Yes
Rio
❑ 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
F
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
..erNo❑
ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
;2,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternativcs that need
❑ Yes
P'No
❑ NA
❑ NE
maintenance or improvement?
TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
PeNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
P�'1;Io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
[] NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®'No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Wo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j(No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 31 - Co Date of inspection:
24. T)id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONO
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JE:rNo
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes PfNo
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 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?
Use drawings off
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ;NNo ❑ NA ❑ NE
❑ Yes ZNo
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �No [DNA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
[216
❑ NA
❑ NE
❑ Yes
[2 No
❑ NA
❑ NE
to question ft Explaln any YES answers:and/or:any addit]onal:recotiimeiidations�nrrany'nthee:comments. r.: ;;
acklittyto better ex lain situations (use additional pages as'necessa
5 1_�_/ Ir
cj, 32,
G'(, t
,�-I�-I/s a-18
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P S u T %__ �_�I I r-t. rtg
A�Au
L Phone:?12 3
t� Date: 1
2112014

Division of Water Resources
Facility Number ©- Division of Svil and Water - nservation
Q Other Agency
Type of Visit: omplinnce Inspection 0 Operation Review 0 Structure Evaluation ❑ Technical Assistance
Reason for Visit: 'Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other D Denied Access
Date of Visit: OArrival Time: Departure Time: County:
Farm Name: 1'Y1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 62 t I l _67 2'CDl'I
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
I
Certification Number:
Certification Number:
Longitude:
Region: \ VA
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
airy Cow
Wean to Feeder
Non -I Layer
Dai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P,oultr
Ca acit
P,v
Non-Dai
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
rother
Turkey Poults
Other_[Other
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 JZ_No ❑ NA ❑ NE
❑ Yes 2-No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
[:]Yes �'No
❑ Yes 0No
❑ Yes [;�<o
[3 NA [3 NE
❑NA ❑NE
[3 NA ❑NE
Page I of 3 21412014 Continued

]Facility Number: Llk> Date of Inspection:
Waste Collection & Treatment
4. ls�storagp capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P No
❑ NA
❑ NE
• a. If yes, is waste level into the structural freeboard?
❑ Yes PNo
❑ 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 an of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. 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 OWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E' No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 7fNo ❑ 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? 14
Waste ADDllcatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EjNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fait 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?
Reguuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑Yes
46No
❑NA
❑NE
E] Yes
No
[] NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
RfNo
❑ NA
❑ NE
❑ Yes ;3 No ❑ NA ❑ NE
❑Yes ANo ❑NA ❑NE
❑ Yes RfNo ❑ NA ❑ NE
❑ WUP El Checklists [:]Design [:]Maps [:]Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ectlon: p
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. 4s 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes jNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ( No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes qNo ❑ NA ❑ NE
Comments. (refer to question #): Explain any. YES answers:and/or:any addit[60iil,iec6iiim6iidittion-s.oriany.I
Use drawings of fucillty to better explain:situations{usc.additional.pages as necessary] .. •All
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone : 910 / 96 7�3
Date:
21412014

:j
i '-- U Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Reason for Visit: ZRoutine Q Complaint Q Follow-up a Referral Q Emergency Q Other Q Denied Access
Date of Visit: 6 Arrival Time: ' U eparture Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative
Phone:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
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
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I E I I Layer
Non -La er
Poults
Design Current
Discharees and Stream Impact
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?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ;JNo ❑ NA ❑ NE
❑ Yes ETNo
❑ Yes ❑"No
❑ Yes E^1Vo
❑ Yes �ZNo
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Conh'nued

m

F)
/Facility Number: -A[ - y A S I jDate of Inspection: JQ/T11VI
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes jNo ❑ 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 0 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 ❑ LagoonfStorage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
lComments. (refer to question M). Explain any YES answers and/or any additional reeommendatioas::or any;dther;comr ie_nts;
ike drawings.of facility to Netter'explain situations tune additional pages'as' *ecessaryj.: . ,r Fps �3'N 1777 � k
Reviewer/Inspector Name: lNev t n_
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T0/�/�
Date:
21412014

[FaQUE Number: - Date of Inspection: ,d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
PrNo
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —3 7—
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
P.
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
7'
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 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
[]Yes No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
'�ZNo
❑ NA
❑ NE
❑ Yes
;ffNo
❑ NA
❑ NE
❑ Yes [24No ❑ NA ❑ NE
❑ Yes P 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
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? E] Yes )Z N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PN
❑NA ❑NE
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

liaeifi Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm' . ❑ Yes [E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z 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? [:]Yes 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZI No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2J 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
J0 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
Pr
❑ 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
P' No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�' No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
^GklI1r1 �eae / e F'?_1 C?5-9e
w#' N
13 p
71p 113 0,71
7// //3 0.7h
Reviewer/Inspector Name- a ci Id'. UL
Reviewer/Inspector Signature:
Page 3 aj3
re e oVs A irk j
Phone: ?/// a 7 '; ,
Date: D f 13
2112011

r,*44 01!6ivision of Water Quality 1
Facility Number Q Division of Soil and Water Conservation 1►
Q Other Agency
Type of Visit .42Mompilance Inspection n Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit ,@ Routine D Complaint Q Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Regions
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �_066 &=rf4
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
Owner Email:
Phone:
ZePhone No.
Integrator• n
Operator Certification Number:
Back-up Certification Number:
Latitude: o = f Longitude: = ° = 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer --
Other
❑ Other— - - ------ --.w�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey PouIts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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 .r_ ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 't!�No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
Page / of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes ONo
❑ NA ❑ NE
a. 1f 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
ElNA ElNE:
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 12rNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ;;�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ,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
❑ NA ❑ NE
maintenance or improvement?
,ffNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes JNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 06o
❑ 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
5,N-6
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
r
71Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennirtation ?
❑ Yes
;2]rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XN❑
❑ NA
❑ NE
Comments ;(refer .to question #):; Explain any YES.answers andlnrg any,recommendattons,or any other comments:.
Use=drawiuOs o faciiify to better explain situations {use additional,pag6s as
Reviewerlins ector Name g`' ��� '
p s s Phone:
Reviewer/Inspector Signature: Date: r e
121 R104 t:ontimmed
n •1

Facility Number:e,3t3� Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wlo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes 0i 10 ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes -6No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes
FzMo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
)No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YeS)21No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JzNo
❑ 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
V`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
;eNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/�'o
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
;No
❑ NA
❑ NE
:u
Additional Comments:andlnr Drarvings:
�, L009V
-
of—
C�
L50
r
4e4,
o= 77
•
rQ eo
lief`.
l6 o��U�
1�
Page 3 of 3 12128.104

(Type of Visit �Qf Compfance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for V1sit_,4?Routine O Complaint O Fallow up O Referral O Emergency O other ❑ Denied Access
Date of Visit:
Farm Name:_,
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: •[.Lf Departure Time: County:
Facility Contact: �9 , Title:
Onsite Representative: � �/Cil
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: ❑ e = I = Longitude: = o = ` 0 "
Design Current
Swine Capa`ity Population
Design Current
Wet Poultry Capacity Population
Design Current
Fettle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl I
❑ Turke s
Other
❑ Turkey Pouhs
❑ Other
IEJ Other I
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)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility N« her: — Date of Inspection
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures requite ❑ 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
maimen ance/i mprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA W MP?
❑ 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 acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations.or any -other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):.
/05crj� eve s ca
T,,,ck ue Se�- p ter[ yu� - e cj 4�ij i
T
ReviewerAnspector Name Phone: �r
Reviewer/Inspector Signature: Date:
Page 2 oj3 ]V2&04 Continued

6VacifiWNumber:31 Date of Inspection
y Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, aver application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional. Comments and/or Drawings:
Page 3 of 3 12128.104

IType of Visit OIC—ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Z Routine O Complaint O Follow up O Referral O Emergency ❑ Other ❑ Denied Access
Date of Visit: V 3 I Arrival Time: Departure Time: County: 211, Region:
Farm Name: 44 1-3- � Zk3 — ___ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: "/J 'Title:
l'' Onsite Representative: r?V l,
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: 0 0 = 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish I %YOC7 11000
❑ Farrow to Wean
❑ Farrow to Feeder f
❑ Farrow to Finish
❑ Gilts
❑ Boars �
Other
❑ Other
❑ La er
10 Non -La et
Dry Poultry
Pullets
ID
LI Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ {other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes D-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑-No
❑ NA
❑ NE
❑ Yes
El-Ko
❑ NA
❑ NE
12128104 Continued

Facility number: Date of InspectionL�i ram}
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Oqo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA FINE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Stricture 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity ❑f any of the structures observed? ❑ Yes J"No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J2 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 j2N0 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ['No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind DriR ❑ 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
2`No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O''ltiio
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
O'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�*o
❑ NA
❑ NE
r Reviewer/Inspector Name Phone
Reviewer/Inspector Signature: Date:
12128104 Continued

F cilityNtimher: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ZYes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists Zesign ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 'Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
12 Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑'Monthly and 1" Rain Inspections [24eather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes jErNo
❑ NA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
[DNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
[
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes 2-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
L2 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes -ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes DNo
❑ 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 _E2T10
❑ 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 ;"Ao
❑ 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 rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes _E�'No
❑ NA
❑ NE
I
Additiunai Co ents /o rrilm and/or. Drawin s:
go) f lease C)��l lr• G Copy o a �oa� e Sl ny, r oY-,
a � � e ire � or- d w e ac�. �- � � a rn � n w � 1
� �,dm b i f'�-df
jnSrpeG`i'1oh5 G�
� R �- or ti
UUK f --)
feet ofC�
12128104

Type of Visit 0,Compliance Inspection O Operation Review D Lagoon Evaluation
Reason for Visit 4Routine Q Complaint D Follow up D Emergency Notification 9 Other ❑ Denied Access
Facility Number Date of Visit: ca Time: . `0
/IdNot Operational O Set
0 Permitted 13 Certified 0 Conditionally Certified © Registered Date Last Operated or Abgwe Threshold: „ ......».».»•
Farm Name: .. ._,! . _.__....__...._ ... ...._» County: »�
Owner Name: _ ._ __._.� ......._._ ......» » .
Phone No:
MailingAddress:......__......__._.... . _.........„» .. »».„.»..»...» .....».»....»» ._M.» »...»» _. » » .. ». » »..».......... ».... „.„.».„ ......„ .»._ .
Facility Contact: ...... ...
_.. ....»... .. Title: .......... _ .._._..._ .__. ._.. P o e .NO:
Onsite Representative: „ ��._�. _ ... .._ Integrator:
Certified Operator:...._.__._...—_... -..—...» ....». »„ »..». » ».„.» »...» ».»...............». Operator Certification Num r:.»„_ ___ ......„.„_ ..._
Location of Farm:
I
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude ' "
I.F :T%. 1_ . ..;r-..
---_--a
+►' `s:CS aPD
77___---;;�:;
Ptllatl4n^
Wean to Feeder
Feeder to Finish
77-7
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
Boars
Cnrreat= • • gr�-�
Poi, tion. ';Cattle: -Po datioa`
❑ Layer
'❑ D ;3
❑ Non -Layer ::::j­ ❑ Non -Dairy
a;:i
YA"
_1
Other
2.1
= µ-TotaI'SSLW
. :HA�[;1f4iFflTI R 1�q-li[�-T1"dl1R•;
Disc es 8 S Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ;;No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes '� ""
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1
Identifier: »...__. _»... .._ .. _ . » . _ ...... »..... »_. _._ ..- _„ ._» . _ ._. _ .»» .........._. . ..» ....
Freeboard (inches):
12112103 Continued

6 Facility Number:/ — 5-1 Date of Inspection 1
5. 4re there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes _E71lo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E2No
closure plan?
(If any of questions 4•6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWg)
7. Do any of the structures need maintenance/improvement? ❑ Yes evo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ,.ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes _2No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes .,2No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ;2Vo
❑ Excessive Ponding ❑ PAN Q Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc ..�
12. Crop type / ; '?'eW, f /Y/, A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,0'K0
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'a"No
16. Is there a lack of adequate waste application equipment? ❑ Yes -j:J`No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ETRo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes -0 No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O-Ko
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 ,f 3-Nd
Air Quality representative immediately.
;�Q�ACOts,{refer
.7
❑ Field Copy ❑ Final Notes
Reviewer■ kispector Name `: '_ ` ,;, Sin .
Reviewer/Inspector Signature: [r. Date: /f C-

Facility Number: j —kyt
Date of Inspection i► c
Ranuireditecords & Document.%
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(it/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewlrnspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NP ES-ftw4tted Facilities
30. Is the facility covered under a NPD]~S Permit? (If no, skip questions 31-35)
3 L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required fors need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield For ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes , j]No
❑ Yes .M No
❑ Yes J2-No
❑ Yes •ONo
❑ Yes ,ZNo
❑ Yes E;Na
❑ Yes —ETNo
❑ Yes .TNo
❑ Yes U Na
❑ Yes Li4o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit JEl"Compiiance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit -(! Routine Q Complaint Q Fallow up Q Emergency Notification 0 Other ❑ Denied Access
Dale of Visit: D 'time: �� !•r
Facility Number
10 Not Onerational. JQ VelowThreshold
Permitted „Certified 13 Conditionally Certified 0 Registered Date Last Operated o Above Threshold:
Farm Name: ,i - & 2 a- - __ County: _ e- `n
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: _U�✓� s
Certified Operator:
Location of Farm:
Title:
Phone No:
�Phone No:
Integrator:_ -
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` G6 Longitude ' 6 066
Design Current
Design Current. Design Current
Swine Cavackv Po nlation
Poultry
CRIDneltv Po ulation Cattle capacib, Population
❑ Wean to Feeder
I
I
El Layer
❑ aiEy
I
1
Feeder to Finish
I 1,VPV
Non -La er
❑ Non -Dairy
3
Farrow to Wean
❑ Farrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
❑ Giits
❑ soars
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present I,a eon Area
Halding'Ponds l;Solid Traps. Di ❑ No Liquid Waste Management System
Discharecs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made?
b. If dischargc is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): [ r
❑ Yes
la"No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
J!T-No
❑ Yes
2'Ro
❑ Yes
,f I-Ko
Structure 6
05103101 Continued

ft
Facility Nuinber: —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anoli
❑ Yes Ef No
❑ Yes ❑ No
❑ Yes No
❑ Yes Q[ No
❑ Yes ZNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ZNo
11. Is there evidence of over application? ,L� El Excessive Pondingg El PAN ❑ Hydraulic Overload ❑ Yes [Z No
12. Crop type ;s 1_l o - e 11 G fe e r/ s,-,� � — -- •
a
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes O No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes eNo
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
Z No
Regul
-Rd Records & Dog,},gMgnts
17,
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[�'No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
PrNo
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
11No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
['No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
fZ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑-No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer: to.question 0): Explain any :YES paswtirs and/or aay,recommendations or; any other ,comments.
Ilse rlrarvlogs'of facility, ta' bct.'ter expla n'situatiops;' (use atditional OR as neeessaryj: ]Field Copy ❑ Final Notes '
lee A`W�f pi- /5--1-77 ZAP IZ5
Reviewer/Inspector Name - /J'
Reviewer/Inspector Signature: Date: '2 D
05103101 ` Continued

Faci it Number: — Date of i n.epection
L)4or l*sl[w
26,
Does the discharge pine from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
TfNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
allo
28.
Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
d No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
O No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
['No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
[7 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
16 No
Additional Comments an. ❑r:::.. raw ngs: r'.' .•i_•� :;iu A;a,.--i S � His,v eij a" "

of Visit .0'Compliance Inspection O Operation Review ❑ Lagoon Evaluation
for Visit Aioutine O Complaint O Follow up O Emergency Notilication O Other I ❑ Denied Access
Facility Number jDateorvisit;
O Permitted ©Certified [r Conditionally Certified 0 Registered
Farm Name: ......... .....e... v.}Gi" ...., N 0` .`.....'................
Owner Name:....... ' a7 4'1....5`155 'r... q'�`'"1...........I...................
Facility Contact:
Title:
Time: I I q,56
Not Operational d Below Threshold
Date Last Operated or Above Threshold:..
County:..,.,;f. V�...►.` ...............................
Phone No . .............................................................. . .......... ...... _.
Phone No:
MailingAddress:.............................................................................................,,................................................................................_............................... ..........................
Onsite Representative: „ `?. Ab...I.. .np.....No p,,NA~1........................ Integrator ..m ` ..............................................
Certified Operator: ............................................. . ....
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle [] Horse Latitude �' 0� �416 Longitude • 4 44
E. a Design Current:
Ca ,
aci . Po ulatiari
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry CapacityCipacity Population Cattle Ca aci Po nlatian
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total MW°
:Nunnbcr of Lagoons !' ' Subsurface Drains Present L goon Area Spray Field Area
-
Holding Ponds'1 Solid Traps. ❑ No Liquid Waste Management System 'E
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 13`No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Oi No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes �o
c. If discharge is observed, what is the estimated flow in gallmin? " i lc,
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes12rNo
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'W4o
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 'PNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idenlifser:....'�S".`.•...................................................................•.........................................................................
Freeboard (inches): rj
5/00 Continued on back

Facility Number: 1 — Date of Inspectiont
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
[] Yes XNo
seepage, etc.)
6. Are there structures on-sile which are not property addressed and/or managed through a waste management or
closure plan?
ElYes�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 XNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ YesHTo
Waste Application
10• Are there any buffers that need maintenance/improvement?
❑ Yes 2�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes XNO
12• Crop type Ge rw. u�r tie, yn.�w ►'r1 „1
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 ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes ZNa
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes JdNo
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 ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes O No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 2(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,eNo
23. Did Rcviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
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 R!rNo
i'i#10t �45•�+k caenc�i� ire p �priog this.vsit; Yuji x0 1 0 40 tt . .
etiri•es iy ideirce. ah6UA this visit.
rnxrteats re[ r. to yues#lon #):: Explain any, YES answers and/or any recommendations or any othew c�±patta
Llsc d6a dip of facility tq Better ezplali situations: (use addltional pages aa't€,ecessary};"
sure use 'q wc,s-�c a �,ai s►s d�-}e.•t wH ti (�o d"'y.s
ei r! 1; rorti ah QVe,vn-JS Dvi +f -ie a,rr•ec4 4�e Gat [6 Vlc,4 ;eels 0
4 tie v" a4 vr, �'ie Id :L . - 2..
]S. Y�'1oy► � p r r4l L e n stare a -2-00-7- .
e Fen, c ; � ►� ►� , c a��, A^ of recDrdl AT 0 "e.041 ke po-
Reviewer/Inspector Name 5�-1+ o CcrJA ( es tt i ;s i €
Reviewer/Inspector Signature: ketVPtrAl 9A11 ,,jk , Date: ] ,f ;# V U) 5/00

FacllitxNumber: Date of Inspection 1 '
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes j2wo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes _ Xo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesZ1 No
30. Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,) ❑ Yes E No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ YesXNa
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments an or Drawings: u
A.

Division of Water Quality
Division of Soil and'Water Conservation
»'0 Other Agency
(Type of Visit D Compliance Inspection p Operation Review 4 Lagoon Evaluation
Reason for Visit (D Routine Q Complaint a Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 31 46g Irate of Visit: ] 1-14-2uQ] Time:
Q Not ❑ erational Q Below Threshold
® Permitted ® Certified r] Conditionally Certified [3 Registered Date Last Operated or Above Threshold: - -- -- -- -- -- -•
Farm Name: Nixtry.Ann.UuP farm ......................................................... - County: ftdja .................................... }? IR0......
Owner Name: �'E'�.1�'.�tQt]tCi1]._._. ._._ lYsarman,JD._._..._-_-_--- Phone No: �J�$9_4,fOD.-----...---------------------
MailingAddress: JPQ..HQX.3.8 ............................................................................................... Ron=-M ........................................................ 2845A ..............
Facility Contact:...........................................................Title: ...................... Phone No:
...............................................................
Onsite Representative: 1�slteb.&Artu.L�utulaR----------------.._----•---- Integrator: laur�hx�amilx��xrrl�_--•--------------•
Certified Operator: dutch..W................................. Norman ............................................ Operator Certification Number: 17217..............................
Location of Farm:
northeast of Wallace. On South side of SR 1148 approx. 0.5 mile West of Hwy 11.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 340 r-4--879 17 16 Longitude 77 • 57 ° 11 u
Design Current
Design
Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
® Feeder to Finish
1400
❑ Non -Layer
❑Nan -Dairy
❑ Farrow to Wean
[3 Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
1,400
❑ Gilts
Total SSLW
189,000
❑ Boars
Number of Lagoons Z 10 Subsurface Drains Present I ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. Ifdischarge 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)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway [_-]Yes ® No
Structure I Structure 2 Stnicture 3 Structure 4 Structure 5 Structure 6
Identifier: ....... Iststage---.-_.......Iad stagc..--............................ ...... .---------- ...... -.............................
Freeboard (inches): 55
n r,n � in I

ua"aa/u¢ s unrtnueu
Facility -Number: 31-465 Date of Inspection 11-14-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding [:]PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Gverseed Manua
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ®No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ VrUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use dra►vings of facility to better explain situations, (use additional pages as. necessary):Field Copyy [] Final Notes
..
. N-1 - -... _ .
19. Be sure to use a waste analysis dated within 60 days of application events on the IRR-2's. Correct the calculations on the Manua field
IRR-2.
_+
15. Monitor pull 2 and ensure a good Bermuda coverage in 2002. Overall, the facility, crops, and records are neatly kept.
qW
Reviewer/inspector Name Stonewall Mathis.. entered by Bette Rose
Reviewer/Inspector Signature: Date:

•-05103)61
4
Facillty Number: 31-465
©ate of Inspection 11-14-2001
Continued
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[--]:Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
®No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/or Drawings:: ; : ... ....

a,. 0. Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency Y,
Type of Visit D Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit a Routine Q Complaint p Follow up 0 Emergency Notification 0 Other p Denied Access
Facility Number 31 4G5 Date of Visit: 11-14-2A4] 'rime: 14:Sfl
0 Not Operational 0 Below Threshold
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: • .. -- -- -- -- -•
Farm Name: MarYAnnAusgr.Farm ......................................................... County: Dilpliu.................................... 1' jRQ......
Owner Name: lYl..�'V.�[&ufckl}.--------- lY�rnlau*lu.---•-----------•------ Phone No: ?JQ$:SOD------•-------•-----•---------
Mailing Address: JPjJj.9;K.3.$............................................................................................... JR059MILAC ....................................................... 2.N.45A ..............
FacilityContact:...........................................................Title:.............•...............•..........•...... Phone No: ......................................
Onsite Representative:)ui�b.&A�w.L1A�tn$R----.---------.-------.-----. Integrator:117#txpl�x�tamilY-E'a---.-.-----.------•
Certified Operator: BlutclI.. ............................... NOX.Mla............................................ Operator Certification Number: l72,57............................
Location of Farm:
Northeast of Wallace, On South side of SR 1148 approx. 0.5 mile West of Hwy 11.
® Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude 34 ' 4$ ° 17 ii Longitude 77 • 57 ` 11 i°
Design Current
Swine rnnaeitv Pnnnlatinn
❑ Wean to Feeder
® Feeder to Finish
1400
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer F
Dairy
❑Nan -Layer Non -Dairy
❑ Other
Total Design Capacity 1,400
Total SAW 189,0oa
Number of Lagoons 2 ❑ Subsurface Drains Present 110Lagoon Area IDSpray Field Area
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ------- I-st.sr. a.............22nrd_Stw..............................-• ........................... ...........................
Freeboard (inches): 55

c, vaunueu
Facil ty Nutither: 31-465 Date of Inspection I1-14-2001
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(It 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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Matua
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes IN No
❑Yes ®No
❑ Yes ® No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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?
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
[I Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Com;' meats (refer to'question 0 Explain any YES: answers and/or any recommendations or any other comments.
Use d rawings i of facility.to better explain. situations:(use additional pages as necessa )' 1❑ Field Copy ❑ Final Notes
19. Be sure to use a waste analysis dated within 60 days of application events on the IRR-2's. Correct the calculations on the Matua field
IRR-2.
—
15. Monitor pull 2 and ensure a good Bermuda coverage in 2002.Overall, the facility, crops, and records are neatly kept.
wer/Inspector Name Stonewall Mathis entered by Bette Rose.
E
wer/Inspector Signature: Date:

05103101
Facility Number: 31-455
[)ate of Inspection i1-14-20111
Continued
Odor issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[] Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
®No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not Iocated near the liquid surface of the lagoon?
❑ Yes
®No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
® No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
t on omments n ar r ►v n s:.
a s s

.: • Division of Water Quality'
Q Division of Soil and Water Conservation
Q Other Agency
(Type of Visit p Compliance Inspection Q Operation Review ❑ Lagoon Evaluation I
Reason for Visit @) Routine Q Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number 31 465 Rate of Visit: i1-14-2401 'Time: 14:50
Q Not ❑ erational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: N.lary..Tin.,Saxsr1:JF%lruj......................................................... County: papli.................................... WIRO......
Owner Name: l'l�. .t�&litgl�l---------- NAlJIl1lD+----------------------- Phone No: 9J.Q289.4300.-----._._,-._.---------------
MailingAddress: �4�. 9�[. 8............................................................................................... R030MUM ........................................................ z&.45N ..............
FacilityContact:........................................................... Title: ............................................... Phone No:......................................
Onsite Representative: Duteb.&Ana.LV�xutaR--.-------------.-------.---- Integrator:�urp)7,Y�>imilY�ax�ta.�---.-----------• -.
Certified Operator: BuIcI... ............................... Nt3x mia............................................ Operator Certification Number: l.7257..............................
Location of Farm:
Vortheast of Wallace. On South side of SR 1148 approx. 0.5 mile West of Hwy 11. +
® swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' 4$ 17 longitude 77 • 57 11
Design Current
Swine Canneity Ponulation
❑ Wean to Feeder
® Feeder to Finish
1400
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity. Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 1,400
Total SSLW 189,0
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ®No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Stricture 1 Structure 2 Structure 3 Structure 4 Structure S Structure G
Identifier: .......Lst staff....... ...... 2a&stagc...... .......................... ........................... ........................... ........................
Freeboard (inches): 55

UNW/ul t unti uem
Facility Number: 31-465 Bate of Inspection 11-14-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Apolication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Matua
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel 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?
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments:(refer;to question}; Explain anyiYlS answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. {use additional. pages as necessary): {LEField Copy �[] Final Notes
19. Be sure to use a waste analysis dated within 60 days of application events on the IRR-2's. Correct the calculations on the Matua field
IRR-2.
15. Monitor pull 2 and ensure a good Bermuda coverage in 2002. Overall, the facility, crops, and records are neatly kept.
V
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

. 05103,01
Facility Number: 31-465
Date of Inspection 11-14-2001
Continued
Odor Issues
25,
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28,
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
®No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
®No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
® No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
bona Comments an ur. raw ngs
• :ti....

oUWater Quality
1Ai i in
.,."
Q.DlYision of Soil and'Water.ConS£rvation
0 Other Agency.=
Type of Visit Acompliance Inspection 0 Operation Review p Lagoon Evaluation
Reason for Vislt Routine Q Complaint 0 Follow up ❑ Emergency Notification Q Other
da:- " y ?
❑ Denied Access
Facility Number [)ate of visit: Time: W Printed on- 7/21/2000
Q Not Operational 0 Below Threshold
0 Permitted `Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Thresholdj:� ......................... f�
Farm Name•/ ,� .. �ik1.1a.... .S jl! f+4.1 m Countv:......lray�................................1�! ..'.i.'-3~.1.....
OwnerName:.........(,1.-rim.n.............................................. Phone No:..........................,....................,....,..................................
FacilityContact: ..... ......................................................................... 'l'itle:.......................................... ..................... Phone No:..........:.........................,..............
MailingAddress: ...................................................................,,........................................................................................... ..........................
Onsite Representative:....... .... V.......`.".C�►"..................
.................
Integrator: ......... ....................... ............. ............. ............................
Certified Operatorr:.....................Aloe.-.m.-qq......... ................. Operator Certification Number:....f..� .........................
Z
Location of farm:
b5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� ��' Longitude
Design Current
Swine CanaCity Population
❑ Wean to Feeder
•ceder to Finish
11400
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ ❑ther
Total Design Capacity
Total SSLW
Number of Lagoons I Z= ❑ Subsurface Drains Present ❑ I.ag—n Area JEJ Spray Field Area
Holding Ponds 1 Solid Traps ❑ Nn Liquid Waste Management System .
Discharaes & Stream Im act;
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is ohservcd. v.-as the convoyancc man-made" ❑ Yes ❑ No
h, If discharge is observed, did it reach Water raf the State'? (lf' yes, notify C7WCl) ❑ Yes ❑ No
c, It'discharge is observed. what is the estimated flow in gallmin? !t1
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 �o
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 & 'l'reatment
h. Is storage capacity (freeboard plus storm sloragcy less than adequate? ❑ Spillway ❑ Yes o
Structure,j StruCtOrc 2 Structure I Structure 4 Structure 5 SITUCture 6 �I`■`
Iderttifit r: ....................................................
Freeboard finches):
5100 Continued on back

Facility Number: Date of Inspection Q Printed on: 7/21/2000
43. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, [] Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? Yes �0
(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 o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes r 'I+Io
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 maintenancelimprovement? ❑ Yes o
11. Is there evidence of r application? ❑ Excessive Ponding ❑ PANT ❑ Hydraulic Overload ❑ Yes No
12. Crop type eSGtJ .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMPV
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ 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. Pail 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?
II:.I; d'Va yibl �tgrjs of dot'jcjen+ io *(� riar►ged- O(Witig #h js'vis)t, • Yojx ;will •i-eet iye 06 fu"her
rorxes' ontience. about. this .visit. :
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):
r_r_c,.1;4-' (00 ICS Dpodr
❑ Yes 010
❑ Yes i No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ko
❑ Yes )(No
❑ Yes KNO
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes �N0
❑ Yes No
El Yes ; . o
❑ Yes No
❑ Yes +++ No
Reviewer/Inspector Name
Reviewer/Inspector Signature: '/ Utvt4l'_1 Date: ail%GC% 5/00

Facility Number: 'St -q Date of Inspection (5 2 d Printed on: 7/21/2000
Odor IsNues
26. hoes the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hplow ❑ Yes k1NO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes YNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes N0
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YeSXNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. ❑❑ the animals feed storage bins fail to have appropriate cover? ❑ Yes No
5/00

j� Division of Soil and Water Cbnsei•vation -Operation. Review. ?.
i.� .
13 Division of Soil and Water Co
nservution'- Compliance inspection
i J'.Division of Water.Quality - ldm4liance Inspection '
p i. Other Agency = etrativn U Review,
E2Routine 0 Complaint Q follow-up of DL'VQ inspection D Follow -rip of DSWC review 0 Other
Facility Number Date of Inspection
1 ImR Of Inspection 24 hr. (hh.mm)
Permitted EXCertified C1 Conditionally Certified 13 Registered Not Operational] Date Last Operated:
Farm Name: Axt/.h►)L......s4sse!(........... Fj(.►!tra....... ....... I....... County:............. ...1� J.l.!?4�....................Q...... ........ I..........
Owner Name: ... ...1!![.....•►A+t•:...... (8!1+(A)....�.V.k�[!t!k#.14.. ZT K......... ......... Phone No:....(�i�� .. -, ..~.. 1...................................
Facility Contact: �Yrl•..1A.&x..............Title:......d.l!Vju. .V.......................... . Phone lYa#...(��fJ
.�............ .....
:Mailing Address: ........:�RQ ............................................................. ....... 5f.......
x T1..�..1...�........I�'..�..................... .t2�.��d .....
Onsite Representative: p Integrator: f J��...........
................ .................................. ...............................r7 -} r�
Certified Operator:......... .{.:..............1!yz, Operator Certification Number:......J..1„P..,,1............
...............
Location of Farm:
Latitude • 4 �• Longitude 0 ° "
Desi n Current. esign g Current .: Design Current
Swine Capacity PopulationPo41tY o ulation. Cattle Capacity Population ..
❑ Wean to Feeder ❑ Layer ElDairy
�$ Feeder to Finish 1 iJ ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish
Total,Design Capacity
❑ Gilts
❑ Boars i . Total-SSLW
1, . ",l .. i-. er af:Lagnons... ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
I t.
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a, If discharge is observed, was the conveyance man-made?
h. 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 gallmin?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier; [� i x A6e,
Freeb[rird (inches): -1 3 f................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes � No
❑ Yes
No
❑ Yes
J No
N/A
❑ Yes
50 No
❑ Yes
No
❑ Yes
No
❑ Yes to No
Structure 6
❑ Yes 0 No
Continued on back
3/23/99

Facility Number: 3 1 — W 4 /lath rot' Inspection
,r6. 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 j No
8. Does any part of the waste management system other than waste structures require ntaintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
eievation markings? ❑ Yes yy
M No
Waste rinvlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 4 No
11. Is there evidence Of over application? ❑ Excessive Ponding ❑ PAN XYes ❑ No
12. Crop type s On
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Q(No
14, a) Does [lie 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? PQ Yes ❑ No
15. Does [he receiving crop need improvement'? ❑ Yes �(No
16. Is there a lack of adequate waste application equipment? ❑ Yes 4 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
I'No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
KNo
(ic/ WUP, checklists, design, maps, etc.)
19.
Docs record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
0�.N❑
20.
Is facility not in compliance with any applicable setback criteria in effect at (lie time of design?
❑ Yes
J No
21.
Did the Facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does Facility require a follow-up visit by same agency?
❑ Yes
[ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
l'V .yiolpiQgs'or . cjen�tes wi' re jr 0fpO• ft-ring � hjs'visit; - ;Y:op will •r�-eeciye od ruttho
correspondence. about. this visit_ .... .
Comments (refer tol question #} Explain.any YESlanswers and/or any recommendations or, any other comments:
[.Ise drawings of #facility. to better.explain situations. (use additional pages as necessary}:
3e CnveA,� nab 0w exLred PA:A1 VeIk .j Atri �ni�r -r� Wi,wlaw 1*8] c� Q+iL~z •►
Shm l) +r. 4 eXc1l pl 27,P 0 1 At e-t ert �+l � 5� S eed. u irei
[�� tt�� 1 I ,- .1 � � I iQ Epp �.�-� �y � '� p
-4I Mgt In i 1 tl otS # Y A+�it # L � � uL or-e
�-pr[ it e?1,,¢�al �r W t 6 ��e Ae rf�-6 cd �+ c,�,a.► r►.,.
Reviewer/Inspector Name ( lot
P r,
Reviewer/Inspector Signature: Date:
3123199

Facility Number: — (�
/laic of {nspection
-.Odor Issues
26.
Does the discharge pipe From the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
P�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
W Nn
28.
Is there any evidence (if wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Vpo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
J No
l
30.
Were any major maintenance problems with the ventilation fan(s) noted? O.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
ElYcs
*N❑
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
fgNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover`?
❑ Yes
PNo
AdditiunuTCon—iments and or Drawln s:'
1;.
3123/99

❑ DSNVC Animal Feedlot Operation
A dla t o Review
D NV Q AnimaI Feedlot Operation Si s ec i to In p t o n
:N .. �•�5: ;H�F..
1toutint O Currlplainf Q Fullot 4-up of DWO insprrtinn Q Foil trw-un of DSNVC review Q Other
Date of Inspection �----�
Facility Number i t••FG
Time of Inspection i ► l� 24.hr. (hh-.rnm)
Registered ® Certified © Applied for Permit 13 Permitted 113 Not D -rational Date Last operated:
Farm Name k&r ..A kr........ .................. . ............... County: b.v. aL.,....................
Ojjrner Name: ...........................►I..k...... ......... 11V3V'10'j ........................................... Phone No:..........................................................................
Facili(y Cnntact:
Mailing Address:
Title.
Phone No:
Onsite Representative: ....... ........... ] LL..--- j.U.0m.. �tr-...................................... Integrator:.. ......
................
............
. ........................
.......
Certified Operator.....................................................................I............... ... Operator Certification Number;.........'
Lom ion of Farm-.
Latitude �' �� �.� Longitude
Swine" _,4,. Capacity: Population. ' .Poultry.. Capacity Population Cattle;" ;Capa-.ityPapulatioia;
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ soars
J❑ Laver El
E1 Nan -Laver 10 Non -Dairy
❑ Other
Total Design Capacity,
Total'SSLWLM
er -Numg gber of La oons 1 Holdin Ponds, ?� ❑ Subsurface Drains Present ❑ Lagnnn Area ❑ Spray Field Area
".s r<<y 'r ❑ No Liquid Waste 1Vianagement System
Waste
0
'eneral
I... Are there any buffers that need maintenance/improvement? ❑ Yes [j No
2. is any discharge observed from any part of the operation? ❑ Yes U1 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 ves. notify DWQI) ❑ Yes No
c. If discharge is observed, what is the estimated flwx- in gal/min?
d. Does discharge bypass n lagoon system? (if yes, nntify DWQ) ❑ Yes [WNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes qNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 10 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
. maintenancelimprovement?
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 [P No
7l25/97 Continued on hack

Facility Number:
43. -Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 'No
Structures (Laanou,�iolding fonds, Flush Fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes �j No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: y'1�
1 ...W..
Freeboard(fl):.....� �' .. �: ..............:.................................................................................................... .........
10. Is seepage observed from any of the structures? ❑ Yes EA 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?
Va Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13 "Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste App lication
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, orrunoffentering waters of the State, notify DWQ)
15. Crop type �1C1��!a......................... ..................... .......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
fK No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
1B No
20. Does facility require a follow-up visit by same agency?
❑ Yes
V' No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
(Yes
❑ No
for C—ertilked or Pe t' led Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
O'Nv.violations nr deficiencies were -noted during this.'AA -• Yo'u will receive no further ' -
correspiatidence $bout this:visit:•', • ;
Z. W�YjoSitjn �.1IYU.S ors Sh � C W- L3h:k [ _d(,T,j '6qi'M—j l'- YELLiLy�Aoul�{ l�r (����li W. Cl,� 4-
�'[-SC,f 6� � • 1.]G.Y''-' G+�:4-$ S�J ijf �i� 1^�.V��S.cw W • 4�]ppd � � j�4..�� i�'}'L O7~ �S �'I`
�^Ow.i
l� rSiC- it•M'LOiY�
❑ {f`Q1�
�� Co[ie�C Ci�t►� �tls)�� be
tv-
VSQ� �pr.•[Gc�
CYnP enc:k
1A
p
s4,OVQ toe-
!sp-ol �avtl �,.jN_
�{,� earrc��"
�c�yt�e.
�algpo�. Jests Z'k oo,
, 1nOW bo w (r k"
712a197
�sz°^.r, :s,ra.�;;c•:Y_ '"'�a[•^•-iuA} a+�r,..�:u==:^5 ..rr••x. ":.. l'ii�t�a-a..c•.t�x,�r'?� �. .yfI�`fi�r�: ..r ,i;n�s:?stp!;f'�jRm,..x.'-:..sv.;�"ereet:•„:�: �,�•... 3 �rr.w-...K -s«- •n�;m?r.•-� ;«a�+i'-='A�.�.�rRevtewerllnsP� for Name i���ia-AT
."
Reviewer/Inspector Signature: f ,,,,. ._ [,, ._ Date: -1

s
�:. AltllmaI'Feedlflf Up atignRe�ie
- ❑ DSW E F,
'F
Fe
C�' er w'� `
'•fie.. xii::
..F': .Fi b, sFs• .; �:? :. .>< ::s":': �.: �!.. ....n�' : (' �W. 5.
i �� ... .�
Alnmal:Feedlot 4 eratlon'Slte Ins eeton °E:
Q, p
,: P
:':F::F€: �.� .3. 'e{ 5'.e .:3�ii;>i;'i�;�i
LLL
Routine Q Complaint Q Folrow-up of W2 Inspection 0 Follow-n of f)SWC review 0 Other
Date of Inspection FacilityNumber Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status- KRegistered ❑ Applied for Permit (ex:.1.25 for 1 hr .15 min)) Spent on Review
❑ Certified ❑ Permitted or Ins rection includes travel andprocessing)
❑ Not Operational Date Last Operated :..................... »».............. .».... »»...... _...... ..............,,....»......_........ ......................
,_-. .....h...
Farm Na
rne: _ &: Y1.».51.... r.lCl 1. ,.... ....._........_...... County: .!k�..... ................ ».... y'.1....Y
w1 C No:
».Phone Land Owner Nante:....L!..!C�tc�... 1!L .........» ? ..SSA:. ........ ...... .............., .........! .. :L...... .. ............................
Facility Conetact:....... .... ........ ........... ....... ........... .................. ............ Title: .......... .................. _...... .... Phone No
�s %.»..... .�..... .......... �........ ...... ..........
Mailing Address:... s .. .t►x.!. :ilk:��..... J4.......».......................... dsC-�.t.. l,...T.....,1'.:. ......... ...- .2r .
Onsite Representative:..„Q .... ....... 4 �4'{........» ....................... »....... Integrator:..MJAX.................... ......... ................. _.
Certified Operator: hxta.... .-su(...».......................... ........... ..... ».... Operator Certification Number:. �(�-�. ................ „...
Location of Farm:
Latitude ■4 =i Longitude ` ©"
Type of Operation and Design Capacity
:i;•CE�:4 ": i.E:x�..y€ :�:x f. ;;; i'�:`: • '1 : ii iiii ii.};:....„ s.
.•
�.. ...
::.....:,,,�=�:Design=..;-:'fCurrent�,,.eiCuirrent=,:
f� ....F::.::: ^..:. .
'. .35331E K.:F3....�.,3y'€v.s6;z
:,...Pa
e�
'sir'. �. S1F='1"f4�•.-r:i'�Fe'.SFiFI;•;:F Ca aLi •APO ula#ion
.5:. .
Pnultt'Y�=��•°:=Ca acI 'Cattle,�.:F,,;, :;'�','
ulatian.'. E .. •Ca a�I ..'.Po ulati!nn..
❑Wean to Feeder
ii
�L r:: Dairy_
i
M Feeder to Finish
Q Non -La er g3r ::,. -Dairy
Farrow to Wea
`�
E Farrow to Feeder
F"; :ff:,F":EF:0%'y?4;..:..... x. .. E:..: .. :.:'tt�
€.I.F:: i't:e� S:
; ,5 .,..F1..... I , ,. .. ��€�€'i333i: �ii3[s....s :i:ie.,n�i:t;'t.t'•:?:=:ti3'.,
5• Sx -.F•,is�i3 (.°'rf�..�t.: [i.3�F5€�
acit 4s5:F"F-::.
tTttotalDesignCa E`eFF ,�: �5:
y:�s 3t 4 _ P Y.: •.E �, .:...:.,:
3. Farrow to Finish.:5....F:,
il;
��..�.�..�_.��.....�.........w......�..?�Tvta��ssLw3
.. ❑Other
.. �: �i �' 3'> �. ��. t : • t:.s� �,3::i .:. ......: '.�3 3'F"i ..L)F• .
3:',' P3i . t'' � 'i.3y' :.ta•;5;3 �.. i
jE? rD. .'FF] t°::,:..,.:'!.:: �:: •'s:,. .=F (:!�-:SLR,.
£ i `�
5:''��S''��'�:3�
[[l %55u;�" .Nu,m•her; aFLAgoansSSS J HqaldingPSaSNSnds:..
3 3 3CS F Iji i :3,i�i€F4�oFii€ E1i&�fsk Ff',,f
g� n u =,
4 .d, 3=' 3,»:€3
L..,....:.�.,.
.. ;,;;=;-:uKP10 Subsurface Drains Present
]je'tesss. 5 q• ix. vr.. L,i Y r SSF ;,.�<i
; ti: 1; ��I ❑ Lagoon Area ❑ Spray Field Area
Queral
1. Are there any buffers that need maintenance/improvement? ® Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes R 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? 41A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoonstholding ponds) require bKYes ❑ No
4/30/97 maintenance/improvement? Continued on back

Facility Number: 11....... — .U...
d`6. Is facif ity 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
S. Are there lagoons or storage ponds on site which need to be properly closed?
® Yes
❑ No
Strl ctures LUgoony undlor 1191d.illz'Ppnds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Structure C
y
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
❑ 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
Wastc Application
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 ....................................... ....... ........... ........... ........... ...... _......... ................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Cl Yes
B No
17. Does the facility have a lack of adequate acreage for land application?
Yes
❑ No
19, Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
3 No
24. Does facility require a follow-up visit by same agency?
® Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ER No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
19 yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
B No
24. Does record keeping need improvement?
® Yes
❑ No
.
Comments, refer. to" uestion;# "Tx lair `an YES answers aiidlar;any, recommendations or:any, other. comments:.
,. q ) 1? Y
Ilse drawings,of facility to l Biter expIatn situatioris.`(use addttional pages as necessary): P
I. Sow• ,e arc.-Cq c. i, �, t 5 '-�--t e idL w jLS v e eJC.• ► e 4 r
w e. � Lwi. Tk e.re 0'..e � s �; o+ �+ + � E 1e e- s P , ,. „ V
5. Par t-i a ►-3 1i i r r i 4Lt, Q 5�{ 5 � �•� w £ L—Lu—✓_tl V-.J� fv @ wA-c V & .
S • i � a r e.v-o�� r d a �� wo t- i ••► i�-e.,..�� � p .► f w�-� �..-� ►-t �, ,.� ; ,�.4+� � r a F-
�� t. t: I. o a f o .j t L d r c, p yv P Y; �d { i o a,,� k o o .� L..) al 4 r�tkL"'V1V_
o 0 k-r Of w 4. NJ A- OL d f ► �� S o f_� --4A.L 6
PIL'o-30 C a +•. t ci i{ D v r
x EA,,e i o d
f ..... ..
Reviewer/Inspector Name - :r
-.� �1fft, rys4 ': F 1F `
'. «». ..
:. ,. ,�,: ����� .,,:�, _:..,: -_;
+�itisi' ,:Ni'<,`
�,'����.;�:(�;;PI��: � �_.,F �i.
7
. Ff RIF
�` Fii4�x=�°
Reviewer/Inspector Signature:
Date:
z
cc. Vivision of Water L'uaU1y, Water trluality Section, Facility Assessment Unit 4/30/97

Facility Number:-?.j........ —A,l 5. Date of Inspection. -I 7t I,
W■
dditional Comments and/or Drawin
g
t� ,n E• } a w�� n�,�.Q d t-k�p
v tv �--+
7• w ti f1�. W �a--•-� dL P ` U c) d e q v%^ t --C
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c-o v e.•� Q. P p Z-� c l,-.o k-� o U f
r idVS )r-iS #-�,! • r
2-,4 ojv v- e ( 141 k_a_4 Lu�,, K_Q,,( sf
�1 E s � � . s � } I v••u�ii � as � �"a- SFr + s '�-�-s>�� - --"7 1
t 6 n, kA r_-I . S tx .0 4 t�,V— oL CS,-
-e , -er r �•rf s h-e c c a „�.� e s 1�-e 5 +� v -.� e- �L I
4/30/97

•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: /D - , 1995 -{-
Time:
3p �C 1
I
Farm Na
Mailing
County:
Intec-att
On Site Representative: Phone:
Physical Address/Location: 5� I 7A:_mi
Type of Operatiori: Swine Poultry Cattle
Design Capacity: 1500 Number of Animals on Site: _ t 50 D
DEM Certification Number: ACE DEM Cei-tification Number: ACNEW
Latitude: 34- - 4_' 17, IVII Longitude: 3) ' S7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm eve:.t
(approximately 1 Foot + 7 inches) Yes r Nv Actual Freeboard. Ft. � Inches
Was any seepage observed from the lagoons)? Yes o No Was any erasion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crap adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinzs? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of liSGS Blue Lire StrLam'! Yes ❑ No
Is animal waste land applied or spray irrigated within 25 Feet of a US OS lkl ap Blue Line? Yes ❑ �i a
Is animal waste discharged into wate-s of the state by man-made ditch, f!.as`»ng system, or other
similar man-made devices? Yes o No If Yes, Please Expl:_
Does the facility maintain adequate waste management records (;folurnes of ma,-iure, land applied,
spray irrigated on specific acrea e with cover c:�:n]? Yes r 1da
Additional Comments: '- -0' � V1 1 e-6) -Jr—C]
11 Con r -'ciht
V_ 0,t
t i V �n�GS Cle2reA,❑rm:�( 5 Con n ecf ,
10 lnspe; Ior I alne -� .. _._
S i Mtn a.ut•e. z �-- �-- �.
Us, .%it:.ichments if Needed.

,4 .
REGISTRATION FORM FOR ANIMAL FEEDLOT CPERATI(
Department of Environment, Health and Natural ne
Division of Environmental Management
Water Quality Section
r
t
If the animal waste management system for your feedlot
designed to serve more than or equal to 100 head of
horses, 250 swine, 1,000 sheep, or 30,000 birds that a:
a liquid waste system, then this form must be filled ou•
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in
deemed permitted by DEM. Please print clearly.
Farm Name: a',() cza�u]
Mailing Address:�5
County:
Owner(s) Name:
Manager (s) Name -'r _ "-
Lessee Name
ZI
Phone No.
Farm Location (Be as specific as possible: road names direction,
milepost, et- .,) : _Lom -t+ 7 o�- c: L ( "i ` lam- r,—�—��.
Latitude/Longitude if known
Design capacity of animal waste management system (Number and type
of conf_npd animal (s)
U
Average animal popu at ion on the farm (Number and type of animal (s)
raised) :
Year Production Began: jlASCS Tract No.:
Type of Waste Management System Used: _-
Acres'Available'for Land Application of
Owner (s) Signature (s):
t e : ) A
TE.4-2-�-9
DATE:
(.? -p q - aq-9s)

State of North Carolina
Department of Environment, ;
Health and Natural Resources
ti
Division of Environmental Management
� T T
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
February 17, 1994
Mary Sasser
245 Murphy Store Rd.
Rose Hill NC 28458
Dear Mr. Sasser:
This is to inform you that your completed registration form required by the recently
modified nondischarge rule has been received by the Division of Environmental Management
(DEM), Water Quality Section.
On December 10, 1992 the Environmental Management Commission adopted a water
quality rule which governs animal waste management systems. The goal of the rule is for
animal operations to be managed such that animal waste is not discharged to surface waters
of the state. The rule allows animal waste systems to be "deemed permitted" if certain
minimum criteria are met (15A NCAC 211.0217). By submitting this registration you have
met one of the criteria for being deemed permitted.
We would like to remind you that existing feedlots which meet the size thresholds
listed in the rule, and any new or expanded feedlots constructed between February 1, 1993
and December 31, 1993 must submit a signed certification form (copy enclosed) to DEM by
December 31, 1997. New or expanded feedlots constructed after December 31, 1993 must
obtain signed certification before animals are stocked on the farm. Certification of an
approved animal waste management plan can be obtained after the Soil and Water
Conservation Commission adopts rules later this year.
We appreciate you providing us with this information. If you have any question about
the new nondischarge rule, please contact David Harding at [phone].
enc:
Sincerely,
/-n Steve Tedder, Chief
Water Quality Section
P.O. Box 29535, Rdeigh, North Carollna 2762643635 Telephone [phone] FAX [phone]
An Equal opportunity Afirma ire Action Employer 60%recycled/ 10% post-conwmer paper

REG I S TFLkT iON FORM FCR ANIMAL F EEDLCT OP RATICW
Department of Environment, health and Natural :ReS,4u'rces' -]V
Division of Environmental Management" ,':;, ,
Water Quality Section
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be filled out and mailed
by December 31, 1993 pursuant to 15A NCAC 2H.0217 (c) in order to be
deemed permitted by DEM. Please print clearly.
Farm dame: 1?2gr2 005
Mail'-ng Address:
County:
Cwner (s) Name: 11)9f,
Manager(s) Name:
Lessee dame:
re j
zIP
Phone No.
rcr,
Farm Location (Be as specific as possible: read jrames, direction,
milepost, etc.) (��� a'� Sl From Wallace take NC 41 S and turn Lt. at
Baptist Church onto Airport Rd, cross
Rock Fish Creek, follow SR 1307 2.3 miles
and turn Rt. onto SR 1001, go 0.6 mile
then turn Lt. onto 5R 1300 (Englishtown
Rd), go 3.3 miles to farm entrance on Rt.
(TT-18 min.; TD=12 miles)
de if known: 0-60 �a3 -D � -�'f `L]� -- - - • - -
esic:a c::caY_tl. o? a::i^al waste management system (Number and tvve
cf conf in e d anima1(s) ) :_33'-__�5cm-��. .t ��r r-•- c�w«�,,,Q
Average animal population on the farm (Number and type of animal(s)
-raised) z-
Year Production Began:_ ASCS Tract No.: #1W d �O
- - n /.
Typ,q o.�. Waste Management System Used:
Acres Available for Land Application of waste:
Owner(s) Signature (s) :
W.a
DATE:

iState of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmentai Management
Jcmes B. Hunt, Jr., Governor
Jonathan B. Hawes, Secretary
A. Preston Howard, Jr„ P,E„ Director
March 22, 1994
Mary Ann Sasser
245 Murphy Store Rd.
Rose Hill NC 28458
Dear Ms. Sasser:
This is to inform you that your completed registration form required by the recently
modified nondischarge rule has been received by the Division of Environmental Management
(DEM), Water Quality Section.
On December 10, 1992 the Environmental Management Commission adopted a water
quality rule which governs animal waste management systems. The goal of the rule is for animal
operas ons to be managed such that animal waste is not discharged to surface waters of the state.
The rule allows animal waste systems to be "deemed permitted" if certain minimum criteria are
met (15A NCAC 2H A217). By submitting this registration you have met one of the criteria for
being deemed permitted.
We would like to remind you that existing feedlots which meet the size thresholds listed
in the rule, and any new or expanded feedlots constructed between February 1, 1993 and
December 31, 1993 must submit a signed certification form (copy enclosed) to DEM by
December 31. 1997, New or expanded feedlots constructed after December 31, 1993 must
obtain signed certification re a ni Mg l rg I tg g k on th p fa rm. Certification of an
approved animal waste management plan can be obtained after the Soil and Water Conservation
Commission adopts rules later this year.
We appreciate you providing us with this information. If you have any question about
the new nondischarge rule, please contact David Harding at [phone].
enc:
S incerely,
/-n S teve Tedder, Chief
Water Quality Section
P.O. Box 29535, Rdeigh. North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Qpportunity Affirmative Action Employer W% recycled/ 10% post -consumer paper

I M•
REGISTRATION FORM FCR ANIMAL FEEDLOT OPEP �,CO-=j
Department of Environment, Health and Natura �esaurces. ; ±
Division of Environmental Managemen
Water Quality Section r�3n�
If the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattie, 75
horses, 250 swine, 1,000 sheep, or 30,000 birds that are served by
a liquid waste system, then this form must be f lied out and mailed
by December 31, 1553 pursuant to 15A NCAC 2H.0217(c) in order to be
deemed permitted by DEM. Please print clearly.
Farm
Name :_In4 r,�
14I,4
4 45 st +...,.
_.
hail''-ng
Address:
7r—
u�
f�,,
zIp
County : 1 Phone No. -
Owner (s) Name: ry 1`12 , AJ,3P_ f
Manager (s) Name S Mj If _i cR'0RVG -
Lessee Name:
Farm Location (Be as specific as possible: road names, direction,
f_ A'C'.0 //.. ._.- 11 n,A M.O. n1
i po t C Turn Lt. onto 5R 1148 (Rosemary Rd) go
4.5 miles to farm entrance on Rt. (TT=8
min.; TD=5 miles)
if known: 0 8 S P--
Design capacity of animal waste management +system (Number and type
or. confined ani.mai (s )] /J�06 L.2--
�9-4
a�h.
Average animal population on the farm. (Number and type of animal (s)
-raised) __L�0_ � b D __.LW i r, e 'C' � iv- 4I "P ..._ .nu:k I a; -
Year Production Began: Q ASCS Tract No.:/
Type of waste Management System Used: -.sue_, Ir`ri� 4+ la N
Acres Available for Land Application
Owner (s) Signature (s) : DATE :%%l ^`
DATE:

,. State of North Carolina
Department of Environment,
73MA
Health and Natural Resources 0 v
Division of Gnvironmer,tai Management
Jcmes B. Hunt, Jr., Governor A±dMft9%=0bXW= 41�� INIM
Jonathan$. Howes, Secretary ID a
A. Preston Howard, Jr„ P.E.. Director
March 22, 1994
Mary Ann Sasser
245 Murphy Store Rd
Rose F iII NC 28458
Dear Ms. Sasser;
This is to inform you that your completed registration form required by the recently
modified nondischarge rule has been received by the Division of Environmental Management
(DEM), Water Quality Section.
On December 10, 1992 the Environmental Management Commission adopted a water
quality rule which governs animal waste management systems. The goal of the rule is for animal
operations to be managed such that animal waste is not discharged to surface waters of the state.
The rule allows animal waste systems to be "deemed permitted" if certain minimum criteria are
met (15A NCAC 2H .0217). By submitting this registration you have met one of the criteria for
being deemed permitted.
We would like to remind you that existing feedlots which meet the size thresholds listed
in the rule, and any new or expanded feedlots constructed between February 1, 1993 and
December 31, 1993 must submit a signed certification form (copy enclosed) to DEM by
DeCCIU der 31. 1997. New or expanded feedlots constructed after December 31, 1993 must
obtain signed certification before animals are stocked on the farm. Certification of an
approved animal waste management plan can be obtained after the Soil and Water Conservation
Commission adapts rules later this year.
We appreciate you providing us with this information. If you have any question about
the new nondischarge rule, please contact David Harding at [phone].
enc: .
Sincerely,
-a444��
Steve Tedder, Chief
Water Quality Section
P.C. Box 29535. Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/ 10% post -consumer paper

•
Site Requires Immediate Attention: Vv
Facility No. —?
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 1_� y5—
Farm Name/Owner
Mailing Address:
County:
Integrator: — - t re C ti� N Phone: f �� �L a ltq 2-1
On Site Representative: , 2 ��-c tz- W e ( rtit _ Phone:
Physical Address/Location: 3 f Ce r r vim- C- i
• n. 'G1Z u w� N C '
Type of Operation: Swine Poultry Cattle
aFhUs_0f
Design Capacity: I, �UR2_ Number of Animals on Site:��-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �' y ' 1 Longitude: ��]' �" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have suffici t freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes orgy Actual Freeboard: _Ft. Inches
Was any seepage observed from the iagoon(s)? Yes or No Was any erosion observed? e or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes oro
Crop(s) being utilized: _L)J P;
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? fe or No
100 Feet from Wells?6�s 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 or N 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 o;rl�o
Additional Comments: _7 La -a rjzrN( a ko k V-1
Z
3r�i��..+'�1.►� " ■'� .t�i74'l11r����;�r�1L�i�. a■�■'�rre�l�a'y.
Inspector Name
S ign ature
cc: Facility Assessment Unit
Use Attachments if Needed.

•
•
State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr. Division of Environmental Management Jonathan B. Howes -
Governor
Certified Mail # Z 441 2.605
RETURN RECEIPT _REQUESTED
Mary Anil Sasser
245 Murphy's Store Road
Rose Hill, North Carolina 28458
Dear Ms. Sasser:
Water Quality Section
August 10, 1995
Subject: Mary Ann Sasser Farm
Facility Number 31-465
Duplin County
Secretary
On August 9, 1995 staff from the Wilmington Regional office of the Division of Environmental
Management inspected your animal operation and the lagoons serving this operation. it was observed that
one lagoon had only six inches of freeboard and there was evidence of a recent overflow at this location.
There was extensive tree growth on dike wall. The dike wall was very narrow and in need of repair. A
4" green PVC pipe was found installed through the dike wall. A screw in plug was in the discharge end
of the pipe.
The following corrective actions should be taken: NRCS guidelines for Best Management Practices
require that animal operations maintain at least one foot of freeboard plus additional storage to contain the
rainfall from a 25 year 24 hour storm event. This totals approximately 19" of required lagoon freeboard.
Your lagoon should be pumped down and spray irrigated on a suitable cover crop to maintain at least 19"
of freeboard. It is recommended that the lagoon be pumped low enough to allow repairs to the dike wall
to be performed and to allow the safe removal of the 4" discharge pipe.
To remain a deemed permitted facility, all corrective actions must be made within seven (7) days.
Failure to do so may result in the facility losing it's deemed permitted status, requiring a certified waste
management plan and certification form for the facility to be submitted prior to the December 31, 1997
deadline, and being required to obtain an individual non discharge permit for the facility.
127 Cardinal Drive Extension, Wilmington, N.C. 28405.3845 ■ Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

Mary Ann Sasser Farm F
August 10, 1995
Page Two
Please be aware it is a violation of North Carolina General Statutes to discharge wastewater to the
surface waters of the State without a permit. The Division of Environmental Management has the authority
to levy a civil penalty of not more than $10,000 per day per violation.
When the required corrective actions are complete, please notify this office in writing at the address below.
If you have any questions concerning this matter, please call Jim Gregson or Dave Adkins at (910) 395-
3900.
Sincerely,
Specialist I
cc: Dave Adkins Regional Water Quality Supervisor
Duplin County Soil and Water Conservation District
Duplin County Health Department
Tom Jones - NC Division of Soil and Water Conservation
Operations Branch
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