310655_INSPECTIONS_20171231

2 V
NOHTH CAHOLINA
Department of Environmental Qual

`Type of Visit: grComplce Inspection O Operation Review p Structure Evaluation Q Technical Assistance I
(Reason for Visit: Qzo'outine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: (j O Departure Time: E2;1�1 County:
Farm Name: 3104n 13ro A U—S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Jd(j1p,` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
FNon-La
Design Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
er
Dairy Calf
Feeder to Finish
C
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D_ . P.oultr. Ca aci P.o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes eNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (tf yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes Er NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yesro[03
NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

�Facility Number: jDate 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 o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): cj
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ 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 ❑ 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): _1{"1 e. r rm' d S% 11 h J'
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LEI 1` NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes gN ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZN. ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1 " Rainfall Inspections ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued
t-.

Facili Number: - Date of Inspection: I i? -2z— j 7
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 No ❑ NA [:]NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[]No
[DNA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Cammen'ts (referto question #) Explam,any YESFanswers and/or sny additional recommendations=or any other coriiinents:"
Use-drawrn s of facdi, to ;better ex lam.situa#rons: use additions[ a es as:neces
fa t3- P ( P g sary,)`
Reviewer/Inspector Name: 2
Reviewer/Inspector Signature: JLt S lew f
Page 3 of 3
Phone: Ci/ g% I t Y 200
Date: I J- 2,2 — 1 '7
21412015

Type of Visit: JaTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Od Departure Time: County: , up��
Farm Name: v !_lU4 6 E a s Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Phone:
Title: Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: 11_ko�e
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pap.
Design Current
Cattle Capacity Pop.
DallyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
I) . P,oultr.
La ers
Non -Layers
Design
Ca aci_
Current
P,o
Da' Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar¢es 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 DA R)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ,] No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
[:]Yes
PNo
❑ NA
❑ NE
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 JE No
❑ Yes PNo
❑ Yes �No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of ins ection: y A
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 o ❑ NA ❑ NE
the appropriate box(es) below. 91
[] Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes 1p"1110
❑ Yes 0No
❑ Yes XNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
KN o
dNo
No
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA - ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
J1015 61' ;2 0 0/7
WA
I0/4/ y l ,� l� �c�Yl ba�r.� Ate&/ t" tVZ&*- . 149 cri er
t NPV �J un fir/
X0/s. c �t
leorrol. y� rd /s '5c"'A'�3
12
/0 A, t
i L M rvd-ol 19ty
yov
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: L
/4a 14

[Facility Number: - Date of inspection:
Waste Collection & Treatment
44. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No ❑ NA 0 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d V
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2No
❑ 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
[ZNo
❑ 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
0 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
�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 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
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vf No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
1;21No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps []Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ 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 En o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Vo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Type of Visit: erCompliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: JOVoutine Q Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit:
1 I
Arrival Time: eparture Time: County:
Regioi[:-C/�ZZ
Farm Name:
�] �j Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Finish
7ieeder
et Poultry
La er
Design
Eapacity
Current
Pop.
Design C►urrent
Cow
Feeder
Non -La er
EllDai
Dai Calf
o Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Di, P,ouitr.
Layers
Design
Ca aci
Current
Plo ,.
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turke s
i urkey Poults
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes J'No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
[-]Yes No
❑ Yes [2eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continaed

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes ❑ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes JZ 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 B 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)
'12
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ,Yes RfNo ❑ NA ❑ NE
maintenance or improvement? 1'�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P 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
[� o
❑ 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
jo No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
O No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ NA
❑ NE
the appropriate box. -
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box b ❑ Yes ❑ No
❑ Waste Application CZWeckly Freeboard ❑ Waste Analysis oil Analysis ❑ Waste Transfers
5 'Rainfall ❑ Stocking ❑ Crop Yield P 120 Minute Inspections JZ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
6
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the pern t? ❑ Yes m No ❑ NA ❑ NE
4.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes m No 0 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes
❑ No
m NA
❑ NE
❑ Yes
VI No
❑ NA
❑ NE
❑ Yes lam-' No ❑ NA ❑ NE
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes Vj No ❑ NA ❑ NE
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
141 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary). MX1'&-_A)rK
N WES
710
q1 -3 ol
zeg
s
I od 5arn ' t
i °� Ive w ��►� ���
_� be r6P'p&,lC
AC
d1k Wall
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
r i\) e ec9 necJ �'ge,
CeS Cede(/ a5 [r��,b�'a fa✓rs
p Gr�a��ze Cyr«
Page 3 of 3 - .,Cl�l 1 operw ore Cf V( /1 a;95haa - a' "`r'Prk ., .h&.-, t n Qel-G4ee-1-
Phone: 9/fjl 7
Date:
21412011

Facility Number 3
_AEhvision of Water Quality
Q Division of Soil and Water Conservation's
O Other Agency
Type of Visit JO'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,210utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Y/Xlv—;;"
rrivalTime: ' Q eparture Time: County: Region:Farm Name:Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Z7
Back-up Certifcation Number:
Latitude: [= o = t 0 « Longitude: = ° = 6
•. _ >_.: ,,. ._ , .� �= �»�.�.:M „„,ram ix`�
Design Current Design Current�Des�gnCrre n
Swine Capacity. Population "` "Wet Poultry `"'"Capacity 'Population." Cattle °Capacity u[atyon
❑ Wean to Finish PEI]Layer ElDai Cow
Wean to Feeder Non -Layer aityCalf
❑ Feeder to Finish a R Dairy Heifer
c ❑ Farrow to Wean .Dry. Poult ❑ D Cow
r1
❑ Farrow to Feeder " " ❑ Non -Dairy
M ❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
El Gilts ❑ Non -Layer
s ❑ Beef Feeder
El Boars El Pullets ❑ Beef Brood Co
77.­❑ Turkeys
Other = ❑ Turkey Poults �•,
❑ Other ❑ Other
.� � � Number5of,�St„�rues
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
v-
Page 1 of 3
❑ YesNo ❑ NA ❑ NE
e.
El Yes WNo
El NA
[I NE
❑ Yes j2l�o
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes fiEt►No
❑ Yes �,ETL
❑ NA
❑ NE
❑ Yes ETNo
❑ NA
❑ NE
0
12128104 Continued

Facility Number: - Date of Inspection: [
31,aste collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o
iiVNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes dNo
❑ 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)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes �oNo
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes XNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes J'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy 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 JE?'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;;3mo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;"No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
;;�7No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[;J.�4o
❑ 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.
Oyes
o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis
11 Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
LNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
TTTTT��� �No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of inspection:
;4. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes C31No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes JZ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the tine of the inspection did the facility pose an odor or air quality concern? ❑ Yes 7No ❑ 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 J[a No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes j� No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond El Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes )ZfNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes RTNo
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
_]Yes CZNo
❑ NA
❑ NE
Comments (refer to question '#): Explain any YES answers and/or any, additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pales "as necessary).
LW1J�
Yv-A niphlie
Pe
4,e
,:�i-6Hrn C c?)je e
-reCk, 6- &5
,f/o --7 r6 r 739 �
910- V70 - 003 0.
Reviewer/Inspector Name:
Se. le(Q mon !� ®0�'-01
• ' o n 1 `i, arm w �s Jc. �-�-''� s. � .ems a. z,
' Pot S b [ 1S—
. mpj,��3 e-ve,,J-5. hqve_
b G() Ve(-
4)(t3t1c_ ctr4l�slj ;2-o13,-
avoid a n6h(e tholes &i
&)I !/ a (sa AcaVe Azoe
�/
Reviewer/Inspect, ,Signature: / - / L/ c:�
!T -
Page 3 oj3,� �O p1✓1�V1 CG[2 G�c/�CQ O✓t �^Q f'
JFdfdZCLV1 S rciee S. � I[iHe LA, 51 a /rf eove/
Phone:
Date: �Z
roc.A, "A4/2011
�vn

J
Type of Visit ,j�Knmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _-P4outine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name;
Owner Name:
Mailing Address:
Physical Address:
Time: _` 3 Aparture Time: County: _' Region:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
�ypPhone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = I = 4i Longitude: = ° 0 d =
di
Design Current
Design
C►urrent
Design C*urrent
Swine
Capatypulahon
Wet Poultry Capacity
Population
Cattle Capacitya Population
❑ Wean to Finish
❑ Laver
❑Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai 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
Beef Fee der
❑ Boars
❑El
Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number
-Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;0No
❑ 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
Rof o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of inspection E'
"WasieZ ollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [Mo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
P-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
El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
9No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
[7No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
5KNo
❑ NA ❑ NE
maintenance/improvement?
i t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
JZNo
❑ 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
P'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
;;rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
)2TNo
❑ 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):
41-) Pj&,3,e_
-- e e- -oo ll� L q [0 '- 3S-0 •- cam 00y
Reviewer/Inspector Name -zzlff
P Phone:
Reviewer/Inspector Signature: Date: [
AW
1212810 Continued

Facility Number: Date of Inspection
`Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
6Waste Application El Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;jNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;3 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
aO No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P1No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[/No
❑ NA
❑ NE
Additio.nai Comments and/or Drawings , r
-7316S /1
0,J 0 cam+ t r...kt..i Lj" t
� �S
,fie c,6
. ��r 1Ci v� � �-z �- ;�-�.�� c ►�-e:-+-��� d�c DUI �
3 f- e,�C% �
,. 13t -nary - vto Ca 100ta •VLah.S 4- Sol 1 ke-4 -For ace
R e ,
Page 3 of 3 %_j 12128104

T
Type of Visit P'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / - I Arrival Time: Departure Time: County: Regionf/"z
Farm Name: ' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _S QQ
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
Phone:
one No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = A = « Longitude: 0 0 = ` 0 „
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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: F]
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,Jallo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
;-No
❑ NA
❑ NE
12128104 Continued

FacilityfNumber: 31-7—
STI Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes -0'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ 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 AD'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 _2No ❑ 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 .a No [I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes E] 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
g No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ElNA ElNE
maintenance/improvement?
ep
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C] 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 Drifl ❑ Application Outside of Area
12. Crop type(s) r /�l � -56
13. Soil type(s)--
14. Do the receiving crops differ from those designated in the CAWMP?
,2 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
c.J�q F-� � C'�JrG�/ � ✓i sT
Reviewer/Inspector Name L
Reviewer/Inspector Signature:
Phone: 7
Date: /
17,710.
Continued
M, ,

Facilit3; Number: Date of Inspection / G
r
Required Records & _Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )�!rNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropirate box.
❑ W1JP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking OCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes .,0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes E] No
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
.IN£
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes --n No
❑ NA
❑ NE
29,
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes .EI'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 2-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes _[]-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E2-no
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 1.No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a t,) Please- )&f C1gr-7 ylel .s a,;' alpqvve
--
8e Sum fv S
�l 12-1,4 S~ e� .Sor� e- CtJa Ar
I2128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit Qf Routine Q Complaint Q Follow up O Emergency
Facility Number Date of Visit:
© Permitted 0 Certif ed E3 Conditionally Certified ❑ Registered
Farm Name: » xd��%...... .
Sfication O Other ❑ Denied Access
FIm
Q Not rational O Below Threshold k,
DateLast Opera f or A ve Threshold:
County:
Owner Name: »»» »_ »_ » »_.». .» » » » . » Phone No: ___----- ...-
mailing Address:
Facility Contact: . » » » » » .._». W Title:. _
Onsite Representative:;
Certified Operator:
Location of Farm:
» .. �Phone No: . .
Integrator:
Operator Certification umber•
L
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude �• �d �C.4 Longitude • 9 Ou
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes .Ada
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 O'go
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JaKo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q'M
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: . _ _ .t
Freeboard (inches):
12112103 Condnued

Facility Number: 3 t 5' 5T Date of Inspection
5. Are these any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes J214o
`i seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ;R•No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DViWQ)
7. Do any of the structures need maintenancehmprovement? ❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? [:]Yes Ja'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes P-No
elevation markings?
Waste Aanlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? If yes, check the appropriate box below.
[I Yes J3 No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ ui those designated in the Certified Anflnal 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 ,O No
16. Is there a lack of adequate waste application equipment? ❑ Yes PNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes EJ-Ro
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, [IYes )'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes PNo
Air Quality representative immediately.
C (re#erm question } a�v i aa5wets sad/or. sup or_ aay¢ather off.
Zise draw of fac�ky better ezplam s tnat�c s. (use:additiaasl p gas m
F _..-
ad _ Field Copy ❑Final Notes
tr
II// 11 �
j}'1i 4, � c: r c
S
My
ReviewerllnspectorName
Reviewertor Signature: ��_ Date:
12112103 Corufnued

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

Division of Water'Quality 0...'
- 0 Division of Soil and Water Conservation
O Other Agency
(Type of Visit J&Compliance Inspection O Operation Review O Lagoon Evaluation I
IReason for Visit O Routine O Complaint Emergency Notification W,Other ❑ Denied Access
Facility Number Date of Visit: -`�41- Time: /(�4 ►►-,
0 Not Operational Q Below Threshold
® Permitted aCertified (] Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: }................................
...... �1..4.k�.........!��11.T/�.P.✓..�.......................................................... Count,.
Owner`Tame:...... 4.; l.................... .... Phone No:......................................................................................
.... .......... .....................
NailingAddress:...... ... .... ...............................................................................
FacilityContact: ............................................................... ............... Title:................................................................ Phone No:...................................................
Onsite Representative: ......... li%f! rs .... I ..... Integrator• br
CertifiedOperator: ................................. ................. ............................................................. Operator Certification Number:..........................................
Location of Farm:
..
IT
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Design Current
Swine Canacitv Population
❑ Wean to Feeder
❑ Feeder to Finish
2
❑ 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 FEE] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons % ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds 1 Solid Traps I I JEJ 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-tnade? ❑ Yes ❑ No
h. li'dischawc is uhscrvrd. did it reach Water of the Staic'? (If yes. notify DWQ) ❑yes ❑ No
c. If dischar e is observed. what is the estimated flow in gal/ruin'?
d. Does discharge hvpass a lagoon system? (D' 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 nNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X No
Structure l Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier: ......................................................................................................................................................
Frcchoard (inches): Z46
05103101 ___ Continued

Facility Number: G
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 pan 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 Anulication
❑ Yes W No
❑ Yes [4 No
❑ Yes rM No
WY
❑ Yes P No
❑ Yes 15Q No
10. Are there any buffers that need maintenance/improvement? ❑ Yes J No
11. Is there evidence of over application? ❑ Excessive /Ponding El PAN ❑ Hydraulic Overload ❑ Yes j No
12. Crop type APTM u.NLt�
- /'474 d' 4y / �� Dy�✓SPP 1 %� G- uA �L�'PSG�
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 [A No
b) Does the facility need a wettable acre determination? ❑ Yes K No
c) This facility is pended for a wettable acre determination? ❑ Yes f No
15. Does the receiving crop need improvement'? ❑ Yes Z No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Rewired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[&No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
NJ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
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
[K 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
M No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JZ] 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 drawings of facility to better explain situations. (use additional pages as necessary): ❑ Field Copy ❑ Final Notes
(r'rowP✓ ",f,4 _?j�D Pkr, on --TrQg Z 44) elms �o. 13P"'Atu rl t., 04-fe f,✓Pn 1 k-
2.50, J)► o%✓ app)j`c.4f�)vt his 6 1c. &of I
A _ (yoW e.,- will 64Ar+ P tLjl. ,-� 7 WAslz qro ►null quwto4y! L� /i/v) �-i �e von t lies, --
C-Om It`lxK��Ge_ 0q 0 w1ay (al l n �D u�1 't7ze 5 6/t � f 512n p!b YW l 20 0
I�(Lf�
Y f7rWP� _ 0k ��l ym�ld� �z/j , /t��Ltl r Jed ,6 ih '77fti
Reviewer/Inspector Name J feh c�
Reviewer/Inspector Signature: Dad: 9 Z
V
05103101 Continued

.r .
Facility Number: 31 _ 4V Date of inspection 1 9 Dz Printed on: 5/4/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below .moo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Wo
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 D5No
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 MNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P5No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional omments an orDrawings:
a-�11dc� �i� -7n.5 r ZT-0 11PI
pew, .1.•t s�O. v
Ilk Z G>zf SD�r! re
"n 1� k
5- / ,
Vk ���
�te� s �to
re - do -4e Id �v�•, d�.is
/u4dt
J
05103101

(Type of Visit 45 Compliance Inspection 0 Operation Review O Lagoon Evaluation I
Reason far Visit 6Routine ()Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: i % Time:
rO Not Operational 0 Below Threshold
11 Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: _ 7 Z ,SA0 At ✓ Integrator: /0- i�'/
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 I� G u Longitude 0 4 u
Swine
Design Current
Ca acity P.o put ion
Design Current Design Current
to I try Ca aci P,o ulation Cattle Ca aci P,o ulation
Wean to Feeder
z
❑ La er
❑Dai
❑ Feeder to Finish
10 Non -Dairy
❑ Farrow to Wean
❑Other
Total Design Capacity
T©tal SSLW
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
Holding Ponds / S©lid 'Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VINO
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 J4No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes '9[No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 19 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %
Freeboard (inches):
05103101 Continued

Facility Number: 3 — Date of Inspection �
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes WLNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes � No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Aunlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
99No
11.
Is there evidence of over application? Excessive Ponding El PAN ❑ Hydraulic Overload
❑ Yes
® No
12.
//`/i�❑
Crop type !��l a'OAFi C/7XV
,
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
r�.,"
Oi 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
[qNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
9LNo
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
[KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
EQ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
8 No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[Z 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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
i— f faeility to�better�eaplain sltuatitins:r(use ad€itttonalpages as'necessary) ❑ Field Copy ❑ Final Notes
rY<</� � �'`''��lo� 61t-chi ��°'� irt�[K/��ia► !cam/l�
Reviewer/Inspector Name .G.C/L.V,
a
Reviewer/Inspector Signature: Date: Z 7 2
05103101 Continued

Facility Number: Date of Inspection
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes PSNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes E�JNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes MNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ElYes ,bNo
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 Jn No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes BNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 91 No
;Additional Comments and/or Drawings:
05103101

Ihv�sxon of Water Quality'
Ihynion of Soil andMater Conservation
Q Other Agency
r .x
Type of Visit CLCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit &Routine O Complaint O Fallow up O Emergency Notification O Other, ❑ Denied Access
Facility Number
Date of Visit: � �/ Time: JJ'1 Printed on: 7/21/2000
31
Q Not Operational O Below Threshold
Permitted 13 Certified Q Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ...................
Farm Name:�tt.!#. �JiP.�`J... �t..............................................
........ ..... .................................................................... County:._........Aul!.'?......
OwnerName: .......... r'-r#. ....p'' 4 fSyl.......................................................................... Phone No:................................................................................._.....
Facility Contact: .............................................................................. Title:..................... Phone No:
MailingAddress:.......................................................................................................................�.................................................. ...............
OnsiteRepresentative: ....... QPy............. Integrator:.,.., f%v/�/ky(_ .
Certified Operator;,,,,,,,,,,,,,,, Operator Certification Number:..............................
Location 'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • C�` 1t Longitude • & 69
Design,' Current
(?ono�.i#v Pnnnlsfinn
R Wean to Feeder
Feeder to Finish
"+ Farrow to Wean
= Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current
Poultry Caiacity Population Cattle.
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW'
Current
_�Numberh of Lagootas ,
-
❑ Subsurface Drains Present
110 l.ag^m Area
❑ Spray Field Area
P©nds ! Solid T Ho
llding raps.
-
.. ❑ No Liquid Waste Management System
,
t
_
Discharges & Stream ImpaciS
1. Is any discharge observed from any part of the operation?
❑ Yes
Rd 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/ruin?
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
[8 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
El No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
j9 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................................................................................................ ....................................
....... I ...........................
.
Feeehoard (inches):
5/00
Continued on bark

Facility Number: "fir — Date of Inspection 2(i l Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [2!.No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 19 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
Q�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
.01 Yes
WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[&No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
29No
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?
JEYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
-1KNo
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)
t9 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
NLNo
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
CE3.No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[ No
: Rio yiolafiQris :ai def eiewies were noted iluWifMi this'visit: - Y;oo wit! - eeeiye iiti futtji r . .
correspondence abouA thiit. s'vis...... .
i5 Lime. 4 n e)i.
-9,4 rS O-3 Z y 2.004 T")) Sks,/hf, ,
I&
6,160;1 lam" 04- AQf-,
,� Lu fpvn 5 P f *Aen G127 !.= z L
� (,rjmf Ile-eds * 6e
4 CiIG- -& taA9 Gool,',elf, 1A5%n4 iTtme_ O ca Ac A,,- X 6
Reviewer/Inspector Namer�/p
Reviewer/Inspector Signature:
Date:
5100

Facilrty'Nun ber: — Date of Inspection 2 zQ
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
Q�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
IN 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
2;No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
J'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
9No
0
3/23/99

�. _ b D Division of Soil and Water Conservation -Operation Review
_�
:e. Division of Soil an-W dater.Conser*ai i ii 'Compliance Inspeetioa -°; , v
ry ~ { Division of Water Quality Comp)sance Inspecttod_
'Other Agency, Operation Itev>lew� Y g
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection aQ 24 hr. (hh:mm)
Permitted © Certified [] Conditionally Certified © Registered [] Not Operational Date Last Operated:
..........................
r
Farm Name: G '1 !Zj`5�.................................... County: -..... ..t.L......................
.. .............................
Owner Name: ................................................... Phone No: ..................... .
FacilityContact:.............................................................................. Title:...................... .... Phone No:....................................
MailingAddress: ....................................................................................................................................................................................................... ..........................
Onsite Representative:..w............................................................................ Integrator: ......... ✓,�'..�.............................
..................
Certified Operator: ................................................... ............................................................. Operator Certification Number: •.........................................
Location of Farm:
i
......................................................................................................................................................................I.................................................................................................. 1
Latitude ' 6 Longitude • 6 66
�Desi n Current "Desi. . .: g gn C�irrerit Design Current
Swine , Poult r _ u. :,.
Ca achy Po ulahon 13' _ Capacity, Po elation Cattle- Capacity Po elation
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish <' ❑ Non -Layer r= ❑ Non -Dairy -
❑ Farrow to Wean x.- ._. ,...., -... :.r
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish - Total Design Capacity
Gilts,
-
❑ Boars Total
;
Number of Lagoons m ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
.y _.
Holdu><g•Pvnds / Solid Traps ❑ No Liquid Waste Management System LL
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4No
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 Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes (rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Struciure 4 Structure 5 Structure 6
Identifier: n' �
Freeboard(inches): ......... ....................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes RNo
seepage, etc.)
3/23/99 Continued on back

FacIlity Number:'j) — S Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 4
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence f ove plication? ❑ Excessive Ponding ❑ PAN
12. Crop type lYj , 1 Sq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
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?
. . i. . V1. ttQnS or &ficjendo WQTC lip @a diWifni this•vlslt;- Y:ou will-teceive Rio further
coriespon[�eHe agouti this visit. .. . .. . . . .
❑ Yes XNo
❑ Yes XNo
[:]Yes XNo
❑ Yes D�No
❑ Yes D�No
❑ Yes X No
❑ Yes jXNo
❑ Yes DdNo
XYes ❑ No
❑ Yes jj No
9Yes ❑ No
❑ Yes XNo
JZ Yes ❑ No
❑ Yes NfNo
X Yes Q No
❑ Yes Ej No
❑ Yes jV No
❑ Yes CR No
❑ Yes PNo
❑ Yes "No
❑ Yes 0 No
Coriim-ents.(refer to uestian #)-: Ex lairi an YES answers a'hd/orany recommendations or.any-other eomment&tE
Usedrawings of facility to°better explain situatibiis (iise additional pages as necessary) q _
1pLA1''�2 1r�tti Q
1�� ii ✓ n� II
Reviewer/Inspector Name , . 2a -1
Reviewer/Inspector Signature: Date: F— 0-22-1
3123199

5X Facility Number: — Date of Inspection
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below TIYes ❑ 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 0(110
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 ONo
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 kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes NqNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? XYes ❑ No
itiona..._. enr ._ravvings•
..L � oin _ .r _ �ts and/or .
A.t
3/23/99

r'
r" O'Drv�s�on ofSoiil and Water Conservaaon:=TOpera4on
[y Divisx►n of$oil and Water Conserva4ots ' Compliance 1(nspectron r- :� '_
-
Drvision of Water Qualrty Compiiance L�spectlon a s ' s
-., ... Other °A,gency"� Operation Review & w _ x eT
UR Routine O Complaint Q Follow-up of DWQ inspection Q Follow-ue of DSWC review O Other
Facility Number Date of Inspection L�
Time of Inspection lI 3wJ 24 hr. (hh:mm)
© Permitted X Certified © Conditionally Certified [3 Registered U3 Not Operational Date Last Operated:
Farm Name: '
.................. ........
�Y-`--s.... 5.............. ............................ County....... .]1..... �.� 1.............................
Owner Name
Facility Contact:
Mailing Address:
.. Title:
Phone No:
Onsite Representative: _.. ....... Integrator
Phone No:
Certified Operator: ................................................. : . ............................................................. Operator Certification Number:..........................................
Location of Farm:
.... ..................... ............... _ .... ._ .... ..............
Latitude ���° ��° Longitude
Design : .,.:Current -
Swine °Capacity- Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design-_ `.Ciient
PoultryCattle
Capacity _: Population 'Ca aci ' Po ulatiou`;
❑ Layer ❑ Dairy
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total DeOgn Capacity::-
Total'SSLW .:,
Number of Lagoons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present J110 Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
�C
Discharge- & 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'? (II' yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway -
Structure 1 Structure 2- Structure 3 Structure 4 Structure 5
Idcntitier: -7
Freeboard (inches): ......... 1r
......................
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Dd No
❑ Yes
D�No
❑ Yes gNo
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O, No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 k — fn Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes b�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes NNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes MNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes tKNo
16. Is there a lack of adequate waste application equipment? ❑ Yes C�No
Required Records &_Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NdNo
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
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
NfNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
YNo
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
tNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 5(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JZ 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
�Vo yiolh .ions.or• dgfciehdLe were ngted. Otttiog this;visit: - Y;oa ;will r' eeeive titi fuf ft
cor'ris oridence: abi f this visit: ... .
Comments (refer to question #): Explain any YES answers and/or any recommendations orany other comments r .
„.
Use"drawings of facility ta._better-ex plain ^srtuations (use`additronal pages as,necessary) ~: =< "f- t F r
v
Reviewer/Inspector Name T "7(} _
Reviewer/Inspector Signature: Q ����� Date:

.FacUity Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below Yes ElNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes t�No
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 9No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover? ❑ Yes No
itiona : omments' an or_ rw a�ngs: =,� t K £,

Lagoon Dike Inspection Report
Name of Farm/Facility -3 a S S
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection 4 Names of Inspectors A - zip�sel.
Structural Height, Feet / L Freeboard, Feet
Lagoon Surface Area, Acres (- 7 S4 c— Top Width, Feet s f
Upstream Slope,xH:IV 31r{ t 1 ✓ Downstream Slope, xH:1V !-(• l 1/
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes �)�'= NO
(Check One, Describe if Yes)
Erosion? Yes_ No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? -Yes. No
Is Daze Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility -3
Location of Farm/Facility
Owner's Name, Address
and Telephone Number _
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
g Q Names of Inspectors A
�- Freeboard, Feet c� -
1 S64 C_ Top Width, Feet 5
/.{ l ✓ _ _ Downstream Slope, xH:1V
Yes No
Yes No
Yes No
Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
■ Permitted 0 Certified 13 Conditionally Certified 13 Registered 10 Not Operatrorta Date Last Operated:
Farm Name: Sloan.Rrothers.................................. County: Duplin WIRO
.............................................................
Owner Name: Troy..&.Caney. .................... Sloan ........................................................... Phone No:29&TA023..orA158 ..................................................
FacilityContact: ............. .....................Title:............................................................... Phone No:..................................................--
Mailing Address: 17ASSN.C.1.11...................................................................................... CW quaNtx..NC................................................... 285.21..............
Onsite Representative: .................................................... ..... .... [ittegrator:Mrxrµhy..Family..E.arms...................... .... ......................................... ................
Certified Operator:Tray..l1L................................ Sloa.0... ............................................... Operator Certification Number: 1959G.............................
Location of Farm:
Latitude ®. ®i FTF7« Longitude ©• ®4 ®11
estgn ...- , urrent Design Current - Design - -C urrent
Swine- Capacity:' Population Poultry Capacity Population Cattle Capacity _P9pulatiori-
p Wean to Feeder
® Feeder to Fiuts2448
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑Layer ❑ airy
❑ Non -Layer p on -Dairy
p ter
Total Design.Capacity 2,448
Total SSLW- 330,480
_ ® Subsurface rains resent ❑ agoon rea In pray �e rea
Number of,Lagoons
I3oldtn -Ponds/SoLd.Tra s o Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge ori--inated at: ❑ Lagoon ❑ Spray Field p 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) [3 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? p Spillway ❑ Yes ❑ No
Structure l Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............2A.............................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
[]Yes ❑ No
Continued on bank

hFsacility Number: 31-655 Date of Inspection
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Apytication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[]No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
[]Yes
[]No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
p 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?
p 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
t! - No.viuiations;or -dcficiencires•were:i�joted _durin'ithis •visit:.Ya�u, will:ieceiva na farther.:.: .
:: .corxesobtidehti. aboirf this :visit: - : • : - : - ::::::: ::..:::::::. _ . _ :.:.:.:::.:... .
Cflmments (refer to=qucstion #}�_Expla�n any YES an°savers and/or any recomtnendaii6hs or any other ca�nmE
freeboard available and no problems observed on outside/inside of dike walls. Good grass cover on dike walls. No
at this time.
Reviewer/ins ector Name
P AlamJolinsort m _ C. Koantz:(1)LQ)
Reviewer/lnspector Signature: Date:

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
14P Routine O Complaint O Follow-up of D«'Q inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 1tl=Y5 24 hr. (hh:mm)
© Registered Certified [3 Applied for Permit[3 Permitted 10 Not Operational Date Last Operated:
.........................
FarmName: County:........ t,l�an...........................................................
.....-----. n�u.......!�..----................rr................................................ I�
Owner Name: ................Tlt�......'S�".. .............5tMi4 .. Phone No:.. `��Q .Jr ' .. 3. ..............
Facility Contact: ...................................:.......................................... Title: Phone 1\ro•
.............................................................................. ..................
MailingAddress:.... 1.1.5..c...i5..,..t4L,.. (L.....................:.....f.........................:................. ...... -intnai �rk.r.,C...................................... .� r2J...........
Onsite Representative:..... i.-:.... oN.... t..Ca1:fj .k•................... .... Integrator: .....�!� 1 ......
Certified Operator; ............................
....................... .............. ..............:............................ .... Operator Certification Number:..........��,'..... ...............
I:ocation of Farm:
.........tr1x�....:,5....0?^.:............ .I�ST.... ` ....al......�.iR..�.�.l...t..9:�.r�!�5...�QC!...�:..c?.......�.R...l�.................................................... A
........................ ...... .................. .._._.. ... ......
Latitude L.__T.._J•� �" Longitude 0• �' �"
'Design Current-
vinr v 'rshnneity Pnnnlatinn
;' ❑ Wean to Feeder
Feeder to Finish
Z a}
u ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
°: ❑ Boars
A: Design_ Current Design
Poultry Capacity Population Cattle _Capacity,f
❑ Layer ❑ Dairy
L❑ Subsurface Drains PresentJI❑ Lagoon Area J0 Spray Field Area
❑ No Liquid Waste Management System.
�......
General
1-. -Are there any buffers that need maintenancetimprovement?
❑ 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
q3 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
1P 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
09 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
Dj No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
0 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
1P No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
`A No
7/25/97 Continued on back

Facility \umber: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaLoons,Holding Ponds, Flush Its, et�.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identi Fier:
Freeboard (ft): ..........I...1.5.......
10. Is seepage observed from any of the structures"
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ® No
AYes 0 No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) l
13. Do any of the structures lack adequate: minimum or maximum liquid level markers?
Waste Application '
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...............Mu \XMJ0W_ ................ t.................... ...... " Y"............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fait to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes [ANo
❑ Yes U9 No
10 Yes
ElNo
❑ Yes
RhNo
❑ Yes
N No
❑ Yes
(g No
❑ Yes
fly No
0 No. violations or deftciencies.were.noted-during this. visit. Aou.will receive no further
. correspondence shout this.visit.-
%Yes f] No
❑ Yes N No
[� Yes El No
❑ Yes 09•No
VW Yes ❑ No
N(Ycs
X No "
Yes
No
❑ Yes
No
Cortttments;(tefer to. question#); Explain any.�r`ES'answers and/or any recomniendat�ons or any,otlter cop,=e.nt., � ,
F
Use drawings of fticEltty tobetfer ezplain situatitins.'(usesdditional pages as necessary).
._
9. tt ,Ciwj- coo l_err` � S64 �z t�W a r, -_ rtsrnli�L + -hpady mom:
Z• a+y,_ LAO _% oXOA b_ +n,"Q.
�'• E�GLPSS � Ni��t�+-- �D we.5 a.��`iee} �S5 �C�(� �2 ��1� I. �,e¢i Sp��a/ac �� �-
wul calls kor.
7/25/97
Reviewer/Inspector Name x
Reviewer/Inspector Signature: y Date:

'f RECEIVED
APR 2 4 199&
�' S'

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number Time of Inspection 3 tap 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: IM Registered El Applied for Permit (ex:l 25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: ... . .... ....._ .... _._.. _ .... _.... _. .. ..__.......... __._..
Farm Name: ..... ......... ......... __.._ _ _.... County: _41�a..__.... r.........__.... _...... _ .
Land Owner Name:.. .... — •._ ��e+ir� ....__.... ........_..........- Phone No:
Facility Conctact:..._ Iv Title: _.]k.. __...._ Phone No:...(`tla� Z`.' " 6Z3..._........
Mailing Address: �� �r ... r .....ir��ra ��.L.... ......... ._.._........... "ija face......... ......._ ..... _ .......
OnsiteRepresentative: Integrator:
j.1 d y/. ! L� !P.. tiara......__....__ ...._ ... Operator Certification Number: lt�... Certified Operator: i ... �............... p .__....._...
Location of Farm:
..... _ ..Dt^..... ...... 9.... . _.1! Tt.rfaa.....n ' .. 4
..
�...mtl�ts, .... i......_ .. �.... F ram...... .....,.. ty
GSM
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
4/30/97
❑ Yes 9No
❑ Yes U No
❑ Yes No
❑ Yes No
❑ Yes
IR No
❑ Yes
E'No
❑ Yes
&.No
51 Yes
❑ No
Continued on back

Facility Number: _31 ...... —..L
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes R No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fiaagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
�.__.... ........ ._..... .,.......
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Agglicatign
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes -U No
❑ Yes RNo
❑ Yes &No
Structure 5 Structure 6
15. Crop type .._.... clew ....... ..... ............... ....... . ........................ nclxs'.6�................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r Certified Eadlitiesmy
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes 0 No
❑ Yes 6j No
JR Yes ❑ No
❑ Yes $R No
❑ Yes 2 No
❑ Yes E$ No
❑ Yes JZ No
9 Yes ❑ No
❑ Yes 5kNo
❑ Yes 2kNo
❑ Yes KNo
❑ Yes KNo
❑ Yes No
& Yes ❑ No
Comments (refer to question # Ezplam any YES answers and/or any recommendations or any otherA. comments
Use'drawings: of facility to better explain situations (use ad tonal as necessary) m x Y,
11 Ba 1 L� U► 0 �QI th Ck V VIJ OL 11H►i li ux' l i aG uross i �1ig1' ZrOSiOIA1L.
I+llnl•V- wc-k` o� `agaovs 5►�WVO uP. W' Oi W • ce
C' J dv%_ iKna-1r WA0. Of 1W SIWIi
`
y0e ��� W;�, Gl� q,,,� r�set�cc�. � S� SYteci(a �e� 4'tSert�,
r«
1g ue, aj c C rods S�o��c� bQ i rwProve rJ.
za. stcert�s S��Ed �e.
Reviewer/InspectorNam .n Gtl4.. �..
Reviewer/Inspector Signature: � Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

Site Requires Immediate Attend n: NO
Facility No. S_J
DrVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:/� /7GlJJ7�S a SLR/ h
Mailing Address:
County: LI
Integrator: 1 Phone: o Y
On Site Representative: 6Z PWAZJ2- Phone:
Physical Address/Location: Ale 1%j !On/ J1CLe
Type of Operation: Swine __ Poultry Cattle
Design Capacity: _ h448 Number of Animals on Site: 44
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:_°' 1_ _;�' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inche Yes r No Actual Freeboard: _/_Ft_ /,9 Inches
• Was any seepage observed from the lagoon(s)? Yes Owas any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequat .Yes r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling Yes No
100 Feet from Well . Yes r No
Is the animal waste stockpiled within I00 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 r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: e-W
• L�i !� 9
Inspector Name
S iinature
cc: Facility Assessment Unit
�i
Use Attachments if Needed.