310692_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: OrCom nce Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I (r9 Departure Time: County: Region:
Farm Name: Owner Email:
Owner [tame: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: AZ
try Q`L ft- Integrator:
Certified Operator: Certification Number: ZS
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Curren
Swine Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity op.
DairyCow
Feeder gyp
Non -La er
DairyEl Calf
o Finish
rFarrow
Dign Current
D . P,aultr Ga aci P.o
Layers
Dairy_Heifer
D Cow
Non -Dairy
Beef Stocker
o Wean
o Feeder
o Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes rNo❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ N E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑YesE5'No
❑NA
ONE
Page I of 3 21412015 Continued

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

Facility Number- - Date of —Inspection: G t
24. laid the facility fail to calibrate waste application equipment as required by the permit? es ism❑ NA ❑ NE
'No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑•?j NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? El Yes No fA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes q��D
NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air -quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes ❑ No ❑ NA ZfNE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA
❑ Yes No ❑ NA
[:]Yes No ❑ NA
Comments(refer 4o quesfiii;h #.) Explihijj ny YES aiaswers and/or any„additional recommendiitiods or an other comments:
Use drawrngsoifaciliEy11to,betteresplaro srtuatns=(use add�tionalpages as_necessary).
�i(0779 21G�
❑ NE
❑ NE
❑ NE
I ' ,n ey C w 1 '
�(SCu
pE c ItL
CA I .�. ! (o c-- �' •.., /^� S
fi A. f�
4-
Reviewer/Inspector Name: 00 ./ P P .A 4 Phone: (<i 7? 1 7 3a f _
Reviewer/]nspector Signature: -L,4� Date: 1�A-7
Page 3 of 3 214YI2015

NCDAWS Agronomic Division Phone: [phone] Websits: www.ncagr.gov/agronomi/
Report No. FY16-SL000215
4
prodiietiye
'Client:
Eugene Nethercutt
Advisor:
s
Liberty Farms
Mehlich-3 Extraction
Po Box 857
.50��. RepQ
Magnolia, NC 28453
Links to Helpful Information
Sampled: ' 06/30/2014
Sampled County: Duplin
Received: 07/07/2014
Fa •" M.7692.
Completed: 07/15/2014
Client [D: 243392
Advisor 1D:
'Sample ID:. 1
Recommendations:.
Lime
Nutrients acre
More
Crop
(tonslecre) N P206
K20 Mg S
Mn
Zn
Cu
a
Information
Lime History:
1 -Bermuda hay/past., M
1.0 180-220 0
30 0 20
0
0
0
0
Nye,: 12
2-
$ H
Test Results (units- WN In glcrn?; CEC and Na In meg1100 cars; NO3-N In mg/drift'
Soil Class:
Mineral
HM% WN
CEC B$% Ac pH
P-1 K4 Ca% Mg%
S-i Mn-1 Mn-All Mn-Al2
Zn4
Zn-AI
Cu4 Na
ESP SS4 NO3-N
0.32 1.26.
4.2 61 I.S. 5.0
253 :97 38 12
24 50 47
1174.
1174
138 0.2
5•.
Sample ID:. 2
Recommendations:
Lime
Nutrients acre
More
Crop
(tonslacre) N P205
- K20 Mg 8
Mn
Zn
Cu
B
Information
Lima History:
1- Bermuda haylpast., M
1.0 180-220 0
40 0 0
0
0
0
0
Note: 12
2_
$ H
Test Results [units - WN in glans; CEC and Na In meg1100 cO; NO2-N In mgldms]:
Soil Class:
Mineral
HM%. WN .
CEC BS% Ac pH
P-1 Ka Ca%. Mg%
6-1 Mn-I Mn4U1 Mn-AI2
Zn4
Zn-Al
Cu-1 Na
ESP SS4 NO2-N
2.01 1.14
7.2 68 2.3 5.5. :319
89 47 15
26 57 51
1015
1015
200 0.2
3
North Carolina
Tobacco Trust Fund Gomm Wkm
Reprogramming of the laboratory -information -management system that makes this report possible is
being funded through a grant from the North Carolina Tobacco Trust Fund Commission.
Thank you for using agronomic services to manage nutrients and safeguard environmental quality.
- Steve Troxier, Commissioner of Agriculture

NCDA&C8 Agronomic Division Phone: [phone] Webeft: www.ncagr.govlagronomll .
Report No. FYI&aL000215
Eugene Nathercut't
Page 2 of 2
Understanding the Soil Report: explanation of measurements, abbreviations and units
Recommendations
Report Abbreviations
Lim@
Ac
exchangeable acidity
If testing finds that soil pH is too low for the crop(s) indicated, -a lime recommendation will be. given In units of either
B
boron
tonlacre or Ib/1000 sq ft. For. best results, mix the lime into the top 6 to 8 inches of. soil several months before planting..
B8%
% GEC occupied by basic cations
For no -Eli or established plantings where this is. not possible, apply no more than 1 to 1.5 ton/acts (50 W1000 sq ft) at oni
i Ca%
% CEC occupied by calcium
time, even if.the report•rawmmends more. You can apply the rest In similar increments every six months until ttie full rate
CEC
cation exchange capacity
Is applied. -If MG is recommended and lime is needed, use dolomitric lime.
cu-t
copper index
ESP
exchangeable sodium percent
iliz r
HM%
percent humic matter
Recommendations for field c►ops.or other large areas are listed separately for each nutrient to be added (in units of
K4
potassium index
lb/acre unless otherwise specified). Recommendations for N (and sometimes for B) are based on researcltlfield studies •
K20
potash
for the crop being grown, not on:soil test results: K-1 and P-1 values are based on test results and should be > 50. If they •
'.Mg% .
; % CEC occupied by magnesium
are not, follow the fertilizer recommendations given. If Mg is needed and no lime is recommended, 0-0-22 (11.5% Mg) is
MIN
mineral soil class
an excellent source; 175 to 260 lb per acre alone or a fertilizer blend will usually satisfy crop needs, SS-1 levels appear
Mn
manganese
only on reports for greenhouse soil or problem samples:.
Mn-All
Mn- availability index far crop 1
Mn-M
Mn-availability index for crop 2
Farmers and other commercial -producers should pay special attention to micronutdont levels. if $, pH$, $pH, C or Z
Mn-1
M.O
manganese index
mineral -organic sail class
notations appear on the soil report, refer to $Note: k%wWary Nulvfants and Micmnutrients In general, homeowners do not
N
nitrogen
need to be concerned about inicronutrients. Various crop notes also address lime fertilizer needs; visit
Na
sodium
ncagr.govlagronomilpubsAtm.
NO3-N
nitrate nitrogen
ORG
organic soil class.
Recommendations-forsmall areas, such as home lawns/gardens, are listed in units of ib11000 sq ft . If you cannot find
pH
current soil pH
the exact fertilizer grade recommended on the report, visit www wear coylogronomitboarta:h- n1 nd information that
P-I
phosphorus index
may help you choose a comparable alternate. For more information, read A Homeownees QUd@ to Fertilizer,
P20s
phosphate
Sa
sulfur index
Test Results
8S-1
soluble salt index
WN
weight per volume
The first seven values.[soii doss, HM%, WN, CEC, BS%, Ac and. pH] describe the soil and its degree of acidity. The
Z.n Al
zinc availability index
remaining 16 [P-I, K-,I.'Ca%, Mg%, Mn-l;-Mn A11; Mn-Al2, Zn-i, zn-Af, Cu-I, 5-1, SS -I, No, ESP, SS -I, NO3-N (not radnel
�I
zinc index
available)] indicate levels of plant nutrients or other fertility measurement. Visit svti+ caor.aov/adronomi/uvrst.htm

w
HCDE
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Eugene Nethercutt
Liberty Farm
PO. Box 234
Kenansville, NC 28349
Dear Eugene Nethercutt.
John E. Skvada, III
Secretary
October 1, 2014
Subject: Certificate of Coverage No. AWS310692
Liberty Farm
Swine Waste Collection, Treatment,
Storage and Application System
Daplin County
In. accordance with your renewal request, we are hereby forwarding to. you this Certificate of Coverage
(COC) issued to Eugene Nethereutt, authorizing the operation of the subject animal waste management
system in accordance with General Permit AWG 100000.
This approval shall consist of the operation of this system including, but not limited to, the management
and land application of animal waste as specified in the facility's Certified, Animal Waste Management
Plan.(CAWMP) for Liberty Farm, located in Duplin County, with a swine animal capacity of no: greater
than the following -annual averages:
Wean to Finish: Feeder to Finish: Boar/Stud:
Wean to Feeder: 3552 Farrow to Wean: Gilts:
Farrow to Finish: Farrow to Feeder: Other:
If this is a Farrow to Wean or Farrow to Feeder operation, there may be one boar for each 15 sows. Where
boars are unnecessary, they may be replaced by an equivalent. number of sows. Any of the sows .may be
replaced by gilts at a rate.of 4 gilts for every 3 sows.
This COC shall be effective from the date of issuance until September 30, 2019,,and shall hereby void
Certificate of Coverage Number AWS310692 that was previously issued to this facility. Pursuant to this
COC, you are authorized and required to operate the system in conformity with the conditions and
limitations as specified in the General Permit, the facility's CAWMP, and this COC. An adequate system
for collecting and maintaining the' required monitoring data • and operational * information must be
established for this facility. Any increase in waste production greater than the certified design capacity or
increase in number of animals authorized by this COC (as provided above) will require a modification to
the CAWMP and this COC and must be completed prior to actual increase in either wastewater flow or
number of animals:
Please read -this COC and the enclosed State General Permit carefully. Please pqy careful attention to the
record keeping and monitoring conditions in this permit. Record kMing forms are unchanW with Us
General Permit, - Please continue to use the same record keeping forms.
1636 Mail Service Center.'Rat*h, North Ca olina 27699-1636
Phone: 919-W-W Internet h1tPIMiww.nodenmayl
An Equal Ott 1 Ailln a loon Employer —Uade in PM by wiled paper

if your Waste Utilization Plan (WUP) has 'been developed based. on site -specific information, careful
evaluation of future samples is necessary. Should your records show that the current WUP is inaccurate
you will need to have a new WUP developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a. COC to operate
under this permit.convey any. property rights in either -real or personal property.
Per NRCS standards a 100-foot separation shall be maintained between water supply wells. and any.
-lagoon, storage pond, or any wetted area of a spray field.
Please be advised that any. violation of the terns and conditions specified in this COC, the General Permit
or the CAWMP may result. in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If any parts,, requirements, or limitations contained in this COC are unacceptable, you have. the right to
apply foram individual permit. by contacting the.Animal Feeding Operations Program. for information on
this process: Unless such . a request is made within 30 days, this COC shall be final and binding.
In accordance with Condition 11.22 of the General Permit, waste application shall cease. within four (4)
hours of the time that the National Weather Service issues a Hurricane Warning, Tropical Storm Warning,.
or a Flood Watch associated with a tropical system for the county in which the facility is located. You
may find detailed, watch/warning information for your county by calling the Newpoit/Morehead City, NC
National Weather Service office at [phone], or by. visiting' their 'website at:
htt://www.weather.ggy/mhx/
This facility is located in a county covered by our Wilmington Regional Office. The Regional Office staff . .
may be reached at 910-796-7215. If you need additional information concerning this COC or the General
Permit, please contact the Animal. Feeding Operations Program staff at [phone].
Sincerely,
for Thomas A. Reeder
Director, Division of Water Resources
Enclosure (General Permit AWG100000)
cc:. (Certificate of Coverage only for all ccs)'
Wilmington Regional Office, Water Quality Regional Operations Section
Duplin County Health Department
Duplin County Soil and Water Conservation District
WQROS Central Files (Permit No. AW9310692)
AFO Notebooks
Murphy -Brown LLC .

hype of Visit: t� oroutine
nce Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: s 3 9 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: {^ �% �'� AIC �C �"--( Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: sS
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
v99
Non -Layer
Da Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr}y I ult , C•_a aci P,op.
Layers
D Cow
Non -Dal
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other"Turkey
Other
I
Turke s
Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑Application Field ❑Other-,
a. Was the conveyance man-made?",
b. Did the discharge reach waters of the State? (If yes, notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [�
❑ Yes ] 1No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facili Number: - T Date of Inspection:
''Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA
❑ NE
eNo
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 2rNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 �rNo ❑ NA ❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable ❑ Yes ONo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes❑
rNoNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check th ppropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El"Nio ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? es ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ No ❑ NA ❑ NE
the appr 'ate box(es) below.
allure 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 ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑' A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
2No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to Netter explain situations (use additional pagesas necessary).
4- C �� o f C9 C (/f"_ i I .�_ a 0 � ( r- de C D.- ds
; n ,
2`-( A5 Y-%- O CQ
bXZI( (,,*IN
p r
r
, h S �� S
M�e c(
I a �4--
7�r,
c ro-� S y n V,.,��r`L'`�r`Lrs
S V-Fcrw 5ori M-- Z 5e `e t [ re �° 3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: e27673, y
Date:
21412014
C

RRIGATION EQUIPMENT
FLOW METER
FIELD CALIBRATION
GOCATION:&Ae 'LQ, 4dh"-C 4 . phone:
4
)ATE OF FIELD CALIBRATION:
METER SERIAL NUMBER:
REEL/GUN/SPRINKLER MAKE AND MODEL,:
(see reverse for solid set system)
MEASURED RING SIZE (from irrigation design):
Is ring within .0111 of expected manufacturer size?
f not, ring must be replaced.
RESSURE READINGS AT PUMP:ysi
AT REEL: psi
AT GUN: psi
1 W RATE (GPn
m manufacturers chart
flow meter readout)
NETTED DIAMETER (ft)
see wettable. acres determination
'or expected diameter)
EXPECTED:
MEASURED.
VARIANCE:
EXPECTED:
MEASURED
VARIANCE:
_.inrlies
(_0 .16"ap i 11.Ca-+(6-
(optional)
(optional)
(required)
3a
%
Ja-7 ft yad;US
�$:.ftft i'Ctc�S
wetted diameter is greater than 15°/9 or flow rate variance is greater than 10%,
ntact a Certified Technical Specialist or irrigation specialist for assistance,
:id/or Explain findings: �mn
! SDPe+ 1A ]P,2V k - ra Ir on a� dry rn � fre c grA In Wf'' -d
CALIBRATOR:
(print name) (signature)
PLone: Email
NCSTATR ►JNMMSM
A&T 5rATE UNMRSFrY
COOPERATME
�Ml EXTENSION
- Hdpinr People PalInowledre to War*
`e4dq

Appetttiix 1. Lagoon Sludge Survey Form Revised August 2008 j
Top 47.19 l
A Farm Permit or DWQ identification Number Eugene Nethercutt Start 46.3
B. Lagoon Identification La on 1 Present 45.5
C. Person(s) Taking Measurements Amanda Hatcher $ Savannah Wiggins Stop 44.3
D. Date of Measurement 5/31/16 Bottom 36.9
E. Methods/Devices Used for Measurement of: 29 in or 2.4 ft
a. Distance from the lagoon liquid surface to the top of the sludge layer. 3:1 SS
Disk on a rope �^8^
b. Distance from the lagoon liquid surface to the bottom (soil) of the lagoon. 220 ft x 135 ft � +D S E
Lagoon deslan I ^ S
a Thickness of the sludge layer If making a direct measurement with 'core sampler".
N/A
F. Lagoon Surface Area (using dimensions at inside top of bank): 0.68 (acres) , -4� 3 a
(Draw a sketch of the lagoon on a separate sheet, list dimensions, and calculate surface area The lagoon
may have been built different than designed, so measurements should be made.) 5 U —� $
G. Estimate number of sampling points:
a. Less than 1.33 acres: Use 8 points
b. If more than 1.33 ac. acres x 6 , with maximum of 24.�
(Using sketch and dimensions, develop a unirorm grid that has the same number of intersections as the
estimated number of sampling points needed. Number the intemedion points on the lagoon grid so that data
recorded at each can be easily matched.)
H. Conduct sludge survey and record data on "Sludge Survey Data Sheet' (Appendix 2). Also, at the
location of the pump Intake, take measurements of distance from liquid surface to top of sludge
layer and record It on the Oats Sheet (last row); this must be at least 2.5 ft. when irrigating.
I. At the time of the survey. also measure the distance from the Maximum Liquid Level to the Present Liquid
Level (measure at the Lagoon gauge pole): 0.8
J. Determine the distance from the top of bank to the Maximum Liquid Level 1.6
(use lagoon management plan or other lagoon records)
K. Determine the distance from the Maximum Liquid to the Minimum Liquid level: 2.0
(use lagoon management plan or other lagoon records)
L. Calculate ft distance from the present liquid surface level to the Minimum Liquid Level 1.2
(item K Minus Item I, assuming the present liquid level is below the Maximum Liquid Level)
M. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level to the
lagoon bottom (average far all the measurement points) 8.6
N. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level to the top
of the sludge layer (average for all the measurement points): 6.4
O. Record from the Sludge Survey Data Sheet the average thickness of the sludge layer. 2.2
P. Calculate thte thickness of the existing Liquid Treatment Zone (Item N minus Item L): 5.2
Q. If Item O Is greater than Item P, proceed to the Workaheat for Sludge volume and Treatment Volume. �� p
U Item O is equal to or lase than Item P, you do not have to determine volumes.
Completed by: Amanda Hatcher/NCCES-Du 14 2W2143 Date: 6/8116
Print Name /Signature

�.-
Appendix 2. Sludge survey Data sheet' Revised August 2008
Lagoon Identification Eugene Nethercutt Lagoon 1
Completed by Amanda HatcherJ'V�f�v� Date: 618116
Print Name Signature
(A)
(B)
(C)
Grid Point
Distance from liquid surface
Distance from liquid surface
Thickness of sludge layer
No.
to top of studa
to lagoon bottom soil
Ft. & in.
Ft. tenths
Ft. & in.
Ft. tenths
Ft. & in.
Ft. enths
1
8.0
8.6
0.6
2
7.5
8.6
1 A
3
5.0
8.6
3.6
4
7.2
8.6
1.4
5
5.0
8.6
3.6
6
4.0
8.6
4.6
7
6.5
8.6
2.1
8
8.0
8.6
0.6
9
0.0
0.0
0.0
10
0.0
0.0
0.0
11
0.0
0.0
0.0
12
0.0
. 0.0
0.0
13
0.0
0.0
0.0
14
0.0
0.0
0.0
15
0.0
0.0
0.0
1e
0.0
0.0
0.0
17
0.0
0.0
O.p
18
0.0
0.0
0.0
19
0.0
0.0
0.0
20
0.0
0.0
0.0
21
0.0
0.0
0.0
22
0.0
0.0
0.0
23
0.0
0.0
0.0
24
1
0.0
0.0
0.0
Number of pWnts with readiM
8.0
X X
8.0
X X
8.0
Average of
ints
X X
6.4
X X
8.6
X X
2.2
At pump
1
4
8.0
A
X X X X X X
Intake
*Ail Grid Points and corresponding sludge layer thicknesses must be shown on a sketch attached to this
Sludge Survey Data Sheet.
Appendix 3. Workshest for sludge volume and treatment volume
Revised August 2000
The average thickness of the sludge toyer and the thickness of the existing liquid (sludge -free) treatment zone are determined
from the information on the Lagoon Sludge Survey Form ( Items 0 and P, respecttvely). In this example, the average sludge

layer thickness is 2.5 feet and the existing liquid treatment zone Is 3.5 feet. If the lagoon has a designed sludge storage volume,
rase notes at and of the worksheet. The dimensions of the lagoon as measured and the side slope are needed
for calculations of sludge volume and of total treatment volume. if the lagoon is a standard geometric shape, the sludge
volume and the treatment volume in the lagoon can be estimated by using standard equations. For approximate volumes
of rectangular lagoons with constant side slope, calculate length and width at the midpoint of the layer, and multiply by layer
thickness to calculate layer volume, as shown in the example. For irregular shapes, convert the total surface area to a square
or rectangular shape. For exact volumes for lagoons with constant side slope, the ' Prlsmoidal Equations' may be used.
Example
Your Lagoon
1. Average sludge Layer Thickness (T)
2.5
ft.
2.2
ft.
2. Depth of the lagoon from top of bank to bottom soil surface (D)
11
ft.
11.0
ft.
3. Slope = Horizontal/ vertical side slope (S)
3
3.0
4. Length at the top of inside bank (L)
457
ft.
220.0
ft.
5. Width at top inside slope (W)
229
ft.
135.0
ft.
6. Length at midpoint of sludge layer Lm = L-2S(D-(Tl2))
398.5
ft.
160-6
ft_
7. Width at midpoint of sludge layer Wm= W 2S(D-(Tl2))
170.5
ft.
75.6
ft.
8. Volume of sludge (Vs) Vs=Lm W,. T
169,860
ft
26,711
ft
9. Volume in gallons: Vsg--V7.5 galJW.
1,273,950
gal.
200,332
gal.
10. Thickness of existing liquid tmt. zone (Y)
3.5
ft
5.2
ft
11. Thickness of total treatment zone (Z) Z= T+Y
6
ft
7.4
ft
12. Length at midpoint of total tmt. zone Lz = L-2(SXDgZ(2)
409
ft.
176.2
ft.
13. Width at midpoint of total trot. Zone Wz = W-2(S)(D-(Z(2)
181
ft.
91.2
ft.
14. Volume of total treatment zone (Vz) Vz = Lz WZZ
444,174
1`13
118,914
1`0
15. Ratio ( R ) of sludge layer volume to total Treatment Volume
R = Vs/Vz
0.38
0.22
If the ratio R exceeds 0.50, than a sludge Plan of Action may be required. Check with DWQ for information
on filing the Plan of Action.
Mote: If the lagoon has a designed sludge storage volume (DSSV), subtract that volume from both the volume
of sludge (Vs) (item 6) and from the volume of total treatment zone (Vz) (Item 14), and take the ratio.
Then, R = (Vs-DSSV) I (Vz - DSSV)
Example: If DSSV = 85.000 fle, then R = (169,860 - 85,000)1(444,174 - 85,000) = 84,8601359,174 = 0.24.
16. Design sludge storage volume (DSSV) 85,000 0
17. Ratio (R) of sludge layer volume to treatment volume adjusted
for designed sludge storage volume 0.24 0.22

h
�7 101 O
Type of Visit: DCom nce Inspection U 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: C Arrival Time: s r~ Departure Time: S O County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: L Title: Phone:
OnsiteRepresentative: Q✓afAc VIntegrator:
7
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number: _ 2 s S
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop. Wet Poultry
Layer
Design Current
C►apacity Pop.
Design
Cattle Capacity
Dai Cow
Current
Pop.
Wean to Feeder Z
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
to Finish
Riqpbujt .
La ers
Design Current
C_a aci P.o
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
1Farrow
Beef Feeder1
-d
Boars
Pullets
Beef Brood Cow
-_
Other
Other FTOther
Turke s
Turkcy Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes BNo ❑ 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 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 ❑ No ❑ NA ❑ NE
❑ Yes [ 'No ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ 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 �NoD ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo
� ❑ NA ❑ NE
& Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 El No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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):
l4. 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
�JNNN ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yeso
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
c ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L Nci ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rN ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need 7irovement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE
❑ ste Application [ekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
Rainfall ❑ Stocking rop Yield 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E 'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 3- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. es No NA NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [:]No NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes o NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA [ZNE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E i10
NA
[D NE
Yes
E]rNo
NA
NE
[� Yes
No
NA
NE
Yes
Q No
❑ NA
[] NE
Yes CfNo NA NE
Yes [3 No NA NE
Yes FD/No NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommenuations or_ any other comments.-',
Use drawings of facility to better explain situations (use additional pages as necessary).
e V A -re &ord, skac e- sprcf��.,�
U r�/{ �i R /ti r\r^,e
a
a �
. � � Sl�►���S�rveyy f0�
`ZS S� ��Y'
/
/1P Z1"r],AslPG!rogs Sf
Z ( A(P C/_0 P yl`r //
C9 e j k � 4,
s C,_ 4 _.e.� fs
r.4 (`a�(\ r bond F- (_ 0cVA10 lt9fe- "I
Reviewer/Inspector Name: Va L (� QO C am{ f (
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q 4Q ;1 { )
Date: A
21412014

' ivisipn of Water Quality
Maciftliumber - ® 0 DivisiFUof SVinfi"55w-5ealiq�n
OQ Qthernc
y
type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
lesson for Visit: OrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:- Arrival Time: Departure Time: �� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number: 2' !�)
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C**specify Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to FeederF
Non -La er
Daia Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,flul . Ca aci_ P,o ,
Layers
Dairy Heifer
Pry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
0 1 JEJ
Turke s
Turkey Poults
I Other
Discharges and 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 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 ZrNo ❑ NA ❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
FrNo
❑ NA
❑ NE
[:)Yes
FfNo
❑ NA
❑ NE
[:]Yes
VfNo
❑ NA
❑ NE
❑ Yes
[]f No
❑ NA
❑ NE
Page I of 3
21412011 Continued

e'.
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ 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
)a —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
ONo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 'VNo ❑ 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 4 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? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z] 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? 0
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No ❑ NA
❑ Yes No ❑ NA
❑ Yes 16 No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J;?] No
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 ,d No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eo N
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

y �
Facility Number: 3 1 - Vq Date of Inspection:
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 9 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �] No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: `S�.us�4� 10atra Phone: 2 5 k U l- gait)
Reviewer/Inspector Signature: ���,, �� Date: 1 Lf
Page 3 of 3 21412014

I I
sion of Water'�Quality
Facility Number - �9 ®Division of Soil and Water Conservation
® Other Agency
Type of Visit: 9�Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: r Routine O Complaint 0 Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:kL
Farm Name: L rif EVk�i{ Owner Email:
Owner Name: Phone:
Mailing Address: .
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Region: LIX/19 b
Integrator:
0l3
Certification Number: 55 99
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Curren#
Capacity Pop.
Wet Poultry
Design
Capacity
Cur:et
Pop.
Ell
Cattle C►.a acity
DairyCow
Pop.
Wean to Feeder
55
EEINon-Layer
DairyCalf
Feeder to Finish
Q—ryl P,oultr.
Layers
Design
C•a aci
Current
P.o A.
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili umber: 1 - �. Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1=-
7rNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7No ❑ 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 VfNo
❑ 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 ,2TNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes V'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 FrNo
❑ 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?
'P�`No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
K❑
❑ 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 )2TNo
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes t] 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?
to
17. Does the facility lack adequate acreage for land application?
❑ Yes FfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes C;j'IVo
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ 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 below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑Waste
sfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f!!fNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F .
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OKNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r ZNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phgsphorus loss assessments (PLAT) certification? ❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes"
VfNo
❑ 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
;ZrNo
❑ 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
Po
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): 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 necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
J� Date:
i
21412011

Cype of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Season for Visit: Routine Q Complaint O Follow-up O Referral C) Emergency O Other Q Denied Access
Date of Visit: rM371 SE Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: F T LLT Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish I ILayer
Design
Capacity
I
Current
Pop.
Design Current
C*attle Capacity Pop.
Dairy Cow
Wean to Feeder
I iNon-Layer
I
Dairy Calf
Feeder to Finish
Dr, P,o_uI ,
Des ign
C*a aci.
Current
P.o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I A
Turke s
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
rN
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes6NO
❑ 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
0
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
4No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes[ No ❑ NA ❑ NE
X maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No [DNA ❑ 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 0 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
DWUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Q Waste Application 0 Weekly Freeboard Q Waste Analysis •❑ Soil Analysis 0 Waste Tr sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections 0 Monthly and V 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 4
No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0 Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: % js
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1ANo ❑ 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 ANA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes] No ❑ NA ❑ NE
0 and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes RNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ 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 l
Use drawings of facility to better, explain situations (use additionsl pages as necessamry).
;�(�?�lll . �3
�3'4e SeNr OFF 1N Aids
i 3 firma sur�E 70 �T �uo�l� �� F�S aL
nn) a 0 C,
— Lwtt� G< �� A15-i /nAK�Si�-E A�i1U�c
Cop
( 6aT1 t�'G- S 1 C 1 j S
'5-jvuS
SAP -Ye G G� c�SiG AAA U6 i S
(90 WAS
�IJfl 1 iS�tAD6C GL-CAN a�i
�S uC—� as &Act �►�c.D
1 o 5 ROl� H a� Imucr� I� Aee ou RrrN A, A�r G'01N�S
S&ND�- g10-350-
c��lt�ts�,NG�Sk S
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: a Date:
Page 3 of 3 21412011

C 16a.4v ,7t" lO%,
Nutrient Management PIan For Animal Waste Utilization
This plan has been prepared for:
Liberty Nursery LLC.31692
Liberty Nursery LLC.
PO Box 857
Kenenaville, NC 28349
910-296-1685
01-18-2012
This plan has been developed by:
Billy W Houston
Duplin Soil & Water
165 Agriculture Dr
Suite B
Kenansville, NC 28349
910-296-2120
n�f I-�r4-
Developer Signature
Type of Plan: Nutrient Management with Manure Only
w
Owner/Manager/Producer Agreement
I (we) understand and agree to the specifications and the operation and maintenance procedures
established in this nutrient management plan which includes an animal waste utilization plan for
the farm named above. I have read and understand the Required Specifications concerning animal
waste management that are included with this plan.
Signature (owner) Date
Signature (manager or producer) Date
This plan meets the minimum standards and specifications of the U.S. Department of Agriculture -
Natural Resources Conservation Service or the standard of practices adopted by the Soil and Water
Conservation Commission.
Plan Approved By:
Technical Specialist Signature Date
------------------------------ -------------- I -------------- -- --- ..---------------- ----------.--
997744 Database Version 3.1 Date Printed: 01-18-2012 Cover Page 1

Nutrients applied in accordance with this plan will be supplied from the following
source(s):
Commercial Fertilizer is not included in this plan.
U1
lNethercutt Sludge waste generated 440,839 gals in a i year(s) and 2 month(s) period by
a 3,552 animal Swine Weanling-Feeder Liquid Manure Slurry operation.
Estimated Pounds of Plant Available Nitrogen Generated
Broadcast
3419
Incorporated
5504
Injected
6505
Irrigated
2836
Max. Avail,
PAN (lbs) *
Actual PAN
Applied (lbs)
PAN Surplus/
Deficit (lbs)
Actual Volume
Applied (Gallops)
Volume Surplus/
Deficit (Gallons)
Year 1
5,504
6988
-1,484
601,461
-160,622
This plan includes a User Defined Source to determine the total pounds of PAN in lieu
of NRCS Standard values. Refer to North Carolina Cooperative Extension Service publication AG-439-42
entitled "Soil Facts: Use of On -Farm Records for Modifying a Certified Animal Waste Management Plan" for
guidance on using on -farm records to develop a User Defined Source.
------- •-------------------------------------------------------------------------------------- .........------------------------------.-....----
Note: In source ID, S means standard source, U means user defined source.
* Max. Available PAN is calculated on the basis of the actual application method(s) identified in the plan for this source.
997744 Database Version 3.1 Date Printed: 01-18-2012 Source Page Page 1 of I

Narrative
This VVUP is written based on the total amount of waste available to be removed. See page three(3) Ul.
Total gallons (440839 gal) of waste based on 2011 lagoon sludge survey and a waste sample of
8.71bsN/1000gal.
------------------------------------- ----------------------------------- .-.-.....-----------...-....-------------------------------------------------------------
997744 Database Version 3.1 Date Printed: 01-18-2012 Narrative Page Page 1 of 1

The table shown below provides a summary of the crops or rotations included in this plan for each field. Realistic Yield estimates are
also provided for each crop, as well as the crop's P205 Removal Rate. The Leaching Index (LI) and the Phosphorous Loss Assessment
Tool (PLAT) Rating are also provided for each field, where available.
If a field's PLAT Rating is High, any planned manure application is limited to the phosphorous removal rate of the harvested plant
biomass for the crop rotation or multiple years in the crop sequence. Fields with a Very High PLAT Rating should receive no
additional applications of manure. Regardless of the PLAT rating, starter fertilizers may be recommended in accordance with North
Carolina State University guidelines or recommendations. The quantity of P205 applied to each crop is shown in the following table if
the field's PLAT rating is High or Very High:
Planned Crops Summary
Tract
Field
Total
Acres
Useable
Acres
Plat
Rating
Ll
Soil Series
Crop Sequence
RYE
P205
Removal
(lbslacre)
Applied
(Ibs/acre)
3974
13
11.62
9.80
Unknown
N/A
Noboco
Corn, Grain
115 bu.
51
N/A
3974
1 14
5.56
4.70
Unknown
1 N/A
Noboco
Com, Grain
115 bu,
51
N/A
3974
4
14.04
11-90
Unknown
NIA
Nohocw
Com, Grain
115 bu.
51
N/A
3974
9
8.81
7.40
Unknown
N/A
Noboco
Com, Grain
115 bu.
51
N/A
73137
2
10.11
8,60
Unknown
N/A
Johns
Com, Grain
120 bu.
53
NIA
7328,32
4
2.30
2.00
Unknown
N/A
Autryvillc
Corn, Grain
85 bu.
37
NIA
7328,32
5
1.30
1.10
Unknown
N/A
Autryville
Corn, Grain
85 bu.
37
NIA
7328,32
6
2.30
nknown
NIA
Autryville
Corn, Grain
85 bu.
37
NIA
73389
1
16.43
14.00
Unknown
NIA
Johns
Corn, Grain
120 bu.
53
NIA
73717
5
8.94
7.601
Unknown
NIA
Noboco
Corn, Grain
115 bu.
51
NIA
PLAN TOTALS_ 81.41 69.10
Potennal.Geaching ? ! ;
i <TecFirucauidance
Low potential to contribute to soluble
None
< 2
nutrient leaching below the root zone.
Moderate potential to contribute to soluble
Nutrient Management (590) should be planned.
�— 2 &
nutrient leaching below the root zone.
<— 10
High potential to contribute to soluble
Nutrient Management (590) should be planned. Other conservation practices that improve the soils
nutrient leaching below the root zone.
available water holding capacity and improve nutrient use efficiency should be considered. Examp]
> 10
are Cover Crops (340) to scavenge nutrients, Sod -Based Rotations (328), Long -Term No -Till (778),
and edge -of -field practices such as Filter Strips (393) and Riparian Forest Buffers (391).
0 - 25 Low No adjustment needed; N based application
25 - 50 Medium No adjustment needed; N based application
51 - 100 High Application limited to crop P removal
> 100 Very High Starter P application only
997744 Database Version 3.1
Date Printed 1/19/2012
NOTE: Symbol * means user entered data.
PCS Page Page I of I

The Waste Utilization table shown below summarizes the waste utilization plan for this operation. This plan provides an estimate of the number of acres of cropland needed to use
the nutrients being produced. The plan requires consideration of the realistic yields of the crops to be grown, their nutrient requirements, and proper timing of applications to
maximize nutrient uptake.
This table provides an estimate of the amount of nitrogen required by the crop being grown and an estimate of the nitrogen amount being supplied by manure or other by-products,
commercial fertilizer and residual from previous crops. An estimate of the quantity of solid and liquid waste that will be applied on each field in order to supply the indicated quantity
of nitrogen from each source is also included. A balance of the total manure produced and the total manure applied is included in the table to ensure that the plan adequately provides
for the utilization of the manure generated by the operation.
Waste Utilization Table
Year 1
Tract
Field
source
10
Soil Series
Total
Acres
Use.
Acres
Crop
RYE
Applic.
Period
Nitrogen
PA
Nutrient
Req'd
(lbslA)
Comm.
Fert.
Nutrient
Applied
(lbs1A)
Res.
(lbslA)
Applic.
'Method
Manure
PA
NutrientA
pplied
(lbs/A)
Liquid
ManureA
pplied
(acre)
Solid
Manure
Applied
(acre)
Liquid
Manure
Applied
(Field)
Solid
Manure
Applied
(Field)
N
N
N
N
1000
gal/A
Tons
1000 gals
tons
3974
13
U1
Noboco
11.62
9.80
Corn, Grain
115 bu.
2/15-6/30
131
0
*20
Incor.
111
8.89
0.00
87.12
0.00
3974
4
Ul
Noboco
14.04
11.90
Corn, Grain
115 hu.
2115-6/30
131
0
*20
Incor.
111
8.89
0.00
105.79
0.00
3974
9
U1
Noboco
8.81
7.40
Corn, Grain
115 bu.
2/15-6/30
131
0
*20
Incor.
111
8.89
0.00
65.79
0.00
73137
2
U1
Johns
10.11
8.60
Corn, Grain
120 bu.
2/15-6/30
130
0
*20
Incor.
110
8.81
0.00
75.77
0.00
7329,32
4
UI
Autryville
2.30
2.00
Corn, Grain
85 bu.
2/15-6/30
104
0
*20
Incor.
84
6.73
0.00
13.46
0.00
7328,32
5
U1
Autryville
1.30
1.10
Corn, Grain
85 bu.
2115-6130
104
0
*20
Incor.
84
6.73
0.00
7.40
0.00
7328,32
6
UI
Autryville
2,30
2.00
Corn, Grain
85 bu.
2115-6130
104
0
*20
Incor.
84
6,731
0.00
13.46
0.00
73389
1
UI
Johns
16,43
14.00
Corn, Grain
120 bu.
2115-6130
130
0
*20
Incor.
110
8.81
0.00
123.34
0.00
73717
5
UI
Noboco
8.941
7.60
Corn, Grain
115 bu.
2/15-6130
131
0
*20
[neor.
111
8.89
0.00
67.56
0.00
Total Applied, 1000 gallons
559.6811,094
}
Total Produced, 1000 gallons
440.84
Balance, 1000 gallons
-118.84
!j#
Total Applied, tons
;ly 1
Phl
0.00
Total Produced, tans
^,k 101. l !:
0,00
Balance, sans
0.00
Notes: 1. In the tract column, - symbol means leased, otherwise, owned. 2. Symbol * means user entered data.
997744 Database Version 3.1 Date Printed; 1/18/2012
WUT Page Page 1 of 1

The Nutrient Management Recommendations table shown below provides an annual summary of the nutrient management plan
developed for this operation. This table provides a nutrient balance for the listed fields and crops for each year of the plan.
Required nutrients are based on the realistic yields of the crops to be grown, their nutrient requirements and soil test results. The
quantity of nutrient supplied by each source is also identified.
The total quantity of nitrogen applied to each crop should not exceed the required amount. However, the quantity of other
nutrients applied may exceed their required amounts. This most commonly occurs when manure or other byproducts are utilized
to meet the nitrogen needs of the crop. Nutrient management plans may require that the application of animal waste be limited so
as to prevent over application of phosphorous when excessive levels of this nutrient are detected in a field. In such situations,
additional nitrogen applications from nonorganic sources may be required to supply the recommended amounts of nitrogen.
Nutrient Management Recommendations Test
YEAR
N
(lbs/A)
P205
(lbs/A)
K20
(lbs/A)
Mg
(lbs/A)
Mn
(lbs/A)
Zn
(lbs/A)
. Cu
(lbs/A)
Lime
(tons/A)
Tract
Field
3974
13
Req'd Nutrients
13 t
0
80
0
0
0
0
1
Acres I
App. Period
9.80
2115-6l30
Supplied B
-VT�-`�am.
�- ='-
-,:..
w �-"s`
e,a
CROP
Corn, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
N oboco
Residual
*20
0
0
0
0
0
0
0
RYEJ Samplc Date
115 bu.
01-18-12
Manure
111
223
40
98
3
54
11
0
P Removal
Rating
51 lbslac.
Unknown
BALANCE
0
223
-40
981
3
54
11
1
Tract
Field
3974
14
Req'd Nutrients
131
0
50
0
0
0
0
1
Acres
App. Period
4.70
2115-6/30
Supplied By:
Mr
_fi
c...v--
":
-��,;�,- a
.'"-.�-... �__
...�m
_
CROP
Corn, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Noboco
Residual
*20
0
0
0
0
0
0
0
RYE I Sample
Date
115 bu.
01-18-12
Manure
0
0
0
0
0
0
0
0
P Removal
I Rating
51 lbs/ac.
Unknown
'BALANCE
-111
0
-50
0
0
0
0
-1
Tract
Field
3974
4
Req'd Nutrients
131
0
0
0
0
0
0
1
Acres
App. Period
11.90
2115 6l30
Supplied By:
_
��i
W ,
CROP
Com, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Noboco
Residual
*20
0
0
0
0
0
0
0
RYE Sample
Date
115 bu.
01-18-12
Manure
111
223
40
98
31
54
11
0
P Removal
Rating
51 lbs/ac_
Unknown
BALANCE
0
223
40
98
3
54
11
-1
Tract
Field
3974
9
Req'd Nutrients
131
0
100
0
0
0
0
0
Acres
App. Period
7.40
2115-6130
Supplied By:
A`��—,
CROP
Corn, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Noboco
Residual
*20
0
0
0
0
0
0
0
Sample
PPR..
Date
115 bu.
01-18-12
Manure
111
223
40
98
3
54
11
0
oval
I Rating
51 Ibslac.
Unknown
BALANCE
0
223
-60
98
3
54
Ill
0
997744 Database Version 3.1 Date Printed: 1/18/2012 NMR Page Page 1 of 3

Nutrient Management Recommendations Test
YEAR
j
N
(lbs/A)
P205
(lbs/A)
K20
(lbs/A)
Mg
(lbs/A)
Mn
(lbs/A)
Zn
(lbs/A)
Cu
(lbs/A)
Lime
(tons/A)
Tract Field
73137
2
Req'd Nutrients
130
0
50
0
0
0
0
1
Acres
App. Period
8,60
2115-6/30
Supplied By:
z
4 ­
CROP
Corn, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Johns
Residual
*20
0
0
0
0
0
0
0
RYE Sample
Date
120 bu.
01-12-12
Manure
110
221
39
97
3
54
11
0
P Removal
Rating
53 lbs/ac. lunknown
BALANCE
0
221
-11
97
3
54
11
-1
Tract
Field
7328,32
4
Req'd Nutrients
104
0
100
0
0
0
0
0
Acres
App. Period
2.00
2/15-6/30
Supplied By:
ow
NM
—
�� ��
CROP
Com, Grain
Starer
0
0
0
0
0
0
0
0
Commercial,Fert
0
0
0
0
0
0
0
0
Soil Series
Autryville
Residual
*20
0
0
0
0
0
0
0
RYE Sample
Date
85 bu.
01-12-12
Manure
84
169
30
74
2
41
8
0
P Removal
Rating
37 lbs/ac.
Unknown
BALANCE
0
169
-70
74
2
41
8
0
Tract
Field
7328,32
5
Req'd Nutrients
104
0
100
0
0
0
0
1
Acres
App. Period
1.10
2115.6130
Supplied By:
�
CROP
Corn, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Autryville
Residual
*20
0
0
0
01
0
01
0
RYE Sample
Date
85 bu,
01-12-12
Manure
84
169
30
74
2
41
8
0
P Removal
Rating
37 Ibs/ac.
Unknown
BALANCE
0
169
-70
74
2
41
8
-1
Tract
Field
7328,32
6
Req'd Nutrient
104
0
40
0
0
0
0
1
Acres
A Pcriod
PP�
2.00
2/15-6/30
Su lied B
PP Y=
=
r
x
CROP
Com, Grain
Starter
0
0
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Autryville
Residual
*20
0
0
0
0
0
0
0
RYE Sample
Date
85 bu.
01.12-12
Manure
84
169
30
74
2
41
8
0
P Removal Rating
37 lbs/ac.
Unknown
BALANCE
0
169
-10
74
21
411
8
-1
Tract
Field
73389
1
Req'd Nutrients
130
0
0
0
0
0
0
1
Acres
App. Period
14.00
2/15-6/30
Supplied By:
--- rii
tZ
MW
�`
CROP
Com, Grain
Starer
01
D
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Sail Series
Johns
Residual
*20
0
0
0
0
01
01
0
RYE Sample
Date
120 bu.
01-12-12
Manure
110
221
39
97
3
54
I1
0
P Removal
Rating
53 lbs/ac.
Unknown
BALANCE
0
221
39
97
3
54
I 1
-1
997744 Database Version 3.1 Date Printed: 1/I8t2012 NMR Page Page 2 of 3

Nutrient Management Recommendations Test
YEAR
j
N
(lbs/A)
P205
(lbs/A)
K20
(lbs/A)
Mg
(lbs/A)
Mn
(lbs/A)
Zn
(lbs/A)
Cu
(lbs/A)
Lime
(tons/A)
Tract
Field
73717
5
Req'd Nutrients
131
0
80
0
0
0
0
1
Acres
App.Period
7.60
2/15-6/30
SuPPltedBy
�. t
— - ry
CROP
Corn, Grain
Starter
0
01
0
0
0
0
0
0
Commercial Fert
0
0
0
0
0
0
0
0
Soil Series
Noboco
Residual
*20
0
0
01
01
0
0
0
RYE Sample
Date
115 bu.
01-12-12
Manure
111
223
40
99
3
54
l ]
0
P Removal
Rating
51 lbslac.
Unknown
I BALANCE
01
223
40
98
31
54
11
-1
NOTE: Symbol * means user entered data.
997744 Database Version 3.1 Date Printed: 1/18/2012 NMR Page Page 3 of 3

The Required Soil Test Values shown in the following table provide a summary of recommended actions that should be taken if soil tests indicate excessive levels of
copper or zinc. Fields that receive manure must have an annual soil analysis for these elements. High levels of zinc and copper can adversely affect plant growth.
Alternative crop sites must be used when the concentration of these metals approach excessive levels. Site life can be estimated by dividing the amount of copper and
zinc to be applied in lbs/acre by 0.036 and 0.071, respectively and multiplying the result by 0.85. By adding this quantity to the current soil index for copper or zinc, we
can predict life of the site for waste disposal.
In addition to copper and zinc indices, this table also provides a summary of lime recommendations for each crop based on the most recent soil sample. Application of
lime at recommended rates is necessary to maintain soil pH in the optimum range for crop production .
Required Soil Test Values
Tract
Field
Crop
pH
Lime Recom.
(tons/acre)
Cu-1
Copper Recommendation
Zn-1
Zinc Recommendation
3974
13
Corn, Grain
5.4
0.7
538
None
742
None
3974
14
Corn, Grain
5.4
0.6
712
None
4150
Cease application (all crops). Maintain
PH at 6.0 or above.
3974
4
Coro, Grain
5.2
1.2
305
None
584
None
3974
9
Corn, Grain
6.0
0.0
332
None
285
None
73137
2
Corn, Grain
5.1
1.2
436
None
494
None
7328,32
4
Com, Grain
6.0
0.0
332
None
285
None
7328,32
5
Corn, Grain
5.5
0.5
311
None
242
None
7328,321
6
Com, Grain
5.2
1.0
487
None
536
None
73389
1
Com, Grain
5.2
1.2
305
None
584
None
73717
5
Com, Grain
5.4
0.7
538
1 None
742
None
997744 Database Version 3.1 Date Printed: 01-18-2012 STV Page Page 1 of I

Required Specifications For Animal Waste Management
1. Animal waste shall not reach surface waters of the state by runoff, drift,
manmade -conveyances, direct application, or direct discharge during operation
or land application. Any discharge of waste that reaches surface water is
prohibited.
2. There must be documentation in the design folder that the producer either owns
or has an agreement for use of adequate land on which to properly apply the
waste. If the producer does not own adequate land to properly dispose of the
waste, he/she shall provide evidence of an agreement with a landowner, who is
within a reasonable proximity, allowing him/her the use of the land for waste
application. It is the responsibility of the owner of the waste production facility to
secure an update of the Nutrient Management Plan when there is a change in the
operation, increase in the number of animals, method of application, receiving
crop type, or available land.
3. Animal waste shall be applied to meet, but not exceed, the nitrogen needs for
realistic crop yields based upon soil type, available moisture, historical data,
climatic conditions, and level of management, unless there are regulations that
restrict the rate of applications for other nutrients.
4. Animal waste shall be applied to land eroding less than 5 tons per acre per year.
Waste may be applied to land eroding at more than 5 tons per acre per year but
less than 10 tons per acre per year provided grass filter strips are installed where
runoff leaves the field (see USDA, NRCS Field Office Technical Guide Standard
393 - Filter Strips).
5. Odors can be reduced by injecting the waste or by disking after waste application.
Waste should not be applied when there is danger of drift from the land
application field.
5. When animal waste is to be applied on acres subject to flooding,.waste will be soil
incorporated on conventionally tilled cropland. When waste is applied to
conservation tilled crops or grassland, the waste may be broadcast provided the
application does not occur during a season prone to flooding (see "Weather and
Climate in North Carolina" for guidance).
7. Liquid waste shall be applied at rates not to exceed the soil infiltration rate such
that runoff does not occur offsite or to surface waters and in a method which does
not cause drift from the site during application. No ponding should occur in order
to control odor and flies.
-

8. Animal waste shall not be applied to saturated soils, during rainfall events, or
when the soil surface is frozen.
9. Animal waste shall be applied on actively growing crops in such a manner that
the crop is not covered with waste to a depth that would inhibit growth. The
potential for salt damage from animal "waste should also be considered.
10. Nutrients from waste shall not be applied in fall or winter for spring planted
crops on soils with a high potential for leaching. Waste/nutrient loading rates on
these soils should be held to a minimum and a suitable winter cover crop planted
to take up released nutrients. Waste shall not be applied more than 30 days prior
to planting of the crop or forages breaking dormancy.
11. Any new swine facility sited on or after October 1, 1995 shall comply with the
following: The outer perimeter of the land area onto which waste is applied from
a lagoon that is a component of a swine farm shall be at least 50 feet from any
residential property boundary and canal. Animal waste, other than swine waste
from facilities sited on or after October 1, 1995, shall not be applied closer that 25
feet to perennial waters.
12. Animal waste shall not be applied closer than 100 feet to wells.
13. Animal waste shall not be applied closer than 200 feet of dwellings other than
those owned by the landowner.
14. Waste shall be applied in a manner not to reach other property and public
right-of-ways.
15. Animal waste shall not be discharged into surface waters; drainageways, or
wetlands by a discharge or by over -spraying. Animal waste may be applied to
prior converted cropland provided the fields have been approved as a land
application site by a "technical specialist". Animal waste shall not be applied on
grassed waterways that discharge directly into water courses, and on other
grassed waterways, waste shall be applied at agronomic rates in a manner that
causes no runoff or drift from the site.
16. Domestic and industrial waste from washdown facilities, showers, toilets, sinks,
etc., shall not be discharged into the animal waste management system.
----------------------------- ---------------- ----- -----------------------------------------------------------------------------------------------
997744 Database Version 3.1 Date Printed: 1/18/2012 Specification Page 2

17. A protective cover of appropriate vegetation will be established on all disturbed
areas (lagoon embankments, berms, pipe runs, etc.). Areas shall be fenced, as
necessary, to protect the vegetation. Vegetation such as trees, shrubs, and other
woody species, etc., are limited to areas where considered appropriate. Lagoon
areas should be kept mowed and accessible. Berms and structures should be
inspected regularly for evidence of erosion, leakage, or discharge.
18. If animal production at the facility is to be suspended or terminated, the owner is
responsible for obtaining and implementing a "closure plan" which will eliminate
the possibility of an illegal discharge, pollution, and erosion.
19. Waste handling structures, piping, pumps, reels, etc., should be inspected on a
regular basis to prevent breakdowns, leaks, and spills. A regular maintenance
checklist should be kept on site.
20. Animal waste can be used in a rotation that includes vegetables and other crops
for direct human consumption. However, if animal waste is used on crops for
direct human consumption, it should only be applied pre -plant with no further
applications of animal waste during the crop season.
21. Highly visible markers shall be installed to mark the top and bottom elevations of
the temporary storage (pumping volume) of all waste treatment lagoons.
Pumping shall be managed to maintain the liquid level between the markers..A
marker will be required to mark the maximum storage volume for waste storage
ponds.
2L Waste shall be tested within 60 days of utilization and soil shall be tested at least
annually at crop sites where waste products are applied. Nitrogen shall be the
rate -determining nutrient, unless other restrictions require waste to be applied
based on other nutrients, resulting in a lower application rate than a nitrogen
based rate. Zinc and copper levels in the soils shall be monitored and alternative
crop sites shall be used when these metals approach excessive levels. pH shall be
adjusted and maintained for optimum crop production. Soil and waste analysis
records shall be kept for a minimum of five years. Poultry dry waste application
records shall be maintained for a minimum of three years.
Waste application records for all other waste shall be maintained for five (5)
years.
23. Dead animals will be disposed of in a manner that meets North Carolina
regulations.
----------------------------------------------------------------------------------------------------------------------------------------- ------
997744 Database Version 3.1 Date Printed: 1/]8/2012 Specification Pale 3

Crop Notes
The following crop note applies to field(s): 1, 2
Corn 1: CP, Mineral Soil, low -leachable
In the Coastal Plain, corn is normally planted when soil temperatures reach 52 to 55 degrees fahrenheit.
Review the Official Variety "green book" and information from private companies to select a high
yielding variety with the characteristics needed for your area and conditions. Plant 1-2" deep. Plant
populations should be determined by the hybrid being planted. Increase the seeding rate by 10% when
planting no -till. Phosphorus and potassium recommended by a soil test can be broadcast or banded at
planting. When planting early in cool, wet soil, banded phosphorus will be more available to the young
plants. An accepted practice is to apply 20-30 lbslacre N and 20-30 lbs/acre phosphorus banded as a
starter and one-half the remaining N behind the planter. The rest of the N should be applied about 30-40
days after emergence. The total amount of N is dependent on soil type. When including a starter in the
fertilizer program, the recommended potassium and any additional phosphorus is normally broadcast at
planting. Plant samples can be analyzed during the growing season to monitor the overall nutrient status
of the corn. Timely management of weeds and insects are essential for corn production.
The following crop note applies to field(s): 13, 14, 4, 5, 9
Corn: CP, Mineral Soil, medium leaching
In the Coastal Plain, corn is normally planted when soil temperatures reach 52 to 55 degrees fahrenheit.
Review the Official Variety "green book" and information from private companies to select a high
yielding variety with the characteristics needed for your area and conditions. Plant 1-2 deep. Plant
populations should be determined by the hybrid being planted. increase the seeding rate by 10% when
planting no -till. Phosphorus and potassium recommended by a soil test can be broadcast or banded at
planting. When planting early in cool, wet soil, banded phosphorus will be more available to the young
plants. An accepted practice is to apply 20-30 lbs/acre N and 20-30 lbs/acre phosphorus banded as a
starter and one-half the remaining N behind the planter. The rest of the N should be applied about 30-40
days after emergence. The total amount of is dependent on soil type. When including a starter in the
fertilizer program, the recommended potassium and any additional phosphorus is normally broadcast at
planting. Plant samples can be analyzed during the growing season to monitor the overall nutrient status
of the corn. Timely management of weeds and insects are essential for corn production._
------------------ - - ­ -------------------------------------------------------------------------------------- -- ---------------------------------
997744 Database Version 3.1 Date Printed: 01-18-2012 Crop Note Page Page 1 of 2

The following crop note applies to field(s): 4, 5, 6
Corn. CP, Mineral Soil, medium leaching
In the Coastal Plain, corn is normally planted when soil temperatures reach 52 to 55 degrees fahrenheit.
Review the Official Variety "green book" and information from private companies to.select a high
yielding variety with the characteristics needed for your area and conditions. Plant 1-2" deep. Plant
populations should be determined by the hybrid being planted. Increase the seeding rate by 10% when
planting no -till. Phosphorus and potassium recommended by a soil test can be broadcast or banded at
planting. When planting early in cool, wet soil, banded phosphorus will be more available to the young
plants. An accepted practice is to apply 20-30 Ibs/acre N and 20-30 lbslacre phosphorus banded as a
starter and one-half the remaining N behind the planter. The rest of the N should be applied about 30-40
days after emergence. The total amount of N is dependent on soil type. When including a starter in the
fertilizer program, the recommended potassium and any additional phosphorus is normally broadcast at
planting. Plant samples can be analyzed during the growing season to monitor the overall nutrient status
of the corn. Timely management of weeds and insects are essential for corn production.
-- ----- ---- ------------------------ -- -- ------------------------------------
997744 Database Version 3.1 Date Printed: 01-18-2012 Crop Note Page Page 2 of 2

Division of Water Quality
F il�i y Number 3 - ® Division of Soil and Water Conservation
® ether Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 36Routine O Complaint O Follow-up p Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: 1 f a Departure Time: County: �-]�(�U /l/ Region:
Farm Name: Ll (se�z T cA FACz M Owner Email:
Owner Name: 1PM %EA1& IV Er T0GgCU i i Phone:
Mailing Address: P. d . t]OiC o�_J �'! �//4NS U S �� 1 1.. O� y -1
Physical Address:
Facility Contact:
Title:
On site Representative: 4)N_ U/Vr: A1E714CZC L7-
Certified Operator: V&LAL
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Int:
Mti 9 Certification Number: Q- C,55
Certification Number:
Longitude:
Design ourrent
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
rj
Non -La er
Ell
Da Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , PTu-ltry
C*_a a�i_
Pao
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
LIHTurkevs
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
FEIher
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: -R Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ` No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA-603(y
Spillway?:
Designed Freeboard (in): 1 . S
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 f� No ❑ NA ❑ NE
waste management or closure plan? 3�
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 [DNA ❑ 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? 7�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? P�No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes ❑ 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): 56 E iz 10,
13. Soil Type(s): r y <_
th e
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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YeskNo
No
❑ NA
❑ NE
Required Records & Documents 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
b
appropriate ox.
QWUP El Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lr No
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Ate Transfers
Q Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections 0 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
[�7eather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -LQCI Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes *o ❑ NA ❑ NE
25.1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes]
No
0
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
0
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
I YI No
`T�
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIvIP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question 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).
w. A
SJa�1u
- 760H rT F-oec G 7` t i GAS- p,�� j oN D(A Q
E C LC_JlAlr Bu, !N
7 ►c r"s �
Lg�ooN s�j ro 6 aC an I o s��pc;c
.)- ,� T a E T
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
��r , off, a
Phone: 9lo '­3%
Date: Ih/]
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: c f J Arrival Time: Departure Time: County: h�tL W Region:
Farm Name: Owner Email:
Owner Name: E c.aC-�EI�I % YlF__N U_Cc�y7/T Phone: 10
Mailing Address: •Q V� o� 1`—�NI�N SUIL NC C1G03y V
Physical Address:
Facility Contact: r Title:
Onsite Representative: t—LaeNe
Certified Operator: yr I M OTH L� / V IvT# CaCU-T .
Back-up Operator:
Phone No:
Integrator•
/0 0SS`�ii Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=] o = ' 0 Longitude: a ° = ` =
Design Current
Design Current
Design Current
Swine
Capacity Population
,..�
Wet Poultry Capacity Population
ID Layer I I
Cattle Capacity Population
❑ Dq4y Cow
❑ Wean to Finish
Wean to Feeder
IQ Non -Layer I I
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
❑ Farrow to Feeder
❑Layers
❑ Non -Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
El Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page I of 3 12128104 Condnaed

F
pciliLy Number:
Date of Inspection i K)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: LA-Goolq
Structure 4
❑ Yes KNO
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?: nn
Designed Freeboard (in): 1—1 . S
Observed Freeboard (in): to
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ElNE
maintenance or improvement?
91.
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/ improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ElNA ❑ NE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground [IHeavy 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 El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Sc Q �P
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No ❑ NA ElNE
❑ 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 ElNE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes o ❑ NA ❑ NE
Commenis (refer;io question-#) Explain any YES answers and/or, any recommendations or any other comments::
Use drawings of facility to better explain situations. (use additiohal"pages asnecessary). MN
CQLI��TI C� �•l� �� �
�
P �C N ul`PDgT S� c zap G WTJ i oN GZ cpQ.O S
ON AvVtov E C.�, Fc,Q nn g
Reviewer/Inspector Name P jN G I Phone: 9 10 ' fp
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number; `� � —� Date of Inspection
�' _
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes XNo
ElNA
❑ NE
the appropriate box. El WUP ElChecklists [D Design ElMaps ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes ❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Xaste Transfers ❑jnnual Certification
❑ Rainfall 0 Stocking XCrop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes P(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
0NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify -the regional office of emergency situations as required by
❑ Yes C(No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:..: ✓ ,
t,v A
3j1 gl�v t.�
Pliv �•
as �6� CC o"
,� C- �a 1103,E o�
LNr PtA(n?1N6 P-r—_CO2i.�.S 1A)DICAIC %\`--,_I6,PT16N
-r►r�. ON �-1 a 10 NGL� 1��1GATlLw�'�S TU Fi�LA1N ig��
1 1
ioN Good c_F u E
A � S vR- 4H P� 11CW I C-)
� 71cov. ,�rr1u • flmAnrDA G,aiNES
�-R15i: I�MANf,� �H1N�S �� IQ� �RD1N'4LIVe Z��US
QUO �QCn' � tJV1L.MtAt6T0�`�#
IFOOtt J ��VV dCJ��
Page 3 of 3 I2128104

(Type of Visit XCompliance inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit IXLRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Qd Departure Time: County: b6ADQ Al Region:
Farm Name: L, e 1 Ul ��rii lam_ _ Owner Email:
Owner Name: uGr�VE /V�TNESZCyC/�T! Phone: )�-ag&-1-12 )
Mailing Address: r + K—
OX r GWQNS U 1 LLE c c98 3y
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: , _ EN F _ 1y F Tf�l✓� CL.kT Integrator:
Certified Operator: V " N G7 HFP�Cu r 1 Operator Certification Number:
Back-up Operator:
Location of Farm:
�o
LaEitude:
Back-up Certification Number:
❑ Longitude: = o ET 0 "
Design ,, rent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I 1
❑ Dairy Cow
Wean to Feeder
JE1 Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder'El
Non-Dairy
❑ Farrow to Finish
❑ Layers
El Stocker
El Gilts
❑ Non-ts ers
El Beef Feeder
El Boars
❑Pulle
❑ Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other INumber
of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 N No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
❑ Yes
tNo
❑ NA
❑ NE
12128104 Continued
lI

Facility Number: 3 1 —6%� Date of Inspection
Waste Collection & Treatment j
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑` No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _( -co-o /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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 X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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)�i� S11
13.
Soil type(s) (f,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ElNA ElNE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo ❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
4 No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No ElNA ElNE
lNo
18.
Is there a lack of properly operating waste application equipment?
ElYes
❑ NA ❑ NE
Comments (refer to question #) .Explain any YES answers and/or any recomnnendations ar any�othe comonents �
Use drawings of facillty,6 better.-ezplaih "situations. (use additional }ages as necessary):
..
�.n.
&111)69 ,. b
0
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 6"13l
12128104 Continued

r 1Ab.
Facility Number: 31 -- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
.8fNo
❑ 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 0 Checklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
*No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ I/aste Transfers ❑ Yinual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
5(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
( No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
xlai-12-Q du� JPwq C61-L64LO+LQw '�&uti Yc-G--AsE
"�Ag5l f RNA To '�LXnnpA/Vc ors N;s
12128104

Type of visit aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ,Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: L 1� 9FEE k f 70Q-f 1 Owner Email:
OwnerName: f -due EN-_" lj/' c—rNG(LC� t I /Phone:
Mailing Address: T •O . (�Ox O'��l Kg?yt i LE A C Q RSL /9
Physical Address:
Facility Contact: Title:
Onsite Representative: G_' L-k -T
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E:] o ❑ ' = « Longitude: 0 0 [=] - = «
Design Current
Swine Capacity Population
❑ Wean to Finish
Design Current
VjjWjj'
Capacity Population
❑ Layer
Design Current
Cattle Capacity Population
❑ DairyCow
® Wean to Feeder
SS
OO
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
❑ Layers
Non -La ersEl Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
FEIGilts
Boars
Other.
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
kNID
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
%No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Fiscility Number: & f — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: C/C} C60AI
Spillway?:
Designed Freeboard (in): / 9• S
Observed Freeboard (in):
❑ Yes ANo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M No ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JZ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes &No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P9LNo ❑ 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
IV No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IN No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
pLNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�[No
❑ NA
❑ NE
TO GI=T A 3oaL_ SOMPC E �� ��cD o �dg�
eeT ,✓,acaGR-+�T+tv c.�r-�r�vcLZ ��c3rg�vS�.� �rc,1c�1�
�QaPTe CZOP LA,1 Eta
Ai
Reviewer/inspector Name H C- 1¢� 5 Phone:
Reviewer/Inspector Signature: Date:IQ ql6g
Page 2 of 3 12128104 Continued

facilit3TNumber:31( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking El Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 10 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
INo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes]
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Uj-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IVNo.
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;4 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
ANo
❑ 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'gNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
H.,
Page 3 of 3 1 12128104

I
'S Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit VJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: to o(/ Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: , Title:
Ev�E ►J
Onsite Representative: jETS (L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
n°
Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Longitude:
° = 4 = [I
Design Current = Design "Current'" . Desrgn Current
wine
' a aci tyPo Population' attle nSCapacity Population Wet Poultry C-
o
❑ Wean to Finish
91 Wean to Feeder
35&-1-
'L
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures. .
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes EI'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
❑ N
❑ Yes
fo
❑ NA
❑ NE
❑ Yes
EK
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No
❑ 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: LA 6 [xin)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a9g
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
,_.,/
hd No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes ❑ NA ❑ NE
l�[No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ln No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Lips
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3 No ❑ NA ❑ NE
I No ❑ NA ❑ NE
No ❑ NA ❑ NE
LE'N El NA El NE
No ❑ NA ❑ NE
Comments (refer to question # Explain any YES answers and/or any recommendations or any- other comments - :.
Use drawings of facility to better explain situations.. (use additional.pages as'necessary.) .
c.Rcr? �-fL44 L9 le =47,9-t6a71.6,J y0-S9CtrZQjKj S Dam S.CuCE LAST Tdj-KCTZUO
`
�LvDG� SVft-J6� ��IE Fz�+JtrJG t�1L1S ToA To RAI.Gi�.
y,) d nil u m1J ST o Aw 0 U at_ AV &LA GE Fri w- �' n,T e &R AM R-
w
_
Reviewer/Inspector Name �— - - So14 ri �q� (�� -----) Phone:
Reviewer/Inspector Signature: Date: !b 06
Page 2 of 3 12128104 Continued

P
Facility Number: 3) — 92 Date of Inspection ro air vb
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes wwo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropriate box. ❑ W`LJp ❑ Checklists ❑ Design ❑ Maps ❑ Other
�
21.
Does record keeping need improvement? If yes, check the appropriate box below.
U es
❑ No
❑ NA
❑ NE
❑ Waste Applica ' n El Weekly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Transfers
El Annual Certification
El Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�V,, /NNo
E?<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
eNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LfJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
;],N0
❑ 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?
Ell� Yes
�,i
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�eo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

3)
Type of Visit CCo�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : y s Departure Time: County: 4yPtlr Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative: ✓ G C� t✓ e n " f T_4 ESL CVTT
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = 4 0 " Longitude: [= o =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
© Wean to Feeder 3 55`2, S9CO
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - - -- -- .. -
ED]La er
Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poutts
❑ 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?
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifei
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — �, Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA G 001J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes pAo ❑ 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 E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 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) Cl) S
13. Soil type(s) /JofLG dL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NNo
3,
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
,F
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
�DNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo
❑ NA
❑ NE
Comraeents(refer;tosquestionj#)ExplainanyY,ESaaswersYanoranyepmodr any other comments.
SyJ � ru'7C..ak�3
Use draRings;ofacEhty totbetter egplain�s�tuateons (useraddit►onalrpagesfas necessary):
I .} U ►� DAi C R.oP ,.= E. t. 0 FO rC.M , a rS ZTZ-rL N C C O j-a { Z C t_, L 0 t
ANroeEc,T La,J �� �Vw,P -r.-n ter= i !lIVJ 2l��vn-5. � E
SVIZE hnoallaLSF AV6n.AC,6
Reviewer/InspectorName �a "' Phon 9/0 7q-
Reviewer/Inspector Signature: Date:____&2o
12128104 Continued

Facility Number: — �a Date of Inspection ib v S
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
El Annual Certification
❑ Rainfall Stocking [Crop Yield 20 1Minute Inspections ❑ Monthly and V
Rain Inspections , Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
O NNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[J No
E NA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ErNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZN
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E a*N� o
❑ 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
EK
❑ 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 EI�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 ,,,,o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? El Yes M//o ❑ NA ❑ NE
Additional Comments and/or Drawmi s ` h ' S ,
12128104

Type of Visit 0 7Routine
pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
]Date of Visit: t a 14 o Tine:
Facility Number �9 2
Q Not Operational O Below Threshold
Permitted Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: — LBWnt County: UP ._
Owner Name: _ . .... _. ...„.._ w.. » »» . .. ... M_ Phone No: ... .
-Mailing Address:
Facility Contact: ------------ ----Title: Phone No:
Onsite Representative: E.0 �3 t._-T11E_- . Integrator. �AMIL At'oS
Certified Operator.
Location of Farm:
Operator Certification Number.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 44
Swine
Wean to Feeder
35 52
2 4-16
❑ Layer
Feeder to Finish
❑ Non -Layer
Farrow to Wean
-
Fazrow to Feeder
Totgj Desk
Farrow to Finish
Gilts
µ x
K 3§
7
Boars
x
Discharges & Stream Iniyacts
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?
.7
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: — 1 .�. . _ .
Freeboard (inches): 2-9
❑ Yes dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
dNo
❑ Yes
21<o
❑ Yes ❑ No
Structure 6
12112103 Condnued

l; acility Number: 3 — 109 Z Date of Inspection !O
5. `;clre there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [;(No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Q No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 131No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [1To
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Eio
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes WNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type _ t A
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 7No
o
[I Yes
❑ Yes 12 No
❑ Yes j h10
❑ Yes [! No
❑ Yes [g'No
❑ Yes !Vo
❑ Yes [�No
❑ Yes [!(No
❑ Yes ®No
Field Covy ❑ Final Notes
a3J WAsce ANAUr� Goon f� C� N-es 9R rot , At-kD A F SanzPc oaTE ,
,,5,Atl T*11 706311,-4 56-0 too V.O j S4$V' m.
c5 c, 5o 0""4 ^' 5 tb '00 two GW ,
N LW W (�� �° �' 6 c� wl G yJ �w L t' zNSi R l�E� C k. Tf= � ?-r- 'r, f a-0 , NA S
P tgrJ&GD FR'(5rn r'-E2n�WARISCyo To OdLy WilEAt /Soyam')S.
s �t4 6 C c�[va+K- PAPEar- aL. WEw Pe w,� SooeTL` ,
!�ApoA wku- VV'-AVN TAsN?_D.,
i 6CAt - w�+r� �,�*EvR Aro�t. Ag ou_r NEW L- . CL CsAU&E. Ii CNE C.K t VECL or,J
Ar A rv��t �AvM
Reviewerthmpector Name
Reviewer/inspector Signature:
Date: to
12112103 Confinued

Facility Number: .31 -.. (.,� Z, Date of Inspection o q
RdQuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�
[20
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Y
+To
Oe/ WUP, checklists, design, maps, etc.)
s
Q'
23. Does record keeping need improvement? If es, check the appropriate box below.
Yes
❑ No
El Waste Application ❑ Freeboard aste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
El Yes
ETNo
0<0
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
27_ Did Reviewer/Inspector fail to discuss reviewfrnspection with on -site representative?
❑ Yes
CjKo
28. Does facility require a follow-up visit by same agency?
❑ Yes
/
❑'lq�No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NTPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 0'NO
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crap Yield Farm ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Type of Visit Ocoompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Q7 Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
Permitted 0 Certified O Conditionally Certified 0 Registered
Farm Name:
Owner Name: _�itr�lli�
Mailing Address:
Facility Contact: Title:
Onsite Representative:
r
Certified Operator: _�� fL,♦i���
Location of Farm:
Time: % 0
Date Last Operated or Above 'Threshold:
County-\Ll UPLXAJ A29
Phone No: I�7(P ~ pte-7,35
Phone No:
Integrator: 246Lus
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude 0' ° 0"
Wean to Feeder .52- 1LJ Layer LJ D
Feeder to Finish ❑ Non -La er ❑ N
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Tinfal TfPcivn %an
Subsurface Drains
No Liquid Waste A
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifyes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes WrNo
❑ Yes ❑ No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes ONO
❑ Yes ONO
Structure 6
Continued

i
4 �
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ieTT/TTtreees, severe erosion, ❑ Yes No
seepage, etc.) I
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ,�J
closure plan? ❑ Yes Ld No
(If any of questions 4-6 was answered yes, and the situation poses an T
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 0No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VfNo
11. Is there evidence of over application? , , ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overlgad ❑ Yes VNo
12. Crop type 9MV1190153,R -s5 (Aw 1 \_DAV/ (44; J 141jr-��D1 (_0& IvIleo
� ff--
13. Do the receiving crops differ with those desi ated in the Certified Animal Waste M a ement Ian (CA WMPr
❑ Yes
gNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ONO
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
VJ
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
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El
No
24.
Does facility require a follow-up visit by same agency?
ElYes
El
No
VJ
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
ElYes
XNO
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coniment refer to<question EX Lain any YES answers and/or any reco iim�endahons o� nytoE)ier comments. `
ruse-iirawrngs of facilityto betterexplaan sttuahons: (use ad�lihoiiahpages as necessary)
Field Capv El Final Notes
PK . w
I F '0 co/z o ISR l &.� S 1&5o0e r /v"5,4e5e
01jr,
/Y%ty`Fa �-�7 l�0���•t ��,��r.11 �, �,r��.tl.sz ,� SEe ��C.- ;?0-
�SFF LF /h/F
A P/0
Reviewer/Inspector Named -d .
Reviewer/Inspector Signature: Date:
0510310I Continued

i
Facility Number: 3 — Date of Inspection / d Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes Ld No
roads, building structure, and/or public property) T
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 101No
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 G�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32..Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes .21No
Additional Comments and/orDrawings:
r us►oGzW S ✓`Sr�zC f� �`g�f
'�
M7W •" �Ig��� EL1J� &'6
�F �" p�/ f/-y-t�F� !'`/Ny Cj [l�5ftoa✓ j �ZriF � i /� /T
5100

L
Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency ,
Type of Visit QkCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ARoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number date or visit: imp: Printed on: 7/21/2000
Not O erational 0 Below Threshold
© Permitted Acertified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ............'^�.flfJ�............... .L'ax..►'%�.................................................. Counts':............,D, ! ................ .........
Owner Name:..., . ✓•L •� mil.. Phone No:...../..�........r...........
Facility Contact: WAY.. ... ,(.rin.�(�... ......... le:....� ......... ...... Phone \o:
Iailin Address: ...... <......`7...... ........................ 1... .................
r
Onsite Representative: ...................................... / ..... Integrator: ..........,!1....
Y.,ClIj.........................................
Certified Operator .... Operator Certification Number:
......................................................................................................................................
Location of Farm:
Ir
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder -6 Serf,. ❑ Layer Fr -
Non -Dairy
Dairy
❑ Feeder to Finish ❑Non -Layer
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 l ag-�on Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N 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) El Yes ❑ No
c. If discharge is observed. what is the estimated flow in galhnM2 - #- -
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 o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 StruCtUrc , Structure 4 Structure 5 Structure 6
Identifier: ........ .?..................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Niiinber: — Date of Inspection O Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures o®rvee/ trees, severe erosion, ❑ Yes j� No
seepage, etc_) n
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes o
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 ANo
I I _ Is there evidence ofoverapplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type /o i/ee s V- <,e
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 VNo
b) Does the facility need a wettable acre determination? ❑ Yes 0T0
c) This facility is pended for a wettable acre determination? ❑ Yes KNo
15. Does the receiving crop need improvement? ❑ Yes 1;�No
16. Is there a lack of adequate waste application equipment? ❑ Yes gNo
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?
violatigris:or deficiencies were noted iiirri .. t..... s. .. .oil will receive Rio further, • : •
carrel one ence: abnut: 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):
❑ Yes K
o
❑ Yes No
❑ Yes No
❑ Yes IkNo
❑ Yes Wo
❑ Yes 'KNo
❑ Yes ;KN0
❑ Yes No
❑ Yes No
1AAW19141r Aju WM Af wssm� 61V/14;1�
Reviewer/Ins 'ec or Name 4Lf- /1" C �1
Reviewer/Inspector Signature-` }, r1 ,'o I Date:

FZi—RWMimber: —1741 L Date of inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge it/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Ayes ❑ No
❑ Yes kNo
❑ Yes P(No
❑ Yes gNo
❑ Yes ONo
❑ Yes [YNo
❑ Yes OdNo
5100

5
[] Division of Soil and`Water: Conservattou'- Operation Review =
E Division of Soil and Water Conservabton` 'Compiance 1& ection
D�visian of Wa#er Qualaty Compliance lnspecti W
- w
W -El Other Agency Operation Revrew� w
Lo Routine 0 Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number Z Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permittedrtified ©Conditionally Certified E3 RegisteredJE3 Not O erational Date Last Operated:
Farm Name: �' t �. y �tfht-....... County:..........:'l�J. .�a�.! f.................................................
...................
Owner Name
Facility Contact: .................................................
Mailing Address:
Phone No:
..Title: ............................................. .................. Phone No:.............................
Onsite Representative: , ..q..rp.e+f . • Integrator ..........A"-.:n.U,S�.........................................
Certified Operator: ...................... . .......... .............................................................. Operator Certification Number: .... 4�b.t!.7...................
Location of Farm:
.................................. ........r.. ,. 7 ..................................
.......................................
................................. .................... .......... ....-..-...-.-..............
....
.........................................................................................y....................................................--................................................................. .................... �
Latitude Longitude •°�
- Design Current _ w ;., Desig - Current gn Design Current
SwineCa Capacity Po ulatio?oultry lation Cattle Capacity Po Mahon-n -Ca acityPou>.
can to Feeder ❑Layer "' ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Gapaeity
❑ Gilts
❑ Boars Total'-SSLW
1Number ;Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Hald�ng Ponds /Solid Traps ❑ No Liquid Waste Management System
m �..
Discharges & Stream Imparts
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 tnan-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ........ .......................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes /No
❑ Yes ONo
❑ Yes P4o
❑ Yes 10f,40
❑ Yes ;3No
❑ Yes P15o
❑ Yes XrNo
Structure 6
...............................
❑ Yes ANo
Continued on back

Facility Number: 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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type C. _
C aA A.AQZAT-/s-.
�r7�'7Fiy
■IFA
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 & Generaf Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZNo
❑ Yes YfNo
❑ Yes ,0No
❑ Yes J2(No
[]Yes ,NNo
❑ Yes �No
❑ Yes
❑ Yes yg
❑ Yes No
❑ Yes ONo
❑ Yes ENO
❑ Yes <
❑ Yes 7No
❑ Yes
❑ Yes ;2rNO
❑ Yes �10
❑ Yes �No
❑ Yes VNo
[I Yes No
❑ Yes ,,ErNo
................................................ .......
::Rio vo�a[4tjtis:or d'aheiencies were noted• during •this;visit;-:Y;ou will-cebON Rio further
corresponc#enee. about this visit.
,Comments (refer to question #):` Explai i`an yt answers`and/or any recorti mendations or any other comments - Wr
Use di-awinis of facility to;tietter eXplatn.sttuAti ns (usegadditroiial pages as recess#
fu,%ASOA- tS rntP2.�JtnrCr I+
j jeA oLtGE4 Aov•"s ED CArl &ri— ip To 3 ibs aPj C QCoeu vl--.
1eo Y10 j 3? 5- -
Reviewer/Inspector Name —
Reviewer/Inspector Signature. �b Date: 7 <�!Fj 99
3/23/99

Facility Number: — 7, Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 26es ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes /No
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes ;! No
roads, building structure, and/or public property) P
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes zNo
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 i No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes iNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ;dNo
Additional. omments an or Drawings:-.
Ak
0 v&r'r-C Roes dTCXLO 'V-
�
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
JqD Routine w O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of inspection
�I (�. Z
Time of Inspection 10�-, 24 hr. (hh:mm)
13 Registered 03 Certified [a Applied for Permit © Permitted 113 Not O erational I Date Last Operated:
Farm Name:.. ................: ,�e�l- County: ....... .L.tt.r4,li.rh ...................................... .......................
Owner Name: ............................... C--V. •----...�JXW—LK_k......-•---................... Phone No: .... Li. I j� --- 7-2 fa ".t.23.!.........................................
Facility Contact: .............................................................................. Title:......................... ......................... Phone No:
MailingAddress: ................... D...%ok..........z.......................................................... .....1! din i `... I...N.L............................... Za S4, .........
Onsite Representative: :............... p f-l-W,........N.ALt.................................. Integrator: ........... .�:w..Q.��.s...... .............................................
Certified Operator;............................................................................................. .... Operator Certification Number-_ .......................................
Location of Farm:
Da-.....S�,u. ......si.i3[....¢.. Y.......... m. aL5.... wxi. � ....,d........ � 1�....?...................................................................................... A
-- ---... ... ................................................. .
Latitude =*=t =" Longitude =- =' =11
ry Design Current
x , i?estgn Ctarrent ,• Destgn ;Current
A.
Somme _ Capacity Population yPouttiy Capacity',_Population Cattle Capacity Population
Wean to Feeder
3�-2.
r'•
❑ Layer
El Dairy
❑ Feeder to Finish
s'
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
}
❑ Farrow to Feeder
❑Other
. .. F�
Y
Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑Boars
Total SSLW
mber of Lagoons / Holchng Pondsf:
Subsurface Drains Present
❑Lagoon Area
pray Field Area
E-11'k �£;
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
P No
2. Is any discharge observed from any part of the operation?
❑ Yes
PNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
CH
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
1P No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
EP No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
CA No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Farii1ty Number: 3 k —1 L 9
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 00 No
Structures (LaPoonsAo-lding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ............ .............
-..
10.. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement? _]
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
O No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
PO No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
r..M.U.I�A..........��!.+.68......... f�... (psi ................
15. Crop type S4"w- - ---------------------------------------------------------------
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[A No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18.
Does the receiving crop need improvement?
[giYes
f
❑ No
19.
Is there a lack of available waste application equipment?
❑'Yes
191 No
20.
Does facility require a follow-up visit by same agency?
MYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
A No
22.
Does record keeping need improvement?
TftYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
0•No.violations•or. deficiencies.were noted-d6ffiig this.visit.- Yo_u:vKill ::recei�e•nolfiirilier
c0frespi)6&h a dhout this:yisit.• : .. .: ::::: . . .. f . . : . ::. .... • ..
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Z.
14,11 o_Wew�or- cOt''�w-weiiA ]n��et. �j�cellD
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I
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e
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A, 1401bs/0.L
I-._ 7/25/97
I Reviewer/Inspector Name
IReviewer/Inspector Signature:
Date:

' Division of Soil and Water Conservation ❑Other Agency � �� � � � � �� � � �
y ®Diviswn of Water QualityAll
F ��
Routine O Complaint O Follow-up of DIVQ inspection O Follow-up cif DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection top 24 hr. (hh:mm)
© Registered ® Certified 0 Applied for Permit [3 Permitted 10 Not O erational Date Last Operated:
.....��1\.................... Farm Name: �............................................
Owner Name:....... 4haR:.....A.&x- t: PhoneNo: ... �`ilit�.��ila:...Li.Ls.3S.........................................
Facility Contact:....�tayEE<,*-....�.e �.[ ....................... Title: .....Dt�+su.f......................................... Phone No:.( 1Q12U..:7.JZ S:...........
14iailing Address:.... 0-taY....... ;u................................... .................... .. ......—................................ ..z 3, %.......
Onsite Representative: ....... EI. .JI.........�Jzlurt.a.d Integrator:
......!!!!,.5..................................i...`.....................
Certified Operator,..... poet,,,.• ...... At('irl-Vh.................................................... Operator Certification Number :...... �.�..l..f.. ............
Location of Farm:
�`.. ....�. 4...... S� ... ..... ..t.11 .n.....�.1i1Ct!�.... i°!�...... a.�...1.1.3Zw......f1Y fM...:�.....n.Tw ..iklL �..........
r, h
a.^........�IZCi. ca ..- ! ....... ...:.........................................................°j.................................. ....... .......................... ............. ........... I...........................
Latitude • 04 " Longitude 0• 04 "
Design , .Current
Design Current ' Design Curreiat
Swine ' °. x Capacity I?opulatian
°` Paulfry Capacity Pop3ilatioa Cattle Caacity °Population
Wean to Feeder
10 Layer
I
I
❑Dairy
❑ Feeder to Finish
❑Non Layer
El Dairy
.
❑ Farrow to Wean_
....:... r•'�
'
❑ Farrow to Feeder'
❑ Other
Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑ Boars
a_ Total-SSLW
0
Number of Lagaons / Holding Pcrnds 0', �{ Subsurface Drains Present ❑ Lagoon Area
6ESpray Field Area
Y
❑ No Liyuid Waste Management System
r r.
General
1. Are there any buffers that need maintenancelimprovement? ❑ 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 ® No
b. If discharge is obsened, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in eal/min?
-d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes W No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 91 No
5. Does any part of the waste management system (other than lagoonstholding ponds) require Yes ® No
rnaintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7125/97
Continued on back

Wr
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
U[No
Structures (Lagoonsdiolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
R] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:
`
Freeboard (ft):.........r :7.....................
10. is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste application
14. Is there physical evidence of over application?
❑ Yes
5& No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
rf
15. Crop type +� Y.7N1t1�? ..............................IYtLun.......................... ......... 1n1r...........SD.y1S�!►.......................................................I........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
b?No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement?
% Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
®No
20. Does facility require a follow-up visit by same agency?
❑ Yes
bg No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
22. Does record keeping need improvement?
91 Yes
❑ No
For Certified or Pernutted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWNIP?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
No.violitions-or deficiencies.were noted -during this.visit: Yoittwill receive•no-ftirther-
.�:correspondence.about�this�visit:":�;-;��-;-:�--���:��
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7/25/97
I Reviewer/Inspector ]Fame I,a "n t,y>' � _ ', �
iI Reviewer/Inspector Signature. L K �,�_ Date: