310742_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

i
z
Type of Visit: Or Compliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Q / Arrival Time: Departure Time: 03' County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Q/'[i► /► Integrator:
Certified Operator: Certification Number: 1 O` 00 6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Desiga Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design C►urrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
O CIO
fv7
Non -La er
Il . P,oult .
Layers
Design
Ca ae
Current
P.o
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
tither
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable '.adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes2No
No NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

t
Facili Number: 31- Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2fi6❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'Z t ` 2. Z _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0-1 O ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Io ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes To NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ LT 0 0 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 10 ❑ 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 r To ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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
n No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
es
❑ No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[g-Wo Ll NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej1'qo ❑ NA
❑ NE
Required Records & Documents
WN0,
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
FIC ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes❑
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
]Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Yes
NA
"No[:]
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
❑ NE
Page 2 of 3
21412015 Continued

1
Facility Number: jj - c{ Date of Inspection: c> /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? lfyes, check ❑ Yes & IE� O/[:]NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No L A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes B`'G ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
❑ Yes OXNo ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes to ❑ NA
❑ Yes ❑ NA
[:]Yes 5j o/❑ NA
Comments (refer to gyesVon 4) Explainiany YES.answersand/or:any,,,additio©al recormibenda#tons or any pt4er comments.'
,a
Use dra��in s.of iac�tv't6lbetter exalam situations (use_additional vajzes aas necessary).' , A�: `
�r S o � S C r o P " Z_ // , 1� _ ^� • �
r< l_�� �i v�s7� i s �c<-aP Il 4'pt /�c pA-Al
(krP%.C10C4 `g_y�'*Cr"P.
4
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name: �- t � 4 "'�'�-//' -le 7
Phone: f `9 PG 730
Reviewer/Inspector Signature: Date: .;/ & 7
Page 3 of 3 2/4,,201 S

i
Type of Visit: 0 Corn nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
sit: Rout Reason for Viine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: li I Arrival Time: ® Departure Time: I County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: ` Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: I f4 9 ZP7100-Ir
Certification Number:
Longitude:
Design Current
Po
Swine Capacity p.
Design Current
Wet Po'ltry Capacity Pop.
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Finish
FNon-La
La er
W to Feeder
er
DairyCalf
feeder to Finish
p f9
,00
DairyHeifer
Farrow to Wean
Design Current
Dry P�oult , Ca aci P,o ,
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
11 Other
Turkeys
TurkeyPoults
Other
Discharzes 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 No ❑ NA ❑ NE
❑ Yes
[:]No
DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
[2,N_o__❑
NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: _7[(Date of Inspection: It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: __TB CJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z f— Z `�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes P40-, ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes 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 ErNo ❑ 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 Q ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [j" Flo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ffNo ❑ 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?
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [�K ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑i rNo ❑ 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 [2-1V D❑ 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 �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z2_Nw-❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Y
Facili Number: - Date of Inspection: I 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �10 . ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Rio ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List 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 ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No JD -NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'r-�J' r'o
[:]Yes [ '90 ❑ NA ❑ NE
❑ Yes [' Ko ❑ NA ❑ NE
❑ Yes
z F2 1To
❑ NA
❑ NE
❑ Yes
0 o
❑ NA
❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
❑ Yes [a-1To' ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone: 71'97'FL 1-"3r.,y
Date: it r %A6
21412015

ivi'sion of a#er Resources
Facility Number - 7q L Divis;qn,,5:fS6Zi1andkW.3ter Conservation
0 Otheenc
Type of Visit: Com ance Inspection Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up Q Referral O Emergency p Other O Denied Access
Date of Visit: t� '/ ZI j/ Arrival Time: O o� Departure Time: D o County: Region:
Farm Name: `--�`- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 7 �P r V & " "
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: G
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
W an to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
' Feeder to Finish
Non -La er
DairyCalf
7�
Lao
DairyHeifer
Farrow to Wean
Farrow to Feeder
W1 fe7ign Current
ltr, C•a aci P,o
Dry Cow
Non -Dairy
Farrow to Finish
rj
Beef Stocker
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
Other
NJ Other
Turke s
Turkey Poults
Other
Discharzes 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 51<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes E rNo ❑ NA ❑ NE
❑ Yes [3<o ❑ NA ❑ NE
Page I of 3
21412015 Continued

IFaciUty Number: 71j Z Date of Inspection: 21 T—
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C
Spillway?:
Designed Freeboard (in): • s t s
Observed Freeboard (in): 2 t 21
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ 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 U ' c_ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ENo ❑ 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 Oo ❑ 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 I_J N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes '� ❑ NA ❑ NE
LJ
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 VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box bel�Soil
Yes ❑ No
DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis alysis
❑ 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 [3'1Go
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes dNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

lFaQity Number: - Date of Inspection: ^ zl
` 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 0 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 ffNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E5NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
rNo ❑ NA ❑ NE
L`J 1V ❑ NA ❑ NE
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).
F,�'^- tp"ffs o
2 I 50 1 1 k Sir C�PI� 7 rc cor c��' SC�1� San.. /rr
Reviewer/Inspector Name: VGA %, q Q0 tt
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I (o 7 76 73oy
Date: o/ /y-
2141201 S

Type of Visit: 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:242�_ Region: L=6�-"�'
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:i7457/
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pup.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oult .
Layers
Design
Ca aci.
Current
P,o
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
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 C2r"No ❑ NA ❑ NE
❑ Yes
;2 No
❑ NA
❑ NE
❑ Yes
ZNo
❑ 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 � o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Contra

Facili Number: - 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
Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
0 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 0 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 1ZSNo ❑ 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 environment 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ff 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 17fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
015No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E!fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
J27No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�' o
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T?ansfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ 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 '2 4o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes / o ❑ NA ❑ NE
.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
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 No
[:]Yes PdNo
❑ Yes 52,No
[:]Yes ZINo
❑ Yes El No
❑ Yes Ej No
❑ Yes k] No
❑ Yes VrNo
❑ Yes [,7 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: IL / Date:
Page 3 of 3 21412014

Division of Water Resources
❑ Division of Soil and Water Conservation
Other Agency
Facility Number. 310742 Facility Status: 'ewe
Permit: AWS310742
❑ Denied Access
Inpsectlon Type: Compliance Inspection
Inactive Or Closed Date:
Reason for visit: Routine County:
Duplin Region:
Wilmington
Date of Visit: 10/21/2015 Entry Time: 09:00 am Exit Time: 9:30 am Incident g
Farm Name. Chris and Jeremy Bond Farm
Owner Email:
Owner Chris Bond
Phone:
910-285-3993
Mailing Address: 220 Matthew Rd
Wallace NC 284667388
Physical Address. 378 Angola Bay Rd
Wallace NC 28466
Facility Status: ❑ Compliant ❑ Not Compliant Integgrator.
Murphy -Brown LLC
Location of Farm: Latitude:
34° 45' 45" Longitude:
77' 49' 46"
South of Sloan. On South side of SR 1977 approx. 1.1 miles SE of SR 1827 at Sloan.
Question Areas:
Oischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator.
Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
On,site representative Jeremy Bond
Phone:
Primary Inspector. David Powell
Phone:
Inspector Signature:
Date:
Secondary Inspector(s):
Inspection Summary:
Farm looks good.
21. Soil test. - send copy of records. Sen in samples.
page: 1

Kermit: AWS310742 Owner - Facility : Chris Bond Facility Number: 310742
Inspection Date: 10/21/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity
Current promotions
Swine
LE Swine - Feeder to Finish 7,040 3,200
Total Design Capacity: 7,040
Total SSLW: 950,400
Waste Structures
Disignated Observed
Type Identifier Closed Data Start Date Freeboard Freeboard
Lagoon
CHRIS BOND
19.50
23.00
Lagoon
JEREMY BOND
19.50
T 24.00
0
page: 2

Kermit: AWS310742 Owner - Facility : Chris Bond Facility Number: 310742
Inspection Date: 10/21/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharnes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:
Structure
Application Field
Other
a. Was conveyance man-made?
b. Did 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 observable adverse impacts or potential adverse impacts to Waters of the
State other than from a discharge?
Waste Collection, Storace & Treatment
4. Is storage capacity less than adequate?
If yes, is waste level into structural freeboard?
5. Are there any immediate threats to the integrity of any of the structures observed (I.e.1 large
trees, severe erosion, seepage, etc.)?
B. Are there structures on -site that are not property addressed and/or managed through a
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit? (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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect application?
If yes, check the appropriate box below.
Excessive Ponding?
Hydraulic Overload?
Frozen Ground?
Heavy metals (Cu, Zn, etc)?
PAN?
Is PAN > 10%/10 lbs.?
Total Phosphorus?
Failure to incorporate manure/sludge into bare soil?
Outside of acceptable crop window?
Evidence of wind draft?
Application outside of application area?
Yes No Na No
❑■❑❑
❑■❑❑
❑■❑❑
❑■❑❑
)to No Na No
❑■❑❑
❑■❑❑
❑ M ❑ ❑
❑■❑❑
❑■❑❑
Yes No Na No
❑■❑❑
❑ 0013
page: 3

. Ptrtmd: AWS310742 Owner - Facility : Chris Bond Facility Number. 310742
Inspection Date: 10/21/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes
Na
Na Me
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0
❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
M
❑
❑
18. Is there a lack of property operating waste application equipment?
❑
MEDD
Records and Documents
Yes No Na He
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0
❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
M
❑
❑
If yes, check the appropriate box below.
Wt1P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other'?
❑
If Other, please specify
21. Does record keeping need improvement?
0 ❑ ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
[]
page: 4

• • . Phftnit: AWS310742 Owner - Facility : Chris Bond Facility Number. 310742
Inspection Date: 10/21/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
N2 eoMe
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑01111
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑
❑
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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
❑ 0
❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
M ❑
❑
(i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility?
❑
00
❑
If yes, check the appropriate box below.
Application Field ❑
Lagoon I Storage Pond ❑
Other ❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ ❑ ❑
CAWMP?
33. Did the Reviewerflnspector fail to discuss review/inspection with on -site representative? 0000
34. Does the facility require a follow-up visit by same agency? 001111
page: 5

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number:
310742 Facility Status:
Active
Permit: AWS310742
❑ Denied Access
Inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine
County:
Duplin Region:
Wilmington
Date of Visit.
12/13/2014 Entry Time: 09:30 am
Exit Time: 10:30 am Incident #
Farm Name:
Chris and Jeremy Bond Farm
Owner Email:
Owner.
Chris Bond
Phone:
910-285-3993
Mailing Address:
220 Matthew Rd
Wallace NC 284667388
Physical Address:
378 Angola Bay Rd
Wallace NC 28466
Facility Status:
❑ Compliant ❑ Not Compliant
Integrator:
Murphy -Brown LLC
Location of Farm:
Latitude:
34` 45' 45" Longitude:
77' 4T 46"
South of Sloan. On South side of SR 1977 approx. 1.1 miles SE of
SR 1827 at Sloan.
Question Areas:
Dischrge & Stream Impacts Waste Col, Star, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Jemmy D. Bond Operator Certification Number: 18006
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Jeremy Bond Phone:
On -site representative Jeremy Bond Phone
Primary Inspector: Kevin Rowland Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS310742 Owner - Facility : Chris Bond Facility Number: 310742
`9nspectibn Date: 12/13/14 Inpsedian Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Design Capacity
Current promotions
Swine
Shrine - Feeder to Finish 7,040 6,400
Total Design Capacity: 7.040
Total SSLW: 950,400
Waste stmotures
Dlsignated Observed
Type Identifier Closed Date start Date Freeboard Freeboard
Lagoon
CHRIS BOND
19.50
24.00
Lagoon
JEREMY BOND
19.50
22.00
page: 2

Permit: AWS310742 Owner- Facility: Chris Bond Facility Number. 310742
Inspection Date: 12/13/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharnes & Stream Impacts
Yes No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (f 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 Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collection Storage & Treatment
Yes
No Na No
4. Is storage rapacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
B. Are there structures on -site that are not properly addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
01111
maintenance or improvement?
Waste ARRIIcation
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ 0 ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manurelsludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310742 Owner - Facility : Chris Bond Facility Number. 310742
` inspectidn Date: 12/13/14 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes_ No NA me
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
N ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
0000
18. Is there a lack of properly operating waste application equipment?
❑
❑
❑
Records and Documents
Yes
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑ E ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑ 0 ❑ 0-
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑ No ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS310742
Owner - Facility : Chris Bond Facility Number: 310742
»� Inspection Date: 12/13/14 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and V Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
❑ ❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑ ❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
M ❑ ❑
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 change?
❑
0 ❑ ❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
0 ❑ ❑
Other Issues
Yes
No Na No
28. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
00110
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the ReviewerRnspector fail to discuss reviewfinspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
M ❑
❑
page: 5

r
Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: KRoutine 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: Ch�� ,t7�b Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
ao�3
Certification Number: nco-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design urrent Design Current
C
Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
Non -La er
I El Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
D . P,oul_ C►_a aci_ P,o , Non-Dai
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Beef Brood Cow
-4—Pullets
Other
Other
Turke s
Turkey Poults
EFTOther
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 Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facili Number: -11 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E!j No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C, L.-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VjNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ZNo [DNA ❑ NE
❑ Excessive Pending ❑ 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 7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
9No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ 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 RTNo
❑ 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 iffNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZN
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2!'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ 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 4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WrNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes VTNo ❑ 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 VI No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑' NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ WE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[:jNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments::
Use drawines of facilitv to better exDlain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone:p�
Reviewer/Inspector Signature: V Date:
Page 3 of 3 2/4/2011

F,
Type of Visit: %Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: CountyRegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: — (rVL J1% Integgrrator:�
Certified Operator: C��s jop}/ER —. �Qi�l CertiSccaatioaNumber:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design%Gffir—rent Design Current
Wet Poultry Capacity Cattle itAN Pop.
Layer Da' Cow
Wean to Feeder
Non -La er
I
alf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult . CaWHY,P,o
Layers
Non -Layers
Pullets
Dry Cow
Non-Da'iry
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
In
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 1� No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes . ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

41
Facility Number: jDate of Inspection: S
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 TTT❑"` No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J�
Spillway?: Designed Freeboard (in): n S � T)�
Observed Freeboard (in): S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes % No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable
�,Crop
, Window ,� /❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s): 1 �Jc: _1�-1�i� �1t-t��� S 1 SG (6) C _C2/V LA_�) 06A-7
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
R
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IM.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
DNA
❑ NE
the appropriate box.
QWUP ❑Checklists ❑Design E] Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes . No ❑ NA ❑ NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ } taste Transfers M Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections ►❑ Monthly and V Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes , No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Focility plumber: Date of Inspection: C3 1
24 'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes A 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
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 No
❑ Yes IY I No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
9No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
hi No
❑ NA
❑ NE
Comments (refer to question #f): 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};,:
g4_j_)0/v
r
90i S o I (_ S R-rn PLE5
�i
iz svz-omP���
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
AnqAoft < //YFfi Phone:
Date: )C> dS�Ia
21412011

� �— Division�of Water Quality
Facility Numbeion of Sail an Wafer Conservation
© Other Agency
Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Tune: Departure Time: County:Region:
Farm Name: Waj S q �C(Z C MLA )4 D IRRM Owner Email:
Owner Name: (Z 1 S rJCaN Phone:
Mailing Address: PQ (Y1A-TT#EW L:vq LL ECE , NC jr (o —43 �a
Physical Address:
Facility Contact:
Title:
Onsite Representative: ]Fcc, em u k (60/-v
Certified Operator: E (L E fA u, D. aO N
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integ�rator:
Certification Number:
Certification Number:
Longitude:
Design
Swine C*specify
Wean to Finish
Current
Pop.
Design C►urrent Design Current
Wet Poultry C►specify Pop. Cattle Capacity Pop.
La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish Lo
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
D , P,oul Ca aci. P,o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turke s
Turke Poults
Other
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
T�
❑ 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
dNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
tkNo
"`iii���T
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

1?acili ` Number: - N Date of Inspection: 11130_711
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes yq No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6 `�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Iq. S 1G1.5
_3 c>
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �j No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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
[3Application Outside of Approved Area
� n
12. Crop Type(s): C/ 1nd�4G\�. 5< LA� I-J [AT
1�
--
13. Soil Type(s): LN 4 Pj A
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?
7"\
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design Q Maps [:]Lease Agreements
❑ Yes
1� No
❑ NA
❑ NE
[:)Yes
VNo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes % No
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections Q 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 No
❑ NA ❑ NE
Q Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

k aciliNumber: I I - , -J Date of Inspection: 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
'the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ YesP
No
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
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
)A NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations: or. any -other eomments
Use drawings of facility to better explain situations (use additional pages as necessary). h"1
�. A. G-S
LI]golIi a•q Q.0
1;M)1 0 1.5
GA 4 0/V bC& a of 1;�
I T (-O( 6 G-T !! 1 LV,DC E S LAC2 uc
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q169�-�3a
Date: j ! 2c)
21412011

Type of Visit K Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: (� Departure Time: County: c IN Region:
Farm Name: _ Cj4Q1S C* Q-FfAuD li:�A RM Owner Email•
OwnerName: C"(2-IS ] /`� �_ _ (� Phone: 9101" QR5�-ryr.,�fi'
Mailing Address: P,90 mj47T4G w
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: rn O Inte r��ator:
Certified Operator: w pQ`eratorCeCertification Number: gd0
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = 6 = u Longitude: = ° = 1
Design C*urreut
Design Current
Design Current
Swine Capacity Population
Wet Paultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
Dairy Cow
❑ Wean to Feeder
I ILI Non -Layer
I
I
Dairy Calf
Feeder to Finish Ut-i
Dry Poultry
❑ DairyHeifer
❑ D Cow
Farrow to Wean
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
❑Nan -La ers
❑ Beef Feeder
❑ Beef Brood Co
❑ Pullets
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
12128104 Continued

`'
Facility Number: j
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 9 .
Observed Freeboard (in): 9 �S_ 9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
INo ❑ 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
El NE
through a waste management or closure plan?
v
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
RNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No El 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 Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�ANo ❑ 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable- Crop Window ❑ Evidence of Wind Drift ❑r Application Outside ooff Area
12. Crop type(s) CnZIJl L E R- �i� l2-l_G ] W H"'T
6 l C
(�
S U
13. Soil type(s) L N A Go
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
[gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
IX No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question- #): Explain any YES answers andfor any recommendations.or any other�comments -:
.� . -._.
Use drawings situ of facility to better explain ation's. (use additional pages as necessary) ..
AL
Reviewer/Inspector Name S"`
Phone: C773�
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

�I
1
Facility Number:-3 S/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo []NA ❑ NE
the appropriate box. El WUP El Checklists 0 Design 0 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application 3 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ )aste Transfers
❑/inual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections [11 Monthly and 1"
Rain Inspections O
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
UIDA cQ
�9N
/'n iaL.l
gQR-7/6At DCAC
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 3kcompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit kRoutine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: C-I IV Region:
Farm Name: C14alS m �rD FAczm Owner Email:
Owner Name: (n� M r . \ Phone: �d¢��S
Mailing Address: of 1 f ' 0-71-9 Ei01 � IJV P C_C A� . / YjC 00966—_q t3o%a-
Physical Address:
Facility Contact:
Title:
Onsite Representative: rn [�0!yf_'._)
Certified Operator: �Lem - +� CAN
Back-up Operator [�i`t"� g "-'11� HE-9� •
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 0000 Q
Back-up Certification Number: �4 V /
Latitude: E__1 p E--] ' E] Longitude: E__1 ° E 0 N
Design Current Design Current
Design
Current
Swine Capacity Population Wet Poultry Capacity Population
C►attle C►apacity
Population
❑ Wean to Finish I I
J[j Layer I
I
Dairy Cow
❑ Wean to Feeder I I
ID Non -Layer I I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
ElBeef Brood Cowl
I
El Turkeys
Other ❑ Turke Pouets
❑ 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 x No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [�No
El YesYes ,
12128104
❑ NA ❑ NE
[I NA ONE
Continued

's
.r FaciiityNumber: ?]
Date of Inspection Ort
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo [INA ❑ NE
a. If yes, is waste level into the structural freeboard? El 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
laNo
0
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
9No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑yes
No
❑ NA El 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 1 O lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window! Evidence of WindDrift ❑ Application Outsides of/Area
12.
r❑l
Croptype(s) Ca�+ w J C1 .+�'TL'�1�
SV�(�
13.
Soil type(s) C A Gz A
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
qNo
''``
❑ NA El NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
[INA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA ❑ NE
Use drawings of foci/ to better explain situations. {use a sand/or any recommendations=or any other comments.,. ents refer to uestionO# : Ex laic an YES`answe _
g facility M q`. dditional pages as necessary)`� ��" b `. :
C,ti� � � • e� -S `
�Jy loci 1. Le 1. Ll
Reviewer/Inspector Name 1 `'. Phone: ��
Reviewer/Inspector Signature: Date: 9 13 )6
12128104 Continued

.� Facility Number: Date of Inspection �--
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ANo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o
IN
❑ NA
El NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�.No
ElNA
ElNE
!!
ElWaste Application 3 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ �aste Transfers ❑ Aual Certification
0 Rainfall ❑ Stocking [] Crop Yield [] 120 Minute Inspections 0 Monthly and 1"
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ANo
❑ NA
❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
.�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Oj(No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
rAl 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
0 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
12128104

Division of Water Quality
[Facility Number O Division of Soil and Water Conservation ✓
Q Other Agency
Type of Visit 0 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ji) 073 6 Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Region:
Facility Contact: Title: Phone No:
Onsite Representative: _ �� E /V t".� Integrator:
Certified Operator: CgiL4 S Low �• P_-r3N b Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = f = « Longitude: = o = = r
s Design Current` Design Current Design Current
ry' : Capacity Population Cattle.. Cap Swine Capacity, Population Wet Poult acityPopulation
❑ Wean to Finish
; ❑ La er
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
Dry Poultry ..
❑ yarrow to Wean
❑ Farrow to Feeder
h.,
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
El Layers
El 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 El Application Field ❑ Other
a. Was the conveyance man-made?
El
Dairy Cow
El
Dairy Calf
El
Dairy Heifer
❑
D Cow
El
Non-Dairy
El
Beef Stocker
i
El
Beef Feeder
El
Beef Brood Co
Number of Structures::Y .�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ( No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
MNo
El NA
El 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 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes KNo ❑ 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 J(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 ❑ YesNo ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r
o ElNA ❑ NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
)�'No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesNo
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yeso
[I NA
lo
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #)i .Explain any YES answers and/or any recommendations or any. other, cornrnents..
Use drawings of facility to better explain situations. (use additional pages as necessary)-
aCT cop! pF LRCCCdN [)(_�S 16W 4- p-"T W1 �2- Vb'>
(�' T C C3 o f r�-M R�ViVI�t A t- A U 6 S ToC-1�! nIC�' t CoR-� %4- �L4-r
� QDS
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: avr--') Date: /d 3
Page 2 of 3 12128104 Continued

N_
Facility Number: 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 appropriate box. ❑ WUP ❑ Checklists g p El Other
❑ Design ❑ Maps
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ElStacking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
fqNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
jj�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N3 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z.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
[X 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
94 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
VNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

1
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
-- 0 Other Agency.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit U Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /0 a5 OL Arrival Time: L /06 Departure Time: County: lll°-1t.— Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ��r"�`1' &LZ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude: f f c
Phone No:
Operator Certification Number:
Back-up Certification Number:
0 Longitude: =0 = ' = "
3
..
M
Design Current .
Design Current .
Designs Current:.
Swine
Capacity Population Wet Poultry
Capacity Population Cattle
Capacity,<Population
❑ Wean to Finish
❑ Layer
Dairy Cow
❑Wean to Feeder
Non -Layer
❑Dai Calf
® Feeder to Finish
?o46
(oyc�
_
_
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
4
❑ Dry Cow
�i
❑F F d
❑N D '
arrow to ee er
❑ Farrow to Finish
❑ Gilts
❑ Boars
',Other
❑ Other
❑ 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?
on- ary
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes I[J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2<0
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection IG fv
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: t' flQ)pJ % Ert.wr CACoZO C 9L'iE
Spillway?:
Designed Freeboard (in): 9• S
Observed Freeboard (in): 3 I 3 `L
5. Are there any immediate threats to the integrity of any of the structures observed? Cl Yes
ErNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ICJ 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 environm ntal 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
rJ 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
O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers; setbacks, or compliance alternatives that need ❑ Yes
`j No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
tj'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) ewS 3 C H) S 6 O
13. Soil type(s) 04I AB uR G
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LE No
[3NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
CJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
o
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
wwo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
l 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):
��} l7Jcr wawi JJ6Fp C-"gs W��K { +
SMAt[ Chi- NEEDJ ( IL,3�fLI1T3 ' ai�j�4Z L L�aAid.
Reviewer/Inspector Name ` Phone:pC % - % 3Y9
Reviewer/Inspector Signature: I Date: 2 6 G
--gc L Vf J lL/LO/VY I.VI{L{{{NGL/

Facility Number: f — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
Lj N ❑ NA
El NE
❑ Yes
❑ NE
ElYes
ZNoElNA
L�❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
L"J No
❑ NA
❑ NE
❑ Yes
E]�No
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes R o ❑ NA ❑ NE
❑ Yes 0� 4o
El Yes L3No
❑NA ❑NE
[_3 NA ❑NE
Page 3 of 3 12128104

Type of Visit Q gRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 4a 1rt o5 Arrival Time: Departure Time: County: 7UPt__r0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Z00 n „-, ,._ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = Longitude: = o ❑ , 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish '?o%4o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: ❑1
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
ElYes
NA
ElNE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility' Number: 'S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CuttZS ' ErLC- K^`e
Spillway?:
Designed Freeboard (in): _ %q.S Nat, 5
Observed Freeboard (in): az Z-k
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETN' o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes lJ 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? D'IK'es 0 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
[TNo
❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EJ-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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) C o s a C rt.' u a aN S 6 0
13. Soil type(s) LWjCA Vson_C, UJ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ir No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
El Yes
DNo
❑ NA ❑ NE
t
17. Does the facility lack adequate acreage for land application?
❑ Yes
I
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EI No
❑ NA ❑ NE
'),-) U-(:Arl-TO-ASN aRGk5L0k- of CHft S tAGofix,� A"O c4_EA2 S4[Y1.LX-65.
al.} i�C. ep C,o9'" o Nt.Iup, c CG2.TrAc ZCAT.SarJ AIIJ 6 STOCXXO(7 1-J T1.1 ?E.4.02J5,
Reviewer/Inspector Name Q a H N o--,j c 1, t Phone:
Reviewer/Inspector Signature: Date: too :)--t 10 S

Facility Number: 31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesdTo ❑ 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 El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ld Yes
❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
O Annual Certification
❑ Rainfall 13 Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
E N ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
u N ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No ❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�,
EK El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V. GAA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EI'�No
El NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
IGI 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
LI 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
LI 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
Vo
❑ NA ❑ NE
12128104

ANSMAL FACILITY ANNUAL CERTIFICATION FORM
Certificate of Coverage or Permit Number 23017' ; County u n Year 20OL-V
F 3�1-74!
Facility Name (as shown on Certificate of Coverage or Permit) CL� r- 45 d Lem n
Operator in Charge for this Facility J %-Pmu n Certification #_ ] g6o
Land lication of animal -waste as allowed by the above permit occurred during the past calendar year
)YES NO. If NO, ski Part I and Part II and proceed to the certification. Also, if animal waste
was generate not land applied, pease attach an explanation on how the animal waste was handled.
Part I : Faeiilty Information:
l . Total number of application Fields ❑ or Pulls 41ease check the appropriate box) in the Certified Animal
Waste Management Plan (CAW1v1P): - 15 Total Useable Acres approved in the CAWMP
2. Total number of Fields ❑ or Pulls Ey (please check the appropriate box) on which land application
occurred during the year: I Total Acres on which waste was applied
3. Total pounds of Plant Available Nitrogen (PAN) applied during the year for all application sites:
a= 3 �-7
4. To pounds of Plant Available Nitrogen (PAN) allowed to be land applied annually by the CAWMP and
the permit: --1 1-j q.), _ _ -
5. Estimated amount of total manure, litter and process wastewater sold or given to other persons and taken
off site during the year i� _ tons ❑ or gallons ❑ (please check the appropriate box)
6. Annual average number of animals by type at this facility during the previous year:
7. Largest and smallest number of animals by type at this facility at any one time during the previous year=
Largest L}li
Smallest 5 it o o
(These numbers are for informational purposes only since the only permit limit on the number of animals
at the facility is the annual average numbers) !
8. Facility's Integrator if applicable: I ` [ u r 0 , ,� �Q , ✓,ti
Part H: Facility Status:
IF THE ANSWER TO ANY STATEMENT BELOW IS `BYO", PLEASE PROVIDE A WRITTEN
DESCRIPTION AS TO WHY THE FACILITY WAS NOT COMPLIANT, THE DATES OF ANY NON
COMPLIANCE, AND EXPLAIN CORRECTIVE ACTION TAKEN OR PROPOSED TO BE TAKEN TO
BRING THIS FACILITY BACK INTO COMPLIANCE.
1. Only animal waste generated at this facility was applied to the permitted siteSiluring lid Yes ❑ No
the past calendar year.
3.-
eraer. 12_4A n1j

%— ti
I The facility was ooppaencezedin such a way that there was no direct runoff of waste from
the facility (snclu lingthe houses, lagoons/storage ponds and the application sites) during
the past calendar year.
3. There was no discharge of waste to surface water from this facility during the past
calendar year.
4. Them was no freeboard violation in any lagoons or storage po at fac"1-Y. during
the calendar year. ^^ CYr L> �0. n• r 0vf P k � V D f p n5 L✓0.S
. 1?� Y � ri a a o 1 � � �' d �' [[[
dT0.
S. There was no PAN application to any fields or crops atet facility than the
levels specified in this facility's CAWMP during the past calendar year.
6. All _d applicatipn p �,nt }vas call to at least once g the past calendar year.
7. Sludge barn"on`in . boons did not�exceeed the vol-4me for which the lagoon �� ��
was designed or reduce the lagoon's minimum treatment volume to less than the volume
for which the lagoon was designed. -
8. Afio p�fAe Annual SludgR Survey �qFo foreps f is to Certification.
9. Aaauil sous analysis we e performed o each fieldbreceiving� during the
past calendar yew-
10. Soil pH was maintained as specified in the permit during the past calendar Year?
11. All required monitoring and reporting was performed in accordance with the facility's
permit during the past calendar year.
12. All operations and maintenance requirements in the pernut were complied with during
the past calendar year or, in the case of a deviation, prior authoriratio was received
from the Division of Water Quality. See tt ups FCC �.S t t� L1 7 1
13. Crops as specified in the CAWMP were maintained during the past calendar year on all
sites receiving animal waste and the crops grown were removed in accordance with
the facility's pear.
14. All buffer requirements as specified on the permit and the CAWMP for this facility were
maintained during each application of animal waste during the past calendar year.
1 Yes
❑ No i
M
f(Yes
❑ No
❑ Yes
Sen+ tKO+ne 0u/4
des
❑ No
❑ Yes
ErNo
❑ Yes
❑ No
❑ Yes
E(No
®''Yes
❑ No
Q'Yes
❑ No
R'Yes
❑ No
❑ Yes 1 No
L2 Yes ❑ No
9/Ye s ❑ No
"I certify under penalty of law that this document and all attachments were prepared under my direction or
supervmon m accordance with a system designed to assure tl� qualified personnel properly gather'and
evaluate the information submitted. Based on my inquiry of the person or persons who manage .the system, or
those persons directly responsible for gathering to information, the information submitted is, to the best of
my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for
submitting Use information, including the possibility of fines and imprisonment for knowing violations."
Date
Date
diflawt from Permittee)
IVE�
2004
AFACF .3-1 "1 2

c
Appendix 1. Lagoon Sludge Survey Form
A. Farm Permit or DWQ Identi t' n Number
B. Lagoon Identification
C. Person(s) Taking Measurements
• 1 D. Date of Measurements •Q 44
E. Methods/Devices Used for Measurement of:
a. Distance from the lagoon li surface to the top of t ludjfarS
:
b. Distance from the lagoon liq ' a t t bm oon:
c.Thickness of the sludge.layer WM
irect measurement with "core sampler":
F. Lagoon Surface Area (using dimensions at inside top of bank): I? . 7 (acres)
(Draw a sketch of the lagoon on a separate sheet, list dimensions, and calculate surface area.)
G. Estimate number of sampling points:
a. Less than 1.33 acres: Us 1
b. If more than 1.33 acres, 9 0 ! Ores x 6 = , with maximum of 24.
(Using sketch and dimensions, develop a uniform grid that has the same number of intersections as the
estimated number of sampling points needed. Number the intersection 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).
I. At the time of the sludge survey, also measure the distance from the Maximum Liquid Level
to the Present Liquid Level (measure at the lagoon gauge pole):
J. Determine the distance from the Maximum Liquid Level to the Minimum Liquid Level
(use lagoon management plan or other lagoon records):
�' ��
K. Calculate the distance from the present liquid surface level to the Minimum Liquid Level
(Item J minus Item I, assuming the present liquid level is below the Maximum -Liquid Level):
L. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level
%�
to the lagoon bottom (average for all the measurement points):
�
� —
M. 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): (/
N. Record from the Sludge Survey Data Sheet the average thickness of the sludge layer:
O. Calculate the thickness of the existing Liquid Treatment Zone (Item M minus Item K): "I' •
(Note: If Item O is less than 4 feet, a sludge removal and utilization plan may be required by '
N.C. DWQ. See your specific permit or contact DWQ for more information.)
P
Procce
f! apc-4
Completed
6;?143
volume for a rectangular
Date: + iq
14

Appendix 4. Conversion table from inches to tenths of a foot.
nches
Tenths of
foot
Inches
Tenths of
foot
1
0.1
7
0.6
2
0.2
8
0.7
3 '
0.2
9
0.7
4
0.3
10
0.8
5
0.4
11
0.9
6
0.5
�r
yes 30
1
I
17

G
r
Appendix 2. Sludge Survey Data Sheet*
Lagoon
Sludge Surve
Completed by!
PointGrid
Distance from liquid surface
Thickness of
sludgeNo.
a�-��,,MWJW
MW
©t'•
�:�•7irMU
•
e"MMW"ffn
1
M7JWM
eWwm
�tPIMMt,01"w
Mr;w■
�.
®■�■■■�,�■
tom■
Sludge Survey Data Sheet.
See Appendix 4 for conversion from inches to tenths of afoot.
15
1

Appendix 1. Lagoon Sludge Survey Form
i
. Fa er
n Identiftca -0 C AC42 4Z
.Person{s} Takin easurements
D. Date of Measurements
E. Methods/Devices Used for Measurement of:
a. Distance from the lagoon
b. Distance from the lagoon
c. Thickness of the sludge layer if ti}AAtng §ki#cpnjffurement with "core sampler":
F. Lagoon Surface Area (using dimensions at inside top of bank): / _ f%-..Of (acres)
(Draw a sketch of the lagoon on a separate sheet, list dimensions, and calculate surface area.)
G. Estimate number of sampling point4�es
:
a. Less than 1.33 acres: Use
b. If more than 1.33 acres, x 6 = / , with maximum of 24.
(Using sketch and dimension , develop a uniform grid that has the same number of intersections as the
estimated number of sampling points needed. Number the intersection 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).
1. At the time of the sludge survey, also measure the distance from the Maximum Liquid Level
to the Present Liquid Level (measure at the lagoon gauge pole): 19-
J. Determine the distance from the Maximum Liquid Level to the Minimum Liquid Level •
(use Iagoon management plan or other lagoon records):
K. Calculate the distance from the present liquid surface level to the Minimum Liquid Level
{item J minus Item 1, assuming the present liquid level is below the Maximum Liquid Level):
L. Record from the Sludge Survey Data Sheet the distance from the present liquid surface level
to the lagoon bottom (average for all the measurement points): •
M. 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): 71--US
N. Record from the Sludge Survey Data Sheet the average thickness of the sludge layer:
O. Calculate the thickness of the existing Liquid Treatment Zone (Item M minus Item In: 1674
(Note: If item O is less than 4 feet, a sludge removal and utilization plan may be required by
N.C. DWQ. See your specific permit or contact DWQ for more information.)
Procee
shaped
Completed
for a rectangularI ek&l
-
14

Appendix 4. Conversion table from inches to tenths of a foot.
Inches
Tenths of
foot
Inches
Tenths of
foot
1
0.1
7
0.6
2
0.2
8
0.7
3
0.2
9
0.7
4
0.3
10
0.8
5
0.4
11
0.9
6
0.5

Appendix 2. Sludge Survey Data Sheet*
Sludge Survey
Completed by:
G
PointGdd
to top of sludge
Distance from liquid surface
to lagoon bottom (soil
Thickness of
sludgeNo.
layer
Ft. (tenths)
,.
o�-
�
■ram �
*All Grid Points and corresponding sludge laver thicknesses must be shown on a sketch atfached to this
Sludge Survey Data Sheet.
See Appendix 4 for conversion from inches to Tenths of afoot.
15

• ;' RECEIVED
Field Calibration Procedures APR 2 7 2004
for Animal Wastewater Application Equipment
WATER G'JALk iY SECT
r-
F
Calibration Dat ;(continued) ,
Gauge'.' `"~Distance V ~hire _ �. uvprlap t t - orrected Deviation
Y-e
No. from Center Collected N ,�Adjusvpppt Volume from Average'
,r , jfeet� Vgct)6s) '(EncFil: j (inches) (inches)
Lz�: Z� • Oz.
D
..� Z
L6 •�O •W
La • /Wyk •r ~�;' ,
t8 •ACV OWN" dOMM'
a � •ate . • tom• k ..•�
L9
L10
R1
R2 • • W
R3 •
f4
R4 �� . • •
R7 �! •
i ♦.= • �i
•� R8 %o _
-- 9�Y �► +'' '
O k R10 r
'Absolute value,' , . ,j ,1'. ��(jr+ �I i+/� V /I •
treat all values as positive.
Left RkjlU
kowd a 7 6 5 4 3 2 1 l 2 3 4 5 6 7 8
ke cocdort o 0 0 0 9 O O O o 0 0 0 0 0 0 O
Bates
can
'- Direction d travel
5 i we4ed dian*tx Rt least one wetred
(320 Feet) -k diameter end or 6e4tl
� •� is .,.,.... -► F�,a.. , " �; ".
r

HARD HOSE AND CABLE TOW TRAVELER
IRRIGATION SYSTEMS
recn IZtGl
Irrigation Sy tern Caiibra "on Data Sheet for Hard Hose Traveler Irrigation System
DATE: r Z-a �nd Owner Farm No.
a. Manufacturers' Specifications: Gun Model /,�V
Type
Nozzle in :: Pe�sure (Gur)) _
#ft�ppufiw 49
Wet[edtdia'meter �ftt !'Effective Spacing ft
Flo 6,} A�.M
Hose Size:'Len�th 4iameter
aa=
ft in
b. Spacing.t3et� veep collection446njainers (diameter., ft)Ova
C. :', " ° Mnrettd diameter (it
Nrttiber.of gauges
'gauge spacing (ft)
d. Start of Irrigation event40
��— -
;
NWA
e. End of Irrigation event
-• '�
E ] 5 5 1 ] 2 1 1 2 ] / 5 • ]
oeoa ooae nooa a a oa
=O•�
f. Duration (e-d) mim
I �
0 715 5 1 ]]-L
• a a a a
D—a er Ewa •
"o. I
1 23 S fi 17
I
-
g. Travel distahc��
h. 'Operate the,sxstern, collect
and record on the w rks page 8.
i. Sum of,atl catches es
Apol�
j. Average4eakch (i/number 6'[!ej es)
Pistance traveled j(q
'
k. Avbrage'travel speed • �
Time (min) t=
q
I. Sum of all deviations from the average catch -
m. Average deviation from average catch
n. Uniformity coefficient !!,, -• -
.; 'x A
make necessary
55 /i?AW
For travelers with proper overlap and operated in light wind, an application uniformity Coefficient greater
than 85 is common.
Application uniformity between 70 to 85 is in the "good" range and is acceptable -for wastewater application.
Gener iy, n ica o un• r ity below 70 is considered unacceptable for wastewater irrigation using
travele . If h om t is ss than 70, system adjustments are required. Contact your irrigation dealer
or Ce ie T 5p i
OA041
u�-ice y�m�..
s)2
C

Type of Visit grCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f25 Routine O Complaint Q Follow up O Emergency Notification Q Other
Facility Num r Date of Visit: I
i
Permitted ^Cee-rtified 0 Conditionally Certified Registered
Farm Name:
Owner Name:
Mailing Address:
ffllp7a
Not
❑ Denied Access
ional O Below Threshold
Date Last Opera" Above Threshold: .
County.
..... _ .._ . . �.. ... . Phone No: .�. _ ..
Facility Contact-... _ Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator.
Operator Certification Number.
_Q4W_ ne,.,0'Poultry 0 Cattle ❑ Horse Latitude • 0 " Longitude • 6
` *Desigte 4 , ,Cnrr�nt k �'Des�gs `iCurrent -- ,„ m Desagn x Cturrent
Ca Po" nia#ion Ponitr cr - Po iron ;, Catde <<Yo ' tioa
Dairy
Non -Dairy
Capac>lty v
a1�
I�iuiaber o .Lagoons = _
Wean to Feeder
Layer
�-�= Non -Layer
_ Feeder to Finish
.Farrow to WeanFarrow
to Feeder
.' ��
Farrow to Finish
Tow -De sign
- }
Gilts
Boars
t G � C
Discharges S Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made-? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑Yes [ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;No
o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: fWLIR '5 -Aakky
Freeboard (inches): 2Z Z�
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie( trees, severe erosion, ❑ Yes O/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 1 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? ef Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes M No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes UNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelunprovement? El�io
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes B No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑o
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
�� NN<o
Ldo
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor issues ��
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes 0<0-
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes &fNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes U 1 o
Air Quality representative immediately_
u4 bkTE UZ4CP `?TE tD
EX*y tic' F+.1NUAL-
L jXAL— Su V 4'T�A1-lam
�.} CLEfl/J fJlkCk W>qw
(3 ,? P1J c.t.S A�J,r) PAa)
Reviewerlluspector Name
ReviewerAWspector Signature:
Field Copy ❑ Final Notes
Date: `L >'Zh-A
12112103 Continued

Facility Number: T—
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Pere any additional problems noted which cause noncompliance of the Certified AWMP?
Ni MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32_ Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for ES required forms need imtInspection'After
ent? If yes, check the appropriate box below.
❑ Stocking Form Crop Yiel orm ❑ Rainfall 1" Rain
❑ 120 Minute Inspections Annual Certification Form
❑ Yes No
❑ Yes 7WO
�
❑ Yes
❑ Yes �o
❑ Yes 7NO
❑ Yes
❑ Yes 7Nq
❑ Yes
❑ Yes
Yes ❑ No
❑ Yes L o
❑ Yes No
❑ Yes
❑ Ye r'No/
es ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
._ . • 'caal Cosaine��"and�aar'Dr.�rinigs� - �` - —
µ
12/12103

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Jatoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
5 I
Time:
TL=
Q Not O erational Q Below Threshold
XPermitted,dCertified
13 Conditionally Certified © Registered
L
Date Last Operated or Above Threshold: ...... .
Farm Name: .........
FA x
_� ....
k 7
!..`. + �...........
I1
County: .......... 1,!!'�N.........., ...... ......_........
Owner Name: .... .. . .....................................
.. .�'e91�iEt(2...nrr�d!.�..........
Phone No:.......................................................................................
MailingAddress: ... .................. ............ ........... ............. ...................... ...................... ._.... ..........-...... _.... ... ............. ..........
FacilityContact: ............................G...............__.................... . Title:.................... ......... ....... Phone No: ... .............................. —........
Onsite Representative:.._J._SLL..... 1... 1 _ .. .....__ ._ .. Integrator: -•
Certified Operator:. _._._........ ... _ .- _... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 «
Design Current Desagra Y � Current - Design Current
-- -
_
"elation. Ca
c��`.. y Ca ci
Po .°;Poultr3'.- ciPa`iilat;on- ,Cattle aCl Po ula66A _
_
Wean
z
to Feeder
v
Discharges & Stream Impacts ❑ Yes L�'No
1. Is any discharge observed from any part of the operation? 0�
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes El No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes El No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ['j No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway [I Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._.�.- .................. _ ._.,._......_. __ .. _........ - -- ...... __.. ..... - -
Freeboard (inches):
12112103 Continued

Facility Number: Date of Inspection ,
5,. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E3No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes do
closure plan?
(If any of questions 46 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 maintenan�mprovement? ❑ Yes L7 o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 21
elevation markings? -
Waste Amilication
10. Are there any buffers that need maintenance/improvement? ❑ Yes E No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ YesD
❑ Excessive Ponding ❑ PAN 1a❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type UV
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N
14. a) Does the facility lack adequate acreage for land application? [:I Yes No
b) Does the facility need a wettable acre determination? ❑ Yes u:Xo
c) This facility is pended for a wettable acre determination? ❑ Yes Ld'
15. Does the receiving crop need improvement? ❑ Yes 944
16. Is there a lack of adequate waste application equipment? ❑ Yes L 4
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes t o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 12-11o'
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 01 o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 914
Air Quality representative immediately.
Comments`(irefer to gnesban.#)Eiepla�n any YFS'answers and/or any r ec+an�aueudahons or:any3otliec commeats. " _ .
Use drawutgs of facility,to heft ezplaiw srtuatzons. (use ad�ttonal pages as necessary) ❑Field Copy ❑Final Notes
x
C406,r Qgr M AMM F 7b k V- 7—Ar—n4
2_0 Co C q, e_&i=r /VE60EV G..srN K&"•
�.r�M
eviewer pector Name ,�
Reviewer/Inspector Signature:
0 Date: t5l_ �Jl

Facility Number: 3 _ (�Z Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? [�/Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes N
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes To
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes �eNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [] No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 2<0
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 Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit yCo iance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other >L7 Denied Access
Date of Visit: -� b 2 Time: 3
Facility Number J � '�
0 Not Operational Q Below Threshold
© Permitted 13 Certified 13 Conditionally Certified E3 Registered Date Last Operat or Above Threshold: m.... ...
_} �uP�N
Farm Name:. _.�li�.� ..__.i.i.... County: .. W--- —
Owner Name: ........... Els- ....... .............. Phone No:.
MailingAddress: ............... .............._....----•---................... ......
Facility Contact: ........................ ...... ...._............. _........................... Title:........................... ..... Phone No:.....�..........._................
................................
Onsite Representative: , 3 .&.-E .... ....... Integrator:. .;� .
Certified Operator .......... ...... ....... ..,. „._... .... Operator Certification Number:
Location of Farm:
2f Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �•�— �" Longitude �• ` �
Wean to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Non-
Dischar?es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: © Lagoon ❑ Spray Field [] Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes El No
❑ Yes'.".❑ No .
e s.�
Yes No, a�
❑ Yes XNo ._
El Yes �No
Structure 6
Identifier: .......................... ......... .......... --... .................. ............ ....................... .................................... ._................................. ................ ....... ............
Freeboard(inches):.:, ._. Z .!.................. ................................ ._................................. .1.................................

[JFadfity Number. Date of Inspection
5. Are there any immediate threats to the integnty of amy of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefimprovement?
8. Does any part of the waste management system other than waste structui-es require maintenazicefimprovement?
9. Do any stuctures lack adequate, gauged maskers with, required maximum and minimum liquid level
elevation makings?
Waste Application
10, Are there any buffm that Deed maintenance/improvement?
11. Is there evidence of over application? E] Excessive Poudmg 0 PAN 0
12, Crop type Z EIRM (4 1) A I� ' 0,10A2 17�_ . 6ffl 1; LL Ga A2
0 0 Yes �No
El Yes �No
0 Yes EdNo
El Yes /No
ED Yes lglNo
❑ Yes No
Overload ❑ YesXNo
Cana 5,0ye'MS w404,1-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Maitagement Plan
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Aninial Waste Management Plan readily available?
(id WLJP, checklist--, design, maps, etc-)
19. Does record keeping need improvement? (iel irrigation, h=board, waste analysis & soil sample reports)
.20. Isfaeffitymotin complizacevath any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified opm-aormi charge?
El Yes P, No
❑ Yes XNo
El Yes [I No
El Yes '[3 No
El Yes XN0
0 Yes xlo
Dyes �No
0 Yes 'zNo.
El Yes
XNo
El Yes NO
.0 Yes XNo
27. Fail to -notify TegionaIDWQ of emergency situations as.requued by General Permit?
(iel discharge, freeboard problems, over. application) .0-Yes No
0
23. Did Reviewer/hispectcr fail to discuss review)mspection with on -site representative? 13-yes XNo
24. Does facility require a follow-up visit by.
sanie agenc.y? .0 Yes XNo
25. Were any additional problems -noted which cause noncompliance of the Certified AVJNIP? . _'0 Yes NO
1 -You-wffl xeceive no'further-cormpondence about this visit.
iolation&er.de Pnri weremote&during-this visiL 13 No v fici
jFa VrRe-a V&or:_ F-oR bnry\F-,)rs.
Final Notes
ReviewerlUBpector Wame
Reviewer/Inspector Signature:
.Date:

Facility Number: 7,77—Wa-
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
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?
❑ Yes ! o
❑ Yes �(J o
El Yes / No
❑ Yes No
❑ Yes o
ElYesF[:]
o
❑ Ye o
Additional Comments and/or Drawings:, - - .
uanlER5t-3 T"RDCSS Dr- l.p Mi,20��a- FARMS Fi9C�i��
J �UP
-'�LI2 AND �3 )- �q �Rs SrENr �� ��F- L,�
11 _
F- F LJ A -A, TV5
z � S �C PaR J-r3DrCR7EO
} 5 moo F Mo5T OF T4L s�c��yFz
R
SPC__7P��L� ��-
�4�oR
�07�; V � ��l,L ✓ � 7� �5
OR DER .
� pt t 1� �rJ El�.
05103101

Q iitvr�sron o[ SoB and Water Conservah�n''` � .� . � � � �,
OF
Type of Visit x6orripliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Foflow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: EONot
Time: (Operational Q Below Threshold
Permitted 13 Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name •.................. g........................................................ _... _..
. ............. ...................�..� ` County:.. ......-•----..._..........------..........
OwnerName: ...�¢.......... 0..................... I............................................ Phone No: ......................................... ........ ............. ....
_. .....
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress:.........................................................................................................................................
.,,.e6 ^1`.R�4,1'hr-ns...�!d�. .fin Integrator: ,- C�KA01f f
, . -Onsite Representative:U....
Certified Operator: ................................................... ............................................................. Operator Certification Number:......:................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 44 Longitude • 4 66
:.-- Design . Current Design Current _- Desigp ' Carreat
SwimCapadty Po ulation Poultry capacity Population Cattle Ca `acity -Po ulatwto.=:._
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish IONan-Layer I I Non -Dairy
Farrow to Wean 5 ZD _
❑Farrow to Feeder ❑ Other
s ❑ Farrow to Finish Tonal Design Capacity
Gilts
❑ Boars Total SSLW
Number -of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area . ❑Spray Field Area t
.Holding Pond§ / Solid Traps:; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gaVmin?
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
❑ Yes allo
❑ Yes ONo
❑ Yes ONo
1,la
❑ Yes ffNo
❑ Yes ONo
❑ Yes ;31No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes j No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .L /�r. h..'.5...................�...... L........................................_............................................................................................................
Freeboard (inches): 32- 2?
5100 Continued on hack

Facility Number: 23 1 --7 Z Date of Inspection 2p li Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes jZNo
seepage, etc.) ✓✓✓
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 2"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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Be f epIv44 6fc;?Q Pern 1/4 tk
13. Do the receiving crops differ with those designated in the Ce4 ti
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?
Sn4,111 . ►, Aea+ ,
Animal Waste Management Plan
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?
�'Vo v�ola�iQns;or def cien�;es were nS►fed durFng his;visi#. Y;ou Will •Cee iW ii0 Mirth& • ;
corresponc ence. abuui thIS AIit' ' ' ' -
Com nents:(refer_to.q iestion #):.Explain any YES answers.and/or any.
Use drawings of facility to better explain situations (use additional pag
15- Apply /;tee 4U-0f�%-t5 40 _eo;l : keef
Q><QrG�,j� e CaG,�Ca4- 9 recAr eve- WO-1/
pwomn
❑ Yes 2rNo
❑ Yes ;M
❑ Yes _R1<0
❑ Yes )21"No
❑ Yes J&No
❑ Yes X No
❑ Yes P No
❑ Yes eNo
❑ Yes XfNo
❑ Yes �No
❑ Yes/ETNo
❑ Yes E�No
❑ Yes BNo
❑ Yes ErNo
❑ Yes �No
❑ Yes, PrNo
❑ Yes �ErNo
❑ Yes _J:�No
❑ Yes�iVo
❑ Yes _.EfNo
�,,eeDrfS ih ch�c.� ; Panl b--r-tu,14 .�
Aql-
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: of 0 5/qp

Facility Number: j — Date of inspection 2 Q 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 Wor below ❑ Yes P"No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 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 —E]rNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JE2'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
5100

n : -
:Q=DlY1SIDn Of SOiI and Water CDnservatlan ` Operatioa'Revlew r r az
Dlvlsoa of Soil and Water Conservaboa Compliauce Inspection ��,~xz,
- _ ff"Diiiiion of Water Quality :COIDpilaaC@ IILSpeCtlan r
ZR_
`Other Agex Operati6&Re_vlew _ ., fi x }
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection : 3p 24 hr. (hh:mm)
Permitted ❑ Certified © Conditionally Certified (] Registered [3 Not Operational Date Last Operated:
� y
Farm Name: Llt i5 j �Gfc _ .&fY ........................... ..... County:...........��.................... ../..�....,..,.,.........
Owner Name:..L lr l:1 ..... �7 ............................ Phone Na:....../y�1f.��.. ... ~ ��9/... ....................... ............ l
14
Facility Contact: Jere . ....... Title:... ................................. Phone No:....
Mailing Address:...a...`,T. ../....Xr2AA#1 91 .. l:..t�I-.:. �'fdr�l,.,4�5-�... l..l. �r....................... e��'���S�.yeo. ......... .........................
... .........
Onsite Representative:., fn2!4....1� X,_1YVG1�t_._. L.lG? Integrator: 6�tmllS.............................................
...... ........ ...........
Certified Operator:.....Jzre �,r�` ,� .... .. Operator Certification Number:................ ..........................
Location of Farm:
Latitude ' F 6 Longitude 0 r 66
Design „__,`CurreeiV Design Current
Swine CapacltyA Population Poultry Capacity population_ :Cattle
❑ Wean to Feeder
Feeder to Finish
rj
7
L r
❑ Farrow to Wean
❑ Farrow to Feeder
==
❑ Farrow to Finish
❑ Gilts
,''
❑ Boars
Number -of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area. IDSpray 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?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L%p A
Freeboard(inches): ..........121 ....................................................................................................
❑ Yes K No
❑ Yes ❑ No
❑ Yes ❑ No
_�l/A -
❑ Yes ❑ No
❑ Yes *0
❑ Yes 'CR(No
❑ Yes $No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

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?
$. 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 Pondinntg ❑ PAN
12. Crop type w5 . S'G/6 rG 2 1 /'jhj
i
❑ Yes � No
❑ Yes EXNo
❑ Yes P(No
M Yes ❑ No
❑ Yes No
❑ Yes No
13. Do the receiving crops differ with those signated in 4ie Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
IS. 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?
.. Rio yi... . r... deficiencies ►. q - hO ed- O(wing �bis:visit; - Y;oi.t Will-i•eceiye ijq further
correspondence. about this .visit: ..
FV1
YU Yes ❑ No
❑ Yes No
,20 Yes �'No 0/*Y -
9Yes 4RNoll`
0-Yes J3rNoj-
0 Yes No
❑ Yes ;No
❑ Yes RNo
❑ Yes gNo
❑ Yes EqNo
❑ Yes kfNo
Comments (refer tocquestiori #): Explain any YES answers ikAd/or any-. ecoi-atndaations or any other comments
Use drawings oi1f cility to better explain situations: (use additioiial.pages asinecessary)
L�] Car -ter -01WO �vitl ear,fat4 �w4; J �N 'f C4.t-r'-r -b Gom:? ore-F- ar.�(- Vcvrr�c� 4•
-L
! � k e $ o.,. � j t ra r~. v.� G K� 1 � S 1 � cJi � w w► o- F_ c� C wv r� l e7 (rs) g � C y � �
1-t.,d j� /ve v 2
/ �,l l ' (e� -ass YVOiI W V• L 1 !/l -t• t' a �+� ty 11i�1 a s T S o; r "Y"
i CJv�'c .-e 1t aI s14 - }�a K Sj� , h c.
�Al1�n o A- We
�tVCts �� 'Wt�r
)9•
\ p Cu yt�tevf •�-t i�''t -t� boa t-*t- � c V G �S C�►c�` bwl fit- Stnriclr (�iilYiwl - .
Al-ecd r r}•F- i Anno-k ct ie,. rt.c J !7x Si
Reviewer/Inspector Name f.lC�
G ri
Reviewer/Inspector Signature: / , Date: j 0_L268K
_j
- r

Facility Number: 3 — `]�� Date of Inspection p
(;dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes OxNo
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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [Yes ❑ No
Additional Comments :an or; rawings:-.. =' _:• TM j 3 , -,
'\N� ttk 40 �Xkvtr C' C r 4- K14-Al Pt I- VV64
A,
dart' ar f-&5 OLlll ,,� UM �t3 K)
1 �

Facility Number. 31-742 1 Date of Inspection 2/15/2000 printed on: 3/23/2000
5. Are there`y immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions "was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/unprovement?
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 maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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/lnspector fail to discuss review/mspection 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?
No i►ualations 6r'&efrciendes-were.noie Arming ibis wlli:receive ao hiftfi
freeboard check. No one on facility.
p
❑ Yes ❑ No
❑ Yes ❑ No
[-]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewer/Inspector Name

10 Routine Q Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Facility Number 31 742 Date of Inspection 2/15/2000
Time of Inspection 15:15 24 hr. (hh:mm)
® Permitted M Certified 13 Conditionally Certified E3 Registered 10 Not O erational Date Last Operated:
FarmName: deax=.Z9n d.E..................................................................................... County: Uup& ............................................... N IR4.........
Owner Name: dmmy.................................... Bajad............................................................ • Phone No: 9.I% 298:39.17.................---------
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: 250.11m:y diu n n PUtU.Boad..................................................... Draida ydie..NC.................................................... Z85.18.............
Onsite Representative: ................................................................................... Integrator: C.a]C]CQUA.koAdfilu... ..................................................................
Certified Operator: Jerrxtly.D.,............................. B................................................. Operator Certification Number: .18.00.6.............................
Location of Farm:
........................................................................................................................................................................................................................................................................
aa[tsids.41 raxth Ai �SR Z4.7.G.............................
.................................................................................................................................................._....................._................................... .._.... _.......................
Latitude 34 * 45 ' 45 K Longitude 77 * 49 , 46
❑ Wean to Feeder
® Feeder to Finish
3520
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [j Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................................... .........
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Freeboard(inches):...............21................ .................................... ................................... ........ ...................... .............
.................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

&-AlityVumber: 31-742 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(1f any of questions 4fi was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvemcnt?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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?
A„
(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/lnspector 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?
2/15/2000
❑ Yes
❑ No
0 Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
N6-V' 1atians. ar.defrciericies-vvere.aoied'duriizg this visit:. (riu iva1:riieivie.n fvrJtier.
rnrraciiriui�arira alvi�it'tiii$.vatii.'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
freeboard check. No one on facility.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewer/Inspector Name
.�r
Reviewer/Inspector Signature: Date:

Information contained in this database is from non agency sources and is considered unconfirmed
Farm Number
Farm Name
Owner Frist Name
Owner Last Name
Source
Breached
Depopulated
Overflowed
LQ Issue
Perm issionToPump
Inudated
Flooded
Pumping Equipment
Comments
Farm Emergengy Call Form
— ® Date
eremy Bond Farm Time
eremy Call Number
Pond
p Reporting p Complaint
eremy Bon
10 Yes O p
Freeboard Level 1
O es O O
Freeboard Level 2
O es 0 O
Freeboard Level 3
O Yes O o
Freeboard Level
O Yes O o
-
O Yes O o
Freeboard Level 5
O Yes O O
Freeboard Level 6
O Yes O o

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Jeremy Bond
Jeremy Bond Farm
250 Henry Dunn Pickett Road
Beaulaville NC 28518
Dear Jeremy Bond:
fflZ.0;W'A
IT4
A& f
NCDENR
Nc*i'TH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES.
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 31-742
Duplin County
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. 1RR1, IRR2, DRY1, DRY2, DRY3, SLUR1, SLUR2,
SLD1, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincerely,
Kerr T. Stevens, Director
Division of Water Quality
cc: Wilmington Regional Office
Duplin County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources BAN
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Mr. Vaden Bond
Chris Bond Farm
152 Washout -Lane
Wallace, North Carolina 28466
Mr. Jeremy Bond
Jeremy Bond Farm
250 Henry Dunn Pickett Road
Beaulaville, North Carolina 28518
Dear Vaden Bond and Jeremy Bond:
t�
0 2
3200 1 f
NCDENR
NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 28, 1999
Subject: Combination of Swine Waste
Management Systems
Permit Number AWS310742
Permit Number AWS310869
It has come to the attention of the Division of Water Quality during a site visit of the subject facilities that
the swine waste management systems are operated as one system. If these waste management systems are
operated as a combined system it is necessary that one permit be issued to the combined facility. Currently
these facilities are covered separately under the general permit for Swine Waste Management In order to
combine these facility's permits please submit a Waste Utilization Plan for the combined facilities.
Coverage under the General permit will then be reissued to the combined facility.
If you have any questions or comments please feel free to contact me at 919-733-5083 extension 502.
erely,
ue Homewood
Cc: Wilmington Regional. Office, --Water Quality.Section
Non -Discharge Compliance and Enforcement Unit
Permit File AWS310742
Permit File AWS310869
16I7 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post -consumer paper

� Division of Soil an&Water Conseri
[ :Division of Soil axid-Water Cociser
Division of Water Quality . Compli
Other Agency Operation Revrew
ition .._Operation•Review e
drop- Compliance inspection
nee Inspection _
JQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection {
Time of Inspection I 2A hr. (hh:mm) '_
Permitted (3 Certified (,a Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated:
�� [ County:.. Da,�......................
Farm Name:............!-��'..W..?3s..........�J!1.�1�....".-� .......................................
Owner Name: ................ �P-V . ... 4%L......... .{lafJ.......................................... Phone No. ...........................................
Facility Contact: ........ --------•............................................................ Title:........................ ...... Phone No:
Mailing Address: ..... .......q...�.unt-x.—ki-4.+'-:41................................. U£.iJ•lG bs..� . f..i ....................... $S.Z..........
QQ�� �`� rf i
Onsite Representative:.1,......:.��.......? 1T21 Integrator:.......{ r[� j 1rQ.l.[.......................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
..........................................................................................................................................................................................................................................................................
Latitude Longitude
Design Current "..- ;-._. _<,-Desigii --
Current_, ,-.. _
Design Current
Swine-:
foulCcity
PoulatioCatpy
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
_j (�
(� 8
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
'-
'
❑ Farrow to Feeder
.
Other
.-
[]Farrow to Finish
� •- .- --
Total Design Capacity
,
T
..
❑ Gilts
-
=:-
❑ Boars
=
, Tbtal'SSLW
" , - .
_ ❑ 'Number of Lagoons - Subsurface Drains Present ❑ ❑ Lagoon Area Spray Fi
Holdrug-Ponds Soltd-Traps eld Area
7 r� ❑ No Liquid Waste Management System
Discharg & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑.Yes §J No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made'? ❑ Yes f4 No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin?
d. Dees 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 Structurc 3 Structure 4 Structure 5
Identifier: C3 JA
Freeboard(inches): .............................................................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes
to No
❑ Yes
[P No
❑ Yes
[�R No
Yes
❑ No
❑ Yes EpNo
Structure 6
❑ Yes P No
Continued on back
3/23/99

Facility Number: 3} — Date cal• Inspection
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? excessive Ponding ❑ PAN
12. Crop type l
13. Do the receiving crops differ with those designated in the Certified Ani al W
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
t Plan (CAWMP)?
❑ Yes P No
Yes ❑ No
❑ Yes No
[]Yes jg] No
❑ Yes RNo
[AYes ❑ No
❑ Yes [P)No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,l No
❑ Yes JR No
IT
Fail to have Certificate of Coverage & General Permit readily available?
U Yes ❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yes ❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes IS No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes tgNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes X) No
24.
Does facility require a follow-up visit by same agency?
❑ Yes MNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,M No
�:
�'Vo YiolatiQtis:o'r defcier�cies were npfed d}tz`irng -fhis;visit:- Yoir Will•iebO*0 46 futthOf;
-'comes• ont#ence:a�out~this:visit:-•: '- .-.•.-.:.:..:.-... _- ..•.....:.:...:.
Comments (refer zto question #} :Explain.any YES answers and/or any recom�rrendattons or any'other comments:'
-.
Use,¢rawings of facility ta-better.explaiit srhrations (rise additional pages as necessary)
�- ., _ W.. Oa ..
1} . o�Osetivec� +r, �t ttds Bt at f 0Or(I low 041"- fD wUe
l�potl�►`ry � o� �Si,
��� �f�` •�- re cfxrk
t8. �aat�or� aeslkn •met I I Por Cis &rt Imoor, ShoA be- {r16 ern.
Reviewer/Inspector Name
CL
Reviewer/Inspector Signature: 0�� t _ Date: t I I -7) 9''
3123/99

. Facility Number: — 7 ]late of hispection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
RNo
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
❑ Yes
W No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
(!;No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
AA No
tional omments anor rawings.
w
iE

Revised April 20,1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number��--i Z_
Farm Name: -s
On -Site Representative: .
InspectorlReviewer's Name:
Date of site visit: I
Date of most recent WUP:
Annual farm PAN deficit: _ J-1I pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility items) F1 F2 F3 F4
�peration not required to secure WA
determination at- 's time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circfe . 1 hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system permanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigatfon operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part 111).
PART II. 75% Rule.Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required.because operation fails one of the. eligibility
requirements listed below:
_ F1 Lack of zcreagewhichTesultedinmvermpplicationnfwastewateE(PAN) on:spray_
fields) according-io!arm'sdastfwo-years nf-ima2tion-iecords.-_
F2 Unclear, -illegible, -or lack of information/map.
F3 Obvious -field -limitations -(numerousditches; ailurefo:deductsequired_.._
bufferlsetback�acre:.oe;-or25%nflatal:acreaaejdenti iiedlr-CAWMP.:.includes
small ;-irreculady-shaped.fields=fields-less -than -5-acresJor.trave!ers-or.less-than
2 acres -for stationary -sprinklers).
Fc WA determination required because CAWMP credits fie!d(s)'s acreage -in excess

Revised Apni 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER'S IRRIGATION ACRES ACRES %
SYSTEM
FIELD NUMBER' - hydrant, pull, zone, or -point numbers maybe used in place of field numbers depending on CAWMP
and type of irritation system.- if pulls, etc. cross more than one field, inspectoureviewer will have to combine fields to
caicuiate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FiELD NUMBER2 - must be clearly delineated on reap_
COMMENTS' - back-up fields with CAWMP acFeaae-exceeding75% of its total.acres end ravine received less than 50%
of its annual PAN as documented in the farm's-previous -two years' ('Ic97 & 1998) of irricationTecords;cannot serve as ti,,e
sole basis -for retiuirina a WA Determination.:-Lack-uo:flelds-must -be noied in the -commentseu.ion Grid must be accessible
by irritation system.
Par: IV. Pending WA Determinations -
P t Plan 1acks.following -information:,
P2 Plan -revision m2y:S2tisiy_75% rule based on adequate overall PAN deficit and by
adjusting all field:acreaae�o below 75% use rate
P3
Otter (ie!in process of installing new imrjgation system):

,-v_&td An---Z 20, 1 ago
JUS T IF iCATiON & DOCUMENTATION FOR MANDATORY_WA DETERMINATION
Facility Number �? / Operateon is flagged for a wettable
Farm Name: ) acre determination due to failure of
On -Site Represen tive: 14'6� Part R eligibility ftem(s) F1 - F2 1=3 F4
InspectorfReviewer's Name�i. f Operafion not required to secure WA_ = -
- determination at this time based on
bate of site visit � exemption E1 E2 E3 E4
Date of most recent WUP: ZS ef t/ Opemtion-pended for wefiable acre
determination used on P7 P2
Annual farm PAN deficit+ pounds
Jr'6gation Systerri(s"� - circle' valet '.Pent--r--PivCA system; 3. Iinear-move system;
4. stabonary sprinkler system wlparmanrnt per; .b_ siatianary sprinkler system wlporiable p7jpn;-
:6. stationary gun system wlpen zanantpipr; 7. stafionary gran system wlportable pipe -
.PA-F11 ?_ VVA uetermination Exemptions (Bigibiiiityiailure, Part II, overrides Part I exernnubn.)
F1 Adequate irrigation design, induding-map depicting wettable acres, is cam date
and signed by an l ar PE.
E2 ' -Adequats D, and DJD .irrigation operating parameter sheets, including rnan
depicting w6tiable acresjs complete and sinned by an I or PE.
F3 Adequate D, irrigation ope aiing parameter sheet, including rnaD depicting
wadeacres, is correlate and sinned by a WUP_
E4 75 111D rule exemaUon as verged in P7.art lil_ (ND%E=7� oa exernpiiori -cannot be
anpiaed ;armsi;ai tali pia eiigibiiiiy checkiis in Par if. Comp}�e-eirgib`1i'rty
cheriUst,"P_art II - F I F.2 F3, beinre'compi=-ung :compulaBnnaliBbie ih Part lll).
'ART IL i5%'r�ulnl��ii}�l�t]l Cffecist�ndl3ocumerrauan c; VIIA�ezernir,afln
:er?uiremen ._"1NADe ",anonaagdirrd L'saDU� r7n 1;s�7n?Di173?�iiQIDIffly
�Quiramen�i:;tedd�lnw: .
F'I!:.ksr3arraei'su#dann�iiinr-==iTrf} �nray_
fr✓id�s��n?maio�arm�astfwfaa�as�fd;ri,�n��ds_w.
_ 2 Unclear ;�ilrgibie;�r :acl; ni rrior�f-3iiarurr,3p::.
F 3 ODvinus�Id�lmr,Isara�numero�:s�itci�����Iu��edirc�oui-�d ti-.� - - , -
- b ���;fs�ack��.rag;�r2a�pat�f��3g=�gemm���Al�iJl�yliiciur�es-� ` -.
sr,:all;��guxariy�h�a�d��IG�S ��ii.'}S�ss�rar�3,.;��-�r�veler�;.fie=gran-
- -� acres-tororary�prinislers).- -
4 WA dater ifma ionTeouired cause CA'1IMP.-bi—adks _aid(s)'s ac age -in excess
of 75'/'D if, he respeaiva field's 'dial acreage as naiad in :abie in Pan' ill_

Ap-mi 20, 1 090
acilir Number
Part lll, Feld by Meld Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBERM
HELD
TYPE. OF
s�
TOTAL
AC
CAWMP
FIELD
Y.
—SY
D-NiJM3.,-a>"1 - hyQ:art �L, r , �r ��m r�sn *spray as u5sd irr pia=e � f ld nurnb--,:�; za8pandmg on CAWMP
and ff DLES -Oem: C1 Cssll 't.an -Ona Id,`irs rinrrr=viswar will Gam' .cornh rtteJelds ip
al a� 7 � Bald iay ld dmw+ - on7or� �trw-sei on wHI be strhie::t m WA-d r--rm r aho -
��inrr�rlq=�n'�
=nTe? �TpL7Itrincm WA-—
, 333lGa= --,-% -M
W. Pending WAD
`'i �,�n�3�Y,��liowinG7rtr"arrn3i7aiZ: -.
-2 dencr end :by
adiusiing i4az� d �.r�age ��ivW �°i� uSs
3 Dine'r'Ciehn pmc:-aas Y; insaliirn naw impabon [.+

Rsys--d A p-_-2 20. 1999
JUS T iFiCATiON DOCUMENTATION FOR MANDATORY -WA DETERMINATION
Facility Numbe1 - �� Operation is flagged for a wettable
Farm Name: 3 r.2�� ` �a acre determination due to failure of
.On -Site Represen five: 14de... Part 11 eligibility item(s) F1 . F2 , F3 F.4
lnspector/Reviewees Name _- k J
Bate of site visi#i
Date of mrst recent. WUP:
Operalffon not required to secure WA � - -
determination at this time based on
exemption F7 .E2 E3 E4
V Operation-pended for wettable acre
deterrninafion .used an P1 P2
Annual farm PAN deficit: 'r , cZ. paunds
irrigation System[s).- circle Bier' canter -pivot systerM 3. linear nove.system;
4. stationary sprinkler:system w/permanent pipe; .S. s�nonary sprinkler sys m-wlporiable pig;
:6. ��onary gun system wlpem anerttpipa; 7. stationary gun system wlportabie :pipr -
PAr' i a. Yin Determination Exemptions (EligibTty failure, Part .11, overrides mart .l axemptibn_)
EI Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an 1 or PE.
E2 Adequate D, and D203 jrrigabDn operating parameter sheets, including map
depng wettable acres, :is complete and signed by an .l .or PE_
icti
E3 Adequate D, urination open rmng parameter sheet, including map daniciing
wettable acres, is comnlate and signed by a WUP:
.E4 75% rule 3xem?iion as vedfied 111. (NO E-75 °p exem, mD i _Mnriat i-_
appHad io :armstiaz mil the eliaiDi iEy checia:si in �3ri 1i. Gamgiete eilQiburry
ci�ecic�+s7,, smart it - r 1 F21-3, baibrascornpk-tng camputafional Ala in Pari 111)-
'ART=iL r51p RulQ..�iigibiiiryafion
:egnirnmenis. _ 1hfA Dry j " ,anon auiredbecause --oDerah
Dndails:Dne ptiha eiiainurty
equiremen>s-i:�--tad�law= - .
an:spray_
Sarin_aarritda,�tirnman3�irigaona�a
I _ 7_2 lln :la3r,�llagiiaFa;�r:acic m-�-�uani;�-n :_
I
r3 Obvioumfaldznzu ans nurnaro��s�it a: ttr= a ii- d �
Durnrf�al�ack�cr�age�r25�a4r.3; ia��a�-.�crag��z��m>��n�AV�tI►���nciudas�=-=.--
srr;all;s; ,ariyzi�apad olds aids- ss ;arm a- r valers r�aYs pan
F4 WA deierminaiianTaquired Because GAlW::' (s)'s.acreage in -excess :-
o; f5%D at the respe-ctive iaid's zoitai acrrage-as noted in table in Part 1il_

r -sic A-pn7 20, 1999
acility Number _
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBERS
IRRIG DH
ACRES
ACRES
%
SYSTEM
=" �33►iiJf ' - iryd,2s zs�L;_ csr ,'za; ��a rs1ray j)-- steed in 131SM -3:6 neid r unme s Ti--pendinq nn CAVVMP
;rtd i}! rs irrignnars}SWrr_` F, nir0s, -n-i.anne wlli have iD.cvrina-f^5 ;o
aim 7 ' %aid ,by>) --id der m-amn-r , obI-n+v a Q. um wM be sui i-e= L is WA eaiarmiraii r3
Tia_ariYSFelII2..�t 32nmap-
:OM i-.-it _v CAWRIfF ar dinG_:: °a Er liz tav[ngTecaived_= — frian 509n
-.im mmz,--1PAN ms3ja j-A--,dintse:;m rri vbLmiwn_v-.ter' (!297 1an.98`) err ri uan �,-s na �a�►re s
of IV. Pending WAD--te.;,ti.na-bom-
P2 AN denfr3nd t)y
X73 der �eiFn �ro�e n; ir. lsin r�ew iricauan S}s em}: {,c.��- ,`

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number i 2_
Time of Inspection =L= 24 hr. (hh:mm)
©Registered laCertified 0 Applied for Permit Mermitted JUNotOperatinnal Date Last Operated:
Farm Name: L..t t` S ...s l' ...- U.- .. County: .... N.k........................... ... ........... ... I ...........
........
Owner Name :..... �Yt-`...{t14t.... ....... ..................................................... Phone No }
Facility Contact:
Mailing Address:.........j?�Z...... WIt4.O.'ti...... �..............
Onsite Representative:............. -- ......... ............
Certified Operator:.......................................................................
Location of Farm:
Title:.......................................................... . Phone No:
................................. ........4.1'.t... :...............,
...................................... Integrator :....... t"ts.yV-0.if 1..
...... Operator Certification Number;
............-..... .....................................
................. ................. ................................... .... .................
Latitude • �' " Longitude ©• 6 "
MT, �
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes
0 No
❑ Yes
No
} BEd
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes No
❑ Yes No

[Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures La oons Holdin 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: ..............GIS ............................... All ............ ........................... ......... ................................... ................................... ...................................
+'
Freeboard(ft):............... 5.................. ........... 1.�................. ................................... ...................
.........................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ObNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ja 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 §4 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes PR No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type .tY.mrtu 4- ............... C tk...]Ccair�............ CV........1 tA+t..25.+Ubr................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 19 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
&No
18.
Does the receiving crop need improvement?
❑ Yes
29 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
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
t9 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
19 No
24.
Were any additional problems noted which cause noncompliance*of the Certified AWMP?
❑ Yes
$3 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
0- No:vialations•or' Mkiencies. were 'no'o'teddliritig this:visit.- Yo_ 4,will recei've-iroItirdiei-
.•correspQnde�ceab'ouEthis:visit�.•: ..�_.-:-:-: �..:-:-:: .•'•. . •.:-.�.�::::-.::.::. .•
��. Nl;nov, eoiwt or-. tr,•Ar dK+- rwxk4I of C9 S64 be 6- 1W o*J Yvseeded. � h
Ga,4wit e ff&,+'( � VZ�,2k{K ka..rt, aeA& 5, C g d i v.., Gut,.
`,� `1�-fll, "krV, Cc4r�-;co'b6m to-ryms.
�- G6� �-�►^�-��- �.
�;Y.e Copper �S sktstll� �ae w,o nt{�yrt b Q v set
7/25/97
Reviewer/ins ector Name
p °xil G-rUrixz
�„ON M.0
'
Reviewer/Inspector Signature:
r
, //A, ,�. _ -
Date:�?�J 4)Q
r�L

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
y r— 742 I Date of Inspection 12/R/97
Facilit � Number 31
Time of Inspection 13:20 24 hr. (hh:mm)
13Registered JMCertified Q Applied for Permit ❑ Permitted JE3 Not Operational I Date Last Operated:
FarmName: dsrcmJ'.Aour1.F.arm..................................................................................... County: Ruplin............................................... ..IR.Q.........
OwnerName: deremy'.....................................B.aud............................................................ Phone No: 9.10.-29.&39.1Z..........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 250..I auW.Du ui.Fi&ctt.Rd.......................................................... Beaulaville..N.C.................................................... 185.18.............
Onsite Representative:,lctcm3:.B.aud......................... .:.................................................... Integrator: C.arrull'.S.Fnotls. Lttc..............................................
Certified Operator: Jcrcmy:.D ............................... Bond .................................................. Operator Certification Number: .18.QU6 ............
.................
Location of Farm:
Latitude 34 • 4-545 Longitude 77 • 49 46
General
1. Are there any buffers that need maintenance/improvement?
Q Yes
© No
2. Is any discharge observed from any part of lie operation?
❑ Yes
0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (if yes, notify D WQ)
❑ Yes
© No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
© No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
i] No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
[j Yes
© No
5. Does any part of the waste management system (other than lagoonAolding ponds) require
❑ Yes
❑ 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 tail to have a certified operator in responsible charge?
❑ Yes
© No
7/25/97

Facility, Number: 31-742
8. Are there lagoons or storage ponds on site which -need to be properly closed? ❑ Yes ❑ No
Structures (La2nons,Holdin2 Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Yes ❑ No
Stricture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(R):...............................................................................
10. Is seepage observed from any of the structures? ❑ Yes © No
1 l . Is erosion, or any other threats to the integrity of any of the structures observed? [3 Yes ❑ No
12, Do any of the structures need maintenance/innprovement? ❑ Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ❑ No
Waste Application
14. is there physical evidence of over application? (Q Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
l5. Crop type
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
[:]Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
❑ No
18.
Does the receiving crop need improvement?
❑ 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
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Onlv
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 die Certified AWHIP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
.• •No•io. ... s'ti>•'d•efiCietiEieS•iv...rioted'cti;rah tltis•iiSit.' `t'ot..... .e' ' .t�... .t .. . .
:, , crrresi�atideitceab�oaf this:visit::::::::::::..:::::::::::::::::..:: .
follow-up visit was made to determine if the problems noted during the previous inspection (on 5/30/97) had been corrected. The
)sion at the toe of lagoon wall caused by stormwater drainage had been fixed. Other erosion areas on the lagoon wall had also been
erected. In addition, the lagoon wall now has a good vegetative cover. During the previous inspection, there were some problems wi
iste application. These problems appear to have been resolved, and the original spray fields now have a good cover crop established.
Reviewer/Inspector Name
Reviciver/Inspector Signature:,
7/25/97 r
Date: tz If q -7

❑DSWC AniinaI Feedlot Operation Review,
f �DWQAnimal Feedlot Operation Site Inspection `
® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 31 Time of Inspection : OD 124 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: .... . .... . ...... . ..... . . ..... . ...... . ...... . . ..... . . .... .._..... _ .. _...._ .....-.........
Farm Name: ... jrycem . .�sx.r�...... .._....... County:_
Land Owner Name:.. >7 mar e ►^�. ........ g.ka. �. _ ..... ....T.... _ Phone No: .�`11.R.� ....` c�..� .. °1..R. ..... ............
Facility Conctact:... _._..... _ ...._ .... _ ..... ...._......._.. . Title: .............._. Phone No:
Mailing Address:..2a.0.__..LA..r.N=1......
OnsiteRepresentative; ...,5 re.w,_ 1... �_�Rtk,G� .... _.... ...._ Integrator: _ �.�..t_.... _.....
Certified Operator: -.........._ W.... __...._w....._... Operator Certification Number:
Location of Farm:
.�...,�s�sr..�!^_.---� ti.. .....8. T... ...1.�.�.....r...f�4.{�.T.x:a..)t.,l_r.�..n.. ..........�..::±.^_..,..e..5.....t<u.t�.s. .....�. .... � � ....-.... 4
_�.................................
VIM
Longitude
❑ Wean to Feeder
Layer_
Feeder to Finish
❑Nan -Layer
Farrow to Wean
Farrow to Feeder
R 3
�TotalDestgn�Capaclty
-
Farrow to Finish
s�>
General
1. Are there any buffers that need maintenance/improvement? RYes ❑ No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ®. No
❑ Yes CR No
❑ Yes D9 No
❑ Yes
!q No
13 Yes
❑ No
❑ Yes
® No
CRYes
❑ No
Continued on back

Facility Number:....]..._. —._'!`LT
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures .aao n. and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
Z
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes RNo
❑ Yes R1 No
❑ Yes ® No
❑ Yes Ea No
Structure 5 Structure 6
12. Do any of the structures need maintcnance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste A 1':cation
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2I. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For,Qertifid Facilities, Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
Coinmentse{refer to'questronj EX}slarn any YES'::answeri
❑ Yes 9No
18 Yes ❑ No
9 Yes ❑ No
❑ Yes ®' No
9( Yes ❑ No
❑ Yes CR No
❑ Yes ® No
❑ Yes U No
❑ Yes CR No
JaYes ❑ No
❑ Yes 2 No
❑ Yes ES No
❑ Yes ®•No
2 Yes ❑ No
k
t
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

IFacility Number: ..aJ ..... Date of Inspection: 1 3 1 3 o I q T 1
4/-iU/91

•
•
Site Requires Immediate-Attentio�-
Facility No. ,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD ��!Z
DATE: , 1995
Time: l d
Farm Name/Owner: 'Q e r 'e— '7K
yia- Zw -- 3
Mailing Address:' 2 SO l�%N }y 42&A. `N Zlk f!e _
County: f 1 ou L- 7,p�-'l�
Integrator: ' , Phone:
On Site Representative: — 06*J Phone: 1AN¢d 41 / If, A
Physical Address/I
Type of Operation: Swine -V.' Poultry , Cattle
Design Capacity: 3,� a-� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude- LLongitude: ° 4' Elevation: Feet
Circle Yes,or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: Zd _Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or l@o Was any erosion observed? Yes or�l
Is adequate land available for spray? �.�3 or No Is the cover crop adequate? (E) or No
Crop(s) being utilized: C4%
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(�dI
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land, applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
• N
Inspector Name
S
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.