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670041_INSPECTIONS_20171231
NUH I H UAHULINA Department of Environmental Qua NNEEMNLOr 0iiioTf Water Resources Facility Number ©- © OO Division of Soiland Water Conservation OQ Other Agency Type of visit: ompliance 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: I (,—] ) Arrival Time: D ,'� Departure Time: � County: 42tU13 -r Region: Farm Name: 4U n L -Ptj r,.��j a y-� %4✓�` Owner Email: Owner Name: 4A,,J Phone: Mailing Address: Physical Address: Facility Contact: Onsite Representative: Certified Operator: Back-up Operator: /oe!%h Phone: Integrator: Certification Number: Certification Number: Location of Farm: Latitude: Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Wet Poultry Capacity Pop. Layer Design Current Cattle Capacity Pop. Dairy Cow Dairy Calf Wean to Feeder I jNon-Layer EE Feeder to Finish L 0 Dairy Heifer Farrow to Wean Design Current D , P,oult . Ca aci P,o Dry Cow Farrow to Feeder Farrow to Finish Non -Dairy Beef Stocker Gilts _Layers Non -La ers Beef Feeder Boars Pullets Beef Brood Cow Other C+ther Turke s 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? ❑ Yes ®-No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) [] Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [allo ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE of the State other than from a discharge? 'CRNo Page I of 3 21412015 Continued [Facility Number: - Date of Inspection: — -1-7 Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F�jNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O 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 J. 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 [3 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 P .-No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LE�,1+To ❑ 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):�/'�yr!/�c %r�d��!-r�% /rsGli-�- 13. Soil Type(s): 7rrl7rlr�/t-1��`---� 14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? 0-Yes ❑ No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Yes EaNo ❑ NA ❑ NE [:]Yes allo ❑ NA ❑ NE ❑ Yes FZ No ❑ NA ❑ NE [:]Yes [3,No ❑ NA 0 NE ❑ Yes jj`No ❑ NA ❑ NE ❑ Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes HNo ❑ 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 [&No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U3-No ❑ NA ❑ NE Page 2 of 3 21412015 Continued Facility Number: 7-q 1 jDate of Inspection:_ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E. No ' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o 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 RNo 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 ❑ Yes allo 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 ("�2,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 E4,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 ZL No ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [P3.No 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0No 34. Does the facility require a follow-up visit by the same agency? ❑ Yes �o ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE ❑ 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). Reviewer/Inspector Name: Reviewer/Inspector Signatui Page 3 of 3 Phone: Date: 21412015 Type of Visit: 0 7Routine pliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: S ii Arrival Time: Departure Time:® County: OtiLbL ,.% Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: J(IL �(�� Certified Operator: Back-up Operator: Location of Farm: Latitude: Owner Email: Phone: Phone: Integrator: Certification Number: Certification Number: Longitude: Design Current Swine Capacity Pop. Wet Poultry Design C+urrent Capacity Pop. Cattle Design C►apacity Current Pop. Wean to Finish Layer DairyCow Wean to Feeder Nan -La er DairyCalf Feeder to Finish Q DairyHeifer Farrow to Wean Design Current Ca aci P,o DEXCow Farrow to Feeder Farrow to Finish 1? r Poultry Layers Non-Dai Beef Stocker Gilts Non -La ers Beef Feeder Boars Pullets Beef Brood Cow Other Other Turkeys urke Poults Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes No ❑ Yes ❑ No ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑Yes ❑ o ❑NA ❑NE ❑ Yes ZZN o ❑ NA ❑ NE ❑ Yeso ❑ NA ❑ NE Page I of 3 21412015 Continued acili 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 ❑ 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 environmen threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ YesVNo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require [] Yes O/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 2 No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo ❑ NA ❑ NE acres determination? IT Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ElYes No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo ❑ NA ❑ 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 if acility Number: 7 - Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes ZN ❑ NA 0 NE 15. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes zo ❑ 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? mments:(refer to-.4_uestr6n :#) E ilain any YES. answers.and drawings of facility to better ex� ' pla�n.sit�at7ons-:(useeatldtiv Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes [�No ❑ NA ❑ NE ❑ Yes 2:j'No ❑ NA ❑ NE ❑ Yes ❑ Yes ❑ Yes 0NNo ❑ NA ❑ NE VN�o ❑ NA ❑ NE o ❑ NA ❑ NE z ELe's as'Recessary). Phone r �a — Date. I 214/20 5 • ivi'sion of Water Resources Division of Soil and Water Conservation � Other Agency Cype of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance leason for Visit: Dr-Rioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: 2'{ Arrival Time: It Departure Time: County: Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: 55 llr' Certified Operator: Back-up Operator: Location of Farm: Latitude: Owner Email: Phone: Phone: Integrator: Certification Number: l b � )A Certification Number: Longitude: Wean to Finish I Layer Dairy Cow Wean to Feeder ]Non -Layer DairyCalf Feeder to Finish DairyHeifer Farrow to Wean Design Current D Cow Farrow to Feeder Dr. P,ouItr, C►_a sci P,o Non -Dairy PNon-Layers Farrow to Finish Layers Beef Stocker Gilts Beef Feeder Boars Pullets Beef Brood Cow Poults Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE Discharge originated at. ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ 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 1 of 3 21412015 Continued Facili Number: 61 - Lj jDate of Inspection: L Wgstd Cdilection & 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): 2Z 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ NA ONE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes 2fNo ❑ 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 environmenta hreat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes &No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? f 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 E6No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE t6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes TNo ❑ NA ❑ NE Reguired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? D 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 [� No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1� No ❑ NA ❑ NE Page 2 of 3 21412015 Continued Facili Number: - Date of Inspection: Q 7 Z f� 24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes - E No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El Yes r4 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 fait provide documentation of an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE and report mortality rates that were higher than normal? 24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP? ❑ Yes No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No qNo [] NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE Comments (refer, to question ##): Explain any YES answers and/or -any additional recommendations;or;;any-other comments—, Use drawings of facility to better explain situations (use additional pages as necessary). - Reviewer/Inspector Name: fJ A V t Z & ` -11 Reviewer/]nspector Signature: Page 3 of 3 Phone: 719 71 t /73�� Date: y ! ZY Z) �r 214,12015 Type of Visit: 1�Co pliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: 3 lz t Arrival Time: Departure Time: County: L Region: Farm Name: Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: O U GA Rs�A F-4.1 RM Integrator: Certified Operator: Phone: Certification Number: JW Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Current Swine C►apacity Pop. ean to Finish Design C►urgent Wet Poultry Capacity Pop. Layer Design Current Cattle Capacity Pop. DairyCow ean to Feeder Non -La er DairyCalf eeder to Finish RF: Design D . P,aulti, Ca aci Layers Cnrrent P,o , Da' Heifer D Cow Non -Dairy Beef Stocker arrow to Wean ow to Feeder ow to Finish Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow t7ther Other HOther Turkeys TurkeyPoults Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes aNNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ ❑ NA ❑ NE ❑ Yes o ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE Page I of 3 21412011 Continued 1 Facili W Number: - jDate of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Identifier: c-A���N Spillway?: Designed Freeboard (in): Observed Freeboard (in): Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 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 No ❑ NA ❑ NE ❑ Yes Z/No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system oiher than the waste structures require ❑ Yes 2feNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z2rNo ❑ 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? 15. Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Yes [Ejo ❑ NA ❑ NE ❑ Yes NY ❑ NA ❑ NE ❑ Yes ONo ❑ NA ❑ NE ❑ Yes �No ❑ NA ❑ NE ❑ Yes o ❑ NA ❑ NE ❑ Yes [!�No ❑ NA ❑ NE ❑ Yes ❑ NA ❑ NE ❑ Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZNo ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? Yes NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes2Zo ❑ NA ❑ NE Page 2 of 3 21412011 Continued FaciliNumber: jDate of Inspection: t 24P. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes '� ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �;No❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE gNo 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes o ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes M401❑ 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 �lCJ XN0❑ NA ❑ NE 34. Does the facility require afollow-up visit by the same agency? ❑Yes ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations fuse additional Dazes as necessarv). Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 C')I Phone( d Date: 2J 011 (Type of Visit: Q 7Routine ]lance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance I Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: /CkXa Departure Time: //Q0 County: b1J S (,dW Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Title: Owner Email: Phone: Phone: Onsite Representative: 14 UGN FA_5,'�T-�1 6AIntegrator: i Q Certified Operator: Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Wet Poultry CaP ci tVj MP. La er Cattle Dairy Cow Design Current Capacity Pop. Wean to Feeder Non -La er Dairy Calf Feeder to Finish d Dairy Heifer Farrow to Wean Farrow to Feeder Farrow to Finish Design Current D . P,o_ult , Ca aci P,o Layers Cow Non -Dairy Beef Stocker Gilts Non -Layer Beef Feeder Boars Pullets Beef Brood Cow Other Other Turke s Turke Poults Other Discharees and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? [:]Yes ZNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ o ❑ NA ❑ NE ❑ Yes go ❑ NA C] NE [] Yes ENo ❑ NA ❑ NE Page I of 3 21412011 Continued Facility Number: jDate of Inspection: 3 ') I 3Xaste 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 1I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 7-13 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IdNo ❑ 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 Z] 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 E] 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 E�/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 13N0 ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes YNo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2/No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes [%f No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes 0'/No ❑ NA ❑ NE Rectuired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? o ❑ Yes dVNo ❑ 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 No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E� ❑ 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 Fagifity Number: jDate of inspection: 3 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 6No ❑ 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 fast survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [,—J/No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes M No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 34. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes �No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ]�No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑Yes do ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE Reviewer/Inspector Signature: Date: -7 13 Page 3 of 3 2/4/201I 12 Type of Visit: QiCom lance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: ® Departure Time: 'Zp County: -ja&jy g26) Region: Farm Name: Owner Email: Owner Name: Mailing Address: Phone: Physical Address: Facility Contact: Title: Phone: Onsite Representative: f a's M Integrator: Certification Number: 16 19d7 Certified Operator: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Wet Paultey Capacity Pop. Cattle La er Dairy Cow Design Current Capacity Pop. Wean to Feeder Non -La er Dairy Calf Feeder to Finish Farrow to Wean Dairy Heifer Design Current Dry Cow D , P,oulti. C*_a aci P,o Non -Dairy La ers Beef Stocker Farrow to Feeder Farrow to Finish Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Other Other Turke s Turke Poults Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes To ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes �No NA ❑ NE Yes ❑ NA ❑ NE Page I of 3 21412011 Continued Facili umber: - Date of Inspection: Z Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes a. If yes, is waste level into the structural freeboard? ❑ Yes Structure 1 Structure 2 Structure 3 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): Z No ❑ NA ❑ NE ❑ No ❑ NA ❑ NE Structure 4 Structure 5 Structure 6 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 ❑ NA ❑ NE ❑ Yes;�No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ 7. Do any of the structures need maintenance or improvement? 0 Yes N ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ +, a 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 Q _ ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ 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 N ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes y ❑ 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 rr/No NA [] NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE Reguired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 6 ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE h b t e appropriate ox. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑Yes o ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facili umber: 6=7 - c4l jDate of Inspection: t 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes9 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 ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 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 40 ❑ NA ❑ NE ❑ Yes Rio1-", ❑ NA ❑ NE ❑ Yes /No ❑ NA ❑ NE ❑ Yes EfNo ❑ NA ❑ NE [—]Yes E ❑ Yes FNo Yes ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any -other comments.::,-:::_ Use drawings of facility.to better explain situations (use additional pages as necessary). A.. Reviewer/Inspector Name: Reviewer/Inspector Signature Page 3 of 3 . W(- Phone: Date: 141 Z.. 2/4/2 I . Division of Water. Quali � acilitV,Number 7 l O Division of Soil and Water Conservation .-_ - ., ,.�� 0 Other•A ene a .�. Type of Visit GrCo'pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit (;Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access Date of Visit: �� l . j� Farm Name: Owner Name: Mailing Address: Physical Address: Arrival Time: Departure Time: I� County: ONSC � Region: Owner Email: Facility Contact: Title: Onsite Representative: WIJG4l PASSSrJGi )OWN Phone: Integrator• Phone No: Certified Operator: Operator Certification Number: Back-up Operator: Location of Farm: Back-up Certification Number: Latitude: = c = g = Longitude: = ° 0 d Design Curren#. Design`s Current Ate. Swine Capacity Population Wet Poultry Capacity Populatton ` ❑ Wean to Finish j❑ Layer ❑ Wean to Feeder ' ❑ Non -Layer ® Feeder to Finish fop U ❑ Farrow to Wean Dry Poultry ❑ Farrow to Feeder A ❑ Farrow to Finish ❑ La ers ❑Gilts ❑ Non -Layers El Boars ❑Pullets ❑ Turkeys Other' = [] Turkey Poults ❑Other ; ❑ 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? Calf Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood 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 [2 No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes V ElNA ElNE ElYes 0 Zo ❑ NA ❑ NE Page I of 3 12128104 Continued Facility Number: — Date of Inspection i l Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 Identifier: LA(rd od ❑ Yes No ❑ NA ❑ NE [--]Yes [-]No ❑ NA ❑ NE Structure 5 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 C4o ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Ko ❑ 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 environmentaYN eat, notify DWQ El7. Do any of the structures need maintenance or improvement? Yes Zo El NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) �,� 9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes UKo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) [--]PAN ❑ PAN > 10% or 10 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? 15. Does the receiving crop and/or land application site need improvement? ❑ Yes Cl Yes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes 17. Does the facility lack adequate acreage for land application? ❑ Yes 18. Is there a lack of properly operating waste application equipment? ❑ Yes L� o ❑ NA ❑ NE Vr4 ❑ NA El NE o ❑ NA [I NE [I NA El NE o ❑ NA ❑ NE Comments (refer to.questitk •#). °Explain �tn any.YES answers and/or any recommendations or anypflth, er comments Used awin s of facility toy better ei lain situations. (use additional pages as necessary): ' g. P Reviewer/Inspector Name �4/y�% .+2/Lt✓� Phone: 7. Reviewer/Inspector Signature: Date: Page 2 of 3 17178104 Continued Factlity Number: 67 — q1 Date of Inspection Reg_aired Records & Documents r 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 El"No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Ma s ❑Other p 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Cl/No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ElYes E No ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes iCJ No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes B No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes P�) ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes <o ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 21No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [�No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2 No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewerhnspector fail to discuss review/inspection with an on -site representative? 33. Does facility require a follow-up visit by same agency? ❑ Yes CAo ❑ NA ❑ NE ❑ Yes ❑ Yes ❑ NA ❑ NE El NA El NE Additional Comments and/or Drawings:,;M AM �.. x . • �,. M`* n � r Page 3 of 3 12128104 A Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: © Departure Time: County: WSWW Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: , / Title: Onsite Representative: I�UG-H Certified Operator: Owner Email: Phone: Phone No: Integrator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: [= o = = Longitude: 0 ° = 4 0 Design Current Design Current Design Current Swine Cap�cYty Population Wet Poultry Capacity Population Cattle Capacity Population ❑ Wean to Finish ❑ Layer ❑ Dairy Cow ❑ Wean to Feeder IQ Non -Layer I I ❑ Dai Calf Feeder to Finish [ 6 ❑ Dairy Heifer ❑ Farrow to Wean Dry Poultry ❑ Dry Cow ❑ Farrow to Feeder ElNon-Dairy El Farrow to Finish ElN Layers ❑ Beef Stocker ❑Gilts ❑on -La Non -Layers ❑ Beef Feeder ❑ Boars ❑ Pullets ❑ Beef Brood Co ❑ Turke s Othe urkey Poults ❑ Other ❑Other Number of Structures: Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ElU Yes , No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑No ❑ NA [INE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E?//o ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes E(No ❑ NA ❑ NE other than from a discharge? Page I of 3 12128104 Continued Facility Number: &? — Date of Inspection i D Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 /No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE Structure 5 Structure 6 ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes 2/No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes DNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W-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 ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ER<o ❑ 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 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) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E(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 ? ❑ Yes [� No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes o ElNA ElNE 18. Is there a lack of properly operating waste application equipment? ElYes WN o ❑ NA' ❑ NE Comments (refer to question:#): Explain any YES answeris,andlor any recommendations or:any othencomments Use drawings of facility to better explain situations (use additiot al pages as necessary): ' F ,Zci� ,JE6!) ro c4cIL- Ar wU' P F4U/E �ifl1V... AP0 MTAL... AA) Reviewer/Inspector Name 77va t Phone: Qr0 Reviewer/Inspector Signature: Date: q Page 2 of 3 G 12128104 ' Continued Facility Number: Date of inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have a components of the CAWMP readily available? If yes, check the appropriate box. r7fWUP ❑ Checklists ❑ Design ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking . ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F.4 ❑ NA El NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ,��No [I NA El NE 25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes D'�o ❑ NA ElNE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes E3 No ❑ 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: ❑ Yes 2/No ❑ NA ❑ NE 0/yes ❑ No ❑ NA ❑ NE ❑ Yes To ❑ NA ❑ NE ❑ Yes E;Ko ❑ NA ❑ NE ❑ Yes 3/No ❑ NA ❑ NE ❑ Yes 2 o ❑ NA ❑ NE ❑ Yes ff No ❑ NA ❑ NE No ❑ Yes ❑ ❑ NA ❑ NE Page 3 of 3 12128104 W7 M. y I Type of Visit d C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: ct C>O Departure Time: County: dNsU'J Region: Farm Name: Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: IAUCG4 +?A5&ZM&-WA0A Integrator: Phone No: Certified Operator: I Operator Certification Number: Back-up Operator: Location of Farm: Back-up Certification Number: Latitude: 0 e 0 4 Longitude: C ra11111111v10 Design C+urgent Design C►argent Design Current Swine Capacity Ropulation Wet Poultry _ALCapacity Population Cattle Capacity Population ❑ Wean to Finish ❑ La er ❑ DairyCow ❑ Wean to Feeder ❑ Non -Layer ❑ DairyCalf © Feeder to Finish 1 ❑ DairyHeifer ❑ Farrow to Wean Dry Poultry ❑ D Cow ❑ Farrow to Feeder ❑ Non -Dairy ❑ Farrow to Finish ❑ La ers ❑ Beef Stocker ❑ Gilts ❑ Non -Layers ❑ Beef Feeder ❑ Boars ❑ Pullets ❑ Beef Brood Co ❑ Turkeys Other ❑ Turkey Poults ❑ Other ❑ Other Number of Structures: Discharges & Stream Impacts t . 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? Page I of 3 ❑ Yes CdNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE El NA El NE ❑Yes El No ❑ Yes VNo ❑ NA ❑ NE ❑ Yes ENo ❑ NA ❑ NE 12128104 Continued Facility Number: {p17 — q 1 Date of Inspection 4 oQ Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VXo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: LA&—#J Spillway?: Designed Freeboard (in): Observed Freeboard (in): Z-t_ 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ NA ❑ NE through a waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes 0 NNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3/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 Q No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ,.,/ 14 No ❑ NA ❑ NE maintenance/improvement? 11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 E�`No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2�No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes [3 No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ["No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes allo ❑ NA ❑ NE Comments (refer to question #) �Explatn�auy�YES nswcrs"andlo�r�any�t,recommendationo any otttecomments. Use�drawtngs of facthty to better explain s�tuat�ons. (use addthonal,pages,�as necessary: Reviewer/inspector Name J R I Phone: o y— Reviewer/Inspector Signature: Date: 3 ct 16 Page 2 of 3 0.12128104 Continued Facility Number: (a — 4l Date of Inspection 3 9 0 Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E(No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ YesYN o ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes o ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o El NA El NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes WNo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 11"No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes WNo ❑ 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 [IrNo ❑ 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 o ❑ NA ElNE 33. Does facility require a follow-up visit by same agency? ElYes No ❑ NA ❑ NE Additional Comments and/or Drawings: Page 3 of 3 12128104 hk1 q Type of Visit O Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: S /] 6 Arrival Time: Departure Time: County: _dIVS[QJI6� — Region: Farm Name: Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: n Title: . Phone No: Onsite Representative: �r W4 !"ASSz;t1Cr &ArrL __ Integrator: Certified Operator: Back-up Operator: Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: [= n = i = gj Longitude: = o = I = u �Popqlratnio Design Currentn Wet Poultry Capacity Population ❑ Layer Cattle Capacity Population ❑ Dairy Cow ❑ Wean to Finish ❑ Wean to Feeder 6 10 Non-Layer__L I ❑ Dairy Calf ❑ Dairy Heifer ® Feeder to Finish V40 ❑ Farrow to Wean pry Poultry ❑ Dry Cow ❑ Farrow to Feeder, ❑ Non -Dairy El Farrow to Finish ❑ Layers El Stocker El Gilts El Non-Layers El El Pullets ❑ Turkeys El Beef Feeder El Beef Brood Co El Boars Other ❑ Turkey Poults ❑ Other ❑Other Number of Structures: Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ NNoo ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? Yes [IE El NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ElL Yes ���'/No No ❑ NA ❑ NE other than from a discharge? Page I of 3 12128104 Continued IF"acility Number: 6*1 — qt Date of Inspection l a 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: ita Spillway?: Designed Freeboard (in): Observed Freeboard (in): ?f1 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L'J No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Id No ❑ NA ❑ NE through a waste management or closure plan? eat, notify DWQ If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7No 7. Do any of the structures need maintenance or improvement? ElYes ❑ 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 [3 No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes O No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? E] YYes 0 No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? Yes ❑0No El NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ✓I No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes 2fNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA ❑ NE �S•� ��E �JEF �! fa 8E Cur 6'V7 At ki rAU /A[ I✓dT AUXt-A.o • Reviewer/]nspector Name f0, l_ Phone: Reviewer/Inspector Signature: A.Aoff Date: S OP .rage-, of .s JZ-1401vv L.Uns[nNru Facility Number: 61 — Date of Inspection I a Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections Weather Code 22. Did the facility fail to install and maintain a rain gauge? El Yes No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes UNo ❑ NA ❑ NE ❑ Yes UdNo ❑ NA ❑ NE ❑ Yes C�No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes d o ❑ NA ElNE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 2No ZNA A El NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ No ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes LrNo ❑ 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? ElYes EI 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 O/No ❑ NA ❑ NE General Permit? (iel discharge, freeboard problems, over application) �NN 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE r. Page 3 of 3 .I2128104 (Division of Water Quality =Facilitymber O Division of Soil and Water Conservation O Other Agency Type of Visit (0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 42 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access ' Date of Visit: 1311 S O'1 Arrival Time: []C� Departure Time: �� County: _40X rl - Region: Farm Name: Owner Email: Owner Name: Mailing Address: Physical Address: Phone: Facility Contact: I Title: Phone No: Onsite Representative: IAY&O RMU-0481A Integrator: Certified Operator: Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Operator Certification Number: Back-up Certification Number: Latitude: [= o = A = i4 Longitude: =° 0 Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er - - I ❑ Non -La et Dry Poultry N Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Design Current.. Cattle Capacity Population ❑ Daia Cow ❑ Dairy Calf ❑ Dairy Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stockct ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E34 ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes 2No ❑ NA ❑ NE ❑ Yes ZrNo ❑ NA ❑ NE 12128104 Continued Facility Number: (p) — ' Date of Inspection E=kl Waste Collection & Treatment 4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 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.A&-m►J Spillway?: Designed Freeboard (in): 7A Observed Freeboard (in): W. 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LI Flo ❑ 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 ENo El NA El NE 8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Lei 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 E1 No ❑ NA ❑ NE maintenance or improvement? Waste Application �� 10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes E? o ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ElNA ElNE 15. Does the receiving crop and/or land application site need improvement? ElYes �E L7 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes DIN' o ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes [;PKo ElNA ElNE 18. Is there a lack of properly operating waste application equipment? ElE Yes o ❑ 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): a w Reviewer/Inspector Name H t j �7A LW Phone: Reviewer/Inspector Signature: Date: 3 Ji o 1 12128104 Continued Facility Number: — Date of Inspection 3 5 0l Required Records & Documents ��,// 19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E3<o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2'�Io ❑ NA ❑ NE the appropirate box. ❑ W" ❑ Checklists ❑ Design El Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D'No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [?"N' o ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE 24. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes Q o ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [a'No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Ea**No NSA El NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [II� No ,❑,, NA ❑ NE Other Issues f 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElE Yes No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes dNo ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �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 EI'No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El Yes �,/ L'7 No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes �No ❑ NA ❑ NE Comments and/or Drawings: 12128104 3 Division of Water Quality Facility Number 1 1 0 Division of Soil and Water Conservation -- - 0 Other Agency Type of Visit Q1i:om lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance/ Reason for Visit l outine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: Departure Time: County: d�%SLOW _ Region: Farm Name: Owner Email: Owner Name: Mailing Address: Physical Address: Phone: Facility Contact: !!�� Title: Onsite Representative: MO& A T"ASSsAAAAM Integrator: Certified Operator: Back-up Operator: Location of Farm: Swine. Phone No: Operator Certification Number: Back-up Certification Number: Latitude: 0 0 = 6 = Longitude: = ° = . = « Design Current, Designer Current Design Cur, Capacity" Population Wet Poultry' Capacity "Population `" Cattle `Capacity Poptl ❑ Wean to Finish ❑ Wean to Feeder Feeder to Finish a'XJ o ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other ❑ Layer , < ❑ Non -La er L - ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Cowl Dry Poultry, ❑ La ers ❑ Non -Layers ❑ Pullets ❑ Turkeys - JE]Turkey Poults I ❑ Other-- Discharges & Stream Impacts L Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? °. Number.,of Structures b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Page 1 of 3 ❑ Yes 2 No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes [:]No ❑ Yes ,❑ 9110 ❑ NA ❑ NE ❑ Yes PNo ❑ NA ❑ NE 12128104 Continued facility Number: (� — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 Identifier: LA GAEA2 Spillway?: Designed Freeboard (in): 20 Observed Freeboard (in): go 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ Yes 0No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE Structure 5 Structure 6 ❑ Yes �No El NA El NE ❑ Yes LI No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes En/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 E No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2 No - ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or t0 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence ofWind Drift ❑ Application Outside of Area 12. Crop type(s) FESG ���12 1✓>!/rDA Y�� i rr 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ Yes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 17. Does the facility lack adequate acreage for land application? ❑ Yes 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE C'No ❑ NA ❑ NE �No ❑ NA ❑ NE VEl NA El NE ❑ 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): AL �14K!'►1 �- �EI✓o�DS C.�l� (rcnp � 4u. � RIECOMI S On-OP_1� tic- Vj_0j j-Ali twc , Zda/ T Reviewer/Inspector Name ToAld ad i 6. if t, � Phone: �/Q 7Q�� 7 a (e Reviewer/Inspector Signature: Page 2 of 3 Date: &/7/06 12128104 Continued facility Number: Date of Inspection Required Records & Documents • 19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes o El NA El NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE the appropriate box. ❑ WUP El Checklists El Design El Maps ❑Other /No 21. Does record keeping need improvement? if es, check the appropriate box below. P g P Y ❑ Yes ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Cade 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes , /E] El NA El NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes 7No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ElNE 25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes ElNo ,Ej'NA [! NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 'No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ®NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes � E?<o/ ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [2 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 C 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 El Yes ,_,/ Jr 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? El Yes �% [3 No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes 0 No ❑ NA ❑ NE Additional Comments and/or Drawings: Page 3 of 3 12128104 Type of Visit Co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: im 4 Arrival Time: S Departure Time: County: _6i00 Region: Farm Name: Owner Name: Mailing Address: Physical Address: Owner Email: Phone: Facility Contact: Title: I Phone No: Onsite Representative: P&O &IN6 ��,� �_ Integrator: Certified Operator: Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Operator Certification Number: Back-up Certification Number: Latitude: = o = i ❑ « Longitude: [= ° = g = Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer ❑Non -La et Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes U4 ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ ❑ NA ❑ NE ❑ Yes ❑ Yes [ ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE 12128104 Continued "'cility 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 Structu e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: dJ Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [INA ElNE (ie/ large trees, severe erosion, seepage, etc.) 6.. Are there structures on -site which are not properly addressed and/or managed El Yes o ❑ 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 t eat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes N 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❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;No 'N El NA El NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl []Application Outside of Area 12. Crop type(s) Fcsc.Ut L &[LM L/DA CO 13. Soil type(s) S 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ N%o ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'!❑ Yes Ld NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes u O ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE I4.) IC,r_&C caQ 1' C-6ful • J} a 4dbti §jG( AdD NE1tiN'VLT w±TW vsE S Epe0_AT PA►�+ fi� rz� s �� �% d P OAT( sra�,K-,LO( ES C &Ua to a� Ctia i �� i D a.1.� A F-rcrz- (51 Reviewer/Inspector Name ,' �J O {� : ; s � �` �q Phone: Mo� 3f5` Mao X ZZY Reviewer/Inspector Signature: Date: � o — 12/28/04 Continued facility Number: &7 --�-/! I Date of Inspection I Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes No ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Ch k]' t ❑ D ' ❑ M ❑ Oth as ec s esign aps er 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Applic n ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall Iftockirig El Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections Weather Code 22. 23. Did the facility fail to install and maintain a rain gauge? If did facility fail install irrigation El Yes 2 El NA ❑ NE selected, the to and maintain rainbreakers on equipment? El Yes CJ 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 N ; 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 Xfo fN A ❑ NE Other Issues 29. 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 1No ❑ 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 do ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 3 I. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes �No ❑ NA ❑ NE Additional Comments and/or Drawings: 12128104 f Facility Number Hate of Visit: Tune: - Not Operational C Below Threshold ,rPermittedXCeriified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: Farm Name://////..�County: OwnerName: .... 4k.�................................ 4mblim"........................... Phone No: _....»................ ..._.......... ......... _......»_.......... . ,Mailing Address: Facility Contact: .. �.. ... . _. _ Phone No: Title:.........._............................................�..... �_,._�..�............................._...... 11A MA Onsite Representative:...., CY-N....� _.. . Integrators Auj�i�,,... ......... ., .. Certified Operator: Location of Farm: Operator Certification Number: ❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Or ` " Longitude 0 ` " .. SI II ` C[Irrent ' - �I I Erlrrerit i ; t n a DCS�p CUrren E. _Ca aci -- Po elation:--P--.101 ' �_Ca aci - oµuia>'ianzCattles _ Ca' err MPo alatron t`= Wean to Feeder ❑Layer a Dairy Feeder to Finish ❑ Non -Layer ❑Non -Dairy El Farrow to Weans Other Farrow to Feeder Farrow to Finish- TOW DeSigI1 C3paq ti 14 Gilts50 Boars 3SL■f20 =Number o€ Lagoons _ 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 gallmin'? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Identifier: ........1.................................... ........ -................ .............. ......... ........ ...................... . Freeboard (inches): 12112103 ❑ Yes t No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes gfNo []Yes ONO ❑ Yes XNo Structure 6 Continued Facgity Number: 7 — Date of Inspection 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ZNo closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes No 8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes $No elevation markings? Waste Anolication 10. Are there any buffers that need maintenance/improvement? ❑ Yes 9fNo 11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes J6 No ❑ Excessive Ponding ❑ PAN ❑ HydraulicOverload ❑ Frozen round ❑ Copper and/or Zinc 12. Crop type 13. Do the receiving crops differ with those designated in the Certified al Waste Management Plan (CAWMP)? ❑ Yes eNo 14. a) Does the facility lack adequate acreage for land application? ❑ Yes ino 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? ZYes ❑ No 16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo Odor Issues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONo liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9No 19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo 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 ZtNo Air Quality representative immediately. Camianiefuts {refer tommgnestaon ) F.zpiarp ahy Y&S answeis and/or a� =ecommendatioiis ar any^otJsei comments _ ' f 4 Use drawutgsaf iacmfy to betterexPlarn sttuat onus. {use arldttaonai pages as iaecessary,) ❑ Faeld COPY ❑Final Notes r Iq_t3 i �aeo4a atj jc�FGa'�l �E �'�r�,C�-ZL7 yi` � / O Q Avy eh,q Z3��,Nfeo Dk fi�95 rG (awon �2 �ie/r► 4%d �ro �.c%r%/t/..,✓T �YS R�L/ ! - fit d Y Reviewer/Inspector Name Reviewer/Inspector Signature: Date: 2 Z7 12112103 — , Continued 3• IF 0l ty Number: 7 Date of Inspection Required Records & Documents 21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes JZNo 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 RNo 23. Does record keeping need improvement? If yes, check the appropriate box below. ,Yes ❑ No ❑ Waste Application ❑ Freeboard ❑ Waste Analysis J2rSoil Sampling 24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo 25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONo 26. FaiI to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) ❑ Yes ONo 27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No 28. Does facility require a follow-up visit by same agency? ❑ Yes dNo 29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo NPDES Permitted Facilities 30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes XNo 3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No 33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No 34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No 35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain ❑ 120 Minute Inspections ❑ Annual Certification Form 10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 12112103 03/0112004 10:15 9109892444 SOIL AND WATER PAGE 01 .w J , onskrw soil MW Water ConM Will tbn District Onslow County Muldpurpose Complex 4028 RkhlarXIs Hwy ]acksoWlle, NC 28540 Tek taw: (910) 455-4472 Ext 3. Fax: (910) 989-2444 Nil Norris Deparb,mi Head Cart larby District Conservationist Donna Card Animal Operations Lynn Mandew Ile Adminisbailve Secretary F� FAX: 910-350-2004 PWME: 910-39S-3900 NO. OF PAGES: 2 tgtOM: Donna Cab DATE: March 1, 2004 Hugh Passingham's Amendment to Nutrient Management Plan. SOIL AND WATER 03/01/2004 10:15 9109892444 c,. Amendment to Nutrient Management Plan For Animal Waste Utilization 01-05-2001 Hugh Pa in ham Farm Mr_ Passingham has the option to overseed his Bermudagrass fields 2-3. at a rate of 50 lb N, with an application period of i0/01-3/31. Technical Specialist 10/23/03 Date &7w 41 Type of Visit ?k Compliance Inspection 0 Operation Review O Lagoon Evaluation Reason for Visit O Routine Q Complaint O Follow up O Emergency Notification Other ❑ Denied Access Facility Number Date of Visit: G Time: Not Operational 0 Below Threshold 0 Permitted 0 Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold: Farm Name: pass1_1 _ _ County: nt—L-4— _ Owner Name: Phone No: Mailing Address: Facility Contact: Title: Phone No: Onsite Representative: hGh.P _ Integrator: c Y"_A 5 _ Certified Operator: Operator Certification Number: Location of Farm: []Swine []Poultry []Cattle ❑ Horse Latitude ' C " Longitude 0 6 o" Design Current Design Current*' I) gn C•urrent Swine Ca aci P.a ulation $oUl_t_ry Ca aci P,o ulation Cattle Ca achy Eo ulation ❑ Wean to Feeder I Layer 1 10 Da' ❑ Feeder to Finish on —Layer ❑ Non -Dairy ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Other ❑ Farrow to Finish Total Design C►apacity ❑ Gilts ❑ Boas Total SSLW Number of Lagoons =191:1 Subsurface Drains Present ❑ La oon Area ID Spray Field Area Holding Ponds /Solid Traps ❑ No Liquid Waste Management Sys m Discharees & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made? b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) c. If discharge is observed, what is the estimated flow in gal/min? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure i Structure 2 Structure 3 Structure 4 Structure 5 Identifier: Freeboard (inches): 1) 05103101 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Structure 6 Continued Facilitv Number: — Date of inspection 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? 8. Does any part of the waste management system other than waste structures require maintenance/improvement? 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? Waste Application 10. Are there any buffers that need maintenance/improvement? 11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Oveiioad 12. Crop type ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA)A MP)? ❑ Yes ❑ No 14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No b) Does the facility need a wettable acre determination? ❑ Yes ❑ No c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No 15_ Does the receiving crop need improvement? ❑ Yes ❑ No 16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No Required Records & Documents 17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? El Yes ❑ No 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design. maps, etc.) ❑ Yes ❑ No 19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No 21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No 22. Fail to notify regional DWQ of emergency situations as required by General Permit? 0e./ discharge. freeboard problems. over application) ❑ Yes ❑ No 23. Did ReviewerAnspector fail to discuss reviewhnspection with on -site representative? ❑ Yes ❑ No 24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No (] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. W ._.m... -Sc' - '. Y : .+-t9'..^,� 2" Lr" : ..,,,J,._.�... s`.� .%r3 •-:'.:.i "'a,'xi.� �"'N� YA - - "s „�SCV{rv9�S.a', Lea: ".�'p` y..k...: �`"V1.w'1..'4..F x Y'• �.��. r . other cts, Goia3meats'{refe>r to question YES :=Eipisiri'airy sns�ve�s andlor apyrrreeommi abdadons or-avv oommen , s_ _. _..... .� _ Use drawings of facility to better explain situatioas:;(use additional pages as aeceiiary) µ ❑ Field Copy ❑ Final Notes Reviewer/Inspector Namez •-'°.�_ Reviewer/Inspector Signature: Date:q�- 0SIV31VI Continued Type of Visit 'O'Complianoe Inspection 0 Operation Review 0 Lagoon Evaluation Reason for Visit oRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access Facility Number Date of visit: Permitted M Certified 0 Conditionally Certified D Registered Farm Name: I1% '(AV.S;'-c� Owner Name: Mailing Address: Facility Contact: Title: Onsite Representative: H u a) M ��.35 i✓� r+h Certified Operator: Location of Farm: 3 t4 D3 Time: 13'55 110 Not Operational OBelowThreshold Date Last Operated or Above Threshold: County: O nS jO tv Phone No: Phone No: Integrator: M _ D r 0 6VA,7 Operator Certification Number: ❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 4 " Longitude a of Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes XNo Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) c. if discharge is observed, what is the estimated flow in gal/min? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste CALegfign & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure I Structure 2 Structure 3 Structure 4 Structure 3 Identifier: Freeboard (inches): 05103101 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes )dNo ❑ Yes ErNo ❑ Yes XNo Structure 6 Continued • Facility Number: — Date of Inspection D3 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes ONO 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 ❑ Yes J'No immediate public health or environmental threat, notify DWQ) , 7. Do any of the structures need maintenancelimprovement? ❑ Yes No 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO 9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level elevation markines? ❑ Yes [gNo N'°aste Application 10. Are there any buffers that need maintenanceiimprovement? ❑ Yes TNo 11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO 1111 12_ Crop type geev toot A ►'1 a des G V e cti 13_ Do the receiving crops differ with those designated in the Certified imal Waste Management Plan (CAWMP)? V ElYes 2No 14_ a) Does the facility lack adequate acreage for land application? ❑ Yes 2rNo b) Does the facility need a wettable acre determination? ❑ Yes ONO c) This facility is pended for a wettable acre determination? ❑ Yes ,ZrNo 15. Does the receiving crop need improvement? )zYes ❑ No 16. Is there a lack of adequate waste application equipment? ❑ Yes _Z No Re uired R cords & Documents 17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? El Yes 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? -10No Oe/ WUP, checklists, design, maps, etc.) ❑ Yes JZNo 19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes .2rlvo 20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes A No 21. Did the facility- fail to have a actively certified operator in charge? ❑ Yes ZINo 22. Fail to notify- regional DWQ of emergency situations as required by General Permit? ,,j [I Yes No (ie' discharge. freeboard problems, over application) �1 23. Did Reviewtngnspector fail to discuss review/inspection -"ith on -site representative? ❑ Yes ,2TNo 24. Does facility require a follow-up visit by same agency? ❑ Yes �ZNo 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ZffNo �] No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit ' Comments {refer to"gaestion .-Eiglaia any YES snssveis andlor airy recoibm�bdstions or anv_o#it r eommeMs: r_ .. Use drawings of faciLty tobetter ezpiatn situatEous. {use addttcoaal pages as nee�esmiry [] Field Copy ❑ Final Notes = � �...�-•_emu �_ �..�-.�.,-��.$,.�-���-•..�.:.--. _��-.;� ...�=,�.:�_,.,.._,._ Q ve Y`R l ~}-�, e �'a Fs we (� +^� a �I-}Gt �r� e a( 'T t e reco r-d s a re +�+-�, ve✓7 ,.<,c11 ep .�, well ov AVI 6.ate - T-Ae _`w;-,e hoL.,5e Are' a vkd l gvvtnl vx,'Gv Leo{ . Y11 e . r'ass ." 1 a "� r-asesaied 41,e esGve e n ►-,, os4 et rc^s n"d be tor -or , 000( • Please 1,A ke Ac-i ► ah a h ''esLL'ejP� r e Id _f r° 9 Reviewer/Inspector Name Reviewer/Inspector Signature: Date: 3 3 n O5103101 Condnaed Facility Number: — Date of Inspection i 3 Odor Issues 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 permanentitemporary cover? Additional Comments and/or Drawings: t„►e of sctJsseTip --itik b Lt -Fa, Orcr ef-FO- move +he "JQ— fie! -.a•1 en. r ❑ Yes ❑ No ❑ Yes J[2 TO ❑ Yes ONo ❑ Yes _Z"No ❑ Yes ,ONo ❑ Yes ;TNo ❑ Yes ❑ No 05103101 1ss ision of Water Qwdity - isioof Sod and V[rater C nonser'vatiori ier.Agency ... _- _.-. _. , � '.- ....._.•ter ._ a. f .. ... _. .. .. Type of Visit OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation Reason for Visit KRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access Date orvisit: Time: � Printed on: 7/21/2000 Facility Number Q Not operational O Below Threshold Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: Faun Name: ........ ?.............. I ........ .................... County:...`4...................................... ......... .......... .... OwnerName:.................._.._.._..................................................................... .............. Phone No: FacilityContact:..............................................................................Title................................................................. Phone No. ......................... ........................... MailingAddress: ........................... .............................................................. .......................... [.............................. .......................... Onsite Representative:... .�^!4 ..............................................................•-•• Integrator: ...Q_C . ..`.\........................................................ ` Certified Operator: Location of Farm: ..................................................................... Operator Certification Number:.... ❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • • i Longitude �0 �� �14 Design Current Design Current Design Current Swine Capacity Population Poultry Capacity Population Cattle Capacity Population ❑ Wean to Feeder ❑ Layer ❑ Dairy ceder to Finish 6L1 ❑ Non -Layer ❑ Non -Dairy ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Other ❑ Farrow to Finish Total Design Capacity ❑ Gilts ❑ Boars Total SSLW Number of Lagoons ID Subsurface Drains Present ❑ L-g"=ln Area ID Spray Field Area Holding Ponds / Solid Traps JE1 No Liquid 'Waste Management System Discharges & Stream Impaci5 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 convcyancc nian-made? b. If discharge is observed. did it reach Water of the State-? (Ir yes, notify DWQ) c. If discharge is observed- what is the estimated flow in galhnin? 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 I Structure 2 Structure 3 Structure 4 ❑ Yes ONo ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes []No ❑ Yes �dNo ❑ Yes I j No ❑ Yes KNo Structure 5 Structure b Identifier : ........................ Freeboard (inches): ` _3 5100 Continued on back Facility Number: ,/ r) Date of Inspection Printed on: 10/26/2000 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or kNo closure plan? ❑ Yes (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes (�(No 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes kNo 9. Do any stuutures lack adequate, gauged markers with required maximum and minimum liquid level No elevation markings? Yes ❑ Waste Application 10. Are there any buffers that need maintenance/improvement? ❑ Yes �] No 11. Is there evidencof over ap Iication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 1 f No 12. Crop type pS 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes DNo 14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0 No b) Does the facility need a wettable acre determination? ❑ Yes ONO c) This facility is pended for a wettable acre determination? ❑ Yes CA No 15. Does the receiving crop need improvement? 14Yes ❑ No 16. Is there a lack of adequate waste application equipment? ❑ Yes b�No Required Records & Documents 17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes VNo 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? �(No (ie/ WUP, checklists, design, maps, etc.) ❑ Yes 19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) N[Yes ❑ No 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo 21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO 22. Fail to notify regional DWQ of emergency situations as required by General Permit? ❑ Yes DrNo (ie/ discharge, freeboard problems, over application) 23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 9No 24. Does facility require a follow-up visit by same agency? ❑ Yes • 6No 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo o violaiioris;or• di -fide ties were noted• during this;visit: • y6ji will •tr. eeeiye Rio further • ; ; • cor7r �spomcience' aboulk this visit.: Comments (refer to question #) Explain any YES answers and/or any recommendations or any other comments..- Use:drawingsrof facility to :better explain situations. (use additional pages as:necessary) v'y t-t s h4 e, JeXC �s L� , Reviewer/Inspector Name Reviewer/Inspector Signature: Date: a-14-0 5100 ti i Facility Number: —1, 1 Date of Juspection 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 eRNo liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No 28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EVNo 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 QNo 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 t9"No 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO 32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No bona .;omments"an or Drawings: cs,.,r-e4 'k "4-�k PAS l �� �� 1�v c� C�,1ST�tC� � Ste_ �l i` �� ►.�-� Qd � Y �+-e c 4 J, V'l 5/00 0 Division of Soil and,VVater Conservation ,Operation Review 7 t �" v T' r �=Division of Soil and Water Conservatirui Compliance Inspectiioit _ _ r 'Divisionof Water Quah 'Comphance Inspection Y- x` OtherAgency:- Uperakon Review`, - _._ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other Facility Number Date of Inspection - _M Time of Inspection ® 24 hr. (hh:mm) 0 rn-dtted [3 Certified [3 Conditionally Certified 0 Registered 113 Not Operational Date Last Operated: FarmName: ..................... I ................. I........... County- ...0.4Gt'?.............................. ....................... Owner Name: Facility Contact: Title:. ......................... Phone No: Phone No: MailingAddress: ..................................................................................................................... ..................................................................................... .......................... Onsite Representative :....L."'.4::�.................................................... ................ Integrator:...... �Y'�' ". �.!�............................... I ............. ..... Certified Operator: ...................................... Operator Certification Number: .......................................... Location of Farm: Latitude ' 6 64 Longitude ' ' " _. .. - - Design :.:. Swine _ Ca aci P '- ❑ Wean to Feeder gj Feeder to Finish Poultry Design .:Current �- _.Design Current Ca aci Po ulatio"n' Cattle ... a _Ca acit . -Po elation'' ❑ Layer 1 Dairy ❑ Non -Layer ? ' ❑ Non -Dairy Farrow to Wean ❑ Other El Farrow to Feeder _ {# s Farrow to Finish Tota! Desi E Ca acif ❑ Gilts _� P Y ❑Boars - _ Total'SSLW�- "- Number of..Lagoons = ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area Holding.Pon&1S6hd-Traps- 3 ❑ No Liquid Waste Management System ;F... . Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes j5�No Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No c. If discharge is observed, what is the estimated Flow in gal/min? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No 2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D(No Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ((No Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Freeboard(inches): ........................ ........... .................................................................................................................................................................................... 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A No seepage, etc.) 3/23/99 Continued on hack Facility Number: - L.[ Date of Inspection 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ Yes Dd No (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes D(No 8. Does any part of the waste management system other than waste structures require maintenancetimprovement? ❑ Yes 5`No 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? [ayes ❑ No Waste Application 10. Are there any buffers that need maintenance/improvement? ❑ Yes C5No 11. Is there evidence oveUrlicat ion? ❑ Excessive Ponding ❑ PAN ❑ Yes �No 12. Crop type - 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? 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 IT. 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? (ieJ W1JP, 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? �'Vc� yiolafigris:or defciertcie *Vre pQte#OUrisig�his:visit; Yo>j� wili ee aye doIFu>!-th r correspondence: about this visit: ❑ Yes MNo ❑ Yes ❑ No ❑ Yes ❑ No VYes ❑ No ❑ Yes gNo ❑ Yes XNo KYes O(No<A& ❑ Yes WNo Yes [:]No ❑ Yes D(No ❑ Yes WNo ❑ Yes P( No ❑ Yes &No ❑ Yes [Rio ❑ Yes KNo .Comments (refer wquestion #) =Explain any:YES answers andionany recommendahons.ofany othercomments.; Use,drawutgs o€facility to better explaiin situations (use dit►vnal pages as,necessary) -~ - •-,* � - M - - ►., i 1 ��e ►�e ex� a i e114 , �� � '��� a— ►- Asa-. 1,.,( ��-.��� 093 3qq J"l l� 1�. l � �[a� $C L`�' }� � f s �ii-c• l� Q�ci, t �CL�� 1 frr� ��`c�+� Reviewer/Inspector Name { Reviewer/Inspector Signature: Date: 3 — {�-Qp Facility Number: Date of Inspection Qd Odor Issues 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes [)'No liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ®Tlo 28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No roads, building structure, and/or public property) 29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ki No 30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo 32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes OfNo ,kdditionW7C-omments,and/ora_DraVYIIIg$: — _ � � :: , 1 e � = -OLI Ae, wise � f �y r Facility Number Date of Inspection 114171qll Time of Inspection ryQj 24 hr. (hh:mm) ® Permitted ® Certified Q Conditionally Certified [3 Registered Not OperationalOperationall Date Last Operated: P • .......................... Faun Name: HIOW............. Owner Name: ... A.UC H.......�A..45..5.tI 5.N1804 ....................... County:... �W wl..!ea...... q................ .---...... Phone No: ................................... FacilityContact: ..H R15.0......RA56.It06.H. A .................... Title:................................................................ Phone No:..............--..--.--...................--....... Mailing Address: .... ....HA Iti a..9.....pp:...........................:..................... ...M.v................................. 02 :a ..... Onsite Representative: ..... ......, .... ••„ Integrator: ,,,,C{� RRd LL 5.,..Y D4l?.V.} /1lIC .. Certified Operator: .... llws6o..... R,,....... N........................................ Operator Certification Number: ........ i C08Z ...... Location of Farm: �G.....F.4Jr!`�.....N!u .I .SD....A.!`�. ......5 R..f.4.�S....1^[T rLS c rioi.l....... ."............... 9 i G N r................................................................................................................................:..................................................................................................... Latitude Longitude 0 • ©` ©�= Design Current' Design._'' Current Design Cuirrent ' Swine Capacity Population Pou)try. >.Capacity Population Cattle_. Capacity Population ❑ Wean to Feeder Feeder to Finish / a 140 ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts, ❑ Boars Number of Lagoons ❑ Subsurface Drains Presen❑t Lagoon Area ❑ Spray Feld Area �' Holdirig 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 I Structure 2 Structure 3 Structure 4 Identifier: 30 Freeboard (inches):.................................................................................................... ❑ Yes WNo, ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes D1�4o ❑ Yes I<% ❑ Yes ❑ No Structure 5 Structure b 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 3/23199 ❑ Yes �Io Continued on back Facility Number: ��— (� Date (if Inspection 2 7 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑Yes o (I€ any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes 6(zqo 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? ❑ Yes Waste Anolication 10. Are there any buffers that need maintenance/improvement? ❑ Yes Wo 11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes f�(No 12. Crop type 6,6C , J- 6 f -- AU, --Q4T 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo 14. a) Does the facility lack adequate acreage for land application? ❑ Yes S;Mo b) Does the facility need a wettable acre determination? ❑ Yes JKN0 c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No 15. Does the receiving crop need improvement? ❑ Yes X�N* 16. Is there a lack of adequate waste application equipment? ❑ Yes XNO Required Records & Documents IT Fail to have Certificate of Coverage & General Permit readily available? NYes ❑ No 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? Yes 8[No (ie/ WUP, checklists, design, maps, etc.) ❑ 19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes N No 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes CkNo 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 dlk4o 23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative? ❑ Yes k10 24. Does facility require a follow-up visit by same agency? ❑ Yes - kErNo 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNO CVO VlOIa tOIl5.0% &flcj6ndp$ Were h. ed• during this,visit. • Yoi} Will •teed vqe lib futthgt` • , correspondence. abtriit, this .visit . . . . mrients (refer t6 question #) ;Explain any YES answers and/or. airy recommendations of"any other comments:`- a i ewgof ac�ttoterex 1 essary} yelain situations use additioaPa esasnecW Reviewer/Inspector Name Reviewer/Inspector Signature: Date: 3/23/99 f Facilit Number: '! Date of Inspection y �' — 7' 1 p Odor .Issue i 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes CkNo liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes W.No 28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes klo roads, building structure, and/or public property) 29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,kNo 30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,[flo 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o 32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No Additional- omments an or ravvrngs m: H, 3/23/99 Revised A ril ZO> 1999 P JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION Facility Numbe 161I - If Farm Name:�,,rs+ On -Site Representative: InspectorlReviewer's Name: Date of site visit:_��`"�� Date of most recent WUP: 1-7-13--C11 Annual farm PAN deficit: 3 pounds Operation is flagged for a wettable acre determination due to failure of Part 11 eligibility items) F1 F2 F3 F4 Operation not required to secure WA determination at this time based on exemption E1 E2. E3 E4 P Operation p ended for wett le acre P determination based on P1 P2 P3 irrigation Systems) - circle #: 1. hard -hose traveler, 2. center:pivot system; 3. linear -move system; 4. stationary sprinkler system w/permanent pi e; 5. stationary sprinkler system wlportable pipe; 5. stationary gun system w/permanent pipeU77 stationary gun system w/portable pipe PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption_) El Adequate irrigation design, including map depicting wettable acres, is complete and signed by an I or PE. E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map depicting wettable acres, is complete and signed by an 1 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 11. Complete eligibility checklist, Part 11- F1 F2 F3, before completing computational table in Part 111). PART 11. 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 .ofzcreage=whichTesultedin:overmpplication-of_-wastewater(PAN) onzpray_ feld(s) :accordingfofarm'sdasttwoyearsmf:irriaafion7ecords: F2 Unclear* -illegible; 'or tack of -information/map. F3 Obvious -field limitations -(numerous�dtches;faiiure:-io:deductTegvired ...... bufferlsetbackzcreage;-or2b%-of:total_acreageddenimed:in-CAWMP.]nr eludes small ;-irregularlyshaped.fields _ fields:lessihan-b�cresforfravelers-or.less-than 2 acresfor.:stationary sprinklers). F4 WA determination required because CAWMP creditsfield(s)'s acreage in excess of 75% of the respective field's total acreage as noted in table in Part Ill. Revised April 20, 1999. ` Facility Number - Tarr iris. t-iela oy rrela uetermmation of ra i8 r_xemprion rcuie Tor vvH uetermination TRACT NUMBER FIELD NUMBER'S TYPE OF E SYSTEM SYSTEM TOTAL ACRES CAWMP ACRES FIELD % COMMENTS3 FIELD NUMBER'- hvdrant. oull. zone. ormoint numbers may be used in place of field numbers &--Dendino on CAWMP and type of irrigation system. - If pulls, etc. cross Tnore-than one field, inspectorireviewer will have to combine fields to calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination. FIELD NUMBER - must be cfeady delineated on -map. COMMENTS'- back-up fields with CAWMP acFeage.exceedingV5% of its total:acres and having Teceived Jess.than 50% of its annual PAN as documented in the farm'sprevious -two years' ('la97 & 1998) of irrigaiion-records,-cannot serve -as -the sole basis-forrequiring a WA Deter ination::-Back-up:fields-must'benoted in the-commentsectionand must -be accessible by irrigation system. Part Iv. Pending WA Determinationsr f PI Plan: lacks.following information: °` — ���►.. P2 Plan revision ,maysatisfy-75% rule based on adequate overall PAN deficit and by adjusfing-all fiefdacreage_to below 75% use rate P3 Other (fern process of installing new irrigation system): Lagoon_ Dike Inspection Report Nance of Farm I Facility Location of Farm 1 Facility Owner's Name, Address and Telephone Number Date of Inspection Structural Height, Feet Lagoon Surface Area, Acres Upstream Slope, x1f:1 V Embankment Sliding? ( Check One, Describe if Yes } Seepage? ( Check One, Describe if Yes } Erosion? [ Check One, Describe if Yes ) Condition of Vegetative Cover ( Grass, Trees) Did Dike Overtop? P in h 67 - 4 SR 1195 9127192 Names of Inspectors ri Janet Paith -- -- 1911 - Freeboard, Feet 1.0 - 1.2 0.75 - 1-0 Top Width, Feet _ 8 - 10 2 IQ 1_____ Downstream Slope, xH:1v 3 to 1 Yes _ X No Yes_ No Yes X No Yes X - No If Yes, Depth of Overtopping, Feet Follow -Up Inspection Needed? Yes . X No Engineering Study Needed? Yes --X- -- No Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No Other Comments Mgy Mun tQ gonta-clr Division of Soil and Water Conservation (3 Other Agency Division of Water Quality I17,Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other Facility Number Date of Inspection If} Time of Inspection lkl=24 hr. (hh:mm) © Registered WCertiried © Applied for Permit 13 Permitted [3 Not Operational Date Last Operated: Farm Name:....... 5 7.C.1.................?..!,C.iJ. .. ......................... County:.....------L 'f5lt�!:rt.F` .............................. Owner Name:..... .............................. p.FAss).&t[�........ Phone No:.......... . ` .�.....� G.;....................................... Facility Contact: ......PJS�/ ........ � .; t), / Fitle ...... Phone No: ....................... Mailing Address:.......- :. 9 ` .....'�.-4), . ..?5............. .....R4.... ............. ...... &r. 0.1........'...1.. ..'J.�....... I............ ... : .�- 7 Onsite Representative :........ fl. ----------------- rf..N.................... Integrator: ........... ,C/.` �4 ..................................... Certified Operator; ...... gt dui ........................... ...... Operator Certification Number;....................... Location of Farm.: Latitude =' =' =11 Longitude 0' 4 0" Design Current Design Current a Design Current S e Capacity :Popii&d0n ; -Poultry Capacity Populattan _._Cat#le Capacity Population f ❑ Wean to Feeder ❑ Layer ❑ Dairy eeder to Finish �� Z / IE]Non-Layerl❑ Non Dairy ❑ Farrow to Wean _ ❑ Farrow to Feeder : ❑Other ❑ Farrow to Finish Total Design Aokity ❑ Gilts _ q Boars�w jaT©tal ss Number of Lagoons / Holding Ponds _ ❑Subsurface Drains Present I[] Lagoon Area ❑Spray Feld Area ❑ No Liquid Waste Management System e ,.� General 1. Are there any buffers that need maintenance/improvement? ❑ Yes Ia No 2. Is any discharge observed from any part of the operation? ❑ Yes O(No Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other a. if discharge is observed, was the conveyance man-made? ❑ Yes V] No b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No c. If discharge is observed, what is the estimated flow in gal/min? d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No 3. Is there evidence of past discharge from any part of the operation? ❑ Yes No 4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes to No 5. Does any part of the waste management system (other than lagoons/holding 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 fail to have a certified operator in responsible charge? ❑ Yes No 7/25/97 Facility Number: 8. Are there lagoons or storage ponds on site which need to be properly closed? Structures (Laeoons,nolding Ponds, Flush Pits, etc_) 9. Is storage capacity (freeboard plus storm storage) less than adequate? Structure I Structure 2 Structure 3 Structure 4 Structure 5 ❑ Yes fikNo ❑ Yes A No Structure 6 Identifier: �............................................................................................................................................. Freeboard........ ft ................................... . ( )' ..................................................................................................................................................................................................... 10. Is seepage observed From any of the structures? ❑ Yes Q No 11. Is erosion, or any other threats to the integrity of any of the structures observed? Yes CKNo 12. Do any of the structures need maintenance/improvement? AYes ❑ 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? ❑ Yes No (If in excess of WNW, gr rgnoff entering waters of the State, notify DWQ) 15. Crop type ............ V.. 0 ................................... ....................... ............................ ........................................ .............................................................................. 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 EANo 20. Does facility require a follow-up visit by same agency? ❑ Yes RNo 21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 19 No 22. Does record keeping need improvement? ❑ Yes 9No For Certified or Permitted Facilities Only 23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes W;No 24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No 25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No 0-No.vio'lations or deficiencies.were no'ted-during this,visit.•.Y.ou:will i-eceive•nti•ftrther, : corrispOfideitce about this:visit'.• : : _ . ,::::: _ : _:.'. :: ' : : ` .: : 5. / I$, � fJrr.7 r elWl 1,-1 A-tf9-V 4 rt,14e, D rJLt wvaee_,S AZ S ,,J 614,W- i ore, al s/T'd &,1_ SA- cq-)� -Ci ,�& 't `(� O".0 f e, cC3 =fit r>7� QrlcrlL.,f� ii- to s jP 1,r�• �` 1 ply. �sww ,G(, ,% — - _ . _ i. 7/25197 Reviewer/Inspector Name x Reviewer/Inspector Signature: Date: ko E: Facility Number D_�{� Date of Inspection !nil Time of Inspection 24 hr. (hh:mm) Total Time (in fraction of hours M Registered 0 Applied for Permit (ex:115 for I hr 15 min)) Spent on Review Farm Status: 10 Certified El Permitted or Inspection (includes travel and processing) D Not Operational Date Last Operated: .......... Farm Name. .... . ...... Land Owner Name: ............. Phone Facility Title: Phone No: . . ..... Mailing Address: Lq�6 IAAW-S 'eOv-,.__JZ . ..... .... Onsite Representative: ... . .... . ..... . Integrator: Certified Operator: ..... . ..... . . ..... Operator Certification Number: _LkX�2 ... . .... Location of Farm: 4AW .... &V.% ......... . .... . .............. ........... ........................................ ...........................................................W.., ... ........ . .............. . ....... . . .. I .. ............... ............. Latitude Longitude r ;Zlt Tvine of Operation and Desien Capacity e lgn.rreIIt:0W.. A .Capacity.. iifaii n. Cattle uavaclMPonaido�& 0 Dairy I Non -Dairy Farrow to WeanW. ".5 [731 Farrow Feeder jrUqDeSign"'Ra" Far-row to Finish L .......... .. _V MW RMW 0, Iss e Drains Present Spray Field General 1. Are there any buffers that need maintenance/improvement? 2. Is any discharge observed from any part of the operation? Discharge originated at: [I Lagoon El Spray field 0 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? I--- 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? 0 yes ENO [I Yes EM ❑ Yes G-M ❑ Yes GWO Ei Yes UNO 0 Yes G-No 0 Yes B-lqo-- 0 Yes swo, Continued on back Facility Number: ..(F............ �.- 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 9 No 7. Did the facility fail to have a certified operator in responsible charge? 8. Are there lagoons or storage ponds on site which need to be properly closed? Structures (1agroons and/or Holding fonds) 9. Is storage capacity (freeboard plus storm storage) less than adequate? Freeboard (ft): Structure 1 Structure 2 Structure 3 10. Is seepage observed from any of the structures? Structure 4 11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes �To ❑ Yes B-No ❑ Yes - G-7qo Structure 5 Structure 6 12. Do any of the structures need maintenance/improvement? (If any of questions 9-12 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 13. Do any of the structures lack adequate minimum or maximum liquid level markers? Waste Application 14. Is there physical evidence of over application? (If in excess of WMP, or runoff entering waters of the State, notify DWQ) 15. Crop type ..-......, IF 5 4 "t L 16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? 17. Does the facility have a lack of adequate acreage for land application? 18. Does the receiving crop need improvement? 19. Is there a lack of available waste application equipment? 20. Does facility require a follow-up visit by same agency? 21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? For Certified il' ' n 22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? 23. Were any additional problems noted which cause noncompliance of the Certified AWMP? 24. Does record keeping need improvement? ❑ Yes (]'No ❑ Yes 9-No-- ❑ Yes E-Pdtii ❑ Yes ®-Ndo ❑ Yes B-No ❑ Yes [-a ❑ Yes E-No ❑ Yes allo ❑ Yes laINo ❑ Yes Qw ❑ Yes Q-No ❑ Yes [- No-0 Yes Q-Nd- ❑ Yes ONO Comments (refer to`question #/} Explain any YES answers` and/or any recommendations"or any, other comments ^ ;` Use drarv�ngs;of facility to.better expla►n s►tuahons {use additional pages as necessary). ^ ^ . , 1 9A0 ILA Cr rzr t 4', � �y P t 044-r r �.�� ��� ! � a-y :a 41L A -r Q mkt=S a Reviewer/Inspector Name Reviewer/Inspector Signature: Date: z ] 7 T cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97 • • Site Requires Immediate Attention: Iq d Facility No. r 7- DIVISION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD DATE: 8 13 , 1995 Time: Farm Name/Owner: H U G H 1Z PA 55 I MG N AM Mailing Address: 1 a [A HAW 5 ?,u f A R16, M A P C.E JA t L L{ N C Z 8,4 5 c/ County: Integrator. (2 ar vo l l s _ _ Phone: On Site Representative: nonce Phone: C)M 34G - ,?G 3 i Physical Address/Location: 5 2 11 c,5 4u,.,s eg_^ kd 3/,4 n LG_ ��vn. 4wy _-;6 � 2 ! I tJ S ! ►1-i-e i s.a� e� Type of Operation: Swine +/ Design Capacity: Poultry Cattle Number of Animals on Site: DEM Certification Number: ACE DEM Certification Number: ACNEW Latitude. 34 39 ' 4/, 77" Longitude: 7 -7 ' 2a 3 Elevation: a`y 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) 6�or No Actual Freeboard: a2-- Ft. _-- Inches Was any seepage observed from the lagoon(s)? Yes or No " Was any erosion observed? Yes 0<5 Is adequate land available for spray? for No Is the cover crap adequate? �'�e 7s or No Crop(s) being utilized: P S c Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(ne or No 100 Feet from Wells? y,J r 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 io Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other similar man-made devices? Yes orcv 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 ajl�b • UR-R-, s Inspector Name Signature cc: Facility Assessment Unit Use Attachments if Needed.