670077_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Q Co lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ` c Departure Time:/ �} 0 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 70 n GI/ �7 � a I // e r-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 2 2. S- 6, T
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poulytr
Capacity
Pop.
Cattle Capacity Pop.
Wean.to Finish
Layer
Dai Cow
Wean to Feeder 2 fJ�E]
Feeder to Finish
Non -La er
DairyCalf
DairyHeifer
Farrow to Wean
Farrow to Feeder
1)0,P,ault .
Design
C►.a aci
Current
P■o P.
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
11
Turke s
U.the
urkey Poults
Other I L
Other
==M
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 ❑' lI� O Q NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili 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 environmental t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VN
❑ 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 Ej 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 or ❑ 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
t2. Crop Type(s):
t3. Soil Type(s):
t4. 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
�rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 ;D/ 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 �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of'3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did.tht facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ICJ ' _A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 plo ❑ NA ❑ NE
[] Yes dNo ❑ -NA ❑ NE
[:]Yes No ❑ NA 0 NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any -other comments.
Use drawings of facility to better ex iiain situations -fuse additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: le9716 -7 ay
Date: lP 7
21412015

Ft
Type of Visit: 0 7Routine
pliance Inspection V Operation Review U Structure Evaluation t,� Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ®O Departure Time: ® County: OAoSUOti,,) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: V105G4
Certification Number:
Longitude:
Design
Swine C►apacity
Wean to Finish
Current
Pop.
Design Current
We Poultry Capacity Pop.
Layer
Dcsign Current
C•attic Capacity- Pop.
DairyCow
�(
Wean to Feeder 7,Ota
526
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dcsign Current
Ca aeit P,o ,
Dairy Pfeifer
D Cow
Non-DairyFarrow
to Finish
Beef Stocker
Gilts
Pr
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turke Pouets
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
[] Yes
❑ 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
Z o
❑ 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

Fmility Number: fe- Date of inspection:
Waste Collection &Treatment
4. I- 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: I&IeNl LACv6WZ
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
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
I threat,
notify DWR
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
�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
PNo
❑ 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 ZNo ❑ 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
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
�Po
❑ Yes o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes WNo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes �Jo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes l_J o
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes k
❑ 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

Facility Number: - Date of Inspection: !
244;I�id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo
the appropriate box(es) below.
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 ZNo ❑ 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 E 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 M/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below.
❑ Yes 27/No ❑ NA ❑ NE
❑ 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/lnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo
❑ Yes ZNo
❑ Yes FM'No
❑ 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 explainp situations (use additional pagesasnecessary). .
NO PoA 560—
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T/ it ! G'. /I (.
Date: 114
14,1 5

Type of Visit: (D loutine
Hance Inspection Q Operation Review 0 Structure Evaluation 0 'Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:y CralN A � Integrator:
Certified Operator: Certification Number: _ i9 as
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
ILayer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Nan -La er EEI
—Dairy
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
pM. P■oultr, C_a acl P,o
Layers
Non-Dai
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
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?
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 c No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes �Ko
❑ Yes Yes NNo
❑ NA ❑ NE
❑NA [3 NE
❑ NA ❑ NE
Page l of 3 21412014 Continued

F)icili Number: -71 Date of Inspection: `
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t7`dr'
5. Are there any immediate threats two the integrity of any of the structures observed?
❑ Yes
�No[:]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Yes , ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L (No [DNA ❑ 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 EJ No [] NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement.
I. 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 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):
t3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
D Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes WIS
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
(] NA
❑ NE
acres determination?
1
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VN
❑ NA
❑ NE
Required Records & Documents
ZZN
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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? ❑ Yes rl"'No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? _❑ Yes L�J o ❑ NA ❑ NE
25.�Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,No ❑ NA ❑ NE
the appropriate box(es) below.
❑ 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 ErNo ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
hlo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
[] NE
[]Yes
,/ No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
12/Vo ❑NA ❑NE
W❑ NA ❑ NE
N o ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: ! '�4' 6
Date:
214120151

Type of Visit: m ZRoutine
mpliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up 0 Referral Q Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: &1CL41.1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: tJoNpTkjjq� La,(_:tL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 2"� S
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop. Cattle
Wean to Finish La er airy Cow
Design Current
Capacity Pop.
Wean to Feeder
on -Layer
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dai Heifer
Design Current D Cow
Dr, P,oultr. C•a acity P■o Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other
Turkeys
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
' 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: 60 LA60JZ
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 al threat,
notify DWR
o
7. Do any of the structures need maintenance or improvement? ❑ YesWNo
❑ NA
❑ NE
8. Do any of the structures 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 ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [71No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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 0 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
[j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
eyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes]
N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
c
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FZ
❑ NA
❑ NE
the appropriate box.
❑ W UP [—]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 � o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

acili Number: jDate of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 01<13 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss assessments (PLAT) certification? [] Yes F3<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 4o ❑ 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 E2 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 E2'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 2 lvo ❑ 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 2-<o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes fo ❑ NA ❑ NE
Comments' (refer to;question:#) EXplain any=YES,answers.. and/or, any,. additional recommendations. or any other comnients s
_ n € Ch - ` �3 I"rW y.x£g4-ct}6eY l i £4� Bib .6
Use drawings' of facilitvto: better. explain skfiailons'(use'aitditional pagevas necessary. ,).'
/s') �J60 7b C41-jr, rs6t_bs
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
jo e,— t✓ L.. Phone:
�.' ADate:
14/2014

!Type of Visit: Q ?6Routine
pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrivai Time:® Departure Time: County: 0VJSL4DV* Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish
I
I
JLayer I
I Dairy Cow
Wean to Feeder
-L06 9VA0906
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. R Itr. Ca aci -VAMP
Layers
Dairy Heifer
D Cow
-Dairy
Beef Stocker
Gilts
rpNon-Layers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Poults
Other I I IMI (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 m No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ o ❑ NA ❑ NE
[:]Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fa 'lit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is;storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2fNo
❑ 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: uA66W (.A&-od
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):j'b
5. Are there any immediate threats to the integrity of any of the structures observed?
0 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 env'ronmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �j/) o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Nc ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes 1LJ 1"" ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ 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

Fa ilit Number: - Date of Inspection:
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 ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes U o ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes��/o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3/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
ZNo ❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o [] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
a>J W_r�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CkJQ�s c0\016�
Phon ql�) M
Date:
21412011

Type of Visit: 0 Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: /S County:g! Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: JAIUA-44&d _ Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swinc
Design
Capacity
Current
Pop.
Design Current
Wet Poultry C*apacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
Dairy Cow
I
INon-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
Dr, P,oultr, Ca aci PoINon-Daity
Layers
Non -Layers
Pullets
urkes
urke Poults
fTo"ther
DairyHeifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
er
er
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I! l No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�To
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FacilityNumber: - Date of Inspection: v
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): ` 9 7 7
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 ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env onmental threat, notify DWQ
❑ 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 El 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 o ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
[xNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
El Yes
[]
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No.
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
[]
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑PAN > 10% or 10 lbs. ❑Total Phosphorus ❑Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window []Evidence of Wind Drift [:]Application Outside of Approved Area
12, Crop Type(s):
13, Soil Types}:
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
No
[] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑Yes
�To
❑ NA
❑ NE
Required Records &Documents
l9. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
No❑
NA
❑ NE
the appropriate box.
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 Number: &I - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes go
N ❑ NA ❑ NE
2S.•Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ NA ❑ NE
• the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
es
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
YNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ENo
❑ 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
<o
❑ 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 Q No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 546j ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anyother comments
Use drawings.offacility to better explain situations (use additional pages as_necessary),
7. )
LA c wtx-d
Z
O z Lc-
wA%-L, oj?OC 0�
64I-.A SS
k/a "L,
U.)
�C e P
co p'�
a r
Cu&V_CovT
1'am
R 05N-v 5 ,
Reviewer/Inspector Name: L.� NN CjA 9•tJC-it,
Reviewer/inspector Signature:
Page 3 of 3
Phone. NO ` 73 u
Date: q S
2141 11

Type of Visit: 6 Corp{liance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: dRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ?� ? f Arrival Time: 0 Departure Time: County: &IrLdw Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Saw MA,J luau tF4L. T _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capaci
Design Current
i5 —ac it_VM Pop.
Wean to Finish
I 11-ayer
iry Cow
Wean to Feeder
.! UU
Ov
I INon-Layer I
i Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,ou[tr. C*.a aci P,o
I Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes1No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

I /
Facility Number: 1'7 Date of Inspection: I JAI ( I(I
Waste Collection & Treatment
4� Is stoi�agc capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes [dNo [] NA I—] NE
a. If yes, is waste level into the structural freeboard? Yes [j No E] NA 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. LA aJ I �_A &dmj
Spillway?:
Designed Freeboard (in):
Observed Frecboard (in); 1Z
No E] NA C3 NE
5. Are there any immediate threats to the integrity of any of the structures observed? Yes 1��
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a []Yes dNo E] NA [3 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 t reat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes [;Zo [:] NA NI
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes [��o E] NA NI
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes [Z],Ko E] NA 0 NI
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes EJ/No NA [3 N1
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes ETNo NA [—] NI
Excessive Ponding C] Hydraulic Overload C3 Frozen Ground M Heavy Metals (Cu, Zn, etc.)
PAN M PAN> 10%or 10lbs. Total Phosphorus [:] Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window Evidence of Wind Drift E3Application 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
Z"No
NA
NE
15. Doe . s the receiving crop and/or land application site need improvement?
Yes
2r/?Nj
NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
WNo
NA
NE
acres determination?
/No
17. Does the facility lack adequate acreage for land application?
Yes
Q
E] NA
NE
18. Is there a lack of properly operating waste application equipment?
[3 Yes
Q/Nco
E] NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
Cn"Nc
NA
E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
E]�`No
NA
NE
the appropriate box.
F�WUP [:]Checklists E] Design [3 Maps [] Lease Agreements
F]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
F] Yes
[ff"No
NA
NE
Waste Application Weekly Freeboard [] Waste Analysis E3SoiI Analysis
E] Waste Transfers
Weather Code
Rainfall [] Stocking Crop Yield 0 120 Minute Inspections E] Monthly and I" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
E] Yes
Ej-<o
[:] NA
[:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
Eg-14'o
[3 NA
[3 NE
Page 2 of 3
21412011 Continued

Facility Number: Date of inspe�it_ion: 77 12,rl I I
0
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes / [:3 NA NE
25. Is tlfe) 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 F1 Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes 0 NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes WNo NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes ZNo NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the faciiity fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
7 Application Field 0 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 21/No [:] NA E] NE
Ej Yes No E] NA E] NE
[:]Yes C� No [:] NA [:] NE
E: ] Y e s
[:1 Yes
E] Yes No
E] NA E] 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 facilitv to better explain situations (use additional pages as necessary).
?L(,AS(� Wof4C To V-11 (RC-LOO 5--roe A4_'110
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0/0 77L -723v
Date: 7/2—/Jl )
21412011(

i
s' R' tip°
s -s a t�
�' cv1ti t'�IV1510n Of W2tter Q §U.iitlty s: ,'a a t e > rS` 't
FaCtltty'Number Dlvlslon ofSoil antl Water Conservation
i�',.-`"�C3'!t''
sA1 ,e n y VN
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: J I Departure Time: County: LWS06Z Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �Title:
Onsite Representative: L(IV4-rWIY IW.t_ktl
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= e = f =,S Longitude: = ° = I 0 q
t De51 'n + CUCrent•, : Rti 5 'S 1
g tir r �,Designy . Current ,�� , Design }Current
u. Swine :Capa, ity�Piipufation$ .Wet Poultry4 Capacity •Population. CattieY , _ , Capacity Populationq `
❑ Layer
❑ Non -Layer
s Dry ]l'oultr<;;3`h
z. t�y.�'
i
,a
,, 5 a
»; 3 _% ' '
.,OtheC:'
M y� c{
v '.'s ,T .. •--^—. i a -. 1 v.h a q ., is IB ry M��7�1 ytyres; ❑ Other b 4 Y "
'
❑
Wean to Finish
Wean to Feeder
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder.
❑
Farrow to Finish
❑
Gilts
❑
Boars
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
El Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
ElNo
❑ Yes
El NA
❑ NE
El Yes
ElNA
❑ NE
Page 1 of 3 12/28/04 Continued

— . \ I /
FFacility'Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes O/No [] NA [I NE
a. If yes, is waste level into the structural freeboard? 0 Yes C1 No [1 NA El NE
Structure 1 Structur Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1A61*J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2:5
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes C�No 0 NA 0 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [3 Yes VNo El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thrat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes C No E:1 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? 1:1 Yes [2/No El NA [__1 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 0 Yes M/No El NA [:1 NE
maintenance or improvement?
Waste Application
'4
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes [3'NI( El NA 0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. E]Yes No El NA D NE
0 Excessive Ponding El Hydraulic Overload El Frozen Ground C1 Heavy Metals (Cu, Zn, etc.)
El PAN EIPAN>10%orl0lbs 0 Total Phosphorus ED Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window D Evidence of Wind Drift [3 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
[2ry'c 0 NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
En 0 El NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
D Yes
o D NA
El NE
17. Does the facility lack adequate acreage for land application?
El Y
El NA
0 NE
18. Is there a lack of properly operating waste application equipment?
El Yes
� Zo [j NA
[__1 NE
Comm ents.1(reler',to",questionp): tXxplain �any YE S,aii`sWe'r s`�'Aiffi`d/oi` E:'anyirecomm endal tpub, ur, v, oth c mmen S.
'A
kuseidra,
,�vingspjqacility, tometter�ex plain situation E�t useiaaa itional, pages as. aftr
ky
%A
Y A V6
Reviewer/Inspector Name Phone: ( U/ 27
-33
Reviewer/Inspector Signature. Piz/ Date: 4,
Page 2 of 3 f 12128104 Continued

Number: Date of Inspection Fk /0-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes 12 No 0 NA ONE
' L'
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes El NA [:1 NE
the appropriate box. 0 WUP 0 Checklists El Design 0 Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ZNo 0 NA [] NE
[:1 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers El Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes 12<o [] NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes 1Z /Nco [:1 NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
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?
jAdditioniall Comments and/or Drawings:
El Yes 2 <' El NA El NE
"vj'7
Y s N El NA 0 NE
I/
El Yes �No 0 NA El NE
0 Yes E5"No El NA El NE
El Yes
0 'No
[:1 NA
0 NE
El Yes
3"No
C:1 NA
El NE
El Yes
EI/No
[:1 NA
0 NE
El Yes
�N o
0 NA
0 NE
El yes
0 NA
0 NE
0 Yes
No
0 NA
ONE
Page 3 of 3 12128104

to
Type of Visit 6 C plianceinspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other C] Denied Access
Date of Visit: Arrival Time: I DepartureTime: County: 2MLAIN/ — Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title- Phone No:
Onsite Representative: Nlaj_t'r_� Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =I =61 Longitude: =0=1 =11
LJEJ 0,11 EN =Design
esig5=101,
S.Tine gacil
lWaychiffsafi4m
6�apal =RPORE e 0
Ec. sapma-c.
�fftion
Wean to Finish
El Dairy Cow
Wean to Feeder
9'14-0
r
0 Dairy Calf
El Feeder to Finish
El Dairy Heifer
El Dry Cow
D Farrow to Wean
El Farrow to Feeder
Layers
0 Non-Daia
El Farrow to Finish
Non -Layers
El Beef Stocker
Gilts
El Beef Feeder
Boars
Pullets
0 Beef Brood Cow
El Turkeys
El Turkey Pouits
I
ures:
er
El Other
ju,._ a ruc
Discharges & Stream Impacts
1. Is any discharge observcd from any part of the operation?
0 Yes
EXNo
F-1 NA
0 NE
Discharge originated at: [] Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
0 Yes
El No
El NA
0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
D Yes
E]No
0 NA
[I NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
0 No
El NA
ONE
2. is there evidence of a past discharge from any part of the operation?
0 Yes
B'N'o
[:] NA
0 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
C1 Yes
D<o
El NA
[I NE
other than from a discharge?
Page I of 3
12128104
Continued

Facillity Number: (4 Date of Inspection
I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Lga=pj 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 131
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 property addressed and/or managed
through a waste management or closure plan?
El Yes JNo [:1 NA El NE
0 Yes El No El NA El NE
Structure 5 Structure 6
D Yes dNo EJ NA [I NE
El Yes 2(No El NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental ?th eat, notify DWQ
N
7. Do any of the structures need maintenance or improvement? Yes E No 0 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? [3Yes VNo EJ NA El 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 [3 Yes 53"N/o C3 NA D NE
maintenance or improvement?
Waste Ag)olication
10. Are there any required buffers, setbacks, or compliance alternatives that need E]yes O/N(o [INA EINE
maintenance/irnprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ;�o D NA C3 NE
Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground El Heavy Metals (Cu, Zn, etc.)
PAN EIPAN > 10% or 10 lbs El Total Phosphorus [I Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window C1 Evidence of Wind Drift D Application Outside of Area
12. Crop type(s)
13. Soil typc(s)
14. Do the receiving crops differ from those designated in the CAWMP?
D Yes
13No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
D Yes
O/N o
C:1 NA
El N I,
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determ i nation?[] Yes
D/No.
ONA
[I NE
17. Does the facility lack adequate acreage for land application?
C3 Yes
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�No
[I NA
El NE
A "t
Mon'# f
�'V'E S offier, com ent
ommeints,,(refer' to'quilis �answers,q
"14 k 0 1
:,Us�rdraWings�.of,fA'cility'tb'bettei.,��x
k'.' "XI k5
Reviewer/inspector Name Phone: [phone]:9
A 0
Reviewer/Inspector Signature: Date:
Page 2 of 3 9 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ffNo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes E(No El NA [I NE
the appropriate box. El WUP El Checklists El Design El Maps El Other
2 1.
Does record keeping need improvement? If yes, check the appropriate box below.
C-1 Yes
0"No
El NA
El NE
D Waste Application El Weekly Freeboard El Waste Analysis [I $oil Analysis 0 Waste Transfers
C:1 Annual Certification
El Rainfall C1 Stocking El Crop Yield D 120 Minute Inspections El Monthly and I"
Rain Inspections 0
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
[3 Yes
dNo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[I Yes
E�No
[__1 NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[R(No
El NA
[__1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
O�No
[I NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
EZ"No
El NA
El NE
27.
Did the facility fail to secure a phosphor -us loss assessment (PLAT) certification?
D Yes
E�No
Ej NA
[:1 NE
Other issues
28. Were anv additional moblems noted which cause non-comvliance of the vermit or CAWMP? [:3 Yes [2'*No 0 NA El NE
29, Did the facility fail to property dispose of dead animals within 24 hours and/or document
El Yes
E3"N'o
El NA
[:1 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?
0 Yes
Z(No
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
t_-No
[I NA
[I 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
El NA
E] NE
33. Does facility require a follow-up visit by same agency?
D Yes
C��o
El NA
El NE
12128104

TypeofVisit (;(Corilence Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
I t.
Reason for Visit QA ou ine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0/U-T40J-J — Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =' =Ig Longitude: =0=1 =11
-ur -el
esign Gurrent
D I)esig, C
=FoH
LPq
u rLr
_,ent
sign
sign urren
I 1' 110 C 4 acity Dili
C, =paci(
_y, Pop
P p
.t
If SylEapaci ulation
A
C"ttle Illation
Wean to Finish
Dairy Cow
Wean to Feeder
.5 2AFo
Dairy Calf
Feeder to Finish
0 Dairy Heifer
Farrow to Wean
D oul
0 Dry Cow
El Farrow to Feeder,
E3 Non -Dairy
10 Farrow to Finish
LaXers
0 Beef Stocker
JEI Gilts
Non -Layers
0 Beef Feeder
10 Boars
0 Pullets
10 Beef Brood Co—w
", ....... ........ ..... ........ .......
0 Turkeys
El Turkey P_
o:u I:t IS
0 Other
um e ures,.
r
Discharizes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Oyes
V�o
F—INA
EINE
Discharge originated at: 0 Structure 0 Application Field El Other
a. Was the conveyance man-made?
0 Yes
0 No
0 NA
0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
0 Yes
El No
El NA
0 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)
El Yes
[] No
E] NA
ONE
2. is there evidence of a past discharge from any part of the operation?
0 Yes
0<
0 NA
0 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
7N o
[I NA
[:] NE
other than from a discharge?
Page I of 3
12128104
Continued

Pkility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes ONo [:1 NA F-1 NE
a. If yes, is waste level into the structural freeboard? El Yes El No [I NA F-1 NE
Structure-1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A ( 4,v kJ LA tO�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q *7
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes E�No [I NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 0 Yes dNo El NA F-1 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 thr at, notify DWQ
7
7. Do any of the structures need maintenance or improvement? El Yes [ No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes E�No [I NA El 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 El Yes C21/No [] NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes [T<o [:1 NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [2/No El NA [I NE
D Excessive Ponding D Hydraulic Overload El Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
[]PAN [1PAN>10%orl0ibs El Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
[I Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
2�No
[:1 NA
[:] NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[]/No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Ej`No
[:1 NA
[:1 NE
17. Does the facility lack adequate acreage for land application?
D Yes
El"No
NA
[I NE
18. Is there a lack of properly operating waste application equipment?
El Yes
D/N o
NA
[:1 NE
N, " � . 411� �X " - "� j " ' ";1W. _; ' " 4 'i
Z&14' i ��'
4Lommetitb�kFuit:i�,t�A.question,fF,):,Il�x KES 10i rec&6irnenil n 9 an othe, comment
,4answerl
.50ndut
C
%aduinqnallpagcs.-as�R ess
se a�wingstolpeiiityito�,oe.iter-4xpiainisituations., usf
144
S(_mo Coe y o r dZ�-
Reviewer/Inspector Name 00 ew &t Phone:
41,P) 7?4 21 IL
A V
Reviewer/Inspector Signature: 4='tL, Date: ?/j
Page 2 of 1 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 dillo [:1 NA [:1 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes Z/No El NA [:1 NE
the appropirate box. El WUP 0 Checklists El Design El Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes 3/No [I NA [:1 NE
0 Waste Application El Weekly Freeboard E] Waste Analysis El Soil Analysis [I Waste Transfers El Annual Certification
El Rainfall El Stocking 0 Crop Yield E3 120 Minute Inspections El Monthly and V Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
ErNo
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
D Yes
eNo
El N A
[I NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
E211
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
7N o
[:1 NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
EfYes
[:1 No
[I NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
dN o
[I NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
EJ'No
El NA
[:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
[2-'�o
[I NA
D 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?
[I Yes
E�<o
[I NA
0 NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
ETNo
[I NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 yes
E�-
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
7No
[:1 NA
[I NE
Page 3 of 3 12128104

:r - - -
Facility Number
(D Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit 0 Compliance Inspe ion 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
71
Reason for Visit 0 Routine 0"Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: "A)SI-4k-) — Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: —
BHek-up Operator: —
Location of Farm:
6(-;ja 4PA)6DI
Title:
Latitude: E] 0
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=" Longitude: = 0 = I = 11
Design Current Design Current
Swine Capacity Population WetPoultry Capacity Population Cattle
10 Wean to Finish I I
[0 Wean to Feeder I &24-o 13 COP
El Feeder to Finish
El Farrow to Wean
Ej Farrow to Feeder
El Farrow to Finish
El Gilts
El l3oars
Other
IC Other
D Layer
ID Non-Layet
Dry Poultry
E] Layers
El Non -Layers
Ej Pulicts
11 Turkeys
CO3 urkey Poults
10 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field El Other
a. Was the conveyance man-made?
Design Current
Capacity Population
El
Dairy Cow
El
Dairy Calf
El
Dairy Heifei
Ej
DEX Cow
El
Non -Dairy
0
Beef Stockei
El
Beef Feeder
El
Beef Brood Cow
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?
El Yes ZNo EINA [I NE
El Yes
D No
0 NA
El NE
C3 Yes
[I No
C3 NA
El NE
[--] NA
El NE
El Yes
El No
1:1 Yes dNo [I NA El NE
Cl Yes 9"No [I NA El NE
12128104 Continued

LFacilit 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 I Structure 2 Structure 3 Structure 4
Identifier: Ljg &'V0'j I LA &.COAJ 7-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D-1 X4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
through a waste management or closure plan?
Elyes EA/No CINA EINE
[I Yes El No [] NA El NE
Structure 5 Structure 6
Dyes M�110 EINA [:INE
0 Yes ZNo El NA [:1 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t7hat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes E, No El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? 0 Yes C�No El NA El 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 El Yes O/No 0 NA F-1 NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes d� o El NA El NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes No El NA El NE
Excessive Ponding [I Hydraulic Overload El Frozen Ground El Heavy Metals (Cu., Zn, etc.)
PAN [I PAN > 10% or 10 lbs D Total Phosphorus [I Failure to Incorporate ManureYSludge into Bare Soil
Outside of Acceptable Crop Window D Evidence of Wind Drifl 0 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?
El Yes
Villyles
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?El Yes
17. Does the facility lack adequate acreage for land application? Yes
18. Is there a lack of properly operating waste application equipment? Yes
MNo
D NA
El NE
[__1 No
El NA
0 NE
E��11 o
0 NA
El NE
No
E N
0 NA
El NE
[�(No
[INA
0 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):
15) Sc o wAs war FL_AVTCq:> _rN Z4aj ?VMftW6, EftNT- ?JL4 fog of
A560T 13WWO-S'. ?jCED
C) o C_U PA W I-AT14 0 ,j seE vz,�� (,r -a 0 T.CLKf,- -rS , ( Puft r-k ASE, ,
LEI -I -Ca- wi-7 a pJ'A t z 4
of Ej(_Wr. ft_Qr,(_a" LAG-vall UV 0 0(,r I -MI Vj Lkli-OUL, CAVJ 14 OLL-
PLw, fe A Qv (9 - ((kGuL44 (IL So S et q.;z6vj
s4i a t
�4aV^ Z5 -UJ f"C-C-Sf &C_T�J& S6L-D, 40 1p"VMotF3 PUWOJ CALLC-b
rLOIAN.At',J7 TA L40L14JG Ap�r.
ReviewerA nspector Name J'14"/ rAewcu_
Phone: 80) 726 '�39
Reviewer/Inspector Signature: Jai& ���i
Date: - U rL Ax
r 12128104 Continued

�0 . I
J�Vacilitv Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No El NA ErN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes [:1 No F1 NA
the appropirate box. El WUP [I Checklists D Design 0 Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes El No EINA ZNE
El Waste Application [:1 Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall El Stocking El Crop Yield El 120 Minute Inspections C3 Monthly and I" Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
D Yes
D No
El NA
B—N E
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:1 Yes
[:1 No
El NA
DNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
F-1 No
[__1 NA
eN I,
25.
Did the facility fail to conduct a sludge survey as required by the permit?
C3 Yes
[I No
[I NA
C�<E
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
El No
El NA
dy�4 E
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
E] No
[:1 NA
NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
EJ'No
El NA
NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
UrNo
El 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'?
El Yes
ErNo
El NA
0 NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
El"No
D 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
M"No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
Ej'N o
[:1 NA
[:1 NE
Additional Comments and/or Drawings:
CAST(E�
12128104

Division of Water Quality
rFacility Number 0 Division of Soil and Water Conservation
— - -----Agency
Type of Visit 0 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
—1 Departure Time: County: Region:
Date of Visit: Arrival Time: g qT
Farm Name- Owner Email: wsuw
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L�Ajd
9� &L
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
ID Other I
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =I = Longitude: =0=1 =ot
Design Current Design Current
Capacity Population WetPaultry Capacity Population
1 10 Layer I I
S-2,OZ I GZ�.v6 I[] N n-Layet I I
Dry Poultry
ElLayers
El Non -Layers
El Pullets
El Turkeys
El Turkey Pou Its
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part ol'the operation?
Discharge originated at: OStructure [3Application Field 0 Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
El
Dairy Cow
El
Dairy Calf
El
Dairy Heifej
[I
Dry_Cow
El
Non -Dairy
D
Beef Stocket
El
Beef Feeder
El
Beef Brood Cot
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 systern? (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?
El Yes �_erNo [:1 NA El NE
E]Yes
El No
[I NA
El NE
E]Yes
El No
[:1 NA
El NE
[j NA
El NE
El Yes
0 No
1:1 Yes
2rN-o NA
El NE
El Yes
� A�oE_]
NA
[:1 NE
12128104 Continued

Facility Number: 6 7 - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes dNo ED NA El NE
a. If yes, is waste level into the structural freeboard? El Yes El No C3 NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L4 rwod I .Acoa) -1,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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?
El Yes
El NA
[:1 NE
El Yes
No
El NA
El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes o El NA [] NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? 0 Yes No [1 NA El 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 ZNo [:1 NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes EZ/No El NA 0 NE
maintenance/improvement? NA
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes �No F-1 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[:]PAN EIPAN>10%orl0lbs []Tota]Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drifl [I Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
EJ�N
El NA
D NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
� Zo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ON/
[I NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
�Z
XNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�
El NA
[:1 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):
2A) A.P06 t4tY 6012 1VW JAWRX111rip .41VI) 00P (00' '�K POW
(,4pVy(P,SAtV
Reviewer/Juspector Name /1,41/_)�( Phone(& -
Reviewer/Inspector Signature: Date:
12128104 1 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0Yes ONo CINA ONE
20, Does the facility fail to have/I components of the CAWMP readily available? if yes, check ErYes El No El NA El NE
the appropirate box. 0 WUP El Checklists 0 Design, El Maps 0 Other
2 1.
Does record keeping need improvement? If yes, check the appropriate box below.
11 Yes
ONo
El NA
El NE
[I Waste Application D Weekly Freeboard El Waste Analysis El Soil Analysis [I Waste Transfers
0 Annual Certification
El Rainfall El Stocking El Crop Yield 0 120 Minute Inspections El Monthly and I "
Rain Inspections [I
Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
El Yes
ET'No
D NA
[__1 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
El"N'o
El NA
[:1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
DKO
El NA
[I NE
25,
Did the facility fail to conduct a sludge survey as required by the pen -nit?
El Yes
�XN o
El NA
El NE
26,
Did the facility fail to have an actively certified operator in charge?
0 Yes
QKo
El NA
D NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
0 No
EKA
El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
ETNo El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
EJ'No [__1 NA
[I 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?
El Yes
MNo El NA
D NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
ET<o [I NA
El NE
General Permit? (ic/ discharge, freeboard problems, over application)
/Nc
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
11 Yes
CT El NA
[I NE
33. Does facility require a follow-up visit by same agency?
El Yes
�No [I NA
[:1 NE
Comments and/or Drawings:
12128104

wislon of Water. Quality..
Numbp.r 0,; Division of Soil and: Water Conservation
Cy.
OtherAgen.
Type of Visit 11:5—compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit _(�60outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Dateaffi5it:
.11)1-y-21z­4
I hX 1- bg
rrval Time:
� t2l
Departure Time: County:
Farm Name:
;4wf
kWZ9
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ila"
Certified Operator:
Phone:
Phone No:
Integrator: 1!!�S/-_"
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Design.,
S wine Capacit�'w- P
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Region:
Latitude: = [� I =41 Longitude: =O=d =61
Design Current Design Current"
irrent
flatio n' Wet Poultry Capacity Population Cattle— Cap acl ty Pop ulation
10 Layer I
JEI Non -Layer L C I
Dry Poultry
Layers
Non -Layers
Pullets
0 Turkeys
ey Poults
r
Other
rk
El u
Other J1 I0 Othe
Discharizes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
El Non -Dairy
Beef Stocker
El Beef Feeder
Beef Brood Cowl
Numbe . r'of Structures::.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes El No El NA El NE
0 Yes
El No
El NA
ONE
El Yes
El No
El NA
El NE
NA
n NE
El Yes
[I No
El Yes
El No
C1 NA
El NE
0 Yes
El No
El NA
El NE
12128104 Continued

Facility N�mber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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?
El Yes El No El NA [I NE
El Yes [:1 No [:1 NA El NE
Structure 5 Structure 6
El Yes El No 0 NA EINE
El Yes [:] No El NA El 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? F es [:]No EINA EINE
8. Do any of the stuctures lack adequate markers as required by the permit? Yly
(Not applicable to roofed pits, dry stacks and/or wet stacks) [:1 Yes [:1 No El NA [] NE
9. Does any part of the waste management system other than the waste structures require El Yes [I No [] NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes 0 No 0 NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [] No [:1 NA [I NE
0 Excessive Ponding 0 Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
[]PAN EIPAN>10%orl0lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift [:1 Apptic;tion Outside of Area
12. Crop type(s) 6 /� /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? El Yes 0 No C] NA C1 NE
15. Does the receiving crop and/or land application site need improvement? Yes 0 No 0 NA [I NE
/_Y 11
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes [I No [I NA [I NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
0 Yes 0 No 0 NA El NE
El Yes El No El NA El 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):
0'
AL
7) 7 ZZ Y,
e (:57 `7 —<3
ora 17
Reviewer/Inspector Name I Phone:
Reviewer/Inspector Signature: Date:
M_
Page 2 of 3 121728104' Continued

F�a$ifity_14umber: 7 Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 0 No El NA [:1 NE
the appropriate box. El WUP El Checklists El Design [I maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes El No [:1 NA El NE
El Waste Application [I Weekly Freeboard El Waste Analysis [I Soil Analysis E]Waste Transfers ElAnnual Certification
El Rainfall El Stocking El Crop Yield El 120 Minute Inspections [I Monthly and V Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Vid the facility fail to calibrate waste application equipment as required by the permit?
5Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
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?
El Yes
El No
[:1 NA
[:1 NE
0 Yes
El No
[I NA
El NE
El Yes
El No
El NA
El NE
El Yes
E] No
El NA
El NE
El Yes
El No
El NA
El NE
El Yes El No El NA El NE
El Yes El No El NA El NE
El Yes [:1 No [:].NA E:1 NE
C1 Yes 0 No '[�]'-NA /13 NE
El Yes [:1 No [3 NA El NE
I
El Yes El No [_-1 NA El NE
El Yes 0 No [:1 NA El NE
Additional Comments and/or Drawings:
cc)yy�)Ie 64 da o 5 r ve
"25) Be
-zA 5-
Page 3 of 3 12128104

111HO 1!111
L ision of boil ana are ionwrivitian
It e
TypeofVislt (E� Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit, (3(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure'rime: County- OP'SLfj'-J — Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: GeAj.
Certifled Operator: 6 a6viA
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No -
Integrator:
Operator Certifleation Number:
Back-up Certification Number:
Latitude: =0 =d =1 Longitude: =0[=i
Design Current Design Current
Swine. Capacity Population WetPoultry Capacity Population
Elwean to Finish I I I
Wean to Feeder -52-00 9.(' bey
El Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars J 11
Other
Other
10 Layer
IE] Non-_!-,ayet
Dry Poultry
El Layers
El Non -Layers
7P_u 1 _1e t s
El Turkeys
El T i rkey Pou Its
I
I -
i -
Discharges & Stream Impacts -
1. Is any discharge observed frorn any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El
Dairy Cow
Qgairy
C a If
aDaiiry
Fleifei
1:1
Dry Cow
El
Non -Dairy
El
Beef Stocker
El
Beef Feeder
I
El
Beef Brood Cowl
Number of Structures.
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volunie that reached waters of the State (gallons)?
d. Does discharge bypass the waste management systein? (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?
1:1 Yes E�No [I NA [I NE
[I Yes
EJNo
El NA
[I NE
El Yc!;
[I No
ED NA
D NE
El NA
El NE
D Yes
El No
El Yes
[�No
[I NA
El NE
[I Yes
EiNo
El NA
E I NE
.12128104 Continued

Fac�illty Number: Date of Inspection
fWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes � No El NA [I NE
a. If yes, is waste level into the structural freeboard?
El Yes D No El NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(,aa#A I UA oa ki 2-
Spillway?:
Designed Freeboard (in): 14,
Observed Frecboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed? 0Yes
tNo
[INA EINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
[�No
El NA [I 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 ofthe structures need maintenance or improvement? El Yes
d No
NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 El Yes
JNo
[:1 NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes
Ea�/No
0 NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [I Yes
[3/No
[__1 NA El NE
0 Excessive Ponding, El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[:]PAN [:IPAN>10%orl0lbs Ej Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drifi El Application Outside of Area
12. Crop type(s) Seaf­oA C t4)
13. Soil type(s) Rua
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
C�No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
O'No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
[2No
[:1 NA
El NE
17. Does the facility lack adequate acreage for land application?
[I Yes
E5/No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
O'No
0 NA
0 NE
�AWII� P.01� Q-6c" (r's L-0 a k. C-0 t>.
h
Reviewer/Inspector Name P one: (110) -35-7— 349 60 x Z.03
Reviewer/Inspector Signature: Date: 312.045- 1
12128104 Continued

77 Date of Inspection
Fa�Wty Number: (P'7 — 7
Required Records & Documents
19. Did the facility fail to havc Certificate of Coverage & Permit readily available? El Yes No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No D NA 0 NE
the appropirate box. El WUP 0 Checklists [3 Design E]Maps E] Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
E]yes
ONo
EINA
EINE
El Waste Application El Weekly Freeboard E]WasteAnalysis E]Soi]Analysis D Waste Transfers
El Annual Certification
EIRainfall E]Stocking E]CropYield El 120 Minute Inspections El Monthly and I"
Rain Inspections E]WcatherCode
22.
Did tile facility fail to install and maintain a rain gauge?
El Yes
ZNo
[:1 NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
iN o
El NA
[] NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[] No
ffN A
El NE
25.
Did tile facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
EfNA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
D Yes
ETNo
El NA
[] NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
D No
0"'NA
[I NE
Other Issues
28.
Were any additional problems noted which cause nori-compliance of the permit or CAWMP?
El Yes
0"No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E]Yes
EfNo
[_1 NA
El NE
and report the mortality rates that were higher than normal?
30.
At the tirne of the inspection did the facility pose an odor or air quality concern?
Ej Yes
Ej<o
[] NA
El N E
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
D Yes
S/N o
El NA
C3 NE
General Permit? (ic/ discharge, freeboard problems, over application)
/No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
D
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
ErNo
0 NA
[:] NE
Additional Comments and/or Drawings:
12128104

Facility Number Date of Visit: 3 Time: ii
Q Not Operational Q Below Threshold
© Permitted M-Cerrttiified, [&Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .......... L/...f' ` .,v7........,�!�uK r............................................. County: ...........
............................. .......................
OwnerName: ....................................... ; .......... ........................................................................ Phone No:.......................................................................................
MailingAddress:.............................................................................................................................. ................ »......................................................... ..........................
FacilityContact: .............................................................................. Title............................................................... Phone No: ,... ............................... ................
Onsite Representative: Integrator: l'P
Certified Operator:
Location of Farm:
Operator Certification Number: ..... ....................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. It discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ............... ................................... r............... .._................................ ................................... ......................................................................
Freeboard (inches): 2-2— z Z
12112103 Continued

1�acility Number: .17 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 ffirough a waste management or
closure plan? (If any of questions 4.6 was answered yes, and the situation poses an
. mediate 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? If yes, check the appropriate box below.
[] Excessive Ponding [] PAN [j Hydraulic Overload [] Frozen Ground [] Copper and/or Zinc
12. Crop type
0 Yes (3 No
0 Yes El No
D Yes [I No
Yes 0 No
Yes El No
0 Yes 0 No
0 Yes [I No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes [:] No
14. a) Does the facility lack adequate acreage for land application? Yes El No
b) Does the facility need a wettable acre determination? El Yes No
c) This facility is pended for a wettable acre determination? [] Yes No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
0 Yes 0 No
0 Yes El No
0 Yes [I No
0 Yes 0 No
0 Yes El No
El Yes El No

IFacility Number: 47- Date of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
0 Yes
[:3 No
22,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
0 Yes
0 No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
El No
El Waste Application [I Freeboard [] Waste Analysis [:1 Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes
[__1 No
25.
Did the facility fail to have a actively certified operator in charge?
0 Yes
[I No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
0 Yes
El No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[I Yes
[I No
28.
Does facility require a follow-up visit by same agency?
Yes
[3 No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
El No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
El Yes
El No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:] Yes
[] No
32.
Did the facility fail to install and maintain a rain gauge?
0 Yes
[I No
33.
Did the facility fail to conduct an annual sludge survey?
0 Yes
0 No
34.
Did the facility fail to calibrate waste application equipment?
El Yes
No
35.
Does record keeping for NPDES. required forms need improvement? If yes, check the appropriate box below.
0 Yes
No
[]StockingForm OCrop Yield Form ORainfall OInspection After I" Rain
[3 120 Minute Inspections [I Annual Certification Form
12112103

Type of Visit Z7Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
ReasonforVisit ORoutirle Ocomplaint OFollowup () Emergency Notification 0 Other 0 Denied Access
Facility Number Date of Visit. 3 1 Time: FR7?__1
'2'r=Not0T'erationaI 0 Belo
[3 Permitted [3 Certified 13 Conditionally Certifled [3 Registered Date Last Operated or Above Threshold:
Farm Name: , ow ij �J r County: INA04"d
Owner Name: -6,-,* V') Phone No:
Mailing Address:
Facility Contact: - Title:
Onsite Representative- ke -9 -,ew L-1
Certified Operator:
Location of Farm:
Phone No:
Integrator: MVN- kelt'l
I I
Operator Certification Number:
13swine 0Poultry OCattle [:]Horse Latitude 0 4 4. Longitude 0 6 66
Designl�:
- Current Design Current ples: I g n Current
Swine Capacity,
P Capacit
Population oultry y Population Cattle Capacitv Population
Wean to Feeder
JEI Layer JE] Dairy
El Feeder to Finish
10--Non-LaXer 1 10 Non -Dairy I
Farrow to Wean
El Farrow to Feeder
IEJ Other I
U Farrow to Finish
Total Design Capacity
IQ Gilts
10 Boars
Total SSLW:
NOmber oftagooni�,
-.10 Subsurface Drains Present 11E]LaRoonAre.E�os­ Fiel
_�ej[j No Liquid Waste Management System
7'. 1
i,
Hold ng Pbd'dgf/AS611id4kalis��*­
Discharges _4 Stream LWaxts.
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon El Smay Field El Other
a. If discharge is obsmed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (IJ'ycs, 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?
Wast Collection _& Tuntm
. -ejit
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier 1 2-
Freeboard (inches): q 21q
El Yes /.11N0
[] Yes [:1 No
El Yes E]No
0 Yes El No
El Ycs,;2rNo
[3 Yes [1 No
El Yes gNo
Structure 6
05103101
Continued

lypeility Number; 67 _r7 Date of Inspection 13&7k.7__
5. Arc there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes XNo
seepage, etc.)
6. Arc 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 E]Yes XNo
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? E]Yes ErNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes �2�o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes /0 No
Waste Application
10. Are there any buffers that need maintenance/improvement? El Yes ZNo
11. Is there evidence of over application? EJ Excessive Ponding El PAN 0 Hydraulic Overload Yes J60
12. Crop type �F49r'Y'A kf&k le-14 // Se -A
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes r_1 No
14. a) Does the facility lack adequate acreage for land application? El Yes XN 0
b) Does the facility need a wettable acre determination? Yes WNo
c) This facility is pended for a wettable acre determination? Yes b(No
15. Does the receiving crop need improvement? El Yes EfNo
16. Is there a lack of adequate waste application equipment? El Yes ANo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
2 1 � 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/inspcction with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
'Yes
No id.
eZ WP,�
EINoo/4.41k
djo-Yes
Aes
E]No sm;.
[3 Yes
No
0!
D Yes
�ffN 0
El Yes /No
Yes �&No
Yes 'PfN0
Xyes; [:1 No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
7 "144 i"
Codimlents (rcNr'to-qU 6&*).kEiP!alnj�ny MS -answers afi'd/ orlany reconi�i�ndition-'-s'�'o�-�-lahyl,oth���.�meiii4s
0
_4� drawings,61"faellity)to bcI iti6fts.'(use add
r,4situf Itibriallp es as , necessa y Field Copy
-Does int34� kAve A eir 2 o6l se; Ava ;jt Ve;,n Ife nee.4
fp,�a &( sod 4e!54 ez?,'Po-ey LVIA A`A�e_ op, 4 -lo L/ey,
A.-e 4foqe /U
T�
44 4.,, ke wAj4e, S-^-"pIC5 _Ncl, 4�,o,4 41%e -le I
M -L rvr 41,ey-e f fta 4
A fs
bt.�e /A
Reviewer/Inspector Name 4 IP-16 I, e L'V A
Reviewer/Inspector Signature: Date: 42-blP
05103101 Confinued

,LFacility Number: r7 —q?
Date of Inspection
Oder lasues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29� Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes 'P(NO
El Yes ONo
El Yes XNO
D Yes JZrNo
El Yes J�!rNo
El Yes ONo
El Yes 0 No
Additional Ciiminents�and/pr.�Drkyyings.:
lei 60 dA e -04, even-) < -/P �C-v let qe- 41-,e in,'4 147� a V\aprl4d
-1 Sla 1 11
4ke 0 t., s,% e I's Lt
y
C,02 Q,-�
mp-Ott, :C�4 ArrrAr5 4kA-� PNIVO-ec 4"P% 5�� 14s-, 11,1f been
bIM4 I PNC-. I dele,11M)"ne. Mcad -�o dedtlr4 4"�
1 t -,�
pl,qel s4y-s �5-er4-PJOV W,AAOw cv% sr`k,--i
.1:74 :J' upi-tJor ois 4e CvAqf w AL4& f I a tt "'L
bo,�
cvrre4lly 'Orer4-�' 1 vri dc K,, 4 h ere 6k yr e A P url e' o�
WA.s4 e I-nks IJ 1, Ik 4 ke <A YL%e Aa4e. tMer erew^ ne-Cl(S
f I W e4e" 4,f relVe C4 h 1,.r erep-44r, P-� W; 4,
r7 4e_<
6f I?fy)J 71,0 6) ) 5 ; jy7 V"�
4ed . a/
Aprl�calioi, t-Av,,dous s),,6KIA be
owl fl'ok.
05103101

'g
� Wr(l
C? ti , N IF
en
Type of Visit R Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Emergency Notification () Other Denied Access
I i Q G (—j --I
Facility Number f)ate of Visit. Time. Printed on: 7/21/2000
ro Not Operational 0 Below Threshold
[3 Permitted Wertified 13 Conditionally Certified E311egistered Date Last Operated or Above Threshold: .........................
Farm Name. County: . ............................... .......................
........... ............ ......................................... ......
OwnerName: ................................................... ........................................................................ Phone No: .......................................................................................
FacilityContact: ...................................................................
MailingAddress: .....................................................................
Onsite . .........................
.... ...........
Certified Operator:
Location of Farm:
Title: ................................................ I ............... Phone No . ...................................................
.... ...... — ............. 11— ....... - ........... ...... I ...... I ................... ..........................
....................................... Integrator: .....
...............................................
...................................... Operator Certification Number . ............. . ...........................
[] Swine 0 Poultry 0 Cattle 0 Horse Latitude 0 1 LL Longitude 0 1 44
Design Current
Swine CaDacitv Ponulation
tj�wean to Feeder
[] Feeder to Finish
E] Farr6v to Wean
E] Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
JE1 Layer I I E]'Dairy
JE1 Non -Layer I I [j Non -Dairy
FI--]Olhrr
Total Design Capacity
Total SSLW
Number of Lagoons JE3 Subsurface Drains Present agann Area JLJ Spray Field Ar - ea
=10 L
Holding Ponds / Solid Traps FEI No Liquid Waste Nlanagement Kys�tem
Discharge & Stream Impac
1. Is any discharge observed from any part of the operation?
Discharge originated at� E] Lagoon E3 Spray Field M Other
0 0
a. II'discharge is observed, was the conveyance nian-made!
h. If discharge is observed, did it reach Water (if the State'! (If yes, notify DWQ)
c. li'discharge is observed. what is the U1.111TIMCd flow in gal/min'!
d. Does discharge bypass a lagoon syslem? (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? El Spillway
S11-UG[Ure I Structure 2 StFUCtUre -� Structure 4 Structure 5
Identifier: ................................... .................................... ................................... ........ :: ...................... ... ....... : .....................
Freeboard f inches): 30
5100
Cl Yes , )KI N o
[] Yes E] No
E] Yes E] No
0 Yes El No
El Yes NrNo
El Yes NfNo
El Yes �(Nu
Structure 6
Continued on back

jFaiciliCy Number: 6r)_ — 9r) I Date of Inspection Printed on: 10/26/2000
5, Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
0 Yes
No
seepage, etc,)
6, Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
0 Yes
No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
El Yes
ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
0 Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
WNo
elevation markings?
Yes
Waste Application
10. Are there any buffers that need maintenance/improvement?
Cl Yes
ONO
IL Is there evidence of over application? Excess'ive Ponding [] PAN [:] Hydraulic Overload
El Yes
ONO
12. Crop type cvkl3j�.C,41
�=, 1 yl,14
13. Do the receiving crops differ with those I designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
gNo
14. a) Does the facility lack adequate acreage for land application?
Yes
ONO
b) Does the facility need a wettable acre determination'?
0 Yes
jP No
C) This facility is pended for a wettable acre determination?
0 Yes
WNo
15. Does the receiving crop need improvement?
El Yes
ONO
16. Is there a lack of adequate waste application equipment?
El Yes
9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?.
0 Yes
No
18, Does the facility fail to have all components ofthe Certified Animal Waste Management Plan readily available?
Yes
No
(ict WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
ONO
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?
0 Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
tZNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
D Yes
t No
24. Does facility require a follow-up visit by same agency?
0 Yes
KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
[�TNo
........................ ......... "*-,-* ..............
...........................
'b' f thE . . . . . . . .
,.,C0ire*sp'6fiden'ce.a ou Lsn I
Tiommk�ts �ief��,t6 quistion Explain any YE&answers and/or any recommendationioriiihy othek comme
Use,drawings of facility to better ex lain situations. (use additional pa;
p ges as,necegsary)
el� � S " I&
Az� gv�r�-_
4
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 9L_,� 0 1 5/00

Facility Number: Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [-] Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? C1 Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, 0 Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutterS7 CtC.) El Yes No
31. Do the animals feed storage bins fail to have appropriate cover? E] Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes KNo
7 , rO q � e, ;'�'
5100

Revised April 20,1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numb
Q. A, -
Farm Name: M
On -Site Representative:
Inspector/Reviewer's Name.
Date of site visit: -
Operation is flagged for a wettable
acre determination due to failure of
Part /I eligibility item(s) F1 F2 F3 -F4
Operation not required to secure WA
determination at this time based on'
exemption El (0_e E4
Date of most recent WUP:- Operation pended for wettable. acre
determination based on PI P2 P3
Annual farm PAN deficit: j ��_ pounds
Irrigation System(�) - circle #0 hard -hose traveler, _2..center-�pivot system; 3. linear­�rriove system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. �tationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irfigation design, including map'depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
-V—/ E 3 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 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibi* 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.operatic)n fails one of the -eligibility
requirements'listed below:
F1 Lack ofmc.reageiwhich Tesulted in:over,-applicationmf-wastewater�.(PAN) on:spray-.
field(s)-zccordinglo-farrn'siasttwo.years:ofimgaijon7ecords.-..-
_� F2 Unclear,JIlegible,-Dr lack of -information/map.,
F3 Obvious --field -1 imitation s -(nu merous:d itches idall Liredo ' :deductTequired
bufferlsetback:acreage;-Dr-25%'-Of iotalzacreageidentifibd jrECAWIVI P.:­in�dl u des
small --irregulady-shaped fields =-fields 1ess -than -5 mcres -fortravelers-or.less -than
2 acres -for.-stationary sprinklers).
F4 W-A determin abon required because CAWMP'credfts field(s)'s acreagein excess,
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised Aprfl 20, 1999
Facility Number
Part Ill. Field
by Field Determination
of 75% Exemption Rule tor WA Uetermination
TRACT
NUMBER
FIELD
NUMBER',2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES1
CAWMP
ACRES
FIELD.1
%
COMMENTS3
FIELD NUMBER' - hvdr2nt- oull.:zana orDoint numbers rn2v be used in r)lace of field numbers
daDnndinn nn CAWMP
and type of irrigation -�ystem­- If 'Pulls, etc. �rossTnorelhan,o'ne field, inspe'ctor/revi ewer 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 clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acFeageiexceeding--75% of its total:acres -and having Teceived less.than 50%
of its annual PAN as -documented in the farm's.previous -two years'(1 997 & 1998) of irrigation TecordS,-C2nnot ser-ve-as-the
sole basis -forrequ iring a WA Deterrnination.-_-Back-up fields -mustbe -noted in the -commentzection 7and must be accessible
by irrigation -system.
Part IV. Pending WA Determinations -
_P1 Plan Ja cks 1ollowing -information-
P2 Plan -revision -may--safisfy-75% rule based on adequate overall PAN deficit -and by
b adjusting -all field. -acreage --to -below 75% use rate -
- P3 Other (iefin process of installing new irrigation system):

•
Routine 0 Com laint Q Follow-up .of DWQ inspection Q Follow-up of DSWC review Q Other
... I �j Facility Number Date of Inspection—OC1
Time of Inspection 24 hr. (hh:mm)
0 Permitted Certified 13 Conditionally Certified [3Registered JQ Not Operational Date Last Operated:
Farm Name: ... �►-e �i-`.�f.2 ............ County:.....'`"'..........................................I........
Owner Name:.. ..................
......... ..... I ...... ...................................... Phone No:..
Facility Contact: ................ ....... Title Phone No
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: ....................5 ., :........................................................ Integrator: ........ 1• r`�F..........................................................
Certified Operator:................................................................................................................ Operator Certification Number:....
Location of Farm:
A
................. ...................... .... .... .... ...............
Latitude 0 6 .6 Longitude 0 6 &4
t °..
Desi Current .
gn nt
Swine ' Caeaci Po ulation
Poultr Ca' agn
Y ci Po ulati6n Cattle "'S tion'
D e`ci Po ula
Wean to Feeder ;160 dd
Layer ''❑ Dairy,.t<
❑ Feeder to Finish
FoNon-Layer ]❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other "'
❑ Farrow to Finish
Total Design Capacity;;,:
❑ Gilts
❑Boars
Wa,TotalSSLyW `i
Number of Lagpons
❑ Subsurface Drains Present ❑ Lagoon Area
Field Area ,
❑ Spray t�.
bldin&Ponds / Solid,Traps
❑ No Liquid Waste Management System
, j,, I 1
Discharges & Stream Im� )Facts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
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? (Il'yes, notily DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IxNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EXNo
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 P(No
seepage, etc.)
3/23/99 Continued on back

fFac'llfty Number: 4�9 Date ol'Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? El Excessive Ponding [] PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) Thisfacility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
�1. 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?
(ic/ 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?
P., ­* ............. 1 ­4'� ' ' ' ' ­.''.';':i�.'-'-h1't .... * ........
NO .. iola(idAs'or. Oorjcje�nt L-� �y rL- hofp (ttiog �hjs'vjisjt ti:Wi - 60iW ii6 fufthof
....... ................
corresporid66e'ab' ' t'th' ' isit" ............. . . . . . . . . . . . . . . . .
OU . ISS . . . . . . . . . . . . . . . . . . 0 0 . . . . . . . . . . . . . . . .
C_�
'nieii6 (ret�j lol'-'q­ u"'e' s�`6-6-n 0 Txplaifi-any'-YE 'answers,an or4,anyerecornml
om
�'i;drawiin&6ffacility 161beti�r exo ain situa�'ti'6ii§.�'(ii'�k'additidn'al",p'a�g''es'la�s�n6c
3 LT 550
AL, ---
'y
.n'
0 Yes b(No
Yes [�(No
Yes R& 0
0 Yes WNo
* Yes �eNo
* Yes WNO
0 Yes XNo
C3 Yes 14 No
C1 Yes RNo
El Yes rOrNo
Pt
El Yes Wo
C3 Yes DjrNo
[I Yes VNo
No
El Yes K
El Yes 0 No
El Yes �<No
El Yes KNo
Yes XNo
Yes &N o
0 Yes �No
0 Yes eg No
A,
Reviewer/Inspector Name
J
Reviewer/Inspector Signature: Date: q,- R 0 0 1

Division of Soil andWater'Conservatlon Operation Review dt = r �i i� t,',
i i© Division of Soil and:Water Conservation CompllancelInspection:
DlVlslon Of WaternQu.allty Compliance Inspection 4r, € t '° i� �l a
i if '.{ - ii h
„<' •, : Other Agency
O erahoR ltevleW
C1 4 i ppP �i
10 Routine 0 C`mpl` int 0 Follow-up_of_DW2 inspection 0 Follow -op of DSWC review 0 Other
Facility Number (p r} Date of Inspection `] R
Dime of inspection 3 0 24 hr. (hh:mm)
13 Permitted [3 Certified 0 Conditionally Certified © Registered 113 Not Operational Date Last Operated:
Farm Name: ....Nu.K,..#..i......... County: ................................ 'v&J.4-ko.....
Owner Name: ... .ay Ok1►�I. ... .... Phone No: „` l L?..4.`$...!..................................
..
FacilityContact: .............................................................................. Title:...................................... Phone No:
Mailing Address:.....l.i .. ?.....G..R.I.E...QRY... q&!Z ....F.D.... .... ........RlC H. -AN.D .... z,aS �4
Onsite Representative::.... RR`l...S Qt?. .......................................................... Integrator:_{.�% ���.Y.......t41j�.y..FA PZ
% 5..........
Certified Operator:....... 0`f.....L.,..,t?.j1,Q,.w. .t4 ........................................................... Operator Certification Number: ....... f (,p.3,..q.a............
Location of Farm:
Oq µ� ns Rt.l a o
.La..............t................,t�....1?..�1?............l.�F..T:...A.l�.�i?...�S..R....I�dct...-.�,.........�...�..H.h....T.....Ela.RAM... G—:.t�T..Fi;P..N�I�.....QN.....f.�.l.�.H.T-......... .
Latitude ©• ICJ'
oPiY 'J Design Current
Swine Capacity Pouulation
® Wean to Feeder
(000
i1
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Longitude I f l �' ="
Cae ac ty P:.a illatnon,. CattleDeco n Current sy
g
Poultry',. -CapacityPo ulation
❑ Layer ❑Dairy
,f
❑ Non -Layer ❑Non -Dairy
Other I
' Total Design Capacity o ld00 ., ,
"F 'ON
Total'SSLW
aea
Number of L.agoons. IR3.Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding PaWd Solid Traps ;'; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes 4 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 1�(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ANo
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: 1
Freeboard(inches): ..............(..!................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes � No
seepage, etc.)
3/23/99 Continued on back

kacilityNumber:_�q— '111i Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 0 Yes g 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 ofthe structures need maintenance/improvement? El Yes �ZNo
8. Does any part of the waste management system other than waste structures require maintenancehmprovement? E] Yes IV No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? M Yes 9 No
Waste Applicatio
10. Are there any buffers that need maintenance/improvement?
0 Yes
�(No
11. Is there evidence of over application? 0 Excessive Ponding 0 PAN
E] Yes
kilo
12. Crop type w , rk 9!4�L - u-, 1 �:�:E a-eWX 4 Q ta'r" - 64 own
7 P/-" -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
5LYes
C3 No
14. a) Does the facility lack adequate acreage for land application?
0 Yes
Dflslo
b) Does the facility need a wettable acre determination?
[] Yes
jff No
c) This facility is pended for a wettable acre determination?
E] Yes
E] No
15. Does the receiving crop need improvement?
El Yes
�fNo
16. Is there a lack of adequate waste application equipment? EJ Yes krNo
Required Records & Documents
17. Fai I to have Certificate of Coverage & General Permit readily available? 0 Yes RNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) [I Yes [360
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) 0 Yes 6�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? Yes oe� 0
21. Did the facility fail to have a actively certified operator in charge? Yes �KNO
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
Yes
O(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes
0
24. Does facility require a follow-up visit by same agency?
[I Yes
E�K�O
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes
P�No
lNo mw ioris'oe- wicwnvip� -woreoo
.... ......... ....................
-ro . . i - � . . - i - - -. . . . . . . . . . . . . . . . . . . . . . . . .
th&nsi . . . . . . . . ........ . . . . . . . . . . . . .
rresnondence. ahout. L ....... ...
3/23/99

1,Facility Number: Date of Inspection
Odor Issims
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or I below E] Yes XZNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Yes qNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes X�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? E]Yes VNO
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 ��o
3 1. Do the animals feed storage bins fail to have appropriate cover? Yes ;<No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 . Yes )<No
Additional'Comments and/or Drawings. f
46
3/23/99

V/
Lagoon Dike Inspection Report
Name of Farm / Facility Roy and Brandon Broiyn NUrsery # 2 67 - 77
Location of Farm / Facility SX-1222
Owner's Name, Address Rgy & Bromm Brandon. 1106 Greg= EgA -Road,
and Telephone Number ]jjcWan& NC28574 910-324-4811
Date of Inspection 9 1 Z8/ 99 Names of Inspectors Zahid Khan
Yincent Leyds
Structural Height, Feet 8-10 Freeboard, Feet 20 Inches
Lagoon Surface Area, Sq. Ft. 24,Q00 Top Width, Feet 4-5
Upstream Slope, xH:lV
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?
2 to I - Downstream Slope, xH: 1v 3 jo I
Yes X No
Yes _X__ No
Yes X No
Yes 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 No
Other Comments . Well maintaingd. Mowcd- jzood grass cover

Lagoon Dike Inspection Report
Name of Farm / Facility
Boy and Brandon
Brown -Nursery # 2
67 -78
Location of Farm / Facility
SR 1229
Owner's Name, Address
Rgy & B rQMm
Brandon, 1106 GregoEy Fork
-R-qad,
and Telephone Number
FjgWaads,
NC 285Z4- 91Q-324-481-1
Date of Inspection
9 / 2819-9—
Names of Inspectors Zahid
Vincent
Khan
LCwis
Structural Height, Feet
8-10-- -
Freeboard, Feet
22 Inghes-
Lagoon Surface Area, Sq. Ft.
25,000
Top Width, Feet
4 -j_
Upstream Slope, xH:1V
2 IQ I
Downstream Slope, xH:lv
3 to 1
Embankment Sliding?
— Yes
X No
r116 11 n h r%r
I V%. JLA%;;g %, va I
Seepage?
( Check One, Describe if Yes
Erosion?
( Check One, Describe if Yes
Condition of
Vegetative Cover
( Grass, Trees )
— Yes X_ No
Yes X No
Did Dike Overtop? 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 No
Other Comments )MI maintaingdMgwed. good grass cover

ht. 0 Division of Soil and ,Water, Con
servation- Operation Review
, c ; F r: i 1 " ,a R E `.: i i E 1 - V la - w1 r 1 �i U,
0 Division of Soil and Water Conse°ryabon Compliance Lspection F ; , qi-1
E i,�. �;•r E d �� Division of WateC ' ll�i r �� ( E r IE <f
® Q ty Goirtpl� mcci Inspection Er E s' ,! GIs -<d 7
0 ,.Other Agency - Operation
....
10 Routine 0 Complaint 0 hollow -up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number r{ Date of inspection
Time of Inspection t ; � 24 hr. (bh:mm)
0 Permitted 0 Certified 0 Conditionally Certified [3 Registered 0 Not Operational Date Last Operated:
Farm Name: ...R. ....... County:..!`j�`!SLOV�I.............................. Vit.g.a..
c sr� xtr
Owner Name:... R(?YE...... B.....-....Ar.,!pD1.14...... 3,PWr-j . Phone No: ,9Q.... A..�.0............3�'41(06..
FacilityContact: .............................................................................. Title:................................................................ Phone No:...............
Mailing Address: ...i �l� (e .... ?. gal X.... ?r21c............. .......................... ... ..C'............................. .2-05. 7.rxL
FZv 2t� �• ......................................................................................
Onsite Representative: ...............�......Q................................................................... .Integrator:
Certified Operator: ......K\(, i_ agqu3 !4 ................ O erator Certification Number:
t6
P'...................
UVVN«V�>•
V� i ua ui.
cefT
.
Q.N a...SR..i
a.axi...`......n
........... .N...!....."'D...rue�.r
`C.0 pn.....PX.........n..... .f:• fCA.Ua...71 ��R.x .......................
Latitude ®• 53 ` ®" Longitude ` 7 • %-7 ` ®"
. Cac'it Population t'y�� ,� �Caeaci �°gent '., r, Design 'Current
Wine 3; 1 � � � � �:E., DesignP011lt° at � PO ui latiOn' "Cattle � Capacity Population:
® Wean to Feeder Qd (n 0 ❑ Layer ❑Dairy
❑ Feeder to Finish ❑Non -Layer I JE3 Non -Dairy
❑ Farrow to Wean. r�r,
❑ Farrow to Feeder ❑Other r
❑ Farrow to Finish Total Design Capacity pp
rr
❑ Gilts, Y
❑ ;> A: �Tota1,,SSLW
Boars
Number of.Lagoons Subsurface Drains Present ❑ Lagoon Area [j'Spray Field Area
'.
Holding'Ponds`L Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes El 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 ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: %
Freeboard(inches): .............. ........I................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes NNo
seepage, etc.) Jl \\
3/23/99 Continued on back

IFac*ity Number: 69':t — Datc of laspv.ction
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 0 Yes JVNO
(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 ofthe structures need maintenance/improvement? Elyes VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El Yes 9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? El Yes 14 No
Waste Anplication
16.
Are there any buffers that need main tenance/improvement?
[:] Yes
0 No
11,
Is there evidence of over application? E] Excessive Ponding PAN
C1 Yes
M-4 No
12.
Crop type SbH 29 Q &Lr_S91-A
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
M-Yes
C] No
14,
a) Does the facility lack adequate acreage for land application?
El Yes
No
b) Does the facility need a wettable acre determination?
Yes
No
,7�
c) This facility is pended for a wettable acre determination?
El Yes
El No
15.
Does the receiving crop need improvement?
Yes
�eNo
16.
Is there a lack of adequate waste application equipment?
Yes
XNo
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
0 Yes
E%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.)
El Yes
EOo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
L] Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at (he time of design?
El Yes
qNo
21.
Did the facility fail to have a actively certified operator in charge?
Yes
5(NO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
ONo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes
ONo
24.
Does facility' require a follow-up visit by same agency?
El Yes
A No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMPZ
El Yes
1KNo
61-�tidi�s`o' �' d, �flcie . ncip� . w4�re` h, 4e,if 4
, , 0-�ihg 4]hjs'v1sjt. Yoti 'Will -teb�i�� 06 fufftf
......... .... ... I ......... .... ...
........................ .......
'ro C C U Lc..V] I . . . . . . . . . . . . . . . . . . . . . . . . . . .
nremnonden e'. An f th'
3/23/99

FacDatc ofinspection
Aty Number: (0 ET� 7n
Odor ISSIMN
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below E] 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? 0 Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes ONO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surf ace of the lagoon? o Yes XNU
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 1� No
31, Do the animals feed storage bins fail to have appropriate cover? Yes JN(NO
32� Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? E] Yes XNo
Additional Comments and/or Drawin - ' ' ' - - ' ' ". � . 11�'. In, " i -; ;,., ': �. ! �' ; , , � ;'.". I - . k . I
.1 � - .. . .1 1 - � . -1-P, .1 1. ...; 14. '; - ";' " ,, v . , f, 1 A- , . 'A';� � , '!� I �: . � " � 'x ! . 'i 1 �' '� ". �
Ad
3/23/99

-
�b13
Division of Soil and Water Conservation
Other 4,enc
'
Division of Water Quality�����,
i
Routine O Complaint 0 Follow-up of DWQ ins action 0 Follow -tie of DSWC review Q Other
Date of Inspection I� Z Z'
Facility Number Time of Inspection � �' ' 24 hr. (hh:mm)
13 Registered 91Certitied [3 Applied for Permit [3 Permitted Not Operational Date Last Operated:
Farm Name:....�..county:............? A ...... .......
OwnerName: -051 ... ....... . . .............-n........................... Phone No: .-............/I.......................................
Facility Contact: ........ sr�.............� ..................... Title:......a. .++^� ` ............................. Phone No:...................................................
MailingAddress:........r!�. i .......rr.►... 1..!".....` +�........ %......................... ....... ........................................... ..........................
Onsite Representative:...... P4117 ...... Ac .e4x_ %._'..................................................... Integrator:........,n?.,c •/� y
Certified Operator;............. �'z,r'll ..'E. ................................. Operator Certification Nu-m/ber,.........................................
..�............
Location of Farm:
Latitude E=• Longitude 0•. ��"
� ���? Desig
,Current
a
Design Ci� rrent ' : Desr n rCurretit � F
Swnle "N Gapacrty
Population
Poultry; :..Capacity
Populatioin. Cattle Capacity Popplat on'
Wean to Feeder (xj
� ❑Layer
❑Dairy
.- ❑ Feeder to Finish
❑ Non -Layer
10 Non -Dairy
❑ Farrow to Wean
>, ❑Farrow to Feeder
❑Other
e
[I Farrow to Finish
s
Total Design CaPactty F
❑ Gilts
❑soars
Total SSLW
Ne[tnbyer o> La twos / Holdtttg Ponds
I0Spray Field Area s
m
❑ Subsurface Drains Present]❑
Lagoon Area
.. ... . .......
❑ No Liquid Waste Management System��
{e
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes J;LNo
2. Is any discharge observed from any part of the operation? ❑ Yes )qNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes] No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes , No
5, Does any part of the waste management system (other than 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 19No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes O No
7/25/97

lFaqUityNtimber:
6. Is facility not in compliance with
licable setback criteria in effect at the time
7. id facilit fail to have a c ified opera charge?
8. !Are :therelagoons =.age ponds on site which need to be properly closed?
.Structures 41.,agoons andfor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Struct U e Structure 2 Structure 3
3,7
......... !� ........ ..... I ................................ .., ................ ........
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/irnprovement?
(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 mininium or maximurn 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)
El Yes 0 No
El Yes [I No
0 Yes R'No
0 Yes )d No
Structure 5 Structure 6
15. Crop type ............. ... 1� ................ ................ ....................................................................................... I .... ....................... .
M. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
C,
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 Facilities Ord
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?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date-
............ ........................
El Yes J�LNo
El Yes �a No
C1 Yes 96 No
C3 Yes A!fNo
C3 Yes vdNo
..........................................
Aq_yes
[I No
0 Yes
JA No
El Yes
4jdNo
0 Yes
Q No
El Yes
jo No
El Yes
ONO
C] Yes EWNo
El Yes QrNo
El Yesoo No
cc: Division of Water Quality, Water Quality Section, Facility Assessinent Unit
4/30/97

w�� -"" ^.�.��, �. �,. w;;...a.w�.,'i«r,� �'%�CS3;-< ,, ,',,,�.« Fa"'...-.::-_ -.-'.�..ua:.x""- -d - �i �s _..,�}_ �,�;• `� �'�' w�'��,�'F
❑ Division of Soil and Water Conservation ❑ Other Agencyka
, Division of Water Quality
outine O Complaint O Follow-up of DWQ inspection C Follow-up of DSWC review G Other
Facility Number Date of Inspection t�
Time of Inspection 24 hr. (hh:mm)
[] Registered Certified D Applied for Permit [3 Permitted 113 Not Operational I Date Last Operated:..-
.......................
FarmName: ...'i � - y:................. ............ .................. .................... ..............5!� - ................... .....- Count ..' 4 - .... .
Owner Name:... ......Y......... �.?t .r�f......... .,�" . n.................................... Phone No:........ ..,..: �P..1../.................................,
Facility Contact:......:...... .. Title: ........ . Phone No: .............
MailingAddress:......1 .. ....... .. Gam......... ..........P!':....... .............�.r.......................... ......................... ........... ..........................
Onsite Representative:.......01",................................................... integrxtor:.......i4!l41-.^....... ...................... ^- ........
......-
Certified Operator;........... j
............................. ............................... Operator Certification Number:..................
Location of Farm:
Latitude • =' = 11 Longitude ' =' ="
Design Cui rent
I3e5tgn Current
Design Current Y
� ..
Swine :: � Capacity
Poultry V Capacity Population..
Cattle' Capacity Population
;1'apiilation
can to Feeder Z4,
❑Layer 1
❑Dairy
❑ Feeder to Finish
❑ Non -Layer
JEJ Non-Dairy
J
❑ Farrow to WeanA.
r
❑ Farrow to Feeder
❑other
I,
Farrow to Finish
Total Design Capacity
❑ Gilts
$*:
❑soars,
Tata1 SSLW.
w
Ntunber Lagoons / Holding' Ponds ❑ Subsurface Drains Present
of
❑ Lagoon Area ❑ Spray Field Area
K
fN:
❑ No Liquid Waste Management System. '
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes i9 No
2. Is any discharge observed from any part of the operation? ❑ Yes FXLNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes { No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes FQ 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 RNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [2No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes LR No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes k4 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 5d No
7/25/97

T
Facilit� Number: 67- W
.
6. Is
n in Uornplianc � any appli ble etback cri n in effect at ti me dcss�dgn?
El Yes [:1 No
7. Di
7acility
eb
-a ge? �of
cility f tor r
the cility "I to ve a cer 'fied o rator in r ible ch ge?
El Yes El No
8. Are there lagoons or storage ponds on site which need to be properly closed'?
El Yes d4No
Strtictures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
El Yes P9 No
Freeboard (ft): St t
ructu_Lp Structure 2 Structure 3 Structure 4 Structure 5
............... - .. ........ I ............. .......... ­..... ........ ....................................... .......... ...........
Structure 6
.......................................
10. Is seepage observed from any of the structures?
0 Yes A2NO
11. Is erosion, or any other threats to the integrity of any of the structures observed?
Yes MNo
12. Do any of the structures need maintenance/improvement?
El YesadNo
(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?
DYes PNo
Waste Application
14, Is there physical evidence of over application'?
El. Yes J�rNo
(if in excess of WM.P, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... .................................................. .................. ............................................ _ ................................................. ............. .............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
&Yes El No
17. Does the facility have a lack of adequate acreage for land application?
El Yes §j�No
18. Does the receiving crop need improvement?
El YesaqNo
19. Is there a lack of available waste application equipment?
C1 Yes 29NO
20. Does facility require a follow-up visit by same agency?
0 Yes,.KNo
21. Did Reviewer/Inspector fail to discuss review/inspectibn with on -site representative?
El Yes ONO
For Certified Facilities Oni
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
El Yes EYNo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 Yes LtNo
24. Does record keeping need improvement?
El Yes &No
Reviewer/Inspector Name r
- - ---- -----
Reviewer/Inspector Signature: Date: 75,f,
cc: Divisiott of Water Quality, Water Quality Section, Facility Assessment UW1 4/30/97

'di
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number '1 "']`7
Farm Status: [I Registered ❑ Applied for Permit
Certified ❑ Permitted
Date of Inspection
Time of Inspection LLa 24 hr. (hh:mm)
Total Time (in fraction of hours �---;�
(ex:1.25 for 1 hr 15 min)) Spent on Review
or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated
perated................................... ................................. ......_...................................j.......................... ................ .........................
Farm Name• .. ..�'f . 1i�A�C1f�Ot�....�i�[W..6......1.Y ......................... County: ...... 0.n;..�RQ........................................ .......................
LandOwner Name:.. }.....&WM............. ..................................... Phone No: ............................................
Facility Conctact:.......
A1.. /.. t.�Y0.4 n......................................... Title:.... aW 4r.......................�...... Phone No:..� ��i. .� �.............
Mailing Address:..�.l (o+....4?f'� {2 ... �. ............................................. ...(]�S V��IX!!(1...........r... l................_.................!�7......
OnsiteRepresentative:.......1 U1 ....... i4s1(............................................................... Integrator:..-..&W............................. _...............................
CertifiedOperator: ............. . ................................... ....................................... ...................... Operator Certification Number:..........................................
Location of Farm:
..TO... ........ ..... � . #�!!.. 4.�... ..5 w .... ,.... s.t1S .. �tk..........1�4.t... 5�... ...... , r ... v` .... Lira ......... 4
.�, I y-....R.1,ti1:....r.... .... m:.................�"�-..s.�......... r�.. �� � 5..%�...�?1�.... ..1!!li4.... ... +�1....J`�........4�.r1... r ..... i sia o� �...
Latitude ®0L.J7 Longitude ©' ©4 46
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? [--]Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes J�j No
c. If discharge is observed, what is the estimated flow in galhnin? !J
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 19 Yes ❑ No
maintenance/improvement? 4/30/97 Continued on back

Facility Number: .... 67.1 .. Z .... .
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lag!oonsand/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
4
.................. I ......... ........... . . ..... . ...... ............................
10. Is seepage observed from any of the structures?
Structure 4
0 Yes rANo
El Yes No
El Yes No
El Yes CA No
Structure 5 Structure 6
............ . ............ ..................... . .... .................. . ........
0 Yes C§No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
)Yastg
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
0,
15. Crop type ............... 0 1�1-6d .... 6U.&WICL .......................... .............................................. ..............................................
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?
2 1. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Eor CeLlified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
n �r V P V, � n n"Q_W'i-. r� � q it ei /nr n niv � r'P f !'n'
Ij
... Ell, I " ­ :�,
Z.,
­7� 57.
-6
14. &-oe OV"\ (Cyon 5kwld 6p- rtwejej.
ovev--e-4 'Ot qev skP.L'O 6e- �Cs- rvW �V-' C
Ia. CCO-SW Cvrz� -SkOW loe_ woo,
L 1 � ux cA w AA
2.3. Mr, &oot, Ka% 15"J -ft"_
0 Yes P No
E9 Yes El No
[I Yes [&No
0 Yes JS No
W Yes 0 No
0 Yes N No
Ef Yes 0 No
0 Yes IN No
Im Yes ONO
El Yes 0 No
[I Yes Q No
5d Yes El No
C1 Yes [9 No
C6T,6J D�*C�
mamo:
M�A
I %: Ir
Reviewer/Inspector Name' '� m MR
Reviewer/Inspector Signature: T�J�� eL All Date: V2_ 3 Iq -7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30197

toutine 0 Complaint 0 Follow-uk of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 67 Time of Inspection e, d 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review 3
(9 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated :....... ...........................................»...............................................................................................
Farm Name:... 5?I�.. ....11} LL'if J�1.... _j&411 L...... �!sx.s.1~cy.... . ......... County: ..... 41�k?.t)............................................................
.. Land Owner Name:. ... Y..... 43j0!1,...._g0W..Yl....................................... Phone No:..(1.0."A.u.............'..r...............................
Facility Conctact:........ If .... Kr k�........................ .............. Title: ...... Q.QM�........................ Phone No:.0 .�G }. :T..` 1!.....`............
Mailing Address:.....�.� ._3S}�t�...l�t^r.,Kj.ar............................5`i........
Onsite Representative: ........[1Xl...... .1�:10AUV1................................................................. Integrator; ........1'! ...........................................................
Certified Operator: ... &Q `r.......�:1 ..................... .... l q u.,A...................................., Operator Certification Number:1.671�.........................
Location of Farm:
.-Y. 1. a vi..l.a<... !4 k...�2n w.....�a.,.... z s..... • z i.. �....,�aa .... ...h. ..tan...
.. ........ ......... . . .... ....... .
..�.P.....�.+1.�m;.�....rne.�....iu�n.....��:�:....�x�...:�....SR..4,?�i:..I�,Get'.t?:�......��.........r�:►ai�....,px.�....��.�r.�1ra..s1��...�!^�... �...
Latitude ®' 4 ?�" Longitude ©' ©& �46
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes C9 No
❑ Yes q No
❑ Yes M No
❑ Yes 0 No
OIL
❑ Yes M No
❑ Yes ® No
❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
ps Yes El No
Continued on hack

Number: .... 6.1 .... . ....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures, (Lagggos andlgr Holdilig Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Frecboard (ft): Structure I Structure 2 Structure 3 Structure 4
........... 4 ---- ............ . ...... ...... ........... ..... .......
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate pubflc health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste AMlication
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 .......... . .... 1=nw ...... �.� U�&
El Yes 65 No
Yes 19 No
El Yes D9 No
[] Yes 19 No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
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?
............................
[I Yes Ed No
[I Yes [X No
JE Yes 0 No
El Yes JJ�No
0 Yes Q9 No
0 Yes [I No
0 Yes la No
10 Yes [j No
[I Yes [RNo
Yes [:I No
Yes J@ No
0 Yes Eff No
Yes 10 No
Yes 09 No
'C I , ";' " " � 'I'll
'4469tion #):', Exp Ain, any, ES-Answers'a Mm
orriments.,,(reflerto' i Y h d,/.o"r`a'n'y' -redo- m m-'eind -a t. i o. &�-P-6-r-'a n y. o the-r-, 6o e6
dra� "­s 6f fact to etteren am::situa ions. (tise�idditi6 Al.pag6s is�necess
b' ary
StsytCL rv,, CAWK�.
L)MYSC4 J- je skoA W-
IT. Coa�u ( ,
�o P\oA)ej o,4 sfrojcd.
0" zOcL&+-_ Scqk�Ijt. a*10 a4-c_e, 4r 5101 ry-codS.
An VX WIN. OF
Reviewer/Inspector Name MINOR BOWL, , M� WFOU . I , UMMINUM
Reviewer/Inspector Signature: AA.;_ '0111"— Xj��� Date: z&3A �
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30197

M
Al�l
Owner:
Mailing Aciaress:
-01grf 'Capacity:
DEM Certificatic
Latitude:
aL&-V� gj--,
� / - 94��-
Site Requires Immediate Attention: 427/9
Facility No.
,1T,MENTAL MANAGEMENT
.ONS SIT - VISITAUON RECORD
12..1996
Number of Animals on Site:
CE DEM. Certification Number:
Longitude: _Z L* _2_t '-Y Elevation: Feet
Circle Yes or No
NWA
Im
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year,24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: t. . Inches
7
Was any seep?L-7e observed from the lagoon(s) es or No Was any erosion obsep/.ed9 Yes or No
Is adequate land available for spra 9 jj�fqo, Ik the cover crop adequate? r No
V Des
Crop(s) being utilized:
Fe
Does the facility meet SCS minimum setback criteria?. 200 e/frnm Dwelling Y s or No'
es or
100 Feet from Wells? 6, 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 Lin
tv e? Yes ot��
Tz nnimffl wncri- eiicrh Pri intr) wnti-r-, r-.f Hii-gntp h man-made dirch flushing s qi-m nr nthpr
similar man-made devices? Yes 0 If Yes, Please Explain.
Does the facility maintain adequate waVse�management rec o-rds (volumes of manure, land appl . ied,
spray irrigated on specific acreage with cov p1l or No
Additional Comments: . b , -, - /-S q " Ta—)` cl-T ir,- r a PLA _.� 0 C-- 5 J--)�74
I
I r \ f D ? Y\ r* �f r,i -4 1A fl, u I r,7,e t--e J
cc.- Facility Assessment Unit Use AttachmenEs if Needed.
Jr

.RGAO CLEV - EX5 NO _ L_ TA,' AO
i
18alw PAD-
J I)Q, , ••n" .Y %ZE
P1:i VQ . t `:Im T
1
LOW -?SO CPLA E
BUILDIHIG PAD SEC--1F.10N____(LENGTH...
N. T.
2 BUILDING
s .zY r'tD VL;"h -- --It
-
1
-r*-
IT��-_
PAD SECTION (WIDTH_
N.T.S.
Ii S*F " Cf L f - - - 12,11f
-- --
I STAX.'v!;
—� �.A:'LCATAL OFFSET VCR - slT-3P TGH'::Gll. eFTC,9C F4LLNG GSFE
FIAT L"ZR _ &F4'
if WYE
3' _ _ -T -- - - - -------- - ---
1-
'E 1.5' CLAY L4r�
LINER DI ICE CROSS SEC-1-10--N­
2 N.T.S,
%Kr MURPHY
'`,
,t•.zco .tit" rE Y TARMS - a
rive..
P. 0. BOX 759 ROSE N+±
PHONE : (910) 289 - 2111 NORTH CAROLI4 : A 28458
--- le, i F',C31 MADE Top Cf C.+SE ---
T rCV A,F PI& CAP AT
TCP C.£ C,KE Tf P OF OAKE ilfvA"r:r;
3/4' PVC F-,Pt COlUED A140- R ''
- # r UED 'JNTD r PIF E ,} '
11-IIIIII—III— PAIN RED —
1.
�s
k —.� ITA.2T K1.4P EL _ r..7,:�
k �I l II r II I ICI I I— - °-`Frp>
�-111--�111�11I�I I�
Slop fl,:uF a_ 102-30
I I l� III I I ICI I I—1 I I- 8,ACXFU AA�;'.hO s-r,&.�0E
M rH SUO TCWE A.NO CCCPAc r
-_--
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C
CEMENT BLOCK PAD
STAFF GAUGE_______
N.T.S.
-1 1­ 4.J'
t _ THE (��? J •';t �' '.� tJ`;E EITHER 1
- "'ter tr <•r .r-i fl \h ("C7
� -,/ V ,i_ 1,_ LJ L. V \.. , JI L_'•'-J° . 1 r ,J v .
SCOUR 11 R PROTI~_CTiOl",
DEVICE,
2. THE SPLASH PAD SHALL EXTENE
A MINIMUM OF 1.0' UPSLOPE OF THE
PIPE END TO 4.0' BEYOND THE TOE
OF THE SLOPE.
3. PLASTIC PIPL SHALL BE LONG
ENOUGH TO EXTEND A MIN1i1UM OF
4.0' FLAT ALONG THE LAGOON
BOTTOM.
RPE SUFF"T
—I {— 1rH 0' tj+Ltic o'lci �W-lA91'AD - 10
A CL WA-,�lE U CKK &-'ALL M LX0
HAirF
PJPE i,LLC0 ft T�1tii HSHALLA Y SIC- TOGEDIER TIGHTLY YA TH NO
CIAGAPS BE-rAt EN
AND COWPACT£D
-- I I— 4, R' W N ut W
FLEXIBLE PLASTIC PIPE
FLE- EL_E P -FE W AU 9 SCE -,` LR
DIS�tR+� P'P t ],i1N;Sil Fl -r 1'
AAD % ALL
F"PE sUs1�r
Vcy
P,PE SUPPGKT %4N L BE
BACARUED iM TH CLAY ,
AkO COAPACT>:D � T' ---
—I ��--• 4.O' lRl1
SCOUR PIROTECTION DEVICES
2 N.T.S.
RoAND BRA`VDON BR OTVN NUh'
2600 N URSER Y
MI K I DATE
DESCRIPTION
c',r��rAA,til��,�. L�-•-5„ zc.`��t l.>;Ea, =err
2o' vN C'•E;.i,EAD CLEAA-,,,L-E
TtlAyc:) r0 11' fe:H
FRt'M EAR Sr1E
- --- ..-- . 22' L:N TO 31 04
---- ----- 14' AlN - r
ALL *AEAI kY TRAYEL 41prH
4
�� :CAS?AC �FJ3 JIiELL—C`?A,r.ED FOti:f�!
`� F�rV'Gti AJE�A;JA'E JI;TL�f
a t-
MINH�JUM REQUIRED FARM ROAD
2
N.T.S. :)
— — -- - — --- STATE UANTA.!,ED R40AZ - PAVED 09 SCOL
- - -- --- - — --- 9a� - —�- ROAD3CC Crra1 —_—
Y Y YYYYY 'Y �r� A r
5G' 6'1 L •:.;1r. I
13' VN Et31Eiit Z•L''NF
J,a. =, TY :A ;F 3
ftAr�D So
_N r1Q71i f*LCTKAS
ti
14' V4 All W-A r(L2 TRA'rEL 600iH
22' S.'Y j CVTrH TD I CiTa1
MINIMUM ENTRANCE REQUIREMENTS———
2 N.T.s.
+^vt�r2 Ltn$j—
r r S1 h iO PVC
BUTtt IRL-11BFR
+1 AhT r/ C,4 CX SAL
JL NC . k.,i ,1< Y
} - -
Fa ; '.R PL'KP CtYd':,CL
�I rr - - -
- I f-
S' PVC Dtaj- q:,£ PIPE x g
Ji
Ln
s
z_
5 (TAN IN:- A
I
1 �
Y
}A P A
d' COt,F'L1kC, -
PLAN
rxrKn4J u:it
r {uRCE MAN TO U,-,fV-N
PIPE Flrr;,r,5
J N.
PIT RECHARGES .
6LDG. PUMP 'I
ONSLOW COUNTY
DRAWN BY: JWR
MARCH 4, 1996
CHECKED BY. JNT
SHEE F 2 OF 2
SCALE: NONE-

�0
-
U R� P ],I,- y
FARATS
I
INC.
P. Q. b . F
p L_�fO11'f (910) 2C "� - % ! i N10R TH l / - -A -
SEEDING NOTES:
1. ALL DISTURBED AREAS SHALL BE SEEDED, FERTILIZED AND MULCHED AS
SOON AS POSSIBLE AFTER FINAL GRADING IS COMPLETED. THIS
INCLUDES INSIDE SLOPES OF THE LAGOON.
2. PREPARE DISTURBED AREAS FOR SEEDING BY GRADING IN ALL SURFACE
WATER DIVERSIONS AND SHAPING TO FINAL GRADES SHOWN ON PLAN.
3. APPLY LIME AND FERTILIZER THEN DISK TO PREPARE A 3 TO 4 INCH
SMOOTH SEEDBED. APPLY SEED AND FIRM SEEDBED WITH A
CULTIPACKER OR SIMILAR EQUIPMENT- APPLY MULCH AND SECURE WITH
A MULCH ANCHORING TOOL OR NETTING. I
I
SOIL AMENDMENTS:
2500 LBS OF 10-10-10 FERTILIZER (1000 LBS/ACRE)
5 TONS OF DOLOMITIC UME (2 TONS/ACRE)
250 BALLS OF $!,(ALL GRAIN STRAW (100 BALES/ACRE)
s
SEEDING SCHEDULE:
\
minter
{'UhtiE' INFO,
150 LBS
OF
FESCUE (60 LBS/ACRE) - SEPT 1 TO NOV 30
MYERS W IR10, CAT. # WHR10P- 2
'
100 LBS
OF
RYE GRASS DEC 1 TO AR 30
40 LBSACRE
( / ) M'
`
2.r SOLIDS HANDLING PUMP,PUMP,DI
p!E<
75 LBS
OF
RYE GRAIN (30 LBS/ACRE) - nurse crop for fescue
r
1 HP., 1750 RPM, 23OV, 10,
25 LBS
OF UNHULLED COMMON BERMUDA GRASS (10 LBS/ACRE)
PUMP TO BE F-URNISIIED V4TH
- JAN 1 TO VAR 30
PIGGY -BACK CONTROL SV0 T GH
;
,.' LU5
_�J
%;F
G . � �,O r 1 J 10 JUNL 15
�;-�E, � �_ .._: ,.,�:Lr, iA GRASS �t L.e�S/AC;.RE)-- E��.r�
� U
i
0 LBS
OF
HULLED COMMON BERMUDA GRASS (8 LBS/ACRE)--APR 1 JUL_Y
- _' TAL AREA
TO BE SEEDED AND WULCHFD = 2.5 ACRES (/,PPROX)
---CONTROL PNT P1082
BURIED REBAR
i
3
N = 5267-8404
E = 5724.3905
I
i
` n
O
ELEV. = 94.71
Ln
PRECAST CONC. PUMP C! lA,YL3F_R-
�
t 0;
(STANDARD PULL PLUG BOX SIZE
V�,T'H
SOLID BOTTOM AND 16" RISER SECTION)
TOP ELEV. = 93.27
HIGH END OF Pt D ti
BOTTOM ELEV. = 94.27
ELEV. 96.80
1 •
1
GENERAL NOTES:
1. ELEVATIONS SHOWN ON THIS PLAN ARE BASED ON AN ASSUMLD E3E-NCH
MARK E=LLVAT10N AND DO NOT REPRESENT MEAN SEA LEVEL DATUM.
2. ANY HEAVY VEGETATION AND/OR ROOT MAT SHALL BE STRIPPED FROM
PAD AND LAGOON AREAS PRIOR TO PLACING FILL. ROOTS IN EXCESS
OF 2 INCHES IN DIAMETER ,'ILL NOT BE ALLOYiED IN FILL SECT1014S.
ANY STUMPS ENCOUNTERED IN LAGOON SIDE SLOPES OR BOTTOM MUST BE
REMOVED.
3. THE SOILS INVESTIGATION DONE BY MURPHY FARMS INDICATE; ► ON -
SUITABLE MATERIAL IN THE PROPOSED LAGOON AREA AND CLAY LIMING
WILL BE REQUIRED. THE BOTTOM AND SIDE SLOPES OF THE LAGOON
SHALL BE UNDERCUT FOR A 1.5' THICK LINER. THE UNFR AAA ;ERIAL
SHALL BE COMPACTED TO 95% OF THE STANDARD PROCTOR MAXIMUM DRY
DENSITY. THE MURPHY FARMS ENGINEERING DEPT. MUST APPROVE
LINER MATERIAL PRIOR TO PLACEMENT. SEE LINER DETAIL ON SHEET 2.
4. THE LAGOON IS BEING PLACED IN A WET AREA WITH TNIE WATER TABI-E
BEING VERY NEAR EXISTING GRADE. IT IS IMPERATIVE THAT THE
CONTRACTOR INSTALL DRAINAGE MEASURES AT THE START OF IHE
PROJECT AND MAINTAIN IT UNTIL ALL GRADING IS COMPLETED.
5. THE GROWER IS STRONGLY ADVISED 10 CHARGE THE, LAGO(YN W- TH WATER
TO THE LEVEL OF EXISTING GRADE OUTSIDE THE LAGOON AS S:)O14 AS
THE LINER IS COMPLETE. THIS IS IMPORTANT TO GUARD hG41!.ST
SLOUGHING OF THE LINER MATERIAL.
6. ALL FILL MATERIAL PLACED ON THE BUILDING PAD AND LAGOON PIKE
SHALE- RE COMPACTED TO 95% OF THE STANDARD ;":RY
DENSITY. IT IS RECOMMENDED _THAT COMPACTION HL_ DONE. et.;;1 A
SHE_EPSE=OOT ROLLER.
7. BUILDING PAD ELEV/,TTONS SHOA74 ON THIS PLAN REPRESE-1:T 6�C
SLAB SUBGRADEE `SEE PAD CROSS SECTIOI,IS FOR GRADE REFEI-�L'�,:E
POINT.
8. BUILDING PAD AND LAGOON DIKE SIDE SLOPES ARE 3:1 UNLESS
OTHERWISE NOTED ON PLAN.
9. THE LAGOON Di�, :F ".0 SIDE SLOPES MUST BE FERTILIZED, SEEDLD AIND
VULI CHLL) DOA%' i-1 THE LAGOON BOTTOM, OR TO THE µATLR LF'v,FL IF
CHAR(,+ D, REFC" c- T1iE LAGOON CONSTRUCTION CAN BE CLRTIs IE D.
1 L. HE CGNC�"L TE E; 0 K t'L�. �� PAD OR OTHER APPROVED
PROTECTION DEVICE; SHALL BE INSTALLED AT PHIE DISCH.AR(',F F:P i.
BEVORE LAGOON CONSTRUCTION CAN BE CERTIFIED.
11. ANY WATER SUPPLY WELLS PLACED ON THE SITE MUST HF A OF
100' FROM THE CLOSEST POINT OF THE LAGOON.
12. THE STAFF GUAGE SHALL BE FABRICATED AS SHOWN ON SHEET 2 AND
'RILL BE INSTALLED BY MURPHY FARMS PERSONNEL BEFORE CONSTRUCTION
IS CERTIFIED.
FAR <_RK CAL-CULATIC)',.I DATA ,
WLTHOD U`Sf.7: 5' {:r.1U
I
f
TOTAL EXCAVATION 1,881 CY *« EXCAVATED PLAY
PAD AND DIKE FILE 7,392 CY + / � RFO'D F()r� i Irl'L R
-- NET 5,511 CY
_11T/',FILE FOR LINER - --0 CY -
1,0RR05,511 CY
FILE Y
VOLUWI S b Y i _` % F 0 H �1 il!611
* i TOTAL EYC,I..','r"+ T I�)'v' `'UI 1.11.E P. t JI)E
off,
~ CONTROL PNT' 43 --
BURIED REBAR
N = 4835.13B1
E � 5276-5431
ELEV. = 98.45
CONTROL PNT k1021
BURIED REBAR
N = 5421.6378
E = 5998.3727
ELEV. = 91.83
TP
0-12
FP-2
PA0-6
D
Ok
-
:-�-.� � 13 � 4 A r3o.co - S.G. -
Y; ,n (10PAD c PE ! L_- 3
fEF_[)
E.I.E_�
. `:f• n;.7 ----.__y'}� I 0.25._!= -'` ✓ - � �
r
LOW END OF PAD-
l f'1,I1C)�JT CFlU1F gh. `- _J� .•� -Y ti'��t '
PROPOSED ROAD
SET AT EXISTING GE: i �� _� _ 0-7
1 � �
TOP OF Dtt`;I` EL. = 101.50
START PL1M!P EL. = 99.70
STOP PL111,P E1_. = 97.70 LEGEItiE D
'J >I r �� ,�f• FINISHED BOi-T01M EL. -- 91.50 ---
S
Z
EXISTING WQ C} D S L! 'J E
�,o - - --- - -._ -._. _ EXISTING CON TOU r`-',
_-------.----- 5 0 -- F 1NISHED CONTOUR
F E!
3" PVC FORCE MAIN
CONTROL E'1JT f 1081
L3UR,ED RFE3hR I Ml1N1t1Ut�4 BUILDING / L�.G v ONN= 4984.731E � -_.�_ - -� SETBACK LINE
GRAI-111IC SCALE 0WNER:
ROY LEE BROWN
IF
1105 GREGORY FORA -GOAD
RICHLANDS, IBC 28',
EIP
( IN FEFT -- -- - - - ----
1 iroc:h = 40 ft. R( Y- AND BRANDON 13HO
TITAT N
U
6 0 0 N UR Y
1, 11, ..., 01, .-
SWALE / DIVERSION .
4' x 8' coNc. BL`JC;K
SPLASH PAD
STAFF GAUGE
SOIL TEST PIT
PAD, LAGOON, OF -=SET
STAKEOUT POINTS
GNSLG'+h' COUNTY DRA µ7J 8Y: JWR
V�,RCH 4, 1 996 CHECKLE-0 BY' JNT
sHEE r 1 of 2 SCALE: 1"
= -too