710030_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quaff

Date of Visit: I ) at QS 1 Arrival Ti,,: g o Departure Time: County: PC+QDC�- Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: r Title: Phone No:
Onsite Representative: VCrr_,1�.J } F,��e� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
=o =4 ��� g =o=i �
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish k
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
FE-11urkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
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?
1
❑ Yes LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [l"No ❑ NA ❑ NE
ElE Yes No ❑ NA ❑ NE
12128104 Continued

i
Date of Visit: 21107 1 Arrival Time: $ n Departure Time: County: 0C JDER_ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
�o =' = g o
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 0'4 -t S
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
I.Q. Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design ' Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: E-
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 LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ErNNo ❑ NA ❑ NE
❑ Yes LI No ❑ NA ❑ NE
12128104 Continued

Facility Number: it — 3v Date of Inspection I �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: LA6r60PJ
Spillway?:
Designed Freeboard (in): `L6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [[�NNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes [Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ fI o
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) i.1J3 (Rr r r k,)o N i W0 S&
13.
Soil type(s) .,.... tAe:- 1pow�
14.
Do the receiving crops differ from those designated in the CAWMP? El Yes
,._,/
ld��N'' o
❑ NA ElNE
15.
Does the receiving crop and/or land application site need improvement? ElE Yes
NNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
Z"No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
0b
El NA El NE
18.
Is there a lack of properly operating waste application equipment? El Yes
Kco
❑ NA ❑ NE
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Reviewer/Ins ector Name ^`g' _
p ,�a� <r..U�,u fit_ Phone: ,$.
Reviewer/Inspector Signature: Date: i 1.0.+ rU S"
12128104 Continued

Facility Number: ') — ti Date of Inspection Q
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes CJ No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, appropriate box below.
❑ Yes
[INo
[INA
❑ NE
Zhethe
[IWaste Application ElW kly Freeboard aste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
El Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain InspectionZ�40
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Zo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
2"NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
E NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,�
L"1 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L'I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L` J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ba `"
❑ NA
[I NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
.. _ .. _.
Additional Comments'atidlar Drawings #
12128104

(Type of Visit oCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit JO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: I
j ,3Q
Permitted 0 Certified 0 Conditionally ed [3 Registered
Farm Name: ..R.00 F—LL bRo 5.-.......... .....................................
Owner Name:........Qf f'.0'IJ Q0......�. �����..... C—C-ON N G.LV
20 Time:
Not Operational O Below Threshold
Date Last Opejjed or Above Threshold: .,
County:....!.. p ER ..............................
Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
FacilityContact:......................%..................................... ............. Title:................................................................ Phone No:...................................................
kk
Onsite Representative:...... .......... /...JEl�1,�� ............................... Integrator:....., . \. .R�. P..................................................
CertifiedOperator: ................... ............................... .. . ......................................................... Operator Certification Number:..........................................
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' A fit Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes VNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes 0 No
Waste Cotlection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... ........................................................................................................................................................................................................
Freeboard (inches): 25
12112103 Continued

iFacility.Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
JZ No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
ONO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
'0
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
ONO
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ZrNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Grou d ❑ opper and/or Zinc
12. Crop type 8 Z L (r`11iWd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
XYes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there a lack of adequate waste application equipment?
❑ Yes
J� No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONO
Air Quality representative immediately.
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Rev�ewer/Inspector Name s/�` �,:._, . ".!:.... .., .� ..t.; Kd:,.
Reviewer/inspector Signature: Date:
12112103 _ Continued

Facility Number: — Date of Inspection
ReQuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ;E(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.) zYes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;allo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PNo
26.
FaiI to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
VNo
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JZ No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
NPDES Permitted facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes eNo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After l " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were rooted during this visit You will receive no further correspondence about this visit.
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12112103

N.C. DIVISION OF..WA TER QUALITY
Water Quality Section
Complaint/Emergency Report Form
WILMINGTON REGIONAL OFFICE
Received by c� i ✓� JSu SL-I-a r-' � Rafe `7 3 OZ lime
Emergency Complaint City County Pe 3-tAe V-
Report Received Flom
Agency Phone No.
Complainant A worn 4a y%, r,
Address Phone No.
Check One: Fish Kill Spill Bypass L-Animal NPDES N.D.
�Stormwater Wetland
Nature of Referral yv--, _ r4 Lf-S
kE►1 �, K4 s-e- 1412ri.
Other, Specify:
rune and Date Occurred
Location ofAreaAffected Cg� a"`� .Sv ✓'ou�ZG��'"� �i �� 4� LeA- '"LLCA
Surface Waters Impacted Classification
Other Agencies
Investigation
lnvesflgatot;
--r- ;^X
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��n nF1-Uti l / M-141t,,'.s
Z
SA WOS ISHEL L S WEP OR T. SHL
EPA Region tV [phone] Pesticides 733-3556 Emergency Management 733.3867 Wlldlile Resources 733-7291
Solid and Hazardous Waste 733.2178 Marine Fisheries 726-7021 Water Supply 733-2321 Coast Guard MSO 343-4881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 9 Telephone [phone] • Fax [phone]

Type of Visit Xcompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine fp complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number r% s I
(late of Visit:
0 Permitted [3 Certified [3 Conditionally Certified [3 Registered
Farm Name: ran rle tl B`d )vas ;� 2-
Owner Name:
T^
Mailing Address:
3 D2 Time: (Or00
rO Not O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County: e✓'
Phone No:
Facility Contact: Title: y Phone No:
VBr'M�-, rl✓12�� T� �en�Ei!� Tae r� f Onsite Representative: _ '� ,! tegrator: U i1
Certified Operator: Operator Certilication Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 0 °° Longitude 0• 6 [[
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Non -Laver I I 11R1LJ Non -
Other
Subsurface Drains Present 1LJ Lagoon Area ILJ Spray Field Area
No Liuuid Waste Management Svstem
Discharges &i Stream ImUct
1. Is any discharge observed from any part of the operation? [Yes ElNo
Discharge originated at: [I Lagoon Spray Field El Other /
a. If discharge is observed, wastheconveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 2r" lcs ❑ 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) �f+ ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? 611 es ❑ 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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 36.5
05103101 Continued

Facility Number: Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ErExcessive Ponding ❑ PAN VHydraulic Overload
2Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & D-ocuments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes "No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�a >. MUM 4Comme s (i ewer 4o`qu stun # Explain any YES answers ;end/or anytrecoii iiiiddii<tlons or.M other compoents `.
y
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e see ided -!-e o't Ce,-voleon4- a pAsse_-by Ca,r lead bce4, sp ed
t-a 141, waS4e . _T 5?.4 6 y 44e eneLd fog q 4rcw ^--;,,t o-kS Gvv( d g ee "I
see or qw� del17 Gom* 4 -�lte rood; 7T d;d ��ts}����-l�si-� Ae
LV4
s y.q, s tumid be lvened of,1` si _►cQif -tverf 4Lje,,Ac wrs scltF W".-Lc( b
OvS4.5 aid - tie sys4e_`-► 1I/rt:C 4V,-_jec( cIAC.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3 (j
O5103101 Continued

Facility Number: 171 —3Q Date of inspection ,9Z
Odor DUOS
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
AdditionalCommentsand/or Drawings:
i
�. VnOFf fro^^ 4he 5 -^Q%/'� 1d d�'Scmerged
Wa4cy- 3v t ,5gmf1CS 4Pid i c4 vreVs weee. 44k pi .
off' a wg141 WCJ r-Oq fa,,,�( J /+?f. fennel! Pee M,y ;"J4rv,- ors .
?. Need -IO e,ee,,1e%^t ►2es Sk,rVbr, Av& hood
�► Qt C c• rt rci n roc Q w -� - 9'red C 49 ' rtee�' i 49,64; cue s - 7e l y-. , -- -e
4,4 S 5 e-ow4A 4� 4l,e 4-re or 4 �e I Mg60�'b es1-,961 ,'.Jr1, 9 r,^s s
Gov c f. Gel help 16 J vPrf V j S P &1 Ae / -fill r ;FAO >J Sc i 1 111144e e,
,feu- .Se.' VP re Gore f Arty J ez vtid 01 4W• OL
11 • 0 -� h er ne eW i 7 14e," ► I, t Al Je o rZ of ► •..q o�t�/iip� fd,�
�vi't oFF' d+? awe✓' plreq� vF Fseld asSoGl�a-1e� tom; -EL, �LIJe
�'1'i�� �a��6•,s of east► 0f r,refj used �od�Y. Also,,
Yak i✓���G�-��l�l �Lta� sDwte9 ewt.064 401 Yple inla 01', aeeq
ekk,acem. -}v -1 ke srAet7le;e td''ll A)eed rkan.;
YG'l'lr 51"71Teu) 0164;v-4ie$ To eYjs<Ufe �'10 �erid:►�rJ, q Ael
f U o,F c, S:. ►n, P l es 4 tP ► cl v rdS 4-,q k-c r Irlee-t 4e be S v►•e 40
07.0� h'Id"O 01 Celt,I ov'er'lem (1,17D ►r'e-f��l�t� O r� ivl/lZrJ Os'i
Q Y sal,d ,se4 eoveer part., cv1ae1 7 Iy 15T
Mo-1e a need e'e las epe Ike records �'a� -5
ioti�s. � y oFrjCe . a e leav;►,� q
6 �S • �esS GArd , S-e-,d 6,y R-pr=,1 10 )2 6 z
Aked -fie also SeYZA w 4h S'°{a,%4 5 QJtih W evp )tFA?;•ti;&,O
-41te ra"4,,,,1 and evrZof�r event a(esG.-; "53k1a4
{, eV pvvN,,c,%A ,r2G vrre-v6e .
V,,ti hay c-F e tecorided 411P even4-1 fa. -��t S �v . AJeed
-�o Peoa,-d eve 14r of lenO d-t
05103101

a � q'a3''i{a�»,ar` 1F .DiVtston of Water Qualsty
ird a » 4 O Dtvtston of Soil and Water Conservation My
geneyO .
Type of Visit e Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Woutine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number
Date of Visit: Time: 1&4A vL Printed oil: 7/21/2000
%�
O Not Operational O Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ....�,hp.3 A...& ............ ". .� ................................................... County: ........1..5'�1�C1.4°✓.......................................................
OwnerName �y.................................. Phone No:.......................................................................................
Facility Contact: .......t/.�..�h ..................................................... Title:......,................................. Phone No: ...................................................
.
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative:...�� �r .......... .......... .. integrator:... J���..................................................
..�r.,r•••.
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location'of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 0« Longitude ' 6 064
Design Current
Design Current Design Cnrreut
Capkity Population
Poultry Capacity Po ulation Cattle Ca'� of :. ;" �tisste6
Wean eeder
❑Layer Dairy
Finish Z
❑Non -Layer ❑Non -Dairy
Wean
kFarTowto
FeederOther
FinishToEal
Design Capaclt
TOtal3SLW `
Nom rPl'6 'ag9efio:.:. ,.::
❑ S
Lag'"'n Area
❑Spray F Area'
a ol!dingPo�tadslSolid^Traps
❑ No Liquid Waste Management System
1
l Y
_ __.. .,
;
n�celd
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. hoes discharge bypass a lagoon system'? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes 04 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idcn ti fi c r:................................................................... ..........
r1
Freeboard (inches):
5100 Continued on back

Facility Number: 77 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes jI,No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes '® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes R No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ®.No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JANo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type Z&AaAet t&tAZ {J (sm. 5e t, , GUl pit 44ve5ee l Kve
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
SNo
b) Does the facility need a wettable acre determination?
❑ Yes
91 No
c) This facility is pended for a wettable acre determination?
❑ Yes
($LNo
15.
Does the receiving crop need improvement?
❑ Yes
(9No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Q No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
50 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
D,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
I@ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Dq No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.
19 No
`*.*i0F;3001ls.or' dtflcknoii *vTe 00,04 �11H` 69 this:visit; • XO WJIV UOKi # futth%r .
correspotideace: about this visit` . . .
�19 �s�t! i✓ is t�O�,�'P� sn 9'��fl �Zq c.�; � 3. jr�waf�r s,���1Q r�k 1,+� , .��yJl�t
'NetlC -/n 1od.c'A�Y sow,
e r>rs rf e RW15 are /it rs r
ur , ' .- d - �'� ; aE ' a
Reviewer/Inspector Nami'tt.A
Reviewer/Inspector Signature: Date: �zl/Q� __ 5100

Facility Number: 7 Date of Inspection 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below ❑ Yes $JNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JXNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
Additional Comments an orDrawings: - , . i .::_ 1�1 ' >" 77
,
5/00

,rOther onCew'p
aA i .el,
Routine O Com laint 0 Follow-up ofDWQ inspection Q Follow-up of DSWC review Q Other
Facility Number j 3D Date of Inspection Time of Inspection 1 124 hr. (hh:mm)
0 Permitted 0 Certified `©/ Conditionally Certified E] Registered Not Operational Date Last Operated:
FarmName: ........ Amell ........... &A......# .......................................... County:............ . ....!.ram ..............................
' Vtru .(" ell ............................................ Phone No:....(...�1��. ............................................
Owner Name* ....................................................... .
Facility Contact: ................... ... ...Title: D Phone No: '1 -ps-
.....�D.......................
MailingAddress: .....................................................................................................
Onsite Representative:........ 4#{J ltKell
t
Certified Operator:... yztI en.. !try, ....... ..........
Location of Farm:
integrator:.....................................................................
Operator Certification Number: ..........................................
............................ '.......... ... ...... ........ ... ...
Latitude 0 1 64 Longitude • 4 "
{ : Design '' Current; Design Current' 3 ttDe'sign t Current'
Swine Ca`act 'Po uEsition Poultry Ca acit I Po `elation Cattle �,`'Xa aci "Po"ulaEioin
❑ Wean to Feeder ❑ La er Dairy
Y ❑ y-.k
T Feeder to Finish 7�1� ❑Non -Layer
'; ❑ Non -Dairy
❑ Farrow to Wean I <<
❑ Farrow to Feeder
❑ `Other r
ff Farrow to Finish Total DbAgn.Capaeity..,;;
❑ Gilts
,
❑ Boars ;'Total"SSLW
Number of'Lagatiris i,}` 1 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
,.
Holding Ponds /:Solid Traps ❑ No Liquid Waste Management System a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �tNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes IV No
b. II' discharge is observed, did it reach Water of the State? (II' yes, notify DWQ) ❑ Yes [(No
c. If discharge is observed, what is the estimated flow in gal/min? ::dh
d. Dues discharge bypass a lagoon system'?•(If ycs, notify DWQ) ❑ Yes 5fNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 19 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes OkNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 11
Freeboard(inches): .......... v..................................................................I.....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [X No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — _V I Date of Inspection
6. Arp 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 or 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
//o}}f over application? ❑ Excessive PondingA❑]PAN
12. Crop type "/7 Jil ur�t elii . bw, , i < Y azaz.
13. Do the receiving crops differ with fhae dKignated in the Certif-i
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This'facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
❑ Yes PNo
❑ Yes %No
❑ Yes XNo
❑ Yes ONo
❑ Yes 9No
❑ Yes ZNo
mal Waste Management Plan (CAWMP)? ❑ Yes
U(No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
0 No
❑ Yes
04 No
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
❑ Yes
R[No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
�(No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
%No
iq vtQ ir1s.or. 0 fjcjetn figs mere pgfpd- ii�tring • bjs:vjsjtf - Y:olr will •r' eetriye i)4 futfte
• corres�ondeh'e:ab' this visit: .. .
3 t 911 , 1 A I.: I� � `b-1 }- - I.
Corttments {refer to question #}" 'Explatn'any YEs answers and/or any:irecommendations or:any other comments
'E "� t : n I ;
Use drawrngs"of fac�hty to better, explain situations {use addthonal�pages3as;necessary) i+' >>r t E
Il �
I � tr. ������ I5 tZDW % � ��� 50�' Q�l I � �Ffrdi•-- l°�G1� f5 �� �j G��it��S
y
i�l IW5 &OW
6�W
JOYOIIWOL
(_7MIZ22
ReviewerlIns ectorName
'e
Reviewer/Inspector Si
v]
1;`/ X�I
Date: , ��/—hJ)

Facility Number: Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon Fail to discharge at/or below
❑ Yes
MNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
j 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 Can belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
allo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9Na
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
�.. . Additiona-.�. n.i..m.. �e..n.,..t,, s :. and/or Drawings:..... .i: .n: ,frair
pp tF,
Et �

Rtviscd January 22, 1995
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number '1 l - 30
Farm Name:
On -Site Representative: Ve-1,w.,
lnspectorlReviewer's Name:
Date of site visit: LA
Date of most recent WUP: qq
Operation is flagged for a wettable
acre determination due to failure of
Part if eligibility items) Fl F2 F3 F4
JOperation not required to secure WA
determination at this'time based on
exemption E1 E2 E34
Annual farm PAN deficit: pounds
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5, stationary sprinkler system wlportable pipe;
fi. stationary gu6 system wlpermanent pipe dstatlonary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, -is complete
and signed by an I or PE.
E2 Adequate D, and DJD3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
N E4 75% rule exemption as ven ied in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part If. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part 111).
PART H. 75% Rule EIigibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the elia_lbiiity
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
t field(s)according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
bufferlsetback acreage; or 25% of total acreage identified in CAINMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F" WA determination required because CAWMP credits feld(s)'s ac-reage in excess
of 75% of the respective field's total acreage as noted in table in Part ill.

Revised Jznuary 22, 19
Facility Number 9 � - e10
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS'
NUMBER NUMBEW-7
IRRIGATION
ACRES
ACRES
%
SYSTEM
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place offie!d numbers depending on CAWMP
and type of irritation system. if pulls, etc. cross more than one field, irspectorlreviewer will have to combine fields to
calculate 75:o meld by field determination for exemption if possible; otherwise ope-ation will be subject to WA
determination. 1.
FIELD NUMBER' - must be c!early delineated on map.
COMMENTS' - back-u? fields with CAWIAP acreage exceeding 759'0 of its total aces and having received less than 5001e
of its annual PAN as documented in the farm's previous two ves-s' (1997 & 1996) of irritation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numbr0VN1V1\
- �d--� :,n Operation is'flagged for a wettable
Farm Name: El r��z�r acre determination due to failure of
On -Site Representative: e Z__o Part 11 eligibility item(s) Fl F2 F3 F4
Inspector/Reviewer's Name: .
Date of site visit:!.
Date of most recent WUP:
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Annual farm PAN deficit: C5 pounds
Irrigation System(s).- circle #: 1. hard -hose traveler-, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipeDstationary sprinkler system w/portable pipe;
6. stationary gun system wlpermanent pipeC7 stationary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acresjs complete
and signed by an I or PE.
E2 Adequate D, and D21D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 76 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before- completing computational table in Part Ill).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements Iisted below:
F.1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
rfield(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches;. failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised Janua-,y 22, 199:
Facility Number -?I _-,; C,_
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
G9
I
1
1
I
E
I
I
I
1
�
i
I
I
�
I
I
I
I
I
MELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWIVIR
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field detarmination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWl`AP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1 998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

_",
i
,.I M—M — �
Rtvised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number `� - 3O Operation is•flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative: Vega►•. Part 11 eligibility items) F1 F2 F3 F4
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP:
V Operation not required to secure WA
determination at this time based on
exemption E1 E2 E34
m lGK j
Annual farm PAN deficit: S1.S pounds
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear. -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6, stationary gun system w/permanent pipe (nstationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, -Fs 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. .
E3 Adequate D, irrigation operating parameter sheet, including map depicting
/ wettable acres, is complete and signed by a WUP.
�! E4 75% rule exemption as veri led in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination •
Requirements. WA Determ_ _ination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revis:d January 22, 19
Facility Number 9 � - 30
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER''2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS'
�a�
c
Tql
3
ll.'1
3
f
�
1
!
i
1
FIELD NUMBER' - hydrant pull zone or point numbers may be used in place of field numbers
depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER2 - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

i
Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numb e d e3 Operation is'flagged fora wettable
Farm .es Name: ++ua acre determination due to failure of
On -Site Representative: e _U Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name:
Date of site visit:_
Date recent a f most nt WU r c P-
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Annual farm PAN deficit: pounds
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe%stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part If. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part 111).
PART If. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
%eld(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Re-ised January 22, 1999
Facility Number
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER1.2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
3
�S, Sal
lS' a9
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER' - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

" ' Dlv"`ioR Of SDil and WMe `6 nkrvati n r . N -Operation Review
" E. Division Of Soil and Water Conservation - Compliance inspection'r
�DlVl46n of'Water Qn pity-:CompliilnCC Inspection
` Other: Agency - Operation Review
_ r. Ni•J y
RRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review Q Other
Tom!
Facility Number Date of Inspection
Time of Inspection �3 'f 24 hr. (hh:mm)
© Permitted Certified 0 Conditionally Certified © Registered 10 Not O erational Date Last Operated:
FarmName: .... .... { .................................................... County:..........:... '"..................................................
Owner Nome: Phone No:
.....................
FacilityContact: .............................................................................. Title:................................................................ Phone No: ...................................................
MailingAddress : ......................................... .. ....... Q............ .
Onsitc Representative :...ti..rt SssQJr 1 Integrator:.....1,"��^r....
..............................:......
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Locatiop of FArm: I % r r 1\ t I . .
. ,! .<. ....1 .�.... ... `-�... ^y`z, �.-... ►. 4...... �....'.�. ..`.:..lu...�...... � :` "ccz ... ....TN. .............. i
.......................................... ...... ..... .......... .......................�
Latitude 44 Longitude ' 4 "
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I JE1 Dairy I I —d
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated al: []Lagoon ❑ Spray Field ❑ Other
a. li` discharge is observed, was the conveyance nian-madc'?
h. Ii'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. lf` discharge is observed. what is the estimated liow in gal/thin?
d. Does discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes Wo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X No
❑ Yes OrNo
❑ Yes [YNo
Structure 5 Structure 6
identifier:
Freeboard(inches):..........3.I ........................ ...................................... .....................................,.,....................................I.......................
1/6/99 Continued on back

F,pcility Number: F71 Mac of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement'?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, 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`? ❑ Ponding ❑ Nitrogen
, �.....................
12. Crop type .................j.........��.....�,...............,......,. .................... t"4�i . ................
0
❑ Yes 0 No
❑ Yes N No
❑ Yes M No
❑ Yes Nr No
❑ Yes LokNo
❑ Yes �io
❑ Yes XNO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes 2[No
15. Does the receiving crop need improvement`? ❑ Yes N(No
16. Is there a lack of adequate waste application equipment'? ❑ Yes [XNo
Rcuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
NNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19,
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
>31Yes
ElNo
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 certified operator in responsible charge?
❑ Yes
[ONo
22. Fail to notify regional DWQ of emergency -situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes N No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [XNo
24. Does facility require a follow-up visit by same agency? r ❑ Yes N No
0•. NA.violations'or. deficiencies .were nateed. during .tliis.visit..'Y.ou vvill.reeeive no further .:.
correspondence; t3botit'this :visit.:: :::::::::::: :::: :.............. . .
Comments (refer to question;#): Explain,any YES answers and/or any recommendations or any other comments
IIl�Se draWmgsi of faciiivt yto� bette�r ex�lam situa�ti2ons. (use addittilonal a e,s.:as neces
ram ;
x"
cc:
Reviewer/Inspector Name `
Reviewer/Inspector Signature:
Date: 3 l 1 /6/99

0 ❑
L� Division of Soil and Water Conservation Other Agency v ' '
afbivision of Water Quality f
10 Routine O Complaint O Follow-up of DWQ,inspection O Follow-up of DSWC review G Other
Date of Inspection I q—Z2--W
Facility Number
© Registered WCertified )Applied for Permit © Permitted ,
Farm Namc:.......e.h.n11....��.,....2
Owner Name:...... ri.,o....+....... ....
Facility Contact: ................ ...... "'.. l..G...... !.`.':`.: tle:..................
Mailing Address: ............ .00 L-, (fle Y....................................
Onsite Representative:...................................................................................................
rr
Certified Operator-,.................`� !......- e j oe y...........................................
Location of Farm:,
Time of Inspection ! 0 24 hr. (hh:mm)
© Not Operational Date Last Operated :.................
Count
Phone No: ... j%..'.... �7.....`�..'Z..J.........................
.............................................. Phone.No:...................................................
Integrator:....... .....................
I........................
....... Operator Certification Number ,...... k.6- .............
................................................................. �r
Latitude =- =, 46 Longitude =• =1 11
;
Design zr a
Uesigri =' Current ;' a
Design Cut'iret t
a >$wme
�.
Capacity FPopulataan „Poultry
Capacity: Pnpulattan-• Catttle,
CapacttyePo u[at og,
[] Wean to Feeder
❑ Layer I
I
❑ Dairy
Feeder to Finish
Z Ll I
I0 Non -Layer 1
❑ Non -Dairy
',
❑ Farrow to Wean
❑ Others
„
❑Farrow to Feeder
❑ Farrow to Finish
"'Total Design Capacity
❑ Gilts.>.a
❑Boars
: ,Total SSLW.
Numbng P er, of Lagoons / Holdi►�ds ❑ Subsurface Drains Present
❑Lagoon Area ❑Spray Field Area
......... .
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
2. Is any discharge observed from any part of the operation?
❑ Yes
o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
[[��
a. If discharge is observed, was the conveyance man-made?
❑ Yes
VNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
VNo
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
,_/
b No
Y Is there evidence of past discharge from any part of the operation?
❑ Yes
VNo
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
�fNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
7. Did'the facility fail to have a certified operator in responsible charge?
❑ Yes
OfNo
7/25/97

Facility Number:' — 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons.Noldina Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Freeboard (ft):
Structure 1
..............I..... ........
.Z r r lr
Structure 2 Structure 3
la. Is seepage observed from any of the structures?
❑ Yes KNO
❑ Yes gNO
Structure 4 Structure 5 Structure f
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 Iack adequate minimum or maximum liquid level markers?
Waste Application
14. is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15 Crop type NQ_" filV d'•.
..................................................................................
❑ Yes , "No
❑ Yes KNO
At Yes ❑ No
❑ Yes �No
❑ Yes lkfNo
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ffl"No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes �frqo
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment? ❑ Yes K 140
24. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes )�No
22. Does record keeping need improvement? ❑ Yes KNO
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes
[] No.via'litiohs oi deficiencies were-n6tid-during this.visit.-..You:wilt rereive-no-ftirth�er�:
. • eti�respui�dehce about �t�is: visit: ' . , ; , :.....
4e,5Dvh 4—((..
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: _iyJ '� Date: 9 — Z 2--

... . ......
.. ... ..... . . .....
63 DWO. a -A ime
al F'edlot,Opeiafion ite,I'ns'pection,;:�,....,..,;,,:
k.
R Routine 0 Complaint. 0 Follow w-up of DWQ inspection 0 Follo-uo of USWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection = 2-07 Use 24 hr. time
Farm Status: t.
Total Time (in hours) Spent onReiiew
or Inspection (includes travel and processing)
Farm Name: --E fe'so a e- county:
Owner Name:.,J Phone No:la 1 —0
Mailing Address:--- S1)-Q L;
Onsite Representative: -tt&st—, E e Integrator:
Certified Operator:—_�vc W.�
Operator Certification IN umber:
Location of F2rxn-
0r- L""Ing 141449 ---K%
. .. . .... --.— Fc,
0
Latitudeonitude 'i
�•���� Lv
rE—J Not Operational Date List Operated:
7
rype of Operation and Design Capacity
-.Nl ib Cattl e
44D,
m
❑ Wean to Feeder T
Laver
Dairy
aleeder to Finish
V
i/k/ 4�jM-JEI Non -Laver I
Beef
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other Type of Livestock L-1
.. . .. ....
Subs Present
Number ''o* filig"do- a dhd urface Drains
Lagoon Area FEI Spray Field Area
General
1. Are there azy buffe-s that need maintenancelimprovement? ❑ Yes 14 No
2. Is any disc: arze observed from any part of the operation? El Yes ®.No
a- If discharge is observed, %xms the conveyance man-made? ❑ Yes 9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 9 No
c. If discharge is observed, what is the estimated flow in gal/min?
JA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes. 9 No
I
of past discharge from any part of the operation? Is there evidence El Yes No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
3. Does any part of the waste manap-emenc system (other than lazoons/holding ponds) require [j Yes No
rraint—anctimprovemcnt?
I
Continued on barl,

6. Is facility not in compliance with any applicable setback criteria?
❑ Yes
1KNo
7. Did the facility fail to have a certified operator in responsible charge (if inspection after l/l/97)?
❑ Yes
C5No
8. Arc there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
®,No
Structtires (Lagoons and/or Holding Ponds
9. Is structural freeboard less than adequate?
❑ Yes
?❑ No
Frccboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
1z
Lagoon 4
_ .�
10. Is seepage observed from any of the structures?
❑ Yes
(.No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
15?�No
12. Do any of the'structures need maintenancelirnprovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the"struct&es Iack adquate markers to identify start and stop pumping levels?
❑ Yes
%No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
gWo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .. �..;r ..,,, ,t A-,%_ ..,;j�y".1 -A
16. Do the active crops differ with those designated in the Animal Waste Management Plzn?
❑ Ycs
lL\To,
17. Does the facility have a lack of adequate acreage for land application? • .
❑ Yes
& o
18. Does the cover crop need improvement? ❑ Yes KNo .
19.. Is there�a lack of available irrigation equipment? ❑ Yes LN'o
For Certified Facilities Only.
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes fgNo
2I. Does tha facility fail to comply with the Animal, Waste Management PIan in any way? ❑ Yes KNO
22. Does record keeping need improvement? 19 Yes JkNo
23. Does facility require a follow-up visit by same agency? ❑ Yes E,No
24. Did Reviewer/Inspector fad to discuss reviewliaspection with owner or operator in charge? ❑ Yes W40
11•
Mcw la.gDc^ Wa.l1
av,.iL cvt
do,-JV'%
LZ .
Cv r Y, t ✓t
1 tL � V%
w a,j r C
ct V"GL
s; v6s.
Sc1tSfd "vim bz t-�Ke�►.
Reviewer/Inspector Name "'
Rerlwer/Inspector Signature:-rX.�i.��a�r � -- n Date:
cc: Division of Water Ounlln•_ meter Oualiti•Seetinn_ Fariliiv Assessment Unit 11114196

} Site Requires Immediate Attention:
Facility No..,7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONGSITE VISITATION RECORD
• : DATE: 1 , 1995
1 ! Time:
0 �j Fast Name/Owner:
Mailing Address: eg
0 County:
\JA V\ Integrator: 4tarl
�On Site Representative:
r Physical Address/Location:
Type of Operation -
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:'Longitude: ?' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon havees�sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)j(Y or No Actual Freeboard:;2,—Ft. Inches
Was any seepage observed from thAllaoon(s)? Yes 0 Was any erosion observed? Tes o" NoIs adequate land available for sprayr No Is the cover cr p adequate? Gor No
Crop(s) being utilized: '� /Y s
Does the facility meet SCS minimum setback crit ria? 0 Feet from Dwellings? or No
100 Feet from Wells? a or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oro
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orf
Is an'imaI waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:. Gci fod� 'S
/'O
-11i - i�_rii i� u.
Phone:
cc: Facility Assessment Unit Use Attachments if Needed.

•
•
Site Requires Immediate Attention
Facility Number: - 3
SITE VISITATION RECORD
DATE: June 17 91995
Ownervernon Fennell N.farm Name: F32
County: Ppndar
Agent Visiting Site: aH & F§ C S ,- _ -_ Phone: [phone] _
Operator: _Vernga F ,nnell _ _�_ _, , _ Phone: [phone]
On Site Representative: SAME Phone:
Physical Address: Little Kelly Road Bur aw, N.C. 28425 - 1.5 miles south of the
intersection of SR 1400 and SR 1409.
Mailing Address;
Type of Operation; 'Swine x Poultry Cattle
Design Capacity; 2448 FinishinNumber of Animals on Site: 2448 Finishing^
Latitude: 4 " Longitude:c "
Type of Inspection: Ground x Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: _k— Feet _2_ Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or N8o Was there erosion of the dam?: Yes or No
Is adequate land available for land application? eof No Is the cover crop adequate? S or No
Additional Comments: erosion one aide but
apparent danger to the integrity of the dike. Temporary storage is
full, pumping should proceed whenever possible.
Fax to [phone] Signature of Agent