710034_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

.... ... Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
— -- O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 3&Complaint O Follow up O Referral O Emergency Q Ot>gr ❑ Denied Access
Date of Visit: 2 Q Arrival Time: ' Departure Time: �County: Region:
Farm Name: '� / Owner Email:
Owner Name: Pham—
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: Longitude: = °
Design Current Desigin . Current Design Ci€rrent;:_
Swine Capacity Population,' Wet Poultry Capacity Population 'Cattle Capacity. Population
❑ Wean to Finish 10 Layer
❑ Wean to Feeder ❑ Non -La er
Feeder to FinishEl ZO��
Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
0 Daia Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: nr
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L(J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
I
[:INA
El NE
❑ Yes
LYtvo
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struc re 1
Identifier:11
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
❑ Yes — No
El Yes /❑ No
Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /UINo
through a waste management or closure plan?
El NA El NE
El NA ❑NE
Structure 6
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes oNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ❑ No ❑ NA�/9NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA UNE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No ❑ NA /Z NE
ElNo ElNA ;dT
❑ No ❑ NA I�NE
❑ No El NA //�/NE
El No El NA ld NE
Comments (refer to question #): Explain any YES answers and/or any,recommendations or any other.,comm ents:
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
�15
�yT�� ��vz 5 Zoe �� 5��� � L�.¢r�.� ��✓ 5� /�/.�-y�oNd
Reviewer/Inspector Name 1 j Phone: 9110 p— 737-7
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2/2 /04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA �NF
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA YINE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA YfNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA �N1E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA T
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[:]No
❑ NA
I1NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ElNo
❑ NA
`VNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ffNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
PdNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0No
❑ NA
❑ NE
Additional Comments and/or Drawings:
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l
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c�
Page 3 of 3 I2128104

�I N 31+
Type of Visit 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: $13 U S Arrivai Time: l l a Departure Time: County: 2r_2J DEii._ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:yCQxz._y. H EtlG-F-
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 o = 6 0 " Longitude: ❑ o = ` =
is
Design Curr A
ine
OWNDesign
VVet Poultry
Current i@
Cattle
Design Current
Capacity
Population
Capactyopulation "I .I .
Cap_ acityrP pulation
Weanto Finisha
rEl
er
"r
❑ Dai Cow
Wean to Feeder
on -Layer
❑ DairyCalf
Feeder to Finish a
�3d
❑ DairyHeifej
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
Non -La ers
e❑ Beef Feeder
PE113oars
❑ Pullets
❑Beef Broad Cow
El Turkeys
Other
❑ Turke Pouets
❑Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
['No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
lwl
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: It— 3 y
Date of Inspection 8 3 oS
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: LA G ovr-
Spillway?:
Designed Freeboard (in): ay'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E]�No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
40 ❑ NA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[1 No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[] Yes
O No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,��
[! No ❑ NA
❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
12'No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1-,ZE e_N,,u-om G-)
13. Soil type(s) 00 l%Fb
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&NNo
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
D<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,0
Yes
[;I/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Lh No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:]No
❑ NA
❑ NE
act.] Vj T" CRC44 ZoNc CA1✓LuL�A-re' T4E L02a.Es?o0P:1_Q& WCT-tcD
LA &oc-Q EXS.SG N Orgy L-q "A S 642. u_lzrJG A
rvmP L-CVEL ,
Reviewertinspector Name aN ` Phone:
Reviewer/InspectorSignature: Date: f/3b
12128104 Continued

r
Facility Number: -] I -- 3 Date of Inspection
Re uired 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 appropiiate box. r7KJ'UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes 10 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes El No ❑ NA ❑ NE
[�Ks ❑No ❑NA ❑NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E]�No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E31�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
'NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
E NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑<
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[3 A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9'0
❑ 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
Q 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
B No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D-1
❑ NA
❑ NE
Additional Conimetits ard7or,Drawings
12128104

Date of Visit: �=-=1-ffx� Time: t
Facility Number J
1 0 NNot Operational C Below Threshold
t Permitted 13 Certified [3 Conditionally Certified CJ Registered Date -Last Operatedor Above Threshold: ..
Farm Name: .. _ . 1 ._. /jl'/ Wy) County:
Owner Name: �/ �`� 'Phone No:
Mailing Address:
Facility Contact: __ Title:... . _ ._ .. Phone No:
Onsite Representative: ku�L Integrator: 9_4Z ,&141
Certified Operator:
Location of Farm:
Operator Certification Number:
i
;dSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 9 �u
Swipe
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
nrrenf _ Ue�ga -,�C&Tlnt
illation. :Cattle c _ ` ,.iCanac�ty>":Ponfiktion
7,1,1
K -� Total Des
y
Discha!Mes & Stream Impa
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?
❑ Yes 4No
❑ 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 ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes RrNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifies:
Freeboard (inches): 3
12/12/03 Continued

Facility Number: —_3 Date of Inspection i
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes A No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes (Z 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 gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 2rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ONo
elevation markings?
Waste A heation
10. Are there any buffers that need maintenance/improvement?
❑ Yes PNo
11. Is there evidence of over application? If yes, cheek the appropriate box below.
❑ Yes 0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen and ❑ Copper and/ Zinc
/011
12. Crop type E fj F F
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management P (CAWMP)?
❑ Yes ZNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ZNo
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 WNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes JZNo
liquid level of lagoon or storage pond with no agitation?
I8. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes '0 No
19. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
❑ Yes ;ZNo
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.
Field Copy ❑ Final Notes
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ReviewerAampector Nance
ReviewerfInspector Signature:
W-C 7,V_ Accv6p 5
12, lf�Ca�in�NO ru
Av&A -Wd' ��rAA:-Ja e(,5j
Date: /Z13/10
12,82/03 Continued

Faciiiq Number: — Date of Inspection
R_ eguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 'Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 0 No
23. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Freeboard )j Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JZNo
25_ Did the facility fail to have a acdveIy certified operator in charge? ❑ Yes JgNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes 12 No
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0 No
28. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes V No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (if no, skip questions 31-35) ❑ Yes ONo
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 NPDFS 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
a No violations or deficiencies were noted during this visit. You win receive no further correspondence about this visit. E
25) lVf4o. r �� U4r 54&
.12/I2/03

Type of Visit JaCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit QrRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted [] Certified 0 Conditionally Certified Q Registered
Farm Name: __ 7_ " 22:.., %{ �, Vt., 6 a.'k.
Owner Name: 'r'� L? W cA( c
Mailing Address:
Facility Contact: — f' Title: � J ,/�
Onsite Representative: c1 ✓ '� "} p�of� Se �E' "1- CIC��l�tE7r
Certified Operator:
Location of Farm:
Time: 2 0
Date Last Operapd or Above Threshold:
County: grkde-
Phone No:
Phone No:
Integrator• t'
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° �" Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2, is there evidence of past discharge from any part of the operation?
❑ Yes fidNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,l 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 X1No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number. 71 -34 Date of Inspection 2 0 Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
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 Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZrNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ZPAN ❑ Hydraulic Overload .0Yes ❑ No
12. Crop type P" .$) v r e ,S,,% 11 D v [/SCCO(
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes Jallo
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement? ❑ Yes ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONO
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
ZNo
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?
ffYes.
Lf No
(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?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Use drawings ofk actltyto better expiate sttuattons (use addihonalpegesafnecessary}.. El Field Copy El Final Notes
cI a
e c d s r n C­ o-:�' a i. 4e l W r, j j. .Se .-we 1 r 10 rr7Sre_"4,1.
,-geed -FG 9,ade 41 cse eVet,r. ..s"vr AWC )-arJ cover apt Ia�?oabq.
I1 �1-je TKP--2's St mo , 10W Dvertr�1�Of�r_a{ian�-�L,; s IS 1►-�-I�.e a�'�cu►'►} O
4. )Z 1 &S1c cG -e O� "ZDvNQ 5 of 4ke Zed) bee- w ti4a.
r9. IUa L,,l&s4G th^4r1rfS w,-}Itirn �� o1ay1 � Sep4enf;er4h--Ut
Novc, ­ 6 e -- Zoo 1 e vc 4 fS . NEcA L. ,,%f -I v e, na 1 ; s w ; 44 0 r) bO dells 61�61-71
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — 3Y Date of Inspection 1) Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 10Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes J2 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes "No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ffNo
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
/11No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Of No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings: T
t9. eveiiiS anal Vle 4o Gcttc y1 eAc vl�-�rnoJ�►.• a.�°Pi�ep� a�-, 2t'e2-2rr •
Need A sa— r jP +6 c-evcr {he �cx.zv��`1 •b eveA'f<J
and tr�Ga�C-'t+4e r-C601-d GiLCo,rG�:r��1
'rinere is Hb IVavct 60." 3O, Zoo 1 Ap-t4 DC4,; gber rj -.DO t
-rec boA,o1 recz, --d � tie Yv-,e +oe 4o kzer east, week.
Z) . C'-e'L-1cr has CurreYt fi 0:1G t "'+ I r piv-� e(esi9"4c'A
as OTC i.4 oLt,- e4a4ab4se i An, )c4vlr,5 -4kc 0 C
•F"o,rm 4 o be 4'41 ed oLA4 � send n
2 Z. O-(-titre ove.-arp�--Ccf4'on
o, s ;n O c4eber q ee co uh4r-d -{o ward laer t i1 ��
i, zoo). W4L1.c rlct►, 4br ber-tvcl^ 41,
M" jhd je 'f�'�j! �ctf6t�-vrne.r 4kU4,Dli 2.Qol 4e -,)few 4hrm,)
oe4pbe.+r )45. Neeof deev► NCn 4A4 i at, to✓ „ )�S 4 SeD� ." of ColI
ir
sy--All lrct"n Llar
o~-, ,-a+Nce o-F
o� zjoed 6Da-1.+r0I ✓rA?';-y '17ys4eM
;s hen! /<e-14.
4ve^o" ri / -Ikc
5/00

,Division of Water Quality.
r` Q Division of Soil, and Water Conservation
_ V . Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 7+ Date of Visit:
kPermitted ❑ Certified © Conditionally Certified E3 Registered
Farm Name: � ^t K i-v I
'.:M.........'tj ................. j��.'.. ... (.C..........................
Owner Name: �''�'`„• ,r1G d P-
...... ..............AJ-.................................................
Time- ? : j Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County:.... ...................................
Phone No:
FacilityContact:..............................................................................Title:............................ Phone No:
MailingAddress:...................................................... .................................................................................................................................................... ..........................
Onsite Representative:.... .... ....T !.�..... e............................................. Intef;rator:... .. -
CertifiedOperator:................................................................................................................ Operator Certification Number:.....................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude ' t «
Current
Wean to Feeder
Feeder to Finish
Z4 4Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nuar<ber oiLLagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE3 Spray Field Area
iolldwg Ponds 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: [I 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 2�No
c. If discharge is observed, what is the estimated flow in gal/min? h
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes J9No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes *0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes $No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................i................. .................................... .................................... ... ..................................
Freeboard (inches): Td
5100 Continued on back

Facility Number: !r1 — - Date of fnspection i 15 O Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 §fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JKNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes FZFNo
12. Crop type errh.%j) c. G--az e.Shy l Gael i.1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PINo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit 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)
`jdYes
❑ 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
13 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
0 No
23.
Did Reviewer/]nspector fail to discuss review/inspection with on -site representative'?
❑ Yes
fig No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NO.*igfatidds.Ok. 00101e0609 *&iD noted• OpOinis;visit. Y64 Will•reegiye too urth�r;
:
corresoori�eitce: about this :visit ................ ..................
Comments (refer to:question #) Explain any YES answers and/or any ecomm— dations ur;any other comments
[Ise drawings of facityto-better explain situations. (use, additional pages as necessary}
W
�W
g. Eh S v r C wri4e - ; s n e-; e•)l-6r-►' ) In o 0-f-' q I ot5od -'\ d+ e v%d
6t kausP l cares 1aa04Vh-
�q . -ra kc q t,%jrV*L7 Sak" la for e-v e,V, 3 r.,a v4 , iJ se a wc:, 4 e
s'o'r
Aff p l,`G A-�� a to 'ar cat 1 t U t C C0-vr o►'1
,e IeR � 2 ��, lose {�e�;��, �••� �lN 01I(fujo, ice Fromm was�� p f a � ay.+
•z:dzA— Zl1, �kw Cop>as W P44-Peec6oa,,1 reed, -A aid I -owe RvA.'JgD[c
Reviewer/Inspector Name , ' a -`
Reviewer/Inspector Signature: f Date: 1 Z 15,Da 5100

Facility Number: — ,i Date of Inspection J�!_( J Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ,� Yes ❑ No -
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
28. 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)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes CA 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 J9No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Of No
32. Do the flush tanks lack a submerged fill pipe or a peiTnanent/temporary cover? V Yes ❑ No
taona -omments and/orDrawings:
l�1 = F";11oL" ary I'-e-64 Arv\ wI''rao u .r i ✓ems in wq-f e, plan.
J
5100

_ R4rised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - 3 Operation is'flagged fora wettable
Farm Name: c!. KV acre determination due to failure of
On -Site Representa0e: OL-� Qv _ Part 1l eligibility item(s) F9 (9 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 El E2 E3 E4
Annual farm PAN deficit: pounds
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
®stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
fi. stationary gun system w/permanent pipe; 7. 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 acres, is complete
and signed by an I or PE.
E2 Adequate D, and Dz/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an 1 or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part H. 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 Determina__tion 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.
V 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 Ill.

Revised Janua:%, 22, 1999
Facility Number 9 1 -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT -FIELD —TYPE-OF— -TOTALJ__CAWMP__J_F1ELD__ COMMENTS)
NUMBER NUMBER'S IRRIGATION ACRES ACRES %
SYSTEM
mmor'.1
,,�.o
FIELD NUMBFR1 - hvrirnnt_ mill_ 7nne_ nr nnint numhem may be Used in plane of field ntjmhPr� riPnPnrtinn nn r:AWMP
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.
COMMENTS3 - 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.

13 Division of Soil and Water:Conservation = Operation Review - xk
_..
Q
Division of Soil and Water Conservation -Compliance Inspection
•� Division of Water Quality. =Compliance Inspection
T 13 Other -Agency -Operation Review
JR.Routine 0 Complaint 0 Follo.v-up of DWQ inspection 0 Follow-up of DSWC review 0 Other �
Facility Number Date. of Inspection
Time of Inspection b 24 hr. (hh:mm)
© Permitted OCertified © Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
Farm Name: County: -............... I ....... ............
.......-..
Owner Name: Phone No: - .........
Facility Contact: ............. Title:....................... ..................... Phone No:.............
Flailing, Address: ............................ .....................
Onsite Rep resentative:.0.wu z► (.,..L�. 1 �P. ............. �. ..... .......... Intevrator A. �- ......................................................
VV4ttt r�
Certified Operator: .......................................... Operator Certification Number:............
E.......Q h..-x+�2 ..» .R...................:..................................................................................................................................................................................... ...........j
Latitude Longitude �• ��°� ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder - ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JOSprayField Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes [XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in valhnin?
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �(No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes C' No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............ 1D
116I99 Continued on back

acility Number: —3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pact 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 Agplication.
10. Are there any buffers that need maintenance/improvement?
1 _ Is there evidence of over application'? ❑ Ponding ❑ Nitrogen
12. Crop type.&Lf ..... ..............................................................................................................................................
13. ' Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not -in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes 9No
[I Yes t5 No
❑ Yes
($( No
❑ Yes
MrNo
❑ Yes
]KfNo
❑ Yes
kfNo
❑ Yes
{q No
❑ Yes
bd No
❑ Yes
R(No
❑ Yes
Wo
❑ Yes
C�No
❑ Yes 0 No
❑ Yes 0 No
[]Yes ff No
❑ Yes XNo
❑ Yes X No
❑ Yes allo
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 2'No
l�n.vi a,tions or. deficiencies .were noted du.rin' Ais:visii.. You will.reuceive .. Mrifi& .:. :
'Co spo'dence; about; this "visit.: ; ; . ; _ : : ; : ;
Comments (refer to question #): Explain.any YES answers and/or any recommendationsor any other comments
Use ditiwings of:facility- to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature: �`� X. i��� Date: 3/a
1 /6/99

�2c^`�s`•.'.� �aE .� �e��'.�k'i i� f N��a`xWr:E.�'�akR u..x <,'a±'A`Q' -:' _ .,. ...#: ,. ,.. , - - _....:: _ ;
.. z4 :....: .�
Other
� lyri � f+Y' � •t. F
..
13 Division of Soil and Water Conservation
Agency
'' � �Division
of Water Quality
Routine. 0 Complaint 0 Follow-up of'DW2 ins cation 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number Time of Inspection Z ! coo 24 hr. (hh:mm)
0 Registered. xCertified XApplied for Permit [3 Permitted 10 Not Operational Date Last Operated:
Farm Name: ......... ....... ....1�... ............ .....................................................
y -,�
`-� t!l^. . r ��...............................�------............... County:....Jt �':+, ��✓... . !
�Srt- ... Owner Name: ..... .......................................................... `� .. r..,c...... �..►..`rr I............. Phone No:...Q. �....................y }..7..... ...............................
Facility Contact:........................................................ .. Title: ....... Phone No:
MailingAddress:........................................................................... ............................................................................................................................... ..........................
Onsite Representative:...................................`...... ..... Integrator:.....('.}.`J `...............................................
f .. ii
p `) ' 2' Operator Certification Number:......r. r 1
Certified O CEator:................."9.�.............V.�....r................................... J.r..................
Location of Farm:
Latitude • =` " Longitude • =1 =11
v Design Current r Design.='�•' Current Destgu ;` Current`s _
Swuie n F Capacity P©pulatioh...
Poultry Capacity Population. : Cattle ' Capacityx:=Population
❑ Wean to Feeder
❑ Layer ❑ Dairy
m
Feeder to Finish t{
❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder
❑ Other
❑ Farrow to Finish
Toiai Design Capac><ty,�
❑ Gilts
_
❑ soars
Total W
Number of Lagoons I Holding Ponds
❑Subsurface Drains Present
©Lagoon Area
❑Spray Field AI rea
Pill w
❑ No Liquid Waste Management System
m ...
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
b. 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?
7/25/97
❑ Yes dNo
❑ Yes 0 No
❑ Yes �fNo
❑ Yes [YNo
❑ Yes 9No
❑ Yes VNo
❑ Yes KNo
❑ Yes PNo
❑ Yes tNo
❑ Yes r No

Facility Number: __-k —3Ll
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes No
Structures.( La2oonsjjolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I
..................�......I..........................................................................................................
Freeboard(ft):......... ....................................................................................................................................
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 public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...........................................................
❑ Yes I o
Structure 5 Structuree( `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 record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0, No-violations•or. dertcieiicies.were noted during this:visit. You:wiU ieceive,ilo-ftirih'er
_ ebrrespQiid6ke A oijt this. visit. :.:: :: .:.: :
❑ Yes )PNo
❑ Yes Po
❑ Yes OING
❑ YesNo
❑ Yes #No
❑ Yes �[No
❑ Yes 91 No
❑ Yes No
❑ Yes No
❑ Yes KNIO
❑ Yes �CNO
❑ Yes �No
❑ Yes )] No
❑ Yes k�_ o
0 Yes r 0
Reviewer/Inspector Name
Reviewer/Inspector Signature: G T Date: Z 2 _9 Y

'Routine O Complaint O Follow-up of DWQ inspection Q Follow-un of DSWC review O Other
Date of Inspection 5 Zg aT
Facility dumber "1 Time of Inspection = I b Use 24 hr. time
Farm Status-—C'-&—,-- i i Total Time (in hours) Spent onResze,*v
or Inspection (includes travel and processing)
Farm Name: N .I e..n County:
Owner Maine: .. _. ,,,•. ^^ 1 ,Z. LPhone No:..Lq— Z 51 ' 9-77.1....
Mailing Address: - - S 9 � e_; ,'r r , C In.-Zx 'gI .,_ �e1.---- -- -y r�_ �.
Onsite Representative: Integrator: r
Certified Operator.. j�L4q&k Z 1 c __ Operator Certification number:
Location of Farm:
Latitude • �� u Longitude
Not Operational Date Last Operated:
Fype of Operation and Design Capacity
Swine = �vFumber> Poultry, .timber:
x...-
; Cattie�'umber }
„=
❑ Wean to Feeder
µ❑ Laver I
Dairy
Feeder to Finish
❑Non I
❑ Beef
LL -Laver
Farrow to Wean
Farrow to Feeder�,�
Farrow to FinishV-i
x ❑ Other Type of Livestock
_
2 umber of Lagoaas / ]3aldingPonds ❑Subsurface Drains PresentM.
ri� a ❑ Lagoon Area ❑ Spray Field Area E
._:.. 7
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
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
I. Is there evidence of past discharge from any part of the operation?. ❑ Yes No
3. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any pan of the waste management system (other than lagoons/hoidin- ponds) require D§ Yes ❑ No
rnaintenancelimproverriertt'!
Continued on ba_k

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/l/97)?
❑ Yes RNo
❑ Yes MNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ANo
Structures (Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate? ❑ Yes ®.No
_Freeboard (ft):_____Lagoon_l—_ Lagoon 2 — Lagoon 3 —-L-agoon-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 public health or environmental threat, notify DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste ARRlication
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 4ay CL a�... S vu. A r-.; ,
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a Iack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a Iack of available irrigation equipment?
For Certified Facilities Only -
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review�inspection with owner or operator in charge?
❑ Yes
IgNo
❑ Yes
1K No
Yes
❑ No
❑ Yes
($No
❑ Yes
'0 No
❑ Yes ®' No
❑ Yes KNo
RYes ❑ No
❑ Yes .R No
❑ Yes f No
❑ Yes No
❑ Yes EINO
❑ Yes RNo
❑ Yes R1 No
p 6 "O., to r- re t O"N t- r to.... � L�
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10 a- r e_ o_
Reviewer/Inspector Name
Reviwer/Inspector Signature: Date:
cc. Division of Water Quality, Water Qualit3, Section, Facility Assessment Unit 1 1114/96

r�
If
1 Site Requires Immediate Attention:
Facility No. 9,1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ' 4 , 1995
Time:�
Farm Name/Owner:
Mailing Address: _
County:
Integrator. U ►�- -
On Site Representative:
Physical Address/Location:
Phone:
S
Type of Operation: Swine C/ _ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude Cb 'T&" Elevation: LFeet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: --6—Ft. Inches
Was any seepage observed from the la n(s)? Yes or i�o Was any erosion observed? Yes
Is adequate land available for spray?or No Is the cover crop adequate? Ye or No
Crop(s) being utilized: O t "hn
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellinees�E.�,4o
or No
100 Feet from Wells?
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oTIQ
Is animal waste discharged into waters of a state by'man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management reco ds (volumes of manure, land applied,
spray irrigated on specific acrea a with cover crop) . a or No
Additional Comments: �/!'�,�' 1 r/, vi � i� ✓Yt
inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.

07/19J1995 16:25 5102591291 PENDER COOP E::T SEP
PAGE 15
•
..
0
Site Requires Immediate Attention
Facility Number.- W'3
SITE VISITATION RECORD
DATE: July 17 , 1995
Owner: Jimmy R' nbark Farm Name: Quarter M Farm
County:
Agent Visiting Site, 51 & N —C_ as - - - Phone: , [phone]
Operator: Jimmy Rivenbark W __ phOIIe: [phone]
On Site Representative: same . Phone:
Physical Address: Fe=1town Boad -
and SR 1402. Farm road is on the left..
Mailing Address: 559 jjerriMs Chap2j Road
Burgaw, N.C. 28425
Type of Operation: `Swine z, - Poultry Cattle
Design Capacity: 2448 Finishing Number of Animals on Site: 2448 Finishing
Latitude: a Longitude- a
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: 5 Feet 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 oG Was there erosion of the dam?: Yes o
Is adequate land available for land application? (Ye or No Is the cover crop adequate? � or No
Additional Comments: Any erosion appears to be old and is satisfactorily stabilized
with vegetation and does not; compromise the integrity of the dike,'
Fax to [phone] Signature of Agent