330017_PERMIT FILE_20171231

33-17
• Nutrient Management Plan For Animal Waste Utilization
This plan has been prepared for:
G. Kent Johnson Hog Farm
Roland H. Mohesky
P. O. Box 215
Sharpsburg, NC 2 78 78
252-977-7881
05-I3-2004
This plan has been developed by:
Greg Grill n
Edgecombe SWCD
P.O. Box 10
Tarboro, NC 27886
252 1-7900
Develope ignature
Type of Plan: Nitrogen Only with Manure Only
Owner/Manager/Producer Agreement
• r i... i.1 a . a µma s. af. .:r. .a:... . ,.a Fe, ....�:.... --A .'^� 4�......,,.... �......,�..�.,.
s. �.r �� . i.ti. ., .... a.e� +iii .thy: a.�..... iu�, ui���ei�. as .,i:...:, .. .. �......�.... ......:... .. ......... �... ��. .; .,..ut._ �.•,
established in this nutrient management plan which includes an animal waste utilization plain for
a . ,a ,,..dnr,-+. nfi ft,,.
-1ti �: _3J,e..�-_ ems- _s +t-•j •a. _ y :.aa.=--= �.. _..-.-_ _. _`:� �__.... z.
waste management that are included with this plan.
Signature (owner) Date
/Signature (manager or producer) Date
- slai .: C. e;, :'.i ;rei _ --: ::.�.• -- •: a_-- �'s �=.i'!�._�l�i€� .:i c.it � _=�. -_ `•:a'f -_.3�a =._ �'f��---=l=s- —
.3:
Natural Resources Conservation Service or (he Standard Or practices adopted by the Soil and Water
Conservation Commission.
r
Plan Approved By:
Tech ical Specialist Signature Date
• -----------------------------------------------------------------
494525 Database VerSitlll 3_1 Pate- Printed: 05-13-2004 Cover Page 1

Nutrients applied in accordance with this plan will be supplied from the following
source(s):
Commercial Fertilizer is not included in this plan.
S7
Swine Feeder -Finish Lagoon Liquid waste generated 1,175,436 gals/year
by a 1,268 animal Swine Finishing Lagoon Liquid operation. This
production facility has waste storage capacities of approximately 180 days.
Estimated Pounds of Plant Available Nitrogen Generated per Year
Broadcast
2707
Incorporated
4649
Injected
5120
Irrigated
2943
Actual PAN Applied
(Pounds)
Actual Volume Applied
(Gallons)
Volume Surplus/Deficit
(Gallons)
Year 1 7
5,336.40
2,131,577
-956,141
-- -- -- - ------ -- -- -- •---------- -- •-- -- -- -- -- - -- -- ---- -- - --•- -
Note: in source ID, S means standard source, U means user defined source.
494525 Database Version 3.1 Date Printed: 05-13-2004 Source Page Page I of 1

Narrative
This farm is operating as a finishing operation with a 1268 feeder to finish animal capacity. The
certification for the farm lists the animal population as 2000 wean to feeder and 850 feeder to finish.
This plan is for 1268 feeder to finish animals which equals the steady state live weight for the 2000 wean
to feeder and 850 feeder to finish.
----------------------------------------------------------------------- --------------------------------------------------------------------------------------------
494525 Database Version 3.1 Date printed: 05-13-2004 Narrative Page Page 1 of 1

The table shown below provides a summary of the crops or rotations included in this plan for each field. Realistic Yield estimates
are also provided for each crop in the plan. In addition, the beaching Index for each field is shown, where available.
Planned Crops Summary
Tract
Field
Total
Acres
Useable
Acres
Leaching
Index (LI)
Soil Series
Crop Sequence
RYE
1975
3
14.50
5.00
2.0
Norfolk
Small Grain Overseed
1.0 Tons
Hybrid Bermudagrass Hay
6.5 Tons
1975
5
9.70
8.70
2.0
Norfolk
fescue Hay
3.5 Tons
1975
6
4.00
4.00
2.0
Norfolk
Small Grain Overseed
1.0 Tons
Hybrid Bermudagrass Hay
6.5 Tons
1980
4
2.40
2.401
2.0
Norfolk
Small Grain Overseed
1.0 Tons
Hybrid Bermudagrass Hay
6.5 Tons
PLAN TOTALS: 30.60 20.10
L!
Potential Leaching
Technical Guidance
Low potential to contribute to soluble
None
`
nutrient leaching below the root zone.
>= 2 &
Moderate potential to contribute to
Nutrient Management (590) should be planned.
<= 10
soluble nutrient leaching below the root
zone.
High potential to contribute to soluble
Nutrient Management (590) should be planned. Other conservation practices that improve
nutrient leaching below the root zone.
the soils available water holding capacity and improve nutrient use efficiency should be
> 10
considered. Examples are Cover Crops (340) to scavenge nutrients, Sod -Based Rotations
(328), Long -Term No -Till (778), and edge -of -field practices such as Filter Strips (393) and
Riparian Forest Buffers (391).
494525 Database Version 3.1 Date Printcd 5/13/2004
PC5 Page Page l of 1
NOTE: Symbol * means user entered data.

The Waste Utilization table shown below summarizes the waste utilization plan for this operation. This plan provides an estimate of the number of acres of cropland needed to use
the nutrients being produced. The plan requires consideration of the realistic yields of the crops to be grown, their nutrient requirements, and proper timing of applications to
maximize nutrient uptake.
This table provides an estimate of the amount of nitrogen required by the crop being grown and an estimate of the nitrogen amount being supplied by manure or other by-products,
commercial fertilizer and residual from previous crops. An estimate of the quantity of solid and liquid waste that will be applied on each field in order to supply the indicated quantity
of nitrogen from each source is also included. A balance of the total manure produced and the total manure applied is included in the table to ensure that the plan adequately provides
for the utilization of the manure generated by the operation.
Waste Utilization Table
Year 1
Tract
Field
Source
ID
Soil Series
Total
Acres
Use.
Acres
Crap
RYE
Applic.
Period
Nitrogen
PA
Nutrient
Req'd
(lbslA)
Comm.
FerL
Nutrient
Applied
(lbs/A)
Res.
(lbslA)
Applic.
Method
Manure
PA
NutrienLA
pplied
(lbslA)
liquid
ManureA
pplied
(acre)
Solid
Manure
Applied
(acre)
Liquid
Manure
Applied
(Field)
Solid
Manure
Applied
(Field)
N
N
N
N
1000
gal/A
Tons
1000 gals
tons
1975
3
S7
Norfolk
14.50
5.00
Small Grain Overseed
1.0 Tons
10/1-3/31
50
0
0
Irrig.
5
19.97
0.00
99.86
0.00
1975
3
S7
Norfolk
14.50
5.00
Hybrid Bermudagrass Hay
6.5 Tons
3/1-9l30
296
0
0
brig.
296
118.24
0.00
591A7
0.00
1975
5
S7
Norfolk
9.70
8.70
Fescue Hay
3.5 Tons
8/1-7131
160
0
0
IM8.
160
63.91
0.00
556.02
0.00
1975
6
S7
Norfolk
4A0
4.00
Small Grain Overseed
1.0 Tons
1011-3131
50
0
0
brig.
50
19.97
0.00
79.89
0.00
1975
6
S7
Norfolk
4.00
4.00
hybrid Bermudagrass Hay
6.5 Tons
3/1-9/30
296
0
0
Irrig.
296
118.24
0.00
472.94
0.00
1980
4
S7
Norfolk
2.40
2.40
Small Grain Ovemeed
1.0 Tons
1011-3131
50
0
0
Irrig.
50
19.97
0.00
47.93
0.00
1980
4
S7
Norfolk
2,40
2.40
Hybrid Bermudagrass Hay
6.5 Tons
311-9/30
296
0
0
Lrig,
296
118.24
0.0
283.76
0.00
Total Applied. 1000 gallon
2,131.58
Total Produced, 1000 gallons
1,175.44�?
Balance, 1000 gallons
-956.14a"
Total Applied, tons
s >`;
Q00
Total Produced, tons
? "_
0.00
Balance, tons
0.00
Notes: 1. In the tract column, -- symbol means leased, otherwise, owned. 2. Symbol * means user entered data.
494525 Database Version 3.1 r,�`naie Printed:
WUT Page Page 1 of 1

The Irrigation Application Factors for each field in this plan are shown in the following table. Infiltration rate varies with soils. If
applying waste nutrients through an irrigation system, you must apply at a rate that will not result in runoff. This table provides the
" maximum application rate per hour that may be applied to each field selected to receive wastewater. It also lists the maximum
application amount that each field may receive in any one application event.
Irrigation Application Factors
Tract
Field
Soil Series
Application Rate
(inches/hour)
Application Amount
(inches)
1975
3
Norfolk
0.50
1.0
1975
5
Norfolk
0.50
1.0
1975
6
Norfolk
0.50
1.0
1980
4
Norfolk
0.50
1.0
494525 Database Version 3.1 Date Printed 5/13/2004 IAF Page Page 1 of I
NOTE: Symbol * means user entered data.

The following Lagoon Sludge Nitrogen Utilization table provides an estimate of the number of acres needed for sludge
utilization for the indicated accumulation period. These estimates are based on average nitrogen concentrations for each source,
the number of animals in the facility and the plant available nitrogen application rates shown in the second column.
Lagoon sludge contains nutrients and organic matter remaining after treatment and application of the effluent. At clean out, this
material must be utilized for crop production and applied at agronomic rates. In most cases, the priority nutrient is nitrogen but
other nutrients including phosphorous, copper and zinc can also be limiting, Since nutrient levels are generally very high,
application of sludge must be carefully applied.
Sites must first be evaluated for their suitability for sludge application. Ideally, effluent spray fields should not be used for
sludge application. If this is not possible, care should be taken not to load effluent application fields with high amounts of
copper and zinc so that additional effluent cannot be applied. On sites vulnerable to surface water moving to streams and lakes,
phosphorous is a concern. Soils containing very high phosphorous levels may also be a concern.
Lagoon Sludge Nitrogen Utilization Table
Crop
Maximum
PA-N Rate
lb/ac
Maximum Sludge
Application Rate
1000 gal/ac
Minimum Acres
5 Years Accumulation
Minimum Acres
10 Years Accumulation
Minimum Acres
15 Years Accumulation
Swine Feeder -Finish Lagoon Sludge - Standard
Corn 120 bu
150
13.16
15.90
31.79
47.69
Hay 6 ton R.Y.E.
300
26.32
7.95
15.90
23.84
Soybean 40 bu
160
14.04
14.90
29.91
44.71
.--- ------ ..--------------------------------------. .---------------- -.---------------------- --
494525 Database Version 3.1 Date Printed: 05-13-2004 Sludge Page Page 1 of

The Available Waste Storage Capacity table provides an estimate of the number of days of storage capacity available
at the end of each month of the plan. Available storage capacity is calculated as the design storage capacity in days
minus the number of days of net storage volume accumulated. The start date is a value entered by the user and is
defined as the date prior to applying nutrients to the first crop in the plan at which storage volume in the lagoon or
holding pond is equal to zero.
Available storage capacity should be greater than or equal to zero and less than or equal to the design storage
capacity of the facility. If the available storage capacity is greater than the design storage capacity, this indicates that
the plan calls for the application of nutrients that have not yet accumulated. If available storage capacity is negative,
the estimated volume of accumulated waste exceeds the design storage volume of the structure. Either of these
situations indicates that the planned application interval in the waste utilization plan is inconsistent with the
structure's temporary storage capacity.
Available Waste Storage Cavacity
Source Name
I Swine Feeder -Finish La oon Li uid
Design Storage Capacity (Days)
Start Date
911
180
Plan Year
Month
Available Storage Capacity (Days)
1
1
180
1
2
180
1
3
180
1
4
180
1
5
180
1
6
180
1
7
180
1
8
180
1
9
180
1
10
156
I
11
175
1
12
HO
* Available Storage Capacity is calculated as of the end of each month.
-----•------------------------------------------------------------------------- ----------•-------------------------------------------------------------------------
494525 Database Version 3.1 Date Printed: 05-13-2004 Capacity Page Page 1 of 1

OSO ,,
0
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
R.H. MoHESKY
PO Box 215
SHARPssURG NC 27878
Dear R.H. Mohesky:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
December 19, 2002
Subject: Notice of Violation and Revocation for Nonpayment
Clover M Farms Inc - Conetoe Farm
Permit Number: AWS330052
Edgecombe County
In accordance with North Carolina General Statute 143-215.10G, all animal operations who receive an animal
waste management system permit will be charged in each year of the term an annual permit fee. Annual permit fees are
billed following the issuance of the permit and then annually thereafter on the anniversary of that date. Your animal waste
management system permit was issued on 9/27/2000.
Your annual permit fee for the period of 9/27/2002 - 9/26/2003 is $150.00. Your payment was due 11/7/2002.
Because this fee was not fully paid within 30 days after being billed, this letter initiates action to revoke the subject permit,
pursuant to 15 NCAC 2H .0205 (c) (4). and G.S. 143-215.1 (b) (3).
Effective 60 days from receipt of this notice, the subject permit is hereby revoked unless the required Annual
Animal Waste Management System Permit fee for your animal operation is received within that time. Operation of an
animal waste management system without a valid permit is a violation of North Carolina General Statute 143-215.1 and is
subject to the assessment of a civil penalty of up to $10,000 per day. Your payment should be sent to:
N.C. Department of Environment and Natural Resources
Division of Water Quality
Budget Office
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If you have any questions, please contact Fran McPherson at (919) 733-70I5 ext. 210.
Sincerely,
Alan W. Klimek, P.E.
cc: Non -Discharge Branch Compliance/Enforcement Unit
Raleigh Regional Office
Edgecombe County Health Department
Permit File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled / 10% post -consumer paper

7'JL-14-1995 15: 26 FROM DGM WATER QUALITY SECTION TO
Rj .1D P . 02/02
W(4,5 v /
Farm N
Mailing
Counry:
Site Requires tinmediate Attenann-
Facility No. 3-4::r�
DIVISION OF ENVIRONMENTAL MANAGEMENT'
ANIMAL FEEDLOT OPERA1710N SITE VISITATION RECORDF
DATE: 2 1995
✓I __ ��_ d
Integrator:
On Site Representative:
Physical Addres99A)cadon:
r none:
Phone:
Type of Operation: Swine —k— Poultry Cattle
Design Capacity: 4 Number of Animals on Site:' 3
2,5
DEM Certification Number. ACE DEM Ctxdficatioti Number: ACNEW
Ladtude: ?,�-o_' _2`b�" Longitude: ��- " Elevation: IVe Feet �r
Circle Yes or No
Does the .Animal Waste Lagoon have sufficient.. freeboard of l-Foot�25 year 244hhour storm event
(approximately I Foot + 7 inches) Yes ore Actual Freeboard: _ rt. f Inches
Was any seepage observed from the lagoou(s)? Yes or coWas any erosion observed? Yes -or
Is adequate land available for spray? De or Nd Is the cover crop adequate? or No' F
Croo(s) being utilized. r.,r
Does the facility meet SCS minirnum setback criteria'? 200 Feet from Dwellings? or No
100 Feet. from Wells? Yd% or No
_:ne animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oreq
arwnal waste land applied or spray irrigated within 25 Feet of a liSGS Map Blue Line? Yes or o
's animal waste discharged into waters of the state by inan-made ditch, flushing system, or other
�imi,ar rn3n-made de,,,ices'? Yes or if Y ws. Please Explaitx-
r)icS i6c: facility ruainmin adequate waste wartttgeracrit records (volumes of manure, 13nd applied_
spray irrigated on specific acreage with cover crop)'' Yes or
Signature
cc: Facility Assessment Unit
Use Attachments if Needed_
TOTFL P:02

Division of Environmental Management
October 4, 1995
Mr. Roland Mohesky
P.O. Box 215
Sharpsburg NC 27878
Subject: Management Deficiency Notification
Hog Operation
Hwy 301/ Swift Creek
Nash County
Dear Mr. Mohesky:
On August 22, 1995, Mr. Danny Smith from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. This inspection is a part of the Division's efforts to
determine potential problems associated with liquid waste disposal
systems.
Mr. Smith's site visit determined that wastewater from your
facility was not discharging to the surface waters of the state.
Also, no manmade pipes, ditches, or other prohibited conveyances
(for the purpose of willfully discharging wastewater) were
observed.
However, as a result of the inspection, the following
significant management deficiencies were observed:
-Your lagoons h4 little freeboard, less than 12 inch in some
areas. This problem should receive prompt attention in order
to prevent a future discharge or a lagoon breach. A properly
functioning lagoon should have at least 19 inches of
freeboard.
In addition to continued waste facility management, this
deficiency must be immediately addressed to help prevent the
possibility of an illegal discharge. Please respond in writing to
the Raleigh Regional Office within 30 days of receipt of this
letter. You should specifically address how you plan to correct
this problem. Also you should submit a schedule (with dates)
stating when these management deficiencies will be corrected.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facilities. The Division of
Environmental Management is required to enforce water quality
regulations in order to protect the natural resources of the State.
Accordingly, illegal discharges of wastewater to surface waters of
the State are subject to the assessment of cavil penalties of up to

Mr. Mohesky
Page -2-
$10,000 per day, and may also result in the loss of deemed
permitted status, requiring immediate submission of a waste
management plan.
This office would also like to take this opportunity to remind
you that you are required to have an approved animal waste
management plan by December 1997. This plan must be Certified by
a designated technical specialist or a professional engineer. For
a listing of certified technical specialists or assistance with
your waste management plan you should contact your local Soil and
Water Conservation District.
The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions regarding your inspection
please call Danny Smith at [phone].
Sincerely,
Kenneth Schuster, P. E.
Regional Supervisor
/ds
H:\animdnl3
cc: Nash County Health Department
Nash County Soil and Water Conservation District
Steve Bennett - Regional Coordinator, Division of Soil and
Water Conservation

State of North Carolina
Department of Environment
aw
and Natural Resources
Division of Water Quality .
}
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
G. Kent Johnson
G. Kent Johnson Hog Farm
3662 Cokey Road
Rocky Mount NC 27801
Dear G. Kent Johnson:
IT JW
NCDENR
NORTH CAROL.INA DEPARTMENT OF
ENVIRONMENT AND NATURAL_ RESOURCES
March 17, 2000
Subject: Certificate of Coverage No. AWS330017
G. Kent Johnson Hog Farm
Swine Waste Collection, Treatment,
Storage and Application System
Edgecombe County
In accordance with your application received on December 1, 1999, we are forwarding this
Certificate of Coverage (COC) issued to G. Kent Johnson, authorizing the operation of the subject
animal waste collection, treatment, storage and land application system in accordance with General
Permit AWG100000. This approval shall consist of the operation of this system including, but not
limited to, the management of animal waste from the G. Kent Johnson Hog Farm, located in Edgecombe
County, with an animal capacity of no greater than 2000 Wean to Feeder and 850 Feeder to Finish and
the application to land.as specified in the Certified Animal Waste Management Plan (CAWMP).
The COC shall be effective from the date of issuance until April 30, 2003. Pursuant to this COC,
you are authorized and required to operate the system in conformity with the conditions and limitations
as specified in the General Permit, the facility's CAWMP, and this COC, with no discharge of wastes to
surface waters. An adequate system for collecting and maintaining the required monitoring data and
operational information must be established for this farm. Any increase in waste production greater than
the certified design capacity or increase in number of stocked animals above the number authorized by
this COC will require a modification to the CAWMP and this COC and shall be completed prior to
actual increase in either wastewater flow or number of animals.
Please be advised that any violation of the terms and conditions specified in this COC, the General
Permit or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS
143-215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
The facility's CAWMP meets all requirements in place at the time of certification. However, it
appears that the irrigation system on site may not adequately cover all acreage listed in the Waste
Utilization Plan. The owner should address this inconsistency as soon as possible.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Certificate of Coverage AWS330017
G. Kent Johnson Hog Farm
Page 2
a
Upon notification by the Division of this COC's expiration, you shall apply for its renewal. This ..
request shall be made within 30 days of notification by the Division.
This COC is not automatically transferable. A name/ownership change application must be
submitted to the DWQ prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the
right to apply for an individual non -discharge permit by contacting the engineer listed below for
information on this process. Unless such a request is made within 30 days, this COC shall be final and
binding.
The subject farm is located in the Raleigh Regional Office. The Regional Office Water Quality
Staff may be reached at [phone]. If you need additional information concerning this COC or the
General Permit, please contact JR Joshi at [phone] ext. 363.
Sincerely,
err T. Stevens
cc: (Certificate of Coverage only for all cc's)
Edgecombe County Health Department
Raleigh Regional Office, Water Quality Section
Edgecombe County Soil and Water Conservation District
Permit File
NDPU Files

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality DEC, 0 !yS 3
Non -Discharge Permit Application Form Non-f,.ar
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL) g" ermltfirq
General Permit - Existing Animal Waste Operations
The following questions have been completed utilizing information on rile with the Division. Please
review the information for completeness and make any corrections that are appropriate. If a
question has not been completed by the Division, please complete as best as possible. Do not leave
any question unanswered.
I. GENERAL INFORMATION:
1.1 Facility Name: Doug Johnson Farm
1.2 Print Land Owner's name: Bea�e#serr
.1 r
1.3 Mailing address: 7335 Red Road
City, State: Nashville NC Zip: 27856
Telephone Number (include area code): 919-443-9920 or 446-7579
1.4 County where facility is located: Ed ecombe
1.5 Facility Location (Directions from nearest major highway. Please include SR numbers for state roads. Please include a copy
of a county road map with the location of the farm identified): 5 miles East of Rocky —Mount on Noble's Mill Pond Rd. and
1.6 Print Farm Manager's name (if different from Land Owner): 1404�4 Je %ru ;,,rkj
1.7 Lessee's / Integrator's name (if applicable; please circle which type is listed): 00 � ,� r Ar r r A et,t s
1.8 Date Facility Originally Began Operation: otlo inn
1.9 Date(s) of Facility Expansion(s) (if applicable): ) 0 oU g-
2. OPERATION INFORMATION:
2.1 Facility No.: 33 (county number); 17 (facility number).
2.2 Operation Description: Swine operation
Wean to Feeder
Feeder to Finish
2800- Certified Design Capacity
Is the above information correct? 0 yes; Llno. If no, correct below using the design capacity of the facility
The "No. of Animals" should be the maximum number for which the waste management structures were designed.
Type of Swine No. of Animals
• Wean to Feeder
• Feeder to Finish
• Farrow to Wean (# sow)
• Farrow to Feeder (# sow)
• Farrow to Finish (# sow)
Other Type of Livestock on the farm:
Type of Poultry No. of Animals
• Layer
• Non -Layer
• Turkey
Type of Cattle No. of Animals
• Dairy
• Beef
No. of Animals:
FORM: AWO-G-E 5/28/98 Page 1 of 4 33 - 17

3.
2.3 Acreage cleared and available for application (excluding all required buffers and areas not covered by the application
system): 31.8 ; Required Acreage (as listed in the AWMP): 9.6
2.4 Number of lagoons/ storage ponds (circle which is applicable):
2.5 Are subsurface drains present within 100' of any of the application fields? YES o ND (please circle one)
2.6 Are subsurface drains present in the vicinity or under the lagoon(s)? YES or NO please circle one)
2.7 Does this facility meet all applicable siting requirements? (Swine Farm Siting Act, NRCS Standards, etc.) (Swine Only)
ES ' or NO (please circle one)
What was the date that this facility's swine houses and lagoon were sited? _ -_ jMAr-c-h i 9 7d
What was the date that this facility's land application areas were sited? '(ttteck fGf i
REQUIRED ITEMS CHECKLIST
Please indicate that you have included the following required items by signing your initials in the space provided next to each
item. -
3.1 One completed and signed original and one copy of the application for General Permit - Animal
Waste Operations;
3.2 Two copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is land applied;
3.3 Two copies of the entire Certified Animal Waste Management Plan (CAWMP). If the facility
does not have a CAWMP, it must be completed prior to submittal of a general permit application
for animal waste operations.
The CAWMP must include the following components. Some of these components may not
have been required at the time the facility was certified but should be added to the
CAWMP for permitting purposes:
3.3.1 The Waste Utilization Plan (WUP) must include the amount of Plant Available
Nitrogen (PAN) produced and utilized by the facility.
3.3.2 The method by which waste is applied to the disposal fields (e.g. irrigation,
injection, etc.)
3.3.3 A map of every field used for land application.
3.3.4 The soil series present on every land application field.
3.3.5 The crops grown on every land application field.
3.3.6 The Realistic Yield Expectation (RYE) for every crop shown in the WUP.
3.3.7 The PAN applied to every -land application field.
3.3.8 The waste application windows for every crop utilized in the WUP.
3.3.9 The required NRCS Standard specifications.
3.3.10 A site schematic.
3.3.11 Emergency Action Plan.
3.3.12 Insect Control Checklist with chosen best management practices noted.
3.3.13 Odor Control Checklist with chosen best management practices noted.
3.3.14 Mortality Control Checklist with the selected method noted.
3.3.15 Lagoon/storage pond capacity documentation (design, calculations, etc.). Please be
sure to include any site evaluations, wetland determinations, or hazard classifications
that may be applicable to your facility.
3.3.16 Operation and Maintenance Plan.
If your CAWMP includes any components not shown on this list, please include the
additional components with your submittal.
Applicants Initials
c.�
FORM: AWO-G-E 5/28/98 Page 2 of 4 33 -17

Facility Number: 33 - 17
Facility Name: Doug Johnson Farm
4. APPLICANT'S(�!/CERTIFICATION:
600 (Land Owner's name listed in question 1.2), attest that
this application for (Facility name listed in question 1.1)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not co pleted an that if all equired supporting information and attachments are not included, this application package
will be returned to a as r ca et .
Signature ` DateI Z_/_
5. MANAGER'S CER
I, 'bat-L6
CATION: (complete only if different from the Land Owner)
(Manager's name listed in question 1.6), attest that this
application for -Ua o k1ruSC4%J t-*F_ (Facility name listed in question 1.1)
has been reviewed by me an is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information and attachments are not included; this application package
will be returned as incomplete.
Signature
Date ! I- ka -Ci 9
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF WATER QUALITY
WATER QUALITY SECTION
NON -DISCHARGE PERMITTING UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
I' SECT ON
of ` ' -" I
I I rY f
Non -Discharge Pem;it4rig
FORM: AWO-G-E 5/28/98 Page 3 of 4 33 - 17

THIS DESIGN IS FOR A SINGLE STAGE LAGOON
CLIENTS NAME _---_________---_______>
Doug Johnson
COUNTY -
-
Edgecombe
--------- ---_= >
TODAYS DATE
=--- =___
March 21,19 9 6
_--_-_ ___-__>
DISTANCE TO NEAREST NONFARM RESIDENCE _>
2000 FEET
NUMBER OF PIGS
WEAKLING TO FEEDER = ---->
2000
NUMBER OF PIGS
FEEDER TO FINISH
850
NUMBER OF SOWS
FARROW TO WEAKLING =---->
0
NUMBER OF SOWS
FARROW TO FEEDER == =___>
0
NUMBER OF SOWS
FARROW TO FINISH =---__=>
0
DEGREE OF ODOR
CONTROL =___-=______=__>
1.0
(minimum 1.0
cu. ft. per lb SSLW)
(maximum 3.0
cu. ft. per lb SSLW)
NUMBER OF YEARS
OF SLUDGE ACCUMULATION >
5.0 YEARS
TOP LENGTH AT NORMAL WATER LEVEL =_____> 365.0 FEET
TOP WIDTH AT NORMAL WATER LEVEL =-_____> 105.0 FEET
NORMAL WATER LEVEL ELEVATION =_-_--__--_> 41.5 FEET Ir,
SEASONAL HIGH-WATER TABLE ELEVATION =__> 41.0 FEET
LAGOON BOTTOM ELEVATION _______________> 33.5 FEET
Depth of Permanent Water 8.0 feet
(minimum depth without sludge = 6 feet)
(minimum depth with sludge = 8 feet)
SIDE SLOPES -------- __2.0:1
Permanent Volume Required 244650.0 cubic feet
Permanent Volume Provided 249170.7 cubic feet
ADDITIONAL DRAINAGE AREA IN SQUARE FEET>
(i.e. pumpout pond & other outside area)
LENGTH OF PUMPING CYCLE
GALLONS OF FRESH WATER ADDED DAILY =_.-_>
EXCESS RAINFALL ABOVE EVAPORATION =____>
25YR/24HR STORM RAINFALL
FREEBOARD_____________
0 SQUARE FEET
3 00---DAYS
0 GALLONS ~ �'
13.4 INCHES
6.7 INCHES
1.0 FEET.
ESTIMATED TOP OF DAM ELEVATION =_______> 46.4 FEET
Temporary Storage Volume 151392.8 cubic feet
Top of Dam Elevation =
Inside Dimensions of Lagoon at
Length = 384.6 feet Width =
Begin Pumping Elevation =
Stop Pumping Elevation =
Volume To Be Pumped =
46.4 feet
Top of Dam
124.6 feet
44.8 feet
41.5 feet
124636.8 cubic feet

1. STEADY STATE LIVE WEIGHT
2000
head
weanling
to feeder
x 30 lbs. =
60000
lbs
850
head
feeder
to
finishing
x 135 lbs. =
114750
lbs
0
sows
farrow
to
weanling
x 433 lbs. -
0
lbs
0
sows
farrow
to
feeder x
522 lbs. --
0
lbs.
0
sows
farrow
to
finish x
1417 lbs. =
0
lbs
TOTAL STEADY STATE LIVE WEIGHT (SSLW) = 174750 lbs
2. SLUDGE ACCUMULATION
Sludge accumulates at the rate of 0.080 cu. ft. per year
per pound of STEADY STATE LIVE WEIGHT in swine.
Years of sludge accumulation in design? 5.0
Sludge Volume = 69900.0 cubic feet
3. REQUIRED LIQUID VOLUME OF LAGOON
Design for 1.0 cu. ft. per pound SSLW
Total Volume = (SSLW * Design factor) + Sludge Volume
Total Volume = 244650.0 cubic feet
4. NORMAL LAGOON LIQUID LEVEL
Maintain normal lagoon liquid level at elevation 41.5 feet
Construct lagoon bottom elevation 33:5 feet
Lagoon size for normal lagoon liquid volume using prismodial formula
SS/END1 SS/END2 SS/SIDE1 SS/SIDE2 DEPTH
2.0 2.0 2.0 2.0 8.0
AREA OF TOP
LENGTH *WIDTH =
365.0 105.0
AREA OF BOTTOM
Lb * Wb -
333.0 73.0
AREA OF MIDSECTION
(Lm * Wm) _
349.0 89.0
38325.0 (AREA OF TOP)
24309.0 (AREA OF BOTTOM)
31061.0 (AREA OF MIDSECTION)
CU. YD. = [AREA TOP + (4*AREA MIDSECTION) + AREA BOTTOM] * DEPTH/6
38325.0 124244.0 24309.0 1.333
VOLUME OF LAGOON AT NORMAL LAGOON LIQUID LEVEL=49170.7 CU. FT.
VOLUME NEEDED = 244650.0 CU. FT.
THE -SURFACE DIMENSIONS --OF THE -LAGOON AT NODAL LIQUID LEVEL
ARE 365.0 FEET LONG BY 105.0 FEET WIDE

5. DIKE
Place spoil as a continuous dike to elevation 46.4 feet.
6. TEMPORARY STORAGE REQUIRED
DRAINAGE AREA:
Lagoon (top of dike)
Length * Width =
384.6 124.6 47921 square feet
Additional Drainage Area
0 square feet
TOTAL DA 47921 square feet
Pumping cycle to be 300 days.
6A. Volume of waste produced
Volume = 174750 SSLW * 0.0101481 gallon/lb. SSLW/day
in the pumping cycle / 7.48 gallons per cu. ft.
Volume = 71124.9 cubic feet
6B. Volume of wash water
This is the amount of fresh water used for washing floors or
volume fresh water used for a flush system. Flush systems that
recycle the lagoon water are accounted for in 6A.
Volume = 0 gallons/day * 300 days in the pumping
cycle divided by 7.48 gallons per cu. ft.
Volume =
0.0 cubic feet
6C. Volume of rainfall in excess of evaporation
Use period of time when rainfall exceeds evaporation by largest
amount.
Excess rainfall (difference) = 13.4 inches
Volume = 13.4 inches * DA / 12 inches per foot
Volume = 53512.0 cubic feet
6D. Volume of 25 year - 24 hour storm
Volume = 6.7 inches * DA / 12 inches per foot
Volume = 26756.0 cubic feet
TOTAL REQUIRED TEMPORARY STORAGE
6A.
71124.9
cubic
feet
6B. .__-'
0.0
cubic
feet
6C.
53512.0
cubic
feet
6D.
26756.0
cubic
feet
TOTAL TEMPORARY STORAGE 151392.8 cubic feet

7. DEPTH OF STORAGE REQUIRED (ABOVE NORMAL LIQUID ELEVATION OF LAGOON)
Depth required = Volume of temporary storage divided by surface
area of lagoon.
Depth required = 151393 cu.ft. / 38325 sq. ft.
Depth required = 4.0 feet
Normal lagoon liquid elevation = 41.5 feet
Depth required = 4.0 feet
Freeboard = 1.0 feet
Top of Dam = 46.4 feet
THE DIMENSIONS OF THE INSIDE EDGE OF THE DAM AT ELEVATION 46.4
ARE 384.6 FEET BY 124.6 FEET
8. SET BEGIN PUMPING ELEVATION
PUMPED STORAGE VOLUME
6A. 71124.9 cubic feet
6B. 0.0 cubic feet
6C. 53512.0 cubic feet
TOTAL PUMPED VOLUME = 124636.8 cubic feet
Depth required = Volume of pumped storage divided by surface
area of lagoon at normal water level.
Depth required = 124636.8 cu.ft. / 38325.0 sq. ft.
Depth required = 3.2 feet
DESIGNED BY:
DATE:
APPROVED BY:
DATE:

. Producer:
Location:
Address:
Telephone:
Type Operation:
Number of Animal Units:
Da 3o(.Ms e K. N0, D- - ,�yy
�;!33S teed
Pas&gdl e- MG, 27,As o
%- d .K
Z,. as o• P 54:1
The waste from your animal facility must be land applied at a
specified rate to prevent pollution of surface and/or ground water.
The plant nutrients in the animal waste should be used to reduce the
amount of commercial fertilizer required for the crops on the fields
where the waste is to be applied. This waste should be analyzed
before each application cycle and annual soil tests are encouraged
so that all plant nutrients can be balanced for realistic yields of
the crops to be grown.
Several factors are important in implementing your waste utilization
plan in order to maximize the fertilizer value of the waste and to
ensure that it is applied in an environmentally safe manner. Always
apply waste based on the needs of the crop to be grown and the
nutrient content of the waste. Do not apply more nitrogen than the
crop can utilize. Soil types are important as they have different
infiltration rates and leaching potential. Waste shall not be
applied to land eroding at greater than 5 tons per acre per year.
Do not apply waste on saturated soils or on land when the surface is
frozen. Either of these conditions may result in runoff to surface
waters. Wind conditions should also be considered to avoid drift
and downwind odor problems. To maximize the value of nutrients for
crop production and to reduce the potential for pollution, the waste
should be applied to a growing crop or not more than 30 days prior
to planting. Injecting the waste or disking will conserve nutrients
and reduce odor problems.
The acres needed to apply the animal waste is based on typical
nutrient content for this type of facility. Acreage requirements
may be more or less based on the waste analysis report from your
waste management facility.
Amount of waste produced per vear
Zroa r2 ) � � 38�r000
8S� animal units X waste/animal unit/year = '787 YSO
L 1�5$ocaNaste/year f
Amount of nitrogen produced per year C}
4,0
P5149 animal units X �,. _ lbs. N/animal unit/year = Y IS S
2, 91 S lbs . N/year
Applying the above amount of waste is a big job. You should plan
time and have appropriate equipment to apply the waste in.a timely
manner.
page 1

The following acreage will be needed for waste application based on the crop to be grown and surface
application:
Table 1: ACRES OWNED BY PRODUCER
Tract Field Soil Crop Real. Lbs. N Acres Lbs. N Month of
# Type Yield Per Ac. Utilized Application
NoB
Improved
1975
6
Bermuda
6.1
305
4
1220
April - Sept
NoB
Improved
3
Bermuda
6.1
305
5
1525
Aril - Sept
NoB
Improved
1980
4
Bermuda
6.1
305
2.4
732
April - Sept
Winter
NoB'
Annual
1975
--6
50
1
4
200
Oct - Mar
in er
NoB
Annual
—3
50
1
5
250
Oct - Mar
Winter
NoB
Annual
1980
1 —4
50
1
2.4
1 120
1 Oct - Mar
TOTAL TABLE 1 1 1 4047

Table 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
Tract Field Soil Crop Real. Lbs. N Acres Lbs. N Month of
# Type Yield Per Ac. Utilized Application
Total Table 1
Total Table 2
Total
Amount of N Produced
Surplus or Deficit
Your facility is designed for 300 days of temporary storage and needs to have the temporary storage
removed every 10 months.

0
The following acreage will be needed for waste application based on
the crop to be grown and surface application:
Table 1: ACRES OWNED BY PRODUCER
Tract Field Soil Crop Real. Lbs. N Acres Lbs. N Month of
# Type Yield Per Ac Utilized Application
N6(3 n
, J7 da
.I
T
30 5
l
2 ZD
! ��U
3
No ►�
. IT
3 e .S
IT
3 o s
? e
722.
W
135
135
4'i
1 309
-1
Total Table 1 L -1 � q f
Table 2. ACRES WITH AGREEMENT OR LONG TERM LEASE
Tract Field Soil Crop Real. Lbs. N Acres Lbs. N Month of
# Type Yield Per Ac Utilized Application
Total Table 1
Total Table 2
Total
Amount of N Prbduced.
Surplus of Deficit
LU�yn`���
Your facility is -designed for 3py days of temporary storage and
needs to have the temporary storage removed every /p months.
Page 2

Where owners of animal operations do not have adequate amounts of
land to apply the waste, the producer must provide a written
agreement whereby another landowner has agreed to land apply or
allow land application on his or her land.
Call the Soil Conservation service or Soil and Water Conservation
District office after you receive the waste analysis report to
obtain the amount per acre to apply and the application rate prior
to applying the waste.
See attached map showing the fields to be used for the disposal of
waste water. 41
Application of Waste by Irrigation
Field
No.
Soil Type
Crop
Application
Rate(In/Hr)
Application
Amount(In.)
'J
JVQ
il- rc,-ys
Page 3

WASTE MANAGEMENT PLAN AGREEMENT
I agree to carry out this waste management plan according to the
terms of the agreement. Failure to comply with the waste management
plan will automatically require any cost share funds to be refunded
to their sourc 4
Producer: Date: 3.2
I understand that Mr./Mrs. does not have
ample land to apply the animal waste produced from his/her animal
operation. I have agreed to utilize the waste produced from the
operation and agree to carry out this waste management plan on land
that I own or operate.
Recipient Landowner: Date:
System Designer: Lt�;8 ,, Date: -7
Cr
SWCD Representative:
Design Approval:
Date:
Date: 3-21-16
Page 4

11/12/99 FRI 16:34 FAX [phone] NC COOP EXT. SER Z001
' VOTEQUALM SE IFION
?DEC 0 1 i y 99
EMERGENCY ACTION PbANPermituno
PHONE NUMBERS
DWQ 919 571- 4700 q3
EMERGENCY MANAGEMENT SYSTEM 919
a�3-,P SWCD 919- 4 ` J_
W
This plan will be implemented in the event that wastes from
Your operation are leaking, overflowing, or running off
site. You should not wait until wastes reach surface waters
or leave your property to consider that you have a problem. -
You should make every effort to ensure that this does not
happen. This elan should be gosted 3n as accessible
location for all employees at the facility. The following
are some action items you should take.
Z. stop the release of wastes. Depending on the
situation, this may or may,not be possible. Suggested
responses to some possible problems are listed below.
A. Lagoon overflow -possible solutions are:
a. Add soil to berm to increase elevation of'dam.
b. Pump wastes to fields at an acceptable rate.
c. Stop all flows to the lagoon immediately.
d. Call a pumping contractor.
e. Make sure no surface water is entering lagoon.
S: Runoff from waste application field -actions
include:
a_ Immmediately stop waste application.
b. Create a temporary diversion to contain waste.
c. Incorporate waste to reduce runoff.
d. Evaluate and eliminate the reason(s) that
caused the runoff.
e. Evaluate the application rates for the fields
where runoff occurred.
C: Leakage from the waste pipes and sprinklers -action
include:
a. stop recycle pump.
b. Stop irrigation pump.
c. close valves to eliminate further discharge.

11/I2/99 FRI 16:34 FAX [phone] NC COOP EXT. SER
Z002
RECEIVED
• liti'Y7�-" nt M1 frr r-r.T►oN
DEC 0 1 17;;1
d. Repair all leaks prior to restarting pumps. oPesrrtiktin9
• Non-pisc..��9
D: Leakage from flush systems, houses, solid
separators -action include:
a: Stop recycle pump.
b. Stop irrigation pump.
c., Kake sure no siphon occurs.
d. Stop all flows in the house, flush systems, or
solid separators. .
e. Repair all leaks prior to restarting pumps.
E: Leakage from base or aidevall of lagoon. often
this is seepage as opposed to flowing leaks -
possible action;
a. Dig a small well or ditch to catch all seepage,
put in a submersible pump, and pump back to
lagoon.
b. If holes are caused by burrowing animals, trap
or remove animals and fill holes and compact
with a clay type soil.
C. Have a professional evaluate the condition of
the side walls and lagoon bottom as soon as
possible.
2. Assess the extent of the spill and note any obvious
damages.
a- Did the waste reach any surface waters?
b. Approximately how much was released and for what
duration?
c. Any damage noted, such as employee injury, fish
kills, or property damage?
d. Did the spill leave the property?
e- Does the spill have the potential to reach surface
waters?
f. Could a future rain event cause the spill to reach
surface waters?
q. Are potable water wells in danger (either on or off
of the property) ?
h. How much reached surface waters?
3: Contact appropriate agencies.
a. During normal business hours, call your DWQ
(Division of water Quality) regional office; Phone
919 571 - 4700. After hours, emergency number: 419-
733-3942. Your phone call should include: your
name, facility, telephone number, the details,of

11/12!99 FRI 16:55 FAX [phone] NC COOP EXT. SER
[in 003
the incident from item 2 above, the exact location
of the facility, the location or direction of
movement of the spill, weather and Wind conditions.
The corrective measures that have been under taken,
and the seriousness of the situation. `
b. If spill leaves property or enters surface waters,
call local EMS Phone number 919-459-7376.
c. Instruct EMS to contact local health Department.
d. contact CES, phone number 919-459 -9810 , local SWCD
office -phone number 919-459- 4114 and local NRCs
office for advice/technical. assistance phone number
919- 459-4115.
4; If none of the above works call 911 or the Sheriff's
Department and explain your problem to them and ask
that person to contact the proper agencies for -you.
5: Contact the contractor of your choice to begin repair
of problem to minimize off -site damage.
a. Contractors Name: rn r, 1- n n .)� r2 .
b. Contractors Address: N�t �Ii4,
c. Contractors Phone:
5: Contact the technical specialist who certified the
lagoon (MRCS, Consulting Engineer, etc.)
a. Name: NRCS SWCD
b. Phone: �.)-
7: Implement procedures as advised by DWQ and technical
assistance agencies to rectify the damage, repair the
system, and reassess the waste management plan to keep
problems with release of wastes from happening again.
we 12A4

Insect Control Checklist for Animal Operations
Sourd:e Cause 11M1's to Control tnsccis Site Specific Practices
uld Syslcnus
1'lu1h Glitters Accurtittlation of solids rY Flttsb system is designed and operated
sufficiently to remove accumulated solids front
ttters as designed.
AE Remove bridging of accumulated solids at
�cbarge
Lagoons and fits Crusted Solids Maintain lagoons, sending basins and pits where
pest breeding is apparent to ininintize the
crusting of solids to a deptlt of no more than 6 -
Inches over more than 30% of surface.
Excessive Vegetative Dixtlying we -gelation "Gr Maintain vegetative control alrnig banks of
t irowdb lagoons and other impoundments to prevent
aceunttlalion of decaying vegetative matter,
along water's edge on impoundment's perimeter.
I�cc�icla
feed Stoeage
Iced Spillage
n
n
Accumulations of feed resid,acs 17
n
Dry Sysicnts
hesign, operate aml nudwain feed systems
bunkers and troughs) to minimize the
accuanulation of decaying wastage.
Clem up spillage on a routine basis (e.g., 7 - 10
clay interval during summer; 15-30 day interval
during winter).
lieduce mnisture accuiluil ation within and
around inunudinte perimeter of Iced storage
areas by insuring draiarage away front site
and/or providing adequate containment (e.g.,
covered) bin for brewer's grain and similar Nigh
moisture grain proddtcts).
Inspect ibr and remove or break op accurntalated
solids in filter strips around Peer[ slnroge :as
needed.
AMIt - November 11. 096, Page I

Source Cause
BMPs to Control Insects. Site Specific Practices
Animal Holding Areas Accumulations of animal wastes
❑
Eliminate low areas that trap moisture along
and feed wastage
fences and other locations where waste
accumulates and disturbance by animals is
minimal.
Cl
Maintain fence rows and filter *strips around
animal holding areas to minimize
accumulations of wastes (i.e., inspect for and
remove or break tip accumulated solids as
needed).
Dry Manure I landlinb • Accumulations of animal wastes
Cl
Remove spillage on a routine basis (e.g., 7 - 10
systems
day interval during summer; 15-30 day interval
during winter) where mamtre is loaded for land
application or disposal.
Cl
Provide for adequate drainage around manure
stockpiles.
❑
Inspect for and remove or break up accinnul:ued
wastes in filter strips around stockpiles and
Manure hondling areas as needed.
For inure information contact the Cooperative Extension Service, Department of Entomology, Box 7613, North Carolina State University,
Raleigh. NC. 27695-7613.
M
AAIIG- NIIVU111hCr 11. 1996, Paget

Suuree CUu5C BMI's to Minimize Odor Site Specific Practices
Standing water around 0 Improper drainage; 0 Grade and landscape such iliac water drains
facilities a Microbial decomposition of away from facilities
organic tuatter
41tuture tracked onto • Poorly maintained access roads 0 Fami access road maintenance
public roads from farm
access
Additinnal information :
Swine Manure Management ; 0200 Rulelf3MP Packet
Swine Production l-ann Potential Odor Sources and Remedies ; EBAC Fact Sheet
Swine Production Facility Manure Management: Pit Recilarge - Lagoon Treatment ; EBAf3 128-89
Swine Production Facility Manurcm Management: Underfloor Fittsh - Lagoon Treatment ; C-BAE 129-88
Lagoon Design and Management for Livesiocl; Manure Treatment and Storage ; EBAR 103-93
Calibration of Manure zinc] Wastewater Application Equipment ; EBAE Fact Sheet
Contrullin6 Odors front Swine Buildings ; PH 1-33
Environmental Assurance Program ; NI'PC Manual
Otttiuns for Managing Odor ; a report from the Swine Odor Task Force
NuiSLJJICe CnnCUMS in Animal Manure Management: Odors and Flies ; 1'110107. 1995 Conference Pmccedings
AK4if{' - 14ovcm1mr 11. 1990. rage 5
Available From :
NCSI.J, County Fixtension Center
NCSIJ - IIAI:
NCti13 - BAF
NCSIJ - IIAE
NCSI I - IIAI:
NCSU - BAH
NCSU - Swine Extension
NC Pork Producers Assoc
NCSIJ Agri Cnnununications
Horiih (:onperative lixtensinn

Smlrcc Cause IIMPs to Mitriruize Odor Site Specific Practices
IJI'l stalions Agitation during sump tank ❑ Sump tank covers
filling and drawdown -
1_nd of drainflipes at
• Agitation during wastewater
Extend discharge point of pipes underneath
lagoon
conveyance
lagoon liquid level
Lagoon snrl'accs
0 Volatile gas en►issions;
proper lagoon liquid capacity;
�V�-t
• Biological mixing;
orrect lagoon startup procedures;
• Agitation gtirnum
:/Mmininmrn
surface area -to -volume ratio; _
agitation while pumping;
❑
Mechanical aeration; I%,R-
❑
ioven biological additives
Irrigadun sprinkler
a I Iigh pressure agiialion;
Ur
igate on dry days with little or no wind;
nuccics
. Wind drift
Minimum recommended operating procedure;
�punip
intake near lagoon liquid surface;
Cl
Pump from second -stage lagoon Pm-
1)e;u] hit�ls
Carcass decomposilion
❑
Proper disposition of carcasses
1)caJ Ilit1l,bsposal pits
0 Carcass decomposition
❑
Complelc covering of carcasses in hrtriai pits;
❑
Proper locatiorticonstruction of disposal pits;
❑
p1sposal pit covers tight filling
Standing wilier arutnul
0 Improper drainage;
f4
Grade and landscape such that water drains L J
t'ei1111t'a
Microbial decomposition of
away from facllitics
organic matter
Ntud IraekCrl onto public Poorly nlainlained access roads Karat access road mailuenanee
wilds loam t um access
Addilinnnl Informaliun :
I'uoltry Manure Mam+gentem ; 0200 Rulclr]MP Packet
hillItty layer Pr1ldttclion Facility Manure Management: I ligh Rise, Deep Pil ; FHA13 13l-HH
Poultry Layer Productiun Facility Manure Mauagemenl: I lmlercage Flush - Lagoon Treatment ; l,'BAI: 130-HH
I.agooll Design ;nld Management fur Livestock Manrtre Treatment and Storage ; EDAF 103-83
calibration of Manure and Wastewater Application L•qutpment ; EBAi: Fact Sheet
I'rolscr I )ispus;tl of Dead I'orrltty ; I'SLI' Guide No. 11)
Ntos;wcc Concerns in Animal Manure Managemenl: Odors and Flics ; 11110107, 1995 Conference Proceedings
ANlf)C: - Nuvcnlhcr 11. 1996, Page 7
Available From :
NCSIJ, Cottnly I:xrcnsion Centel
NC'tilt • I)AI?
N(:SlI - IIAI.
NCS1.1 - IIAIi
NC5t r - 1IA I.
N(:SI1 - I'miliry Scicace
Florida Cooperalive lsxtension

a 1 / s � • �r r� " c d t � !; s t 1 t o ,7''ff: ���.�.p:
aem'eht lMethods
•�1•Iortalitv'1�Iana� 1,+, xs F r tr is •;�;•jr,t";�,�_ ��-�
(check'which ^ine'thod{s) are being implemented}
1, f a
2 r C yr •a rt v
' •1r. �a �: fi; ryt.'�h. � "'��f'�`.'��� x��r Wr �1Y�` 'l i'�`rtl. �� r,r,' 'far"�d: ,3J,� �`!�((` i #� #��� ;8 •� '������i�'�"�' � "'fad 3d 'r; ...... ..'. t.�._F•.._ i.,�r:r'• i .'� ��•5��%�s }1 & ram• r..S '�tkx T:i�a t.�.! alr:�......�'�i4Ai. C•U"F - .. �' r ..ai, :_ r_.._ x.r..•.,+^>tern.. L
`• S'g t � r i j:F'pk
w.YyI �.y4+"i" srr•r s ¢�rqy r%1, fd' �.'F Y%i :7 �"t/ Pr �h" �� r' r 1` czk Ft�;. L F,c fi .Cy }Y .,e
xJ } rl ..y " 'r}j1 =pw�'•,�,i1s41�, ''Y, 'P,7 /�', -#Zi} f i• !r 1':!i i ry'' f i, -+, J rr {r tr n iY 2, L,. +�k .4•
aJ . Rendenn� at a rendertn� plant licensed under
Complete incineration r
r. f le 1 v�yy�3
❑ In the ease of dead poultry only'placi '- f to a disposal pit of a size and desisn ., ;+
approved by the Department of AQnculture �`�`'°
7iYsf.
Anv method which in the professional opinion the State Veterinarian would
make possible.the'salvage'of part,`of„a dead animal's waloe with endangering ! lsslcw
r
human or animal health.' {Written approval of the'State Veterinarian must be ��'�•`
attached)
• 'J - ; '�' y7r ✓ - 3 r 4 -,( F S ) 1' ; �� 1 adJT � Y.,+�.�.4LA. '�
' Y r t+s. Ji 1 5 s ?• J ; ..... .' .......'r i tE r w. ••3- 4 f ( �f�^n' ✓.. r, l y�G��y f ti
' r: ty; r.~+t3 7 r''� '� `;��_ + ��� t. +�:, r� �n�y{,�Y•p�r'� ry+�� r ': } �,�1+"x_r' a�,s• "� ; '`�' �'� J} - -_� ��� t., �.1 i'.,�J 1 �1. f �'d� � u ��'Q'�rh'..`.r:µ .r`.Krit.��'�, 'i
f �I,a:3_ti K,. s,:; i35�i t �„ '� "-p,`�,S.S.yT'r :r�3.''. r'w• •$,_F � -i �r �u r r7 � iJ eh p� arE� s i� fk dAs 't'+ f,�r:r,; :;i ���1; iir +ys .��' �'�T�Sa• �_
, f f W-j 1Y1 �.�e �+, r i a 4 a s r � r - �.-(if rF.�"rf !rS r�Y •kk.
- s��rs�- ^^, d C JYi �h i r �{ ,:,l. apt }4J,,.�+ h,l y �,�.f�+ - �� •4s a r- ,i} ,� I.. + �'f'"i' .s cr-'s, �J �,�j � . ;
, F�� � r :r•:s�r+ 7�"� .�.• rL r:,= r s'L,1 r,,l7v+ � r 'x4 r Y x f prr.,f �. s '' t rw h.i �+.,.
r z; �4,S�,a� 1{� �4, •••'{ � lMi'�• rs �, �seG� ;�..�„{E.L3,� •.�r��r�r �. kC.. /.+r*". •t �X:e �Sf .,;r�C,M1"v' r�.: nr r- '\ «� „red. �\ ,r�. l�f r +'S
'�.�ry'r��! } }•; � i 15Mc;� ;�f�`J��� Ns. Fr�.i';t�st14 4'�� �: lli��� +� ta>. y C�;3�• �'4 iu; ri^s' .��/� ��� �rY!'y�aily'% ` r`'��` ;,+'
r��,*��-YI s�, �.?} � M` yY�r,' 3'T "���y�3r 9 ��':'��i�' `'Isp'�ifai;^ �i'�j.�r i. a.-Y'.y �'�,'��e,,',r ��I���ro�y+i".`Y(Ssri�y',yp�,,."R•��ii .° n„� i^�,�i �gli,� �. ? tf'�.
1--. ., ri.�,i=�:�Na+"e:�^j�j{�l�,�r��7�4� �J.�i.'�:3iS2-ba7 �+:i ���'•�rt��i�:R�.�.��.:��r��q2,�t�"�`C��.'�,'.'k'1t�e�LitrLi��`Y�.'�fw.+�ib r.� 4'�'ii.r..4'i.�. 3�T,.���' -i

Notification of. Change of 0 wnership
1 �: ��". � •{'t � , ; .s n tau,. ,,
-`Anima; Waste N anagement Facility
y f f e .(Please type or print all information that does not require a signature)
n accordance,„"with theof '15A NCAC 2H .0217(a)(1)(H)(xii) this fo
}noiifcation 'to:the'Division of Environmental Management (DEM) of the transfer of ov
�+ { Animal Waste Management Facility. This form must be submitted to DEM no later
} = 'fth' Transfer of ownership.
•r"
• '�ANamc`of Farm KaN-r'sol�+tu oa "Fnti Facility.No:
,4 , vtous'Owner(s)'Namc Phone No: z
New-Owrier s Name: F Phone No:
Matiing Address: 3 Z P.- i?o o uNr e. o f
Farin'Locarion :Fourteen Digit Hydrologic Unit:_ Q3Q ZO 103 0 Z UO 10
Latitude and Longitude: 4 4 61 Z8•fo" Count E a
` ase.:I:t,tac.hr co,py of-acountyf .road map1 with location identified and describe below (Be sI
r `"► names, directions, -Milepost, etc.): S� 2- t5mr ck IY vjjT
5, Nj�j ,� S F .r,•
-77
E J
C .•• i
Type?a�9, No. ojAnimals Type of Poultry No, of Animals Type of Cattle 1�
ti. �1 F O:Wran"to°Feeder Zobo' ❑ Layer ❑ Dairy
Feeder to Finish $Oo CI Pullets 0 Beef
��4,,�,
� � ��'t ��} , ©Farrow tti •Feeder , . : ,
gi�i6v Finish. - Other Type of Livestock: Number of Animals,
Acreage Available for Application: 314 -_Required _ Required Acreage:��.
Nut tb'er of �46�n�­*'iorige Ponds :, I Total Capacity: S1o3 Ct>;1
/yy'�h �,D�vitef /Manager Agreement
That all the above' infot=nation is wrrect and will be updated upon changing. I (we) understand
R r' maintenance proctdures established in the approved animal waste management plan for the farm named,
i� u implement -I here procedures. I (we)•know that any expansion to the existing design capacity of the wastF
ITs, ,�{s strinr or'construcuon ct.naw�'„fac�litse5 will..mquire,a-;new'.certirication-toMbe,-submiued• to 0
E,zEnvironmlvlana$e.ment before the'tiew animals are stocked. `I (we) understand that there must be no disr�l
waste from the storage or application system to surface waters of the state either directly through a rtian-made
from a storm event less severe than the 25-year. 24-hour storm and there must not be run-off from the appli
5,+'waste"'I7(wc) unaerstand•ihaftun-aif,of pollutants from lounging and heavy use areas must be minimized
standards developed -by, the' Natural Resources Conservation Service: The approved plan will be filed at the i
office of the i" `Soil and Waier Conservation District•.'.I (we) know that any modification must be approv c
��'sp'ecialist andisvbmitted to the Soil anti-Water.Conservasion District prior to implementation. A change irt�l
refit:,ti='s'wirit}ten=dficazion to DFM or zsew cerffiration (if!the approved plan is changed) within 50 days o I.
t ,� Name,bf New a 4 er
} ,c
T' Name of.Ma i o
- r
c ' r, ,Slgn�ture:
,..pliaseJsion and.return+this arm to:
'`NCO:;'hiay 31996 �. .
N. C..Division Of Environmental M2nagemR6(
Water Quality Section, Compliance Group
4 1617 MAIL SERVICE CENTER, MARRALEIGH, NORTH CAROLINA, 27699-1617
UA
.is official
rship of an
m .60 days
EM
cific: road .
i
' of Animals "
is Feet (ft3)
operation and
Bove and will
treatment and I
i .DMsion"of
arge of ani nal
-onveyance or
tion of animal•
sing technical
arse and at the
by a technical
wd ownership
tide tzansfer.
1VED
SECrb
'lime En t

it i
',
�I{Fllrlh i�ifi�,
�xyJ��a j f IF Y
l
Fh�
WASTEMANAGEMENTSYSTEM'
AND MAMENANCE PLAN
r s
�,j! 'i�frr� i qqua+�; Rt1' ='�:4�II�' �''y a'.��1�' rla yY'1«�r �a �i'`iY ls�•. I 'h? i;:•; ' r 3 `�4C'+. r ` •' -
; W:,
ucer .Doug Johnson;
-
{Purpose ofthis,plan is to provide guidelines for carrying out the routine, operation
r
aud� maui#enance work' fieedw1oJkeep this swine waste management'system functioning
as pianiued. Routine! maintenance, is considered to,be normal, good care of the system. '
hL
Goodlma�ntenance a=,to=b�iuty,'usefulness, and permanence.,
'
���7�+,,r
'A'!6i 1 ,7�J.c i>#s .L{Ew IL.�`••t• y it e
•i[ - {''' The routine of the oon involves the folIowin
ntenance lag g''.
`
�,y, 1 ,= r Mauitenance of a'vegetative,cover on the embankrent,top and side
�,,
,; �F �'
"r�' a `` 'slo: Cciastal Bermuda is being established on these areas.: Beginning
pes
';,in
1983 and each:year,thereafter the embankment should be fertilized. with
1800
"'pounds-of 10-10-10 per acre to maintain a vigorous stand:
2 f ; 'Control of brush and trees on the embankment Mowing, spraying, or
choPPing, or a combination of all three may do this. This will need.to be -.
!•
done at least' once each year and possibly twice in years favorable to heavy
growth of vegetation.
I
A _' y
S
i
Ma�ntciaance:inspections.ofthe. lagoon should be made during the initial filling of
Y
lagoon and' at, least annually: Items to be checked should include, as a
i
1; cfrW`m1nlIYILtTn, the following:' .
_! -
4 11 S i
W.asterInlet Pipes, Overflow Pipes
a) ,Condition of pipes 1
' : I) Separation of joints
a • k
•-2)
yy��, �s 1��1� , }poi
h�I E•,2 k_ lF ;f :4"4�r L1 \ 4 r 'i.. r _ - '. ' 1 • r
•',+racks or breaks71
k
r r I r k f c v 2) Pool
;
e, 1'
4W,
a) .Undesirable vegetative growth
S
• ;
L r q
b) 'Floating ar lodged debris
3): Ent
a) ,.Settlement,'cracking or `Jug" holes
f ,'
b} Side slope stability— slumps or bulges,
c)Erasion and rodent damage
,.�)
yl. iy
-••i1LWWi I'yiL�p.
_
,d.•�f r° - 71ri".: 1 Is y fie„ , ,�a - f
J ..�
r
,�''I,
1 M
+r

r
i F 'L I.:f+l •�' � t F} T '1 3 ,. - -' - :
Ov
`Your antmal waste ma�agement'facility was designed for a total of 2800 animals
r ,
1
,(WEAN TO FEEDER). The lagoon contains both permanent and temporary
t storage. The permanent storage is not to be pumped in order to ensure that
anaerobic action will occur, The design includes permanent storage of one cubic
i , i" foot :per pound of steady state live weight.
%� 'IN The ternp %o e.- rtion of the lagoon. includes ca for the volume of
""""1'��'! JI 1 1'„ "'C 1"'�ity
(waste prioduced over 300 days, the amount of rainfall in a 25 year 24 hour storm
ilarrl rt r;rr crp , u a,.
r r Y 'event and rainfall in excess of evaporation. 'Your facility is designed for 300 -
:.
da soft 'sto e; therefore, it will need to be' d ev ten months..
y emlm Y p+ Pe �y
i �• y Begs pump=out of the ]agoon when fluid level reaches elevation of 44.8 feet as
d7 tni f� r I Grp r r111 „1 k n c
; ;s� ; ' ;1,`,7'marked by permanent iriarkers. Stop pump out when the fluid level reaches
\ 1 f r r I r f= - ,
�R i" `,' +;t11�lele�t�on 41.5 feet.: ;
attached waste management plan should be followed.` .This plan recommends
sampling and testuig of,waste-( Attachment B) fare land application.
see n be The.. .
Waste material should be analyzed befo e;each'application cycle,to:determine its.
nutrienfcont•ent A soil test of the area of application should be made annually to
waste.is applied`as reasonably'and practically possible to.recommended
yIt is strangly recommended that the treatment lagoon be precharged to %s its
-capacity to prevent excessive odors during start-up. Pre -charging reduces the .'
concentration of the, initial waste entering the lagoon thereby•reducing odors.
Sol:ds should be capered with effluent at all times.
F t The Clear Water Act of 1977 prohibits the discharge of pollutants into waters of
#; the United States: ` The Department of Environment, Health, and Natural "
�, t4 s s 5 y f ;Rne�so7unrces;�Doi]vnision of Environment Management, has the responsibility for • .
I Lei i i Z 3 4, P'r-enfarc this law
�v�G �p'�l4 iJJJ q4�kt 6�x.
''y: :, ' 3' a 5�:"f •r t ' ;
� �r,•N�1r� yy.;; 'itiYt. r r' •i 7• - 1 ..

................................................................... .....'............. ........
T E U T I L Z;A T 1 Q N� P °LAA N
........................................�................» .......................Xi
.... ..«..»...
1 1 , YES, '('H i _ , 1 ' 1• ` ' '
5 �. t r t, ✓, i
s tiREQ UIRED` SPECIFICATIONS
��'Z'#�' n Anzmal waste shall not reach .surface .waters of the state by rung
drift, manmade ;conveyances', `direct application," or direct discha'r
'durIngi•rioperation or;land application. ' Any discharge:' of waste ,whi
t tiP �hrL'r.s - , r.
a"�^ reachesi�surface water ,ris-prohibited. .. ' y
fry
t',Ajr2 ��Thdre`lmu's.tr bey documentatrion•.'in the design folder that the produ
yEither;�owns or has "long term access to -adequate' -land on whic4'to-
f aply? �hd,!Waste`:.n;I,f Fthe�,producer does. ,not own adequate land :to p
OSFe` of"waste,,. heyshe, shall' provide-NRCS with a copy of a writ
agreement; (sample .encl'os'ed). with 'a landowner who is -within a reas
GS, pro`xa.m t, aT-lowing.,hi.m%her the use !'of•� the land for' waste applica
a .,
�the�llfe� expectancy. of".the, production facility to secure an update
;N1
U.tlli•zat'ion'Plan when "there " is a change in .the operation,: ,i
tbe�number �;of� animals,' 'method 'af' :utilization; or tavail•able can
n1mal.,�waste"sha1l bii ;applied to.:meet .but not, exceed, the -Nitro
' needs 'fcr realis 'ic .crop' yields on -.soil' type, available moisture -
I: v t LP
,5�historical data, climate conditions.',' and level of management, unl
hBre e � regulationsL"that;.'restrict-, the rate of application of,' of
N,'#nutrtlents
:�`rAnima'1 rwaste:'shall be applied to land eroding`''less than 5 tons
Lpe`r year Waste',may be .applied to land that is eroding at 5 or m
k�a ton's; �ibut� less,-, than, 10; , tons peracre' per,;, year providing that grass
Fstra.ps'�I are.. installed where; runoff leaves 'the field. (See FOTG. St
~} 393'.� F11ter Strip) `
f,� -f5, ' ,'Odors` cari',bereduced.'by injecting the waste or disking after was
appltoatio.n. Waste-sho,uld-,not be applied when there,is-danger of
'r�from,tte�Yirrxgataon field..
,i kp6. 'When animal jwaste. as`.to :be applied on acres subject to flooding,
` N , A.
-,incorporated on conventionally, tilled' cropland. When
t applied; to , conservatio' ri tilled crops or grassland,_; the .waste may
fir;brvadcastproicied. the:application doesnot occurL during a season
to%'flooding. {See '!Weather, and Climate in North Carolina" in -the
4f, Techn{lcalReference ,Environment .'file, for guidance.),
Waste_sha11 be` applied at rates not to exceed.the soil
rl�nfl��trStIon rate:, such;1 that runoff, does not occuroff. site or' to s'
wat'ers "and in a "method; which does not cause drift: from the site du
r-*Yr,con'ilda eidt oNorpordflgeshould occur in' order to control conditi
i
�A vAnimalt334aste .shall; not,be applied, to -saturated: soils, during rai
�3Y:,�erents, or, when .'the, surface is . frozen.
M.
ff;
er.. --
roperly
aper-ly
=n
cable. _
ion' for
,o f the
,cease :...
an
r acre-
i.lter '
dard'
e.
rift
i t:
rove
.rface' `
ing
is ;
ifall

M
r
Ss
.............................................
....... . . . .................... . .............................................................. ........... ...........................................
STE U.TPLAN A
WAILIZATION'
;,7' 1
.... .......................................... I ................... I ............. ................................................
......... ............ .......... :
16`e,"
rite, -­`,`sha I."1a pp I ied on' actively grow.ing crops in suc
a
snot.covered", with, waste.;.toa.depth that
The ,OR��ptialfforsalt - damage animal waste
oUld.",,"
be. applied "''in fall ' or' winter, for'-sprir
'leaching.
)ps­Fon'.,I, so' high for Waste
h-'
)ad-in4'-,,xa,te's,,,'o'n,.. these, soils, 'should >be held to a minimum
nd%, j
,.,iwi,nt'e'rl"tr-ovlercrops"planted .',-to take 'up -released � nutrients'.
"d"'niore.- thandays prior :.to planting of 'the �O
.
;w-1,ne J, f ac 1, 2. fiy, �,,�sit d.d on '•or'i rafter October- 1 1995. shall
r
mp
ilt'lowinc . ;The' outer' perimeter,,of the,..land area onto 'whi:h
- 1,
that, r-is'. a,., component �of -:a.,swine, farm
shah_ `.`-'­,-,501 "
p and -froVian
y
.'pro
.,r an,an,irri trqamo ­, .".river"' (other 'than gation-,,ditch or-, canaml,'
ne.7"W"ast e',.f rom',, f a c.i I i ties sited after
lon.or
,19951"�,�'shi�,1,1,?"'n;o"t-,be., applied `closer: than %25.'.'feet. to perenal71
ee Standard. 3, 9Tilte..3', - r."Strips)
sate shall not Abe applied ,'d loser than 100 feetll�to wells.,
suer '-s. h ".be '-applied -'closer than .200 feet -of dwelli
119 s
those- owned'­,Fby,,tAe landowner—
d other, property ,ai
in ­,a, manner ..,to, reach"
,I .,.,,1app-lTe
-ways
s,teI,-w"shaID t"'b ischargp4_ihto surface -,waters', drainageways
,'no e
T ;.b ;b a,�d Is' ?charge:,. or. by over-c�prayinge Animal waste may;;b
'iited.�,'! cropland pr�qvided' �they ha e,'be �prd:or�.,conve v been approv
, 1.,
I . a
"",
t tI
�,ti, o n site chn"ical, specialist',". '.iAnimal- waste s
.,y�'a te
.
o'uld,,,r­­. -
n, g i y into....
lqd,o 7A ssed�,',waterw''a'yp 'that directly
ezr'""'
-other`te-,'sh ,,.,,.grasse I; watprways,, :was a' beapo lied �,at
ates�'!-'I-n-, 1'1manner­­that , causes' no runoffor-'.drift from the,site--,`
a
id" d
.an - in ustraa:1,.,,w,�ste."from washdown' facilities, show6rs,
s­�-, etc n sha 1 IY' 'not be discharged into the animal' avast
system
.1ve,'��'cover,,,;eo'fi,,.�'appFopriate"vege.tation. will be established
)n
led -j!ar6as (10"o"'on, embankment's -berms, pipe-, runs, etc'
,
to �.protect, the vegetation.., Vegetat
'e shrubs; a'n'd other "M o o d y r' limited t
species, .a. e
area s
d'dred;!I'approp,r,ipte.- should be' kept mowed a
-Be' d.'st-r6ctiares should be larly'fo
Berms inspected, regu
,an
E erosion; leakage`;; or discha�'-ge.
"Lprodl�ct ion:Iat,'I,,-the- facility' is; to; be ;suspended or termi r
te d-
s�_responsl 6il� e, !1or-obtaining and implementing -..'a '.'closure
P 1 an!"­
e rriiii-nate`ithei,,,poss i b 111 ty' 'o f ah i 1 lega.-i "-discharge ,pall
rion

} LT
............n WASTEUTI LIZATI C �N. PLAN
ti 1.9 , twaste ~handling,..structures,' piping, pumps, reels, etc., should b�
f�.lb,R Y,anspected on a -regular'. basis to prevent, breakdowns, leaks, and sp
Ff{ t4A't;,regul'ar'mainten'a-ncei,checklist should be kept. on site.
�Anima'1 iwaste ;can ,be .used in a rotation that includes vegetables
F� e:F;;iocrops, for-` direct Thuman• consumption. However, if, animal .was
}a;TkKused,;on' crops ffl.,or direct' human consumption it should be- applied p
further:�applzcations ' of ani.mal..'waste during the cropping
[f 1�"f��'A1 r�' iF�; iY' Ins! ,• ! � w r; .`. -
'ighly visible markers shall be installed to -mark -the top and bq
Fayelevations,sof,-temporary°storage,(pumping volume)' of all waste trek
l�agoor�si, � Pump n,g= shall' be managedto maintain''the.liquid level bj
.gv- the,'markers:,".: A ,marker 'will be. required to mark :the maximum stora
:'�'Volume 'for'N.waste storage, ponds.
� V7,22 3" Wast64 hall =be. tested! within Go• days of utilization and soil shl
atleast rannua'lly at crop sites where waste products are ap
f , Nitrogen shall .,be the rate -,, determining : element: ' Zinc, and copped
,f�}'�.nthe,.soitls3 shall° be monitored and alternative [crop .sites shall.
�U .11­,when athese,�nietals approach excessive levels. pH shall be adjuste
r 'op mum;��roptiproduct�on� and. maintained: Soil and 'waste analysis'
shall;,;�lo �kept',for f vea,years. ;' Poultry,'dry waste application record
I ; 'siia� :� ti b"�y may ntained ,'for ;?three years,. I Waste app
r,� waste lication records f
eshall bep madnta,ined • f or • five '(5) �years . ,
*23. pead animals will :be disposed of in' 'a manner that, meets North c
JI
rl' regulations .' � _ ; • ' , - _ •
IiP
�d"I w1Y14r ty °I. '1
FYI ':4�%�yt.S, i � 5 [1� i � y;� r.• r� .
H `�Y
r,
-
1hT}'z
ind Y
splant} �-�
:ason 'l
.tom
.ment
,weer.
Ll be
plied: '
j levels
' used
for, •
pcords
�sa1�1
�oli.na
1
[
f
l •
l '

�
i s
VI 4
eel
7.
.
k'�,Theifollawing acreage will be needed for waste application based on the crop to be grown and surface
dh , �'' . ,,,•, ,
appIicati= ; w
.ta
J�;s'�
h r •.I,Y 'gars �
k
t Y 4 ,:
n S t
'
i� �, • %'' Table 1.
ACRES OWNED BY PRODUCER
`,Tractt' x Field Soil., Crop
Real. Lbs. N Acres Lbs. N Month
j
- ",! ' a '' Type iy` ,
Yield Per Ac. Utilized Applica
.
li r
1,-I.4yEl�z
akrf�k"«41Cr'elV
Improved
" 41975 '
B
6.1
305
4
A220 L
Aril - Se
.
•Bermuda
improved,
.
NoB
Bermuda
6.1
305
5
1525
Aril Se
e
» +
Improved
4980 ,
Ile'
!s .'4 �,
i N0B �"
'`Bermuda
6.1
305
2.4
732
Aril - Se
'
' '
r
NoB'
'-Annual
r1975i,+;r
-6
50
1
4
200
Oct - Mar
7
inter
�--3
NoB� i
r" "'
;Annual,
'
S0
1
5
250
Oct - Mar
DA,i r",
- NoBr
Annual
'
:1580''
-4
50
1
2.4
120
Oct Marl_
#r TOTAL TABLE 1 . 4047
4'!r },j� f .� j� 3 . A� .1 M � • ,P M, `:S ' /' - r , - F '.d. - .. , 7kis is T n¢ c OPP J i /�t '
/3
�, -Cy, i,re % n fr_, �� •' 't
0 o-
1.
.1
r�arSva
+ p� a� i
i

Animal Waste Management Plan Certification
(Please type or print all information that does not require a signature)
lq'a: - ' 0fiii7iii-FT�iSi
RECEIVED
DEC 18 19m
Name of Farm: ry Facility No: 33 - t -7
Owner(s) Name: Lb v b __bg Nam& r Phone No: q t - A 4 3 - 97 zo
Mailing Address: ' -7335
Farm Location: Fourteen Digit Hydrologic Unit:_ a30201 0 3 o •zoo ( 0 _
Latitude and Longitude:--_� t;-3, 4q.1-"/ 17a yf ! Z�•� " County: E-0C�Ecen.gE
Please attach a copy of a county road map with location identified and describe below (Be specific: road
names, directions, milepost, etc.): SR 12-2-y EAST CE RAC ryx)0rJT .
Operatign_Descrintio-n:
Type of Swine No. of Animals
Q Wean to Feeder Zd o0
®-Feeder to Fetish 65D
❑ Farrow to Wean
O Farrow to Feeder
❑ Farrow to Finish
Type of Poultry
❑ Layer
O Pullets
No. of Animals
Type of Cattle
O Dairy
O Beef
No. of Animals
Other Type of Livestock: Number of Animals:
Acreage Available for Application:__ 31. 6 Required Acreage: 9• c.
Number o agoons Storage Ponds : 1 Total Capacit Lk)c , 546 3 Cubic Feet (ft3)
Are subsurface drains present on the farm: YES or O (please circle one)
Owner 1 Manager Agreement
I (we) verify that all the above information is correct and will be updated upon changing. I (we) understand the operation and
maintenance procedures established in the approved animal waste management plan for the farm named above and will
implement these procedures. I (we) know that any expansion to the existing design capacity of the waste treatment and
storage system or construction of new facilities will require a new certification to be submitted to the Division of
Environmental Management before the new Animals are stocked. I (we) understand that there must be no discharge of animal
waste from the storage or application system to surface waters of the state either directly through a man-made conveyance or
from a storm event less severe than the 25-year, 24-hour storm and there must not be run-off from the application of animal
waste. I (we) understand that run-off of pollutants from lounging and heavy use areas must be minimized using technical
standards developed by the Natural Resources Conservation Smice. The approved plan will be filed at the farm and at the
office of the local Soil and Water Conservation District. I (we) know that any modification must be approved by a technical
specialist and submitted to the Soil and Water Conservation District prior to implementation. A change in land ownership
requires written notification to DEM or a new certification (if the approved plan is changed) within 60 days of a title transfer.
Name of Land Owner:
Signatu
Date: 5/(3
Name of Manager(if different from owner):
Signature: Date:
ANV Anril24. 199E ]

Technical Specialist Certification
I. As a technical specialist designated by the North Carolina Soil and Water Conservation Commission
pursuant to 15A NCAC 6F .0005, I certify that the animal waste management system for the farm
named above has an animal waste management plan that meets or exceeds standards and specifications
" of the Division of Environmental Management (DEM) as specified in 15A NCAC 2H.0217 and the
USDA -Natural Resources Conservation Service (NRCS) and/or the North Carolina Soil and Water
Conservation Commission pursuant to 15A NCAC 2H.0217 and I5A NCAC 6F .0001,0005. The
following elements are included in the plan as applicable. While each category designates a technical
specialist who may sign each certification (SD, SI, WUP, RC, 1), the technical specialist should only
certify parts for which they are technically competent.
IL Certification of Design
A) Collection. Storage._`I'rea_tment_Svst m
Chee appropriate box ck h
Existing-facility without retrofit (SD or WUP)
Storage volume is adequate for operation capacity; storage capability consistent with
waste utilization requirements.
New expanded or retrofitted facility (SD)
Animal waste storage and treatment structures, such as but not limited to collection systems,
lagoons and ponds, have been designed to meet or exceed the minimum standards and
specifications.
Name of Technical Specialist (Please Print):. w µ tTt'6-_-�jj—FIT
Affiliation: r.SRCS
Address(Agency): o AfZa"ZD N-Y_ a766L Phone No.: Cgl� to q I- 790-
Signature: C. -1111 Date: % l 7 _ T
B) Land AV121iotionSile (WUP)
The plan provides for minimum separations (buffers); adequate amount of land for waste
utilization; chosen crop is suitable for waste management; hydraulic and nutrient loading rates.
Name of Technical Specialist (PIease Print): A_. Fes, Wit jlg_-
Affiliation:. ry 2CS
Address (Agency): 4, D. . Y22& 10 't`24,Q.-L50 rvL a-7eB/. Phone No.: 1 Iel) to �(t - 7-1
Signature:-. C�%Date: y
.�
C) Runoff Qontrol&rom ENterior Lots
Check the appropriate box
O---Facili,ty„without exterior lots (SD or WUP or RC)
This facility does not contain any exterior lots.
O Facility with exterior lots (RC)
Methods to minimize the run off of pollutants from lounging and heavy use areas have been r
designed in accordance with technical standards developed by NRCS.
Name of Technical Specialist (Please Print): LC-'i�-
Affiliation: CS
Address (Agency):_F. _o . 36x- t o TI�SZude �, Nc- a-�eB6 phone No.: (A 19) 4 q 7 9 ao
Signature: ;g Date:
AWC -- April 24, 1996

t
B) I.,and-Anolication,Site (WUP)
Check the appropriate box
The cropping system is in place on all land as specified in the animal waste management plan.
❑ Conditional Approval: all required land as specified in the plan is cleared for planting; the
cropping system as specified in the waste utilization plan has not been established and the
owner has committed to establish the vegetation as specified in the plan by
(month/day/year); the proposed cover crop is appropriate for compliance with the waste
utilization plan.
0 Also check this box if appropriate
if the cropping system as specified in the plan can not be established on newly cleared
land within 30 days of this certification, the owner has committed to establish an interim
crop for erosion control;
Name of Technical Specialist (Please Print): W+-{ TT�7
Affiliation: _ MRCS
Address(Agenc ):� _a .- -i�, s?,. PO TA P-i3aRo, Svc..Re, Phone No.: (I 1 Gi
Signature: - �~ Date:
This following signature block is only to be used when the box for conditional approval in III. B
above has been checked.
I (we) certify that I (we) have committed to establish the cropping system as specified in my (our) waste
utilization plan, and if appropriate to establish the interim crop for erosion control, and will,'
to
DEM a verification of completion from a Technical Specialist within 15 calendar days following the date
specified in the conditional certification. I (we) realize that failure tc submit this verification is a
violation of the waste management plan and will subject me (us) to an enforcement action from DEM.
Name of Land Owner:
Signature: Date:
Name of Manager(if different from owner):
Signature: I Date:
C) �t nosl ff Controls from Exterior Lots (RC)
Facilitv with exterior lots
Methods to minimize the run off of pollutants from lounging and heavy use areas have been
installed as specified in the plan.
For facilities without exterior lots, no certification is necessary.
Name of Technical Specialist (Please Print):
Affiliation:
Address (Agency): Phone No,:
Signature: Date: "
AWC -- April 24, I99G

D) An_glication and Handling Eguiument
Check the appropriate box
U"'Existin facili with existin waste application equipment.: (WUP or I)
Animal waste application equipment specified in the plan has been either field calibrated or
evaluated in accordance with existing design charts and tables and is abieito=apply`waste as
necessary to accommodate the waste management plan: (existing application. .equipihent can
cover the area required by the plan at rates not to exceed either the specified �hyditulic or
nutrient loading rates, a schedule for timing of applications has been established;,tdquired
buffers can be maintained and calibration and adjustment guidance are contained as part of the
plan).
❑ New -or expanded facility, or existing facility without existing waste application equipment (I)
Animal waste application equipment specified in the plan has been designed to apply waste as
necessary to accommodate the waste management plan; (proposed application equipment can
cover the area required by the plan at rates not to exceed either the specified hydraulic or
nutrient loading rates; a schedule for timing of applications has been established; required
buffers can be maintained; calibration and adjustment guidance are contained as part of the
plan).
.Name of Technical Specialist (Please'Print): 1P IT_Lf__ _T:4
Affiliation: QCS _
Address(Agenc ): o ►� to iAQ$aeo_ rsc._ 2F_Q Phone No.: (tl9 .6 - 79ba
Signature: - ` - Date: / Zf /
III. Certification of Installation
A) Collection, Storage,Treatment ln Il ion
New _expanded or retrofitted facility (SI)
Animal waste storage and treatment structures, such as but not limited to lagoons and ponds,
have been installed in accordance with the approved plan to meet or exceed the minimum
standards and specifications.
For existing facilities without retrofits, no certification is necessary.
Name of Technical Specialist (Please Print):
Affiliation:
Address(Agency): Phone No.:_.,_. ,•
Signature: Date:
AWC -- April 24, 1996

D} Annlication and Handling Euioment_Installation (WUP or i)
Check the appropriate block
w
& Animal waste application and handling -equipment specified in the plan is on site and ready
for use; calibration and adjustment materials have been provided to the owners hnd -are
contained as part of the plan.
❑ Animal waste application and handling equipment specified in the -plan has not been
installed but the owner has proposed leasing or third party application and has -provided a
signed contract; equipment specified in the contract agrees with the requirements of the
plan; required buffers can be maintained; calibration and adjustment guidance have been
provided to the owners and are contained as part of the plan.
❑ Conditional approvalAnimal waste application and handling equipment specified in the
plan has been purchased and will be on site and installed by
(month/day/year); there is adequate storage to hold the waste until the equipment is installed
and until the waste can be land applied in accordance with the cropping system contained
in the plan; and calibration and adjustment guidance have been provided to the owners and
are contained as part of the plan: ,
Name of Technical Specialist (PIease Print): W
Affiliation:_ _ 1JQ'C5 _--
Address (Agency): P. D rX It) `rA e-a ago N-�c- a76%Phone No.:_(-qI-?90a
Signature: Date:
The following signature block is'only to be used when the box for conditional approval in M D
above has been checked.
I (we) certify that I (we) have committed to purchase the animal waste application and handling
equipment as specified in my (our) waste management plan and will submit to DEM a verification of
delivery and installation from a Technical Specialist within 15 calendar days following the date specified
in the conditional certification. I (we) realize. that failure to submit this -verification is a violation. of the
waste management plan and will subject me (us) to an enforcement action from DEM.
Name of Land Owner:
Signature: I Date:
Name of Manager(if different from owner):
Signature: Date:
Please return the completed form to the Division of Environmental Management at the
following address:
Department of Environment, Health, and Natural Resources
Division Of Environmental Management
Water Quality Section, Compliance Group
P.O. Box 29535
Raleigh, NC 27626-0535
Please also remember to submit a copy of this form along with the complete Animal Waste
Management PIan to the local Soil and Water Conservation District Office and to keep a copy in
Your files with your Animal Waste Management Plan.
AWC -- April 24, I996

TECHNICAL SPECIALIST FOR ANIMAL WASTE MANAGEMENT CERTIFICATION
DESIGNATION CATEGORY
CODE
AREA OF A13THORITY
Collection, Storage,
SD (design)
- lagoons, storage ponds, dry stacks, storage structures,
and/or Treatment
SI (installation)
composters, pushoff ramps, curbing and other similar
structures
Waste utilization Plan
WUP
- design and installation (development and
implementation) of land application plans
including crop and acreages available to meet nutrient
budget, hydraulic and nutrient loading rates, placement
of application site buffers
- measurement of existing storage volume
-confirmation of existence and compatibility of land
application equipment with waste utilization plan
- certification of cropping systems
- confirmation of absence of exterior lots
- confirmation of sludge and effluent removal and
application at agronomic rates for lagoon closure
Runoff Controls
RC
- design and installation of filter strips, grass
channels, and related bmps used to reduce runoff from
exterior lots (primarily dairy operations)
Irrigation Equipment
I
- design and installation of irrigation systems to
include pipe size, pump horsepower, nozzle size, system
layout, thrust blocks, etc. and operation plan to meet
criteria of Waste Utilization Plan (hours per set, etc.)
Technical Specialists are designated by the Soil and Water Conservation Commission pursuant to 15A NCAC 6F.0005.
Technical Specialists should only certify parts of a plan for which they are technically competent'.

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
September 15, 1999
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Doug Johnson
Doug Johnson Farm
7335 Red Road
Nashville NC 27856
Farm Number c23 -�
Dear Doug Johnson:
IT
1 • •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
You are hereby notified that Doug Johnson Farm, in accordance with G.S. 143-215.10C, must apply for coverage
under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm has sixty (60) days to submit the
attached application and all supporting documentation. In accordance with Chapter 626 of 1995 Session Laws (Regular
Session 1996), Section 19(c)(2), any owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date. Your application must be
returned within sixty (60) days of receipt of this letter. Failure to submit the application as required may also subject your
facility to a civil penalty and other enforcement actions for each day the facility is operated following the due date of the
application.
The attached application has been partially completed using information listed in your Animal Waste Management
Plan Certification Form. If any of the general or operation information listed is incorrect please make corrections as noted on
the application before returning the application package. The signed original application, one copy of the signed application,
two copies of a general location map, and two copies of the Certified Animal Waste Management Plan must be returned to
complete the application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
1617Mai1 Service Center
Raleigh, NC 27699-1617
If you have any questions concerning this letter, please call Susan Cauley at [phone] extension 546 or Charles
Alvarez with the Raleigh Regional Office at [phone].
Sincerely,
for Kerr T. Stevens
cc: Permit File (w/o encl.)
Raleigh Regional Office (w/0 encl.)
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Doug Johnson
Doug Johnson Farm
7335 Red Road
Nashville NC 27856
Dear Doug Johnson:
1 ffl.?WAJ •
NCDENR
NORTH CAROL'INA-DEPARTMENT OR
ENVIRONMENT AND NATURAL? RESOURCES•-_
.I-p!F5 `' [}--U-ly--g
December 30, 1999 t
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 3` 3-17:
(EdgecombtCounty
This letter is being sent to clarify the recordkeeping requirement for Plant Available Nitrogen (PAN)
application on fields that are part of your Certified Animal Waste Management Plan.
In order to show that the agronomic loading rates for the crops being grown are not being exceeded, you
must keep records of all sources of nitrogen that are being added to these sites. This would include nitrogen
from all types of animal waste as well as municipal and industrial sludges/residuals, and commercial fertilizers.
Beginning January 1, 2000, all nitrogen sources applied to land receiving animal waste are required to
be kept on the appropriate recordkeeping forms (i.e. 1RR1,1RR2, DRY1, DRY2, DRY3, SLUR], SLUR2,
SLDI, and SLD2) and maintained in the facility records for review. The Division of Water Quality (DWQ)
compliance inspectors and Division of Soil and Water operation reviewers will review all recordkeeping during
routine inspections. Facilities not documenting all sources of nitrogen application will be subject to an
appropriate enforcement action.
Please be advised that nothing in this letter should be taken as removing from you the responsibility or
liability for failure to comply with any State Rule, State Statute, Local County Ordinance, or permitting
requirement.
If you have any questions regarding this letter, please do not hesitate to contact Ms. Sonya Avant of the
DWQ staff at [phone] ext. 571.
Sincere ,
Kerr T. Stevens, Director
Division of Water Quality
cc; Raleigh Regional Office
Edgecombe County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
February 3, 2000
G. Kent Johnson
Doug Johnson Farm
7335 Red Road
Nashville NC 27856
VIVA
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. AWS33001.7—
Additional Information Request
mug Johnson -Farm,-
Animal Waste Operation
1✓dgecombe-County
Dear G. Kent Johnson:
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject application.
Additional information is required before we can continue our review. Please address the following by March 4, 2000:
The facility was certified on 5/13/97 for Doug Johnson as an owner, However, the permit application shows
G. Kent Johnson as the new owner. Please verify the ownership, fill out and submit enclosed Ownership
Change Form.
2. Operation and Maintenance Plan for your facility is missing in the permit package.
3. A list of required NRCS specifications are missing as part of your waste utilization plan and should be
included in the permit package.
4. It appears that you have recently revised your waste utilization plan but have included both old and new
cropping scheme. Please verify the current scheme that is in effect.
Please note that all WUP revisions must be signed and dated by both the owner and the technical specialist.
Please reference the subject permit application number when providing the requested information. All information
should be signed, sealed, and submitted in duplicate to my attention at the address below. The information requested by this
letter must be submitted on or before March 4, 2000 or the Division will return your application as incomplete in accordance
with 15A N.C.A.C. 2H .0200 and your facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit is a violation
of North Carolina General Statute 143-215.1 and will subject you to the enforcement authority of the Environmental
Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 363.
Si re
JR Joshi
Non -Disc arge Permitting Unit
cc: Raleigh Regional Office, Water Quality
Permit File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
Department of Environment and Natural Resources
Raleigh Regional Office
3800 Barrett Drive, Suite 101, Raleigh, NC 27609
919/571-4700
File Access Record
SECTION
TIMEIDATE
NAME
REPRESENTING:
Guidelines for Access: The staff of the:: Raleigh Regional Office is dedicated to making public records in our
custody readily available to the public for review and copying. We also have the responsibility to the public to
safeguard these records and to carry out our day-to-day program obligations. Please read carefully the following
auidelines before si nina the form:
We prefer that you call at least a day in advance to schedule an appointment to review the files.
Appointments will be scheduled between 9:00 a.m. and 3:00 p.m. Viewing time ends at 5:00
p.m. Anyone arriving without an appointment may view the files to the extent that time and
staff supervision is available.
2. You must specify files you want to review by facility name. The number of files that you may
review at one time will be limited to five.
3. You may make copies of a file when the copier is not in use by the staff and if time permits. Cost
per copy is 10 cents for ALL copies if you make more than 25 copies - there is no charge for
less than 25 copies; payment may be made by check, money order, or cash at the reception
desk. You can also be invoiced.
4. FILES MUST BE KEPT IN THE ORDER YOU FOUND THEM. Files may not be taken from the
office. To remove, alter, deface, mutilate, or destroy material in one of these files is a misdemeanor
for which you can be fined up to $500.00.
5. In accordance with General Statute 25-3-512, a $20.00 processing fee will be charged and
collected for checks on which payment has been refused.
1.
2.
3.
4.
5.
FACILITY NAME
0 S+A
SE.c
Signature &Ad Na a of Firm/Business Date
Please attach a bust ma card to Oils form
COUNTY
( ,5b l ;h
Time In Time Out

........� _
Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number -( 7_,Z Operation is'flagged for a wettable
Farm Name: Dvu3 .Tvf}tfe-, A4+r— acre determination due to failure of
On -Site Representative: Dme e .Te t_rex Part I1 eligibility item(s) Ft F2 F3 F4
Inspector/Reviewer's Name:_7 _e� J2, Operation not required to secure WA
determination at this time based on
Date of site visit: �� 9/ p �' exemption E1 E2 E3 E4
Date of most recent WUP: - 2,1 -9 G Annual farm PAN deficit: y63 pounds
Irrigation System(s) - circle #: 1. rd-hose traveler; 2 enter -pivot system; 3. linear -move system;
4.stationary sprinkler system wlperm stationary sprinkler system w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable 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 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 Ili. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack 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
sm 11, irregularly shaped fields - fields less than 5 acres for travelers or less than
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.

Revised January 22, 1999
Y Number 33
,t ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
AL
FIELD TYPE OF FAC
NUMBER'.' IRRIGATIONES
SYSTEM
CAWMP
ACRES
FIELD
%
COMMENTS3
/1
?. Lr
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 irrication system.

NORTH CAROLlNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
RALEIGH REGIONAL_ OFFICE
Division of Water Quality
September 28, 1998
Mr. Doug Johnson
7335 Red Road
Nashville, North Carolina 27856
Subject: Notice of Deficiency
Doug Johnson Farm
Facility # 33-17
Edgecombe County
Dear Mr. Johnson:
On September 23, 1998, Mr. Buster Towel] of the Raleigh Regional Office
conducted a compliance inspection at your swine operation. The inspection revealed
the following deficiencies:
The lnsectlOdor Control check list needs to be completed and kept with your
Waste Management Plan.
2. Land Application Records need improvement. Your field records should be
transferred to the 1RR-2 form which is designed to give you your nitrogen
balance for land application events.
You should respond to this Notice within 30 days of your receipt outlining your
plans to correct the above referenced deficiencies.
The Raleigh Regional Office appreciates your cooperation in resolving this matter. if
you have any questions regarding this correspondence, please call Mr. Buster Towel]
at [phone].
i
rely,
�Q
Kenneth Schuster, P.E.
Regional Water Quality Supervisor
cc: Edgecombe County Health Department
Mr. A.B. Whitley, Edgecombe Soil & Water Conservation District
Ms. Margaret O'Keefe, RRO-DSWC
DWQ Non -Discharge Compliance Group
RRO Files
3800 BARRETT DRIVE, SUITE 101, RALEIGH, NORTH CAROLINA 27609
PHoNE [phone] FAX [phone] B
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POST -CONSUMER PAPER
f 7*.►pz:�Mh:.

kx� X '-, h.v, 5..=a ma.a5a;a•':'", xe; ,,...L.,,,`k-e --::i -- ,. :.:-.-.-x::d3 ....,. a.ecv.<a::1
t ,�kivrio
''n of Soil and Water Conservation 0 Other Agency g
y :h" n of Water Quality
101toutine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other I
Date of Inspection Z31)
Facility Number Time of Inspection ® 24 hr. (hh:mm)
0 Registered Certified U Applied for' Permit Mermitted 1 )\ot O erational Date Last Operated:
Farm Name: !...... ......................................... County:..L .",J'....`............................................
OwnerName:..... lJ ..J+t'.. ..�r�. 7................................................................ Phone No:.. ..z...... ��.......y �.�.: ��........................
FacilityContact: S . �'`. Q................................................... Title:................................................................ Phone No....................................................
Mailing Address: ... ..�.. ].. ... ....1 � ........... ! f. '..�':..� �t... ..'. .�............... '.7...?....S.'.
.............................. ..........................
r
OnsiEe Representative:.......... v.,►" .....,� .... Integrator: .... .......
Certified Operator;.,.-.. . C !G ...... /j tn•�/.............................................. Operator Certification Number..........................................
........ ............ .......
Location of Farm: ,) Z. z?
A6
Latitude • ' " Longitude • ' 66
Design -:>..Current
Design ' Current Design Current
i5 a
Capacity Population
:Poultry
Capacity Population Cattle Capacity Population
Wean to Feeder
q
Layer
10 Dairy
Feeder to Finish
ro
Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
-- --
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
`. ❑ Gilts
❑Boars
"'.Total SSLW
Number of, o / oldtn Ponds r�
g
❑Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
;;
❑ No
Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
2. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
QNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
10
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
0 No,-'
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
❑ N
S. Does any part of the waste management system (other than lagoonstholding ponds) require
❑ Yes
No
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No

FaciGty`Numher: 3 —12
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes PA, 0
Structures (Lagoons.11olding Poltds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 'o
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboiird(ft): ........ C...........................................................................................................................................................................................
;
10. Is seepage observed from any of the structures?
❑ Yes
J
❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
�1' 0
12. Do any of the structures need maintenance/improvement?
❑ Yes
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
'o
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
[Dyes
, .
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type./.......................... ;.
................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes © No
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?
❑ Yes P_Ko
❑ Yes a<o
El Yes No
❑ Yes 1:3
❑ Ye, ❑ No
22. Does record keeping need improvement? 2'Yes ❑ No
For Certified -or Pemiitted Facilities Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No.
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes V",
'
25. Were any additional problems noted which cause noncompliance of the Permit? El Yes
0 No violations or deficiencies were noted during this'visit. You.will receive no further
correspondence 6bout this. visit...,'..
Comments (refer to question #): Explain any'YES answers and/or any recommendations or any other comments.' .:w. r
Use/drawings of facility to better explain situations. (use additional pages as necessary):
[ L7� 12 o I n � y j � /1I j rP-,-•
IZ iL Z
7/25/97
1W
P
er/Insector Nameer/Inspector
Signature:' �' Date: Z %
E

State of North Carolina
Department of Environment,
Health and Natural Resources
Raleigh Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Division of Soil and Water Conservation
May 23, 1997
Gerald Kent Johnson
3662 Cokey Rd.
Rocky Mount, NC 27801
SUBJECT: Operation Review Summary and Corrective Action Recommendation
Gerald Johnson Farm Facility No. 33-17
Edgecombe County
Dear Mr. Johnson,
4?
cy 199? / ZP/l
On May 19, an Operation Review was conducted of Upper Coastal Plain Research Farm, facility no.
33-43. This Review, undertaken in accordance with G.S. 143-215.10D, is one of two visits scheduled for all
registered livestock operations during the 1997 calendar year. The Division of Water Quality will conduct a
second site inspection.
During the Review, it was determined that waste was not being discharged to the waters of the State,
and the animal waste collection, treatment, storage and disposal systems were properly maintained and
operated under the responsible charge of a certified operator. A copy of the completed review form is
enclosed for your information. The following observances and management deficiencies were discovered
and noted for corrective action or response:
1. The lagoon has some animal burrows present that need to be filled.
2. An amendment for your waste utilization plan is required for any changes in cropping and/or
harvesting methods. If the hay is grazed instead of harvested, additional land will be required as the
cows will deposit nitrogen on the grazed land. The millet needs to be included in the plan to provide
guidelines for the proper pumping amount and time. Please contact your technical specialist to take
care of this.
3. This was not required at the time of review but in preparation for the upcoming general permit, you
will need to secure and maintain the following records for your farm: odor, insect and mortality
checklists; an operation and maintenance plan; and an emergency action plan. You should be able to
secure these items from your technical specialist.
The Division of Soil and Water Conservation appreciates your cooperation with this Operation Review.
Please do not hesitate to call me at 919/571-4700 ext. 208 if you have any questions, concerns or need
additional information.
Sincerely, 01
Marg ret O'Keefe
Environmental Engineer I
cc: Edgecombe Soil and Water Conservation District
Judy Garrett, Water Quality Regional Supervisor
DSWC Regional Files
3800 Barrett Drive, Suite 101, FAX [phone]
Raleigh, North Carolina 27609 X&P C An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50% recycled/10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Gerald Kent Johnson
Gerald Johnson Farm
3662 Cokey Rd
Rocky Mount NC 27801
SUBJECT: Operator In Charge Designation
Facility: Gerald Johnson Farm
Facility ID#: 33-17
Edgecombe County
Dear Mr. Johnson:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sin:in
Howard, Jr., ., erector
Division of Water Quality
Enclosure
cc: Raleigh Regional Office
Water Quality Files
P,O, Box 27687, W 14CRaleigh, North Carolina 27611-7687 �An Equal Opportunity/Af iirmative Action Employer
Voice 919-715-4100 50% recycled/10% post -consumer paper

a State of North .Carolina
Department of Environment,
Health and Natural Resources « •
Raleigh Regional Office
James B. Hunt, Jr., Governor
Jonathan B, Howes, Secretary
Boyce A, Hudson, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
August 8, 1995
Mr. Charles D. Johnsonn
Route 1, Box 427
Nashville, North Carolina 27856
Subject: Compliance Evaluation Inspection
Swine Operation
State Road 1224
Edgecombe County
Dear Mr. Johnson:
On August 4, 1995, Mr. Eric Fleek from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. This inspection is part of the Division's efforts to
determine potential problems associated with liquid waste disposal
systems.
Mr. Fleek's site visit determined that wastewater from your
facility was not discharging to the surface waters of the state.
Nor were any manmade pipes, ditches, or other prohibited
conveyances (for the purpose of willfully discharging wastewater)
observed. As a result, your facility was found to be in compliance
during this visit.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facilities. The Division of
Environmental Management is required to enforce water quality
regulations in order to protect the natural resources of the State.
Accordingly, illegal discharges of wastewater to surface waters of
the State are subject to the assessment of civil penalties and may
also result in the loss of deemed permitted status, requiring
immediate submission of a waste management plan.
This office would also like to take this opportunity to remind
you that you are required to have an approved animal waste
management plan by December 1997. This plan must be Certified by a
designated technical specialist or a professional engineer. For a
listing of certified technical specialists or assistance with your
waste management plan you should contact your local Soil and Water
Conservation District.
38M Barrett Drive, Suite 101, Raleigh, North Carolina 27609 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/ 10%post-consumer paper

Charles D. Johnson
Compliance Evaluation Inspection
Page 2
The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions regarding your inspection
please call Eric Fleek at [phone].
Sincerely, e
'6 t"
dtydy E . Garrett
Water Quality Supervisor
/ds
H:\animdn
cc: Edgecombe County Health Department
Edgecombe County Soil and Water Conservation District
Steve Bennett - Regional Coordinator, Division of Soil and
Water Conservation

• JUL-14-1995 15 2S FROM DEH WATER QUALITY SECTION TO
RFC P.O2/O2
Farm Na
Mailing
County:
Site Requires €mmediate Artenr�?n
Facility No.
DIVISION OF ENV>iRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS YFE VISITATION RECORD
Time:
Integrator: Phone:
On Site Representative: Phone:
Physical Address/Location: Z
Type of Operation: Swine'Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE_T DEM Certification Number: ACNEW
Latitude: ' ' � " Longitude: ` �' Elevation:
�53 _____`meet
Circle Yes or No
Does the Ani-mal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storms event
(approximately l Foot + 7 inche OY or No k al Freeboard: t. inches
Was any seepage observed from the lagoou(s)? Yes or Was any erosion observed? Yes or 01
Is adequate land available for s ay' Yes No Is the cover crop adequate?60)r No
Crop(s) being utilized: vqe� ^d�°�
Does the facility meet SCS minimum setback criteria'? 200 Feet from Dwellin^7or No
100 Feet from Wells? or N- o
ar-irnal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�(o j
xr> mal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(No]
animal waste discharged into waters of the state by inan-made ditch, flushing system, or other
�imi;a.r man-made devices? i;cs or
No If Yes, 'lease Explain.
"ss,cs the facility tuaintain adequate waste mattagenacnt records (volumes ofmanure, land applied
spray irrigated on specific acre Eh c er crop)? Yes or o
Additional Corrtments: r
�,.. � � � - ��. �� �`�t_ (fin. - - -- - -
Si
cc: Facility Assessment Unit
Use Attachments if Needed..
TOTF L. P . 02

Type of Visit: () Cohee Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
sit: Reason for ViRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival TyimeJ Departure Time: County:
Farm Name: ` Jt— Owner Email:l'L
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Phone:
Integrator:
Phone:
Certified Operator: rs ' ko S —L Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poult V_
Capacity
Pop.
Cattle
Capacity Pop.
ean to Finish
Layer
Dai Cow
ean to Feeder
Non -La er
Dai Calf
eder to Finish
airy Heifer
to Wean
Design
Current
D Cow
rrow to Feeder
D , RouIt .
Ca aci
POP.
Non -Dairy
L!Farrow
rrow to Finish
La ers
Beef Stocker
lts
Non -La ers
Beef Feeder
ars
Pullets
Beef Brood Cow
er
HTurkeys
Turke Poults
El her
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑Yes o 0 NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes N NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued
9

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

Facilit Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments � ,, ,° , +. .
Use drawings of facility to better explain situations (use additional pages as necessary)-,
Reviewer/Inspector Name: Phone: 75l — "ZZ 412 -
Reviewer/]nspector Signature: Date: 115 t (7 I Z
Page 3 of 3 21412011

j- q-2i
`Type of Visit: U Com Inspection U Operation Review U Structure Evaluation U Technical Assistance +
Reason for Visit: WHoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1f
Date of Visit: Arrival Time: / Departure Time: County: Region:
Farm Name: . ��ks0'-, r4-72� = Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: f _ _ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
I {I!
i ;1 , , •
-1• ,}:.�
i1
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,1_ ,
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y�j
;ff r , 1,
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1.
YA,` -
y;�,.
15�.
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-_
'� �V Sr�}Nii� �'�I"/: 1't�t� r ` �4
I ' j ,:
! l i ' I 1 A sll� '•.
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-may-
.
tii
�,jl _
VN?'� �' 7 5k 7
�,U 'sib{ 4 �o i,S��'4t�.s
� ' I ?.�
■
■
--
-�'
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- - 1 . •
I,}7�!
'' �
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■
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--
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■
. • 1 � - 1 '
--
■
1 � .
--
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-- yo�,�,i
-- _ 1h4ittajSfSs
-'V�'r
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y i. 0 r VS, ,Ir; I�jiS
';1 iIY � � � li
If +'luw#ke,4jrr'I�trjljU;.
'
■
■
•
AflHll
�S :{i �iL 1 � ` �I-
R ;,.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection: r 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
o ❑NA ❑NE
o ❑NA ❑NE
Structure 6
[:]Yes No ENA. ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate Public health or environjNo
s reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesN ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �,�� y.M h LJ �+� EJt r A' !2 5, L�S1.� —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes N ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No A ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Dumber: - / Date of Inspection: V, 2-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesgNo"'�E] NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
[] NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
C4 I e,,� rr�-�� ev 3 - 3 (- I
5 (hdS e Sa-r✓a-r
65
P % 5-3
(z - t 17 N_ I 4t Lw,&-z C*4 ji-"
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Phone:
Date: - 2 —1
21412015
Page 3 of 3

r- I
Type of Visit: ,JO Cory fiance Inspection U Operation Review (-) Structure Evaluation Q) Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up ( Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: '-/ Arrival Time: Departure Time: County:
Farm Name: i'3/&Zy r Jd Mtn S'D*7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 7- 13 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design
Current
Design
Current
gn Current
Des!RMI
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle CSIMI ty Pop.
Wean to Finish
La er
Dair
y Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
—Dairy
Dry Cow
Farrow to Feeder
C_a cit
Po
Non -Dairy
row to Finish
La ers
Beef Stocker
Layers
Beef Feeder
rs
Pullets
Beef Brood Cow
Turkeys
IkGilts
er
Turke Poults
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Z rNo❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes 0 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes 05
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesFNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

acilit ;Number: - Date of inspection: - l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
3X
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
IZ'N' ❑ NA ❑ NE
F2<o ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
N
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ 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 P - �01
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): [ 2D 4, /n A- d 4 , Fr2 S' e4-Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes VNo
❑ NA
❑ NE
acres determination?
�
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check
❑ Yes gNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

f
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes;�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #).: Explain auy-YES answers and/or any additional recommendations or any other comments.-,
Use drawings of facility to betterexplain situations,(use additional pages as necessary-).,, _.
f h Us 2 �Gc Y dQ
(v ~r
0 5- 3 6
Reviewer/Inspector Name:
Phone:
Reviewer/inspector Signature: .0- k 5 T41— (OL.. .I? ( ,
Page 3 of 3
Date: i ` (1— 17
21412015

Type of Visit: 0 Co
nce Inspection O Operation Review C) Structure Evaluation 0 Technical AssistanceReason for Visit: Q Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access !`
Date of Visit: r // Arrival Time: Departure Departure Time: ii County:
Farm Name: Ja h r1,5� ^�— i r�4 �/*�--- Owner E
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D�, P�oultr. Ca aeit P,o ,
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
PPullets
Non -Layers
Beef Feeder
Boars
Turke s
Turke Points
Other
Beef Brood Cow
Qther—rH
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
N ❑ NA
5No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R)
❑ Yes
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued _

Facili Number: - Date of Ins ection: , - •—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
Structure 5
No NA ❑ NE
M.
o ❑ NA ❑ NE
Structure 6
❑ Yes o NA ❑ NE
❑ Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): f 'r P7 k c sc� /Z
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes OrNo ❑ NA ❑ NE
acres determination.
17. Does the facility lack adequate acreage for land application'?
❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 2f
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rNo
❑. NA
❑ NI?
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Survey
22. Did the facility fail to install and maintain a rain gauge?
'11-Sludge
❑ Yes Er
❑ NA
0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesVNo❑
NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
0 NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
[:]No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
C] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary)."
P
C-VXI t �.-A at-, C(u P ?�-V / L
Reviewer/Inspector Name:
Phone: .79 ! - v Z Ad
Reviewer/Inspector Signature: aG, 5 zep- � �
- -— - - -
Page 3of3
Date: / ,L
21412015

po-
bi" r
IType of Visit: t2'Com ' cc Inspection O Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: FID Arrival/Time:] Departure Time: County: Region:
Farm Name: /Y A 2 S i/ — ��P �r "� ''1 hSch. �'rl•r.� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 2.• /- i?n yj h D S
Back-up Operator:
Location of Farm:
Title:,
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
C►urrent
Design
Current
Design C►urrent
Swine
Capacity
Pop.
Wet Paultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Non -La er
I
Dairy Cow
Dairy Calf
Wean to Feeder
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr P■oultr.
C•_a acit
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes yNg ,NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ YesrNo
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fa6lity N mber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JCJ 1"0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmZ[:]
at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 6 "firOn4 CIA , 1rQ SLL_
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ej�o❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fatili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
-1 :1 1�
Comments (refer to question #): Explain any YES answers andlor any additional recommendations or anyfother comments r
Use,�drawings_of facility, to better explain -situations (useadditional pages as necessar'y).'�
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

!Type of Visit: ,� Com ante Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
(Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: j Q Departure Time: County:
Farm Name: L (� Ut��L � Nam' „% f +?.SJh Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: I j Title:
Onsite Representative: JZ `'i - Ii')�! r! Q�� LIntegrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Region:
Wean to Finish
I I
I Layer
I
I Dairy Cow
Wean to Feeder
11 1
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Poultr..` Ca aci
P,o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Poults
OtherI
,Turkey
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZI �No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑•NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑YesgNo"
❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [3 Yes E] ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

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

[Facility Number: - Date of Ins ection: r`
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VNo
[3 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 No
❑ NA
[] NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments_ (refer to question ft Explain any YES answers and/or any additionai xecommendations or:any other comments ,
Use drawings of faeility to better explain situations (use additional page's as neeessary)i
G; �� �LL ✓✓� I t C_� sop/ 1 73 Za
r
Reviewer/Inspector Name: Phone: ? r
1
ReviewerlInspector Signature: �Q e--c4 Date: - � ZU r`
Page 3 of 3 21412014

3.-'q-IY
(Type of Visit: 0 ;Zutine
nce Inspection U Operation Review U Structure Evaluation U Technical Assistance
sit:Reason for Vi0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �T Arrival Time: Departure Time: County: Region:
Farm Name: /¢� + j Owner Email:
Owner Name: Phone:
Mailing Address: !
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
In b-e,.
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
11 Maw
Design
Current
Design Current
Swine Capacity Pop.
WMPolltr,�y
C«apacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C**arrant
Dry Cow
Farrow to Feeder
Dr P,oultr
Ca acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Puults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes N ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesrNoo
NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [3 Yes NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

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

Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:]No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[:]No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use.drawin2s:of facility to�better exalaio situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: 17 (— Y Zo b
Date: 2 ( �4( 1
21412011

�7/2VIf
Type of Visit: WCoFOU'a'ne
Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: Q Complaint 0 Follow-up 0 Referral O Emergency 0 Other (:) Denied Access 1
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �L _ - ) k h 5 a" 1 Owner Email:
Owner [Same: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Integrator:
Phone:
Certified Operator: P f l Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
C►urrent
Swine C*apac'sty Pop.
Wet Poultry
CapacityCattlapacity
e NaPap.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , Poult , ;`
Ca aci
.
Pao
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
!. is any discharge observed from any part of the operation? ❑ Yes "o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ONo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes 0<0 ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes No NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ElYes o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: Xj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
o ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
217No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental t at, notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
No , ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
��o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
NA
❑ NE
maintenance or improvement?
rNoO
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
NA
❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop TYPe(s): re STAig- r"r-% &,4 taw.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes . +y
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes N ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Refired Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No 0 NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Judge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0.'
VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection- Sol
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No A ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �N0 NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain_any°YES answers.`'and/or any additional recommendations, or any other�6mments.'..
Use, drawings of facility to better explain situations (use additional pages as necessary,)
5'
Reviewer/Inspector Name:
Reviewer/Inspector Signature: at�_S kA -Ti7 tv e— f
Page 3 of 3
Phone:
Date: f-1 '@At r 3
21412011

Type of Visit Ef;Routine
m ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r Z i Arrival Time: Departure Time: County: Region:
Farm Name: l 1( l7+ �.] �'} nc��' ti �✓>�-�i/�— _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ® r / Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 9 � Longitude: = ° = 1
Swine
Design Current
Capacity Population
Design Current Design Current
Wet Poultry. Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er
❑ We Feeder ❑Non -La er
ceder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Gilts ❑ Non -Layers
❑ Pullets
❑ Boars
❑ Turke s
Other ❑Turke Poults
❑ Other ❑Other
❑ Dai Cow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non
-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes �NoFO_]
NA ❑ NE
❑ Yes NA ❑ NE
❑ YesrNoEl
❑ NE
❑ Yes ❑ NE
❑ Yes ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No A ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eNo J 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
o NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
[IYes
;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
ONo ❑ NA [:IN E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Fe .S 4G: D /,&P,,, µ k J.la-- jr�j 4)t-4 i -,� -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
.IJ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No ❑ NA
❑ NE
1.6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
El NA
NFNo[3
El NE
17. Does the facility lack adequate acreage for land application?
El
NA
ElNE
18. Is there a lack of properly operating waste application equipment?
[IYesNA
❑ NE
Reviewer/Inspector Name - -F a� phone:
Reviewer/Inspector Signature: 5 'L 7v tam / Date: L3
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 <No❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Y;;/es
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes,
�(J<NNEl NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No ❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VN❑ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
❑ 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
❑ 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
❑ No
❑ NA
❑ NE
&
A'dditi.onal Comments a.n llor Drawin
Page 3 of 3 12128104

Vol
s _, } 4{1rY1f 11 � %�'1} �. FIE n, Ikl� 0_Drvision of Soil and�Water`Conservation' `¢ s.. i� t, 3t3r:' I i�liE,k�3 ��3iS-��.i.5�., E 54,}E. k E.n.'�r ' f '..r
€ Ep � 9€ .'•� °f �b I� ill E� I i' t E xY IE `did.§ � �} $I l ,..::'ai ,,� Y ii�� `1:5 11 �p 5jF{ r� f� iE.i i �} . � Ian ° t 1 . � �. 1 .. a t'' ., 1 .. . -� t ... ik ' 11
Type of Visit © Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Facility Number 33 17 Date of 'Visit: 1112Z12004 Tirne: 1400
Q Not Operational Q Below Threshold
© Permitted ® Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: GaAul.,Lah art.KQg.Fairm ........................... County: EdgRgQAjjl2P.,.................................... Bits?.....,.....,
Owner Name: f,jKfrl t............................ hJulson"..
Mailing Address: 366j.GAlicy..RQjKd ...............................
Facility Contact: ..........................................................
Onsite Representative:
Phone No:(-91.9).443-99ZO..Qr..(Z52.)..4.4.6-7.57.9.................
................................. I ....... .,.... Rocky..i?4Quwt... K............... .......................... ..... 2.7.801..............
Title: ................................................................ Phone No:....................... ............................
.......... Integrator:........................................I.........
Certified Operator: Ralaja 1.H.............................. IY. QhgSky.......................................... Operator Certification Nurnbcr:16629 .............................
Location of Farm:
i miles East of Rocky Mount on Noble's Mill Pond Rd. and 0.5 mile West of the Upper Coastal Plain Research Station. A
t
® Swine ❑ Poultry ❑Cattle ❑Horse Latitude 35 ' 53 G 44.6 « Longitude 77 • 41 28.6
Design Current
Swine . Canacity : Ponulation
® Wean to Feeder
2000
® Feeder to Finish
850
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Discharges & Stream Impacts
'Design Current Design Current
Poultry Capacity Population , .Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 2,850
Total SSLW 174,750
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure I Structure 2 Structure 3 Structure 4 StrLlCiu!'C 5 Structure 6
Identifier: ............................................................................................................................................. ........................
Freeboard (inches): 29
12112103
Continued

l;acllity Number: 33-17 Date of inspection I lU212004
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?
F
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level,
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc > 3000
12. Crop type Coastal Bermuda (Hay) Fescue (Hay) Small Grain Overseed
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
® Yes ❑ No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (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 Iack of adequate waste application equipment? ❑ Yes ® No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or 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 ❑ No
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 ❑ No
Air Quality representative immediately.
3' v e .a(r'F. t l4 r 1 E�,,i ) +�?,.�,� A ..! i ny.. :`. I Rp:l, 1 e,,'t'7y 3 yi.,._r3 IOnS oT:.anyiather, comments.
Comments refer to uest�on # Ex lam an YES answers and/ar an recommendat
Usejdrawings of facility to better explain situations. (use addtttonalipages as necessary): [� Field Copy ❑Final Notes
Need to adjust WUP for fields # 5 pulls A & B from bermuda to fescue.
rn employee initialed pumpimg records start 8 AM and end 12:30 PM on 11\18\04. BT did drive by on 11117 and observed land
plication ongoing from 12-2 PM. Also saw wastewater hitting edge of woods and actuallu did get into woods. Did not hit any surface
s OIC Mohesky stated that he did not check site within 24 hours of this land application event.
IV
Reviewer/Inspector Name bust, towel['
Reviewer/Inspector Signature: Date:
12112103 Continued

Type of Visit t�C;Routine
mpli nspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
F Number Date of Visit: Z3� - 'irne: � �7 r)
Nat O erational 0 Below Threshold
Permitted 0 Ci�e„„rtified [3Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ��L ___ �f/� of C7� a,�� County:
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Title: Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 0" Longitude De 4
Design Current
Design Current
Design Current
ne Ca act P,o ulation P■oultr.
Ca act P,o ulation Cattle
Ca act P,o ulation
to Feeder ❑ La erFeeder
rWean
to Finish ❑Non -La er
❑ Non-DalFarrow
to Wean
rBoars
Farrow to FeederOther
Farrow to Finish
'Total DesignGilts
Total SSLW
Number of Mi.;
Subsurface
Drains Present ❑La oonArea
❑ S ra Field Area
Holding Pands /Solid T
❑ No Liquid Waste Management System
Discharges 8& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 11
05103101
❑ Yes
❑ Yes N
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes o
❑ Yes No
Structure 6
Continued

' r
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
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
El Yes
No
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
❑
o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑
o
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑
o
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑
o
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Cl
o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑
b) Does the facility need a wettable acre determination?
❑ Yes.,
❑
_
c) This facility is pended for a wettable acre determination?
❑ Yes
❑
15. Does the receiving crop need improvement?
❑ Yes
❑
t6.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ N
Required
Records & Documents
17.
Fait to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ N
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
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Elo
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
El o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ o
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments,(refer to questign #i) "Explain any YES�answers;andlorany recommendehonsor. any�otliercomments ;`
6Use drawings of facrlity to better eaplam situation"s:,(use additional pages;as'-necessary) .
� "'" ❑Field Copy ❑Final Notes
,
Reviewer/Inspector Name gip;
Reviewer/Inspector Signature: Date:
05103101 Continued

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
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 i��NZo
❑ Yes
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or ©i•iiwmgs'
05103101
05103101

.y
Type of Visit .B'Com nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r p b Arrival Time: Departure Time: County:
Farm Name:Owner Email.:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator: _
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: ❑ c = = Longitude: = ° = d 0
Design C*urreut
Capacity Population
Wet Poultry Capaulation Cattle Capacity Population
DesiMnGur,rent DesignrE]Feeder
n to Finish
❑ Layer
❑Dai Cow
n to Feeder
❑Non -La Non -Layer
❑ DairyCalf
to Finish
❑ Dai Heifer
u❑ D Cow
❑ Non -Dairy
❑ Layers
El Beef Stocker
❑ Non -Layers ❑Beef Feeder
ow to Wean
ow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
El Pullets
❑ Turke s
❑ Turkey Poults
IM Other
❑ Beef Brood Cow
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 ErNo ❑ NA ❑ NE
❑ Yes 12 o ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes Nji;o NA ❑ NE
El Yes o A ❑ NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No A El NE
❑ Yes o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ ElNE
❑ Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental three t►fy DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o A El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ 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 Id'No I_l NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes o NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. El o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (;ef- M " `� , $ W\'; ' ,q t - S , Pre SCc,.
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
0�01'NA ❑ NE
NA ❑ NE
6❑NAN NA ❑ NE
o A ❑ NE
❑
El NE
,Connments (refer to question #): Explain any YES;answers and/or any recommendations o`ry any€other-coniment`s ` �Y,
-!
Use"drawings of facility to better.explain situations: {use addrtianal pages;as necessary) fi��i�
Reviewer/Inspector Name
f G YW Phone:
Z1�
Reviewer/inspector Signature:
Date: Z
Page 2 of J 12128104 Continued

Facility Number: , Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No A ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other �,�
21. Does record keeping need improvement? If es check the appropriate box below. ❑ Yes 0<10 o NA ❑ NE
P g p Y�
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ eather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes;NNNo
o NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
El ❑' III o NA ❑ NE
❑ Yes No NA [I NE
El Yes:No NA El NE
El Yes o ❑NA [I NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number ".0 Division of Soil and Water Conservation
i
Q Other Agency
1Type of Visit 119I� Co ance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
11easonforVi!ik Routine O Complaint O Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I / Departure Time: County:
Farm Name: o sn'i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: /A
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e 0 = Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
❑ 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?
Cattle
Design . ': YCurrent
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
Number of Structures:
a
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 eNo 0 NA ❑ NE
❑ Yes ZNo❑ NA El NE
❑ Yes No ❑ NA ❑ NE
E ;�2_1
❑ Yes F
N / ❑NE
Yes NA ElNE
❑ Yes El ❑ NE
12128104 Continued

Facility Number: 33 - 1.2Date of Inspection VJ2 G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If es, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
p g p Y
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain InspectioZN
eather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Vo[E
El NE
26. Did the facility fail to have an actively certified operator in charge? El ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ NE
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ 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
❑ 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
❑ No
❑ NA
❑ NE
1 Comments and/or Drawings:
12128104

FacilityNumber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ;-o
NA [INE
ElYes ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):L `
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ 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 three otify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes;�NNoO-NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No ❑ NA FINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 2fGG� , t3 P_ e- ivv
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
lCl No NA
No NA
Fo
e[O]NA
o
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question 4). Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
s
Reviewer/inspector Name 5 �! Q� Phone:
Reviewer/Inspector Signature: Date: (% Z
12128104 Continued

it 2 7 (a-i
Type of Visit Co Nance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D Arrival Time: %rJ i Departure Time: County:
Farm Name: u e, Owner Email:
-- -- F --
Owner Name:
Mailing Address: _
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: YVI ' 1e_5 L
Back-up Operator:
Location of Farm:
Title:
�o
Latitude:
Phone:
Phone No:
Integrator: M r f 5
Operator Certification Number:
Back-up Certification Number:
Longitude:
Region:
Swine
Design Current
Capacity Population
Design Current Design Current
Wet Poultry Cap�y Population Cattle Capiay Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Dry Poultry.
❑ Layers
Non -La ers
❑ Pullets❑
❑ DairyHeifer
❑ D Cow
Non -Dairy
❑ Beef Stocker
Beef Feeder
SE-1 Boars
10 Beef Brood Cow
❑ Turkeys
Qti
❑ Other
Number of Structures: a
❑ Turkey Poults
10 Other
Discharges & Stream impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes No A ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes N NA ❑ NE
❑ Yes o ❑ NA ❑ NE
El Ye ❑No ❑NA ❑NE
Page l of 3 12128104 Continued

Facility Nurhber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
throe h a waste mana ement or closure Ian?
❑ Yes N NA ❑ NE
[IYes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
g g P
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement`? El Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes N / ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Rf No NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) rX
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dN NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
N El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
El NA
0/PNo
❑ NE
17.
Does the facility lack adequate acreage for land application?
El Yes
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Name I I Phone: 79 f- y 7 �^
Reviewer/Inspector Signature: Date: % 6 / "y L a Q
Page 2 of 3 12128104 Continued

Facility Number: 3 3 — Date of Inspection /Zilh
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ZNo NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 'Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes T 'NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
❑ 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
❑ 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
❑ No
❑ NA
❑ NE
AdditioaalCommentsand/or,Draivmgs'::e
d:
Page 3 of 3 12128104

0 vision of Water Quality .
0 � •
Divis€on of Soifan& Water Conservation I
� _ - f E i l.•. - 1 I 1 , I � ' i I.i,; VI E� "i � 3 '` .i i •
t t t 0 Other Agency k a
(Type of Visit Q t✓ompliaWwrnspection O Operation Review O Lagoon Evaluation
(Reason for Vleit 01qoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Nunther Date of Visit: " 0, Time: © Printed ton; 7/21/2000
0 Not Operational 0 Below Threshold
Permitted © Certified [3 Conditionally Certified 0 Registered ' Date Last Operated or Above Threshold: .........................
Farm Name: '�.tr j. ..... . ``, `... r' 1. !'!--:........................................ County:.....................................................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
FacilityContact: ..............................................................................Title...............................................................• Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: ......................, .... . Integrator:C(VVL �4'` ,. �`n; v-A —
:..............
....................
Certified Operator 0 !...:q. �d "! S Operator Certification Number•
I:ocation of Farm:
.,
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' ��� Longitude �• �° ���
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
ean,to Feeder JEJ Layer ❑ Dairy
g,Feder to Finish '-a ❑ Non -Layer ❑ Non -Dairy
❑ FarroW to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
EE
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag -on Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imuacty
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. li'discharge is observed. what is the estimated flow in galhnin`?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Spray Field Area
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
StRICtrlrc I Structure 2 Structure 3 Structure 4
Identifier:...........3..Q....It .....................................I................I.............................. .
❑ Yes DWO
1�
❑ Yes' "10
❑ Yes a, To
❑ Yes No
❑ Yes No
❑ Yes Y " o
❑ Yes o
Structure 5 Structure 6
Freeboard (inches):
5100 Continued on back

Facility lumber: 3j — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, e(c.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement'?
Is there evidence of over application'? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12, Crop type
k-
13. Do the receiving crops differ wA those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination'?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? Oe/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any•applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Rev iewer/lns2�ator fail to discuss review/inspection with on -site representative?
24. Does facierequire a follow-up visit by same agency'?
25. Wp� any additional problems noted which cause noncompliance of the Certified AWMP?
�;vioiaticjns or itef.. .. l.. were noted .. . . g this;v .. Y:o�r will receive tr.. .. her
:. ;corresvondence. aboU .this viset:......:.::::::::::::::::::::::::::: :
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes o
[]Yes ,®"No
❑ Yes 0140
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes Leo
❑ Yes 0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑i'No
❑ Yes 0<0
❑ Yes L�Ko
❑ Yes iJ No
ElYes slO
❑ Yes �O
❑ Yes
❑ YesIo
El Yes rNo
o
❑ Yes
El Yes o
.ld

Facility. Number 1 — — - Date of Inspection
Time of Inspection l� 24 hr. (hh:mm)
rmitted Certified © Conditionally Certified © Registered 10 Not Operational I Date Last Operated:
Farm Name: ..r>�.q..K. ......J......�` �.:...� 11—..`........................................ County:r..........
, f C>......
Owner Name: �- Phone No: Z� 4/3 99 Zp
Facility Contact: . ..............................Title:
Mailing Address: ........�.3.3 S �� � D ............... fitl�sjt
Onsite Representative:... .tl[tp_„ an
S
........................... Phone No:
4". 6..........7..:.'.................................................................
Integrator: �'ldt.-1 oP_
............ g ...........'...... ...............................
Certified Operator: .............,. .............. Operator Certification Number:..........................................
Location of Farm:
I&
... ........... ...... ................... ....
Latitude 0 ' " Longitude 0 4 "
Design Current
Swint/ Canacity Population
Wean to Feeder
d
C3416c-der to Finish
r Q
❑ Farrow to Wean
[]Farrow to Feeder
❑ Farrow to Finish
❑ ults
❑ Boars
Design Current-•.,;De§ign .`-Current
Poultry Ca acit Po ulation Cattle Ca {acrty Po ulation
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other j
Total Design Capacity
€ Number of Lagoons ! ❑ Subsurface Drains, ,Present ❑ LatGonn Area ❑ Spray Fietd Area ,
I3olriing 1Pond9/3Solid Traps ; ❑ No Liquid Waste Management System
d.
Disc�hargts & 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
❑ Yes :�o
❑ Yes
❑ Yes o /
❑ Yes O
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes LLL— o
Waste Collection &Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Spillway Yes //
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .................................................1....................
... /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1
seepage, etc.)
3/23/99 Continued on

2
i
Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
r
17. Fail to have Certificate of Coverage & General Permit readily available? /V 04 Y a- !
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
U.
10 yiglafiQris'oP. deficiencies were )noted• doing tbis'vjsit, ;Y;o>j ;wiil >�eceiye ij fufther •
correspondence: about: this :visit: •.:.............::::..:.............
El Yes ;2 " "'
❑ Yes
❑ Yes
o
:�O
❑ Yes
❑ Yes
❑ Yes ❑ No
"Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
es ❑ No
❑ Yes o
❑ Yes ❑ No
:E;� �esoo
;es ❑ No
ElYes Ld'No
El Yes o
es ❑ No
❑ Yes No
es ❑ No
❑ Yes ❑ No
. ....,.., �,.. . ,.r. , 3 �j , -, 3 :...�.. .�. �,,. . o r_..a �.u•���r ,..y:,•w.���> >•. aa�ya >_ri e.=.r••i'-.«s« . n:., iy. ,,,.,.,_, _
5 �/ 00 � r •, p GMf G.-s-zw •or d'� 2� 2� i d �1,, /drys"• CdY4 � G.� y �,fJ A.
y� S P' r !
L9,, .1 /jo L1 ksy�e ✓s- �ccn.lr .vJ ,7�- > �a �w4 . �ek�
Reviewer/Inspector Name's
Reviewer/Inspector Signature: Date:

Routine;` Q Com 1aint':.,' O Follow-u"'bf DWQ ins ection�2 Q Follow'`of DSWC riview O Other [
Facility Number -- ''� 1 ime of Intip thon ' 24 hr. (hh:mm)
[3 Permitted ❑ Certified:. 13 Conditionally Certified : 0 Registered 0 Not O'crational Date Last O 'erated:
Farm Name: ...... ... ... ...................... C ourity ,...=�rT'7:I:L.....................................
Owner Name:.' ........ ........................... ......... R Phone No: " .:................ ............................ .
,-- }
Facility Contact .... ... .Title• ..... .................. Phone No: .....:..............................................
\-laiiing Address.....I............:................ _, rs .....................
Onsite Representative: ... �G`1�.�:......_.L lj...Q.4,?... Itttc�;ratcrr;......... f CAL.....�!%7....� cY .Vr0......... ....'?
Certified Operator: ......................................... ......... ................. ........................ Operator Certification Number:..........................................
Locution of Farm:
q',
Latitude �• �' o.Longitude �• �° C�'
Designs,--;' Current. Design '. Current Design . ; Current
Swine : _ - =: ... Capacity Po ul.a 'on Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish V 0 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other _ r-
❑ Farrow to Finish Total Design Capacity
❑ Gifts : ...
❑ Boars = Total Ssb
Number of Lagoons: � : ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holden SPonds / SaLd Ta s No Li uid Waste Mana ement S stem
g. rr. p�, ❑ 9 g Y
Discharg,es & Stream Ind
1. Is any discharge observed from any part of the operation? Yes �No
Discharge originated at: ❑ Lagoon El Spray Field El 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 ONo
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 0 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ( No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4' Structure 5 StrUC i Stru ti rc. 6
Identifier: _
Freeboard(inches): ............ .::.::.............. ................... ................ ..... ............................... .... ............. ............. ...........................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
-V, seepage, etc.)
3123/99 ? `3 _ '`; " Continued n back

Facility Number:. t ; �` _ t., Q *a ;" I) iti,rl Irrsp�c tu,n j V jG
. r � !
+'
.". a T•-3t't t f i s..ts , 1 �r Ff . Y �• S t F r s 3
.
'
• lF..
.� e �w
•i.:.tt..-++:r;vr.m«':.`: �w - p.: 7 .�•.�a� _ , t ,�y,...,''" - ...i �. 4 .: &
G.� Are there structures inn Site which are: not properly addre tiled ariti/cir_rn�rna�i d—through a waste mariagrrncnt nr-
a T.ri.°Jt5 CSFy� i+++�•,•..-g '�''�l£ c} 7"ii'pA�"' ss .: '•ZIT " *,aa ^.`?'?�j. tr-���c't?. n.�
e•• ' ❑ Yes
�J,/,�
NO
Insure plane' : " r 'iT� nw j s e iy q o(, r" fi n ... Vxi h 'S ti j r t
i-it-s�'ei3r� •.'ii t• a r s , . Yy _
�(If ariy of 4-6 was answered yes; and the sifuatitin poses an r,
P
questions, 1 r
E f"`;;,I-
t.,'i. 1 S'.Ya• n? .+.^iP•" 3� iY
�. s immediaepublic health or,environmentalwthreat, note-fy DWQ) r.
r .. � `h i •• �^. S - r�.r `Ri i}, i �� ,
structures �ti ` r Yes
❑ No
7. Do any of the need inarntenanc.e/improvement' �' '', i ,.,
•- p " "•�l ,.,;s` t 7�a, i r. y,. �• A t4•
R. Does any part of the waste management systcrn other than waste strut turns require matnterianc e/improvemcnt ! Yes
I�}'No
9. Do any stuctures lack adequate: gauged markers with required maximumfiind minimum liquid level'--
elevation rriarkings? r F` ' ❑ Yes
12h4o
;'
Waste 1pplrcation
�w,l`. vv 1 �
_
r!--r~ -� � , .ix., .t-._�S-.. t �E ii.� t4.r T t r r, ` I •,4 y �.✓^'r � � +x P� `v ] ¢.. , a' - ❑•YCS� �
10: Are there any buffers that need.matrttenancehmprovement?t ` !` _ 'f� rS .r _
•aL ` y
O.
1V1V
•;- . ..'. rE +-..•ir ,,. •:,•; s -" r.. s. r • r +•'^-r a. { 3 ..
Exc ins ❑ PAN
11. Is there evident a of over apP ic.tticin' Y. 0 csst� c f'•rmd s _., • : s . � ❑ Yes -
❑ No •
CroptY,�a
3�, rx :,
x12, _
.
13, Do the receiving crops differ with those designated in the, Certified Animal,Waste Management PEan'(CAWMP)? ❑ Yes
'o
f4. a) Does the facility lack adequate acreage for land applicationY•' El Yes
�J No
b) Does the facility need a wettable acre_deiermination? ! ❑Yes
❑ No
0This facility is pended for wettable titre dctcrmination'? w ❑ Yes'
[I No
15. Does the receiving crop need improvement'? :. ❑ Yes
LXNo
16. Is there a lack of adequate waste application equipment'? ❑ Yes9110
Reouired Records & Doc•trmenl.s
17,
Fail to have Certificate of Cavcruge & General Permit readily ,rvailable?
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
X
r
❑ i�o
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample repurts)
211Yes
❑ No
20.
Is racility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
zNl o
21.
Did the facility fail to have a actively certified operator in charve•?
❑ Yes
ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) El Yes �INo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNO
24. Does facility require a follow-up visit by sarne agency? _ ❑ Yes VN0
25. Were any additional problems noted which cause rioncompfiance of the Certified AWMP? ❑ Yes 0
❑; 10 yiol:afioris:or de#iciNnc;7es ► t re ni>teci during this:visit; YOO ivill•reeeive -n #'urt4,
-Correspandenee: about this :visit: • .:. : • , . . : ::: :. • :::.::..... .. ..: :.:.: :
Comments (refer to question #i): Explain any YES answers and/or any reconimendations'or any other comments.
Use drawings of facility to beite'r explain situations. (use additional pages. -as: necessary} F' Y't ',�G�i .
k ..
7. A) 7 D is r C l� ��7G�`r d u� G t ie9 rip �i o ,v p u -6-4 �S �
h�tiul i,rl•t�ciZ 5 �. oil �� N S ,�vk (r f ✓� rU
TL'q'v� (r�'f T7G-tJ��(Lt.ltGat) L�
.1040
�
- ,gin• v � • V4'tlrC S` JC.fL=
Reviewer/Inspector,Name. /,��'////j i =r t f/�d nrV F " �' w +T rG�il^G✓ :+ ��1
Reviewer/Inspector Signature: "� r n:f F.ii_r'y �'i, +f _ tY' Date �/

1
�rx
Faciill'ty Number: - Date of IrLspectton Rv N�y
B7.
)aOC T5sues
yE. r 4.x ..� a w- ;✓ '-u _ .
"the "building
_
26. Does the discharge pipe from confinement to the storage pond or lagoon fail,to discharge*at/or below ❑ Yes - No
liquid level of lagoon or storage pond with no agitation?
.^
f
27. Are there any dead animals not disposed of properly within 24 hours? ";
❑Yeso ..
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 ja No .
.
30. Were any major maintenance problems with the.ventilation fan(s) noted (i e. broken fan belts; missing or.. .
or broken fan blade(s) inoperable shutters, etc:);- "' =
❑ Yes No '
3I . Do the animals feed storage.bins fail to have appropriate cover? r
❑ Yes ..5,NO:
32.. Do the flush tanks Iack;a submerged fill *pipe or a permanent/temporary cover? ;'
`❑ Yes::4 0
A.
. -
". •. _ • _.. 1. �
3/23/99

.
el�:
WWI
Type of Visit Complia inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit out
Co Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of. Visit: Time:
Not Operational Q Below Threshold
13 Permitted El Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....v.5.1. ....`rr1— County: L..T!!.!1.. ..............................
OwnerName: ................................................... ........................................................................ Phone No:
Facility Contact: ....................
Mailing Address;,,,,,,,,,,,,,,,,,,,,
Onsite Representative:.........
.................................... Title:
Certified Operator: •LY. u O nS 6'-,
p ............................
Location'of Farm:
.............................. Phone No:...................................................
................................................................................... ..........................
Integrator:... .�pvg (rz
Operator Certification Number: .... ....................... 1-1. ...........
❑ Swine ❑ Poultry []Cattle ❑ Horse Latitude " 4 66 Longitude • 6 64
g
Design Current
Swinei Capacity Povulation
can to Feeder
[:Weeder to Finish
Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design: Current' Design ,. Guru+
Poultry. Capacity Population,— Cattle Ca acr Po rule
❑ Layer 10 Dairy
❑ Non -Layer ;.' ❑Non -Dairy
t
❑ Other
TbtallDesign CapAc1ty
Total SSLW.:
Nuinber'of�Lagoons ❑ Subsurface Drains Present 1111 Lagoon Area ❑Spray Field Area I,E.
Holdi ng Ponds /Solid Traps ❑ No Liquid Waste Management System ,e 4,
Discharges & Stream Iml)acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
IdcnliFier: 1
S t }ie I Structure 2 Structure 3 Structure 4 Structure S
II
i
❑ Yes o
❑ zz
Yes o
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes
o
ElYes No
Structure b
...................................................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number:—1,2 Date of Inspection AA Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
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 rNo
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ___<
elevation markings? ❑Yes
Waste AURlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes o
12. Crop type l_ r' �i TA7 3' 1"4
13. Do the receiving crops diff�r with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the- facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
,,.... , Documents Required ,Records
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
P. 'yiQl 4wr S.0 defC enC1e5 wgre pgted-d(ririg tbjs'vjsjt;. YoO wjiI•Xeeoiye 40 i'u>�th
:. corresAoridence: agouti this :visit: :.:.....::...::....:.. ............
... .
❑ Yes t:fN
❑ Yes
❑ Yes
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
Use drawings of facility,to better explaen situations (�seE'addiaonal'pagesFas neCessa y) ' $l.' gull q. N ^',".?'r,� C
t n3
Reviewer/Inspector Name ? s g 4 (i?g E;I FE :€ . ' F,i t:'1';ili39�s 1 6q f iF�..
Reviewer/Inspector Signature: Date: Z s/00

Facility Number: — Date of Inspection Z 1 Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONo
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 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 o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑
5100

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time:
Facility Number
Not O erational Below Threshold
ermitted O Certtified O Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: �/ r N oil— County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: ��{_`.5Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Cavacitv Population Cattle Capacity Population
❑ Wean to Feeder ❑ La er FDai
❑ Feeder to Finish ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gitts
❑ Boars Total SSLW i.
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
. . ..
HoldngePands / Sohd Traps EEE]❑ No Li uid Waste Mana ement S stem
Discharges & tream Impacts,
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c, if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches): 21I
05103101
❑ Yes No
ElYes 21�
El YesjNo
❑ YesN
El Yes
❑ Yes o
❑ Yes o
Structu e 6
Continued

Facility Number: — Date of Inspection I / bW43 -�
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? 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 o�
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
_W_aste Application /
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ElExcessive Ponding ElPAN ElHydraulic Overload ElYes No
12, Crop type f1 /AF'l KlB� .3 M-F's'-A e - .7'
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 l o
Reauired Records & Documents /
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,l—�,'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 ,., 019. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes I�N0
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,0
21. Did the facility fail Ito have a actively certified operator in charge? El Yes Ld'N0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �Io
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes o
24. Does facility require a follow-up visit by same agency? ❑ Yes o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes o
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,,: rim'` 4
Eiimments Explain,anvYES
(rwefertn que"stian#/) apswers andlot any recommendationsarany other comments:,:
Use, drawings of facility to better explain situations: (use additional pages psynecess ryj 4
,..., � ❑Field COPv ❑ Final Notes..
. aa�> w
IVO e /AI
V 9 tAl a l/ �/ r, f/� Al 4. MIXWS ti72 ryiJtioJ/Lr
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

? Divrslon Of SOII and Witter' Conse'rvatron - O erirttfJn Revtc w 3 s g �
©_
roar of_Soil and Water Conservation - Compliance Inspection
€ 'Division Of Water QUallty'-,COmphance lnspeetiUn
f Other Agency Op'cration Review . ,.: 3 , .
IS�koutine Q Complaint 0 Follow-up of l)WQ inspection O Follow-uh of DSWC review 0 Other
Facility Number Bate of Inspcc(im)
���k Time of Inspectionpb 24 hr. (hh:mm)
© Permitted Certified © Conditionally Certified E3 Registered JE3 Not O er.rtional Date Last Operated:
Farm Name: ... .5?. U..Q �1=5 !.....AF i� County-..ty '�...e�............................................
.... .
Owner Name:..... t.4�g.... 1i�11�1•rS............................. I ................. ........ Phone No:..ti�Z.-..�1�3 ..'... 4..Z ()
..
e.y
Facility Contact: .... .?'+..rPi.......................... ...l itle:................................................................ l'hcrne No:. .%S �/
.........................................................
Mailing Address: 7.3.E S fi?lf7j) .................. ............Vrhf v+...... �L I., .Z 75..................................... ..........................
Onsite Representative: L7P74t ,,Jo E{.,S' fusel;rotor:(%v~?..........................................................
�1..... .............................................................................
Certified Operator:.......! ,A.e..� ..... . 71?,f. 1....... ......... I .................... ..,.... Operator Certification Number:.......,..................................
Location of Farm: �� 'R-- /7 -y U
Latitude " Longitude • C�' �"
Design Current
Design Current Design Current
Swine Capacity Population
Poultry_
Capacity Population Cattle Capacity Population
can to Feeder
❑-Layer
❑ Dairy
eeder to Finish
2-?o o
JE1 Non -Layer
I
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 1E1 Subsurface Drains Present ❑ Lagoon Area JE1 Spray Fietd Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ).1
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. II' discharge is observed, did it roach: ❑ Stn'filCe Waters ❑ Waters of the State
c. If discharge: is observed, what is the estimated flow in gal/min?
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 Structure 5
Identifier:
❑ Yes 20
❑ Yes ZNo
ElYes o
❑ Yes
❑ Yes
❑ Yes No
/Strue'tYes o
re 6
1
` i.......................................................................................................................I
Freeboard (inches): ................................................
1/6/99 Continued on back

Facility Number: 3 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
�'16. 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?
S. Does any pat t of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures Pack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes Io
❑ Yes No
❑ Yes N
❑ Yes No
Yes ❑ No
❑ Yes o
1 I. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes ❑ No
12. Crop type �%T�¢�•r.a�..C[Y�I. /t.7..t.................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Wes ❑ No
14. Does the facility lack wettable acreage for land application? (footprint) es No
15. Does the receiving crop need improvement'? Yes ❑ N
16, Is there a lack of adequate waste application equipment'? El Yes ;O'�
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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
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?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by satne agency?
0: No.violutions :or. derciencies wereat ried duri'ng .tliis-visit:. You vviIfre�ceive na further . - .
correspandehi� e' about; this Visit.'.,
; ; ;
❑ Yes
❑ Yc No
es ❑ No
❑ Yes No
❑ Yes 0 No
if
❑ Yes No
Z KO
Comments (refer to questionExplain any YES answers and/or anyrecommendations or any other comments t ' I
Use drawings of facility'to better'explain situations. (use additional pakes as necessary): 7 'i
r r� y r ,c J -r -� r� l n f t3W t b-a� w►19 rJ� 4-a �Nvc s� � J k L Pa, 4 -
w L`� � �/s � �„ (,.l r-w t✓ --- ce►g S�i +4 "' J l� � c q vr�-r.I SFr � rz � mob, �'djtp � r'��''�-•
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rtjj 1 -�-� f p pv, ~, ILy c 5 � .S 1) ►4S' n o � � ww s �Q j1 o rj &Y"Tsf.-/ u.K 4ehW.44f%
Reviewer/Inspector Name
Reviewer/Inspector Signature:
+ r��Asml

❑ Di
n of Soil and Water Conservation ❑ Other Agency
ivision of Water Quality
191toutine. O Complaint 0 Follow-up of DWQ inspection O Follow-up dDSWC review 0 Other
Facility Number Date of Inspection Z3
Time of Inspection ® 24 hr. (hh:mm)
0 Registered Certified 0 Applied for Permit 0 Permitted 10 Not Operational Date Last Operated:
Farm Name: ... ��.4�•�.� :.rlt� y.�-� .... ......................................... County:........`�.�...----........... ..........................................
Owner Name:...................................................................... Phone No:.. .... Zd ........................
FacilityContact:..... P,;'� Q- Title. Phone No........n...............................................................................................................................................................................................
Mailing Address:...? .. ..j...t`�.,�..... .. r 1'1 i �' y. � ... W- C 7 �t7
............. . ..............................I.....................
Onsite Representative: :................ ....,�S'0�
.!............................................................ Integrator: .................................................. ........................
Certified Operator; ....... �D.. 9(4;, ...........................rI .. Operator Certification Number;,- ...........
Locution of Farm: S R_ Z Z
................................................................. .. ........................................ ... .
Latitude ' =' =" Longitude =' =` =11
s fDes lgn k Current j Design ,� Current . ; ; < . Design ;Current
»FCapacity' Population Poultry,, . Capacity, Population "Cattle #: aCapacity Population ^
k, a......._ ._. .
W n to Feeder p ❑Layer ❑ Dairy
eeder to Finish �� ❑ Non Layer k ❑ Non Dairy
❑ Farrow to Wean
pp
❑ Farrow to Feeder
❑ Other g
❑ Farrow to Finish Total Design CapaCtty
❑ Gilts,
❑ Boars is S W
81Nu fiber o agpo is 6ld:. Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
�,t „ ,. � � .� . ;� ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gaUmin?
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
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑Yes ��No
❑ Yes
❑ Yes 12<0
ElYes o
❑ Yes
El Yes:ZZ
❑ Yes N
❑ zX
Yes No
❑ Yes o
❑ Yes No

lracilvy'tiumher:
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes��
Structures (LagoonsMolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes , o
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft):.........} d......I.......... ........ I ........ I .................. ....................................................................................I............
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
,O
12. Do any of the structures need maintenancelimprove ment?
❑ Yes
❑r
(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
❑ Yes
a o
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type � f
`?.. ... 6191.1-.....`.'............................ ................ ........ ..... ............. ................................. .................................................. I ............. ....
16. Do the receiving crops differ with those designated in the Animal Waste Management flan (AWMP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes �'`""
18. Does the receiving cropneed improvement? ❑ Yes INN
19, Is there a lack of available waste application equipment? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes i o
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?
[3 No.violatio'ns-or deficiencies r ere'noted-dur.ing this.visit.- .You.will receive no further
eorresportde`rtce al$out this;visit., : `. ;
in ments (refer to;questions#): • Explairiany YES answers andlar anv recommendatio
e'drawings of facility to better.explain situations "(usc additional pages as necessa`rv)
Q i h L F� c 1 /Ltcv„ j n 'U X�
-� b , ! d
__� ru Z F, Frov-s "
❑ Yes ❑ No
es ❑ No
❑ Yes No
❑ Yes No
Cl Yes o
)f / V P 4h - Ft1Yk-- y►.(c
�7e A/,i- 5�"Grleja4
7/25197

Routine O Compivint O Follow-up of D
Facility Number
13 Registered 0 Certified [3 Applied for Permit U Permitted
Follow-up of DSWC review O Other
Date of Inspection j
Time of Inspection � 24 hr. (hh:mm)
0 Not Operational I Date Last Operated:......••„
Farm Name .......................................... County:....`.�.lr��..%r1�`J. ............
OwnerName : ................................................... ........................................................................ Phone No:
FacilityContact:.............................................................................. Title:..........................,..................................... Phone No:...................................................
)Mailing Address: ............................................. �...............................................................................................................,..................................... ..........................
Onsite Representative:...��v,.�L.. ....4 r?. '. ... Integrator :.....C-i:-11r1..1~...Z........�.....................................
Certified Operator;............................................................................................................... Operator Certification Number;.........................................
Location of Farm:
...........1—...... ......................................................................................................................................... ............................................... ............ I........... •r
Latitude Longitude
Design Current Design Current Design Current
Swine• 'Capacity. Population Poultry Capacity Population Cattle. Capacity Population ,
❑ Wean to Feeder ❑ Layer JEI Dairy
❑ Feeder to Finish = ❑ Non -Laver ❑Non Daiiti
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons I Holdihe:Pon
., 4S!:1
10 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area r
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑Yestio
Dischar;e originated at, ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made'?
❑ Yes
116 No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
❑ Yes
�'No
�
c. Ifdischarge is observed, what is the estimated flow in g:d/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
4VNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
UrNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
J{No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
)E�No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7125/97
, ... _....../
..

Facility Number-3 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 1
0
Structures (Lagoons,Holding Ponds, Flush Pits, tc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1XNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft): ......- ..:.................................................................................................................................................................. ......
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 P'No
12. Do any of the structures need maintenance/improvement? [.,dyes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes �2(No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP or runoff a tering waters of the State, notify DWQ)
15. Crop type ��............................��...�Ld.................................................................................................................................................................
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 reviewlinspection 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. deficiencies.wre-noted-during this" visit.- You will recei've''no ftirttier'
correspondence about this.visit:
❑ Yes No
❑ Ye l o
❑ Yes � 00
❑ Yes [,-INo
❑ Yes [9Vo
❑ Yes /[,No
Q-Yoc's ❑ No
❑ Yes P�No
❑ Yes P(No
❑ Yes E�10
4 J _)CEt_ P VE_C-E_7",177ru0 )-0 N o-Vrk-&Z an je-ss
!L 5)-d P E�S A/E_L'�_P TO 13 c- mdw it-p —1-0 (3,k­kLo re k
►no
00
50 , t- S #P7X �.SL ,�/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: I-10'Irl aL14A.L1r j I/K, Date: i

State of North Carolina
Department of Environment,
Health and Natural Resources
Raleigh Regional Office
James B, Hunt, Jr., Governor
Jonathan B. Howes, Secretary
IDF=HNF;Z
DIVISION OF WATER QUALITY
July 26, 1997
Mr. Gerald Kent Johnson
3662 Cokey Road
Rocky Mount, North Carolina 27801
Subject:Compliance Evaluation Inspection
Facility # 33-17
Kent Johnson Farm
Edgecombe County
Dear Mr. Johnson:
On July 23, 1997, Mr. Buster Towell from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. This inspection is part of the Division's efforts to
determine compliance with the State's animal waste nondischarge
rules.
The inspection determined that your animal operation was not
discharging wastewater into waters of the State and that the
waste lagoon had the required amount of freeboard. As a result of
the inspection the facility was found to be in compliance with the
State's animal nondischarge regulations.
This office would also like to take this opportunity to remind you
that you are required to have an approved animal waste management
plan by December 31, 1997. This plan must be Certified by a
designated technical specialist or a professional engineer. For a
listing of certified technical specialists or assistance with your
waste management plan you should contact. your local Soil and Water
Conservation District office.
The Raleigh Reg4.orial Office app-rE-ciates your cooperation in this
matter. If you have any questions regarding this inspection please
call Mr. Buster Towell at (919) 571--4100.
Sincerel
qty�r&.arett
Water Quality Section Supervisor
cc: Edgecombe County Health Department
Mr. A.B. Whitley, Edgecomk.-e Soil and Water
Conservation District
Ms. Margaret O'Keefe, DSWC--,-RRO
DWQ Compliance Group
RRO Files
3800 Barrett Drive, Suite 101, FAX [phone]
Raleigh, North Carolina 27609 NZ 4f C An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50% recycled/100/a post -consumer paper

Facility Number Date of Inspection 7 2_3 - 11Time of Inspection [gu24 hr. (hh:mm)
Total Time (in fraction of hours
Registered [I Applied for Permit ex:1.25 for 1 hr 15 min view
Farm Status: ( )) Spent on Re
❑ Certified ❑ Permitted or Inspection (includes travel and nrnceccinn\
❑ +Not Operational) Date Last O/perated:.................................
L.7.Farm Name: ... 9r.... lf.4....1�4%!xT..... �.�!..^... ..!�> ...._....__......._.......
LandOwner Nante:.//1... JM_ . S.................................................................................
Facility Conctact:.....L�..P^1:.T....1(1 Li nS_U` .................... Title: ._................
County: it- ........_....
Phone No:
Phone No:./..�..1.............%:;.... _99..�.
Mailing Address: .I`.ff.._2: ? F....L..:............... I`"
..._.._%ree_Mo'ti-f- ........../
Z ?9 a. /
............................_..............
Onsite Representative: 1. ................................................ Integrator: .... c........................................................
...........
Certified Operator:..._ ! 1..9�....... .. S"a................................................... Operator Certification Number:
Location of Farm:
5 P V '..7 �...v
Latitude Longitude 0'0,=«
General
1. Are there any buffer; that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 0 No
❑ Yes Ko
❑ Yes
❑ Yes Io
❑ Yes
B� NNoo
❑ Yes
❑ Yes
CZ No
No
❑ Yes
T
Continued
on back

" Facility Number:...3�.... — .�..Z...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Ergo
7. Did the facility fail to have a certified operator in responsible charge? El Yes � o
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes o
fitructures_(Lagoans and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes o
Frechoard (11): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1
10. Is seepage observed from any of the structures? ❑ Yes � 0
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 0
12. Do any of the structures need maintenance/improvement? ❑ Yes o
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes IdN0
Waste Appliciltion
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .....................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW)? ❑ Yes ❑ No
!Yu jylp» y .
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes . 01! 0
18. Does the receiving crop need improvement? ❑ Yes E No
19. Is there a lack of available waste application equipment? ❑ Yes
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
FQ[ CCrtifltd Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? [:]Yes ❑ No
24. Does record keeping need improvement? ❑ Yes ❑ No
Comments`{refer#o question,#) , Explain any YES;answer`s�and/or any recommend at tons or any o her comments h
Use draranngs of facility�to better. explaimsituations.. (use additional pages as necessary)
4
V
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� f Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97