330020_PERMIT FILE_20171231

State of North Carolina
Department of Environment
and Natural Resources
Raleigh Regional Office
Michael F. Easley, Governor
William G. (Bill) Ross, Secretary
Alan W. Klimek, P.E., Director
Division of Water Quality
August 26, 2002
Mr. Ferrell Blount
Blount Brothers Farm
Route 1, Box 145
Bethel, North Carolina 27812
Subject: Notice of Deficiency
Blount Brothers Sow Farm
COC AWS330020
Edgecombe County
Dear Mr. Blount:
AN
Alloomillsommin�L
NCDENii
NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND N/QURAL RESOURCES
On August 20, 2002, Mr. Buster Towell of the Raleigh Regional Office conducted an
inspection at the subject swine facility. Mr. George Pettus with Goldsboro Hog Farms was on
site to answer questions and help with the records review portion of the inspection.
The inspection noted the following deficiency with regard to your spray fields:
There were several large areas in most of your land application fields that appeared to be brown
and void of any growing vegetation.These receiving crops are in much need of improvement. It
is vital that you maintain these fields in good condition so that they maximize nutrient uptake
and do not allow run off from the fields to adjacent surface waters.
Please note that any violations of your Certificate of Coverage and General Permit may be
subject to civil penalties of up to $ 10,000.00 per day, per violation, and in some cases up to $
25,000.00 per day.
The Raleigh Regional Office would also like to remind you that now you are listed as the
Operator In Charge (OIC) of the subject facility. Please note that the Operator Rules state that if
the OIC is not the actual person conducting land application activity, then the OIC is required to
inspect the site within 24 hours of the waste application.
1628 Mail Service Center, Raleigh, NC 21699-1628 Telephone [phone]oo FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled110% post -consumer paper

Mr. Ferrell Blount
Page 2
Please respond to this Notice in writing within fourteen days of your receipt. Your response
should include your plans to remedy the aforcmentioned deficiencies concerning the receiving
crops at your farm.
If you have any questions regarding this Notice please call Buster Towel] at [phone],
extension 240.
Sincerely,
Kennet Schus er, P.E.
Regional Water Quality Supervisor
cc: Edgecombe County Health Department
Mr. AR Whitley, Edgecombe Soil & Water Conservation District
Mr. George Pettus, Goldsboro Hog Farms
Ms. Margaret O'Keefe, RRO-DSWC
L)WQ Nondischarge Compliance Group
R'AO Files

WASTE UTILIZATION PLAN
Goldsboro Hog Farms, Inc.
3302 0
Thursday, August 07, 1997
Producer: J.L.M. Mayo Farms LLC
Farm Name: J.L.M. Mayo Farms
P.O. Soc 10009
Goldsboro,NC 27532
Telephone # : [phone]
Type of Operation : Farrow to Weanting Swine
Number of Animals: 2150 sows design capacity
Application Method: Irrigation
The waste from your animal facility must be land applied at a specified rate to prevent
pollution of surface and/or groundwater. The plant nutrients in the animal waste should be
used to reduce the amount of commercial fertilizer required for the crops in the fields where
waste is to be applied. This waste utilization plan uses nitrogen as the limiting nutrient.
Waste should be analyzed before each application cycle. Annual soil tests are strongly
encouraged so that all plant nutrients can be balanced for realistic yields of the crop 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 contents of the waste. Do not apply more nitrogen than the crop
can utilize. Soil types are important as they have different infiltration rates, leaching
potentials, cation exchange capacities, and avaialable water holding capacities. Normally
waste shall not be applied to land eroding at greater than 5 tons per acre per year. With
special pre -cautions, waste may be applied to land eroding at up to 10 tons per acre per
year. Do not apply waste on saturated soils, when it is raining, or when the surface is frozen.
Either of these conditions may result in runoff to surface waters which is not allowed under
DEM regulations. Wind conditions should also be considered to avoid drift and downwind
odor problems. To maximize the value of the nutrients for crop production and to reduce the
potential for pollution, the waste should be applied to a growing crop or applied to bare
ground not more than 30 days prior to planting. Injecting the waste or dishing will conserve
nutrients and reduce odor problems. This plan is based on waste application through
irrigation for this is the manner in which you have chosen to apply your waste. If you choose
to inject the waste in the future, you need to revise this plan. Nutrient levels for injecting
waste and irrigating waste are not the same.
The estimated acres needed to apply the animal waste is based on typical nutrient content
for this type of facility. Acreage requirements should be based on the waste analysis report
from your waste management facility. Attached you will find information on proper sampling
techniques, preparation, and transfer of waste samples to the lab for ananlysis. This waste
utilization plan, if carried out, meets the requirements for compliance with 15A NCAC
2H.0217 adopted by the Environmental Management Commission.
Page 1

AMOUNT OF WASTE PRODUCED PER YEAR (gallons, ft3, tons, etc.)
2150 sows X 6.1 tons waste/sows/year =13115 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
2150 sows X 5.4 Ibs PAN/sows/year = 11610 PAN/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.
The following acreage will be needed for waste application based on the crop to be grown,
soil type and suface application.
TABLE 1 : ACRES OWNED BY PRODUCER
TRACT FIELD SOIL TYPE &CLASS- CROP YIELD L13S AW COMM ACRES LSS AW APPLIC.
DETERMINING PHASE CODE NIACRE NIACRE USED TIME
289
4A
FORESTON ALL
BH
6
300
0
1.06
318
MAR-SEP
289
- 4A
FORESTON ALL
SG
1
100
0
1.06
106
SEP-MAR
289
4B
FORESTON ALL
BH
6
300
0
2.12
636
MAR-SEP
289
_ 413
FORESTON ALL
SG
1
100
0
2.12
212
SEP-MAR
289
5A
FORESTON ALL
C
120
130
20
3,53
458.9
MAR-JUN
289
5A
FORESTON ALL
W
55
132
0
3.53
485.96
SEP-APR
289
5A
FORESTON ALL
SB
35
140
0
3.53
494.2
APR-SEP 15
289
5B
FORESTON ALL
c
120
130
20
3.52
457.6
MAR-JUN
289
5B
FORESTON ALL
W
55
132
0
3.52
464.64
SEP-APR
289
56
FORESTON ALL
SB
35
140
0
3.521
492.8
APR-SEP 15
289
5C
FORESTON ALL
C
120
130
20
3.39
440.7
MAR-JUN
289
5c
FORESTON ALL
W
55
132
0
3.39
447.
SEP-APR
289
Sc
FORESTON ALL
SB
35
140
0
3.39
474.6
APR-SEP 15
289
5D
FORESTON ALL
C
120
130
20
1.95
253.5
MAR-JUN
289
5D
FORESTON ALL
W
55
132
0
1.95
257.
SEP-APR
289
5D
FORESTON ALL
SB
35
140
0
1.95
273
APR-SEP 15
289
SS1
FORESTON ALL
BH
6
300
0
3.93
1179
MAR-SEP
289
_ SS1
FORESTON ALL
SG
1
100
0
3.93
393
SEP-MAR
289
SS2
FORESTON ALL
BH
6
300
0
3.42
1026
MAR-SEP
289
-- SS2
FORESTON ALL
SG
1
1000
3.42
342
SEP-MAR
289
SS3
FORESTON ALL
BH
6
300
0
2.55
765
MAR-SEP
289
- SS3
FORESTON ALL
SG
1
100
0
2.55
255
SEP-MAR
289
SS4
FORESTON ALL
BH
6
300
0
2.81
843
MAR-SEP
289
- SS4
FORESTON ALL
$G
1
100
D
2.81
281
SEP-MAR
289
SS5
FORESTON ALL
BH
6
300
0
1.73
519
MAR-SEP
289
- SS5
FORESTON ALL
SG
1
100
Q
1.731
173
SEP-MAR
289
SS6
FORESTON ALL
BH
6
300
0
4.26
1278
MAR-SEP
289
- SS6
FORESTON ALL
SG
1
100
0
4.26
425
SEP-MAR
289
SS7
iWAGRAM 0.6%
SH
5.5
275
0
6.47
1779.25
MAR-SEP
289
- SS7
WAGRAM 0-6%
SG
11
1001
01
6.47
647
SEP-MAR
TOTALS: 13669.6
- Indicates that this field is being overseeded (i.e. interplanted) or winter annuals follow
summer annuals.
Indicates a Crop Rotation
NOTE: The applicator is cautioned that P and K may be over applied while meeting the N
requirments. Beginning in 1996 the Coastal Zone Management Act will require farmers in
some eastern counties of NC to have a nutrient management plan that addresses all
nutrients. This plan only addresses Nitrogen.
Page 2

TABLE 2, ACRES WITH AGREEMENT OR LONG TERM LEAS
(Agreement with adjacent landowners must be attached.)
(Required only if operator does not own adequate land. See required specifications 2.)
There are no Acres Leased
Indicates that this field is being overseeded (i.e. interplanted) or winter annuals follow
summer annuals.
* Indicates a Crop Rotation
* Acreage figures may exceed total acreage in field due to overseeding.
**Lbs AW N (animal waste nitrogen) equals total required nitrogen less any commercial
nitrogen (COMM N) supplied.
The following legend explains the crop codes used in TABLES 'I and 2 above:
CROP CODE CROP UNITS LBS NIUNIT
C
CORN
BUSHELS
1.25
BH
HYBRID BERMUDAGRASS-HAY
TONS
5o
SG
SMALL GRAIN OVERSEEDED
AC
50
SB
SOYBEANS
BUSHELS
4
W
WHEAT
Page 3

TOTALS FROM TABLES 1 AND
ACRES LBS AIN
N USED
ABLE 1 40.7 13,669
TOTALS: 40.74 13,669
AMOUNT OF N PRODUCED. 11,610
" BALANCE -2,059
*** This number must be less than or equal to 0 in order to fully utilize the animal waste
N produced.
Acres show in each of the preceeding tables are considered to be the usable acres
excluding required buffers, filter strips along ditches, odd areas unable to be irrigated, and
perimeter areas not receiving full application rates due to equipment limitations. Actual total
acres in the fields listed may, and most likely will be, more than the acres shown in the
tables.
NOTE: The Waste Utilization Plan must contain provisions for periodic land application of
sludge at agronomic rates. The sludge will be nurturient rich and will require precautionary
measures to prevent over application of nutrients or other elements. Your. production facility
will produce approximately 1892 pounds of plant available nitrogen (PAN) per year in the
sludge that will need to be removed on a periodic basis. This figure is PAN when
broadcasting the sludge. Please be aware that additional acres of land, as well special
equipment, may be needed when you remove this sludge.
See the attached map showing the fields to be used for the utilization of waste water
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of the soil at the time of
irrigation such that runoff or ponding occurs. This rate is limited by initial soil moisture
content, soil structure, soil texture, water droplet size, and organic solids. The application
amount should not exceed the available water holding capacity of the soil at the time of
irrigation nor should the plant available nitrogen applied exceed the nitrogen needs of the
crop.
Your facility is designed for 180 days of temporary storage and the temporary storage must
be removed on the average of once every 5.92 months. In no instance should the volume
of waste being stored in your structure be within 1.56 feet of the top of the dike.
If surface irrigation is the method of land application for this plan, it is the responsiblity of the
producer and irrigation designer to ensure that an irrigation system is installed to property
irrigate the acres shown in Tables 1 and 2. Failure to apply the recommended rates and
amounts of Nitrogen shown in the tables may make this plan invalid.
The following table is provided as a guide for establishing application rates and amounts.
APPLICATION APPLICATION
TRACT FIELD SOIL TYPE CROP RATE (iNhr) AiNT (inches)
289
"SS7
WAGRAM M%
SG
0.60
'1
7B9
SS7
WAGRAM 0-6%
BM
0.60
"1
2B9
*5A, *5B, *5C, *5D
FORESTON ALL
W
0.60
'1
289
1.--SS1. -SSZ --SS3, -SS4, -S
FORESTON ALL
SG
0.50
`1
2139
*5A, *5B, *5C, *5D
FORESTON ALL
$B
0,50
"1
2139
*5A, *5B, *5c, *5D
FORESTON ALL
C
0.50
'1
289
4B, SS I. SSZ SS3, SS4, SS5,
FORESTON ALL
Bit
0.50
•1
* This is the maximum application amount allowed for the soil assuming the amount of
nitrogen allowed for the crop is not over applied. In many situations, the application
amount shown cannot be applied because the nitrogen limitation. The maximum
application amount shown can be applied under optimum soil conditions.
Page 4

NARRATIVE OF OPERATION
This WUP has been amended to wettable acres by irrigation pulls and solid set zones as
indicated on the most current FSA maps. Actual survey maps are also available that
indicate that the FSA map figures are in error and that even with the required buffers and
setbacks, there are more actual acres available for land application than the FSA maps
indicate. The WUP is written by irrigation pulls and solid set zones and the required
information is documented on the D-1 form.
This WUP also utilizes the 100 lb overseed option with the following conditions: (1) no
animal waste may be applied to the bermuda after August 31, (2) the small grain must be
applied to in split applications between Sept - Oct and Feb - Mar, with no appliction in Nov -
Jan, and (3) the small grain must be harvested by April 7. This guidance provided by NCSU
Forage Production Workgroup.
20 lbs of PAN has been deducted from the corn PAN allowance for residual N following a
soybean crop in rotation. In the event corn is planted and does not follow a soybean crop,
the 20 lbs of PAN will need to be added back to the PAN allowance in Table 1.
This WUP was amended just for Change of Ownership on December 1, 2006,
Page 5

PLANS & SPECIFICATIONS
1. Animal waste shall not reach surface waters of the state by runoff, drift, manmade
conveyances, direct application, or direct discharge during operation or land application. Any
discharge of waste which reaches surface water is prohibited. Illegal discharges are subject
to assessment of civil penalties of $10,000 per day by the Division of Water Quality for
every day the discharge continues.
2. The Field Office must have documentation in the design folder that the producer either
owns or has long term access to adequate land to properly dispose of waste. If the producer
does not own adequate land to properly dispose of waste, he shall provide NRCS with a
copy of a written agreement with a landowner who is within a reasonable proximity, allowing
him/her the use of the land for waste application for the life expectancy of the production
facility. It is the responsibility of the owner of the facility to secure an update of the Waste
Utilization Plan when there is a change in the operation, increase in the number of animals,
method of utilization, or available land.
3. Animal waste shall be applied to meet, but not exceed, the Nitrogen needs for realistic
crop yields based on soil type, available moisture, historical data, climate conditions, and
level of management, unless there are regulations that restrict the rate of application for
other nutrients.
4. Animal waste may be applied to land that has a Resource Management System (RMS) or
an Alternative Conservation System (ACS). If an ACS is used the soil loss shall be no
greater than 10 tons per acre per year and appropriate filter strips will be used where runoff
leaves the field. These filter strips will be in addition to "Buffers" required by DEM. (See
FOTG Stantard 393 - Filter Strips and Standard 390 Interim Riparian Forest Buffers).
5. Odors can be reduced by injecting the waste or disking after waste application. Waste
should not be applied when there is danger of drift from the irrigation field.
6. When animal waste is to be applied on acres subject to flooding, it will be soil
incorporated on conventionally tilled cropland. When applied to conservation tilled crops or
grassland, the waste may be broadcast provided the application does not occur during a
season prone to flooding. (See "Weather and Climate in North Carolina" in the NRCS
Technical Reference - Environment file for guidance.)
*7. Liquid waste shall be applied at rates not to exceed the soil infiltration rate such that
runoff does not occur offsite or to surface waters and in a method which does not cause drift
from the site during application. No ponding should occur in order to control conditions
conducive to odor or flies and to provide uniformity of application.
S. Animal waste shall not be applied to saturated soils, during rainfall events, or when the
surface is frozen.
9. Animal waste shall be applied on actively growing crops in such a manner that the crop is
not covered with waste to a depth that would inhibit growth.
10. Waste nutrients shall not be applied in fall or winter for spring planted crops on soils with
a high potential for leaching. Waste nutrient loading rates on these soils should be held to a
minimum and a suitable winter cover crop planted to take up released nutrients. Waste shall
not be applied more than 30 days prior to planting of a crop on bare soil.
11. Any new swine facility sited on or after October 1, 1995 shalt comply with the following:
the outer perimeter of the land area onto which waste is applied from a lagoon that is a
Page 6

component of a swine farm shall be at least 50 feet from any residential property boundary
and from any perennial stream or river (other that an irrigation ditch or canal. Animal waste
other than swine waste from facilities sited on or after October 1, 1995), shall not be applied
closer than 25 feet to perennial waters. (See Standard 393 - Filter Strips)
12. Animal waste shall not be applied closer than 100 feet to wells.
13. Animal Waste shall not be applied closer than 200 feet of dwellings other than those
owned by the landownwer.
14. Waste shall be applied in a manner not to reach other property and public right - of ways.
15. Animal waste shall not be discharged into surface waters, drainageways, or wetlands by
discharge or by over -spraying. Animal waste may be applied to prior converted croplands
provided they have been approved as a land application site by a "technical specialist".
Animal waste should not be applied on grassed waterways that discharge directly into water
courses, except when applied at agronomic rates and the application causes no runoff or
drift from the site.
*16. Domestic and industrial waste from washdown facilities, showers, toilets, sinks, etc.,
shall not be discharged into the animal waste management system.
*17. A protective cover of appropriate vegetation will be established on all disturbed areas
(lagoon embankments, berms, pipe runs, etc.). If needed, special vegetation shall be
provided for these areas and shall be fenced, as necessary, to protect the vegetation.
Vegetation such as trees, shrubs, and other woody species, etc. are limited to areas where
considered appropriate. Lagoon areas should be kept mowed and accessible. Lagoon
berms and structures should be inspected regularly for evidence of erosion, leakage or
discharge.
*18. If animal production at the facility is to be suspended or terminated, the owner is
responsible for obtaining and implementing a "closure plan" which will eliminate the
possibility of an illegal discharge, pollution and erosion.
*19. Waste handling structures, piping, pumps, reels, etc., should be inspected on a regular
basis to prevent breakdowns, leaks, and spills. A regular maintenance checklist should be
kept on site.
20. Animal waste can be used in a rotation that includes vegetables and other crops for
direct human consumption. However, if animal waste is used on crops for direct human
consumption, it should only be applied as a preemergence with no other applications of
animal waste during the crop season.
*21. Highly visible markers shall be installed to mark the top and bottom elevations of the
temporary storage (pumping volume) of all waste treatment lagoons. Pumping shall be
managed to maintain the liquid level between the markers. A marker will be required to mark
the maximum storage volume fpr waste storage ponds.
22. Waste shall be tested within 60 days of utilization and soil shall be tested at least
annually at crop sites where waste products are applied. Nitrogen shall be the rate -
determining element. Zinc and copper levels in the soils shall be monitored and alternative
crop sites shall be used when these metals approach excessive levels. pH shall be adjusted
for optimum crop production amd maintained. Soil and waste analysis records shall be kept
for five (5) years. Poultry dry waste application records shall be maintained for three (3)
years. Waste application records for all other waste shall be maintained for five (5) years.
Page 7

23. Dead animals will be disposed of in a manner that meets North Carolina Department of
Agriculture regulations.
* Liquid Systems
Page 8

NAME OF FARM: J.L.M. Mayo Farms
OWNER I MANAGER AGREEMENT
I (we) understand and will follow and implement the specifications and the operation and
maintenance precedures estalished in the approved animal waste utilization plan for the
farm named above. I (we) know that any expansion to the existing design capacity of the
waste treatment and/or storage system or construction of new facilities will require a new
utilization plan and a new certification to be submitted to DEM before the new animals are
stocked.
I (we) understand that I must own or have acces to equipment, primarily irrigation
equipment, to land apply the animal waste described in this waste utilization plan. This
equipment must be available at the appropriate pumping time such that no discharge occurs
from the lagoon in a 25-year 1-day storm event. I also certify that the waste will be applied
on the land according to this plan at the appropriate times and at rates that no runoff occurs.
NAME OF FACILITY -OWNER: J.L.M. Mayo FarmsiLC
SIGNATUR
NAME OF NAGER (if different from owner):
DATE: / 6 (o
please print
SIGNATURE: I DATE:
NAME OF TECHNICAL SPECIALIST: George H. Pettus
AFFILIATION: Maxwell Foods, Inc.
ADDRESS (AGENCY): PO Box 10009
Goldsboro, NC 27532
[phone]
SIGNATURE: DATE: b I 'DVZZ�,0Z 06
Page 9

State of North Carolina
Department of Environment,
Health and Natural Resources •
Division of Water Quality
James B. Hunt, Jr., Governor p E H N R
Jonathan B. Howes, Secretary -
A. Preston Howard, Jr., P.E., Director
April 3, 1997
William Blount U � U E
Blount Bros Swine Farm
PO Box 400 Aft MIT'
Bethel NC 27812
MHNR RALEIGH
REGI tice of Violation
Designation of Operator in Charge
Blount Bros Swine F
Facility N --46
d mbe County
Dear Mr, Blount:
You were notified by letter dated November 12, 1996, that you were required to designate a
certified animal waste management system operator as Operator in Charge for the subject facility by
January 1, 1997. Enclosed with that letter was an Operator in Charge Designation Form for your
facility. Our records indicate that this completed Form has not yet been returned to our office.
For your convenience we are sending you another Operator in Charge Designation Form for your
facility. Please return this completed Form to this office as soon as possible but in no case later
than April 25, 1997. This office maintains a list of certified operators in your area if you need
assistance in locating a certified operator.
Please note that failure to designate an Operator in Charge of your animal waste management
system, is a violation of N.C.G.S. 90A-47.2 and you will be assessed a civil penalty unless an
appropriately certified operator is designated. Please be advised that nothing in this letter should be
taken as absolving you of the responsibility and liability for any past or future violations for your
failure to designate an appropriate Operator in Charge by January 1, 1997.
If you have .questions concerning this matter, please contact our Technical Assistance and
Certification Group at [phone].
Sincerely,
W. t. 7
For Steve W. Tedder, Chief
Water Quality Section
bb/awdeslet 1
cc: Raleigh Regional Office
Facility File
Enclosure
P.O. Box 29535, 1�P� FAX [phone]
Raleigh, North Carolina 27626-0535 X�f An Equal Opportunity/Affirmative Action Employer
Telephone [phone]M. recycles/10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
July 24, 1997
A40;1i go
[DEHNR
Meredith Ozimek
Blount Bros. Sw alntLo
Blount Bros. F d
PO Box 400 199i
Bethel, NC 2781 JUL 2 5
i. Subject: Farm No. 33-20
Additional Information Request
�tEGl4�1AL 04F4CE
Blount Bros. Farms
Animal Waste Operation
Edgecumbe County
Dear Meredith Ozimek:
The Permits and Engineering Unit has completed a preliminary engineering review of the subject
application.- Additional information is required before we can continue our review. The number of
animals (2150) indicated in Part 111.2 of Non -discharge permit application form and the certification form
(2070 sows and 80 isolation unit) do not agree with the numbers (2000 sows) on the Animal Waste
Utilization Plan. Please make necessary corrections on your waste utilization plan to reflect the
designed and certified capacity of 2070 Farrow to Wean and 80 isolation operation and send to this
office by August 24, 1997.
Please reference the subject farm number when providing the requested information. All
information should be signed, and submitted to my attention at the address below. Please note that failure
to provide this additional information on or before the above requested date can result in your application
being returned as incomplete.
If you have any questions regarding this request, please call me at [phone], extension 363.
Sincerely,
J.R. Joshi
Soil Scientist
State Engineering Review Group
cc: Raleigh Regional Office, Water Quality
Permit File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 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
William Blount
Blount Bros Swine Farm
PO Box 400
Bethel NC 27812
X", AV
IDE-=HNR
November 13, 1996
SUBJECT: Operator In Charge Designation
Facility: Blount Bros Swine Farm
Facility ID#: 33-46
Edgecombe County
Dear Mr. Blount:
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.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc. Raleigh Regional Office
Water Quality Files
P.O. Box 27687,
Raleigh, North Carolina 2761 1-7687 C An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/10°/. post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
April 17, 1997
MEMORANDUM
TO: Raleigh Regional Water Quality Supervi
FROM: Sue Homewood
SUBJECT: Notification of Facility Number Change
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MOM
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The following changes have been made to the Animal Operations Database. Please make
appropriate changes in your files.
Facility numbers 33-20 and 33-46 were two portions of the same farm. They
were certified separately but have been combined in the animal operations
database under facility number 33-20.
If you have any comments or questions please feel free to call me at [phone] ext 502.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 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
Blount Bros. Swine Farms LLC
Blount Bros. Farm
PO Box 400
Bethel NC 27812
ATMELM ?VrA
4
EDF-=F-iNR
November 12, 1996
SUBJECT: Operator In Charge Designation
Facility: Blount Bros. Farm
Facility ID#: 33-20
Edgecombe County
Dear Farm Owner:
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 91gn33-0026.
Sincerely,
A. Preston Howard, -Jr., P..&�r-L�fector
Division of Water Quality
Enclosure
cc: Raleigh Regional Office
Water Quality Files
P.O. Box 27687, 4. FAX [phone]
Raleigh, North Carolina 2761 1-7687 f An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 - 50% recycled/10% post -consumer paper

JUL-14-1995 15:26 FROM DEM WATER DUALITY SECTION TO
Rr�D P.02/02
Site Requires Immediate A!tenaon-
Facility No.
DIVISION'OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SrM VISITATION RECORD
DATE: 7 t 3 , 1995 Q{1 a-, �kz2
Time: I
No. 14--
Farm Name/owner:/ �vc � )
�4 �/✓ �`�`
Mailing Address: P 0 Loy 4-00 j J G 2, 71 t
County. -
Integrator. Phone:
On Site Representative: Phone:
Physical Address)Location: N
Type of Operation: Swine �� Poultry Cattle
Design Capacity: Number of Animals on S ite:
DEM Certification Number: ACE DEM Certification Number: ACNEW_
Latitude: _ Longitude: Elevation: Feet
Circle Yes or No �� Fr, gt`
o
Does the Animal Waste Lagoon have sufficienr. $eeboard of 1 Fact + 25 y 24 hour storm event 'l
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: %>~t. Inches.
Was any seepage observed from the la oou(s)? Yes or o as any erosion obs ? Yes -or ZVoI
Is adequate land available f r spray' Ye or No Is the cover crop adequate Yes No
C (s) being utilized: ��a
..:tit°.•.1.Fiid
Does the facility meet SCS minimum setback cxiteria? 200 Feet from Dwellings - �Y,�sNo
100 Feet ftfotn WellYYs? or-No.w-
^r animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 1�0
71
a;zimal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line'? Yes oiR
.S animal waste discharged into waters of the state by inan-made ditch, flushing system; or other
•,imilarr man-made devices? Yes or t o if Yws. Please Explain.
tilt facility inaimain adequate waste maxiagerticrit records (volumes of manure; land applied_
spray irrigated on s-pecific acreage with cover crop 0 Yes or No
Adetional Comments:
Signature
cc: Facility Assessment Unit
Use Attachments if itieeded_
TOTAL P.e2

North Carolina
Department of Environment and Natural Resources
Water Pollution Control System Operator Certification Commission
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Coleen H. Sullins, Chairman
June 28, 2002
Ferrell Blount
Route 1 Box 145
Bethel NC 27812
Subject: Designation of Operator in Charge
Facility: Blount Bros Farm
Facility ID#: 33-20
County: Edgecombe
Dear Mr. Blount:
D
e��
NCDENR
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on Agricultural
Waste, was enacted by the 1996 North Carolina General Assembly. This legislation requires the owner of any
animal waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more horses,
1,000 or more sheep, or 30,000 or more confined poultry with a liquid waste management system, to designate a
properly certified Operator in Charge (OIC). 15A NCAC 8F .0201(a)(2) requires the owner of such a system to
designate a new OTC within 30 days of a vacancy of the OTC position.
On May 20, 2002, the Water Pollution Control System Operators Certification Commission received. a letter from
Meredith Ozemik stating that she resigned as OIC of your facility effective June 19, 2002, Please complete and
return the enclosed Operator in Charge designation form within 30 days of receipt of this letter. Failure to designate
an Operator in Charge is a violation of N.C.G.S. 90A-47.2 and 15A NCAC 8F .0201(a) and may result in the
assessment of civil penalties.
If you have any questions, please contact me at 919-733-0026, extension 313.
Sincerely,
C -
Beth Buffingto
Technical Assistance and Certification Unit
cc: TAC Facility Files
Non -Discharge Compliance/Enforcement Unit
,Raleigh Regional Office
Central Files
Enclosure
1618 Mail -Service Center, Raleigh, North Carolina 27699-1618
Phone: 919 — 733-0026 1 FAX: 919 — 733-1338
AN EQUAL OPPORTUNITY 1 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
Ferrell Blount
Blount Bros. Farm
Route 1, Box 145
Bethel NC 27812
Dear Ferrell Blount:
Ar Tk?WA
- 4, 0
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
I
December 30, 1999 — 1
L ! J�
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 33=20.
-Edgqcqmbe-Qounty
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. IRR1, IRR2, DRY I, DRY2, DRYS, SLUR I, SLUR2,
SLD1, 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.
Sincerely,
1
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% recycle&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
9191571-4700
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 cant' out our day-to-day program obligations. Please read carefully the following
uidelines before signing the form:
1. 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 Vim. 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,
S.
1.
2.
3.
4.
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.
FACILITY NAME COUNTY
avocsx-o� -0� r&mu:s
Signature an ame of Firm/Business Date Time In Time Out
Please attach a buslr� card to thin 110M

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 33 - z,-)
Farm Name: Vats �- B'" r1 kw A±r�
On -Site Representative:••
Inspector/Reviewer's Name: R
Date of site visit: e T 7
Date of most recent WUP: y
Operation is flagged for a wettable
acre determination due to failure of
Part // eligibility item(s) F1 F2 F3 F4
Opera#ion not required to secure WA
determina#ion a# #his a based on
exemption E1 E2 3 E4
Annual farm PAN deficit: 3 pounds
Irri at' - e trave . center -pivot system; 3. linear -move system;
stationary sprinkler system wlpermanent pip , 5. stationary sprinkler system w/portable pipe;
system w permannt pi
6. stationary gun epe; . stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part III).
PART il. 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
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

....
Jlity Number .
Revised January 22, 1999
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD
TYPE OF TOTAL
CAWMP FIELD
COMMENTS'
NUMBER NUMBER',2
IRRIGATION ACRES
ACRES %
SYSTEM
1
I
I
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 acreaee exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

4
�►— State of North Carolina
• Department of Environment, Health and Natural Resources Pav
Division of Water Quality
Non -Discharge Permit Application Form / Survey
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
General Permit - Liquid Animal Waste Operations
The following questions have been completed utilizing information on file with the
Division. Please review the information for completeness and make any corrections
which are appropriate. If a question has not been completed by the Division, please
complete as best as possible. Do not lemma g.a stion unanswered.
Application Date: _ - _I
1. REQUIRED ITEMS CHECKLIST
Please indicate that you have included the following required items by.signm y r in the space provided next to each
item. pEHNR RA E1G4i REGOr1�i�
Applicants Initials
1. One completed and signed original and one copy of lh application for General Permit - Animal
Waste Operations;
2. Two copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is disposed;
3. Two copies of the Certified Animal Waste Management Plan (CAWMP). If the facility does
not have a CAWMP, one must be completed prior to submittal of a general permit application
for animal waste operations. +
II. GENERAL INFORMATION:
Farin's name: Blount Br
2. Print Land Owner's name: 131ount Bros, Swine Farms LLC
3. Land Owner's Mailing address: _PO_Box 400
City: Bethel NC Zip: 27812
Telephone Number: _825-3701
4. County where faun is located: EdMombe
5. Farm 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): '/Z M 11 pQge d Iria /05 ,y- t 5 ovI RfAF, C �- Ly ,Yo2 E)
6. Print Farm Manager's name (if different from I -arid Owner): &rgdilh QZftme[C
7. Lessee' 1 Integrator name (if applicable; please circle which type is listed): Qoldsbgro Hog EgrmsGolclsboro Ho&Farms
33 - 20
FORM: AWO-G-E 2/26/97 Page I of 3

• III. OPERATION INFORMATION:
1. Farm No.: _31-2b
2. Operation Description:.Swine operation
Farrow to Wean
2150 - Certified De 'gn Capacity
Is the above information correct? yes; E:j no. If no, correct below using the design capacity of the facility
TyM-Qf Swine No. of Animals Tie of PoultLy No. of Animals Type of Cattle Np, of Animals
0 Wean to Feeder 0 Layer 0 Dairy
0 Feeder to Finish 0 Non -Layer 0 Beef
0 Farrow to Wean (# sow) 0 Turkey
0 Farrow to Feeder (# sow)
0 Farrow to Finish (# sow)
Other Type of Livestock on the farm: No. of Animals: r G
3. Acreage cleared and available for application: 37.00 _ -; Required A�reage (as listed in the CAWMP):
4. Number of Lagoons: 2 ; Total Capacity: JA M. M , 190Cubic Feet (ft3)
Number of Storage Ponds: ; Total Capacity: Cubic Feet (ft3)
5. Is animal waste being applied on any field which has subsurface drains? YES or (please circle one)
6. Are subsurface drains present in the vicinity of or under the lagoon? YES or NO (please circle one)
IV. APPLICANT,}'S QCERRjTIFICATION: y
�hl1Ai �1�+'LL S'i'..�. Jr. I C (f and nwnar'c nnnin liclarl in miPctinn ri 71 nttvct that
this application for 'S '.:-::r:� _ (Farm name listed in question 11.1)
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 completed and that if all required supporting information and attachments are not included, this application package
will he returned to me as incoslavlete.
Signature
V . MANAGER'S CER
Date '?—I (r" S)
CATION: (complete only if different from the Land Owner)
(Manager's name listed in question II.6), attest that this
application for Dbu ni 0 So (Farm name listed in question IL 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 completed and that if all required supporting information and attachments are not included; This application package
will be returned as incomplete.
Signature
Date
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
PERMITS AND ENGINEERING UNIT
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: [phone]
FORM: AWO-G-E 2/26/97 Page 2 of 3

A-n=AL WASTE HANAGZ*1T PtAH C37=7ICATIO2i FOR UZW OR Z. AIMLPD PMEDLOTS
Pleaaa ratur3 the Cc=;)Iated form to the Division of E3visaaaetital Haaagemeat at
,the addxeaa on the revarae side of thin fors.
Name of farm (Please print) X 136,4 _ ��ofi [ram_ _5.�:,,t ta, -)
Address : x P 0 S-x 400 aekl.tl NG -.11fs1 .
Phone No.: 2C 911 •gas -.1'7o r
County: �P&d g e dwnl e-
Farm location: Latitude and Longitude:IJ ff 35 /77 22 1_0 (required). Also,
please attach a copy of a county road map with location identified.
Type of operation (swine, layer, dairy, etc.) _, SsAW& (FAw.WW To WEAN_
Design capacity (number of animals): ZO 0
Average size of operation'(12 month population avg.): ZVOLI
Average acreage needed for land application of waste (acres):
saaasaaaasaaaaaaaaaaaaaaaazaaaaaagaagataqstaoepanaaa�eqaaaaaaaaaa�raaassaaqasaaasss
Technical Specialist Certificatiaa
As a technical specialist designated by the North Carolina Soil and water
Consecration Commission pursuant to 15A NCAC 6F .0005, I certify that the new or
expanded animal waste management system as installed for the farm named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Soil Conservation Service and/or the North
Carolina Soil and Water Consecration Commission pursuant to 15A NCAC 2H.0217 and
15A NCAC 6F .0001-.0005. The following e'levents and their corresponding minimum
criteria -have -been verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party); access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stormwater runoff events less severe than the 25-year, 24-hour
storm.
Name of Tecb,xxical, Specialist (Please Print) : &60V*6 N. POrru
Affiliation: 6WVIR9NMfWrAL GIN6eR - 6VW19WW 1400 lxft5 � C ,
Address (Agency) : 0. SOX- 10019g &vL9iaM9, NG 17532 Phone No
Signature: 2 Y&�N Date : 22 Nov 414
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Owner/liaaager - eat
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 additional 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) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of Land owner (Please Print) X�,t o�nf (j�v .a sr'�MI 4••" , �L4.
Signature:, X _�' d � Date• 22 NOV 9l+
Name of Hanag if differe from owner (Please print) : &m2a 'f _QZ4of -
)
Signature: Date:
?•Tote: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
DEM USE ONLY:Aa EW#
Q0
r
5�
a

AVrvnr• WAST3 HMAGZf`r PLA2i C3R__?ICATIQN POR Nrif OR 3:?ADDED FEEDLOTS
Please ratu= the completed form to the Division of Eari_on3aatal 2iaaagemeilt at
t-he ade3_—_nsa as the reverse side of this fora.
Name of farm (Please print) : 84oUNT 1DF_0WLMy 51IfNk FAgMr,
Add: es s : P 0. WK ` o $jr EF NG 27912. .�.
Phone No. I 2 7
County: VD6 !. na89_
Fars location: Latitude and Longitude: IL .11 /_ 22 a (required). Also,
please attach a copy of a county road map with location. identified.
Type or operation (swine, layer, dairy, etc.): SWIN O
Design capacity (number of animals) :_ SD hoW J404ATION_
Average size of operation' (12 month population avg.) . fLOy e. _
Average ac_eage needed for land application of waste (acres): 2; pGyt&S
' anaaaaaaaaaaaaaaaaa=asaaa3aaaaa��a�a��raaQaStaaaaaaavaa�gaaagaaaoxsaaaaaassaaa�eaas
Tach=Ical Specialist Certification
As a technical specialist designated by, the North Carolina Soil and Water
Conservation Commission pursuant to 15A NCAC 67 .0005, I certify that the new or
expanded animal waste management system as installed for th; far: named above
has an animal _waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the USDA -Sail Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to 15A NCAC 214.0217 and
15A NCAC 6F .0001-.0005. The following e7 events and their corresponding minimum
criter'_a-haue_been verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste storage ponds; waste storage capacity; adequate
quantity and amount of land for waste utilization (or use of third party); access
or ownership of proper waste application equipment; schedule for timing of
applications; application rates; loading rates; and the control of the discharge
at pollutants from stox-iwater runoff events less severe than the 25-year, 24-;Hour
storm.
llama of Technical Specialist (Please Print) &TT_"'
Affiliation: E04VIAVNMgL47A4 nn"Ab02 - &VLye77W" N06PftNor., we'. _
Address (Agent'.J) F•0- P70x 10004 6rVLV rW. NG �JOZ Phone No.
Signature: Me-SN M�� Date: 201 WCA
nnp��aaa�a�aaa as aaaaasaagaasaaaaaasaaaanaaaa3aaasaaaa�asa3p�agaaaaa
dwmer/manager A t
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 additional 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) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Ha=e of Land Owner (Please Print):
Signature:- �^ Date:_
Name of HanaQar, if differs from owner (Please print) :
Signature: bate:
'_dote: A change in land owners ip requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer.
D04 USE ONLY:AC:IEW4

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CONET4E " UADRANGLE�-
r! ' NORTH CAROLINA I. '} UNITED STATES
7.5 MINUTE 'SERIES • (TOPOGRA.PHCC'DEPARTMENT OF THE INTERIOR '
SW14 PAWME 15' QUADRAMcuE ;.- , ;, GEOLOGICAL SURVEY 5'C4�ie
f.4 KM TO N.C. ff sg4 2 480000 FEET ±7�2?r3(r =$fi°0°"'E s
vtr {mii Gt' r Ni
87
41
xi
20
41
�- ui' � 'ai 'J '� LrfLLi� Y �3� ` , �'_�. ` \ '���`�, �I r � r���y' n rr�•� 1
14 r . Mayor -
GT SfOAdS" O
F Y
231
C.
Johnoott
^t° r r ilia' 1 O f
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S�
e
20
�l�}}l `]f —! Q 1�--• li T� L; iN
' .-J�Yt >• •G�r' L� SOBM
! • `' !fi r' g�► `C $ : 22.4
ai
em1=E'' fTt*p r' /a.r.r.---�.•��I
LLA
u

.YA
�='•�Untied States
Noarmont of
Agocudure
Sod
Cona ervellon
s4mce
GPERATOR: FEV-IzIrLL 51-OU4-r
?lease review the attached plan and specifications care.`ully. Retain
this plan for your use and records. It is strongly recommended that you,
your contractor, and Soli Conservation Service personnel are in agreement
as 'to how the waste lagoon Is to be constructed. The Solt Conservatlon
Service personnel will meet with all concerned parties and walk over the
site to explain all flags and markings. It is important that everyone
vndtrstand what is -expected so that final construction meets plans and
specification and the job can be certified for payment (if cost -sharing
is involved).
The pad dimensions and grades are the best estimate. The BUILDER or
CONTRACTOR is-RESPONSIOLE for final layout and design of the pads. The
Soil Conservation Service personnel will assist in a limited capacity,
as its major concern is the proper design and construction of the waste
treatment lagoon.
The actual amount of material required for pads and dam may vary from the
estimates. The design.will attempt to balance cuts and fills as close as
possible. I.f additional material Is required after construction Is complete
on the lagoon, the contractor and owner will negotiate on the price and
location of borrow area.
NOTE- Design Requirement: 133g780 tuft., r _ cu.yds.
Estimate'of Excavation: cu. ft. R 402$1 cu.yds.
Estimate or Pad L Dike: cu. ft. ig613 cu.yds.
1,26 : i Rat ion '
Job Class ZgAQIZILg4
Da to
Designed By
N m
Design Approval
tr
S to
ate
O :nr So. Ganaa..atlo� Sa.rrrr ...
.'.=..7+ant ar a�r.ewrua
4—

I
Form Approved - OMB No. 0560-OM
AD-11 I0e47.91j UNITED STATES DEPARTMENT OF AGRICULTURE;, ..-.,:'• `•:
,,
HIGHLY ERODIBLE LAND CONS,gRVATIQN:(HE�C) AND WETLAND
CONSERVATION (WC) CERTIFICATION
w
1. ' Naive .of Producer
2. Identificati6n Number
3. Crop Year '
+i:.L+: '. ...
+ !f :!' :/t+`: .:5,` • Wit;+,•.•• •
-• •,r _
.. ... is ... ..
4. ' Do thd•attached AD'1026A(s) list all youi'fafming interests by county, an show current
YES
NO
SCS determinations? If -"No", contact -your County ASCS Office before completing this form.
Llel
5. Are you now applying for, or do you have a FmHA insured or guaranteed loan?
6.. Do.you have a crop insurance contract issued'or reinsured by the Federal Crop
Insurance Corporation?✓,
7. Are you -a landlord on any farm listed on AD-1026A that will not be in compliance with
HELL and WC provisions?
8. Has a HELC exemption been approved on any farms listed on AD-1026A because the
landlord refuses to comply?
9. List here or attach a list of affiliated persons with farming interests. See reverse for an
explanation. Enter "None", if applicable. '
If items 7 or S are answered "YES", circle the applicable farm number on AD-1026A.
During either the crop year entered in Item 3 above, or the term of a requested USDA loan:..,,•
_
I0. Will you plant or produce an agricultural commodity on land ..for yvhich a highly erodible
YES
NO-
land determination has not been made?
11. Will you plant or produce an agricultural commodity on any land that is or was a wet area
on which planting was made possible by draining, dredging, filling, or leveling or any other
means after December 23, 1985?
12. Will you, or have you since November 28, 1990, made possible the planting of any crop,.
pasture, agricultural commodity, or other such crop by: (a) converting any wet areas by
draining, dredging, filling, leveling, or any other means, or, (b) improving, modifying, or
maintaining,. an existing drainage system?
13. Will you convert any wet areas for fish production, trees, vineyards, shrubs, building
construction, or other.non-agricultural use? .. ;
f
If answers to Items ."YES" for any one of these items, sign and date in item 14 below. Circle the applicable tract
'• number on AD-1026A, or list tract number in item 12 on AD-1026A. ASCS will refer this AD-1026
12, or 13 are: 10, 11, to SCS for a determination. DO NOT sign in item 16 until SCS determination is complete.
"NO" for all of these items or SCS determinations are complete, complete item 16.
I hereby certify that.the above Information, and the Information on attached AD-1026A's, to true and correct to the'best of my
14. Signature of , wledge and.bellet: .
Producer f y%
15. Referral Iro SCS Enter a Y if"a SCS determination is no d because j� pate Referred SiOnalure oT ASGS/Ryepresenlative '
(Completed by ASCS).. 'Yes' is answered in item 10, 11, 12, or 13. L�,_'7_
NOTE: Before signing In Item 16, Read AD-1026 Appendix. U.
I hereby certify that the above information, and the Information on attached AD-1026A's, la true and correct to the best of my
knowledge and belief. It Is my responsibility to flle•e new AD-1026 In the event there am any changes In ray farming
operation(s). In signing this form, I also certify that l have received and will comply with the compliance requirements on
AD-1026 dix.
16. Signature of
Producer _ A/
7.
SCS COPY

_Lu �61L-1026?_ , C'(1i3I:_- : ---- .
1. STATE:IIOR111 CAROLINA 37 2, COUHTY:FflGECOMF 065 3—CROP- YEAR:94 _ 4. IO N0, 243-40-6007
5, PRODUCER. NAME 6 ADDRESS TELEPHONE b, COUNTY OFFICE NAME & ADDRESS — TELEPHONE
F L BLOUNT JR EDGECOMBE COUNTY ASCS OFFICE [phone]
PO BOX 382 BOX 340 201 ST, ANDREUS
-BETHEL, NC 270120382 TARBORO NC 27886
--
,t !
i::•e;`
�:,.. _,.
rrcitlta.c:c�ri
7, Circle each tract
for which
a "YES" answer applies to the tract for Items 10, 11,
12, OR
13
on
AD-1026, (OP =
Operator,
OW = Owner,
00 = Owner -Operator),
FARM
OP/ TRACT
CR13PLAND
OUNER
PHOTO/GRID
-SCS
DETERMINATIONS
-
NO
OW/ NO
8,
9,
10,
11,.
00
HEL
027
A027
kletland
2472
OW 290
197,6
F L SLGUHT
JR
1114/3A,It3
N
N
N
Y
2473
OU 294
167,9
F L BLOUNT
JR
N12/IA
N
N
N
Y
2474
OU 289
89,9
F L BLOUNT
JR
H WIA
N
N
N
Y
2474
01I 291
71.7
F L BLOUNT
JR
L08/1B
:N
N
N
} t,
H
2, You are recorded as a tenant or sharecropper on the farm numbers listed below.
Please specify the tracts that apply to you by completing items (a) and (b),
(a) Circle "YES" or "NO" in the "FARMING INTEREST" column beside each tract number below to indicate whether you have a
farming interest in the tract.' The HELC and WC provisions will apply to all land in which you have a farming interest,
(b) If any "YES' answer .to questions 10,11,12,or 13 an AD-102E applies to,your land listed below, circle
the applicable tract in the "Tract No" column.
FARM TRACT FARMING CROPLAND OUNER PHOTO/GRID =SCS DETERMINATIONS- *, .
NO NO INTEREST8, 9, 10, 11.
HEL 027 A027 Vetland
NONE FOUN(
13, MULTIPLE COUNTY INTEREST: (CONTROL. COUNTY:PITT NC)'
OTHER COUNTIES & STATES
EDGECOMBE NC'
• r.. ]: bail.. I�'�C,F:::

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Type and Size et (bemtion:
a -ParI'z)u) Weanfi rq
GCS .dab Classt
nd•
Other: Adenti
Chul-ch 14ply- a3Do �
�PSiderlCe Q�0/t�C• .J�fiO �' .
Distance to welts and other water sources:
Hazarrt Cla& cationf fQ /xtzar-d
a r- rah a 6/e �u�ur@
Ass dor�n.Sil/Y�
exf i eV P
irn�oravevnP,�fs slaw ld occur �AMW a 154&ye1Z &.CaCh .
o using a-dt • •
Spec' c
piiC ,��a�ye �a'qobr
Fumnine Cycle:
/do days ;
r .
page I

.
Land Applicahon,o�', W stg(acre, ,available, cmpz etc. ES' WrDx. G �f aCraP clrcp/and
afar rums �e ego%cc n
�Cxo.sa_c�s •r �4 /6f N/ah.rxa//y.-= �0,8'eo /6. n//yam �o Ge /aid apF��C� -
IAJas,� 7b ,fie crlpI,rd on /a,7d �� c4orn, why, � 6ernruda- �e-uf ��ay, �
Waste Irrigation EgyI�2menl:
ermits a u're :
404 peol,`4- W;11,6e /rePde-d 1i1.c ocd!z• Clewed near
Summaa of Soils Investigation:
LU
�
,S-o;/ of/s / 2 3 sh0u�d Yer f/ /•i/�e. sup�Gla� d
.z'{' f i/! 7viP :7,,ea a� �Pse ��s Cf/ay irxtr-Pr,cr/ u�Clk� fiuvP �' f C Gi��/c� �7
r0 air, /� pia-C�o�.i�irr['.,7� l.�•d :rzrdf <s/oX,5 VV bDAbe''t O-wu -/0 1;
5; 4 ;" shw"ed .suift<�/� nr4 rlcr/ Gu.`/d
Pm.,l it�r�1F�? .Snrne li7iil� 07� ig(e �:rlVes a.,vl1&5,00r& wi// bP l7ermszary w%re
rra/rr; d/ is ec p a soya 1 h1� ti u�d /er AGI e ��arx.1y fa 5 fee`!-
If interested in
Slav mower:
a m e•
a b a.Igr:
Hav_trailer: '
Hay market: '
Miscellaneous_Items:
rctl nCsac�re�s �octr�d d�r�n . �a�ls if7ve5iidahD2,
'u.5 ' �l .
ne !r►e'c�f-s .5��5 � c':e .ca/,O,l on d;s 61rct -lb re6 f r�s�`o'Pr e, pub/ lacr %o l>
-1e
�r;ri.5 ,svrnc��rxf i s n/a,�Pd ,
. eg daft= a�eraye. -a d elops - aasoe 4"iG►/`cat�ro�. I �'
'541; � .soy/s-�'or�j �?nd God rtk�
pLLS5i6;/,`fy o7�ps�rre /ii►:�?� 6-t Pxerr✓!-d s/ova
i r) 71/xp Crr�G�' cJr Pi7��3 47 a . �I.7' !� S
�'i PCo r. r,ea d kE'ryo% /df•oOA
S Sup»r�cr�/� Si�
,`s u1fa6l� Aor Q afro - Cjr► cv fo aja), r� oa`'rccfian,
f/�e
Page Z
Py o +•

t
FS_'C�0Department of Agriculture NC-EKG-34
nservation Service September 1980
HAZARD CLASSIFICATION DATA SHEET -FOR DAMS
Landowner F� ,r�}_.T L��p�I _ _ County. 'Fry,- j:_� c•_nMAE_
Community or Group No. Conservation Plan No.
f•rorn �oa>esA 0• a6v
Estimated Depth of Water to Top of Dam. (o•Q Ft. Length of Flood Pool s 9 Ft.
Date of Field Hazard Investigation ; Lz Z23
Evaluation by reach of flood plain downstream to the point of estimated minor effect
from sudden dam failure.
:EH.
Elev. :Est.
Elevition
Kind of :Improvements:'
'of Breach
Reach: Length: Width: Slope:
Land Use ;
Improvements :
Above :Floodwater Above
Flood Plain:
Flood Plain
Ft. Ft. :
it /'CIO lard
ris Creek
FO
�.¢i
.ago :.,
-7
:
3
.
Describe potential for loss of life and damage to existing or probable future downstream
improvements from a sudden breach _CJ iM- Proyer9ent
/Irauai'15 �l�y�2 /iIDD/.1m&thze •-1`tf;i Lre-C&'."I'J.S7�CM rrt i+rn�T✓Prn� S/
Hazard Classification of -Dam (a, b,'c) (see REM -Part 520.21) a- r
Dam Classification (I, II, III, IV, V)_ _ -r
By
name t tie)
Concurred By GGV.�/w,nrc� , 0• L, ,
�6am ti le
NOTE:, 1. Instructions on reverse side.
2., Attach additional sheets as needed.
Date /mac ZZ
Date d .3

i .rPa,..w•an.,-,�-uw
' OE
r CONET QUADRANG , ,..,.y,• , .w.�..,....
:• UNITED STATES - ~•
N01kTH CARD LINA •• t�"'''
7.5 MINUTE'SERIES .(TOPOGRAPHIC); EPARTMENT OF THE INTERIOR
SWf4 PARMELE 19' aluwRMAyGLE GEOLOGICAL SURVEY
t RM u M ro c r84 • r Il
F FF 2 480 000 FEET 7rZ'30" q6w "E scaler • 1
`t� '. r{ �•
Y.
g
_ '. ',� � •'i,l"I (�(.KG,`4 +' „f ,.::. .e�„• :1��� ��' r+, .It, { Yfie'�' ���n yr.:\�'!- it{ 4:
UAN
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_ r $� r� � 'J�� �..! rrl�Yrii � Pi tit f �. r ). , r, �s�! t, .){ `•.
4
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SCS- EN G-538
Ili+. 6-70
U: S. UCPARTmENT OF ALMICUOJl ,E
SOIL CONSERVATION SERVICE
SOIL INVESTIGATION TO DETERMINE SUITABILITY OF --PROPOSED POND SITE
�
A I
1116
WATERSREV AREA MEASUREMENTS
I
CROPLAND w
WOODLAND -ACRES• ••
SKETCH OF PROPOSED POND SHOWING WHERE BORINGS WERE MADE (Approx. "e Illm-feet)"
Loewe reference point %n center line of darn ond Ide"Iffli on sketch.
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-A'.

producer:�iytQ,v�
Location:
Address:
Telephone:
Type Operation: 5 «; n e. Fovej�&Je-kl
Number of Animal Units: 2000 so-.ys
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'ehcouraged
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 producedper year
4Q U animal units X 32 p z waste/animal unit/year
6. ,jo_q .yor�.. waste/year
Amount of nitrogen produced Per year
2 000sows animal. units X _..S�. q lbs. N/animal unit/year
/,2 ko o _ 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
2
3
�J
ca�5
�� itwi
3O U
rIL� !
q
36 o
5. U
5 U o
<< �
G
ry
kfi 4�m
30o
3. 1
3 D
rc
l
F
��
6.0
30c,
8.3
1
f,
6d
30o
�(
2 o 70
3L
2.0
Total Table 1
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' (4�`
Amount of N Produced
Surplus of efic'
+
a�O
Your facility is designed for ) WD days of temporary, storage and
needs to have the temporary storage removed every 6 months.
Page 2

C
r
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.
Narrati too C1rACrM* i r "
'V
See attached map showing the fields to be used for the disposal of
waste water.
Application of Waste by Irrigation
Field
Soil Type
Crop
Application
Application
No.
Rate(In/Hr)
Amount(In.)
.5
y
�
. Fv
� � 1��.
o . 5
•1. �
r�
a . s
�.
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 source.
,ice
Producer.* Date:
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.
.y
Recipient Landowner: �~ r Date:
System Designer: G ' w Date: f �p
SWCD Representative: _ Date: G
Design Approval: , Date:' ��4 f
t
r
f
Page 4

cknerator:Ferrell Blount' County: Edgecombe
Distance to nearest residence (other than owner):
1. AVERAGE LIVE WEIGHT (ALW)
Date: 04/29/94
2500.0 feet
0 sows (farrow to finish) x 1417 lbs. = 0 lbs-
0 sows (farrow to feeder) x 522'lbs. = 0 lbs
0 head (finishing only) x 135 lbs. = 0 lbs
2000 sows (farrow to wean) x 433 lbs. = 866000 lbs
0 head (wean to feeder) x 30 lbs. = 0 lbs
Describe other 0
Total Average Live Weight = 866000 lbs
Z. MINIMUM REQUIRED TREATMENT VOLUME OF LAGOON
Volume = 866000 lbs. ALW x Treatment Volume(CF)/lb. ALW
Treatment Volume(CF)/lb. ALW = 1 CF/lb. ALW -r
Volume = 866000 cubic feet
3. STORAGE VOLUME FOR SLUDGE ACCUMULATION ���W N �� REQu ND ScuDbE 5fdtrAGE.
Volume = 0.0 cubic feet 6LUV610 Wiw DE ReMovED AS HEEDEV. `
�. TOTAL DESIGNED VOLUME
Inside top length (feet) ------------------ ---
Inside top width (feet) ----------------------
Top of.,dike elevation (feet) -----------------
Bottom of lagoon elevation (feet) ---------
Freeboard ( feet) ------------------------------
Side slopes (inside lagoon) ------------------
,
Total design volume using prismoidal formula
SS/END1 SS/END2 SS/SIDE1 SS/SIDE2 LENGTH
•3.0 3.0 3.0 3.0 574.0
AREA OF ' TOP
LENGTH *!WIDTH =
574.0 264.0
AREA OF BOTTOM
• LENGTH *., ;WIDTH'.=
508.0 198.0
580.0
270.0
56.4
44.4
1.0
3.0 : 1
.j
WIDTH DEPTH
264.0 11.0
151536 (AREA OF TOP)
-100584 (AREA OF BOTTOM)
,
AREA OF MIDSECTION
LENGTH * WIDTH * 4
541.0 ­231.0 499884 (AREA OF MIDSECTION * 4)
CU. FT. = [AREA TOP + (4*AREA MIDSECTION) + AREA BOTTOM] * DEPTH/6
151536.0 499884.0 100584.0 . 1.8
Total Designed Volume Available = 1378674 CU. FT.

5. TEMPORARY STORAGE REQUIRED
DRAINAGE AREA:
Lagoon (top.of dike)
Length * Width =
580.0 270.0 156600.0 square feet
Buildings (roof and lot water)
.0.0 square -feet Describe this area.
TOTAL DA 156600.0 square feet
Design temporary storage period to be 180 days.
5A. Volume of waste produced
Feces & urine'production in gal./day per 135 1b. ALW 1.37
Volume = 866000 lbs. ALW/135 lbs. ALW * 1.37 gal/day 180 days
Volume = 1581893 gals. or 211483.1 cubic feet
5B. Volume of wash`water
This`is the amount of fresh water used for washing floors or volume
of fresh water used for a flush system. Flush systems that recirculate
the Lagoon water are accounted for in 5A.
Volume = 0.0 gallons/day * 180 days storage/7.48 gallons
per CF
Volume = 0.0 cubic feet !
5C. Volume of rainfall in"excess of evaporation s.
Use period of time when rainfall exceeds evaporation'by largest amount.
180 days excess rainfall = 13.4 inches
Volume' = 13.4, in- * DA /. 12, inches per foot,
Volume =`174870,0 cubic feet

�r
5D. Volume of 25-year
24;hour storm
Volume .= .-.,,6.7 inches / 12 inches per foot * DA
Volume = .87435.0 cubic feet
TOTAL REQUIRED TEMPORARY STORAGE
5A. 211483 cubic feet
5B. 0 cubic feet
5C. 174870 cubic feet
5D. 87435 cubic feet
TOTAL 473788 cubic feet
6.' SUMMARY
r
Temporary storage period=====__=__________-_> 180 days
Rainfall in excess of evaporation=====_=__=_> 13.4 inches
25 year 24 hour -rainfall_____________=====> .6.7 inches
Freeboard====-____--________________________=> 1.0 feet
Side slopes____________________---__-________> 3.0 : 1
Inside top length======= == __== -_> 580.0 feet
Inside top width____________________________> 270.0 feet
Top of dike elevation=====_________________=> 56.4 feet
Bottom of lagoon elevation=====___=___=_____> 44.4 feet
Total required volume=====__________________> 1339788 cu. ft.
Actual design volume=====___=__= __=__=___> 1378674 cu. ft.
Seasonal high watertable elevation (SHWT)===> 49.7 feet
Stop pumping e1ev.-=----__--___--___--_----_> 51.9 feet.
Must be > or = to the SHWT elev.=_---_---___> 49.7 feet
Must be > or = to min, req, treatment el.=> 50.4 feet
Required minimum treatment volume==--=______> 866000 cu. ft.
Volume at stop pumping elevation=====_______> 878580 cu. ft.
Start pumping elev.==----_____________________> 54.7 Feet
Must be at bottom of freeboard & 25 yr. rainfall
Actual volume less 25 yr.- 24 hr. rainfall==> 1291239 cu. ft.
Volume at start pumping elevation=====______> 1273827 cu. ft.
Required volume to be pumped===_____________> 386353 cu.tft.
Actual volume planned to be pumped=====_____> 395247 cu. ft.
Min. thickness of soil liner when required==> 1.8 feet
7. DESIGNED BY: RPM.)APPROVED BY: �6y Q ��injY,, (2 IF��z
DATE: 2q i L qL} DATE : 5/a ��9�
NOTE: SEE ATTACHED WASTE UTILIZATION PLAN
COMMENTS: "566 WILA, PaizUK u wA!�I:M un uUnOtJ PL+f4.

Site Balance Report
Grid cell size: 5.42 by 5.46
original drawing scale: 100.00 ft/in
Project: Ferrell.Blount
Drawing: Drawing 2
Number: GHF055
Locations Edgecombe Co.
Bid Date;
Engineer: G. Pettus
Owner: F.'Blount
Estimator:
Prepared by: GOLDSBORO HOG FARM using SITEWORK
Date: 04/29/94 Time: 08:49:11
'final surface: Balanced
nitial surface: Existing
'here are no "Balanced" structures.
'ill shrink/swell percent: 25.00 Cut shrink/swell percent: 0.00
lalancing to 0.0 +/- 10.0
cubic yards
r >j:•
delta
Cut
Fill
Cut - Fill` "• ='
0.000
40281.30
39959.39
321.91
0.019
40179.12
40234.44
-55.32
0.016
40193.91
401.93.86
0.05
taise "Balanced" by 0.016
feet.
• i s

Total Volumes by Project
(combined volumes for each drawing)
Project: Ferrell Blount
Drawing: Drawing 2
Number: GHF055
Location: Edgecombe Co.
Bid Date:
Engineer; G.:, Pettus
Owner: F.•' Blount {
Estimator:
Prepared by: GOLDSBORO HOG FARM using SITEWORK
Date: 04/29/94 Time: 07:32:48
)cawing: Drawing 2 1
Grid cell size: 5.42 by 5.46 Original drawing scale:.100.00 ft/in
CUT y FILL ExCUTded I ExFILL ed
Balancedd I 40281.301 31967.511 40281.3)I (39959.3j
Existing( 0.00$ 25.00%
-------------------------------- _..____..-_____ ____ __ _ ___---- __---
let: 8313.791 j 321.911
?roject: Ferrell Blount
I Expanded I Expanded
CUT FILL UTILL -
Project Totals: 40281.30 31967.51 40281.30 39959'.39
Average Shrink/Swell Percent I , ( D.00%)I'( 25.00%)
__________- ..--_--..-------- i 8313.79 � � - 'w -- ^
?ro ject Net: 321.911. ,
",t
r

Orientation
65.
60.
55.
50.
45.
40.
Lower Left
3D Mesh Surface
Balanced
Project: Ferrell Blount
Drawing: Drawing 2
Number: GHF055
Location: Edgecombe Co.
Bid Date:
Engineer: 6. Pettus
Owner: F. Blount
Estimator:
Prepared by: GOLDSBORO HOG FARM using SITEWORK
n,4- adl"104 Time' 07:38:46
3D Mesh surface

jr
Report: Plan View Cross-section Locations
Project: Ferrell Blount
Drawing: Drawing 2
Surface: Balanced
Prepared by: GOLDSBORO HOG FARM using SITEWORK
Date: 04/29/94 Time: 07:44:06
Scale: 1!9 ftifn

62.6
60.6
58.6
56.6
54.6
52.6
50.6
48.6
46.6
44.6
42.6
40.6
Cross -Section Plots
Digitized Points
Noriz. scale: 80 ftiin Vert. scale: 4 ftiin
Project:
Ferrell Blount
Drawing:
Drawing 2
Number:
GWO55
Location:
Edgecombe Co.
Bid Date:
Owner:
�: �ftotgun
Estimator:
by.480LDSBORO SITEWOW
Date:
Time: :using
A - A'
Mrr.•r« « � _ GYM- ..............
.... ��....•..............................................:...I�^•.................... ............................................................................................................
_ ••-
..................... .�. •..•.1 A ...•:VyTw y..................................................... r.•11............................................................................. ..........
Exist ing.«
I
1 1
•............................................. ............................. .....««« ..•....•..................••...................................r.r..... •..............•.. �. .... �. .......
r
............................................................................................................... T: �J................................................ ............ �....
�Y « .• _ « «�_ ,ram« — I ,a
...................................................r.........................................................•...................................................... ....... ...... .. ...:�.�.
...... .................
Bala iced

b1.5
59.5
57.5
55.5
53.5
51.5
49.5
47.5
45.5
43.5
41.5
39.5
Cross -Section Plots
Digitized Points
Horiz. scale: 80 ftiin Vert. scale: 4 ftiin
ProJect:
Ferrell Blount
Drawing:
Drawing 2
Humber:
GHF055
Location:
Edgecombe Co.
Bid Date:
EngineOwrWr: :
F: gftit�'9
Estinator:
Prep%red by: GMMBM HOG FARM using SITEWOW
Date: 04/29/94 Time: 07:51:04
B -B'
........+...................................................................................................................................................................... ............
}
.........g................ -"..................................................................,— .s :..................................................... ;.........5.........
.. ��."� :... ,.•..............................................................................................................................�.:�r ................ ............ ....
............. .....................................................................................................................................................�............�_
-:1
i
..................................................................................................................................................................... .} ........................
Bala iced
...................i.............................................................................................................................................. ........................
6". 4
720.8
y.;

SHEET 1 OF 2
SPECIFICATIONS FOR CONSTRUCTION OF WASTE TREATMENT LAGOONS
----------------------------------------------
FOUNDATION PREPARATION:.
The foundation area of the lagoon -embankment and building pad shall be
cleared of trees, logs, stumps, roots, brush, boulders,sod and rubbish.
Satisfactory disposition will be made of all debris. The topsoil from
the lagoon and pad area should be stripped and stockpiled for use on
the dike and pad areas. After stripping, the foundation area of the
lagoon embankment and building pad shall be thoroughly loosened prior
to placing the first lift of fill material to, get a good bond.
EXCAVATION AND EARTHFILL PLACEMENT:
-----------------------------------
The completed excavation and earthfill shall conform to the lines,
grades, and elevations shown on the plans. Earthfill material shall
be free of material such as sod, roots., frozen soil, stones over �e
6 inches in diameter, and other objectionable material. To the extent, � r,
they are suitable, excavated materials can be used as fill. The fill onl o"
shall be brought up in approximately horizontal layers not to exceed ou-40dc-
inches in thickness when loose and prior to'compaction. Each layer SIDPet
will be compacted by -complete coverage with the hauling and spreading e n
equipment or standard tamping roller or other equivalent method (m11er-1#1'1;-F+s
Compaction will be considered adequate when fill material is observed
to consolidate to the point that settlement is not readily detectible.
NOTE THE SPECIAL REQUIREMENTS FOR PLACEMENT OF LINERS IN THE LINER
SECTION OF THIS SPECIFICATION. The embankment of the lagoon shall be
installed using the more impervious materials from the required ('3C)CW
excavations. Construction of fill heights shall include 5 percent for
settlement. Dikes over 15 feet in height and with an impoundment
capacity of 10 acre-feet or more fall under the jurisdiction of the NC
Dam Safety Law. The height is defined as the difference in elevation
from the constructed height to the downstream toe of the dike.
Precautions shall be taken during construction to prevent excessive
erosion and sedimentation.
LINER: THE MINIMUM REQUIRED THICKNESS SHALL BE 1.8 ft.
NOTE: LINERS (PARTIAL OR FULL) ARE REQUIRED WHEN THE ATTACHED SOILS
INVESTIGATION REPORT SO INDICATES OR WHEN UNSUITABLE MATERIAL IS (5M,5 0
ENCOUNTERED DURING CONSTRUCTION. A TYPICAL CROSS SECTION OF THE LINER
IS INCLUDED IN THE DESIGN WHEN LINERS ARE REQUIRED'BY THE SOILS REPORT.
When areas of unsuitable material are encountered, they will be over --
excavated below finish grade to the specified depth as measured
perpendicular to the finish grade. The foundation shall be backfilled
as specified to grade with a SCS approved material (ie - CL,SC,CH).
REFER TO THE SOILS INVESTIGATION INFORMATION IN THE PLANS FOR SPECIAL
CONSIDERATIONS.

SEEDING -SPECIFICATIONS
---------------------- r.
AREA TO BE SEEDED: 4.0 ACRES..
USE THE SEED MIXTURE INDICATED AS FOLLOWS: r
• 0.0 LBS. FESCUE GRASS AT 60 LBS./ACRE
(BEST SUITED ON CLAYEY OR WET SOIL CONDITIONS)
SEEDING DATES: SEPTEMBER 1 TO NOVEMBER 30
FEBRUARY 1 TO MARCH 30
0.0 LBS. RYE GRAIN AT 30 LBS./ACRE.(NURSERY FOR FESCUE)
0.0 LBS. 'PENSACOLA' BAHIA GRASS AT 60 LBS./ACRE
(SEE FOOTNOTE NO. 1)
SEEDING DATES: MARCH 15 TO JUNE 15
32.0 LBS. HULLED COMMON BERMUDA GRASS AT 8 LBS./ACRE
(SUITED FOR MOST SOIL CONDITIONS)
SEEDING DATES: APRIL 1 TO JULY 31
0.0 LBS. UNHULLED COMMON BERMUDA GRASS AT 10 LBS./ACRE
SEEDING DATES: JANUARY 1 TO MARCH 30
0.0 LBS. RYE GRASS AT 40 LBS./ACRE (TEMPORARY VEGETATION)
SEEDING DATES: DECEMBER 1 TO MARCH 30
LBS.
APPLY THE FOLLOWING: '
4000.0 LBS. OF 10-10-10 FERTILIZER (1000 LBS./ACRE)
8.0 TONS OF DOLOMITIC LIME (2 TONS/ACRE)
400.0 BALES OF SMALL GRAIN STRAW (100 BALES/ACRE) .•
ALL SURFACE DRAINS SHOULD BE INSTALLED PRIOR TO SEEDING: SHAPE
ALL DISTURBED AREA IMMEDIATELY AFTER EARTH MOVING IS COMPLETED.
APPLY LIME AND FERTILIZER THEN DISK TO PREPARE A 3 TO 4-INCH
SMOOTH SEEDBED: APPLY SEED AND FIRM SEEDBED WITH A CULTIPACKER
OR SIMILAR EQUIPMENT. APPLY MULCH AND SECURE WITH A MULCH
ANCHORING TOOL OR NETTING.
1. PENSACOLA BAHIAGRASS IS SLOWER TO ESTABLISH THAN COMMON
BERMUDA GRASS. WHEN USING BAHIA, IT IS RECOMMENDED THAT 8
LBS./ACRE OF COMMON BERMUDA,BE INCLUDED TO PROVIDE COVER
UNTIL BAHIAGRASS IS ESTABLISHED.

0�
T.

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:;RICULTURE APPROX. SCALE 4" = 1 MILE 1, ZZ13 ' �' �! � SOIL SURVEY FIELD SHF_ET
SERVICE EDGECOIBE COUNTY, NORTH CAROM
' TH �USDA.Scs-ronT WORTH. TEXAS 1976 501 l P�-5 ADVANCE COPY • SUBJECT TO CHANGE
RIMENT STATION 6/76
,URV [Y MAS npT C[[M COYP1�[O NOR CORK [LATED•`

I

North Carolina Agricultural Extension Service
Agri''Waste Management
iolo ' ca a d ricul t ral En ineerz a ort Caro a na Un fivers ' t
LIVESTOCK WASTE'SAMPLING, ANALYSIS AND CALCULATION
OF LAND APPLICATION RATES
James C. Barker
I. SAMPLE COLLECTION
A. Semi -Solid Lot Manure
i. Scraped directly from lot into spreader
a. From loaded spreader, collect about 2 lbs of
manure from different locations using nonmetallic
collectors.-
ii. From storage
a. ' Collect about 2 lbs of manure from under the surface
crust avoiding bedding materials and using nonmetallic
collectors.
B. Liquid Manure Slurry.
.a, , ,.� • .. .. . ,'fir
i. Under-slotted-floor'pit
a. Extend a 1/2" nonmetallic conduit open on both
ends into manure to pit floor.
b. Seal upper end of conduit (e.g., by placing a
thumb over end of conduit) trapping manure that
has entered lower end, remove and empty slurry
into plastic bucket or nonmetallic container.
c. Take subsamples.from 5 or more locations or at
least 1 quart.
d. Mix and'add about 3/4 pint to nonmetallic sample'
container.
ii. Exterior storage basin or tank
a. Make sure manure has been well mixed with a liquid
manure chopper -agitator pump or propeller agitator.
b. Take subsample from about 5 pit locations, from
agitator pump or. from manure spreader and place in a
t plastic bucket.
*Professor and Extension Specialist, Biological and Agricultural
Engineering Department, North Carolina State University, Raleigh, NC

Attachment B.
Page 2 of 3
C. Mix and add 3/4 pint to a nonmetallic sample container.
C. Lagoon Liquid
i. Collect about 3/4 pint of recycled lagoon liquid from inflow
pipe to.flush tanks in a nonmetallic sample container— ,
ii. From Lagoon -
a. Place a small bottle (1/2 pint or less) on end of
10-15' pole.
b. Extend bottle 10-15, away from bank edge.
C. Brush away floating scum or debris.
d. Submerge bottle with 1' of liquid surface.
e. Empty into a plastic bucket, repeat about 5 times
around lagoon, mix and add 3/4 pint to nonmetallic
sample container.
D. Broiler or Turkey Litter
i. House Litter
a. visually inspect litter for areas of varying quality
e.g., areas around feeders and waterers, and estimate
percent of floor surface in each area.
b. Take about 5 litter subsamples at locations '
proportionate to item a. E.g.,,if 20% of litter
of similar visual quality is around feeders and
waters, take 1 subsample there and the other 4
subsamples from remainder of floor surface.
' r
C. At each location,. collect litter from a 6" by 6"
area down to earth floor and place in a plastic bucket.
d. After 5 subsamples have been added to the bucket, mix
and add about 2-3 lbs litter to a nonmetallic sample
container such as.a 1-gallon freezer bag and seal.
ii. From Stockpile
a. Take subsamples , from about . 5. locations at least
into pile.
b. Mix, add 2-3 lbs to nonmetallic sample container and
seal.
II. SAMPLE PREPARATION AND TRANSFER
A. Place sample into an expandable container that can be sealed.
residues from container with clean water but do not use
disinfectants, soaps or treat in any other way.

Of
Attachment B
Page 3 of 3
B. Pack sample- in ice, refrigerate, freeze or transfer to lab
quickly.
C., Hand -delivery is the most reliable way of sample transfer.
D. If mailed, protect sample container with packing material such
as newspaper, box or package with wrapping paper and tape.
E. Commercial sample containers and mailers are also available.
Contacts:
i. A&L Eastern Agricultural Lab, Inc. iii. Polyfoam Packers
7621 WNtepine Road 2320 S. Foster Ave.
Richmond, VA 23237 Wheeling, IL 60090
Ph: [phone] Ph: [phone]
ii. Fisher Scientific Ca iv. NASCO
3315 Winton Road 901 Janesville Ave.
Raleigh, NC 27604 Ft Atkinson, WI 53538
s ,
F. Private analytical labs are also available, but sample analysis
costly-
G. The NCDA provides this service for North Carolina residents.
i. Address: North Carolina Department of Agriculture
Agronomic Division
Plant/Waste/Solution Advisory section
Blue Ridge Road Center
P. 4:'Box 27647
Raleigh, NC 27611
Ph: [phone]
Attn:••Ray Campbell
Forward $4.'00 along with the sample.
Include the following identification information with
sample:
A. Livestock species (dairry, swine, turkey, etc.)
b.' Livestock usage (swine -nursery, finishing; turkey
breaders, brooderhouse, grower, number flocks grown'
on litter; etc.j
C. Waste type (dairy -lot scraped manure, liquid slurry;
swine -pit slurry, lagoon liquid, sludge; broiler -
house litter, stockpile)
iv. Routine analysis performed on all samples:'N, P, K, Ca,
Mg, Na, 5, Fe,
Mn, Zn, Cu, B
V. Additional analysis performed upon request: DM, Mo, Cd,-
Ni, Pb

wr ---------------- i ---------------
SHEET 1 OF 2
OPERATION AND MAINTENANCE PLAN
This lagoon is designed for waste treatment (permanent storage) and
180 days of temporary storage. The time required for the planned
fluid level (permanent and temporary storage) to be reached may vary
due to site conditions, weather, flushing operations, and the amount
of fresh water added to the system.
The designed temporary storage consists of 180 days storage for:
(1) waste from animals and (2) excess rainfall after evaporation. Also
included is storage_for'the 25 year - 24 hour storm for the location.
The volume of waste generated from a given number of animals will be
fairly constant throughout the year and from year to year, but excess
rainfall will vary from year to year. The 25 year rainfall will not
be a factor to consider in an annual pumping cycle, but this storage
volume must always be available.
A maximum elevation is determined in each design to begin
pumping and this is usually the outlet invert of pipe(s) from
building(s). If the outlet pipe is not installed at the elevation to
begin pumping, a'permanent marker must be installed at this elevation
to indicate when pumping should begin. An elevation must be established
to stop pumping to maintain lagoon treatment depth.
Pumping can be started or stopped at any time between these two
elevations for operating convenience as site conditions permit, such as
weather, soils, crop, and equipment in order to apply waste without
runoff or leaching.
Land application of waste water is recognized as an acceptable
method of disposal. Methods of application include solid set,
center pivot, guns, and traveling gun irrigation. Care should be
taken when applying waste to prevent damage to crops.
The following items are to be carried out:
1. It is strongly recommended that the treatment lagoon be pre -
charged to 1/2 its capacity to prevent excessive odors during
start-up. Pre -charging reduces the concentration of the initial
waste entering the lagoon thereby reducing odors. Solids should be
covered with effluent at all times. When precharging is complete,
flush buildings with recycled lagoon liquid. Fresh water should not
be used for flushing after initial filling.
2. The attached waste utilization plan shall be followed.' This
plan recommends sampling and testing of waste (see attachment)
before land application.
3. Begin temporary storage pump --out of the lagoon when fluid level
reaches the elevation 54.7 as marked by permanent marker. Stop pump -
out when the fluid level reaches elevation .51.9 . This temporary
storage, less 25 yr- 24 hr storm, contains 386353 cubic feet or
2889921 gallons.

SHEET 2 OF 2
4. The recommended maximum amount to apply per irrigation is
one (1) inch'and'the recommended maximum application rate is 0.3
inch per hour.'Refer to the waste utilization plan for further detail's.
5. Keep vegetation on the embankment and areas adjacent to the
lagoon mowed annually. Vegetation should be fertilized as needed
to maintain a vigorous stand.
6. Repair any eroded areas or areas damaged by rodents and
establish in vegetation.
7. All surface runoff is to be diverted from the lagoon to stable
outlets.
S. Keep a minimum of 25 feet of grass vegetated buffer around
waste utilization fields adjacent to perennial streams. Waste will
not be applied in open ditches. Do not pump within 200 feet of a
residence or within 100 feet of a well. Waste shall be applied in a
manner not to reach other property and public right-of-ways.
9. 'The Clean Water Act of 1977 prohibits the discharge of
pollutants into waters -of the United States. The Department of
Environment, Health, and Natural Resources, Division of Environ-
mental Management, has the responsibility for enforcing this law.
1
i
1
11

'!Zi
•'�,
Ornf.d Staffs soil
0e04r:ment Of con3Nvaflon
1;1iCu41ud! $rraG!
t
CPERATOR; BrOuxr rsa�.ar>ot�
Please review the attached plan and specifications carefully. Retain
v ;'
this plan for your use and records. It is strongly recommended that you,
ycur contractor, and Soil Conservation Service personnel are in agreement
_t
as to how the waste lagoon is to be constructed. The Soil Conservation
Service personnel will meet with all concerned parties and walk over the
v �:
site to explaih all flags and markings. It is.important that everyone
;;ndarstand what is -expected so that final construction meets plans and
—
specification and the job can be certified for payment (if cost -sharing .
is involved).
The pad dimensions and grades are the best estimate. The BUILDER or
CONTRACTOR is -RESPONSIBLE for final layout and design of the pads. The
Soil Conservation Service personnel will assist In a limited capacity,
as its maior concern is the proper design and construction of the waste
treatment lagoon.
The actual amount of material required for pads and dam may'vary from the
estimates. The design.will attempt to balance cuts and fills as close as
possible. If additional material Is required after construction is complete
on the lagoon, the contractor and -owner will negotiate on the price and
'
location of borrow area. .
NOTE": Design Requirement: gbq-ty tuft. - cu.yds.
Estimate of Excavation: cu.ft. = 1120 cu.yds.
Estimate of Pad 6 Dike: cu.ft. 1705 cu.yds.
1.26 : I • Ration
Job Class 2 25 Au& Q�
V�te
Designed By W , "F.114&.
h me ►�
fir'
Design Approval
Name 97
II GG
L�
A
,,.f - -.
'A• kd tan/ser,l 0A serwer
•� �n a�rn
00%l/\�.J\7
1 1 ;0

fY
-�OPerator:Blount Iso.
County: Edgecombe
Distance to nearest residence (other than owner):
1. AVERAGE LIVE WEIGHT (ALW)
Date: 08/25/94
1100.0 feet
0 sows
0 sows
(farrow
(farrow
to finish)
to feeder)
x 1417
x 522
lbs. -
lbs. -
0
0
lbs
lbs
0 sows
(farrow
to wean)
x 433
lbs. =
0
lbs
0 head
(wean to
feeder)
x 30
lbs. =
0
lbs
Describe other
S0 HEAD '? 2701- f
� 2cc Lee,
0
IScul rloo uNir
Total
Average Live Weight W
21600
lbs
2. MINIMUM REQUIRED TREATMENT VOLUME OF LAGOON
Volume = 21600 lbs.,ALW x Treatment Volume(CF)/lb. ALW
Treatment Volume(CF)/lb. ALW = 1 CF/lb. ALW
Volume = 21600 cubic feet
3. STORAGE VOLUME FOR SLUDGE ACCUMULATION
Volume = 0.0 cubic feet a wrrau REQ#e?t� uo 5u�v6� yr IWE.
i;u4mE wm. u-'p-a&uNev As NeMov."
4. TOTAL DESIGNED VOLUME
Inside top length ( feet) ------ -•---------------
Inside top width (feet) ----------------------
Top of dike elevation (feet) -----------------
Bottom of lagoon elevation (feet) ------------
Freeboard (feet) --------------------- --------
Side slopes (inside lagoon) ------------ -----
Total design volume using prismoidal formula
SS/END1 SS/END2 SS/SIDE1 SS/SIDE2 LENGTH
3.0 3.0 3.0 3.0 94.0
AREA OF TOP
LENGTH * WIDTH =
94.0 114.0
AREA OF BOTTOM
LENGTH * WIDTH ='
34.0 54i.0
AREA OF MIDSECTION
LENGTH * WIDTH * 4
- 64.0 84.0
100.0
120.0
54.0
43.0
1.0
3.0 1
WIDTH DEPTH
114.0 10.0
10716 (AREA OF TOP)
1836-(AREA OF BOTTOM)
IL
21504 (AREA OF MIDSECTION * 4)
CU. FT. - [AREA TOP + (4*AREA-MIDSECTION) + AREA BOTTOM]
10716.0 - 21504.0 1836.0- -
DEPTH/
1
Total Designed Volume Available 56760 CU. FT

/-TEX
PORARY STORAGE REQUIRED
DRAINAGE AREA:
Lagoon (top of dike)
Length * Width —
100.0 120.0 12000.0 square feet
Buildings (roof and lot water)
0..0 square feet
Describe this area.
TOTAL DA 12000.0 square feet
Design temporary storage period to be
180 days.
5A. Volume of waste produced
Feces & urine production in gal./day per
135 lb. ALW 1.37
Volume = 21600 lbs. ALW/135 lbs. ALW *
1.37 gal/day 180 days
Volume = 39456 gals. or 5274.9 cubic
feet
5B. Volume of wash water
This is the amount of fresh water used for
washing floors or volume
of fresh water.used for a flush system. Flush systems that recirculat
the lagoon water are accounted for in 5A.
Volume = 0.0 gallons/day *
180 days storage/7.48 gallons
per CF
Volume = 0.0 cubic feet
5C. Volume of rainfall in excess of evaporation
Use period of time when rainfall exceeds.
evaporation by largest amount
180 days excess rainfall =
13.4 inc)ies
Volume = 13-.4 in * DA / 12 inches per
foot
Volume 13400.O.tcubic feet

5D.
Volume of 25.year -.24 hour storm
--"
Volume = 6.7 inches / 12 inches per -foot *
DA
Volume = 6700.0 cubic feet
'TOTAL REQUIRED TEMPORARY STORAGE
5A. 5275 cubic feet
5B. 0 cubic feet
5C. 13400 cubic feet
5D. 6700 cubic feet
TOTAL 25375 cubic feet
6.
SUMMARY
Temporary storage period====================>
180 days
Rainfall in excess of evaporation===========>
13.4 inches
25 year -- 24 hour rainfall==================>
6.7 inches
Freeboard===================================>
1.0 feet
Side sI.opes=================================>
3.0 : 1
Inside top length===========================>
100.0 feet
Inside top width============================>
120.0 feet,
Top of dike elevation=========== ===========>
.54.0 feet
Bottom of lagoon elevation==================>
43:0 feet -
Total required.volume=======================>
46975 cu. ft.
Actual design volume========================>
56760 cu. ft.
Seasonal high watertable elevation (SHWT)===>
49.4 feet
Stop pumping elev._-_-__________--_-_-----____>
49.4 feet
Must be > or = to the SHWT elev.==========>
49.4 feet
Must be > or = to min. req. treatment el.=>
49.0 feet
Required minimum treatment volume===========>
21600 cu. ft.
Volume at stop pumping elevation============>
25710 cu. ft.
Start pumping elev._________________________>
52.3 feet
Must be.at bottom of freeboard & 25 yr. rainfall
Actual volume less 25 yr.- 24 hr. rainfall==> -50060
cu, ft.
Volume at start pumping elevation===========>
49560 cu. ft.
Required volume to be pumped================>
18675 cu. €t.
Actual volume planned to be pumped==========>
23851 cu.t-ft.
Min. thicknessof sail liner when required==>
1.6 feet
.7.
DESIGNED BY: APPROVED BY:
Gt oil , &ttE,it1G. .
DATE : 25 �+ .. DATE : '
NOTE:.SEE.ATTACHED WASTE UTILIZATION PLAN
COMMENTS: M5DA t"' Wet.. Arr=AC'44 WAyre NnLMArION ec".
*
*

SHEET 1 OF 2
,; OPERATION AND MAINTENANCE PLAN
- -------------------------------
• This lagoon is designed for waste treatment -(permanent storage) and
180 days of temporary storage. The time required for the planned
fluid level (permanent and temporary storage) to be reached may vary
due to site conditions, weather, flushing operations, and the amount
of fresh water added to the system.
The designed temporary storage consists of 180 days storage for:
(1) waste from animals and (2) excess rainfall after evaporation. Also
included is storage for the 25 year - 24 hour storm for the location.
The volume of waste generated from a given number of animals will be
fairly constant throughout the year and from year to year, but excess
rainfall will vary from year to year. The 25 year rainfall will not
be a factor to'consider in an annual pumping cycle, but this storage
volume must always be available.
A maximum elevation is determined in each design to begin
pumping and this is usually the outlet invert of pipe(s) from
building(s). If the outlet pipe is not installed at the elevation to
begin pumping, a permanent marker must be installed at this elevation
to indicate when pumping should begin. An elevation must be established
to stop pumping to maintain lagoon treatment depth.
Pumping can be started or stopped at any time between these two
elevations for operating convenience as site conditions permit, such as
weather, soils, crop, and equipment in order to apply waste without
runoff or leaching.
Land application of waste water is recognized as an acceptable
method of disposal. Methods of application include solid set,
center pivot, guns, and traveling gun irrigation. Care should be
taken when applying waste to prevent damage to crops.
The following items are to be carried out:
I. It is strongly recommended that the treatment lagoon be pre -
charged to 1/2 its capacity to prevent excessive odors during
start-up. Pre -charging reduces the concentration of the initial
waste entering the lagoon thereby reducing odors. Solids should be
covered with effluent at all times. When precharging is complete,
flush buildings with recycled lagoon liquid. Fresh water should not
be used for flushing after initial filling.
A
2. The attached waste utilization plan shall be followed. This
plan recommends sampling and testing of waste (see attachment)
before land application.
3. Begin temporary storage pump -out of the lagoon when fluid level
reaches•the elevation 52.3 as marked by permanent marker. Stop pump -
out when the fluid level reaches elevation 49.4 . This temporary
storage,.less 25 yr- 24 hr storm, contains 18675 cubic feet or
139688 gallons.

SHEET 2 OF 2
4. The recommended maximum amount to apply per irrigation is
one (1) inch and the recommended maximum application rate is 0.3
inch per hour. Refer to the waste utilization plan for further details.
5. Keep vegetation on the embankment and areas adjacent to the
lagoon mowed annually. Vegetation should be fertilized as needed
to maintain a vigorous stand.
6. Repair any eroded areas or areas damaged by rodents and
establish in vegetation.
7. All surface runoff is to be diverted from the lagoon to stable
outlets.
B. Keep a minimum of 25 feet of grass vegetated buffer around
waste utilization fields adjacent to perennial streams. Waste will
not be applied in open ditches. Do not pump within 200 feet of a
residence or within 100 feet of a well. Waste shall be applied in a
manner not to reach other property and public right-of-ways.
9. The Clean Water Act of 1977 prohibits the discharge of
pollutants .into waters of the United States. The Department of
Environment, Health, and Natural Resources, Division of Environ-
mental Management, has the responsibility.for enforcing this law.

SEEDING 'SPECIFICATIONS•
----------------------
AREA_TO BE SEEDED: 1:5 ACRES
USE THE SEED MIXTURE INDICATED AS FOLLOWS:
90.0 LBS. FESCUE GRASS AT 60 LBS./ACRE
(BEST SUITED ON CLAYEY.OR WET SOIL CONDITIONS)
SEEDING DATES: SEPTEMBER 1 TO NOVEMBER 30
FEBRUARY 1 TO MARCH 30
0.0 LBS. RYE GRAIN AT 30 LBS./ACRE (NURSERY FOR FESCUE)
0.0 LBS. 'PENSACOLA' BAHIA GRASS AT 60 LBS./ACRE
(SEE FOOTNOTE NO. 1)
SEEDING DATES: MARCH 15 TO JUNE 15
0.0 LBS. HULLED COMMON BERMUDA GRASS AT S LBS./ACRE
(SUITED FOR MOST SOIL CONDITIONS)
SEEDING DATES: APRIL 1 TO JULY 31
0.0 LBS. UNHULLED COMMON BERMUDA GRASS AT 10 LBS./ACRE
SEEDING DATES: JANUARY 1 TO MARCH 30
60.0 LBS. RYE GRASS AT 40 LBS./ACRE (TEMPORARY VEGETATION)
SEEDING DATES: DECEMBER 1 TO MARCH 30
LBS.
APPLY THE'FOLLOWING:
1500.0 LBS. OF 10-10-10 FERTILIZER (1000 LBS./ACRE)
3.0'TONS OF -DOLOMITIC LIME (2 TONS/ACRE)
150.0 BALES OF SMALL GRAIN STRAW (100 BALES/ACRE)
ALL SURFACE DRAINS SHOULD BE INSTALLED PRIOR TO SEEDING. SHAPE
ALL DISTURBED AREA IMMEDIATELY AFTER EARTH MOVING IS COMPLETED.
APPLY LIME AND FERTILIZER THEN DISK TO PREPARE A 3 TO 4 INCH
SMOOTH SEEDBED. APPLY SEED AND FIRM SEEDBED WITH A CUL•TIPACKER
OR SIMILAR EQUIPMENT. APPLY MULCH AND SECURE WITH A MULCH
ANCHORING TOOL OR NETTING.
1. PENSACOLA BAHIAGRASS IS SLOWER TO ESTABLISH THAN COMMON
BERMUDA GRASS. WHEN USING BAHIA, IT IS RECOMMENDED THAT S
LBS./ACRE OF COMMON BERMUDA BE INCLUDED TO PROVIDE COVER
UNTIL BAHIAGRASS IS -ESTABLISHED.

SHEET 1-OF 2
SPECIFICATIONS FOR CONSTRUCTION OF WASTE TREATMENT LAGOONS
r----------------------------------------------------
FOUNDATION PREPARATION:
-----------------------
The foundation area of the lagoon. embankment and building pad shall be
cleared of trees, logs, stumps, roots, brush, boulders,sod and rubbish.
Satisfactory disposition will be made of all debris. The topsoil From
the lagoon and pad area should be stripped and stockpiled for use on
the dike and pad areas. After stripping, the foundation area of the
lagoon embankment and building pad shall be thoroughly loosened prior
to placing the first lift of fill material to get a good bond.
EXCAVATION AND EARTHFILL PLACEMENT:
-----------------------------------
The completed excavation and earthfill shall conform to the lines,
grades, and elevations shown on the plans. Earthfill material shall
be free of material such as sod, roots, frozen soil, stones over
6 inches in diameter, and other objectionable material. To the extent
they are suitable, excavated materials can be used as fill. The fill
shall be brought up in approximately horizontal layers not to exceed.9
inches in thickness when loose and prior to compaction. Each layer
will be compacted by complete coverage with the hauling and spreading
equipment or standard tamping roller or other equivalent method.
Compaction will be considered adequate when fill material is observed
to consolidate to the point that settlement is not readily detectible.
NOTE THE SPECIAL REQUIREMENTS FOR PLACEMENT OF LINERS IN THE LINER
SECTION OF THIS SPECIFICATION. The embankment of the lagoon shall be
installed using the more impervious materials from the required
excavations. Construction of fill heights shall include 5 percent for
settlement. Dikes over 15 feet in height and with an impoundment
capacity of 10 acre-feet or more fall under the jurisdiction of the NC
Dam Safety Law. The height is defined as the difference in elevation
from the constructed height to the downstream toe of the dike.
Precautions shall be taken during construction to prevent excessive
erosion and sedimentation.
LINER: THE MINIMUM REQUIRED THICKNESS SHALL BE 1.6 ft.
NOTE: LINERS (PARTIAL OR FULL) ARE REQUIRED WHEN THE ATTACHEDISOILS
INVESTIGATION REPORT SO INDICATES OR WHEN UNSUITABLE MATERIAL"IS
ENCOUNTERED DURING CONSTRUCTION. A TYPICAL CROSS SECTION OF THE LINER
IS INCLUDED IN THE DESIGN WHEN LINERS ARE REQUIRED BY THE SOILS REPORT.
When. areas of unsuitable material are encountered, they will be. over -
excavated below finish grade to the specified depth as measured
perpendicular to the finish grade. The foundation shall be backfilled
as specified to grade with a SCS approved material (ie - CL,SC,CH).
REFER TO THE SOILS INVESTIGATION INFORMATION IN THE PLANS FOR SPECIAL
CONSIDERATIONS.

SHEET 2 OF-2
Soil liner material shall come from an approved borrow area. The
minimum water content of the liner material shall be optimum moisture
content which relates to that moisture content when -the soil is kneaded
in the hand it will form a ball which does not readily separate. Water
P
shall be added to borrow as necessary to insure proper moisture content
during placement of the liner.. The moisture content of the liner
material shall not be less than optimum water content during placement.
The maximum water content relates to the soil material being too wet
for efficient use of hauling equipment and proper compaction. Proper
compaction of the liner includes placement in 9 inch lifts and
compacted to at least 90 percent of the maximum ASTM D698 Dry Unit
Weight of the liner material. When smooth or hard, the previous lift
shall be scarified and moistened as needed before placement of the next
lift.
The single most important factor affecting the overall compacted perme-
ability of a clay liner, other than the type of clay used for the
liner, is the efficient construction processing of the compacted liner.
The sequence of equipment use and the routing of equipment in an estab-
lished pattern helps assure uniformity in the whole placement and
compaction process. For most clay soils, a tamping or sheepsfoot
roller is the preferable type of compaction equipment.
The soil liner shall be protected from thetdischarge of waste outlet
pipes. This can be done by using some type of energy dissipator(rocks)
or using flexible outlets on waste pipes.
Alternatives to soil liners are synthetic liners and bentonite sealant.
When these are specified, additional construction specifications are
included with this Construction Specification.
CUTOFF TRENCH:
A cutoff trench shall be constructed under the embankment area when
shown on a typical cross section in the plans. The final depth of the
cutoff trench shall be determined by observation of the foundation
materials.
VEGETATION:
All exposed embankment and other -bare constructed areas shall be seeded
to the planned type of vegetation as soon as possible after construc-
tion according to the seeding specifications. Topsoil should be placed
on areas of the dike and pad to be seeded. Temporary seeding or mulch
shall be used if the recommended permanent vegetation is out of season
dates for seeding. Permanent vegetation should be established as soon
as possible during the.next period of approved seeding dates.
REMOVAL OF EXISTING TILE DRAINS
-------------------------------
When the drains are encountered, the tile will be removed to a minimum
of 10 feet beyond the outside toe of slope of the dike. The tile
trench shall be backfilled and compacted with good material such as
SC, CL, or CH.

Total Volumes ..by -'Project
(combined volumes for each drawing)
Project: Blount Iso..
Drawing: Drawing 1'
_Number: GHF084
Location: Edgecombe Co..t,
Bid Date:.
Engineer: G. Pettus
Owner: Blount Bros.
Estimator:
Prepared by: GOLDSBORO HOG FARM using SITEWORK
Date: 08/25/94 Time: 09:45:44
Drawing: Drawing 1
Grid cell size: 1.58 by 1.58 Original drawing scale: 100.00 ft/in
Expanded Expanded
CUT FILL I CUT I FILL
Balanced 1720.151. 1363-671 ( 1720.151 ( 2174.5
5000$(
Existing
------------------------------------------------------------ -
Net: 1 356.481 I 15.561
Project: Blount 'Iso.
Expanded Expanded
I CUT FILL CUT FILL
Project Totals: - I 1720.151 1363.671 1720.15I 1704,55
Average Shrink/Swell Percent ( 0.00%) ( 25.00%;
----------------------------- --___----�-----�,5.5fi�- ---
Project Net:356.481
t.

Site Balance Report .
Grid cell size: 1.58 by 1.58
Original drawing scale: 100.00 ft/in
---------------
Project:• Blount Iso.
Drawing: Drawing I
Number: GHF084
Location: Edgecombe Co.
Bid Date:
Engineer: G. Pettus
Owner: Blount Bros.
Estimator:
Prepared by: GOLDSBORO HOG FARM using SITEWORK
Date: 08/25/94• Time: 09:44:29
Final surface: Balanced:
Initial surface: Existing:
There are no "Balanced'17 structures.','
Fill shrink/swell percent: 25.00 Cut shrink/swell percent: 0.00
Balancing to 0.0 +/- 10.0 cubic yards,
delta Cut . Fill Cut -- Fill
0.000 1720.15 1704.59 15.56
0.012 1713.52 1715.79 --2.26
Raise "Balanced" by 0.012;rfeet,- ;

Orientation: -AR-p
56.00,
54.00
52.00
50.00 '
48.
46. 00 '
44.00.
42.0 4
Lower Left
Z Magnification: 6.0
jr
3D Mesh Surface
Balanced
Project: Blount Iso.
Drawing: Drawing 1
Number: GWO84
Location: Edgecombe Co.
Bid Date:
Engineer: G. Pettus
Owner: Blount Bros.
Estimator:
Inclination:.20.8
3D Mesh 'Surface
Prepared by: GOLDSBORO HOG FARM using SITEWORK

SCS-ING-538 ? Jti 4 U. S. DEPARTMENT OF AGRICULTURE
Rer, 5-70 f f �'SOIL CONSERVATION SERVICE
SOIL INVESTIGATION TO DETERMINE SUITABILITY OF PROPOSED POND SITE
FARMER'S NAME- DISTRICT
DATE COUNTY
S. C. S. PHOTO SHEET NO. WORK UNIT
WATERSHED AREA MEASVREMENTS
CROPLAND ACRES PASTURE ACRES
WOODLAND ACRES TOTAL ACRES POND CLASS WORK UNIT CONSERVATIOi- IST
SKETCH OF PROPOSED POND SHOWING WHERE BORINGS WERE NLAUDE (Approx. scale 1r'= feet)
Locale rtitrmce point In ctnitr line at dam and idmhly on sketch.
NAME ENO
�
imiimom
N
MOVES
■
mmm
un
Ma■�ii
SHOW! r•Z
BORING NUMBER AND PROFILE
DEPTH! �a a and Ii. darn site and saillwaV bn^ngs brit - then Bonded area and borrow Drt borings - separate with uerdrai red line.
'Continued art back where necward Show water table eleuaffnn- ni dom-site borings.
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BORING, SIADE BY _ SIGNATURE & TITLE _ _ J

WASTE UTILIZATION PLAN
Goldsboro Hog Farms, Inc.
Thursday, August 07, 1997
Producer: Blount Bros.
-'
Farm Name: Blount Bros. Swine Farm.LLC
`r
P.O. Box 400
Bethel,NC 27812
Telephone # : [phone]�
Type of Operation : Farrow to Weanling Swine
_..
Number of Animals: 2150 sows design capacity
Application Method: Irrigation
The waste from your animal facility must be land applied at a specified rate to prevent
pollution of surface and/or groundwater. The plant nutrients in the animal waste should be
used to reduce the amount of commercial fertilizer required for the crops in the fields where
waste is to be applied. This waste utilization plan uses nitrogen as the limiting nutrient.
Waste should be analyzed before each application cycle. Annual soil tests are strongly
encouraged so that all plant nutrients can be balanced for realistic yields of the crop 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 contents of the waste. Do not apply more nitrogen than the crop
can utilize. Soil types are important as they have different infiltration rates, leaching
potentials, cation exchange capacities, and avaialable water holding capacities. Normally
waste shall not be applied to land eroding at greater than 5 tons per acre per year. With
special pre -cautions, waste may be applied to land eroding at up to 10 tons per acre per
year. Do not apply waste on saturated soils, when it is raining, or when the surface is frozen.
Either of these conditions may result in runoff to surface waters which is not allowed under
DEM regulations. Wind conditions should also be considered to avoid drift and downwind
odor problems. To maximize the value of the nutrients for crop production and to reduce the
potential for pollution, the waste should be applied to a growing crop or applied to bare
ground not more than 30 days prior to planting. Injecting the waste or disking will conserve
nutrients and reduce odor problems. This plan is based on waste application through
irrigation for this is the manner in which you have chosen to apply your waste. If you choose
to inject the waste in the future, you need to revise this plan. Nutrient levels for injecting
waste and irrigating waste are not the same.
The estimated acres needed to apply the animal waste is based on typical nutrient content
for this type of facility. Acreage requirements should be based on the waste analysis report
from your waste management facility. Attached you will find information on proper sampling
techniques, preparation, and transfer of waste samples to the lab for ananlysis. This waste
utilization plan, if carried out, meets the requirements for compliance with 15A NCAC
2H.0217 adopted by the Environmental Management Commission.
Page 1 of 9

AMOUNT OF WASTE PRODUCED PER YEAR (gallons, ft3, tons, etc.)
2150 sows X 6.1 tons waste/sows/year = 13115 tons
AMOUNT OF PLANT AVAILABLE NITROGEN (PAN) PRODUCED PER YEAR
2150 sows X 6.4Ibs PANlsowslyear : 11610 PANlyear
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.
The following acreage will be needed for waste application based on the crop to be grown,
soil type and suface application.
TABLE 1 : ACRES OWNED BY PRODUCER
TRACT FIELD SOIL TYPE &CLASS- CROP YIELD LBS AW COMM ACRES LBS AW APPLIC.
DETERMINING PHASE CODE WACRE NIACRE USED TIME
289
10
WAGRAM 0-6%
BH
5.5
275
0
9.4
; 2585
MAR-OCT
289
-. 10
WAGRAM 0-6%
SG
1
50
0
9A
470
SEP-MAY
289
11
FORESTON ALL
9H
6
3001
0
3.5
1050
MAR-OCT
289
11
FORESTON ALL
SG
1
50
0
3.5
175
SEP-MAY
289
4
FORESTON ALL
BH
6
300
0
4.1
1230
MAR-OCT
289
4
FORESTON ALL
SG
1
50
0
4.1
205
SEP-MAY
289
6
FORESTON ALL
BH
6
300
f 0
2.5
750
MAR-OCT
289
6
FORESTON ALL
SG
1
50
0
2.5
125
SEP-MAY
289
7
FORESTON ALL
SH
6
300,
0
6.7
2010
MAR-OCT
289
7
FORESTON ALL
SG
1
50
0
6.7
335
SEP-MAY
289
8
FORESTON ALL
BH
6
300,
0
5.6
1680
MAR-OCT
289
8
FORESTON ALL
SG
1
50
0
5.6
280
SEP-MAY
289
9
FORESTON ALL
BH
6
300
,, 0
5.1
1530
MAR-OCT
289
9
FORESTON ALL
SG
1
50
0
5.1
265
SEP-MAY
TOTALS: 12580
— Indicates that this field is being overseeded (i.e. interplanted) or winter annuals follow
summer annuals.
* Indicates a Crop Rotation
NOTE: The applicator is cautioned that P and K may be over applied while meeting the N
requirments. Beginning in 1996 the Coastal Zone Management Act will require farmers in
some eastern counties of NC to have a nutrient management plan that addresses all
nutrients. This plan only addresses Nitrogen.
Pang 9 of 4

TABLE 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowners must be attached.)
(Required only if operator does not own adequate land. See required specifications 2.)
There are no Acres Leased
Indicates that this field is being overseeded (i.e. interplanted) or winter annuals follow
summer annuals.
* Indicates a Crop Rotation
* Acreage figures may exceed total acreage in field due to overseeding.
**Lbs AW N (animal waste nitrogen) equals total required nitrogen less any commercial
nitrogen (COMM N) supplied:
The following legend explains the crop codes used in TABLES 1 and 2 above:
CROP CODE CROP UNITS LBS NIUNIT
BH HYBRID BURMUDAGRASS-HAY TANS 50
SG SMALL GRAIN OVERSEEDED AC 50
n,-_ n _r n

TOTALS FROM TABLES 1 AND 2
ACRES LBS AW
N USED
TABLE 1 36.9 12,680
TOTALS: 38.9 12,680
AMOUNT OF N PRODUCED: 11,610
""" BALANCE .1,070
*** This number must be less than or equal to 0 in order to fully utilize the animal
waste N produced.
Acres show in each of the proceeding tables are considered to be the usable acres
excluding required buffers, filter strips along ditches, odd areas unable to be irrigated, and
perimeter areas not receiving full application rates due to equipment limitations. Actual total
acres in the fields listed may, and most likely will be, more than the acres shown in the
tables.
NOTE: The Waste Utilization Plan must contain provisions for periodic land application of
sludge at agronomic rates. The sludge will be nurturient rich and will require precautionary
measures to prevent over application of nutrients or other elements. Your production facility
will produce approximately 1892 pounds of plant available nitrogen (PAN) per year in the
sludge that will need to be removed on a periodic basis. This figure is PAN when
broadcasting the sludge. Please be aware that additional acres of land, as well special
equipment, may be needed when you remove this sludge.
See the attached map showing the fields to be used for the utilization of waste water.
APPLICATION OF WASTE BY IRRIGATION
The irrigation application rate should not exceed the intake rate of the soil at the time of
irrigation such that runoff or ponding occurs. This rate is limited by initial soil moisture
content, soil structure, soil texture, water droplet size, and organic solids. The application
amount should not exceed the available water holding capacity of the soil at the time of
irrigation nor should the plant available nitrogen applied exceed the nitrogen needs of the
crop.
Your facility is designed for 180 days of temporary storage and the temporary storage must
be removed on the average of once every 5.92 months. In no instance should the volume
of waste being stored in your structure be within 1.56 feet of the top,of the dike.
If surface irrigation is the method of land application for this plan, it is the responsiblity of the
producer and irrigation designer to ensure that an irrigation system is installed to properly
irrigate the acres shown in Tables 1 and 2. Failure to apply the recommended rates and
amounts of Nitrogen shown in the tables may make this plan invalid.
The following table is provided as a guide for establishing application rates and amounts.
APPLICATION APPLICATION
TRACT FIELD SOIL TYPE CROP RATE (in/hr) AMT (inches)
289
-10
WAGRAM M%
SG
0.60
•1
289
to
WAGRAM 0-6%
BH
0.60
•1
289
--11, -A, --6, -7, --8, -9
FORESTON ALL
SG
0.50
'1
289
1 t, n, 6, 7, 8, 9
FOR ESTON ALL
BH
0.50
•1
* This is the maximum application amount allowed for the soil assuming the amount of
nitrogen allowed for the crop is not over applied. In many situations, the application
amount shown cannot be applied because the nitrogen limitation. The maximum
application amount shown can be applied under optimum soil conditions.
IY__.- I _B /1

PLANS & SPECIFICATIONS
1. Animal waste shall not reach surface waters of the state by runoff, drift, manmade
conveyances, direct application, or direct discharge during operation or land application.
Any discharge of waste which reaches surface water is prohibited. Illegal discharges are
subject to assessment of civil penalties of $10,000 per day by the Division of Water Quality
for every day the discharge continues.
2. The Field Office must have documentation in the design folder that the producer either
owns or has long term access to adequate land to properly dispose of waste. If the producer
does not own adequate land to properly dispose of waste, he shall provide NRCS with a
copy of a written agreement with a landowner who is within a reasonable proximity, allowing
him/her the use of the land for waste application for the life expectancy of the production
facility. It is the responsibility of the owner. -.of the facility to secure an update of the Waste
Utilization Plan when there is a change in the operation, increase in the number of animals,
method of utilization, or available land.
3. Animal waste shall be applied to meet, but not exceed, the Nitrogen needs for realistic
crop yields based on soil type, available moisture, historical data, climate conditions, and
level of management, unless there are regulations that restrict the rate of application for
other nutrients.
4. Animal waste may be applied to land that has a Resource Management System (RMS)
or an Alternative Conservation System (ACS). If an ACS is used the soil loss shall be no
greater than 10 tons per acre per year and appropriate filter strips will be used where runoff
leaves the field. These filter strips will be in addition to "Buffers" required by DEM. (See
FOTG Stantard 393 - Filter Strips and Standard 390 Interim Riparian Forest Buffers).
5. Odors can be reduced by injecting the waste or disking after waste application. Waste
should not be applied when there is danger of drift from the irrigation field.
6. When animal waste is to be applied on acres subject to flooding, it will be soil
incorporated on conventionally tilled cropland. When applied to conservation tilled crops or
grassland, the waste may be broadcast provided the application does not occur during a
season prone to flooding. (See "Weather and Climate in North Carolina" in the NRCS
Technical Reference - Environment file for guidance.)
*7. Liquid waste shall be applied at rates not to exceed the soil infiltration rate such that
runoff does not occur offsite or to surface waters and in a method which does not cause drift
from the site during application. No ponding should occur in order to control conditions
conducive to odor or flies and to provide uniformity of application.
8. Animal waste shall not be applied to saturated soils, during rainfall events, or when the
surface is frozen.
9. Animal waste shall be applied on actively growing crops in such a manner that the crop is
not covered with waste to a depth that would inhibit growth.
10. Waste nutrients shall not be applied in fall or winter for spring planted crops on soils with
a high potential for leaching. Waste nutrient loading rates on these soils should be held to a
minimum and a suitable winter cover crop planted to take up released nutrients. Waste shall
not be applied more than 30 days prior to planting of a crop on bare soil.

11. Any new swine facility sited on or after October 1, 1995 shall comply with the following'.
the outer perimeter of the land area onto which waste is applied from a lagoon that is a
component of a swine farm shall be at least 50 feet from any residential property boundary
and from any perennial stream or river (other that an irrigation ditch or canal. Animal waste
other than swine .waste from facilities sited on or after October 1, 1995), shall not be applied
closer than 25 feet to perennial waters. (See Standard 393 - Filter Strips)
12. Animal waste shall not be applied closer than 100 feet to wells.
13. Animal Waste shall not be applied closer than 200 feet of dwellings other than those
owned by the landownwer.
14. Waste shall be applied in a manner not to reach other property and public right - of ways.
15. Animal waste shall not be discharged into surface waters, drainageways, or wetlands by
discharge or by over -spraying. Animal waste may be applied to prior converted croplands
provided they have been approved as a land application site by a "technical specialist".
Animal waste should not be applied on grassed waterways that discharge directly into water
courses, except when applied at agronomic rates and the application causes no runoff or
drift from the site.
*16. Domestic and industrial waste from washdown facilities, showers, toilets, sinks, etc.,
shall not be discharged into the animal waste management system.
*17. A protective cover of appropriate vegetation will be established on all disturbed areas
(lagoon embankments,' berms, pipe runs, etc.). If needed, special vegetation shall be
provided for these areas and shall be fenced, as necessary, to protect the vegetation.
Vegetation such as trees, shrubs, and other woody species, etc. are limited to areas where
considered appropriate. Lagoon areas should be kept mowed and accessible. Lagoon
berms and structures should be inspected regularly for evidence of erosion, leakage or
discharge.
*18. If animal production at the facility is to be suspended or terminated, the owner is
responsible for obtaining and implementing a "closure plan" which will eliminate the
possibility of an illegal discharge, pollution and erosion.
*19. Waste handling structures, piping, pumps, reels, etc., should be inspected on a regular
basis to prevent breakdowns, leaks, and spills. A regular maintenance checklist should be
kept on site.
20. Animal waste can be used in a rotation that includes vegetables and other crops for
direct human consumption. However, if animal waste is used on crops for direct human
consumption, it should only be applied as a preemergence with no other applications of
animal waste during the crop season.
*21. Highly visible markers shall be installed to mark the top and bottom elevations of the
temporary storage (pumping volume) of all waste treatment lagoons. Pumping shall be
managed to maintain the liquid level between the markers. A market will be required to mark
the maximum storage volume fpr waste storage ponds.
Paae 7 of 9

M
22. Waste shall be tested within 60 days of utilization and soil shall be tested at least
annually at crop sites where waste products are applied. Nitrogen shall be the rate -
determining element. Zinc and copper levels in the soils shall be monitored and alternative
crop sites shall be used when these metals approach excessive levels. pH shall be
adjusted for optimum crop production amd maintained. Soil and waste analysis records
shall be kept for five (5) years. Poultry dry waste application records shall be maintained for
three (3) years. Waste application records for all other waste shall be maintained for five (5)
years.
23. Dead animals will be disposed of in a manner that meets North Carolina Department of
Agriculture regulations.
* Liquid Systems
r,_-._ n -c A

NAME OF FARM: Blount Bros. Swine Farm,LLC
OWNER 1 MANAGER AGREEMENT
I (we) understand and will follow and implement the specifications and the operation and
maintenance precedures estalished in the approved animal waste utilization plan for the
farm named above. I (we) know that any expansion to the existing design capacity of the
waste treatment and/or storage system or construction of new facilities will require a new
utilization plan and a new certification to be submitted to DEM before the new animals are
stocked.
I (we) understand that I must own or have acces to equipment, primarily irrigation
equipment, to land apply the animal waste described in this waste utilization plan. This
equipment must be available at the appropriate pumping time such that no discharge
occurs from the lagoon in a 25-year 1-day storm event. I also certify that the waste will be
applied on the land according to this plan at the appropriate times and at rates that no
runoff occurs.
NAME OF FACILITY OYAER: Blount Bros.
SIGNATURE: DATE:
NAME OF MANAGER (if different from o _ _.. .
'. caner): a1 t?iler`t(s17
please print
SIGNATURE: �.00_',4,7L01C DATE:. �117 c7 %
NAME OF TECHNICAL SPECIALIST: George H. Pettus
AFFILIATION: Goldsboro Hog Farms, Inc.
ADDRESS (AGENCY): PO Box 10009
Goldsboro, NC 27632
[phone]
SIGNATURE: DATE: 07 AU6 a7

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State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Meredith Ozimek
Blount Bros. Farm
PO Box 400
Bethel NC 27812
Dear Meredith
September 9, 1997
ri
j
SEP 5 1991�.
t�ir�ri4t Ill. (51
Subject: Certificate of Coverage No. AWS330020
Blount Bros. Farm
Swine Waste Collection, Treatment, Storage
and Application System
Edgecombe County
In accordance with your application received on July. 24, 1997, we are forwarding this Certificate
of Coverage (COC) to Farm No. 33-20, authorizing the operation of an.animal waste collection, treatment,
storage and land application system in' accordance with the State's General Permit (attached). This
approval shall consist of the operation of this system including, but not limited to, the management of
animal waste from the Blount Bros.Farm, located in Edgecombe County, with an animal capacity of no
greater than 2150 Farrow to Wean and the application to a minimum of 36.9 acres of land as specified in
the Certified Animal Waste Management Plan (CAWMP).
The COC shall be effective from the date of issuance until December 31, 2001. 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.
In accordance with General Statue 143-215.10C, Animal Waste Management Plans shall include
the following components:
- A checklist of odor sources and best management practices to minimize these sources.
- A checklist of insect sources and best management practices to minimize these sources.
- Provisions set forth for acceptable methods of disposing of mortalities.
- Provisions regarding emergency action plans.
Your existing Certified Animal Waste Management Plan must include the above elements, by
December 31, 1998. Documentation of the certification must be available to inspectors ' onsite. Submittal
of the amended certification statement shall be required upon renewal of your permit coverage in 2001.
Please be advised that any violation of the teri 'ns and conditions specified in` this COC, the General
Permit or the CAWMP may result in the revocation of this COC.
P.O. Box 29535, Raleigh, North Carolina.27626-0535, Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Upon notification by the Division of this COC's expiration, you shall apply for its renewal. This
request shall br,- 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 Perrrut, please contact J R Joshi at [phone] ext. 363.
Sincerely,
/r
IL'/A. Preston Howard, Jr., P.E.
cc: (Certificate of Coverage only for all ec's)
Edgecombe County Health Department
Raleigh Regional Office, Water Quality Section
Edgecombe County Soil and Water Conservation District
Permit File

State of North Carolina
Department of Environment,
Health and Natural Resources
Raleigh Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Al"WA
DEHNR
DIVISION OF WATER QUALITY
July 28, 1997
Mr. Ferrell Blount
Blount Brothers Farms
P.O. Box 400
Bethel, North Carolina 27812
Subject: Compliance Evaluation Inspection
Facility # 33-20 & 46
Blount Brothers Farms
Edgecombe County
Dear Mr. Blount:
On July 17, 1997, Mr. Buster Towell from the Raleigh Regional
Office conducted a compliance inspection of the subject animal
facility. The inspection is part of the Division's efforts to
determine compliance with the State's animal waste nondischarge
rules.
The inspection determined that the operation was not discharging
wastewater into waters of the State and that operations were
proceeding according to your approved Animal Waste Management Plan.
As a result of the inspection, the facility was found to be in
compliance with the State's animal nondischarge regulations.
Effective wastewater treatment and facility maintenance are an
important responsibility of all animal waste producers. The
Division of Water Quality has the responsibility to enforce water
quality regulations in order to protect the natural resources of
the State.
The Raleigh Regional Off-ce appreciates your cooperation and
compliance. If you have any questions regarding this inspection
please call Mr.. Buster Towell at [phone].
Sincerely,
J y Garrett,
Water Quality Section Supervisor
cc: Edgecombe County Health Department
Mr. A.B. Whitley, Edgecombe Soil. and Water
Conservation District
Ms. Margaret O'Keefe, DSWC-RRO
DWQ Compliance Group
RRO Files
3800 Barrett Drive. Suite 101, 0!' FAX [phone]
Raleigh, North Carolina 27609 C An Equal Opportun€ty Affirmative Action Employer
Voice 919-571-4700 50% recycled/10% post -consumer paper

Facility Number
Dte offIn
Tmsp
oection 7-/7• P7
Inspection 24 hr. (hh:mm)
Farm Status: ❑ 499tstered ❑ Applied for Permit
ErCertified ❑ Permitted
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review
❑Q Not Operrational Date Last Operated:....__...............».......__....._....._».................................................._............................................
Farm Name: _.d7.I.Q_ tf...r....nro i S....I )i/Ii+� ........................ County:C��:.C�'.•. ,b e-.... _......................... ...__........ ........... :.....»....
Land Owner Name: Phone No:._�... »...�r..S �7 D
..............................................................». .... . _ ..... ... a......
Facility Conctact: Aki :.(.c Z�,,,_ �dcc , , Phone No: !^
Q......................_.......p....... Title: .................... ........................ __...............
Mailing Address:...... . f� J3 d.. yr7 Q .ba. LLI i?/ C :2- 7
Onsite Representative:.!n e�G�i �/ f p M L�L o�j p
/......... ..... _ /........................................ Integrator:.�.R.l..........._......_.».0— v
..._......._.........._......._.........,
Certified Operator:.. ? �(j�y,,. fr7lpec. / )"e"J1iH OZ.Mii1C
_ .............._................_............ Operator Certification Number:.........................................,
Location of Farm:
Latitude =* =' =« Longitude 0* 0. ="
•,enerai
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the opemtion?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ZIC
❑ Yes ONo
❑ Yes ❑ YesgNo�-
No
❑ Yes N
❑ Yes No
❑ Yes W N
❑ Yes lN0
Continued on back

facility Number:.,.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ld'N0
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
U<01
Structures (Lagoons and/or li lg dirtg Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
2<0
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
S70 ............................ I..................
............................ ............................ ......... ............................
............................
<0
10. Is seepage observed from any of the structures?
❑ Yes
11, Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
O No
12. Do any of the structures need maintenance/improvement?
❑ Yes
No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
waatc Application
14. Is there physical evidence of over application?
❑ Yes
(If in excess of or runoff entering waters of the State, notify DWQ)
fWM�P,,
15. Crop
type L......................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No ,
18. Does the receiving crop need improvement?
❑ Yes
IdNo
19. Is there a lack of available waste application equipment?
❑ Yes�N�
20. Does facilityrequire a follow-up visit b same agency?
q P Y❑
Yes
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
For Certified Factlifies 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?
❑ YesN
jNo
24. Does record keeping need improvement?
❑ Yes
t:o"Ok
i
Reviewer/Inspector Name �: • z ;n
Reviewer/Inspector Signature: �� Date: -7—
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Facility Number
Farm Status: ❑ R
r„�El Applied for Permit
m tertified ❑ Permitted
❑ Not Operational Date Last Operated:
Date of Inspection
Time of Inspection �24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review ' . O i7
or Inspection includes travel andprocessing)
Farm Name:A.(.n-Z..^.t.,::.7_......13X...f7.4r:... t! 1 SL!-�........._...._............... County: cQ.. Cl?�L^../! e'............. ......... __..........
Land Owner IVame:...1125E n.. �....^ d r uT �¢�s %1 /Lws................... Phone No: ................................/s ._^.. 590
...�.._............
......_.......... _....... _....... _....
Facility Conctact:...r..... ��...........Il(tj/ ! ... .......... Title: ... (9. 422.7.92 l.L-................ Phone No:.. .....................................
MailingAddress:...'P-.._e_..... q.UJ... �4.....1.....�.V.._4......................41.. _�! ..... ........... ..�... t'. z............................., ..........................
Onsite Representative: Y!'I.PrY �q .� / . Z, M� �C Integrator:. Q1 /
�........................_�......................................._..... .. 1J..{N..l�............................................
Certified Operator:.,Fe!Y. ��.. .�f�(h. ?..I /! D r Gc� 4 H, U ZL'Operator Certification Number:
II
Location of Farm: �N�� , , v'2--'
Latitude =* =' = ° Longitude =* =, ="
Type of Operation and Design Capacity
4eneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
Qw
2. Is any discharge observed from any part of the operation? El Yes No No
Discharge originated at: [I Lagoon [I Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes N
3. Is there evidence of past discharge from any part of the operation? ❑ Yes l�J N
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
4/30/97 Continued on back

V r
Facility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes la'No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 21 No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Co
Structlires (Lagoons and/flr Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IdNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.....�....... ............................ . ............................ ............................ ............................
10. Is seepage observed from any of the structures? ❑ Yes Ohio
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation posesan
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes Z1410
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 !!x ...L. .... ............. _...... -....
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? El Yes No
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste a lication equipment? ❑ Yes ON
PP
20. Does facility require a follow-up visit by same agency? ❑ Yes
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
For Certified Facilities -Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
24. Does record keeping need improvement? ❑ Yes No
Comments (refer to question #) rExplam ana y YES nswers and/or any recommendations or any other comments
Use drawings of facility to better explainsituatsons (use additional pages as necessary)ti
Reviewer/Inspector Name ` ..: lit' -i
Reviewer/Inspector Signature: �^ Dater
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

May, 3, 2017 9:34AM
No, 5585 P. 2
Animal Waste Management System Operator Designation Form
Facility/Farm Name:
Permit: AWG100000
WPCSOCC
NCAC I SA 8F .0201
SLM MAYO FARMS, LLC
Operator In Charge (OIC)
Facility ID#: 33 - 20 County
EDGECOMBE
Name: JIMMY STEVEN STEWAitT II
Fla madle Las! Jr, Sr, etc.
Celt Type 1 Ntutlber: AWA-1002865 Work Phone: (919 ) 634 - 5260
Signature: 4J1 Dale: . )
"I certify that I et ree to my'designation'Ss the Operator in Charge for cite futility noted. I understand and will abide by the rules and regulations
pertaining to the responsibilities set forth in ISA NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the Water
Pollution Control System Operators Certification Commission."
Back-up Operator In Cfiarge (Back-up(Optional)
Name:
Cent Type i Number:
Signature:
F'sv Middle Lasr Jr, Sr, etc,
Work Phone. ( )
Date:
"1 certify that I "e to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the rules rind
regulations pertaining to the responsibilities set forth in 15A NCAC 08F ,0203 and failing to do so can mult in Disciplinary Actions by the
Water Pollution Control System Operators Certification Commission"
Owner/Perm[ttee Name: MAXWELL FOODS, LLC
Phone #: [phone]
Signature:
(Owner or authoriU4
malt' jax or emau the
original to:
Mall or fax a copy to the
appropriate Regional Office.-
-. 4UWti-, . V . . -.� . -I..1
Email: certndmiinQ)ncdenr.eov
Asheville
2090 CIS Hwy 70
Swannanoa 28779
Fax: [phone]
Phone: 828,296.4500
Washington
943 Washington Sq Mall
Washington 27889
Fax: [phone]
Phone: 252.94&6481
F'ax#:.(�19)778-5762
enter,
Fayetteville
225 Green St
Suite 714
Fayetteville 29301-5043
I'ax: 910.486.0707
Phoen: 910.433,3300
Wilmington
127 Cardinal Dr
Wilrningwri 28405-2845
Fax: [phone]
Phone: 910,796.7215
Date.0 s/02.
M40ro9mlle
Raleigh
610E Center Ave
380013arrett Dr
Suite 301
12sleiglr27609
MODMSVI1to 29115
Fax:[phone]
Far; 704.663.6040
Phonei919.791.4100
Phone: [phone]
Winston-Salem
450 W, Hanes Mall Rd
Winston-Salem 27105
Fax: [phone]
Phone,. 336.776.9800
(Retain a copy of this form for your retards)
liovi red 05-20 r 5

May, 3.2017 9:340
MAXWELL FOODS, INC.
GOLDSBORO HOG ANNEX
pO BOX 10009
943'MILLERS CHAPEL RD,
GOLDSBORO, NC 27534
[phone]
FAX [phone]
FAX TRANSMISSION COVER SHEET
DATE: 5-3- I rt
TO: gi�ah %WILL gfru,
FAX: Q i Q — 5? I — ►f 1'3
R E : �f '� IV "w"
SENDER: 111iay t 4v,.rre✓ll
No.5585 P. 1
YOU SHOULD RECEIVE PAGE(S), INCLUDING THIS COVER SHEET. IF YOU
DO NOT RECEIVE ALL THE PAGES, PLEASE CALL [phone]. Y, II+p
IMPORTANT CONFIDENTIALITY NOTICE
THIS FAX COMMUNICATION IS INTENDED ONLY FOR THE USE OF THE INDIVIDUAL TO WHOM IT IS ADDRESSEE)
AND MAY CONTAIN INFORMATION THAT IS PROPRIETARY, CONFIDENTIAL OR PRIVILEDGED. IF YOU ARE NOT
THE INTENDED RECIP[ENT (OR AN EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THIS COMMUNICATION
TO THE INTENDED RECIPIENT). YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR
COPYING OF THIS COMMUNICATION IS STRICTLY PROH181TEO. IF YOU HAVE RECEIVED THIS COMMUNICATION .
IN ERROR, PLEASE NOTIVY THE SENDER IMMEDIATELY BY TELEPHONE AND RETURN IT TO THE SENDER BY
MAIL. SENDER WILL REIMBURSE YOU FOR ANY EXPENSE INCURRI~D. THANK YOU

M
Type of Visit: Wompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: I Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p� rrival Time: 61� b Departure Time: County: r Region
Farm Name: _�LI'j� 1'Yl( i p,,p, } �i,1,�.�,� Owner Email:
Owner Name: + Phone:
Mailing Address: �Jil m/Eyjn
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: Faso ro N D bS
Back-up Operator:
Location of Farm:
Title:
Latitude:
Discharges and 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 DWR)
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
❑ Yes p'No ❑ NA ❑ NE
❑ Yes
A6No
❑ NA
❑ NE
❑ Yes
W1 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 /v No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 oj'3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ,.
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '7 l
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 threat, notify DWR
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 2�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 12,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): t f 01 Q L
13. Soil Type(s): , fop n1 n ` &eV1 1 2O%o
14. Do the receiving crops differ from those designated in the CAW map? ❑ Yes Ej No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes F ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
VfNo
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ZNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ZNo ❑ 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

Facilit Number: - J
24. Did trhUilityU5M`to-fr'oRm_`pliance
aci ' fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ No ❑ NA ❑ NE
dh) with permit conditions related to sludge? If yes, check ❑ Yes e No ❑ NA ❑ NE
the appropriate box(es) below. &, 0 1 Lo
❑ 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 V] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes pa No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q 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 P] 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
P 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
J ] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[A No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C�fNo
❑ NA
❑ NE
Cotnments'(refertto `questiop.#).- Explain any YES answers and/or any additional recon rn6idations or any other comments �:
Use drawings of facility to'betterexplain situ adons (use additional, pages; as necessary),' i
'ID f 0la/!t� GOd 31�5 laf� r1r., = 015i
Cr ! too I d q � ���� j(j= o,s7 rt) 0. `K3
g/I � Icy WOO 0 '3j1d =�� � N : o,Yy
v
111 �v �000�` all//& 6U: 11,It od. a,�y
y11j t000yyo7 1II9//c--;, 1j; It15 01(f3
191311
"o,1 a- y,v P= 3, (,,
d,cs C.XAN,6( t��
Reviewer/Inspector Name
Reviewer/Inspector Signat
Page 3 of 3
Phone: / 7 / / / 2
Date: �Jqfl 7
1 / F
21412015

� Divi"sion of Water Resources
Facility Number ®- ®Q Division of SoiljanUMM—ermonserNatton
0 Other Agency
Type of Visit: 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: jo Routine 0 Complaint 0 Hollow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: a Departure Time: County: ��2 Region:
Farm Name: jam}-, Bpa 51 FcLl; YYN Owner Email:
Owner Name: , L ; YN'\ In(\A\I fi FCl (-1M.SLj0 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: _ Certification Number: Q C(
Back-up Operator: Certification Number:
Location of Farm:
■
Latitude:
Longitude:
Design Current Design C►urrent
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish La er DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Qesigo Current D Cow
De, P,oult . Ca aci P■o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouits
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E No
❑ Yes, No
❑ Yes No
❑ Yes No
❑ Yes �o
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Faciii Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes d No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes V 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.) 0
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes r_VNo ❑ NA ❑ NE
waste management or closure plan? '7
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 EyNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ExNo
❑ 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 VI No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [�j 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
0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
T
❑ 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?
r
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 3No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [�] No ❑ NA ❑ NE
❑ Yes 1� No ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: = Date of Inspection:
24. Did he facili/fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. 1�taf3ty dut 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 0-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [3 Yes ZNo ❑ 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
[ Yes 0"No ❑ NA ❑ NE
1] Yes 1j No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes V5 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments., �a
Use drawings of facility to better explain situations (use additional pages as necessary).
10 - - L55 0 , q q
9; -1- Is o- q
bIt OS
�/ • - CS 1 a-© o .
q j 15 dr. 3,6 , s -Jzi- t
7)15 0 L113 Y _-IJ a
aLl
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0Fri
Phone: "
Date: 1 L2
lilMr

s
gn of Water Quality
Facility Number ®- ® Division of Soii and Water Conservation
® Other Agency
Type of Visit: OTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tMS—Arrival Time: Departure Time: County: Region: OR a
Farm Name. i2r),4i- Owner Email:
Owner Name: OR 1 1 n FC.�r.r.nr.ia Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:��[�� Deo.�Or�7
Sack -up Operator:
Title:
Phone:
Integrator:
Certification Number: (}{,spy 9Q9 X09
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ,No [_]NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [] Yes 6No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes .E�j'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Z]No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ;2F4o
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )Z_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 7 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 in 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 ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ONo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,EfrVo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes jEfNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes ONo ❑ NA ❑ NE
❑ Ycs 2fNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FerNo ❑ 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 VNo
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ o� Ana ysis ❑Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EI'No ❑ NA ❑ NE
1 � O�f
25. s the facility out of compliance! with permit conditions related to sludge? If yes, check ❑ Yes JE No ❑ NA ❑ NE
the appropriate box(es) below. Q 0+h 1 Qo©O r-, 5 d V e }h%5 �I e C OAO)(4)
❑ 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 ;Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes pr"Ro ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes J�TNo ❑ NA ❑ NE
❑ Yes jZ7No ❑ NA ❑ NE
❑ Yes L2-No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 7-No
❑ Yes ❑'No
[—]Yes c2rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations.or any other,comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
rollllq
o,
a-
9, ,
'31il/(y
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tf
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l33 '
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H'0 P- 5, 1
e�nn"_P Le_�
1145
t4r- J- We-O'
Reviewer/Inspector Name: 7��,r\ AG-pu--xs-csz~ Phone: gjq_9 q1 - �o�+
Reviewer/Inspector Signature: 42M L Date: La_2zo.�E__
Page 3 of 3 21412011

Type of visit: Z Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: f�Routine O Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of visit: A Arrival Time: Departure Time: County: Region:2
1� I U c.7rll+ (` C �1 tsar.. �r-�..�..r--�
Farm Name: - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: '7U yYx L» fib- Title:
Onsite Representative:
Certified Operator: N.2
Back-up Operator:
Location of Farm:
5.135cn V r) 7. 30 (1 LO
Latitude:
Phone:
Integrator: C-1-12 US Qf-0
Certification Number: d�.7rci y cP
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine
Capacity Po
apacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
er to Finish
DairyHeifer
w to Wean
1
Design Current
D Cow
w to Feeder
Dr, P■oultr,
Ca acit P■o
Non -Dairy
w to Finish
Layers
Non -La ers
Beef Stocker
Beef Feeder
!Gilts
s
Pullets
Beef Brood Cow
r
rke s
Turke Poults
r ja
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes'L'1 o. ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yesj�No
❑ NA ❑ NE
❑NA ❑NE
El NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilit Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: MS d J�OC4.11)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pC y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�Noo
❑ 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 E!(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,,,[21no
❑ 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 L3-N-o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes.ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ Ko ❑ 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): 41g
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ NA [] NE
.12<0
❑ Yes,o'No
❑ NA ❑ NE
❑ Yes _;21<o
❑ NA ❑ NE
❑ Yes No
❑ Yes ZNo
❑ Yes 4
❑ Yes P No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fiFf&,o
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
_E;I.?Vo ❑ NA ❑ 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 provide documentation of an actively certified operator in charge?
❑ Yes
Ca No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
j2l�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
eNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
6No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[jdo ❑ NA ❑ NE
Comments (refer to'question ft Explain any YES answers; and/or any a'dditional'recom`mendations or any Ether; comments.-ky '_ t
Use drawings of facility to better explain situations (use additional pages asneeessary):
G�/-n-31 - 1�
Otb
IaAXVr�ZpOn
Yr aeLch
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
JQ�ecl �.
nCclent^��o�
Phone:
Date: /R r
21412011

3 -3-
11-3o-1a— i3 Q1170
9/71
Q��s
�-31-12- f)Rg1
c V-
D- - rX
Ll-9-1�
���-� � �.
01.1a-
Ll a -I
b 5 G
9-30 -f(
`y

Type of Visit: j2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: j2Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,� Departure Time: County:
Farm Name: , Owner Email:
Owner Name: _Z L r \ Q[. Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Integrator:
Certified Operator: �(bf� (�j-�y-�q_{� Certification Number: s a� 4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
1 e C`os 5 ya
S e rJ �
Swine
Wean to Finish
Design Current Design Current
Capacity Pop, Wet Poultry Capacity Pop.
La er
Design C►urrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design C►►urrent
Dr, Ploultr, Ca aci Pao
ers
DairyHeifer
D Cow
Non -Dairy
Farrow to Finish
ILa
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
m 0
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
DNA ❑NE
Page I of 3 21412011 Continued

Facilr Number: -7T jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �NO
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
Structure tructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A h_p__�
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.) T
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 '0 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 VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes T��'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes %o [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes JETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box be]a. ('9 '? $o ❑ Yes ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoiJ�Ana�l�yysis ❑ Waste Transfers
id�o�l—I�
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes )2fNo ❑ 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. T
❑ 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 ONo ❑ 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 JZ'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 ONo
❑ 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 ZNo
❑ 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 0No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 12rNo
❑ NA
[3 NE
34. Does the facility require a follow-up visit by the same agency?
[3 Yes YNo
❑ NA
❑ NE
Comments (refer to gaestioq#): Explain any YES: answers and/or any additipnalrecammendations or.any other comments
Us. 'drawings of facility to better explain situations (use additional pages as necessary.)
vLU
_tN t '.Oz� t� on t o- 3 1- a C) ,
CUU G-n en t a -37 - /L/
LOOO a 659 rnYA� l-0 9� mA-19-0t39
Logo©$ �� -o,�� m>A��-©.w�
Loon (0 9L-7a.
3-5 r7
CVW
Reviewer/Inspector Name:
7
Reviewer/Inspector Signature:
Page 3 of 3
hcdeloy

v-
Type of Visit: Q Com ante Inspection U Operation Review U Structure Evaluation U Technical Assistance j
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: // ArrivalTimed
1 Departure Time:© County:
Farm Name: m��y-`�� 2 (�jIUG: t �7iyS, Owner Email:
7
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Oeyy—z Pa-Hk_.:5- Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design Current 't Design Current Design C►arrant
r=tK
Swine
Capacity Pop. Wet Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Dai Cow
Wean to Feeder
on -Layer
Dai Calf
Fee -Finish
Dai Heifer
Tar —row to Wean
Z
Design Current
D Cow
Farrow to Feeder
Dr. P,oultr..
Ca aci P,o
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Tur ey Poults
Other
r
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �00 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 NVNo
❑ 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

Facility Number: - Date of Inspection;
T—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ff. 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: - U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2<o ❑ 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
P _ __ ❑ 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
No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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 Approved Area
12. Crop Type(s):aC��•,•-
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
�Noo
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[3 Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N ❑ NA
❑ NE ,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the a ro riate box
Pp p
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 16 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 Inspection Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [3 Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [3Yes No ❑ NA ❑ NE
Page 2 of 3 214,12011 Continued

[Facility Number: 33 - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �NoEo]
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No A ❑ NE
Other Issues
28. Did the facility fail to property 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 NES;answers and/or any additional recoi mmendutionsiorunY otheracomments'W : s q
r' 'o,,
Use drawings of facili to ex lam'situations use additional pages as necessa r 1
g tJ p ( P 1; ry). F r
Reviewer/Inspector Name:
Phone: 07C/ _ Y U b
Reviewer/] nspector Signature: 43k k7?— 1c) 4/ Z
Page 3 of 3
Date: / / /! ( ( Z,—
21412011

ws Division of Soil and Water Conservatioin - Operation Review r-
�� 71
Drvisron of Soil and Water Conservation Compliance Inspection 't�; N°k
11 Dtvisaon of Water Quality - Compliance Inspection
0 Other Agenc = 0' Brat on Revie
y p A5 . a VkP$ wE A l
Routine Q Complaint Q Follow-up of DWQ inspection O Follow-ug of DSWC review Q Other
Facility' Number rp
Date of Inspection
Ting of Inspection 24 hr. (hh:mm)
0 Permitted [3 Certified (] Conditionally Certified © Registered JE3 Not Operational I Date Last Operated:
r
Farm -Name: ................................ .... ....... County:...�.lr ECJL!?.C.L::..................... .................
..
Owner Name: Phone Not ..... ..............
Facility Contact: ..................................................... ...... Title. ......... Phone No:
Mailin Address:
i
Onsite Representad e: , /l•f E - LL..l....f.. - Intc ,rrator `� �—b`✓- �!f....................................:..........
'....................................d
Certified Operator: ......... . .....................................:................................................... Operator Certification Number:..........................................
Location of Farm:
T
Latitude =' =" Longitude =• =` ="
Design Current Design Current Design Current
Swine Capacity Po ulation Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to \Vean
❑ Farrow to Feeder ❑ Other „
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Soars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field A. -ea
t
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System '. t
Discharge- & Stream Inilmets
1. Is any discharge observed from any part of the operation?
Di,::harge 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? (Il'yes, notify DWQ)
c. li' discharge is observed, what is the estimated now in gal/thin?
d. Does discharge bypass a lagoon system'? (II -yea, notify DWQ)
1 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?
1Vaste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure.? Structure 3 Structure: 4 Structure 5
Identifier:
F-ccbciarcl [inches): ........ r............ .........,, .................................................................................. ...........................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
1/Z 3/99
❑ Yes r No
❑ Yes / No
❑ Yes ("I
No
❑ Yes /Z] No
❑ Yes © No
❑ Yes /�] No
❑ Yes ? No
Structure 6
❑Yes ZNo
Continued on br

\
Facilit}' Number: �-- � 1)atcof iu,txrtion
6. Are there structures on -sire which are not properly addressed and/or manaucd through a waste mana��ernent or
ip4closure plan'? ❑ Yes o
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement•? El /No
H. Does any part of the waste niana«ernent systern other than waste structures require maintenancchniprovemcnt•? ❑ Yes [ fo
9. Do any stuctures lack adequate- gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes X
No
Waste Application
10, Are there any buffers that need maintenancehniproverrteni"
❑ Yes
'o
11, Is there evidence of over application? ❑ Excessive Pondin, ❑ PAN
❑ Y
No
12. Crop type
1i- Do the receiving crops differ with those desipiawd in the Certified Animal Waste Management Plan (CAWMP)`.'
❑ Yes
No
14, a} Does the facility lack adequate acreage for land application?
❑ Yes
E5No
h) Does the facility need a wettahle acre determination"
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination''
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
io
M. Is there a lack of adequate waste application equipment''
❑ Yes
7NO
ketruired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ZNO
IK Does [he facility fail to have a]: components of the Certified Animal Waste Management Plan readily available'?
Oe/ WUP, checklists. design, mtrps. etc.)
❑ Yes
00
19. Does record keeping need improvement? Oe/ irrigation. freehoard. waste analysis & soil sample reports)
❑ Yes
ZNo
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;2�40
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by Gencral Permit?
❑ Yes
Oe/ discharge, freeboard problems• over application)
2rNo
23. Did Reviewer/Inspector fail to discuss review/inspection with tin -site representative'?
❑ Yes
�No
14. Does facility require a follow-up visit by same agency'?
❑ Yes
❑l No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
notdii. t:his:v. ........r. ....'
6rresp6iiderrce: abatit: this :visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name l`
Reviewer/Inspector Signature: Date: 15

Facility Number: — Date of Inspection 7
r•
Odbbr 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
ZNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Q 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
J[YNo
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
;?fNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
C010
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'?
❑ Yes
PVo
Addliltional.,jqqnqpxpor,Drawings:
AA
3/23/99

::-
Piwision of Soil and Water Conservation 0 Other Agency
Division of Water Quality
Trn 1- 2'7-"
Routine 0 Co�laint� O Follow-up of DWQ inspectionw0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
13 Not Operational Date Last Operated: 0 Registered 22� Certified ©Applied for Permit' ermitted p
Farm Name: !�l (�Glr?+..f..saw.. �!'� County:.....................................................................................
Owner Name :......11�f?. .. 1d.lo` .................................. Phone No:
.... ..Z��.L... ... ........................` .....................
Facility Contact: .. ". cJ,f l...'I °r►. �i� Title �'7TG MA s'✓4.G�,�...... Phone No: ...................................................
............... ......... I.
a .f! Q e, f
Mailing Address:.. ..[.......:...x... {.....................�............ ............ fir............. .7.. �. Z.................................... ........................
...
! L I
Onsite Rep resentative:..........Qr-. L G�v2......................................................: Integratora�„70d.. .I7aj�.it.....�7
Certified Operator,..........,,:.... 5], M Q- .... Operator Certification Number,,,,,,,,,,,,,,,,,,,
... ........ .........
Location of Farm:
r•
LatitudeLongitude
Design Current' . V . Design Current Design Current
Svi me Capacity Population
:'Poultry Capacity ;Population 'Cattle Capacity, Population
y
#%
❑ Wean to Feeder
:
(] Layer
❑ Dairy
❑ Feeddfto Finish
❑ Non -Layer
❑ Non -Dairy
.'.
r
arrow to Wean��
x a a
[� Farrow to Feeder
❑Other
r
`
❑ Farrow to Finish
Total Design�Capac�ty
❑ Gilts
.
€
❑ Boars
Total SSLW
.
..... .
Number o. Lagoo 1 Holding P;onds
❑ Subsurface Drains Present
❑ Lagoon Area
ID Spray Field Area
f
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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
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 ONo
❑ Yes o
❑ Yes ,� Noo
❑ Yes Ld'No
❑ Yes
;?9
❑ Yes ;FN9,11�
❑ Yes XNo
❑ Yes
❑Yes ❑Zo
El Yes j
Continued on back

•
Faciliiy Num er• 33-7
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes o
Structures (Lagoons,Iiolding fonds, Flush fits etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes C;t o
Structure I----��Struc�t�ur�e/2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .... ... .I.�. �`�'T�:(�1...........................................................................................................
....................... ........ .........................................
Freeboard(ft):.... J.1.... ............... ....�.r...J�../.........................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes 4o
11. Is erosion, or any other threats to the integrity of any of the structures observed? ElYes No
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
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or ru off entering waters of the State, notify DWQ) '
15. Crop type �.. -t �r .... �1+a.. ' t:..`..'?..s.......................................... .............. ....................................................................................�No
....... ....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? - ❑ Yes
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment? ❑ Yes No
a
20. Does facility require a follow-up visit by same agency? ❑ Yes o
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes�No
22. Does record keeping need improvement? ❑Yes
For Certitied or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ;�No
24. Were any add' ' nal problems noted which cause noncompliance of the Certified AWMP? ❑ Yes25. Wenyadditional problems noted which cause noncompliance of the Permit? ❑ Yes
No.vitilationso' d6riciencies4i ere.n6t;ed,dtiring this:vis.it You.wily receive no.ftirther,'
.•correspQr�dei�ceafiou�this'visit:•: - ::•:: :: ..•,.•, .-.:.::.:... .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Routine
Facility Number
flow -up of DSWC review O Other
Date of Inspection 7
Time of Inspection 24 hr. (hh:mrn)
E3 Registered © Certified [] Applied for Permit [3 Permitted 113 Not Operational I Date Last Operated: ,•
Farm Name:...../ .. fi ... !-�.. .. .. .. County • i� Z'� .a ............................
Owner Name:..
Facility Contact:
Follow.
..................................................................................... Phone No: .......................................................... .............................
................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:.......................................................................................................................•..........................................................I....................... ..........................
J�,
Onsite Representative:...�1 .�y .. %...�..-1-.t'�- ............ z�!`1 �� .. Integrator:....Q.6... j3...OX .......................
Certified Operator: .............................. .......... Operator Certification Number;....................
Location of Farm:
Latitude Longitude C� • �� ��
Wean to Feeder{ ❑Layer
❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non Dai
Farrow to Wean
Farrow to Feeder ❑Other
d �
Farrow to Finish Total Design C*aalcitl
Gilts ,
Iota! oSSLV_V.
Boars ��� n� .� . �"��� j,� .n ��
C
C
Subsurface Drains Present 110 Lagoon Area Spray Field Area
14,
No Liquid Waste Management System�kp
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 [IOther
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
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?
7/25/97
❑ Yes PIN' o
❑ Yes Vf No
❑ Yes [7`No
❑ Yes A No
❑ Yes P`No
❑ Yes P�No
❑ Yes �ffNo
RrYes ❑ No
❑ Yes RNo
❑ Yes P"10
Continued on back �.

Facility Number:
8. Aie there lagoons or storage ponds on site which need to be properly closed? ❑ Yes XrNo
Structures (Lagoons.Holding Ponds, Flush Pits, etc.) l
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes XJ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ..... ��, 4......�.........(�..-.....�..................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes j2rNo
IL Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes XNO
I2. Do any of the structures need maintenance/improvement? ❑ Yes 91No
(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 ;allo
Waste ARiplication
14. Is there physical evidence of over application? ❑ Yes ❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
I,IL=
15. Crop type ..!!'' va..A................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [�No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ETNo
18. Does the receiving crop need improvement? ❑ Yes "*No
19. Is there a lack of available waste application equipment? ❑ Yes 0No
20. Does facility require a follow-up visit by same agency? ❑ Yes ,WINO
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes E�No
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?
[]: No.vialationsor de:rciencies. were:noted'duiiug this'.visit.. You:iiiO. recei've:ino.Furtheri
151 I)/-4v Tv 1EF5"P OF
XAj
k*rAr/6 P1vGx1C1a_41
❑ Yes ,.(TNo
❑ Yes gNo
❑ Yes EJ No
❑ Yes No
7/25/97 '
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Blount Bros. Swine Farms LLC
Blount Bros. Farm
PO Box 400
Bethel NC 27812
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
June 26, 1998
Subject: Reissuance of Certificate of Coverage
No.AWS330020
Blount Bros. Farm
Swine Waste Collection, Treatment, Storage and
Application System
Edgecombe County
Dear Blount Bros. Swine Farms LLC:
The Division of Water Quality modified the Swine Waste Operation General Permit originally issued to
this facility on September 9, 1997. In accordance with the issuance of the revised General Permit, we
are forwarding this Certificate of Coverage (COC) to Blount Bros. Swine Farms LLC, 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 Blount Bros. Farm,
located in Edgecombe County, with an animal capacity of no greater than 2150 Farrow to Wean 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, and shall hereby void
COC No AWS330020 dated September 9, 1997. The COC shall hereby incorporate by reference any
specific conditions of the previous COC issued to this facility. The purpose of this COC is to allow
coverage under the revised General Permit. Please review the revised General Permit (enclosed) and pay
particular attention to Condition II.10 regarding tree removal from lagoon embankments, Condition I1I.1
regarding inspection frequency of the waste treatment, storage and collection system and Condition II1.6
regarding notification requirements for system failures, spills and emergencies. 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.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Certificate of Coverage AWS330020
Blount Eros. Farm
Page 2
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 Katharine Keaton at [phone] ext. 533.
Sincerely,
for A. Preston Howard, Jr., P.E.
cc: (Certificate of Coverage only for all cc's)
E,dgecombe County Health Department
Raleigh Regional Office, Water Quality Section
Edgecombe County Soil and Water Conservation District
Permit File

0 Division of Soil and Water Conservalion - Operation Review ?'9i
13 Diiv• • n of Soil and Water Conservation - Compliance Inspection
ivishm of Water, Quality - Compliance Inspection
S•
© Other: Agency - Operati6n.Review
jp-Routine Q Comelaint Q Follow-up of DWQ inspection 0 Follow-up of• DSWC review O Other J
Facility Number �� ?T� I)sat.e of Inspection /tt
Inspection p 24 hr. (hh:mm}
Permitted ❑ Certified © Conditionally Certified © Registered 13 Not [) erational Date Last Operated:
Farm Name: �� .[..l�.Gi �r.T....... � .l... �?. �s �. it t ................ County:.L:�.. Gf "' . e........................................
yy !!ll 2 I
) per Name:. .......... .ram. L.3 .. .........�ti.7.�i .�i.! Phone No: .... z .z.......... ..... (.Y.7r ..............
..1.....� ..... .....
Faulity Contact: rn er r % 7'atic i 4'` .C.P!� Phone No
�L / 1 �+
Mailing;lcidress:...l�.i.. .�!..'ti ..�..r. ......... s.....G.S, ... .........................••.•......,................................................................... ..........................
Onsite Representative: Pr-K ?.................................
C. ..... Integrator: •C701 Sh!)! d 7 '��'hs
........
Certified Operator: .................. Operator Certification Number :..........................................
Location of Farm: 7 z� o j0,A r V, LS X �rj S'•
............................................... ........ ...................................................... ........................... I........
Latitude r c 9 Longitude 0 1 16
Swine
Design Current Design Current
Capacity Population Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Feeder
❑ Feeder to Finish
ff'FZrrow to Wean
' (1
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Cattle Capacity Population
❑ Dairy I I ±d
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischar�cs & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated al: ❑ Lagoon ❑ Sway Field ❑ Other
a. If discharge is observed, was the conveyance nlaa-tnadcV
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the cslimatud flow in gal/tnlnY
d. Does discharge bypass 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 adeduatc7
❑ Yes No
❑ Yes
❑ Yes;>No y
❑ Yes F
Cl
❑ Yes
❑ Yes No
Structure 1 Structure 2 Structure 3 Structure a Structure 5 Structure 6
Identifier:
Frechourd(inches): ...... ��U1........................ ........�..�`........................................................................._..................................................................................
1 /6/99
i
Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/itprovement?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
12. Crop type .... .................
..................
MESTA
■ I �
❑ Yes
❑ Yes �N�o
[]Yes
❑ Yes No
❑ Yes No
❑ Yes No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. Does the facility lack wettable acreage for land application'? (footprint) El Yes
15. Does the receiving crop need improvement'? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, reaps, etc.) ❑ Yes
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes
22. Fail to notify re r tSnal DWQ of emergency situations as required by General Permit?
(iel dischar = , freeboard problems, over application) El Yes
23.Did/viewer/Inspector fail to discuss review/inspection with on -site representative`? El Yes
24.cility require a fallow -up visit by same agency? ❑ Yes
N:o :vialations or: deficiencies :were noted du:ren'g :tliis:visit:: /You wvi11're-ceive 'no further ::: :
eorrespaidebee: about: this :visit:.: .. :: :. :.. ...:. ... :: :: ::...:::: : :
Comments;(refe'r to question #): ; Explain any YES answers and/oe any recommendations .or any other comments
Use deawings'of,facility to better explain situations. (use additional pages as necessary):'=
J-
T
1 /6/99

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
E::�EHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
September 18, 1995
Mr. William Blount
Blount Brothers Swine Farm
P. O. Box 400
Bethel, North Carolina 27812
Subject: Compliance Evaluation Inspection
Swine Operation
NC Highway 42
Edgecombe County
Dear Mr. Blount:
On September 13, 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.
380D Barrett Drive, Suite 101, Raleigh, North Carolina 27609 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 60% recycled/ 10% post -consumer paper

William Blount
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,
1' .�
1jy . 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

3 M Z0
Type of Visit XCCom nce Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Z psf Arrivai Time: f Departure Time: County:
Farm Name: 31 VU W_( b r frEcg- ,� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feder to Finish
a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Region:
Back-up Certification Number:
=0 =` 0�� g =o��
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
j
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharees & 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 frorn a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes idNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes FNE]
NA ❑ NE
[I Yes NA ❑ NE
❑ Yes NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection D�
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 o ❑ NA ❑ NE
Structure r1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (S F Mqi ^
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
(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 thre ,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ A El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo A ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) & e , , 4,q4 50-. I - a r -_
13. Soil type(s) 1 4 r0,r q_0 _ 1:�- Are1``--a— /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
YNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El
NA
LdrNo�,
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ Yes
NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Reviewer/Inspector Name sa?f Phone:
Reviewer/Inspector Signature: t7L Date: b�
12128104 Continued

Facility Number: 23 _ Date of Inspection �9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2rNo ❑ 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 El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo ❑ 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
No - NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Th o
12 ❑ 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
ZNo ❑ 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? (iel 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
,F: _. �: . ,. �. .� f � nt� i' r f- t�
Additional Conxments_andlor',:Draw�rigs ,;; y ,. � � � �� F
��ti _� _�.
12128104

o to
Type of Visit Q'Colutine
li nspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: J I Arrival Time: 13 C Departure Time: County:
Farm Name: o La r-:::,* iZ 4, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: �`'� 0 f �: E Opt + + LlS
Certified Operator: " n
!sack -up Operator:
Location of Farm:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 6 = 1{ Longitude: = o = L =
16
Design Current
Swine Capacity Population
Design Current Design
Wet Poultry C*specify Population Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Layer I
1 ❑ Dairy Cow
ElWean to Feeder
1 10 Non -Layer I
I ❑ Dairy Calf
ElFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ N ers
Non -Layers ers
❑ Dairy Heifer
❑ D Cow
ElNon-Dairy
ElBeef Stacker
❑ Beef Feeder
❑ Pullets
El Beef Brood Cow
Number of Structures:
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 VNo ❑ NA
❑ NE
❑ Yes /No//'❑ NA
❑ NE
El Yes NA
❑ NE
❑ Yes dt ❑ NA
❑ NE
o ❑ NA
ElYes;No
[I NE
El Yes ❑ NA
❑ NE
12128104 Continued

r
Facility Dumber: 3 3 --
Date of Inspection r
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: "45 D
❑ Yes No NA ElNE
ElYes No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 �r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ,NA ElNE
(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 thre , " otify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes;No0No NA El
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No 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) L' 0 0 S a $ 1 5';^19/
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
VINo ❑NA ❑NE
❑NA ❑NE
No ❑ NA ❑ NE
L�[:]NA ❑ NE
/❑ No ❑ NA ❑ NE
„ �r #s�#°'1iifJiIfsiic
Comments (refer to question #} Explain anyTYES-answersiand/or any,:recommendations or any other comments.
Use drawings of facility to better explain situatioiii:(use_aadiditional pxagyesbas necessary,):
Reviewer/inspector ector Name x
P
Reviewer/Inspector Signature:
i �
— t/ Z
I t U
Date: I
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections;NoF_1
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 K
A ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ YesA ❑ NE
26. Did the facilit fail to have an active) certified o erator in char e? ❑ Yes A ❑ NE
Y Y p g27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑YesA ❑ 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
Additiopal Cotninents attdTai• Dra►yings�t`+
& "O�
i
jqV
12128104

t Z(2<(-t 0
3
Type of Visit 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /� Departure Time: County:
Farm Name: L �'1'L Al `Y f� �iL/i� Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:(�A/'u 6L—
Certified Operator:
Back-up Operator:
Title:
Phone:
r Phone No:
Integrator: rPlcjy �i - ca
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = I = ff Longitude: ❑ o = i =
Design
C*urrent
Design Current
Design Current
Swtne Capacity
Population
Wet.PouiEltry� {' Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dr Poultr.
y y
❑ Dry Cow
❑ Farrow to Feeder
`"
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Boni
Discharges & Stream Imoacts
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 Z <No[C:l NA [INE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes N El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El o ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection �W
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes No �A El NE
a. If yes, is waste level into the structural freeboard? El Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:S(%•
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l/ '3 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ 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 El 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes:�N�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) & om & G4 J 4 r,A f, n 1'
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?
El Yes:N�o
NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
o ❑ NA
❑ NE
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
o ❑ NA
❑ NE
4a X� 5 lu 4e s-ft ,-W_ -r
IZ/3I/za?Y
Reviewer/inspector Name I Phone: '21 Z
Reviewer/Inspector Signature: Date: j L/Z3 //()
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather 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 �To El NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �ro
NNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ElKo[----]
NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
ElYes o ❑ NA ❑ NE
❑ Yes �o[__] A ❑ 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
�:., ,_
Additional Comments andlor=Drawmgsi
Page 3 of 3 12128104

_ cility Dumber hate of visit: %li crr�e:
10 Not Operational Below Threshold
Permitted OCertified
/ [3 Conditionally Certified [3 Registered Date Last Operated or Above 'Threshold:
Farm Name: 0 �T 1� r 1,'T I�+'3'1.�� County:
Owner Name: Phone No:
Mailing Address: /� L
Facility Contact: �� I "dam 1 f S Title: Phone No:
Onsite Representative: d Integrator: Ids 46
Certified Operator:._ �' r,! P !� 3 �a �` -� Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 64 Longitude o �• �~
g
D C
VI ,>, E ; , !"sign '��� Desacantv�.'�Po"
. (Current
3 g '. I `Ft i �.S E
�' •Pt ieletion� Cattie' . �il8ent
Iswine= EI I' sa aciri Po ulaUon tton
❑ Wean to Feeder"
❑ La er ❑ Dai ?'
❑ Feeder to Finish
[Ell Non -La er ❑Non -Dairy °
❑ Farrow to Wean
,
❑ Farrow to Feeder;
�, �c6 ;' ° `,�' EE� 'il c;;$',, _ `, ;9
❑{{
i ❑ Farrow to Finish
jOther ,I
Etlt •' ,��.
¢ I{ 1 fB /� � E€iE�S��y£f!E(�3�i�p���s� � { SfE�E
�E{�1% I��I 1 i I TAJt�� ��eS�QQ�i a�[}�' F `.
W 4
b ( 171�I iF E P ¢j L 'I �iI _ E b 7
1 ❑ Gilts
Ity,.,
°
Boars
TotsS�'SLW❑
k
i `, Numher of Lagoons y ' I
'Ili+� IE K i ❑Ir
Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
/
tHolding=Ponds 13 Solid Traps �,
IEttj i{ t� ❑ No Liquid Management System
r
�, Waste 1d
, Ck.�.3 _ 1 , �.•
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes .. No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other /
a. If discharge is observed, was the conveyance man-made? ❑ Yes:No
o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes
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 N
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste CUllection && Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Struvure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: AiU
Freeboard (inches): I� L
05103101 Continued

Facility Number:lj —
Date of Inspection �—
5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type f ( f Y✓S
13. Do the receiving crops differ wit 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?
Ree uired Records & Documents
17 Fail to have Certificate of Covers e & General Permit or other Permit readil available?
❑ Yes No
• ❑ Yes tNo
❑ Yes No
❑ Yes
❑ Yes o
El Yes o
El Yes o
❑ Yeso
❑ Yes No
❑ Yes LINO
❑ Yes o
es ,❑ No
ElYes L o
g y ❑ Yes M<TJQ1VO
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 o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 1'
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer, to gttestiun #) 'IWxplaln any;YES answers and/or �tny recamtneridations or anv other comments. (! ' `E <` ';
Else`drawing''s of facility to lietter` explatri sttuatio©s (nse'sdiditroiial pages as necessary) E;',�.❑ Field ryCory yN"[] Final Notes c,
i a n 1 M r i c ?C,�
3,.. �,,+.w=•� .x r: .a- i . E 1 ' i ;drys-lia.
%y yr 5-gj C r �� J 4 •� d s it Ui �. -' ; S lP.y t7i�.�Y/J�� —r
W.r /*-r-x iVpa 9-_ b A-r Or A�4 jy d 1-- a -�
EV ,� Or d t-v i n i,,�q ah file. s .4 drn� .
it , ire �{. r rp �� a � _ .�.... { �.. .._ { ., Y E E e 3^•.�,�
Reviewer/Inspector Name
� I •i i�- 1 - 9
Reviewer/Inspector Signature: Date: 7� d
05103101 Continued

Facility Number: —'7a 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?
and/or
❑ Yes ETNo
❑ Yes
❑ Yes jN5o
❑ Yes No
El Yes
❑ Yes �No
Yes
J
05103101

II
Fkifity Number.
91Division
vision of"Water Quality of Soil and. Water Conservation
Q Other Agency
iType of Visit ,Qj Com nce Inspection Q Operation Review Structure Evaluation Technical Assistance
ReasonforVi!it Routine 0 Complaint 0 Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Z i) Arrival Time: 0 p Departure Time: County:
Farm Name: L P./rt✓! ( (5 /Pt" Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Region:
Phone No: ��""
Integrator: ��S Yl� TUG
Certified Operator: c // 13&t _n Operator Certification Number:
Back-up Operator:
Location of Farm:
Design
Swine':. Capacity ;I
❑ Wean to Finish
❑ Wean to Feeder
❑ Fe-eder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other;;
❑ Other
Title:
Back-up Certification Number:
Latitude: = e = d Longitude: = ° = 4
mC Design Current , De
t►nn E� WeEPoultryr Capacity :Population '� Cattle' . Chj
�..❑Layer
.
❑ Non -Layer I }
Dry Poultry
i
❑ Layers
91Division
vision of"Water Quality of Soil and. Water Conservation
Q Other Agency
iType of Visit ,Qj Com nce Inspection Q Operation Review Structure Evaluation Technical Assistance
ReasonforVi!it Routine 0 Complaint 0 Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Z i) Arrival Time: 0 p Departure Time: County:
Farm Name: L P./rt✓! ( (5 /Pt" Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Region:
Phone No: ��""
Integrator: ��S Yl� TUG
Certified Operator: c // 13&t _n Operator Certification Number:
Back-up Operator:
Location of Farm:
Design
Swine':. Capacity ;I
❑ Wean to Finish
❑ Wean to Feeder
❑ Fe-eder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other;;
❑ Other
Title:
Back-up Certification Number:
Latitude: = e = d Longitude: = ° = 4
mC Design Current , De
t►nn E� WeEPoultryr Capacity :Population '� Cattle' . Chj
�..❑Layer
.
❑ Non -Layer I }
Dry Poultry
i
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number af,Strucl
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 ;No
No A ❑ NE
[I YesN NA ❑ NE
El Yes ETA ❑ NE
❑ Ye?,ZN NA ElNE
ElYe❑ NA ❑NE
❑ Ye ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection 2 ,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Eel 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: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r{
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No NA ❑ NE
(ic/ 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 thre otify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes;No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes No I NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
1 �l�
12. Crop type(s) I� �� # A . 57 -, A .\ n� s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Nq/❑ NA ❑ NE
o,ZNA ONE
❑ NE
NR,"❑ NA ❑ NE
No ❑ NA ❑ NE
Comments refer to question # : Explain an YES answers and/or an recommendations or an Other ;comments "i
( a ) � y y .., y
Use drawings of facility to better explain situations. (use additional pages as. necessary.)..
AL
I
Reviewer/inspector Name I -- - -Y --� Phone:
Reviewer/Inspector Signature: .ems f Date:
Page 2 of 3 12128104 Continued

Facility Number: 35 — Date of Inspection 7 Z
Re uired 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 ElYes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections eather Code
22. Did the facility fail to install and maintain a rain gauge? El Ng�❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
gt�60[:]
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
N NA
❑ NE
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
Additional Comments and/or Drawings:. .
Page 3 of 3 12128104

i
Facility Number
Division of Water Quality
0: Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Corn ce Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: D Arrival Time: E Z Departure Time: County: Region:
Farm Name: : L h-\- " 4 7 D 1`7�2 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 02+0 r! _,4
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 No:
Integrator:)
Operator Certification Number:
Sack -up Certification Number:
Latitude: 0 0 = Longitude: = ° = I =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_I Layer �
❑Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Design Current
Cattle Capacity Population,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o <EIN ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes VC0 NA ElNE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes �N�
A ElNE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yee ❑ NE
other than from a discharge?
12128104 Continued

I
1 �
Facility Number: 3 3 — Ld i Date of Inspection /Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes WNo"'O
ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑Yes NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: S F O
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No ❑ NA ❑ NE
or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drifl [I Application Outside of Area
12. Crop type(s) t l r^ k.c�
13. Soil type(s) f
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
(' N ElNA
o ❑ NA
N ❑ NA
❑ NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/inspector Name ,3" f 7 I��[ ' Phone:
Reviewerllnspector Signature: Date:
12128104 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eNo, ❑ 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 El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZrNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No [INA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNoo El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�,
la No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N ❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes7T'jo
NA
[I NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
❑ 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? (ic/ 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
Additional Comments and/or Drawings:
12128104

.j
Type of Visit Com nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Jf l7/ Arrival Time: ® Departure Time: County:
Farm Name: fr r L<- n -� st�� e7+eh-- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [= o = = Longitude: = ° 01 0
11
Design
Swine Capa�ctty
Current
Population
ign Current Design Current
Wet Poultry Ca�pac�ity Population Cattle Capacity Population
❑ We to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
Dry Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
El Beef Brood Cow
El Turke s
❑ Turkey Poults
❑ Other
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes, No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes N ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El
No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ZN ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation`? ❑ Yes N ❑ NA ❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes No ❑ NA ❑ NE
Y P P P
other than from a discharge?
Page l of 3 12128104 Continued

tf
Facility Number: —
Date of Inspection b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 5W P-1+4I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
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 J2 No NA El
ElYes �No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes o "NA El
ElYes No ❑ NA ❑ NE
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 r
0 NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYeso NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;No
o NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
/, ' 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
No NA
�
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6i��❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA
❑ NE
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3 12128104
Continued

•1
Date of Inspection �t r
Facility Number: — Zzj
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ZrNo NA
❑ NE
20.
Does the facility fail to have ail components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ ather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
No NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
NA
rKN
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
[:I NE
26.
Did the facility fail to have an actively certified operator in charge?
El
No NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
El
o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Cl 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 reviewhrispection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments indlor Drawing"s
i
7
Page 3 of 3 12128104

-N-uunber 3 Date of Inspection 'v� , J
Time of Inspection / Zp 0 24 hr. (hh:mm)
0 Certified [3 Conditionally Certified [3 Registered Not O erational Date Last Operated: ,•••„•,•„•,•,•„•„•....
Farm Name: Ll..r...Q./.4:..7.J�.... I-Cd-f.4./7:702w.................................... County:....!.' 4000�1M6 Z
..................................................
Owner Name:.._e.// 8 .......................// (3....... �pY............................................... Phone No:...Z Z ....1 '/Y� 3
...........................................................................................
Facility Contact: .... Z, a /L Title: ................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
OnsiteRepresentative: ..m.G�.,�, .`.I;, . A"'e—�� Integrator.,• Ol �{'„ 0..._CY,F..•��G•-.r'
..............................................
z
Design ':Current
Design - Current �� 4 ; ', �t ,Design' tCurrent 3
$wme,:
Cact a
Put
"Tattle:,
Capacity udon "; }Ci Po 'ulation
�� ❑Layer
4 ❑ Dairy
❑ Non -Layer
Non -Dairy
!,�,�.:
��• a,t.��,.ur�s,
❑Other
....... ...� I,. .-
{
r11 :ti,
o
ti t t rF , N n"�.'
it
Total Design Capacity;,_.
t.
•
'' `
TotaltSSLW z,,i
_
@ ..''
iOp
a •"11 ,'i'Number of Lagoonst �,�n�(; ,' ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area 4
lj
„4 fi hl, Holding Ponds / SolidyTrape
0;
❑ No
Liquid Waste Management System ��, ,� ,�1q d n,l t,�q'
Wean to Feeder
❑ Fee o Finish
arzow [o Wean
2 / j
❑ Farrow to Feeder
1
Farrow [o Finish
❑ Gills
❑Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑'N/o
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑Yes ,
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (II' yes, notify DWQ) ❑ Yes N�
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;�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: � � f� �
Freeboard(inchesl:.................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
3/23/99 Continued on back

lF'acility Number: 3 — Date of Inspection FST/ Tr 61
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? I (:]Yes
�tvo
(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 a 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 0<0
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes d No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ElYes No
12. Crop type �y-,.�, �9 -0w-, _g
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ��No
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes �No
15. Does the receiving crop need improvement? ❑ Yes JQN0 '
16. Is there'a lack of adequate waste application equipment? ❑ Yes No
Rc uircd Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes o
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes FNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time.of design? ❑ Yes21. Did the facility fail to have a actively certified operator in charge? ❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ YesN
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes
24. Does facility require.a follow-up visit by same agency? ❑ Yes o
25. Were additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes o
_ ' �'�i� •yigla�ign�s'o� d��c�e�c�e� •ire pQte�3• �iH`i4g t��s:v�sit; • Y'o>j� with •�ee�iye �o fu4-th�r • . •
corres ori�enee. abautr this .visit. •
Reviewer/Inspector Name
5 r f... . s�' N•,�: �—�' ' 'yq 1��, �, i� ` k Ys'4dn i� Reviewer/Inspector Signature: Alth Date:

Facility Number: 3 j — p Date of Inspection S/ti/'sue
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 o
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes N
❑ Yes No
❑ o Yes

acility Number: — 1 Date of Inspection
Printed on: 4/24/2000
l�q yib[a ig s'o� ile cie�teie$ were tioie�l clp i�rg fl�assi#: YYou"will•teeeik•nq •fug#het
:corres ondehc' e ab.oirt this'visit: • :.... :...... .
❑ Field Notes ❑ Final Copy 3 J-' S" l 13 i -7 2 Z / (
Aso
(Loy
3 a x3
ME
i
,� k��,
i
Reviewer/Inspector Name ;r'�.1 .. ;. '?, ., `', t ,�.
Reviewer/Inspector Signature: Date:

Type of Visit f?ICompli a Ins{tection O Operation Review O Lagoon Evaluation
Reason for Vls/It autine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 2 C7 Time:
Facility Number
O Not Operational O Below Threshold
13 Permitted 13 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ....................
Farm Name: 1177d ....!/ Y�...................................................................................
JC....................'..:......................... Count ..
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact:..............................................................................Title:................................................................ Phone No:...................................................
MailingAddress:.................................................................................................................................................................(.........._................................. ....................:.....
Onsite Representative . ... Integrator: „ +?,� d�� �" V i'elc ,
Certified Operator:....... a4-....�!. A..........................1............................................ Operator Certification Number:....:............. ..................
Location' of Farm:
[]Swine []Poultry []Cattle []Horse Latitude �' �� ��� Longitude '
Swine
Design
ennarity
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
° Neiinber;of Lagoons
:voiding Ponds 1 Solid Traps',
° 'Design - Current Design Cutrin
Poultry Capacity 'Population Cattle Cif , cl`Po `ula
❑ Layer ❑ Dairy
❑ Non -Layer JE3 Non -Dairy
❑ Other '3
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present 11❑ Lagoon Area I❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. 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
("4' Structure 1 Structure 2 P`tt� truclure 3 Structure 4 Structure 5
]] �4
identifier: .........7.�0..'..............................................................................................................................................................
Freeboard (inches): ,
5100
❑ Yes _e_9�0
❑ Yes �"l�o
❑ Yes �'No
❑ Yes 3 No
❑ Yes No
❑ Yes a
❑ Yes No
Structure 6
Continued on back

Facility Number: a��v�L Date of Inspection Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public. health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste_ Application_
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over
/application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type �.A+'lSfi9'! �iYK3
13. Do the receiving crops diff6r 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 itprovement?
16. Is there a lack of adequate waste application equipment?
Rectuired 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? (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 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. Wreany additional problems noted which cause noncompliance of the Certified AWMP?
fthjc}ent W. 00 )nOipd• i>��ng tb js,vis}t,, :Y60 3011 tebvi*0 00 iFll1)J ftf
:. cor:resporidence: abotit: this visit: ..::.......::........:::....:....:. .
+ditiona! pages as necessary) 8 ;; R
❑ Yes 0•No J
❑ Yes qNo
❑ Yes
_Q'No
❑ Yes:No
o
❑ Yes
❑ Yes
o
❑ Yes
IJO
❑ No
❑ Yes , NNo
El Yes�No
❑ Yes
❑ Yes
❑ YesNo
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes No
❑ Yes o
ElYes o
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
A6
f 1
.�
Reviewer/Inspector Name ' ✓� '� r 1 {� a �� '� ` 61 1 f
s q [ f
Reviewer/Inspector Signature: t Date: S/pp

Facility Number: z, -1 —Z Date of Inspection L L 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 atlor 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 biade(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 ;31
❑ Yes o
❑ Yes o
❑ Yes xo
❑ Yes o
❑ Yes
❑ Yes No
ona ommen an or rawrtwgs I
� •3 �,
�� • ..,, ';�,m€' C . �"A 6- :.
A.
5100

Fa Number Date of visit: 'rime: ��
10 Not Operational 0 Below Threshold
jEfPermitted [3 Certified eQ^ Conditionally Certified 0 Registered
Farm Name: 1�1/� _ �� /]17T.✓
Owner Name: e, rl__ C64C17
Mailing Address:
Date Last Operated or Above'rhreshold: _
County:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Z� integrator: ��s ✓""
Certified Operator: en'�`( 6 d4 Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 46 Longitude 0 1 «
Design;, Current
Swine C'anacity Ponulation
❑ Wean to Feeder
❑ Fe to Finish
arrow to Wean
?i
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
of'Lagos"��
L,Solid Traps
Design Current Design, Current '
Poultry Capacitv Population Cattle Capseltv Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
I
Total Design Capacity
Total SSLW
JLJ x ., ❑ No Liquid Waste Management System
Field Area
Subsurface Drams Present Lagoon Area Spray
s; P
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Ifdischarge 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 Structure 3 Structure 4
Identifier: 04 4i h
Freeboard (inches):
05103101
Structure S
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes ffNo
❑ Yes o
❑ Yes o
❑ Yes No
Structure 6
Continued
L

Facility Number: > —
Date of Inspection Z a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 117 e1
13. Do the receiving crops differ ith those designated in t e 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 or other 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? (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 fa ility require a follow-up visit by same agency?
25. W re any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONo
❑ Yes eN,
❑ Yes VNo
El Yes
❑ Yes No
❑Yes No
ElYes i
o
i
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
N
No
No
No
o
❑ Yes
❑ Yes o
El Yes N
El Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Co`mments'(r'efer to question #): Explain any YES answers and/or any recommendations dr any other comments '
Use drawings of facility to better explain�sit`"ilonst (use additional pages as necos.sary� " ❑ Field Cony ❑ Final Notes
01
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: z D
05/03/01 Continued

Type of Visit Otompli ce Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9,'Aoutine Q Complaint O Follow up O Emergency Notification O Other © Denied Access
cility Number Date of Visit:
Permitted 0 Certified 0 Conditionally Certified 0 Registered
FarmName:.�Ql f w� ........................................`..................................................
PD Time: ri0 d
Q Not O erational Q Below Threshold
Date Last Operated or Above Threshold:
County: .........................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
MailingAddress: .....................................................................................................................
Facility Contact: .............................................................................. Title:
Onsite Representative:
Certified Operator: ...................................................
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
❑ Yes 2<0
El Yes No
_�j7Z
❑ Yes No
❑ Yes!No
NO
ClYeso
❑ Yes
Structure/1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ o:t ^� IS
Freeboard (inches): t'f
12112103
Continued

F'neility Number. � -- 2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ;��o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes N
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
l I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes9N�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type bekA- i"Ja,
13. Do the receiving crops differ with 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?
IS. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
❑ Yes N
❑ Yes
❑ Yes N
❑ Yes
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�._.:`:lNf}'e'I��L�'a�n".&=.. "3i Y�+"�.'1tfi•!E'st '�lNJ..y,Y•G._•�:.,t '.�-w "tL-� ''•-" � 1,:'�sd6F"t�.,,..i��....'� y:M-�y2_.i��..�.L'i€,"'t,:.i:"P233. J"`e3', r"br&]r L;;�:. .>.,�.:' ��.:f ..A�i�E):.1a W^°u. �A'.�s°P i s4. �- �'.:i�4i;_:
Z-1
Use draw�ngs:ofacilityatotbetter,explaYnEs�tuataon' {useaddttional pages as3aecessary} ;.,• Field Co Final Notes i''}�. `'`_;
;r, �-�'�:=,'j''r � k;; �'���,t`�' i' ,. _ ���•r � + �.� � �-� .��.�''ir r..,ar . �: ,. , . �� t ,� , �ea� �p� asp �- �� ,F�
.i Y._.�il '1.. <. I..ih l ,.I:ir�. M. �, �.fiN?�..,.. tM� li:.,�t..k. .31� „dza.: i ..,. M: � � '� i 1 .�1:- ,� � ';-_�x..3P:�,:�k ��,'1'•a. � 4'.t t� §�•t `.. `S ,
i
Reviewer/InspectorNamer �,',�'''"'`-�-;trm/ I Yr�{u;'°o:�Hrr�r��
Ran*
RU
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ Yes E;`N�o'
❑Yes ❑' IhO
❑ Yes 0No
❑ Yes No
ElYes/N4/"
El Yes
❑ Yes No
❑ Yes o
❑ Yes ld't�o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

JU'L-14--1995 15:26 FROM DEM WATER QUALITY SECTION TO
RRO P.02/02
Site Requires Immediate _Artentlittr-
r� �J Facility No. 3 -
�j- ( DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ , 1995
Time: Q - , �� rQl
Farm Name/Owns
Mailing Address:
County: 2yt-�: ��;.�
Integrator:
On Site Representative:
Physical Address/Location: n"l�-
C-
-'aType of Operation: win 2 Poultry Cattle
Phone:
Phone:
C►-An X,
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _ Longitude: ` _' Elevation: ______meet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 ye?�t.
4 hour storm event
es
(approximately 1 Foot + 7 inches) r No Actual Freeboard: _ Inches
Was any seepage observed from the lagoou(s)? Yes 90Was any erosion observed? Yes or
Is adequate land available for spray? es No .Is the cover crop adequate? Yes Of& H
Crop(s) being utilized-.
Does the facility meet SCS rninimurn setback criteria'? 200 Feet from Dwelling or No
100 Feet from Wells? or No
>. Le animal waste stockpiled within 100 Feet of USGS Blue Line Strearn?r&
anknal waste land applied or spray irrigated within 25 Feat of a USGS Map Blue Line'? Yes
's animal waste discharged into waters of state by man-made ditch, flushing system, or other
similar man-made devices'? Yes o N; if Y -s, Please Explain.
'), s Ric facility waintain adequate waste nixiagernetit records (volumes of manure, land applied,
Spray irrigated on specific acreage with cover crop)? Yes or No Ytv�
Additional Comments: 0�A5�" Au•,�'_- - _
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.
TOTAL P.02

�- ��'�/� ►fir"""_
~. ,Di —Rion of Water Resources
Facility NUm�er ©- L4R� O Division of Soil and Water Conservati1 MR
on
0 Other Agency
Type of Visit: ACompliance Inspection F5 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 hollow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /!/-( Arrival Time: Departure Time: 1571 County: Wegion:
Farm !Name:
Owner Email:
Owner Name: 'Bl o u t-A- E o o +h e t'S Fo. c, rn Phone:
Mailing Address: rN-%, yy\r,
Physical Address:
Facility Contact: Title:
Onsite Representative: �j-Q.tty� &5
Certified Operator: �rn� } C
Back-up Operator:
Location or Farm: Latitude:
Phone:
Integrator:
Certification Number: ALA) 100 a $ (o S
Certification Number:
Longitude:
Design C*urrent
'
Design
Current
Design Current
Swine
Capacity Pop.
WetIPoultry
Capacity
Pop.
Cattle Capacity P.
lilt 1
Wean to Finish
I
11-ayer
Dairy Cow
Wean to Feeder
I
INon-La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Q
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr,
C>_a aeit
P,o P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
i 0
on -Layers
Beef Feeder
Boars
1pullets
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
N ❑ 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
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
NA
rNo
CD 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 21412015 Continued

Facility Number: r_ - 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 I Structure 2 Structure 3 Structure 4
Identifier: Z 5 Q L IA 50W.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
(i,e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes
❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No NA ❑ NE
❑ Yes No DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environreat, notify DWR
7. Do any of the structures need maintenance or improvement? El
YesrNo
[] 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❑ 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?
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): &/- &? Aj 6,
13. Soil Type(s): 4 Q 1 p S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesP.N
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yeso
❑ 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?
❑ YesgNo
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 eather 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 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 21412015 Continued

Facili Number: - Q jDate of Inspection: - ( -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
QAAA_ a 0 1
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes g No ❑ NA D NE
the appropriate box(es) below. a Q 1 'l
❑ 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 ❑ ❑ 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.
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
Cojhments_(referjo 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).,
wov ad5a. 10-1-11 mwv0,*11
woo'151 L4 46-l-1'7
tvoo 1YGa19 a - 1- 1-1 toti
Woo 3145 to-alo -ltt ass 1
p; s..r O -4.o
p = 4--7
C_4 W f'10 109 9 -0 -16
Rcviewer/Inspector Name:
Reviewer/[nspector Signature: L(.
M" v, LO s nol5 1:L ut03 6 10
o.gtq r
OtR Ce
o ,5fr
Phone: g t Q n 11 C4 - 1 3 !o
Date: l V_ i d
Page 3 of 3 21412015