660014_PERMIT FILE_20171231

w
Type of Visit /d Com ' ce Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
F ' tv Number Date or Visit: 'Time: U
Not O erational 0 Below Threshold
Permitted LO Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: i, f '�� County:
Owner Name: v' Mrv� c Phone No:
Mailing Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator: "4c" Gt
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' * " Longitude ' ' �~
Design Current Design Current ` Design Current
Swine Capacity Population P ultry Cavacitv Population ; Cattle ' J Carineltv Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
❑ Other ...:g:
❑ Farrow to Finish L._ ,. Total Design .Capaeity
❑Gilts �
❑ Boars Total SSLW
U Subsurface Drains Present
1
Discharges _4 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?
Area 10 Snrav Field Area
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): !
05103101
$ i5ar
:...ram
❑ Yes
❑ Yes
No
No
ElYes No
❑ Yes N
❑ Yes N
❑ Yes VNo
El Yes
Structure 6
Continued

Facility Number: F1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 11 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
WasAe Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes N
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type i, ems'
13. Do the receiving crops differ with those designat d in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑, No
16. Is there a lack of adequate waste application equipment? ElYes Id 0
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) es VNo
❑ NN
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El
21. Did the facility fail to have a actively certified operator in charge? El Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ElYes FNo
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? ❑ Yes
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
y ._ . y d ments y .-:,
Comments(refer to questron)Explain an „YES answers,andLor an recommendations or`=C�Feld
Use drawings of facility to better explain situations.;(use=additional`pages as nee sary,) py ❑_Final Notes
YV As cv l w- pL,- Iq y �.�H 4- pillI
(D�J�Sr ��S�a*-J 01=
Reviewer/Inspector Name s aN l/I X
.�
Reviewer/inspector Signature: r Date: L
05103101 Continued

Facility Number: — l Date of Inspection
Odor Issues
25. 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, andlor 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 ErNo
❑ Yes E No
❑ Yes No
❑ Yes OlNo
❑ Yes No
❑ Yes �'No
❑ Yes No
Additional Comments and/or Drawings:
05103101
05103101

Z! 4 l 1 o
Type of Visit RI -co ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L2_2Z41j ID I Arrival Time: VEZ=1Departure Time: County:
Farm Name: � (4,1 ) S� .� .. Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =] o = ' = Longitude: [=] o =
Design Current
Design Current
Design
ineCapacity Population
Wet Poultry ,opacity Population
opacity Pn
ffitio
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑ Non -Layers
El Pullets
❑ Beef Stocker
El Beef Feeder
❑Beef Brood Cow
❑ Gilts
❑.Boars
❑ Turke s
❑Turkey Poults
❑Other
N umber of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
No NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[:]Yes
No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
[:]yes
NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
NA
PNo
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Numher: -- Date of Inspection ?- b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �oo
'NA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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
(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 thr , 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
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 El NE
maintenance/improvement?
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 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) S rc C-�7✓ r1
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZI N NA El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
N NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
N A ❑ 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
No ❑ NA ❑ NE
Commenis {refer to question #): Explai `fin} YES. answers and/or any; recornmeniiations oe,,any other corriments
Use drawings of facilityto better explain isituattons {use additional' pages as necessary): win r�r
J
T
Reviewer/Inspector Name
Phone: l— y ZO
Reviewer/Inspector Signature:
L'_ .G Date:
12128104 Continued

Facility Number: Date of Inspection 2 2 0
Required Records & Documents ,��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes 0<0 .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. 0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ ather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ YesMN
N . ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesNA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ YesNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes
A ❑ NE
27. 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? ❑ YesA ❑ 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
AdditionaI�Cornments and/oi Drawings a
12128104

WASTE UTILIZATION PLAN
F 1
Producer Bhl7E ROSE; INC
Location ,,Old Mill, located)on s'
18225 Three; Creek
Telephane'. 804-8342109 i
Type Operation Topping° Y
Number of Arnmal Units:_.1300
i
r� J a I 1'1iJ+x trla'
outh side of Jenkins' Mill
Rd ;,JCaproi Va 23829'IP
;1 4
I f Y 1
Y r
f JT
it
�
i
s
4
1
} 1
4 3.
1
The waste from your animal facility must be land applied at a specified rate to prevent pollution of surface
and/or ground water. The plant nutrients in the animal waste should be used to reduce the amount of
commercial fertilizer required for the crops on the fields where the waste is to be applied. This waste
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 content 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 available water holding capacities. Normally waste shall not be
applied to land eroding at greater than 5 tons per acre per year. With special precautions, waste may be
applied to land eroding at up to 10 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, Either of these
conditions may result in runoff to surface waters which is not allowed under DWQ regulations. 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 applied to bare ground not more than 30 days prior to planting. Injecting the waste or
disking will conserve nutrients and reduce odor problems.
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 analysis.
This waste utilization plan, if carried out, meets the requirements for compliance with 15A NCAC 21-1.0217
adopted by the Environmental Management Commission.
Amount of Waste Produced Per Year (gallons, tons, etc.)
1300 animals X 751 gal. waste/animal/year = 976,300 gals. wastelyear.
Amount of Plant Available Nitrogen (PAN) produced Per Year
1300 animals X 2.3lbs. PAN/animal/year = 2990lbs. PAN/year. (PAN from N. C. Tech. Guide Std. 633)
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.
RECEIVED 1 DENR J DWQ Ar
r
�1
Aquifip r R!-r,t—t;r» gpntion
a 4'

The following acreage will be needed for waste application based on the crop to be grown and surface
application:
Year 1
Tract
Field
Soil Type
Crop
Real
Lbs. N
Acres
Lbs.N
Months
YEAR 1
Yld./Ac
per acre
Used
Applied
239
3
NoA
Com
110
14
1848
Feb 151Jun
Sm grn
50
16
800
30
Sept 1/Apr
30
3
BOB
Peanuts
0
16
0
Apr 1/Sept
Sm gm
50
16
800
30
Sept 1/Apr
30
YEAR 1
30
3448
TOTAL
239
YEAR
Bob
Cotton
700
84
5
420
Mar 15/Aug
2,3
Sm gm
50
5
250
1
3
Sept 1/Apr
30
3
NoA
Cotton
700
84
25
2100
Mar 15/Aug
Sm grn
50
25
1250
1
Sept 1/Apr
30
YEAR
30
4020
2,3
TOTAL
T 21
1
BOB
Soybeans/d
23
4
1 X75%
69
Apr 1-Sept
ble crop
15
NoB
Soybeans/d
33
4
4.4 x75%
435
Apr 1-Sept
ble crop
15
2
BOB
Soybeans/d
23
4
6 x 75%
414
Apr 1-Sept
ble crop
15
NoB
Soybeans/d
33
4
6.4 x
633
Apr 1-Sept
ble crop
75%
15
3
BOB
Soybeans/d
23
4
3 x 75%
207
Apr 1-Sept
ble crop
15
NOB
Soybeans/d
33
4
4.1 x
406
Apr 1-Sept
ble crop
75%
15
4
BOB
Soybeans/d
23
4
4 x 75%
276
Apr 1-Sept
ble crop
15
NoB
.Soybeans/d
33
4.3 x
425
Apr 1-Sept
ble crop
ni
75%
15

i 21
1
BOB
Cotton
700
.12
1 X75%
63
Mar 15-Aug
Sm gm
50
37
1
Sept 1 -Apr
30
NoB
Cotton
700
.12
4.4 x75%
277
Mar 15-Aug
Sm gm
50
165
1
Sept 1 -Apr
30
2
BOB
Cotton
700
.12
6 x 75%
378
Mar 15-Aug
Sm gm
50
247
1
Sept 1 -Apr
30
NoB
Cotton
700
.12
6.4 x
403
Mar 15-Aug
Sm gm
50
75%
240
Sept 1 -Apr
30
3
BoB
Cotton
700
.12
3 x 75%
189
Mar 15-Aug
Sm grn
50
112
1
Sept 1 -Apr
30
NoB
Cotton
700
.12
4.1 x
258
Mar 15-Aug
Sm grn
50
75%
154
Sept 1 Apr
30
4
BOB
Cotton
700
.12
4 x 75%
252
Mar 15-Aug
Sm grn
50
150
1
Sept 1 -Apr
30
NoB
Cotton
700
.12
4.3 x
271
Mar 15-Aug
Sm gm
50
75%
161
Sept 1 -Apr
30
3257
Year2006
1
BOB
Peanuts
0
1 X75%
0
Apr 1/Sept
Sm gm
50-20=30
22
30
Sept 1/Apr
30
NoB
Peanuts
0
4.4 x75%
0
Apr 1/Sept
Sm grn
30
99
30
Sept 1/Apr
30
3
BOB
Peanuts
0
6 x 75%
0
Apr 1JSept
Sm gm
30
135
30
Sept 1/Apr
30
NoB
Peanuts
0
6.4 x
0
Apr 1/Sept
Sm gm
30
75%
144
30
Sept 1/Apr
30
3
BoB
Peanuts
0
3 x 75%
0
Apr 1/Sept
Sm gm
30
67
30
Sept 1/Apr
30
NoB
Peanuts
0
4.1 x
0
Apr 1/Sept
Sm grn
30
75%
92
30
Sept 1/Apr
30
4
BOB
Peanuts
0
4 x 75%
0
Apr 1/Sept
Sm grn
30
90
30
Sept 1/Apr
30
NoB
Peanuts
0
4.3 x
0
Apr 1/Sept
Sm gm
30
75%
97
30 1/Apr
30

T 239
3
BoB
Sept 1-Apr
Wheat grain
55
1.7
20 X75%
1402
30
June 1-Sept
Soybeans/
15
double crop
23
4
20 X75%
1380
3
NoB
Sept 1-Apr
Wheat grain
60
1.7
16 x75%
1224
30
June 1-Sept
Soybeans/
15
double crop
33
4
16 x75%
1584
Total Table 1 YEAR 1 = 3448 Lbs. N
YEAR 2, 3 = 4020 Lbs. N
YEAR 1 T 21 =2865 lbs. N
YEAR 2, 3 T 21= 3257 Ibs N
Year 2006 = 6336 Ibs N
Amount of N Produced = 2990 Lbs. N*
Surplus or deficit c -458 YEAR 1
.1030 YEAR 2, 3
with tract 21 = -3323 Ibs N year 1
r 4287 Ibs N year 2
Year 2006 (t 239 and t 21) = 4046 Ibs N
* This N is from animal waste only. If nutrients from other sources such as commercial fertilizer are applied,
they must be accounted for. N must be based on realistic yield expectation.
NOTE: The applicator is cautioned that P and K may be over applied while meeting the N requirements.
This plan only addresses Nitrogen.
NOTE: The Waste Utilization Plan must contain provisions for periodic land application of sludge at
agronomic rates. The sludge will be nutrient rich and will require precautionary measures to prevent over
application of nutrients or other elements.
NOTE: The applicator is cautioned that P and K may be over applied while meeting the N requirements.
This plan only addresses Nitrogen. When using soybeans and peanuts in the rotation 20_pounds of_N
sh uld be reduced from the following year's crop. No nitrogen is applied to peanuts.
See attached map showing the fields to be used for the utilization of wastewater.

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Field
No.
Application of Waste by Irrigation
Soil Type Crop
Application Application
Rate In/Hr Amount In.
3
Norfolk
Com
0.4
1.0
3
Bonneau
Cotton
0.5
1.0
3
Norfolk
Small grain
0.4
1.0
3
Bonneau
Small grain
0.5
1.0
T21-f1,2,3,4
Norfolk
Soybeans, peanuts
0.4
1.0
Bonneau
Soybeans, peanuts
0.4
1.0
Norfolk
Cotton, sm gr,
anuts
0.4
1.0
Bonneau
Cotton, sm gr,
peanuts
0.4
1.0
Your facility is designed for 180 days of temporary storage and the temporary storage must be removed on
the average of once every 6 months. In no instance should the volume of waste being stored in your
structure exceed Elevation 99.5.
Call the local Natural Resources Conservation Service office (252-534-2591) after you receive the waste
analysis report for assistance in determining the amount per acre to apply and the proper application rate
prior to applying the waste.
Narrative of Operation:
Waste will be applied to com, or cotton and small grain in the fall. Tract 21 will be used as agreed to by
Bobby Lassiter. Waste will be applied to soybeans and to cotton and small grain cover. Soybean rates
have been reduced by 7 bushels per acre when double cropped. Crops planted after the soybeans (i.e.
cotton or small grain) must deduct 20 lbs. of N per acre as a result of residual carryover.

REQUIRED 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.
2. There must be documentation in the design folder that the
producer either owns or has a notarized agreement for use of adequate.
land on which to properly apply the waste. If the producer does not
own adequate land to properly dispose of waste, he/she shall provide a
copy of a notarized agreement with a landowner who is within a
reasonable proximity, allowing him/her the use of the land for waste
application. 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. Actual yields may be used in lieu of realistic yield tables
at the discretion of the planner.
4. Animal waste shall be applied on land eroding less than 5 ton per
acre per year. Waste may be applied to land that is eroding at more
than 5 tons but less than 10 tons per acre per year providing grass
filter strips are installed where runoff leaves the field. (See FOTG
Standard 393-Filter Strips)
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 N.C." for guidance.)
7. Liquid Waste shall be applied at rates not to exceed the soil
infiltration rate such that runoff does not occur off site 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
odor and flies.
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 depth that would
prohibit growth. The potential for salt damage from animal waste
should also be considered.

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 or forages breaking dormancy.
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
any perennial stream or river other than an irrigation ditch or canal.
Animal waste other than swine waste from facilities sited on or after
October 1, 1996, shall not be applied closer than 25 feet to surface
water. This distance may be reduced for waters that are not perennial
provided adequate vegetative filter strips are present (See Standard
393-Filter Strips).
12. Animal waste shall not be applied closer than 100 feet from
wells.
13. Animal waste shall not be applied closer than 200 feet of dwellings
other than those owned by the landowner.
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 a discharge or by overspraying. Animal waste may be
applied to prior converted cropland provided it has been approved
as a land applications site by a "technical specialist'. Animal waste
applied on grassed waterways shall be at agronomic rates and in a
manner that 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.). Areas
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 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
preplant with no further applications of animal waste during the crop
season.
21. Highly visible permanent 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 for waste storage ponds.
22. Soil tests shall be made every two years and a liquid waste analysis
be taken at least twice each year consistent with waste utilization
plan. Poultry litter shall be tested prior to application. Soil
and waste analysis records shall be kept for five years.
23. Dead animals will be disposed of in a manner that meets NC regulations.

WASTE UTILIZATION PLAN AGREEMENT
Name of Farm: Old Mill, BLUE ROSE INC.
Owner/Manager Agreement
I (we) understand and will follow and implement the specification and the operation and maintenance
procedures established 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 storage system or
construction of new facilities will require a new certification to be submitted to the Division of Water Quality
(DWQ) 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 from a storm event less severe than the 25-
year, 24-hour storm. The approved plan will be filed on -site at the farm office and at the office of the local
Soil and Water Conservation District and will be available for review by DWQ upon request.
Name of Facility Owner: BLUE ROSE INC.
Signature: ? 7I C1,/ '`�� Date: µ �'�
Technical Representative: Tony Short
Affiliation: Natural Resources Conservation Service
Address Agency: P.O. Box 218
Jackson N.C. 27845
919-534-2591
Signature: Date:

Type of Visit: �"C0 lance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: ,x 7-/ ArrivalTimed Q S Departure Time: County:
Farm Name: 131L(.Q. 1205f- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: hl /1 ff #,7 "1 Q s Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:
¢'
Design Current
Design.
Current
Design
eity
Current
Pop
Swine
Caapacilty
Pop
Wet Poultry
Capacity
'Pop
Cattle
Carpi
fll E
llJNlHI,11 �I
i4 Ylhufll
i t fh Arifr#HlFifls, r
ifl4 rfllAfltitlui
I ilnirif
Ilflt3Will
�ld$rH#1139 €n
filiflblei[f
Wean to Finish
La er
Dairy Cow
W n to Feeder
Non -La er
Dairy Calf
eeder to Finish
Q
Daia Heifer
Farrow to Wean
Design
Cur`:rent
Dry Cow
Farrow to Feeder
D • , Poult
Catlflaci
Pop.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Ot11!111
1 1
Turkey Poults
Other
vt46€§EtlWI+ouWbi33M3flvwwtl7E4Nelu IwKYWLYm34iBk})3El�ulnliNs}q}yil3.mneFrFk3ioirnnV
Other
!.
t
!
€
.
� h4Nnrtuna�RiNiErFypign3§ru}INHtiE333Yi1iMwflnitE}§€IDkntFaeululllffPf{mry1ry16NAl1ufffYlifE€3133
�
€i�HfNbi
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
o ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of 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
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility, Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;Zo
o NA ❑ NE
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34 &
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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:�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
rent, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
n 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): C-0 A/ S
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VI ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
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 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continuer!

Facility, Number: - l Date of Inspection: —X7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NI
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' uestinn;# Ex lam an YES;answers'andlorian additional recommendatians'or'an other commentsi'!�`'
'.lass• _ u . ".!-,e,.,, ,.i ,.kt..<{i E [t:.F �,t� ..t. ".r ;�
I,,;" I:nV'il"., n ilk , It . [:I< .t,[ ,III, 441 +4,', I%" ! ,4 tli.., .t IIN, Ilisis ., Et.iE; .. i,i Ili, :IEctiic"tl i I iI!li,l i�i3111i9;IllilYl'�iiiililbid !,l j lr ii
Use,drawingsi:oflfacili,,,to„better,,expiaio,situot>Ions. (useiadditional ages,as,;.pecessa :).!�I?i,,!iO!�I�d��i��f�tlli��li��iIli,3���1�1�ji�i�l�t�9!�illlllllli=
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: r FJ t ,S T eiI'
Date: 3 —J- -7 — 1 k
Page 3 of 3 21412015

Type of Visit: �Q Com ' ce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance j
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access it
Date of Visit: � Arrival Time: Departure Time: County:
Farm Name_ --6-1 4A __�3Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
can to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. F,oul
Layers
Design
C►urgent
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Points
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 ZrNo ❑ NA ❑ NE
❑ YesF.(,X
❑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 ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214,12014 Continued

Facility Number: - Date of Inspection: 3 -- 7 ,G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3s `i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
ZrNo ❑ 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 eat, 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 Zf No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ 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): 4-0_ 4 64k,4,,� t�&A+,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
❑ NA
VJrNo
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
gNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
12<0 ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� NA
❑ NE.
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No ❑ NA
❑ NE
Page 2 of 3
21412014 Continued

acifi Number: - Date of inspection: / 7 -/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E:fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ZINZ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �OO NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:)Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES,answers and/or any, additional,recommendi tions or an*4other comments -'...
Use drawings of facility to better explain situation'sJuse additional. pages, s neces"saryj ;' Hf
4-12--/-r
r ';�-3 $
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Phone: '% g I ^ -(ZeD
Date: '3-- / 7 -- i
21412014
Page 3 of 3

-1/7
Type of Visit: f0Co jance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: Departure Time: � County: Region:
Farm Name: �� $ 3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Al". nl.l L--r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Non -La er
i
Dairy Cow
DairyCalf
DairyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design Current
WW
D Cow
Farrow to Feeder
D P,oultr,
Layers
Ca aeit
P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Pullets
Turke s
Beef Feeder
Beef Brood Cow Ell
Boars
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? []Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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?
CDYes
o ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facil'st Number: - G Date of Inspection: — -2v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 fl
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 environment reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZfNoz 0 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):�"'rQ�� '
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
th t
❑ Yes Z
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
' b
e approprta e VA.
❑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 Transfe ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesV013 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 N ❑ 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑' Yes 0 No ❑ NA D NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
Comments (refer_to question #):FExplatn any YES=answers and/or,, any, additional.recommendat,ions or any other. comments ,�,
Use drawings of,facility to better explain �situationsuse additional pages as necessary).
Co- //be,rti o- e, z -7 _If
:5114 J52- su7 � -r -/�
Reviewer/Inspector Name:
Reviewer/Inspector Signature: 1.3 Gt s+z4 . -Taz, a- h
Phone: -%q f ' t( zo P
Date: 3 -- -;-o I ')
Page 3 of 3 21412015

(Type of Visit: QF Co lance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:'�f�" Departure Time: EZ3T:] County:
Farm Name: Mix J�Q j (7 _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: /)1�-f h7 Jr ,=s Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
C►urrent
Design Current
Swine Capacity Pop.
Wet Poultry Capacity
Pop.
C►attle capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
iry Heifer
Farrow to Wean
I Dry Cow
Farrow to Feeder
D , P.oult . Ca aci
P,o ..
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes rNo
❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ 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 [—]No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: jDate 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?
❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
2N�0
NA ❑ NE
No ❑ NA ❑ NE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): It
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No
NA
(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 ❑ NA
waste management or closure plan?
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o 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 T'ype(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VN�O NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes N NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No NA ❑ NE
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 o ❑ NA 0 NE
th a r riate b x
e pp op o
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspecti;No�NA
dge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility 1Qumber: &6 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes r(No
NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge'? ❑ Yes N ❑ 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 properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations oar any other:comments. E a
Use drawing&' f facility to better explain"sifuations'(use additional pages;as necessary). 4
i
5 so r%✓z lD - 2� -t ��
Clq s
Reviewer/Inspector Name:
Phone: -M
Reviewer/Inspector Signature: Date:
u- !
Page 3 of 3 21412011

i
(Type of Visit: 'Corn ia�ce Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emerizency O Other 0 Denied Access 11
Date of Visit: ///�., Arrival Time: Departure Time: County:
Farm Name: L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsitc Representative:
Title:
Phone:
Integrator:
Phone:
Certified Operator: m . "L h'! , ! f -s Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P.oultr, Ca aci Ho
I Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
11111111
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
eNo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NA
gNo
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
'
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
[] No [] NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

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

Facilfty Number: L Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations -(use additional pages as necessary)
I- I.,; — tJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 t'f 2(% 'a
Date:
21412011

I_--_ f 1 ( L)( eZ-
Hype or visit: g�t_piiance inspection t1 operation Keview V structure rvaivanon tV iecnmcai Assistance I
Reason for Visit:outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: L 0 3 d County: Region:
Farm Name: 13L r & Sie-3 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: &7! j tl'-- M i r i? —f
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Designs .:Current
Wet Poultry Capaty Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
De. $oultr. Ca acit
I;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
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
LTNo ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
0 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
NA
FNNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes❑
NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 1 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
111 N- o NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
o ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). Q ��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
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 at, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
;;No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 0 fib— f `r IV,. 5'�-N T T 4 i r3 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?
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.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes PN ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes hl ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �rNo
< ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Other:
2l . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: _
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes e No 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(cs) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations br: 'any. otheir comments.
Use drawings of facility to better explain situations (use additional pages as necessary):; '; .i
d,55�irve
7
p,. 3
Reviewer/Inspector Name: Phone: 2�z � d
Reviewer/Inspector Signature: L Date:
Page 3 of 3 21412011

12(1S1 1
G
{Type of Visit: &. Co nee Inspection O Operation Review O Structure Evaluation p Technical Assistance
(Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z ( Arrival Time: ' !p Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator: %%?
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Design
Capacity
Current
Pop.
Wet Poultry
Desigq., .Current
Capacity Pop.
Design
Cattle C►apaeity
Current
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Nan -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I)r, P■oultr,
Ca aci
P■o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ YesgNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NA
FNoo
❑ 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 Ins ection: z f
f'J1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
Y " o NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
io 0 NA
❑ NE
Structure I 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
Z.,No NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
o ❑ 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 rent, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 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 ❑t Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): '] /'? a} ! n J , Gc1 ` t �7►-L
U. 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?
I& 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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes Q No ❑ NA ❑ NE
❑ Yes L!J N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ff No . ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes gN
NA ❑ NE
Yeso ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZI No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes o ❑ NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facilit y Numlier: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit'? ❑ Yes N❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesEre-
❑ 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? El Yes No ❑ 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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
[]No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any3other comments
Use drawings of facility to better explain situations (use, additional pagevas necessary}': A, , 11),
gr
P- Li,:5­f
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '79/— Zd O
Date: 1 Z / l y�
21412011

1
Type of Visit Com ' ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z(1 Arrival Time: I / / Departure Time: County: Region:
Farm Name: _�I w e R-0,5C 3 .__ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j
Certified Operator: %y I:f„ � ` 1 1
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = = 1{ Longitude: = o = ' 0
Design Current
Design Current Design Current
Swine Capacity Popuation
Wet Poultry C•apctty Population C►attle Capacity Population
❑ Layer ❑ Dairy Cow
❑'Non -Layer I ❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
ElNon-Dairy
❑ Layers
❑ Beef Stocker
on -Layers
❑Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other I ures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes Zo
El NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [3 Yes ❑ 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 rNo
NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes NA El NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes NA ❑ NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes �`No❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Avplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tNo
❑ NA ❑ NE
maintenance/improvement?
It. 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 AcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) � Z 42 P-, z Sr`' r,q
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
F/-rTN
❑NA
ONE
El No
❑ NA
❑ NE
1�
❑NA
❑NE
/// No
❑ NA
❑ NE
❑No
El NA
❑NE
-- --- G�
Reviewer/Inspector Name il° �i.A '� a`�=r Phone:
Reviewer/Inspector Signature: L. ,1 Q/L Date: r/12 Qj L 1 0
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?
❑ 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Ma g ❑ Other
ps
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ve AtoO NA ❑ NE
f
❑ 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? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes N NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes o ❑ 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
t rttonallCa,mmentsundlc►r,brawingsT_r Va ;w ,1A V�.
01
i
T
Page 3 of 3 12128104

''
3/z0 Y
Divicign of Water
n i-'M
Division afSoil and WhterConServahon�
Other A enc $1� A �:
g pr
.wm.
Type of Visit Co
lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Time: Q %j O Departure Time: � County: Region:
Farm Name: l;�
go
go SQ � Owner Email:
Owner Name:
Phone:
� �Fa'ctltty� ,NUm_-
Mailing Address:
Physical Address
Facility Contact: Title: Phone No:
t�
Onsite Representative: Integrator: � �j
Certified Operator: t r�J Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: � o = ( = N Longitude: = ° = , = ,i
V t� Design: CuYrentA ' Design;, )Current.
`.. Design Current s.
5wute Gapacrty=Popitlat�on ytWet Poultry :Capacity P�pulatfon Cattle Capacity iftilatton
a. T; °. ;.,.rr. �. Y-.kt �x4 -
❑ Wean to Finish ; ❑ La er�`
❑ Wean to Feeder ❑ Non -La er I
❑ Feeder to Finish .
❑ Farrow to Wean Dry Poultry
❑Farrow to Feeder
F.
i ❑
Farrow to Finish
❑ Gilts
El Boars - --- r - --- —
= 4a
F Other'J.
i s
i,
❑ Other - �T -� N be f¢S rtuctures k 1+-
row
um
�!�
� a
❑ Layers
Mailing Address:
Physical Address
Facility Contact: Title: Phone No:
t�
Onsite Representative: Integrator: � �j
Certified Operator: t r�J Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: � o = ( = N Longitude: = ° = , = ,i
V t� Design: CuYrentA ' Design;, )Current.
`.. Design Current s.
5wute Gapacrty=Popitlat�on ytWet Poultry :Capacity P�pulatfon Cattle Capacity iftilatton
a. T; °. ;.,.rr. �. Y-.kt �x4 -
❑ Wean to Finish ; ❑ La er�`
❑ Wean to Feeder ❑ Non -La er I
❑ Feeder to Finish .
❑ Farrow to Wean Dry Poultry
❑Farrow to Feeder
F.
i ❑
Farrow to Finish
❑ Gilts
El Boars - --- r - --- —
= 4a
F Other'J.
i s
i,
❑ Other - �T -� N be f¢S rtuctures k 1+-
row
um
�!�
� a
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Puuets
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beet Brood Cow
'
Discharges & Stream Im_-_pacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made'?
❑ Yes
N NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No A
❑ 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 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
o ❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters or the State
❑ Yes
❑ No ❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104 Continued

r
Facility ]Number: DIP Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V
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 o NA [I NE
❑ Yes;No[] NA ❑ NE
Structure 5 Structure 6
❑ Yes No A ❑ NE
❑ Yes No ❑ NA ❑ NE
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? El Yes No NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes "NoNA ❑ 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) /'f , lj
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
ONo NA
<No NA
Wo
❑ 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):
Reviewer/inspector Name Phone: Z-uD
Reviewer/Inspector Signature: Date: (� Q
I2128104 Continued

r
' r
Facility Number• — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No A
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
o ❑ NA
❑ NE
the appropriate box. WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
A<oo 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 ❑ W er Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No A
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NoNA
❑ NE
24.
Did the facilityfail to calibrate waste application equipment as re required b the permit?
q Y
❑ Yes
�,
2< NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No ❑ NA
❑ NE
Additional Comments and/or Drawings.s . '
o
Page 3 of 3 12128104

IrINaeilit4y Number
I
G
Aloffivision of Water Qualit y
Q Division of Soil and Water Conservation,
O Other Agency
Tape of Visit A5'Com nce Inspection O Operation l eOieW O Structure IWaluation O Technical Assistance I
Reason for Visit l outine O Complaint O FolloW up O Referral O I:mergencj O Other ❑ Denied Access Ij
Date of Visit:
Z h)
Arrival Time:
Departure Time: County: Region:
Farm Name:,
Lr
%Zt3-
_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:,__ 1
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
I Back-up Certification Number: -
Latitude: e = = Longitude: = °
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
l❑ 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`?
_1
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dix Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes �No❑ NA
❑ NE
NA
❑ YYEM:INo
❑ NI,
❑ YNA
❑ NE
❑YNA
El NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes�ANoCDINA ❑ NE
Structure I 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 o 'NA El 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 thr , notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes No NA ElNE
(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 ElYes No ElNA ❑ 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?
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 [__1PAN > ] 0% or I0 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)
ir7—Y
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
;TNX0O NA
No ❑ NA
P�'y ❑,NA
V, j� 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
r
Reviewer/inspector Name Phone:
Reviewerllnspector Signature: // Date: z
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.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes s2 o A ❑ NE
❑ Yes o ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
hlo ❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
9 XN ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/�o ❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes❑
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
Comments and/or Drawings:
12128104

4L
Division of Water Quality 4i4
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
E
of Visit Com nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
on for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: r t'a R2,o'ILe. Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J A4 % 7-(.,SG 1G//�� & t?
Certified Operator: ),l t I�.
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = d Q Longitude: ❑ ° = r ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑
Dairy Calf
❑
Daia Heifej
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
❑ Yes
o Ni
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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?
12128104 Continued

Facility•Number: — C
Date of Inspection 2 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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Ge/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
through a waste management or closure plan?
❑ Yes o ❑ NA El NE
❑ Yes;N`Cl NA ❑ NE
Structure 5 Structure 6
❑ Yes 01'No NA ❑ NE
ElYes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �NoNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes;N�oj-NA ElNE
(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 f 'NA ElNE
maintenance/improvement?
It. 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 to lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifil ❑ Application Outside of 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
o NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ NA
El
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ 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):
ze140 JW4 Sl AtAe-mWV-44 Po 'I—
Reviewer/inspector Name e, : Phone:
Reviewer/Inspector Signature: Date: Z a
12128104 Continued

Facility Number: — Date of Inspection Z C
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑.NA ❑ N)
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 [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes;N�o,0
o NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes
A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 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? (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: I
12128104

um . ac�ltty N1>ier.
ivision ofWaterQualrty =,
Division of Soil and.Water. Conservation
0 Other Agency
Type of Visit (�tompli�nce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0ZU't"utine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Z (7 Arrival Time: Departure Time: County:
Farm Name: t ") � � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: A JI-M I T.�n CX L I-z--
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
' ❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other...
❑ Other
Phone No:
Integrator: �� t� l:t -r i2-U i �--
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' = Longitude: = ° =' 0 "
Design Current Design Current A
Capacity Population ;Wet. Poultry Capacity Population.
❑ Layer
❑ Non -Layer ---
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
----- - - - ❑ Turkeys
❑ Turkey Poults
ILJ Other j
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow_
❑ Dairy Calf ^
❑ Dairy Heifer
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 1 of 3
Design
Capacity ~_]
ent
a�hon'•-
❑ Yes No ❑ NA ❑ NE
❑ Yes Z
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE'
❑ Yes
❑ Yes
❑ Yes
rNA [INE
❑ NA ❑ NE
No ❑ NA ❑ NE
12128104 Continued

Facility'Number: — IV I
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 1 i
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
El Yes No ❑ NA El NE
❑ Yes o ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes o NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7No,,,
; notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 o NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S 0 1 / ,64' -0-
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
V
A ❑ NE
A ❑ NE
6 NA ❑ NE 6
A ❑ NE
No N El NE
Comments (refer to question #): Explain any YES answers and/oir any recomn�endatio614 any,othe . cornments
`Use drawings of facility to better explain situations. (use additional pagesas necessary).; 5F, ry ry
Reviewer/Inspector Name
�t Phone:
Reviewerlinspector Signature:
l c Date:
Page 2 of 3 12128104 Continued

Facility Number: — L Date of Inspection Y C
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 2 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. ❑ W`UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If es, check the appropriate box below.
P g P Y
❑ Yes
(�'No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El YesVN
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[]Yes
No ❑ NA
❑ NE
24.
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:
AL
�\h' Page 3 of 3 .12/28/04

Type of Visit Qtom - ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 a)Arrival Time: [� Departure Time: County:
Farm Name: G1 Owner Email:
Owner Name: r3 L� �V 7-TYN [ Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: /
Certified Operator: i2e. A I T-4-132AL—.
Back-up Operator:
Title:
Region:
Phone No:
Integrator: 1iLt,{�D- / _�_%�/QYi✓h _ 5-
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = Longitude: = ° ❑ & = {1
Swine
Design ,C,urrent
Capacity Population
Des>gn Current
Wet Poultry ryap�aity� Po\pion
Cattle
Design
Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ W No Feeder
❑Non -La el
❑Dai Calf
eeder to Finish
❑ Farrow to Wean
i,,
r s H
El Layers
❑ Non -Layers
r
❑ Dai tleifei
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
i°^
❑ Beef Feeder
El Pullets
❑ Boars_
[] Beef Brood Cow
❑ Turke s
Other
Number of Structures:
❑ Turkey Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
ZNo ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ yes
2<o ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑NA
❑NE
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State
[IYes
201"El
NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: — C Date of Inspection j 5�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: w
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y ,
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 o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Mlo ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threw notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑' lh O ❑ 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) ,._,�
4. Does any part of the waste management system other than the waste structures require ❑ Yes L-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ 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) CY446- y S ► �► ' '� 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
ErNo NA
No NA
No NA
No NA
o ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name L. �-(" j`„f:/l ,':;� egg' Phone:
Reviewer/Inspector Signature: Date: Q
12128104 Continued

Facility Number: — / L Date of Inspection 3 3 D�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes OZNo . ❑ 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 No ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
OINA
❑ NE
❑ Yes
❑ NA
❑ NE
El Yes
ZoQE01
NA❑
NE
❑ Yes
❑ No
❑1,�A ❑ NE
❑ Yes
No ❑ NA
❑ N E
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No .❑ NA
❑ NE
❑ Yes
�N ❑ NA
❑ NE
ElYes
No ❑ NA
❑ NE
Y
Additional Comments andlor_Drawings <� � °` � a � "
.wi.� 4 - 9 .:i- K .W .3 Y EA. .mks, k.-k i. s 1:...: E.A�
l(
y� �
l
61
12128104

r
Faci.li umber Date of Visit: Z Time: /U p D
Nvt O eratianal Below Threshold
ermitted [3 Certified [3 Conditionally Certified [3 Registered
Farm Name: t"- 11 h3t6-. r__
Owner Name: __-17h 1?v &) 77_4,,- C
Mailing Address:
Facility Contact:
Onsite Representative: I �j
Certified Operator: 0 dnl Try.&A—
Location of Farm:
Date Last Operated or Above Thr hold
county:
lI11%'`f1' �`�
Phone No. -
Title: Phone No:
Integrator, I?L rak'
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 ff Longitude 0 ' "
Design Current
awrne
We -to Feeder
eederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current', ...
Poultry Capacity Population Cattle capacitv Po ulation"'
❑ Layer 10 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
�'r bfaJa'-oohs
ds / Solid Traps 0'
Discharges & Stream I-.Racts
1. Is any discharge observed from any part of the operation?
Total Design Capacity
Total SSLW �E
Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
No Liquid Waste Management System
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If'discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. li'discharge is observed, what is the estimated flow in 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?
a to Collection G Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes _1
Yes
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes o
Structure 6
Continued

Facility Number: Date of Inspection L G t
Required Records & Document.~
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?
(iel 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 ❑ No
❑Yes 0'N0 '~
❑ Yes No
1__
❑ Yes O'lo
❑ Yes Id N o
❑ Yes
❑ Yes No fF .
El Yes o
❑ Yes o
❑ Yes 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 Farm [:]Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number: , — �G Date of Inspection L
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes .8 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes UWO
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' o�
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes...-- No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste ApUlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes To
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 12'No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes �jr10
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
-�a!:���:r.E:�'�tuF•:t�-�„xuM��+raE'��,;el-.lu�€C'y..y�'-'_�, ss, ,..t�-.. ��� a �:r•>.atr..t«..'t�:<<,�»�t�r=.,,,...t.n�w„�t�..����.t�:M.raxr!.ru-��,u;«„e:.�;3�.,�nar?€:� �..�,.;.....,�at�f� a�;mr.unr.������i���?iljr!��;Ri.?�y§ �(�us,���g'4�;
Comments,(refer to;,quesdan #), Explam�aaya+YES°answers and/or anyvrecommendatioas,or any other, comments. e�I„ � �� s,,,a¢„ ,, �4,t:, �;
1.: € ?;}a ..F,.`::§f1..4s.E1f1''�s.•_6._ .€yf� ,s;¢4 lk�:t. 2...:i�a.4¢.�`�d??4'1�.s>;';cl,�5dl..d6:..:€:w»"'.`t€'".hFs�it� p.�::$k64L�`.Y".li`f?:"'���,wRQ��3>f§.ilNl?�'tll.,.:§fte4t R'ak...fi°'�:.3R' ���u:n.9,mw.,:_�Pt:f.w.Eus..-:,x,.-.muua:.t�.ul..11�uK..3...�a:: .�E� �.4�tri §�
;;Use draw�ngs;oiiaerLty tobetter ea�cplatn!situattops. {ase,�ditranai psrges:as aecess�ry)•=l�i�� Field Co � Final Notes �� ``�6`�i-��
+I ii>?.is !:, a' i,st4li "i3;4.4 '.?.d Fn4:c[' ti ' t,� if%.:3i .i;:<. }� - ;'t � §`fl S4..:: 49 -4 ae:ri"'I'4°i � Si t<-,. 4 :�6E` a Y t, '.d•V" E6'4E�... t';4%s i. ❑ py ❑ .}. E °�e �
4`, s,a. i°".n E 3}� e� ix=:fl➢ �E6 �i9c.r, :<,��SFt �!t 1 i��e � t� k x:Ei x. ��' 31 "i .'?i �iieE 6 & - ' "'!t � _� 1.. esa! � (:. a € . �,x � � ( +y� ,. !t f. Sii ; �[¢q ,4 iK _ 1. I f.I E a'.�..
.Dkt. -. a_etie._ �rf34l..€,!. �ti.�5ii1.1.,,.ti,..i_. i...3...r41�... �(Max...t..-'�ie.,,f..r.IRf-n&, tw3., �,....S:terEi�-s�t..n{_�,..v9Ye.el:fn=��:SH-...���si-�us:cf3L.: AF.F�f��. i9 xB.xJ., �9:.�..�.-. #x�3i31,3�I S- ier..�._.s.,.flt .r�Yli'��y 33i1i..,.i-.3:.P:18.S�9:i•IJYGIrfi..l3,e......E=k'4:.f:�:§�i�{IEIf<tE
.. i E �}Ei a it t y
Reviewer/Inspector Name Reviewer/Inspector Signature: Date: 22 10
12112103 Continued

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number ( Date of Visit: 1 Time: E=
Not O erational 0 Below Threshold
Eller ied © Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: { y/ jam_ County:
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
1 Certified Operator: 'Lf--- _T 4
Location of Farm:
Title:
Phone No:
Phone No. -
Integrator:
t7 C—
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Ov 06 CJ66 Longitude a 6 Du
Design Current Design Current Design Currenk'
Swine Capacity Population Poultry Capacitv Population Cattle Capacitv Population
❑ Wean to Feeder F-1
Layer ❑ Dairy
El Feeder to Finish Non -Layer I I J[j Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other I
El Farrow to Finish Total Des[dn Capacity
❑ Gilts
❑ Boars Total SSLW
Number orLagoons
❑ Subsurface Drains Present ❑ La von Area ❑ S ra Field Area
Holdiri j Ponds /ESolid 7 raps � � ❑ No Li uid Waste Mana ement S stem
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 8& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 0 No
❑ Yes aN,
❑ Yes No
❑ Yes
❑ Yes
❑ Yes rN,
❑ Yes No
Structure 6
Identifier:
Freeboard (inches): LlIt
05103101 Continued

Facility Number: — Date of Inspection 0
5. Are integrity
there any immediate threats to the of any of the structures observed? (iel trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
o
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 maintenance/improvement?
❑ Yes
- No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Anolication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type art y i9-/ R i c
13. Do the receiving crops differ with those designated in de Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
&No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
���No
c) This facilityis pended for a wettable acre determination?
El Yes
,
15. Does the receiving crop need improvement?
❑ Yes
o
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Reaulred Records & Documents
17. Fait to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? �- (ie/ WUP, checklists, design, maps, etc.) El 0J N
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) El VN,,�_
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
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
24. Does facility require a follow-up visit by same agency? ❑ Yes �No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Field Copy ❑ Final Notes
Date:
05103101
Continued

Facility Number: &0 -1 ( Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes No
❑ Yes
❑ Yes tNo
El Yes
Additional Comments, and/or_Drawings:
AL
05103101

-Z.
Faci Number Date of Visit: L(,/ 2)711 Time:
I j 0 Not Operational 0 Below Threshold
ermltted �mmCerti�ied Conditionally Certified Registered Date Last Operated or Above Threshold: .........................
FarmName: ...�1.1 ,{^J,,........k.,.. �.....1.. r ........... County: .............................................................. ......................
Owner Name:._......................................................................... _. Phone No:
FacilityContact:....................:........................................................ Title:................................................................ Phone No:...................................................
Mailing Address:
OnsiteRepresentative:........................................................................................................... Integrator: ......................................................................................
Certified Operator:..... i-6-n...j.:fi +- .............. ............. Operator Certification Number:..........................................
Location of Farm: (l
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & " Longitude • d fit
Current
Poultry,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
gn Current.` 7 gn
city. ,:.Populatioit., Cattle Ca;piiicit
of Lagoons ` ' _4 ❑ Subsurface Drains Present ❑Lagoon Area . ❑Spray Field Area
Holding Ponds ! Sohd'Traps' ❑ No Liquid Waste Management System t .771
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes;No
'
b, if discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes
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 Pri
2. Is there evidence of past discharge from any part of the operation? ❑ Yes YW/
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 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �..............................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back,

r—
Facility Number: — 4 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the rec
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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 faciljWrequire a follow-up visit by same agency?
25. Wep"any additional problems noted which cause noncompliance of the Certified AWMP?
>rignjs;or.dtfclencie5, 4.... ed- d. Ding fbis'visit! • Yoo wiii-t&0iye rho fuh r • _
• corresaolicleiit e: a))atiti this visit: .................................. .
❑ Yes 40
Z.
❑ Yes W2
❑ Yes 0140
❑ Yes o
❑ Yes No
❑ Yes ' tvo
❑ Yes �
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑�N0
❑ Yes
❑ Yes o
❑ Yes N
❑ Yes �N0
❑ YesPO
❑ Yes
❑ Yes o
❑ Yes;�No
❑ Yes o
❑ Yes ❑

Facility Number: — C. Date of Inspection � Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
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 a
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 N
3 L Do the animals feed storage bins fail to have appropriate cover? ElYes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes o
Additional Comments and/ror Drawings:
E
5100

Facility Number Date of Inspection
Time of Inspection El= 24 hr. (hh:mm)
ermitted 0 Certified © Conditionally Certified 0 Registered 13 Not O erationa! Date Last Operated: ..........................
Farm fume:.....ut.o ... ��..�!...'.�.J.........�t?...".'-- .......................... County:4%}.t--f ............................................
OwnerName:......s ?r"..e� .... /z%..1.... r......... 'T....................................................... Phone No:.......................................................................................
Facility Contact: ..................................................... ....................Title Phone No
Mailing Address: ............................. ..... .............
Onsite Representative:....!.:%! 'L ....l.:........'� Integrator:..�L...........................................................
Certified Operator: J1!" 4f > > J S Operator Certification Number: ..........................................
Location of Farm: r
Ai
......................
..................................................................................................................................................................................................................................................... {
.......................................................................................................................... ................................. ....................................................................
Latitude �•�� ��� Longitude �• �°
Design. ' Current` Design Current Design €u"r`rent
Swine Capacity °'Population poultry Ca acit' Po ulatibn Cattle
Capacity .Population
❑ Wean to Feeder��
[:]Feeder to Finish
¢1y
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Da
❑ Other 2;
, TotAFDeMzn, Capacit`
Total SSLV4
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑Yes
b. If discharge is observed, did it reach Water of the State'? (Il'yes, notify DWQ) ❑ Yes INo
c. If discharge is observed, whit is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes nN
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........'.l...r.+......... ............................... .......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

-' . r-•
Facility Number: — Date of Inspvction
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
12. Crop type /'.f� -{�1-- , f 0
❑ Yes o
❑ Yes
;
❑ Yes
No
�No,
❑ Yes
❑ Yes
N
❑ Yes
No
13.' Do the receiving crops differ with tKose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
pi'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
to
b) Does the facility need a wettable acre determination?
❑ Yes
�10
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop.need improvement?
❑ Yes
WNo
5
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents %
17. Fail to have Certificate of Coverage & General Permit readily available? El 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 7Nja'
19. Does record keeping need improvement? (ie/ 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 actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes
23. Did Reviewer/Inspector fail to discuss rev iew/inspection.with on -site representative? ❑ Yes
24. Does fa ity` require a follow-up visit by same agency? ❑ Yes N
25. ere any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0//
No
Rio violaficjt>!s or deficiencies ."re• nQtsd• dt.i•ring this'visit. • Y:ou wiil-teeeiye nti further: :
-4) rrespondenc'e: about: this visit: ::.....: :
3/23/99

Facility Number: — Date of .Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 10
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
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 o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No

iEFD'i1i�EsSjj!o0n]R
v' [if Soil and`Water,§Gonsehrvatfon ` Operation Review I (, �x
r,w - f.. i I i .s✓ j;�E�fl �I a' hR �€ r� �' i - M
{ of Soil andlWater�Conservat<on Cof Water ual>t r Com l>lance Ins ection ` w
! i
i 7 OtheiA Agency �,Q CiatI0i1Rei1CW p .p �!I� Mai ref �h� II ( rl!' rS�ilam4
g �',..i..,� ...:`;�! .. r. a
outine Q Complaint Q Follow-up of DWQ ins ection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection D 24 hr. (hh:mm)
[3 Permitted Certified © Conditionally Certified Q Registered JE3 Not Operational Date Last Operated:
Farm Name:).........'..r..1....-s1...i-''i......�'>........................................ County: t+Jl�.�'f..f�....... ..........................
OwnerName:.....1..''.`. ~......... i.............................:................................ Phone No:. Z.. ... . SS......... �.�......................,
Facilit Contact Title: ................................................................ Phone No:...................................................
wr
y:...........................................2.-....-...................
Mailing Address: -Z 43 b Y 3 Z ! l...y vV �7 iT -D
.............-.(...... ...........`..........�............I......................... Q................................................................................,.
Onsite Representative:......... `. . ..IA.j�.!. � .........................I... Integrator: •........................,................................
Certified Operator:.........- ......!.."`..M........� . r., ; t,G. J Operator Certification Number : ..........................................
Location of Farm: 5' I � 1t/ 0 d
.........................................................................................................................................................................................................
Latitude �� �� �•° Longitude �• �° ���
DES1gI1 Current
Swine 2!fl- ,€ Ca acity Po ulation �!! Poultry, ,!!,!ii-pCii acity., Po 'tilat>t'on , Cattl
❑ We o Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
f
❑ Gilts,
❑ Boars
❑ Layer F
Dairy
❑ Non -Layer Non -Dam
❑ Other
�! , + Total Design Capactty
�1 !,
I S i p
r'.. iiv f! ITOiBI $SLWL
7
........... "..'.................
Design ;'Current,
:apacrt . Po ulation s'`
i
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? (Il'yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/ruin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 01 o
❑ Yes No
❑ Yes o
❑ Yes No
El Yes 1;
❑ Yes o
Structure 6
Identifier:
Freeboard(inches):......:�........................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ( Ye No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ 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? ❑ Yes o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level_
elevation markings? ❑ Yes o
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes o
12. Crop type bAawj, to, 1 p 1 CJ44m,
r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Revictyer/Inspector fail to discuss review/inspection with on -site representative?
24. DoesAility require a follow-up visit by same agency?
25. Xere any additional problems noted which cause noncompliance of the Certified AWMP?
�: Rio yiolaticjris:or ftficiencies rare pQtbd during 4his:visit: • ;Y:oO Will•reeeive iio furth. . .
correspond nce. about. this :visit. . :
ReviewerAnspector Name #
Reviewer/Inspector Signature:
t
❑ Yes 1;160/
❑ Yes FElYes`Yes
❑ Yes
❑ Yes o
❑ Yes o
❑ Yes No
❑ Yes �.
El Yes No�
❑ Yes No
❑ Yes No
❑ Yes INo
❑ Yes
❑ Yes r� No
Date:
J
3/23/99 j'

F
Facility Number& Date of luspection /�
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 proper[y 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 rill pipe or a permanent/temporary cover?
❑ Yes ZN<o
❑ Yes
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes rN❑ Yes
Additional omments' an or, bs rawlnvp
f
L
4
3/23/99

o
^ �
�Q R6utine 0 Complaint 0 Follow,_up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date'ofl aspec Lion
C] Permitted [3 Certified [3 Conditionally Certified 13 Registered 1[3 Not Operational Date Last Operated: ..........................
Farm Name: ______ Omm�� ______
'--_— _-----__---____---_—' —_--——_---'_—�
`
Owner Name: �6vuc�v�
---------'-----'----'------------------' '------------'----'-------
`
Facility Contact . --_--'---'..._______'-----'7iMc:—'—_--'—_---------` Phone No: ________________
Mailing Address . __________________' —_�_- ^ ---- '-----_--_-----'---'------ ' '-----'
OnutcBcper*ootuGve . __ ______ Integrator: —/@���.����.--'
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location of farm:
Swine Capicit� pooillation Poultry Capacity,! Population Cattle t�l st­ i0icio,':. Population
Ej Wean to Feeder 10 Layer Dairy
Weeder to Finish 1;V Q Non -Layer I on -Dairy
Farrow to Wean
[3 Farrow to Feeder FEI Other
El Farrow to Finish Total Design C acit I Yr
Q Gilts
Boars Total W
Discharges & Stream &mQac�
'.
' i lnany di�churcoobserved from any part of the ion?
hur��mi��numdxc []�u�oon []�ycuy��N []O/h�r
upu
u. l[discharge & observed, was the conveyance muu-nuude? `
lz I[discharge ixobserved, did itreach Water o[dhxState? ([l'ycw.nob[yDWQ)
c. If discharge is observed. what is the estimated flow in guVoin?
d. Does discharge bypass u|agoon.systern?(lFycs, notify DWQ)
%[uthere evidence ofpast discharge from any part efthe operation?
3.Were there any adverse impacts or potential adverse impacts mthe Waters of the State other than from udischarge?
Waste Collection J6Treatment
4. lustorage capacity (freeboard plus storm storage) less than adequate? El Spillway
Structure I Simcmn I Structure 3 Structure Structure
0oobfier
Freeboard
(inches): ................................... ................................... .................................... ................................. ............................
5. An: there any immediate thneais tointegrityof any thestructures observed?(|c/�ncco."orc
erosion,
seepage, etc.)3/23199
Structure
1L
[]Yeo 9nNo

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or manages) through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? XYes W
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [/No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level .
elevation markings? ❑ YesNo
Waste Application
10. Are there any buffers that need maintenancefimprovement? ❑ Yes 0140
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes [INo
12. Crop type W EZ�T 1 t � / �` =.e3 5 - — -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes /rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes � No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? Cl Yes No
15. Does the receiving crop need improvement? ❑ Yes ONO
16. Is there a lack of adequate waste application equipment? ❑ Yes [�l4o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 16No
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 2Io
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) D"es ❑ No
26. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ;140
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,ZNO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
14No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
- ,�-, O�i�}•yiola�igt�}s or t��ficaeacies •v�re pQte�1• d�rritig f}�is•vis�tT • Yoir wi�i•>reet�iye �o furth�� •' •
ctirres 6fideh& abotut this :visit.. ... ... ... ... ... ... • ... •
7. e,00 Tb 'rc) til- s t}n� �L G'� U,'Cr LtN (o r'��9Ys ®FS.�r�/oL-&_-j. 15
0-IfOa- rT `16,ogl2 49 v,� PtA .Ito GovE7LaA
U
Reviewer/Inspector Name
Reviewer/Inspector Signature: -- _- Date:. ��z -?
3/23/99

Facility Number: V1— Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
J No
liquid level of lagoon or storage pond with no agitation?
/
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
0 Yes
�No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
PNo
LLL
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ lye
14
Mgt inm'ents � or r�wiri s °'�� �� � �..... ;, .�� � � � � �� � � � ��
L � ��..� r,..�.,.��c��:�'�;�s�'�:J�Y�,�;�1� .. s�'°��q'.+�,':�;,��'��"��hkt i,�tixi�'�, ��:s,'�4i�;,���s�.<, i,�. i" •'�;.
3/23/99
3/23/99

'i . v
Di of Soil and Water Conservation [3 Other Agency'
Ak�W
ivision of Water Quality f�:omnlaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility NumberE�� �Date of Inspection I �/I9/9j?
Time of Inspection � 24 hr. (hh:mm)
0 Registered Certified [3 Applied for Permit © Permitted 10 Not Operational I Date Last Operated:
Farm Narrec:....i�? �..4�..... 1..�.......'�✓.!.............::.... County:....NO r!^ y�...................... ... ........
.:
..... ..... ..........
Owner Name:I mh.- /.�r ! J YhoneNo:. ��Z ` S 'r~l 33`3......................:
......................�'+r..................................................................................... .
FacilityContact:.......J.%:�'� ..�....................... ............... Title:................................................................ Phone No:...................................................
Mailing Address:..... .. Z..........�..7�....>?.z.................�6-.L7.. ....................... .................. ..........................
frf
Onsite Representative: ........J...I...M'�`.�......
...r:......j.f ..................... Integrator: ... 4✓/..!�..'..`........................................
.....�a "'�rator Certification Number•..........................................Certifed Operator ��.................../.......O e
.. .....................................
Location of Farm:
................................ .. .. .......
Latitude Longitude
'Design Current
Design Current a , Design "",Current ,i
5rvine
Capactty,'Populatton
Capac ty Populattoq; Cattle
Capacity Papulat one
❑ W o Feeder
~Poultry
❑ Layer ❑ Dairy
❑Non -Layer ❑Non -Dairy
eider to Finish
❑ Farrow to Wean
J
" '
10 Other r"
❑ Farrow to [seeder
[] Farrow Finish
to
Total Design Capacity
"
❑Gilts
y , i.
n ffig
�> al SSLW
Tot
❑_
Boars
Nuitnber: Lfaggq / Holding Ponds'
❑ Subsurface Drains Present ❑ Lagoon Area
❑Spray Field Area 11
`.
` ❑ No Liquid Waste Management System All
y €
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?
7/25/97
❑ Yes VNo
❑ Yes
❑ Yes �No
ElYes
❑ Yes N
❑ Yes N
❑ Yes
❑ Yes N
El Yes
El Yes No

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
P_ojjd,4A
9. Is storage capacity (freeboard plus storm storage) less than adequate`?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Q Yas c
❑ yes ta'Nct
Structure 6
Identifier:
Freeboard (ft):........ �f.:... .... ...... ................ ...........
............................................................................................................................ .......................
10. Is seepage observed from an of the structures? C] Yes No
Y
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
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) .
13. Do an of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes I �'1Vo
Y 9 q
Waste Applicatio
14. Is there physical evidence of over application? ❑ Yes o
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop typed?. f :...{.... ..!"! !..^.................................................................................................................................................
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 No
18, Does the receiving crop need improvement? ❑ Yes Id N
19, Is there a Iack of available waste application equipment? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21, Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes <No�
22. Does record keeping need improvement? ❑ Yes No
Eox Cedlflvd o e
23, Does the facility fail to have a copy of the Animal Waste Management Plan readily available? Cl YesVNo
'
24. Were an dditional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes
25, W e any additional problems noted which cause noncompliance of the Permit? Q Yes
�L" No:viaiations yr deficieincies. were noted- dl iin� this visit. Y,ou wtill'receive no further- i ,
000s'pbndehce about this visit'.
i�

0
DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
Routine O Crim taint 0 Follow-up of .f}w)inspection O F{sllo«-ti of Dswc review 0 Other
Date of Iv spertion O
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time fin fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex.1.25 for I hr 15 min)) Spent on Review
11 Certified ❑ Permitted or Inspection (includes travel and processing)
10 Not Operational I Date Last Operated: ...............................................................................................
Farm Name: ........... ...... County :............... ........................
Owner Name:..lS}tyi............ LIN.G.y4............J,%Z.l.l�........../...... Phone No: .......................................
G E..
FacilityContact: ................................ :............................................ .`hitle:......,..,...................................................... Phone No:...................................................
1SailingAddress: ........................................./..........................,.1,..,........../..�.....,.............................................................................. I .................. ........., .,.......... I.............
Onsite Representative:...... 1."L., t�............. 6e.1....14.!.� .. .. Integrator:......................................................................................
Certified Operator: .................................................. .......................................................... Operator Certification Number: ..............
Location of Farm:
Latitude Longitude
Type of Operation Design Current Destn Currentf Design Current
Swine zCapacrty Population ,Poultry ' hFCapactty� Population 'a Cattle = ; Capacsty �Populatian
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish ❑ Non -Layer k ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ;N Total Resign Capacity
w Farrow to Ftnrsh ,
ry
.❑Other Total SSLW�, `
x.
Number of Lagoons /Holding Ponds ❑ Subsurface Drains Present ❑ ❑ Spray Lagoon Area Field Area t
General
I - Are there any buffers that need maintenance/improvement? ❑ Yes 111 No
2. Is any discharge observed from any part of the operation? ❑ Yes e No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other �No
a. If discharee is observed, was the conveyance roan -made'? ❑ Yes
b. Ifdischarge is observed, slid it reach Surface Water? (If yes, notify DWQ) ❑ Yes �No
c. If discharge is observed, what is the estimates[ flow in Cal/min?
d. Does discharge bypass a lagoon system? (If yes', notify DWQ) ❑Yes 9No
3. is there evidence of past discharge from any part of the operation? ❑ Yes Er"No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes��No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes
maintenance/improvement?
4/fit)/97
Continued on back

.' her: Facility Num
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. 'Ate there lagoons or storage ponds on site which need to be properly closed?
Sfructures fl,agootts andlor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): S rOctyre,l Structure 2 Structure 3 Structure 4
...........................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
in No
❑ Yes
E6�o
❑ Yes
UrNo
❑ Yes
VNo
Structure i
Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify D"'Q)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Agplic-ation
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of theel State, notify WQ)
15. CroPtyPe �'a...rr..! ......... ....... ...... ,..........L.GD'1L:.............15i,......................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes Z No
❑ Yes JzNo
Yes ❑ No
❑ Yes lQ No
❑ Yes r3/No
................................................
❑ Yes
❑ No
❑ Yes
INo
❑ Yes
0<o
❑ Yes
�No
❑ Yes
� o
❑ Yes
XJ No
❑ Yes 10 No
❑ Yes KNo
m Yes ❑ No
sig 6A16 14 V G G4--TftT o.v OtisiQ ��-oP� Te 104i-r w7' ea,�/
PIP[ To Pi21 4-. C -FI t) all t Poed _ 11)4E;y
,-214. Da /l1 rT/LO G E-J �i¢,L/4 iv
E o nU
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc: Division of Water Quality, Water Qual►Yy Section, Facility Assessment Unit 4/30/97

�} State of North Carolina
Department of Environment,
Health and Natural Resources ` •
Raleigh Regional Office
A00000%�-
James B. Hunt, Jr., Governor
Wayne McDevitt; SecretaryIDEE:HNF;Z
DIVISION OF WATER QUALITY
August 29, 1997
Mr ..lames D. Bridgers
Old Mill Swine Farm.
Route 2,13ox 324
Conway, North Carolina 27820
Subject: Compliance Evaluation Inspection
Facility # 66-14
Old Mill Swine Farm
Northampton County
Dear Mr. Bridgers:
On August 21, 1997, Mr. Buster Towell from the Raleigh Regional Office conducted a compliance inspection of the subjcet
animal facility. This inspection is part of the Division's efforts to determine compliance with the State's animal waste
nondischarge rules.
The inspection determined that your animal operation was not discharging wastewater into waters of the State and that the
waste lagoon had the required amount of freeboard. As a result of the inspection the facility was found to be in compliance
with the State's animal nondischarge regulations.
This office would also like to take this opportunity to remind you that you are required to have an approved animal waste
mans genncnt >an by December 31, 1997. This plan must be Certified by a designated technical specialist or a professional
engineer. For a listing of certified technical specialists or assistance with your waste management plan you should contact
your local Soil and Water Conservation District offee.
The Raleigh Regional Office appreciatesyour cuoperation in this matter. If you have any questions regarding this inspection
please call Mr, Buster- Towel] at [phone].
Sincerely, J�
Judy Garrett
Water Quality Section Supervisor
cc: Northampton County Health Department
Mr. Tony Shoal, Northampton Soil and Water Conservation District
Ms. Margaret O'Keefe, DSWC --- RRO
DWQ Compliance Group
RRO Files
3800 Barrett Drive, Suite 101, N%4
FAX [phone]
Raleigh, North Carolina 27609 f An Equal Opportunity Affirmative Action Employer
Voice 919-57I 4700 50% recycled/ I0°/. post -consumer paper

`❑ DSWC Animal Feedlot Operation Review
KC311UQ Animal Feedlot Operation Site Inspection k
40 Routine O Complaint O Follow-up of DWO inspection O follow-up of DSX C review O Other
Facility Number
Farm Status: �egistered ❑ Applied for Permit
❑ Certified ❑ Permitted
Date of Inspection
Time ol'Inspection �J 24 hr. (hh:mm)
Total Time in fraction (it' hours
(ex:1.25 for I hr 15 min)) Spent on Review ; O�
or Inspection (includes travel and processing)
E3Not JJOperational Date bast Operated: ....................................................................................................1............................................
Farm Name:..O.�.lw.... ..y .!/.. / ..� F9,1a. ►--- County: �.�r�%�l. ,�� T�''1.............................
........................................................... Q
Owner Nance:. ?► .....r�........ L'.!.,f ...T ' .... ... Phone No: J.��.. �?�5................................................
Facility contact: � vi,!s r� C�► ►'f .......................................................
.. .....t.:}.:l........,.,�...........�'................... ritic:............................,......,....................,... Phone No:
Mailing Address:......Z..6...D.......:.....1-1...... w! .............
t.' L:..........
3'...7....................................,......, ..........................
Onsile Representa.tiveA�u�I .. ./l...c........................................... Integrator:... ...............................................
-.7-i
Certified Operator:...! `` m!n.� ......... Operator Certification Number: .........................................
Location of Farm:
...................................... .................. ..... ................ ............ .. ................ .................................................
.... ....... .... . .... F
Latitude • 1 .4 Longittide 0 c c4
Type of Operation
�Swine
Design' Current Design ° Current Design Current
Capacity Population Poultry- Capacity„ Population., Cattle, °Capacity ; Population >.
❑ apeto Feeder
'eerier to Finish
f J p t)
ti
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
{
Number' agog ,Holdui9:Po'nds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes <o,,
2. Is any discharge observed from any part of the operation`? El Yes 10
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes U �N/b. It'discharge is observed, did it reach Surface Water'!(If yes, notify DWQ) ElYes
c. If discharge is observed, what is the estimated flow in gal/fain?
d, Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes 240
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? El Yes ('o
t
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

Facility Number: —
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes NoZ .
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes I1'No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 6 Ko
Structures (I.,agooris and/or Iloldintl Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes LdN0
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
........... ..................................................._ ................................... ....................................... ...................................... ...............................
10. Is seepage observed from any of the structures? ❑ Yes o
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 y.es, 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? es ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 0
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type t ..............................................................................................................................................................................
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?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
❑ Yes B No
❑ Yes 0 10
❑ Yes ErNo
❑ Yes No
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 r_' 40
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �j Nr
24. Does record keeping need improvement? ❑ Yes J No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit
Date:
4/30/97

... u.r :... « ..
DSWC Animal Feedlot Operation Review
❑ DWQ Animal Feedlot Operation Site Inspection
i
Routine O Com laint O Follow-u of D41' .) inspection O Follo►%--tiof f)S1VC revicLv O Other
Date of Inspection
Facility Number
Time of Inspection to" 00 124 hr. (hh:mm)
Total Time fin traction of hours
Farm Status: Registered, ❑ Applied for Permit (cxJ.25 for I hr IS min)) Spent on Review
® Certified ❑ Permitted or Inspection (includes travel and processing)
113 Not Operational Date Last Operated: .....................................................................................................n....................
Farm Name: t .1,. i..... 1 !�` �. County: (.� r.�u+ . �../..Z .....................
OwnerName: ................................................... .................... ................................................... Phone No........................................................................................
FacilityContact: ...................... ..................... ................................... .ritlV:................................................................ Phone No: .............................................
NlailingAddress . .................................................................................................................................................... ..........................
Onsite Representative :.....�L....' z?'?.. ....... integrator:.... J.''a. - -..1...................................
Certified Operator:................................................................................................................ Operator Certification Number:...........
Location of Farm;
............ ...... ... .... ............. . ...... ......... . ..... .... . .. .......... .... ........ .. . .............................T
Latitude a f 94 Longitude 0 G Li
Type of operation Design Current Design Current Design Current
Swine;::%- Capacity Population Poultry Capacity. Population Cattle ' Capacity: Population
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number iif Lagoons./.Holding Ponds ; ❑ Subsurface Drains Present [3 Lagoon area 0 Spray rield Area
General
1. Are there anv buffers that need maintenance/improvement'.' ❑ Yes �No
2. Is anv discharYe observed from any part of the operation? ❑ Yes A No
Dischar,e ori, mated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If di�char-e is observed, was the conveyance than -made:' El Yes ZI No
b. Ifdischarge is observed, did it reach Surface Water'? (If yes, notify DWQ) ❑ Yes m No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑yes RfNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes VN0
d. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [/No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
4/30/97 atuainten:uue/improvement'?
Coniiuued on hack

r
•Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed`?
Structures (Lagoons.11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
' .............................................................................................................................. .............................
Freeboard (ft): .......... ..... .............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ❑1Vo
❑ Yes [(No
Structure 6
Eli Yes f No
❑ Yes eNo
12. Do any of the structures need maintenance/improvement? j 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type .................... , ...r.....................................................................................................................................................,.,...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
I8. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violatiohs oc deficiencies. were noted during this;visit. Yo'44'ill receiv',ho ftirtherr :
'. correspondence dboitt this'. visit
❑ Yes 19 No
❑ Yes V' No
❑ Yes 111)
(No
❑ Yes No
Yes ❑ No
❑ Yes 6No
❑ Yes eNo
❑ Yes P No
❑ Yes LYNo
❑ Yes No
❑ Yes ¢ No
❑ Yes No
J C I-� i p ntGr '40n C i5AUS �� .� 5
���
�.Mri6 � G-�I�jS
j 7/25/97

• 7UL-14-1995 15:26 FROM DEt.i WATER QUALITY SECTION TO
RF-10 F.02/02
Site Requires immediate Atten!�nn-
Facility No. a
DIVISION OF ENVIRONMENTAL MANAGEMENT 66 -. y / 3-5.1okU-
ANIMAL FEEDLOT OPERAI IONS SI'Tir VISITATION RECORD
DATE: ` 21 , 1995
Time: 13 D
Farm Name/owner:_•' +''^`/
Mailing Address:
County:
Integrator: Phone: i?3_3
On Site Representative: Phone:
S 2 � c3
Physical Address/Location: 1-�_
Type of Operation: Swine _ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM_ Certification Number: ACNEW
Latitude:.' ZS ' jL • Longitude: ' ' _ Elevation: Feet
Circle Yes or No
Does the .Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approxirnateiv 1 Foot -r 7 inches)/ r No Actual Freeboard: Wit. Inches
Was any seepage observed from the lagoon(,, ? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray'? Yes or No Is the cover crop adequate? Yes otlp
Crop(s) being utilized: 4.t7�,
Does the facility meet SCS minimum setback criteria! 200 Feet from Dwellings? Por No
100 Feet from Wells? � or No
anima! waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or -
arvmal waste land applied or spray irrigated within 25 Feet or a USGS Map Blue Line'? Yes o�
animal waste discharged into waters of the state by roan -made ditch, flushing system, or other
iTnfar than -made devices') �'es or 'o if I s, Please, Explain_
fir Ks 1iic t:,icility tt.raintain adequate waste niattabenlcett Tecords (v mes of ntanure, land :applied_" . 17
spray irrigated on specific acreage with cover crop)'' Yes
:additional Comments: A/, 0 L � L 'T 0`^
cc: Facility Assessment Unit Use Attachments if Needed
TOTAL P . C2

of
0
0�
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
BLUE ROSE, INC.
704 ANDREW HALE, ROAD
LrrTLETON NC 27850
Dear Blue Rose, Inc.:
L2
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
-ti
Subject: Notice of Violation and Revocation for Nonpayment
Blue Rose 3
Permit Number: AWS660014
Northampton County
In accordance with North Carolina General Statute 143-215.1 OG, all animal operations who receive an animal
waste management system permit will be charged in each year of the term an annual permit fee. Annual permit fees are
billed following the issuance of the permit and then annually thereafter on the anniversary of that date. Your animal waste
management system permit was issued on 8/27/1999.
Your annual permit fee for the period of 8/27/2002 - 8/26/2003 is $150.00. Your payment was due 10/12/2002.
Because this fee was not fully paid within 30 days after being billed, this letter initiates action to revoke the subject permit,
pursuant to 15 NCAC 2H .0205 (c) (4). and G.S. 143-215.1 (b) (3).
Effective 60 days from receipt of this notice, the subject permit is hereby revoked unless the required Annual
Animal Waste Management System Permit fee for your animal operation is received within that time. Operation of an
animal waste management system without a valid permit is a violation of North Carolina General Statute 143-215.1 and is
subject to the assessment of a civil penalty of up to $10,000 per day. Your payment should be sent to:
N.C. Department of Environment and Natural Resources
Division of Water Quality
Budget Office
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
If you have any questions, please contact Fran McPherson at [phone] ext. 210.
Sincerely,,-
Alan W. Klimek, P.E.
cc: Non -Discharge Branch Compliance/Enforcement Unit
Ral a ig h' Re giana l' O ffi c e
Northampton County Health Department
Permit File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
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0

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
August 27, 1999 -
James Duncan Bridgers, Jr.
Old Mill Swine Farm
Rt 2 Box 324
Conway NC 27820
IT 7
1 Ilk" •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND'NATURAL RESOURCES
I
_ Subject: Certificate of Coverage No. AWS660014
._ Old Mill Swine Farm
Swine Waste Collection, Treatment,
Storage and Application System
Northampton County
Dear James Duncan Bridgers, Jr.:
In accordance with your application received on April 16, 1999, we are forwarding this
Certificate of Coverage (COC) issued to James Duncan Bridgers, Jr., 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 Old Mill Swine Farm, located in Northampton
County, with an animal capacity of no greater than 1300 Feeder to Finish and the application to land as
specified in the Certified Animal Waste Management Plan (CAWMP).
The COC shall be effective from the date of issuance until April 30, 2003. Pursuant to this COC,
you are authorized and required to operate the system in conformity with the conditions and limitations
as specified in the General Permit, the facility's CAWMP; and this COC, with no discharge of wastes to
surface waters. An adequate system for collecting and maintaining the required monitoring data and
operational information must be established for this farm. Any increase in waste production greater than
the certified design capacity or increase in number of stocked animals above the number authorized by
this COC will require a modification to the CAWMP and this COC and shall be completed prior to
actual increase in either wastewater flow or number of animals.
Please be advised that any violation of the terms and conditions specified in this COC, the General
Permit or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS
143-215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
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.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
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Certificate of Coverage AWS660014
Old Mill Swine Farm
Page 2
This COC is not automatically transferable. A name/ownership change application must be
submitted to the DWQ prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the
right to apply for an individual non -discharge permit by contacting the engineer listed below for
information on this process. Unless such a request is made within 30 days, this COC shall be final and
binding.
The subject farm is located in the Raleigh Regional Office. The Regional Office Water Quality
Staff may be reached at [phone]. If you need additional information concerning this COC or the
General Permit, please contact JR Joshi at [phone] ext. 363.
Sincerely,
r
err T. Stevens
cc: (Certificate of Coverage only for all cc's)
Northampton County Health Department
Raleigh Regional Office, Water Quality.Section
Northampton County Soil and Water Conservation District
Permit File
NDPU Files

a
State of North Carolina RECEIVED 616 `1
Department of Environment and Natural Resogfmol�a�,n/4IDN
Division of Water Quality
Non -Discharge Permit Application Form 4PR 16 1999
(THIS FORM MA Y BE PHOTOCOPIED FOR USE AS AN ORIGI AL
General Permit - Existing Liquid Animal WaAt 1*4 "§Ung
The following questions have been completed utilizing information on file with the Division. Please
r review the information for completeness and snake any corrections which are appropriate. If a
question has not been completed by the Division, please complete as best as possible. Do not leave
any question unanswered.
L GENERAL INFORMATION:
1.1 Facility Name: Old Mill Swine Farm
1.2 Print Land Owner's name: James Duncan Bridgers
1.3 Mailing address: Rt 2 Box 324
City, State: Conway NC Zip: 27C'20
Telephone Number (include area code): 585-1833
1.4 County where facility is located:CN!6rthatnpton
1.5 Facility Location (Directions from nearest major highway. Please include SR numbers for state roads. Please include a
copy of a county road map with the location of the farm identified): 2 miles east of Creebsville on SR 1510 (Jenkins Mill
Rd.IFarm is 3/4 miles south of road
1.6 Print Farm Manager's name (if different from Land Owner):
1.7 Lessee's / Integrator's name (if applicable; please circle which type is listed): Carroll's Foods Of Va Inc
1.8 Date Facility Originally Began Operation: 0 1/0 1/80
1.9 Date(s) of Facility Expansion(s) (if applicable):
2. OPERATION INFORMATION:
2.1 Facility No.: r--66----> (county number); [l4� (facility number).
2.2 Operation Des rriptton: Swine operation
Fir to Finish
1300- Certified Design Capacity
Is the above information correct? yes; Fno. tf no, correct below using the design capacity of the facility
The "No. of Animals" should be the maximum num er or which the waste management structures were designed.
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
0 Wean to Feeder 0 Layer 0 Dairy
0 Feeder to Finish 0 Non -Layer 0 Beef
0 Farrow to Wean (# sow) O Turkey
0 Farrow to Feeder (# sow)
0 Farrow to Finish (# sow)
Other Type of Livestock on the farm: No. of Animals:
FORM: AWO-G-E 5/28/98 Page I of 4 66 - 14

3.
2.3 Acreage cleared and available for application (excluding all required buffers and areas not covered by the application
system): 37 ; Required Acreage (as listed in the AWMP): 30A
2.4 Number of agoons storage ponds (circle which is applicable):
2.5 Are subsurface drains present within 100' of any of the application fields? YES or A
(please circle one)
2.6 Are subsurface drains present in the vicinity or under the lagoon(s)? YES or (please circle one)
2.7 Does this facility meet all applicable siting requirements? (Swine Farm Siting Act, NRCS Standards, etc.) (Swine Only)
YE or NO (please circle one)
What was the date that this facility's swine houses and lagoon were sited? 1186
What was the date that this facility's land application areas were sited? 16 /�
REQUIRED ITEMS CHECKLIST
Please indicate that you have included the following required items by signing your initials in the space provided next to each
item.
Applicants Initials
3.1 One completed and signed original and one copy of the application for General Permit - Animal
Waste Operations;
3.2 Two copies of a general location map indicating the location of the animal waste facilities and
field locations where animal waste is land applied;
3.3 Two copies of the entire Certified Animal Waste Management Plan (CAWMP). If the facility
does not have a CAWMP, it must be completed prior to submittal of general permit
application for animal waste operations.
The CAWMP must include the following components:
3.3.1 The Waste Utilization Plan (WUP) must include the amount of Plant Available
Nitrogen (PAN) produced and utilized by the facility.
3.3.2 The method by which waste is applied to the disposal fields (e.g. irrigation,
injection, etc.)
3.3.3 A map of every field used for land application.
3.3.4 The soil series present on every land application field.
3.3.5 The crops grown on every land application field.
3.3.6 The Realistic Yield Expectation (RYE) for every crop shown in the WUP.
3.3.7 The PAN applied to every land application field.
3.3.8 The waste application windows for every crop utilized in the WUP.
3.3.9 The required NRCS Standard specifications.
3.3.10 A site schematic.
3.3.1 1 Emergency Action Plan.
3.3.12 Insect Control Checklist with chosen best management practices noted.
3.3.13 Odor Control Checklist with chosen best management practices noted.
3.3.14 Mortality Control Checklist with the selected method noted.
3.3.15 Lagoon/storage pond capacity documentation (design, calculations, etc.). Please be
sure to include any site evaluations, wetland determinations, or hazard classifications
that may be applicable to your facility.
3.3.16 Operation and Maintenance Plan.
If your CAWMP includes any components not shown on this list, please include the
additional components with your submittal.
FORM: AWO-G-E 5/28/98 Page 2 of 4 66 - 14

r
Facility Number: 66 - 14
Facility Name: Old Mill Swine Farm
RECENED
V'1A,'ER (VA1',Tl 5,137,1011
%qa 16 M9
4. APPLICANT'S CERTIFICATION: Nott-OlschaTge permitting
1, (Land Owner's name listed in question 1.2), attest that
this a plication for Qld %i�•�%1 swln'e_ 1 Gttr,'L (Facility name listed in question l,!)
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 to me as incomplete. (J p
Signature sr+M� tea, ` t�dzc.d'll�t o - -,�Q? - - -- --.. _ Date--
5. MANAGER'S CERTIFICATION: (complete only if different from the Land Owner)
I, (Manager's name listed in question 1.6), attest that this
application for (Facility name listed in question I .l )
has been reviewed by me and is accurate and complete to the best ol' 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
NON -DISCHARGE PERMITTING UNIT
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
FORM: AWO-G-E 5/28/98 Page 3 of 4 66 -14

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Animal Waste Management Plait Certification
(Please type or print all infoiniation that does not require a signature)
�il�ttse circle. ilte}. " � � •�
Narne of Farm. _ f9 %V A/ f % Facility No:
Owner(s) Name.—J i42r►2 U _______Phone No: J—as—/933
Mailing Address: n 2 , Z '96 X C�Q!7 c✓ Al iVC 1-7d"2o
Farnt Location: Fourteen Digit Hydrologic Unit:_ 67 D to 2-o y 2 / 0e L
Latitude and Longitude: -_ 7 2,2 9! County: If/oA de AL'
Please attach a copy of a county road map with location identified and describe below (Be specific: road
names, directions, milepost, etc.): A70ACI Zecme Z arf
Crce /6 ►., %Ie } e.,,, r Ow.
t:
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
O Wean to Fccder a Layer O Dairy
XFccder to Finish t T 00 0 Pullets O Beer
O Farrow to Wean
❑ Farrow to Feeder
U Farrow to Finish Other 7 ype of Livestock: Number of Animals:
Acreage Available for Application: 37 Required Acreage: to. y
Number of Lagoons / Storage Ponds: Total Capacity:ZV" 7 Cubic Feet (ft3)
Are subsurface drains present on the farin: YES or To7 (please circle one)
Owner / Manager Agreement
I (we) verify that all die above information is correct and will be updated upon changing. 1 (we) understand the operation and
maintenance procedures established in the approved animal waste management plan for the farm named above and will
implement dies- procedures. I (we) know that any expansion to the existing design capacity of the waste treatment and
storage system or construction of new facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked. I (we) understand that there must be no discharge of animal
waste from the storage or application system to surface waters of the state either directly through a man-made conveyance or
from a storm event less severe than the 25-year. 24-hour storm and there must not be run-off from the application of animal
waste. I (we) understand that run-off of pollutants froin lounging and heavy use areas must be minimized using technical
standards developed by die Natural Resources Conservation Service. The approved plan will be filed at the farm and at the
office of the local Soil and Water Conservation District. I (we) know that any modification must be approved by a technical
specialist and submitted to the Soil and Water Conservation District prior to implementation, A change in land ownership
requires written notification to DEM or a new certification (if the afpxoved plan is changed) within t50 bays of a title transfer.
' rr- n
Name of Land Owner ;
Signature;
Date: 9-2-2-22
Name of Mattfter(if different from owner):
Signature: , , Date:
A1VC -- April 24, 1996 1

�I
�I
"t
Technical Specialist Certification
1. As a technical specialist designated by the North Carolina Soil and Water Conservation Commission
pursuant to 15A NCAC 6F .0005, I certify that the animal waste management system for the farm
med above has an animal waste management plan that meets or exceeds standards and specification -
'of the Division of Environmental Management (DEM) as specified in 15A NCAC 2H.0217 and the
USDA -Natural Resources Conservation Service (NRCS) and/or the North Carolina Soil and Water
Conservation Commission pursuant to 15A NCAC 21H.0217 and 15A NCAC 6F .0001-.0005. The
following elements are included in the plan as applicable. While each category designates a technical
specialist who may sign each certification (SD, SI, WUP, RC, I), the technical specialist should only
certify parts for which they an technically competent.
11. Certification o, f Design
A) CgIltel on. Storage. TreatMent Svstetn
Check ,the appropriate box ,
Existing Licil ty without retz= at (SD or WUP)
Storage volume is adequate for operation capacity; storage capability consistent with
waste utilization requirements.
❑ Nrw. gxpaudcd or retrofitted facility (SD)
Animal waste storage and treatment structures, such as but not limited to collection systems.
lagoons and ponds, have been designed to meet or exceed the minimum standards and
spccifications.
Name of Technical Specialist (Please Print):_ _T c ej .S14ytr -
Affiliation: Pit C r
Address(Agency): o dp-Ut'jAC Phone No.:,_LY_5'-2Jy_'
Signature: z- ---Date: 2 - ZJ:12
1� and Appligglijili So e (WUP)
The plan provides for minimum separations (buffers); adequate amount of land for waste
utilization; chosen crop is suitable for waste management; hydraulic and nutrient loading rates.
Natne of Technical Specialist (Please Print): 'aA4 f!s?•L� ___
Affiliation: "Cr
Address(Agency): !!o �hdX U- c%AeIgo%— A& Phone No.:_X.?Y- 2,
Signature: Date:
C) is
Check the appropriate box
Eacili y widjout axtuiof 1=1 (SD or WUP or RC)
This facility does not contain any exterior lots.
❑ Facility with cxterior_lots (RC)
Methods to minimize the run off of pollutants from lounging and heavy use areas have been
designed in accordance with technical standards developed by NRCS.
Name of Technical Specialist (Please Print):
Affiliation:_
Address(Agency): Phone No.:
Signature: Date:
`.
AWC -- April 24,1996

D) Al2p3icatlon and 1120dl'jag Eauiplugnt '
"heck the appropriate box
Existing facilitv wilhcxisting waste apQlication cQuipm n (WUP or 1)
Animal waste application equipment specified in the plan has been either field calibrated or
evaluated in accordance with existing design charts and tables and is able to apply waste as
necessary to accommodate the waste management plan: (existing application equipment can
cover the area required by the plan at rates not to exceed either the specified hydraulic or
nutrient loading rates, a schedule for timing of applications has been established; required
buffers can be maintained and calibration and adjustment guidance are contained as part of the
plan). • '
❑ New or exngpded facility- or existing facility__witxisting waste applicedon a uion�ent (1)
Animal waste application equipment specified in the plan has been designed to apply waste as
necessary to accommodate the waste management plan; (proposed application equipment can
cover the area required by the plan at rates not to exceed either the specified hydraulic or
nutrient loading rates; a schedule for timing of applications has been established; required
buffers can be maintained; calibration and adjustment guidance are contained as part of the
plan).
Nante of Technical Specialist (Please Print): William A. Stalls
Affiliation:_ _Revelle Agri -Products, Inc.' _
s Address(Ageney): P -C• Box 68 Murfreesboro,�NC. 278 55r +Phone No. 919-398-3116
Signature: Date:_
.��
111. Certification of Installation
.A) Collection. Storage,
,.� I=gg(mCnt_Ltstallallon
wL. 93VW1dCd Qr Eftrofitted facility(Sl)
Animal waste storage and treatment structures, such as but not limited to lagoons and ponds,
have been installed in accordance with the approved plan to meet or exceed the minimum
standards and specifications.
For existing facilities without retrofits, no cert(fication is necessary.
Name of Technical Specialist (Please Print):
Affiliation:
Address(Agency): Phone No.:
Signature: _ Date:
AWC -- April 24, 1996 3

t;
0) Lanj Applicaliall Sile (WUP)
Check the appropriate box
�. The cropping system is in place on all land as specified in the animal waste management plan.
❑ Conditional Approval: all required land as specified in the plan is cleared for planting; the
cropping, system as specified in the waste utilization plan has not been established and the
owner has committed to establish the vegetation as specified in the plan by
(niontlhlday/ ear); the proposed cover crop is appropriate for compliance with the waste
utilization plan.
O Also clicck this box if appropriate
if the cropping systenn as specified in the plan can not be established on newly cleared
land within 30 days of this certification, the owner has committed to establish an interim
crop for erosion control; '
Name of Technical Specialist (Please Print): ~Tear S%
Affiliation: Nxe1
Address (A genc y):-. Ao 6a,,ZiT .7ifzC«'Gtir X/G _ _Phone No.: EiY "2 S-'i -
This following signature block is only to be used when the box for conditional approval In III. B
above has been checked.
I (we) certify that I (we) have committed to establish the cropping system as specified in my (our) waste
utilization plan, and if appropriate to establish the interim crop for erosion control, and will submit to
DEM a verification of completion from a Technical Specialist within 15 calendar days following the date
specified in the conditional certification. 1(we) realize that failure to submit this verification is a
violation of the waste management plan and will subject me (us) to an enforcement action from DEM.
`- Name of Land Owner ;
Signature: Date:
Name of Manager(if different from owner):
Signature: Dale:
Q Runoff Cgnlrols frottI Li 3tCfio,r Lpts (RC)
Ett_cility wjJlJ exteior lots
Methods to minimize the run off of pollutants from lounging and heavy use areas have been
installed as specified in the plan.
For facifilies without exterior lots, no cerlif cation Is necessary.
Name of Technical Specialist (Please Print):
Affiliation:
Address(Agcncy): Phone No.:
Signature:
Date:
AWC -- April 24, 1996 4

D) AgolicIfign and 11andling.EsuLyMel)ti Illstalla ion (WUP or I)
Check the appropriate block
Animal waste application and handling equipment specified in the plan is on site and ready
for use; calibration and adjustment materials have been provided to the owners and are
contained as part of the plan. '
S
❑ Animal waste application and handling equipment specified in the plan has not been
installed but the owner has proposed leasing or third party application and has provided a
signed contract; equipment specified in the contract agrees with the requirements of the
plan; required buffers can be maintained; calibration and adjustment guidance have been
provided to the owners and are contained as part of the plan.
❑ Conditional approvalAnimal waste application and handling equipment specified in the
plan has been purchased and will be on site and installed by
(month/day/year); there is adequate storage to hold the waste until the equipment is installed
and until the waste can be land applied in accordance with the cropping system contained
in the plan; and calibration and adjustment guidance have been provided to the owners and
are contained as part of the plan. `
Name o(Technicat Specialist (Please Print):
Affiliation:��
Address (Age ncy); �'{'`'� ''«r bo �C '� Phone Ho.:-."-
Signature:- —Date:
The following signature block is only to be used when tite box for conditional approval in III D
above has been checked. i
i
'we) certify that 1(we) have committed to purchase the animal waste application and handling
aiptment as specified in my (our) waste management plan and will submit to DEM a verification of
�c elivery and installation from a Technical Specialist within 15 calendar days following the date specified
in the conditional certification. I (we) realize that failure to submit this verification is a violation of the
waste management plan and will subject me (us) to an enforcement action from DEM.
Name of Land Owner:
Signature: Date:
Name of Manager(if different from owner):
Signature: Date:
Please return the completed form to the Division of Environmental Management at the
following address:
Department of Environment, Health, and Natural Resources
Division Of Environmental Management
Water Quality Section, Compliance Group
P.O. Box 29535
Raleigh, NC 27626-0535
Please also renientber to submit a copy of this fortn aion tvith the complete Animal Waste
Management Plan to the local Soil and Water Conservation District Office and to keep a copy in
ri
les iles with your Aointai Waste Management Plan.
Al /•- April 14,1996 S

WASTE;;UTILIZATION PLAN.-
Producer: Jimmy Bridgers
Location: Old Mill, located on south side of Jenkins Mill Rd.
Telephone: [phone]
Type Operation: Topping
Number of Animal Units: 1300
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 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.
everal factors are important in implementing your waste utilization plan
"'�n 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, leaching potentials,
cation exchange capacities, and available water holding capacities..
Normally waste shall not be applied to land eroding at greater than 5 tons
per acre per year. With special precautions, waste may be applied to land
eroding at up to 10 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. Either of these
conditions may result in runoff to surface waters which is not allowed
under DWQ regulations. 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 applied to bare ground not more than
30 days prior to planting. Injecting the waste or disking will conserve
nutrients and reduce odor problems.
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 analysis.
'*mfnis waste utilization plan, if carried out, meets the requirements for
compliance with 15A NCAC 2H.0217 adopted by the Environmental Management
Commission

r WASTE UTILIZATION PLAN �i
Table 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowner must be attached)
(Required only if operator does not own
adequate land [see Required Specification 21)
Tract Field Soil Crop Lbs. N Acres Lbs. N Month of
# Type Per Ac.* Utilized Application
7
}See footnote for Table 1.
Totals from above Tables
Acres Lbs. N
Utilized
Table 1 0 2
Table 2
Total fo ' L L
Amount of N Produced , , , 2-210
Surplus or Deficit -- i A 3 2-
NOTE: The Waste Utilization Plan must contain provisions for periodic land
application of sludge at agronomic rates. The sludge will be nutrient rich
and will require precautionary measures to prevent over application of
nutrients or other elements.
wee attached map showing the fields to be used for the utilization of waste
water.

0
� WASTE UTILIZATION PLAN
Name of Farm: DG d I�/G (i
Owner/Manager Agreement
I (we) understand and will follow and implement the specification and the
operation and maintenance procedures established 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
storage system or construction of new facilities will require a new
certification to be submitted to the Division of Water Quality (DWQ) 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
from a storm event less severe than the 25-year, 24-hour storm. The
approved plan will be filed on -site at the farm office and at the office of
e local Soil and Water Conservation District and will be available for
Lwview by DWQ upon request.
Name of Facility owner: (Please print) OL
Signature:
Date ---
Name of Manages` (If different from owner:
Signature: Date:
Technical Representative: Tony Short
Affiliation: Natural Resources Conservation Service
Address (Agency:
Signature:
P.O. Box 218
Jackson N.C. 27845
919-53AI2591.
Date: /o-LS�p�

WASTE. UTILIZATION PLAN'
animals X gal. waste/animal/year gals. waste/year.
amount 0f,.._P1a11t Available Nitrogen (PAN) ProducedRer Year
1300 animals X 2.3 lbs. PAN/animal/year 2990 lbs. PAN/year. (PAN
from N. C. Tech. Guide Std. 633)
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 and surface application:
Table 1: ACRES OWNED BY PRODUCER
Tract Field Soil Crop Lbs. N Acres Lbs. N Month of
# No. Type Per Ac.* Utilized Application 7i?a
I
* This N is from animal waste only. If nutrients from other sources such
as commercial fertilizer are applied, they must be accounted for. N =at
b-e-_bzsed on rpgalistic yield exnectatig;a.
NOTE: The applicator is cautioned that P and K may be over applied while
meeting the N requirements. This plan only addresses Nitrogen.
NOTE:
,.%W-

r WA.S.TF.,"IUTIL.IZ-ATI,O.N P.LAN:.f
Application of Waste by Irrigation
Field
No.
Soil Type
Crop
Application
Rate(In/Hr)
Application
Amount(In.)
This table Is not needed If waste is not being applied by Irrigation, however a slmllw table will be needed for dry lifter or sludge.
r1.0
(to'`
�'— Your facility is designed for 180 days of temporary storage and the
temporary storage must be removed on the average of once every 6 months,
In no instance should the volume of waste being stored in your structure
exceed Elevation 2.9.5.
Call the local Natural Resources Conservation Service (formerly Soil
Conservation Service) or Soil and Water Conservation District office after
you receive the waste analysis report for assistance in determining the
amount per acre to apply and the proper application rate prior to applying
the waste.
xarrgtive
Waste will be applied to corn or cotton and small grain in the fall.

WAS-TE.:.,.:U.TiLIZATION',,.�PLAN
REQUIRED 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.
2. There must be documentation in the design folder that the
producer either owns or has a notarized agreement for use of adequate.
land on which to properly apply the waste. If the producer does not
own adequate land to properly dispose of waste, he/she shall provide a
copy of a notarized agreement with a landowner who is within a
reasonable proximity, allowing him/her the use of the land for waste
application. 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. Actual yields may be used in lieu of realistic yield tables
at the discretion of the planner.
4. Animal waste shall be applied on land eroding less than 5 ton per
acre per year. Waste may be applied to land that is eroding at more
than 5 tons but less than 10 tons per acre per year providing grass
filter strips are installed where runoff leaves the field. (See FOTG
Standard 393-Filter Strips)
5. Odors can be reduced by injecting
application. Waste should not be
from the irrigation field.
the waste or disking after waste
applied when there is danger of drift
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 N.C." for guidance.)
7. Liquid Waste shall be applied at rates not to exceed the soil
infiltration rate such that runoff does not occur off site 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
odor and flies.
S. Animal waste shall not be applied to saturated soils, during rainfall
events, or when the surface is frozen.

WASTE UTILIZATION PLAN
9. -Animal waste shall be applied on actively growing crops in such a
manner that the crop is not covered with waste to depth that 0ould
prohibit growth. The potential for salt damage from animal waste
should also be considered.
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 or forages breaking dormancy.
11. Any new swine facility sited on or after October 1, 1995 shall comply
with the following; The outer perimiter.,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
any perennial stream or river other than 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 surface
water. This distance may be reduced for waters that are not perennial
provided adequate vegetative filter strips are present (See Standard
393-Filter Strips).
"-12. Animal waste shall not be applied closer than 100 feet from
wells.
13. Animal waste shall not be applied closer than 200 feet of dwellings
other than those owned by the landowner.
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 a discharge or by overspraying. Animal waste may be
applied to prior converted cropland provided it has been approved
as a land applications site by a "technical specialist". Animal waste
applied on grassed waterways shall be at agronomic rates and in a
manner that 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.). Areas
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.

WASTE" UTItIZATl01
18. If animal production at the facility is to be 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
preplant with no further applications of animal waste during the crop
season.
21. Highly visible permanent 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 for waste storage ponds.
22. Soil tests shall be made every two years and a liquid waste analysis
be taken at least twice each year consistent with waste utilization
plan. Poultry litter shall be tested prior to application. Soil
and waste analysis records shall be kept'for five years.
23. Dead animals will be disposed of in a manner that meets NC regulations.

�Q Z
WASTE UTILIZATION PLAN
Table 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowner must be attached)
(Required only if operator does not own adequate land [See Required Specification 21)
Tract Field Soil Crop Lbs. N Acres Lbs. N Month of
# Tvne Per An. * LHilized Anniication
r���■��.��r.�r
mrrm- Uri
, •
* See footnote for Table 1.
Table 1
Table 2
Total
Total I ,I i
Totals from above Tables
Acres
count of N Produc
Surplus or Deficit
7XS �-Ad F7
Lbs. N Utilized
NOTE: The Waste Utilization Plan must contain provisions for periodic land application of sludge
at agronomic rates. The sludge will be nutrient rich and will require precautionary measures to
prevent over application of nutrients or other elements.
3

7m
Ft
OLA

r
TABLE 2: Trvlia iion� . ' Selling
Maka. Model
and Typo of F�qu>pmctrl:
f6 4
6
TGga ao 4
irr Al� /Son /oo E., 64117 W/o
,
EQUIPMENT
SCrM—NM
Fidd W
Tnn-d
Application
TRAVEL LANL
Wetted
Na 7kV
Operating
Operating
and
Speed'
Ralc
i.Rcctivc
Clfodir•c
. I)ianxtcr
DianxAcr
1' amme
PTIMMM
Are
li�ekant Non
(Nmin)
(inlhr)
Width(R)
LceW(R)
(R)
(in)
irA Gun (psi)
Q Rod (psi)
PaUcrW
Connnaus
zn •
. Its
') v
/.a
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0
d9a
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7 a
ao
!: ae-.
&Q.s O
1 1.4.6 1 ..1" 1 a03 1 1 ato 1 •d?s I na 1 i.21 1 avo I I
s Sec aHached aaP provkkd by the Fidel OMcc far lidd kwatia (s).
`SbM separala entries for each bum location in tech Iidd_•
of Arc
Sepkmtw 25, 1995
L: p..._-r r 4 _�, r.;•./, �. '*f/ r.
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USDA -MRCS
NoMi. Carolina
0

Insect Control Checklist for Animal Operations
Source
Cause
B&M to Control insects Site SpedGc Practices
Flush Gutters
• Accumulation of so"
Of Fhash systean is designed and operated
sufficiently to Mmove accumulated solids &M
gutters as designed.
ff Remove bridging of accmulated solids at
- -
ischarge
Lagoons and Pits
• Crusted Solids
- - - — --
Maintain lagoons, scaling basins and pits where
pest breeding is apparent to minimize the
crusting of solids to a depth of no more dm 6 -
8 inches over more than 30% of surface.
Excessive Vegetative
• Decaying vegetation
fir Maintain vegetative control along banks of
Growth
lagoons and affect impoundments to prevent
accumulation of decaying vegetative matter
along waters edge on impoinadineurs perimeter.
Dry Systems
Feeders Feed Spillage Gr Design, operate and maintain feed system (e.g.,
bunkers and troughs) to minimize the
/accumulation of decaying wastage-
6a Clean-up spillage on a routine basis (e.g., 7 - 10
day interval during summer, 15-30 day inloval
Luring winter). '
Feed Storage Accumulations of feed residues cK Reduce moisture accumulation within surd
around immediate perimeter of feud stomgo
areas by insuring drainage away from site
and/or providing adequate containment (e.g.,
covered bin for brewers grain and similar ith
/'�'oisture grain products).
2 Inspcc-t for and remove or break up accumulated
solids in falter strips around feed storage as
needed.
A►" 'wember 11, 1996, Page 1

Source
Cause
BMPa to Control losed Site itic Practices
Animal Holding Ames
Accumulations of animal wastes
13
Eliminate low areas did trap amistu a along
and feed wastage
fences and other locations where wad
auamtwlates and disturbance by animals is
minimal.
17
Maintain femm rows and filter strips around
animal bolding areas to minitmiZe
accumulations of wastes (ire., inspect for and
remove or break up accumulated solids as
1
needed).
Dry Manure Handling
+ Accumulations of animal wastes
13
Remove Spillage on a routine basis (e g,, 7 - 10
Symms
day interval during summer, 15-30 day interval
during winter) where manure is loaded for land
application or disposal
O
Provide for adequate drainage around manure
stockpiles.
(7
Inspect for and remove or break up accumulated
wastes in filter strips around stockpiles and -
manure handling areas as needed.
For more information contact the Cooperative Extension Service, Department of Entomology, Box 7613, North Cuo inn State University.
Raleigh, NC. 27695-7613.
AMIC - )amber 11, 1996, Page 2

W
Swine Farm Waste Management Odor Control Checklist
Source Cause BMPs to Minimize Odor Site 'frc Praetam
Farmstead • Swine production Vegetative or wooded bu€fas;
�' Recammen�d best management practices;
N'"Good judgment and common sense
Animal body:scufaees • Dirty manure -covered. animals OF Dry floors - - - -
Ffox surfaces • Wet manure -covered floors Gr Slotted floors;
!� Waterers looted over slotted floors;
p Feeders at high Gad of solid floors;
:9( e'pe manure buildup from floors;
Underfloor ventilation for drying
Manure collection pits • Urine; Frequent manure removal by flush, pit rechairA
• Partial microbial decomposition or scrape:
VUndertloor ventilation
Ventilation exhaust Cans • Volatile gases; —/Fan maintenance;
Dust W Eff'ecient air movement
Indoor surfaces • Dust QeWashdown between groups of animals;
O Feed additives;
Cl Feeder covers;
O Feed delivery downspout extenders to i'ee4r
covers
Flush tanks Agitation of recycled lagoon O Flush tank covers;
liquid while tanks are filling O Extend fill lines to near bottom of tanks with
anti -siphon vents
Flush alleys • Agitation during wastewater ZPUnderfloor flush with underfloor ventilation
conveyance 1
Pit recharge points • Agitation of recycled lagoon 13 Extend recharge lines to near bottom of pits
liquid while pits are filling with anti -siphon vents
Lift stations • Agitation during sump tank 13 Sump tank covers
filling and drawdown
Outside drain collection • Agitation during wastewater 17 Box covers
or junction boxes conveyance
AMOC Jvernbef 11, 1996. Page 3

Source Cause BMPs to Minitnke Odor Site Specific PneUces
End of drainpipes at • Agitation during wastewater Extend discharge point of pipes undanentb
lagoon conveyance lagoon liquid level
Lagoon surfacac • VOW& gas emissions; Gr Proper lagoon liquid capacity;
Biologics! mixing; � Correct lagoon startup ptoaednues;
• Agitation hT Minittttrm surface area -to -volume ratio;
Minimum agitation) wheu.pumping;
❑ Mechanical aWAiorr;
O Proven biological additives
Irrigation sprinkler High pressure agitation; IiY irrigate on dry days with little or no wind;
nozzles • Wind drift VMinimum recommended operating pressure;
1( Pump intake near lagoon liquid surface;
❑ Pump f"Xn seoorti-stage lagoon
Storage tank or basin • Partial microbial decomposition; ❑ Bottom or midlevel loading;
surface • Mixing while filling; [i Tank covers;
• Agitation when emptying p Basin surface mats of solids;
❑ Proven biological additives or oxidants
Settling basin surface • Partial microbial decomposition; O Extend drainpipe outlets underneath liquid
• Mixing while filling; level;
• Agitation when emptying O Remove settled solids regularly
Manure. slurry or sludge • Agitation when spreading; ❑ Soil injection of shM/sludges; '
spreader outlets . • Volatile gas emissions p Wash residual manure from spreader after use;
❑ Proven biological additives or oxidants
Uncovered nmanure. • Volatile gas emissions while ❑ Soil injection of slurry/sludges
slurry or sludge on field drying p Soil incorporation within 49 hrs.;
surfaces
O Spread in thin uniform layers for rapid drying;
❑ Proven biological additives or oxidants
` n
Dead animals • Cmcass decomposition Proper disposition of carcasses
Dead animal disposal • Carcass decomposition ❑ Complete covaing of carcasses in burial pits;
pry O Proper locatimdconstructioa of disposal phs
Incinerators • hrc wnpldc combustion O Secondary stack burners
AWY ovember 11, 1996, Page 4

it
to
Standing water around • improper drainage; 00-Grade and landscape such that water dram
facilities a Microbial decomposition of away 5om facilities
organic matter
Manure tracked onto • Poorly maintained access roads Farts access road matrtttmance - -. - -
public roads from farm
access _... -
Additional Information: Available From:
Swint Mature Management ; 0200 RulelBMP Packet NCSU, County Extension Center
Swine Production Farm Potential Odor Sources and Remedies ; EBAE Fact Street NCSU - BAE
Swine Production Facility Manure Managettnetu: Pit Recharge - Lagoon Treatment; EBAE 129-99 NCSU - BAE
Swine Production Facility Manure Management: Underfloor Flush - Lagoon Treatment; EBAE 129-88 NCSU - BAE
Lagoon Design and Management for Livestock Manure Treatment and Storage ; EBAE 103-93 NCSU - BAE
Calibration of Manure and Wastewater Application Equipment; EBAE Fact Sheet NCSU - BAE
Controlling Odors from Swine Buildings; PIH-33 NCSU - Swine Extension
Environmental Assurance Program ; NPPC Manual NC Pork Producers Assoc
Options for Managing Odor; a report from the Swine Odor Task Force NCSU Agri Communications
Nuisance Concerns in Animal Manure Management: Odors and Flies; PRO107, 1995 Conference Proceedings Florida Cooperative Extension
r
A - November l 1. 1996, Page 5

Cu
Mortality Management Methods
(check which method(s) are being implemented)
•J
© Burial three feet beneath the surface of the ground within 24 hours after
knowledge of the death. The burial must be at least 300 feet from any flowing
stream or public body of water.
i� Rendering at a rendering plant licensed under G.S.106-168.7
❑ Complete incineration
❑ In the case of dead poultry only, placing in a disposal pit of a size and design
approved by the Department of Agriculture
U Any method which in the professional opinion of the State Veterinarian_would
make possible the salvage of part of a dead animal's value without endangering
human or animal health. (Written approval of the State Veterinarian must be
attached)
December 18, 1996

EMERGENCY ACTION PLAN
PHONE NUMBERS
DWQ -
EMERGENCY MANAGEMEE9T SYSTEM
SWCD - 5 7
NRCS ' 91
This plan will be implemented in the event that wastes from your operation are leaking,
overflowing, or running off site. You should not wait until wastes reach surface waters or
leave your property to consider that you have a problem. You should make every effort to
ensure that this does not happen. This plan should be posted in an accessible location for
all employees at the facility. The following are some action items you should take.
1. Stop the release of wastes. Depending on the situation, this may or may not be
possible. Suggested responses to some possible problems are listed below.
A. Lagoon overflow -possible solutions are:
a. Add soil to berm to increase elevation of dam.
b. Pump wastes to fields at an acceptable rate.
c. Stop all flows to the lagoon immediately.
d. Call a pumping contractor.
e. Make sure no surface water is entering lagoon.
B: Runoff from waste application field -actions include:
a. Immediately stop waste application.
b. Create a temporary diversion to contain waste.
c. Incorporate waste to reduce runoff.
d. Evaluate and eliminate the reason(s) that caused the runoff.
e. Evaluate the applicazion rates for the fields -where runoff occurred.
C:- Leakage from the waste pipes and sprinklers -action include:
a. Stop recycle pump.
b. Stop irrigation pump.
c. Close valves to eliminate further discharge.
d. Repair all leaks prior to restarting pumps.
D: Leakage from flush systems, houses, solid separators -action include:
a. Stop recycle pump.
`.. b. Stop irrigation pump.
c. Make sure no siphon occurs. '
d. Stop all flows in the house, flush systems, or solid separators.
1 December 18, 1996

e. Repair all leaks prior to restarting pumps.
E: Leakaae from base or sidewali of lagoon. Often this is seepage as opposed to
flowing leaks- possible action:
a. Dig a small sump or ditch away from the embankment to catch all seepage,
put in a submersible pump, and pump back to lagoon...
b. If holes are caused by burrowing animals, trap or remove animals and fill
holes and compact with a clay type soil.
c. Have a professional evaluate the condition of the side walls and lagoon
bottom as soon as possible.
2. Assess the extent of the spill and note any obvious damages.
a. Did the waste reach any surface waters?
b. Approximately how much was released and for what duration?
c. Any damage noted, such as emVoyee injury, fish kills, or property damage?
d. Did the spill leave the property.
e. Does the spill have the potential to reach surface waters?
f. Could a future rain event cause the sill to reach surface waters?
g. Are potable water wells in danger (either on or off of the property)?
h. How much reached surface waters?
3: Contact appropriate agencies.
a. During normal business hours, call your DWQ (Division of Water Quality)
regional office; Phone - . After hours, emergency number:' 9I9-733-3942.
Your phone call should include: your name, facility, telephone number, the details
of the incident from item 2 above, the exact location of the facility, the location or
direction of movement 'of the spill, weather and wind conditions. The corrective
measures that have been under taken, and the seriousness of the situation.
b. If spill leaves property, or enters surface waters, call local EMS Phone number -
c. instruct EMS to contact local Health Department.
& Contact CES, phone nunftr" '- = , local SWCD office phone number
and local NRCS office for adviceltechnical assistance phone number." - -
4: If none of the above works call 911 or the Sheriffs Department and explain your
problem to them and ask that person to contact the proper agencies for you.
5: Contact the contractor of your choice to begin repair of problem to nunimize off -site
damage.
a. Contractors Name: S r rril �4,,� - Pn V.
b. Contractors Address:
C. Contractors Phone: 2 19, 5L - r-
2
December 18, 1996

6: Contact the technical specialist who certified the lagoon (NRCS, Consulting
Engineer, etc,)
a. Name: o
b. Phone: , ''
7: Implement procedures as advised by DWQ and technical assistance agencies to
rectify the damage, repair the system, and reassess the waste management plan to
keep problems with release of wastes from happening again.
W.
.O�
3 December 18, 1996

Producer: Jimmy Bridgers
The purpose of this plan is to provide guidelines for carrying out
} the routine operation and maintenance work needed to keep this swine
waste management system functioning as planned. Routine maintenance
is considered to be normal good care of the system. Good
maintenance adds to beauty, usefulness, and permanence.
A. Mainbenpce
The routine maintenance of the lagoon involves the following:
1. Maintenance of a vegetative cover on the embankment top and
side slopes: Fescue should be established on these areas.
Beginning in 1999 and each year thereafter, the embankment
should be fertilized with 800 pounds of 10710-10 per acre to
maintain a vigorous stand.
2. Control of brush and trees on the embankment. This may be
done by mowing, spraying, or chopping, or a combination of
all three. This will need to be done at least once each
year and possibly twice in years favorable to heavy growth
of vegetation.
Maintenance inspections of the lagoon should be made during the
initial filling of the lagoon and at least annually. Items to
be checked should include, as a minimum, the following:
1. Waste Inlet Pipes, Overflow Pipes
a. condition of pipes
(1) separation of joints
(2) cracks or breaks
2. Pool Area
a. undesirable vegetative growth
b. floating or lodged debris
3. Embankment
a. settlement, cracking or "jug" holes
b. side slope stability - slumps or bulges
c. erosion and rodent damage
1

II
T
Your animal waste management facility was designed for a total
of 175500 lbs. live wt ( 176458 cu. ft. capacity). Present
total capacity is not known because of sludge accumulation.
The lagoon contains both permanent and temporary storage. The
permanent storage is not to be pumped in order to ensure that
anaerobic action will occur, at least six feet of permanent
storage should be retained. The design includes permanent
storage of one cubic foot per pound of steady state live weight.
The temporary storage portion of the lagoon includes capacity
for the volume of waste produced over 180 days, the amount of
rainfall in a 25 year 24 hour storm event, and rainfall in
excess of evaporation. Your facility is designed for 180 days
of temporary storage; therefore, it will need to be pumped
every six months.
The waste utilization plan should be followed. This plan
recommends sampling and testing of waste before land
application. The waste material should be analyzed before each
application cycle to determine its nutrient content. A soil
test of the area of application should be made annually to
insure the waste is applied as reasonably and practically
possible to recommended rates.
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
Environmental Management, has the responsibility for enforcing
this law.

4 THIS DESIGN IS FOR A SINGLE STAGE LAGOON yl�
/usr/all/eng/lagoons/owners/designs tt M
sassiter Farm d 1a
-CLIENTS NAME aaaaaaaaaaaaaaa==aaaaa=a=r, Jimmy Bridgers
.COUNTY=====a=as===aaaaaa==aa====--_..__, Northampton
,TODAYS DATE=aaaaaaaa=as========-=aaaa=> 10/11/96
''DISTANCE TO NEAREST NONFARM RESIDENCE => 2000+ FEET
NUMBER OF PIGS WEANLING TO FEEDER
NUMBER OF PIGS FEEDER TO FINISH =======>
NUMBER OF SOWS FARROW TO WEANLING ===a=>
NUMBER OF SOWS FARROW TO FEEDER =a=aaaa)
NUMBER OF SOWS FARROW TO FINISH=====Y=>
DEGREE OF ODOR CONTROL
(minimum 1.0 cu. ft. per lb SSLW)
(maximum 3.0 cu. ft. per lb SSLW)
NUMBER OF YEARS OF SLUDGE ACCUMULATION >
TOP LENGTH AT NORMAL WATER LEVEL
TOP WIDTH AT NORMAL WATER LEVEL
NORMAL WATER LEVEL ELEVATION ==========>
SEASONAL HIGH WATER TABLE ELEVATION aaa)
LAGOON BOTTOM ELEVATION aaa==saaaaaaa=aa,
Depth of Permanent Water 7.0
(minimum depth without sludge = 6 feet)
(minimum depth with sludge = 8 feet)
SIDE SLOPES
Permanent Volume Required 175500.0
Permanent Volume Provided 176458.3
ADDITIONAL DRAINAGE AREA IN SQUARE FEET>
(i.e. pumpout pond & other outside area)
LENGTH OF PUMPING CYCLE===aaaaaaaa=aaa)
GALLONS OF FRESH WATER ADDED DAILY a===>
EXCESS RAINFALL ABOVE EVAPORATION
25YR/24HR STORM RAINFALL =aaaaars=a==a==>
FREEBOARD aaaa=aaaaaaaaaaaaaaaaaaa==aaa)
ESTIMATED TOP OF DAM ELEVATION ========>
Temporary Storage Volume 94630.6
will
Top of Dam Elevation =
Inside Dimensions of Lagoon at Top
Length = 295.0 feet Width -
Begin Pumping Elevation a
Stop Pumping Elevation =
Volume To Be Pumped =
-7 WCif r 1�U�
L .. 7 111
0
1300.
0
0
0
1.0
0.0 YEARS
275.0
FEET
115.0
FEET
97.2
FEET
96.0
FEET
90.2
FEET
feet
2 . 5 : 1
cubic feet
cubic feet
0 SQUARE FEET
OMD"Wsrr _
0 GALLONS
8.9 INCHES
6.7 INCHES
1.0 FEET
cubic feet ,Or
raisede�„spillway
o Dam
135.0 feet
.5 feet
97.2 feet
2 feet
is 100.0

P.
v
,1. STEADY STATE LIVE WEIGHT
0
head
weanling to feeder
x 30 lbs. -
0
lbs
1300
head
feeder
to
finishing
x 135 lbs. =
175500
lbs
0
sows
farrow
to
weanling
x 433 lbs. =
0
lbs
0
sows
farrow
to
feeder x
522 lbs.
0
lbs
0
sows
farrow
to
finish x
1417 lbs.
0
The
TOTAL STEADY STATE LIVE WEIGHT (SSLW) - 175500 lbs
2. SLUDGE ACCUMULATION
Sludge accumulates at the rate of 0.080 cu. ft. per year
per pound of STEADY STATE LIVE.WEIGHT in swine.
Years of sludge accumulation in design? 0.0
Sludge volume =
0.0 cubic feet
3. REQUIRED LIQUID VOLUME OF LAGOON
Design for 1.0 cu. ft. per pound SSLW
Total Volume = (SSLW * Design factor) + Sludge Volume
Total Volume - 175500.0 cubic feet
4. NORMAL LAGOON LIQUID LEVEL
Maintain normal lagoon liquid level at elevation 97.2 feet
Construct lagoon bottom elevation 90.2 feet
Lagoon size for normal lagoon liquid volume using prismodial formula
SS/END1 SS/END2 SS/SIDE1 SS/SIDE2 DEPTH
2.5 2.5 2.5 2.5 7.0
AREA OF TOP
LENGTH *WIDTH =
275.0 115.0
AREA OF BOTTOM
Lb * Wb =
240.0 80.0
31625.0 (AREA OF TOP)
19200.0 (AREA OF BOTTOM)
AREA OF MIDSECTION
(Lm * Wm) _
257.5 97.5 25106.2 (AREA OF MIDSECTION)
CU. YD. = [AREA TOP + (4*AREA MIDSECTION) + AREA BOTTOM) * DEPTH/6
31625.0 100425.0 19200.0 1.167
VOLUME OF LAGOON AT NORMAL LAGOON LIQUID LEVEL-76458.3 CU. FT.

VOLUME NEEDED s 175500.0 CU. FT.
,4
THE SURFACE DIMENSIONS OF THE LAGOON AT NORMAL LIQUID LEVEL
ARE 275.0 FEET LONG BY 115.0 FEET WIDE
y
5. DIKE
Place spoil as a continuous dike to elevation 101.2 feet.
6. TEMPORARY STORAGE REQUIRED
DRAINAGE AREA:
Lagoon (top of dike)
Length * Width
295.0 135.0 39825 square feet
Additional Drainage Area
0 square feet
TOTAL DA 39825 square feet
Pumping cycle to be 180 days.
6A. Volume of waste produced
Volume - 175500 SSLW * 0.0101481 gallon/lb. SSLW/day
in the pumping cycle / 7.48 gallons per cu. ft.
Volume n 42858.1 cubic feet
6B. Volume of wash water
This is the amount of fresh water used for washing floors or
volume fresh water used for a flush system. Flush systems that
recycle the lagoon water are accounted for in 6A.
Volume o 0 gallons/day * 180 days in the pumping
cycle divided by 7.48 gallons per cu. ft.
Volume = 0.0 cubic feet
6C. Volume of rainfall in excess of evaporation
Use period of time when rainfall exceeds evaporation by largest
amount.
Excess rainfall (difference) = 8.9 inches
Volume 0 8.9 inches * DA / 12 inches per foot
Volume d 29536.9 cubic feet

r
i
6D. Volume of 25 year - 24 hour storm
Volume m 6.7 inches * DA / 12 inches per foot
Volume @ 22235.6 cubic feet
TOTAL REQUIRED TEMPORARY STORAGE
6A.
42858.1
cubic
feet
6B .
0.0
cubic
feet
6C.
29536.9
cubic
feet
6D.
22235.6
cubic
feet
TOTAL TEMPORARY STORAGE 94630.6 cubic feet
DEPTH OF STORAGE REQUIRED (ABOVE NORMAL LIQUID ELEVATION OF LAGOON)
Depth required - Volume of temporary storage divided by surface
area of Lagoon.
Depth required
Depth required s
94630 cu.ft. / 31625 sq. ft.
3.0 feet
Normal lagoon liquid elevation 97.2 feet
Depth required _ 3.0 feet
Freeboard 1.0 feet
Top of Dam _ 101.2 feet
THE DIMENSIONS OF THE INSIDE EDGE OF THE DAM AT ELEVATION 101.2
ARE 295.0 FEET BY 135.0 FEET
SET BEGIN PUMPING ELEVATION
PUMPED STORAGE VOLUME
6A.
6B.
6C.
TOTAL PUMPED VOLUME c
42858.1 cubic feet
0.0 cubic feet
29536.9 cubic feet
72395.0 cubic feet
Depth required = Volume of pumped storage divided by surface
area of lagoon at normal water level.
Depth required
Depth required
DESIGNED BY:
Tong Short
DATE:
72395.0 cu.ft. /
2.3 feet
APPROVED BY:
DATE:
31625.0 sq. ft.

Vpk
WAS.-TE"'U."TILIZATION PL,AN
3UD animals X�?•3 lbs. PAN/ anima I/year = Z Ulbs. PAN/year. (PAN from
N. C. Tech. Guide Std. 633)
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 neede& for waste application based on the,
crop to be grown and surface application:
Table I: ACRES OWNED BY PRODUCER
Tract Field Soil Crop Lbs. N Acres Lbs. N Month of
4 No. Type Per Ac.* Utilized Application
MIS
Man.
I
•
I��a
�.
WL'I1�ii�UL' w
Total j 3p _ 1
I
* This N is from animal waste'only. If nutrients from other sources such
as commercial fertilizer are applied, they must be accounted for.N--mus
be based on realistic yield expectation.
NOTE: The applicator is cautioned that P and K may be over applied while
meeting the N requirements. This plan only addresses Nitrogen.
NOTE:

TlT®! W dL30 Ed
4ble 2: ACRES WITH AGREEMENT OR LONG TERM LEASE
(Agreement with adjacent landowner must be attached)
(Required only if operator does not own
adequate land [see Required Specification 2])
Z
m
'6->Gt2 1-UUL11OLe Lox' 'VaDle t .
Totals from above Tables
Acres Lbs. N
Utilized
Table 1 AO
Table 2
Total r o 4 `f S--'o
Amount of N Produced 2-270 -- i-4 90
Surplus or Deficit -- i ? /5460
NOTE: The Waste Utilization Plan must contain provisions for periodic land
application of sludge at agronomic rates. The sludge will be nutrient rich
and will require precautionary measures to prevent over application of
nutrients or other elements.
-ee attached map showing the fields to be used for the utilization of waste
+eater. .

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
April 20, 1999
James Duncan Bridgers, Jr.
Old Mill Swine Farm
Rt 2 Box 324
Conway NC 27820
1 ••
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. AWS660014
Additional Information Request
Old Mill Swine Farm
Animal Waste Operation
Northampton County
Dear James Duncan Bridgers, Jr.:
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject application.
Additional information is required before we can continue our review. Please address the following by May 20, 1999:
1. The section of your waste utilization pan that shows the amount of waste produced per year on your farm is left
empty. Please consult your technical specialist and have it filled out.
2. Table 2 of your waste utilization plan lists some additional crops. Please clarify in the narratives if these crops
are to be used as alternative crops.
Please note that all WUP revisions must be signed and dated by both the owner and the technical specialist.
Please reference the subject permit application number when providing the requested information. All information
should be signed, sealed, and submitted in duplicate to my attention at the address below. The information requested by this
letter, must be submitted on or before May 20, 1999 or the Division will return your application as incomplete in accordance
with 15A N.C.A.C. 2H .0200 and your facility will be considered to be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit is a
violation of North Carolina General Statute 143-215A and will subject you to the enforcement authority of the
Environmental Management Commission. /
If you have an questions re ardin 'this request, lease call me at 919 733-5083, ext �nr(3.
Y Y q gg q p )
Sincerel }
JOS 1
Soil $Cl list
Non-D� charge Permitting
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
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
February 24. 1999
CERTIFIED MAIL
RETURN RE EIPT REQUESTED
James Duncan Bridgers
61'T1?W'A
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
l
Old Mill Swine Farm
Rt 2 Box 324 d
Conway NC 27820
Farm Number: 66 - 14
Dear James Duncan Bridgers:
You are hereby notified that Old Mill Swine Farm, in accordance with G.S. 143-215.1 OC, must
apply for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your
farm has six 60 da s to submit the attached application and all supporting documentation. In
accordance with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any
owner or operator who fails to submit an application by the date specified by the Department
SHALL NOT OPERATE the animal waste system after the specified date. Your application must
be returned within sixty (60) days of receipt of this letter. Failure to submit the application as required
may also subject your facility to a civil penalty and other enforcement actions for each day the facility is
operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call Susan Cauley at [phone]
extension 546 or Charles Alvarez with the Raleigh Regional Office at [phone].
SincerelZPreston
for oward, Jr.,
cc: Permit File (w/o encl.)
Raleigh --Regional Gffie-- (w/o=encl'.)
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
November 13, 1996
James Duncan Bridgers
Old Mill Swine Farm
Rt 2 Box 324
Conway NC 27820
SUBJECT: Operator In Charge Designation
Facility: Old Mill Swine Farm
Facility ID#: 66-14
Northampton County
Dear Mr. Bridgers:
EDF=HNF;Z
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 919n33-0026.
Sincerely,
A. reston Howard, Jr., P. erector
Division of Water Quality
Enclosure
cc: Raleigh Regional Office
Water Quality Files
P,O. Box 27687, 4
Raleigh, North Carolina 27611-7687 Nief
C An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/1 G% 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
James Duncan Bridgers, Jr.
Old Mill Swine Farm
Rt 2 Box 324
Conway NC 27820
Dear James Duncan Bridgers, Jr.:
A&41
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 30, 1999
Subject: Fertilizer Application Recordkeeping
Animal Waste Management System
Facility Number 66_1;4,
tNorthampton-County
This letter is being sent to clarify the recordkeeping requirement for PIant 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. IRRI, IRR2, DRY1, DRY2, DRY3, SLUR1, 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.
Sincerel ,
Kerr T. Stevens, Director
Division of Water Quality
cc: Raleigh Regional Office
Northampton County Soil and Water Conservation District
Facility File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
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O
WArFa-yr
1
September 3, 2004
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Matt Miles
18225 Three Creeks Road
Capon, Virginia 23829
Subject: Notice of Violation
Permit No. AWS660014
Blue Rose Farm # 3
Northampton County
Dear Mr. Miles:
Michael F. Easley, Governor
William G. Ross It., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
On August 31, 2004, the Raleigh Regional Office received a phone call from Mr. Neal Thacker
reporting that the subject lagoon had only 18 inches of freeboard. This is less than the required design
freeboard for this facility and is considered a violation of your COC and General Permit.
The phone call does satisfy the reporting requirements stated within you Permit and Mr. Thacker indicated
that he would also send in the required Plan of Action (POA) summarizing how this facility was to to be
brought back into compliance.
Please note that the lack of required freeboard in this facility is a violation and may be subject to civil
penalties of up to $ 25,000.00 per day, per violation.
Within ten day of your receipt of this Notice you should respond in writing with the following information.
1. All land application records from January 1, 2004 to present.
2. Freeboard records from January 1, 2004 to present.
3. Rainfall records for the same time period.
4. A copy of your current Waste Utilization Plan (WUP).
If you have any questions regarding this Notice you should call Buster Towel] at [phone].
Sincerely,
S. Jay Zimmerman, Supervisor
Aquifer Protection Section
Cc: Tony Short, Northampton Soil & Water Conservation District
Ms. Betsy Gerwig, RRO-DSWC
DWQ/Aquifer Protection Section Compliance Unit
RRO Files
Aquifer Protection Section - Raleigh Regional Office
lie
1628 Mail Service Center Raleigh, NC 27699-1628 Phone (919) 57E-4700 Customer Service 1-877b23-6748 No-.�o�,�`}`,'CaTolina
3800 Barrett Dr. Raleigh, NC 27609 FAX [phone] Internet: h0p.11h2o,encstate.mus /'/atmally
An Equal Opportunity/Affirmative Actlon Employer- 50% Recycled110% Post Consumer Paper f ;/

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Matt Miles
18225 Three Creeks Road
Capon, Virginia 23829
September 3, 2004
Subject: Notice of Violation
Permit No. AWS660014
Blue Rose Farm # 3
Northampton County
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Dear Mr. Miles:
On August 31, 2004, the Raleigh Regional Office received a phone call from Mr. Neal Thacker
reporting that the subject lagoon had only 18 inches of freeboard. This is less than the required design
freeboard for this facility and is considered a violation of your COC and General Permit.
The phone call does satisfy the reporting requirements stated within you Permit and Mr. Thacker indicated
that he would also send in the required Plan of Action (POA) summarizing how this facility was to to be
brought back into compliance.
Please note that the lack of required freeboard in this facility is a violation and may be subject to civil
penalties of up to $ 25,000.00 per day, per violation.
Within ten day of your receipt of this Notice you should respond in writing with the following information.
1. All land application records from January 1, 2004 to present.
2. Freeboard records from January 1, 2004 to present.
3. Rainfall records for the same time period.
4. A copy of your current Waste Utilization Plan (WUP).
If you have any questions regarding this Notice you should call Buster Toweil at (919) 5714700.
S' erely,
cccc-e-�—
y erman, Supervisor
Aquif r Protection Section
Cc: Tony Short, Northampton Soil & Water Conservation District
Ms. Betsy Gerwig, RRO-DSWC
DWQIAquifer Protection Section Compliance Unit
,,RRQFiles_ _-A
Aquifer Protection Section - Raleigh Regional Office *�
1628 Mail Service Center Raleigh, NC 27699-1628 Phone [phone] Customer Service 1-877-623-6748 N ne Carolina
3800 Barrett Dr. Raleigh, NC 27609 FAX [phone] Internet http:lm2o.enr.state.nc,us Xaatumll
An Equal OpportunitylAfBrmative Action Employer - 50% Recyded110% Post Consumer Paper