680008_PERMIT FILE_20171231

Animal WaStMeTt"orage Pond and Laoroon C457ure eport aorta
(Please type or arint all information that does not require a sicnature)
General Information:
Name of Farm: ANILORAC FARMS Charles Snipes) Facility No: 68 _ 8
Ownen's) Name: Charles Snipes
,lailin-a Address: 92no DairvlandPhone No: 942-1406
Hillsborough, NC 27278 County: Orange
Ooeration Description (remainin- animals onlv)_:
XP Please Check this box if there will be no animals on this fart, aster lagoon closure. If there xiil soil be animals on the site
aver lasoon closure. please proVide the foilowine inrertnatiort on arirnals that wlill remain.
Operation Description:
T,,-pe or $ivine NO. 01*.4ni17tulS Trpe or Pouirrr No. of .4nimals T;:pz of Grr:.'e No. or Animcls
-11 Wean to Feder ;' Lave: -, Mir,.
J F,--der to Finish r Pullets Bee:
`I Farrow to hear
Z Farrow to Fetdo,- _
.J Farrow to Finish Q:%ter Tvpe of Lives:ock: Mintber u..Aniina;S
Will the farm maintain a number of animals greater than the 2H .0217 threshold? Yes Non
Will other lagoons be in operation at this farm after.this one closes? Yes I No °-Xj
How manv lagoons are left in use on this farm?:� Npy6
(Name) Terry Hollingsworth of the Water Quality Section's staff in the Division
of Water Qualitv's Haicigh Regional Office (see rnaP on back)
,vas contacted on 10/7/97 (dare) for notification of the pending closure of rhis pond or lavoort.
This notification was at least 2-4 hours prior to the stare of closure which began on 10/10/97 (dare),
and was completed on 10/29/97.
I verify that the above information is correct and complete. I have followed a closure plan which meets
all NR CS specifications and criteria. I realize that I will be subject to enforcement action per .article 21
of the North Carolina General Statutes if I fail to properly close out the lagoon.
Name of Land Owner (Please Print):_ f harl PG Snipes
Si -nature: .!�� �„ �� Date:_
The facility has followed a closure plan which meets all requirements set forth in the MRCS Technical
Guide Standard 993. The followiitg items were compl,tt�d by the owne, and vcrilied by me: all waste
liquids and sludges have bee,: rcrnoved and land appllcd �it agronomic rate, aIi input pipes have beet[
removed, all slopes have bcen stabilized as necessary, and vegetation established on ail disturbed areas.
Name of Technical Specialist (Please- Print;): Gail Hughes
a.fftliation: Or6hge'Sozl and -Water Conservation
address (
Sil-Mature
Plione N0.:919-732-8181 ext .2750
Dare: 11/1819?
heturn tirtthin 15 tIays tos owin7 coTTIOL:tton or antmul w;lter smra-Ft., porla Or la(��un c:()sure to:
N. '.. Division Of Wver Qllalitr- Water Ou;ALv Setitit)n
Compliance Croup

Animal Waste Storage Pond and Lagoon Closure Report F01-1,11
f P leas,: ty1)c nr prim all intornrarion that &cs nut ,r <i,n,ittrrc}
Gtmeral Inform.ition:
. N�irne of Farm:DeJ
Owner(s) Name:_,_.._..._-ti;5ant JA) f 5e AJ
V[ailin� Address: D S7j 3
P Phon`roe :
Jr)e-bane G • a 73Cz- County: klsfinqez M4re
Operation Descriptiott lremainin� �,Znimals onlvl:.
G Please check this box if there will be no animals on this farm after lagoon closure. If,hent will still be animals on the site
after lagoon closure. please provide the followin_• information on the animals that Mill remain.
Operation Descrit)tion:
T'�•pe of Swine No. of An. i als
— Wean to Feeder
J Feeder !o Finish _
J Farrow to Wean
J Farrow to Feeder
,D Farrow to Finish
Type of PoOrn
:1 Layer
D Pullets
Nv. ofAirimals
Other T. pe of Livestock.
Type n( Cattle Ai. of,-lnimals
,$( Daic y -- a —
IT-1118ce f - so - 7s A4ad
Number (.7j'Animils:
Will the farni maintain a number of ,nitnals ,rcatcr thar, the 211 .02 17 threshold'? Yes U No i�-,
Will other lagoons be in operation at this farm alter this one closes? Yes 0 LN0 Gk,
How manv lagoons are left in use on this farm?: O
(Name)Jim of the Water Quality Section's staff in the Division
of Water Quality's a Regional OfFice (,see n,ap ott back)
. was contacted on 3125 JU (date) for notification of the pending closure of this pond or laupon.
This notification was at least 24 hours prior to the start of closure which began on 3,(�z4r �g - (date)_
I verify that the above information is correct and complete. I have followed a closure plan which meets
all MRCS specifications and criteria. I realize that I will be subject to enforcement action per Article 21
of the Nu,-th Carolina General Statutes if I fail to properly close out the lagoon.
Name of Land Owner (Please Print): Sam W t' i Soil _-
Signature:7 _ Date:.`�'r
The facility has followed a closure plan which meets all requirements set forth in the MRCS Technical
Guide Standard 998. The following items were completed by the owner and verified by me: all waste
liquids and sludges have been removed and land applied at agronomic rate. all input pipes have been
removed, all slopes have been stabilized as necessary, and vegetation established on all disturbed areas.
Name of Technical Specialist (Please Print):
Affiliation: 0Y-o �e So; I V��,T� Cons \,ATteA +S.TMtCT
Address (,
Signature:
ne No.:7352.2181 )--Z-7S0
Return within 15 days following completion of anima water storage pun ur a ;non closure to:
N. C. Division Of Water Quality- Water Quality Section
Cornpliaitcu Group
P.O. Box 29535
Rnlei,h, NC 27(26-0535

animal *Waste 'Storaae roncl ana i.agoon L.susure t%ePvx c r v1 ill .
(Pleas ' ,',.)or print ail information that does not req;-," . a signaturcr
General information: ,, rr
:Name or Farm: �/ /4 c kae,, Facility No: C r f ­ Zct
OWnerls) Name: r P -
Mailing Address:.._ ,,. �" 3C 3 r, 4 Phone No. 917
County: C'I-a-
O .eration Descri tion (remaining animals onlv):
Please- check this box if there will be no animals A this farm after lagoon closure. If there will still be animals on the site
after lagoon closure, please provide the foilowing information on tht: animals that will remain.
Operation Description:
? ype rrf saline No. -of Animals
Wean to Feeder
J Feeder to Finish
Farrow to Wean
Q Farrow to Feeder
0 Farrow to Finish
u Gilts
Type of Poulriti• No. of :Arrinials
❑ Laver
Non -Layer _ _-
Type of Beef No. of ,Animals
Q Brood
Q Feeders
D S Lockers
Tree of Drin,
;Milking
.j Dry
0 Heifers
Calves
No. of Animals
Bears T Other TI-pe of Livestock: Number of Animals:
Will the farm maintain a number of animals greater than the 2H ,0217 threshold" Yes ;D -No
Will other lagoons be in operation at this farm after this one closes? Yes,-' Nox
How many lagoons are left in use on this farm'?: Dnh )n JLL
(Ncu�ie} t,T'Al — e-si-e C _ of the Water Quality Section's staff in the Division of
Wares' Quality's r. f` % Reeianal Office (.see map on back) was contacted on / ' e- Y (dare)
for notification of the pe�dine closure of this pond or lagoon. This notification was at least ? hours prior to the
starr of closure• Nvhich bean on !, %�5� (dare).
I verify that the above 'inforrnation is correct and complete. I have followed a closure plan. which meets all FRCS
Y specifications and criteria. I realize that I will be subject to enforcement action per article 21 of the North
Carolina General `�arutes if I fail to properly close out the lagoon.
Name of Land Owner (Please Print): H oc i-_fFt y, Pce.
Signature:
Date: 7 ,1,�5-1/ a7 4
The facility has followed a closure plan which meets all requirements set forth in the MRCS Technical Guide
Standard 998. The following items were completed by the owner and verified by me- all waste liquids and
sludges have been removed and land applied at agronomic rate. all input pipes have been removed, all slopes have
been stabilized as necessary. and vegetation established on all disturbed areas.
7
Name of Technical Specialist (Please Print): �� �� l L- tk ��e S
Affiliation: �nyri title
Address (A_enc� is - 3c�x f `S I' .l l �� t. �, tiC Phone No.:_`` 1``1 246-2�7:5'
Si�rnature: ���` pate:
Return within 15 days following completion of animal water sroruge pond or lagoon closure to:
N. C. Division O A'ater Qtiality- Water Quiulity Section
. Conipliarice Group
1h17 Mail Scrvice Center
Raicigh. N(" '_7699-161'7
j
PLC - l 'luiV 12L 2000

Animal Waste Storage Pond and Lagoan Closure Rtport Form
tplelsr type & print all lnfor natitm blot deem trot require a sigh3ixiter
�. Nan%: aFFa.tm�____.sZ ��.:� ��� T�YE�.s _.�au�7�Y > Facilit)• No:�•_ �.. .�
-
Mailing Addre,... Phone Nd• 9/ • tQa.3S
fs: �---�
County;-
1 `•
please check this box if there will be no tm1mals an this fatter 3Ror lagoon closure. If there will stilt he anlmrlls vn tht Site
after iateerl obium. please provide thtr fbilowing Information no the onitnals that will tenwin.
�gNan �scxl�tiatt:
1:%pr ors whre Np, of Anirtidlr
a Wean fo Feeder
1 PecUar to PimiIll
a Farrow to Wean
a Farrow Ia Peeder _
�] Ferree to Finish
Cl Gilts
aBoats r.,�.......-
Typf of Pmolr T No. ofArdoidti
Ti-pe of Reef No, of AP44Wls
��StOci:crs _
Other 71rpe of
Will the Farm maintain a number or animals greater than the; 2H .0217 threshold?
Will other lagoons, be in operation 31 thiv farm after this one closes?
• Now.many lagoon% are left in We do this farm"•
Type of Dairy No, OJAA(walt
is Milking
Dr1•
❑ KeifcrR _ _.... ..._
MiortherclAirirrtttlr,
Yes :) No �
Yes :Zl NOR
(N1rNrr) f of the Water QuaTity Section's staff In the Div'IrioA ar
Vrntr:r Qtalit�'s . `Q Re fldnat Office rare mop an back) was eontatted oft i �derrrr
for nutification or the pending closure of this pond or lagoon, Thi9 nollftcatitm w1% at lea%t 24ours prior to the
start of closure. wh{ch began an (dare),
I verify that ihr above information Is correct and , ornplcte. 1 have followed a citmure plan. ~Teich meets all 1`RC5
specifications and edleria. i realize that I will' Ix subject to enforretnent action per Article I I of the North
Caroliaa General statutes it I fail to properly ciase out the (agoon.
Name of Land Ow"ee�[.r Il Ioast Priintt):Jij)�_
81$nattzrrt:'6 1r!& Dater /a
The thcillty has followed a closure plun which metly all rtgtsimments s6forth In the MRCS Technical Guider
StandaM 999. The (ollowing itami were completed by the owner and werifled by me, all write ligtlids and
Fludget have beets remo.vd and land appliCd at agronornic rate. all input pipes have been remrived. nil siopen have
been stabilized an necelis:lry, and %--getation e►t4bli+hed on all disturbed ztttxs.
Name atTechnitstl SpeclBllist 1Plta.4 pri{nli:-
Afflliatiam, ch-ma 7o 014-1% trVar'm _v _ .._- .�_I,•� ...
AddrtS% iAgency . f'• 4 . 1$l .&bye .i1�7-phone No.;-jl2416' 1163
Sign3tura•: butt`_
. Return K'{tttln is dn?s fatlnwing cottipletian of animal %rater storoge pond tar lagoon tlo'ure tat
N. C. 171vlsiou Of Witetro"litr- WaterQLWIlty Swil "
Cempliwace Gee UP
11137 NlaIt Serwlec Center
Rulrith. NC 27699-1If17
snisn 'fid wiq eT/11JCAT/T777alPTe-- HC.! �MkIHVn Orr) <rc mP)r•cn mire-7,rT

MAW: -rh DuZ
Animal Wasce StOraM;e Pond anct Lagoon Closure- Report �+orl-il
(Please type: stir print all informotion that sloes not rrd►+ire I si-VIMM :l
• General information:
Name of Farm: -OlLt K6 Facilily No:k/2(11)_- "`l ---
Owner(s) Name: 6LA-S LC
ivlailinv Address: 211 :7T• M I Phone Na: 3 - 3132,
' �LSRt;RCt,�6t�LIL,aUrly,county:—n2LM- f,E
O erati n Descri Lion fremaining animals gale):
Tease check this box if there will be no anirnals on this farm after lagoon closure. if there: will still be animals on the site
after lagoon cloture. please provide the followinginforrtiatiun on the animals that Mill remain.
Oueration Descrimion:
Type of Swing No. of Anintals
• Wean to Feeder
• Feeder to Finish
• Farrow to Wean
-1�1-farro%v to Feeder O
,J Farrow to Finish
Tape of Poultn• No, of Alrinaals Type of Cntrle
Layer :1 Dairy
D Pullets Beef
No. of Animals
Or1+e.r Trl+r. of Liresrnr.•k;� __ rVrrv++brrr nf,4nrmals:
Will the farm maintain a nuitiber oC animals arca(cr th;.tn the 21-1 .0217 tliicshold ? Yes U No C4--'
Will other lagoons be in operation at this farm :after this one closes? Yes ❑ No Ctt'
How many lagoons are left in use on this farm?: O
ovame) of the Water Quality Section's staff in the Division
•of Water Quality's N Regional Office (see map on back)
was contacted on (date) for notification of the pending closure of this po d or lagogn.
This notification was at least 24 hours prior to the start of closure which began on Zb obi (date).
I verify that the above information is correct and complete. I have followed a closure plan which meets
all NRCS specifications and criteria. I realize that I will be subject to enforcement action per Article 21
of the North Carolina General Statutes if l fail to properly close out the lagoon.
Name of Land Owner (Please Print):
Signature: -
Date:
The facility has followed a closure plan which meets all requirements set forth in the MRCS Technical
Guide Standard 998. The following items were completed by the owner and vet-ified by me: all waste
liquids and sludges have been removed and land applied at agronomic rate. all input pipes have been
removed, all slopes have been stabilized as necessary, and vegetation established on all disturbed areas.
Name of T
Affiliation.
Address (Agencv):s`hl�
Signature:
C 8329�i Plione No.: 19 � 2EL-SZ
Date: 3- .2 7'0 2 _
Return wit to 15 -days—foilolying completion of animal water storage pond or lagoon closure to:
I N. C. Division Of Water Quality- Water Quality Section
Compliance Group
Q.O. Box 29535
Milei,h, NC 27626-0535
PLC - 1 %-itty 3. 1996

• Animal Waste Storage Pond and Lagoon Closure Report Form
(Plt:zae type or print all information that does not require a signature P
neral Information:
' G Facility No:
--. Name o; Farm• t
.vrtexts) . amc._._ _ ——
Mailine Address: 4 1 SPJ C 5? fe N _ - _ Phone No:
RoL56orolA13h t Nf.4 1S _ ^ —county: K
ti2n VMSd eonf rtmainingafta as1v
21please check this box if there will be no animab an this farm a1W lagoon cicstim If there will still be anitnals on the site
after to r on closure. please provide the following inromnadon on tree naitnalt that will renmin.
oerat on Pm+rlydon;
T)•pe of swi►te No. of Anetnair Type of Pot#1n7 No. of Animals Type of Dairy No, of Animals
❑ Wean to Fender layer Cl N illkiay
Ftc bar to Finish Noa4.atrar :I D"
G Farrow to Wean Ttpe of 9rrf Ne ofAnirnals 0 heifers
:I Farrow to �eedcr ] 9roo1 Cah'e+
G F-m-mm, to Finish _ ,, 21 Fee t"
a Gilts D•Stocxers
Beans Other Typr t:f G'veatoet_w �� Nurnher of Anitnalsr
Will the farm maintain a number of animals getter th4n the 2H .0217 threshold? Yes 0 iota
Will other iagotins be in operation at this farm after this one closes? Yes :3 Ne
How m1nr laguotm are left in uie on this farm?:, fro !j Z _
Warne) Q. '`'t r of the Water Quality Section's staff in the Diviciot of
Water Quality'% . Kale-Lfl Regional Office rare trap an back) was contacted out I & 1- 03 1dare,
for yatiflcatian of the ptemdft clw. ure of this pond or lagoon. This notification was at least i.4 hours prior to the
start of closure. whie:s begun on _SkC. 9�2X03 (date),
I Verify that the aboys information ii correct and : ornpbew I have foilowed a elmure plat+, which meats all FRCS
specifications and criteria, i realize that I will be subject to enforcement action peter Article 31 of the Notch
Carotins General Statutes in fail to properly closa out the bean.
Name of Land Qwper tlslFrint?,
Signature: --� Date:
'he faility has followed it closure plan which meets ail requirements sri forth In the N. RCS Technical Guide
Standarni 995. The following items wets completed by the owner and verified by me: all waste liquids and
%leaches have been rerno,.Yd and land applied at agronomic rate. all input pipe., have !seer[ reserved. all slopeu have
been stabilized as necessary, and v%-ptation established on ale disturbed areas.
Name of Technical Specialist I Plea.+% Prirtl:
Affiliation: 4 rawm e 5 ;I C[t'tl
Addrese (Agerres):
N offimii
• Retum within 15 days rallowing completion of anbnol %voter storage pond or lagoon closure to.,
N. C. Divisiou Of Water Quality- Water Quullty Section
Compliance Group
1617 Mail Semice Center
Rslcigh. NC 27ft+39-1617
=�&75 1+
i00/BOG 'd S[:E IDS 6i5 ]� OU INIGON :1:tf (NOWIZO.fe-'Un

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
December 27, 1996
Charles Snipes
Anilorae Farms
6602 Orange Grove Rd
Hillsborogh NC 27278
JAN 2 1997
Dui RALEIGN
REGIONAL Oi I ICE
Subject: Removal of Registration
Facility Number 68-8
Orange County
Dear Mr./Mrs. Snipes:
This is to acknowledge receipt of your request that your facility no longer be registered as an animal waste
management system per the terms of 15A NCAC 2H .0217. The information you provided us indicated that your operation's
animal population does not exceed the number set forth by 15A NCAC 2H .0217, and therefore does not require registration
for a certified animal waste management plan.
Under 15A NCAC 2H .0217, your facility is deemed permitted if waste is properly managed and does not reach the
surface waters of the state. Any system determined to have an adverse impact on water quality may be required to obtain a
waste management plan or an individual permit. You are reminded that a discharge of wastes to the surface waters of the state
will subject you to a civil penalty up to $10,000 per day.
Should you decide to increase the number of animals housed at your facility beyond the threshold limits listed below,
you will be required to obtain a certified animal waste management plan prior to stocking animals to that level. Threshold
numbers of animals which require certified animal waste management plans are as follows:
Swine
250
Confined Cattle
100
Horses
75
Sheep
1,000
Poultry
30,000
If you have questions regarding this letter or the status of your operation. please call Sue Homewood of our staff at
[phone] ext 502.
Sincerely,
A. Preston Howard, Jr., P.E.
cc: Raleigh Watc r ua ity-Regional Office
Orange Soil and Water Conservation District
Facility File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources a
RIFFMA,
. a
James B. Hunt, Jr., Governor [:)EE:HNF;Z
Jonathan B. Howes, Secretary
Steve W. Tedder, Chairman December 5,1996
Charles Snipes
Anilorac Farms
6602 Orange Grove Rd
Hillsborogh NC 27278
Subject: Operator In Charge Designation
Facility: Anilorac Farms
Facility ID #: 68-8
Orange County
Dear Mr. Snipes:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge by January 1, 1997, for each animal
waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more horses,
1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management system. Our
records indicate that your facility is registered with the Division of Water Quality and meets the requirements
for designating an OIC.
A training and certification program is not yet available for animal waste management systems involving
cattle, horses, sheep, or poultry. Owners and operators of these systems will be issued temporary animal waste
management certificates by the Water Pollution Control System Operators Certification Commission
(WPCSOCC). The temporary certificates will expire December 31, 1997, and will not be renewed. To obtain
a permanent certification, you will be required to complete ten hours of training and pass an examination by
December 31, 1997. A training and certification program for operators of animal waste management systems
involving cattle, sheep, horses, and poultry is now being developed and should be available by the spring of
1997. The type of training and certification required for the operator of each system will be based on the nature
of the wastes to be treated and the treatment process(es) primarily used to treat the animal waste.
As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not intend to
operate your animal waste management system yourself, you must designate an employee or engage a contract
operator to be the Operator in Charge. The person designated as the Operator in Charge, whether yourself or
another person, must complete the enclosed application form for temporary certification as an animal waste
management system operator. Both the designation form and the application form must be completed and
returned by December 31, 1996.
If you have questions about the new requirements for animal waste management system operators, please call
Beth Buffington or Barry Huneycutt at 91gn33-0026.
Sincerely,
FOR Steve W. Tedder
Enclosures
cc: Raleigh Regional Office
Water Quality Files 4
Water Polluton Control System �a Voice 919-733-0026 FAX [phone]
Operators Certification Commission NvfcAn Equal Opportunity/Affirmative Action Employer
P.O. Box 29535 Raleigh, NC 27626-0535 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources • •
Raleigh Regional Office
James B. Hunt, Jr,, Governor
Jonathan B. Howes, Secretary
Boyce A. Hudson, Regional Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
October 24, 1995
Mr. Charles Snipes
5200 Dairyland Road
Hillsborough, NC 27278
Subject: Compliance Inspection
Anilorac Dairy Farm
Facility No. 68-8
Orange County
Dear Mr. Snipes:
On September 14, 1995, Mr. Ted Cashion from this office conducted a
compliance inspection of the subject facility. This inspection is a part of the
Division's efforts to determine potential problems associated with waste disposal
systems.
Mr. Cashion's site visit determined that wastewater from this facility was
not discharging to the surface waters of the State. No manmade pipes, ditches,
or other prohibited conveyances (for the purpose of willfully discharging
wastewater) were observed. The facility was not in operation at the time'of the
inspection. If the facility is placed in operation in the future, we recommend
that you contact the Orange Soil and Water Conservation District prior to
operation.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facility operators. The Division of Environmental
Management is required to enforce water quality regulations in order to protect
the natural resources of the State.
If the facility is placed back in operation, an approved animal waste
ma�ns �ement plan must be incorporated by December 1997. This plan must be
certified by a designated technical specialist or a professional engineer. For
a listing of certified technical specialists or assistance with your waste
management plan you should contact your local Soil and Water Conservation
District.
The Raleigh Regional Office appreciates your cooperation in this matter.
If you have any questions regarding your inspection please call Mr. Cashion at
919-571-4700.
Sincerely,
Judy Garrett
Regional Water Quality Supervisor
cc: Orange County Health Department
Orange County Soil and Water Conservation District
Facilities Assessment Unit
h:\animal\anilorac.ins
3800 Barrett Drive, Suite 101, Raleigh, North Carolina 27609 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/ 10%poe-consumer paper

UCI'1 WH I CK UUHU 1 V "I :JCI:. I i UV4 1 U ..
Site Requires Immediate Acren6or-
'Facility No.
DIVISION OF ENVIRONMENTAL. MANAGEMETNT �, $
ANTMA.L FEEDLOT OPERA FIONS S11M VISITATION RECORD
DATE: S� `t , 1995
Time: ���0. G
Farm Name/cvwner
Mailing Address: SA0? Q�+��> ¢Kv� . �� �:Ifl �r.a
Counry: 0ha eIntegrator. Phone:
Phone:
On Site Representative: Phone:
Physical Addmss/Locadori: ervt g2f 4 ,10,0
Type of Operation_ Swine Poultry Cattle
Design Capacity: Number ofAaimals on -Site: / 0
DEM Cerrificaaiin Number: ACE DEM Cepcation Number: ACNEW
Latitude: 3•1— 3S 'Longitude: �� /E Q� Elevarion: Feet
Circle Yes or No
GUcs the animal Waste Lagoon have sufficient freeboard of I Foot + 2S year 24 hour storm everit
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: ____Fr. Inches
Was any seepage observed from the 1a oau(s)? Yes 49 Was any erosion observed? Yes o No
Is. adequate laud available for spray'.> Ye or No Is the cover crop adequate? Ye or No
Crop(s) being utilized: qMYr
Does the facility meet SCS miaitrtum sr-tback criteria'? 200 Feet from,Dwellings? Ye or No
100 Feet from Wells? &or No r
-Itanimal waste stockpiled within 100 Feet of USGS:Blue Li e S or� a;rixnai waste land applied or spray irrigated.within'25 Feet of a USGS iV1ap $luz Line f Yes No
's animal waste discharged into waters of the state by rnan-made ditch,.tiusbing sysmm. or other.`
;irnilar rn3n-rltatle Cie��ices! Yea o No 1T Yes. Please Explain.
'a+xC1 10C tadli[y ruai-ntain adequate waste matragerncnt.Tecords (volurnes of ruanure, land applied,.
spray inigared on a-pccific acreage,ewith civet cro�)7 Yes or No
Additional Comments: �� 01 . o zva ,, u �,
h v eS p L
gc1 CYp ,e I�
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V.ems:.. Signaaue
cc: Facility AsseSsment Unit Use Attachments if Needed..
TCITPL P • 22