820703_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

tivision
ivision of Water Quality
1 r.
Faciflty Number r%d of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit oRoutine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
f���
Date of Visit: Z, Q Arrival Time: lTbO Departure Time: d(i County: Region:
Farm Name: p O -ner Email:
Owner Name: �ten.:�,r�� �o �+�•s n�� �►Rirt rbl�hp;
Mailing Address:
Physical Address:
L
Facility Contact: alt?'z I 1(r Title: LN Phone No:
('
Onsite Representative: �—` r 1U i Integrator: f. i l _e)
Certified Operator: Eayx r Operator Certification Number:o`�
Back-up Operator: ' O nn T`i ny� r � ty Back-up Certification ]Number: /939
__—
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude: ='
=' = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
_ 1 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Laver-
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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?
I
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
❑ No
�A
❑ NE
--
❑ Yes
❑ No
PVA
❑ NE
[:]Yes
Ado
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
12/2$/04 Continued

Facility Number. ."�_— 03
Date of Inspection L t1
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?
❑ Yes PNo
ElYes 9No
❑ NA ❑ NE
❑ 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 No ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ yes fgNo ❑ NA CINE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 19No ❑ 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 requireYes [� No E]NA ❑ NE
maintenance or improvement'? ❑
Waste Apatication
10_
Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes
No
P
[:1NA El 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 I 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [IEvidence of Wind Drift ❑ Application Outside of Area
12.
Q —s
Crop type(s)
13.
Soiltype(s) GoA
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
KNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
O;LNo
❑ NA ❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
Wo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
,) No
❑ NA ❑ NE
Comments (refer to question ft 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): L
Reviewer/Inspector Name Q / fA% Phone:
Reviewer/inspector Signature: Date: <',e7:29 e:3&7
12/28/04 Continued

Facility Number: — Date of Inspection
Reguired 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes 0 No ❑ NA
❑ NE
❑ 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
Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes ❑ NoNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PCqo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0 No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �allo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No [kNA
❑ NE
Other Issues
2$_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes X No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M)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
Pallo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I . Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
JKNo
❑ 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
SdNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional Comments and/or Drawings:
aAaa"
Sc,, ace- rA5
12,IV04

Facility No. � Time In Time Out Dale
Farm Name S �-- Integrator i.
Owner, `' Site Rep
Orator r c,,, „fit_.,.,Otw.- No.
� q 53,1
Back-up {; Y%A No. 1 L4 -�
COC Circle:General or NPDES �-----
Design Current
Design Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - FinishGilts
/ Boars
Farrow - Wean _
Others
FREEBOARD: Design
Sludge Survey
Crop Yield
Rai
Soil Test
reeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Wettable Acres
Daily Rainfall
120 min Inspections
Date Nitrogen (N)
III 7-0
Lo
Us iKi
Observed C:Z� 3
Calibration/GPM 1 t (+ h -11., Ci � 61
Waste Transfers
Rain Breaker
PLAT
1 -in Inspections
Date Nitrogen (N)
� .S
U •v
1
Pull/Field Soil Crop Pan Window
r
,3 Z
5 3
1y
w !S
;I

vision of Water Quality
Facility Number �_ �V� O Division of Soil and Water Conservation
Other Agency 1&
Ao�
(Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit @(,Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I b 2 Arrival Time: a V I Departure Time: County!
Farm Name: Owner Email:
Owner Name: r 1�mi pt m _C G—V ry1 c MC Phone: _
Mailing Address:
Region:
Physical Address: I
Facility Contact: I� 1 5� V1_ Title: Phone No:
Onsite Representative: ' 0.V1 h iS r+cl Integrator: 1 tyy-� S4
Certified Operator: �� >'� ✓ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Effarrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = ' Longitude: = o = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
ob
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
DINo
❑ NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
❑ No
MNA
❑ NE
bR)NA
❑ NE
❑ Yes
❑ No
❑ Yes &No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
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? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ 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 El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes � No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes _C6 No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EoNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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) Coy f1 �o �.71 a1 0j V� 'J6*'O"
13. Soil type(s) UJI"n CP�b Lou- F O e S
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
�_4
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
ElN A
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.NNo
❑ 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): _
B,, so e/ q_ -�-o 4-o-Jue. PAN (e d uc+-by\ pn o n'� C.Volp �O � �61�� ►'t�if
W . l 1 abum C' iss a cs cL ra2.h %,a i A s
Reviewer/Inspector Name �_LAA'Z-MT
Reviewer/Inspector Signature:
Page 2 of 3
Phone: q to q 33 3:100
Date: DC T Z 3 2cD (P
12128104 Continued

Facility Number: — Date of Inspection 3 y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ W'Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1,VNo ❑ 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?
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
No
❑NA
El NE
❑ Yes
JW No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
;<No
❑ NA
❑ NE
❑ Yes
1KNo
❑ NA
❑ NE
❑ Yes kNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
Page 3 of 3 12128104

Facility No. Time In Time Out Date O c�3
Farm Name Integrator
Owner �S_� ��i� Site Repm c G ,At,C , Czh 0,14-1 447 —
Operator No.
Back-up No.
COC
Circle: General or NPDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed - Finish
Gilts / Boars
row - ea
o -
Others
FREEBOARD:
Design
Observed(
Sludge Survey
i___
Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge in Breaker
Soil Test PLAT Wettable Acres
Weekly Freeboard Daily Rainfall ✓ 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
.3gZ
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
q$ (. � I _ 20 2 1 3 1?
% ^ I 5111 Z. o Z Lu l
Pull/Field Soil Crop Pan Window
1f
---------------
or o (,v.
I
i2

82 H -+0
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit $1 Routine 0 Complaint O Follow up a Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,'Z y d Arrival Time: ^ y s Departure Time- County: 'E�bt —j25Cr1­ Region:
Farm Name: S - .Z Owner Entail:
Owner Name: Pr am', u ►xL zL--A EIL,f v%& Phone: -7l0 - Sg 2.. - Z 1 O!q
Mailing Address: PO gox 3q -dl _ CA Aim Z 3 Z
Physical Address:
Facility Contact: L'.rgnj Title: Phone No: 110 - 2-22 - 3OZ
Onsite Representative: -, �� Integrator:
Certified Operator: ±► wk�_ C Operator Certification Number:
Back-up Operator: _ 5.Q Z WN�kwv Back-up Certification Number:
Location of Farm:
Latitude: Q fl ,. Longitude: 7$ ° (3 ' g2] N
Design Current Design Current
Swine r Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 10 Layer
❑ Wean to Feeder 10Non-La et
❑ Feeder to Finish I Iµ
ESFarrow to Wean 3100 1 YflU
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other-
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
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-inade?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry_ Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:ED'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Q. 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 [gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[--INA
❑ NE
❑ Yes
❑ No
❑ Yes
�XNo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12/28/04 Continued

acility Number: - }p?' Date of Inspection t.�1
Waste Collection ,& Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,i
Observed Freeboard (in): s�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�d 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
RNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and tate situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo
❑ 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
EgNo
❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U,No
❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0,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 off Wind Drift ❑ Application Outside
of Area
12. Crop type(s)t :ori . WLt.ea.4-_-
13. Soil type(s) Lk
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
13No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
&No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
kNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®,No
❑ NA ❑ NE
#}: Eacplain�a�y'YES.;
tter explain sitnativris
Reviewer/inspector Name Il o 4N' Phone:(Q
Reviewer/Inspector Signature: Date: 2, -S—
12/28/04 Continued

Facility Number: gZ —_o Date of Inspection K 0
Rattuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z -Vo ❑ NA ❑ NE
20., Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M -No ❑ NA ❑ NE
the appropirate box. ❑ WUpk'F_1 Checklists C Desigrf- ❑ Maps'❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. &Yes [_1No ❑ NA ❑ NE
❑ Waste Application' ❑ Weekly FreeboarW ,c❑ Waste Analysi" ❑ Soil Analys < ❑ Waste Transfers ❑ Annual Certification--
❑ Rainfalir RStocking ®,Crop Yield [:1120 Minute Inspection K Monthly and 1" Rain Inspections ❑ Weather Code. &I
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to instal I and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
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
54JVo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
EINE
❑ Yes
®.No
❑ NA
❑ NE
❑ Yes
R1 No
. ❑ NA
❑ NE
❑ Yes
(&NO
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
ayes
t-1 No
❑ NA
❑ NE
❑ Yes
9[No
❑ NA
❑ NE
❑ Yes
P�No
❑ NA
❑ NE
❑ Yes
6No
❑ NA
❑ NE
❑ Yes
L6No
❑ NA
❑ NE
❑ Yes
P.No
❑ NA
❑ NE
Additional Comments and/or Drawings:
u�3a s{c Ali sps 5_17,81oY t-1
�1 1101 l •i{ 513/0Y 2-!r
a !y 1eK 2. o
401arw 4+ -4 �) t W er-s ex c e JeA
i ..� A,, � •� s•� ~ ��c-.+�.�ao� ZC7o `{ C re � Z2 �� 9 ` sc DY ,
2 I , Ske7r�•,.o�-`�rra�s � C� •� i e 405, a.�.a l " f a� •� �vcs�Q��esvt e>)el �w"�e����cn1
1S ` �•CaU �� `�'�£_ CM-5:`�4 i��bCb�S _ ��-e&s� �r�c� v0.S
>0cv- 4S.
p 7Ams% v, 1&s ace_ r re� azul. wt -a( vi-sie- pro'
0 "` vm A.0 U s S�A*_ -JA S: i kj- S`1e vesled
�pe� �p�,nnO\r4 a.J i uFaS vt.o� Acca 12/28/04
A
r

i
Type of Visit p'Com fiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other I] Denied Access
Facility Number p 113ate of Visit: 7 o Tune: I &: 5"
O Not erational Q Below Threshold
EI�Perrnitted Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: --
Farm Name: -•--- ......._------------- County:.... !.. .. _ .» ».......---- ---- ----------
Owner Name:T tw +r^ �*�, SJ Farn s Phone No: q A - A 1 �{,. _ ,,,•
Mailing Address:.
.�I'ytfor_.r...a4-^.
Facility Contact; �a &UATitle: Phone No: _____ —_-•
Onsite Representative: - (n*`} _.� .� �t _ _ _ .. Integrator:
Certified Operator: Operator Certification Number: a�
Location of Farm:
Is/Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude • Q°d
Currin
Si6ne ['gearefv .,Pnii�Slatin
El Wean to Feeder
El Feeder to Finish
Ekfarrow to Wean Do 3 0
Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
-�
'-
__ .t -
Curree
4tr'Y�=���_Ca �cx=Po
nlatian Esttle .� am. Ca' i
Layer
❑Dairy
Non -Layer
T ❑ Non -Dairy
Other
;
rK■�■�
-
//J�w�H
Total Design CaPaclt3'
-
.F iri
7 .
Total SSLWC
Number of Lagoons
r a x:xa z Irvt
. �tllnldiree`Dnw.iof.Q..l..i _'T.....,..::. �•.. r _ ,�'>. .,.� x _-....x _a .�;:
Discharges & Stream I_ mpacts
1. Is any discharge observed from any part of the operation? ❑ Yes [filo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D'Ro
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �To
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �io
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier 1
Freeboard (inches): S4
12112/03 Continued

Facility Number: p''
Date of Inspection / b
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 46 was ,answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
S. 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 maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below_
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper andfor Zinc
12. Crop type Coro , tJ
❑ Yes [RrNo
❑ Yes ["No
❑ Yes [fNo
❑ Yes [TNo
❑ Yes [rNo
❑ Yes BNO
❑ Yes ER-io
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 9 No
b) Does the facility need a wettable acre determination? ❑ Yes ErNo
c) This facility is pended for a wettable acre determination? [:]Yes RNo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes [No
❑ Yes 2�No
❑ Yes ErNo
❑ Yes R No
❑ Yes [31No
❑ Yes ["No
Com�rnts{re%r too questsoii #) Ezplain amy VManswers and/or simy_recoinmradat:ons or anp oth_cr aorrmnmtS. —N ...
_Use dlraw�ngs'od l�ctTity to better txplata silanations. {ese addifsaaal pages as necessary'? Geld Copy ❑ Fatal Notes � � � F
r
's a;.,;_ _,.. ..'s .�-"Y"y},� "3 r. -t -� a z �,��._.r v....»�.. �., f _ "'E .._. i�.na_ w.'Y+'.y �,_x�..ra�-..-�•,.. .s-�_-..a+- _
121.12103
P6 /Ar Imo.
ReviewerAnspector Name i�r.1`d u "JL�
17 a
ReviewerAnspector Signature: Date: 5117104--
121.12103 /�
Continued

Facility Number: — Date of Inspection
R+enuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have alI components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [�lo
❑ Yes [3f4o
❑ Yes IiKo
❑ Yes EfNo
❑ Yes 2f4o
❑ Yes 2 No
❑ Yes Ef No
❑ Yes [ffNo
❑ Yes ErNo
EfYes ❑ No
❑ Yes ["No
❑ Yes [ No
❑ Yes BONo
❑ Yes [(No
❑ Yes 2 No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
ddtt:oaal.Camments'apd/orDrawtngs = �- . ' —� - - �w� . � y =
ct SCIS
VVI
12/12103

13 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
149 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 1D�
Facility Number
Time of Inspection -' O 24 hr. (hh:mni)
13Registered O Certified 0 Applied for PermitPermitted 113 Not O erational Date Last Operated:
Farm Name: - .S �`...... y:............... �..................................
..............�1rlj... f..!? �._................... Count
Owner Name: ( {X 1� Phone No: 1�� %%� ¢
_.........................� .y7........................ ... ..................I.......----..........
Facility Contact:
Mailing Address: :'
Onsite Representative: .............�..,.I.
Certified Operator...................,..
Location of Farm:
Title: ................................. . ............................. Phone No:...............................
....................
'1� N..........
....................................... l... G ....... .... .....
. .. ... ......
.............................. Integrator: ................ io 4?j�_.....toW.
........................ Operator Certification Number ..........................................
Latitude ' 6 « Longitude • 4 46
' Design ,.H• Current ADesign ` GurcentDesign Current max;,
�7 Si4nne "". Capacity Population Poultry `Capacity Population Cattle , Capacity=Populatton
, ❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ soars
.; .
❑ Layer I0 Dairy
t, ❑ Non -Layer 'x°;' ❑ Non -Dairy
❑ Other s
Total Desigi
xTu
❑ Subsurface Drains Present
�79 ❑ No Liquid Waste Managen
Lagoon Area 10 Spray Field Area
S
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin? A/
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ 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 ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97

acility Number:
8. Are there Lagoons or storage ponds on site which need to be properly closed?
Structures (Laxoons„11olding Ponds, Flush Pits, etc.)
9. Is storage capacity {freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard(ft) .......................... ....................
Structure 4 Structure 5
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of anv of the structures observed'?
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
❑ Yes ❑ No
❑ Yes ❑ No
12.. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmenlal threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers" ❑ Yes ❑ No
Waste Application
14• Is there physical evidence of over application? ❑ Yes ❑ No
(1f in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ❑ No
1$. Does the receiving crop need improvement? ❑ Yes ❑ No
19. ,1s there a lack of available waste application equipment? ❑ Yes' ❑ No
20. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
21, Divi Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes ❑ No
22. Does record keeping need improvement? ` ❑ Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes ❑ No
0 No.vio'lations or. deficiencies were-no'ted-during' this visit. Nou.will receive no further
correspondente �hoitt this.visit. : .
,
Comments, ii iferto question #}:y -Explain and/or anF recommendations -or any;other comments °
s<,
❑se'drawifitgs of faetlity to better explain-sitaatinn5,'(use additional pagesas mc�cessarw)
w Awl— 04
J
7/25/97
Reviewer/inspector Name M'F
Reviewer/Inspector Signature: ryj�_ Date: