710044_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua.
II

4 y4
Type of Visit: Q Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: _T_V_ Arrival Timer Departure Time:® County: ?6NDEr& Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: GO-&e(L PAOO 7 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 0191 5 2 8
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
k Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. Poultry
C•a .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 Pouits
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?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [jNNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
D. NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
6 o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 11 - Date of Inspection: 1
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 F2Ko ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LJ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoD ❑ 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 �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 environmZo
hreat, 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
Vf NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
0 PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Faiiure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
e
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑ No
❑ NA
ONE
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
❑ No
❑ NA
<
20. Does the facility fail to have all components of the CAWMP'readily available? If yes, check
❑ Yes
❑ No
❑ NA
VNE
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
D 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
❑ No
❑ NA
�f
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
E
Page 2 of 3
21412015 Continued

T'acili Number: jDate of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ENE
Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA
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 N
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA w NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
21"No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:)Yes
dNo
❑ 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
EJ/No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility9 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
o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any, additional, recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages. as, .necessai y).
qj �c-&OwD LevE,L i
-!�cusj A c-74:6-d5 TO FdLLO 1A)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
v�
L,
Phone b I? ! -"
Date: '
214120 5

Type of Visit: (D Compliance Inspection U Operation Review Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Arrival Time: /'J ZO Departure Time: County: F - JX�— Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ?d P60&)1'Ge2AA E
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:�j 2
Certification Number: f ✓�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry Capacity Pop.
ILayer I
Design Current
Cattle Capacity Pop.
Da!a Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
d0
Design Current
D . P,oul Ca aci Pao
Layers
Da'a Heifer
Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
6
❑ NA
❑ NE '
[:]Yes
No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? �es ❑
a. If yes, is waste level into the structural freeboard? ❑ Yes No
S*
❑ NA ❑ NE
❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 Jam-' - -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 environments 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 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 0 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 [2/No ❑ NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s);
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej No
❑ 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
Noo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNIN3
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
"o
❑ 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
❑Ot
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NE
ste Application ❑ Weekly Freeboar ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
���///jjj Weather Code
Rainfall 0 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
I_ 1 o
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

1FAUlty Number: 11 - LM Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑
❑ NA rNE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
wl"o
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?
D 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 ❑ YesNo ❑ 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 Wo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes �o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes W ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). a
CSC C 11-6 °'i / DIu /l S-
f_AA4V\ tJE7 C �3
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Date: / d / I r

Type of Visit Q Compliance Inspection C? Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint Q Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: � Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: AR12y Y�)4 1 IrS
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o [=,
= is Longitude: = o =' 0 «
W-FUNWHO'
urrent
Swine opulation
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow'to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
I
Discharges & Stream Impacts
Design Current
Wet Poultry Capacity_ P,opulati��
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
�❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
!❑ Other
DesignIGurrentCattle Capcityopulation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Is any discharge observed from any part of the operation? ❑ Yes V No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
bkNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Wo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: — Date of Inspection Mm
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4No ❑ 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: C%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
W No
❑ NA [:INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
]4 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 0 Yes
ONo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ANo
❑ 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)
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 ❑ No
❑ Yes ❑ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ❑ No
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
18. is there a lack of properly operating waste application equipment? ❑ Yes ❑ No
❑ NA )I NE
❑NA El NE
El NA ONE
❑ NA X NE
❑ NA IqNE
1 jjeq�-' - C -c1b IN -jz_� w I WC-3 two o i XIc 406' •
Wa�1 OQQ(L'11'�l U'Pi --r tR CAN CQ i�i. OIR, �c►JQ ��aX!�€� U'4 W�u-&
-TItLR� 15 �tC) C_v1D)CAK o r iirca&R2PC-7- 049PO c.rq 716;�V
mET u5 0Als I ►- T ICIc,�s w4Acry JAALLS H C
WiXlb wA-> (?;>L- OL-)INC a (Lk --TOE oV_- WA--, +}-A dc),u149
Reviewer/inspector Name j N S O*W 6LL Phone: `-j _1'_1(0 -3 Sd7t
Reviewer/Inspector Signature: C Date: O a
Page 2 of 3 12128104 Continued
I

Facility Number: 41 — G( Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [ rNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes ❑ No ❑ NA t9NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 9NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
5�NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
R NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
4 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
JRNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
11�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
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
XNo
❑ 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
JANo
❑ 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
[4vo
❑ 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
iXNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
S A-t b i (kqx�e� L4 rTc� I A I G S � 9 EA UI�&Ti+A
Page 3 of 3 12128104

Type of Visit (!5 XRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I Vfl Departure Time: County. Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: (l Title:
Onsite Representative: 7trlJA%1tJ(C2 LI"
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 = 6 = Ii Longitude: = ° = 1 = 6{
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultr.� Capacity Population
Cattle
Capacity Population
❑ an to Finish
❑ La er
❑Dai Cow
❑ We to Feeder
❑ Non -La et
❑Dai Calf
® Feeder to Finish
t�`s
❑ DairyHeifei
❑ Farrow to Wean
pry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Gilts
ElNon-La ersEl
❑Beef Feeder
PE]Boars
Pullets
❑ Beef Brood Cow
❑ Turke s
Other
El Turkey Poults
-
Number of Structures: l
❑ Other
Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El Ye
❑NA
[I NE
❑ Yes
V/No❑ NA
❑ NE
El Yes
No ❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number: 1 —
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
Structurell Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 314
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N ❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
;No
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
E3 Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
eNo ❑ 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
[3'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/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
,_ �
2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) 5 (s 0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E�3o
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
E3 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
IIauc, c otua EP- a C CMLk w Rw rJ ��� s G2�a s s c �.1F�- ? U'_1 Ems` G"SZ to AJ
Li
�co�e� � G•.bv9 S1tAAc4
Reviewer/Inspector Name ?dU.1�jq jy � 5. Phone: (A
Reviewer/Inspector Signature: Date:
IZIZ61U4 connnueu

Facility Number: /)j -- 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 E rNo❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21.
keeP in need improvement? If yes, check the appropriate box below.
Does record g
ElYes
61No
ElNA
ElNE
❑ 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
/
D .
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L' I No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
7NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[r NNA
❑ 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
L' 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
X0
❑ 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
El Yes
,—
EXo
❑ 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
1. 401
❑ NA
[INE
33. Does facility require a follow-up visit by same agency?
ElYes
Ld O
❑ NA
❑ NE
Addttio"nalsCommeats. Drawing
12128104

Type of Visit 95 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: I LiAPIP 6 Tune: E=
Q Not Operational Q Below Threshold
/PlIermitted Q C/er<�ifi © Conditionally Certified [Q Registered Date Last Opera ,_Above Threshold:
Farm Name: County:
,� �,c# one No:
Owner Name. $1'h
Mailing Address:
Facility Contact: _ . hone No:
Onsite Representative:. [/ �' 'V� . �lf T _L{o Integrator. r x Sr
Certified Operator: _ , _ _ _ , , . , , , _ Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle 0 Horse Latitude Longitude '
Design Correct I?esrgn Cnneat 1gn Carrot
..,r.�
Cattle Pd lion
Wean io Feeder ❑Layer Dairy
Feeder to Finish Ql7 O Non -Layer Non -Dairy
Farrow to Wean`
Farrow to Feeder Other
Farrow to Finish TAM LIes, m-
Gilts
Boars Teal SSLW
Nr fi.�gootes
n
Dischmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other /
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes A No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 10 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): J�
12112103 Continued

FacilitTNumber: 07 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes No
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 A No
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 RfNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes No
❑ Excessive P000n�nding ❑ PAN Hydra 'c Overload ❑ Frozen Ground ❑ Co and/or Zinc
12. Crop type yC J ii1 �5�
13. Do the receiving crops differ with those designAk in the Certified Animal Waste Management Plan (CA }?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
No
❑ Yes )01
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 P(No
16. Is there a lack of adequate waste application equipment?
❑ Yes No
/
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes j 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
❑ YesNo
Air Quality representative immediately_
t777 �> r>
Comrnmis {refer to gaestion}Eam aayYFS answers aadlar aa9 or any�othsr eomrarnts:
i7se drawings of4torettetr acglamsrEaations. �e:addtt:anal P rY ❑ Field Copy ❑ Final Notes
l--i�ZP4 iv Z,&-oa^)
J
be- C
_
lee
CLI -5 r ° S^A
ftj
1 `2�7'I
f19ti,T
- Y'•"- �,=^.e.'= g k..�.: .= :3x'c:...�...�,
Reviewer/Inspector Nance: = _ =—'
Reviewer/Iaspector Signature: Date:
12112103 Confined

Fa 114 Number: — Date of ,Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available?
❑ Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes �No
23. Does record keeping need improvement? If yes, check the appropriate box below.
)(Yes ❑ No
]Waste Application &Reeboard ❑ Waste Analysis ❑ Soil Sampling
24./Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes )ZNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ZNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes X.No
27. Did Reviewerfimpector fail to discuss review/inspection with on -site representative?
❑ Yes ANo
28. Does facility require a follow-up visit by same agency?
❑ Yes VNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes VrNo
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes /z No
33. Did the facility fail to conduct an annual sludge survey? ElYes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record creeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
j© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. f
' F4fw 6wlk- n- v '
KA15 A4 4'6Ve'1"O-- 70' ME,
AAq
l2/l2fO3

r-
Il!'bii-0sion of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 e^rtified%Conditionally Certified D Registered
Farm Name:
Owner Name: tuoL .'-
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Time:
Date Last Operated or Abqye Threshold: _
County:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 u Longitude 0 6
Design Current
sw1ne Ca ac
❑ Wpn to Feeder
FRfeedcr Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Cl-Boars-
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Cavacitv Population
❑ Layer I I ❑ Dairy
❑ Non -Layer 1 10 Non-Dai
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present IILI Lagoon Area
0 ❑_No Liquid Waste
Discharges & Stream Impacts
i. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laizoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): L�
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

r�
Facility Number"? — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion. ❑ Yes [--]No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [:]No
(if anyof 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 ❑ No
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 Application
10. Are there any buffers that need maintenanceiimprovcment? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVI'MP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility° need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required 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?
(ie/ WUP, checklists, design. maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility- fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify- regional UN-Q of emergency situations as required by General Permit?
(iei discharge. freeboard problems, over application) ❑ Yes ❑ No
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
© No violations or deficiencies were noted during this visit You will receive no. further correspondence about this visit
-r..;a:...:.....':•=�a:--'•. `' ,-•.— ...y Y..-..... ..:...:.v - 9-i F-i-;"•tzr-"."-iale.r'"�..:w�r*.-'&:�t^.."�.•:';ir
Gomments'(refei to question #yTijA gay YES adswei S,and/or ae-y t-etonimendatzong,or sny other comments. t , m
Use drawings of ia�it.»ihty to better explain_ pages as aeressary) ❑Field Copv ❑Final Notes
-- .�-w�.ai,.:.1-za .:ai �f Y'?�-•• ..�^-�C �..+..wa-"+ar.m'�.«-.-� �»�'.
/06
ll2sve
4r [ct,7Von S eelp -�
9
Reviewer/Inspector Name
"C : �a'C� � -.-ti . r+.�:-v.,.�v".,•.w t.�a`r: i.. ,>ri��,.�' ei�...::.c.�xsr7.�=rrz:»�b:*�:s`c=�.:+ iL.:�,::4: ��:.s.ri_,!-�' ".,
Reviewer/Inspector Signature: Date:
05103101 f Continued

N.C. DIVISION OF....WATER QUALITY
Received by J-to P1
Water Quality Section
ComplaintlEmergency Report Form
WILMINGTON REGIONAL OFFICE
a f h'-s
.3/2-010 Z_-. Time l n ?n
Emergency Complaint j_ City County. Fc"�dE'�-
Report Received From
Agency Phone No.
Camplainant ��t '� ' G,O 14 c, � j a r A
Address Phone No. 2 8 S
Check One: Fish Ki71 SpIff
Stormwater Wetland
Bypass F-�Animal NPDES N.D.
Other, Specify:
Nature of Referral A tom- A r W c,- -7L' �e '�j 5� ro, y e i,.) lQt 1 -� a
7 1 — tf L4 r,
Time and Date Occurred 40 i f-g
Location of Area Affected
Surface Waters Impacted Classification
OtherAgencies Notified
Investigation Details G lie-5 -
4.v Xe See fxlwd inrpec�;a�-�
Investigator s4o i-tE W, aF ! �''1a lz s'1 Date lie
S: iINO S iSHEL L S 1REPO R T. SHL
EPA Region !1/( W)U74062 Pesticides 733-3556 Emergency Management 733,3867 Wildlife Resources 733-7291
Solid and Ha2ardous Waste 733-2178 Marine Fisheries 726-7021 Water Supply 733-2321 Coast Guard MSO 343-4881
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 0 Telephone [phone] a Fax [phone]

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility NumberEZM_C9ZD
Date or visit: Time:
Not O erational 013elowThreshold
Q Permitted 0 Certified 0 Conditionally Certified ©Registered Date Last Oper d or Above Threshold: n
Farm Name: County: Eof_)f *q_ O R I)
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: -
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Location of Farm:
Ul5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 04 0 u Longitude 0' 06
Wean to Feeder IU La er J Da'
Feeder to Finish ❑Non -La er ❑Non
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design CapaCi
Gilts
Boars Total SSI
Number of Lagoons U Subsurface Drains Present ��U Lagoon Area U Spray Field Arecs
_- T. ---
Holding Ponds / Solid Traps ❑ No Liauid Waste Manaeement Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes INo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection -& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [:]No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes El 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? ,ryes ❑ No
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 Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PA ❑ Hydraulic Overlaid ❑ Yes ❑ No
12. Crop type 'bc- RinuoA 6F_E
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
gNo=C
❑ Yes
❑ No
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Co mentsg refer to uest:o # E larnan YES answers;a�nd/arairecornmendat:on or n otliercvmments:*
se, drawings of fac aty3to b er explain sttuahons"": {use additioiial�pages as necessary): `a f Field Copy ❑Final Notes
R .y'
�nr��UCYF_1p
�SPEc� i©N. ��CI.c�E OF 6>
OF LAc� o P� cQ� � a>� 9r� Go s -r-r We 41:LE-
Reviewer/lnspector Name - 6;; rle L7, Pr� rr
Reviewer/Inspector Signature:LL&ZALDate:
05103101 L I Continued

Facility Number: — Date of Inspection a O
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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional 2omments`andlo D_"rawmgs:;2" ..
r
_ PE
� x
00-C 2eE Q �� Z=CM�F
; r�►J R
l✓ LC�k NEc�oS ( �jE ADDR�SSGp.
�0'A 0 S A r p 1� e- S T A{L�co eurripp-o fir AepRz)k. ITI) A tJ D
�0RVb A f
E 6 A---- C) S rD 0 -P FED & 1)) tt)-77- rj4z-tJ IYL""
0 ro klpz� k),
-
c•cJ E Rfl f� 4 20 u /' Li gA-z N S �fo w S ON 1 N �EQ.6 f3 7� `f 0
IAS T44 tJCl- l a
Fw M,
-- N n � WC W C'el` ON TN1E FA92r, Slid tt)As
f9tr-r,� I�o F0� D Eric � VF
0,4 I s4e FPf,.M r asl�
69 : OF L P60z a WNs { F 715M D-L--,-COE5 Lr-1A�zNa
I I-�-� FiF e-t- ,vas
Gt�45 AOD&o �DN SteG? FA C E OF
\�S LAG-C-FS-r-aN
F;L -rRA-r:�7-vA?
05103101

Type of Visit 95 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 95 Routine () Complaint Q Follow up O Emergency Notification O Other `~ ❑ Denied Access
Date of Visit: Time: /I 7 .FQ
Facility Number
10 Not Operational 0 Below Threshold71
Permitted ❑ Certified 13ConrAZ
By Certified [3Registered Date Last Operate Above Threshold:
Farm Name: m County:
Owner Name: , n �'k/-�� Phone No:
Mailing Address: -
Facility Contact: f / Title: Phone No:
/�/f
Onsite Representative: �/1IytLAO8L47 Integrator: / K161n,"allj
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �'
�• Dy
-- Design. Clil r ent W Design ; - 'CLLrrent -Design ' Current
Swne; Capacity try J* ..Po ulation aide Ca aciY W'Po ulation1r_C'm.
❑ Wean to Feeder ❑ Layer i. Daiw:
Feeder to Finish = ❑ Non -Laver ?' FON on-Dai
r-:
�_
-, -
Farrow to Wean
❑ Farrow to Feeder ❑ Other :
❑ Farrow to Finish `- Total Design Capacity
p
^ a _ T
❑ Gilts e
❑Boars m ':. Total §kw -
e
Number of Lagoons l�.�l = A ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
Hoidring Ponds"! So Traps �; ❑ No Li uid Waste Management System
Discharnes & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes ZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes ZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure b
Identifier:
r�
Freeboard (inches):
05103101
Continued

Facility Number: — FKI Date of Inspection /d n
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
VrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
l
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
'It�'I No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
YNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Waste Application
IVNO
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�No
l 1. Is there evidence of over application? ❑ xcessive Ponding 4PAN ❑ ydraulic Overload
❑Yes
No
/1 %�
12. Crop type
13. Do the receiving crops differ with those designate 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
VNo
15. Does the receiving crop need improvement?
❑ Yes
R(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP; checklists, design, maps, etc.)
❑ Yes
'ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
YesNo�
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
orNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
X.
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Z'No
r] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to.,questinii #} Explatn any YES answers cornmendateons or anv othercocumeitts
,Use drawing of facility td better explain iftations. (use addittorial pages es necessary) ❑ Field Cony
❑ Final Notes 1
ffP DFf loPvr /+% Z- 4Gvo tl : Are �rC/�S�C��4T� /� �i s
Tf .�STF�Yi
y
�]
ReviewerAnspector Name a
Reviewer/Inspector Signature: Date:
05103101 Continued

r
Facility Number: z—t 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?
A 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 ❑ No
❑ Yes ti'o
❑ Yes No
❑ Yes /Y.No
❑ Yes 90No
El Yes X20
❑ Yes ❑ No
additional Comments and/or Drawings:
A,
/s r�
o,e 2�v
75
M�o 71,�e-i"7
6w1y-a'Q'q' �ie-o 7 Z �-
%O�,4 N ��D. af2���
7A)-e2ACC 7ZO-N 7r�lr\ fff 3-5
05103101

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine XComplaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 3 O Time: 135D
i
Not Operational 0 ]Below Threshold
0 Permitted O Certified O11Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: W "11ke) County Joe 11c(e ✓'
Owner Name: c�41 eh 4t5 Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: u -0b7 Oct 0'r3D'n
Certified Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
❑ Swine ❑ Poultry ❑ cattle ❑Horse Latitude 0' 0` �u Longitude 0' 4 �_JK
Design
Current Design Current Design Current
Swine Ca aci
Cattle Ca acity P,o ulation
P,o Wation Poultry Ca aci P.o ulati17EPECT
El Wean to Feeder
❑ Layer :)airy
❑ Feeder to Finish110
Non -Layer Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons�� ❑ Subsurface Drains Present jill La oon Area ❑ S rav Field Area
l
Holding Ponds 1 Solid Traps
❑ No Li uid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Laizoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? 011yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Freeboard (inches): 23
05103101 Continued

FacilityNumber:,r] —
Date of Inspection 4Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 L Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J&No
❑ Yes ❑ No
❑ Yes ❑ No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coh menf§� refe Ito tiestlon Ex latn an YES answer's andlor an recommendations or ao" _other comments., t
{. _ qi f P y Y ,. y �i �.
.,
Usedrawuigs of facility toaietter explatnsituahons'.;(use addtttonal`pages as necessary) s ❑ Field Copy ❑ Final Notes
z . :Z:-P c�rperlrS 4kr+ a� wA,34e- rG,, t ;e
��r�� � Q.nOt Gfi.SG�gri��G� irf-fa q Lilot��rWpe4 `�'t`1�i-� L�rOLiYt1
7i-tiJ 1✓tS�eC�irn V✓�1 C��dUG�e� rh /P��4n$e -tin 4 Caryt�I�t►n-�.
Reviewer/InspectorName —,j er.uq %�d y►rI Gct�� „S.�C, (,�'le r' o 17
Reviewer/Inspector Signature: Date:
O510310I Continued

IType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit 0 Routine Q Complaint. O Follow up Q Emergency Notification O Other
Facility Number Date of Visit:
© Permitted 0 Certified 0 Conditionally Certified [3 Registered
FarmName: ........ l t) ................. •..........................
aJ
Time:
❑ Denied Access
10 Not Operational O Below Threshold i
Date Last Operatedff Above Threshold:
County: ....... ,1.! F ........ ..
OwnerName:....... % ........... J....... ... r��✓!' �� .......................... Phone No: ...... ._........ ........... ......... ...... ...... ......... .......
»..
FacilityContact: .............................................................................. Title: ....................................................... ........ Phone No:................. .»._.....» »..».... .
MailingAddress: ................................. ............................. ...................
Onsite Representative . s � a ... ........................... Integrator: ,J.'•1. 1 �'l........ r.....
Certified Operator: ................................................... .............................. ...................... Operator Certification Number:..............
Location of Farm:
Swine Poultry ❑ Cattle ❑ Horse Latitude �a �� �66 Longitude + ��«
Design Cuirirent Design Current De iga Current
Swore
.Ca cr -Po Matron. -:,Poultry _ : Ca acr Po elation Cattle .. Ca ap =Po lilatian
El Wean to Feeder
El Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
TdtW Design Capacity
Number -of l agoons ❑ Subsurface Drains Present D Lagoon Area ❑ Spray Field Ares �,
raps- ❑ No Liquid Waste Management System Holding Ponds / Sot<d T F
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed.. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes No
❑ Yes No
❑ Yes YNO
❑ Yes o
❑ Yes No
❑ Yes o
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ........................................................
Freeboard (inches):
5100
Continued on hack

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ 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? ❑Yes [� No
(If any of questions 4-6 was answered yes, and the situation poses an /
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
V.
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimumliquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evidence of over applic do ? ❑� cessive Ponding []PAN HydraulicOverlo
?f7
0Yes
�No
12. CroP type JL� ��L/L�
P��/e345,4
(Tzf
13. Do the receiving crops differ withlthose des noted in the Certified Animal Waste Managemen Plan (CAWMP)?
El Yes
� No
14. a) Does the facility lack adequate acreage or 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
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�No
I& Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
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
(VrNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNO
24. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/ZNo
:: INO -yiolaftgris W deficiencies -were rooted- dirritig �his'Asit: - Y:oir witl •tr& Ke rio further • : •
correspondence. about^ this visit _ ... .
ComiEients (t efer to questtoa #) Explain any YES answers and/or any recominendatxons or'any other commentss. 'a Y
NU d awtngs of.facilrty to=lbetterexpLatii'situations (nse additibnal pages as aeeessary)�;na}
lJ`J Fr-7 F, EL 0,Y66rzi9dAe66 ,�
Reviewer/Inspector Name tf hl�.t� ,� f�� : , -. -...,_ t r r i a t
Reviewer/Inspector Signature: I/ ;&_1&' ( �}/'�/� Date: /G/2O e7/ g/pp

e
Facility Number: — Date of Inspection / p
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 [jf No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
5100

r• '� Division of Water w
Quality • . ,
Division of Soil and Water Conservation
O Other Agency.
Type of Visit P Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit IkRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Bate of Visit: FR--F-4' 6 Time, (f 4 Printed on: 7/21/2000
O Not Operational O Below Threshold
*Permitted 0 Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name `�" County':......:].t`''�.................................................
...............................................................................................
Owner Name: .............................................. .... ............................................................ Phone No:
Facility Contact: ...............................................................................ritle:................................... . Phone Rio:...
............................
.Mailing Address: .. .......................................................................... ........................................ .................................................................................... ..........
Onsite Representative:.. ��C' ... v ! �r........................................- ......... Integratar:........5..............................................
Certified Operator: .......................................1 Operator Certification Number:....................... .
Location of Farm:
A
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 44 Longitude • 94
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish O ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lag—n Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream )impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 4No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If clischarte is observed. did it reach Water of the State'? (if yes, notify DWQ) ❑Yes . ❑ No
c. If discharge is observed. what is the estimated flow in gal/thin?
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 t'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes qN0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [<No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................... .
Freeboard (inches):
5100 Continued on back

Facility Number: Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
kNo
(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
MNo
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
XNo
elevation markings?
❑
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
b<No
H. Is there evidence of ov application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
bANo
12. Crop V'
type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
g 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?
,grYes
❑ No.
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Re wired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have ail components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
j'No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
19:No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
NfNo
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representa[ive'? ❑ 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 2(No
�: �1o•yiolatigtis:o�• defciertcies -were no�teti� during this:visit: • Y:oi� wi�l•reeeive tio: i'urther" •
. . , corres ondeizce. about this visit. :::::: :::: :... ................. . •
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to
better explain situations. (use( additional pages as necessary): -
ReviewerlInspector Name ll l l&h� �� S — -
Reviewer/Inspector Signature: V Date: --CA 5100

Facility Number: U I Date of inspection I zz I Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor blow
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 peimanent/temporary cover?
VYes []No,
❑ Yes 6(No
❑ Yes � No
❑ Yes �No
❑ Yes 0 No
❑ Yes r0
ElYes KNO
Additional Comments and/orDrawings:
Alp
� S
ra -
mil/
J
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - 0
Farm Name-�r4r,.,._
On -Site Representative: ;i
Inspector/Reviewer's Name:
Date of site visit: I
Operation is flagged for a wettable
acre determination due to failure of
Part 1l eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time b d on
exemption E1 E2 E3 (��5
Date of most recent WUP:31 L5611,11 Operation pended for wettable acre
determination based on P1 P2 P3
Annual farm PAN deficit: pounds
Irrigation System(s) - circle #. . hard -hose travel center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
t/ E4 75% rule exemption as verified in Part III. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - Fi F2 F3, before completing computational table in Part II1).
PART 11.75% Rule .Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed.below: k
_ F'i Lack: ofacreage:which7esulted:in over-applicationof-Wastewaten(PAN) on -spray
fields) according tofarm'slast two -years of-.Tmgatonlecords. .
F2 Unclear,�-iliegibie,-or lack of information/map.
_F3 Obviousfeldlimitations Inumerous:ditches ;failurelodeductxequired _
buffer/setback-acreage; or25%:of.total _acreage dentfied-in7CAWMPJncludes
small, -irregularly shaped -fields -fields :lessfhan-5-acresfor..travelers-or less than
2 acresfor.:stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

� R
Revised April 20, 1919 ;
Facility Number -11 --g�
Part Ill. Field by Field Determination of
75% Exemption Rule for WA Determination
TRACT FIELD
NUMBER NUMBER'2
TYPE OF
IRRIGATION
SYSTEM
TOTAL CAWMP
ACRES ACRES
FIELD
%
COMMENTS3
- 51-
I
I
-
I
I
I
I I
!
I
I
I
I I
1
I
I
I
I
I
I
I
I
I
I
FIELD NUMBER' - hydrant•, pull,zone, or -point numbers-rnay be used in place of field numbers depending on CAWMP
and type of, irrigation system." If pulls, etc. cross -more -than -one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption: -otherwise operation will be subject to WA determination.
FIELD NUMSER2 - must be clearly delineated on map." -
COMMENTS' - back-up fields with CAWMP acFeaae_excee;ding 75% of its total acres and having received less than 50%
of its annual PAN as:documented in the-farm's previous two years' (1997 & .1998) of irrigation records -cannot serve as -the
sole basis -for requiring a WA Determination:=Back-up:fieIds -must tenoted in the,comment section Q must be accessible
by irrigation system. -
Part IV. Pending WA Determinations -
P1 Plan.lacks-_following--information:
P2 Plan -revision may:satisfy75% rule based on adequate overall PAN deficit -and by
adjusting -all field -acreage -to below 75% use rate
P3 Other (ielin process of installing new irrigation system):

60
Revised January 22, 199!
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number -% i - 4
Farm Name:T
On -Site Representative: lk;,(_ KcWja
Inspector/Reviewer's Name: lw`�w. Inr•
1/ Operation is flagged for a wettable
acre determination due to failure. of --
Part 11 eligibility item(s) Fl F2 `F3-
Operation not required to secure WA
determination at this time based on
Date of site visit: 31111ti01 _ _ exemption El E2 E3 E4
313411 -- 32Sz
Date of most recent WUP: �j Ja -q 7 Annual -farm PAN deficit: ~S"`71 L pounds
Irrigation System(s) - circle hard -hose traveler 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanen e; . stationary sprinkler system wlportable pipe;
fi. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D21D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
bufr"erlsetback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
�F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revis--d January 22, 1
Facility Number _` 1 -_'�4 -
Part 111. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUM13ER112
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
Iq •�
s�
I
I
I
i
I
I
FIELD NUMBER'
- hydrant. Pull. zone. or point numbers may be used in place of field numbers
deoendina on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER' - must be clearly delineated on map.
COMMENTS'- back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

O'Division of Soil and Water Conservation - Operation:Review
Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance:Inspection
[ :Other Agency - Operation Review.
10 Routine Q Complaint Q Follow -tip of DWQ inspection Q Follow-nE of DSWC review Q Other
Facility Number
[)ate of Inspection I g
— ____j I'iine of Inspection I I I: SS 124 hr. (hh:mm)
M Permitted Celrtiif`i'ed E3 Conditionally Certified © Registered C] Not Open, Date Last Operated:
Farm Name:!!!!!�0......�1�..................:. .. County: ��!W4�.............-..............-................................
Owner Name: ................. ! `.- .. ... Phone No: ... Q ��
'tom ................... .7!! 1� .�ctA�tt ..-.......-.................. �., lo.)-..............---...-.................. ....-.................
Facility Contact: ................................................ Title:............. Phone No:
MailingAddress:...... Qt.A...... ....... r...........................................................I ..........W..' J1-......................................... ... `! Z�.........
Onsite Representative: M. .....M.Q11................................................................ Integrator: ......... L. 5..............................................................
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Q.n-...nfl........... 1:..6.....5.........!.3.is..�.....�...t!y±....-..-. ...... �........ o.........r........................................................I.......-.....-................ _.
...........................................................................................................................................................................................................................................................................
Latitude �' �� ��� Longitude • �� �« -
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ftp ig100 ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity wo
❑ Gilts
❑ Boars EEI Total SSLW
Number of Lagoons JE1 Subsurface Drains Present Irn Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. II' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ........1 �,..... -
❑ Yes ® No
❑ Yes Od No
❑ Yes ' [29 No
❑ Yes [j No
❑ Yes [[ No
❑ Yes 0 No
Structure 6
1 /6/44 Continued on back

aciliYy,Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? 4
Waste Application
10. Are there any buffers that need maintenance/improvement?
t1 g
1A Yes ❑ No
❑ Yes 0 No
® Yes ❑ No
❑ Yes 10 No
❑ Yes 0 No
❑ Yes R No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes M No
12. Crop type
Y4VR04..........:............ ............... af�....lrZatl`...........................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. Does the facility lack wettable acreage for land application? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
[- N.o.vialations;tin'- deficiencies .were noted during .Niis:visit:. You "f receive n6 further .: .
cOrrespgiidertee'abbtifthls Visit.; •' ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ;
® Yes ❑ No
❑ Yes ® No
❑ Yes (0 No
❑ Yes 8 No
❑ Yes ® No
® Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
Comments (refe"r 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 nece`ssary):
5 irw, q- S"-,. s>O)be PV 4*-, ej taa 4 Icr". ei-
sa .1 4- Wok-v- 4r ass; s;&,Lt. .
i-IAitnbr 40-O-- or }t4w"4- �%-V. V.iW 0� iojw-, CJ Vzrei!7�
A -Farr•- (Ur VA vt+,ss R� oilat�itr� cA�, he
-iJvi� 1;5�i� 1x�5 �� `15°l0 0���.1ac.i-tc- t �� �c�- 'r�r� �t-e�� for U%�ts•k a-la�lic�.�ian.
14.5 nu is %r fie a�l,u.. vit��tic Were 1G�4 �'clf� sl.pUlr} doe av�s�C �o g�tr +nGzvc�s
Reviewer/Inspector Name
Reviewer/Inspector Signature: .74
Date- Z.1 f I Ig I . 11/6/99

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.,
Walter Strickland
Watha Farm
3000 Lamb Rd.
Willard NC 28478
Dear Walter Strickland:
'T 3W
RECEIVED lik"o V
FEB 0 8 1999
BY:
Director
February 5, 1999
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No.71-0044
Additional Information Request
Watha Farm
Animal Waste Operation
fender County
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 and submit
the following information by March 7, 1999:
1. Operation and Maintenance Plan for your Iagoons is missing.
2. TotaI acreage in individual fields are unclear on the field map provided. Please provide a
clearer field map identifying all tract numbers, field numbers, and total acreage listed on
your waste utilization plan.
Please note that all revisions or amendments made to the waste utilization plan (WUP) or a
portion thereof are required to be signed and dated by both the landowner and the Technical
Specialist before they are submitted for review.
Please reference the subject permit application number when providing the requested information. All
information should be signed, sealed, and submitted in duplicate to my attention at the address below. The
information requested by this letter must be submitted on or before March 7, 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 143-215.1 and will subject you to the enforcement authority of the
Environmental Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 363.
Sincerely,
JR Joshi
Soil Scientist
Non -Discharge Permitting Unit
cc: Wilmington 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

r..
��_ ��..' ._- .,<.•�, 4•..�«a .,�x. r_' Y,sei:a>a`-�`�...�'i.: ;_ ... y. �ma. t r�� ""
w 0 on of Soil and Water Conservation' [ Other Agency 2 4
Division of Water Quality
�Y
Routine
IFacility Number
Follow-un of
Registered #Certified �A^pplied for Permit E3 Permitted
Farm Name: r
Owner Name: �' 4 at s�....................................
+^% (4 4 `
....................................................................
Follow-up of DSWC review O Other
Date of Inspection
Time of Inspection { : 30 24 hr. (hh:mm)
Not Operational I Date Last Operated:
... County:........ kLe� §r........................... ...............
....I... Phone No:.....� o Z � �- Lo S f. ....................................................................
FacilityContact:........................................................................... Title:................................
Mailing Address:...........:3 0.0 0. L� .., � . i...:. iG ¢�V!► C............................................................. ........... ..........................
................................................................................. ......
Integrator:.......h........_....:.'......................................
Operator Certification Number ;....1.1. C7....L.qq..........
Onsite Representative:.........
Certified Operator:...........ley .............................
Location of Farm:
z gglz
Latitude 0' 04 046 Longitude • ` 'G
Phone No:.... ...................................
Mc
C
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
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 OfNo
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 qfNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [CNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes VNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 46No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes KNO
7125/97

f
Facility Number:'- -L
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits, etc.) -
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I 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?
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 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 ent ring waters of the State, notify DWQ)
15. Crop type .................. i
........................................................................................................................
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 Iand application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
26. 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 Onl
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?
❑ Yes 'FfNo
❑ Yes ❑ No
Structure 6
❑ Yes
ONo
❑ Yes
U(No
Yes
❑ No
0 - No.vio'lations-vt d6riciencies_ were noted during this.visiC- Your'ill receivn e'-o°further, : .
correspQndeuce ai oiit -this. visit:....: , : ; ::. .
11. work oK• ha-L areas I'+5hou , IreS� el l
IT �H}7+�L 1� ;3uprrrt GoY�GS4 oAL 6�rAu.te%
❑ Yes VNo
❑ Yes �No
❑ Yes b(No
❑ Yes L11.No
tdYes ❑ No
❑ Yes VNo
❑ Yes J f No
El Yes VNo
❑ Yes OfNo
Yes No
❑ Yes X No
❑ Yes No
7I25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: '�JJ c� � Date: `� - [` �7 ` j S

Animal Review
Yy
®DWQ Feedlot Ojj'efatioq Site,
.;Anbnaal:
.0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Farm Status:.- Sg�e-.r " —
Time of Inspection I J3.00=Use 24hr. time
Total Time (in hours) Spent onRe,%iew
or Inspection (includes travel and processing)
FarmNaine:
Owner Name: ja L
Phone No:.-JAS. ....L
OS
Mailing Address: 30-o-C) ---- Lca",-6 z2[ q -7
Onsite Representative: MoIkIntegrator:
Certified Operator- r-1. Operator Certification Number:
Location of Farm:
z
Latitude Lonaitude
113 Not Operational Date Last Operated:
-pe of Operation and Design Capacity
wlnp�g- u ""Nu]llbe e Number-:
C ittl e
,.poultry
x Wean to Feeder
El
L aver
E1 Dairy
J
❑ Fe -.der to Finish
N. on -Laver
10 Beef
Farrow to Wean
Farrow to Feeder
[E] Farrow to Finish
ME Other Type of Livestock
Subsurface Drains Present
JE1 Lagoon Area Fia—st—wav Field Are
General
1. Are there anv buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
El Yes 91 No
0 Yes No
El Yes 91 No
0 Yes [R No
h"
El Yes El No
D Yes fgNo
❑ Yes P No
yes El No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
n-mintnance,'improvemcnt?

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes No
7: 'Did the facility fail to have a terrified operator in responsible charge (if inspection after 111/97)? ❑ Yes NLNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes JKNo
Structures (Lagoons and/or Holdinrt ?onds
9. Is structural freeboard less than adequate? ❑ Yes gNo
Freeboard (ft): Lagoon I Lagoon 2 Lagoon 3 Lagoon 4
l.i
10. Is seepage observed from any of the structures? ❑ Yes GINo
11: Is erosion, or any other threats to the integrity of any of the structures observed? F1 Yes ❑ No
12. Do any of the structures need maintenance/improvement? d 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 Iack adquate markets to identify start and stop pumping levels? &es CANo
Waste ADolication
14. Is there physical evidence of over application? ❑ Yes t,No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
_.
16. Do the active crops differ with those designated in the Animal Waste Management Plan? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?. ❑ Yes [,No
18. Does the cover crop need improvement? ❑ Yes (Ri� o
19. Is there a lack of available irrigation equipment? ❑ Yes 10 No
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
21. Does the facility fail to comply with the Animal Waste Management Plan in any way? ❑ Yes ❑ No
22. Does record keeping need improvement? ❑ Yes ❑ No
23. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge? ❑YesNo
h
Comments (refer to question,} Explain any,:�FS artsRrers andlor any recommendations or: any -other comments. .
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Reviewer/inspector Name
Reviwer/Inspector Sidmature:
cc. Division of Water Oualirj; ;Barer Quality Section, Facility Assessment Unit
11/14/96