710069_INSPECTIONS_20171231

NORTH CAROLINA ...�
Department of Environmental Qual

Type of Visit: p'Compliance Inspection O Operation Review p Structure uation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Fallow -up 0 Referral Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Z 0 Departure Time: E--�= County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: (ht..c 1` ti„_004v-
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design Current Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
I JLayer Dairy Cow
Wean to Feeder
I INon-Layer
I
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
©r, P,oultr, C•_a aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑'No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
/
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
N ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Dumber: - �,� Date of Inspection: 'Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? s ❑ No
a. If yes, is waste level into the structural freeboard? JrYes ❑ No
Identifier:
Spillway?:
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[_] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes []"No [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
a -threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ' ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ No ❑ NA [/"NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—] Yes [:]No ❑ NA ZINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []No ❑ NA Zf NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA Zj"NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[:]No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
TEn--NIE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
El"NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
EE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ENE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:]No
❑ NA
EfNIE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
❑ No
❑ NA
El"NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Surve
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
F(NE
Page 2 of 3 21412015 Continued

Facilltv umber; —71 - l: I--1 Date of Inspection: ZIR113
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA EnNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA [/] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ No
❑ NA
eNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [:]No
F:rNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No
❑ NA
NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes [] No ❑ NA 1NE
❑ Yes
❑ Yes
❑ Yes
dNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/inspector Signature: �c-- Date: 2 /
Page 3 of 3 2141201

i
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,C,00mpliance
CJ Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 1 a Arrival Time: / 6 O Departure Time: County: ' C( Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: CWAR-LDS W061Fd Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = = Longitude: [� ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyd
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�wo
El NA
El NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: f),
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier: L6 (1100IJ
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
7No
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Id N ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 3 E R-M vD N L G} 5 G D
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination., El Yes
L��, NNoo
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
r
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
FNo
❑ NA
❑ NE
a1.) U4P Y7 6L,0 1v(-(= C3S sb a4� 00
�L� Sao tZ4 6-6 o.
Reviewer/Inspector Name �Anj`a :-�' Phone: o)
Reviewer/Inspector Signature: Date: % o
12128104 Continued

Facility Number: I 1 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
P g
[ Yes
❑ No
El NA
❑ NE
❑ Waste Application ❑ Wekl rEl Waste Analysis Soil Analysis Waste Transfers
❑ Annual
Certification
El Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections [I Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
Ll No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
El
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�, NN(o
El NA
El 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
Ea2K
❑ NA
❑ NE
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L10 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3No ❑ 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?
ElYes
0< ❑ 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
0"No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
l2128)(04

Type of Visit )9 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 110Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date or visit: �/ � Time:
Q Not Operational O Below Threshold
Permitted © Certified Q Conditionally Certified 0 Registered Date Last Operateprpir Above Threshold:
Farm Name: _ - ... County:
Owner Nacre: . ._ .... . _ . .. _ _.... Phone No: _ ...... .
Mailing Address:
Facility Contact: __ _ _ Title:.__
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator. ,,:6—
Operator Certification Number.
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �"
Deagn Carr ent 4 _ Des3ga' r, C11Fre!!t
.Swine i SD9CItY z- OnH1 ttOII �P*� i+� =-%8C'lty paIItll�ilrill
Wean to Feeder
Layer
1seeder to FinishO�
0 Non -Layer
13 Farrow to Wean
Farrow t0 Feeder
Other
Farrow to Finish
„'-
T 0#al Desij
Gilts
Boars
Longitude 0 • 6
FNs
Y
9-
Discharges & 3treaIIi Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ;11No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JZ No
❑ Yes VNo
❑ Yes ZNo
Structure b
Identifier:
Freeboard (inches): W
12112103 Continued

a ity+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 maintenancerunprovement?
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 A hcation
10. Are there any buffers that need maintenancerunprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN p Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
,5vo
❑ Yes JZNo
❑ Yes P No
❑ Yes g No
❑ Yes VNo
❑ Yes VrNo
❑ Yes ZNo
❑ Yes O No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes UfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,0 No
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?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Z No
❑ Yes 0 No
❑ Yes [2'No
❑ Yes 0 No
❑ Yes RfNo
❑ Yes )2No
Field CoDv ❑ Final Notes
g) Frr Yvz o,�A-�-r fGys�,1 ro✓�-, S��,E l/� 75r G , .¢�.. ��IIIv-07-'C 6 0
S/!7/¢G� (/`��,9�.� �6�r�E�aEF�O� ,��Gi4nlT�nl�, /�v Q�✓�/�SE�i?
23� ✓� ,y �� 002GzEO ��2" , �' /¢Nr¢� y/�r5 lr/h'%d0
�- -�_ ASTA s �.��, _
55}
Reviewer/Inspector Name
ReviewerAkopector Signature:
Date:
lLllL/VJ _ a+wuwaur�s .

c Facility Number: — Date of Inspection D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
9 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
9No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O(No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27_ Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
jg No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Na
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[SNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
jz No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
JZNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
J6 No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ Stocking Form PYCrop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Cerdfication Form
to No violations or deficiencies were noted daring this visit. You will receive no further correspondence about this visit. I
N-
�:e�."-�.��.,-�-�r��
)0&" z y� �. —,see, 171Aeroe L��� ��5-emu J�i�fokl F
I
S-1 rP R `/ 0'
12112103

Type of Visit (Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: X&CA'p
Owner Name: _ , �A� ",01ZOlJ
Mailing Address:
Facility Contact: . / L Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operate r Above Threshold: _
Phone No:
Phone No: ,Q
Integrator: Azw�%— AJROY. w _
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �� �" Longitude 0 C
Desig
MUMgn Current
Swine
Ca acity
Po alation Ploultry Ca acity Pv ula 'on Cattle Ea achy P,o ula 'on
❑
Wean to Feeder
❑ La er
❑ Dairy
eeder to Finish
&
❑Non -La er
10 Non -Dairy
❑
Farrow to Wean
❑
Farrow to Feeder
❑Other
❑
Farrow to Finish
Total Design C►apacity
❑
Gilts
❑
Boars
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area
Number of Lagoons 17EmNo
❑ Spray Field Area
Bolding Ponds /Solid Traps
0 Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2, is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & 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):
05103101
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
OYes
❑ No
❑ Yes
ZNo
,ZYes
❑ No
Structure 6
Continued

r
Facility Number: 9 — 0 on Date of Inspection / O
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?
S. 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
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Cl Yes ❑ No
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 ❑ 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?
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?
I& 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;2"No
❑ Yes /21NO
El Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Co"aiments'(refer to off #) Eiplain any YES answersand/vr any recommendah nskoc any`other'co€nments'
A.
Use drawings of facilt to. better
.explain situations .(use additional pages as necess ry} ❑Field Copy ❑Final Notes
4 g ty .,
�� .. �.•15pELtT��n/ GvaVouCrE,o Er'.9 aE r6c- 'f� �.Q,EE,Boi4i20
No-sFzcs� 7�oiJ.
1� Rio ar��fr4-ems �rBs�R via• D� .�- �c�
/1/p r-tse746d t�E7r EnJ �N T
Alaws A,v,o E L�go,J. A Vv7,F-
o.v .� Ao T
A',?"V /fAk A-4 Ako ej4e%49 ai° /14/49 �iy1� • s r� w�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: /O
05103101 Continued

a . 3
Facility Number: — Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ 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
orbroken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanentftemporary cover? ❑ Yes ❑ No
Additional Comments.andlor Drawings:..
/ �- ou,S15 JA/ AORA7104 EW ,ram ---r J FF,J 4,W64 Amo
10F:-7�(jE
00 7 PYE /1 /�7 1►�O Wi}$�F /,f �� .17 %d
�r.A TF_ �? , U)OV7-,Er�
gx v7f,1�/,�/�<A �o7L2��F� fri�Q� r�S lVldO /�i.
-r }�R �N� ES �NEr1 J`�5� l�5 FLUS1-3F_5 FOR-JORD
C►� ECG[ E
�so�ez�u� �Ecfll�sl✓ �� �-�--►� ��og� gyp.
�,I� nAy ANC
�
lows A2," t:!�8
,rEcp fY1 � �orzF��D.
5'� N omp � F & v-
fla �+ c ®� rs z �
P�,7 CT2
RECE©mr�E�p CFcKz �G i-Czo"00 [A m use5 (o M R [-F 60PI ' Nd
Sa Rf P C�
Lv Pt_7F R � -s ��m `�` ��
KS f�� �umP�r� a C,(�Z7�
�RLO007E-� � � mop,[*,
D� 5 F �� 'OOF5 n}o 7 R6�� Ad d
ou � � y ,p
L� Foa LJaRt:�S ®a �OSg2a¢3L�
- Cl��e K 1- �C�n fl ►�
/ s
PR ° D 26C1-e-rA.
05103101 Owvz�

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit / Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
hate of Visit:
Facility ]Number
❑ Permitted 0 Certified Q Conditionally Certified M13 Registered
Farm Name: C !' )
Owner Name: L �!/O0rf,61
Mailing Address:
/3 O Time:
Not Operational JQ Below Threshold
Date Last Operat r Above Threshold:
County:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' 0• Du Longitude
Design Current u Design Current -Design -Current -
_ ..:
CaacitPopulation. ouhnCasiWPoatoa_'Catte .PopulationSyiie
---
❑ can to Feeder [} La er ❑ Dairy
e
Feeder to Finish ❑ Non -Lay er I F, 10 Non -Dairy
Farrow to Wean -
❑ Farrow to Feeder ❑Other
~ _ Y Total Dest Ca at'
❑ Farrow to Finish
❑ � P �t3'
Gilts
- ❑Boars Total SSL- W
Namber of.LBgoons W ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
Holdte g;Ponds I Solid Traps - ` ❑ No Li uid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
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: r�r�
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
Continued

Facility Number: 7 1 — 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?
(If any of questions 4-6 was answered yes, and the situation poses an
❑Yes
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
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONo
_Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
o
I L Is there evidence of over application? ❑ E essive Pond' g El ❑ Hy lic Overload
❑ Yes
jto
� n
12. Crop type (/ ✓
13. Do the receiving crops differ with those designated in 6te Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
( No
b) Does the facility need a wettable acre determination?
❑ Yes
XNo
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
VNo
16, Is there a lack of adequate waste application equipment?
❑ Yes
;Z(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
YNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ YesXNo
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
I
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
�No
24. Does facility require a follow-up visit by same agency?
❑ Yes
X No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence -about this visit.
£omments (rMer_t6J uestian #}: �'Explahn any YES answeis-anevor many recommadat�ns or any l er-comments.
Use drawings of fact�ity to better a tptasn siittahons. (aye additional pagq s's necessary) : Field Conv ]Final Notes
_ .
AA/ D� TAU
e)Do AD D��,� ��� D� r�l, �,e � �
4'"e'X s
4-T
D,J 44.0
..rN
Gr
�-----�
Reviewer/Inspector Name �­7 __
Reviewer/Inspector Signature: Date:
d7i
05103101 Continued

)Facility lumber: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior 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 permanentitemporary cover?
Additional omments:and/or Drawings:
❑ Yes ❑ No
❑ Yes jLl No
❑ Yes NO
❑ Yes L [j No
❑ Yes No
❑ Yes No
❑ Yes No
J46COA) 5wr�C�7
Ntr �j�/j'1F l ���75 l�lJ2ld� i 1�CY��.45,
/ �'D�� % �dE11f}!� � �ZT� �S Li✓ �000 (�mNo�72��!
�a'z-
/�/ewpyI qcf yr vv � , 4 �ff 2i1
�O a L�F � 5?oP OgMP GFt/�F L A Il
O5103101

Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation '
Reason for Visit 4Routine O Complaint. O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: I
*ermitted 13 CeerrtilSe`d 0 Conditionally Certified 13 Registered
FarmName: ........�":`....���................................................................................
0 i G¢ Time:
Q Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: --------_
kk
County:.. ............................................
OwnerName: ................................................... ........................................................................ Phone No:.................................................................... .» ..__.
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:,(!!��.................................... Integrator: .... i `\�
Certified Operator -................................................... ............................................................. Operator Certification Number: .....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
Design : Carrent Design : Curirent Design Current
Swuue Capacity .Pa nladon Poultry ,Ca" aci ' Po Wation Cattle
Ca aci Po�-ui�tion
Wean to Feeder ❑ Layer ❑Dairy _
El Feeder to Finish ❑ Non -Layer 710Non-Dairy
❑ Farrow to Wean
1-1 Farrow to Feeder ❑Other
❑ Farrow to Finish TOt� =Design CBpSCIty
Gilts 3 Y
❑ Boars-Tolial SSL.W
Number ❑ Subsurface Drains Present❑ Lagoon Area ❑ Spray Field Area
H61d ng iPuia& Solid Traps_ ❑ No Liquid Waste Management System r
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 4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9;qo
❑ Yes Vj�No
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): �S
5100 Continued on back

l,\
� u
Facility Number: r]k — Date of Inspection
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 �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 Ej No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes EfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONo
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes 8(No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IM No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes V.
No
b) Does the facility need a wettable acre determination? ❑ Yes Pq No
c) This facility is pended for a wettable acre determination? ❑ Yes EfNo
15. Does the receiving crop need improvement? ❑ Yes XfNo
16. Is there a lack of adequate waste application equipment? XYes ❑ No
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? D(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 ,qNo
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 $j No
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes &No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes )!j No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IffNo
24, Does facility require a follow-up visit by same agency? ❑ Yes eKNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes X$ No
•*i0rgt1gtjs;e�r dtfclejmciiM fxo P0:4 a g this:Nit, • :Y:Q0 '01-t e�iye 40 FUMO • . .
;comes deuce: about this visit:
Comments (re%r to.question #) ,.Explain any YES answers andhai any recommendations or.:any other comine�ts. �r
Usedrii mp,q fid1ity "to better expisin 0itudtip'w {use ,additional pages as necesscary.) �, � �"
v� t!�^'•�� ,C_{•-� --7-�1 �`t�t--.V�.�_.tI�,V'�J -1 `wl,- �C may$ �SVI�, �.�,� Qt� (•;�Q
Reviewer/Inspector Name��;r.
Reviewer/Inspector Signature: Date: kl—a3 — GSA 5100

. a
Facility Number: — Date of Inspection G B(
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 9No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ,�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C5No
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 V 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 T<rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes &No
Additional'Comments an orDrawings:
g f
5100

§ion of Soi! and Water Consei=v peration ewe Y
a .Din _. s ateflII. ..0 Reyi
°Division of Soil and-'lNater Coiiservattfln :Comptiance0.lnspection
s % '-Division Of Water Quality "`COmplian inspectioIIr�' Yf v
x r 1 Q, r'Agency: �3C7<at1011=Review
10 Routine Q Complaint
® Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number
I
Date of Inspection
14/ 14 00
Time of Inspection
! 1 24 hr. (hh:mm)
® Permitted © Certified
(] Conditionally Certified
© Registered Not Operational I
Date Last Operated: ..........................
Farm Name: g e-ti t
................................5.............................................................................
'R ; d e. r,, r ram.
County:...fe n of C V,
......................................................................
G °
OwnerName:........G h i i �.............................-.7.1.e........
�.......r................... ......... Phone No:.......................................................................................
Facility Contact: ........
Mailing Address: ................................
Title:....
Onsite Representative:
...............................................
Certified Operator:
Location of Farm:
Phone No:
Integrator: U r ✓ h ]r4 r'"` S
.....................................................
Operator Certification Number: ..........................................
Latitude 0 A " Longitude • 6 «
Design , Current -
Swine Capacity Poimlation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current .Design-.DesignCurre'nt
Poultry Capacity -Po ulation Cattle Ca acity°`­Po ulati*n,
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total.MMgn Capacity;.
:.Total ssLW
Number of. Lagoons Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area M
Holding Ponds /Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system? (Il' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
❑ Yes ❑ No
Continued on back

111e6104llumber: 71 — (oq Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
l4 00
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
I4. 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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio yiolaiiQns:or dib ieie db,9 were h0 ed• du�ririd this;visit: • Y;ou Wfli-Teeeiye tid Ifufthgr -
corresporidence.'about; this visit:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JR No
❑ Yes ❑ No
❑ Yes ❑ No
CoEnments-(refer to-questi6__ Explaid any'YES.answers and/or,any"recom nendationk or;any.other comments:
Use:drawings'of lacility to'better explain situations (use aiiditional pages asin, ' -
x.
1rtsPcr(:ati GahciurrEso( GS A felt ow-ur dF 41-4 i�J.sco}
3/4o wkicL, a d%.S[_hnr)e t•,,�s d;Sc-pvQieG1�.
fVorE � Y►,s-j�v�•fcd N'i,-. ►�loa-�ev� -io P�rn� t,,i•.s-}e .�r,A� d,fc11 evt--l-� vc�Ce-i��;orti
i� s�Qray(,c(d -tKd eV1} vrfak«_
Al OTC +'luck �['"c w'uts sPevti du,-Zh) 4ke- ;1'.1.)4ke 4-+rd
4k\c di _<c -w --6 to el e+G L r +^� � e 4 k-c ,aed. -Fa ys s v a ;rt c e o F
01 PP, ess rye 1eaS2. Z -5'4 �ir.s4,-Uri e pe"? release .{ar�
d./Lr 1,DQO c'►gllD�s Df o,••�;hg1 1..�.�5-�e d:schw�•�G• �
Reviewer/Inspector Name
Reviewer/Inspector Signature: �p.�„uN gy;,pfv Y Date: Lt (�

Facili Number: 71 Date of Inspection �--�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ❑ No
2& 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 ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
'AAditional Comments and/or rarvings: _. - r
N aI £ - A 14 0 rL f- a ►^ SP r cL `� V e� s +- G1 Q 5 e I 1 ;.I
V } rG -�p AVAi-f'U,r-�b�e� P a �d �W / Y'tin OAT l d iSG�arcl �.
Wa-I-- peal �`- SCIAOAPIes � 19,c-4vres were
3/23/99

- - - -
D,Divisi©n of S,oii andWate
94.
�.'t,. • ,,, r �Dtv�s�on of Soil and$Wate
rnsiou of Water Qaalitj
- s
UK Routine Q Complaint Q Follow-up of DWQ inspection. Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection ' 3
Time of Inspection 24 hr. (hh:mm)
�Pern-dtted [3 Cert' ted © Conditionally Certified ❑ Registered JE3 Not Operational Date Last Operated:
P ..........
Farm Name: l...!!> 1.. County :............ ...1 ��c:JtLlr`.......................... �....
r.............a...
................. .........
Owner Name:...... �{r ... .. ...... .. Phone No. ..... 1U IL .y�.1... SF� � ..................
Facility Contact: ... 1C ......W141K...J'r Title. _......M-10'r.............................. Phone No:... ................................................
MailingAddress:........................................................................................ ......... ...
Onsite Representative:.... :�I��........4.v �[L... �1.�..:.. Integrator: L.' 1......................................................
.. ..... .... ..........
Certified Operator:......... „1 WZYYM .... .r :................... Operator Certification Number:..........................................
Location of Farm:
...................................................................................................................................................................................................... .............................
.........._._...._........... Y
Latitude �' �� �" Longitude
= Desrgn; Current . Design Current ;: Desrgn ' _ -Current' ,
Poultry
-Cattle ,,..`Populatio.nSwine �Ca aci Po elation Ca acity Po ulation .
❑ Wean to Feeder ❑Layer [] Dairy
Feeder to Finish 3 tit 9 Z 3 6 De) ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity ;
❑ Gilts,
Boars
Number
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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? ;Q Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M 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: 1
Freeboard (inches): ........... r
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 14 No
seepage, etc.)
3/23/99 Continued on back

(Facility Number: 7/ — 6g I Date of Inspection
6. Are.therestructures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence
of ove application? ❑ Excessive Ponding" �❑ PAN
12. Crop type ��%/� il�/! #1)j1e
L'=
13. Do the receiving gfops differ with those designated infhe Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility Lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did 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 10 No
❑ Yes .R No
❑ Yes 9 No
❑ Yes 11 No
❑ Yes El No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
i
❑ Yes No
❑ Yes IE9 No
❑ Yes 0 No
® Yes ❑ No
❑ Yes JZ No
❑ Yes g No
❑ Yes 14 No
❑ Yes 1� No
❑ Yes 14 No
9 Yes ❑ No
yiolat�itjtis;ar de#ic.. pes rare pQted during this;visit;: Yoii wiil:reeeipe iio further ; ..I
correspondence: about. this visit' ' .. J
Comments (refer.to.questiodm Explain•any.-YES:answers and/orany recommendations br` any'otlierco4mments = ,
Use drawtngss of facaLtysto better explain situateons (use addihonal pages as�necessary)
Z • War�`e o{:tGt,.,n�ed f'� o•vt sfrct -rr: z id 61,-ce{ 4oicrd d:�G�1- �re��+laq�
PC- 'If-r"ldrd 1
dock /Czk4s -6 d:sc_k, e, 4o �7�grtGt,Wafer l �gV1;- ►♦
.S�a vim. F ! C f h p[ I r; c 4 v r eJ Gee e -� e r� . lti:,t 7s�:7� o� e sc lts+ a r c s e! O'd 4" oI --,'
eA 4/11f oe r{> ca-�;Gn .6ram 4o
ors 4 of 19'16 aGfcs. ,) r, /�r
��. toP-+( .d G;Grct W iFrv�O�c4erev%,I aJye 9mtv___ rV6rrt.'T 1'1"j TlIt'-fO'i140'-J :
�-}eh �,scd o Wet4fmd acres of ir�eP'L94Tioii dccs-1'9 n
Reviewer/Inspector Name
Reviewer/Inspector Signatur
's L�/a�Jgg; J4ba

Facility plumber: Date of Inspection
Odor1ssues
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? ❑ Yes ;RNo
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 `VT 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 Jj No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes '6 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Shona.' _ommentsan or Drawings:-
m
V e ✓ 11c -cet � i,,'" 71,,% -o Ln de-< $o- # L ; A Lla�►•��p1 e4 of v !
eiO7 vr'1 � ferSOi^I s• / '/ i
IS. �Fnq,q F;e-W is rDin�:�el.j Cm4 far ctlai cP
�-e;re area, in -tke F; e,Iot . jBqe1c are r,J Cet zd 4o v-vn0JV xGherie
rrc^� t�P �' ..� Fib �� C ✓Dt� s�o �� C ,4 ASS iS�A h c-�/�O✓� +�G� r� i Cv►
S G:ct?c-rr+FerG;-;:SIG QX+4V1Sl0Vt 4
!�, Grower' St-.oLild r--T4qri -PAA] balcgnt;-' 44 A- 6-e5i+lrl;+�l`} 0 ' Cdwl'
r.,,r� slc"lon, p ?Zero,4 qP�l Gad►ons oh �IQfZ`Z's
0% c c, o rd ""J, 7o A fr l l t.CO ."6 Y1 w i vO i7 Les TOY' C r 4,P s•
ZS. �rowCr` S11av'ei �011Otnl °1Up�iGii�lo� L�linl.�oLVS ><o✓' G�'a�S.
�IG4Sp s o-b ";' 111�O�Y'�a1�iC11 iFCQV lC� 1�'i � tj t.Sa,'prr �a
S40r1L'lgal mG'tl�:s r
Ne pEN r<
! 7- Ord
Z Sqd
Al p4e = C rec,.�e.Y Slt z, Lt « ; s11 v . r e g b a tl � hot,.,) 4d ✓ Gc a r d PAN � q h, e S
IV : H, Ae J%rr42H c rc�� :,J sY:.49 nn
3/23/99

Revised April 20, 1999
.JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
5rr}
Facility Number 7 Operation is flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative:
GLnq- I ct L✓oa4a1
Inspector/Reviewer's Name: Sy''►�-�� ' s
Date of site visit:-
Date of most recent WUP:
Annual farm PAN deficit: / 6 7 pounds
Part 11 eligibility items) F1 F2 F3 F4
s v-�
Operation not required to secure WA
determinatio t this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
l
Irrigation Systems) - circf : 1 fiard-hose#raveler, 2. center -pivot system; 3. linear. -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system wlportable 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.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation ope, sting parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, 'including man 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 eligibiiity checklist in Part 11. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part 11I).
PART 11. 75% Rule Eligibility Checklist and. Documentation of WA Determination
Requirements. WA Determination .required .because operation rails Dne of the -.eligibility
requirements listedbelow:
_ Fl Lack.ofacreage-vi"icnTesultedinnver-mnplicafion:bf-�vastewater_(PAN) onmp—my.
fie] ds):accordingfo7arm'sdastiwoyears:of maation-xerords.
F2 Unclear,11legible; or lack of informationimap.
F3 Obvious -Field limitations -(numerous-ditches,dailure:to_deductTequired_
bufferlsetback:acreage;-or25%:ofiotalacreageidentifieddn-LAWMR-indcdes
small,-irregulady-shaped fields = fields-less#han-5 mcresfor-travelers-nr.lessfhan
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.

Facility Number 7 r -GI
Revised April 20, 1999
Part lll. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD TYPE OF
TOTAL CAWMP
FIELD
COMMENTS3
NUMBER
NUMBER1,2 IRRIGATION
ACRES ACRES
%
SYSTEM
HELL) N Lu mbtrt - hydrant, puu, zone, or:pusni nurnners Tnay oe c sea in place or rie:a numbers depending on CAWMP
and type of irrication-system.- If pulls, etc. cross more than one field, inspectorireviewer will have to combine fields to
calculate 75% field by field determination for exempfion; -otherwise operation will be subject to WA determination.
FIELD NUMHERz -must be clearly delineated an mad
COMMENTS' -back-Lip fields with CAWMP acFeage_exceeding75% of its total.acres and havinaTeceived less than 50% of its annual PAN as -documented in the farm's.-Plevious-two years' (1297 & 1998) of irrigationTecords,-cannot serve -as -the
sole basis for requiring a WA Determination.hack-uofields-must -be moted in the-commentzeciianznd muetbe accessible
by irrigation -system. _
Part IV. Pending WA Determinations -
Pi
Plan Jacks _following information:.
P2 Plan Tevision ,may:satisfy-75% rule based on adequate overall PAN deficit and by
adjusting all field -acreage--to below 75% use rate
P3 Other (iefin process of installing new irrigation system): .

19
�g -
[� Division of Soil and'Water Conservation Operation Reiriew
z
tvision of Soil and Water Conservation Comphance Inspection r� :„
5 Division of Water Qualtiy CompLance Inspection
e -
Other>Agency_ Oper�atton-Review:- -
- -
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection [ 2 —
971
Time of Inspection 00 2.4 hr. (hh:mm)
�Permitted �certified E3 Conditionally Certified 0 Registered Q Not Operational I Date Last Operated:
Farm Name: ........... �.4_. c. Y-....��.`. .... .r-.r-............................................... County:........ "'..........................``'..�...v...............
Owner Name:............. �. c r �h..... L✓cCt?.T.e'`.......... J r................................ Phone No:......-..-.......
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: .................. ....... ................................................................-
Onsite Representative: C� ..1G...........V......f J Integrator:......./.......................................................
j o� 4`....�................................
Certified Operator:................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
r...................................................................... ......---................--- _
Latitude Longitude • �' �"
v - Design Current Design Ciieret t Design Current
Swine m toCa deft Po ulatioil Poult
.. y rT; Capacity •.Population _Cattle Capacity Po
❑ can to Feeder
Feeder to Finish
3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discha�gr es & Stream Impacts
I. 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. I€ 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 X�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `
Freeboard(inches): ................................... ............................................................................................................................................. .----..............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3123/99 Continued on back

t
Facility Number: — Date of Inspection
jr
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 maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
`Paste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type.
P.r kk"
tir ,g�
)<No
❑ Yes
❑ Yes
5�10
[]Yes
Wiio
❑ Yes
)�(No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable -acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement? '
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did 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?
_ : _N� '*Wati6ris:or• d4eient&9 •were potted during �his:visit; • Y:oit :witl•reeeiye Rio: further
.••correspondtence.a�autt�isvisit...�..-. .-..-. .� � .. ............... .. -...-.-.-. .�
❑ Yes 4No
❑ Yes t
0
❑ Yes � ' No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes �No
❑ Yes *No
❑ Yes
ElYes PfNo
� No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes JKNo
❑ Yes No
❑ Yes No
Comments (refer to -question #):__Explain any YES answers and/or: any recommendations;o any other comments _
Use'drawings of facihty,to betteeexplai i situations use additionalrtpages as:necessary)
GW _
Reviewer/Inspector Name
Reviewer/Inspector Signature:
AIV / Date:
3123199

vir
Facility Number: — Date of Mspeetion
it
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
o
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
t ywo
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, ctc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
3/23/99

<<
P Q Division of Soil and Water Conservation 0 Other Agency ..3
Division of Water Quality
Routine O Com laint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Date of inspection
Facility Number
Time of Inspection 24 hr. {hh:mm)
Registered Certified 13 Applied four Permit Permitted j] Not Operational Date Last Operated: .............
perated:.............
Farm Name: . P_C, v I?TA'_ F-c- '- County :....:.......... G✓..................................r..�......
...............!...................................................... ..........
Owner Name: ....... C�:.c._14. .... .°� '�....J r.............
Facility Contact:
Title:....... ......................
Phone No: ..... . �e..... '� r !
Phone No:
14iailing Address:......... zao....... . `�...
4�1I4.. L !.'. �� 1"' ..................
11.....�....~-.....Z.......
�. ....
�.'�.. .
OnsiteRepresentative :......4�:4p'�.�e. ......�o.....`1..r
.............................
Integrator: ............
j
'..Y...!..�'.✓ ...k
Certified Operator;........... G.!��! ►'�� ........... 0.0 ..................... 1`I� Operator Certification Number;..] � �.
...................... ....................
Location of Farm:
0
Latitude Longitude �• �� ���
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
2.
Is any discharge observed from any part of the operation?
❑ Yes
F"10
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
((��
a. If discharge is observed, was the conveyance man-made?
❑ YeI-N
o
b.if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ YeNo
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
3.
is there evidence of past discharge from any part of the operation?
❑ Yes
�No
h.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ONo
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
No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7125/97

aciGty nber:71
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes �fNo
Structures (LaEoons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes (Io
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures? ❑ Yes kfNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 0lo
12. D6 any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff
%%entering waters of the State, notify DWQ)
15. Crop type 0L,� n. , ..... .l.. fZKI C............................. .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
13-No.violatioitsor. deficiencies.were"noted-dnririg this -visit:• Yon`M11 rec've•no•furtfier, :
. eofrespntidepce dliou:f thisvisit:: ::
Z.. LlF4y Fr G4 iOo—J re_ b-, _4 v 5/� . f
.- I`� Q $ L� 4i� Q le_ 4t [_i� qlr. a _. c ti� � � ° � r 49p U `` A-,27
//`i f
Wale- A,� (rs�s nGc �!!r.,iC"''� 6,0d , IaS G��lic&1: Q i.
S0:( /4ncIIY6;1 vtecdcC/ �si�3 plead,
❑ Yes (No
❑ Yes K'NO
❑ Yes 060
❑ Yes VNo
❑ Yes &No
❑ Yes VNo
❑ Yes VNo
❑ Yes UNo
[6Yes ❑ No
❑ Yes yf No
❑ Yes Ill No
❑ Yes VNo
7/25/97
Lf\

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of Inspection
Facility Number �
Time of inspection !rSJ 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review u
tK Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name. ._... _ ..._ . ...
......... 4t .....L�.iS�4. ..�..... .. __.... ... ......_...... .... Counts:. ..� f�..... » _ _.......�
Land Owner Name: .._�r.S.L k.._...it�,L��l_ �� ......._ ..... _.... _ ...... Phone
Facility Contact:...`!�!14 £�5 ...y1 7qt ...� �Gs---....------- Title: Phone No: ..L`��Q�Z�-4(�i
Mailing Address: ��.__ �G� ... �... �.f _.... �..._ ....... _ ._.._ ..... _.M�.�A I.�. f . ...._.�.... _...._...... _ ...
Onsite Representative......CLULL5.....w ..,Jr.............._ _... _ Integrator:
Certified Operator: »� �S. ..». �✓111a.]yG.... ». ........., Operator Certification Number: _ ............_..... .........
_ ,
Location of Farm:
Latitude •6 (L2, u Longitude ' E wr` 44
Type of Operation and Design Capacity
` ._..
s Des�gii Currrent Destga' Current NDesiga s Current
�Swtne Foul Cattle: :Ca aciPo ula"hon Ca aci P.o` ulation�7' Ca act Po alation'
❑ Wean to Feeder I❑ La ❑ Dairy
Feeder to Finish `7 ❑Non -La er ❑ Non -Dairy I
Farrow to Wean
Farrow to Feeder Tatal Design Capacity
10 Farrow to Finish �T S
Other
Number of Lagoons f Haldmg IPonds ❑ Subsurface Drains Present
❑ 5 prayField Area
t F Lagoon Area ❑
sv,...
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes RNo
❑ Yes J2 No
❑ Yes
P No
❑ Yes
Od No
❑ Yes
P No
❑ Yes
[I] No
❑ Yes No
C9 Yes ❑ No
Continued on back

Facility Number: ...11.... (a�...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structn es CLaffoons and/or 11olding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure i Structure 2 Structure 3
Structure 4
❑ Yes (N No
❑ Yes -fffNo
❑ Yes JA No
❑ Yes 0 No
Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes J4 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ®Yes ❑ No
12. Do any of the structures need maintenance/improvement? JO Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste ADDlication
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMt P, or entering waters of the State, notify DWQI)
15.
}runoff
Crop type ........... ......... ................... ...... _ SqVit.f ....— .... _ ....
16.
Do the receiving crops differ with those designated in the Animal Waste Management PIan (AWMP)?
❑ Yes
RNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IgNo
Eor
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JgNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JgNo
24.
Does record keeping need improvement?
[:1 Yes
IN No
Comments (refer t9,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)
5� w ,off �r spry �ejd alb as" Jjru. 4&0 be- file OLJ Mseejej . 4
6�6s7or, &ye&% do 44,k..,h► 1ou4cr t-ktI j4 4'L IaScor, skavlJ ]ae MW and,
ftsee�ca A#j ri-S skod� be, tt see l. 1 nYu{ L'V'11 of I&Iocr. z�ould be -
cc. "tviston of eraser Vuattty, ►rarer %!ttatay aecuon, rartttry Assessment Unit 4/JU/V /