710071_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental 06

-71 M.
Type of Visit ZRoutine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVisit 0 Complaint O Follow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: `) oS Arrival Time: i za o Departure Time: County: 2QJb 1L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facilitv Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Sack -up Certification Number:
Latitude: = o = I = Longitude: 0 ° = 6 ❑
6.
Design
6MMMU ; <�
Current Design Current, . ,. Design
Current
Swine
@apaclty
Population We6t Pou�it , apact -' opulatton
t W.
Ca _ _Cap sty
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
® Wean to Feeder
a
❑ Non -La ei
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Pbultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stacker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of 5truetures:
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
�{
YJ 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
o
[I NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WN o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Ilacility Number: Date of Inspection �5
Waste Collection & Treatment
4. [s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: iEAc.HC 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
❑ Yes ONO ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
L! 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?
ElYes
[3hrNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ErNo
❑ 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
,,.,__, //
E o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CJ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) t3 ozx V Ik Cc,) S G o Fcs we Lc,,
13. Soil type(s) Fc-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N'Noo
❑ NA El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,�,
Lt
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
El Yes
[3'No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B-No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3'No
❑ NA ❑ NE
�26.) UPDATE LJVP A -r#J _71,-aM _BJ.CPEcr4r1, o�TArtJ roP d '
D FSi6N
Reviewer/Inspector Name j a ELU' ` � Phone: Q'V 4)
Reviewer/Inspector Signature: Date:
I2128104 Continued

Facility Number: �] — `] Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesdN110 El NA El NE
P readily available? If yes, check
20. Does the facility fail to haVWUP
components of the CXDesign
the appropiate box.
es
❑ No
❑ NA
❑ NE
0 Checklists Ma s
❑ p ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee " Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers
[I Annual Certification
El Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�No
A
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
EA
L"JfNNA
[INE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L3'<o
❑/NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
[I No
2 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
[ o
❑ NA
Cl 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
LI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
I:J No
❑ NA
❑ NE
Additional Comments. andlorD
12128104

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit JO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or Visit:
Permitted [3 Certified Q Conditually Certified © Registered
c Z
Farm Name: ZiMe-&-L/�, �R �
Owner Name: _,�Ljl,! c _.�� ---
Mailing Address:.._ ��. •_ ,
$ Tune: O0
Q Not Operational Q Below Threshold
Date Last Opera r Above Threshold:
County:
Phone No:
Facility Contact: — .. .. —Title:, EU4 Phone No:
Onsite Representative: ZA_,(!'�2rL f�&�. "O _-• Lr. tor: , V"�
Certified Operator:..
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * " Longitude • ° Du
Discharges & Stream ImRl s
1. Is any discharge observed from any part of the operation? ❑ Yes EfNo
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) j] 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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (incites):
12112103 Continued

aciittyNumber: Date of Inspection V#53/0-�'
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes gNo
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 ;Z No
S. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid. level ❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
No
❑ Excessive Ponding ❑ PAN ❑ Hy alit Overload ❑ Frozen Ground Copper and/or Zinc
type2. Crop e M49 IQ 21 r
13. Do the receiving crops differ wlffi 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?
❑ Yes
ZNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
;EfNo
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?
JO
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
JO No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Z No
roads, building structure, and/or public property)
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes.,A
No
Air Quality representative immediately.
Field Cote+ ❑ Final Notes
�i PPGZ�/��7 4N 1���1Q DcJ I`vj� �j0 Rm A0A s��T,�4
�wm� �6r,47S 71 1&0AZ 77,510 - 0 rC
YA'7
!ten A411 P f"a 6) cc q'Q�1j ,2
�F
Reviewer/Inspector Name 9
Reviewer/Inspector Signature:
Date: 17/ q/O
12112103 Continued

Faeilk Number: 11 — 211 Date of inspection
Required Records & Documente
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes P'No
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ;ffNo
23. Does record keeping need improvement? If yes, check the appropriate box below.] Yes ❑ No
❑ Waste Application ❑ Freeboard A Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 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?
(iel discharge, freeboard problems, over application)
[:]Yes ;'No
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes P'No
28. Does facility require a follow-up visit by same agency?
❑ Yes PNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes gNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes )Z(No
31. If selected, did the facility fail to install and maintain rainbmakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35_ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocldng Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:y .. ... P yam._.?--
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:�_ -1t- _i T_ a�-rd.�..3: r.,aeti.wsz.�'.a"' h:.._w....��e' net:.<s.-c-s.. Ks:A�;� ._... '.. , .M.,uPs:
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r�lfnl �5 Ouf5z46 uJ5�� 4AW- ysz 5 s��Doccl,
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GAC � _ 6Of}QQ
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No7es
I21I2103

w �"Divis�on of Wster I�naltty - _--- _ .�
ro--
-_
W
Type of Visit -4aCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date ni visit:
13 Permitted 0 Certified [3Conditionally Certified ❑ Registered
Farm Name: .-. 012`� _.�v✓ _n1V .#-2-
Owner Name: T ►^+; �
I ee C,4c
Mailing Address:
Facility Contact: 'Title:
Onsite Representative: ��' • Q�C'�¢
Certified Operator:
Location of Farm:
Time: Z�
Date Last Operated or Above Threshold:
County
Phone No:
Phone No:
Integrator: t-vi V rpt" in
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' K Longitude 0' 0 0
Design Current ' Design Current _ Desiign Current
Swine = Ca `aciri . -Population > :=Poal W Ca achy .`i?o illation n;Cattle . Ca achy Population,
❑ Wean to Feeder ❑ Layer ❑ Dairy
j
T_
❑ Feeder to Finish ; . ❑ Non -Layer I I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
;. [] Farrow to Finish Total Design ,CapaCi0,,,
❑ Gilts
-':: ❑ Boars U- " Total SSLW .
:Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ S ray Field Area
Holding Pondsf Solid Traps �' ❑ No Liquid Waste Management System
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 ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: �1
Freeboard (inches): ZD
❑ Yes 91No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes IzNo
❑ Yes 10 No
❑ YesNo
Structure
05103101 Continued

Facility Number. r% - ) 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
El Yes [1No
/
immediate public health or environmental threat, notih- 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 maintenance/improvement?
❑ Yes )�fNo
11. Is there evidence of over application? E Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes No
a
12. Crop type 6ea j �1zt�-1 D�,r�recd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
No
El Yes9No
14. a) Does the facility lack adequate acreage for land application?
El Yes
b) Does the facility need a wettable acre determination?
❑ Yes jo No
c) This facility is pended for a wettable acre determination?
❑ Yes XNo
15. Does the receiving crop need improvement?
❑ Yes PNo
16. 1s there a lack of adequate waste application equipment?
❑ Yes 0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZNo
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 Z No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ZNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes PNo
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes J:2No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 0 No
24, Does facility require a follow-up visit by same agency?
❑ Yes ONo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes _1 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..__ _ .mom. _«�--
Comments.(refer to; _fidh omeadations"ors 4thercomments -
q ) . _ ay.o
ezplsituatxans. otse add ironsla $y
Irse draivi— s of fariirty to bitter `i p g as necessary)
_ e❑Field Conv ❑ Final Notes
L�ell �PP�. Ttic ✓eGD�o(S c��e :� gadl� o'��e''" ,
Tile P;CIA A �� >� el e ' ' q r e GIJ e f l tee, n � of , h�? GX - —`h2
.fit,,, ; •� e tipus < AreA and j�tcJoo,� i Well WLArl ; r U"� e.(. `rAa t �_
� _
Reviewer/Inspector Name - +
Reviewer/Inspector Signature: Date: l !? 7
O5103101 Continued

FacilitA �•Number: % f —J71 Date of Inspection I Z D
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?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
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 -T�] 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 2'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J'No
32. Do the flush tanks lack a submerged fill pipe or a permanentftemporary cover? ❑ Yes ❑ No
05103101

R
{ @-Dtvisian'ollWater Quality
Q Drvisjon of Soil and -.Water Conservateon Y -
ry :� Q Dtlier Age cy _
of Visit eXompliance Inspection Q Operation Review O Lagoon Evaluation
IReason for Visit @Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
I.
Facility Number / Date of Visit: �J Time: � Primed on: 7/21/2000
/
rO Nat Operational Q Below Threshold
SPermitted 13 Certified [3 Conditionally Certified [] Registered Date Last Operated or Above Threshold: ..............
FarmName: ..... ............................................................ County: .............................................................. .......................
OwnerName:.....................................1..°(........................................... Phone No:.....1,��...................-....7..3.7..T.....................................
$! 7Y
FacilityContact:.............................................................................. Title:................................................................ Phone No:
MailingAddress:......................I........I.....I...I............................ ................................. .. .................... I.......... ..........................
Onsite Representative:.._...u)tic.�._. 1.Integrator:.....1n .......
Certified Operator: .......................... Operator Certification Number:....................
Location *of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude • 9 69
Design Current
Design Current DesiCurrent
n
``C
Puty cattle Pulation
i Wean to Feeder
❑Layer ❑ Dairy
Feeder to Finish 10
Non -Layer 1 1[:] Non -Dairy
Farrow to Wean
Farrow to Feeder
10 Other
Farrow to Finish
Total Dmign Ca dt Y
GiltsLEE
Boars
Tow,SSLW
,•
S L DVS ii
Subsurface Drains Present
Lagnan Area
10 Spray Field Area
No Liquid Waste Management System
Hag POnds! Sad Traps _
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ 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
g.No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
9LNo
Structure I Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identi fter:................................................................... ..................................................................
Freeboard (inches): -3Z-
5100
Continued
on back

Facility Number: 7/ — 7 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 P: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 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
CRNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
91 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
jd No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
R9 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
54 No
12. Crop type &A'a AF+'A!6 ,QU_I's'� 5G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Q No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
19 No
b) Does the facility need a wettable acre determination?
❑ Yes
(B:No
c) This facility is pended for a wettable acre determination?
❑ Yes
t&No
15.
Does the receiving crop need improvement?
❑ Yes
� No
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 readily available?
❑ Yes
1�1 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
R9 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
;SNo
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
�J No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ;R No
23, Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes (R 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
iNO•yi0 atiQns or dgf cieucies -were noted diWing �his:visit; - Y:oit w.1. i-eeeiye Rio urtiier
:: corresnoiidence: ibotiti this :visit.:.::::::::::::::::: .....

Facility Number: — % Date of .l.rispection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �&No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ELNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes C)d No
I-Additionat Comments and/or, Drawin
gs•
A.t
J
3/23199

[3 D>i,"sion`of Soil and Water Conservat,on Qperadon Review
�� ._ � � r = ;��Ihvdsron of.Soil and Water,Conservat<on � Compliance inspections ..�.x�- =y �`��- -�
n,sraA of Water Quality Com banes InspectioA ?3c +k 3r
Other A %nc O Tat10A ReVlew r s x�
•�. �- �_ � __.... ;�g, 3' _Per- �.an -� �-.�-�. ��-: �.A..:
Routine Q Complaint O Follow-up of DWQ inspection Q Follow-ue of DSWC review Q Other
Facility Number 'r Date of Inspection Z�
Time of Inspection a:00 24 hr. (hh:mm)
U Permitted ACertified 0 Conditionally Certified 13Registered 0 Not Operational I Date Last Operated:
Farm Name: &K4.� f 'Count..................................................................... y:......... Pe.�
�............................1.. ...........
i o f
OwnerName :...... 1..L..............................1.�'.. Phone Not ..................................................................................
TT
Facility Contact: >✓ .. �.. ..... Title: JN. � ....... Phone No:.............................. .....................
MailingAddress:....................................................................................... ............
Onsite Representative: ,,,�ni.4.%y1.......................!°Jr�il�.�� Integrator:.............�i�..............................................................
Certified Operator: ......
....t,t• ....... 1.��. .... Operator Certification Number: ........... ..............................
�..... �
Location of Farm:
Latitude �� �� �" Longitude
Design . _--,Current
"Swine Canacttv,`Pooulation
Wean to Feeder
24DD
15 Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Cur`renE ,::Design C
Poultry_ Capacity_ Population ,Cattle C.a'acity` Po'
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other =
Total:Design Capacity:.-
Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area . ❑ 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?
Discharge originated at: [I Lagoon [I 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 ycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (I1' yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
identifier: ��lr
Freeboard (inches):
...........................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
\
❑ Yes 0 No
❑ Yes dirNo
❑ Yes 9No
❑ Yes 'KNo
❑ Yes E'No
❑ Yes KNo
❑ Yes JR No
Structure 6
❑ Yes P(No
Continued on back

Facility Number: 7 -'/ Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes U(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
14 No
8. Does any part of the waste management system other than waste structures require maintenafice/improvement?
❑ Yes
JKNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
'16 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
1�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
5dNo
12. Crop type
13. Do the receiving crops differ(/ith those designated in the tiff Animal Waste nagement 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?
14 Yes
❑ No
15. Does the receiving crop need improvement?
K Yes
❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes `4 No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
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
5dNo
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
ANo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
E*Ro
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes UrNo
24_ Does facility require a follow-up visit by same agency? ❑ Yes 19-No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [(No
.. yi. . . . r. .. dercien... were ........ �his:v.. I Y;oir i . I . . . . .Rio fI i I
�corres ondeRce_ abu' UA this visit.. � . - . - . ....:.:. . .:.:.:.:.:... . .. .
Comments refer to question #): Explatti any aY_ES.answers andlor any"_recommendations or any`other comments:
Use-Arawings of facility_to better. explain situations: (use addition al=pages as necessary)
t�3 Jr, 4-r fym-ca_ % adc 11 f �'r y f's~ouf h"-t &UP re- Vi s4of- 16 r-•GIu* �
ik� �«'`� W.tr<f��l-� f.�c►'�t< n,rcds/-� �w rtf/•���- � r►-tccf 75� /e�...�c �
0-
} Acc„w..�.�C-.
mpy. Cows bVW fit] r1±�1� SoOr� � Psrs�if(,G �'Flwj-
(io! ! � �-�, A w✓ � �%�. 6•+tic •C Si►n- I,�wf- Cwv� �►%�-1� i`�- b8 `�i .
Reviewer/Inspector Name
X-
Reviewer/Inspector Signature 17 "., �" Date: /V-
3/23/99

Facility Number: "7 f — 7/ Date of Inspection �Z'
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? ❑ Yes eNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
kNo
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
KNo
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
I(No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
TTo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
n vp�
rt
3/23/99

Revised April 20, 19 99
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number ( 7/ Operation is flagged fora wettable
Farm Name:-f2&d•�A ^'w' # acre determination due to failure of
On -Site Represe
InspectorlReviewer's Name: 'Ofi
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: 32­�(7 pounds
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
emotion El E2 E3 E4
Operation pended for wettable c
determination based on 'P1. P2 3
l
Irrigation System(s) -circlet: 1. hard-hosetraveler; 2. center -pivot system; 3. linear move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and sioned by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and sioned 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 eligibiiity checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational -table in Part Ill).
PART 11.75% Rule:Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because. operation fails'mne of the .eligibility
requirements listedbelow:
_F1 Leck.ofmcmagewhicnresultedinmver npiic-.ton-�of-vastew,-=-Ier:(PAN) ❑msp,�y.
fields) �ccordingigfarm'sdast�wo Vaars r��cavOn3e�rds.-.
F2 Unc€e r,-illegible,-or lack of-information/map.
- i
F3 Obvious_,ield iimitatians-(numerous-ditches;faiiurefo:deduct7equired _..
but r -rlsetback-acreage;-.or25°/a :ofiota€ acreaceideni€tied:in-DAWMP::inc€udes _ -
srmaliji-regularly,shaped fie€ds fiBids-less than -5mcresfortravelers-ar..lessfhan
'2 acresfor:s:ationary-sprinklers).
F^ WA determination required because CAWMP credits Tield(s)'s acre Zoe in excess
of 75% of the respective field's total acreage as noted in table in Par 111.

7L
Facility Numbers
Part 111. Field by Field Determination of 75% Exem
Revised April 20, 1999
n Rule for WA.Determination
TRACT FIELD TYPE OF I TOTAL CAWMP FIELD COMMENTS:'
NUMBER NUMBER'' IRRIGATION ACRES ACRES %
SYSTEM
sa
f N.o sad
FIELD NUMBER' - hydrant, pull, zone, orpoint numbers -nay be used in place of field numbers depending on CAWMP
and type of in-ication:system. If pulls, etc. cross -more than one field, inspectorireviewer will have to combine fields to
calculate 75% field by field aetemnination for exemption; -otherwise operation will be subject to WA_ determination. _ _ _-
FiELD NUMBER2 = must be cleariy-delineated"dn irzp. — — -
COMMENTS'- back-up fields with CAWMP acFe_=oe exceedina r5 o of its total -acres -and having-eceived less titan SD°o
of its annual PAN as-documenied in the farm'sprevious_two yeYrs' ('lna7 & 1993) of irricaiion7ecords, cannot serve-as-tne
sole basisforrequiring a WA Di=:ennination:�:.eack-ugfrelds-mLst ve-noted in tine-commentzecuon.and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1 Planjacks.followinginformation:
_/F2 Plan zevision -ma :Sans" 75% rule based on add elate ovem[I PAN de�icit
Y rY g -and by
adjusting'all field -acreage--to below 75% use mate
F3 Other (iefin process of installing new irrigation system):

- _ 0 Division of Soil and",Water:Conservation -,Operation Review
Q Division of Soil andWater Conseri+ahon `Compliance Inspection<
vision of Water Quality Comphance Inspection = . r
:. [3 Other. Agency. Operation•12eview e'b
I.Snoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number late of Inspection
Time of Inspection 1 `ae> 24 hr. (hh:min)
J3 Permitted Accertified © Conditionally Certified © Registered 0 Not Operational Date Last Operated .
Farm Name: G� G / we C 4 �. 1G4&W County:........, l„ • �./ ..�
...............r....�^.............--------...................................... - -. r......�d.............................G....................:......
Owner Name:.......... - C- .,..-.... f�.�T.`a/................................................. Phone No:.........4.�.Q..". ` 5.... �..1.'T.......................
Facility Contact: .......!} ."`�. .......6;C e.l ..............Title:... ..t-r.'ti.¢Y.............. .. Phone No:
Mailing Address: ........ �:..o.._..... 13. J 19... .... ......... ....L" s.. ..... V�.................................... ..........................
. ... .............. .........................
Onsite Representative: G ,V� ......... .. Integrator R f`:.r..........................................................
Certified Operator: ................5...................................................................... Operator Certification Number:..........................................
Location of Farm:
Latitude • �� 0a Longitude • ��'
Design Current = Design. Ciirrent`, Design Current
Svi a Capacity Population, `-Poultry Ca acity Population Cattle Capacity Population "
can to Feeder 2-4 , p ❑Layer ❑Dairy
❑ Feeder to Finish ' ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean = _
- -
❑ Farrow to Feeder 7❑Other
❑ Farrow to Finish = _ Total Design Capacity
❑ Gilts,
❑ Boars = _ Total'SSLW
�Nuiuber of Lagoons . ❑ Subsurface Drains Present ❑ Lagoon Area ❑.Spray Field Area
Holding.Ponds / SolidTraps ❑ No Liquid Waste Management System
Discharges & Stream Inp Ls
1. Is any discharge observed frorn any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? [I Yes El No
h. 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. Dues 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 PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .........z.. ............................................................ .................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.) IIIIII������
3/23/99 Continued on back

Facility Number: — i Date of Inspection
1
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 pan of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A,1212lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pondiinrng-- ❑ PAN
12. Crop type ttNbr;r�f 6--r,5Td . Rve— . K5C.Ue
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?
�'S10 yiolafionis:o� cteficiertcies were potea• durint; You will ieceiye Rio farther
correspondeitz _ e. about this visit.. .
❑ Yes >No
OYes ❑ No
❑ Yes >�rNo
❑ Yes �No
❑ Yes N o
❑ Yes XNO
❑ Yes No
❑ Yes 0lo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �;r&o
❑ Yes'XNo
❑ Yes WNO
Cl Yes �No
XYes ❑ No
❑ Yes kNo
❑ Yes Wo
❑ Yes Nk o
❑ Yes XNo
❑ Yes )JINo
❑ Yes ;KrNo
.Comments (refer to question#):. -Explain any YES answers and/or any recommendations-or,any'other eom�nents.
Use',drawings of facility to )letter explain situations , (use additional pages as necessary)
� 26 L514, f rn rb 1 �,• AL
14, W4,54e- QwC_ly5,5
Reviewer/Inspector Name
Reviewer/Inspector Signature:
-{-
Date: l I_ if I— 9 �I
3123199

14 Facility Number: — Date of Inspection
f
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? ❑ Yes 12<0
❑ Yes �190
Cl Yes // +j No
J
❑ Yes (No
❑ Yes Ko
*es ❑ No
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.)
3 L 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?
Xyes ❑ No
AAditional. C6inments and/or Drawin
d-z be-- ����� �l �cG.�,.
3/23/99

Lagoon
Dike Inspection Report
Name of FarmlFacility f t r -7
Location of Farm/Facility �',E _ _At��
Owner's Name, Addresse-!4T_ r and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
V 've Cover
{ rass rees)
Did Dike Overtop?
4 Names of Inspectors d - -J _ 7!a
1:� ap Jz -
1 r.
Freeboard, Feet l _
/ZAC— Top Width, Feet
Downstream Slope, xH:IV�/ l
Yes _ No
Yes No
Yes No
Yes _Y�, No If Yes, Depth of Overtopping, Feet
Fallow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Daze Safety Law of 1957?
Other Comments
Yes No

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH-.IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
(5Ze Cover
CS)
Did Dike Overtop?
Lagoon Dike Inspection Report
7/ �7
e2f-F /0
-2
-Yes No
Yes No
Yes No
Follow -Up Inspection Needed?
Engineering Study Needed?
Names of Inspectors
Freeboard, Feet
Top Width, Feet
Downstream Slope, x1+1V 311
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

V
Division of Soil and Water Conservation ❑ Other Agencyww
ro s ,Division of Water Quality
0 Routine 0 Complaint 0 Follow-u of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection IZ
Facility Number
Time of Inspection 12705 24 hr. (hh:mm)
[] Registered 2Lertified E3 Applied for Permit © Permitted 10 Not Operational Date Last Operated: ....
Farm Name:..i �t ..........�..4..!`{.. G � ..............................................
... ................. County:............. n .7`.......................................
�{
OwnerNatne:.... t..... ' i..��G "............................ Phone No: ........................................................................................
....�.n
Facility Contact: ..GfrhM.��r l�hL�/.t� Title:....��t�.4r�I' ........................ Phone No:...................................................
MailingAddress:....: ..............T.. t;1............................................................................................................................................ ..........................
Onsite Representative:........ .q�...'b.... ` L .�L................... Integrator:.... „(,/ .........................................
Certified Operator................................................................................................................ Operator Certification Number:.................... .
Location of Farm:
Latitude =0=° 06s Longitude 0 6 46
C Design: Current ' Design urrents' Desrgn'Curreiutr
Y .
Swute t Cap*ity Populattan Point' CapactPo ulattan Cattle Capacity Papulatian
Wean to Feeder ❑Layer
❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean V r
❑ Farrow to Feeder ❑ Other $� v
❑ Farrow to Finish n
€_ Total Design Capacity
❑ Gilts
❑ Boars = sTotal.SSLW
F,u
_._
Number of L-awns / Holding Ponds' 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area -.4
f X 4 F ...... ..-
❑ No Liquid Waste Management Systems
-N,
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon El 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 lagoonsfholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 19 No
❑ Yes ® No
❑ Yes W No
❑ Yes EdNo
❑ Yes IN No
❑ Yes 0 No
❑ Yes VNo
❑ Yes ® No
❑ Yes Q No
❑ Yes JRJ No
Continued on back

# r � .liity Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes JR No
Structures (Lagoons.Holding Ponds. Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes J9 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(tt):.........�..........................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes Q No
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 WNW, or runoff entering waters of the State, notify DWQ)
nnPLSjL
15. Crop type ......... Sr .................................................I—ILI
....... .................................................................. .
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?
K No:violations. oar deficiencies. were, noted-during'this:visit._ You.`viH i-eceive:ito:furtfiei .' ,
O&ir spolidehcO atiout this:visit:-
❑ Yes 9�No
❑ Yes 0 No
❑ Yes W No
❑ Yes Q� No
❑ Yes I2LNo
❑ Yes ®'No
❑ Yes RZNo
❑ Yes UNo,
❑ Yes U No
❑ Yes ®' No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No

[j Division of Soil and Water Conservation ❑ Other Agency
ivision of Water Qualityh.
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 1+ollow-u of DSWC review 0 Other
Facility Number
r I Date of Inspection
n _ ,
Time of Inspection .'a � 24 hr. (hh:mm)
0 Registered �(Certified
© Applied for Permit 0 Permitted Q Not Operational ID ate Last Operated:
FarmName i`c�o2cGj Nc'rS�r�/ �7 Z County:.......... E...........°.��....... ...... �j..........................................r.....................7'............................................ �" �'
Owner Name:............ ..� .'` .......1.. G ....... . Phone No: ....�l D..... ..4. ........ . S ..............................•
Facility Contact:.............................................................................. Title:................... ................. Phone No:
......� ,1 "C I t c!!�Z/C Z 11�l fMailing Address:.............................. ........................................I..................................................................................
OnsiteRepresentative:......`�r��+:4 .. fit... .............................................. Integrator:.........v.r�.......
Certified Operator-,., ........... _-&.1 ...................... ... 7. :-:.GA ........................................... Operator Certil"ication Number,... t..............
Location of Farm:
Latitude 0 6 « Longitude 6 66
n Design Current Design Current Design ` 'Current
W
Ca acit Po ulatron Cattle r " Capacity Po Mahon S.v.. --Capacity-Population Poultry P y :::__ p P y p:,_.._
can to Feeder Z 00 ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
,; ❑ Farrow to Feeder ❑Other a ',W . .
❑ Farrow to Finish Iota! Design Capacity
❑ Gilts '
s ❑ Boars 41-TotsirSSLW
Number of Lagoons / Holding Ponds ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
M
MIN MT
,xRi
« ❑ No Liquid Waste Management System
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
�allo
2.
is any discharge observed from any part of the operation?
❑ Yes
`�No
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
❑ Yes
�((
No
)6No
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
o
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
o
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
-[4-No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
O-No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
[ No-
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes,
!
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
�,
�1 No
7/25/97
fff

Facility Number: —
r�
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures UagoonsZolding Pons Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):..........3...!......................I...............------................................... .................. .................
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 maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes 1Qo
❑ Yes �fNo
Structure 5 Structure 6
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 Wl P, or runoff entering waters of the State, notify DWQ)
15. Crop type ..............kx.e.........-----------...................................--------...-----------.........................-----.------------------.------..............
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 reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0° No.violationsot; deficieneies.were'noted-duririg this:visiC Yodwifl iiceive-ito•ftirther
:. co : .
ZZ- ILGGjo 1 e_e_o, F S v+ iwGGiC �Y e hD4i� }��Caril 5 4K S� ��i 1
❑ Yes P'N0
❑ Yes6o
❑ Yes r 0
❑ Yes KNO
❑ Yes �CNO
❑ Yes P—No
❑ Yes No
❑ Yes No
❑ Yes To
❑ Yes o
❑ Yes No
�07YesN o
7/25/97

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other -
Date of Inspection
Facility Number
Time of Inspection 4wo24hr.(hh.mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .... .._..... _.._..
Farm Name: _ _ �P�^4i�. Z ............... w....__.............._...... . county: CI C .. »»..... ............. ...... ...
Land Owner Name:.. .... �.... Phone No: (qAL .as ..� _.
FacWty Conctact:..._�7 54_....1�. Title: Phone No:. �LQ S �Si'`#
p�, — ...... —.... ......
Mailing Address: _.... �..7i.-e...L......_......._........................_......._.----,.............._t!'WhLe.. f . 9.... ..... .... ..... .......
Onsite Representative: ..... qM1V,,..T `............
..._ .....
........
.._......
_........
Integrator:
Certified Operator: .ttx ._„...,. �............J: Pl C� � .... ..... W....- .., Operator Certification Number: _.ILO? .
Location of Farm:
era... f..........5.t�..._ 1r.................... __.... ...... ..... ..........
._ ........... ................_....... a
Latitude Longitude ©• ©µ
Type of Operation and Design Capacity
Design CurrenE :Desrgn Corrent�Destgn�Current
Swine C ,n ..
' a ace Po ul"afion oultry-� �_ Ca aeity Po ulateon� ,' ttte� Ca ad o uia'
Wean to Feeder ccab 14 ❑ Layer [I D
Feeder to Finish ❑ Non -Layer ❑Non -Da'
Farrow to Wean a
Farrow to Feeder Total De ign Capacity 2-bob
IQ Farrow to Finish
a
,r�,�a:.:�.......�.... Total' SSLW pDa
❑ Others
Number ofLagoans / Holding Ponds „x ❑ Subsurface Drains Present
❑Lagoon Area ��x� ❑Spray Field Area
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 �bNo
❑ Yes PNo
❑ Yes 0 No
❑ Yes [59 No
Y
❑ Yes [ jNo
❑ Yes 13 No
❑ Yes %-No
Yes ❑ No
Continued on back

Facility Number:.. i1...._. —...Z l...._
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?
Structures![.aaoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (fl): Structure i Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes R-No
❑ Yes No
❑ Yes j No
❑ Yes P No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Aaste Application
14. Is there physical evidence of over application?
(If in excess of VAMP, or runoff entering waters of the State, notify DWQ)
15.' Crop type ......... hg1_m.V_&=._......... ... _ .... _.......__.... ...... It .... _ ........ .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Qniv
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
its'(refer to_g
❑ Yes RNo
❑ Yes R No
EN Yes ❑ No
❑ Yes O No
❑ Yes ® No
❑ Yes [33No
❑ Yes 19 No
❑ Yes Ea No
❑ Yes MNo
❑ Yes bd No
❑ Yes 19 No
❑ Yes M No
❑ Yes No
Yes ❑ No
�e_ M4wej- %N be%-P, skool/j ` 6e bvi 1� avcvrLj
by �j
Avm�i40r, Ar sKaj 6
+uA� 1i_ (Jid
-+�h• cm-b COOL s 4� ,60 e_
cc: umislan of crater guattry, water guatityaecnon, Facttity rtssessment unit 4/3u/`J

C7
Site Requires Immediate Attention:
` Facility No_
DIVISION OF ENVIRONMENTAL MANAGEMENT 7
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD 7 t
DATE: "-G , 1995
Time: 1 Tu.r
Farm Name/Owner:
Mailing Address:
County:
Integrator:
On Site Representative: w-Q ( .?&,l F
Physical Address/Location:
Type of Operation: Swine `� Poultry Cattle
Design Capacity: '240-0 4 ,z Number of Animals on Site: aL 60 _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �' �{�' 0 (4 Longitude: �1 S 4r' ��" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon haysufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 69, or No Actual Freeboard: Ft. --5— Inches
. Was any seepage observed from the lagoon(s)? Yes orowas any erosion observed? Yes or PO
Is adequate land available for spray? Ye or No Is the cover crop adequate? IS)Dr No
Crop(s) being utilized: �-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? &or No
100 Feet from Wells? �or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ore� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?/Ii'dslor No
Additional Comments: IrIX vim.
0 �0 ft
Inspector Name
cc. Facility Assessment Unit
. v
Sim e
Use Attachments if Needed.