710091_INSPECTIONS_20171231

NORTH CAROLINA
Department of Envimnmentai Qua!

1
Type of Visit
piiance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 7 6N 0e a-- Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: T� Title:
Onsite Representative: J YVl. -(- DA xL - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification }`lumber:
Latitude: [= o = I Longitude: 0 ° =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
I
© Feeder to Finish O:46
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes D No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[I NE
El Yes
YNo
El Yes
❑ NA -
❑ NE
❑ Yes
12 No
❑ NA
❑ NE
12128104 Continued

Date of Inspection I _2SI1) loi' I
Facility Number: '71
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: �A Go-01 r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environ ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
El No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
l.Ao ❑ 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
dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
n No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) Z''C SO2GA drn (jER-MVDF1 L C- ) S6 0
C a-4,
13. Soil type(s) FqA fi A 6 X � o A
_ �C,I �
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 13 Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes DNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes E4 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑Ao ❑ NA ❑ NE
r 5;) W Eto coNT28 L-
-�,) U-rA+j o Lk wA L uS AOO 1 E6M J(L AOUA N14 GOI.E �lLrJUC 02.i-I FS uP
MvjT pa /Zo rr,_rU rA✓SPE C A P, W(A-MOU (406
Zo� #EU WfUP t✓6foS fo lgE tjzrp p6C0g_0,S, ��Ei.OS *� �3f=eL►�t�Ofl tij6W,
Reviewer/Ins ector Name T
P JUj lv Phone: n
Reviewer/Inspector Signature: 4 A4 IV Date:
12128104 Continued

FacilityNumber: — J Date of Inspection S o�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check U Yes ❑ No ❑ NA ❑ NE
the appropirate box. 0�up ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No 0
NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers �A�nnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield K2OMinute Inspections ❑ Monthly and V Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
ZNo
ElNA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ No
&NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
,Yes
Ek es
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
�o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
N o
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�� �
L�lNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ld No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
WN o
❑ 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? (ic/ discharge, freeboard problems, over application)
,,,,..,,, //
'
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
L�'N
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
IJ No
❑ NA
❑ NE
Additional Comments andJor..Drawings . ` , ' Ana
FL747 7/irj
FL747 7/irj

l
Type of Visit otompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P Routine Q Complaint O Follow up O Emergency Notification O Other [3 Denied Access
Facility Number Date of Visit: 7-1 6 Tune:
10 Not Operational O Below Threshold
)aPermitted Pterified p Conditionally Ceerrtti�fi.,ed� f13
Registered Date Last Opera Above Threshold:
Farm Name: County:j� ...... _ .. __
Owner Name:
Mailing Address: ____
Facility Contact: __ _ _ . __._ -----Title: _
�l J�
Onsiite Representative:
Certified Operator.
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certif'icatiou Number:— -------------------------_ ..
wine )219ouftry ❑ Cattle ❑ Horse Latitude ' 4 46 Longitude • & 44
Discharges & Stream acts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes [--]No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gMo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes f3"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 12M
Struu eue 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Numbers — Date of Inspection 16 tr
5:'Are there any immediate threats to the integrity of any of the structures observed? Oe/ 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 strictures 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 maintenanceltmprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [I Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAV rhT)?
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?
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 properly)
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.
/IG---, T 011—
Reviewer/Inspector Name 1�
ReviewerAkupector Signature:
❑ Yes L]-10
❑ Yes Z No
❑ Yes ZNo
❑ Yes ON' o
❑ Yes 0140
❑ Yes FWo
❑ Yes )2No
❑ Yes ,a%
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes {PNo
❑ Yes $,0'No
❑ Yes 014o
❑ Yes ,0No
❑ Yes 2140
❑ Yes Lago
Field Copy ❑ Final Notes
Date:
L1/lZM-1 L:onanuea

Facility Nuinben - _ Date of Inspection
w
Required Records & Documents /1
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ]_-]Yes ;3No
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WUP, checklists, design, maps, etc.) ❑ Yes PNo
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 ,0'�o
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,fio
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(it/ discharge, freeboard problems, over application) ❑ Yes R No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gNo
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes g^No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) dYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JE3No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
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
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of Visit: Time: 1 SOO
Not Operational 0 Below Threshold
Q Permitted 0 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: T!4 �rte_Q_Gr r �- _ County: 110.919L/-
Owner Name: GZ-jy\+ Cti Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: 2"p O�Q Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �6 u Longitude 0 4 u
Design Current
swine
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
­�Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Ca , acity . Po ulation
❑ Layer I I 1E1 Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
T tal SSLW �'
O
Subsurface Drains Present710 Lagoon Area
No Liquid Waste
Discharges & Stream Impacts
I. 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): a-} - 3-9
05103101
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
No
ElYesYes
,❑
INo
Structure 6
Continued

L Facility Number. — C�
Date of Inspection `7 3D 03
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. 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
❑ 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?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional 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?
❑ Yes
❑ No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coinments,(refer to quesgon #j Eaplatn any AYES answersyandlor any�recommendahons or any„ather co�metEts.
a _ Cc -:.. .i ji
se'drawings°o f facility46'better'4explain situatsans. (use Witional�pages'as?neces's'ary,} L
Field Copy Final Notes
❑ ❑
cS Reviewer/Inspector Name
Reviewer/Inspector Signature: T Date:—t1
05103101 Continued

AI
rvrsioii of Water uahty
t Q Drvrsron of Soil and Water Conservation
x
_ O Oth
AgeneY
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: Ci Time: �S Printed on: 7/21/2000
F__Facility Number
Q Not O erational Q Below Threshold
© Permitted 11 Certified ❑ Conditionally Certified [ Registered Date Last Operated or Above Threshold: .................
!t i ...I R.t-...........................
Farm Name: ........��.k....... �......e-e.......�....�a...-................................... County:........... .......................
OwnerName: ................................................... ........................................................................ Phone No:..............................................................
FacilityContact:.............................................................................. Title:............................................................... Phone No.
Mailing Address:
Onsite Representative:.................................................... Integrator:
.......... i•, r .......
Certified Operator:................................................................... Operator Certification Number:
Location 'of Farm:
a
(] Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude �' �� ��� Longitude
67
Design Current
Design Current Design : Current
x Ca id _., Po tilation
Poeiltry Capacity Po elation Cattle . „ . '...Ca ap Po elation
Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish (
❑Non -Layer I[] Non -Dairy
Farrow to Wean
Farrow to Feeder
JO Other
Farrow to Finish
Total Design Capacity.
Gilts
Boars
Total:SSLW
❑Subsurface Drains Present ElLagn Area ❑Spray Field Area
�-Holding Ponds / Soiid Trays
❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
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/ruin?
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 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes 9No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..................................... .....
Freeboard (inches): �d
5100 Continued on back

Facility Number: — Date of Inspection
0 Primed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ,�TTo
(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 maintenancelimprove ment? ❑ Yes �rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )�rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes (1140
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes dNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes VNo
12. Crop type Sd`(t�G� �S'S2� CvrA _ <G
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 154TTo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
I�TNo
I5.
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ENNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc.)
MYes
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
t.
WYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0j'No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
WNo
23.
Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
❑ Yes
N�No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
M-No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
10
yiolatior}s;oi- itefcienc�es r►�ere noted itirring this:visit: •:V64 wiiI•fe;06W trio further
.'.'Coirisi)�de'
ce: agouti this :visit. .................................. .
L
�-C2f �G`� h �-�...�7•—ice ��g G� Cy'�v��J � lj� .

Facility Number: — Date of inspection d a(
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below lwYes ❑ 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 o
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 'VNo
R 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 ,j No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes (DNo
Additional, Comments .,and/or ,Drawings: -
A(zi he.t.-, cl,
Ck Q-S�\ g-,-, + Poy
5 7
Akt S
J

f t
w a .Drvon of Soil'ai%d'Water Conservation .":O ration Review; 59e
x ;r"ion of Soil and Water Conservation ..Compliance Inspection A
. e s
g DrvestoR of Water Quality Compliance Inspection
e Other =A en O eratiOn'Rev1ew
J Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection Q 24 hr. (hh:mm)
Permitted Certified [] Conditionally Certified 0 Registered JE3 Not Operational Date Last Operated:
FarmName: ��............................................. County:.........................................................
Owner Name:
Facility Contact:
Mailing Address:
Title:....
.......... Phone No:
Phone No:
Onsite Representative:.3o�,I.�.".,,,:YG\S.� „•.. Integrator: ,,,,,,• "
CertifiedOperator: ................................................. ; . ................. I ........................................... Operator Certification Number:..........................................
Location of Farm:
... .................................................. I............................................................................................................................................
w
Latitude Longitude
Design Current Design - Current = Design: , :-.Current
Swine .,Capacity;.', -Poo ulatian Poultry Capacity -'Population -: Cattle ty p
Ca'a c� Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
P❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total -Design. Capacity_'.
❑ Gilts
❑ Boars .Total'SSILW
Number of.Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
.a
HoldingPonids / Solid Traps ❑ No Liquid Waste Management System '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes rVNo
Discharge originated at: ❑ Lagoon [I Spray Field El 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 gaUrnin?
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ..
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
NrNo
❑ Yes
XNo
❑ Yes 9No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes XNo
Continued on back

(Facility Number: 7 j —111 I Date of Inspection
u
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
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
DrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
OrNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
MNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
tKNo
12. Crop type 5 %a WC-1, S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
b<No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
bjrNo
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?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
kNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
allo
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
WNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
kNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �NfNo I� 23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes M No
0: Rio yiQlafio ... aefeiei3... were n�tet3 d>�rt`iitg his:v....Y.. will reeei. �#o. #'.... r . .
rorres ofideike: about: this visif: :: ..
Comments 6 efer to question #) .Exploit any YES answers and/or,any'recommendations or;any otlYer comments
faeility to:b'etter.:explam situations (use'add►ttonal pages assnecess
Use drawings of
U
<L. Q.
r� Viv2 �K t S { -dc e
ws+t,.; YeS� v �i �t l" 4LOsot
Reviewer/Inspector Name ° ` s 3 G �!
�.'0 g y
Reviewer/Inspector Signature: _ Date: 0 0

i,
F cility Number: — Date of inspection GG
Odor Issues
26,
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
C�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
KNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
m/No
roads, building structure, and/or public property)
//1\
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?
El Yes
ANo
tttona omments_an or. raMngs:
... _ - _
r 1'-' ALA,
1z -
yz-`
M1

3 Division of Soil and•Water Consetvatson Operation Review u
0 Division of Soil aitd Water,Conservation .Compliance Inspection ice.
Division of Water Qualify - Compliance Inspection s .
` Other Agency:= Operation Review'-
�:
Routine OComplaint Q Follow-up of DW ins ection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection 31 I
Time of Inspection 24 hr. (hh:mm)
[3 Permitted 13 Certified Conditionally Certified © Registered 0 Not Operational Date Last Operated:
..........................
Farm Name: .. `�u'! ..........''... � `.......................................................... C.ounty:......................`1...�Q��............
......
Owner Name:... ............................... Phone No:..........
Facility Contact: .............................................................................. Title: ................................................................ PhoneT(`lYo)........3.....,...r.../.....
Mailing Address: ............................................................
Onsite Representative: u""'`!...`� Ga!`\� -a ............... Integrator:....... t^'�� �y.................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
............................................................................................................ .................................................................... .
Latitude �° Longitude • �� Oar
Design Current.'.., - ..Design Current Design Current
Swine Capacity Population - :Poultry Capacity. Population "Cattle. Capacity Population-
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number -of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding.Poeds /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'?
h. 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
Identifier: j }�
Freeboard (inches): ......... 1-i. +� ..........
Structure 2 Structure 3
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
J�rYes ❑ No
Structure 6
............................
❑ Yes ❑ No
3/23/99 Continued on back

)Facility umber: — i 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
❑ 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
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15_ Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIIP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
:: �4o.* 9iawris:oi deficiencies •►sere noted- during this'Asit' - YOIk will f e6vEi ii6 furthctr ;
• •Torres oiide"�e botitkthis:visit. ; ; : •'•:•:•:•:•-;-:-;-; • '••-:-;-;-'-'-:• -'-
a..viiiiaia.iiw �. 1.i4 ,aV _iiµ�.q}.Vii rr� ..;Lliy u,u iJ „i.x�,u.wni-�a riiR4il Vl. fill, _i Gl.Vllia �. u iw v. � _- J vau w.vi�.aa..a.uaa
Use drawings of facility to better explaiwsituations (use_additiorial pages as necessary)
Saw,
5
t5�cces-s g-o
t � -
Reviewer/Inspector Name ,ti tip - lY�� m t�=`af-
Reviewer/Inspector Signature: (--A - Date:
3/23/99

atility. Number: — ` Date of Inspection isSL� s I
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
or broken fan blade(s), inoperable shutters, ctc.)
❑ 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
tiona_ , . omments arid. o-r' ra*ings: - _
�=:, seal
o'er V'e..L� ►� �e Via, <�VOwe,,-
3/23/99

Revised January 77, 1995
JUSTIFICATION & DOCUMENTATION FOR /MANDATORY WA DETERMINATION
Facili Number �i - "i1 . V O eration is fla ed for a wettable
tY P 99
Farm Name: t�`r GeA-_
On -Site Representative: W t
acre determination due to failure of
Part if eligibility items) F1 (fpF3 F4
Inspector/Reviewer's Name: Operation not required to secure WA
determination at this time based on
Date of site visit: _ 1cm exemption El E2 E3 E4
Date of most recent WUP: f—";L3— [b Annual farm PAN deficit: pounds
Irrigation System(s) - circle #0hard-hose traveler, 2. center -pivot system; 3. linear -move system;
4Q stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun' system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres js complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE. .
E3 Adequate Di irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part II.- F1 F2 F3, before completing computational table in Part Ili).
PART If. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
FI Lack of acreage which resulted in over application of wastewater (PAN) on spray
r field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised 3anua-, 2, 19,
Facility Number '3 � -�
Part Ili. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER1.2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
a.K
I
I
I
1
I
{ �
I
I
I�
!
.I
I
-
I
I
I
I
I
FIELD NUMBER'
- hydrant. Dull. zone. or point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER2 - must be clearly delineated on map.
COMMENTS3 - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

R-vised ArnR 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facili Number - ✓ p fie ed for a wettable
FacilityNumber � Operation is 93
Farm Dame: acre determination due to failure of
On -Site Representative: ✓j. Part 11 eligibility items) F1 F3 F4
InspectorfReviewer's Name: Operation not.required to secure WA -
- - - - determinatfon at.this time based on
Date of site visit: 1 � exemption El E2 E3 E4
Date of most recent WUP: Operation pended for.wettable acre
a �eterrrrination based on F7 P2 F3
Annual farm PAN deficit; pounds
irrigation Systems}_- circie -. 'I..bard-fiose-Jraveler; Z.center-pivot system; 3_.linear move system;
4. stationary sprinkler'system w1permanent.01pe; 5_.stabonary sprinkler system wlportable pipe;
B. stationary gun system w/pe-mianeni.pipe; 7- s� nary gun system wlporta Ile ripe
.PART h V' A uesermination Exemptions (Eligibility failure, Part It, overrides Part 1 exemption.)
El Adequate:irrigauon designjncluding map depicting wettable acres, is complete
and signed by an I or PE_
E2 -Adequate'D, and D2lD3'.irn`ganon -operating parameter sheets, including map
depicitnng wettable'acres, is complete and sioned,by an 1 or PF.
E3 Adequate D,, iniaatian operating parameter sheet, including map depicting
watrable acres, is complete and signed by a WUP_
E4 75% rule exernpnon as verifiedin Part Ill_ {NOTE 75 % exer►umon cannot be
aopiied to ;lanmsti;at.ail the eiigibility checki:st in Part IL Complete-eiigibiI4
checkiist, Pari If - F1 F2 r3, bem- re compieting coinDUtabDnaitable'in-Part Ill)_
'ART 11.75% Rule Eligibiiity-CheckiieLand_Docurnentauon-o WA Determinafion -
Zeauir--mL-nts._ WADat--rnir;auon regriirYdbecaL-se DD--rafion-;aiismne-nice eligibiii y
�C�Lllrrr33rFi�'I;stad�eiDur
F � ! acl�nf�c�agaotiiiicir�s�ii~ddn ���piicauon��siaw�=={PAN} -an3praY-
7iFeld(s) ccDr iingtn�rm jestfwa -ais ;:, 'gaiinna ds .
/72 Lin laariiliegibla�r lack of - " �nro nrationrrr�an::_
c
_F3 Obviaus�aalrf iimriansnumarnus�ircn��=l�rr�Dzl�ducigr�ud-� .
Dur�erisa�ack�cr•.:agY;�r2�1��f=a�l��ag�dailun��n�AWI�I�=rncivaas-�= -
small,-.irrrauiarlyzhapadfi--icis i aldsdassiban �cras€ar va#ar r Yss ran-
2 acras-r'orz'abonary:sprinklers).
-4 WA determinauonT-eQuiredbecause C:AlhrMRcr?aris?iaid(s)'s acreage in -excess
of 75/a of the respecuve i-raid's total acreage 2s noted in able in Part lli.

R vis_d Apt 20, 1999
Facility Number
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE of
TOTAL
CAWMP ' ,
FIELD
COMMEKTS`'
NUMBER
NUMBEW-2
1MGA110N
ACRES
ACRES
%
SYSTEM
and iypa ter -irri on3ysL-rn3 - i, nulls, --�:.crossmore-than "Dne neldjns��ir-e iewer will have to =mbiren lcs'to
caul « ! JII� TiStcl by nn3d -rn m�avon r �r�unriytherwise ape: anon vigil br-- suajsd i iD WA "daiarrrrinaiion_
r-B- D-NUMB---- - mom b-- zi-eady-deimyai-ed mzr ap. =
/Ct�D�M• ^4ti,�.,.i.F.S3-ntacct-up ite_lds.,.jxn�irfi'�fRCAW�M�}?�'+y.�a��- grt�f•-�� .je�,e�rSing �°%i cff jistcds y L-a--r z-an�.�dd 7hayvvin�9yTe----- ived Jes-s fr-,aan�5D
:Jl 3s.i II{1nual PAN S:1jD=ie...Ly1-5�.—.7�.ill+�aJalll��i�r�<K+3.�.�-ir,.Mi7..s.�.., . ��.�j 997&19ZS)L1kriaab01iiy.++Vi�lil�T.-y1.Lii M•i.%L��ivB iw� ,
Bole rl Di ��r� r�� �iisiJx :s�iji ��t-j 1�1�. 1+L+1a L�g�i�F -il�n aZ'DTilrr38ri Dn�1 W � a.", �. irtli?
]y IiT!_G�i3QrS'bixiiL" -
'art TV. Pending WAseterminaiions-
-PI Flanjacks:fvllDvAngiMierr E 'iDn:
P2 Pian-r=visionunay-sausf►-7Z% rulabasedDnadequate -oveat[.PAN dencRandby
'aajus'ring-alf:iiaidmcraagY=ot�--lOw7Ei% uses - -
?3 Dtner(inn DrDcBss-.Di installing.new.irripbon system):

- [3 Division of Soil and Water. Conservation -Operation Review
Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality -Compliance Inspection
_.-:
0 Other Agency - Operation Review x -
Routine 0 Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility `umber Date of Inspection
Time or Inspection 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified [3 Registered [3 Not Operational D'aterL,�ast Operated:
Farm Name: V�^!'" County :..............`
Owner Name:.,,,,,,,,•„., • Phone No:
FacilityContact: ..............................................................................Title:.........................................._..............._..... Phone No:
MailingAddress: ........................................................................................................................................................................................................ ..........................
M.Onsite Representative: ,fit Qv �J t—�Z� .`t. Integrator: G ,,................................................
Certified Operator: .............. ................ ................... ............................................................. Operator Certification Number:..........................................
L ti n of 'a
......p..r...................
---- --..._..G1,w......R_...l.J.....C.+...--._.....a................................................................................... ..........................................................................
Latitude Longitude
Design Current
Swine
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 10 Subsurface Drains Present [] Lagoon Area JEI Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Dischantes & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes NrNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made" ❑ Yes ❑ No
h. II -discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If discharge is observed. what is the estimate(( flow in galhnin''
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? El Yes No
3_ Were there any adverse impacts to the waters of the State other than from a dischar-e? El Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes DdNo
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ...........
.._..... .................................... ............... I ....................
1/6/99 ' Continued on back

Facility Number: 91— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes [�No
seepage, etc.) ✓
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 1%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 ❑ No
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gained markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes INo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �<No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑YesPq No
12. Crop type......... .............................................................................................................................................................................................................
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [)(No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes ONO
15. Does the receiving crop need improvement? (gYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes [ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes [YNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
❑ Yes
[NrNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
WNo •-
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
t.
(ie/ discharge, freeboard problems, over application)
❑ Yes
Ej No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
0: N:o.vi(Aaitions_or. deficiencies .were noted. during' tiis.visit:. You �iil.receive no further
ctjrresb6iideitce' ab)ut; thiis visit.: ; ; ; ; ; ; :: ; :: ; ..
; ; ; :::: ..
Comments (refer to question #):.Explain any YES answers and/or any-:recoriiiRieridations or any other comments t
Usedrawings,of facility to better explainsituations. (use additional pages as necessary): -
�v� �� Tod s°11 slr�e `nee �,i r�►-H�te�,
IS)' ',p -6 ��► be�-1► �.�� ,VeIo
5IJ 9�c� � �� � 1� 4�[� �
Reviewer/inspector Name
Reviewer/Inspector Signature:
Date: Q�
1 /6/99

Facility Number: 3
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: /0 _1 + 9 G &7Y„�o L el 4etJ7
Time: / i Old 4GS P s-S c
General Information:
Farm Name: County: __,DWA AAr
Owner Name: W 1i icw.. M,,C,(F, ,VU Phone No: 607, - 334
On Site Representative: btu, l f Iat..,j Wtcl orAAJ Integrator: OW -
Mailing Address: Aa ¢ 0 K ( S i
otter !
Physical Address/Location: 'U(2n it Z t
Latitude: 1 1 Longitude: I I
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
❑ Sow ❑ Layer ❑ Dairy
❑ Nursery ❑ Non -Layer ❑ Beef
0 Feeder
OtherType of Livestock Number of Animals:
Number of Lagoans:�_ (include in the Drawings and Observations the freeboard of each lagoon)
FaciIity Inspection:
Lagoon
Is lagoon(s) frerbaard less than 1-foot + 25 year 24 hour storm storage?:
Yes ❑
No
Is seepage observed from the lagoon?:
Yes ❑
NoQ
Is erosion observed?:
Yes.4
No ❑
Is any discharge observed?
Yes ❑
Now
❑ Man-made Q Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Yes )Q
No ❑
Does the cover crop need improvement?:
Yes ❑
No ❑
( list the crops which need improvement)
Crop type: 6Jl! 544t Acreage: 24
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Yes ❑
No CY
Is a well located within 100 feet of waste application?
Yes ❑
No IN
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Yes ❑
Now
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
Yes ❑
No
AOI -- January 17,1996

Maintenance
Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Yes ❑
NoVj
Yes ❑
No 19
Yes ❑
No T9
Yes ❑
No M
Explain any Yes answers:_ FtcK cv i f] hE82!�tAg,-Q - L�tjs€S Dvy w
Wd i r .l
(y -r-H _�P a.� cc1 `:.r► 7� u�-ceta 5 -u At
kG U ' AEG .t> L47
i rzT / !1 i�R.lYf�t • TZ] �✓t S'I AC.G A , �D E �r�sti. EE l7 7d ec &
'_'I
Signature: Date; L® " I - 1 (0
cc: Facility Assessment Unit
Drawing5 or Observations:
�, su PON
if Needed
LA (tea
L- Tieeuc0
,A1O r T
�G=
�i
AOI -- January 17,1996

•
•
sue requires
Facility No.
DNISION OF ENVIRONi'VEN AL'vLk1NAGEN1EN_T
A-NrlV1AL FEEDLOT OPERATIONS S= VISITATION RECORD -
DATE: %� " v , 1995 (S 4
Time: = : c757
Farm Name/Owne.: IV
Mi1 e U t/ CQ�-� s�i��7�iJ•,
Mailing Address: Z2 0 W_ 5l 54,
Le%A �a_c f,�t.✓�L_ �'fCoG
Counllf. c, 2
Inter--ator t hy 4ea _ Phone: 91 B- 28' S— Z t I J
On Site Representative: -1-I4 L 5 n Phone: _'910 �;5 --75 S/
Phvsical Address/Locadon: 1 2 �
Type of Operation: Swine Poultry Carrie
Desi-a-i Capacity: _Gr 7 Z _ Numbe: of Animals on Site:
DELI Certification Number: ACE DEM Cermication Number. ACINEW
Laurad:,: Z-�! ' Longitude: '77 ° _I' 57 Elevarion: Fee:
Circle Yes or No
Does tie Animal Waste Lasoon have sufficient E eeboard of 1 Foot + 25 year 24 hour storm eve -it
(approximately 1 Foot 7 inches) Q_-vor No Actual Freeboard: Ft_ Inches
Was any seepage observed from the laaoon(s)? Yes or No Was any erosion obse: fed? Yes or No
Is adequate land available for sprav?
Crop(s) being urhzed: CnrieAd
es og�g Is the cove: crow adequate? Yes or 10
Does the facility mee; SCS rninirrsum setback criteria? 200 Feet from sZ904%
100 Feet frotn We'`s. -es or No
Is the animal waste stociuiled within 100 Feet of USGS Blue Line Stream? Yes N o
Is aodmal waste land applied or spray irrigated within 25 Feet of a tiSGS Pvlap Blue Line? Yes or(E)
Is a* ira�i waste discharEed into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or a If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied:
spray irrigated on specific ac-reage with cover crop)? Yes QOJ
Additional Comments: :j i 1 Z24 liao s E es , ore ie ,rq 1 r._.rr s _ -xaa
Gcl I
i
_ In pector N
cc: Facility Assessrnent Unit
if Needed.