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010036_INSPECTIONS_20171231
ADivision of Water Resourc Facility Number - 0 Division of Soil and Watereiservation 0 Other Agency Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: ra!o j Arrival Time: Departure Time: County: &r-Region: /A-)� 4 Farm Name: 5)a g,mo-n r V Owner Email: Owner Name: O ..1 o h nSo , Ahone: Mailing Address: S _SNff1 T I��a1 � /! YL/ ���V �G a 7 z- ! Physical Address: q 1 4 ��5y' ✓ A., L 1 rV 'Iy c o 7, Facility Contact: �. eQh '�b h r? n Title: Phone: Onsite Representative: O6 Integrator: 7 r 9 _ Certified Operato?;Orl!�n 7 'Certification Number: r 5 Back-up Operato5hf(7 Ord , ,�3(0 96 4` Certification Number: Y I'at:W/2 la Ha Location of Farm: S bee-n ic� t Latitude: 3.3 S 5 Longitude: I o Io PC, t/ -] R a 7 .3 Aia-rn a-rl &e C 2d/,{�� 2 G-5 -L� rn info S r V" SG6OO /" " • 1 fly I s Uj 1 f dxM PIC Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other Other Design Current Design Current Capacity Pop. Wet Poultry Capacity Pop. Layer Non -Laver Design Current Dry Poultry Capacity Pon. La ers Non -Layer Pullets Turkeys Turkey Poults Other Dischar es and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system'? (If yes, notify DWR) 2, Is there evidence of a past discharge from any part of the operation`? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? Design Current Cattle Capacity Pop. Mairy Cow Ign Dairy Calf Dairy Heifer Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow ❑ Yes WNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ N E ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ N E ❑ Yes j(No ❑ NA ❑ NE ❑ Yes )(110 ❑ NA ❑ NE Page 1 of 3 21412015 Continued Facility Number: jo I - � Date of Inspection, l Waste Collection &Treatment 4. Is storage cap ity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure Structure 2 Structure 3 Structure 4 Identifier: w j e lon j �l Spillway?: Designed Freeboard (in): _ Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large 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? ❑ Yes ❑ Yes dNo ❑ NA ❑ NE ❑No ❑NA ONE Structure 5 Structure 6 ❑ Yes .XNo ❑ Yes �No ❑ NA ❑ NE ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 4No ❑ 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 Plo ❑ NA ❑ NE maintenance or improvement? �` 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. dyes ❑ No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN 1� PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? El Yes � No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 6�No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No WA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 0 Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [% No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ f No ❑ NA ❑ NE the appropriate box. 7� ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. oes record keeping neediprovement?. ate-bYonthly ❑ Yes ;'No NA ❑ NE Zste Applica n Weekly Freeboard Waste Analysis Analysis eather Cade RaainfallStocking [Crop Yield 120 Minute Inspections and l" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No A NA ❑ NE Page 2 of 3 21412015 Continued Facili Number: jDate of Inspection: 1 j j 24. Did the facility fail to calibrate waste app�tion equipment as required by the permit? ❑ Yes Xo 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ NA ❑ NE iKNA ❑ NE ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ()�!No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CkNo ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes )&No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes d No ❑ NA ❑ NE ❑ Yes 9 No ❑ Yes JK No ❑ NA ❑ NE ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [<No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes XNo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. UseArawines of facility to better explain situations (use additional vases as necessarv). . U e 'O n MOwed a n a a.rn_ ? -- 7C)17 eAJ b rr_4-ion Sol cle�.� a a I y� �5 jpe,- o �r C.alrt`ice n v i vZ�. br C) w lot _ I rs5ue-- 1ID� . �iv�'�IOotL � l l vr�.+r-Q.i 5 rrin a� t 1 a-c� i n �ie Lc� 5t,� a e�r'e . in a 0-U.- opt Ie-Pt3c irb \f e. e.M0r) �� % ��l ro► w e. S $e EIno�.� � •�,r S � 1ae. a. a S• v e � Ceti; n�3deeY aqq\\s Qi I � `C� p-•^'C.-- {•C.�Y ` 5 �Gi-� YQ4 Feet 16 e_ `LL ( VI d Cb L-t p � -�;'0el Reviewer/Inspector Name: a •• Reviewer/Inspector Sign Page 3 of 3 � P h__� g y 9+ y� �2/4I2015Q QS1 Drvasiowof;Water. Resouree� ` ,$ : Facility Number 01 - aj O'i6ms'io i,of Soil andWaterAgervation h� 0 Other Agency (Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I Reason for Visit: O(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: O O Departure Time: = LE County: fidAWft3Ce Region: WS O� Farm Name: (:0 Qhq Owner Email: Owner Name: ->056M jOM W Phone: r33C, • 376 .3a 76 Mailing Address: 0(555 ?"AO4i U LI-RD , LA iJC Physical Address: 1114k Ski t1W BID., LOMCN, N • (i`/ �- Facility Contact: )0SGPK )OAASC� J Title: Phone: 3U , Vs Onsite Representative: Certified Operator: M } =44• 06 Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder -to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other Other Latitude: Integrator: g-f 0_oi9, Certification Number: Certification Number: Design Current Design Current Capacity Pop. Wet Poultry Capacity Pop. Layer - Non -Layer Dry Poultry Layers Non -Layers Pullets Turkeys Turkey Points Other Design Current Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation`' Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State`? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? Longitude: Design Current Cattle Capacity Pop. Dairy Cow Q Dairy Calf Dairy Heifer Dry Cow 'Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow ❑ Yes XrNo [] NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes FN�No ❑NA ❑NE ❑ NA bNE ❑ NA ❑ NE Page I of 3 21412015 Continued Facilit Number: - Date of Inspection: 1G c Waste Collection & Treatment • 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes +W1 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: U151P Spillway?: Designed Freeboard (in): Ga Observed Freeboard (in): � - 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ff No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a Yes [:]No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? 'Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 rVrNo ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): �NVVLL 6V1NN , C.OR1J S , SoX ggj%A_S 13. Soil Type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RrNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA �NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Vr No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA K) NE ❑ Yes P No ❑ NA -❑ NE Reduired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes CKNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �'No ❑ NA ❑ NE the appropriate box. ❑Checklists ❑Other: 21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes K7rNo ❑ NA ❑ NE e n A'Rste "--a4lais ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code am a 120 Minute Inspections s ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes bNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No KNA ❑ NE Page 2 of 3 21412015 Continued [Facility Number: al - Date of Inspection: I *�_Olyes 24, Did the facility fail to calibrate waste appl�ion equipment as required by the permit? [WNo ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No PSR VA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No XNA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes RrNo ❑ NA ❑ NE ❑ Yes XNo ❑ NA ❑ NE ❑ Yes NKNo ❑ NA ❑ NE [:]Yes ❑ No KNA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes g No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes gNo ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). SURD RDk)GFF A�DW �4, otS CALAWJMdr•� _ F? ID v, hthvs dLo�l7. l� e-"r-CK g(SotO_ 'VA Pu" _0M7_kI3v?fJ'JC- L�C��1 SI�MwA►� `ice W5P O 14� ADAM _M f'{B5C-- )S &W6 kcPLA-cs� (Ci- 3 br? I � 170kj C fQAl , Reviewer/Inspector Name: Reviewer/Inspector Signatut Page 3 of 3 Phone: • 4g0t 3 Date: 2,14,IS 015 Ape I b,e.an S ao a- ? t n to u P- S� Division of Water Resources. 11 : 3ol 16, Q0 Facility Number ®- O Division of Soil and Water Conservation O Other Agency Type of Visit: CoSnpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: - Arrival Time: ® Departure Time: County Q Q��Region: �Q • Farm Name: PA" 2At r'- V Owner Email: 09�e-rYL� dal �t`�1I® �. 11Ct Owner Name: � j.Phf& 3 %6 - 5 y 26 e& A r L A I _ r / I - . I - Mailing Address: Physical Address: 1 hVr 4-C4 . N C_ a-7 z 5vIY04, -gd-.. 1,iheyr4Q . NC- 77 7178' Facility Contact: j—e)5.-P_ ) r� j� 61�1 Title: Phone: 6 7 {p 0 797 Onsite Representative: Integrator: Certified Operator: Certification Number: Back-up Operator: - ibh " tS e' �'+—1 ertification Number: Location of Farm: Latitude: ,3 5 J Q 5 Longitude: 73,4 Design Current Swine Capacity Pop. Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other Other Design Current Wet Poultry Capacity Pop. Layer Non -La er 1)Cy YOunry Layers Non -Layers Pullets Turkeys Turkey Poults Other Design Current DisOar2es and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: Cattle Design Current Capacity Pop. Dairy Cow Dairy Calf Dairy Heifer 5-7 —.Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow ❑ Yes"' No ❑ NA ❑ NE a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA [:].'NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes k,No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes JANo C] NA ❑ NE of the State other than from a discharge? Page I of 3 21412014 Continued Facili Number: -70 jDate of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .1� No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE 0_1 Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): y Observed Freeboard (in): 5. Are here any immediate threats to the integrity of any of the structures observed? ❑ Yes No 0 ❑ NA ❑ NE (i.e. large trees, severe erosion, seepage, etc.) 6. Are�there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes] No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) T 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 No ❑ NA ❑ NE maintenance or improvement? 1 1. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Sf No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area ro 12. Crop Type(s): 7V�,C AA Q f- 1Ys . C-61—h 3tiACR . ''nukPn hS , r5 CUe- (n4S--l'1 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No PXNA ❑ NE acres determination? �7��7"``` 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes E?�No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes &No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? ❑ Yes AfNo ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections y 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �4 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No O�<A ❑ NE Page 2 of 3 21412014 Continued 40 — 6'". F&UW___1 Facili Number: -3010 Date of Ins ection: -7 ' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No #E1 ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes XNo ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. Yes t] No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection wit�an on -site representative? Yes WNo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency?�v Jo �S" �4J OF ❑ Yes TA� �17/7 �6 No '-F-' ❑ NA ❑ NE omments (refer to question #): Explain any YES answers and/or any additional retommendations or any other comments. se,oMvings of facility to better explain situations (use additional pages as necessary). 2Ofs, � - ue. a-q�.c.�� � 017 . 3� Mwet, .P s Q to - - CA LU P do 48 erj-01 �r, Reviewer/Inspector Name: Reviewer/lnspe oorCSignae: Ith a e 3 of 3► a� 3 �-1 � � I T776 r r� 10 .. r o� ivision of Water Quality Facilitpliumber - O Division of Soil and Water C reservation 0 Other Agency - ;C_' N - DV- oonp (Type of Visit: -0-Com ce Inspection O Operation Review p Structure Evaluation O Technical Assistance Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency p Other p Denied Access Date of Visit: Z t L/ Arrival Time: Departure Time: County: Region: Farm Name: Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: 4140— J0 #,7-5 i7 It! Certified Operator: Back-up Operator: Location of Farm: Swine Latitude: Phone: Integrator: Certification Number: Certification Number: Longitude: Design Current Design Current Capacity Pop. Wet Poultry Capacity Pop. La er Non -La er I EEI Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Design Current Dry Poultry Capacity POD. Layers Non -Layers Pullets Turkeys Turkey Pouts Other Design Current Cattle Capacity Pop. Dai Cow 33 `l" Dairy Calf Dairy Heifer Dry Cow Non-Dai Beef Stocker Beef Feeder Beef Brood Cow Other Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Yes ❑ No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field Other: + r'7, �P C_4.44 a. Was the conveyance man-made? ❑ Yes o ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) es ❑ No ❑ NA ❑ NE C. What is the estimated volume that reached waters of the State (gallons)? 11 T r t' t. Ie — d. Does the discharge bypass the waste management system? (If yes, notify DWQ} Yes [] N ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes ❑ No ❑ NA ❑ NE of the State other than from a discharge? Page 1 of 3 21412011 Continued Facili Number: 61 - 3 6 P jDate of Inspection: r Waste Colle-tion & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: apt way.. Designed Freeboard (in): Observed Freeboard (in):� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ni]o 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 ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE maintenance or improvement? 11, 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes p ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): /LvS t-s4t! of , Yn 5:;itga _: ij- A Li-i1'T i C 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ' NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 7No ❑ NA ❑ NE acres determination? / 17. Does the facility lack adequate acreage for land application? 0 Yes 0 NA �No ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes NA E7 ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Zo,,,,n ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectiorNoo Sludge Survey 22. Did the facility fait to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE Page 2 of 3 21412011 Continued Facility Number: Of Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: ❑ NA ❑ NE 5No ❑ NA ❑ NE 26. Did the facilily f 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jrNo ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ONo ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. Use drawines of facility to better exalain situations (use additional paces as necessarv). C1 //17- /xC? (9 144� 4t t va r ck 5 Reviewer/Inspector Name: Phone: - C ( 1 --?q ( ` L(Zp G Reviewer/Inspector Signature: kg= ozvg--G Date: .14 Z6 ( j Page 3 of 3 21412011 Facility Number - Cr Si Division of Water Quality Division of Soil and Water 0 Other Agency NCO- servation 16 A4 Col Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: ! Arrival Time: Departure Time: County: A JQ.jVja_r<P_ Region: !t I �Q FarmName: I .,.r Owner Name: _TS-e,8b TU �\ 4-\ , 2n _ Phone: Mailing Address: a i+ Physical Address: T4 be.v sL FacilityContact: ��5 �} d p Title: Onsite Representative: Certified Operator: Back-up Operator: Location of Farm: �- qa Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other Other 3 : 7 to - 3q 70 2-7 a'1 r Phone: Integrator: Certification Number: Certification Number: Latitude: 3S4 S 2 Longitude: e2 7 3�0 Design Current Design Current Capacity Pop. Wet Poultry Capacity Pop. La er Non -La er Design Current Dry Poultry Capacity Pop. Layers Non -La ers Pullets Turkeys Turkey Poults Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? Design Current Cattle Capacity Pop. C Dairy Cow d Dairy Calf Dairy Heifer Dry Cow ig Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow ❑ Yes �Io ❑ NA ❑ NE ❑ Yes ❑ No [—]Yes [:]No ❑ Yes [::]No ❑ Yes UqNo 9yes ❑ No ❑NA ❑NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page 1 of 3 21412011 Continued Facility Number: 07 jDate of Inspection: 27j 3 7� Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes bjrNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Identifier: Spillway?: Designed Freeboard (in): ,Structure I D Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 EI Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CyNo ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [)k*fio ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require WYes ❑ No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land 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 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Z No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA 0 NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ( NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes P No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ixNo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No [DNA ❑ NE 20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE the appropriate box. l� ❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other: ta21, es record keeping need i rovement? Yes ❑ No ❑ NA ❑ NE ste Applicati - L J W kly Freeboard Waste Analysis Soil An�sis erg- ❑Weather Code jfRainfall tock g Crop Yield 20 Minute Inspections opt y and" Rainfall Inspectio;/No f7 c4.,a ,o c.,n,�, 22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No IQ'NA ❑ NE Page 2 of 3 21412011 Continued lFacility Number: - Date of Inspection: 24. Did the facility fail t calibrate waste application equipment as required by the permit? ❑ Yes bj No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E No �NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to Drovide documentation of 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes [� No t] NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes 0 No [DNA ❑ NE ❑ Yes X. No ❑ NA ❑ NE ❑ Yes 19No ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes] No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes [�(No ❑ NA ❑ NE Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. Use Arawines of facility to better explain situations (use additional pages as necessarv). a d to hr.. 1 a3 1 1120 �{. Sm 1 i d sP��►e.� �.a.ti b ra�fe� r h a� [ � ? �.�- — r u l Cb a� ADla sb)l 1-esf NO J) -►>o �e Ne ea +4D w UP + A e Iva he 'k f_e�5 4- 01 V� Li Co U35 a n lit nO Yl - �a.S �u r-4e.- V Cncr�- uRo u� � ve . f6 Ga.l jl77ro " CVhlt Zrms •in wee#—w-e to r �b�ra� v4 s , p 2� [T ? r r 01 2 S,d-C,� . , IF C. ] [ I hs IJ/ ro \� j1!5[ad �Si�= 1t.o p H1,3 ± 37, 7 1k5. N/I-bry _j Reviewer/Inspector Name: [' Phone: 77:7 1-5 a Reviewer/Inspector Signature: Date: pt c('41 3 Page 3 of 3 Oil � ��� 15�a� � b c r�..5 �or�w ST aS 1 e Division of Water Quali Facility Number l� - Division of Soil and Water Arvation O Other Agency Type of Visit: C mpliance Inspection V Operation Review Q) Structure Evaluation U Technical Assistance Reason for Visit: Routine O Complaint O Follow-up_ (_-) Referral O Emergency O Other O Denied Access, Date of Visit: —Arrival Time: �-F� Departure Time: � County: h C�egion: OZZ i • Farm Name: FnQ LP_ry%n-n -h a r, Ii Owner Email: ame: Phone: Mailing Address: q 5 S O P IeA 5&-;►1'G W 11 c'h Physical Address: 1 1 ` q S u f V �n 1�y`- ' } j, & Facility Contact: V O hn5 of le: Onsite Representative: Certified Operator: ,bey C, ►vim a7, Phone: 3 7 6 -- 1 Integrator: Certification Number: Back-up Operator: Certification Number: Location of Farm: Latitude: So 5 Longitude: +U rh S I n+0 SV / Vtk41 b n 4o 5 u/ VoLn R Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other Other Design Current Design Current Capacity Po - La er Non -Layer Design Current Non-L, Pullets TurkeN Other Puults Capacity Pop. Dairy Cow 3 Dairy Calf Dairy Heifer Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes X�]No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE of the State other than from a discharge? Page I of.3 21412011 Continued Facili Number: - • jDate of Inspection: Waste Collection & Treatment MW 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X_� o ❑ NA ' ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE aStructure 1 Structure 2 Structure 3 Identifier: NQ4161—e—pO rX4 Spillway?: Designed Freeboard (in): Observed Freeboard (in): Structure 4 Structure 5 Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large 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? ❑ Yes No ❑ NA ❑ NE ❑ Yes �No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes ro ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) _/ 9. Does any part of the waste management system other than the waste structures require ❑ Yes I�Q No ❑ NA ❑ NE maintenance or improvement? T' Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc. ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13, Soil Type(s): v 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes CeNo ❑❑!NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ I% Yes ❑ No NA ❑ NE acres determination? T` 17. Does the facility lack adequate acreage for land application? ❑ Yes VNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes X�No [] NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I 6o ❑ NA ❑ NE the appropriate box. �` ❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other: oes recording need ' provement? I�' Yes ❑ No RIA ❑ NE ❑ Waste Applicatio Zeekly Freeboard Waste Analysis Soil Analysis Weather Code tocking Crop Yield 20 Minute Inspections Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [—]No NA ❑ NE Page 2 of 3 21412011 Continued Facility Number: - Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, cheek ❑ Yes ❑ No P<NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE Other Issues y� 28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 4o ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application} 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yeso tN ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yeso ❑ NA ❑ NE (Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I Us_drawings of facility to better explain situations (use additional pages as necessary). �2oi 1 14 -AuL� 13, . o o I=, iAtAk Al qj.�20 Id - L-5 1) =0 -7 511 a L S 0 Y Pac�� ,� I rot r , .� Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: T� —sot O Date: �! 21412011 L O) N 3�, Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit yRoutine O Complaint O follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: Arrival Time: Departure Time: County: AIAMA444 Region: WSP1 D Farm Name: l i}� em �` r Owner E ail: Owner Name: `'1 v `k ASO ✓1 Phoner�C.) 37� Mailing Address: `1 _2 j FJFlk-%7AA� [ I1 dt.r 1`d, L4e_r'r72_'� Physical Address: 9 / 7 1 �s 1 VC111 F—Jl C- Z% Z l O Facility Contact: 0.15'q2l'1 2e'1115"0 ►1 Title: PhoneZ- Onsite Representative: Integrator: Certified Operator: __&/Operator Certification Number: Back-up Operator: Back-up Certification Number: ©o®6❑it Location of Farm: Latitude: Longitude: o�Z 36 ir 4, t K971),A, W11 K,1--JVrfvSy[,JgA /c l 60 II ❑ Wean to Finish ❑ Wean to Feeder ❑ Feeder to Finish ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars ❑ Other Deng"n Current Design Current Capacity Population Wet Poultry ;Capactfy� Populattoq ems, ❑ La er +___Dairy Cow 337D -foe:,❑ Non -Layer L❑ Dairy Calf ❑ 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? Dairy Heifer Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood C b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes >(No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes �No ❑ NA ❑ NE ❑ Yes KNo ❑ NA ❑ NE Page I of 3 12128104 Continued f r Facility Number: — • Date of Inspection Oz • Waste Collection & Treatment 4. Is storage capacity (structural plus stormstorage plus heavy rainfall) less than adequate? ElYes XNo ElNA ❑NE a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ NA ❑ NE I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 rStructure I Identifier: WAA aril Spillway?: Designed Freeboard (in): Observed Freeboard (in): :'Z O 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ElNA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /kNo ❑ NA El NE through a waste management or closure plan? \\ If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes XNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes kNo ❑ 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 El NE maintenance or improvement? '' Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE maintenance/improvement? l `` 11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy 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) 13. Soil type(s) 60irrl 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes �WNo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No X NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes �No ❑ NA ❑ NE I8. Is there a lack of properly operating waste application equipment? ❑ Yes 4/No ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pagers as necessary): 3. 7T�enP� �1c,aJJ (a-1)CvkI 1 e4kr,- CcWf ou7 cv N.ltch Ct1 f�JJ.��e , Nk.. et Cowl Reviewer/Inspector Name �Pa ILfL �� Phone:. Reviewer/Inspector Signature: Date: oZ Zf) -� Page 2 of 3 12128104 Continued Facility Number: D*f Inspection GZ • Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes,,kfNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other 21. Does record keeping need improvement? �,/ ElYes �I No ` ❑ NA El NE LJ Waste Application �kly Freeboard [D Waste Analysis Soil Analysis / Rainfall ETStocking Crop Yield D lvlonthly and I" Rain Inspections [31V—'eather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes XNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑No XNA ❑ NE Did the facility fail to calibrate waste application equipment as required by the permit? El24. Yes XNo NA El❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No )ONA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes XNo El NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the -permit or CAWMP? ❑ Yes *No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes YNo ❑ 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? ❑ Yeso )4�q El NA El 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 �No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes',WNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes )<No ❑ NA ❑ NE Additional Comments Drawings: land/or ! 1 1 6+7 � .` c r'"�''' [. LI,H.� w-s r-JA,,-j F�jt 20la, Gam. A 51La "' � NMI' l l P Page 3 of 3 12128104 A01. aaa9 N1b1C - ablb - fG-- 0q .i�_, amn Division of Water Quality W Facility Nurnber O 3 (p 8Division of Soil and Water Conservation q ; 30 n 0 Other Agency Type of Visit C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visi Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access j� p Ce-Region• 6zab Date of Visit: 1 � J �iJ f rDl Arrival Time: De arture 'Time: County: Farm Name: Foa Le Y1'l_t'i.irs b a' xA Owner Email: Owner Name: S to 'TA Qt50 0 ._„ , /_� ff,R, Phone: _.336 - 3 1 � `� 3� 9 V%� a'rn Mailing Address: 9 5 � � ��� QS�f j� �Yi orcin �(,t- •. Lrf tX� . 27219' Physical Address: 914 s7& ; L "C Facility Contact: To s -e-411 O Title: Phone No: ir Onsite Representative: Integrator: 376 l6 q 0— Certified Operator: IV Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: �o ®d Longitude: ° [01 Im « 46 has t h� o n+o � A lawn �� (�d41\ro_n Sctv),n i2p on -TA !; u I i/a h 2A Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er j ❑Non -La ei Dry Poultry ❑ Layers______ ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ urkey Poults ❑ Other Cattle Design Current Capacity Population Dairy Cow 1330 Dairy Calf ❑ Dairy Heifer I f Q ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocket ❑ Beef Feeder ❑ Beef Brood Cowl Dischars!es & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? L ` uy 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: ELI 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 ko ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes [�No ❑ NA ❑ NE Yes ❑ No ❑ NA ❑ NE 12128104 Continued i Facility Number: 0 6 Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other �p� 21. Does ord keeping need im 'rovement? Yes NNo ❑ NA ❑ NE W ste Applica 'bn [�Weekl Freeboard Waste Analysis Soil Anal si rs Rainfall Stocking Crop Yield _ onthly and l" Rain Inspections Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No WA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No V(NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the pen -nit? ❑ Yes ❑ No XNA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 06 No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE Other issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes *o ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes �No El NA El 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 XNo ❑ 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 ❑ No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ElYes 0No El NA [I NE 33. Does facility require a follow-up visit by same agency? ❑ Yes L ❑ NA ❑ NE Additional Comments and/or Drawings: (7fiD _ �roi I� 31.3 IIsS�/-Fav i/ lJt i+►� Page 3 of 3 = -9, e 2— 12128104 Facility Number: 6 — 0 Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 JIdentifier: / t Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) IIlII! 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ElNE through a waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement'? ❑ Yes �Io ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 14 No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )(No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. f Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes ❑ No XNA ❑ NE IT Does the facility lack adequate acreage for land application'? ❑ Yes �(No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes [KNo ❑ NA ❑ NE Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): 3 4_4� Q 1`e_ a- C- \6LVe_ ENti.0 I ud e!d ? m . � a U Reviewer/Inspector Name e— rot, Phone: — Eagq Reviewer/Inspector Signature: Date: D rd Facility Number o Division of WateeAQuality 1W V Division of Soil and Water Conservation 1 Q Other Agency 1 Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: l I I Departure Time: County: AjgnoaDc_e_ Farm Name: F (- Owner Email: Owner Name: �QSP D j� DSO Phone: (0 Mailing Address:5G ( ��_I_� _ LIQ u rLt1 P"r �-[�► 1� _ a� Physical Address: q'1Lq fSq1 van It I 1� C- a Facility Contact: �.! T ose_40 h 1� L16CL-)i•itle: Phone No: Onsite Representative: S•P �h Integrator: Certified Operator: Tn.�iL�h Za 0'} -!p ' _ Operator Certification Number: 6 Back-up Operator: Location of Farm: Latitude: _ - �o � tb R lc�.-�ma►�eL h u l`C.h f � - R�qh+ on+o Sy I von Sc hoo Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Back-up Certification Number: a i�h-� onto Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er ❑Non -Layer Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ urkey Pouets ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) Longitude: Li ops6/cf/ Region: LISRO 0U77+ ®c6 Design Current Cattle Capacity Population Dairy Cow j Dairy Calf ' ❑ Dairy Heifej ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocke3 ❑ Beef Feeder ❑ Beef Brood Co 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? El Yes 4No El NA ❑NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE 12128104 Continued i ` Facility Number: — Date of Inspection �� ��jyc�� • Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE (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? 0 If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance/improvement? 11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes bdNo ❑ 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) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ❑ No �6A ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes N(No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes M(No ❑ NA ❑ NE Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): Reviewer/Inspector Name L 00Phone: I ] I —5 oL -0 Reviewer/Inspector Signature: Date: 12128104 Continued Facility Number: — Tate of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No'❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other 21. Doe -kcord keeping need iim//provement? ❑ Yes No ❑ NA ❑ NE Waste Applica ion Eg Weekly'Freeboard nPWaste Analysis L9dSoil Analysis Rainfall L11 Stocking Crop Yield WMonthly and 1" Rain lnspections 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? ❑ Yes ❑ No CX""NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No [(NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes O(No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes IxNo ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes XNo ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately iiii ���• 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes XNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE Additional Comments and/or Drawings: a aoa� 5a I f kes 7 I 7-pi /006 _AZ4-"k� LA, 14, Page 3 of 3 12128104 LDttitsion�ofRWater�Qiiali @FaCtltty Number Q s, Dtvtsian of Soil and Watei Lonservation r Other: Agency Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit � Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: 1 1 Arrival Time: �� Departure Time: �{� County: Farm Name: Owner Email: Region: [, 25e_() Owner Name: to Se. oh Phone: Q_37 & ! 33 70 Nailing Address: Physical Address: Facility Contact: .fin nl�� b � n5n(Yitle: Onsite Representative: ! o Certified Operator: hbJb a5an Back-up Operator: .. I 1 10P.r q-4 A . IVL a Phone No4! dw g �� Integrator: Operator Certification Number: _aqt4(2 S-44 0 Back-up Certification Number: Location of Farm: Latitude: �° � Longitude: ° Nil, Rio hI o nl o S u I vo-v\ oo f Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer ❑ Non -Layer Dry Poultry ❑ Layers ❑ 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? Cattle Design Current Capacity Population Dairy Cow Dairy Calf ❑ Dai Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker Beef Feeder 6❑ 113eef Brood Cow Number of Structures: b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 9No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes V(No ❑ NA ❑ NE ",YO5 o ❑ NA ❑ NE 12128104 Continued t Facility Number: Q -- Date of Inspection J Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OKO ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE ,-- llStructure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 �. Identifier: / 'Spillway'?: e—es Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ILL 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 (*10 ❑ 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 thr t, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 �Ko ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes *No❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area a �,, 12. Crop type(s) r �� Q1 �{..�i' �YL ��1� —!� l� 62A 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? Yes ❑ No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? (((❑ Yes 0No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes El No VNA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes Idl No ❑ NA ElNE 18. Is there a lack of properly operating waste application equipment? ElYes [ ❑ NA ❑ NE Comments (refer.to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): ��h�t n� �- o1r � n ►��+�s � nS�a� ll e� otrt �[ � 5 � d es � uree t� � � wed_ Ao, J� ► /`� 7l.A"v, ReviewerAnspector Name r`0 Phone: s Reviewer/Inspector Signature: Date: j �� F— J 12/28/04 Co tinued Facility Number: 0 1 — 361 !te of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes No ,❑ NA ❑ NE the appropirate box. ❑ WCTP ❑Checklists ❑Design ❑Maps �❑Other 21. need Does 'record keeping need i provement? % ❑ Yes No ❑ NA ❑ NE aste Application Freeboard Waste Analysis f pp y ❑Soil Analysis a�Cf 49qa40R— Rainfall king Crop Yield ' [Monthly and 1 "Rain Inspections ther Code bill 22. Did the facility fail to install and maintain a rain gauge`? ❑ Yes _,% L�Q No ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes /❑ No NA ❑ NE 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �(N o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 4No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes 111❑_ ❑ No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document Yes 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 6No ❑ 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 No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewerhnspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency'? ❑ Yes No ❑ NA ❑ NE Additional Comments and/or Drawin=s: l • • tA Division of Water Quality Facility Number 3 0 Division of Soil and Water Conservation 0 Other Agency Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit*,Routine 0 Complaint Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: pa�( Arrival Time: Departure Time: County: ka mainL-�Region: "�%x Farm Name: -ii 6L r Owner Email: ? pcLv A Owner Name: ( 1 n ne Dh T y1 son_ _ Phone: ^� Mailing Address: 1144 oo t a , nl A- hysical Address: T� Facility Contact: Onsite Representative: Certified Operator: Back-up Operator: Title: Integrator: Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: o Longitude: = o = ` ❑ 4t Uzi 4441A- 02 l 51✓Lq�js Lr , b6r..° _ t-Kr .1� (4/ �.v • w c h nc� n ©�t / 1� : -I �1,1 l A `T r) V VA -i XXkyy1 r4Algc 1ta'reQV Swine Capacity Population ❑ Wean to Finish ❑ Wean to Feeder ❑ Feeder to Finish ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other ❑ Other &c. I Wet Poultry Capacity Population Cattle PLayer Non-Layet Dry Poultry ❑ Lavers ❑ Non -Layers ❑ Pullets ❑ Turke s ElTurkey Poults ❑ Other Discharees & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Current Capacity Population Dairy Cow Daia Calf ❑ Dairy Heifei EJDry Cow ❑ Non -Dairy ❑ Beef Stockei ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: M b. Did the discharge reach waters of the State? (if yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or poterp nt l�adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �INo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes 0 No ClNA ElNE 0 Yes ❑ No ❑ NA ❑ NE 12128104 Continued Facility Number: date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure l Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): �.. 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large 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? ❑ Yes No ❑ NA ❑ NE ❑ Yes //❑``l No ❑ NA ❑ NE Structure 5 Structure 6 Cl Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes 4 No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the perm `�5 1\�l� Yes ElNo El NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) �� 7v 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 �No ElNA ElNE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes V No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes —1 No NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes o VN ❑ NA ❑ NE 18. Is there a lack of properly oerating waste application auipment? ❑Yeso ❑ NA ❑ NE P q Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): re�0A r5 �- 3COO Sl u r r Reviewer/I spector Name_Wl o —5 ;b � ' i Phone: Reviewer/Inspector Signature: y Date: Q GA4 `' 12128104 Continued Facility Number: — Date of Inspection 7 Re aired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes No [INA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes ,❑,, -L o ❑ NA ❑ NE the appropirate box. ❑ W-Up ❑ Checklists ❑ Design El Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box b low. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Sail Analysis n .. __._ ____r___ ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ Monthly and I" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? '�J.�^►11 n4,42'a" ❑ Yes )6 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [XNA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? A Yes ❑ No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document 3 + 1 3100 ❑ Yes )(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 0 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 XNo ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C�No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes 14No ❑ NA ❑ NE Additional Comments and/or Drawings: �} r 1q Qd byy) j+ * e- 4P [ t P-�►.� c, � �'�� ��r�,�. 0 5-h,�f se.�d �n=t�,�vn �a ms e re ' V 0 {� l r2� 1 �` � P_a t S �` i1rl t� t SS v au'1c� Not .�• � �d ] n p i,v t tl Y),P-eAt `z dj? i !� e_ OL ') C -tea m r` r tb r ` -I> �'m ,I � P n� iss�e-A � P ._ ��? CG�� l�a� i �I� r U► r2.�P�mi� � S i 55uc'_j . &8104f _'RA &121C _F aE-3� Division of Water Quality ���tCC��� ❑ Division of Soil and Water Conservation ❑ Other Agency Facility Number: 0111046 Facility Status: Proposed Permit: AW0010046 ❑ Denied Access Inspection Type: Compliance Insoection Inactive or Closed Date: Reason for Visit: RqWjineCounty: Allamance _ _ Region: Winston-Salem Date of Visit: 01/16/2007 Entry Time:01:00 PM Exit Time. 05:00 PM Incident #: Farm Name: Joseph Johnson Farm _.. Owner Email: Owner; Joseph JohnPhone: 336-376-3970 Mailing Address; 9144 5ylvan Rd Liberty NG 27298 Physical Address: Facility Status: ❑ Compliant ❑ Not Compliant Integrator: �► Location of Farm: Latitude: 5 S-a L 1 itudee- 1-40 east to US Hwy 421 south. Take Liberty exit and turn left at top of ramp onto Old Libe FtOad�whe entUally turns into W. Swannanoa Ave., then NC-49 north). From 49-N turn right onto Pleasant Hill Liberty Road. Turn right onto Pleasant Hill Ch Question Areas: W Discharges & Stream Impacts Waste Collection & Treatment Other Issues Certified Operator: Operator Certification Number: Secondary OIC(s): On -Site Representative(s): Name Title Phone On -site representative Joseph Johnson Phone: 24 hour contact name Joseph Johnson Phone: 336-376-6397 Primary Inspector: Melissa Rosebrock Phone: Inspector Signature: Date: Secondary Inspector(s): Inspection Summary: Today's inspection by DWQ was at the request of Bill Woods with Alamance Co. SWCD. I met with operator, Joseph Johnson to discuss the steps involved in becoming a permitted facility. He hopes to be permitted for 250 cattle. Manure is spread with honey wagon and solid spreader. Most of the prblems on this farm need to be addressed through fencing, cattle exclusion, and establishment of buffers. Silage leachate problem must be addressed. No cost -share to be involved. Expansion of milk parlor is occuring at this time. DWQ to re -visit prior to permit issuance. Page: 1 C h �� e. br_0 S5 f CQA5 % Q 7 • ' Permit: AWD010046 Owner - Facility: Joseph Johnson Facility Number : 01 C046•-,.. Inspection Date: 01/16/2007 Inspection Type: Compliance Inspection Reason for Visit: Routine Regulated Operations Design Capacity Current Population Cattle Cattle - Milk Cow 116 116 Total Design Capacity: 116 Total SSLW: 162,4fl0 Waste Structures Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard k11-te Pond WASTE POND 24.00 Page: 2 Permit: AVVD010046 owner- Facility: Joseph Johnson Facility Number: 010046 Inspection Date: 01/16/2007 Inspection Type: Compliance Inspection Reason for Visit: Routine Discharges & Stream Impacts Yes No NA NE 1. Is any discharge observed from any part of the operation? ❑ ■ ❑ ❑ Discharge originated at: Structure ❑ Application Field ❑ Other ❑ a. Was conveyance man-made? ❑ ■ ❑ ❑ b. Did discharge reach Waters of the State? (if yes, notify DWQ) ❑ ■ ❑ ❑ c. Estimated volume reaching surface waters? 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 Waters -of the State other than from a ■ ❑ ❑ ❑ discharge? Waste Collection, Storage & Treatment Yes No NA NE 4. Is storage capacity less than adequate? ❑ ■ ❑ ❑ If yes, is waste level into structural freeboard? ❑ 5. Are there any immediate threats to the integrity of any of the structures observed (Led large trees, severe ❑ ■ ❑ ❑ erosion, seepage, etc.)? 6. Are there structures on -site that are not properly addressed and/or managed through a waste management ❑ ■ ❑ ❑ or closure plan? 7. Do any of the structures need maintenance or improvement? ❑ ■ ❑ ❑ B. Do any of the structures lack adequate markers as required by the permit? (Not applicable to roofed pits, ■ ❑ ❑ Cl dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require maintenance or ■ ❑ ❑ ❑ improvement? Other Issues Yes No NA NE 28. Were any additional problems noted which cause non-compliance of the Permit or CAWMP? ■ ❑ ❑ ❑ 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report those ❑ ■ ❑ ❑ mortality rates that exceed normal rates? 30. At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air ❑ ■ ❑ ❑ Quality representative immediately. 31. Did the facility fail to notify regional DWQ of emergency situations as required by Permit? ❑ ■ ❑ ❑ 32. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ ■ ❑ ❑ 33. Does facility, require a follow-up visit by same agency? ■ ❑ ❑ ❑ Page: 3 Permit: AWD010046 Owner -Facility: Joseph Johnson Facility Number : 010046 Inspection Date: 01/16/2007 Inspection Type: Compliance Inspection Reason for Visit: Routine Page: 4 r JLL-14-1"5 15:34 FRM DEM WATER MJFL1TY SECTION TO 61SRO P.02/02 Site Requires immediate Atnentioa: Facility _LLL_L�, DMSION OF ENVIRONMENTAL T NAGENUN No. ANIMAL FEEDLOT OPERATIONS STTE VISITATION RECORD DATE: _ // — �_ .,1995 Time: // . l a Farm Name/Owns Mailing Address: integrator: Phone: On Site Representative: i' Phone:.�1 - L_ Physical Addr+ess/LOcation: Type of Operation: Swine Poultry Cattle ( �y"7) Design Capacity: Number of Animals on Site: DEM Certification Number: ACEDEM Certification Number: ACN W_ Ladmde: 3 `�. j T `/ Longitude: '>"-/7 - 2 2, 3 -s Elevation: t It -evrrhrie ld C,eL5s r_ ds Cale Yes or No Does the Animal Waste lagoon have sufficient fivoeboard of 1 Foot + 25 year 24 hour swam event (approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: ___FL Inches Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No Is adequate land available for splay? Yes or No Is the oovcr crop adequate? Yes or No Chp(s) being utilized: Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes of No 100 Feet from Wells? Yes 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 Mal+ Blue Line? Yes or No U animal waste discharW into waters of the state by man-made ditch, flushing system, or other sitar man-made devices? Yes or No If Yes, Please Explain. Does the facility maintain adequate waste management rocords (volumes of manure, land applied, aptay irrigated on specific acreage with cover crop)? Yes or No Additional Comments: ,4 N Si Cc: Faciiity Assessment Unit Use Anschments if Needed TOTAL P.02 s j TIN 3 QUTH ST ON I I Flo v t11201 y a w t-IZ j511 a r.�r elf M^VN + v ty 1 !trty, ( �r ?+ n CANE C eEK 1 n (N?qE� f _ D R +SL[ 'AQEVAN Try +23321 111141 ALLRED TR. f MOUNTAINS r d ¢ c tttt2� iy apaEp RD C i ''.G S L w t23g5 ♦ 1 E m _ r DESTN'JT.. l G p tlpgt � N M� R Lµ � fjNE CARL - � a 723331 ` i C ry 1 �61 [ 4 ~ A TION 14 'LE TR 2 +Ilan+ STAT SUB. ~ / \ f100 (j 5 4 OfEENS f I EPEEKR I Iz LLPS fq ENS � I M f2.iB51 fURr �k � 1?3�`JI LfDER ry �1 soN TR I ' Ro Fv kC PM E l M 123061 LEN q0 I `fir a re ry .'4 r t2 gTpRE � e 1 ROA S ,z t 2'� S dI V 7j IEMI?NTARY No Mn7,cV.s z Mf RU � I2.v+Fl N 1 P 12;951 - s ✓l i - �CHATHAM /ti z3Rg1l1♦ %1