820444_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Division of Water Resources
❑Division of Soil and Water Conservation
Other Agency
Facility Number: 820444 Facility Status: ActiYe Permit: AWS820444 El Denied Access
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit Routine Fayetteville
County: Sampson
Date of visit: 09/20/2017 Entry Time: 11:30 am Exit Time: 12:15 pm
Farm Name: Boykin Lake Farm
Owner: Ironside Investment Management LLC
Region:
Incident #
Owner Email:
Phone: [phone]
Mailing Address: 107 River Woods Dr Wallace NC 26466
Physical Address: 195 Ebenezer Forest Rd Garland NC 28441
Facility Status: E Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 34° 53' 58" Longltude: 78' 25' 36"
From Roseboro, NC 242 5 1.9 miles, NC 411 SE S miles to McDaniels Xroads, turn left (NE) on SR 1214 (Boykin Bridge Rd) for
1 A mile. Turn Rt. onto SR 1211(Ebenezer Forest Rd), 0.2 miles. Entrance road signs #2288,2052.2053. Meet this farrn,no
c9hoe.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Douglas Stephan Atkins Operator Certification Number: 985738
Secondary OIC(s):
On -Site Re prosentative(s): Name Tide Phone
24 hour contact name Doug Atkins Phone
On -site representative Doug Atkins Phone
Primary Inspector.
Inspector Signature:
Secondary Inspector(s):
Bill Dunlap
Inspection Summary:
Calibration 5-15-2017 No Sludge Survey or Extension in file.
All fields need lime.
Phone:
Date:
It is OK for hay to have a birthday, but not to start kindergarten I understand that Mike Hope of Hope Farming has taken over the
hay production form David Tew. If Mf. Tew does not think he will get the older hay gone this year, have him Call me I know some
farmers that would take it, if it is cheap enough.
page: 1

Permit: AWS820444 Owner- Facility : Ironside Investment ME Facility Number. 820444
Inspection Date: 09/20/17 Inspection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Swine - Farrow to Wean
2,450
2,540
Swine - Feeder to Finish
600
600
Swine - Wean to Feeder
400
400
Total Design Capacity: 3,450
Total SSLW: 1,153,850
Waste Structures Observed
Type Identifier Closed Date Start Data Freeboard Freeboard
Lagoon
1
19.00
1 5200.
Lagoon
2
19.00
78.00
page: 2

0
Permit: AWS820444 Owner - Facility : Ironside Investment ME Facility Number. 820444
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yea
No Na No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
Cl
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑M
❑
❑
b. Did 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?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
❑
❑
State other than from a discharge?
Waste Collections Storage & Treatment
Yes No Na Me
4. Is storage capacity less than adequate?
❑
M ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (1.e./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
01111
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Y New
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ M ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN n 1011c/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS820444 Owner - Facility : Ironside Investment Mr Facility Number. 820444
Inspection Date: 09/20/17 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yea No Na Ne
Crop Type 1
Coastai Bermuda Grass
(Hay, Pasture)
Crop Type 2
Coastal Bermuda Grass wl
Rye Overseed
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Blanton
Soil Type 2
Wagram
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
Cl E ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑ 0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑ 0 ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑ ❑
❑
18. Is there a lack of property operating waste application equipment?
❑ 0 ❑
❑
Records and Documents
Yea
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
E ❑ ❑
If yes, check the appropriate box below,
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
E ❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
page: 4

11
Permit: AWS820444 Owner - Facility : Ironside Investment W Facility Number. 820444
Inspection Date: 09/20/17 Inppection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes No Na No
Stocking?
❑
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
M ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
E ❑
❑
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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
E ❑
❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
0 ❑
❑
and report mortality rates that exceed normal rates?
29, At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e.. discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
E ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or ❑ E ❑ ❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ 0 ❑ ❑
34. Does the facility require a follow-up visit by same agency? ❑ 0 ❑ ❑
page: 5

j IJe C T
ivi`sion of Water Resources _ "'""''�*
Facility Number ®- Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 15Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1,30 Arrival Time: 1 Departure Time: County: _ Region:
Farm Name:dC, �y[�s/V/ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: [-� U.!1 A""M 1
Onsite Representative: !�{
Certified Operator: q
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: �`
Certification lumber: � rs �
Certification Number:
Longitude:
Design Current
]lksign Current -,
.. Design
Current
Swine Capacity l'op.
Wet PoultryCapactty
_
Pop
Cattle' Capacity
Pop.
s-y`R =F=
FeedeItoF
ish 0 (7 'f
[I
.'=>Farroeans "Design
Cdrrent`Farroeder
D . P�oult .
_
3Cs actPo
FarroishLa
ersGilts
Non -La ersBoars
Pullets
,TurkerTurke
PoultsNJ
Other
Other
Wean shWean der Non -La er
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? (1f 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?
Dairy Cow
Dai Calf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef' brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
El Yes
❑No
❑NA
[3NE
[:)Yes
[:]No
❑ NA
[] NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ Na
❑ NA
❑ NE
Page 1 of 2/4/2015 Continued

Facili Number: S�A, - tjDate of Ins ection: dU
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, check ❑ Yes 0-110 ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ro ❑ NA ❑ NE
Yes o ❑ NA ❑ NE
❑ Yes E3<O ❑ NA ❑ NE
❑ Yes ff NNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �io ❑ NA ❑ NE
❑ Yes [ No
❑ Yes E�T`No
❑ Yes E] o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refei to gtiiestio V EEkplain any YES answers and7or any a dditi©nalerecommendationsro_ r'aaygottier;_comments.
Use drawings oflf cilitytetter e�lain situations (use�additionai Pages as necessary,).
Reviewer/Inspector Name:J
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 433 `3 33�
Date: ZD 0001
21412015

Facility Number: - Date of Inspection: JO iu
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑'10—
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q' V9AA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6 o U
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E]'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
[Et<o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
D Yes
[J�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
E3 '"o
❑ NA
❑ NE
maintenance or improvement?
Waste ARDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �io ❑ 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): SV
13. Soil Type(s): [,(�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes i ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �/E No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA Cl NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ W UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
D Yes ETNo ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Efl—No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [' D. NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Type of Visit: QA-16-mpliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: � Arrival Time: /� i S S b' Departure Time:
Farm Name: Le:—, LSY Owner Email:
Owner Name: i NS t - Phone:
Mailing Address:
Physical Address:
Facility Contact: l� Title:
IOnsite Representative: t
Certified Operator: `t
Back-up Operator:
Location of Farm:
Latitude:
T c- -_iv t 2 Z
--t� 2-
s ?- M Region:
ko
Phone:
Integrator: &9 r
Certification Number: US T J
Certification Number:
Longitude:
Design
Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EPKo' ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [3NA ❑ 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes F(No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

7/
- FaciliNumber: U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L2,Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [3-Ko ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '�� (7i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
OX
❑ 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
L6r!X'
0 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
L],Ko
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�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
P
❑ 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?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DNo ❑ 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 'C1rop Window / ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ) `ev, �.( wt f' �4/' V 960
r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D<O [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [4 ❑ NA ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Ea'�o ❑ NA ❑ NE
❑ Yes [rNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ 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 [XNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes &;No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ o
❑NA ❑NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili -Number: ST- Date of Inspection: s
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EErNo [] 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes K3'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fj"No ❑ NA ❑ NE
Outer Issues
28. Did the facility fait 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewcr/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes E No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
[:]Yes 0� o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
C No ❑ NA ❑ NE
ff No ❑ NA ❑ NE
&No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/orany additional recommendationsior aoy other coif meets:
Use drawings of facility to better explain situations (use additional pages as necessary). t
V
Reviewer/Inspector Name: 1.l� Ph4Wone: 33 `r
1 v� Reviewer/Inspector Signature:: � �% Date: L5
Page 3 of 3 2/4/2014

-3'�-
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
of Visit: E)Tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
in for Visit: LTxoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: yrrival Time: Departure Time: D,'pa County: V_1_ Region:
IV
Farm Name_ Eo YAl- .-L Fa e W Owner Email:
Owner Name: lvlaS iL��-✓ - Phone:
Mailing Address:
Physical Address:
Facility Contact: , J63 f1f'-1 Title: z GU ww -0--
Integrator:
Certification Number:
Latitude:
Phone:
Certification Number:
Longitude:
D�gnCurrent
�DesgnCurrent Design Current
Swine
!Capacity
i'op. - _ Wet Pti'ultry, CapactPop Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Q
Non -Layer
s ..,
Da' Calf
pp
Da Heifer
Feeder to Finish
Q
Farrow to Wean
Design
;,
Current
D Cow
;`,
=
D : P,oul . Ga acixI'o
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
_
Beef Feeder
Boars
Beef Brood Cow
Pullets
Y 1 -
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
[:]Yes C�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-]Yes ❑ No
[:]Yes ®,No
[:]Yes ®NO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: IDate of inspection:
i Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
K-A 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:
Spillway?:
Designed Freeboard (in): J_
Observed Freeboard (in): 49(o _
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
J 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
I�SNo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
[KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2!�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence
of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r o Q NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0-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 El No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ELNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JE-No ❑ 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 ELNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5� No
❑NA ❑NE
❑ Weather Code
Sludge Survey
DNA []NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

Facility Number: - L Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes XLNo (DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q!�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 t4No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E,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
allo
❑ 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
Callo
❑ 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
E, 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
B No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
10-No
[] NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone.
Date: :3 —'O�z/.— /4(
214R011
Page 3 of 3

i�
type of visit: UCompliance Inspection V Operation Review 0 Structure Evaluation U Technical Assistance I
Reason for Visit: & xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: --� Arrival Time: ! EWD Departure Time: ►1� County: Region:�fl
Farm Name: Owner Email:
•T
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: °`�� (%Bhizfp •�` Title: N&lpt CI Phone:
Onsite Representative: Integrator:lDwn-
Certified Operator: J�r_Q_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C DestgnCurrent1. i Design Current g ►urrent
�`, P6
Swine Gapactty Pop Wet Poultry Capacity }Pop Cattle Capacity Pop-
Wean to Finish Layer DairyCow
Wean to Feeder p o o Non -Layer DairyCalf
Feeder to Finish p 6 D t� � �,� Y DairyHeifer
XI Farrow to Wean" Design Current : Dry Cow
Farrow to Feeder "`D `,)foul Ca ace ` Po a Non-Dai
Farrow to Finish Layers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
F...
Other �.," Turkey Poults
Other 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?
❑ Yes CE[No ❑ NA ❑ NE
❑ Yes 0 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
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
44 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C, No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Condnued

Faclli Number: -Al At Date of Inspection: — /3
t 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): Z2—
Observed Freeboard (in): 3 T 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No
❑ NA
❑ NE
(Le., 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 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
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
[K No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No
(DNA
❑ 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.)
0 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): 25jZ&tq4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [a 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 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[gNo
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ 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 [N No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I " Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2011 Continued

�s
'i
Facili Number: - Yif Date of inspection: — 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZI No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes C&-No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[DNA ❑NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No 0 NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
g No
[D NA
❑ NE
Phone: 2/p, y
Date:
21412011

Type of Visit: ommpliance inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
a Reason for Visit: xontine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I t�—�Arrival Time: Departure Time: p County:�j-Region:?tE2;y
Farm Name: ' ..v e- Fa - rp` Owner Email:
Owner Name: �_1�� i7 S�n� _ Phone:
Mailing Address:
Physical Address: j
Facility Contact:d S %�fts'�-•-L- Title: Phone:
Onsite Representative:
Certified Operator:
Operator: fry_
Back-up Operator:
Location of Farm:
Latitude:
]integrator: ^,,,-g4 .25a 4u w-
Certification Number:
Certification Number:
Longitude:
P Design Currents Design Current
Swi a Capacity . Pope et,IP u try ,Capacity Pop. Cattle
Design Current
Capacity Pop.
Wean to Finish
La er
DairyCow
DairyCalf
Wean to Feeder
p
—
Non -La er
Feeder to Finish}
Farrow to Wean
ANb
�.,.
Design Current
�n �P,oult , _ Ca aci P,o P.
Layers
Dairy heifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Hrood Cow
01
Other
Other
Turkeys
Turkey Puults
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?
❑ Yes jo No 0 NA ❑ NE
❑ Yes
0 No
0 NA
❑ NE
0 Yes
0 No
0 NA
❑ NE
❑ Yes
0 No
0 NA
❑ NE
❑ Yes
O No
[DNA
❑ NE
0 Yes
01 No
❑ NA
0 NE
Page 1 of 3 21412011 Continued

.!, I 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 1 Structure 2 Structure 3 Structure 4
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �� J
Observed Freeboard (in): 1-3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Pj 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
Z[ 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 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
allo
❑ 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
ENo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[::]Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [E�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): _L=.1i7Lu,ol6
13. Soil Type(s): T t.-,e •^+- ! fAJas/a.:��
v
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
53-No
❑ NA
❑ 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
54 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
allo
❑ NA ❑ NE
the appropriate box.
❑ W UP ❑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 Inspections
[:]Sludge Survey
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
ED No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

14
Facili Number: - Date of Ins ection: �/
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [l No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 5No
❑ Yes [R No
❑ Yes [3 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: �r /}
Date: fc— /
2/4,,20I1

Type of Visit: 4ErC_0mpli2nce Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: (ZY6utine Q Complaint p Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: / Arrival Time: C> I Departure Time: D County: Region:
All
Farm Name: o y k vL A Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: A4!jX Phone:
Onsite Representative lj�Integrator: k,j g�
Certified Operator: ��_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
''Cutr�ent
4
s
PDesi n Currentx_
ryI
Design Curren
SwineF
Ca tz°Y
Pop. Wet Poultry
Capacity Pop .
z
Cattle` Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean t4 Feeder
p0
t�0 Non Laver
DairyCalf
Feeder to Finish
4-D0
Do �
4a7—eorient
Dai Heifer
Farrow to Wean
,SD
~D
esign C
Dry Cow
Farrow io Feeder
1 Dt P It �. •F-D
_
a a€i -P_o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts Non -Layers
Boars
Beef Feeder
Pullets
7.0 �.
era Turkeys
Beef Brood Cow
.._,.
Other
Turkey Poults
Other
Other''
_ _ . _
Discharges and Stream Impacts
I. 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)?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 M 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 21412011 Continued

-[FacWty Number: - 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 0 NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): /y Uf-
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 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Lg No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(a 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 No
❑ NA
ONE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ONE
❑ 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): &—e--ma da.
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
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ 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 Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�J-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No 0 NA 0 NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of Inspection: - — 13 ;
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 permii conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [gNo ❑ 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
CD Yes ®No ❑NA ❑NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
❑ Yes 2LNo
❑ NA ❑ NE
❑ NA ❑ NE
❑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 exulain situations (use additional naves as necessarv).
Reviewer/Inspector Name: sr���—e't/]� v� Phone:/Df��j7J�
Reviewer/Inspector Signature: _ Date:`
Page 3 of 3 21412011

9:rW6 R•-11- 2,01 n
utviSion of Water Quality
iFaciliEty Namber �2 Division of Soil and Water Conservation
0 Other Agency
Type of VisitC,ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Goroutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I q!3-07 Departure Time: County: Region: __?C4
Farm Name: &2 zqk, k /4 y J-_ ' Owner Email•
Owner Name: _ 1,,I * ev14 aD14 015&-, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: —wa-S6 Jo
Certified Operator:
Back-up Operator:
Phone No•
Integrator: a "' /V
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = f = Longitude: = 0 0 t = «
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
91 Wean to Feeder
Q
❑ Non -La er
❑Dai Calf
01 Feeder to Finish
�
❑ Dairy Heifer
19 Farrow to Wean
Z
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Other
❑ Turkey PouIts
❑ Other
Number of Structures:
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)
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 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 ffNA
❑ NE
❑ Yes ❑ No L1'<A
❑ NE
❑ Yes El No L YNA
❑ NE
❑ Yes L_'fNo ❑ NA
❑ NE
El Yes No ❑ NA
❑ NE
Puge 1 of 3 12128104 Continued

1. L
Facility Number:777 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M NNoo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
LTNo ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 5� of
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L`J 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
ErNo ❑ 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 thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E5No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ 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 []No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window• El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) n'L I+-� Z14_0 U ) '504. d r, Ya` _'ic0i S .. )
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,El �NNo
E 1vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,—<o
[: o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F No
❑ NA
❑ NE
.Comments (refer to question.#} Exptam any YES.an'swers and/or any recomtnendatian sf
9!�.any other comn7ients
U.se drawinp"of facility to better.explain situations::{use additional pages as necessary}
Reviewer/Inspector Name �tG. 1Gi/C.C'� _m}' .',_.,. Phone:
Reviewer/Inspector Signature: Date: 7 _ Z!� 24210
12128104 Continued

i
Facility Number: Date of Inspection
Re uired Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElG Yes o [INA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes L7 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
2 1 -
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
[] Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
, /El
Ej ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9 o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
��,/Io
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes
,L�7.�nN.
t� o ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff No ❑ 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
L_TNo
❑ 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?
El Yes
��
i3 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
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
,�,�
L.., <
EI NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E
❑ NA
❑ NE
Adldi, tioIm-c- mnaents and/or Drawings'`
12128104

f
his /0—o-7—z009
Type of Visit CMompliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outme O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of visit: J0-06-OJ Arrival Time: Departure Time: //.�lJO County: -�'"r— Region: F20
Farm Name: V /A 1lG A*_ Owner Email:
Owner Name: �S 'f"'t'Phone:
Mailing Address:
Physical Address:
Facility Contact: /,Eas( '0 Title: 61Ne-v­ Phone No:
Onsite Representative: ,Ls��c^/SO Integrator: y�`z'r�`T'r1 �'��'r'y
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: o Longitude: o
Design Current
Design Current
Design Current
Swine
@opacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
I
I
❑ Da Cow
iry Calf
Wean to Feeder
1 #OD
1 10 Non -Layer
Feeder to Finish
(0D0 1
Dairy Heifer
❑ Farrow to Wean
2
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Pullets
❑Beef Feeder
❑ Beef Brood Co
PGilts
Boars
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Disci & 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
[B<A ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
Eh A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑, NNoo
�❑ NE
2. Is there evidence of a past discharge from any pail of the operation?
ElYes
D NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El yes
,L�B__voo
Lwo
0 NA ❑ NE
other than from a discharge?
12128104
Continued

ti
Facility Number: 8Z — / 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 10 Structuo Structure 3 Structure 4
❑ Yes No ❑ NA ❑ NE
❑ Yes S'No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
N
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[1 No ❑ NA
Cl NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ffNo ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental)�threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
E75o ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[T 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
�/
E ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E5 o ❑ 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 l0 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) �'k C._ ` / !oacL �1`{ �(� �r�':.✓ ar S
13. Soil type(s) d g tv F
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0-Now❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
0,
LTNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 N�c ❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L�'No� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0-9. ❑ NA
❑ NE
Comments Use drawin(referto s of facililletor better exx laen situatin any ed s (use addrteonal a y asnecess�a bans o any outer comments.
la ty P pages rY)
Reviewer/Ins ector Name x a Phone: IF/9'3•
P � Reese/ .5 , „ , R
Reviewer/Inspector Signature: Date: /O ` d 6— Z O p
12128104 Continued

Facility Number: 2-- yy Date of Inspection /o -a�-
Re4uired _Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes crN. ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ 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
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
[I Yes
L�J No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
[INA [INE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ef
No
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes C Nv ❑ NA ❑ 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 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
Jo ❑ 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
Ehqo'—❑
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<
❑ 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
ffNo
❑ NA
NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[3Vo­
❑ NA
❑ NE
1228104

r
Type of Visit Q* Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit aRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: q� Departure Time: r0 '. 3 County: Region:
Farm Name: ��L$�[P_ roh _ Owner Email: �i�lt�l� jn-b!0ior.
Owner Name• M11 A iT has _ Phone: lSga_03 of
Mailing Address: POD Cilrl+l R! C
Physical Address:
Facility Contact:
Title:
Onsite Representative:: L
Certified Operator: Posh U-Apy n
Back-up Operator:
Phone No:
Integrator: l r0W
Operator Certification Number: AWi4 16713
Back-up Certification Number:
Location of Farm: Latitude: =1 e = f ="
Longitude: = ° = I = u
Desi n %Current
g
:g +
Swine Capacity Population
1
We# Poultry.
r
Desy n
g�
CapacityPopitlatton
C rr! n# Design Current
- Cattle Capacity Population
❑ Dai Cow
9EBEL]
er
El Dairy Calf
wtom '""
❑ DairyHeifer
❑
Dry
D Cow
,._..
El Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
Other
❑ Turkeys
❑ TurkeyPoults...._
�.
❑ Other
❑ Other
Number�of Structures:
❑ Wean to Finish
Wean to Feeder
® Feeder to Finis
Farrow to Wean
❑ Farrow to Feeder
e"?tIQ
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑Yes
NNo
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made?
[I Yes
IN No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ}
❑Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
IR No
❑ NA
❑ NE
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

R
Facility Number: Is — y4
Date of Inspection Dg�
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 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes 5;VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): �Q
Observed Freeboard (in):(p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes R-No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes tK 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 14 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CjNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
rop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Caar+Lj I ff4i t LL ( 4q- P) ' H�d HaY , s/V 11 df/I L,6 0 r _
13. Soil type(s) BlaADC) it S B0 B ` alfflffi If S *Q B _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PTNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes CKNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
CkNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
IR No
❑ NA
[:1 NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA
❑ NE
Reviewer/inspector Name [ 149ASCbaplPr.. ^� Phone:
Reviewer/] n spector Signature: Date: O�ifS`IOR
Pape 2 of 3 12128104 Continued

A
Facility Number: 'a- — yy Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ AVP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ®'No ❑ NA ❑ NE
❑ Yes UNo ❑ NA Q NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected.. did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
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 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?
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
❑ No
CRNA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
❑ No
5rNA
❑ NE
❑ Yes
CZNo
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
J'No.
❑ NA
❑ NE
❑ Yes
IgNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes �RNo ❑ NA ❑ NE
A�dd>itival carry
riteutS 80d/br'I)rA►'±Ii1�5 :.
7. Lagosn a wars�,4, aid mI,trAat 0 `Few rvP,e�t ado r 1({��O r�ak� Gh b"y,9*.
Page 3 of 3 12128104

Facility No. <6a- Time In Time Out Date
Farm Name bozke LaQ Owner
Owner B1MS Address & Phone Cell Phone
Site Rep _N_R?- Integrator Operator No.
Backup No. BIMS OIC No.
COC Circle- General or NPDES (Rainbreaker PLAT Annual Cert )
Freeboard
"f">idm;�R:i
;;r -
"f">idm;�R:i
;;r -
. - - . - r
------
Soil Test f j8t 0b J 1d 1S(0-7 Crop Yield 120 min Inspections
PH Fields Lagoon Rain Gauge Transfer Sheets
Lime Needed Weekly Freeboard SpraylFB Drop
Cu Zn Rainfall >1"
Wettable Acres 1 in Inspections
WUP
Waste Analysis
iiu—ll/Field —�Mlli�-_-
VJM
MOM A.
AikscAiur +,'1awrdcAA4,e,

G(Division of Water Quality
Facility Number $� 1 y O Division of Soil and Water Conservation
0 Other Agency
Type of Visit 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint gFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: s S Region: FRO
Farm Name: B �Owner Email:
Owner Name: _!1[4z 1 zohnsQ1 Phone: ff L 3 H
Mailing Address: a5 C l ►ram NC _ DS.3q
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone No:
Integrator:
Certified Operator: Operator Certification Number -
Back -up Operator:
Location of Farm:
Swine
Back. -up Certification Number:
Latitude: = o = ' F—I" Longitude: = a = I ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
_❑ Wean to Finish
❑ Wean to Feeder
00
Other
❑ Other
Dry Poultry
Pullets
L J Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
[I Dairy Cow
El Dairy Calf
[I Dairy Heifer
El Dry Cow
0 Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (I f 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 IffNE
❑ Yes
Number of Structures:
b. Did the discharge reach waters of the State? (I f 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 IffNE
❑ Yes
❑ No
❑ NA
JRNE
❑ Yes
❑ No
❑ NA
j2NE
❑ NA
kfNE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
NNE
❑ Yes
❑ No
❑ NA
DJNE
12128104 Continued

.e'acility Number:ga - yy Date of Inspection90560
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
RNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1q.
r
Observed Freeboard (in): 5 0 sat 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V 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
XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement?
❑ Yes
CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
C9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
S1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
❑ No El NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA J;RNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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
C NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
RfNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
g,NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
❑ No
ElIr�`'NA
NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
VNE
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):
L�5oa, a 6a e_ s rve e_ sp,11 ek �j,1 bef n4k— ft 11�dC�o � e
sfral a,Ca•�d. ! htrn fched -� -r
y� �y
Reviewer/Inspector Name
Phone: 1r0
Reviewer/Inspector Signatu
Date:
12128104 Continued

Facility Number:?�a —!!Lql Date of Inspection a0D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA Od NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA JWNE
the approprrate box. ❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA JR"NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
ISNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
N-NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
b?NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
[9NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
9NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
J@ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
R NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
RNE
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
WNE
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
RNE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
❑ No
❑ NA
KNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
9NE
Additional Comments and/or Dra"ings:
12128104

Type of Visit QyCompliance Inspection O operation Review O Structure Evaluation Q Technical Assistance
Reason far Visit GrIfoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7 Arrival Time: ; Od Departure Time: County '`1 Region:JF
Farm Name:., B r % /—,t k.. Owner Email:
Owner Name., it5 _ s��si^v Phone:
Mailing Address:
Physical Address:
Facility Contact: �fS a S erae Title: Phone No:
Ousite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o E--] ' = " Longitude: ❑ ° ❑ I ❑ u
Design Current
Design, Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
Wean to Feeder
o
❑Non -La er
❑ DairyCalf
Feeder to Finish o0
-
❑ DairyHeifei
Farrow to Wean
Dry Poriltry
El Dry Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
u
❑Pullets
❑ Beef Brood Ca
❑ Turkeys
- --
Other
❑ Other
❑ Turkey Poults
❑Other
Number Structures:
of
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
5d No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
W 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'YQ
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
91 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
IZYes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
M 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
ER No ❑ NA ❑ NE
maintenance or improvement?
Waste AnRUcation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
)U 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. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P 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
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5� 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 pages as necessary):
yC brr-a-,-� v, 1-7 ap
-y60 ^_ �
� c Cd y,� 1�►� rr� Cum, mw l / e m � 64 �r� �f �`rr / 3p7'�
L �jypi•-� r%r'G'Q,� k/��r4 yp.� i`C r : Iy TIi J. Lr &1e. 4val r-0. 400 fC
Reviewer/Inspector Name ,,�,� Phone: PO
Reviewer/Inspector Signature: Date: 7Lyrooa2
11125/U4 connnuea

Facility Number: Date of Inspection
i
Reuuired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 54 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (9 No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps [I Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes IQ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
54 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
J4 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
D9 No
❑ NA
❑ NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6K 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
® 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
% 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
C,No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
C.Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
s
12128104

i
on of Water Quality
Facility Number �pZJ _yy Q Division of Soil and Water -Conservation'
- 0 OtherAgency
Type of Visit ompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: �� Arrival Time: : 9z— Departure Time: D 0 1 County: Region:
Farm Name- f� .� /�c �T/��/tip_ Owner Email:
Owner Name: A105 /'+ U sh Ir��in r2 Phone: /
Mailing Address: a. j3a Sr %?20_�,
Physical Address:
Facility Contact:-1'N05Z Title: Phone No:
Onsite Representative: 'a- Integrator: _ A '�_
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o = + ❑ u Longitude: = ° =
Design Current Design Current
Capacity Population 'Wet Poultry Capacity Population
❑ Layer
p 3 a ❑ Nan -La er
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
D
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Dry Poultry
❑ Layers
ElNon-Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults I
❑ Other I
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
`W_
Catile< _
n
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
[I Beef Brood Cowi
Number of Structures:",..I
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?
Page 1 of 3
❑ Yes 14No ❑ NA ❑ NF
❑ Yes
9 No
❑ NA
❑ NF
❑ Yes
EI-No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
M No
❑ Yes
IRNo
❑ NA
❑ NE
❑ Yes
JgNo
❑ 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? ❑ Yes KNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes RLNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / f 59'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? El NA [I NE
❑ Yes ($.No
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PgNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes 9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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 [3No ❑ 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 9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2,No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
asTo.,
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)-
to-
Reviewer/inspector Name Phone: TZD
Reviewer/Inspector Signature: Date: 'o- 'g, a6
rage z of s 12128/U4 Continued

• Facility Number: k�P — Date of inspection �004,
f
` Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JO 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 ❑ Other
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jo No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E[ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CR No
❑ 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 property 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
RNo
❑ 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
C4 No
❑ NA
❑ NE
General Permit? (it/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

r
rV`
Division of Water Quality.
[Facility Number ti Q Division of Soil and Water Conservation
-- O Other Agencv.
Type of Visit 0 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: /� Arrival Time: �L`U Departure Time: County:.,S AKPP) Region: tWO
Farm Name: _ �SJfI'll kre„t�(,�,rirl Owner Email:
Owner Name: // . Nnr� r��'�,i�n Phone: /d- .a I-P-7 a+f/ - -
Mailing Address: ,-K &c _.29U3k_
Physical Address:
Facility Contact: NamAn ft an _ Title:
Onsite Representative: Il~fcr1&Ja;l
Certified Operator: NZ, 54 rO4_,MsW___
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
ED- Wean to Feeder
jeo
Q-reeder to Finish
I coo
EgTarrow to Wean
;At op
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator- A46W4
Operator Certification Number: /G t)%i
Back-up Certification Number:
Latitude: ❑ o ❑ j ❑Ig Longitude: = ° [� 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I I ::::]
❑ Non -La et
Dry Poultry
No
I ul
Turke
Other
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveva nee man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
e. 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 pan 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 QN•o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
❑i�o
❑ NA
❑ NE
12128104 Continued

Facility Number: R.Ly 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 I Structure 2 Structure 3 Structure 4
Identifier: -- J
Spillway?: 17e2 i12
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 © o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes D rvo ❑ NA ❑ NE
❑ Yes L3No ❑ 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 9--Ko ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D'<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 ['No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Eli; 0 ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 Drifi ❑ Application Outside of Area
O l» s o
12. Croptype(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q-No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
tJ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA
LI NE
17.
Does the facility lack adequate acreage for land application'?
❑ Yes
El No
❑ NA
[3-NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L]I rlo
❑ NA
❑ NE
, /PQ Mon,-4, Oale oleo, /ayoc� G')C^ /P�4b G'S l/E'CllS1G r�
Reviewer/Inspector Name I /t'%a./(. /�l„� f�p` , %/(.r �(„�'p,,.' ;+�c-;o k Qo`,:Phone: yl� YS�'/S4/ I
Reviewer/Inspector Signature: J71„ 6/( „� Date: 'iJ/-oS
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B-<o' ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9'1Vo ❑ NA ❑ NE
the appropirate box.
";l7Fr ❑ Ch "sts ❑ D gn ❑� ❑ O r
21. Does record keeping need improvement? If yes, check the a ropriate b x below. / ❑ Yes LjjNo ❑ NA ❑ NE
❑ ❑ re ❑ ❑Sow— ❑ Wttste- sf ❑
❑-Raitt€mi ❑zwd4ag, ❑-CropVie-ld ❑ I ns ❑ ❑_W athe Cane
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
AG IF 3 / >a
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
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 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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
(
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
El NE
El Yes
,❑d�
o
❑ NA
[I NE
ElEa Yes
�L�.,-
o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
E?�E
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No ❑NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
A ire, GJ[isle- 12ve, s
e•1 61,', /
A,d Ae- w:
[,.rite ! /
12128104

Facility Number o? Date of Visit: FC %9 rv. Time: 1 8 1 30
O Not Operational O Below Threshold
Permitted 13 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .
Farm Name: ,Q LSL. �G+�� County: __-6e? 1� s�,O.e1 .
Owner Name:.,_ ' __ZV aS,4 , �o ' Phone No:
Mailing Address: 100 -Z S a i -IaA,- A/ C
Facility Contact: --- ...__ . -------- Title: --- ......._ . Phone No:
.�S3z'p
Onsite Representative: ,,,,,_, IVQJJ< g!6 s�bu Integrator. ,5g ,;r / ; acv
Certified Operator: , /�/c�J��vs o�� Operator Certification Number:_
Location of Farm:
11 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • I G4 Longitude • 4 Du
Dis�chmes & Stream Imrracts
1. Is any discharge observed from any part of the operation? ❑ Yes �0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? A IAI
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 IM No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 9 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches):
12112103 Cowed

Feahty NAwber. fd -,pyy Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ 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. maintenancelimprovement?
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?
❑ Yes Ij No
❑ Yes 150 No
❑ Yes 0 No
❑ Yes III No
❑ Yes ® No
Waste Aaulication
10. Are there any buffers that need maintenmoefunprovement? ❑ Yes NJ No
I I . Is there evidence of over application? if yes, check the appropriate box below.
❑ Yes M No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18_ Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes P No
❑ Yes P No
❑ Yes W No
❑ Yes 14) No
❑ Yes "i No
❑ Yes JR No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes M No

)cility Number: Sa2 _ yy Date of Inspection /o df''
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22. Docs the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, designs, maps, etc.)
❑ Yes
® No
23. Does record keeping need improvement? If yes, check the appropriate boa 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
® No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
10 No
26. Fail to notify regional DWQ of emergency simations as required by General Permit?
(id discharge, freeboard problems, over application)
Yes
No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
28. Does facility require a follow-up visit by same agency?
❑ Yes
r No
29. Were any additional problems noted which cause noncompliance of the Certified AW fr.
❑ Yes
R No
NPDES Permitted Facilities
30. is the faciiity covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
® No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 12-0 Minute Inspections ❑ Annual Certification Form
I21I2103

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Govemor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Nash Johnson
Boykin Lake Faun
PO Box 25
Clinton NC 28328
L Subject
r r, 1998
FAY E l iiVLi';
Dear Nash Johnson: REta. 0E-F-iC;E
NCDENR
EhmRONMENT AND NAruRAL- FiEsouRGEs
June 26, 1998
Reissuance of Certificate of Coverage
No.AWS820444
Boykin Lake Farm
Swine Waste Collection, Treatment, Storage and
Application System
Sampson County
The Division of Water Quality modified the Swine Waste Operation General Permit originally issued to
this facility on October 13, 1997. In accordance with the issuance of the revised General Permit, we are
forwarding this Certificate of Coverage (COC) to Nash Johnson, authorizing the operation of the subject
animal waste collection, treatment, storage and land application system in accordance with General
Permit AWG100000. This approval shall consist of the operation of this system including, but not
limited to, the management of animal waste from the Boykin Lake Farm, Iocated in Sampson County,
with an animal capacity of no greater than 400 Wean to Feeder, 600 Feeder to Finish and 2450 Farrow to
Wean and the application to land as specified in the Certified Animal Waste Management Plan
(CAWMP),
The COC shall be effective from the date of issuance until April 30, 2003, and shall hereby void
COC No AWS820444 dated October 13, 1997. The COC shall hereby incorporate by reference any
specific conditions of the previous COC issued to this facility. The purpose of this COC is to allow
coverage under the revised General Permit. Please review the revised General Permit (enclosed) and pay
particular attention to Condition II.10 regarding tree removal from lagoon embankments, Condition HI -I
regarding inspection frequency of the waste treatment, storage and collection system and Condition H1.6
regarding notification requirements for system failures, spills and emergencies. Pursuant to this COC,
you are authorized and required to operate the system in conformity with the conditions and limitations
as specified in the General Permit, the facility's CAWNIP, and this COC, with no discharge of wastes to
surface waters. An adequate system for collecting and maintaining the required monitoring data and
operational information must be established for this farm. Any increase in waste production greater than
the certified design capacity or increase in number of stocked animals above the number authorized by
this COC will require a modification to the CAWMP and this COC and shall be completed prior to
actual increase in either wastewater flow or number of animals.
Please be advised that any violation of the terms and conditions specified in this COC, the
General Permit or the CAWMP may result in the revocation of this COC, or penalties in accordance
with NCGS 143-215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive
relief.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recyde& 10% post -consumer paper

Certificate of Coverage AWS820444
Boykin Lake Farm
Page 2
Upon notification by the Division of this COC's expiration, you shall apply for its renewal. This
request shall be made within 30 days of notification by the Division.
This COC is not automatically transferable. A namelownership change application must be
submitted to the DWQ prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the
right to apply for an individual non -discharge permit by contacting the engineer listed below for
information on this process. Unless such a request is made within 30 days, this COC shall be final and
binding.
The subject farm is located in the Fayetteville Regional Office. The Regional Office Water
Quality Staff may be reached at [phone]. If you need additional information concerning this
COC or the General Permit, please contact Katharine Keaton at [phone] ext. 533.
a
Sincerely,
for stun Howard, Jr., F.E.
cc: (Certificate of Coverage only for all cc's)
Sampson County Health Department
Fayetteville Regional Office, Water Quality Section
Sampson County Soil and Water Conservation District
Permit File