820463_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

ti
Type of Visit: Q Compliance Inspection V Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: 3 ; Dr- Departure Time: County: Region:
Farm Name: 'z.r kt-L— Owner Email:
Owner Name: wGty/i r- iJ e r-rr _ - Phone:
Mailing Address:
Physical Address:
Facility Contact: r►-- U) e- k Title: / Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
�trnrrent'
'
Design
Design
Current
�!�''` Design Cnrreut
Swiite
Ca aci Po
` P h' P-
Wet I'ouilt'",
ry
Ca aci
A P tY'
Pa *
P'
'tattle ' Capacity Pap.
Wean to Finish
Layer
DairyCow
can to Feeder
� '�
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Cu1Tretxt
D Cow
Farrow to Feeder
'
r
D 1P,ou1
Ca aciPo
Non -Dairy
Farrow to Finish
La ers
`- '
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
�a
(➢thee
Turkey Poultsi
u
,
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [] Yes RNo ❑ NA [] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
❑ No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
Page I of 3 21412015 Continued

' Facility Number: f5ate of Inspection: -- 6 --
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
JRNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
foNo
❑ 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?
B Yes
[:]No
❑ NA
❑ NE
8. Do any of the structures 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
[:]No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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 CA WMP?
® Yes
1�[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
11:9 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
'® No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
M No
Lvat
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
&jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP [!]Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. LF=ZX Yes ❑ No
❑Waste Application [ eekly Freeboard ®'waste Analysis oil Analysis aste "Transfers
ainfall E stocking Q"Crop Yield E312U-Minute Inspections Q*fonthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes §g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo
❑ NA ❑ NE
BWe—ather Code
Q-Wdge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

` Facility Number: - r jDate of Ins action: —
,! 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
❑Nan -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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 5jNo
Otherlssues
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[—]Yes GjNo ❑NA ❑NE
❑ Yes U No ❑ NA ❑ NE
54 Yes ❑ No [] NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
0 Yes ❑ No ❑ NA ❑ NE
[:]Yes � No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
10'a'-rut IJ D ,ns
D SLRi.'71
X% i� % ,i-` o� 17
.,
U
Tk=!V
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date. /�
2/4/201 S

%a —;z-10S
Type of Visit: &CompUauce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grfro`utine- 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® Arrival Time. , Departure Time: p: fl County: Region: - � O
Farm Name: V 0 ✓ /? x//rew" h i�a r/Owner Email:
Owner Name: _ 1N ply elf UJ r nns4 ry Phone:
Mailing Address:
Physical Address:
Facility Contact: y/�j)ryvl`Yn( Title: ,00s/r�` Phone:
Onsite Representative: f�c.t/ Integrator: AAA
Certified Operator: Certification Number: ��yZ33
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design
Wet Poultry Capacity
Current
Pop.
Design Current
Cattle Capacity Pop -
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -La er I
Calf
Feeder to Finish
�TMw
Dai Heifer
Farrow to Wean
-,. Design
Current
Dry Cow
Farrow to Feeder
Poultry1.2 a.
Pdo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Uther
Turkey Poults
IL 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?
❑ Yes 5' No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State? (If yes, notify D)VR)
❑ 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 DVIR)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
EQ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

FaciliNumber: VL - 1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a, if yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�No ❑NA ❑NE
❑ No ❑ NA ❑ NB
Structure 6
❑ Yes 10 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes C&NO
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes K 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 MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [&No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types)r"/'i�'1�/ti- //
13. Soil Type(s):jjJ�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U4.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 0 No ❑ NA ❑ NE
❑ Yes Ej§.No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Vj No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Eg 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 tE�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " 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? 0 Yes E4 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ONE
Page 2 of 21412014 Continued

Facili,y Number: - Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [k No [DNA ❑ 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:
2& Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes CK No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 ELNo ❑ NA ❑ NE
❑ Yes RI No ❑ NA ❑ NE
[—]Yes gNo (DNA ❑ NE
❑ Yes Z[ No ❑ NA ❑ NE
❑ Yes Jallo
r] Yes 0 No
❑ Yes [2-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to cjuestion ft Explain any YES. answers and/or any additional recommendations or a_ ny other comments:
Use drawings of fac>fi'to better explain situatrotis use�additional
g tY p ( pages as necessary)-
�JVOW 7)(-e
�rrn �S C� s-�✓ -fv /moo ���rri�s �'��' ���-- � ��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9 " ze_s` Oo
Date: D`y —/xv /S­
21412014

ivision of Water Quality
Facility Number �' !- �p'" ®Division of 5oi1 and Water Conservstian
Other Aggcy
Type of Visit: oroutine
'ace Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: J : 00 Departure Time: County: S P'__ .
Farm Name: fi�Q �//�� lrti��'Y/'!Ci t rit.el"61 Owner Email:�—
Owner Name: wGf/�� j�rrd C� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ��!-ru�3- _ Phone:
Onsite Representative: _ Sorc,� Integrator:
Certified Operator: Certification Number -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region: OFF,. D
Design Current
Desikh Curreltt
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da Cow
Wean to Feeder
-Layer
Da' Calf
Feeder to Finish
_ =.
Da' Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
(pp ©rvll',ouit . Ca ace Po
Non -Dairy
Farrow to Finish
..
Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Y
Turkeys
0tber4
_.:.
Turkex Points
Other
rT
Other
Discharees 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 gLNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes E5,No
❑ Yes WL No
❑NA ❑NE
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FFacinty 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
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(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
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E 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
3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [allo ❑ 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): iW� �AU�Sz�A
13. Soil Type(s): o of
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes M.No ❑ 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 K No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes IQ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA D 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 [RNo
❑ 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 21412011 Continued

'[Facility Number: 1 Date of Inspection: --,9014
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
® 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
Co No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
R No [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
LK 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
2 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C&No ❑ NA ❑ NE
Comments (refer to question ff): 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).
Ale,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
21412011
Page 3 of 3

:y VS
g1F
Type of Visit: ID Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 18r Routine Q Complaint 0 Follow-up Q Referral O Emergency O Other ( Denied Access
Date of Visit: Arrival Time: Departure Time:�County:Region: F pz
Farm Name_1NQyp yyr Q/ Owner Email:
Owner Name: T 1rnonP iYf Phone:
t
Mailing Address:
Physical Address:
Facility Contact: Title: Mal a-fl" Phone:
Onsite Representative: t Integrator: * JB
Certified Operator: Certification Number: a�
p fLn N Wk �� f�r5 �-
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Cuent�-- Design�Current - Design Current
410
S Capacity Pop W.et Poultry Capact NOattle Capacity Pop.
�zfarrow
Wean to Finish
Wean to Feeder
I
La er
JNon-per
I
Dairy Cow
Dairy Calf
Feeder to Finish
_- = .rT
Design. Current
D . P,qul Ga aci Po .-
Da'X Heifer
Farrow to Wean
to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
La ens
Beef Stocker
Gilts
Non -La ens
Beef Feeder
Boars
Pullets
Beef Brood Co...
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ® Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
2 Yes
,A111
❑ No
❑ NA
[3NE
;J rx
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 214/2011 Continued

Facili ' Number: - Date of Ins ection: SIMI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 152-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): _ �Q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[:]Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
NNo
❑ 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?
[gYes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2No
❑ 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
g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J)_� 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): I^ifi U BPrmrdl(roL2 -small all d mi) oveledl d
13. Soil Type(s): r
14. Do the receiving crops Affer 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
[2 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
n 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
P 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. JK Yes [:]No
❑ 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 [:]No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA [] NE
® NA ❑ NE
Page 2 of 3 21412011 Continued

Facifi Number; -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR 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 [3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [RNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
'jj 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
t@ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
MNo
❑ 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
& No
❑ NA
❑ NE
33. Did the Reviewed]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�g No
❑ NA
❑ NE
dI'mrC�10-t
rbackide m-Fla9�,, P1�e, remo�o� s edct 0I;~- al
Of Ia ah, 8ackstclo of i ;yh9l � �ro,><e& Mostl
�`l�� Sick L'h job Y1�tir 0�'Cost ( iP o ry ��
�t�",i©lX 1�19�� �� O Ow�I br�h4� 0► 7fdf t �ejA'/*
1Q, 'Pl�1✓ POS�Cfr*c e o Caro i� �'oa, will 1'Ylbl'P aho �i co , Ct`brl yI9I133
r Qs Oralm r Oq k dQys fie' c ad c�-som Ill 1 �j�e`�' �e p-e4i
newch —
�y rvrh new P ram , Sew) sfal eI
P J 0 N re O�q &.,cf•
a6. Plea�� It ChOy to Of in C� e LO�C� foam
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoncgM—
Date: Q1.3
21412011
M

rr
1: 1i+' �.: j': '.� ij?la}�Lri :=L• �.=: 17.°S�ii - .1 : 'e f' �{�
"'il'*77'1:..•7' h;� '•i��,�.:r-.� �ii=�� :I .! !'- 1 a. i. -, !' .. I`s. �' }- 1�' -
- VC
� r •.
Facdity;Na; If.. a Name 1 Date
Pe - •OIC i NPDES (Rainbreaker --,.PLAT-.--,." Annual Cert . [ia -Pipe )
FB Drops:.. �..'��..:�-� ����� ==s'>~ ,� �'_ :3- �� • <� � - - ---
uuL/fP
_
Iml�lf
ll■1:�11
1?�iilA
La oon Namer'
hir illwa
1
2
Desi 'n Free
ard.Vl
:a i ecortfed in
I
;
Observed;releb
? Y1'AaE.s: T
SIud 46 SUNe oat i, I
Slud e'De' th'. ft f-,°.E ��i' i i a ;E. ,,
4
Liquid Trt:
Ratio Sle' e; oTreatlar3trluiine:'i#?
d
0:45
r
:.� :..
Date ouVducdm"
lien :R4.'? +•`:; :�-= :
i
::;:.
Soil Test ; Crop Yield _� Transfer Sheets
pH Fields ? ,'tixb
Wettable Acres RAIN GAUGE
Lime Needed ;�1! E': f. �.. WUP ✓ W Dead box or incinerator
1
Lime Applied. i I ':'l:i! r i:�`s Weekly Freeboard ✓ Mortality Records
Cu-I !' l==� ' ! 1 in Inspections ✓ Check Lists
Needs S (5-I 25 i'`) } ift �20 min Insp. ✓ Storm Water
i�i ' i I !,! - Weather Codas
IkIU 11#,ti N►t'1 VM0 i1r_1i1 AK1L:_-s.k1FL%C_n ■19
•
r
�ilidw4�
� r�
tt
GL[� •
i i,
� r1.
f 11'1A4��',
i
Verify PRONE IT
Date last Wl! F
Date lash u
App.Hardkai 9 '#
' ,�. tad �h: 1 I�{•'�� i
Conversion—;U'-
W.: ,
$
znsf affiliations
'FRO or Fairm Records
Lagoon #
U
Top Dike
i
Stop Pump -�
i' Start Pump
I
I0$
x
I''
Iblac;' Zn-I 3000= 213 Iblac
Jj
14

arms U,) & L911IX
��' Division of Water t�aality
Facility Number ga. - ® fl Division of Soil and Water Conservation
© Other Agency
i'ype of Visit: 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: aRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: BAf) r' l l County: Region: FrM
Farm Name: nip 11'j& l Owner Email:
Owner Name: T 11yn P K(e) - Phone:
Mailing Address:
Physical Address:
kh
/ l
Facility Contact: Title: Hth Phone:
Onsite Representative: �% Integrator: M"_ 13
Certified Operator: / 1 � B1H Certification Number:
Back-up Operator: Certification Number -
Location of Farm:
Latitude:
Longitude:
Design .Current �,
Design
Curre t
gnCurrent
!a�Rwi
le Cacity Pop.
Wean to Finish
?
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
"I
�
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oul
Ga aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Uther
Turkey Poults
Other
Other
Discharges and Stream Lml)acts
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 Q No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
, n No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ff No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Faeilit' Number: - Datc of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CR No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes'. check ❑ Yes �g 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?
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 mortalityrates 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 the 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 W No
[:]Yes [::]No
❑ NA ❑ NE
D;jtNA ❑ NE
[:]Yes g�q No [:]NA [:]NE
❑ Yes JRf No ❑ NA ❑ NE
❑ Yes JR No ❑ NA ❑ NE
[:]Yes JRNo [:]NA ❑ NE
[—]Yes No
❑ Yes No
❑ Yes KNo
❑NA ❑NE
❑NA ❑NE
❑ NA [] NE
Comments (refer to question-#.): Explain any YES answers and/or any additional-reeoffimendations or any other cottimeii
Use drawings orfarilith #o better vxplain situations (use additional pages;as nece_ssary).ME mo
h�� abeL`� 4 m m or '`��1��
ofc ry, �'I�g� InG110� `fix a C°f,,A �dlo� 70*,r ally
n4� G� 0 ( Ah G�1 , J C L bIUJ� 0� CQl�I 1`, MV-
V Y�
0 �✓fl�- �C��l � �ocbi �crrlc .
lal �`I j:�O; C'_OC ?ya- � �� so4\-4oiheva Bess,
0'lm is muCh lmerbed. in ` Ilnf OT mQh+)Aalce ,
Reviewer/Inspector Name: 1lo
Phone: �Q--
Reviewer/Inspector Signature:
Page 3 of 3
i
Date:
21412011

Il
Facility Number: I Date of Inspection: 611911)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 12'No ❑ NA ❑ NE
a. 1f 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?: w/
Designed Freeboard (in): I
Observed Freeboard (in): @L5-
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 '�o 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 §j� No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
[:]Yes .KNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes CR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes allo
❑ 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): , S
13. Soil Type(s):
14. Do the receiving crops differ from those de4ignaludJn the CAWMP?
❑ Yes Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �K'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 D;�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes] No
❑ NA
❑ NE
Rettuired 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 r2"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 r5l'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 1;4'NA ❑ NE
Page 2 of 3 21412011 Continued

Facility No. W Farm Name
Permit ✓ COC
FB Dro s
1
ti
Date �v
OIC_ NPDE ( ain6Naker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
)
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
CalibrationDate
Actual Diam.
Soil Test Date a
pH Fields
Lime Needed !1
Lime Applied
Cu-I tz Zn-I
Needs S (S-1<25) ✓
Needs F
Waste Date
- 60 Day
+ 60 Day
N (lb11000 C
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp. ,G
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
..
..
FAR 1
;t
E,
M.
i
� •
� !, •51
`
s
%'!�
Verify PHONE NUMBERq and affiliations 1� y tgl5
Date last WUP FRO ASP-) P-) FRO or Farm Records 1 /
Date last WUP at farm Lagoon #
App. �rd a�rTop Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac

t ype of vjsit: Q5ttomptiance lnspectton V operation xevtew u structure Lvaivation V i cenmcal Assistance
Reason for Visit: Z"outine O Complaint O Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j� Departure Time: 'tj County:
Farm Name: 1 V ' y parr. Owner Email: —
Owner Name: [ v a 1 V Qnon Phone:
Mailing Address:
Physical Address: q01 bvnap7
Region:
Facility Contact: i"` dahl Wr_er - Title: �" QAjU 13/` Phone:
Onsite Representative: Ad am i Yr±Kb Integrator: N`13
Certified Operator: ubr i'Va IfYlPn r BiHS Certification Number: )-?q3.r
Back-up Operator: AdorfWt4j�AC)) Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine CRM apacity Pop.
Wean to Finish
D""sign Current
W"t Poultry Capacity Pop.
La er
n Cur
Desigrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
"""
Design Current
Dry P,oultry Ca achy Pao
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge? ,
Page 1 of 3 21412011 Continued

Facili Number: - t4 IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
f@ No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
0 Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Idend tier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(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
[2 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?
B Yes
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
J'g No
❑ NA
❑ NE
- (not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
& No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ESJ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
5'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?
U Yes
LI No
U NA
U 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
allo
❑ 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. 29 Yes ❑ No
Waste Application ❑ Weekly Freeboard W 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 N 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
N NA ❑ NE
Page 2 of 3 21412011 Continued

ti'�Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, 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 Ioss assessments (PLAT) certification? [] Yes ❑ No ES NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes U No 0 NA [] NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? [] Yes D? No ❑ NA [] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
MNo
[] 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
'S'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33_ Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
ElYes
P21 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency`?
❑ Yes
1EINo
❑ NA
❑ NE
lComments (refer to question #) Explaiin my YES answers: and/or any.additional recommendations or any other aFoinmeiits. ;
Use.drawings of facility to better'explakn situations fuse additional Pales as necessary).
-71 %6)e- bfv,h brick rrna-e L),) oo-We of-Iq r, Caadt job wivA 0,1
Old eJfeC 10 0) A I'A J9 "M rs- in -he- f"Ot'eff 6f
ho%Q o I e c Jeo, �r11ah o��t A0 061'
py 1 9
15 Sa►-e A e14 Ana � [rime aek - Hod son )W, Ned sdii 'fed 6' )01I ,
Q t ;' OOA Y1 l i rna c erhfi cd� i cc q'� [UGC^
3a��A� C�s� ✓ Fo�� s ra e ] ripe Ca�dtip
a!, �N ',re n�i- ref - cofo4t p4uS y�$t? >xc �f
A01161 1s f- � +i ear, Wose chalk a eoJ, ± (b0c101s,der', C vore 0 ice7
dm� h/ knows Ow io 0
r
Nov +o be— iss4 for Iwe-4io cafe n ao� o b r � have b , cal i 0 J%trP,
� L�1�U�-aqh�-oso�a
ay, Vol h4S1 s"l, -Qv ao��
} jR�ta�01Cforr,d7e
chonle ad ivnp-sl)1'P
of has i -haelaA4 4� t .PLW
ReviewerAnspectorName: Srhoff'BI _ ..- �^ Phone: qj0-43k ( '111
Reviewer/lnspector Signature:
Page 3 of 3
Date: 6YA o
/44011

'Fac1ity' No./$�- �� Farm Name �QynP ti'�'it°i'IU"1 Date
Permit ✓ COC O CT NPDES (Rainbreaker
X0
'ULM"OIRMPH,f1
IMI
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard J
Observed freeboard in
Slud a Survey Date
Sludge Depth ft
Li uid Trt. Zone ft
_
Ratio Sludge to Treatment Volume
mmw
1
-----�
Actual
------
Soil Test Date �1 ` Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections
Cu-1 Zn-1 120 min Insp. W �01a-� Ilala IP
Needs P Weather Codes alai -�31 a3l !
Crop Yield Transfer Shr~ets.
idw :_
r�
i
Verity PHONE NUMB R and affiliations
Date last WUP FRO.
Date lar4WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 lblac; Zn-I 3000= 213 Iblac
�t l� &
App. �ardware ='+-
11 lao
�� on iv

12EMPiv PACE I 101M I(in &" bIH5 0 bollo 0-kr
Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: «'— - --1--r Departure Time: I G � County: Region:
Farm Name: rY nyne _ _W(e�F_ (�_1Owner Email:
I
Owner Name: yVCty np ��nrh Phone:
Mailing Address:
Physical Address: ^ ��`
Facility Contact: ttdf� )nYren Title: I��_r 4 +-C33er _ Phone No:
Onsite Representative: Wdi� am bz� Integrator:
Certified Operator: W wrefirb _ Operator Certification Number: 17 S
Back-up Operator:
Back-up Ce i"cahon Number:
Location of Farm: Latitude: 0 e = . =As Longitude: =° = 1 =
Swine
❑ Wean to Finish
Design Current
Capacity Population
Wet Poultry
❑ La er
Design Current
Capacity Population
Design
C•si#Ie Capacity
❑ Dairy Cow
Current
Population
❑ Wean to Feeder
10 Non -Layer I
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Cave
❑ Gilts
❑ Non -La ers
❑Pullets
❑ Boars
❑ Turkeys
❑ Turkey Poults
Other
plumber of Structures:
❑ Other
El Other
Discharees & Stream Impacts
1. Is any discharge observed From any part of the operation?
Discharge originated at: *N 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 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?
f2 Yes ❑ No ❑ NA ❑ NE
SYes
❑ No
❑ NA
❑ NE
❑ Yes
t9 No
❑ NA
❑ NE
❑ NA
❑ NE
Eyes
❑ No
❑ Yes
IFNo
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
Pine 1 of 3 12128104 Continued

r ,,, i�E✓'�Srory PA-& E a 10(aal 10
acility Number.S� y Date of Inspection 1 Ig
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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway'?:
Designed Freeboard (in): 3
Observed Freeboard (in): .@ 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
UNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
CgNo
❑ NA ❑ N E
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? rRYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
CgNo
❑ 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
R No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
19 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_ ❑ Yes
WNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1.0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ 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
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'.?
❑ Yes
rZ No
❑ NA
❑ NE
Cots (refer to question #): Explain any YES answers and/or any recommendatio
mmenns or ans other comment , . + -q ,k�z
Use drawings of factlih to better explain situations. (use additional pages as necessary):VQ
.N
_
Reviewer/Inspector Name �-�-
Phone: `If
— 3
Reviewer/Inspector Signature:
Date: &_t
a 121
1j PIV IZOCTaD, apt Continued

RE vis/oAJ PA61a w1w1ro
4 Facility Number:S, -H Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes CgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes ❑ No ❑ NA ❑ NE
10 Waste Application �4 Weekly Freeboard B 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? ❑ Yes J;9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 51 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1p NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IgNo
❑ 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
CRNo
❑ 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 reviewAnspeetion with an on -site representative?
❑ Yes
k No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
E—yes
❑ No
❑ NA
❑ NE
Additionkff i m j t&*d/iiir Dra►vtrtgs Y' f
34. Dinh Ti l-es- 4� ?_ known `
`l,p1&ue, VoA pr cut Yvoo ygokv_� ©� bockfi'de C&,j,?-#1 ja�ooj, �"Moxemo1�
1nSlde. -slOp�S
I`'9� de °' a )mr � o,� � G�a� �Udd t � c�prorsncC�i9lw�i
t Pllease cat 1 whe" C 1°al4 Ll
bJ! n6�` rvnn IY1� c b 4s lZas
records a; e+ cL f eo+ KJ7jk a'at s1('
a!� �jeose. wfch V fU!�? �'t?�1 4G1�-1 U n ) y
a rwork i beh�r - �hr I� WO ne- 1n h0i f r 1.
r Sv�rP� Pk� 0-� eA L�ooi raj- Gj7ea'140ali?
�� as.Yvlli n�P Call} a-ho,4s(�dy� rot' -4 c s r rd hdif Miter Ja,rm
J Na aolo,Ab� 1,5 miilo9a1 s 'U : Aibo' Iwl) c/'
)
NKob Wretch b �atid�` i nddll. checked dl
Coo s 01 /Ac
al J
Trii(J eck backCh deol P9-0Smali dtScha-�e.
MC14 kS ciany rmi-of-dal+o da (WA tU?,M� ohd_ V1au*eke_AW � )n Nov&nh r
C9o� i m avem` s `�p �4�r' rn hew ew � s lacF� -�f ocr� 4 �a t� ills I 'n Lf
Page 3 of A1 Sifttip, PQbft( aW co(I diw of -fltehmk i'PeI . 12128104
�n 3J

facility No. $a Farm Name WgYW �/lfil�� Date
Permit COC ✓ OlC_ NPDES (Rainbreaker
.'.-
mom
Ift�r'r� .+�s�aa�trr� ITS � 1
MOM U. I!, M M �21
Annual Cert )
La
goon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Date
Date
mm. I'm
MUMS
M2 0
Design Flow
ActualCalibration
•
iJ
------!
Soil Test Date Q { Ip
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
ITr/
Weekly Freeboard Mortality Records
Lime Appligd
17
1 in Inspections
Cu-I Zn-I
120 min Insp.
Needs P ���
Weather Codes
Cron Yield
Transfer Sheets
PulUField
..
..
IT
L '�
•
s
! GW
J MM
R =1
I �
Verity PHONE NUMBERS and affiliations SiP
Date last WUP FRO Date last WUP at farm J" rApp. Hardware 01%q f?G
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Iblac

J o 14JV -� q j
4,1�2p L 14NO
� a �
--D-V j'b£I
!ge
r
�pf �
J b�
PIS
-4s Ju VA, 4N)AO4
-"A�P�RM SW

w A rFRQG
co 7
Mr. Wayne Wrench
1574 Old Wrench School Rd
Godwin NC 28344
Subject: Inspection Clarification
Wayne Wrench Farm
Facility No. 82-463
Sampson County
Permit No. AWS820463
Dear Mr. Wrench,
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of F',nvironment and Natural Resources
October 20, 2010
Coleen Sullins, Director
Division of Water Quality
Attached is your copy of the revised inspection. You can throw away the original. You
were right. Your lagoon redline is at 19 inches, according to the construction information.
corrected the error on our computer and apologize for any confusion I may have caused. Please
be sure and call us if the freeboard ever gets below 19 inches, because unreported high
freeboards can lead to penalties. Also please keep your lagoon pumped down because, , major
rainy spells can happen on short notice, as we saw last month.
If you have any questions, please do not hesitate to contact me at [phone] 1
enjoyed seeing you and your farm again and wish you a speedy recovery.
Sincerely,
an Schneier
Environmental Specialist
Division of Water Quality
Fayetteville Regional Office
Attachments: Revised inspection
Noe Carolina
Natura!!!l
North Carolina DWQ/Aquifer Protection Section 225 Green SU Suite 714 Fayetteville, NC 28301 Phone [phone]
FAX [phone] Internet: h2o.enr.state.nc.us Customer Service 1-877-623-6748
An Equal Opportunity/Affumd6ve Action Employer— 50% Recycledll0% Post Consumer Paper

Type of Visit ®. Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: I Departure Time: �; �t! County: Region:
f
Farm Name: ► l fvrOwner Email:
Owner Name:F rp Phone: ri
Mailing Address:
Physical Address:
Facility Contact: Adom
/^� y, r Title: Oti n��" Phone No:
H 1 Onsite Representative: &n f ysttoAd) Integrator:
Certified Operator: WQLvl1C WI'iG._ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = OF—] I 0 N Longitude: = ° 0 I = «
Design
Swine M wi-D _2C i t a
Current
Population AlMsltry
Design
Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cowl
❑ Wean to Feeder
❑ Non -Layer
❑ Feeder to Finish
Dry Poultry
La
❑ Layers
❑ Non -La ers
❑ Pullets
aFarrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Structures:
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 178rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
KYes
❑ No
❑ NA
❑ NE
❑ Yes
1 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —463 Date of Inspection a0
Waste Collection & Treatments
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Wo ❑ NA &NE
a. if yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA V NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Arc there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA 1j}NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA J�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 EffNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NNE
(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 [N-NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA RNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E'NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
5aNE
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
❑ No
❑ NA
KNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
1>_�NE
Comr>Qents (refei: to question;#): Explain any YES answers and/or any `recommendations or any other romtnents x_;�n
Use draw�tigs -dt facilih to,lzettet explain situations.. (use additional pal e's as necessary):.NAl_._
_.. .
_ 30$- IvSS t
Reviewer/inspector Name. N Y„ w Phone: 32
Reviewer/inspector Signature: Date:
12128104 Continued

fliacilityNumber: — Date of Inspection Wi��LldV1�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA (R NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA RNE
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 1" 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 fai I 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 CAW MP?
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 visitby same agency?
❑ Yes
❑ No
❑ NA
RNE
❑ Yes
❑ No
❑ NA
(2 NE
❑ Yes
❑ No
❑ NA
UNE
❑ Yes
❑ No
❑ NA
(9 NE
❑ Yes ❑ No ❑ NA ®NE
❑ Yes ❑ No ❑ NA VNE
❑ Yes
❑ No
❑ NA
$1 NE
0 Yes
❑ No
❑ NA
® NEE
Yes
[�No
El NA
ZNE
❑ Yes
EgNo
❑ NA
lE
❑ Yes
ERNo
❑ NA
S E
❑ Yes 15rNo ❑ NA ❑ NE
;a
Additional Gommeafs and/or
Uf AL
), 1�ol1ow.4o checksmalld�'f oro'd h0-6ef aft pfis Wee-fIu�9-V"�`
P10 r s Of-c rNIA Of check' 614 1'dai zlolis/ID R' I01a0lo Oh n0 Pat�ra�J.
owir s vv�e_Ao ffed-t Bi 9tddjr c-o. d� � ,Qof- htw_ie_ year ►fir b i� o`io�„
Area- aowk I owe eJ a h?
graJel aJdi�, Yvar c leanur
r Lm car i l 11Frw
G-ei, up is naw comtkie
Coe/ 3,
Page 3 of 3 12128104

t
0 JMM j_Vj_ q(� 310ri
Type of Visit {grCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �� 3 Departure Time: &,OQAfj I County: Region: FRO
Farm Name: gnp lY1t$t EQ/m _ L Owner Email:
Owner Name: Wilqtiq _ _rf%lUl Phone:
MailingAddress: 157q 01
KAM 5KC-6001 JAL ��wr� aS3
Physical Address
Facility Contact: �Q�f3P_ YYr>�tl. Title: �1Lr/1'�l' Phone No:
Onsite Representative: L I Integrator: /
Certified Operator: ryro" Operator Certification NumberAh/A LIQ3�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E__1 o E--]' ❑ u Longitude: ❑ ° = i = q
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dr. oultrV
❑ D Cow
Farrow to Feeder
❑ Layers
❑ Non-Dai
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Nan -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
dumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JA-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
IP7No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
`ji�No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: X —
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): a Q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
§�No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
KYes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W 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
Oyes
TqNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes. check the appropriate box below_
❑ Yes
IRNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 tbs ❑ 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? v
❑
R No
El NA
El NE
tYes
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
I} No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
1RNo
❑ NA
❑ NE
e
Comments (refer to question #): Egplatn any YES. answers and/or'any recammendaWorh commenUse drawings of facility to better explain situations. (use additional pages as necsa•�:
i
T
Reviewer/Inspector Name �/ �'(� y [r,� Z Phone:
Reviewer/Inspector Signature: Date:
�j 12128104 Continued

Facility Number: T 2k — T631 Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 9'Yes ❑ 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? If yes, check the appropriate box below. R�Ves ❑ No ❑ NA ❑ NE
tilWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections tRWeatherCode
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
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
C'No
❑ NA
❑ NE
❑ Yes
❑ No
(�JNA
❑ NE
❑ Yes
53'No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ❑ No [)kNA ❑ NE
❑ Yes �RNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes CgNo
❑ Yes CRNo
❑ Yes ®'No
❑ Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
PlFrec-je- ckc) -tmh 0✓1-Of 1 a9 h�o� ���� V m ro'�i� atp `'rg' �Or7' D 04
Weedy 4 jffef5 ,ham r9� best � �i4°e-
�'-r'n 1Z►?J ob 4
`� w layer, �[e o �r�. �1a
D-a -P�F'�$ n �'e j
l
s�� �
�af S�Ds�ls bed�e
P� aaooq soil y
r tid -,4 titer,
� f�f�e4691
q00_ I%e see 0018A
-7i D � volov,
`I
aT. w, aDCB S� S� / - S��d Cleon0✓-- oilk h o►''M 1J? O "�� Wolfeyo" can .
rvak re .9� �
0', -514 e Cwve > 3 h7J 0
�1 �ff 1JT� �PMa`�b
vm Va%ej o`�' ag �M E nat aoo
�t, Pge Iq
pve-10'a o-) -Retb ��
Pn�' +4��)hceC P�- �~ �� a 4& Place -®r ryes coil �� i i
Whew colAt. dL m
1 1ept crmbY L T s�
MVCh im�ro✓ o�e�fi ark S i�rt tOttec�, I`i�w CVrt�6�S �opk9orx�i I2/28/04
1q. P1?aP k�0 n� VKMW 4CCr ttiH-� V'k J0(k, YW� it C 0�-,

• Facility No. "(P3 Farm Name �rr��Date
Permit COC IC_ NPDES (Rainbreaker
Pop.Type Design Current
PLAT Annual Cert )
Lagoon
©©■��
Spillway
lesign freeboard
Sludge r ' .
My"
"w J�■---�--
Calibrationbate
Design FlowDesign
�-
Actual Flow
c
F--
-�
Width
Actual
w... •� .T/����
Soil Test Date 71
pH Fields
Lime Needed fk _114S011
Lime Applied
Cu _y,,.-Zn ✓
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard It
Rainfall >1" to A4Vjf�
1 in Inspections Z
i�,rdr,fi annP.
120 min Inspections
`f
Weather Codes
Transfer Sheets_
RAIN GAUGE
Dead box or incinerator
..
��
• urn
.
� I fi►
i R ���I�
��� ll!
r ,
MOM' /0(6 (90l'
Verify PHONE NXBtRS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

t
Type of Visit 0� Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral d Emergency Q Other ❑ Denied Access
Date of Visit: Lu_S Arrival Time: Departure Time: i0� h County: S Region: Pr_Q
Farm Name: ��Owner Email:
Owner Name: ftimp_ _ _ ��/li Phone:
Mailing Address: ©1A W!Gl[% $� 3 Y y
Physical Address
Facility Contact: W01 ne— V/161M Title: Own&- Phone No: 5-&7-5y
1,� y
OnsiteRepresentative: Mow ► /6G6 Integrator:
Certified Operator: ALbr Operator Certification Number:A)VA D135-
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 1 =" Longitude: 0 0 = I =
Design CurrentDesign u rent?
:
Swine Capty Poul bon Wet Poultry CapacifvPpulaton
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Caif
ElFeeder to Finish
Dry Pouf
Dairy Heifer
❑ Farrow to Wean
❑ D Cow
® Farrow to Feederloss-"--
Non -Dairy
❑ La ers
El Farrow to Finish
El Beef Stocker
❑Non-1 a ers
❑ Gilts
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
N umber of Structures:
❑ Other El Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes IN No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance ratan -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 2 No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: gjj, — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J"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) �)D F h r t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
JRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
& Are there structures on -site which are not properly addressed and/or managed ❑ Yes
JR 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 ar improvement? Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo ❑ 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
29 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
SR'No El NA El NE
maintenancelimprovement?
-
11. Is there evidence of incorrect application? If yes, check the appropriate box below. JRYes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or t0 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)
�l MddQ 44Y ' S6 On , Sri
13. Soil type(s) Or g 1S
�, N&A IS ', rjr e�4
1 S
--
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�iNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CTNo
❑ 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
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA
❑ NE
Reviewer/inspector Name // .$C c1�+ j Phone: 10I IWIMVRLJ4�3
Reviewerlinspector Signature:%9±1�e_��Date: 'wab. ga__ I
Page 2 of 3 U 12128104 Continued

• Facility Number: Date of Inspection
Rewired 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 appropiate box. ❑ Wup ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes 1RNo ❑ NA ❑ NE
❑ Yes CWNo ❑ NA ❑ NE °
IR 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 V 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
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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
❑ No
J�JNA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
1 Yes
❑ No
❑ NA
❑ NE
❑ Yes
ja No
❑ NA
❑ NE
❑ Yes ❑ No CRNA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
❑ Yes JRNo ❑ NA ❑ NE
❑ Yes
'] No
❑ NA
❑ NE
❑ Yes
EffNo
❑ NA
❑ NE
❑ Yes
F1 No
❑ NA
❑ NE
Additional Corntiieats addlor DrawtQgs
7. fl 04e, mow a (i k:f4$- down bra k ASOrne-17eei aid pnVet-on backf1ye00b6#&i of
%111
One. No bo t spfnWT q-n AcG . 0tw)►-k CU/9'
I I Ne ( fief ov- 'gfg- 31b5 f �� � Phu �b� . .
lla, P10nnl?� d��rnoe� of r ,n f %Wnng,QVV-- Ode �'�� 11 a
d PI���e,Or air, e era�r here ; �cv ; ��co�r p�►l n4-Jo �e Lie yeajx �dRrtas�we
�
y a11Pv fib,► 4r re
� �e9�e ��f Cro� yre lds -4� aoo8,�lory x�� rem �, rn , � � J
alf• Oet Is w411 need -c be -CA l ldftit-h fs ye4i c,017
�l SJ�' -Wye ��d s fo be (16 .a4nw t l , Lyetruij 1� GZ
u vRyDwQ /
&#V Stsv'1* 1I
441e � kc,o� 30 I
14koX r�ra�s ftr �1 ee �ao� ���'�
hf� �H,
Page 3 of 3 12128/04

Facility No. go)-yb3 Farm Name ne-hv Date
Permit COC OIC_ NPDES (Rainbreaker
Pop -Type Design Current
PLAT Annual Cert) -
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
q
Observed freeboard in
c�
Slud a Survey Date Perm Liquid (ft)
_
Sludge Depth ft
Calibration Date
r -
!-----
-Actuai Width
a4V l jib r will Js-efv,-f+ rr� NR�-oc#-IYad�
Soil Test Date (0 Crop Yield `►�jRtl �w
pH Fields Wettable Acres �[� 1 in Inspections 01h'16k,
Lime Needed Yam— WUP 120 min Inspections n
Lime Applied 1 l6t I.'-' RAIN GAUGE Weather Codes
Cu --' in Weekly Freeboard Transfer Sheets .—
Needs P NIA Rainfall >1" � Pi A jl �
Waste Analysis Date al j 5 a
- 60 Da
+ 60 Da
N Amt (lb/1000 Gal) 1 1 i. l 1.7 11FF L4W ). 14 t -1 1 ,Z
Date of last Waste Plan in FRW Date of last Waste Plan at far
A . Hardware T�
Pull/Field
Soil
Crop
RYE
PAN
Window
Verify phone numbers and affiliations

-ti 1 I /l /4-�S4 -*U iL� rpmaj -- I pa )a
-110 la)1}6
b '1 b1 b
-gb - vh--Iwtv�j
�, xvc- --Qb

J
Type of Visit 0 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint OFollowup O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t!t'v CSDVC� Arrival Time: 10O:q0 aW% Departure Time: p4= ID aw. County:-�'~'�s� Region: FRO
Farm Name: p4a-lM wr1'-nok Farm Owner Email:
Owner Name:. WAS r%e Nyt" _ Phone: /6'-9) .4-67-3— 3 `l w
Mailing Address: 610 SZ7µa3/y(,q_)
Physical Address: ll
Facility Contact: _ M Wf'wCA Title:
Onsite Representative: t`
Certified Operator:
Back-up Operator:
Location of Farm:
M
Phone No.-
M
Integrator: f ' !P f
Operator Certification Number: 179 3S
Back-up Certification Number:
Latitude: [—] o='= u Longitude: 0 0 0'E:] u
Resign Current
Desig Current
Design Curren#
Swine
Capacity Population Wet Poultry
Via` p cif population
Cattle Capacity Population
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ Wean io Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
!'-
=3-=n.. Dairy Heifer
❑ Farrow to Wean
_
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dal
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
' ❑ Beef Feeder
❑ Boars
El Pullets
' ❑Beef Broad Co
_ ❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
-MM
Discharges A Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
®NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
[A NE
other than from a discharge?
Page 1 of 3
12128104
Continued

FaCilityNumber: +8, — q6
Date of inspection 06 0; smG
Waste Collection & Treatment
4- is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
❑ No ❑ NA VINE
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): ao
Observed Freeboard (in): �q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No ❑ NA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA [R 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
10 No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
®No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
P9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:]No ❑ NA NNE
maintenance/improvement?
H . is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ® NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[14 NE
15. Does the receiving crop and/or land application site need improvement?
V9 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination r❑
Yes
❑ No
❑ NA
[NNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[UNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
Reviewer/Inspector Name pGt M Phone:
Reviewer/inspector Signature. Date: 06O
12/28A Continued

Fatility Number: 6;2 — 63 Date of Inspection o6 cs 2av
Required Records & Documents
19. Did the facility fail to have 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 ❑ No ❑ NA C@ NE
the appropirate box. ❑ Vrijp ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If es check the appropriate box below. Yes ❑ No ❑ NA WO
p g p y
❑ Waste Application ❑ Weekly Freeboard rA 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?
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
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
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
DaNE
❑ Yes
❑ No
❑ NA
[0 NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
CR NE
❑ Yes
❑ No
®NA
❑ NE
❑ Yes
❑ No
❑ NA
W NE
❑ Yes
❑ No
❑ NA
Q§ NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
® NE
El Yes
El No
El NA
®NE
U Yes
❑ No
❑ NA
❑ NE
Additional;Caents and/or Drawing tnms: "`y ` `�'
t A tt r v '> o r Sy s
l . U►�aS�e �'` S S J� ct 5 urn w�.. kq s f &Gc � rr l PtW `
Mir , � Sa. a-. u t �S r s jai
Arr. top &
'v�r� reC�i ►`paw Q+�ct�ySrS- C�� S)
I
33 &11Dw_%1f Vis64 ire l00 4a-7S • C Isi
12128104

"h, 1
4
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency t' Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: U r 30County:
Farm Name: _{tii L1/7 W cN- Owner Email:
Owner Name: iV! ev r,e,�-C'�� Phone. -
Mailing Address:
Region: 1- /eo
Physical Address: ��,, //
Facility Contact: &:t T v Gy/ r-�fl(h Title: Phone No:
Onsitc Representative: Integrator: zz&4�
Certified Operator: i� �! Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o =' = u Longitude: = o I=] =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
i
❑ Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
[$ Farrow to Feeder
to
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - - - -- .-
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urksx Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b- Did the discharge reach waters of the State? (if yes, notify DWQ)
Design Ctirient
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: F
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 I,No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[,No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 3 Date of Inspection
Waste Collection & Treatment
�+
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes LRNo ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard?
❑ Yes [@ No ❑ NA ❑ NE
-.Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes [W 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 JONo ❑ 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 maskers as required by the permit?
❑ Yes 5; 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 ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J4 No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes rR 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 ❑ Eviidenec of Wind Drill ❑ Application Outside of Area
12. Crop types) , ct 9f , s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
tZ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes P9 No ❑ NA ❑ NE
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 )Z No ❑ NA ❑ NE
&�
Comm (r ersto gttesbOn #) Eitplatn'any YES answers and/or any°recomm�end ttons oir'any
'd
other comments.
Use d�r�aw-tngs„of fattLty to tietter.eaplain<sittii ns: (use ai"dttiona! psg as Qet essary)
.. - L•
T+'d �� ._is;. Y•_ 4wtiy
/i-i_Y /
/ j
�6— Work k 0-P,_W e_j ��D1�lz°Y►cL f Y� �-e� Yilua�0..
Reviewer/Inspector Name
Phone: ff/�
Reviewer/Inspector Signature:
Date: / Z900 (v
12128104 Continued

Facility Number. Date of Inspection / D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 21No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z 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 DK No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
[KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[KNo
❑ 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
❑ No
[KNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
[9No
❑ 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
2q 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
;qNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Q Yes
❑ No
❑ NA
❑ NE
Additiiunal.Caminents and/or Drawings:Ai
cg �J -rD L a v�­ c& I VV,19D—
12128104

IType of Visit 40 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit ORoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number !�(� Dwe of Visit: FZ_/y Time: .L]�
ro—>\ot O erational 0 Below Threshold
12termitted ©'Certified 0 Condition/ally Certified Registered Date Last Operated or Above Threshold:
Farm Name: _Wox,7 Wee,,c�i _ ruf n, County: __ .5c •*y�un
Owner Name: 14/aNdAe
/ 1A1,1 c�7 I / Phone No:. y/V - s4,`7-51,o3 Y
Mailing address: I SIy O d Wren eA SC hoof /tN �o�4,:r] -2 9 3 2
Facilit�• Contact: k/40ki d e 154e e 4 c 4 // Title: Phone No:
t Ph
Onsite Representative: '1 c `7 tnte-rator: c'
Certified Operator: � G r Wee,!�•_ Operator Certification Number: 7 9 3 F1
Location of Farm:
[911wine ❑Poultry ❑Cattle ❑ Horse Latitude Lone.
gitude �' �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ��]❑ Laver F
Da'ry
ElFeeder to Finisb ❑Nan -Laver ❑ Non-Dain,
ow• to Wean q6 6 1005—
❑ farrow to Feeder ❑Other
❑ Farrow- to Finish Total Design Capacity
❑ Gilts
❑ Boats Total SSLW
Number of Lagoons I LLJ Subsurface Drains Present HU Lagoon Area U Spray Field Area 1
Holding Ponds / SoUd Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is anv discharge observed from any part of the operation? ❑ yes
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes �o
b. if discharge is obsen•ed, did it reach Water of the State? (If yes, notifi• DWp) ❑ 1,eso
c. If discharge is observed, what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 o
2. Is there evidence of past discharge from any part of the operation? ❑ yeso
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ yes [91No
Waste Collection & Tryatment r
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ yes [3'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches):
05103101 Continued
i'

Facility Number: 2 — t/&j I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes [awo
❑ Yes ©No
❑ Yes 2No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [Ilo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [allo
Waste Antrlisation
10. Are there any buffers that need maintenance/improvement? ❑ Yes [3NO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes R&
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [I10
14. a) Does the facility lack adequate acreage for land application? ❑ Yes El-N6
b) Does the facility need a wettable acre determination? ❑ Yes ❑-Irlo
e) This facility is pended for a wettable acre determination? ❑ Yes 9-10
15_ Does the receiving crop need improvement? ❑ Yes 9'1ffo
16. Is there a lack of adequate waste application equipment? ❑ Yes �o
Required )Records & Documents
17. flail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
©-wo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
daps, etc.)
❑ Yes
[ale
Does record keeping need improvement? (ie/ ' ' ' n,, , vWcaste-zra-Siysis & reports)
❑ Yes
Q-No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[}R€e
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
EINo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
QNe
24. Does facility require a follow-up visit by same agency?
❑ Yes
D-No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ENo
JET No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�-i d II yrm,1'°
tiUomments (referlWiluestion�#} Eiplarn any YES`iinswerg atrd/ar;any recommcndattons or any3gther t onrmeQts. " ;°
ary
wwgs --fill to better e><pWil srtuatronsi (use: additroili pages as recess Use dra YY{{[icld Copy
� ❑Final Notes
y
If No Pu,►�/o ng �ias boon cfa�e H4 C-d o� riR�cy
Ar, V"Pte4 %frJ r/CIIS 1Fo Sp -sr rj,- krr4odj pi(.,� rveeli, Nli. WI s
G 4iO3i!' SAn�/L° A.,f tleE�� fAt Woody -sapl`ngt 4"ve Leo." e-'e"ev"I S' IaJG% .So &"d LdXAV-
r
p Mori( f 1
Qra �rr.. i- �i c� er��
Reviewerllnspector Signature: 6
05.103101 Continued

Site Requires Immediate Attention: rto
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:=� ���, 1995
Time: Ub 10
Farm Name/Owner: l,.)civ..LZ_rec c1n ;a a217
Mailing Address: ��- ] _�, x t xq A Imp
County: SQ,np.Son _ -
Integrator: C'a tm \ s ., T,7e c].5 -e c _ — Phone:
On Site Representative:._. ,I SAOi s,, . Cam.mU1 Qad s Phc
Physical Address/Location:. R 1471 _ 1 N.:1e t1e•-IN- or
Type of Operation: Swine X Poultry Cattle
Design Capacity: Number of Animals on Site: _ t000 Scxz
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3e ° -INY' Longitude: ° -31' cam`
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: a Ft. o Inches
Was any seepage observed from the lagoon(s)? Yes or(& Was any erosion observed? Yes or
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? for No
100 Feet from Wells? (i& or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oKlo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or -other
similar man-made devices? Yes +�1 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No s wo L ,v %-: v_I
Additional Comments: r. iper_ 40.,t.
ter- • a � - w �� � � ■a..
Inspector Name f�k,Q;Rt 0 �'e Signature
51j;1-c -711 Q(d,
Fa.y e4ie";(je NC .28301
cc: Facility Assessment Unit Use Attachments if Needed.