820542_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

it
1 416
t ype or visit: L�ompitance inspection V Vperatton tceview V titructure Evaluation V i ecnntcai Assistance
Reason for Visit: Q-ftutine O Complaint 0 Follow-up O Referral 0 Emergency Q Other Q Denied Access
Date of Visit: - / j Arrival Time: ! t?C7 Departure Time:; D!7 County: Region:
Farm Name: Dn_z b I 7- Owner Email:
Owner Name: ; k� Dyl� Phone:
Mailing Address:
Physical Address:
Facility Contact: C/11-;, j _�k tri— Title: CGU a'i r o�
Onsite Representative: �-fIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
s
Certification Number: pg 1 6 b;;2—
Certification Number:
Longitude:
Discharges and Stream Impacts
k. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yescl
-No DNA ONE
[—]Yes
Design Current,)
..
Design
CurrentCnrrestt
❑No
❑ NA
�,
Swttte .
r
Capacity;, Pop.
Wet Poultry
Capacity.
Pap.
Cattke
Cspactt3* op.
Wean to Finish
La er
Dairy Cow
~-3
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
IDairy Heifer
Farrow to Weanrc-12)"malici
gn Current
D Cow
Farrow to Feeder
Moulltrvy��11�
po o�
P
Non -Dairy
Farrow to Finish
Layers.
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
W' r
Poults
II
Other
I I
10ther
Discharges and Stream Impacts
k. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yescl
-No DNA ONE
[—]Yes
❑ No
❑ NA
D NE
[:]Yes
❑No
❑ NA
❑ NE
Page 1 of 3
❑ Yes
[:]No
❑Yes
�No
❑ Yes
RNo
DNA ONE
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

+ Facility Number: - Date of Inspection:
Waste Collection & Treatment
44 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo [:INA ❑ 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�
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes K 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?
❑ Yes
( No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ER No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ga'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
the appropriate box.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0,No
❑ NA
❑ NE
maintenance or improvement?
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes FNo ❑ 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): �^/ A— p
13. Soil Type(s): 1'lfu`re:u'Ik
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop andlor land application site need improvement? ❑ Yes allo [:INA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes Eg 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
®.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 MNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes CKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes P lJ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date o[ Ins tion: — j
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 �o ❑ 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 I,No D NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
If yes, contact a regional Air Quality representative immediately_
3Q. 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-Anspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [SNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes
Lallo
❑ NA
❑ NE
❑ Yes
LK No
❑ NA
❑ NE
[::]Yes
Lg pVo
❑ NA
❑ NE
Mlrawi
ments (refer to gnestioa #) Explain any;YES answers and/or,any additional recommendations or any other �cominents. k
ngsEof faciliity to better, explain situations!(use additional pajes as.necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
f+n m-EfZrry pt4 ;6- 41
�---
Phone:�.�� f-�l
Date:
2/412015

S?z--/ —. "Z & 1i,
(Type of Visit: Q'Co="tim
ce Inspection O Operation Review O Structure Evaluation O Technical Assistance j
Reason for Visit: e O Complaint O Follow-up O Referral Q Emergency () Other O Denied Access I
Date of Visit: F�— Arrival Time: O ,D Departure Time: County Region: iJ
Farm Name:Fc�rw^ Owner Email:
Owner Name: �_S A Tare-,! Phone:
Mailing Address:
Physical Address:
Facility Contact: G�1 i 5 11 a ck5 rr Title: &,017?oro" Phone:
Onsite Representative: - Integrator:
Certified Operator: S te/ Certification Number: _.-u l p -
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
rrent
Manac�vopov
Swine Capacity Pflp.
Wet Pt�ultry
Capacity
Pop.
Cattle .
Wean to Finish
Layer
Dairy Cow _ b —
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to FinishDairy
Heifer
Farrow to Wean
Deslign
Current
Dry Cow
Farrow to Feeder
D , &P,oul
Ca aci
Po
Non -Da'
Farrow to Finish
La ers
111cef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
I . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page l o. f 3
❑ Yes ONo ❑ NA EINE
[:]Yes ❑No
❑ Yes ❑ No
Yes [-]No
❑ Yes ja No
❑ Yes >o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[:INA ❑ NE
2/4/2014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eg-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No ❑ NA ❑ NE
Structure 1 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 KNo ❑ 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
JE�No
❑ NA
❑ NE
waste management or closure plan?
❑ Yes
g No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E2�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
9. Does any part of the waste management system other than the waste structures require
❑ Yes
En No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E2� No
❑ NA
Waste Application
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ NA
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z 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 Type(s):"�r/rYl' Bu rr;�i��>/Jlt7i—Suiliu,r._ i2(;1�-■ f /l��/1 u�
13. Soil Type(s): /`i`„ / Vvit 1 e: / -17 a /15Gc.i -t s /
14. Do the receiving crops diffWfrom those designated in the"CAWMP?
[—]Yes
allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
g No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Callo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
S No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E2� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
O No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 53,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 JL No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/412014 Continued

■ r
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes gNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5a, 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 to provide documentation of an actively certified operator in charge? ❑ Yes C�5 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[KNo
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
I] No
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
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
allo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
_WNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
_No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
_JZ_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
lUse"drawms:ofa�ility to better explain situations fuse additional pales as necessarv)mmendations or any other eom, nta.
Comments refer to me
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V
Date:
2/4/2014

-c- 7--3- / s
Type of Visit: O<om�e Inspection O Operation Review Q Structure Evaluation ()Technical Assistance I
Reason for Visit: outine Q Complaint 0 Follow-up O Referral Q Emergency Q Other () Denied Access I1
Date of Visit:
Arrival Time: ' OD
Departure Time:
County- Region: i'T D
Farm Name��-'l
`
Owner Email:
Wean to Feeder
Non -La er
Owner Name:
�1 S �T��Q •-+..�
Phone:
Mailing Address:
Physical Address:
Facility Contact: ' ; r-- Title: tq-W n,,� Photle:
Onsite Representative: Integrator:
Certified Operator: Certification Number:'2/4(0D.7_
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop_
Design Current
Cattle Capacity Pop.
Dai Cow O�
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P,o
Design
Ea Bei
Carrent
P,o
Dai Heifer
Caw
Non -D au
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Qther
Other
Pullets
Teske s
Turkey Poults
Other
Beef Brood Cow
Discha�es and Stream Impactsand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 5po ❑ NA ❑ NE
D Yes ❑ No
❑ Yes [—]No
❑ Yes ❑ No
[] Yes Sa'No
[:]Yes RLNo
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 214/2014 Continued

J Facility Number: - Date of Inspection:
l
Waste Collection & Treatment
i 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
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 3 -fill
Observed Freeboard (in): l
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
❑ YesNo
❑ 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
fig -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[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
JF�No
❑ NA
❑ NE
maintenance or improvement?
Waste Ayalication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JR No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus p 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): vr✓ e' /►-
13. Soil Type(s):r`� ;

,F'acili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Callo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
allo
❑ 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
RNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® 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
EgNo
❑ 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
JZ.Vo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the pmpriate box below.
Yes
[:]No
❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond �l her:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
[l-No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
25 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
RNo
❑ 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 pagei as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 22'Q'�%33.-oqD
Date: /_ �J
2/412014

fit,• ,_ - _ - ,d i 1.—
i ype or visit: (bTC:ompliance inspection V Operation Review (_) Structure Evaluation L) Technical Assistance I
Reason for Visit: GrRoutine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: ; �f -
Departure Time:r V' County:
Region: fft�
Farm Name:
r /y,
Owner Email:
❑ NE
Finish
La er
Owner Name:
(' 1' D-QCk S &I
Phone:
Da Calf
Mailing Address:
Physical Address: IM, 4 Pj b!An
Facility Contact: Cjy 1 5 LyankSo'-_7 ^ Title: 0 WaI2 - Phone:
Onsite Representative: �� �1 s4 Integrator: n ��
Certified Operator: Curlis �'Q(�2Sd� Certification Number: AlyB oil&oa
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
49,+t'3zw
DeagnCurrent ;}
Design Current
W r� V�'� P
Design Current
I�
Swine51"147-C
Po et+ Dolt Ca acr Po
ry '_ ry p
e Capacity Pop.
Cattl
® No
,.. a, y
❑ NE
Finish
La er
Da Caw 400Feeder
❑ NE
Non -La er
Da Calf
o Finish�
� �
Design Current
D . PoW Ca aci Po -
DaiHeifer
D Cow
Non-Dairyo
o Wean
ElBoars
o Feeder
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
11111. &Miftv
Turkeys
OthuAdEMEMETurkey
Points
Other
Other
Discharges and Stream Impact
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 C3 -No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

acili Number: jDate of lns ection:
Waste Collection & Treatment
❑ Yes
[ No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: WA T
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
Spillway?:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
Designed Freeboard (in): 3$
Required Records & Documents
Observed Freeboard (in):
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
(R No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
the appropriate box.
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
151 No
❑ NA
❑ NE
waste management or closure plan?
21. Does record keeping need improvement? If yes, check the appropriate box below.
ER Yes
❑ No
❑ NA
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
FK] NA
❑ NE
Page 2 of 3
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): &L -in I ",AA f -k 4- Ptq ' i I a , 1/1 �Oy" r �-flln
p `
13. Soil Type(s): f P ti f07
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F!�,] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
ER Yes
❑ No
❑ NA
❑ NE
JE Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
'® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
FK] NA
❑ NE
Page 2 of 3
21412011 Continued

stili -Number: - Date of Inspection:
[R Yes
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [51 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes J'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
❑ Yes
List structure(s) and date of first survey indicating non-compliance:
❑ NA
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[—]Yes Callo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No RNA ❑ NE
Other Issues
❑ NE
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?
❑ NA
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.
[R Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: VA �/I p j a '
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[@ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Wor}elrl� bias a smal Ieak, which 115,1. o n
�S, StYrie dulls ht�( (rm.�
a,, wa®wtj days , 01y 01.P- Naks� fie vAa#4 SefI �� a� lz h�'c rI w0 r0it ��yiRki, S Sf}' IJ�J se Ott � iP�iCl� . �Q !Zan-edn-e_�Cvjl-
� 7� S4'��� Q/' � ���
ea k [ ,cal oo -as 1b5NAmo j11azs "Y'v hd aA *A P
PAY, - t? err ry
cop as a -e m0a'e CYC -C ay, aero-a�J, flare mkr Uf oy
yiel dor D L3
( � � bl'� �9� p
VV c �i'a0r� 1'Y1Q�i y h/�+1%J�luc7?iie
o'Sel !,°ill °Li f V
A It 11 Wo)k Sias e. -rvr HI (ab) �(J
Wok_
bU `For of w �fr ; itIRCS s`fC a�� �t/�
?lm ` 01 Q 1-7,
C'�7�Ui�''
NO�Q a13 -pit j �rfibiiWE t uke Yvoj+e Sieh -j
Reviewer/Inspector Name: �2. oo ri S�t� Phone: 11
Reviewer/Inspector Signature: %Frf, Date: u a
Page 3 of 3 2/412011

L
Facility No. `�^Farm Name
Permit _-,#" COC
4 tT Date 1 1aa f
OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
L iq uid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
r - .IM,
Actual Flow
moi'--_-�--
Design Diam.
�77------
Soil Test Date �a0 Crop Yield Transfer Sheets
pH Fields Wettable Acres ✓ RAIN GAUGE
Lime Needed WUP Dead box or incinerator
Lime Applied Weekly Freeboard ✓ Mortality Records
Cu -i Zn -I 1 in Inspections ✓ Check Lists
Needs S (S-1<25) 120 min Insp. ✓ Storm Water
Needs P Weather Codes
5r -t- A.,,
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Curl 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac
4, -?),
1�
►J1 ; ' J L�.�� l - I
QLL _
„
Q44
qA-
q �
i�
V
1
r
5r -t- A.,,
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Curl 3000= 108 Ib/ac; Zn -I 3000= 213 lb/ac
4, -?),
1�
PCI IS uj a°3 �
QLL _
„
Q44
qA-
q �
i�

1 h VIM3 QVs 1D�a3jfa-
ivision of Water Quality
Facility NuM er ®- 974;tMffffiiiiil,
ffiftn)'i
of-SZ
l and Water Conset-vation
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: R'011>. Arrival Time: (- Departure Time: County: of '
Farm Name: bovolp EQ Owner Email:
Owner Name: OkAj'r A. ttyek,Sa-, Phone:
Mailing Address:
Physical Address:
Region:_
Facility Contact: x--11rlT an(kso" Title: ©]NH$" Phone:
On site Representative: Chrir (�r �(}') Integrator: f1<)Q
Certified Operator: r sr Q CHCS Lia Certification Number: Ay% R1420,
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
'°' i
Uestgn Current Design Current Design Current
7FZder
Z C act.. Pop. tgPo it� C p"acity Pop. CafEle Capacity Pop.
nish i La er Da Cow
eeder Non -La er Da Calf
inish ;' Dairy Heifer
Farrow to Wean 5 `e Desi n Current D Cow
,�Fy: 5�5��:f�bicu � lP_ . �+is"�Y1!tl?
Farrow to Feeder t;.a D . PouI- : Ca act P,o P. � Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets _ Beef Brood Caw
't.0111
Turkeys
Other Turke Poults
Ocher Other
Disehar es and Stream Impacts
I . Is any discharge observed from any part of the operation? [::]Yes P 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
E; -No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Coritinr�ed

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FKJ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ No E'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 CR No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [�JNA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
F�j 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
2 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
'FkCI No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
® Yes
[:]No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
[—]Yes
[RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
CK No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
'RNo
❑ NA
❑ NE
Comments (refer to question ff): Explain any: YES answers and/or any additional recommendations or auy other commeafs.
Use drawings of facility to better explain situations (use additional wees as necessarv).` K
5. �varfe s he leaks s If 41 Wa?-p-peyinforif al- lsecy4 ou ian� ,
1St �� I S►a`� (t i'�Ple- j lm i n t1 a� J b�-saM� In
y d1,
W a� �~2 aia � ore 9 oaf on I o da '•s :e rh' r r� bac��-��s , �a
S v� Yv Pr s 0 ( i a Mo �f Aelds blod C}'�
rc(d''- was S�7 �, ' �� ��a � (4o,s1�siV/
Y e a. js r
/Doo 9a� G�o 4p yvarh ria Pl�a,� y a n�W asje clay.I�f -evr
6o&4 r e cods cT f�'►�fw t r>° .
as, F&M ha, Q w4,4e_ 5 W, e�k j (ti-kood o f
,z, ' i1�j11)D�► r✓ e-0�D� fleall-ft9�rncr� svhs�f� ++ �e d� jYs �x� Gh � �� � ,
C�ea �
(� pje'�fe objaj� hays cap- �vih PG�''fia-, ►� Cm ►�'ak oredirb be
2 of -the dao mai i", ih j11celde
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
�'Cuj SrAnv)Pf-
Phone:g1M 3-3_W/& 7(Y)
Date:
1/412011

Facili Number: - Date of Inspection: 1011X
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. �T
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.)
❑ Yes 2 No ❑ NA ❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes U 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 f,;� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F�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 N No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S�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 p 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
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure an&or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ Yes �2 No ❑ NA ❑ NE
[:]Yes �-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes f�j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes � No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other -
21. Does record keeping need improvement? If yes, check the appropriate box below. Yds No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ MonthIy and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes &�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No E'NA ❑ NE
Page 2 of 3 2/412011 Continued

Facility No. Farm Name 00,,� I t _ Date 11�,
Permit COC OIC NPDES(Rainbreaker PLAT Annual Cert Daily Pipe)
t
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?
moil Tes DJate
Crop Yield ✓
Transfer Sheets
pH Fields
Lime Needed ✓
Wettable Acres , i
WUP
RAIN GAUGE
Dead box or incinerator
Lime Applied
Weekly Freeboard
Mortality Records
Cu -I Zn -I
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp.
Storm Water
Needs P
Weather Codes
Mo
N (lb/1000
W �'zi-zwvsh1CC ai l'i
Verify PHONE NUMBERSrand affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
is Ian 1114
I la -.a q 11 a 01a
Ito
an
1 I�� C p
J
�r��j�l�Jl fIr
. •_
I ■aSii��
�
ur 94M
I
Mo
W �'zi-zwvsh1CC ai l'i
Verify PHONE NUMBERSrand affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
is Ian 1114
I la -.a q 11 a 01a
Ito
an
1 I�� C p
J

BLJ�'0.5 g- /Z - moo/ O
Type of Visit Cir Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9:0.5~A— I Departure Time: County:
Farm Name: O u role- —.3 Ir F v,,,_ Owner Email:
Clwnpr Name• C i ri lr f'5 .i G1 ECSeA/ phnnp•
Mailing Address:
Region: 1=7ZO
Physical Address:
Facility Contact: C— _ 1VO 5 2a&CO'i Title: Dwnle_✓ Phone No:
Onsite Representative: GG�v-�3 _dx-%(C56,J 1=�-� Integrator: �Gdw
Certified Operator: L° ki"s-S Operator Certification Number: Z J I� b Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=g
=61 Longitude: =0='
o=' = ii
Discharees & Stream Impacts ,�
1. Is any discharge observed from any part of the operation? El(ij
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
0'1�A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
E9<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[3<o
[INA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
E:1 Yes
L f No
❑ NA
❑ NE
other than from a discharge?
Page I of 3 12/28/04 Continued

Facility Number. g2 — a2_ 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 31o ❑ NA ❑ NE
Structure ''I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: a..ik l�
Spillway?: X/A
Designed Freeboard (in): 3 eg
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L7No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Lf'No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No El NA
[__1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElL' Yes
—
Hglo ❑ 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
,.,
Ey'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to ❑ NA
e<'
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below.
El Yes
,� _�
L3'tvo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
I l �esw-rr
12. Crop type(s)e(s) ��v� 6%— _� �f �Qy ICKAP1k 4 ) , 57,,t/
,t/ �
13. Soil type(s) AIA PAJ
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 E`_fNo [:1NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? Ela Yes oo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 2<0 ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �<o ❑ NA ❑ NE
Comments(ref r to+questeon #): IEiplatn any YES' answers'and/or any recommeudat, n or any other co men
v ,� k 4,
Use drawings of factlitv�to beter explain sifuahons: (use additional pages as necessary,).': ,
Reviewer/inspector Name I /�e.:ves,� k Phone:/Dp-i��•3 3�0
Reviewer/Inspector Signature: Date: p `Ola ZD/O
/1/18104 Continued

Facility Number: 92 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
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?
❑ Yes
[BNo ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9<oo ❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
L�or El NA
BI
[:1 NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
B o ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ,,N�o El NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElE Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CI 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
Me,
❑ 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
,��
L7ro ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
El Yes
�,��
Ehgoo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑'1qo__0
NA ❑ NE
w
AdditionalFComiifi#o and/oi,Driwings
12128/04
12128/04

C
A 1 u r
! f
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit t'Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:I � / Q� Arrival Time: l±{ : SS M I Departure Tfine: � County: ` g' f Region:`
Farm Name: "' "hf`'o j Blm `�"T07nner Email:
i
Owner Name: 1��tt ��I I- - flt'1 iC`n Phone:
Mailing Address:
Physical Address:
Facility Contact: &rl'r TQcks(h Title: ' OyAe ' , Phone No:
Onsite Representative: -ks -
Integrator: 1) 10
Certified Operator: [ //�H's- _ V. zcC so' Operator Certification Number: AKE a)
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o =1 = Longitude: =0=1 = u
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 J@ No ❑ NA ❑ NE
❑ Yes
Design Current
Design Current
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Design C*nrrent
Swine
Capacity Population
Wet Poaltry Capacity Population
Cattle
Capacity Population
Finish
❑ La cr
Dai Cow
G 100
to Feeder
❑Non -La er
❑ Dai Calf
qllkklj, 10
r to Finish
❑ Dai Heifer
'
w to Wean
Dry Poultry.
❑D Cow
to Feeder
—
Non -Dairy
Fto
to Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
PulletsTurke
❑ Beef Brood Co
s
❑ Turke Poults
Number of Structures:
❑ 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 J@ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Q No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
12/28/04 Continued

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 15�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes GgNo ❑ 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 D No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Facility Number: $a —' Date of Inspection ^i rof�To�
❑ NA
Waste Collection & Treatment
15. Does the receiving crop and/or land application site need improvement?
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes lj '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:
❑ NA
Spillway?:
17. Does the facility lack adequate acreage for land application?
Designed Freeboard (in):
[9 No
Observed Freeboard (in): '� 4 +
❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes §9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NA
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes N No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 15�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes GgNo ❑ 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 D No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t@ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
INNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
CR No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J,;j�No
❑ NA
❑ NE
Comments (refer to.question #): Explain"any YES `answers and/or any recommendatio s or any other conwaiments F_
Use drawings OUOlity to better explain situations. (use additional pages as necessary}
Reviewer/inspector Name Phone: Q�a L
Reviewer/Inspector Signature: Date: U Q q t1V f
V 12128/04 Continued
I

aN1
Facility Number:` -- Date of Inspection -J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IN No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ''Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 151 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 $a No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No L'NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No I2 NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes IRNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
WA
❑ NE
Other Issues
�oie coal s� , o� -- �o c��yy`7
,CA� 9 � I? t
s l",�tyf �� of��
0/14\ s 0 P
j I
1, vv 1jow 4r s ma! t p h r Ma
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
15?No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER 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
t4No
❑ 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
[ff 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
UNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Additional Coin ats aDiL'
I, SM411 r ddle c6- h7&a& IDS not -PtwMj
c� j a ysif'r�� 5 S Gt� e�-k ofvr I�Iq }yak 01a I s� a p
dw
�oie coal s� , o� -- �o c��yy`7
,CA� 9 � I? t
s l",�tyf �� of��
0/14\ s 0 P
j I
1, vv 1jow 4r s ma! t p h r Ma
comer a, -eldts , So1be6nf loose 9004,,
I� i Q so I reed
I�Imf war a fe e t)
r
Vy", d' so i I ems-- cmaipts- h, '61d C� year,
�V? It k� rf b
°,
12!28/04

p I r
Facility No. � Farm Name Dp6 l P T � Date ! 1 It
O l q
Permit COC OIC NPDES (Rainbreaker PLAT Annual Cert)
Pop. Design Current FB
T e Drops
{ j
Lagoon 1 2 3 4
5
6 7
S illwa
Design freeboard
_
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
LfI►iiI� it+�� f .
Calibration Date
Design Flow
Actual Flow
.# SoilDesign Width,
Actual Width
Test Test Date / Wettable Acres RAIN GAUGE
pH Fields WUP Dead box or incinerator
Lime Needed �,WeekIy Freeboard Mortality Records
Lime Applied 5 I iSlpr$ D 1 in Inspections �� Liyyl qg+I- OV4
Cu -1 Zn -I JA[ 120 min Insp. �{ sprig
Needs P _ _,,�� L Weather Codes
CropYield .�, ' �, Transfer Sheets-�►! �10-3�ab��t'°
Verify PHONE NUMBER§ and affiliations
Date last WUP FRO to ��i
Date last WUP at farm 40 1 �� App. Hardware � a-3' 1
pec ���Q
FRO or Farm Records +
Lagoon #
Top Dike
Stop Pump
Start Pump`1S 5
Conversion- Cu -1 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac rD
-aAm-
�� �o� ' 9
S � , 11f
��W, c �.
• 1 .. +�
.,.. n.�.
Verify PHONE NUMBER§ and affiliations
Date last WUP FRO to ��i
Date last WUP at farm 40 1 �� App. Hardware � a-3' 1
pec ���Q
FRO or Farm Records +
Lagoon #
Top Dike
Stop Pump
Start Pump`1S 5
Conversion- Cu -1 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac rD
-aAm-
�� �o� ' 9
S � , 11f
��W, c �.
LfI►iiI� it+�� f .
Verify PHONE NUMBER§ and affiliations
Date last WUP FRO to ��i
Date last WUP at farm 40 1 �� App. Hardware � a-3' 1
pec ���Q
FRO or Farm Records +
Lagoon #
Top Dike
Stop Pump
Start Pump`1S 5
Conversion- Cu -1 3000= 108 Ib/ac; Zn -I 3000= 213 Ib/ac rD
-aAm-
�� �o� ' 9
S � , 11f
��W, c �.

-vi
L
t/ "h
At Ll
souvb
S-0 -W�v , o o
�v�
a e} i
025 Lllkd --(,b 4L
b
Ep) 'jo
�I IS
*d
Z�(90
GdAkob,-)
bOK},�

Il_ .
6 res U .l 11P 1a i btOo
Division of Water Quality
Facility NumberQja Q Division of Soil and Water Conservation
. _.... _ O Other Agency
Type of Visit Nk Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency ()Other ❑ Denied Access
Date of Visit: Arrival Time: ;%1 � Departure Time: ..3Q County: Region:
Farm Name:_ r11�^ Owner Email:
Owner Name: aar(.f- QCkso Phone: 7-21L7a
Mailing Address:
Physical Address:
Facility Contact: ChPI S ;T-,2Ck3Qq Title: 0 WA3L Phone No:
Onsite Representative:
nnLL rl }a 01Integrator:
Certified Operator:
Ch A V QG CS (� Operator Certification Number: VA Qi &Oa
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: E:10 0 ' E u Longitude: Ell) ❑ ' ❑ u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[E]Layer
11 ❑Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
Design Current
Cattle Capacity Population
[RDairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
[INA
❑ NE
❑ Ycs
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®-No
❑ NA
❑ NE
❑ Yes
5?No
❑ NA
❑ NE
12128/04 Continued

1?acility Number: i5a —,5qal Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes IRNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? [--]Yes ❑ No ❑ NA [--INE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -e-Tih
Spillway?:
Designed Freeboard (in): 3 $
Observed Freeboard (in): -7-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
IRNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
14. Do the receiving cropsdiffer from those designated in the CAWNCP?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
C' No
[:INA ❑NE
through a waste management or closure plan?
15. Does the receiving crop and/or land application site need improvement?
f&Yes
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
[,�R No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA [:INE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
17. noes the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
El NA ❑ NE
maintenance or improvement's
❑ Yes
CRNo
Waste Application
❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
I'No
❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
CKNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
17. Crop type(s) Cof
dgI 9m✓ !1 t Tttl,v. P#)*.-eJ, s� Of &01h rn lXnls;
,,
13. Soil type(s) tjc�lfVVj 11P i PI) [iLV
14. Do the receiving cropsdiffer from those designated in the CAWNCP?
❑ Yes
('No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
f&Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?[] Yes
CH No
❑ NA
❑ NE
17. noes the facility lack adequate acreage for land application?
❑ Yes
52 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CRNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ZMAIJ S[W {E g- Phone q @ 4n=x Sao
Reviewer/Inspector Signature: &JAil Date:
U 12/28/04 Continued

Facility Number: 11a —iO Date of Inspection ll.5J2g1>JA I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? IRYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M tato ❑ NA ❑ NE
the appropirate box. ❑ VVrUp ❑ Checklists ❑ Design ❑ Maps ❑ Other ;
21. Does record keeping need improvement? If yes, check the appropriate box below. r9Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 19 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [&No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
ERNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[SNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Ca NA
❑ NE
Other Issues
VVel 1047 -f i eldr (-excei4 lij cr+d rgcoais,
A
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JR No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER 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
N No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
IgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IgNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
y r Hust lime- 1 fo ti a -�-o�1s /rtc. b ef-&e Z7-u't-P_ a 00
a
I q, Cuti44 Coli M AbimW nc# A4. X 11 moil a Copy
Lana wave gQF W YN ai-1���
VVel 1047 -f i eldr (-excei4 lij cr+d rgcoais,
A
�yyp scsi Iin l . # jq ct fr48 W Sl (/ -i'h is spy/f,
D4ifJ� r
rW 11(&k o m- e ms¢ cjwrew tw *
FrI
/2/28/04

I 5`m
Facility No. 464Farm Name
PermitV W, COC b(CL—
Pop. Type Design Current
i ',�
pp"( U �'al Date 1al
OIC NPDES (Rainbreaker PLAT Annual Cert )
3217 -AND as .
02MMM
Lagoon 1 2 3 4
— 5
Spillway
Design freeboard
rj 0060000jo. FMM�ff,'M
Observed freeboard in
Sludge. Survey Date
Sludge Depth ft & %
Liquid Trt. Zone ft
Calibration Date
Design Flow
Actual Flow
Actual
2 13
0
Soil Test Date z I� �l*� h -1-11
1 in Inspections ..�
pH Fields Crop Yield120 min Inspections
Lime Needed Wettable Acres L Weather Codes
Lime Applied WUP Transfer Sheets
Cu Zn Weekly Freeboard ✓ RAIN GAUGE
Needs P Rainfall >1"q 31iq_�.ID Glx
QI(OUK ��,_-—t'��}�i &V
(stmt 06L(oMs ' . ;�a'Ab lDtr PAN — tk(q�0, ,qr laT
Verify PHONE NU ERS and affilia ions
Date last WUP FRO �Ib3 Date last WUP at farm
10k w -t+m �— 10(, rev
FRO or Farm Recgr 4 � �dod- tod iva
Lagoon #
Top DikeMbee Dec
Stop Pump rlijla—►1S .. -A_M,*vAM*_ 14
3�AV
Start Pump t,4 9 s�%
%.+-S
I lE ja�ta�'l r
App.Hardware SII
1103 --Am(;R.GV�7
ice,—loo 1b /plc 1:)5iw oemirk"
5,f j �.�� 3.,:) t- yrs -
Q,re [ a-3 ej 0 .
..
..
000 Gal ... PM
rj 0060000jo. FMM�ff,'M
(stmt 06L(oMs ' . ;�a'Ab lDtr PAN — tk(q�0, ,qr laT
Verify PHONE NU ERS and affilia ions
Date last WUP FRO �Ib3 Date last WUP at farm
10k w -t+m �— 10(, rev
FRO or Farm Recgr 4 � �dod- tod iva
Lagoon #
Top DikeMbee Dec
Stop Pump rlijla—►1S .. -A_M,*vAM*_ 14
3�AV
Start Pump t,4 9 s�%
%.+-S
I lE ja�ta�'l r
App.Hardware SII
1103 --Am(;R.GV�7
ice,—loo 1b /plc 1:)5iw oemirk"
5,f j �.�� 3.,:) t- yrs -
Q,re [ a-3 ej 0 .
..
..
F.' 1�=.2I
~
ISM
/ •• ��
I � !,� � MIS I ;
loll iiT. AL'i�
Cly/c� .rr/
=1 NUIN
(stmt 06L(oMs ' . ;�a'Ab lDtr PAN — tk(q�0, ,qr laT
Verify PHONE NU ERS and affilia ions
Date last WUP FRO �Ib3 Date last WUP at farm
10k w -t+m �— 10(, rev
FRO or Farm Recgr 4 � �dod- tod iva
Lagoon #
Top DikeMbee Dec
Stop Pump rlijla—►1S .. -A_M,*vAM*_ 14
3�AV
Start Pump t,4 9 s�%
%.+-S
I lE ja�ta�'l r
App.Hardware SII
1103 --Am(;R.GV�7
ice,—loo 1b /plc 1:)5iw oemirk"
5,f j �.�� 3.,:) t- yrs -
Q,re [ a-3 ej 0 .

r t Y 1, r i i .i7 Jr
C11�� Watt" ljJ
` i OF Division of Water Quality
Facility Number a sy O Division of Soil and Water Conservation
O Other Agency
Type of Visit gr Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit �RRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: alJE] Arrival Time: $i% Departure Time: (} County: Region- PAO
Farm Name: 6bLe� T �Ltl t _ _ _ Owner Email:
Owner Name:�^� _ _ QCid 1 _ Phone: 910"sk- rIa.1
Mailing Address: (5�(Q NIF4 PA �
Physical Address: r��L.
Facility Contact: chm _U-ack% , Title: Oh'*e,- _ ____ Phone No:00 C
Onsite Representative: Integrator: n laZ
Certified Operator: Gh l ka�— Operator Certification Number: S(20a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
= = Longitude: =0=6
°❑6 [= W
Swine -
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑
Non -Layer
Dry Poultry
❑
Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
0 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 Current
Cattle Capacity Population
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system`? (if yes, notify DWQ)
?. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes & No [INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NF
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
El NA
❑ NE
[_1LB Yes
t�No
No
❑ NA
❑ NE
12/28/04 Continued

Facility Number:Sa,-542.1 Date of Inspection - ll
AL
Waste Collection & Treatment
Reviewer/Inspector Name Q Phone: �t%i0� tip 33Qa
Reviewer/Inspector Signature: .. Date: If
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X 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: Tm
Spillway?:
Designed Freeboard (in): 3$
Observed Freeboard (in);
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
OrNo
❑ NA ❑ NE
through a waste management or closure pian?
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
VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 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
Cd No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
54No
❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑Yes
W No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 1 O 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) Onofaj 8el � , SG OS . A 6fAg Sf11t9'AV.Bd
'SQ ka' j
13. Soil type(s) j6d j Qty
14. Do the receiving crops differ from those designated in the CAWNIF?
❑ Yes
fi'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
'Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
10 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
7
Reviewer/Inspector Name Q Phone: �t%i0� tip 33Qa
Reviewer/Inspector Signature: .. Date: If
v 12/28104 Continued

Facility Number: a. —Mj I Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JR No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Ea Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall UStocking UrCropYield ® 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 0 NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
f5l 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
Ej No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
al. ` hme- s �, -ev� iwk plewd vra_ rins e ��PLO ye J� eb-M ,, Was�c ala s
"of Iva, a,ql
lvffe�e� gffer , 00j :t tarda eSa� l e.
Cow siv i ref" -r 6 h M4 be- o,W m &rf h udl t_ C&led a�
/�� y
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
Gun wily b,e �libra( sep�l`aoaS
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
�U No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
U'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
Wo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fWNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
15, stvflfmi� appi1'C '-Pi-Ids,*soil r-eee�, �a��y r �►�+d¢ho•, ar ago
OAf_ fAe# S�a't'elc� f!� r oir- �S' � f li�l �vrra-n
4V o f e1 I n J Qy " yews 0
f VAA JS * '4 77 `-S, 8
al. ` hme- s �, -ev� iwk plewd vra_ rins e ��PLO ye J� eb-M ,, Was�c ala s
"of Iva, a,ql
lvffe�e� gffer , 00j :t tarda eSa� l e.
Cow siv i ref" -r 6 h M4 be- o,W m &rf h udl t_ C&led a�
/�� y
!QItdl �eedt4ob Cu4ed_ ► ivorrvZ&tnof-sobtis .
4,04e-&4
-Tosj�� nWAP bepaw iter Q hows (raO'V1%L#eV dW1"4
.9
len sera evmfs .
6cofofmisrrh, r�e[a�fr n �� � reco�dr a -e t� jwdrhye_ (mel(-o%�a7+�td(j
�heldj h,q�. C0�'�P1'•
Gun wily b,e �libra( sep�l`aoaS
12/28/04

*Division. of Water Quality.
Facility Num 0 Division ofSoil and Water Conservation
— - '0 Other Agency'
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: $:Dp Departure Time: County: 56-o"4 To Region:
Farm Name: Dou-61 c_ —S. Favi Owner Email:
Owner Name: C 1-t J S , 3 Phone:
Mailing Address:
Physical Address:
Facility Contact: So^1 Title: (i-tv4V- Phone No:
Onsite Representative: Integrator: <-1tidear-.0 rte A1
`1
Certified Operator: _. C �-I S 215- VSo^J Operator Certification Number: zlwoz
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 1--] o Longitude: = ° ❑ l ❑
66
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design'- 'Current Design Current
Capacity., Population Wet Poultry Capacity Population
11:1 Layer
I
❑ Non -Layer
Dry Poultry
❑ L a ers
11 -Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
CattleCapacity :Population
LADairy Cow 1 44001
Lj Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow 4
Number of
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [A No ❑ NA ❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
t4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
U No
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12/28104 Continued

V; t
Facility Number: $Z — S�jfZ Date of Inspection 3/ -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CA No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes MfNo ❑ NA ❑ NE
StructureD Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: fav
Spillway?: _
J/
Designed Freeboard (in): 3 g
Observed Freeboard (in): 191
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[7[No
[:INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes
0 No
❑ NA ❑ NE
through a waste management or closure plan?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
)4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
V1 No
Aj
❑ NA [:3NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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
[0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
JD 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 ofAcceptableCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) /1 t/�. L�✓ryT,�� fo�aSS
/„
13. Soil type(s) �qr Ns a ,�� /!l AV /40
-
—
Z �r _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
5FNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
1 i7�&'moi l , ;:t n ,.,` A., .�+. Sr a,
Comments efer to t{itestiou�#) Explant aany�YES answers and/or anyjrecommexk WSW anylother comments.
eit�x Mp�
Use drawings of�facility toVetier edam srtuations: {use addihonel pagestas necessary):
Reviewer/Inspector NameejV t C S :_' „ Phone:��/OJ
Reviewer/Inspector Signature: Date:
12/28/04 Continued

Facility Number: $Z —$Y Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IN No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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 JZ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
0 NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EX No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
X3 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[B 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
q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�gNo
❑ 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
1p No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;VNo
❑ NA
❑ NE
Addrtionaf cOnaments;andlarDrawings y d
u .p
12/28/04

Type of Visit aCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Ui Routine O Complaint O Follow up O Emergency Notification Omer ❑ Denied Access
Facility Number a tate of Visit: Time:
madv
Q =Not Operational Q Below Threshold
Permitted Q Certified © Conditionally Certified E3 Registered Date Last Operat�e`d' or Above Threshold: ..... • ._ • •....
Farm Name: .. '`' c, _ -- Fca-,­� County:
Owner Name::?°!'
`'�`� 5 K Phone No:
.......'
......................... ! ...... _ .
Mailing Address:...
�nri S �acKSoj r1 `ur,M r�K4 r
Facility Contact• _ —.-.--Title: ..-------...�..... Phone No:........_......._�._.........................
Onsite Representative .......f/..i� .� J;tK5n,!1 _ _ .. Integrator:------ivok eo*
Certified Operator:,_ , L.Ltt^�5 xOperator Certification Number:
Location, of Farm.:
❑ Swine ❑ Poultry ( Cattle ❑ Horse Latitude 0. 0` 0" Longitude �• �� ���
Dischart=_es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2<0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes O'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ekl�o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Identifier: ..................... _....... ....
Structure 2 Structure 3
Structure 4
❑ Yes GKO
Structure 5 Structure 6
Freeboard (inches):
12112103 Continued

Facility Number: b ,� — SL's Date of Inspection O
• 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
b. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes �No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [v Na
& Does any pan of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes d No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Q No
elevation markings?
Waste ARplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0190
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Iff N0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop typeri►+�lou SM[►.�� aivt Ser !'�t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [ErNo
b) Does the facility need a wettable acre determination? ❑ Yes E No
c) This facility is pended for a wettable acre determination? ❑ Yes E+�No
15. Does the receiving crop need improvement? ❑ Yes dNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 2<0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes [gfio
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes D"No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes fNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [3440
Air Quality representative immediately.
Coate (reser. to `quesfi_on #) - ExFlata aay AYES answers and/ar, any. r' any�otbcr`commeats. ' _
Use drai 4 7f �cffi; t� ettir �Yl���n5. �C }3l1U140� �e���
t3' � ( 1 rya , ❑ Fteld Copy ❑ Final Notes i
Low ffu;ls &,.e_ aN sem... br dp�.�
Jou..-. Ik 01 ro lC {yv
�- itrc 'i v �.i � � i r -c I h r r [ nS Wi-s•-i /�[Cd� s►S f7 Lr�..�.+c.. �� i A SD r ( �'�t� S 'i /�`�`'�
iewer/Inspector Nameiewer/Inspector
E
Signature: Date: VT 0
12112103 U Continued

FafTty Number: 4J.1 4 �; Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
eNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
"No
(ie/ WUP, checklists, design, maps, etc.)
❑
[Z
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ef No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ej(No
No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
(
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
El"No
(ie/ discharge, freeboard problems, over application)
❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
VNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
[91NO
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2NO
\TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
__ _ .._
ddtuonal m.rmentsandlarDrawings
�_.7-
- a.. :. '_..ta'+•'—:
7
12112/03

' I � E3 Divis` n of Soil and Water Conservation 0 Other Agency
�A120vision of Water Quality
..s''`r-;`;�+���r.n.kis'�':z�:o.r.'r«.*:.�...,,wkr,��:�:acs�. ,.... ,. ,: .•�.-^^n-=••„um..vwm..o�acttv�i,'sr: �^�.�.xb,:. rca s.,-'�°cr'���d� .»�:. . e;7�w.u..w<x�+ti �... #,s?�3+-.
0 Routine Cont plaint 0 Follow-up of MVQ inspection 0 follow-up of DSIA'C review 0 Other
Date of Inspection
Facility Number
Time of Inspection ET= 24 hr. (hh:mm)
Registered © Certified M Applied for Permit 13 Permitted [3 Not Operational Date Last Operated:
Farm flame: �I?1..r...1. County:
OwnerName:........!r!. !.' �.... •.... ...... V....aG!��.......................... Phone No: .... - — ...........__...._..... _...... ...........................
Facility Contact:. ....... .?..... 5........ •'• ..... Title:...... ... ........................ Phone No:....._ ......._...................
Mailing Address:
Onsite Representative: .... .......r. �:ra- _.. ........... .. Integrator:-.
Certified Operator,_ ....._r�7!!..`......!................ _...... ........... Operator Certification Number:... _...._.........
Location of Farm: 1
Latitude C'�• A fit Longitude a =' ="
Design =- Current .Design' Current: .Design '' Cnrreat f
w
Swine Capacity Population',
Poultry .Capacity .:Population ;Cattle ;.Capactfy :Population ,>
❑ Wean to Feeder ❑ Layer ry� '4000❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean m "�
❑ Farrow to Feeder ❑ Other} .t
t
❑Farrow to FinishTotal Design Capacity M.1 "
❑ Gilts •` •'
❑ Boars -T0 tal SSLW :'
Number of Lagoons/ Hoing Ponds ®. 10 Subsurface Drains Present 110Lagoon Area 10 Spray Field Area
► '$ an`�' Mor A. S �' ❑ No Liquid Waste Management System ,max
General
I. Are there any buffers that need maintenanceAmprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system`! (If yes, notify DWQ)
I Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancelirnprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/47
❑ Yes GKO
❑ Yes [}No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes LI3'No
es ❑ No
❑ Yes ❑ No
es ❑ No
❑ Yes 93441,
❑ Yes 13"O w
Continued on back

�rF I rr Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fl.a o ns Hol in fonds Flush fits etc
9_ Is storage capacity (freeboard plus storm storage) less than adequate?
cture I Structure ? Structure 3 Structure 4
Identifier:.tr.�$ _...�....._ _.. .. .. _. ......�....� ..
Freeboard ft: .4avel ` - .......... ...- - .............. ......_.......
10. Is seepage observed from any of the structures?
I I- Is erosion, or any other threats to the integrity of any of the structures observed?
12_ Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Structure 5
i =�
❑ Yes 4Q4ja _
Structure 6
❑ Yes R?ro
❑ Yes Be-
es ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes LINV —
Waste Application
14. Is there physical evidence of over application? ❑ Yes aIle --
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
Glftr"
11;. Does the receiving crop need improvement?
❑ Yes
2HVT-
19. Is there a lack of available waste application equipment?
❑ Yes
tri
20. Does facility require a follow-up visit by same agency?
❑ Yes
EMS
21. Did Reviewer/inspector fail to discuss reviewl;nspection with on-site representative?
❑ Yes
22. Does record keeping need improvement?
❑ Yes
O -No -
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
❑ No violations or deficiencies were noted during this visit.. You .will receive no further . .
correspondence about this
Comments (refer to quesirou #):,-Explain any YES answers and/or an} recomniendati mns or any, other comments w
[ase drar►zngs of factliti -to better explarn situations.(use additional pages as necessary):.
�a..„
1 � s
vL
s�
►� /'o�..,� -� 1��•�.� � � 6 �-a J Sty
4i dein G%��3di4 �►.4•�� $ �7� (�p�r*'s 25/97
Ax,a eviewer/Inspector Name ; _.
evieRwerAnspectorSignature. Date:

Faced `;umber:._ Date of Inspection:
Additional Comments and/or Drawings:
4/30/47

u
U. S. DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE
Clinton Field Office
CONSERVATION PLAN
SCHEDULE OF OPERATIONS
SCS-LTP-11 I PAGE
2-89 1 1 OF 4
[phone]
------------------------------------------- "---------------
NOW GN 2l; iTiv [ICS O'er
DR/RY R D I
•---+-------- ---------
COUNTY 1 STATE CONPRACT NO. I TOTAL ACRES UNDER CONTRACT
I
DOUBLE s DAIRY / sbb
+1�-y�(/N C 2¢Q3 411-1
-----+------- --------+-----------+-----+--+-----++------------------------i-----------------------------------
N -
Sampson County I
NC M). 112.0
I I I
I
I
COST I
COMPLETION SCHEDULE AND 1
f I PLANNED 1
zsT• I
COST
SNARE)
ESTIMATED COST -SHARE BY YEAR I
ITEM
I 1 CONSERVATION TREATMENT
AMOUNT +
BASIS I
RATE +---------------------+----------+----------------------REF-
NO
I FIELD I (RECORD OF DECISIONS) I
(UNITS) I
5 I
--------
3 I 1996
------------------------------------------------------------------
1
1997 1 1998 I 1999 I 1 NO.
---------------------------------------------------------
I ]Pasture
I
13a ITract 1356 I
I
I
I
I
I I I I
1 IWASTE STORAGE FACILITY (313}
la
I (Reinforced slab work, curbs, 1
27.01
250.001
75AC I
IS
5062.501 I
1 land footings 1
CuYd1
I
I
I
I I I I
lb
1 ]Earth fill material 1
200.01
3.751
75AC 1
I$
562.501 I I I
I f(compacted) from distant site (
CUYd1
I
I
I
I I I I
le
I ]Excavation and spoil removal I
150.OI
0.851
75AC I
Is
35.621 1 I I
1 Ionly I
CuYd1
I
I
I
I I 1 1
ld
I (Roofing felt 1
1.01
16.001
75AC 1
1$
12.001 I I 1
I 1 1
Rolll
. I
I
I
I I I 1
le
1 (Control Panel and Switches 1
1.01
2000.001
75AA I
Is
1500.001 I I 1
I 1 1
No.1
I
I
I
I I I
if
1 INon-reinforced slab work, 1
3.01
108.001
75AC 1
15
243.001 I I I
1 Icurbs, and footings I
CUYd1
I
I
I
I I I
lg
1 (Excavation and spoil removal I
50.01
0-851
75AC 1
1$
31.881 I I 1
1 (only I
CuYd1
I
I
I
I I I 1
----------------------------------------------------------------------------------------
I I Pasture I
I
1
I
I
I I I 1
2
13a ITract 1356 I
I
1
1
I (RUNOFF MANAGEMENT SYSTEM (570)I
I
I
I
1
I 1 1 1
2a
I INon-reinforced ,Blab work, 1
21.01
108.001
75AC 1
I$
1701.001 1 1 1
1 Icuxbing I
CuYdI
I
I
I
I I 1 I
2b
I )Reinforced slab work, curbing 1
30.01
250.001
75AC I
IS
5625.001 1 I I
f 1 1
CuYdI
I
I
I
I 1 I I
2c
I IAeavy grading and shaping, I
0.51
1200.001
75AC I
IS
450.001 l 1 I
1 16• average 1
ACrel
I
I
I
I I I 1
2d
I IEsstablish fescue vegetation 1
0.11
616.001
75AC 1
1$
46.201 1 1 1
l (using bulk lime I
Acrel
I
I
I
I 1 1 I
2e
1 IMulch netting I
2850.01
0.031
75AC 1
1$
63.121 1 I
I I I
SgFt1
I
I
I
I I I f
2f
1 (Earth fill material available f
70.01
3.751
75AC 1
15
196.881 1 1 I
I (adjacent to site I
CuYdI
I
I
1
1 I 1 I
2g
I lGravel A 1
144.01
12.001
75AC 1
15
1296.001 1 I I
1 1 1
Tanl
I
I
I
I I I I
-----------
-------------------------------------------------------------------------------------
I---IPasture
3
134L ITract 1356
IGRASSED WATERWAY (412) I
1
1
l
I
1 1 1 I
I
l (Establish grassed waterway at 1
1
I
1
I
I I I
I Ithe approximate location shownl
I
I
1
I
I I I I
I Ion the conservation plan map.
I ]Construct according to SCS I
1
1
1
I
1 1 1 I
I Istandards and specifications. I
I
I
1
I
1 1 1 1
I ISee Information Sheet, GRPSSEDI
1
I
l
1
1 I 1 1
�E n..�-G 4. � .ems. 2-,9a-97

U. S, DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE
Clinton Field Office
CONSERVATION PLAN
SCHEDULE OF OPERATIONS
SCS-LTP-11 ] PAGE
2-89 ! 2 OF 4
(9101 592-7963
------- -------------------------------------•-----------------t--------+-------------------------*---------------------------
NAME c4kvs T�lC�'SC¢/ 1 COUNTY I STATE ! CONTRACT NO.
! TOTAL ACRES UNDER CONTRACT-------
DOUBLE 3
DAIRY I
Sampson County I
NC 1
] 12.0
---`-+--------+------------------------------+-----------•-----+--+--------------------------------------------------------
! I I
I
I
COST I
COMPLETION SCHEDULE AND 1
I
I PLANNED (
EST. I
COST I
SHARE(
ESTIMATED
COST -SHARE BY YEAR 1
ITEM I
I CONSERVATION TREATMENT I
AMOUNT !
BUIS I
RATE ---------------------
*----------+----------+----------+ REF.
NO 1 FIF,LD ! (RECORD OF DECISIONS) 1
(UNITS) I
$ 1
t 1 1996
1
1997 1 1998 1 1999 1 1 NO.
-----•-------_+------------------------------------------*--------•------+----------+----------•----------+----------+---------------
IWATERWAY, NC -190-112, for I
I
1
!
!
1
! ! !
I
Iseeding and maintenance
I
Idetails.
3a 1
(Heavy grading and shaping, > 1
0.11
1200.001
75AC 1
I$
90.001
! I !
1
16" average I
Acrel
I
I
I
I
1 k k
3b I
ISeedbed prep, est fescue, and !
0.11
616.001
75AC 1
IS
46.201
1 !
1
Imulah (hag limo !
Acrel
I
I
i
I
I I I
3c I
!Mulch netting 1
1800.01
0.031
75AC I
IS
40.501
I
I !
SgFtl
I
I
I
I
I I I
3d I
Ile" stormwater conduit {smooth ]
200.01
10.751
75AC 1
I$
1612.501
! I I
1
linter, corrug iter} 1
Lft1
I
I
I
I
1 ! !
3e I
lsarth fill material from 1
75.01
3.751
75AC I
Is
2:0.941
1 ! 1
I
Idistant site 1
CuYdl
I
I
I
I
I ! I
3f I
]Excavation and spoil removal ]
40.01
0.851
75AC 1
I$
25.501
1 ! I
1
1 only !
CuYd I
I
I
!
I
I k I
3g !
]Geatextile fabric filter clathl
94.01
2.001
75AC I
Is
126.001
I ! I
I
1 1
SgYdl
I
I
I
I
I I I
----------
I
--------------------------------------------------------------------------------------------------------------------------
!Pasture
4 13a
ITract 1356
I
1CLOSORE OF ABANDONED WASTE 1
I
I
I
E
I
I ! !
I
ITREATMENT FACILTIY (INTERIM) [
I
1
I
I
I
I I !
f
1(9981 I
I
I
l
I
I
I I !
!
ICLOSEOUT EXMING BASTE
I
ISTORAGE PONDS AND CONVERT TO I
I
I
!
I
I
I I !
IRIPARIAN BUFFER ZONE. I
I
I
I
I
I
I I !
4a ]
(Waste Appl of liquid slurry 1
$1.01
10.001
1SAA ]
IS
607.501
I I !
I
!using honey wag ]
Mgall
I
1
I
I
I I I
4b 1
1Heavy grading and shaping, > !
0.41
1200,001
75AC 1
15
360.001
I 1 I
1
161 average I
Acrel
I
I
I
I
I I I
4c 1
ISeedbed prep, est fescue, and I
0.41
616.0D1
75AC I
1S
184.801
I I
1
Imulch (bag lime} 1
Acrel
I
I
I
I
! I I
4d 1
IMulch netting 1
5760.01
0.031
75AC 1
1$
129.601
I I 1
I
I i
SgFt I
I
I
I
I I
I I I
----------------
I
I-----------------------------------------------------------------------------------
:Pasture I
I
I
I
I
I
I I I
5 13a
ITract 1356 I
I
I
!
I
I
I I I
IROOF RUNOFF MANAGEMENT (558) 1
1
I
I
1
I
1 1 1
]
I:NSTALL GUTTERS ON ROOF TOPS 1
!
I
I
1
I
I 1 1
]
170 PREVENT RUNOFF INTO WASTE I
I
I
I
I
I
I I
I
I HOLDI IG POND
Sa I
16" Seamless aluminum roof 1
825.01
2.001
75AC 1
IS
1237.501
!
Igutters 1
Lft1
I
I
I
I
5b 1
IDovnspout for guttering I
160.01
1.001
75AC I
IS
120.001
I
I
1 ]
Lft 1
I
I
I
I
I I I

U. S. DEPARTMENT OF AGRICULTURE
NATURAL RESOURCES CONSERVATION SERVICE
Clinton Field Office
CONSERVATION PLAN
SCHEDULE OF OPERATIONS
SCS-LTP-11 I PAGE
2-69 ] 3 OF 4
[phone]
---------------------------------------------+-----------------t--------*-------------------------*-----------------------------------
� T x aD1�
NAME
f
COUNTY
I STATE
I
CONTRACT NO.
I TOTAL ACRES UNDER CONTRACT
DOUBLE J DAIRY I
Sampson County I
NC I
112.0
-----}--------}------------------------------------------+-----*--+-----++------------------------+-----------------------------------
I
I
I
COST I
COMPLETION
SCHEDULE AND 1
PLANNED I
EST. I
COST I
SHARE)
ESTIMATED
COST -SHARE BY YEAR 1
ITEM l
I CONSERVATION TREATMENT 1
AMOUNT I
BASIS I
RATE -----------
t--------------------------------------------
REF,
NO I FIELD
1 (RECORD OF DECISIONS) 1
(UNITS) ]
$ 1
t 1
1996 l
1997 1
1996 1 1959 1 1 140.
-----+--------t------------------------------+-----------t--------+------*--------------------------------+--------------------------
5c I
16" PVC Pipe 1
800.01
4.601
75AC 1
1$ 2760.O01
1 1 1
I
1 1
Lft 1
I
I
I
I
I I I
5d 1
16" PVC fitting 1
45.01
20.001
75AC 1
1$
675.001
1 1 1
i
1 1
each[
I
I
I
I
I I I
Se 1
115• Stormwater conduit(smooth 1
490.01
7.701
75AC 1
1$
2829-751
1 1 1
1
linter, corrug extr) I
Lft1
I
I
I
I
I I I
5f 1
115" strmwater conduit fitting 1
4.01
142.001
75AC 1
1$
426.001
1 1 1
l
I I
eachl
I
I
I
I
I I I
5g 1
136" Removable Grate I
1.01
59-001
75AC 1
1$
44.251
1 1 1
1
1 1
Each1
I
I
I
I
I I I
5h I
1Reinforced slab work, curbing 1
1.01
250-001
75AC 1
I$
187.501
I I I
1
1 1
CuYdI
I
I
I
I
I I I
-------------------------------------------------------------------------------------------------------------------------------------
I
)Pasture 1
I
I
I
I
I
I I I
6 13a
ITract 1356 !
I
I
I
I
(
I I I
(ANIMAL TRAILS AND WALKWAYS l
I
I
I
I
I
I I I
1
1(57s)
1
1HEAVY TRAFFIC TRAILS
1
(CONSTRUCTED WITH FILTER CLOTH I
I
I
I
I
I
I I I
1
1AND 6 COMPACTED INCHES OF I
I
I
I
I
I
I I I
ICRUSH AND RUN GRAVEL. I
I
I
I
l
I
I I I
6a 1
1Earth fill material from 1
703.01
3.751
75AC 1
15
1977-191
I I I
I
[distant site I
CuYd1
I
I
I
I
I I I
6b I
lExcavation and spoil removal 1
540.01
0.851
75AC I
IS
344.251
I I I
1
(only I
CuYd1
I
I
I
I
6c I
(Gravel 1
568.01
12.001
75AC I
Is
5112.001
l I I
1
1 1
Tont
I
I
I
I
I I I
6d I
1Face Plate installed 1
2.01
75.001
75AC I
Is
112.501
I I I
1
1 1
each[
I
I
I
I
I I I
6e I
1Barbed, woven, or high tensile]
1460.01
1.501
75AC 1
1$
1642.501
l I 1
1
1(4 strands) fence I
Lftl
I
I
I
I
I I I
6f I
1Geotextile fabric filter clothl
1217.01
2.001
75AC 1
1$
1825.501
I I I
1
1 1
SgYd I
I
1
I
1
14 I I
6g I
(Gates 1
4.01
65.001
75AC 1
Is
195.001
1 I I
1
-------------------------------------------------------------------------------------------------------------------------------------
1 1
No.)
I
I
I
I
I I I
-97

U. S. DEPARTMENT OF AGRICMTURE
NATURAL RESOURCES CONSERVATION SERVICE
Clinton Field Office
CONSERVATION PLAN
SCHEDULE OF OPERATIONS
SCS-LTP-11B I PAGE
2-89 1 4 OF 4
[phone]
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The following statements are made in accordance with the Privacy Act of 1974 (5 USC S22a)- The authorities for requesting the
information to be supplied on this form are: 16 USC 590a -f (Soil and Water Conservation]. 16 USC 590h(b) (Agriculture
Conservation); 16 USC 590p(b) (Great Plains); 30 USC 236 et seq. (Rural Abandoned Mine Reclamation); 33 USC 128B et seg.
(Rural Clean Water), The Food Security Act of 1985, Public Law 99-198; and the regulations promulgated thereunder. The information
requested is necessary for the development and implementation of a conservation, reclamation or water quality plan as the basis for
satisfying program eligibility and compliance requirements, and for providing technical assistance and/or cost -Sharing under the
previously mentioned authorities. Furnishing this information is voluntary however, failure to furnish correct, complete
information will result in the withholding or withdrawal of such technical or financial assistance. The information may be furnished
to other USDA agencies, the Internal Revenue Service, the Department of Justice, or other State or Federal law enforcement agencies,
or in response to order of a court, magistrate, or administrative tribunal.
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NAME 6144IJ 7 4-,S any I COUNTY
I STATE I CONTRACT N0. I TOTAL ACRES UNDER CONTRACT
DOUBLE J DAIRY I Sampson County I NC I 1 12.0
---------------------------------------------*-----------•----- ----------------­--------- ------------------------------------------------------------
. I I I I COST I COMPLETION SCHEDUIAE AND 1
PLANNED I EST, I COST I SHARE) ESTIMA'T'ED COST -SHARE BY YEAR 1
ITEM 1 I CONSERVATION TREATMENT I AMOUNT I BASIS I RATE' -------------------------------------------- +----------- REF.
NO 1 FIELD ( (RECORD OF DECISIONS) I (UNITS) 1 S 1 t 1 1996 1 1997 1 1998 I 1999 I 1 N0.
-----+---•-----------------------------------+--------------------+------+----------+----------+----------+----------+---------------
I ITotal Cost -Share by Year: I I I 1 1$39,809.171 1 1 I
--------------+------------------------------+-----------+--------+------+----------+----------+---------------------+----------+----
I ITotal Contract Cost -Share: 15 39,809.171 I I I I I I I
-----+ -------- +------------------------------------------ +----------------------------------------------------------- ---------------
NOTES: A. All items numbered under "ITEM NO." must be carried out as part of this contract to prevent violation
B. When established, the conservation practices listed as "PLANNED CONSERVATION TREATMENT' must be maintained by the
participant at no cost to the government.
C. Enter total cost per unit under "COST BASIS" unless the method of cost -share is flat rate. When flat rate, enter
the amount per unit to be paid to the participant.
D. All cost share rates shown under 'COST SHARE RATE R" are based on average cost (AC) with the following exceptions:
AA Actual casts not to exceed average cost
Fit Flat rate
NC Non cost -shared
AN Actual cost not to exceed a specified maximum
E. Modifications will be referenced by number in the "Ref. No." Column.
F. By signing, the participant acknowledges receipt of this conservation plan including the SCS-LTP-11 or SCS-LTP-11A and
agrees to comply with the terms and condition hereof.
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CERTIFICATION OF PARTICIPANT:
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5IGNATLRE I DATE )SIGNATURE I DATE 1SIGNATURE I DATE
f I I i 1
I I I 1 I
RELEVANT OFFICIAL SIGNATURES
-I------------------------
DISTRICT CONSERVATIONIST I DATE 10THER ADMINIS-RING AGENCY 1 DATE )CONSERVATION DISTRICT I DATE
I I I I I
I 1 I I I
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Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: err /._s 1995
Time:
Farm Name/Own
Mailing Address: -'�, ta,& 31z—
County: 13_County:
Integrator_ — _ - — — Phone:
On Site Representative:_ ' _ _ _ Phone:
Physical Address/Location:_-
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: _3W A-0 (tn a„ Z&ek•p -
DEM Certification Number: AC DEM Certification Number: ACNEW ✓
Latitude: Longitude: "
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 NR Actual Freeboard: Ft. Inches �- a
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No Iv,q
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No yaS
Crop(s) being utilized: P. /r.o �,..
Does the facility meet SCS minimum setback criteria? 00 Feet from Dwellings? Yes or No �A4
100 Feet from Wells? Yes or No ,✓�
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No ovft
Is animal waste discharged into water of e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 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)? e or No
Additional Comments: Jr..�e a
Inspector Name
cc: Facility Assessment Unit
Signature U
Use Attachments if Needed.

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