87A-LCID-.pdf

LCID St&tedf North:O&folma
Departmentof Environmental Quality
Division of Waste Management
LAND CLEARING &INERT DEBRIS
LANDFILL
Facility Annual Report
For the period of July 1,2016-June 30,2017
According to G.S.130A-309.09D(b).completed forms must be returned by August 1,2017 and a copy of this report must be sent to the
County Manager of each county from which waste was received.Ifyou have questions or require assistance in completing this report,contact
your Regional Environmental Senior Specialist.
Facility Name:y Permit:ffi '"
ll'l-»4 »'I'll il,Mailing Address
Billing;Coht&6t;PcrsoTiPrimaryFacility'Contact.'Person
1.Tipping Fee:$
Tipping Fee: $
Tipping Fee:$
per
per
2.Estimate the amount of waste taken in an average week at this facility?
3.How many weeks did you operate this year?
D cubic yards
4.What are the hours/days of operation for this facility?Jj oo H <Oh frv\
5.What is the acreage of the footprint of the waste on site as of June 30?
6.Did your facility stop receiving waste during this past Fiscal Year?Q Yes
Ifso,please report the date this occurred:
Acre(s)
KEMINpER:Accopiinjg to G.S.l;30A-309.q9p(b),this
reprl must be settttotheSei^si^^
SR^kjist for your area and a copy of this reportmiiat be
sent to the Cy!int5LMiiffi«sq^^^
waate Was reeeivecl.
Please return your completed report to:
CERTIFICATION:1 certify that the information provided is an accurate representation ofthe activity at this facility.
Signature:rs..-,Date:f%~)"I '
Name:^,Q fr
Phone Number::fi}%-Email:,5+Uff ir\(g)
Division o^VVasfeMtfrtageni^nt ^§blid VVasfe S^ctipti:Risk Assessment Form
Facility Name:
Address:I-
Permit:07-A
Q.A
City:State:North Carolina
Person completing Assessment:
Phone Number:
Date:g-}'/"?
Fax:#.2 £"'4W-9k>0)Email:.
Please indicate either Ves or/Vo for each Receptor and Post Closure Maintenance question.Then please
determine the distance or distances for each Receptor from the Edge of Waste (using range finders and/or GIS
maps)and type that information into the form.Please attach additional information including GIS maps,lists of
potable well locations,etc.
Receptors
1.Are there Residential Structures Within 1,500 feet of the Edge of Waste?
If Yes,how many?
Q-itfo
What are the three closest distances from the Edge of Waste?Feet Feet Feet
2.Are there Water Supply Wells Within 1,500 feet of the Edge of Waste?G Yes
If Yes,how many?j_
What are the three closest distances from the Edge of Waste?j^O O Feet Feet
3.Are there Community/Municipal Wells Within 1,500 feet of the Edge of Waste?□Yes
If Yes,how many?
What are the three closest distances from the Edge of Waste?Feet
4.Are there Surface Water Features Within 1,500 feet of the Edge of Waste?
[
□Yes
If Yes,how many?_
What are the three closest distances from the Edge of Waste?
Please list the names of the water bodies:
Feet
I]No
Feet
Feet
Feet
5. Is Public Water Available Within 1,500 feet of the Edge of Waste?
If Yes,how many of the Residential Structures noted above are connected?
Yes No
Corrective Measures
6.Is there an active methane extraction system (blower,flare,etc.)?□Yes
7.Is there a passive methane extraction system (trench,vents in cap,flare,etc.)?Q Yes jNo
8. Is there groundwater remediation taking place on site?□Yes [^No
If Yes,what is the specific remedial technology used?__^
Comments