N0704_FreedomBaptistChurch

Book 2680 Page 1445
2006046103 00106
FORSYTH CO, NC FEE $35.00
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07-25-2006 10:51 M
DICKIE C WOOD
RC6SSS6F Of OCEp.1
By:SHANNON BOSTIC—GRIFFITH DPTY
BK : RE 2680
PG:1445-1452
��
o�ry� t �eey 8a yam, NCDENR.
Nort Carolina Department of Environment and Natural Resources
Dexter R. Matthews, Director Division of Waste Management Michael F. Easley, Governor
William G. Ross Jr., Secretary
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
Pursuant to 15A NCAC 13B .0563(2)(a), the land owner(s) and operator(s) of any Land Clearing and Inert Debris Landfill
under two (2) acres in size shall submit this notification form to the Division prior to constructing or operating the landfill.
This form must be filed for recordation in the Register of Deeds' Office. The Register of Deeds shall index the notification
under the name of the owner(s) of the land in the county or counties in which the land is located. The Register's seal and
the date, book, and page number of recording must be included on this form when submitted to the Division. This
notification is not valid to authorize operation of a landfill unless complete, accurate, recorded, and submitted to
the Division as required by 15A NCAC 13B .0563(2)(b).
1. Facility Name: F-keEoom *6#4P- 5T a -Ka e-4 1. a D
2. Facility location (street address): 1000 14 VJJ (e 5'
City: RUiAL t4AL.L County: Fodit5yrf; Zip:
3. Directions to Site: & 0 US !;,a a Al 4-oM W eM STON- 5 ALI�w1 To
ALL
or) LEFT
4. The land on which this landfill is located is described in the deed recorded in:
deed book: I 1 1
5. Name of land owner:
county: FOR5IV714
a2C+4. TA,- .
6. Mailing address of land owner: K D. Do1C FS 9
City: l2ue►4L. f4At L State: Ai c Zip: *) 70 .F
7. Telephone number of landowner:( 334 ) 9169 & Cl 37
If the land is owned by more than one person, attach additional sheets with the name, address, and phone
number of all additional land owners. 4
8. Name of operator. FiQ.KPoo0a Qt4fti 3 T
9. Trade or business name of operator: i5 "E-=
10. Mailing address of operator: D AMAIn Ai-$ 000E
City: RILfZAL hiAU, State: uL' Zip: X7D+S
11. Telephone number of operator:( 336) q 6 9 — (o ? 3'7
If the landfill is operated by more than one person, attach additional sheets with the name, address, and phone
number of all additional operators. /1
12. Projected
� use off land after completion of landfill operations: � Mr_A ",,Pr aC A e ✓l Er
bL
T'
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone [phone] \ FAX: [phone] \ Intemet http:Pwastenotnc.org
M Equal Opportunity 1 Affirmative A.c5on Employer— Pmnted on Dual Purpose Recycled Paper

Book 2680 Page 1446
The following are the applicability, siting, and operating criteria for Land Clearing and Inert Debris Landfills operating under notification.
From: North Carolina Solid Waste Management Rules 15A NCAC 13B:
.0101 DEFINITIONS
(53) "Land Gearing waste" means solid waste which is generated solely from land dearing activities such as stumps, trees, limbs, brush, grass, and other naturally
occurring vegetative material.
(54) "Land clearing and inert debris landfill" means a facility for the land disposal of land cleadng waste, concrete, brick, concrete block, uncontaminated soil, gravel
and rock, untreated and unpainted wood, and yard trash.
(55) "Yard trash" means solid waste resulting from landscaping and yard maintenance such as brush, grass, tree limbs, and similar vegetative materials.
.0553 APPLICABILITY REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Management of land clearing and inert debris shall be in accordance with the State hierarchy for managing solid waste as provided for under N.C.G.S. § 130A-309.04(a).
Disposal in a landfill is considered to be the least desirable method of managing lard clearing and inert debits. Where landfilling is necessary, the requirements of this Rule
apply
(1) An individual permit from the Division of Solid Waste Management is not required for Land Clearing and Inert Debris (LCID) landfills that meet all of the following
conditions:
(a) The facility is to be operated for the disposal of land clearing waste, inert debits, untreated wood and yard trash. Operations must be
consistent and in compliance with the local government solid waste management plan as approved by the Division of Solid Waste Management.
(b) The total disposal area is under two acres in size.
(c) The facility and practices comply with the siting criteria under Rule .0564, and operational requirements under Rule .0566.
(d) The fill activity is not exempt from, and must comply with all other Federal, State, or Local laws, ordinances, Rules, regulations, or orders.
including but not limited to zoning restrictions, flood plain restrictions, wetand restrictions, sedimentation and erosion control requirements, and mining
regulations.
(2) Where an individual permit is not required, the following applies:
(a) The owner of the land where the landfill is located must notify the Division on a prescribed forth, duly signed, notarized, and recorded as
per Rule .0563(2)(b). The operator of the landfill, if different from the land owner, shall also sign the notification form.
(b) The owner must file the prescribed notification form for recordation in the Register of Deeds' Office. The Register of Deeds shall index the
notification in the grantor index under the name of the owner of the land in the county or counties in which the land is located. A copy of the recorded
notification, affixed with the Registers seal and the date, book and page number of recording shall be sent to the Division of Solid Waste
Management.
(c) When the lard on which the Land Clearing and Inert Debris Landfill is sold, leased, conveyed, or transferred in any manner, the deed or
other instrument of transfer shall contain in the description sedan in no smaller type than that used in the body of the dead or instrument a statement
that the property has been used as a Land Clearing and Inert Debris Landfill and a reference by book and page to the recordation of the notification.
.0564 SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
The following siting criteria shall apply for Land Clearing and Inert Debris (LCID) landfills:
(1) Facilities or practices, shall not be located in the lWyear floodplain.
(2) Facilities or practices shall not cause or contribute to the taking of any endangered or threatened species of plants, fish, or wildlife.
(3) Facilities or practices shall not result in the destruction or adverse modification of the critical habitat of endangered or threatened species as identified in 50 CFR
Part 17 which is hereby incorporated by reference including any subsequent amendments and editions. This material is available for inspection at the Department
of Environment, Heath, and Natural Resources, Division of Solid Waste Management, 401 Oberlin Road, Raleigh, North Carolina 27605 where copies can be
obtained at no cost.
(4) Facilities or practices shall not damage or destroy an archaeological or historical site.
(5) Facilities or practices shall not cause an adverse impact on a state park, recreation or scenic area, or any other lands included in the state nature and hislonc
Preserve.
(6) Facilities shall not be located in any wetland as defined in the Clean Water Act, Section 404(b).
(7) It must be shown that adequate suitable soils are available for cover, either from on or oft site.
(8) Land Clearing and Inert Debris landfills shall meet the following surface and ground water requirements:
(a) Facilities or practices shall not cause a discharge of pollutants into waters of the state that is in violation of the requirements of the National
Pollutant Discharge Elimination System (NPDES), under Section 402 of the Clean Water Act, as amended.
(b) Facilities or practices shall not cause a discharge of dredged materials or fill material into waters of the stale that is in violation of the
requirements under Section 404 of the Clean Water Act, as amended.
(c) Facilities or practices shall not cause non -point source pollution of waters of the state that violates assigned water quality standards.
(d) Waste in landfills with a disposal area greater than two acres shall be placed a. minimum of four feet above the seasonal high water table,
except where an alternative separation is approved by the Division.
(a) Waste in landfills with a disposal area less than two acres shall be placed above the seasonal high water table.
(9) The facility shall meet the following minimum buffer requirements:
(a) 50 feet from the waste boundary to all surface waters of the state as defined in G.S. 143-212.
(b) 100 feet from the disposal area to property lines, residential dwellings, commercial or public buildings, and wells.
(c) Butter requirements may be adjusted as necessary to insure adequate protection of public health and the environment.
(10) The facility shall meet all requirements of any applicable zoning ordinance.
.0566 OPERATIONAL REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Land Clearing and Inert Debris (LCID) landfills shall meet the following operational requirements:
(1) Operational plans shall be approved and followed as specified for the facility.
(2) The facility shall only accept those solid wastes which it is permitted to receive.
(3) Solid waste shall be restricted to the smallest area feasible and compacted as densely as practical into cells.
(4) Adequate soil cover shall be applied monthly, or when the alive area reaches one acre in size, whichever occurs first.
(5) 120 calendar days after completion of any phase of disposal operations, or upon revocation of a permit, the disposal area shall be covered with a minimum of one
foot of suitable soil cover sloped to allow surface water runoff in a controlled manner. The Division may require further action in order to correct any condition
which is or may become injurious to the public health, or a nuisance to the community.
(6) Adequate erosion control measures, structures, or devices shall be utilized to prevent silt from leaving the site and to prevent excessive on site erasion.
(7) Provisions for a ground cover sufficient to restrain erosion must be accomplished within 30 working days or 120 calendar days upon completion Of any phase of
landfill development.

Book 2680 Page 1447
(6) The facility shall be adequately secured by means of gates, chains, berms, fences, etc. to prevent unauthorized access except when an operator is on duty. An
attendant shall be on duty at all times while the landfill is open for public use to assure compliance with operational requirements and to prevent acceptance of
unauthorized wastes.
(9) Access roads shall be of all-weather construction and property maintained.
(10) Surface weber shall be diverted from the working face and shall not be impounded over waste.
(11) Solid waste shall not be disposed of in water.
(12) Open burning of solid waste is prohibited.
(13) The concentration of explosive gases generated by the facility shall not exceed:
(a) Twenty-five percent of the lower explosive limit for the gases in facility structures.
(b) The lower explosive limit for the gases at the property boundary.
(14) Leachate shall be properly managed on site through the use of current best management practices.
(15) Should the Division deem a necessary, ground water or surface water monitoring, or both, may be required as provided for under Rules .0601 and .0602 of this
Subchapter.
(16) A sign shall be posted at the facility entrance showing the contact name and number in case of an emergency and the permit number. The permit number
requirement is not applicable for facilities not requiring an individual permit.
Certification by Land (honer:
I certify that the information provided by me in this notification is true, accurate, and complete to the best of my
knowledge. The facility siting and disposal operations of this Land Clearing & Inert Debris landfill will comply with the
requirements of Sections .0563, .0564 and .0566 of 15A NCAC 13B, North Carolina Solid Waste Management Rules. The
facility and operations of this landfill will also comply with all applicable Federal, State, and Local laws, rules, regulations,
and ordinances. Where the operator is different from the land owner, I, the land owner, have knowledge of the operator's
plans to dispose of solid waste on the land and I specifically grant permission for the operation of the landfill. I understand
that both the land owner and operator are jointly and severally liable for improper operations and proper closure of the
landfill as provided for by North Carolina General Statute 130A-309.27. I further understand that North Carolina General
Statute 130A-22 provides for administrative penalties of up to five thousand dollars ($5,000.00) per day per each violation
of the Solid Waste Management Rules. I further understand that the Solid Waste Management Rules may be revised or
amended in the future and that the facility siting and operations of this landfill will be required to comply with all such
revisions or amendments.
Print Name (Owner)
North Carolina
that
Signature (Owner)
Date
County
a Notary Public for said County and State, do hereby certify
personally appeared before me this day and acknowledged the due execution of
the foregoing instrument.
Witness my hand and official seal, this the
(Official Seal)
My commission expires 20
day of
Notary Public
20

Book 2680 Page 1448
Certification by Landfill Operator (if different from Owner):
I certify that the information provided by me in this notification is true, accurate, and complete to the best of my
knowledge. The facility siting and disposal operations of this Land Clearing & Inert Debris landfill Will comply with the
requirements of Sections .0563, .0564 and .0566 of 15A NCAC 1313, North Carolina Solid Waste Management Rules. The
facility and operations of this landfill will also comply with all applicable Federal, State, and Local laws, rules, regulations,
and ordinances. I have informed the land owner of my plans to dispose of solid waste on the land and the land owner has
specifically granted permission for the operation of the landfill. I understand that both the operator and land owner are
jointly and severally liable for improper operations and proper closure of the landfill as provided for by North Carolina
General Statute 130A-309.27. I further understand that North Carolina General Statute 130A-22 provides for
administrative penalties of up to five thousand dollars ($5,000.00) per day per each violation of the Solid Waste
Management Rules. I further understand that the Solid Waste Management Rules may be revised or amended in the
future and that the facility siting and operations of this landfill will be required to comply with all such revisions or
amendments.
Print Name (Operator)
North Carolina
that
Signature (Operator) Date
County
a Notary Public for said County and State, do hereby certify
personally appeared before me this day and acknowledged the due execution of
the foregoing instrument.
Witness my hand and official seal, this the
(Official Seal)
My commission expires 20
day of
Notary Public
20
For additional land owners and landfill operators, attach separate notarized certifications for each additional land owner
and landfill operator.
For Corporate land owners and/or operators, use the Corporate Certifications, pages 5 and 6. Contact the Division of
Solid Waste Management for proper applicable certifications.
INSTRUCTIONS
Purpose: Notification of Land Clearing and Inert Debris landfills under two (2) acres in size is required under 15 NCAC 13B .0563(2)(a). Contact the
Solid Waste Section at the address below for further information.
Distribution: Mail completed recorded original notification to the following address:
Division of Solid Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, North Carolina 27699-1646
[phone]
Disposition: This form will be transferred to the State Records Center when reference value ends. Records will be held for agency in the State Records Center five
(5) additional years and then transferred to the custody of the Archives.

Book 2680 Page 1449
Certification by Corporate Land Owner:
I certify that the information provided by me in this notification is true, accurate, and complete to the best of my
knowledge. The facility siting and disposal operations of this Land Clearing & Inert Debris landfill will comply with the
requirements of Sections .0563, .0564 and .0566 of 15A NCAC 13B, North Carolina Solid Waste Management Rules. The
facility and operations of this landfill will also comply with all applicable Federal, State, and Local laws, rules, regulations,
and ordinances. Where the operator is different from the corporate land owner, the corporate land owner, has knowledge
of the operator's plans to dispose of solid waste on the land and is specifically granted permission for the operation of the
landfill. It is understood that both the corporate land owner and operator are jointly and severally liable for improper
operations and proper closure of the landfill as provided for by North Carolina General Statute 130A-309.27. It is further
understand that North Carolina General Statute 130A-22 provides for administrative penalties of up to five thousand
dollars ($5,000.00) per day per each violation of the Solid Waste Management Rules. It is further understood that the
Solid Waste Management Rules may be revised or amended in the future and that the facility siting and operations of this
landfill will be required to comply with all such revisions or amendments.
R Egnook- 13"_my - 7- 13 - 1066
Corporation Name (Print) i Date
(Corporate Seal)
Y&,AYK4__V L - 46&_ J:p•'e4S
Attest:
T " T E4s.14
acknowledged
ration, and that
by authority duly given and as the act of the corporation, the forgoing instrument was signed in its name by its
Trine_ + P4&president or vice-president), sealed with its corporate seal, and attested by himself (or herself)
as its secretary.
Witness my hand and official seal, this the _ day of 20 O (p
(Official Seal)
Notary Public
My commission expires &S �L 20 7
F4`0FFICIAL SEAL
Notary Public, North
a
rolina
coUNTV OF FORSYTH
MICHNFLW. PRIM

Book 2680 Page 1450
Certification by Corporate Landfill Operator (if different from Owner):
I certify that the information provided by me in this notification is true, accurate, and complete to the best of my
knowledge. The facility siting and disposal operations of this Land Clearing & Inert Debris landfill will comply with the
requirements of Sections .0563, .0564 and .0566 of 15A NCAC 1313, North Carolina Solid Waste Management Rules. The
facility and operations of this landfill will also comply with all applicable Federal, State, and Local laws, rules, regulations,
and ordinances. The land owner has been informed of plans to dispose of solid waste on the land and the land owner has
specifically granted permission for the operation of the landfill. It is understood that both the operator and land owner are
jointly and severally liable for improper operations and proper closure of the landfill as provided for by North Carolina
General Statute 130A-309.27. It is further understood that North Carolina General Statute 130A-22 provides for
administrative penalties of up to five thousand dollars ($5,000.00) per day per each violation of the Solid Waste
Management Rules. It is further understood that the Solid Waste Management Rules may be revised or amended in the
future and that the facility siting and operations of this landfill will be required to comply with all such revisions or
amendments.
Frv,:rp &,,k Be,65r Gc 2c.6F fC. - ( 3 ap64
Corporation Name (Print) Date
(Corporate Seal)
North Carolina
Attest:
Foes UTl+ County
I, t AI tkaeA VJ Pr i vs-, a Notary Public for said County and State, do hereby certify
H40—nm L— ✓D iname of secretary) personally a eared before me this day and acknowledged
w a
that he (or she) is secretary f MtId�IN� 174�15 ClwvGlt name'of corporation), a corporation, and that
by authority dully givens aan as the act of the corporation, the forgoing instrument was signed in its name by its
TYt&5 ty�`H e 1 "''(president or vice-president), sealed with its corporate seal, and attested by himself (or herself)
as its secretary.
Witness my hand and official seal, this the (3 day of//J� J k 20 8�
(Official Seal) �%><aaJZ PAA,,,
Notary Public
My commission expires4�ST z" , 20 D%
OFFICfALSEAL
Notary Public, North Carolina H
COUNTY OF FORSYTH
MICHAELK PRIM ..
My Commission Expires August 1, 2007

Book 2680 Page 1451
INSTRUCTIONS TO COMPLETE LCID LANDFILL NOTIFICATION FORM:
1. Contact your county or municipal zoning office for appropriate local requirements, approvals or permits.
2. Please review Solid Waste Management Rules, Section .0564: Siting Criteria for Land Clearing and Inert Debris (LCID)
Landfills, to make sure your facility is suitable. Pay particular attention to minimum buffer requirements, depth to groundwater,
floodplains, wetlands, archeological and historical sites, etc. See page 2 of the notification forth.
3. Completely fill in the information (numbers 1 through 12) on page 1 of the LCID Landfill Notification forth.
4. Sign the appropriate certification(s) by land owner and landfill operator. For additional land owners and landfill operators,
attach separate notarized certifications for each additional land owner and landfill operator. Corporate land owners and/or
operators should use the appropriate Corporate Certifications. Signature on the appropriate certifications indicate that siting
criteria in item #2 above have been met and the facility will be operated in accordance with Solid Waste Management Rules,
Section .0566: Operational Requirements for Land Clearing and Inert Debris (LCID) Landfills. See page 2 of the notification
forth.
5. Have the certifications from item #4 notarized by a Notary Public commissioned in the State of North Carolina.
6. Take the completed LCID Landfill Notification form and accompanying notarized certifications to the county Register of Deeds
Office to be recorded. The Register of Deeds shall index the notification in the grantor index under the name of the owner of
the land in the county or counties in which the land is located.
7. Mail the completed and recorded notification form, affixed with the Register's seal and the date, book, and page number of
recording, to:
Division of Waste Management
Solid Waste Section
Mail Service Center 1646
Raleigh, North Carolina 27699-1646
If you have any additional questions, information can be obtained from the Regional Solid Waste Section Offices located in
Asheville, Fayetteville, Mooresville, Raleigh, Washington, Wilmington, and Winston-Salem, North Carolina.
Disposition: This form will be transferred to the State Records Center when reference value ends. Records will be held for agency
in the State Records Center five (5) additional years and then transferred to the custody of the Archives.
As long as your disposal activities remain in an area under 2 acres in size, you may operate under the provisions of this notification.
This notification is not transferrable.
The Land Clearing and Inert Debris landfill shall receive only:
Land Clearing Waste as provided for in 15A NCAC 13B .0101(53); stumps, trees, limbs, brush, grass, and
other naturally occurring vegetative material.
Inert Debris and untreated wood as provided for in 15A NCAC 13B .0101(54); concrete, brick, concrete
block, uncontaminated soil, gravel and rock, untreated and unpainted wood.
Used asphalt as provided for under North Carolina General Statute §130A-309.09B(a)(1); used asphalt or
used asphalt mixed with dirt, sand, gravel, rock, and concrete.
All sedimentation and erosion control activities shall be conducted in accordance with 15A NCAC 4, Sedimentation Control.
Construction and operations involving sedimentation and erosion control activities greater than 1 acre typically require approval from the
Land Quality Section. Contact the Land Quality Section to determine if your activities require approval.

Book 2680 Page 1452
LCID Area Legal Description
Freedom Baptist Church of Rural Hall, North Carolina
Deed Book 1193, Page 149
BEGINNING at a point that lies South 89 derees 23 minutes 51 seconds West at a distance of
156.70 feet from an existing 5/8" pipe, (the 5 comer of Deed Book 1692, Page 3232, property of
Donald Ray Stewart, and the 7'b corner of Deed Book 2033, Page 895, property of Donald Ray
Stewart.) Said point also being 100.00 feet Southwest and perpendicular to the 5te course of Deed
Book 1193, Page 149, tad tract, property of Freedom Baptist Church of Rural Hall, North Carolina,
(subject property)
Thence South 84 degrees 18 Minutes 54 seconds West for a distance of 258.39 feet to a point that
lies North 83 degrees 39 minutes 06 seconds East at a distance of 538.62 feet from an existing 5/8'
pipe, (the 4th corner of Deed Book 1193, Page 149, 1" tract, subject property,)
Thence North 48 degrees, 00 minutes 34 seconds West for a distance of 70.00 feet to a point;
Thence North 12 degrees 46 minutes 05 seconds East for a distance of 125.79 feet to a point;
Thence South 82 degrees 15 minutes 15 seconds East for a distance of 126.04 feet to a point;
Thence South 50 degrees 57 minutes 00 seconds East parallel to and 100 feet Southwest and
perpendicular to the 5m course of Deed Book 1193, Page 149, 2ad tract for a distance of 201.47 feet
to the Point and Place of BEGINNING.
Containing 0.75 Acres, (32,542 square feet.)