36A_Old27_LCID_AFR14-15

LCID 2015 Page 1
Facility Name:Permit:
Physical Address
Street 1:
Street 2:
City:
State:Zip:
County:
Mailing Address
Street 1:
Street 2:
City:
State:Zip:
Primary Facility Contact Person
Name:
Phone:Fax:
Email:
Billing Contact Person
Name:
Phone:Fax:
Email:
1. Tipping Fee: $per
Tipping Fee: $per
Tipping Fee: $per
2. Estimate the amount of waste taken in an average week at this facility?
3. How many weeks did you operate this year?
4. What are the hours/days of operation for this facility?
5. What is the acreage of the footprint of the waste on site as of June 30?Acre(s)
CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility.
Signature:Date:
Name:Title:
Phone Number:Email:
REMINDER: According to (G.S. 130A-309.09D(b)), this
report must be sent to the Regional Environmental Senior
Specialist for your area and a copy of this report must be
sent to the County Manager of each county from which
waste was received.
Please return your completed report to:
6. Did your facility stop receiving waste during this past Fiscal Year? Yes No
If so, please report the date this occurred:
tons
cubic yards
LCID State of North Carolina
Department of Environment and Natural Resources
Division of Waste Management
LAND CLEARING & INERT DEBRIS
LANDFILL
Facility Annual Report
For the period of July 1, 2014-June 30, 2015
According to (G.S. 130A-309.09D(b)) completed forms must be returned by August 1, 2015 and a copy of this report must be sent to the
County Manager of each county from which waste was received. If you have questions or require assistance in completing this report, contact
your Regional Environmental Senior Specialist.
36A-LCID-2010
Old 27 LCID Landfill 36A-LCID-2010
130 Tate st
Mt Holly
North Carolina 28120
Gaston
PO Box 41
Mt Holly
North Carolina 28120
Dwayne McCorkle
[phone]
[e-mail]
Dwayne McCorkle
704 718638
[e-mail]
90.00 Trailer
65.00 Tri-Axel
55.00 Tandem
160
50
8am-5pm Monday thru Friday (Saturday's upon request)
7
8-4-15
Dwayne McCorkle Owner
[phone] [e-mail]
LCID 2015 Page 2
Instructions:
NC DENR
Division of Waste Management - Solid Waste Section Risk Assessment Form
Facility Name:Permit:
Address:
City:State:Zip:
Date:Person completing Assessment:
Phone Number:Fax:Email:
Please indicate either Yes or No 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 Dwellings Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
2. Are there Potable Wells Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
3. Are there Community/Municipal Wells Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
4. Are there Surface Water Bodies Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
Please list the names of the water bodies:
5. Is Public Water Available Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many of the Residential Dwellings noted above are connected?
Corrective Measures
6. Is there an active methane extraction system (blower, flare, etc.)?Yes No
7. Is there a passive methane extraction system (trench, vents in cap, flare, etc.)?Yes No
8. Is there groundwater remediation taking place on site?Yes No
If Yes, what is the specific remedial technology used?
Comments
[e-mail][phone]
Dwayne McCorkle 8-4-15
28120North CarolinaMt Holly
130 Tate st
36A-LCID-2010Old 27 LCID Landfill
36A-LCID-2010