N0664_ArthurWilliamsNLCID

Book 2586 Page 3668
2005049082 00258
FORSYTH CO, NC FEE $23.00
1 PRESERTED 6 RRCORDED:
07-28-2005 03:28 PHI
DICRIE C WOOD
REGISTER OP DEEDS
By:BETTY C CAMPBELL DPTY
BK:RE 2586
PG:3668-3671
/.2 X.
State of North Carolina
Department of Environment, Health, and Natural Resources
Division of Solid Waste Management
P.O. Box 27687 • Raleigh, North Carolina 27611-7687
James G. Martin, Governor
William W. Cobcy, Jr., secretary
William L. Meyer
Director
LAND CLEARING 4ND INERT DEBRIS LANDFILL NOTIFICATION
Pursuant -to 15A NCAC 13B .056312)ie), the land owners) and operaiodsl 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 record 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 ba included on this form when submitted to the Division. This
notification is not valid to authorize operation of a landfill unless complete, accurate, and recorded as
required by 15A NCAC 1$13 .0563(2)(b).
1. Facility Name:
2. Facility location (street address): &SS ( 5 h G► i O t+J O iz.Gl K Cl
City: ;NC—: L&A';-U ► 1 kE County: F�o Qs y +h Zip:
3. The land on which this landfill.is located is described in the deed recorded in:
deed book:. 22,92, page: ,e,2_L4S1-_ county: F0114Strl'% _
4. Name of land owner: is L _A4%"16L 'fry U)_,_k 1i A, MS
5. Mailing address of land owner: 8.5. Y7 Sh A ll oW j�a fRr P_CI ^
City:-IE W t 5 v r 1 i A State: "-G Zip:_ D 2
6. Telephone number of land owner:l_N5f_
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.
7. Name of operator: rro,l.l �flS'�,tc (�. - „ �rDA rl kCb%A1Q1_ Z'lJc.
9. Trade or business name of operator: C 12A
9. Mailing address of operator: P. Q. 13 i
City: t j E M o►V 5 State: Zip:_ "7 O 1'i/
10. Telephone number of operatorl 231. ) 7 (o g- 915,$6
If the landfill is operated by more than one person, attach additional sheets with the name,
address, and phone number of all additional operators. (�
11. Projected use of land after completion of landfill operations:__ fA'SC,tQ i

Book 2586 Page 3669
The following are the applicability, siting, and operating criteria for Land Clearing and inert Debris
Landfills operating under notification,
.0603 APPLICABILITY REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS iLVIDl LANDFILLS
Managamant of lend cleaving and Inert debris shall be Ire accordance with the State hierarchy for managing solid waste as provided for under
N.C.O.S, 5 1 aa0A-309.O(al. Disposal in a land(ii( is conslderedta bathe least desirable method of managing land clearing And Inert debris, Where
landfilling is necessary, the requirements of this Rule apply.
(it An individual permit tram the Dlv{slon of Solid Waste Management is not required for Land Clearing and inert Debris (LCIDI landfills that
meet all of the following conditions:
Ial The facility is to be operated for the disposal of land clearing waste, Inert debris, untreated wood, and yard trash: Operations
must be consistent end In compliance with the local government solid waste management plan sic approved by the Division
of Solid Waste Managament.
11)) The total disposal area for under two acres In size.
{cl III facility end practices comply with the siting criteria under Rule .0684, and operational requirements under Mule .06GO.
idl The fill activity Is not exempt from, and must comply with all other Federal. State, or Local laws, otdktereces, Rules,
regulations, or orders. including. but not limited to 7ahing mstric*ns, flood'-plgltt ttistrktfons. ;t� OrA rastrlcti8ns,
sedimentation and erosion control requirements, and mining regulations.
(21 Where an individual permit Is not required, the following applies:
(a) The owner of the land m0hers the landfill Is located must notify the Division on a proscribed town, duly signed, notarized, and
recorded as per Rule .OG63f2)fbl. The operator of the landfill, If different from the land owner, shelf alvo sign the notification
form.
(b) The owner must file the prescribed notification form for recordation In the Register of Deeds' Office. 7h6 ilagleterof 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 Regleteet peal and the date, book and page number
of recording shag be sent to the Division of Solid Waste Management.
(cl When the land 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 sheit contain In the description section in no arrtahertype than that used in the body
of the deed or instrument a statement that the property has been used as a Land Clearing and Insit Debris Landfill and a
reference by book and page to the recordation of the notification.
.0664 SITING CRITERIA FOR LAND CLEARING ANO INERT DEBRIS ILCID) LANDFILLS
The following siting cdterla shall apply for Land clearing and Inert Debris (LCID) landfills;
(1) Facilities or practices, shall not be located 1n the 100-year floodplain. I, j
(21 Facilities or practices shall not cause or contribute to the taking of any endangered or threatened species of plants, fish, of wildlife. t
(3) Facilities or mactices; shallnot resuft in the. destruction or adverse modification oftha critical habitat of endangered or threatened species
as identified in SO CFR Fart 17 which is hereby incorporated by reference Including any subsequent amentirnerlts aried o4itibna. This
material is available for inspection at the Department of Environment. Health. and Natural Resources. Divislon of Solid Waste
Management. 401 Oberlin Road. Raleigh, North Carolina 21606 where copies can be obtained at no cost.
(41 Facilities or practices shag not damage or destroy an archaeological or historical site.
151 Facilities or practices shah not cause an adverse impact on a state park, recreation or scenic area, er any other lands lneluded In the
state nature and historic preserve.
(6) Fachitles shall not be located in any wetland as defined In the Clean Water Act, Section 404ib7.
M it must be shown that adequate suitable soils are available for cover, either from on or off eke.
(a) Land Clearing and Inert Debris landfills shall meet the falloxving surface and ground water mquiremertte:
(a) Facilities or practices shah not cause a discharge of pollutants Into waters of the state that Is In violation of the requirements
of the National Poltutaot 01schatgoe eliod matlar; System ANMIESI, un&4'r Sdetlail 402 of the Cleary Wai6r Act, its amended.
{bi Facilities or practices shall not ceune a discharge of dredged materials or fill material Into waters of the state that is in
violation of the requiromnnta under Section 404 of tho'Clean Water Act, as amended.
fcI Facilities or practices shell not cause non -point source pollution of waters al the state that violates naalgnad water quallty
standards.
(d) Waste In landfills with a disposal area greater than two acres shaft be placed a minlmum of four foot above the seasonal high
water table, except where an altemative Separation Is approved by the Dlvtsion.
(el Waste in landfills with a disposal urea less then two acres shell be placed above the seasonal high water tabta.
(ill The facility shall meet the following minimum buffer requirements:
(a) 60 feet from the waste boundary to all surface waters of the stets as defined in G.S. 143-212.
(bi 100 feet from ilia dispose} area to property fines, residential dwellings, commercial or public btiitdinon, and wefts.
(cl Buffer requirements may be adjusted as necessary to Insure adequate protection of puhtic health and the environmont.
(101 The (scility shag meet all requirements of any applicable zoning ordinance.
.0686 OPERATIONAL RlIGIAREMENTS FOR LAND CLEAMNo AND INERT DEBRIS (LCIO) LANDFILLS
Land Clearing and Inert Debris (LCIO) landfills shall moot the following operational requirements -
(it Oporntional plena shall bo approved and followed as specified for the facility.
121 The facility shall only accept those solid wastes which it Is permitted to receive_
131 Solid waste shah 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 active area reaches one sere In size, whichever occurs first.
2

Book 2586 Page 3670
45) 120 calendar days after completion of any phase of disposal operations, or upon revocation of a pormit, the disposal area shall be
covered with a minimum of one loot 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.
16) Adequate erosion control measures, structures, or devices shall be utilized to prevent alit from leaving the sits and to prevent excessive
an site erosion.
(71 10mvielons for a ground cover sufficient to restrain erosion must be accomplished within M vnnrkinp days nr 120 calandar daya upon
completion of any phase of landfill development.
(81 The. faepity shall be adequatety secured by means o1 pates, chairs, berms, fences, etc. to prevent unauthorized access axcept when
an operator is on duty. An attendant shall be on duty at all times whit the landfill fit open for pubfie use to oroure compliance with
operational requirements and to prevent acceptance of unauthorized wastes.
(9) Access wade shalt be of all-weather construction and properly maintained.
1101 Surface water shall be diverted from the working face and shall not be bnpounded over waste.
fill Solid waste shall not be dleposed of In water.
1121 Open burning of solid waste Is prohibited.
031 The concentration of enploslve paces generated by Via facility shall not exceed:
gal Twenty-five percent of the lower explosive limit for the gases in facility structures.
lb] The lowenpxplosive limit for the gases at the property boundary.
1141 Leachate shell be properly managed an site through the use of Current best managerrteht practices.
4161 Should the Division doem-ft necessary, ground water or surface water monitoring, or both, may be required as provided forunder Rulaa
.0001 and .0002 of this Subchapter.
(161 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 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 landfill will comply with the
requirements of sections .0564 and .0566 of the Solid Waste Management Rules. The facility and
operations of this landfill will aiso comply with all applicable Federal, State, and Local laws, rules,
regulations, and ordinances. Where the operator is' different from the land owner, 1, 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 Iandol as provided -for by
North Carolina General Statute 13dA-309.27. I further understand that North Carolina General Statute
130A-22 provides for administrative penalties of up to five hundred dollars (8500.00) per day per etch
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.
�.,•��. .� Vic_ �..-
Print Name (Owner) Signature (Owner) Date
North Carolina
County
I, , a Notary Public for said County and State, do hereby certify
thatAmlr= personally appeared before me this day and acknowledged the
due execution of the foregoing instrument.
Witness my hand and official seal, this the day f
(Official Seal)
Notary Public
My commission expires 4_3��,
r
OFFICIAL SEAL
90, Notary Public, North Carohis 3
COUNTY OF FORSYTH
WANDA KAv TEAQL
MY ComrMlosion Explr" March 3, 2]Otl

Book 2586 Page 3671
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 landfill will comply with the
requirements of sections .0564 and .0566 of the 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 13OA-
309.27. 1 further understand that North Carolina General Statute 13OA-22 provides for administrative
penalties of up t9 five hundred dollars ($500.00) 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
7A"
Print Name (Operator) Signat { per r) Date
North Carolina
r
.QY County
a Notary Public for said County and State, do hereby certify
that afar. S .��g- � ket sonally appeared be€ore m j hi day and acknowledged the
due execution of the foregoing instrument, brklsil-lr ofCesp.
f
OFFICIAL SEAL tFtis the - day of
Notary Pub4tc, NDtth Carolina
r
al 10 COUNTY of roesvm
fANiVE 8. SOLITHERN
My Ccmmissian Explrtie April IOLMN7 Notary Public
My commission expires_ ``o �4..9 Ob�
For additional land owners and landfill operators, attach separate notarized certifications for each
additional land owner and landfill operator.
INSTRUCTIONS
Purpose: Notification of land Clearing and Inert Debris Landfills under two (2) acres in size is required under 15 NCAC 138
.06631211a). Contact the Solid Waste Section at the address below for further information.
Distribution: Mail completed recorded original notification to the foBowing address:
Division of Solid Waste Management
Solid Waste Section
PO Box 27887
Raleigh, North Carolina 27611-7687
(9101 733-0892
Dispositiom This form will be transforred to the State Records Center when reference value ends. Records win behold for agency in the
State Records Center five (5) additional years and than transferred to the custody of the Archives.
STATE QF NC - F0RSYr._TJF1 CO ,.� The foregoing c ficate(s) of:
Is certified to be correct at the date of recordatl s o ter t pa t eof,
Dickie C. Wood, Register of Deeds by: