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North Carolina � �(
DPpartment of Environment and Natural ResourcesA14
r
Division of Waste Management ` �•�.�.
Michael F. Easley, Governor NCDENR
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
Pursuant to 15A NCAC 13B .0563(2)(a), the land owner(s) and o erator
2 acres p (s) of any Land Clearing and Inert
Debris Landfill under two
( ) es 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
Office. The Register of Deed the Register of Deeds'
9 s 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 I and the date, book, and page
number of recording must be included on this form when submitted to the Division.• • •
I
to authorize operation of a landfill 'unless This notification �s not
ess complete, accurate, recorder), and submitted to the Division
as required by 15A NCAC 13B .0563(2)(b).
1. Facilit y Name: 1' Ut0t4,f
;.,���f\�'.. 3
2 • Facility location (street address) :
City. �•. t�,��a:�'����.�''.�� a ""' i r)
County. Zip: '`�^
3. Directions to Site.
-�C3 ''D L) +
4. The land on which this landfill is located is described in the deed re
corded in:
deed book: 3l •
page
county:
5. Name of land owner: bF.
6. Mailing address of land owner: I q 5 r =bL1 liq �Vori P-
city:. k,e_,,;o1'1,:-
.State: �:''� Ej ���t��r�t? �? Zip:
t w
7. Telephone number of land owner: � I V `7 4- `7c cl Ct
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.
8. Name of operator: T C +tip .lt v
9. Trade or business name of operator.�-
10. Mailing address of operator: q J y
L
City:State: 1 ��1�J_ '...:'���'�,� , �,
Ztp .
1 1. Telephone number of operator: d-- �� IF — �Z-
If the landfill is operated by .more than one person,, attach additional •
p additional sheets with the name,
address, and phone number of all additional operators.
12. Projected use of land after completion of landfill operations:
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone: [phone] FAX: [phone] \ Internet: www.enr.state.nc.us/
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER -- 50% RECYCLED / 10% POST CONSUMER PAPER

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 form.
3. Completely fill in the information (numbers 1 through 12) on page 1 of the LCID Landfill Notification form.
4. Sign the appropriate certifications) 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 form.
5. Have the certificationsifrom 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.
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As. long as your disposal activities remain in an area under 2 acres in size, you may operate under the pf ovisions of
i 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.

~vs 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 1313:
.0101 DEFINITIONS
(53) "Land clearing waste" means solid waste which is generated solely from land clearing 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 clearing 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.
.0563 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 land clearing and inert debris. 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 operatod. for the disposal of land clearing waste, inert debris, 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, wetland 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 form, 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 Register's seal and the date, book and page number, of recording shall
be sent to the Division of Solid Waste Management.
(c) 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 shall contain in the description section in no smaller type than that used in the body of the
deed,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 100-year 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
`1 Available for inspection at the Department of Environment, Health; and Natural Resources, Division of Solid Waste Management, 401 Oberlin
4 d Road;ol�aleigh, North Carolina 27605 where copies can be obtained at no cost.
(4) .M 'a OaGilitips'tr practices shall not damage or destroy an archaeological or historical site.
^ (5) ' FaciliV.Fj§ oepractices shall not cause an adverse impact on a state park, recreation or scenic area, or any other lands included in the state
�.. , �e r6 artd .hr;toric preserve.
(6) �_. ��� F� .;cities "r1heWbot be located in any wetland as defined in the Clean Water Act, Section 404(b).
(7) It must by Aoivn that adequate suitable soils are available for cover, either from on or off site.
(8) . r'' " [Ated Cledring Aid Inert Debris landfills shall meet the following surface and ground water requirements:
�Fr'acAities or practices shall not cause a discharge of pollutants into waters of the state that is in violation of the requirements of
�.th 'National Pollutant Discharge Elimination System (NPDES), under Section 402 of the Clean .Water Act as amended.
a , � 9 Y e
(b) w �� ;,� Facilities or practices shall not cause a discharge of dredged materials or fill material into waters of the state that I '*I'n violation
�,$f the requirements under Section 404 of the Clean Water Act, as amended.
'(c) t``;,Facilities or practices shall not cause non -point source pollution of waters of the state that violates `assigned water quality
1"111 # 1111 � 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.
(e), 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) 'Buff er'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 active area reaches one acre in size, whichever occurs first.
0

115
(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 erosion.
(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.
(8) 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 properly maintained.
(10) Surface water shall be diverted fronTthe working face and shall not be impounded over waste.
0 1) 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 it 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 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. 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 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 r quired to comply with all such revisions or amendments.
bd)(IAP 2, 3/ 0 tt-
Print Name (Owner) Signature (Owner) Date
North Carolina"'X
� , •
iV • 1
ounty E. ..dW
•
lto �'� a Notar Public for said ll �� «�►
y d Count and State, do c(W
Y
that d personally eared a before me this .�`
p day y and a c k n o w1� d '�'ne
execution of the foregoing instrument.
. P
Witness my hand and official seal, this the day of , 20 C�
(Official Seal)
Notary Public
North Carolina
My commission expires ", 20 Caldwell County
THE CERTIFICATE OF
�q e��. nth �
IS CERTIFIED CORRECT.
Wayne L. Rash,
REGISTER OF DEEDS
BY:
lJ

' Y
r
i
r
Certification by Landfill Operator (if different from Owner) :
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 05,000.00) 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.
dos
�P_
•VJ of/
P/r�int Name (Oper tor) nature (Operator) Date #00
. •�, /JR;
Aso 8
North Carolina S�.Qclvt,S4.':;' � f% ►
UX County - : , .•. .
VLUIA, ,�►
1�Cit._N a Notary Public for said County and State, do 'fib, ,Ger '
that �ci. `� 1� � e r '' '� �We
p sonally appeared before me thls day and acknoh�
execufion of the foreg6ing Instrument.
Witness my hand and official seal, this the day of 20 (� ,
(Official Seal C
Notary Public
My commission expires 120
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.
51

Certification by Corporate Land Owner:
! 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 era '
disposal o
P p tions.of this Land Clearing &Inert Debris landfill
will comply with. the requirements of Sections .0563 .05164
Solid Waste Management Rules. The facility and � and .0566 of 15A NCAC 13B, North Carolina
operations of this landfill will also ' applicable Federal, State, and Local laws, rules, regulationsCOmpIY with all
different from the corporate land owner,g 1Ons, and ordinances. Where the operator is
the corporate land owner, has knowledge of the o erat '
to dispose of solid waste on the land and is specificallyran P or s plans
It is understood that both the granted permission for the operation of the landfill.
corporate land owner and operator are jointly and severall lia
improper operations and proper closure of the landfill as provided for bY ble for
y North Carolina General Statute
13OA-309.27. It is further understand th
at North Carolina General Statute 130A-22 provides
$5 0 p es for
administrative penalties of up to five thousand dollars Management Rules ( 00.00) per day per each violation of the Solid
Waste Mana
9 . It is further understood that the Solid Waste Management R
or amended in the future and that the facilitysiting g Rules may be revised
9 and operations of this landfill will be required to
comply with all such revisions
or amendments.
r
Corp
tation" Na i6 (Print)
��� ; •; Date
��
a 1 !
•( or orate t
r p Se I)
Attest:
1,1I '
Presidefifi lot, u'ib�'
e-President Name (Print) Corporate Secretary cretary Name Wrint)
President or Vice -President Sig' nature
North Carolina
Corporate Secretary Signature
County
Ilk
I' , a NotaryPublic for said County and State, do hereby certify
that (name of secretary) personally appeared before me this day and
acknowledged that he (or she) is secretary of
(name of
corporation), a corporation, and that by authority duly given and as the act
of the corporation, the forgoing
instrument was signed in its name by its
(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 dayf
o , 20
(Official Seal)
Notary Public
My commission expires 20
5