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NOR7HL ti. AROLiNA DEEPARTMENor
ENVIRONMENT AND NATURAL RESoURcE -
DIYIsiONt OF WASTE MANAGEME:lid',
LAND AND INERT DESM'S LANDFILL N0""F1 1�A- T 10rV
Pursuant to i 5A I 3B .0563(2)(a), the land owner(s) and ode► ator(s) of any Land
Cie,arina and inert Debris Landfill under two (2) acres in size shall submit this notification
Your: to the Division prior to constructinc or operating the landfill. T his Torn must be
filed for recordation in the Register of Deeds' office. The Register of Deeds shall index
the notifi^ation under the name o f the owner(s) o f the land in the county or counties in
which the land is located. The Registers 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 sisbrnitted to the Division. as required by 1Nc C I 3 .0563(2)(b).
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l=aciiit Name: n,;
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2. Faciiity location (streot address): a I
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3 . Dirp crLions to Site : 1,610 aA L L
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�-. T h . land on which this landfill is located is described in the deed recorcied in:
Deed Book- '✓aaep: .oun-ry:
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Name of iand owner:
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^... W,0iiIn adores S. o i land OWner:
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Llitv: FC4 )f AJ C 2 •r - I'\ ter.. P
LO L., p11
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I eieDhonv number
of anl. owner: Foa
if the ianc is owned by more than one. pefrson, attach additional sheR.s With the
name., acaress, and phone number oT all aaoniona! land owners.
Came o opera --or:
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C . ! rane` o flLsin,.ss na_ me of o p e r ato. •� r s
Mkalllnc c dd e'vs o f Op'vl ato~.PY
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``•.. T edieahone n u m bed o f arc tot': "
t= the taridTll' !s operated' by more ti-ian one person, attach -additional stlee s With
the n a m address, and phone number o­F all addi Clonal operators.
L 2. Project 1 use o= iand after co,mple riot► of landfill operations:
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401 06ERL.IX ROAL, SUITr_ 150, RAL60K, NC �7605
PHONE D t 5--7'3a-Q8D6 FAX Q l Si-T 15-3605
AN EQUAL OPPORTUNITY ! AFFIRMATIYE ACTIoN Emp oYER - 50% RE: TCLEDIl 0% POST-CONSUMCR PAPER

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The following are the applicability, siting, and operatingcriteria f cror Land Clearing and inert Debris Larkfitfs
Operating under notification.
.010i DEFINITIONS
(72) !Land clear
waste' means solid waste which is generated solely from land clearing activities such as stun
other naturally occurring vegetative material. P=. trees, limbs brush, grass, and
(73) 'Land clearing and inert debris landfill! means a facility for the land disposal of land clearin waste co
uncontaminated soil, gravel .and rock, untreated and unpainted wood, and yard ,trash. 0 ncrete, brick, concrete block,
(74) 'Yard trash' means solid waste resulting from landscaping -and yard maintenance such as brush,
materials. grass, .tree limbs, and -similar vegetative
•0663 APPLICABILITY REQUiREMIENTS FOR LAND CLEARiNG AND INERT DEBRIS iLCID) LANDFILLS
Management of land clearing and inert debris .shall be in accordance with the -State hierarchy for managing -130A-308.04(a). Disposal in -a landfill is considered to be the least desirable method of managing land clearing landfii{ias provided for under N.C. 5
.
necessary, -the requirements of this Rule apply. 0 inert debris. Where .np is
An individual permit from the Division of Solid Waste Management is not required for Land Mearin .and inert all of the following conditions: g Debris (LC1D) landfills that meet
(a) The facility is to be operated forthe disposal of land clan
ring Inert debris, antra
be consistent and in ca i __. sled wood, and yard trash. Operations mus;
mpaar�ce with the loss{ government solid waste management .plan as -approved by the Division of Solid Waste
Management.
(b) The total .disposal area is .underlwo -acres in size.
(c) The facility and practices comply with the siting criteria under Rule .0564, and .o eration
(d) The fill a -operational requirements under Rule .0566.
ctivity-is not from. and must comply with all other Federal, State, or Local laws, ordinances. Rules re, or
ordem,.inciu ding but not limited 1n zoning restrictions, flood .plain -restrictions, -wetland restrictions, sedimentation and, gulaticon
requirements, and mining regulations. erosion onVof
(2) Where an individual .p rmit k not -required, the following applies:
(a} The owner ofthe .land whecethe Landfill is located must not
ify the Division on a prescribed form, duly signed, •notarized, ,and recorded
-as per Rule .O5e3(2)(b). The operator of -the landfill, If different -from the land owner, shall also -sign the notification -f
(b) Th0 oar mutt file the P� notification form for recordation in the Register of Deeds' Office. The Register cs s
the notification in the grantor index under -the name of the owner of the land in the countyOrator of Deeds shall index
A copy of the recorded notification, -affixed with the Register's seat and -the date, book d page number which
the land is located,
to the Division of .Solid Waste Management. recording shall be sent
(c) When the land on w(vch-the Land Clearing and inert.Debris Landfill is sold, )eased, conveyed, or transf
or other instrument of transfer shall contain in the description section in no smaller e h °mod any manner, -the deed
rratrurnent 'a statement that the ZYP 2 an that used in the .body of the deed or
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.
Procation.
.Oo64 SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS MCIDYLANDF1LLS
The following siting criteria shall apply for Land -Clearing .and inert Debris (LCID) landfills:
('I) Facilities or practices, shall -not be located in the 1 00-year lloodplain.
(2) Facilities or practices shall not -cause or contribute 'to "the -taking of any endangered or threatened species
(3) Facilities or practices shall not -result in the destruction or adverse -modification of the critical habitat f of planted fah, or threatened
identified in E0 CFR Part,17 .which is hereby incorporated by reference" including any subsequent amendmentsOared o ingest This species as
available for inspection .at the Department of Environment, Health. and editions. This -material is
and Natural Resources, Division of Solid Waste Management, 401 Oberlin
Road, Raleigh, North Carolina 276M where copies can be obtained at no cost.
(4) Facilities -or practices shall not damage or destroy an archaeological or historical :or -scenic. area, or ansite.
(5) Facfties or practices " not cause an adverse impact on a state park, recreation and historic preserve, y other lands included in the state nature
(s} 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 off site.
(S) Land Clearing and .Inert Debris landfills shall meet the following surface -and ground water re uire
a Fac�ibrn q ents:
es or practices shalt not cause �a -discharge of pollutants into waters of the state that is in violation of
National Pollutant Discharge Elimination System (NPDES), under Section •402 of the Clean W 'the requirements of the
(b) Facilities or -practices shall not cause a discharge of .dredged.�materiak.or-fill material into v, Ater Act, as amended.
the mquiremerts underSection .404. of the -Clean Water Act, •sa .amended. �°m of the state .that is -in violation of
(c) . f aciiities or Practims SW not cause non -point source .pollution -of waters of the state
-that violates (d) Waste in landfills with al .disposal :area greater -than -two acres .shalt be placed -a minimum of four feet above
d water quality :standards.
table, except where aapproved by the Division.
n .alternative separation is a above the seasonal high water
on.
°) Waste in -landfills with •a -disposal area less than two .acres .shall.be .placed -above the seasonal hi
t8) The facility shall meet the following minimum buffer requirements: gh water table.
(a) 60 feet from the waste boundaryto -all surface waters -of the,state as -defined -in G.S. 143-21 (b) 100 feet from 2
the disposal -area "to property lines, residential dwellings, -commercial or pub! u' ` . '
(c) Buffer requirements may be -adjusted as necessary to insure adequate -protection P i., b tldi�np�an�
(10) The facility shall meet all re q P section of pubic heefth�and the errvronrrment.
quirements of zany applicable zoning ordinance.
.056E OPERATIONAL REaU EN ENTS FOR LAND CLEARING AND INERT DLANDFILLS ►r+ I
Land Clearing and inert Debris (LCID) landfills shall meat the following operational to u{m )
(1) Operational plans :hag be a q nts:
approved and followed :as specified for the facility.
(2) The facility
rtY shall only accept those -solid wastes which it is permitted to receive.
(3) 'Solid waste shall be restricted to -the smallest area feasible and campa - <°`N
(4) Adequate .soil cover shalt be a lied monthly nt°d as densely as practical alto c elis')
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• �} 120 calendar d ,.or when the:active area reaches one acre in size, whictiever'ocQum. -first.
sys altar cornplation of any phase of disposal .operations, or upon revocation of n permit,
a wn of one Boat of Ala sat cover sloped pe , tfie- disposal area shell be covered with
In order to comic: Ped to Allow water runoff in •a controlled manner. -she Division may require futther.action
(g) Adel n any condition �rhich it or may become injurious to the public h�eatth, or a nuisance to the control measures, community,
erosion. _ . 'ar tdavic:as shall be utilized to prevent silt from -leaving the site and to prevent•eic�anaive on site
t7) Pmvsionc for a ground c:oversufficient to restrain erosion must be a
Of any phase of landfill development, ccamplished within 30 working days or '120 calendar days upon completion
(8) 'flre tacat, sizadl be adequately secured by means of pates, chains, berms, fences, etc. to is on dam• An sttandantsW be on dirty at all times PrQvent unauthorized access except when •an.operator
and to prevent acceptance of while the landfill is :open -for public use to assure compliance with operational requirements
unauthorized wastes.
(9) Access roads shall be of all-weather construction and Property maintained,
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(10) Surface water shaft be diverted from the working face and shall not be impounded over waste.
01) SoOd waste shall not be disposed of in water.
(1 2) Open burning of _sobd waste is prohibited.
(13) The concentration of explosive gases generated by the facility shall not exceed:
(a) 'Twenty-five percent of it►e -lower explosive Fmsit for the Cases in facility structures.
(b) The lower explosive iirnit for the gases at the property boundary,
(14) Lenchate shah 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 -monttoring, or both, may be required as provided for under Rules .0601
and .0602 of this Subchapter.
(1 si A sign chap be popd at the facility eIItI81 ee showing the contact name and number an 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:
1 certifythat the information provided by me in this notification is true;+accurate, and complete 'to the
best of m knowled e. The facility siting and disposal operations of this Land Clearing & inert Debris
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landfill will comply with the -requirements of Sections .0563, .0564 -and .0566 of 15A NCAC 138,
North Carolina Solid Waste Management Rules. The facility and operations of this landfill will also
comply with all applicable licable Federal, State, .and Local laws, rules, regulations, and ordinances. Where
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the operator is different from the land owner, 1, the land owner, have knowledge of the operator's
fans to dispose of solid waste on the land and 1 specifically grant permission for the operation of the
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landfill. 1 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. l further understand that North Carolina General Statute 13OA-22 provides for administrative
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enalties of u to five thousand dollars � S 000.00) per day per each violation of the Solid Waste
iVlana9 ement Rules. l 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 amend " tints. a
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Print name (Owner) Signature (Owner) Date
North Carolina
FL County
1,
KF� _Ave� , a Notary public -for said County and State, do hereby certify that
s personallyappe.ared before me this day and acknowledged the due
execution of the foregoi
v1Atnees-ifnxhand and. o
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4b Alf
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_,1r1 'pn_='expires
f �� /• .'t �� f dam...... � ` , o;
North Carolina
Caldwell County
THE. CERTIFICATE OF
crs
L� SIP
IS CERTIFIED TO BE CORRECT.
Wayne I.. Rash,
RE GIS R OF D ED
BY: ..

Certification by Landfill operator (if different from Owner):
1 certify that the information provided b me in notification Y this not�f�cation is true, accurate, and complete
best of my knowledge. The facility siting and disposal P to th:-�
p operations of this Land Clearing &inert Debi: 1
landfill will comply with the requirements of Sections
.0563, .0554 and ..0566 of 1 5A NCAC 13
North Carolina Sold Waste Management Rules. The facility `
and operations of this landfill will also,
comply with all applicable Federal,
informed the land owner of my plState, and Local laws rule s, regulations, -and ordinances. i hav�,
ans to dispose of solid P o id waste on the land and the land owner ha
specifically granted permission for the operation of the landfill. 1
understand that both the operator an-
land owner are jointly and severally liable for improper
provided for b North operations and proper closure of the landfill a:
Y Carolina General Statute 130A-309.27. I further under
provides stand that North Caroler.: General Statute 1 30A-22 ,.
p es for administrative penalties of up to five thous rr
E$�,OOQ.Qo} par day per each violation of the Solid Waste_--.-- -.. .and doila, �-
ste Management Rules. I further understand that.
the Solid Waste Management Rules may be revised or amended in the future and that the facilitysiting
and operations of this landfill will be required to comply with
p y th all such revisions or amendments.
Print Name (Operator} Si
. gn azure (Operator) Date
North Carolina Ak
County
!, a N
otary Public for said County and State, do hereby certify that
personally appeared before me this day and-acknow! edged.the due
execution of the foregoing instrument.
Witness my hand and official seal, this the
_ day of 19
(Official Seal)
Notary Public
MY commission expires 19
For additional Sand owners and landfill operators, attach separate n •
owner and landfill o notarized cer�,fications for each additional land
Aerator.
For Corporate land owners and/or operators, use the Corporate Certifications, pages � and a. Conta;t the 3. v.
sionof Solid Waste Management Tor proper applicable certi^a .ons.
INSTRUCTIONS
Purpose: Notification of Land C kmring and inert Debris Landflts under two (2) acres in size is `
Waste Section at the address below for further information. required under 16 NCpC 13F3 .f'?563(2) (a). Contact the Solid
Distribution: Mail completed recorded original notification to the following address: `
• Division of Waste Management
Solid Waste Section
PCB Box 29603
Raleigh, North Carolina 27611-9803
[phone]
Disposition: This form will be transferred to the State Records Center when reference value end
s. RecorRecords Center five (B) additional years and then transferred to the custody of the Archivess wilt be held for agency in the State.
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THIS MAP IS NOT A CERTIFIED SURVF
AND HAS NOT BEEN REVIEWED
BY A LOCAL GOVERNMENT AGENCY
FOR COMPLIANCE WITH ANY
APPLICABLE LAND DEVELOPMENT