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Home My WebLink AboutN0759_BandKLCID1166 0818 BK.01166 PG-0818 FILED LEE COUNTY MOLLIE A. MCINNIS REGISTER OF DEEDS FILED Mar 24, 2009 AT 04:45.14 pm BOOK 01166 START PAGE 0818 END PAGE . 0820 INSTRUMENT # 01782 NCDENR North 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). I 1. 2. 9 oY'+f• rV r��rq`" 4. The land on which this landfill is located is described in the deed recorded in: + (C- �' P deed book: It 6 3 page:_ county: '� " `ten 5. Name of landowner:_ MIL 6. Mailing address of land owner: L! Ayw//V �f City: 41WAP/110 State: 61 zip: Z -75 3�L 7. Telephone number of land owner:( q'/ SgGO 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 9. Trade or business 1646 Mail Service Center, Raleigh; North Carolina 27699-1646 Phone: 919-508-8400 t FAX: 919-733-48101 Internet http:/iwastenotnc.org An Equal Opportunity ! Affirmative Action Employer - Printed on Dual Purpose Recycled Paper 1166 0819 BK:01166 PG:O819 10. Mailing address of operator: City: lj4N 4C. ✓Z 11. Telephone number of operator:( Zip: 2? 33 15 If the landfill is operated by more than one person, attach additional sheets with the name, address, and phone number of all additional operators. f 12. Projected use of land after completion of landfill operations: 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, 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 fifteen thousand dollars ($15,000.00) 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) Signature (Owner) Date North Carolina L e. qk.. County a Notary Public for said County and State, do hereby certify personally appeared before me this day and acknowledged the due execution of official seal, this the -AI+ day of Mq t-ch 20ri . 2011 Notary4&blic 1166 0820 BK:01166 PG:0820 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 136, 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 fifteen thousand dollars ($15,000.00) per day per each violation of the Solid Waste Management Rules. I further understand that t Solid Waste Management Rules may be revised or amended in the future and that the facility sitingFof this landf i 7required to comply with all such revisions or ant D /y Print Name ( er or) e t r) ate North Carolina L County I, �T_—]'{�6 mct S a Notary Public for said County and State, do hereby certify that 2—oh n n u KLI : S personally appeared before me this day and acknowledged the due execution of 40 official seal, this the _ day of McLrc2061 Notaq_Pjjblic -;-- 4 ,20►1 FOFW ett l 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 (919)508-8400 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.