N0727 AVERY COUNTY MINE

FILED in Avery Count V. NC
on Mar 31 2000 at 12:07:14 PM
y by: Tamla T. Baker
T Register of Deeds
BOOK 424 PAGE 2744
WNW
North Carolina Department of Environment and Natural Resources
Dexter R. Matthews, Director Division of Waste Management Michael F. Easley, Governor
William G. Ross Jr.,Secretanj
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).
1. Facility Name:_ —1 o/JA11_Ihie
2. Facility location (street address): ©1_ b A�, / 6 RO C k ZEQ A N
City: L Ai!4_N County:04k/ Zip: 7 !, 1 pL:S_7
3. Directions to Site: ZJ6 Mc % o i_b kQ>b, C�Je11 D
©L� Dhl Z m)t.L_ (E"67 etiJa of }�aJ M�e1�1" /12u 7Zlt�, f��13T
FR E.1 W_ 5 pFLJ6CW l Aya&e ®tJ z1!y t n) uC 1` A ` M/L & Z/P 9<� /o FRo!'�iQt
4. The land on which this landfill is located is described in the deed recorded in: /
t
a, ,t deed book: D page:_j 1 Z 4 1733 county:
45. Name of landowner: 'RC- Co LI PT*/ LAWN P D it LD 11 J
6. Mailing address of land owner: , o $ C>X SCa
�— City: A FR iJCC '5I � State: C' Zip: Z
"9 7. Telephone number of landowner:( % 6'��p O�
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: "IZ L A \/ G P-V O o ap-�--1 L,4 kJ ts L LC_
9. Trade or business name of operator: Al g �` /_1r3 :J /`) l J J
10. Mailing address of operator:____
City:6 P R Lte-C J� LJ�_ State: IJ C- Zip: Z, —7 % 7
11. Telephone number of operator:( L927,A'7 (o — q
If the landfill is operated by more than one person, attach 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] i Internet hfp:/!wastenotnc.org
An Equal Opportunity/Af€irmative Action Employer— Printed on Dual Purpose Recycled Paper

BOOK 424 PAGE 2745
Certification by Corporate 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 corporate land owner, the corporate land owner, has knowledge
of the operator's plans to dispose of solid waste on the land and is specifically granted permission for the operation of the
landfill. It is understood that both the corporate 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. It is 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. It is further understood 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.
1-4' C, 4\,1169 0 gj1 g--r4 &I LLC- �� I A RC.
Corporation Name (Print) Date
(Corporate Seal) Attest:
NSFAe (Print) MA),,(.4LCRT.,orporate Secretary Name (Print)
Presid nt or Vice- resident Sig ature Corporate Secretary Signature
North Carolina
IU,Itht II County
I, d L1 61 1I(efS a Notary Public for saiCounty and State, do hereby certify
that gr�N Ay ,Q , �(c' PG�t �GP (name ofMseere� personally appeared before me this day and acknowledged
that he (or she) isf of K(.AJ a1Li CDt.�) LAg& NU L6, LLcTname of corporation), a corporation, and that
gr rL
by authority duly given and as the act of the corporation, the forgoing instrument was signed in its name by its
M A l" A L, is IZ ( ), sealed with its corporate seal, and attested by himself (or herself)
as its seepetery.
y APA�6 day of W�, 20
Witness m hand and official seal, this the
(Official Seal)
Notary Public
My commission expire. 3 , 20_.