N0158 DURWOOD HUMPHREY & SONS

PPWe 1 of P
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State of North Carolina ir�q g -5 0
Department of Environment, Health, and Natural Resources
't 512 North Salisbury Sam a Raleigh, North Carolina 27604
Division of Solid Waste Management
�' jama L Hunt; Jr., Governor Solid Waste Section Jonathan R Hawes Sccmwyl
Tokpt,one (919q 7334"6
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
t ;
4 Pursuant to 15A NCAC 138.0563(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 corm 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
tho 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 vard to authorize operation of a landfill unless complete. accurate, and recorded as
required by 15A NCAC B .0563t21(b).
1. Facility Name•
2. Facili location Istreet address):
City, County: Zip:
3. The and on which this landfill is located is described in the deed recorded in:
dead book: page: county:
4. Name of land owner:
5. Mailir address of land owner.
City. �?. ) State: Zip:
6. Telep one number of land owner.1 l
If the land is owned by more than one person, attach additional sheets with the name, address,
I
and phone number o 11 additional an owner I.
7. Name of operator: f`Q�
a. Trace. or business name of operator:
9. Mailing address of operator.
City, State• Tap:
10. Telephone number of operator: ,
If the landfill is operated by more than one petson, attach additional sheets with the name,
r I
address, and phone number of all additional operators.
11. Projected use of land after completion of landfill operations: I 44
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po flu 276U. Rakisk Nwd% G,otim 2701.76P Tele0wnr 919M14 7u Fa r 91% nMM3
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Book 1192 Page, 1977-Current 86 Seq- 1

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ROOK i 19 ti ME 87
The following are the applicability, siting, and operating criteria for Land Clearing and Inert Debris
Landfills operating under notification.
.0101 DFnNITIoms
17J1 'Land clearing wes,*' roes" solid waste vrhwch M 00riarelsd eataflr from land clearing sctivrtes such are sturnpa, treee, bnibs, blush.
Cress, and other natufsov accur g yegelal.ye matartet.
1731 'Lard cleemng end inert debris land041' movie a lacrhty for the lend disposal of land cle&nng waste, soricr*te. bwci. concrete b1pC it.0m neonla•nated Bog, gravel Will reek. untreated and unpainted wood. and yard trash.
1741 'word trash' rne&tie SOW weals reoullirg Iron fandeceping and yard rnaitlenents such as bnah, grase, free Ihtbe, and eWou vegetative
i m.t.ri.io.
G%93 AMICABILITY REQUIREMENTS FOR LAND CLEARINO AND INERT DISAIS RCIDI LANOFILLe
b41109e1TISnl of lend clearing end inert dobno shoo be In occordance with the Slate Ivererchy for managing eebd wooto as provided lot under
N.C.O.&. 1 130A•308.04 tal. D apaess m a landf.g Is considered tabs the least des,reble method of managing land cloom+p and Van debris. Where
Istidfrllirq IS MeeeeOry. the regvallmenle of INS Rule apply.
11I An hd.vndusl psrrml from the D.v sion of Sold Wool• MannSOOment he "1 requited for Lard Clearing end mart Debris ILCIOI laW,14 that
we*l 0100 lh• sOliow.np condrttons:
Sal The faC.I.ty is to be operated Ion the disposal of fared CMarig waste, hen debrio. w ntnoted wood, and yid trod%. Operatlond
must M consistsnt and n tomplisnts with the local govemmern soid wools ftlanalignient plan as approved by the pivieion
of Sohd Waste MMagemenl.
Ib) Th* total duposN aria me under two acres In size,
k) The facility end pnctrcas comply with the ailing criteria wider Rule.06e4, end Operational requir"MrAs under Rule .06ee,
III The fro sclrvity le not •ramps from. and must comply yeah ON other fdbrol. State. or Local law. ordin&ncss. Rules.
repulsliono, or orders, irichrdrig but riot "tsd to toriig re@trktiors, food plain faslrtetiorts, wott" reettitlas ia,
sedim*ntelion and sroslon control requbsmsnls, and rrihitg regulations.
fill 1Mli•re an lydividual pOnrirt In not required. the following apples:
401 The owns. of thelard when the landlin M bxoted must notify the Dlvt@lon an o pr.sertsd foitn duly signed. notarized. errs
recorded are per Rule .06031211bt. The operator Of Ile lid W. It different from Ile land owmar, Shut!alas elan the rioWrcetron
form,
tlil This owner must 14e the pmscnbd matJirsllon form far rerotdatlon In the rlopleter of Dieedo• gore*. Tha ROplefor el Deed•
shag ended the not.licol an in the grantor Silas u doh the memo of the ewnar of the land in the to IV
a cOvntiea In whirA
the bud is located. A copy of the nctxdOd not ilic&tion, afli&ed with the Regyt*Is pet and the data, Ireok and page nurr4 w
of recording shoo be semi to the Division of SOW Was,* Management.
kl When the land on which the Land Clearing and hen Debris Landf.0le soft, leased, cenv*yW. or traw.faned In any mariner,
thO dead Or olhet in@tn"Wnt of transisr shell comlain it the doatnpUOn Section In to omagSr type ihus that wood in the body
of the deed or hditurieni 0 egaternent the% the property has been used M a Lamit Cleartrn0 and Orion 09646 LondfJ and a
t*'Mnc• by boon and page to the rot001114tlon of the notification.
.0664 WTINO CRITERIA FOR LAND CLEARINO AND INERT DEdAIS RCID) LANDFILL&
' The fallowing siting criteria shah apply for Land Cia&rrrg and Inert Debold ILCIDI bridtrl o:
Ill Faco t se or practice*. shalt not bm located in the 106year floodple.n.
121 Faca ties or practices shalt not cause or eontnbirls to the taking al any atidMgered or t)rseloned species Of plants. 1wh, or wildlife.
I33 Fat.Mlweorpnctkdo*hohhotresuhnlhodesTnxt.onsoadwnemoddKalMmoltheenlic&IhabitSoofenderpandOrthreNanadspecies
are idanlrbod in 60 CFR Part 17 which r hereby rgorporalsd by reforence iichrdilg any subsequent amendnante bled od.l.ens. Thy
rnalonat is ava.loblu for inapecliom at the Deportment of Environmont. Health, and NNural Resources, Division Of SOW Waste
• Management, 401 Obsr" Rood. Raio-oh, North Carolnb 27805 when• copies can be obtained at n0 coot.
141 F&cd.tee Or pestl,ee4 Mon not damage or destroy an steha•ologicaror Notedical slue.
Kl ►sr.ktee ar practice* @hall not cause on &dyer@* lmPOct On * olatb park, recreation at sterile wit• or any *Mar, letnde btbtded in the
etsl* naturO wind Malone presets.
161 Facilities @he" not be located In &with wettand be defined it the Clean Water Art, Saction 40411i1.
(71 R must be shown that adequate suitable said are evFleble for cover, ailhor from On or *II site.
1&) Lid Cibering and inert Debris I&mdl.11s shag most the fol4win0 OurlocS and fore" water raquiswen,*:
Of FOC.rwe a practical anon not call&• a dechorge of ponuiente into watts of the Sidi* that le h viofotkin *1 Ile ngiianeMs
of the f:stmn&l Aauul-M C:4CGor;S Eic•Instion ?vale n INP0'111. under pennon 402 Of the plan +Yetsr Act. Se onietWed•
Is) facilities or practices shop not cause a discharge of dredged materials Or fill mstaries hie wetly of U* stale that le on
viobtion Of the tequ.roommid viler Section 404 of the Chan Water Act. as emended.
ft) Facrhtiee or practical shag not e&6-64 hOmPo;nt Scums pollution Of waters of the state that vlolatw apigned water quiet
standSrds.
Id) Wells 011 IMWf.11e with a disposal are@ greater than two acres shop be placed a fltiriWhetl of fair fast ahoy* lilts peeeMlll411
water table, except when On Ortsfn011ye wporallon is approved by the Dlvi@ion•
let Woo,* in Iondf4le with s diepOSO! area Mse than two acres shag Ors placed above the seasenaf high water faros.
19) Tha fsc" shall neat the following rurtrwum buffer wqulAnrwimls:
Ilk) 60 feet front the waste boundary to ON Outlets wbt*r@ Of tie ststs ad delAW in O.S. 141212.
fill 100 last Imm the d aposaf arise to 11#004Iny 1,008. residential do 0. COwrMtCW or pubk blrlhgs, end wwpe.
kl Buller ntluiremanis may be odlwtd me nge&&aary to Insure Odsquats prbtectlefl of p mk Iwo" end do amMOewwlt
(10) Tfq facility shelf mist ad I'll"wynla of ewtf ap frficable tprllq ardinaric*,
•0646 OPERATIONAL REQUIREMENTS FOR LAND CLEARINO AND INERT DEORM fL=DJ ►ANDO LL&
Lard C3earhg and Iran Debrie ILCIOt UwWfJs anal wisest tlid foMewrig *perotiorief tegitietnafita:
It 1 opuetiornal plume chop be approved srd followed as spsollled Fee the fWAft.
(ill The facility sAap *lily accept the" cold wastes wrhicA 4 Ise put ph 4d W rgcslv*.
W . •obit waste ghap be owtA"od to the off* at tree faao8la and two" ad are derlaa1 Not 0 g9kel Ink **Be.
•
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141
AdOWN@ a" CoVW shot! bo%l . De rah �n17CSM i
aro wkh*s trtr micro ti atrs, whfCltsear *rCctmia tonal.
f61
120 eslender days after Completion o1 ari phase of dlapoest eperatiortm, or upon fovaCelien of a psrwA. lh* dispoeml awe eMq be
eoverod wfth s l LYLlmt+rn Of ores loot 01 suitable *oil corer amp" to show surlscs Wolof runoff in a controlled rnsnw, Tire Dhislon
P" require further sedan M order to t:anecl arty Condition whkh le or mew botenr Irwrrlowe to the pulaft hosh h, or a ntisam:e to the
cc FA "rtlty.
to
Adsqusts erosion eancrd meaeurae, stnrcttres, mill devices ehea be tttrtted to prevent st+l from leerArrg tM ohs and to provenrt aaceeshw
on wto @moles.
tit
Provisions for a @pound Cover oulrrclortt to roetrebt erosion mvml be aacornpliehod within 30 woAing days mill t" Colander down upon
eompleton of anw phase of fandlil development.
1/1
The feclfity shall be adoguately secured by means of Oates. citable. forms. fence*. No. to proventt tsnowthorttad *ec*$o except whom
an operator IS on duty. An attendant shag be on duty at all tlrnas whim the fortdfrd is open for ptr09c tree to asewe etrrttpfranea wrth
operelionel requirements and to provent acceptance of unwthorfted waste.
If}
Access road. •hall be of all-weelhor construction and property NAMteMed.
tlC1
surface water shalt be diverted from the working face errd shag not be bnpoundad eves weete.
Ill)
sold waste shelf not be disposed of M water.
1121
Open burr)-g at solid went@ In prohibited.
t131
The concentration of explosive games gonstat*d by the fecWty shag not exceed:
lot Twmnry•flvs percent of the lower explosive rump for the games M lacii" strtroturoa.
(b) TAe lower explosive hm+t lot the Cases of the property boundary.
(14)
le*eh*t* shell be properly mmnagmd on Bite through the use of current bast m*rtegsmeret pr*ctkea.
1161
should tM Division doom it necessary, ground wear or surface water monitoring, at both. Wray be raqufred ss provided for wd*r Mules
OW and .OW2 01 this Subchmptor.
list
A sign shag be ported M I%* locmty entrance showing the collect name and number In come of are sanrfloncy and the parndt number.
The p4rwA number requirement Is not appbcoble for tacMies not requidno on individual perm&
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. 1 further understand that North Carolina General Statute 130A-22 provides for administrative
penalties of up to five thousand dollars IS5,000.001 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 wne �/► , ,,�' I Date
North CarolinaJ��
� \ 0 u1 County
a Notaryy Public'or said County and State, do hereby certify
that _NO na11y appeared before me this day and acknowledged the
due execution of the foregoing instrument. c�
Witness my hand and official seat, this the r day of .19
. tfJifit;al s9a1i;
o _ Notary Pu i
t . Mjc.commissiof, 8zpires\IAL.19
Book: 1192 Page, 1977-Current 46 Seq: 3

Pl�a�j a 1 001 k
BOOK 19 0 , Pig
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 Clearino & Inert Debris
landfill will comply with the requirements of Sections .0563, .0564 and .0566 of 15A NCAC 13B,
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
($5,000.00) per day per each violation of the Solid Waste Management Rules. I further understand that
the Solid Wasto Management Rules may be revised or amended in the future and that the facility siting
and operations of this landfill will beyrequ' to comply it 11 sue visions or amendments..
Print Name (Operator) Signature (Operator) Date
North Carolina
County
I•f, Ch a Notary Public for said County and State, do hereby certify
that personally appeared before me this day and acknowledged the
due execution of the foregoing instru ent. h
Witness my hand and official seal, this the an day of _.J YNP , 19 "1
(Off .rial Z.6�M,
Notary Pu
My commiSsiar. .spires 19,
y.
,For• gpditibnsl tend owners and landfill operators, attach separate notarized certifications for each
additional kind owner and landfill operator.
For Corporate land owners and/or operators, use the Corporate Certifications, pages 5 and $. Contact
the Division of Solid Waste Management for proper applicable certifications.
tNt1'AtlCT10f1e '
purpooe: kol ication of Land CiaarM4 and bwn Dab* LOWIAW U"W tore (21 sofa 1n eite h mgwbW wider 16 NCAC In
.0641t211a1. eommi the solid Waco seeuon at Im "demo bat. for hltrW Infarwtatbn.
Disubmhr4 MM --Oaed wcorded OVISMM netlrkatbn to the f06wM4 addMW
D MOM of Saw west9 f aAMOOR rk
404ia Wane section
r0 ee■ 27ee7
Aafagh. NOR% C&MGM 27611.7407
161 of 73i-0642
Dws" iew. T%W Mow We be trwfewed to the Nate Raearde Ceraer wt w wbgnee Vayo ends. fUeada wo be hw Mr Id I - M dw
et.ta fMaerM Canter five 04 addk'MW lreew WW tr+an trr %ff" to 04 OW96 f of tta ARMve.
4
Book: 1192 Page, 1977-Current: 86

POatje 9 of P
I
Certification by Corporate Land Owner: BOOK 19 2 PAGE �}
1 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 .05`,� of 15A NCAC 13B.
North Carolina Solid Waste Management Rules. The facility and Operations el 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 oporations 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.
Corporation Name (Print) Date
(Corporate Seal)
Attest:
President or Vice -President Name (Print) Corporate Secretary Name (Print)
President or Vice -President Signature Corporate Secretary Signature
North Carolina
County
a Notary Public for said County and State: do hereby certify
that Iname of secretary) personally appeared before me this day and
acknowledged that he for she) is secretary of IremeOf
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 seat, and attested by himself (or herself) as its secretary.
Witness my hand and ofiicial seal, this the dzy of . 19
(Official Seal)
Notary Public
My commission expires .19
5
Book: 1 192 Page, 1977-Current 136 Seq: 5

We � of P
BOOK 119 20 PAGE 91
Certification by Corporate 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 13B,
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. The land
owner has been informed of plans to dispose of solid waste on the land and the land owner has
specifically granted permission for the operation of the landfill. It is understood that both the operator
and land owner are jointly and severally liable for improper oporations and proper closure of the landfill
as provided for by North Carolina General Statute 130A-309.27. It is further understood that North
Carolina General Statute 130A-22 provides for administrative penalties of up to five thousand dollars
(45,000.00) per clay 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..
Ile"
, CSdl
Corporation Name IPrnt) Date
���.•� kUMPyA''•,
(Corporate Seal) O c99ltrc st:
GOQpID
' 'l Y� 1^%/,�l'r.rr.� /r ��'I d/±•��i MY •wJ� .lam 1 '%.'f? 7
Pr ident or Vice- sident Name Prt _� It Ci3rp�rate Secretary Nam (Print)
1911
President or Vice!Preside t Sig tXU '•I0�0.aQbrpo—rate Secretary Signature •�
. ✓ V
North Carolina
County
• I, a Notary Public 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 i Cfnarne of
corporation), a corporation, and that by authority duly given and at the act of the corporation, the
forgoing instrument was signed in its name by its (resident or
vice-presid.-nt), sealed %vi;h its corporate seal, and attested by himself (or herself) is its secretary.
Witness my hand and official seal. this the day of N ►. d1 �P . 19
(Official trial) VA,
Notary Publi
My commissionixpires 19 .
r .
NORM CAROUNI. Qmwv C,,M
The rort:4oi"—tir-iiwoer Carol F. Grant
to k rreet. rbi. lagnseet ru 6
Book n
r v�ua to re�.tretiea Old rea rded is tau ofrim is
i9 si� — L—Thi'-- 5th ee.r� �.1tt1
441Va a.+.. ca" - --
-
Book 1192 Page, 1977-Current 86 SEM- 6