N0647 BOLICK AUTO COLLISION REPAIR

IIII� II 110111011111111111111111111
Doc ID: 006253250004 TVDe: CRP
Recorded: 03/30/2005 at 02:36:19 PM
Fee Amt: $23,00 Page 1 of 4
MorkflowN 648485
Caldwell Countv, NC
4AYNE L RASH Reolster of Deeds
w 1544 PG38M85
North Cazolina
Department of Environment and Natural Resources •
Division of Waste Management
NCDENR
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
Pursuant to 15A NCAC 13B .0563(2)la), the land owner(sl and operator(sl 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 owners) 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)lb).
1. Facility Name: !?kirncle 40o Qol (/i s�i rlr Ee614i Y�'
2. Facility location (street address): 70f urine <�%Odnc cat
City: L4t.l o(( County: 1241dui I zip: 2 S69
3. Directions to Site: IFra; v. 3 2-1 F o 3 2-1 'q T- 4)
:� pc�4 keJ,
4. The land on which this landfill is located is described in the deed recorded in:
deed book: C159. page: county: (\1al,4Lvejif�t ert v
5. Name of land owner:
6. Mailing address of land owner: a 2-0 fe UN^v Z grove Q d
City: Le.vo' r State: 'V L Zip: 1 `6�0 `f S'
7. Telephone number of land owner:( e Z S; I q7 ; 7 - 3 9 '2 e
If the land is owned by more than one person, attach additional sheets with the name, address,
and phone numbeLrX additional land owners. II''
6. Name of operator: ✓✓ AcAL lrl 1��tr'_F�
9. Trade or business name of operator: (pL:i l
10, Mailing address of operator: D`a Con n e-1 it !42
City: f %LLu i i State: /1/ C zip:
11, Telephone number of operator:( is 2. �r
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: f 4 n Ic `e4 ys o J-t
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
e_o Phone: [phone] \FAX: [phone] \Internet: www.enrstate.nc.usl
�� AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER - 50 % RECYCLED / 10 % POST CONSUMER PAPER

�$5
151
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.
16)
Adequate erosion control measures, structures, or devices shall be utilized to prevent silt from leaving the site and to prevent excessive on
site erosion.
l71
Provisions for a ground cover sufficient 10 restrain erosion must be accomplished within 30 working days or 120 calendar days upon
completion of any phase of landfill development.
I8)
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.
191
Access roads shall be of ell -weather construction and properly maintained.
1101
Surface water shall be diverted from the working face and shall not be impounded over waste.
111)
Solid waste shall not be disposed of in water.
1121
Open burning of solid waste is prohibited.
1131
The concentration of explosive gases generated by the facility shall not exceed:
Is) Twenty-five percent of the lower explosive limit for the gases in facility structures.
Ib1 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.
115)
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.
116)
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, 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 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 ay be revised or amended in the future and that the facility
siting and operations of this landfill will b required tLcomply with all such revisions or amendments.
Print Name (Owner) $ignature (Owner) Date
North Carolina
C!aJ ovi Q 11 County
I, 6+1A1� Er , a Notary Public for said County and State, do hereby certify
that rI c K 7. !" r0 1 lC 4e,' personally appeared before me this day and acknowledged the due
'No�fai
'going instrument.
official seal, this the �t
U r
K3

Certification by Landfill Operator {if different from Ownerl:
f 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. 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 ($5,0O0.00) per day per each violation
of the Solid Waste Management Rules. I further understand that the Solid Waste Management Rules may
be revised or amended in the future and that the facility siting and operations of this landfill will be
required to comply with all such" evisio or amen mants.
Print Name (Operator) ignature (Operator) Date
North Carolina
Od Id vie- (I County
I, c)44\ a Notary Public for said County and State, do hereby certify
that V C7GIZ (5, aO l ic'K personally appeared before 4 this day and acknowledged the due
cution�ipf„1hpr,foregoing instrument.
Y T ''�y� 0
nN�,ur!x•"b�Dfficial seal, this the nn
flc op 00
91�50 A R ),go GL
ri a`- �'• i otary Public
v-3 O L % a
>rijnj�sion•�x$il'eg'� �d , 20
For additional {and 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.
INSTRUCTION9 T
Purpose: Notification of Land Clearing and Inerc Debris Landfills under two (21 acres in size is revuired under 15.N�.4G 13e .tr56812)lal.
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 27699-16 6
[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 Canter five (5) additional years and then transferred to the custody of the Archives.
n

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 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. 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.
Corporation Name (Print)
(Corporate Seal)
Presi ntror feo-Bsesidamt Name (Print)
/i
President er-14ee Presidenf Signature
Date
Attest:
Corporat}�e Secretary Name (Print)
J
Corporate Secretary Signature
Nor Carolina
dlc�W'� j County
I, d+n�v 1 NtyefS a Notary Public for said County and State, do hereby certify
that l Cal fJ �� ��IiCI< (name of secretary)11personally appeared before me this day and
acknowledged that he (or she) is secretary of �0I KK rL01) CC(1' S n Rr0iC (name of
corporation), a corporation, and that by authoritydulygiven and as the act of the corporation, the forgoing
instrument was signed in its name by its ° r 51 (president or vice-president),
rt •BU�Ypp�aBe-xn4, and attested by himself (or herself) as its se
}1e�,rrfy1iaNdY�ilt%fficial seal, this the 3l7 day of 1 UIC� �'G
:NOTAgys
ficiat Seeli �
V .
�'% U B LIGi "5 Notary Public
o
My
ary.
North Carolina
Caldwell County
T E CERTIFICATE OF
IS CERTIFIED TO 59 CORRECT,
Wayne L. Rash,
REGISTER OF DEEDS
By: cctc�m� 0 �tO�1�l1fR�