N0666 ANDYS DRIVE SITE ISSAC MILLER

BK 2333 PG 0699
FORSYTH CO,NC FEE:$ 26.00
PRESENTED & RECORDED: 03/24/2003 11:21AN
DICKIE C. WOOD REGISTER OF DEEDS RYAOLESP
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104� �f�a
North Carolina
Department of Environment and Natural Resources
Division of Waste Management
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
^�,. �-,4ek % Ritter, M, MecY.tocciAlDr, &X
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
NR
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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-£o the
Division as required by 15A NCAC 13B .0563(2)(b). 1. Facility Name:.. -PA UB4t� h7l 44e/
2. Facility location (street address)
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- Zip:-.;2-7#o /
3. DirectionstoSite: LlaeS NlreJ-Z✓ a= qewij
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The land on which this landfill is located is described in the deed recorded in:
dead book:p/ o -J /71� page:
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5.
Name of land owner: ISaa r 4 =t a?.! //I
, A' ller
6.
Mailing address of land owner:
City: ZP><,n/ jj1 State: A .L,
Zip,2?",
7.
Telephone number of land owners V2 1 76�
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If the land is owned by more than one person, attach
additional sheets with the name, address,
and phone number of all additional land owns s.
8.
Name of operator: L4 1AAk(-2,r -5teL r
9.
Trade or business name of operator: Ili./
10.
Mailing address of operator:
City: / State: r
Zip: �a
11.
Telephone number of operator:
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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:_ El(�,eA , bacr lWS OF
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone: [phone] \ FAX: [phone] \ Internet: www.enr.state.nc.us/
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER — 50% RECYCLED / 10% POST cpNSUMER PAPER
2

BK 2333 PG 0700
INSTRUCTIONS TO COMPLETE LCID LANDFILL NOWFICATION FORM: /
1. Contact your county or municipal zoning office for appropriate local requirements, approvals or permits. Y
2. Please review Solid Waste Management Rules, Section .0564: Siting Criteria for Land Clearing and Inert
Debris (LCID) Landfills, to make sure your facility is suitable. Pay particular attention to minimum buffer
requirements, depth to groundwater, floodplains, wetlands, archeological and historical sites, etc. See page
2 of the notification form.
3. Completely fill in the information (numbers 1 through 12) on page 1 of the LCID Landfill Notification form.
4. - Sign the appropriate certification(s) by land owner and landfill operator. For additional land owners and
landfill operators, attach separate notarized certifications for each additional land owner and landfill operator.
Corporate land owners and/or operators should use the appropriate Corporate Certifications. .Signature on
the appropriate certifications indicate that siting criteria in item p2 above have been met and the facility will
be operated in accordance with Solid Waste Management Rules, Section .0566: Operational Requirements
for Land Clearing and Inert Debris (LCID) Landfills. See page 2 of the notification form.
5. Have the certifications from item N4 notarized by a Notary Public commissioned in the State of -North
Carolina.
6. Take the completed LCID Landfill Notification form and accompanying notarized certifications to the county
Register of Deeds Office to be recorded. The Register of Deeds shall index the notification in the grantor
index under the name of the owner of the land in the county or counties in which the land is located.
7. Mail the completed and recorded notification form, affixed with the Register's seal and the date, book, and
page number of recording, to:
Division of Waste Management
Solid Waste Section
Mail Service Center 1848
Raleigh, North Carolina 27699-1646
If you have any additional questions, information can be obtained from the Regional Solid Waste Section
Offices located in Asheville, Fayetteville, Mooresville, Raleigh, Washington, Wilmington, and Winston-Salem,
North Caroline.
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.
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As long as your disposal activities remain in an area under 2 acres in size, you may operate under the provisions of
this notification. This notification is not transferrable.
The Land Clearing and Inert Debris landfill shall receive only:
• Land Clearing Waste as provided for in 15A NCAC 13B .0101(53); stumps, trees, limbs, brush,
grass, and other naturally occurring vegetative material.
• Inert Debris and untreated wood as provided for in 15A NCAC 13B .0101(54); concrete, brick,
concrete block, uncontaminated soil, gravel and rock, untreated and unpainted wood.
•. Used asphalt as provided for under North Carolina General Statute §130A-309.09B(a)(1); used
asphalt or used asphalt mixed with dirt, sand, gravel, rock, and concrete.
All sedimentation and erosion control activities shall be conducted in accordance with 15A NCAC 4, Sedimentation
Control. Construction and operations involving sedimentation and erosion control activities greater than 1 acre
typically require approval from the Land Quality Section. Contact the Land Quality Section to determine if your
activities require approval.
Revised 12/20/01
1

BK 2333 PG 0701
The following are the applicability, siting, and operating criteria for Land Gearing and Inert Debris Landfills operating
under notification.
From: North Carolina Solid Waste Management Rules ISA NCAC 11313:
.0101 DEFINITIONS
(53) 'Land clearing waste' means solid waste which is generated solely from lend clearing activities such as stumps, trees, limbs, brush, grass,
end other naturally occurring vegetative material.
(54) 'Land clearing and Inert debris landfill' means a facility for the land disposal of land clearing waste, concrete, brick, concrete block,
uncontaminated soil, gravel and rock, untreated and unpainted wood, and yard trash.
(55) -Yard trash' means solid waste resulting from landscaping and yard maintenance such as brush, grass, tree limbs, and similar vegetative
materials.
.0563 APPLICABILITY REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Management of lend clearing and Inert debris shell be in accordance with the State hierarchy for managing solid waste as provided for under N.C.G.S.
S 130A.309.04(a). Disposal In a landfill is considered to be the least desirable method of managing land clearing and inert debris. Where Iandfilling is
necessary, the requirements of this Rule apply.
(1) An individual permit from the Division of Solid Waste Management is not required for Land Clearing and Inert Debris (LCID) landfills that
meet all of the following conditions:
is) The facility Is to be operated for the disposal of land clearing waste, inert debris, untreated wood, and yard trash. Operations
must be consistent and In compliance with the local government solid waste management plan as approved by the Division of
Solid Waste Management.
(b) The total disposal area is under two acres in size.
(c) The facility and practices comply with the siting criteria under Rule .0564, and operational requirements under Rule .0566.
(d) The fill activity is not exempt from, and must comply with all other Federal, State, or Local laws, ordinances, Rules, regulations,
or orders, including but not limited to zoning restrictions, flood plain restrictions, wetland restrictions, sedimentation and erosion
control requirements, and mining regulations.
(2) Where an Individual permit Is not required, the following applies:
(a) The owner of the land where the landfill Is located must notify the Division on a prescribed form, duly signed, notarized, and
recorded as per Rule .0563(2)(b). The operator of the landfill, if different from the lend owner, shall also sign the notification
form.
(b) The owner must file the prescribed notification form for recordation in the Register of Deeds' Office. The Register of Deeds shell
Index the notification In the grantor Index under the name of the owner of the land in the county or counties In which the land is
located. A copy of the recorded notification, affixed with the Register's seal and the date, book and page number of recording
shall be sent to the Division of Solid Waste Management.
(c) When the land on which the Land Clearing and Inert Debris Landfill Is sold, leased, conveyed, or transferred in any manner, the
deed or other instrument of transfer shall contain In the description section in no smaller type than that used in the body of the
deed or Instrument a statement that the 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.
.0684 SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
The following siting criteria shall apply for Land Clearing and Inert Debris (LCID) landfills:
(1) Facilities or practices, shall not be located in the 100-year floodplain.
(2) Facilities or practices shall not cause or contribute to the taking of any endangered or threatened species of plants, fish, or wildlife.
(3) Facilities or practices shall not result in the destruction or adverse modification of the critical habitat of endangered or threatened species
as identified in 50 CFR Part 17 which Is hereby Incorporated by reference including any subsequent amendments and editions. This material
is available for Inspection at the Department of Environment, Health, and Natural Resources, Division of Solid Waste Management, 401
Oberlin Road, Raleigh, North Carolina 27605 where copies can be obtained at no cost.
(4) Facilities or practices shall not damage or destroy an archaeological or historical site.
(5) Facilities or practices shall not cause an adverse Impact on a state park, recreation or scenic area, or any other lands included in the stele
nature and historic preserve.
(a) 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.
(8) Land Clearing and Inert Debris landfills shell most the following surface and ground water requirements:
(a) Facilities or practices shall not cause a discharge of pollutants Into waters of the state that is in violation of the requirements of
the National Pollutant Discharge Elimination System (NPDES), under Section 402 of the Clean Water Act, as amended.
(b) Facilities or practices shall not cause a discharge of dredged materials or fill material into waters of the state that is in violation
of the requirements under Section 404 of the Clean Water Act, as amended.
(c) Facilities or practices shell not cause non -point source pollution of waters of the state that violates assigned water quality
standards.
(d) Waste in landfills with a disposal area greater then two acres shall be placed a minimum of four feet above the seasonal high
water table, except where an alternative separation is approved by the Division.
(a) Waste in landfills with a disposal area less than two acres shall be placed above the seasonal high water table.
(9) The facility shall most the following minimum buffer requirements:
(a) 50 feet from the waste boundary to all surface waters of the state as defined in G.S. 143-212.
(b) 100 feet from the disposal area to property lines, residential dwellings, commercial or public buildings, end wells.
(0) Buffer requirements may be adjusted as necessary to Insure adequate protection of public health and the environment.
(10) The facility shall most all requirements of any applicable zoning ordinance.
.0566 OPERATIONAL REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Land Clearing and Inert Debris (LCID) landfills shall most the following operational requirements:
(1) Operational plans shall be approved and followed as specified for the facility.
(2) The facility shall only accept those solid wastes which it is permitted to receive.
(3) Solid waste shall be restricted to the smallest area feasible and compacted as densely as practical Into cells.
(4) Adequate sell cover shall be applied monthly, or when the active area reaches one acre in size, whichever occurs first.
(5) 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.
3

BK 2333 PG 0702
(a) Adequate erosion control measures, structures, or devices shell be utilized to prevent silt from leaving the site and to prevent excessive
on site erosion.
(7) Provisions for a ground cover sufficient to restrain erosion must be accomplished within 30 working days or 120 calendar days upon
completion of any phase of landfill development.
(8) 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.
(9) Access roads shall be of all-weather construction and properly maintained.
(10) Surface water shall be diverted from the working face and shell not be Impounded over waste.
(11) Solid waste shall not be disposed of In water.
112) Open burning of solid wane Is prohibited.
(13) The concentration of explosive gases generated by the facility shall not exceed:
(a) Twenty-five percent of the lower explosive limit for the gases In facility structures.
(b) The lower explosive limit for the gases at the property boundary.
(14) Leschats shall be properly managed on site through the use of current best management practices.
(15) Should the Division doom It necessary, ground water or surface water monitoring, or both, may be required as provided for under Rules
.0601 and .0602 of this Subchapter.
(16) 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 .0663, .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 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. 1 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 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 amendment . ` n�
Isaac ,q1 x���y,)�r Miller ��
Print Name (Owner) Sig ture (Owner Date
County
Vey.a Notary Public for said County and State, do hereby certify
appeared before me this day and acknowledged the
rMi i r tni"rn fJUDt.La7 rn
Wit I the �_ day of Jh°,CerilEief . 20 0 1
th CommksbR E �Ihas January 1, 2= I w
(Official Seal) PA
Notar ublic
My commission expires Ja.M iLi k q 200 9
Certification by Landfill Operator (if different from Owner):
4

BK 2333 PG 0703
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 operations 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
($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) Dunn —foster & Spainhour, inc. Date 12,02-02
(Corporate S all Attest:
Pros or Vic -Pros ant Name (Print) orate Se" cretary Na a (Print)
Walter S. oster Ic id;1,-1 Ann B. Allred
President or Vice -President Signature Corporate Secretary Signature
North Carolina
County
I, Dianne B. Southern a Notary Public for said County and State, do hereby certify
that Ann B. Allred (name of secretary) personally appeared before me this day and
acknowledged that he (or she) is secretary of Dunn —Foster & Spainhour , Inc . (name of
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 Waler S. Foster (president or
vice-president), sealed with its corporate seal, and attested by himself (or herself) as its secretary.
Witness my hand and official seal, this the C)2nd day of December 2002
OFFICIAL SEAL
STY Nor,. nro6na
COUNTY sty U
couNraF -, r' Notary Public
'—^ DIANNE S. Sk; 1!,ERN
My Commlecion Ex i;; i ri b. 200�
C I o it 16 2002
S OF1 INC - FORSYTH CO The foregoing certificate(,) of:
Q r\y\-e e r-h NP(s)
NOTIFLC Is/are certified to be correct at the date of recordation s n the page thereof.
Dlckie C. Wood, Register of Deeds by: Depdr