N0224 FRANCES GOUGH LCID LANDFILL

Book 2519 Page 2534
2004078397 00055
FORSYTH CO, NC FEE $50.00
PxxsEMD f RLcoeu6o:
11-12-2001 11:14 AM
DICKIE C WOOD
= asa:s:n or >#Em
By:SHMNON BOSTIC-GRIFFITH DPTY
BK:RE 2519
PG: 2534-2546
-
NORTH CAROLINA DEPARTMENT OF
-
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WASTE MANAGEMENT
���� o� y; ua4. -re):R�'f' Ukafl�e�a�J
'=NCDENR
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
JAM" e. HUNT JR:I'L
Clearing and Inert Debris Landfill under two (2) acres in size shall submit this notification
GOVERNOR
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
`wwrNEMCDEnrr
recording must be included on this form when submitted to the Division. This
scewcrwRr
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).
- r
1 . Facility Name:
-�"WILLIAM L. McrER '-
2. Facility location (street address): S'A l
~
Zi 7 ` 3
City;P.Lili S\J 111e, County: P- �
3. Directions to Site: µ R ! lo+ ci `}
Y>
I A pp �1- I'C 6 O Y� k1 Q�t
4. The land on which this landfill is located is described in the deed recorded in:
P s
Deed Book: q ( 1
�_ Page: L?% County: !'Z0r%,.Q�
5. Name of land owner: r a n ce s
6. Mailing address of land owner: g2-9 AoW_CJ�v 1C�1
t
City: LPAAE,,t, I(e State: Al-C— Zip:'y?OZ3
7. Telephone number of land owner:13 3% 1 44S• 3503
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: �Jo.��w.✓
9. Trade or business name o�r�+:2_1�
10. Mailing address of operator: i�C ls- .3
.x
City: _4&&J7-, 6/le State: Zip: c7702 3
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11. Telephone number of operator:( 3 34, 1 9cfS -
y ?'
If the landfill is operated by more than one person, attach additional sheets with
:-
r
the name, address, and phone number of all additional operators.
5
K•yt
12. Projected use of land after completion of landfill operations:
•� lo-Y.+..' r%�i'=,.. '�•
'�lC C�K C.�st'I �"�-�'l��J
401 OSERLIN ROAD. SUITE 150. R&LCMV.. NC 2760S

Book 2519 Page 2535
The following are the applicability, siting, and operating criteria for Land Clearing and Inert Debris andfille
operating under notification.
.0101 13EFINMONS
172) 'Lend clearing waste' mean solid waste which is generated solely from land clearing activities such as stumps, trees, limbs, brush, Brace, and
other naturally occurring vegetative material.
(73) 'Land clearing and Inert debris landfill' means a facility for the lard disposal of land clearing waste, concrete, brick, concrete block,
uncontaminated soil, gravel and rock, untreated and unpainted wood, and yard trash.
(74) 'Yard trash' means solid waste resulting tram landscaping and yard maintenance such as brush, press, tree limbs, and similar vegetative
materials.
.0663 APPLICABILITY REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Mans%ment of lend clearing and inert debris shag be in accordance with the State hararohy for managing solid waste as provided for under N.C.G.S. li
130A-308.04(a). Disposal In a landfill is considered to be the least desirable method of managing land clearing. and inert debris. Where IandfillinB 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 Debra ILCID) landfills that meet
all of the following conditions:
(a) 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 govemment solid waste management plan es approved by the Division of Solid Waste
Management.
(b) The total disposal &roe is under two acres in size.
Icl The facility and practices comply with the siting criteria under Rule .0504, and operational requirements under Rule .0686.
(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:
W The owner of the land where the landfill is located must notify the Division on a prescribed fort", duly signed, notarized, and recorded
as per Rule .068312)(b). The operator of the landfill, if different from the tend owner, shall also sign the notification form.
lb) The owner must Tale the prescribed notification farm for recordation In the Register of Deeds' Office. The Register of Deeds shag Index
the ratification 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.
(a) When the lard 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 caution 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 Debra Landfill and a reference by book and page
to the moordst)on of the notification.
.0664 SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
The following siting criteria shall apply for Land Clearing and Inert Debra ILCB)) landfills:
11) Facilities or practices, shall not be located in the 100-year Ooodplain.
(2) Facilities or practices shag not cause w conatkuts to the taking of any endangered or threatened species of plants, fah, or wildlife.
(3) Facilities or practices shall not result In the destruction or adverse modification of the critical hahttat of endangered or threatened species as
Identified in 60 CFR Par 17 whichla 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 whom copies can be obtained at no cost.
(4) Facilities or practices shall not damage or destroy an archaeological to historical cite.
16) Facilities or practices shag not cause an adverse Impact on a state park, recreation or scenic area, or any other lands included in the state nature
and historic preserve.
Ili) 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 calls are available for cover, efthw from on or off site.
(B) Land Clearing and Inert Debra landfills shall meet the following surface and ground water requirements:
dal Fac6hies or practices shag 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 (HPOESI, under Section 402 of the Clean Water Act, as amended.
lb) 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 shall not came non•point source pollution of waters of the state that violates assigned water quality standards.
(d) Waste In landfills with a disposal area greater than two acres shall be placed a minimum of four feet above the seasonal high water
table, except where an alternative *operation Is approved by the Division.
al Waste In landfills with a disposal area less then two acres shall be placed &bove the seasonal high wear table.
(a) The facility shall meet the following minimum buffer requiremants:
Is) 60 feet from the waste boundary to all surface waters of the state as defined In G.S. 143-212.
(b) 100 few from the disposal eras to property lines, residential dwellings, commercial or public buildings, and wells.
to) Buffer requirements may be adjusted as necessary to Insure adequate -protection of public health and the environment.
(10) The facility shall meet all requirements of any applicable zoning ordinance.
.0660 OPERATIONAL REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Land Clearing and Inert Debris (LCID) landfills shall meat the following operational regulnmsnts:
(11 Operational plans shag be approved and followed as specified for the facility.
(2) The facility shall only accept those solid wastes which it Is permitted to receive.
13) Solid waste shall be restricted to the smallest area feasible and compacted as densely as practical into calk.
(4) Adequate soil cover shag be applied monthly, or when the active area reach" one acre In size, whichever occurs first
(S) 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 toot of suitable moll 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.
(61 Adequate erosion control measures, structures, or devices shall be utilized to prevent mitt from leaving the site and to prevent excessive on she
erosion.
IT) 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.
(e) The facility shall be mdequotely secured by mean of gates, chains, berms, fences, ate, to prevent unauthorized access except when an operator
is an duty. An attendant shall be on duty at all times while the landfill is open for public me to secure compliance with operational requirements
and to prevent acceptance of unauthorized wastes.
(a) Access made shall be of ell -weather construction and properly maintained.

Book 2519 Page 2536
(1 O) Surface water shall be diwrted from the working; face and shall not be Impounded over wash.
01) Solid waste shall not be disposed of In water.
02I Open burning of solid waste Is prohibited.
(13) The concenbet[on of explosM noses generated by the facility shall not exceed:
(a) Twenty-flw percent of the lower oxplosh a limit for the San" In facility structures.
(bl The lower exploshia limit for the pests at the property boundary.
(14) Leachate shall be properly managed on eke through the use of currant best managemem practices.
(1 S) Should the Division deem It necessary, ground water or surface water monitoring, or both, may be required as provided for under Rules .0801
and .0002 of this Subohapter.
lie) A sign shell be posted at the facility eramutce 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 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; 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 ($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 amendments.
Print Name (Owner) Signature (Owner) bate
North rarnlina
County
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 instrument.
Witness my hand this the -2*7,4� day of r
O& Ax/ z /i�
e e /
ton expires► �✓
E OF C -FORS H CO The oregoin ertificate(s) of:
1 al
NP(s)
it certifled to be correct at the.date of recordation show n t pare thereof,
Diekle C. Wood, Register of Deed, by: Deputy/A41c

Book 2519 Page 2537
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 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 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 (Operator) Signature (Operator) Date
North Carolina
County
I, , 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 instrument.
Witness my hand and official seal, this the
(Official Seal)
day of
Notary Public
My commission expires , 19
For additional land owners and landfill operators, attach separate notarized certifications for each additional land
owner and landfill operator.
For Corporate land owners andior operators, use the Corporate Certifications, pages 5 and 6. Contact the Division
of Solid Waste Management for proper applicable certificati
Purpose: Notification of Land Clearing and Inert Debris Landfills under two (2) acne
W. Contact the Solid
Waste Section at the address below for further information.
Distribution: Mail completed recorded original notification to the foiiR `n address;
Division of Waste Msnap meM r V . .
Solid Waste Section �fi,`:1�
PO Box 29603 `A H .:.H iii{TjJF 1
Raleigh, North Carolina 27eYr.9Q03 );
Disposition: This form will be transferred to the State Records Center when reference •value ends. Records"w(II`bs MM for agency in the State
Records Center five (5) additional years and than transferred to the custody of the Archives.
4

Book 2519 Page 2538
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)
President or Vice -President Name (Print)
President or Vice -President Signature
North Carolina
County
Date
Attest:
Corporate Secretary Name (Print)
Corporate Secretary Signature
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
(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 (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
(Official Seal)
day of
Notary Public
My commission expires , 19
19
5

Book 2519 Page 2539
Certification by Corporate Landfill Operator (if different from Owner):
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 .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) Date
(Corporate Seal)
Attest:
President or Vice -President Name (Print) Corporate Secretary Name (Print)
President or Vice -President Signature
North Carolina
County
Corporate Secretary Signature
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 (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,, (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
(Official Seal)
day of 19
Notary Public
My commission expires , 19
HANOTIFY.FRM
2

Book 2519 Page 2540
North Carolina 4444,A movi,�—
Department of Environment and Natural Resources
Division of Waste Management
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Dexter R. Matthews, Director
NCDENR
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:
2. Facility location (street address):
City: County: Zip:
3. Directions to
4. The land on which this landfill is located is described in the deed recorded in:
deed book: page: county:
5. Name of land owner:
6. Mailing address of land owner:
City: State:
7. Telephone number of land owner:( 1
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
9. Trade or business name of operator:
10. Mailing address of operator:
City: State
11. Telephone number of operator:
Zip:
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 opera
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 CONSUMER PAPER

Book 2519 Page 2541
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1 . Contact your county or municipal zoning office for appropriate local requirements, approvals or permits.
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 #2 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 #4 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 1646
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 Carolina.
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)l 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 .0101453); 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.

Book 2519 Page 2542
The following are the applicability, siting, and operating criteria for Land Clearing and Inert Debris Landfills operating
under notification.
From: North Carolina Solid Waste Management Rules 15A NCAC 1313:
.0101 DEFINITIONS
(53) "Land clearing wane" means solid waste which is generated solely from land clearing activities such as stumps, trees, limbs, brush, grass,
and 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 land clearing and inert debris shall be in accordance with the State hierarchy for managing solid waste as provided for under N.C.G.S.
f 130A-309.04(a). Disposal in a landfill is considered to be the least desirable method of managing land clearing and inert debris. Where landfilling is
necessary, the requirements of this Rule apply.
(1) An individual permit from the Division of Solid Wane Management is not required for Land Clearing and Inert Debris (LCID) landfills that meet
all of the fallowing conditions:
(a) The facility is to be operated for the disposal of land clearing wane, 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
Wane 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:
(al The owner of the lend 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 diffwent from the land owner, shall also sign the notification form.
(b) The owner mum file the prescribed notification form for recordation in the Register of Deeds' Office. 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. A copy of the recorded notification, affixed with the Reginer'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 then 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.
.0564 SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
The following siting criteria shell 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 state
nature and historic preserve.
16) Facilities shall not be located in any watland as defined in the Clean Water An, Section 404(b).
(7) It must be shown that adequate suitable soils are available for cover, either from on or off site.
(B) Land Clearing and Inert Debris landfills shall meet 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 shall not cause non -point source pollution of waters of the state that violates assigned water quality
standards.
(d) Wane in landfills with a disposal area greater than 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.
(e) Waste in landfills with a disposal area less than two acres shall be placed above the seasonal high water table.
(9) The facility shall meet the following minimum buffer requiremens:
(al 50 feet from the waste boundary to all surface waters of the state as defined in G.S. 143-212.
tb) 100 feet from the disposal area to property lines, residential dwellings, commercial or public buildings, and wells.
(c) 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.
.0666 OPERATIONAL REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
Land Clearing and Inert Debris (LCID) landfills shall most the following operational requirements:
11) 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.
13) Solid waste shall be restricted to the smallest area feasible and compacted as densely as practical into cells.
(4) Adequate soil cover shall be applied monthly, or when the active area reaches one acre in size, whichever occurs first.
2

Book 2519 Page 2543
(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 Correa any condition which is or may become injurious to the public health, or a nuisance to the community.
(6) Adequate erosion control measures, structures, or devices shall 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 shall not be impounded over waste.
01) Solid waste shall not be disposed of in water.
(12) Open burning of solid waste 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 structure&.
(bl 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.
(1 5) 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.
(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 .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 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 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)
North Carolina
Signature (Owner( Date
County
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 instrument.
Witness my hand and official seal, this the day of 20
(Official Seap
Notary Public
My commission expires , 20
3

Book 2519 Page 2544
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 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 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.
7ilfit >VAge- ii"1144,nrAA1 2&2?D.t cDGr V tffir �/ OY
Print Name (Operator) Signature D to
North Carolina
-� r7W1 County
I, a Notary Public for said County and State, do hereby certify
tha -LL"Z 10 k'A44ctnm�ersonally appeared before me this day and acknowledged the due
ex jQn Df_tha foregoing instrument.
''( �.. Wag a �J A
U�tpesshand I, th 'the / day of /VLV�Q.'Yu SEA , 20�.
t Notaryry Publb -North Ccrciini I
OAVIDSO Ion Ex i'I , w L M (k4 (J
o ry Public
My commission expiresno,.JA-V NU { irk( , 20�_.
For additional 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 (21 acres in size is required under 15 NCAC 138 .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
[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 Center five 15) additional years and then transferred to the custody of the Archives.
EI

Book 2519 Page 2545
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 13OA-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
North Carolina
that
Corporate Secretary Signature
County
a Notary Public for said County and State, do hereby certify
(name of secretary) personally appeared before me this day and
acknowledged that he (or she) is secretary of
(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 (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 day of
(Official Seal)
My commission expi
Notary Public
20

Book 2519 Page 2546
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) Date
(Corporate Seall Attest:
President or Vice -President Name (Print) Corporate Secretary Name (Print)
President or Vice -President Signature
North Carolina
Corporate Secretary Signature
County
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 (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
(president or vice-president),
sealed with its corporate sea), and attested by himself (or herself) as its secretary.
Witness my hand and official seal, this the day of
(Official Seal)
Notary Public
My commission expires , 20
CAMVDOCU' 1 \SHELUNOTIFV' 1. WPD
20
M