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131099
F )Mnentland Natural
05.09.2002 13124
P73i
I tANb OLR RING' AND INERT DB�RIS LAND}'lLL NOTIFICATION '
i
1 N C 130 . 583(t)(alt the land owner(a) and operator(s) of any land Clearing and
1. fill u der two 2) acres In size shag submit this notification form to the Division prior to
per ing the I ndfill. This form must be filed for recordation In the: Register of Deeds'
R tot f Deeds hag index the notification under the name of the owher(s) of the land In
r unti a In whl the'land Is located. The ftister's seal and the daite, book, and page
e ino ust be I oluded on this form when submitted to the Dlvislon; This notification Is
a or# opetatlo of a landfill unless complete, acourato, recorded, and submitted to the
a ad b 1 gA NO C 138.068312)Ibl.
sIII erne Sexto Farm
gtI k oat n (street ddreesl: Route 3 Box_ 113 Hannd rvnnyi 1 j as Me
nd rsonvil a CountysxPgAF+ran� ,.ZIA�.Z8739
Ct o e to Its• Ran a Rd to Crab' Creek to s
this
of
�rnber of
'owned
l *or of
1
owner:
.lie Ststa: NC Zlps.,�,g739
more than one person, attaoh additional sheets with the name, address,
i additional land owners,
Stets: Zlp:r
mbar of
is oper tad by rnare than ens person, attach addklonal,aheete with the name,
phone n mber of all additional operatorss
of land fter completion of landfill operational
�
F. 2
r

0590992802 13:27
P. 5
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t
31099 P4735 `
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1 oerti t 0 inf It stion pr vided, by me In this notification Is trust scourste, an complete to the
best o n let . The fe lity siting end disposal 4poratlone, of this faro! Cleari1 9 & inert Debris
landfill i o ly, , th the re ulremonts of Sections a0683, .0564 and .0688 of'16A NCAC 1301
North r 114 sots M nagert►ent Rules. The fflallity and operations of thl 1 landfill will also
comp{ I ep011 able Fed raft State, and Local fa s, rule, rt}gutatione, and o dinanoes, I have
infor 1 d or of plane to dispose of solid waste on the land and land owner hot
$poolf it r ed i Weston or tho operation of the lFndfill, I iinderetand that bot the operator and
land in i and sev 411v liable for Improper Oporatlarit and proper closur of the landfill as
provl b r►t?t 1 Carolina anerfll Statute 130A4W9,27, I further understand that North Carolina
Qensr I' t tb A•22 pro vfdes for adminlstrative penalties of up to five Ithoussnd dollars
106,b p dal reach olatloh of the 9olld Waste Mansoement Rulas, I furth r understand that
the 9 1! ( s • Ms(n smant f!��uulos May be revised or, amended in the future and the the faoitity siting
and o er f thi landfill wJ11 be required to comply with all such revisions or smendments,
Print 44ry 0 fratorl 'Instu re rotor) bete _ >'
Jame L ` e on
5-20 02 afi
North I n I ,t,,,, ,`' a R
too 000'.
I I County w'4 • ob'
I, a Notary public for said County and State, dl# her@iit'geYOF gtly
• �, • ' ' a
that personally appeared before me this day and tack wle
p Y pp ! t� t H n`� 800
N ••��aa
du 71 do o I i the foregoing Instrument. •••• ''4
-,
yYttn ee a an' officlat a 10 this the 6 day of 20� ," + "; ' .•
(Offli lal , at),
Notary Rubll
my a Af J1 $I GO go Ail !iP Aciods
For
For
the
t
r
and
Waste
o 1
• NotN
.ot10 �t211v}. ca
Mild �ompleted
7Fps �wm wit M
9t Rsootds Ca
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!
landfill operators, attach Separate notarized certif{oetiona for each
operator. ' ,
operators, ues the tYorporete Certifications, paged 8 and 6. Contact
smsnt for pro�r tippltaable tartltications.
INatRU8T1oNY
n of fond CkerMp end Inert Osbl Undfgs �w two (21 votes In Nto Is r/aovod v,Mm / 6 NCAC 18a
the 9oNd Wsne ae�bn tt the Od�ras Mow for fdRher Informetton.
!ed brwrol nwnwon to th0 Rttgwlrp oddro{n
DWNiOn or aOMd tt1Glli Msnepsm�t
solid Wotto Woo
1841 Merl a�rvko to
hwah, North CvoaM 17699*44e
1918} 7s8 eZ
wferrsd to tM %$ R000rdi C«n r whon ref s VOA ends. Reaores be held for oponoy In tho
live Itl} et Odd rAl yom end than Vsrslforted to Ov custody Of 0% AMNvs1.
Cart�Itna,
tnS`ir}Arl;Lal"ii pr$S?"1$F:t:
r riy Theft3tegatng certificate(e) of
i:ht�;ar.rdla�i���t 1*s � corr�tst, tills
t�;isf�r, �t:cd rncc�rctt�d In this t?fflcQ S

FROM 05.09.2002 13i26 P, 4
1099 P 7 3 6
S
s
0
tat l� to ono U01,r»uw ' otruoWnl, of doems ohm be Wtl�od to prwMt olk from too
tt» s'te Ind to prevent exoNe�w
o�y1 or
q} f t o d cover eM to reatraln +melon maul bs aeoompholp within 30 woMnp dive or 120 odondo diva upon
so of londflp volopr4mo
r 1) to IN dequntely e1 d by moans of pates, olt1irM b*M fen" alit to prevent un4100141 ant" oxospt what an
An atteado +hell b on duty at sy lino+ Is tM londR6 Van
en tot pvb&c we to; aeewe compliance with
t Wr pnd to wnt ae�eptome of Unpoutborl"dv pip.
ip1 ro ah►1 of *Wee baottyogon VW Pt*Pdy malt}towod
t101 eh the w0drrklnp face and shag not WW Inpoundo0 Over'wuta.
t111 all be It water.
lt21 w of a waata 1/ pro Mudit
f t 31 9 og o axplo** a st1oletsd by the fgdtty atop nqI ata/d:
t1ftt} 11,40
pproent of M IoWgt I�oeWe gMlt fof the a l l M high¢ etnmtwes.
p1) lo�v oq"V6 t for the paoes W the ptowy , &ry
(t4) to it W,pr Writ men& ' on sn4 through the use of ow(}nt beat maneoemaM promoss•
tt 5) t Nei cam k Aces ry, Around w&ter or surface W*te monhatnp, or both, may bs required a$ provtdod for under Ruses
a0re this aubOM
I t Q) a 09 si the f o+tmr4o showing the coMaot *m end nt�tibet in case of an emergency and the pormk number,
a1tNf a mam opplIc" for feigns" not ratiulrinp on kWI# Wre4 W permit
Csrtif t . b anil �wnix:
I cortl t i t I ri t into matron p ovided by me In this notification is trust accurate, and complete to the
best f . k isd a. The fa lfity siting and disposal operatiohs of this Land Cleating & Inert Debris
tandfl µf pry ith the r quiroments of Sections 4503, :O684 and ,0588 of, 16A NCAC 130,
Nort In Solid Waste nagement Rules, The facility and operations of t* landfill will also
tom y. 11 ppll able N al, State, and Local laws, rules, regulations, and ordlhanoes, Where the
pets e.
or rent rom the I nd owner, I, the land owner, have knowledge of the t perstor's plans to
dlspo e o i was a on the end and I specifically grant permission for the operstl n of the landfill. I
unde t bpithe Is d owner and operator are jointly and severally pabie for Improper
p.
apsr l0 a proper closure f the landfill as provided for by North Carolina Qen¢ral Statute 130A-
309. 7, ur r On erstand at North Carolina Qsnerat Statute 130A•22 provides! for administrative
psna lee f to f ve thous nd dollars (06,000,00) per day per each violation of the Solid Waste
Man 90t ies. 1 further nderstand that the Solid Waste Mdnegemant Rules'may be revised or
metd0t fut to and t at the facility siting and operations of this landfill will be required to
tom ly h i said revislons r amendments.
Print Na i ner) ` S natu tOwner Date
fame E on
Nort ire 5-20-02 �.���'. oVj+ bo ��.� ,�
tioutlt ap4' �eipe t'
• �, `
1, a Notary Public for said County and State, do hectigiv fy, pf
that personally appeared before me this day and sclCpo10d af!-'t�iA v M l
due >�s ' i f th forogoi instrument. t : �pdp�` k't'
wit ens y a d official sal, this the ,day of 20 ,
' fry b4r1r: ilo "
{Off clap a )
Notary bl
My la i n s�c}}ires � ZOr.d�.
Ce f n LY 1dtW Ooar r I different from Owner),
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