N0633 ROY'S LCID LANDFILL

a North Carolina
Department of Environment and Natural Resources
j j j II I j `` IIj IIII III ` j! j111 Division of Waste Management lll�llll ��� II lll�lllllllllll Illfll�llllllllllllllllllllllllll � II
Roc IR; 06/04/2004 a Type: CRP NCDENR
Recorded: 06/04/2004 at 04:47:14 PM
Fee Amt• 920 00 Page 1 of 3
Michael F. Easley, Governor Iredell County, NC
William G. Ross Jr., Secretary Brenda D. Bell Register of Deeds
Dexter R. Matthews, Director BK 15 5 8 PG4 2 8- 4 3 0
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
Pursuant to 15A NCAC 1313 .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 1 B .0563(2)(b).
1. Facility Name: d- ,SZ !
2. Facilit do {street address):
Cit County:
3. Directions to Site: C G 7 -
4.
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The land on which this landfill is located is described in the deed recorded in:
deed book:
Name of land owner:
Mailing
page: county:
--e. State: ��� _. Zip:,��Il _
Telephone number of land owner: ('7d
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.
Name of operator
Trade or business
Mailing address of
City:
Telephone number of operator:
State: 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.
Projected use of land after completion of landfill operations:_ 1J
C
1646 Mail Service Center, Raleigh, North Carolina 27699-1646
Phone: [phone] FAX: [phone] Internet: www.enr.state.nc.us/
AN EQUAL OPPORTUNITY 1 AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED ! 10% POST CONSUMER PAPER

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(5) 120 calendar days after completion of any phase of disposal operations, or upon revocation of a permit, the disposal area shall tie covered
with a minimum of one foot of suitable sail 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.
171 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.
la) The facility shall be adequately secured by means of gates, chains, berms, fences, etc. to prevent unauthorized access except when an
pperatar is on duty. An attendant shal4 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 structures.
(bl The lower explosive limit for the gases at the property boundary.
114) 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 .0502 at this Suhchapter.
115) 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 1 30A-22 provides for administrative penalties of up to five thousand
dollars ($5,000.00) per day per each violation of the Soli0ora
Man ement Rules. I further understand
that the Solid Waste Management Rules m y-be in the future and that the facility
sand o e ations of this andfill wi[I re tl all such revi ions or am ndments
d L �VY-- t 1 -1 _0 C
Print Nana (Owner) I (Owner) Date
North Carolina
(e(k II County
�._I �,LZ - 1 a Notary Public for said County and State, do hereby certify
that p personally appeared before me this day and acknowledged the due
execution of the foregoing instrument.
Witness `t'1and and official seal, this the ' day of 'LLper_ __ _ 20 �
:';�ti►1
•'� ; , try Public
cTn1 AisS n earlirlp/Cap 20 U
NORTH CAROLINA IREDELL COUNTY
The certificate of:
3
is certified to be correct. Brenda D. II, Register of Deeds
by �sat:/Deputy

Cupp Location For:
ROy Q. Church
Tex Pin: 4759-22-3324
Da te: 04106104 Revised on 04113104
Deed Ref.: 1455-22
Scale: 1 " = 100'
Bethany Township, Iredell County, North Carolina
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