N0167 GLOVER'S LANDSCAPE & GRADING, INC.

BK� 30 PG344
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4 r1,:Y I 0 PE 2 5
02350 State of North Carolina pit of
Department of Environment, Health, and Naturaf '�esources
512 North Salisbury Street • Raleigh, North Carolina 27604
Division of Solid Waste Management
James B Hunt, Jr., Governor Solid Waste Section Jonathan R Howes, Secretary
Telephone [phone]
(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, and recorded as
required by 15A NCAC 13B .0563(2)(b).
1 `
1. Facility Name:, GIs -f , 5 CL 08
2. Facili ocation (street address):E�
City r County:
3.
4.
5.
6.
The land on which this landfill is located is described in the deed
deed book:_ —5-L _ _ page: county:_
Name of land owner:_
Zip: 1 57
,ded in:
Mailing address of land owner:
City: i1. State:
Telephone number of land owner:
If the land is owned by more than one person, attach additional sheets with the name, address,
and phone number of all itional land owners.
7. Name of operator.qobecl+
8. Trade or business name of operator:
9. Mailin address of operator: Jr
City: State: L. Zip: 6Z
10. Telephone number of operator: (2r
If the landfill is operated by more than one person, attach additional sheets with the name,
address, and phone number of all additional operators.
11. Projected use of land after completion of landfill operations:Fore-,4rLA
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PO &rot 27687, Wleih, North Carolina 27&i-76u Tdephone 919-733-4m Fax / 919.733-0 13
An NO Owwwnky Affirmative Action Empbm

BK130 PG345
The following are the applicability, siting, and operating criteria for Land Clearing and Inert Debris
Landfills operating under notification.
.11701 DEFINITIONS
am "Land clearing waste" mean@ solid waste which is gonerated solely from land clearing activities such as clumps, trees, limbs. brush,
Illness. and otter naturally occurring vegetative material.
QIN "Lard clearing and Inert debris landfill' mean* a facility for the land disposal of land clearing waste, concrete, brick, concerto block.
uncontaminated sob, gravel and rock. untreated and unpalr ed wood, and yard trash.
PQ "Yard trssh' means solid waste resulting from landscaping and yard maintenance such a brush, /rasa, trrtt��gr i i ar wgetatlw
materials.
ASS APPLICABILITY REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS ILCID) LANDFILLS
Wragsn+ent of land clearing and kart debris shell be in accordance with the State hierarchy for managing solid waste as provided for under
ILXGG.S. li 130A-309.04(a). Disposal In s landfill is considered to be the least desirable method of managing land clearing and Inert debris. When
Iswdl7lkrg Is necessary, the requimments of this Rule apply.
f1/ An Individual permit from the Division of Sold Waste Monagemw+t is not required for Land Clearing and kart Debris (LCID► landf llethat
meet all of the following conditions:
1*1 The facility Is to be operated for the disposal of land clearing waste, Inert debris, unrested wood, and ywd trash. Operations
must be conaistent and in compliance with the local government solid waste management plan ae approved by the Division
of Solid Waste Management.
(bl — The total disposal area is under two acres in siz".
lei The facility and practices comply with the siting crfterls under Rule .0664, and operational requirements under Rude .0680.
(4) 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, wedwnd restrictions.
sedimentation and erosion control requirements, end mining regulations.
Wham 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 par Rule .0663(2)(b). The operator of the Landfill, if different from the land owner, shag also sign the notification
form.
(b) The owner must file the prescribed notification form for recordation in the Register of Deeds' Offics. 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 Regiaters seal and the date, book and page number
of recording shall be sent to the Division of Solid Watts 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 shag contain in the description section in no smaller type then that used in the body
of the dead or iruwment a statement that the property has been used as a Land Clearing end Inert Debris Landfill and ■
reference by book and page to the recordation of the notification.
Ai84
SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS (LCID) LANDFILLS
mse following siting criteria shag apply for Land Clearing and Mort Debris (LCIO1 loMf ills:
fill
Facilities or practices, shag not be located in the 100-year floodplain.
m
Facilities or practices shag not cause or contribute to the taking of wry endangered or threatened species of plants, fish, or wildlife.
of
Facilities or practices shag not result in the destruction or adverse modification of the critical habitat of endangered orthreatensd species
as idwrdfed in 60 CFR Part 17 which is hereby incorporated by reference including any subsequent amendments end 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 27806 where copies can be obtained at no Coat.
Nit
Facilities or practices shall not damage or destroy on wchasolooieal or historical site.
to
Facilities or practices shag not cause an adverse knpact on a state park, recreation or &conic area, or any other (sods included in the
"a nature and historic preserve.
(gg)
Facilities shag not be located In wry wodand as dati ad in the Clean Water Act, Section 4041b).
171
It must be shown that adequate suitable soils are available for cover. either from on or off site.
his
Lone pawing sod kart Oeeria landfills shed meat the fohowkg surface and ground water requirements:
lei Facilitiee or practices @hall not cause a discharge of pollutants into waters of the state that in in violation of the requirements
of the National Pollutant Discharge ERminstion System (NPOES). under Section 402 of the Clean Water Act, as amended.
(b) Faeelides or practicer shag not came a discharge of dredged materisls or fill material Into waters of the state that In in
violation of the requirements under Section 404 of the Clean Water Act, as amended.
(a) Facilities or practices shag not cause non -point source pollution of waters of the state that violates assigned water quality
standards.
(d) Waste in landfills with a disposal @roe greater than two acne shag be placed a minimum of four feet above the seasonal high
water table, except where on sltemative sepwation is approved by the Division.
to) Waste In landfills with a disposal we* lose than two acres shag be placed above the seasonal high water table.
«
T1e facility @hag meet the following minimum buffer requirements:
44 60 feet from the waste boundary to all surface waters of the state as defined in G.S. 143-212.
ab) 100 foot from the disposal area to property lines, residential dwellings, commercial or public bu !'Hive, end wogs.
la) Buffer requirements may be adjusted as necessary to Insure adequate protection of public health and the environment.
Qq
The facility *hall mast all requir rearh of wey applicable zoning ordinance.
Rill OPERATIONAL REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS ILCID) LANDFILLS
Lard Clearing and Inert Debris (LCtDI landfills shag meet the following operational requirements:
(1) ' Operational plans shag be approved and followed as specified for the facility.
to The facility shag only accept those sold wastes which It is permitted to receive.
q Solid waste shag be restricted to the amallest area feasible and compacted as densely as practical into cogs.
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M13Q PG346
441 Adequate soil cover shall be applied monthly, or when the acthm area reaches one acre in size, whichever occurs firer.
(5) 120 calendar days afar completion of any phase of disposal operations, or upon revocation of a permit, the disposal area shag be
covered with a minimum of one foot of suitable Boil cover sloped to allow surface water runoff in a controlled manner. The Division
may require further action in order to cannot any condition which is or may become Injurious to the public health, or a nuisance to the
commorft-
le1 Adequate erosion control msseunw. souchnes. or devices shell be Utilized to prevent oft from leaving the oft and to prevent auo waive
on she erosion.
rn Irovisans 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 lendfdl development.
(S) The facility shag be adequately secured by means of gates, chains. berms, fences, ate. to prevent unauthorised scores except when
on operator Is on duty. An attendant shag be on duty at ell time@ while the landfill is open for public use to assure ommliance with
operational requirements and to prevent occeptance of umaudmWmed wastes.
a) Access roads shall be of all-wasthar construction end properly maintained.
1101 Surface water shag be diverted from the working face and shag not be Impounded over waste.
(11) solid wants shall not be disposed of in water.
4121 Open buming of sold waste is prohibited.
(131 The concentration of explosive gases generated by the facility shag not exceed:
(a) twenty-five percent of the lower explosive limit for the goes$ In facility structures.
(bl The lower explosiw limit for the gases st the property boundary.
114) Leschrrte shall be properly managed an site through the use of current best management practices.
(15) Should the Division deem it necessary, ground water or surface water monitoring, or both, moy be required as provided for under Rules
.0801 and .0602 of this Subchapter.
Ile) A sign shag be posted at the facill" entrance showing the contact name and number in case of an emergency and the pamdt number.
The permit number requirement is not applicable for facilities not requiring an individual parnit.
Certification by Land Owner:
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
ampI with all such revisions or amendments.
C,n
2iQbO ,*LrN(�A P.CLOJi-k L (Y 7n
9
Print Name (Owner) ignature (OwnDate
North Carolina
VOCE County
I, LW P- R i A.) a Notary Public for said County and State, do hereby certify
that obi C. Awcl LiNdA -&LzJ - personally appeared before me this day and acknowledged the
due execution of the foregoing instrument.
hand and official seal, this the day of All19
• M - otary Public
;1MY comn1WsiV!>E expires JW
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BK730 PG341
Certification by 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 138,
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. 1 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
(r$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 c mply wit al such revisions or amendments.
Print Name (Operator) Signature (Operator) Date
North a/u�r/olina
C County
I. Of A/210 E a Notary Public for said County and State, do hereby certify
that ��2- personally appeared before me this day and acknowledged the
dyq J@Xpcution of the foregoing instrument.
�Aq(+Y tland and official seal, this the day of /,1 .19 7
- Notary Public
S, C1Ny con1caisiio_ n`expires
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ff Otis it 1„'
For additional land owners and landfill operators, attach separate notarized certifications for each
additional land owner and landfill operator.
For CorporLte land owners and/or operators, use the Corpurate Certifications, pages 5 and 6. Contact
the Division of Solid Waste Management for proper applicable certifications.
Distribution:
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INSTRUCTIONS
Notification of Land Clearing and Inert Debris Landfills wrier two (2) acres in she is required under 16 NCAC 13B
.0683(2)(a). Contact the Solid Waste Section at the address below for further information.
Mail completed recorded original notification to the following address:
Division of Solid Waste Management
Solid Waste section
PO Box 27607
Raleigh. North Carolina 27011-7887
191 YI 733-0002
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 15) additional years and then transferred to the custody of the Archives.
4

BWI33 PG348
Certification by Corporate Land 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 136,
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.
t)cjZs C4AJWse�V _-f
ation Name (Print)
1Corbrate Seal)
JPV
P�ertor ice -President Name (Print)
XA
f Presider nil Vice -President Signature
D 99
Date
Attest:
2mr
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- .ZWL //
Corporate Secretary Name (Print) -
Corporate Secretary Signature
North iC�rolina
I/ ,4/4%C County
I, R o L W• • /J a Notary Public for said County and State, do hereby certify
that L I a 4.6Lo v&- (name of secretary) personally appeared before me this day and
acknowledged that he (or she) is secretary of �o VE 2's J-Agdsc e -4 S Z Imme 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 FkES d e N �` (president or
vice-president), sealed with its corporate seal, and attested by himself (or herself) as its secretary.
,rr ©
Winne s r hind and official seal, this the day of h
Wi
Notary Public
'I y�11h rcrrr����r,'
STATE OF NORTH CAROLINA,VANCE COUNTY
The foregoing certificates of Carol W. Currin,Notary Public of Vance
County,N.C.ai�e certified to be correct. This instrument and these
certificates are duly registered at the date and time. and in the
5
book and page shown on the first pageeofa n
SARAH H. HALE, REGISTER OF DEEDS By: Deputy
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