N1013 BURKEMONT

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State of North Carolina
' Department of environment,
Health and Narural Resources
Division of Solid Wcs;e Management FILED '��
ELIZABETH T COOP r a��®
James 6 Hunt, Jr , C-overnor Q/ �11 � /(03 p E H N F�
Jonathcn B. Howes, Secretary d�C r
William L Meyer. Director � `9� 12�— P 2 �37
EGISTC!; OF PLED
LAND CLEARING AND INER'I©�E�I�ISILAINF�FILL NOTIFICATION
Pursuant to 15A NCAC 138 .0563121(al, the land owneris) and operator(sl of any Land Clearing and
Inert Debris Landfill uneer two (2) acres in size shall submit this notification form to the Drvision ro for
to constructing or operating the landfill. This form must be filed for recordation m the Register of
Deeds' Office. The Register of Deeds shall index the notification under the name of the owner(sl of the
land in the county or counties m which the land is located The Register's seal and the date, book, and
Dace number of recorome must be included on this form when submitted to the Drvis�on 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 138 .0563(2)(bl.
t. Facility Name• �I,l�t � C.'Wl I, + /� I
2. �acihty location (street addressl: .5�5� IA/LKLVYtr_r4�-1 I�et
City:„ //ll County: �1.� � Zip: � ���� `�
3. Directions to Si e S K i � 7�
4. The land on which this landfill is located is described in the deed recorded in:
deed book• � �-5 - -page: t� � � county: �(LL � .�
5. Name of land owner
6.
Madinc_ address of 12 O
City: State: n�C� Zip: � llba5
Telephone num er of land ownera %�� 1 u _�3 � � �x�
If the land is owned by more than one person, attach additional streets with the name, address,
and phone number of all additional land owners.
8. Name of operator: /�i'. p�%
9. Trade or business name of operator//: � C %� (� � L n /,�
10. Mailing address of operator: ri� � �J � i' � �.! /l .I„�'I'i_Q (,YI .
City: fl)/l r State• �Ci Zip• � �i%:7� -
11. Telephone numfi r of operator.( ��� 1 lj,�rK' �����
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 �'�i P 1�.Q�
P o box 2J687 Rcleigh North Carolina 27611-7687 Telephone 919-73&4996 F,�,X 919-J1S3605
/ / 9YVVyI Ccac^,.�dy A.Y,tmchve Actwn EmplcYer SC%recycled/ 10%Pq{��c,�r u^��r �G„�,r � `` O
items/�3� � [) U I17 V

161 ' dtleguate erosion c:r::i measures z: uttures, ar devices shall be uulixed to proven[ silt from leaving the sitd and :o prevent excesswe
on sne erosion
l71 Prowmons for a grou-c cover suth: ant tp resaam erosion must be accomplished wnhm 30 working days or 120 calencar days Con
comp euon o any prase o andhll development
181 The laaliry shall be a:squa[ely sec -red by means of gates, chains, berms, lances, etc to prevent unau[honzed ac:sss exce?[ when an
operator IS on u:y ..'1 atlen ani Sna 8 on u y a a mea w i e e an 1 IS Opin pf pu IC use [o aaaLr! CCmpllanpe Wlfh
operational requuemer:s and to prevent acceptance of unautnanzed wastes
191 Access roads shall ee of all-weetner construtxran and properly mamtmned
I101 Surface water shall ea diverted from the working face and shall net he impounded over waste
n 11 Solid waste snail net pe prsooseo of in water-
1121 pan urnmg o soiw warm is pwmm�e
1131 a eoncantraupn o. ezp oswe gases generated by the faubty shall net exceed
lei Twenty-five percent of :he lower explosive limit lac the gases in facility structures
lbl The lower ezplosrva limn for the gases at the property bpundary
n41 Leaehat! shall ha prc:erly managed on site through the use of current best managemen[ practices
1151 pu t e rvumn calm d necessary, ground water pr surface water momronng, or both, may he requued as prowled far under flutes
0601 an o ;-is u c aptm
I161 A vgn shall be postep at the faulity entrance showing the contact name and number in case of an emergency and Ne permit number
The permit number re;uvement is not apPbcabie for facdrtms not regmnng an mdmdual permtt
Certification by 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 taclllr/ siting and disposal operations of this Land Clearing &Inert Debris
landfill will comply with [he 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. 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.
1 understand that both the land owner and operator are jointly and severally liable for improper
operations and proper closure of the landfill as provlded for by North Carolina General Statute 130A-
309.27. Ifurther understand that North Carolina General Statute 130A-22 provides for administrative
penaltl�S of up to five thousand dollars (55,000 001 per day per each violation of the Solid Waste
Management Rules Ifurther 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 ail such revisions or amendments.
W,�f, �1urn� �L�[L� / li-�d-q�
Print Name (Owner) Signature (Owner) Date
North Carolina
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Witn�sS'my }i2n3cpnti official seal, this the 11 day of N�opvember / ` , _1g 96
�lOffic�al Sc�a11R y ,l ", �� Qu-tie-C � �/ "'�`�i-� �
G N Q LS C � - Notary Public
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My cottj�j�slaft e�ires October 26, , 1 g 97
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