N1021 LEN PATTON

State of Norh Carolina
Department of Environment,'A
Health and NCITural Resources FILED
Division or Sciic Wcsie MancalrDW
�IF AFiiIERSON
James 6 Hunt, Jr , Governor 85oi� I yy
Jonaihan M. -owes, Secretary OCT 27 A 407 p E H
William L Meyer. Director
REGI",l((' tMi
RURKi U, . N C
LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
Pursuant to 15A NCAC 136 .0563(2)(a), the land owner(sl and operators) of any Land Clearing and
Inert Debris Landfill under two (21 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 Names %/f1 � s Al
2. Facility location (street address) 14 7 0 3 EA ff O iv Ro/
City: M o 1ss9ANj'`aN A16County _ a a )m Zips Afsv/�X
3. Directions to Site L(/Est e w l 110 To Q4jAPt VILL..ejf
Ts 94 ff . v Pa L e FT l• k m i L s
4 The land on whicn this landfill is located is aescrioed in the deed recorded in:
deed book �/•S J pane ?o � county• AuI- Ks.
5. Name of land owner_ G•a,y P4 tl0 X/
6 Mailing acaress of land owner 47e 3 OA"firiN Rd
Gty.1%i0UAsieVfs.a State Al & Zip. olP0-S J
7 Telephone number of land owner I 70 r{ 1 Se 1/ - bl / 3/
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 ooerator A L F r e d ?AeQ Al �+
9 Trade or ousiness name or ooerator 04 ?. eA7tf AV Cs h//du/i r/9 G� a
10 Mailing accress or ooerator !j% 49 PA2t apt/ Rise/
CityAtOl'J/V;�/.V State N 4�. Zip 62P4S3'
11 Telephone_ numoer or ooerator 1 % G k 1 S X jy-'
If the lanc`ill is operated by more than one person, attach additional sheets with the name,
address, and phone number of all additional operators
12 Projected use or land after completion of landfill operations HA
P O cox 2-oc Rclei_n t.crtn Carolina 2761 i-,-_c7 ielepnone 919-733-d996 r':+X 919-71S360S
/ An Ec_c coo.,-_��;y F`.:mchve Acbc� iEmc.c: e• SC°b recycled/ 1C'4 post-ccrs_mer pcoer

The following are the appllcablllty, slung, and operating criteria for Land Clearing and Inert Debris
Landfills operating under notification
0101 DEFINITIONS
(72) 'Land clearing waste* means solid waste which is generated solely from land clearing activities such as stumps, trees, limbs brush
grass, and other naturally occurring vegetative material
(73) 'Land clearing and Inert debris landfill' means a facility for the land disposal of land clearing waste, concrete brick concrete block,
uncontaminated sail, gravel and rock untreated and unpainted wood, and yard trash
(741 'Yard trash' means solid waste resulting from lanescaomg and yard maintenance such as brush, grass, tree times and similar vegetative
materials
0563 APPLICABILITY REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS ILCID) LANDFlLLS
Management of land Ueanng and Inert debits shall De m aecoroance with the Stain hierarchy for managing sobtl waste as provioetl for antler N C G S
5 130A-309 041a) Disposal in a landfill is considered to be the least desirable method of managing land clearing and mart debris Where landfilling
Is necessary, the requirements of this Rule apply
(1) An mdwdual permit from the Division of Solid Waste Management is not required far Land Gearing and Inert Debris ILCIDI landfills that
meet all of the following concitions
(a) The facility is to be operated for the disposal of land clearing waste, men 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 Waste Management
Ib) The total disposal area is under two acres in size
let The facility and practices comply with the stung criteria under Rule 0564, and operational requirements under Rule 0566
Idl frie fill arnvrtY Is not exempt from, anti must camp Y with all of Federal, State, or Local laws, ordinances, Rules,
regulations, or orders, including but not limited to zoning restrictions, flood plain restrictions, wetland restrictions,
sedimemanon and erosion control requirements, and mining regulations
12) Where an individual permit is not required, the following applies
la) The owner of the land where the landfill is located must notify the Division on a prescribed farm, duly signed, notanzed, and
recorded as per Rule 0563(2)1b1. The operator of the landfill, if different from the land owner, shall also sign the notification
forth
Ili) The owner must file the prescribed notification form for recordation in the Register of Deeds' Office The Register of Deeds
shall moex 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 Register's seal and the date, book and page number
of recording shall be sent to the Division of Solid Waste Management
Icl When the land on wtuch the Land Clearing and Inert Deons 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 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 Debris Landfill and a
reference by book and page to the recordation of the notification
0564 SITING CRITERIA FOR LAND CLEARING AND INERT DEBRIS ILCIDI LANDFILLS
The following siting criteria shall apply for Land Clearing and Inert Debris ILCIDI landfills
(1) Fanimes ar practices, shall not De located m the 100-year floodplam
(2) Facilities or practices shall not cause or coninoule to the taking of any endangered or threatened species of plants, fish, or wildlife
f3) Facdmes or prances snail not result in the destruction or adverse modification of the cnocal habitat of endangerea at threatened species
as identified in 50 C=R Part 17 which is hereby incorporated by reference including any subsequent amendments and editions This
material is available for insoection 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
14) Facilities or practices shall not damage or destroy an archaeological or historical site
15) Faalmes or prances snail not cause an adverse impact on a state park recreation or scenic area or any other lands included in the state
nature and historic creserve
I6) Facilities shall not be located in any wetland as defined in the Clean Water Act Section 404(b)
(7) It must be shown that aceeuate suitable sods are available for cover either from on or off site
18) 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 Nat,onal Pollutant Discharge Elimination System (NPDES), under Section 402 of the Clean Water Act, as amended
(b) Facilities a pra: Ices snail not cause a ischarge of pmoged materials or fill matenal =0 waters of the state that is in violation
of the recuuemems 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
sandares
(d) Waste in ianclills with a bispesal area greater than two acres shall be placed a minimum of four feet above the seasonal high
water :acre except where an alternative separation is aporoved by the Division
(e) Waste in landfills with a pisoosal area less than two acres snail be placed above the seasonal high water table
19) Tne facility snail mer me'ollowing minimum buffer requiremen•s
(a) 50 feet from the waste bounaary to all surface waters
of the state as defined in C S 143-212
Ihl 1t,.•'ee- Atom t',e a .csai area :o DlpDerty Imes iesmential oweillncs commercial or oubhc butloincs anc wells
(c) _ _ ents may oe aorysied as ne^_essary to insure agequale protection of pUD:ti Iic nealm anc e environment
I10) The facility snalil maeally eguueme^•s of any applicable :onm; oremancs
0566 OPERATIONAL REQUIREMENTS FOR LAND CLEARING AND INERT DEBRIS ILCIDI LANDFILLS
Land Clearing and Inert Deons ILCIDI landfills shall meet the following pperabbnal requirements
Il) Operational plans s'dll be aborpvld and followed as soecihld for the facility
12) Tne tacibty shall only accept Loose solid wastes which n is permitted to receive
13) mid waste seal be 'es-Oci2q t0 the smallesi area teaSiDie ano cpmpaciea as densely as pract.cal into cells
(4) Aeeeuate soil cover snail be applied monthly, or when the active area reaches one acre in sae whichever occurs firs.
15) 120 calendar days a—er completion of any phase of disposal operations, or upon revocation of a permit, the disposal area shall be covered
with a minimum of cne tc-: Of suitable sod cover sloped io allow surface water runoff in a controlled manner The Division may require
turner ac•ton in oree• to correct any condition winch is or may become injurious to the public health or a nuisance to the community
21�Uii5tlFG 14'49

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 .0560" of 15A NCAC 138,
North Carolina Solid Waste Management Rules. The facility and operations of this landfill well 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. 1 further understand that North Carolina
General Statute 130A-22 provides for administrative penalties of up to five thousand dollars
IS5,000 001 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.
�G Fr.s � PA tfo ne � l/'f2�" /O/,47/4 s
Print Name (Operator) Signature (Operator) Date
North Carolina
�� County
• o
1, �-�'� . a Notary Public for said County and State, do hereby certify
that ��'�Ladi /ICJ Personally appeared before me this day and acknowledged the
due execution of the foregoing instrument. //�� c�
Witness,my hand and otficial seal, this the � day of C IICi�(.�.a� . 19 /'�
Sri Htl�uuiu„",
j���O i 1Y��;�;�iv-_ Notary Public
M�cdm�ry�irjryye%pires �ji�—�--7-- , 19 �ao4Z7
�pr�i11�r�?;�,y.;.
F6f �rib�F134'land owners and landfill operators, attach separate notarized certifications for each
additional"hand owner and landfill operator
For Corporate land owners and/or operators, use the Corporate Certifications, pages 5 and 6. Contact
the Division of Sol1d Waste Management for proper applicable cettiflcations
INSTRUCTIONS
Puroose Nouf¢a; cr o' Land Clearing and Inen Deons iandhlls unoe• two 121 acres �n sae is reau�ro under 15 NCAC 1..9 C663121ta1
.,on;ar :^a Scud Wane 6ec:ion a; the address below for to^�e• �nformauon
Disvibunon Mail comcre•eC recorded onamal nonficanon io the :dllowmg address
Drvison of sold Waz[e Management
Solid Waste Se=ion
PO Box 27687
Raleign Nortn Carouna 27611-7667
(9191 733-0692
Disoosmor. This form will be transferred co [ne 6tate Records Center wnen reference value entls n drds will be nelC for agency m Ne
State Recc cz Center live (61 addmonal years aria ;nen transferred to the custody of :ne Arcnrves
�� i�3�y� 4
.'
i•
B{�i��5Uf-'G i �:50

I
(61
(71
18)
Atleouate erosion :_ ••: measure: i uciures or devices shall be ubh:etl to prevent silt }rpm leavrg :tie she en: •: prevent excessive
n site erosion
Provisions for a gro.: :over st.-• : tit to restrain erosion mus- oe accomplished within 30 worc -g pays or 1=: manoar days uoon
completion of any phase of lane' :eveloriment
The facility shall be ace:uaialy se: --ad by means of gates, chains berms, fences, etc to prevent .: a_tnonzed ac:sas except when an
operator is on dL:y Aft anenca-- still be on ou.y` a( all times while the landfill Is open for p.: is use to asses a co mpoance with
(9)
110)
111)
(12)
operational raduirerne-•s and to :•evem acceptance of unaumonzed wastes
Access mods shall be c' alkwea--e• :ortstruction and properly maintained
Surface water shall ce : versed t-:— the working face and shall not be Impounded over wane
Solid waste shall n=• of dispose::` in water
Open burning of solid wane is pc:- nitad
(13)
The concentration of explosive gesas generated by the facility shall not exceed
(a) Twenty -live percent c' -fte lower explosive limn for the gases in facility structures
(b) The lower explosive L-- for The gases at the prope^y boundary
114)
Leachate shall be pre:e•ly manage: on site througn the use of current ben management practices
115)
116)
Should the Division dean n neceast-, ground water or surface water monitoring, or both, may be re:aired as o•:.aed for under Rules
0601 and 0602 o' --is Subcnx:•a
A sign snail be postec a: me to=. - entrance showing the contact name and number in case of or e^ ergency arc :tie permit numoer
The permit numoer recwrement is -:: applicable for facilities not reduinng an individual bermr.
Certification by Land Owner:
I certify that the information prcv:ded by me in this notification is true, accurate, and complete ?o the
best of my knowledge. The rac.ty slung and disposal operations of this Land Clearinc &Inert Debris
landfill will comply with the recitrements 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 la ,d owner, 1, the land owner, have knowledge of the ooerator's plans
to dispose of solid waste on tha and and I specifically grant permission for the operation of the landfill.
I understand that botn the la-c owner and operator are )ointly and severally liable for improper
operations and proper closure c- the landfill as provided for by North Carolina General Statute 130A-
309.27. 1 further understand the: North Carolina General Statute 130A-22 provides for aaministrative
penalties of up to five tnousarc dollars ($5,000.00) per day per each violation of the Solid Waste
Management Rules I further urcerstand that the Solid Waste Management Rules may be revised or
amended in the future and tha: the facility siting and ope ions of this landfill will oe required to
comply with all such revisions c• amendme s.
/g ✓ tin 17. %7tf
Print Name (Owner) Si nature (Owner) Date
North Carolina
(Off�lcl
County
Ja Notary Public for Bald County and State, go hereby certify
personally appeared before me this cav and acxnowledged the
awjl-�L,n' tilt; coregolnc -strument
� �f,ha"raffia d crfical _eat, this the a% day of 19�
Notary"Public
My commisslon
STATE OPNORTH CAROLINA—BUR%E COUNTY
The foregoing ttrbfates of �LG✓5[�� C'� offer :50�t/
N.P. dd o coupty u adjudged
to ba ccosCR Lot tk +p.fislacat arl hist�Gtl'ficauM, he fug{.
` Ine aaJ 7 dt g 9S 3
cued.. Tlus W !' 4 5