N1024 PEA RIDGE

r„ ' State of North Carolina FILEO
' Department of Environment, ELIZA©ETI� T ro0!�
Health and Netural Resources � �69 � ��
Division of Solid Wc;te Management � I
'96 SEP 19 Al,�
James B Hunt, Jr ,Governor a
Jonathcn B. Howes, Secretary � tEG ;TCR E U _,lr
William L Meyer, Director BURKE cU . N �,
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LAND CLEARING AND INERT DEBRIS LANDFILL NOTIFICATION
Pursu'dnf td 15A NCAC f 38 .0563(2)(e), the land ownerlsl and operators) of any Land Clearing and
Inert Debris Landfill under two (2) acres in size shall submit this notification form to the Division ro for
to dort�ttucting or operating the landfill. This form must be filed for recordation in the Re ister of
Deedsr Office. The Register of Deeds shall index the notification under the name of the owners) of the
Land in the county or counties in which the land is located. The Register's seal and the date, book, and
pogo number of recording must be included on this form when submitted to tha Division. This
notr rcAtion ie not valid to authorize operation of a landfill unless complete, accurate, recorded, and
submitted to the Division��as77required by 15A NCAC 13B .056312)(b1.
i. facility Name: /'cu. K�`ol�.
2. �ecility location Is;reef addressl: � m • ,BsK Z 2 G
City: Cs��,., P\ � ,,.,` County:_ �.,.r(rc� Zip: 2%(.t8'
3. Directions to Srte: S R /Z z L
4. ' fh��aGndk n whit, ��s landfill is located is described in the deed iecor ed in:
/,'L3Y B
dead book: �53�- - -page: Zat-'f cdunty: L"iuti�,
�. Name of land owner:__ �JbS.rrra. ;� Qi1�
�. Mailing/address of land owner: !�. r7 . $s� � �L
City:,�ET�� �.. $fate: i"IL/ Zip; _?fJ/.28
7. Telephone number of land owner:( 70� 1 SKV- Dt�b
' If the land is awned by more than one person, attach additional sheets with the name, address,
and phone number of ail additional land owners.
B. Name of operator: C � C�mf,w... L. f� �i-
9. Trade or business name of operator.__�e. f�. o .-T"
10. Mailing address of operator: 2 / G / G il/>,e� � t-�ow,,.. C'i. 'I2 ci
City: ��a„ .. � State: �C - Zlp' Z843;S— _
i i. Telephone number of operator:I ?e�F 1 S :Tfr - G Z 75/
If the landfill is operated by more than one person, attach additional sheets with the name,
" eddteSs, and phone number of All additional operators. - _ -
12. Projected use of land after completion of landfill operations:�af.�-�rc.r
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j � P O. box 27687. Rciergh. North Carolina 27611-7687
An Ecxl Ccx'� ny ARamctrve AcUcn Employer
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Telephone [phone] FA)C 919-715.3605
50%recycled/ 10%post-conn.^ier pccer

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I81 ' AdeCua[e erosion c:rsa measures structures. or devices shall be utlllzetl to prevent silt from leaving ma }it8 and :o prevent exce:Slue
on sna eroswn
171 Prowmons for a grout/ cover oath: ant to restrain erosrpn must he accomplished wrthm 30 working days or 120 calencar days uCon
� romp anon a any prase a antlllll development.
I81 � The faapry shall he aespuately seared by mearo of gates, thalns, berms, levees, etc. to prevent unauthonzed aeters except when an
operator IS On U:y nn at !n ant Sn] a on u y Irrle3 w I e e n I Open Of pU IC u3e t0 aSalr! CCmp lance Wlth
o0erauonal reCuvemer:s and to prevent ecceptince of unauthonzed waste3
191 Access reeds !hell Ea of all-weetnar cons[nretmn and properly mamtmned.
I101 Burlacs water shall be diverted from the working lace and snail not be Impounded over waste
Ill) $011d Waite snap nCt pe DlYppeeO o m water.
1121 pen urnmg o soup waa[s Is Drcnmrte
I731 a eontentranon o e3p oswa gases generated by the facility shall not exceed
Isl Twenty-five percent of ;he lower explosive limn }or the gases In facility structures
Ibl The lower axplosrva 1(mlt for the gases at the property boundary
1141 iaachata shall be Drcperly managed on site through the use of current best management practices
1151 ou t e IWslon atom rt necessary, gr and water or suAace water manl[oring, or both, may be repaired as provided for under Rules
.0601 an o � Is u c sprat
(161 A sign shall be postep at the faclll[y entrance showing the tpn[act name and number In Casa of /n emergeney and the permit number
The permit number reeuuement a not ap0licahle far laclbnes not repuinng en Indwldual permit
Certification by Land Owner:
I certify that the information provlded 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 bVaste Management Rules. The facility and operations of this landfill will also
comply with all applicable Federal, State, and Local laws, rules, rAgulations, 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 bath the land owner and operator aril Jointly and severally ifable for improper
operations and proper closure of the landfill as provlded for by North Carolina General Statute 130A-
309.27. (further understand that North Carolina General Statute 130A-22 provides for administrative
penaitlrsS of up to five thousand dollars (S5,000 001 per day per each violation of the Solid Waste
Management Rules. I further understand that the Solid Waste Management Rules may be revised or
>lmended in the future and that the facility siting and operations of this landfill will be required to
comply with all such revisions or amend ants.
ciormma, L. P,��t 9— /8— 96
Print Name (Owner) Signature (Owner Date
North Carolina
BURKE County
1,I✓1 izabeth � T Cooper a Notary Public for said County and State, do hereby certify
tsh�att tDdar�rre�ll�H P�olwegl.�lr�G Gop�eprpsonally appeatred befgore me this �ayOalnd/2,�J(rJUU/Nyif�j7b,§�¢'y}�/
tf"P�F�44t�f'p7 /tP��9iY�4 fn�I�i/ml�9T/ nandPacknow�e�gedt��iefauegexec�ut�onment
WitncSs my hand and official seal, this the 19 day of _ September , 19 96
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..,; '.r; I Notar �ubhc
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�� �1;,,cpr11141�sSlculexpires April 25 19 98
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