3412_OldSalisbury_CDLF_AFR14-15

CDLF 2015 Page 1
C&D
Facility Name:Permit:
Physical Address
Street 1:
Street 2:
City:
State:Zip:
County:
Mailing Address
Street 1:
Street 2:
City:
State:Zip:
Primary Facility Contact Person
Name:
Phone:Fax:
Email:
Billing Contact Person
Name:
Phone:Fax:
Email:
1. Tipping Fee: $per Ton (Attach a schedule of tipping fees if appropriate.)
2. Does the tip fee above include the $2.00 Solid Waste Tax?Yes No
Airspace (Capacity): Questions in this section relate to all cells/units of
the C&D facility operated under the current 4-digit permit number
regardless of whether the cells/units are closed or are not contiguous
at the time of this report. Tonnage questions must be based on scale
records and cover the period between the opening date and the date of
the last survey unless another time period is approved. Airspace
measurements include weekly, intermediate and final cover.
5. Date Facility Last Surveyed:
7. Total Tons Disposed in
Airspace Used (tons):
6. Airspace Used (cubic yards):
State of North Carolina
Department of Environment and Natural Resources
Division of Waste Management
CONSTRUCTION & DEMOLITION WASTE
LANDFILL
Facility Annual Report
For the period of July 1, 2014-June 30, 2015
According to (G.S. 130A-309.09D(b)) completed forms must be returned by August 1, 2015 and a copy of this report must be sent to the
County Manager of each county from which waste was received. If you have questions or require assistance in completing this report, contact
your Regional Environmental Senior Specialist.
4. What other activities occur at this facility? (check all that apply)
Scrap Tire Collection White Goods Collection Household Hazardous Waste CollectionRecycling/Reuse Collection
If you checked Recycling/Reuse Collection, please indicate the materials accepted and amount collected: (check all that apply and provide tonnages)
3. Did your facility stop receiving waste during this past Fiscal Year? Yes No
If so, please report the date this occurred:
Carpet tons
Wood tons
Concrete/rubble/asphalt tons Gypsum/drywall tons
Cardboard tons Electronics tons
Other Metal tons
Other Plastic tonsShinglestons
Other (specify)
3412-CDLF-1995
Old Salisbury Road Landfill 3412-CDLF-1995
3336 Old Salisbury Road
Winston-Salem
North Carolina 27127
Forsyth
P.O. Box 2511
Winston-Salem
North Carolina 27102
Janis McHargue
[phone] [phone]
[e-mail]
Stevie Dulin
[phone] [phone]
[e-mail]
29.00
01/01/2015
1,372,395
2,904,354
CDLF 2015 Page 2
8. Total waste landfilled at this facility during the period of July 1, 2014, through June 30, 2015. Indicate tonnage received by COUNTY of
waste origin. If waste was received from a transfer station, indicate the COUNTY LOCATION OF THE TRANSFER STATION. Do not
include waste diverted for recycling, reuse, mulching, or composting. Please indicate COUNTY and STATE, if received from another state.
Received From Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May June Total
Grand Total
9. If required to file NC E-500K forms with NC Dept. of Revenue, provide the four quarterly tonnages this facility reported for fiscal year
2014-2015.
Quarter Tons Reported
July 1 - September 30
October 1 - December 31
January 1 - March 31
April 1 - June 30
Total
3412-CDLF-1995
Forsyth County 3,353.56 2,633.06 3,564.22 3,158.25 2,293.25 2,267.45 1,722.66 1,382.34 2,097.34 2,388.06 2,820.04 3,221.48 30,901.71
30,901.71
9,550.84
7,718.95
5,202.34
8,429.58
30,901.71
CDLF 2015 Page 3
REMINDER: According to (G.S. 130A-309.09D(b)), this
report must be sent to the Regional Environmental Senior
Specialist for your area and a copy of this report must be
sent to the County Manager of each county from which
waste was received.
CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility.
Signature:Date:
Name:
Phone Number:Email:
Title:
Please return your completed report to:
10. Are there SWANA or other certified operator(s) at this facility?Yes NoIf yes, indicate the following:
Name:
Certification type and expiration date:
Name:
Certification type and expiration date:
Name:
Certification type and expiration date:
Name:Certification type and expiration date:
Name:Certification type and expiration date:
11. Comments, suggestions or notes:
3412-CDLF-1995
Stevie Dulin Digitally signed by Stevie Dulin DN: cn=Stevie Dulin, o=City of Winston-Salem, ou=City Government, email=[e-mail], c=US Date: 2015.07.22 14:42:37 -04'00'Jul 23, 2015
Stevie Dulin
[phone] [e-mail]
Solid Waste Administration Supervisor
C.T. Gerstell
610 East Center Avenue
Mooresville, NC 28115
phone: [phone] email: [e-mail]
Landfill Operations Specialist, 02/08/17
John McClintock
Gray Fultz
Landfill Operations Specialist, 03/24/18
9. Provide the four quarterly tonnages this facility reported on NC E-500K forms between July 1, 2013 and June 30, 2014:
Due to Bad Debt accounts, the tonnage indicated above for the fourth quarter which consist of April 1 - June 30 is 2,418.53 tons more than
what's indicated on the E-500K Tax Returns for the fourth quarter. Based on Article 5G of the Solid Waste Disposal Tax under 105-187.62
Administration, Bad Debt Deduction, taxes can be deducted in the same manner it was paid. Therefore, the tonnage will be different than the
tonnage submitted to the State on the E-500K.
Old Salisbury Road Lanfill 4th Quarter Tonnage 8,429.58
Old Salisbury Road Landfill Tonnage Write-Off (2,418.53)
Old Salisbury Road Landfill Tonnage on E-500K 6,011.05
CDLF 2015 Page 4
Instructions:
NC DENR
Division of Waste Management - Solid Waste Section Risk Assessment Form
Facility Name:Permit:
Address:
City:State:Zip:
Date:Person completing Assessment:
Phone Number:Fax:Email:
Please indicate either Yes or No for each Receptor and Post Closure Maintenance question. Then please
determine the distance or distances for each Receptor from the Edge of Waste (using range finders and/or GIS
maps) and type that information into the form. Please attach additional information including GIS maps, lists of
potable well locations, etc.
Receptors
1. Are there Residential Dwellings Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
2. Are there Potable Wells Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
3. Are there Community/Municipal Wells Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
4. Are there Surface Water Bodies Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many?
What are the three closest distances from the Edge of Waste?Feet Feet Feet
Please list the names of the water bodies:
5. Is Public Water Available Within 1,500 feet of the Edge of Waste?Yes No
If Yes, how many of the Residential Dwellings noted above are connected?
Corrective Measures
6. Is there an active methane extraction system (blower, flare, etc.)?Yes No
7. Is there a passive methane extraction system (trench, vents in cap, flare, etc.)?Yes No
8. Is there groundwater remediation taking place on site?Yes No
If Yes, what is the specific remedial technology used?
Comments
3412-CDLF-1995
Old Salisbury Road Landfill 3412-CDLF-1995
3336 Old Salisbury Road
Winston-Salem North Carolina 27127
Jul 23, 2015Edward Gibson
[phone] [phone] [e-mail]
121
270 320 330
15
•500 •500 •500
5
•50 •50 •50
Unnamed tributaries to South Fork Muddy Creek (2) Ponds (3)
107