8602_SurryCountyMtAiry_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)
8602-CDLF-2001
Surry County Mt. Airy C&D Landfill (Closed) 8602-CDLF-2001
237 Landfill Road
Mt. Airy
North Carolina 27030
Surry
PO Box 342
Dobson
North Carolina 27017
Dennis Bledsoe
[phone] [phone]
[e-mail]
Dennis Bledsoe
[phone] [phone]
[e-mail]
0.00
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
8602-CDLF-2001
000000000000 0
0
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:
8602-CDLF-2001
Jul 9, 2015
Dennis Bledsoe
[phone] [e-mail]
Director
C.T. Gerstell
610 East Center Avenue
Mooresville, NC 28115
phone: [phone] email: [e-mail]
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
8602-CDLF-2001
Surry County Mt. Airy C&D Landfill (Closed) 8602-CDLF-2001
237 Landfill Road
Mt. Airy North Carolina 27030
Jul 9, 2015Dennis Bledsoe
[phone] [phone] [e-mail]
5
800 1050 1450
6
800 1100 1400
4
400 650 515
Ararat River and Tributaries of Stony Creek
Injection