8702T-TRANSFER--FY16-17

TRANS
Jtate of North Carolina
I,Department ofEnvironmental'Quality
I pivision of Waste Management..,
TRANSFER STATION
Facility Annual Report
For the period of July 1,2016-June 30,2017
According to G.S.!30A-309.09D(b),completed forms must be returned by August 1,2017 and a copy of this report must be sent to the
County Manager ofeach county from which waste was received.If you have questions or require assistance in completing this report,contact
your Regional Environmental Senior Specialist.
Facility Name:<X\^Cf)\K>T\\-?Tda t\£g <L-Permit:7-Q2 -r
Physical Address-\.
Street 1:\—j \\j V
Street 2:
State:North Carolina
Primary;,FacfKty Cpptact Person,.,;
Name:Z~2CjD ff
Phone:$3.$"'*/&$'~*/*M*)
Email:^|urf .W @\)
I..,,;-..■■■:■■.:.
rax:$3~&*"
'"i,■--./Mailing Address,:;i
Strcet2:p0 QQ?i ^3 ^)
City:(£>CjSOY\tSlV^
State:North Carolina Zip:J2-07'/3
IJUHng Contact P.erfipn !;
Name:lJ^-£?1 >~\rCo MJSi 1
Phone:f?3.&-Cf6<6~C)'3'7:Z>Fax:$2$~tfS&^^bD)
Email:
1.Tipping Fee:$AJJ,Q Q pel.Ton (Attach a schedule of tipmug fees if appropriate.)
Does the tip fee above include the S2.00 Solid Waste Tax?Qj-Tes Q No
2.Did your facility stop receiving waste during this past Fiscal Year?Q]yes [T^fNo
If so,please report the date this occurred:
3.Are there SWANA or other certified operator(s)at this facilily?
If yes, indicate the following:
Name:\^^n v '1C3._V -<r Certification type and expiration date:
No
Name:
Name:
;d(-\Certification type and expiration date:
Certification type and expiration date:
3-
¥-.
3
L
-)
—J '
-)
9
9
9
4.What other activities occur at this facility?(check all that apply)
0Recycling/Reuse Collection r^fScrap Tire Collection [/fWhite Goods Collection □Household Hazardous Waste Collection
Ifyou checked Recycling/Reuse Collection,please indicate the materials accepted and amount collected:(check all thatapply and provide tonnages)
□Carpet tons fj Concrete/rubble/asphalt tons □Gypsum/drywall it>™g]Other
ions Y/\Other PlasticCardboard
Wood tons
Shingles
Other (specify)
Electronics tons
5.If required (o file NC E-SQOK forms with NC Dept.of Revenue,provide the four quarterly tonnages this facility reported for fiscal year
2016-2017.■Quarter
July 1 -September 30
October 1 -December 31
January 1 -March 31
April 1 -June 30
Total
;Tons
f $31
/>7.9 0
Reported
//?/
.MM
§*\3
9.IX
*6.Total waste received (INCLUDING WASTE TRANSFERRED AND RECYCLED)at this facility dujjngih^period ofJuly 1,20.16,
through June 30.2017.Indicate tonnage received by COUNTY of waste origin.Please indicate COUNTY and STATE,if received from
another state.
Received from
^3u5£*in CO
PJ*ll-e-fc*
r'kcr 6>ia&
JnJ
/^,
^//
Aug
U-99
Si is
Sept
C<>5.f3
Mho
Oet
££7.37
ll-n
Nav
IffOO
33Jo
Dec
SWHH
\2Ot
95
Jan
^W
7.Indicate the facility(s)that received your facility's transferred waste material:
:NAME ■PE'KAftt''#'«nd LOCATION "(city,State)(>f F>VCii4TYv
Pp<"rv\'V J41 ^)/r)(/o~OO 0 0
Re_c/C
Feb Mar
/a-fi
5X
£!■75
Apr
IMS
/00d
8,45
Vlay
7W it
MM
X3^
June
78
Grand Total
cilifcy type
TOTAI
Total
213,o^
B 9
/3'-9t>
#07,32
r
/Sh
/3v>^7
5 8,^6
133.0^
5 ::_..
55%is
be sen
■■,,.,
■■ni in tlia Couhty
be
Please return your completed report to:
CERTIFlCATION:nI certify that the information provided is an accurate representation of the activity at this facility.
Signature:Jw#~is.^VLtfW Date:8~I"[7
Name:Title:
Phone Number:fapy-930-Emai':
LCID St&tedf North:O&folma
Departmentof Environmental Quality
Division of Waste Management
LAND CLEARING &INERT DEBRIS
LANDFILL
Facility Annual Report
For the period of July 1,2016-June 30,2017
According to G.S.130A-309.09D(b).completed forms must be returned by August 1,2017 and a copy of this report must be sent to the
County Manager of each county from which waste was received.Ifyou have questions or require assistance in completing this report,contact
your Regional Environmental Senior Specialist.
Facility Name:y Permit:ffi '"
ll'l-»4 »'I'll il,Mailing Address
Billing;Coht&6t;PcrsoTiPrimaryFacility'Contact.'Person
1.Tipping Fee:$
Tipping Fee: $
Tipping Fee:$
per
per
2.Estimate the amount of waste taken in an average week at this facility?
3.How many weeks did you operate this year?
D cubic yards
4.What are the hours/days of operation for this facility?Jj oo H <Oh frv\
5.What is the acreage of the footprint of the waste on site as of June 30?
6.Did your facility stop receiving waste during this past Fiscal Year?Q Yes
Ifso,please report the date this occurred:
Acre(s)
KEMINpER:Accopiinjg to G.S.l;30A-309.q9p(b),this
reprl must be settttotheSei^si^^
SR^kjist for your area and a copy of this reportmiiat be
sent to the Cy!int5LMiiffi«sq^^^
waate Was reeeivecl.
Please return your completed report to:
CERTIFICATION:1 certify that the information provided is an accurate representation ofthe activity at this facility.
Signature:rs..-,Date:f%~)"I '
Name:^,Q fr
Phone Number::fi}%-Email:,5+Uff ir\(g)
Division o^VVasfeMtfrtageni^nt ^§blid VVasfe S^ctipti:Risk Assessment Form
Facility Name:
Address:I-
Permit:07-A
Q.A
City:State:North Carolina
Person completing Assessment:
Phone Number:
Date:g-}'/"?
Fax:#.2 £"'4W-9k>0)Email:.
Please indicate either Ves or/Vo 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 Structures Within 1,500 feet of the Edge of Waste?
If Yes,how many?
Q-itfo
What are the three closest distances from the Edge of Waste?Feet Feet Feet
2.Are there Water Supply Wells Within 1,500 feet of the Edge of Waste?G Yes
If Yes,how many?j_
What are the three closest distances from the Edge of Waste?j^O O Feet Feet
3.Are there Community/Municipal Wells Within 1,500 feet of the Edge of Waste?□Yes
If Yes,how many?
What are the three closest distances from the Edge of Waste?Feet
4.Are there Surface Water Features Within 1,500 feet of the Edge of Waste?
[
□Yes
If Yes,how many?_
What are the three closest distances from the Edge of Waste?
Please list the names of the water bodies:
Feet
I]No
Feet
Feet
Feet
5. Is Public Water Available Within 1,500 feet of the Edge of Waste?
If Yes,how many of the Residential Structures noted above are connected?
Yes No
Corrective Measures
6.Is there an active methane extraction system (blower,flare,etc.)?□Yes
7.Is there a passive methane extraction system (trench,vents in cap,flare,etc.)?Q Yes jNo
8. Is there groundwater remediation taking place on site?□Yes [^No
If Yes,what is the specific remedial technology used?__^
Comments