4309T-TRANSFER--FY16-17 (2)

Transfer 2017 Page 1
Facility Name:Permit:
Physical AddressStreet 1:
Street 2:
City:
State:Zip:
County:
Mailing AddressStreet 1:
Street 2:
City:
State:Zip:
Primary Facility Contact PersonName:
Phone:Fax:
Email:
Billing Contact PersonName:
Phone:Fax:
Email:
1. Tipping Fee: $per Ton (Attach a schedule of tipping fees if appropriate.)
3. 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:
2. Did your facility stop receiving waste during this past Fiscal Year? Yes NoIf so, please report the date this occurred:
Does the tip fee above include the $2.00 Solid Waste Tax?Yes No
TRANS State of North Carolina Department of Environmental Quality Division of Waste Management
TRANSFER STATION 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. 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 CollectionIf you checked Recycling/Reuse Collection, please indicate the materials accepted and amount collected: (check all that apply and provide tonnages)Carpet tons
Wood tons
Concrete/rubble/asphalt tons Gypsum/drywall tons
Cardboard tons Electronics tons
Other Metal tons
Other Plastic tonsShinglestons
Other (specify)
5. If required to file NC E-500K forms with NC Dept. of Revenue, provide the four quarterly tonnages this facility reported for fiscal year 2016-2017.Quarter Tons ReportedJuly 1 - September 30October 1 - December 31January 1 - March 31April 1 - June 30 Total 4309-T-Transfer
Harnett County Anderson Creek Landfill Transfer 4309-T-Transfer
1086 Poplar Drive
Spring Lane
North Carolina 27546
Harnett
PO Box 2773
Lillington
North Carolina 27546
Amanda Bader,PE
[phone]
[e-mail]
Same
40.00
David Baker
MOLO April 2019
Larry Thomas
Landfill 2019
Andrew Holland
Transfer Station 2020
22.4 28.84
212.16
Co Mingled 86.50 Single Stream 137.32
2,083.692,855.912,408.163,149.5610,497.32
Transfer 2017 Page 2
6. Total waste received (INCLUDING WASTE TRANSFERRED AND RECYCLED) at this facility during the period of July 1, 2016, through June 30, 2017. Indicate tonnage received by COUNTY of waste origin. 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 7. Indicate the facility(s) that received your facility's transferred waste material:NAME, PERMIT #, and LOCATION (city, state) of FACILITY Tons
TOTAL
Facility Type
CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility. Signature:Date:
Name:
Phone Number:Email:
Title:
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.
Please return your completed report to:
4309-T-Transfer
AC Transfer Station 1,713.95 1,771.36 2,940.65 1,790.88 1,544.43 1,727.53 1,734.83 1,555.95 1,706.2 1,826.26 1,940.33 2,012.24 22,264.61
22,264.61
Sampson County Disposal Inc. , Roseboro, NC MSW Landfill 22,264.61
22,264.61
Amanda Bader Digitally signed by Amanda Bader Date: 2017.07.31 13:22:41 -04'00'
Amanda Bader, PE
[phone] [e-mail]
County Engineer/SW Dir.
Liz Patterson 1646 Mail Service Center Raleigh, NC 27699-1646 Tele: 919.707.8286 Email: [e-mail]