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HomeMy WebLinkAbout92V-LCID-.pdfLCID 2017 Page 1 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 Tipping Fee: $per Tipping Fee: $per 2. Estimate the amount of waste taken in an average week at this facility? 3. How many weeks did you operate this year? 4. What are the hours/days of operation for this facility? 5. What is the acreage of the footprint of the waste on site as of June 30?Acre(s) CERTIFICATION: I certify that the information provided is an accurate representation of the activity at this facility. Signature:Date: Name:Title: Phone Number:Email: 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: 6. Did your facility stop receiving waste during this past Fiscal Year? Yes No If so, please report the date this occurred: tons cubic yards LCID State of North Carolina Department of 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. If you have questions or require assistance in completing this report, contact your Regional Environmental Senior Specialist. 92V-LCID Carolina Tree Debris 92V-LCID 1417 Old Watkins Road Raleigh North Carolina 27616 Wake North Carolina Thomas Butler (919) 880-2852 tbutts92@gmail.com N/A - Price depends on truck size (number of axles and body length) 290 52 M-F (8AM - 5PM) NA Thomas Butler (919) 880-2852 tbutts92@gmail.com Liz Patterson 1646 Mail Service Center Raleigh, NC 27699-1646 Tele: 919.707.8286 Email: Elizabeth.Patterson@ncdenr.gov DocuSign Envelope ID: BC9748E7-F8D5-4BA0-BAA5-EB30AB5FAEE3 8/1/2017 LCID 2017 Page 2 Instructions: NC DEQ 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 Structures 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 Water Supply 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 Features 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 Structures 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 92V-LCID Carolina Tree Debris 92V-LCID 1417 Old Watkins Road Raleigh North Carolina 27616 8/1/2017Madeline German (919) 828-0577 (919) 828-3899 madeline@smithgardnerinc.com ~60 based on aerial photo ~375 ~570 ~790 NA NA 3 (1 creek, 2 ponds) ~250 ~350 ~375 Harris Creek, Unnamed Ponds NA Distances are constant from year to year, current distances estimated for Wake County GIS 2015 aerial photo. Tonnage is based on estimates of tonnage with 3356 trucks of various sizes received at site with assumed density of 0.35 tons per cubic yard. DocuSign Envelope ID: BC9748E7-F8D5-4BA0-BAA5-EB30AB5FAEE3