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HomeMy WebLinkAbout5803-CDLF-1995_FAR-FY17-18CD 2018 Page 1 C&D State of North Carolina Department of Environmental Quality Division of Waste Management According to G.S. 130A-309.09D(b), completed forms must be returned by August 1, 2018, 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. 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 5. Date Facility Last Surveyed: 7. Total Tons Disposed in Airspace Used (tons): 6. Airspace Used (cubic yards): 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 daily, intermediate and final cover. CONSTRUCTION & DEMOLITION WASTE LANDFILL Facility Annual Report For the period of July 1, 2017-June 30, 2018 3. Did your facility stop receiving waste during this past Fiscal Year? Yes No If so, please report the date this occurred: 4. How is your leachate transported to the waste water treatment plant? Sewer Connection Pump Truck N/A 8. Do you utilize any alternate daily cover at this facility? If so, please describe below. Received Recycled Landfilled Landfill Rate For Internal Use Only: CD 2018 Page 2 County Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Totals In-State Total 9. Total material RECEIVED (waste + recyclables) at this facility during the period of July 1, 2017, through June 30, 2018. Indicate tonnage received by COUNTY of waste origin. If waste was received from a transfer station, indicate the COUNTY LOCATION OF THE TRANSFER STATION. State County Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Total Out-of-State Total North Carolina Sources Total Material Received (In-State + Out-of-State tons) Outside of North Carolina Sources CD 2018 Page 3 10. 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 and amount recycled (tons): Material Tons Material Tons Paper Concrete/rubble/asphalt Plastic Computer Equipment Carpet Televisions Cardboard Fluorescent Light Bulbs Glass Used oil/oil filters Aluminum Cans Wood Steel Cans Gypsum/Drywall Other Metal Other (specify): Pallets Other (specify): Commingled Recyclables Other (specify): Total Recycled Material 12. If required to file NC E-500K forms with NC Dept. of Revenue, provide the four quarterly tonnages this facility reported for fiscal year 2017-2018. Waste/Material Tons Total Tonnage Received (question 9) Total Received Materials Recycled (question 10)- Total Tons Landfilled at this Facility = Disposed Tons Exempt from Taxation* (if any)- Total Tonnage Subject to Disposal Tax = Quarter Tons Reported July 1 - September 30 (Qtr1) October 1 - December 31 (Qtr2) January 1 - March 31 (Qtr3) April 1 - June 30 (Qtr4) NC E-500K Tax Tonnage Total= 13. If you indicated that your facility disposed tons of waste materials that were exempt from taxation in Question 11*, please provide a description of any tax exempt tons disposed and explain any difference existing between Total Tonnage Subject to Disposal Tax and NC E-500K Tax Tonnage Total. 11. Input total amount of waste that was received, recycled, and that is exempt from taxation (ex-sludge,biosolids). Subtract total recycled material and total tax-exempt tons from total tonnage received. This number should represent the amount of tons subject to the solid waste disposal tax and thus should equal the E-500K tax tonnage total on right. Summary of Facility Activity NC Solid Waste Disposal Tax CD 2018 Page 4 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: 15. Comments, suggestions or notes: 14. Are there SWANA or other certified operator(s) at this facility?Yes No If 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: CD 2018 Page 5 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