0601_Avery_MSWLF_GW_Notification_FID1320706_20190510

DocuSign Envelope ID: 31F4AOOA-117F-4C55-848F-1927EF161A01
NC DEQ 14-Day Notification of Groundwater
Division of Waste Management - Solid Waste Protection Standard Exceedance(s)
per rule: 15A NCAC 136.1633(c)(1)
Notice: This form and any information attached to it are "Public Records" as defined in NC General Statute 132-1. As such, these documents are
available for inspection and examination by any person upon request (NC General Statute 132-6).
Instructions:
Prepare one form for each individually monitored unit.
Please type or print legibly.
Attach a notification table with values that attain or exceed applicable groundwater protection standards.
Send the original signed and sealed form, any tables, and Electronic Data Deliverable to: Compliance Unit, NCDEQ-DWM, Solid Waste
Section, 1646 Mail Service Center, Raleigh, NC 27699-1646.
Solid Waste Monitoring Data Submittal Information
Name of entity submitting data (laboratory, consultant, facility owner):
Smith + Gardner, Inc.
Contact for questions about data formatting. Include data preparer's name, telephone number and E-mail address:
Name: Joan A. Smyth, P. G. Phone: [phone] x 221
E-mail: [e-mail]
Actual sampling dates (e.g.,
Facility name: Facility Address: Facility Permit # October 20-24, 2006)
Avery County Closed MSW Landfill Brushy Creek Road, Newland, NC 06-01 April 2, 2019
Environmental Status: (Check all that apply)
❑ Initial/Background Monitoring ❑X Detection Monitoring ❑ Assessment Monitoring ❑ Corrective Action
Additional Information:
❑X A notification of values exceeding a groundwater protection standard as defined in 15A NCAC 13B .1634(g)(h) is attached. It includes a list of
groundwater monitoring points, dates, analytical values, NC 2L groundwater standard, NC Solid Waste GWPS and preliminary analysis of the
cause and significance of any concentration.
❑ A re -sampling event was conducted to confirm the exceedances.
❑ Alternate Source Demonstration(s) have been approved for the following constituents with report date:
Certification
To the best of my knowledge, the information reported and statements made on this data submittal and attachments are true and correct.
Furthermore, I have attached complete notification of any sampling values meeting or exceeding groundwater standards or explosive gas
levels, and a preliminary analysis of the cause and significance of concentrations exceeding groundwater standards. I am aware that there
are significant penalties for making any false statement, representation, or certification including the possibility of a fine and imprisonment.
Joan A. Smyth, P.G. Senior Hydrogeologist [phone] x 221
F 4ility Re res�r1tatiyM Name (Print)
N
Title
(Area Code) Telephone Number
5/10/2019 Affix NC Licensed/Professional Geologist or Professional
Engineer Seal
Signature Date
14 N. Boylan Avenue, Raleigh, NC 27603
Facility Representative Address
F1370
NC PG/PE Firm License Number (if applicable effective May 1, 2009)
Revised 6/2016
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