5106-TP-2019 West Farms Wood Products T&P SW019-0047 PARF, Data Sheet and Invoice 4-25-19

Modified on 4.25.2019 
Revision #4 
PERMIT APPLICATION REVIEW FORM
Review Requested by: Donna Wilson Date Requested: 4/16/2019
Facility Name and Permit ID West Farms Wood Products T&P
Applicant (Owner) Name Blackwood Associates, LLC
Description of Permit Request
[This is the action the applicant is
requesting in accordance with
NCGS 130A-295.8(b)]
☒(1)a. New – New Facility
☐(1)b. New – Expand Facility Boundary
☐(1)c. New – Expand Waste Boundary
☐(1)d. New – Substantial Amendment
☐(2)a. Amendment – Next Phase of the Approved Facility Plan
☐(2)b. Amendment – Five-year Renewal
☐(2)c. Amendment – Change in Ownership
☐(3)a. Modification – Change to Approved Plans (No CHR)
☐(3)b. Modification – Subsequent Permit to Operate (No CHR)
Permit Fee $50
Date Application Received 3/11/2019
Contact Name, Title & Phone
No. Brian Beall, 812-676-8770
Contact Email Address [e-mail]
Company Name Blackwood Solutions
911 Address 1683 Barefoot Rd, Newton Grove, NC 28366
Mailing Address 1370 That Road
City/State/Zip Bloomington, IN 47403
Parent Company Unknown
Known Subsidiaries Unknown
Other Known Related or
Associated Business Names Unknown
Known Counties of Operation NA
Does the Applicant have a Past
Or Current Solid Waste Permit?
Yes ☐ No ☒ Unknown ☐
Facility Type: Facility Type Permit No.:
Did the Permit Applicant Submit
Financial Assurance Cost
Estimates?
Yes ☒ No ☐ N/A☐ Not Needed ☒
Other Notes
This is a new wood waste T&P facility in Johnston County (even
though Newton Grove in the 911 address would make it appear to be
in a different county). No known solid waste management history in
NC. Landowner is BWS Real Estate, LLC (an Indiana LLC), 1370 W
That Rd, Bloomington IN 47403.
SW019-0047
P1332
5106-TP-2019
APPLICATION FOR NEW PERMIT DATA SHEET (Revised March 2012)
Data Field Description Data
Site_Name
M: name given to the facility. Name can permit name, but does
not have to.West Farms Wood Products T&P
Address1
M: first line of physical address assigned by local 911 service,
may be different than mailing address.1683 Barefoot Rd
Address2 M: second line of physical address, used when necessary.
City M: city, town or locality where facility is located.Newton Grove
State
M: two letter US postal service abbreviation for the state where
the facility is located.NC
Zip M: zip code for the location address.28366
County M: county name where facility is located.Johnston
Latitude M: decimal degrees, should be between 33 and 37.35.298616
Longitude M: decimal degrees, should be between -75 and -85.-78.396016
Horiz_Collection_Method
O: applies to how the coordinates were collected: 001=GPS or
002=geocode or 003=from map 003
Supplemental_Location
O: descriptive text for locating a facility when address is not
practical.
enter at 1683 Barefoot Rd, site is approx 1/2 mile from
entrance
Geometric_Type
M: 001=Fixed or 002=Mobile, e.g. Facility is Fixed, a septage
pumper is Mobile 1
Reference_Point
O: description of point where coordinates were collected at the
facility, 001=front door, 002=permitted feature, 003=for mobile,
004=undefined point on facility 4
Status M: description of the overall facility; Open or Closed.proposed
Owner
M: classification of the owner of the facility as either Public or
Private entities.Private
Start_Date
M: date on which the facility began to be of interest to the
program, Facility Registration Date; Facility's Original Permit
Issue Date; Facility's First Inspection Date; Program's Start Date;
Department's Creation Date (07/01/1989)
Start_Date_Qualifier
O: description of event represented by Start_Date field, e.g.
Facility's Original Permit Issue Date.
End_Date
O: date on which the facility ceased to be of interest to the
program.
End_Date_Qualifier
O: description of event represented by End_Date field, e.g. Date
of Final Closure.
PermitID M: unique id number used for permit 51XX-TP-XXXX
LocationID
M: id number used in location table to identify the facility or
environmental interest subject to this permit. This number is
assigned and is only needed if permit relates to an existing site.
Permit_Name M: Common Name used for this permit West Farms Wood Products T&P
Orig_PermitIssueDate M: Date when first permit issued.
PermitIssueDate M: Date MOST recent permit issued.
PermitExpDate M: Date when current permit expires.
PermitStatus
M: Active=Accepting/handling waste; Inactive=Not accepting
waste; Proposed=Application in-house for NEW permit;
Expired=Past Expiration date but not officially closed; Post-
Closure=Not taking waste but monitoring; Closed=Not accepting
waste and 'official' closure letter sent; Post-Closure
Complete=Not taking waste and monitoring complete;
County=Non-facility within a county Proposed
Rule
M: block of rules governing site e.g. .1600, .0500, .1100, .0800,
etc.1400
EnvMonitoring
M: environmental monitoring required, yes is required or no is not
required.no
PrimaryWaste_Type
M: primary waste type handled under this permit: MSW, CD,
Indus, Tire, LCID, Medical, YW, Septage, HHW, WG LCID
PrimaryOperation_Type
M: primary operation when dealing with waste: LF, Trans,
LandAp, TP, Compost, MatRecovery, Incin, Hauler,
WasteToEnergy, Authorization, Notification, Collection, Detention TP
Owner_Name M: name of owner as appears on the permit.Blackwood Solutions, LLC
Operator_Name M: name of operator/facility manager.Bob Stancombe
SW019-0047
P1332
North Carolina Department of Environmenal Quality
Division of Waste Management
Solid Waste Section
INVOICE
Invoice #:SW019-0047
Date:4/25/2019
Payment Options:
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
phone: [phone] fax: [phone]
email: [e-mail]
To:Brian Beall
West Farms Wood Products T&P
1370 That Road
Bloomington, IN 47403
More information available on the web:
North Carolina Department of Environment and Natural Resources (DENR) - http://portal.ncdenr.org/
North Carolina Solid Waste Program - http://portal.ncdenr.org/web/wm/sw
North Carolina Electronics Management Program - http://portal.ncdenr.org/web/sw/electronics
E-check -Available online at http://go.ncdenr.gov/swpay
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card -Available online at http://go.ncdenr.gov/swpay
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
*Convenience Fee of 2.65% added to amount invoiced.]
Paper check -Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number
on check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy
of this invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Remit paper checks to:
N.C. Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Description Amount Due
Facility-Application:
West Farms Wood Products T&P (New Permit)
1683 Barefoot Road
Newton Grove, NC 28366
New Application for Permit (New Facility) received on 3/11/2019
$50.00
$50.00Total Amount Due
5/25/2019Date Due
Pursuant to North Carolina General Statute 130A-295.8 you are required to pay fee(s) based on your solid waste management activities. The fee(s)
shall be used to support the solid waste management program. An application is deemed incomplete until all fees are received.
Explanation of Invoice Amount is Based on Facility's Current Permit Application:
Billing process:
Mary H. Johnson [phone]
Ed Mussler [phone]
Solid Waste Contacts:
Regulations and Technical Assistance:
Ed Mussler [phone] Landfills, Transfer Stations
Adam Ulishney [phone] Land Application Sites, Compost Facilities
NC Solid Waste Invoice Form I-2014