6713-LCID-2021 BlackJack LCID SW021-0052 PARF & Invoice 04-15-2021

PERMIT APPLICATION REVIEW FORM
Review Requested by: Benjamin Jackson
Date Requested: 4/15/2021
Facility Name and Permit ID Blackjack LCID,
Applicant (Owner) Name W.A. Page & Son’s Inc.
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 – Renewal/Review 5YR 10YR
(2)c. Amendment – Change in Ownership
(3)a. Modification – Change to Approved Plans (No CHR)
(3)b. Modification – Subsequent Permit to Operate (No CHR)
(3)c. Modification – Five-year Limited Review
(4) Major Permit Modification
Permitted Annual Tonnage <25,000tpy
Permit Fee $500.00
Date Application Received 2/2/2021
Contact Name, Title & Phone # Kirk Page, Secretary, [phone]
Email Address [e-mail]
Company W.A. Page & Sons, Inc.
911 Address 321 Belgrade-Swansboro RD, Stella, NC 28582
Mailing Address 308 VFW Road, Swansboro, NC 28584
City/State/Zip Swansboro, NC 28584
Parent Company NA
Known Subsidiaries NA
Other known names business
has operated under
NA
Known Counties of Operation NA
Does the applicant have a past
or current solid waste permit?
Yes No Unknown
Facility Type: Permit #:
Did the permit applicant submit
Financial Assurance cost
estimates?
Yes No Not Needed
Other notes New LCID
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.Blackjack LCID
Address1
M: first line of physical address assigned by local 911 service,
may be different than mailing address.321 Belgrade-Swansboro RD
Address2 M: second line of physical address, used when necessary.
City M: city, town or locality where facility is located.Stella
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.28582
County M: county name where facility is located.Onslow
Latitude M: decimal degrees, should be between 33 and 37.
Longitude M: decimal degrees, should be between -75 and -85.
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.
Geometric_Type
M: 001=Fixed or 002=Mobile, e.g. Facility is Fixed, a septage
pumper is Mobile 001
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 001
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
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 Blackjack LCID
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.0.0500
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
Owner_Name M: name of owner as appears on the permit.W.A. Page & Son's Inc.Operator_Name M: name of operator/facility manager.W.A. Page & Son's Inc.