4906-LCID-2023 Amity Hill LCID SW023-0052 PARF - Data Sheet & Invoice 5-9-23

SW023-0052
P1396
PERMIT APPLICATION REVIEW FORM
Review Requested by:
Claire Osborn
Date Requested:
5/3/2023
Facility Name and Permit ID
Amity Hill LCID, LLC, 4906-LCID-2023
Amity Hill LCID, LLC
Applicant (Owner) Name
Description of Permit Request
® (1)a. New — New Facility
[This is the action the applicant
❑ (1)b. New — Substantial Amendment
is requesting in accordance with
❑ (1)c. New — Expand Waste Boundary
NCGS 130A-294(a3)]
❑ (1)d. New — Waste Category Change
❑ (1)e. New — Permit Less than LoS Duration
❑ (2)a. Amendment — Renewal/Review
❑ (2)b. Amendment — Change in Ownership
❑ (3)a. Modification — Change to Approved Plans (No CHR)
❑ 3 b. Modification — Five-year Limited Review No CHR
Permitted Annual Tonnage
NA
Permit Fee (New Only)
50
Date Application Received
4/7/2023
Contact Name & Title
Mr. Bradley Mills, Manager
Phone #
(704) 657- 2234
Email Address
Dr.bradley.mills(cD-gmail.com
Company
Amity Hill LCID, LLC
911 Address
762 Bethseda Road, Statesville NC
Mailing Address
284 Barfield Road
City/State/Zip
Mooresville, NC 28115
Parent Company
unknown
Known Subsidiaries
Unknown
Other known names business
Unknown
has operated under
Known Counties of Operation
Iredell, Mecklenburg, Cabarrus, Rowan, Catawba, Lincoln
Does the applicant have a past
Yes ❑ No ❑ Unknown
or current solid waste permit?
Facility Type: Permit #: has a notified LCID that is requesting
permit, but there may be others (N1118)
Did the permit applicant submit
Yes ❑ No ® Not Needed ❑
Financial Assurance cost
estimates?
Other notes
Application for new LCID

APPLICATION FOR NEW PERMIT DATA SHEET (Revised March 2012)
Data Field
Description
M: name given to the facility. Name can permit name, but does not
Site Name
have to.
Amity Hill LCID, LLC
M: first line of physical address assigned by local 911 service,
Addressl
may be different than mailing address.
762 Bethseda Road, Statesville, NC
Address2
M: second line of physical address, used when necessary.
City
M: city, town or locality where facility is located.
Statesville
M: two letter US postal service abbreviation for the state where
State
the facility is located.
NC
Zip
M: zip code for the location address.
Count
M: county name where facility is located.
Iredell
Latitude
M: decimal degrees, should be between 33 and 37.
35.724071
Longitude
M: decimal degrees, should be between -75 and -85.
-80.807268
O: applies to how the coordinates were collected: 001=GPS or
Horiz Collection Method
002= eocode or 003=from map
003
O: descriptive text for locating a facility when address is not
Supplemental Location
practical.
M: 001=Fixed or 002=Mobile, e.g. Facility is Fixed, a septage
Geometric Type
pumper is Mobile
001
O: description of point where coordinates were collected at the
facility, 001=front door, 002=permitted feature, 003=for mobile,
Reference Point
004=undefined point on facility
Status
M: description of the overall facility; Open or Closed.
New to construct
M: classification of the owner of the facility as either Public or
Owner
Private entities.
Private
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;
Start Date
Department's Creation Date (07/01/1989)
4/7/23 - New application for construction
O: description of event represented by Start —Date field, e.g.
Start Date Qualifier
Facility's Original Permit Issue Date.
O: date on which the facility ceased to be of interest to the
End Date
program.
O: description of event represented by End_Date field, e.g. Date
End Date Qualifier
of Final Closure.
PermitlD
M: unique id number used for permit
M: id number used in location table to identify the facility or
environmental interest subject to this permit. This number is
LocationlD
assigned and is only needed if permit relates to an existing site.
Permit Name
M: Common Name used for this permit
Amity Hill LCID, LLC
Ori PermitlssueDate
M: Date when first permit issued.
NA
PermitlssueDate
M: Date MOST recent permit issued.
PermitEx Date
M: Date when current permit expires.
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
PermitStatus
a county
Proposed
M: block of rules governing site e.g..1600, .0500, .1100, .0800,
Rule
etc.
.0500
M: environmental monitoring required, yes is required or no is not
EnvMonitoring
required.
no
M: primary waste type handled under this permit: MSW, CD,
Prima Waste Type
Indus, Tire, LCID, Medical, YW, Septage, HHW, WG
LCID
M: primary operation when dealing with waste: LF, Trans,
LandAp, TP, Compost, MatRecovery, Incin, Hauler,
Primary0peration Type
WasteToEnergy, Authorization, Notification, Collection, Detention
LF
Owner Name
M: name of owner as appears on the permit.
Amity Hill LCID, LLC
Operator Name
M: name of operator/facilityoperator/facility manager.
Bradley Mills

North Carolina Department of Environmental Quality INVOICE
Division of Waste Management
NORTH CAROLINA Solid Waste Section
ENORTHC R LINA
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
phone: [phone]
email: [e-mail]
DESCRIPTION
Facility -Application:
Amity Hill LCID (New Facility)
762 Bethseda Road
Statesville, NC 28677
la. New Facility
Pavment Oations:
To: Bradley Mills, Manager
Amity Hill LCID LLC
284 Barfield Road
Mooresvile, NC 28115
Total Amount Due
Invoice Date
Invoice #
AM
$50.00
$50.00
Date Due:
May 08, 2023
SW023-0052
June 07, 2023
E-check - Available online at https://deq.nc.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 alonq with the invoice number.
Credit Card - Available online at https://deq.nc.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.
Mail paper checks to:
N.C. Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Explanation of Invoice Amount is Based on Facility's Current Permit Application:
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.
Solid Waste Contacts:
Billing process:
Theresa Williams [phone] - Payments, e-Payments
Sherri Stanley [phone] - Fee Amounts
Regulations and Technical Assistance:
Sherri Stanley [phone] - Landfills, Transfer Stations, Compost Facilities
Perry Sugg [phone] - Land Application Sites
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - http://deq.nc.gov/
North Carolina Solid Waste Program - http://deq.nc.gov/about/divisions/waste-management/solid-waste-section
NC DEQ:WM Solid Waste Invoice Form 1-2023