6806-HHW-2018 SW018-0017 Eubanks Road Convenience Center PAID Invoice 3-29-18

PERMIT APPLICATION REVIEW FORM
5HYLHZ5HTXHVWHGE\ 6KDQQRQ$XIPDQ
'DWH5HTXHVWHG 
)DFLOLW\1DPHDQG3HUPLW,'
$SSOLFDQW2ZQHU1DPH 2UDQJH&RXQW\
'HVFULSWLRQRI3HUPLW5HTXHVW
>7KLVLVWKHDFWLRQWKHDSSOLFDQW
LVUHTXHVWLQJLQDFFRUGDQFHZLWK
1&*6$E@
;D1HZ±1HZ)DFLOLW\
E1HZ±([SDQG)DFLOLW\%RXQGDU\
F1HZ±([SDQG:DVWH%RXQGDU\
G1HZ±6XEVWDQWLDO$PHQGPHQW
D$PHQGPHQW±1H[W3KDVHRIWKH$SSURYHG)DFLOLW\3ODQ
E$PHQGPHQW±5HQHZDO5HYLHZ <5<5
F$PHQGPHQW±&KDQJHLQ2ZQHUVKLS
D0RGLILFDWLRQ±&KDQJHWR$SSURYHG3ODQV1R&+5
E0RGLILFDWLRQ±6XEVHTXHQW3HUPLWWR2SHUDWH1R&+5
F0RGLILFDWLRQ±)LYH\HDU/LPLWHG5HYLHZ
 0DMRU3HUPLW0RGLILFDWLRQ
3HUPLWWHG$QQXDO7RQQDJH QD
3HUPLW)HH 
'DWH$SSOLFDWLRQ5HFHLYHG 
&RQWDFW1DPH7LWOH 3KRQH $OOLVRQ/RKUHQ]
(PDLO$GGUHVVDORKUHQ]#RUDQJHFRXQW\QFJRY
&RPSDQ\ 2UDQJH&RXQW\6:0
$GGUHVV (XEDQNV5RDG&KDSHO+LOO1&
0DLOLQJ$GGUHVV 32%R[
&LW\6WDWH=LS &KDSHO+LOO1&
3DUHQW&RPSDQ\
.QRZQ6XEVLGLDULHV
2WKHUNQRZQQDPHVEXVLQHVV
KDVRSHUDWHGXQGHU
.QRZQ&RXQWLHVRI2SHUDWLRQ
'RHVWKHDSSOLFDQWKDYHDSDVW
RUFXUUHQWVROLGZDVWHSHUPLW"
<HV; 1R8QNQRZQ
)DFLOLW\7\SH0XOWLSOH& '06:/)++:3HUPLW

'LGWKHSHUPLWDSSOLFDQWVXEPLW
)LQDQFLDO$VVXUDQFHFRVW
HVWLPDWHV"
<HV1R1RW1HHGHG;
2WKHUQRWHV
6:
3
++:
Eubanks Road Convenience Center
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.Eubanks Road Convenience Center
Address1
M: first line of physical address assigned by local 911 service,
may be different than mailing address.1530 Eubanks Road
Address2 M: second line of physical address, used when necessary.
City M: city, town or locality where facility is located.Chapel Hill
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.27516
County M: county name where facility is located.Orange
Latitude M: decimal degrees, should be between 33 and 37.35.969589
Longitude M: decimal degrees, should be between -75 and -85.-79.076315
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 004
Status M: description of the overall facility; Open or Closed.Open
Owner
M: classification of the owner of the facility as either Public or
Private entities.Public
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)5/25/2018
Start_Date_Qualifier
O: description of event represented by Start_Date field, e.g.
Facility's Original Permit Issue Date.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 Eubanks Road Convenience Center
Orig_PermitIssueDate M: Date when first permit issued.5/25/2018
PermitIssueDate M: Date MOST recent permit issued.5/25/2018
PermitExpDate M: Date when current permit expires.5/25/2023
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..0200
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 HHW
PrimaryOperation_Type
M: primary operation when dealing with waste: LF, Trans,
LandAp, TP, Compost, MatRecovery, Incin, Hauler,
WasteToEnergy, Authorization, Notification, Collection, Detention Collection
Owner_Name M: name of owner as appears on the permit.Orange County
Operator_Name M: name of operator/facility manager.Orange County
SW018-0017
P1322
North Carolina Department of Environmenal Quality
Division of Waste Management
Solid Waste Section
INVOICE
Invoice #:SW018-0017
Date:5/29/2018
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:Allison Lohrenz
Orange County Solid Waste Management
PO Box 17177
Chapel Hill, NC 27516
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:
Eubanks Road Convenience Center (6806-HHW-2018)
1530 Eubanks Road
Chapel Hill, NC 27516
New Application for Permit (New Facility) received on 10/31/2017
$500.00
$500.00Total Amount Due
6/28/2018Date 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
PAID 6-1-18