NCS01262_2018Permit_Initial

Date
Michael Holsomback
Paradise Cove Marina
1242 Paradise Shores Rd Merritt NC 28556
Re: Permit to Operate a Septage Management Facility Firm Name NCS-01262
Dear Mr. Holsomback:
The Division of Waste Management, Solid Waste Section, has received your “Application for a Permit to Operate a Septage Management Facility” and payment in the
amount of $200.00.
You are hereby issued a 2018 Permit to Operate a Septage Management Facility for
the following facilities: Septage Detention or Treatment Facility SDTF-69-03

This permit is valid from January 1, 2018 until December 31, 2018. If you have any
questions or need to make any changes to this permit, please feel free to contact Chester Cobb,
Soil Scientist, at 919-707-8283.
Sincerely,

Adam Ulishney Environmental Compliance Branch Head
Solid Waste Section

cc: John Farnell, Environmental Specialist II, Wilmington Regional Office
Pamlico County Health Department

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILITY
(NON-PUMPER - $200 FEE PER FACILITY)

DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646

(1.) Facility name:
Street address of office

Mailing address (if different)

County
(2.) Facility owner's name
Mailing address
Phone: Email:
(3.) Facility operator's name Facility operator’s title
Mailing address

Phone Email:
(4.) Type(s) of septage managed (check all that apply)
Domestic Portable Toilet Waste Grease (restaurant) _________
Treatment Plant Industrial/Commercial

(5) Facility Types: Check all that are applicable and provide the permit numbers.
a) Septage land application site ____________________________________________________
b) Boat pump-out storage _________________________________________________________
c) Septage storage tanks _________________________________________________________
d) Septage treatment _________________________________________________________
e) Grease treatment _________________________________________________________

(6) Name and Permit Number of all permitted Septage Management Firms using facility:
(1) _____________________________________________________________________________
(2) _____________________________________________________________________________
(3) _____________________________________________________________________________
(Use additional sheets if necessary)

Certification Statement
I certify that the information and representations in this application for a permit are true, complete, and accurate to the
best of my knowledge and belief. I am aware that a permit may be suspended or revoked upon a finding that its
issuance was based upon incorrect or inadequate information that materially affected the decision to issue the permit
and that there are criminal penalties for knowingly making a false statement, representation, or certification.

Signature* Date

Print Name Title *Signature of company official required. S:Solid_Waste/CLA/septage/forms/2018 Firm Application/Non-Pumper-2018
Paradise Cove Marina
1242 Paradise Shores Rd. Merritt, NC 28556
Pamlico
Michael Holsomback
1242 Paradise Shores Rd Merritt, NC 28556
336-554-3043 [e-mail]
Michael Holsomback Owner
1242 Paradise Shores Rd. Merritt, NC 28556
336-554-3043 [e-mail]
X
X
No Additional Firms
Michael D Holsomback Owner
8/27/2018