NCS01262_2020Permit_Initial

March 2, 2020 Michael Holsomback
Paradise Cove Marina 1242 Paradise Shores Rd Merritt NC 28556
Re: Permit to Operate a Septage Management Facility Paradise Cove Marina 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 2020 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, 2020 until December 31, 2020. If you have any questions or need to make any changes to this permit, please feel free to contact Mr. Chester Cobb at 919-707-8283 or Mr. Jeffrey Bullard at 919-707-8285.
Sincerely,
Adam Ulishney Environmental Compliance Branch Head Solid Waste Section
cc: Inspector County Health Department
State of North Carolina
Environmental Quality
Waste Management
Non-Pumper Application for a Permit
to Operate a Septage Management
Facility
NON-PUMPER - $200 FEE PER FACILITY
Facility Name:**
Street address:**
Street address - City:**
Street address - State:**
Street address - Zip:**
Street address - County:**
Mailing address same as Street
address:**
Facility Owner's Name:**
Mailing address:**
Mailing address - City:**
Mailing address - State:**
Mailing address - Zip:**
Phone:**
Email:**
Facility Operator's Name:**
Mailing address:**
Mailing address - City:**
Mailing address - State:**
Mailing address - Zip:**
Phone:**
Email:
Type(s) of septage managed:**
Facility Types:
Provide the permit numbers for all that are applicable.
Facility
Paradise Cove Marina
1242 Paradise Shores Rd.
Merritt
NC
28556
Pamlico
Yes No
Owner
Michael Holsomback
1242 Paradise Shores Rd
Merritt
NC
28556
3365543043
[e-mail]
Operator
Michael Holsomback
1242 Paradise Shores Rd.
Merritt
NC
28556
3365543043
[e-mail]
Septage
(check all that apply)
Domestic Portable Toilet Waste Grease (restaurant)
Treatment Plant Industrial/Commercial
a. Septage Land Application Site
b. Boat Pump-Out Storage
c. Septage Storage Tanks
d. Septage Treatment
e. Grease Treatment
Septage Management firms using facility:
Provide name and permit number of all permitted septage management firms using facility.
Permit Number Firm Name
11
22
33
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:
Title:
Email:**
X
Certification
(signature of company official required)
1/26/2020
[e-mail]
PayPoint
Payment Receipt
Application: Solid Waste Credit
Merchant: NDENR-Solid Waste Credit
Merchant City/State: Raleigh, North Carolina
Merchant Location Code: 00001
Payment Status: Settled
Result Message: Payment completed and settled successfully.
Confirmation Number: 20012665916037
Payment Date: 01/26/2020
Posting Date: 01/26/2020
Billing Information: Michael Holsomback 1242 Paradise Shores Rd. Merritt, NC 28556 3365543043 [e-mail]
Payment Amount: 200.00 USD
Card Type: MC
Method: Not Present
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Reference Information: NCS-01262-2020,28556,Paradise Cove Marina,1242 Paradise Shores Rd,Merritt,NC,NCS-01262,$200.00
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https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 1/27/2020