NCS01236_2022Permit_Initial

2022
Permit and Registration
Harbortowne Marina

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01236
and registered as a Septage Management Firm
(NON-PUMPER)
in the State of North Carolina.

This permit to operate a Septage Management Firm is issued to the above named person, business or entity alone and is not transferable to any other person, business or entity. Firm operation shall be in accordance with the provisions of N.C. General Statute 130A-291.1 - 130A-291.3, Title 15A of the N.C. Administrative Code 13B .0800 et.seq., conditions of the permit, and representations made in the application and accompanying documents for a permit. The permit holder is only authorized to operate Septage Management Facilities listed below: 1. Septage Detention or Treatment Facility, SDTF-36-13
This permit does not entitle the permit holder to operate a Septage Land Application Site, a Septage Detention or Treatment Facility, or any other solid waste management facility
not specified herein. Also, this permit does not entitle the permit holder to operate a pumper vehicle for the transportation of septage. Failure to operate as permitted may result in the Department suspending or revoking this permit, initiating action to enjoin the unpermitted operation, imposing administrative penalties, or invoking any other remedy as provided in Chapter 130A, Article 1, part 2 of the North Carolina General Statutes. This permit and registration expires on
December 31, 2022. __________________________________________________ Adam Ulishney, Environmental Compliance Branch Head
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:**
Mailing address:**
Mailing address - City:**
Mailing address - State:**
Mailing address - Zip:**
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:
Facility
Harbortowne Marina
220 Commodore Ct.
Belmont
NC
28012
Gaston
Yes No
P.O. Box 6122
Charlotte
NC
28207
Owner
Harbortowne Marina Company
P.O. Box 6122
Charlotte
NC
28207
7049570509
[e-mail]
Operator
Harbortowne Marina
P.O. Box 6122
Charlotte
NC
28207
7049570509
[e-mail]
Type(s) of septage managed:**
Facility Types:
Provide the permit numbers for all that are applicable.
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:**
Septage
(check all that apply)
Domestic Portable Toilet Waste Grease (restaurant)
Treatment Plant Industrial/Commercial
NCS-01236
Certification
(signature of company official required)
9/23/2021
President
[e-mail]
PAID
FIRM NAME: Harbortowne Marina
PERMIT #: NCS-01236
AMOUNT: $200
PAID BY: Check
DATE: 9/28/2021

Adam Ulishney