NCS01078_2022Permit_Initial

2022
Permit and Registration
Eagletrace Master Home Owner's Association

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01078
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-07-08
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. __________________________________________________ Perry Sugg, 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:**
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
Eagle Trace Master Home Owners Association
212 E. Eagle Nest Trail, #68
Blounts Creek
NC
27814
Beaufort
Yes No
Owner
Eagle Trace Master Home Owners Association
212 Eagle Nest Trail, #68
Blounts Creek
NC
27814
252-904-4584
[e-mail]
Operator
Kenneth Brabble
106 Stratton Place
Washington
NC
27889
252-904-4584
[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:**
SDTF-07-08
None
Certification
(signature of company official required)
10/5/2021
Sec/Treas.
[e-mail]
PAID
FIRM NAME: Eagletrace Master Home Owner’s Association
PERMIT #: NCS-01078
AMOUNT: $200
PAID BY: E-Check
DATE: 10/7/2021

Adam Ulishney