NCS01262_2022Permit_Initial

2022
Permit and Registration
Paradise Cove Marina

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01262
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-69-03
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
8/29/2022
State of North Carolina
Environmental Quality
Waste Management
Non-Pumper Application for a Permitto Operate a Septage ManagementFacility
NON-PUMPER - $200 FEE PER FACILITY
Facility Name:*
NCS Number *
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:
Facility
Paradise Cove Marina
NCS-01262
Ex. "NCS-01234"
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
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
1
2
3
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:*
(check all that apply)
Domestic Portable Toilet Waste Grease (restaurant)
Treatment Plant Industrial/Commercial
X
Certication
(signature of company official required)
1/25/2022
[e-mail]
PAID
FIRM NAME: Paradise Cove Marina
PERMIT #: NCS-01262
AMOUNT: $200
PAID BY: E-Check
DATE: 1/27/2022

PAID (late)
FIRM NAME: Paradise Cove Marina
PERMIT #: NCS-01262
AMOUNT: $100
PAID BY: E-Check
DATE: 1/27/2022

Adam Ulishney