NCS01191_2023Permit_Initial

2023
Permit and Registration
Twin Lakes RV Resort
is hereby issued a Septage Management Firm Permit,
�szArr of
Permit Number NCS-01191
o and registered as a1 7 D
-�= Septage Management Firm �� fE w� nmentalQulity
NORTH CAROLINA (PUMPER)
,Environmental Quality
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 authorized to discharge septage only at the locations(s) listed below:
1. City of Washington WWTP, Washington, NC
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.
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, 2023.
Wm Perr Digitally signed by
Y Wm Perry Sugg
Sugg 114:46:07— 3 05'00'
Perry Sugg, Environmental Compliance Branch Head

For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-707-
8283).
Firm Info
Firm name*
Twin Lakes RV Resort
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01191
Enter the five digits following the NCS #
Street address of office*
Street Address
1618 Memory Lane
Address Line 2
City
State / Province / Region
Chocowinity
North Carolina
Postal / Zip Code
Country
27817
United States
County*
Beaufort
Mailing address same as street address of office?*
• Yes No
Phone* Fax
252-946-5700 252-9742691
Email*
[e-mail]
Owner Info
Firm owner's name*
MHC Twin Lakes LLC
Mailing address same as street address of office?*
Yes •) No
Mailing Address*
Street Address
2 North Riverside Plaza
Address Line 2
Suite 800
city
Chicago
Postal / Zip Code
60606
State / Province / Region
ILLINOIS
Country
United States

Phone* Fax
312-279-1400
Operator Info
Firm operator's name* Firm operator's title
Mark Herron Maintenance Lead
Mailing address same as street address of office?*
• Yes No
Phone* Fax
252-946-5700
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 5,500
Portable Toilet Waste 2,200
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in:
Beaufort
Vehicle Info
Do you plan to operate pumper vehicles?*
• Yes No
"I certify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meets the requirements for safe
and sanitary transportation of septage as required by 15A NCAC 13B .0835(a) and vehicle lettering as required by 15A NCAC .0835(b).
Furthermore, I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 13B .0836(a). I am aware that
there significant penalties for false certification including the possibility of fine and imprisonment."
Signature
ewam 4w
Date*
10/18/2022
Title*
10/18/20
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles

Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage N/A 1 300
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
• Yes No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
subparagraph .0833(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name* Expiration Date* Authorization
City of Washington Wastewater 12/31/2022 septic permit 289.81...
2022.pdf
Septage Land Application Sites (SLAS)*
Yes • No
Septage Detention or Treatment Facility (SDTF)*
Yes • No
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed
Date* Hours*
12/4/2021 4
Location*
Raleigh, NC
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
Date Hours
0
Location
Training Sponsored or Provided by
Registration Type A

Select one*
Registered Portable Sanitation Firm
Registered Septage Management Firm
• Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
Certif cation 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
10/18/2022
09:11:46 AM
Print Name*
Mark Herron
Title*
Maintenance Lead

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Fee assessments and waste determinations will be required at the discretion of the wastewater
treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the
incoming wastewater stream.
Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
252'97s —�210 do hereby authorize
(Phone Number)
(Address)
(Owner/Operator of Septage Management Firm)
of PI PC i ,,, L,?6 1-4 r NCS# o/191
(Septage Manag ent Firm Name and NCS number)
to dispose of: domestic septage )portable toilet waste ""—
grease septage (grease trap pumpings) ---
7 Noun
commercial/industrial septage — from
or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
W
between the hours of
LL /C efvr l
Reintroducing partially treated liquid into a grease trap is acceptable _Yes /No
This authorization shall be valid until loec31 20-2 y
(Usually December 31, Year)
Signed Date
(Facility Operator) Q-}'��1 L I ,, /
Subscribed and affirmed before me this � 7 day of bC:IDbe , 2022
An/ �A l � _ My Commission expires: I
Notary Public) ` %11111111/1
W.
`\%\(�Ct )&L SEAL�Fs
`CC'' Notary
Note: Falsification of this document by the septage management firm shall lead t%perrmit rev9sat" ci 5:/Solid Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018 y+ Z
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