NCS01249_2023Permit_Initial

2023
Permit and Registration
Scenic Ridge Country Campground
is hereby issued a Septage Management Firm Permit,
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Permit Number NCS-01249
o and registered as a
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NORTH CAROLINA (NON -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 only authorized to operate Septage Management Facilities listed below:
1. Septage Detention or Treatment Facility, SDTF-55-03
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, 2023.
Wm Perr Digitally signed by
Y Wm Perry Sugg
Date: 2023.02.23
Sugg 14:57:38-05'00'
Perry Sugg, Environmental Compliance Branch Head

NON -PUMPER - $200 FEE PER FACILITY
Facility
Facility Name:* Richard Todd Black
NCS Number* NCS-01249
Ex. "NCS-01234"
Street address:* 3458 Zion Hill Rd
Street address - City:* Che r ryv i l le
Street address - State:* NC
Street address - Zip:* 28021
Street address - County:* Lincoln
Mailing address same as Street Yes No
address:*
Owner
Facility Owner's Name:* Richard Todd Black
Mailing address:* 3458 Zion hill Road
Mailing address - City:* CHERRYVILLE
Mailing address - State:* NC
Mailing address - Zip:* 28021
Phone:* 704-435-0938
Email:* [e-mail]
Operator
Facility Operator's Name:* Richard Todd Black
Mailing address:* 3458 Zion Hill Rd
Mailing address - City:* Cherryville
Mailing address - State:* NC
Mailing address - Zip:* 28021
Phone:* 704-435-0938
Email: [e-mail]
Septage

Type(s) of septage managed:* (check all that apply)
Domestic ✓ Portable Toilet Waste Grease (restaurant)
Treatment Plant Industrial/Commercial
Facility Types:
Provide the permit numbers for all that are applicable.
a. Septage Land Application Site United States
b. Boat Pump -Out Storage
c. Septage Storage Tanks SDTF-55-03
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 SDTF-55-03 R.V. Campers Only
3
Certif cation
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:
10114122le ;ilz /14-0
(signature of company official required)
Date: 11 /2/2022
Title: Owner
Email:* [e-mail]