NCS01686_2023Permit_Initial

2023
Permit and Registration
Antique Town Campground
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-01686
o and registered as a
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NORTH
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-�� Septage Management Firm�� �� w� ��nffii�utr
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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-63-04
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 Perry Digitallysigned byWrn
Perry Sugg
023.10.25 15:15:06
Sugg 04'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILIT'r
(N0N-PUMPER - $200 FEE PER FACILITY)
DMSION OF WASTE MANAGEMENT - SOLID WASTE SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699.1646
(1.) Facility name: trc//t
Street address of office
Mailing address (If differenfj _ 1 1J, _ 1.
County rvl oo >rc �� Me 0i?- e
(2.) Facility owner's
Mailing address
name_ t j.� .T A%;,mr &/f.+sf��
}
Phonef 41®:� r :- 7 Email:�,`� `tfe® Coma
(3.) Facility operator's name Facility operator's title
Mailing address !
Phone( '!U 490 --IZY 72 ' I
(4.) Type(s) of sep m (check all that apply)
Domestic ,- = Portable Toilet Waste _ _ Grease (restaurant)
Treatment Plant _ Industrial/Commercial
(5) Facility Types: Check all that are applicable and provide the permit numbers.
a) Septage land application site
b) boat pump out storage
,,jSeptage storage tanks
d) Septage treatment r
e) Grease treatment
(6) Name and Permit Number of a8 permitted Se
(1) � pe ptage Management Firms using facility:
0 ► O
(2) _ --"" — N N
(3) - - lf�'
us
(Use additional sheets ff necessary) Doss
Certification 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
andIM are inal Ities knowingly making a false statement, repr sen `on, or certification.
�� 3
Signature* a -- -
Print Now
Signature of company official required. ritiie
S:Sdid Waste/CWseptagefformy2018Firm Application/Non-Pumper-2018