NCS01732_2024Permit_Initial

2024
Permit and Registration
Herds Creek Campground
is hereby issued a Septage Management Firm Permit,
Py�4,NTAr���� Permit Number NCS-01732
- o and registered as a
D EQ�J
e:-e
NORTH CAROUNA
-�� Septage Management Firm Department }Enulr nmentalllty
Esr,�,,.
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-63-05
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, 2024.
Wm Perry Digitallysigned byWm
Perry Sugg
Date: 2024.04.03
Sugg
15:48:01-04'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILITY
(NON -PUMPER - $200 FEE PER FACILITY)
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION
L SERVICE CENTER, "LEIGH, NC 27699-1646
(1.) Facility name:
Street address of office
A -A 3a4
Mailing address (if different)
County _ I na re.
(2.) Facility owner's name
Mailing address IG
Phone:Ql 2!j5-3 a IfA10793 7l tg—Email:_C ,l S�e�G �rt,nlr���ilnk.
(3.) Facility operator's name DW�4\1E onas\N Facility operator's title t% t
Mailing address _Cj�uie
Phone !R16 -743 77'71 CA EmaiL•_ta�p �;C p u n (i n
(4.) Type(s) of septage m}naged (check all that apply) '� I !
Domestic t/ 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
C1 c) Septage storage tanks
r d) Septage treatment
e) Grease treatment
(6) Name and Permit Number of all permitted Septage Management Firms using facility:
(1)
(2)
(3)
(Use additional sheets if necessary)
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 w - based upon incorrect or inadequate information that materially affected the decision to issue the permit
and th t re ate! nal ies for knowingly making a false statement, representation, or certification.
-4 a
Signature* Date
1A Ede cd
Print Name
*Signature of company official required.
6i,)nre-
Title
S:Solid Waste/CLA/septage/forms/2018 Firm Application/Non-Pumper-2018

f Q
G_
APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE DETENTION OR c
TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Operator and Facility Information
1. Applicant+ _ enaLrbr1 a.4�3�2 fa ,:
Address
Phone
2. Contact person for site operation (if different from applicant):
Title or position -,,jam, Phone
Address
3. Landowner
Address
4. Site Location:
Directions to site:
4__! -,� A. A 4e
County _Aocc - State Road Number
# 1-141 51 CmAur WA V ca & , C a+mr ror ,
5. Is the location on a permitted Septage Land Application Site?
If yes, give the site permit number here:
6.
Indicate whether project is: new %./ renewal modification —
For a permit renewal or modification, indicate the existing permit number
permit expiration date
and the
7 Attach written, notarized landowner authorization to operate a septage storage or treatment facility
form signed by the landowner (if the permit applicant does not solely own the property). Na
corporation owns the land use a corporate landowner authorization form. !f Limited Liability
Company owns the land, use a limited liability company landowner authorization form.
8. Aerial photograph scale 1 inch = 400 feet with site property lines accurately located on the photograph
must be enclosed (if 1 inch = 400 feet is not available,1 inch = 660 feet may be substituted).
9. Vicinity map (county road map showing site location).
10. Land application site or wastewater treatment plant to be used after treatment or storage:
(over) IOL14 A��br RCIA, Atclem A C, t 9cr auhl i)

II. Facility Information: the following information shall be included with the application form.
1. Facility to be used for: Storage V Treatment
Types of septage to be stored or treated:
Domestic Septage Grease Trap Pumpings
Portable Toilet Waste Commercial/industrial Septage
3. Types of treatment to be provided: pH Adjustment (lime stabilization)
Screening Other (attach explan tion if other)
ash C.1
4. A description of the proposed detention or treatment facility including the size, type, and number of
structures to be used and how those structures will be constructed or installed (use additional
paper to explain, if necessary):
5. An explanation of how septage will be discharged into and removed from the cility (us
additional paper to explain, if necessary): 14 1C 4" lei c. d . 9r� a���h,c��
6. An explanation of how any leaks or spills at the facility will be cleaned and how odors will be
controlled (use additional paper to explain, if necessary):
III. Certification
I hereby certify that:
1. The information provided on this application is true, complete, and correct to the best of my
knowledge, and
2. 1 have read and understand the N.C. Septage Management Rules.
3. 1 am aware of the potential consequences, including penalties and permit revocation, for
failing to follow all applicable rules and the conditions of a Septage Detention or Treatment
cility permit.
Signature (Signature of company Aial required) Date
Print name Title
Note: This application will not be accepted for review until all parts of the application are complete.
S:Solid Waste\clalseptage\forms\SDTF-Application & Authorization\SDTF Permit Application -Jan 2016.docx
Rev 01-07-16