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Home My WebLink AboutSDTF7113_APPLICATION_INITIAL_2024APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE DETENTION OR 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 F 1. Applicant Address Phone 2. Contact person for site operation (if different from applicant): Title or position Phone Address 3. Landowner Address 4. Site Location: Count y`-c� Q,f State Road Number Directions to site: �, N - 5. Is th location on a permitted Septage Land Application Site? If yes, give the site permit number here: :A 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). if a corporation owns the land use a corporate landowner authorization form. if 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 limes 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 sitp or (over) v r treatment plant to be used after treatment or storage: OV4 11. Facility Information. the folloWng information shall be included with the application form. 1. Facility to be used for: Storage Treatment 2. Types of septage to be stored or treated: / Domestic Septage/ Grease Trap Pumpings Portable Toilet Waste Commercial/Industrial Septage 3. T ypes of treatment to be provided: pH Adjustment dime stabilization) N Screening Other (attach explanation if other) 4. A description of the proposed detention or treatment facility including the size, type, and number of structures to be used and how those tructures will b�c structed or in !led (use dd #tonal paper to explain, if necessary): 5. An explanation of haw septage will be dischargq into and removed from the fa additional aperto explain, if a essary): „_ 6. An expl natioin of how any leaks or spills at the facility will be cle reed and how odors will be controlled (use addifis, al paper to explain, if necess ): 3 V - V 111. Certification 1 hereby certify that: 1. The information provided on this application is true, cornplete, and correct to the best of my knoWedge, 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 revoca#ion, for failing to follow all applicable riles and the conditions of a Septage Detention or Treatment Facllity per /cg-q Sign ure (S ature of company official requrr,- Date --TrI s �- Print narne, Title Note: This application will not he accepted for review until alf parts of the application are complete. S:Soiid Wastelola,septagelforms5SOTF-Application & Authorization',ISDTF Permit Application -Jan 2616.dfocx Rev 01-07-16 APPLICATION FOR A PERMIT TO OPERATE A.SEPTAGE MANAGEMENT FACILITY (NON -PUMPER - $200 FEE PER FACILITY) (1.) Facility name: Street address of office DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION 1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1e4.6 P �trCV-\ \'I �_ 9ON-1j I � LC Mailing address (if different) /J C, or A� IJ(", County Q�P (2.) Facility owner's namesy^-1 Mailing address Phone: C ^ Email: �T (3.) Facility operator's name _ T� T� acilit operator's title_ CSC\kN. Mailing address_fQj CG S a �V� D, k 1 Phone (4.) Tit, otel of septage managed (check all that apply) C 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 c) Septage storage tanks d) Septage treatment e) Grease treatment ame (1) (2) (3) Number of all _ r. (Use additional sheets if necessary) P Vj N e sojoy Nc sold 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 maybe 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 t the,,-,Wa Grim' enaltie*-f% knowln ly making a false statement, repr yenta i n or certification. VLL signature* Date 1' Print Naillne Title (�}•.�� *Signature of company official required. S: Sol id_Waste/CLA/septage/fonns/2018 Firm Application/Non-Pumper-2018 Landowner's Authorization to Operate a Septage Detention or Treatment Facility North Carolina Department of Environmental Quality Division of Waste Management - Solid Waste Section 1646 Mail Service Center, Raleigh, NC 27699-1646 (name of site owner) hereby certify that I am the owner of V�� acres of land located 5 ( !� i Wcti ` I (aJd nd G n identified by Ov('d �t , oi6 13 d 3 3Y (book and page of recorded deed or tax map parcel) and that I agree to allow kN �e ��Vv\ fvV &d (SDTF permit applicant) to use said land for a septage detention or treatment facility for a period of 15 u ccv s (length of time), beginning ` )J tie ((t Z 6 Z 1 (give date) and that I have read the North Carolina Septage Management Rules *. I further understand that no septage may be stored or treated on the land until the Division of Waste Management has issued a permit for a detention or treatmentfacility. The above described property is owned solely by me or jointly with TGt 4 S� C TA R— V 0 C a to,e i ryNNIIS4f ( a ° (names of all co -owners, or state none). J Signature of landownerJgA-c ca - ,,. Date — 6 I J p u Siqnature of landowner Q4�—"� �-- �" �i . Date Signature of landowner Date w Sworn to and subscribed before me this day of Jurw- 20 _. ,1� u c,(U= (0F (Notary Public) My Commission expires: i 3,10'2-(j 01A4 0 * 10 15A N.C. Admin. Code 13B Section .0800 � �. ��Ai/B��11 Apr. 03 - 49 Rev. 01-07-16 III IIIIIIII�IIIIIIIII�IIIII�II Doc No: 20127067 Recorded: 04/08/2024 03:12:19 PM Fee Amt: S26 00 Page 1 of 2 Excise Tax: 850.00 Pander County North Carolina Sharon Lear Willoughby, Register of Deeds BK 4834 PG 359 - 360 (2) Excise Tar $50.00 Recording Time. Book and Page Tax Lot No. Parcel Identifier No. 2393-36-7026-0000 Verified by County on the _ day of , 2024_ ydil after recording to his instrument was prepared by Lawrence S. Boehlin Brief Description for the index NORTH CAROLINA GENERAL WARRANTY DEED THIS DEED made MARCH 22, 2024, GRANTOR WARREN ROBINSON,. unmarried and between GRANTEE MARY LISA TATE ROBINSON, TRUSTEE OF THE JIMMY T. TATE REVOCABLE-0VTFG TRUST dated, April 3, 2020 158 Candlestick Drive Wallace, NC 28466 Enter inappropriate block for each parry: name, address: and, if appropriate, character of entity, e.g.., corporation or partnership. The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as required by context. WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple all our interest in those certain lots or parcels of land situated in PENDER County, North Carolina and more particularly described as follows: BEING all of Tract 1B as shown on that certain plat of survey entitled "Harvey Tate, et al Family Subdivision" dated December 21,2015 and recorded in Map Book 58, page 119 of the Pender County Registry to which reference is hereby made for a complete and accurate description. Together with and subject to all easements and rights of access as shown on the above referenced map. N.C. Bar Assoc. Form No. 3 a 1977 Printed by Agreement with the N.C. Bar Assoc. #003 Pender County Planning and Community Development 805 S. Walker Street PO Box 1519 Burgaw, NC 28425 April 24, 2024 Timothy Guadagno, PLA Summit Design and Engineering Services Mr. Guadagno, Phone: 910-259-1202 Fax: 910-259-1295 www.pendercountync.gov The properties identified by Pender County PINS 2393-36-5596-0000 and 2393-36-7026-0000, further identified as 5514 NC Highway 11, Willard, NC 28478, are located within the RA, Rural Agricultural zoning district and within the zoning jurisdiction of Pender County. These properties have a bona fide farm designation (permit number BFF 2024-175), as the requisite documentation has been submitted to the County to demonstrate that these properties are in farm use and are entitled to the zoning exemptions associated with bona fide farms and agritourism. As such, the installation of 14 pads for the temporary occupancy of RVs, electrical hook-ups, and a waste dump station facility are allowed on the site. Please let me know if you have any questions. Sincerely, Daniel Adams Planning & Community Development Director DocuSign Envelope ID: 11 E339FC-01 AB-4F69-ACFE-978D9A1 08F6D VICINITY MAP (N. T. S) TO WILLARD .i'a i1 i- iE .Ifts— � s y 5500 F 2 � 1 ' a �j V- - ,tit 1• * 1 �. 1_ _ A 5 � 5586 t x of a •+. '�`✓ (rlLi"la�!'•as'-r•• PR7POSFn RV L07 0 6 6.3' \ PROPOSED DUMP TANK A NOTE. PARCEL BOUNDARIES TAKEN FROM PENDER COUNTY GIS AERIAL PHOTOGRAPHY FROM NC ONE MAP DATED 2020 PARCEL IS NOT LOCATED IN A SPECIAL FLOOD HAZARD ZONE PER FEMA MAP No: 3720239300J DATED 211612007 DocuSigned by: EODGu � , J EDB8647F73449... 5/16/2024 ELIZABETH F. SMITH, PLS ROBERT H. GOSLEE &ASSOCIATES, PA LAND SURVEYORS — LAND PLANNERS J 17 E. MURRAY ST. / P.O. BOX 133 WALLACE, NORTH CAROLINA 28466 NC CORPORATE LICENSE No. C-1167 910-285-4210 Emoil: beth®gosleesurveyng.com SKETCH FOR UNION TOWNSHIP - PENDER COUNTY - NORTH CAROLINA SCALE. • 1 " = 100' APRIL 22, 2024 REVISED: MAY 16, 2024 MOVED PROPOSED DUMP TANK 100 0 100 200 300 GRAPHIC SCALE - FEET FILE No. PH-04-1 1 Hwy 19 F FIE4O FIELD �. ylip CABINS (2) 200 SF EACH e fit SHED) 'a � ,a.a qs. 2.'..-. STAGE 450 SF POTENTIAL POND EXPANSION f1 CABINS (3) _./ L� PEDE OGIAN OJTDOOR VENUE FLEX SPACE i"ib SP PARKING FlRE PIT Poo ANIMAL FIELDS BARN VENUE PARKING ANIMAL PENS 8... TEMPORARY VENUE SEATING MAIN DWELLING HOUSE RV PADS 14 FADS 3060 EACH Observation Report Date: [4 r � Project: 24-0099.0241 Tate Master Plan Test Observed: Tank Leak Test - Sewage Holding Tank Summit On -Site Representative: Contractor Preforming Test:: kr\ Contractor Supervisor: Weather Conditions: Tank Material: Liquid Capacity: 1 bd�)_ 13 v.lc� Manufacture's Name (if known): Method of Testing: Test Start: re-\ Test End. Test Duration: c ✓l. Water Level Drop: Comments: PST sue - q�or -5—AS Attachments: KA ofvS o dap I certify that the leak test preformed was observed by myself or by a person under my dimct ervision N1 .thai the test preformed did not indicate a leak was present. .. 00 F • 1� Signature:A Date: 0 Wilmington Office 2715 Ashton Drive, Suite 104, Wilmington, NC 28412 910.415.1208 // www.summitde.com jA See hft ISNa4W 2A W W dpi 24* G=na hM .>y�k IF1we1R Timm y13 VIP00.e- H150 IX3G �n�arp�kory f] SuiaR fM JC i] IFIe Pith Info 0 ihfc}9s8 luny ro 1% 1WAI f9 W4 i s T; WA 3Wi x a92 LIMO f:.fft. 24bn n.rrrc Iola Sypk 1pvw a Um. VIS IHOMW IMW CEO NCM1W.imnp.Omq C] Fy i}a a zl T'b PAh Info ml N. h Info x x ot Ape'e =hove14 W— VM MM WO ItOK . . . . . . . . . . . ...... j!) IM 0% 5— W. XQ4. , L910 V fpl 24hil it Perim lrtc App. .'ivoe I+ 5.7— lfl3 VWW.. 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