SDTF-7705_RENEWAL_APPLICATION_2024

APPLICATION 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 Facility Information
1. Applicant 5C-so2:�s OF f13C
Address -tA
NC 472S I
Phone fe 0 - 42b - 38 q 0
2. Contact person for site operation (if different from applicant): RO a S on3 E5
Title or position rnA,N P�-o,g:e-. Phone 9 fo - yZo -28 yo
Address 1.L2.�"Zciyr'ra.�to2�' n�JE
c 2-7"L f
3. Landowner
Address
C 2.
4. Site Location: Counbf-� State Road Number
Directions to site:
5. Is the location on a permitted Septage Land Application Site?
If yes, give the site permit number here: _
" 6
6. Indicate whether project is: new V"' renewal modification
For a permit renewal or modification, indicate the existing permit number D7 - 77 • c�5 and the
permit expiration date S - '�6/ o - 2
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 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:
Coo Nil W tJ 7- 7'
(over)

II. Facility Information: the following 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. Types of treatment to be provided: pH Adjustment (lime stabilization)
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 structures will be constructed or installed (use additional
paper to explain, if necessary): --r-O dJ i ❑ Cf? LP S i '< S
o t...Lc me ^JT 5
5. An explanation of how septage will be discharged into and removed from the facility (use
additional paper to explain, if necessary): Ey M Pe�D n LIT lw I C'C—
Z a V
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
Facility perm' .
-2- Zq
Signature (§rg"nature 'ot4paryofficialrequired) Date
iTZ
Print name Title
Note: This application will not be accepted for review until all parts of the application are complete.
S:Solid_Waste\cla\septage\forms\SDTF-Application & Authorization\SDTF Permit Application -Jan 2016.docx
Rev 01-07-16

10
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
1, `j' Utz -J3A _., JELL I (name of site owner) hereby certify that I am the owner of
I "5c1 - Z Z acres of land located s CH! t�) N T-) (cam . and
identified byBoot4 '1 1 8 `+PAroe (03 3 (book and page of recorded deed or tax map parcel) and
that I agree to allow --AUr✓=1- , .Fnc�,tz'rS OF AkIM S TF permit applicant) to use
said land for a septage detention or treatment facility for a period of 5 (length
of time), beginning 4 d — nZLf (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 treatment facility. The above
described property is owned solely by me or jointly with " o t,3 c
of all co -owners, or state none).
Date
Si nature of landowner Date
re of landowner
Date
Sworn to and subscribed before me this 41"\ day of UQrGV\ , 20 2
(Notai Public)
My Commission expires: 7-112,00
* 15A N.C. Admin. Code 13B Section .0800
(OFFICIAL SEAL)
Rev. 01-07-16

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
Sent via Email
Mr. Rodney Jones
Travel Resorts of North Carolina, LLC
1059 Sycamore Lane
Jackson Springs, NC 27281
NORTH CAROLINA
Environmental Quality
February 7, 2024
RE: SDTF-77-05 Permit Renewal Notification
Travel Resorts of North Carolina, LLC
SR 1426 in Richmond County
Dear Mr. Jones:
The permit to operate Septage Detention or Treatment Facility with permit # SOTF-77-05 expires on
May 30, 2024. Please note that applications for subsequent permits shall be submitted to the Division at least
ninety (90) days prior to the expiration date of the permit in accordance with Rule 15A NCAC 1313.0837(m).
Please complete the "Application for a Permit to Operate a Septage Detention or Treatment Facility" that I have
attached. To increase your application's success, please follow these suggestions:
Completely answer all questions on both pages (front and back) of the application. For
Question 11.4. of the application, be sure to list all tanks along with their type (steel, plastic,
etc.) and size (gallons). Additional paper can be used if necessary. Be sure to sign and date
application when completed.
If you as the applicant are not the sole landowner of the property, then the appropriate
landowner authorization must be completed. All landowners must sign the authorization.
Remember that only complete permit applications will be processed and approved by the Division.
Failure to submit the application in a timely manner could result in the permit lapsing and closure of the
facility. The use of a septage detention or treatment facility that is not permitted may result in
administrative penalties up to $15,000 per violation per day in accordance with NC General Statute
130A-22. If you wish to discontinue use of this facility, please notify the Division in writing to that effect. If you
have any questions concerning the enclosed permit application, please call me at [phone]
Attachments
copies: Central Files
Sincerely,
ax I
Chester R. Cobb, Environmental Program Consultant
Division of Waste Management, NCDEQ
North Carolina Department of Environmental Quality I Division of Waste Management
217 West Jones Street 11646 Mall Service Center I Raleigh, North Carolina 27699-1646
919.707.8200