SDTF-16-09_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 Fac
1. Applicant
Address
Phone
2. Contact person for sitrce
peration (if different from applicant):��e I
Title or position Phone
Address 10c--- s . '2 7 7irZ.el
3. Landowner
Address
4. Site Location: County° c�e.re� 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:
Indicate whether project is: new renewal modification
For a permit renewal or modification, indicate the existing permit number and the
permit expiration date
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). /f 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:
(over)

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):
An explanation of how septage will be discharged into and removed from the facility (use
additional paper to explain, if necessary):
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
Facilit permit.
Signatu (S' ore ofepppany official required) Date
L cam' — � cr S •
Print name Title
Note: This application will not be accepted for review until all parts of the application are complete.
S:Sol id Wastelclalseptagelforms\SDTF-Application & Authorization\SDTF Permit Application -Jan 2016.docx
Rev 01-07-16

JUN2 I m
Attachment A
4. The proposed detention facility will be a 2000-gallon traffic rated pump
tank since we meet the appropriate setbacks. The 2000 gallon tank is
adequate to hold seven days of pump out waste generated at a rate of 3
gal per slip (70 slips x 3 gal/slip per day x 7 days 1470 gallons). See
Attachment B for a drawing of the pump tank.
5. A conventional marina sewer pump -out has a 2" discharge and a 3x2
reducer will be installed so that the force main can be 3" ductile iron
(freeze protected) pumping to a holding tank located on -site. A permitted
local septage hauler will be contracted with routine pick-up and disposal.
The marina pump -out selected will be a Keco Pump -A -Head Model 175.
See Attachment C (cut sheets) for more information on the pump -out
system.
6. We are proposing to control odors by extending a vent (ductile iron)
underground from the tank and attaching it to the existing utility pole,
raising the vent 8-10 feet high. We do not expect any leaks (leak
detection) and/or spills, but if any occur, the septage hauler will be notified
to clean (vacuum) the soiled area
V_

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE MANAGEMENT FACILITY
PA_
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION
1646 MAIL SERVICE CENTER, RALEIGH, NC 27699.1646
(1.) Facility name:
Street address of office ` ''
(5e o�� 5)
Mailing address (if different) P• 0 !b 2�L - 44'� Ll
County c-re'-
(2.) Facility owner's name_
Mailing address
Phone: Email:
(3.) Facility operator's name Je. 1)4 Facility operators title Pr e lb ce'r7k
Mailing address '2_? "Sqj L�-r
Phone 9�
5e Mon --kc'; C . C vL �
(4.) Type(s) of septage managed (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 i7-T V -1 a - m j
c) Septage storage tanks
d) Septage treatment
e) Grease treatment
(6) Name and Permit Number of all permitted Septage Management Firms using facility•
(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 ed upon incorrect or inadequate information that materially affected the decision to issue the permit
an at et
are rim I pAnlal 'es for knowingly making a false statement, representatt'' iti or rli ication.
r- Signatufe` Date
Print Name Title
*Signature of company official required.
S:Solid_Waste/CLA/septage/forms/2018 Firm Application/Non-Pumper-2018

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