WQ0042246_Pump and Haul Permit Application_20210222

pilgrim
ber 29, 2020
Subject: Permit No, WQ0041789
Wastewater Pump & Haul Permit
Application
Pilgrim's.Staley Feed Mill and Hatchery
Randolph County
We are requesting a duplicate pump and haul permit. We have made many improvements but still have
a few additional areas we would like to address to eliminate more storm water from reaching our
wastewater system: While we had hoped to have had these projects completed by the end of our
original permit, we are requesting additional time due to covid, holidays, and weather delays. We
appreciate your help and understanding while we work to improve our system,
If you have any questions or need any additional information please contact me at 919-895-3457 or at
Tina: [e-mail]:
Thank you
Tina Pedley
484Zimmerman Road • Sanford, NC • 27330
Telephone: [phone] • Fax: [phone].

State of North Carolina
Department of Environmental Quality'
Division of Water Resources
15A NCAC 02T .0200 ....WASTEWATER PUMP AND HA11L,$YSTEMS
Documents shag be prepared in accordance with ISA NCAC 02T .0100,15A NCAC 02T.0200, and Division policies. Failure to submit
all required Items will necessitate additional processing and review time. For more information, visit the Wastewater Branch's
website or contact the Regional Office serving your county.
General This permit application applies to all pump and haul activities of wastewater under the authority of the Division on Water
Resources. Permit coverage SLs required for the system producing the wastewater. This permit does not apply to the transport of
animal waste from an animal waste management systems, not the transport of wastewater residuals or biosolids.
NOTE: Pump and haul permits are not acceptable long term domestic wastewater treatment alternatives and, shall only be issued
in cases of environmental emergencies, nuisance conditions, health problems, or for unavoidable delays in construction of system
previously permitted by the Division.
The Applicant shall submit one original and one copy of the application and supporting documentation.
A. Pre•submittal Contact & Cover Letter
❑ Contact the appropryate Regional/Office prior to submittal
❑ ; Submita cover,Igtter explaining the cfrcumatances associated with this pump and haul permit request
B. Application Fee (Domestic Wastewater Only)
❑ Submit a check made 'payabie to: North Carolina Department of Environmental Quality (NCDEQ)
> The appropriate application fee is: $810.00 for flows <10,000 GPD and $1,310.00 for flows >10,000 GPD
Wastewater Pump and Haul (FORM: P&H 01-16) Applications
> Submit the completed and appropriately executed Wastewater Pump and Haul (FORM: P&H (11-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or
due to, space restrictions, attachments to theapplication may be made, as long as the attachments are numbered to.
correspond to the section and item to which they refer
D. Receiv ng Facility Letter:
❑ ' Submit a letter from the owner/authorty of the receiving, wastewater treatment facility, as required by 15A NCAC 02T .0204
(b), stating that the pumped and hauled wastewater will be accepted and specifying the volume and type of wastewater that
will be accepted. The letter should be signed by an authorized siring official in accordance with 15A NCAC 02T .0106(b)
Contract Hauler Letter:
A Submit a letter from the hauler stating their capability and willingness to perform the pump and haul activity
0 Lettershallinclude: Owner/Company Name, Contact Information, & Hauling Volume of Vehicle(s)
F. Certifications:.
❑ The Applicant's Certification on Page 4 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A
NCAC 02T.01061c). an alternate person may be designated as the signing official if a delegation letter is provided from a
person who meets the criteria in 15A NCAC 02T .0106(b)
❑ The Professional Engineer's Certification on Page 5 of the application shaft be signed, sealed and dated by a North Carolina
licensed Profes`sfonai Engineer Of required)
G. Plans and Specifications required for activities that result in the Practice of Engineering per G.S. 89C-3):
❑ Subnllttwo sets of plans and specifications (signed, sealed and dated by a N.C. Licensed Professional -Engineer)
❑ Plans must Include:
> A general location' map
> Diagram of the components associated with the pump and haul activity (drains, piping, tanks, pumps, etc)
> Tank Details that indk:ate high water alarm
> Other items as required
INSTRUCTIONS FOR APPLICATION P&H 01-16 Page I of 5

Industrial Pump and Haul Activities
Per 15A NCAC 02T .0203(A)t2) Industrial pump and haul activities are deemed permitted provided the following criteria Is met:
A The facility notifies the appropriate Division regional office in writing advising of the type of operation, type and quantity of
rece mg wastewatertreatment facility. A fetter from the facility accepting the
wastewater (type and quantity) specifically agreeing to accept wastewater from the applicant shall be Included.
S. The wastewater does', not contain any human waste:
> The waste is collected and discharged into a sewer or treatment system designed and permitted to accept the type of
wastewater being pumped and hauled.
> The pump and haul activity is not to alleviate a failing wastewater system.
D The Division regional office concurs in writing that the activity meets the criteria in this Rule.
CONTACT THE REGIONAL OFFICE PRIOR TO INITIATING ANY INDUSTRIAL PUMP AND HAUL ACTIVITES. SUBMITTAL OF THIS
APPLICATION/DOCUMENTS AND WRITTEN APPROVAL IS STILL REQUIRED FOR INDUSTRIAL PUMP AND HAUL ACTIVITIES
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND MATERIALS, SHOULD BE SENT TO THE
APPROPRIATE REGIONAL OFFICE'.'
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office'
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Qualfty Operations
Swannanoa, North Carolina. 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,',
(828) 29S-7043 Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Operations
Fayetteville, North Carolina 28301
Montgomery, Moore, Robeson, Richmond,
(910) 433*3300
Sampson, Scotland
[phone] Fax - -
-
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba,
Cleveland,
Water Quality Operations
Mooresville, North Carolina 28115
Gaston, Iredeil, Lincoln, Mecklenburg,
Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe 'Franklin,
Water Quality Operations
Rale gh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
(919
791-4200
Northampton, Orange, Person, Vance, Wake,
(919)
788-7159 Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Operations
Washington, North Carolina 27889 •
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
Water Quality Operations
127 Cardinal Drive Extension
Wilmington, North Carolina
28405
Brunswick, Carteret, Columbus, Dupiun, New
Hanover, 0nslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Allegheny, Ashe, Caswell, Davidson,
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
(336)-776-9800
INSTRUCTIONS FOR APPLICATION P&H 01-16
Page 2 of 5

1. PRESUBMITTAL INFORMATION:
1: Contacted representative from regional office (Pre -submittal)?: ® Yes 0 No
2: Contact name (For Regional Office). Jim€L onsiewski and PatrickNptchel(
II, APPLICANT INFORMATION:
1. Applicant's name (Municipality, Individual,; Corporation, etc): Pilgrims
2. Applicant type: ❑ Municipal ❑ State ❑ Privately -Owned Public Utility
0 County ® Other: Industry
3:
Origin of Wastewater:
Residential Subdivision
❑ Apartments/Condominiums
O Mobile Home Park
❑ School
❑ Restaurant
❑ Office
❑ Retail (Stores, Shopping, Centers)
❑ Institution
❑ Hospital
❑ Church
0 Nursing Home
® Other (specify)
4. Signature authority's name: Jamal:Mohammed per 15A NCAC 02T .0106(b)
Title: Complex Manager
5. Applicant's mailing address:484 Zimmerman Rd
City: Sanford State: NC Zip: 27330-
Applicant's contact information:
Phone number: (91Q) 895-3455 Einail: mohammed.jamal(iajbssa.com
I11. CONTACT/CONSULTANT INFORMATION:
1. Contact name:
Title/Affiliation::.
2. Contact'sinformation:
Phone number: 4 ) - Email:
IV. RECEIVING FACIUTYINFORMATION:
If more than 1 facility has agreed to accept the wastewater, please list all the owners, facility names, and permit
numbers as a separate attachment)
1. Owner: See separate attachment
2. Facility name:
3. Facility permit number:
4. WWTF permit number:
5. WWTF contact name:
Title/Affiliation:
6. WWTF contact information:
Phone number: ()_ Email:
Domestic: 16 %
Commercial:
Industrial: !34 %
Other:
APPLICATION P&H 01-16 Page 3 of 5

yt:T INFORMATION:
Location of Project (physical address): 2607 Old 421 Rd Staley. NC
Approximate Coordinates (Decimal Degrees): Latitude: 35.48'39c)
Duration of Pump and Haul Request (Six Months Typical):.:6.months
Longitude:-79.33'20o
3.. Hasa prior permit been issued? New 0 Prior Pump & Haul Permit
Permit No.:
4. Permanent Method of Wastewater Disposal: Spray Irrigation
5. bate Permanent Disposal will be available:
6. Have permits / approvals for permanent disposal been obtained?
® Yes Ej No Permit Number: W00005681
7. Is there a Pretreatment Program in effect? 0 Yes ® No
8. Describe any pretreatment prior to pumping and hauling:
9. Volume of Wastewater Generated: 4725 daily average over last 12 month Gallons per Day
10. Explain how the wastewater flow was determined: ®1SA NCAC 02T,0114 or Q Representative Data
If representative data, describe:
11. Describe Tank / Container wastewater will be pumped from (attach description if necessary):
204,000 gallon lined lagoon
12. Is Tank / Container in place or will it be installed (attach description if necessary):
in place
13. What type of high water alarm does the container have (and/or):
[jAudible and Visual ❑ Telemetry (Auto Dialer/ SCADA)
VI. CERTIFICATION:
1. Applicant's Certification: (Signature of Signing Official and Project Name) .
1, 300%01 YYlnivuuvsul , attest that this application for ilitseirAS has been reviewed by me and is
accurate and complete to the best of my knowledge. I understand that it II required parts of this application are not completed
and that if all required supporting documentation and attachments are not included, this application package is subject to
being returned as incomplete. I understand that issuance of a permit willrequire pump and haul facilities or activities to be
inspected at least daily by me or a designated representative. Note: In accordance with North Carolina General Statutes 143-
215.6A and 143.215.$B any person who knowingly makes any false statement, representation, or certification in any
application shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties
up to $25,000 per violation.
Signing Official fIgnature
l 11
ate
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL.
ACTIVITIES SHALL BE INSPECTED AT LEAST DAILY BY THE PERMITTEE OR IT'S REPRESENTATIVE PERM NCAC 02T .020414.
APPLICATION P&HOt-16
Page 4 of 5

THE ENGINEER'S CERTFICATION IS REQUIRED FOR ACTIVITIES THAT RESULT IN THE PRACTICE OF ENGINEERING PER.G.S. 89C-3.
' ENGINEERING DOCUMENTS MUST BE COMPLETEDPRIOR TO SUBMITTAL. IF CERTIFICATION 8Y AND ENGINEER IS REQUIRED;
THIS RAGE IS NOT NECESSARY.
1:-rio)essionaitrrgineer•s cern& on: (Signature oFDes)gn Engineer and Project Name)
,attest that this application for - has been reviewed by me and Isaccurate, complete and consistent with the information in the engineering plans; calculations, and all other supporting
documentation to the best ofmy knowledge. I further attest that to the best of my knowledge the proposed design has been
prepared in accordance with all the applicable regulations. Although other professionals may have developed certain portions
of this submittal package, inclusionof these materials under my signature and seal signifies that 1 have reviewed this material
and have judged it to be consistent with the proposed design. Note: In accordance with NC General Statutes 143-215.6A and
143-215.68, any person who knowingly makes any false statement, representation, or certification in any application shall be
guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per
violation.
2a.
2c.
2d.
Professional Engineer Name
Engineering Firm
Mailing Address
'2e.
City
2g.
2i.
State , Zip
Telephone ! Facsimile
E-mail
NC PE Seal,, Signature: & Date
APPLICATION P&H 01-i6 Page 5 of 5

-PO Box 2903
Sanford, NC 27330
{Y1'l' 2o.
Tot,tl tit°Lro Septic & yt fS LC Ph:919-708'5056
Tothtenviroseptic.nc*nnai com
Ms Tina Pedley
Pilgrim's Pride
484 Zimmerman Rd
Sanford NC 27330
RE: Emergency Pump and Haul Agreement
Ms, Pedley,
This letter shall acknowledge the mutual agreement between Total Enviro Septic and Waste LLC, and
Pilgrim's Pride to haul wastewater from the Sanford NC and Staley NC plant.
All wastewater removed from Pilgrim's Pride shall be discharged at the, approved wastewater
treatment facilities. These facilities include Big Buffalo W WTP in Sanford, as well as Asheboro WWTP
in Asheboro.
As always, we appreciate the opportunity to work with you on this project if we can be of further.
service please do not hesitate to contact us!
Thank you!
Zac Scott
Total Enviro Septic & Waste
(919)-356-8950
Accepted signatures
X
CLAADate: 07 I Ore
otal Enviro Septic & Waste LLC
x PectIcir
Pilgrim's Pride
Date: 7- 6o-.Qe

Pump and Haul Application for Staley, NC Pilgrims WQ0005681
IV. RECEIVING FACILITY INFORMATION:
1. Owner: City of Asheboro
2. Facility name: Asheboro Waste Water Treatment Facility
3. Facility permit number:
4. WWTF permit number: NC0026123
5. WWTF contact name: Mike Wiseman
Title/Affiliation: PlantManager
6. WWTF contact information:
Phone number: [phone] Email: mwisemanOci:asheboro.nc.us
1. Owner: City of Sanford
2. Facility name: Big Buffalo Wastewater Treatment Plant
3. Facility permit number:
4. WWTF. permit number: NC0026123
5. WWTF contact name: Scott Siletzky
Title/Affiliation: Plant Manager
6: WWTF contact information:
Phone number: [phone] Email: [e-mail]

PO Box 2903 '0 s �y r y ° i 3 ! = F' l < n $ Ph: 919-708-5066
Sanford, NC 27330 Totelenvlrosep$C.no©gmalloom
Truck. Information
1.) 2000 Mack Septic Hauler
• VIN#:1M1AA08X7YW021164
• License Tag #: YA154564
• Tank Capacity: 4,000 Gallon
2.) 2000 International Vactor 2100
• VIN#: 1HTGMADR4YH321461
• License Tag #: JZ5012
• Tank Capacity: 1,000 Galion
3.) 2013 International Vactor 2100+
• VIN#:1HTGRSJT3DJ3516f4
• License Tag #: YA154563
• Tank Capacity: 1,300 Gallons

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2.19 14:09:38 -05'00'

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT SOLID WASTE SECTION -1646 MAIL SERVICE CENTER RALEIGH, NC 276994646
(1.) Firm name' (The "Firm name" must be Mat as it is shown on your vehiele(s)).
OAb a EYVA V
Street address of office: 2,\Qc+ fw cwc: Doteailt P.J
City, = -"ronJ
Mailing address (if different)Pb Gchr.
City: State` ,,Ur_ Zip 7 1 3
Phone: (gtM\ 'lost- Sc.)Sto Fax;
E-6tailr cs{� l2 5w ;,ma `u 1 \ c .uc. C@ C,1 \ . Co'
County: LCC Septage Management Finnpermiino ber: NCS#0%525
(2.) Firm owner's name: Zoo—. 5c..)41.,
Mailing address (if different):
City: State: Zip
Phone:CR1' 3SCatc'SC) Fax:
(3:) Firm operator's name: Lei-L.'ScoA - Firm operator's He: O
Mailing address (if different):
City: Slate: Zip:
Phone: Fax:
(4.) Type(s) olseptage pumped: Write in the number of callous pumped in last 12 rponths (Example: Domestic_50,00
Updated Firm Name
received by email on
1/27/2021. crc
Staten P Zip: "in O
2Fio'S,
Domestic
Portable Toilet Waste
lorcxc CA\
(5.) N.C. Counties;of Operation:
Grease (Restaurant)
N/r4
Treatment Plant
I-100, U00 ca-1.
IndustiialICommercial
(List each county you are aulhorrzed to do business inj
(6.) Total Number of Pumper Vehicles Operated: 3
Number used for; Domestic Septage: 3 Grease (restaurant):
Other: 3 Portable Tddet Waste:
Vehicle Information: (use additional paper if needed)
License Tag 4
Vehicle Identification #
Tank Capacity
1
`A15r-IS 6,, LA
IAA hARiogX1Nwo2\\ IoL1
r-\loco C,o.\;
2
`S $ol1
1 Vi � Co .AO M') \k 32\ t-4-lu \
1., 000 (,al
3
Ngici15454.5
\\•ITLR. n— MYS3S\ tc La
\j Soo G-
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DMSION OF WASTE MANAGEMENT • SOLID WASTE SE'
RVICE•CENTER, RALEIGH, NC
4 Fern name: (The "Finn name"must bo wd& as I(Is shown on.your vshlcfe(S)J,
Ie4•«-4 Low: Iv 5.6 ;c t ..uat-10* Ll_C
Steel address of office: Z\ 9q bar-Cwc. nn.... A01 s.
City; S+ncon.
Mailing address (If differsk t}t Erb 4Sc . 2 t o S
City: fur "may,;"
SS: .L1 S- Zip: 27 S 3
zip 9--1 33
Phone:C9r9\ 1:bif - SC? rt Fax:
E 1'Tva•-4 F ..S.ro --a Q►;c._, .IUc. P C? .*. i \
County: t.-e.e.. Septage25
(2.) Flnnownefs name: 7s-s.-
dresa(if ,dIffereM t
Phone:
Type(s) of septaga pumped: yYrfaaln fhe number o1aallons aumaeu to les(7I monara
d
Oomasdc
Portable Toilet Waste:
Grease(Reatswrant) '
Tteafinent.Plant
Ind Commercial
IQtPcattr C A\ .
.N / A
!1! W4
LI 00, QUO Ge.;%.
55oo, oob 40..E
OtA
(Um sash county you me cur r�'d W do buabrpe tn)
(S.) Total Number of Pumper VeNclas Operated: . 3
Number used for Domestic Sanwa: 3 . Grease (restaurant);
Other. 3 Portable Toilet Waste:"
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification # "'
Tank Capacity
1
`IA1545 (DIA
IA) 8 02_%\
4,00o C,•.‘,
2
% WI -Coen AOs4.9 2% la1
1,000 61.-1
3
'IA 15�\5(.%
1\kyLy65ST_3OS 51 lip U ..
1,3ia6 4G.\
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APRLICATION)FORtPERMIT TO OPERATE A SEPTAGE CIAANAGEMENT FIRM
(CONTINUED FROM PAGE 1).
rvahidea7(cfkonep(✓f yes ('')no.;T
you cL ticked yesaboire, you ntustattesttothe foibwingstates!
'1 c ertify,under penalty of law,_ that the pumper vehicle orvehicl u.
requirements for aata and sanitary transportation of septage asreq
asregiimdby ISANCAC.0s44(b). Furthennoie, Ialsocatelyehata
required by 18A NCAC 1313.0839(a). I am aware that there are
possibility otfine and Imprisonment"
Do You attest tote statement above? (✓)'yes ( ) no
rPine Disposal Method (cheakons)
a)Appmyad Waalew rlt P* Patti ✓IYes ( ) no,
Merit, as indicated in Ststl+amgreph .D033(c)(14) of theSeptegeManagementRutee
b) Sepiage Land Application Sha(SLAS) Permit Numbers: (use additional shells if needed)
SLASfk 1 Expiration Data` SLASit Expiration Dater ... ,
tact Fa_ (Stir Permit Numbers:(use additional sheets if needed) -:
SDTFtf Expiration. Data:
re a pemeN,rnay be Issued.
a suGmitteit Permit application meets Me
&4 NCAC 13B .0844(a)jand vehicle lettelfng
rnntainedof Bath �ptage primping event as
naltius for fOlsa a fid aefai Including the
Finn Operator Training Com le*:
l°tow La:atlar, „c.nct cwb cyw.sb'a.O Hou
by: .A.)'C: `'ci+r' IA; r� TeH
(10.) Sep tageLend Application Site Operator Training Completed;..
Do: to I1o1u»n Location:
cwr:., Hours:
Training Sponsored or Provided by:
ra tion type retested: MEP( ONE
Registered Portable Sanitarian Fim:
Registered SeetfreManagement Finn:
Registered Portable*italic* and Septage
Certification State
f certify that the bdormatton and representations In thls application
of my knowledge and belief. I am mum that a nem* may be suspended or
based upon Mooned ar Inadequate Information thatrnaterialy affected the dec1slo,
criminal penalties for knowingly making a false statement, represenhtion, or certification.
d accurate to the',
issuance was
there are

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Deperfrnenl of Environment and Natural Resources
Ctvtsaon of 'Waste Management - Solid Waste Section
40t Oberlin Rd:, Ste 150, Rafe lh. N C 27605
Fee assessrncru and waste determinations will be required at the discreton of the naslew.
fadi ty has the aedhm rta firer gnItvv In nary discharges at any wastes to the incoming waste
ranitrkv
➢ieg Buffalo Waste Water treatment Pant
irmetOpoRMo,cx4 tin rr nem
5327 Iron furnace Rd., Unfold, NC 27330
t919}775 5 do here authon2e 7,ac
(Rats NWT rr ir'�x�rri .xsPatrr f m
1e dispose cal; domestic scplage
:grease siptage tgrease trap purnprr�;
Piluprr s Pride
:at the atrour~ named wastewater treatment f,ic:ihl
e
Rein roducfng partially treated liquid into
This authorization shaft be valid until
Signer
Note:Fait'
NtS-O
t .ire and FiCSS re
comments Firdustr l
ge
,ta Guas=

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management -Solid Waste Section
1646`Mail Service Center, Raleigh, NC 27699-1646
Received by email on
1/27/2021. crc
Fee assessments and waste determinations will be required at the discretion of the wastewater
treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the
incoming wastewater stream.
I, Michael R. Wiseman, ORC, WW44987680. City of Asheboro. Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
1032 Bonkeme{ier DrivefRandleman NC.27317
(Address)
336-672-0892 do hereby authorize ZacScott
(Phone Number) (Owner/Operator of Septage Management Firm)
of Total Enviro Septic and Waste LLC NCS# 01525
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage X portable toilet waste.
grease septage (grease trap pumpings) X ; commercial/industrial septage , from
Pilgrim's Pride Corp.,, Staley NC Randolph County
(County.. or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
1032 Bonkemeyer Drive, Randleman, NC 27317
(Location)
between the hours of 7:00 a.m. to 5:00 ti.m. Monday- Friday Only
Reintroducing partially treated liquid into a grease trap is acceptable _Yes
X No
This authorization shall be valid until December 31, 2021
(Usually December 31, Year)
(Facility Operator)
Subscribed and affirmed before me this
tary Public)
`T Sc u-Iz
day of
Date -- li 2
401
My Commission expires:
2024
t��ttne�.44
2s—
sa
�$DY r
(QFFICIAL SEAL)
sor49
rvr.
0 cilLIC i'
Note: Falsification of thls document by the septage management firm shall lead to perm t OR4rcation. +4i��*
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2019 Firm Application/W WTP Authorization Farm 2019.. ��14r�COL1ittil;0��,

Cobb, Chester
From: Total Enviro Septic<[e-mail]>
Sent: Friday, January 15, 2021 3:38 PM
To: Cobb, Chester
Subject: [External] Re: Septage Management Firm Permit Renewal for 2021
Attachments: APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM #1.pdf; APPLICATION FOR
PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM #2.pdf; AUTHORIZATION TO DISCHARGE
SEPTAGE TO A WASTEWATER TREATMENT FACILITY.heic
Chester,
please see our attached applications, and permits. the renewal was paid in full Confirmation #21011523691781
if you have any questions please let me know!
thanks!
Zac Scott
[phone]
On Fri, Jan 15, 2021 at 2:21 PM Cobb, Chester <[e-mail]> wrote:
Zac,
Please find attached information for the renewal of Septage Management Firm Permit, NCS-01512. The first document
is the Invoice. The Invoice has information as to how to pay the permit fee. The permit fee can be paid online. The
Notification Letter covers all the requirements for permit renewal and has the link to our website to where you can
access the paper application, forms, and Online Application. For simplicity, you can click on this link and it will take you
to the Online Application: https://edocs.deq.nc.gov/Forms/wm septagefirm. If you have any questions, please contact
me.
Thanks,
Chester

PAID
INVOICE #: NCS-01525-2021
PERMIT #: NCS-01525
AMOUNT: $800
PAYMENT METHOD: e-card
DATE: 1/18/2021
Chester Cobb