NCS01498_2019Permit_Initial

2019
Permit and Registration

CERT
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01498
And by virtue of completing the annual training
requirements is hereby registered as a Septage Management Firm
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 authorized to discharge septage only at the locations(s) listed below: 1. Clark Creek WWTP, Newton NC
2. Septage Detention or Treatment Facility, SDTF-35-15
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.

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, 2019.

__________________________________________________ Adam Ulishney, Environmental Compliance Branch Head

I
1�f)T
(Owner of Sep age � v� =
to utilize septage detention or treat men 'ac _, = �---_.:.. '?'; -�-== -:septage *
in 20 / q . The facility will be operate
Date: _7�/ 3�/-4-/;�1-­T I
*As defined in G.S. 130A-290{a)(32)** As defined in 15A NCAC 138 .0800
Return the properly completed form to: North Carolina Deoartmen of Environme a Division of Waste Managemen Solid Waste Section 1646 Mail Service Cen er aleig , C 7699-64fi
a
al
= -=-=... = ... - - - :: 5:: -
'
IZA O O I C
(Sept ge Management Firm Name and NCS nu be )
to dispose of: domestic septage V portable toilet waste _____ __,
grease septage (grease trap pumpings) ____ commercial/industrial septage ___ _,
{County or other Geographic Area
at the above named wastewater treatment facility. Septage shall be discharged at:
/ lf D7
7 (Location)
between the hours of ____ __.__!---'()'--"O�e¼-.....---7_ . ._' .-...b-..D_f,,-�--"-'---(}t...;..._.;;M�----�"-"'4:,.__,__.f-=-· ___ _
Reintroducing partialfy treated liquid into a grease trap is acceptable __ Yes
This authorization shall be valid until ____ [)u_"'--_3.a;__l_,1_1d)......__.....,.__,/.,___1t----------(Usually Decemoer 31; Year)
Date -------