NCS01181_2021Permit_Initial

2021
Permit and Registration

G.S.M.R.
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01181
And by virtue of completing the annual training
requirements is hereby registered as a Portable Sanitation &
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. Tuckaseigee Water & Sewer, Sylva NC
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, 2021.

__________________________________________________ Adam Ulishney, Environmental Compliance Branch Head
State of North Carolina
Environmental Quality
Waste Management
Application for Permit to Operate a
Septage Management Firm
For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-
707-8283).
Firm name**
Septage Management Firm permit number (NCS #)**
Street address of office**
County**
Mailing address same as street address of office?**
Phone**Fax
Email**
Firm owner's name**
Mailing address same as street address of office?**
Phone**Fax
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
Phone**Fax
Firm Info
GSMR
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01181
Enter the five digits following the NCS #
City
Bryson City
State / Province / Region
NC
Postal / Zip Code
28713
Country
USA
Street Address
225 Everett St. Suite G&H
Address Line 2
Swain
Yes No
828-488-7008
[e-mail]
Owner Info
Al Harper
Yes No
828-488-7008
Operator Info
Teddy Crawford Maintenance Supervisor
Yes No
828-342-0935
Amount in gallons *
DomesticDomestic
Portable Toilet WastePortable To ilet Waste
Grease (Restaurant)Grease (R estaurant)
Treatment PlantTreatment Plant
Industrial/CommercialIndustrial/Co mmercial
List each county you plan to do business in:**
Do you plan to operate pumper vehicles?**
"I certify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meets the requirements for safe
and sanitary transportation of septage as required by 15A NCAC 13B .0844(a) and vehicle lettering as required by 15A NCAC .0844(b).
Furthermore, I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 13B .0839(a). I am aware that
there significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date**
Title**
Choose how to add vehicle descriptions**
Pumper Vehicles
Usage*License Tag #*Vehicle Identification #*Tank Capacity*
Approved wastewater treatment plant **
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
subparagraph .0833(c)(14) of the Septage Management Rules.
Mail forms to:
Type and amount of septage pumped in the last 12 months
0
49,000
0
0
0
North Carolina counties of operation
Jackson County and Swain County
Vehicle Info
Yes No
12/9/2020
Maintenance Supervisor
Add vehicles
individually
Upload List
Portable Toilet Waste AJ-4866 3D6WG46A77G768782 925
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*Expiration Date*Authorization
Septage Land Application Sites (SLAS)**
Septage Detention or Treatment Facility (SDTF)**
Other disposal method**
Date**Hours**
Location**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Comments or notes
Tuckaseigee Water And Sewer Authoity 12/31/2021 TWSA
Authorization
2020.pdf
508.42…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
9/11/2020 4
Morganton, NC
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
0
Registration Type
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
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 was based upon incorrect or inadequate information that materially affected
the decision to issue the permit and that there are criminal penalties for knowingly making a false statement, representation, or certification.
Signature
Date
Print Name**Title**
12/9/2020
11:54:00 AM
Teddy Crawford Maintenance Supervisor
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental QualityDivisionof Waste Management - Solid Waste Section
1646 Mail Service Center,Raleigh,NC 27699-1646
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.
taa Rson CLie222) snkas ei zee Water Seur Anth
(Plant Operator in Responsible Charge (ORC),ORC License Number, Name of Plant)
194 w. Main SE, 54/ua Uc_9EN79
808 58%-313do hereby authorize, eddnCCasdod
etSmsho Moantdas KallCasd
(Address)
(Phone Number)(Owner/Operatot of Septage Management Firm)
of NCSO (Septage Management Firm Name and NCS number)
to dispose of: domesticseptage portabletoiletwaste
grease septage (grease trap pumpings) commercial/industrial septage from
acKSoa
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
TWSA Plast L 1E)1 Doth RiJa RO.
between the hours of M-E ,(Location) 8:b0aT5.DD pm
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
This authorization shall be valid until deni te
(UsuallyDecember 31, Year)
Signed Sla Date /2//30 (Facility Operator)
Subsfribed and affirmed before me this day ofcombaL, 20
My Commission expires:ovenabey 4,a03(Notary Public)MA,
n
kaneyR Hole MA (OFFICIAL T
Note: Falsification of this document by the septage management firm shall lead to permit revoca S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/wWTP Authorization Form 2018
www
PAID
INVOICE #: NCS‐01181‐2021 
PERMIT #: NCS‐01181 
AMOUNT: $550 
PAYMENT METHOD: e‐card 
DATE: 12/9/2020 

Chester Cobb