NCS01451_2021Permit_Initial

2021
Permit and Registration

Proguard Septic Services
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01451
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. French Broad River Reclamation Facility, Asheville 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
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
PAGE 1
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION – 1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646 (1.) Firm name: (The “Firm name” must be exactly as it is shown on your vehicle(s)).
Street address of office:
City: State: Zip:
Mailing address (if different):
City: State: Zip
Phone: Fax:
E-Mail:
County: Septage Management Firm permit number: NCS #
(2.) Firm owner's name:
Mailing address (if different):
City: State: Zip
Phone: Fax:
(3.) Firm operator's name: Firm operator’s title:
Mailing address (if different):
City: State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in last 12 months (Example: Domestic: 50,000). Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrial/Commercial

(5.) N.C. Counties of Operation:

(List each county you are authorized to do business in) (6.) Total Number of Pumper Vehicles Operated: Number used for: Domestic Septage: Grease (restaurant): Other: Vehicle Information: (use additional paper if needed) Portable Toilet Waste:
License Tag # Vehicle Identification # Tank Capacity 1
2
3
4
5

APPLICATION CONTINUED ON PAGE 2
Proguard Septic
PO Box 507
Clyde NC 28721
Roy Henderson
Roy Henderson
X
1
100%
1600
Buncombe, Haywood, Henderson, Madison, McDowell, Mitchell,Polk, Rutherford, Transylvania, and Yancey Counties
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
PAGE 2
(CONTINUED FROM PAGE 1) (7.) Do you plan to operate pumper vehicles? (check one) ( ) yes ( ) no. If you checked yes above, you must attest to the following statement before a permit may be issued. "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 are significant penalties for false certification including the possibility of fine and imprisonment." Do you attest to the statement above? ( ) yes ( ) no Initial Date (8.) Septage Disposal Method: (check one) a) Approved wastewater treatment plant: ( ) yes ( ) no. If yes, submit Wastewater Treatment Authorization for each plant, as indicated in Subparagraph .0833(c)(14) of the Septage Management Rules. b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed) SLAS#: Expiration Date: SLAS#: Expiration Date:

c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed) SDTF#: Expiration Date: _ SDTF#: Expiration Date:
(9.) Septage Management Firm Operator Training Completed: Date: Location: Hours:
Training Sponsored or Provided by:

(10.) Septage Land Application Site Operator Training Completed: Date: Location: Hours:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm: ______ Registered Septage Management Firm: ______
Registered Portable Sanitation and Septage Management Firm: _____
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 (Signature of company official required) Date Print Name Title Other Comments:
Rev. 10-27-2020
RH 12/28/2020
9/25/2020 Asheville, NC 4 hrs
NCSTA
12/28/2020
Roy Henderson Owner
PAID
INVOICE #: NCS‐01451‐2021 
PERMIT #: NCS‐01451 
AMOUNT: $550 
PAYMENT METHOD: e‐card 
DATE: 12/29/2020 

Chester Cobb