NCS00829_2021Permit_Initial

2021
Permit and Registration

Bumgarner Septic Tank & Grading
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00829
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. City of Lenoir WWTP, Lenoir NC 2. City of Hickory WWTP, Hickory 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?**
Mailing Address**
Phone**Fax
Email**
Firm owner's name**
Mailing address same as street address of office?**
Phone**Fax
Firm Info
Bumgarner septic tank & grading, Inc.
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00829
Enter the five digits following the NCS #
City
Granite Falls
State / Province / Region
North Carolina
Postal / Zip Code
28630
Country
United States
Street Address
1190 Dudley Shoals Road
Address Line 2
Caldwell
Yes No
City
Granite Falls
State / Province / Region
NC
Postal / Zip Code
28630
Country
us
Street Address
PO Box 132
Address Line 2
828-396-1795 828-396-1956
[e-mail]
Owner Info
Michael Bumgarner
Yes No
18283200878
------Struck through Inc. to match firm name
on DWM records. JRB 2/9/2021
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
Phone**Fax
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*
Operator Info
Michael Bumgarner Owner
Yes No
18283200878
Type and amount of septage pumped in the last 12 months
256,000
0
0
0
0
North Carolina counties of operation
Caldwell Catawba Burke Alexander Lincoln Gaston Iredell Watauga Wilkes
Vehicle Info
Yes No
12/31/2020
Owner
Add vehicles
individually
Upload List
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:
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
Domestic Septage YA-160013 1HTSDAAN71H365715 2,500
Domestic Septage YA-135546 1M2P264C4Xmo28771 3,500
Domestic Septage YA150408 1M2AA14Y5XW113081 3,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
City of Lenoir Lower Creek WWTP 12/31/2021 lenoir
wwtp21.pdf
589.86…
City of Hickory 12/31/2021 hickory
wwtp21.pdf
1017.2…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
1/31/2020 6
Hickory
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
0
Select one**
Comments or notes
Signature
Date
Print Name**Title**
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.
12/31/2020
04:25:29 AM
Michael Bumgarner Owner
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section INVOICE
Invoice #:NCS-00829-2021
Date:9/22/2020
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
phone: [phone] fax: [phone]
email: [e-mail]
To:Michael Bumgarner
Bumgarner Septic Tank & Grading
1190 Dudley Shoals Rd
Granite Falls, NC 28630
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - http://deq.nc.gov
North Carolina Solid Waste Program - http://deq.nc.gov/about/divisions/waste-management/solid-waste-section
North Carolina Electronics Management Program - http://deq.nc.gov/about/divisions/waste-management/electronics-management
E-check -Available online at http://go.ncdenr.gov/swpay
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Payment Options:
Credit Card -Available online at http://go.ncdenr.gov/swpay
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
[*Convenience Fee of 2.65% added to amount invoiced.]
Paper check -Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number
on check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy
of this invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Description Amount Due
Septage-Annual:
Bumgarner Septic Tank & Grading (NCS-00829)
1190 Dudley Shoals Rd
Granite Falls, NC 28630
Number of Trucks: 3
$800.00
$800.00Total Amount Due
12/15/2020Date Due
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay fee(s) based on your solid waste management activities. The fee(s)
shall be used to support the septage management program.
Explanation of Invoice Amount is Based on Facility's Current Permit Status:
Billing process:
Mary H. Johnson [phone]

Solid Waste Contacts:
Regulations and Technical Assistance:
Chester Cobb [phone] Septage Management Firms, Land Application Sites, Detention Facilities
Adam Ulishney [phone]
NC Solid Waste Invoice Form I-2016