NCS00280_2022Permit_Initial

2022
Permit and Registration
Belton's Septic Tank Service

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00280
and registered as a Septage Management Firm
(PUMPER)
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. Septage Land Application Site, SLAS-78-23
2. Septage Detention or Treatment Facility, SDTF-78-23
3. Cross Creek WRF/Rockfish Creek WFR, Fayetteville 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, 2022. __________________________________________________
Perry Sugg, Environmental Compliance Branch Head
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISIOiI OF WASTE ]IIANAGEMENT. SOLID WASTE SECTION - 16{6 II'AIL SERVICE CENTER, RALEIGH, I{C 27699.1616
(1.) Firm name: {The "Firm name" musl be elagl& as it is shown on your vehicre(s).
Street address of office;
sate: fl ( zip:
Mailing address (if difierent):
civt E,flhert-l ll< - - -stare: /lC zip ,t I 3tt(o
Phone:Fax q/o' gtr-alK ),
City:
City:
E-Mait: he l{ansefic Stqalroo.<c,rrr
Couty: lkll Septage Management Firm permit number I NCs # ?Lo A8O
(2.) Firmowne/sname: fllax,ne -Ia'res
Mailing address (if difierent):
State: Zip
(3.) Firmoperato/sn" ", {Ylolltutg,d Trves Firmoperatolstitle: Ca' oune^
Mailing address (if different):
City:_State: Zip:_
(a.) Type(s) of septage punped'. Write in tha numhet ot oallons oumpod in (Example: Domestic:
50,000),
(5.) N.C. Couniies of Operation:
"?93?6
Domestic Portable Toilet Waste Grease (Restaurant)Treatment Plant I ndustrial/Commercial
75ooo
(List each county you are autho zed to do business in)
(6.) Total Numberof Pumper Vehicles Operated: 3
Number used for: Domestic Septage: .3 Grease (restaurant):Other: Portable Toilet Waste:
APPLICATION CONTINUED ON PAGE 2
Vehicle lnformation: (use additional paper if
PAGE 1
License Taq #Vehicle ldentifi cation #Tank Capacity
1 Yl,t/baD t /oL/A,t(Y)
2 Vat,/XlqLi AAJ k / H ihzvn k $ ) t-ltiv .<a 2 sr>/>
3 Y A t1'{)s\t^l(ilil.fi) I^fi111 tti.{L, \2.;bD
4
5
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CoNTTNUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (y{yes ( )no.
lf you checked yes above, you must attest to the following statement before a permit may be issued.
"l 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 138 .0835(a) and vehicle lettering
as required by 15A NCAC .0835(b). Furthermore, I also certify that a log is maintained of each septage pumping event as
required by 15A NCAC 138 .0836(a). I am aware that there are signilicant penalties for false certification including the
possibility of flne and imprisonment.'
Do you aftest to the statement above? ( rzlyes ( ) no lattal 7 0 DXe o(-/A- 2022
(8.) Septage Disposal Method: (check one)
a)Approved wastewater keabnent plant: ( 4yes ( ) no. lf yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of theSeptage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets ifneeded)
SLA#: 7fl -,) 3 Expirafron Dale: / t - o? -"l0rq SLA,s#i:Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Pemit Numbers: (use additional sheets if needed)
SDTF#:_Expiration Date:_ SDTF#:_Expiration Date:
(9.) Septage Management Firm Operator Training C
Date: O,rl/alOAl tocation:Horo, 7
Training Spnsored or Provided by:
(10.) Septage Land Application Site Operator Training Completed:
Dale: DA/ d0 / ^ Location: rl Hoursr F
Tnaining Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm: _ ,
Registeed Septage Management Firm: uuz
Registered Portable Sanitation and Septage Management Firm:
CErtif ication Statement
I cefffy that the infonmtion and representations in this application for a permit are true, complete, and accurate to the best
of my knowledge and bellef, I am awate that a permit may be suspended or revoked upon a finding that its issuance was
based upon inconec{ or inadequate infomation that materially affected the decision to issue the permit and that ihere are
criminal penalties for knowlngly making a false statement, representation, or certification.
(, C - (_,_,, ,. "r-Title
Other Commenb:
PAGE 2
Rev.04-26-2021
CLI- '2'ao;?A
Date
AUTHORTZATION TO DISCHARGE SEPTAGE TO AWASTEWATER
TREATMENT FACILITY
North Carolina Department of Environmenlal Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, N.C, 27699-1646
Fee assessments and waste determinations will be required at the discretion of the wastewater healment
facility. The facility has the ultimate prerogative to deny discharges of any wastes to the incoming
uJastewater stream,
I, Scott McCov #24382 Cross Creek WRF / Rockfish Creek WRF
(Plant Operator in Responsible charge (oRc), oRc Llcense Number, Name o{ Plant)
P.O. Box 1089 Favettevitle. NC 28302-1089
(Auoressl
[phone] do hereby authorize
{Phone Numbei)(Ovrner/Operator of Seplage [,ianagement Firm)
Maxine Jones
of Beltgn's Seotic Tank Service NCS# 00280
(Septage lanagemenl Firm Name and NCS number)
to dispose ofi domestic septage X , portable toilet wasie
grcase septage (grease trap pumpings) _ commetcial/industrial septage _, from
Cumberland & surroundino counties
{Counly or other Gaographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Facilitv lnfluent Pump Station
(Localion)
betlveen the hours of Sunrise to Sunset
Reintroducing partially treated liquid into a grease trap is acceptable _Yes *{_No
ort Jiklzl-
Subscribed and af,irmed before me this c?.*i -- Oay ot'/Ja>uzn &eu-- .20 z/
My Commission expires:Auoust 15. 2024
SrSolid_WastelCLA/SEPTAGSFORMSI2o22 Finn AppticationMMP Authorization Form 2022
ilii"9'-i*,
'1m$
PAID
FIRM NAME: Belton’s Septic Tank Service
PERMIT #: NCS-00280
AMOUNT: $800
PAID BY: Check
DATE: 11/8/2021

Adam Ulishney