NCS00672_2022Permit_Initial

2022
Permit and Registration
Triple A Sanitation

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00672
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. Town of Columbus WWTP, Columbus 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
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 oce*
County*
Mailing address same as street address of oce?*
Mailing Address*
Phone*Fax
Email*
Firm owner's name*
Mailing address same as street address of oce?*
Phone*Fax
Firm Info
Triple A Sanitation
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00672
Enter the five digits following the NCS #
City
Mill Spring
State / Province / Region
NC
Postal / Zip Code
28756
Country
USA
Street Address
475 Short Creek Drive
Address Line 2
Polk
Yes No
City
Mill Spring
State / Province / Region
NC
Postal / Zip Code
28756
Country
United States
Street Address
PO Box 219
Address Line 2
828-899-8603
[e-mail]
Owner Info
Stacey Price
Yes No
828-899-8603
Firm operator's name*Firm operator's title
Mailing address same as street address of oce?*
Phone*Fax
Amount in gallons*
Domestic
Portable Toilet Waste
Grease (Restaurant)
Treatment Plant
Industrial/Commercial
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 .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 13B .0836(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
Stacey Price
Yes No
828-894-8603
Type and amount of septage pumped in the last 12 months
50,000
150,000
0
0
0
North Carolina counties of operation
Polk
Vehicle Info
Yes No
12/31/2021
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 YA000599 2NKMH07X81M870022 2,000
Portable Toilet Waste JP4758 3D6WD66A08G214523 500
Portable Toilet Waste JP4787 1FDUF5HTXKDA22462 1,100
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Columbus WWTP 12/31/2022 IMG_0001.pdf 488.91…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
1/28/2021 8
Hickory
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
0
Registration Type
Select one*
Comments or notes
Signature
Date
Print Name*Title*
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Certication 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.
12/31/2021
10:27:51 PM
Stacey Price Owner
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTHWATER TREATMENT FACILITY
North Carolina Department of Environmental euality
Division of Waste Management - Solid Wa:;te Section
1646 MailService Center, Raleigh, NC 27699-1646
Fee assessments and waste determinations will be required at the discretion of the wastewatertreatment facility' The facility has the ultimate prerogative to deny discharges of any wastes to the
incoming wastewater stream.
t,
t operator in Responsible charge (oRc), oRc License lrlumber, Name of plant)
355 Cbl z2:*
(Address)
,do hereby authorize
C i oaS
,L;
of
(Phone Number)-i.ioL ,?e
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable _yes - No
This authorization shatt be vatid untit 0? C- 3 l 2l
(Usuall',, December 31, Year)
Signed Date i2-29 -?t
(Facility Operator)
My Comm
Note: Falsification of this document by the septage management firm shall lead to permit revocation.s:/solid-waste/cLA/SEPTAGE/FoRMS/2018 Firm Application/wwrp Authorization Form 2018
(Septage Management Firm Name and NCS number)
grease septage (grease trap pumpings) _ commercial/industrial septage _, from
ribed and affirmed before me
Management Firm)
,'on)
,o^(
PAID
FIRM NAME: Triple A Sanitation
PERMIT #: NCS-00672
AMOUNT: $800
PAID BY: E-Card
DATE: 12/31/2021

Adam Ulishney