NCS00107_2022Permit_Initial

2022
Permit and Registration
Bennie A Moore Septic Tank Service Inc
is hereby issued a Septage Management Firm Permit,
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Permit Number NCS-00107
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t o and registered as a e:,e DE
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` a= Septage Management Firm Department ofEnvironmental Quality
44 QIIAM
NORTH CAROLINA (PUMPER)
Environmental Quality
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. Greenville Utilities Commission WWTP, Greenville NC
2. Septage Detention or Treatment Facilities, SDTF-59-02 and SDTF-59-05
3. Septage Land Application Sites, SLAS-59-02 and SLAS-59-05
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.
Digitally signed by Wm
Perry Sugg
Date: 2022.10.02 20:21:55
-04'00'
Perry Sugg, Environmental Compliance Branch Head

For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-707-
8283).
Firm Info
Firm name*
BENNIE A. MOORE SEPTIC TANK SERVICE INC.
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00107
Enter the five digits following the NCS #
Street address of office*
Street Address
1150 Eli Bowen Road
Address Line 2
City
State / Province / Region
Willaimston
NC
Postal / Zip Code
Country
27892
United States
County*
Martin
Mailing address same as street address of office?*
• Yes No
Phone* Fax
2527925978 252-292-1074
Email*
[e-mail]
Owner Info {
Firm owner's name*
BENNIE A. MOORE SEPTIC TANK SERVICE INC.
Mailing address same as street address of office?*
• Yes No
Phone* Fax
2527925978 252-792-1074
Operator Info
Firm operator's name* Firm operator's title
Russ Ayers PRESIDENT
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
252-799-7461 252-792-1074
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic
61 3, 000
Portable Toilet Waste
0
Grease (Restaurant)
409,000
Treatment Plant
44,000
Industrial/Commercial
0
North Carolina counties of operation
List each county you plan to do business in: *
BEAUFORT- MARTIN-BERTIE- CHOWAN-TYRELL-HYDE-WASHINGTON-CRAVEN-WILSON-GREEN-
EDGECOMBE-PASQUOTANK-NASH-PERQUIMANS-CAMDEN-DARE-HERTFORD-HALIFAX-DUPLIN-
LENIOR
Vehicle Info]
Do you plan to operate pumper vehicles?*
• Yes No
"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*
11/8/2021
Title*
PRESIDENT
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Grease (restaurant) YA78060 3HAEKTOK1405450 4,100
Grease (restaurant) YA156773 3HTEKTAT7MN616479 4,200
Domestic Septage YA44344 1HTSDAAN8YH52173 2,500
Domestic Septage YA44345 1HTSDNUN8NH418138 2,100

Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
• Yes No
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
GREENVILLE UTLITIES 12/31/2022 Scan_0395.pdf 365.38...
Septage Land Application Sites (SLAS)*
• Yes No
If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site.
SLAS #* Expiration Date* Authorization
SLAS-5902 8/5/2021
SLAS-5905 8/5/2021
Septage Detention or Treatment Facility (SDTF)*
• Yes No
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.
SDTF #* Expiration Date* Authorization
SDTF-5902 10/7/2021
SDTF-5905 8/5/2021
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed ^
Date* Hours*
5/13/2021 6
Location*
WASHINGTON, NC
Training Sponsored or Provided by*
NC Septic Tank Association

Septage Land Application Site Operator Training Completed
Date Hours
5/13/2021 3
Location
WASHINGTON NC
Training Sponsored or Provided by
NC Septic Tank Association
Registration Type
Select one*
Registered Portable Sanitation Firm
• Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes^
Comments or 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
11/8/2021
09:51:17 AM
Print Name* Title*
RUSS T. AYERS PRESIDENT

,'7 Greenville
a�_ Utilities
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of 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.
I, M. Jason Manning, WW-415210 Greenville Utilities WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
240 Aqua Lane PO Box 1847 Greenville, NC 27835
(Address)
[phone] __do hereby authorize Russ vers
(Phone Number) (Owner/Operator of Septage Management Firm)
Of Bennie A. Moore Septic Tank Service N CS # 00107
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage i/ portable toilet waster/
grease septage (grease trap pumpings) commercial/industrial septage , from
Pitt County and Surrounding Areas
(County or other Geographic Area)
at the above -named wastewater treatment facility. Septage shall be discharged at:
Greenville Utilities WWTP
(Location)
between the hours of 8:30AM-4:30 PM Monday through Frida
Reintroducing partially treated liquid into a grease trap is acceptable Yes -4 No
This authorization shall be valid until December31, 2022 _
(Usually December 31, Year)
Signed 14Date
(F cilityOperator)
Note: Falsification of this document by the Septage management firm shall lead to permit revocation.
S:/Solid_Waste/CiA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018
Connected To You Post Office Box 1847 1 Greenville, North Carolina 27835-1847 1 guc.com 1 252-752-7166

PAID
FIRM NAME: Bennie A Moore Septic Tank Service Inc
PERMIT #: NCS-00107
AMOUNT: $800
PAID BY: Check
DATE: 11/10/2021
Adam Ulishney