NCS00321_2022Permit_Initial

2022
Permit and Registration
Goldston's Concrete and Septic Tanks, Inc.
NORTH CAROLINA
Environmental Quality
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00321
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
,:����D E
PfORTH CAROLINA :;.�
Department of Environmental quality
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 Asheboro WWTP, Asheboro NC
2. Town of Siler City WWTP, Siler City 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.
Digitally signed by Wm
Perry Sugg
Date: 2022.10.02
20:24:28-04'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646
(1.) Firm name: (The "Finn name" must be exactly as it is shown on your vehicle(s)).
r
Street address of office: ' 1 Nuillk
City: �?& Vyl mr State:J�j iZip: I ij 16
Mailing address (if different):❑7a,)-7 3
City: r State: N L ip
Phone: ,�� - �-,���. —Fax:
County: - K rA
(2.) Firm owner's name:
Management Firm permit number: NCS # D D 3 I
t 1
Mailing address (if different): Sr�ch& c.s Gt� \/P.
City:_ — State: — Zip —
Phone: Fax:
(3.) Firm operator's name: �S QYky G �, '�-.'rrx 0 )a ty- Firm operator's title:
Mailing address (if different): _
City:_
Phone:
State: Zip:
Fax: —
(4.) Type(s) of septage pumped: Write in the number ofgallons pumped in last 12 months (Example: Domestic: 50,000).
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant
(5.) N.C. Counties of Operation: REA � i7�T �A,n A Q)'1Q12 m
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: S f
Number used for. Domestic Septage: Grease (restaurant):
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License tag #
Vehicle Identification #
Tank Capacity
1
I
O
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(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 .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 are significant penalties for false certification including the
possibility of fine and imprisonment."
Do you attest to the statement above? (K) yes ( ) no InitiDate_ 'r ? ;T
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: (x) yes ( ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of the Septage Management Rules.
Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: _ __ Expiration pate: 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: (o
Date: !Q_L :ZVa! Location: f C _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 (Sig1 tune of companyofficial requireO T
Print Na e
Other Comments:
Date
Title
Rev. 04-26-2021
PAGE 2

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
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, Michael R. Wiseman ORC WW4#987680 City of Asheboro Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
1032 Bonkeme er Drive Randleman, NC 27317 _
(Address)
336-672-0892 do hereby authorize Larry Go ton
(Phone Number) (Owner/Operator of Septage Management Firm)
of Goldston Concrete, Inc. NCS# 500 321
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste ,
grease septage (grease trap pumpings) X commercial/industrial septage _ , from
Randolph County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
1032 Bonkemeyer Drive, Randleman, NC 27317
(Location)
between the hours of 7:00 a.m. to 5:00 p.m. Monday - Friday Only
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2022
(Usually December 31, Year)
Signed .12, Date
(Facility Operator)
Subscribed and affirmed fore me this day of { J��x� 20Qlnc�/Zt
", A My Commission expires: CLn AJK—' Wz�;-
( ary Public)
(P@CIALL SE&L)
V
PUg%? A.
Note: Falsification of this document by the septage management firm shall lead to perm& ation. G�J-S
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2019 Firm Application/WWTP Authorization Form 2019 �I,O LPH''``�\

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
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,
BRITTANY YORK. 1007288. TOWN OF SILER CITY WWTP
(Plant Operator and Name of Plant)
PO BOX769. SILER CITY. NC 27344
(Address)
[phone] do hereby authorize Larry Goldston
(Phone Number) (Owner/Operator of Septage Management Firm)
of Goldson Concrete and Se;,,tic NCS # 500321
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste X
grease septage (grease trap pumping) NO commercial/industrial septage NO from
CHATHAM COUNTY
(County or other Geographic Area)
at the above -named wastewater treatment facility. Septage shall be discharged at:
HEADWORKS
(Location)
between the hours of MON.-FRI. 7AM-4PM
Reintroducing partially treated liquid into a grease trap is acceptable Yes X_ NO
This authorization shall be valid until _ DEC. 31,2022
(Usually December 31, Year)
Signed Date
(Facility rator)
Sworn to and subscribed before me this _ day of 20
My Commission expires: 1 I L3�
(Notary Public)
Sp
iN
ry�rryyCd
gYiISSial
G
Note: Falsification of this document by the septage management firm shall lead to permit revocatidh\.;C7Pq�
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2011 Firm Application/WWTP Authorization Form 2015 y. "1&8LIG y
'A 07,24-24 `��
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First Name Last Name
Received � Credit Hours
of Continuing Education
This Certificate of Attendance Presented By:
rd C STA
NORTH CAROLINA SEPTIC TANK ASSOCIATION
Hours Accredited by:
NCOWCICB
NC Division of Waste Mgmt
Septage Firm Mgmt 4 Hours
REHS Board
WPCSOCC CE03191906 (Subsurface Operator)
❑ Other:
Important: Keep this in a safe place.
Date: 2021
Signed: `
Jerry O. Pearce, NCSTA President
Duplicates are not available.

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicles)
Septage Firm Permit #: NCS-
Number of Pumper Vehicles: I
CERTIFICATION:
" I certify, under penalty of law, that the pumper vehicle or vehicles listed in the
submitted permit application meet the requirements for safe and sanitary
transportation of septage as required by15A NCAC 13B .0844 (a) and vehicle
lettering as required by 15A NCAC 13B .0844 (b). 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."
Signature (Si ature of company official required)
Print Name
r
Date
s r ►^
Title
S:lSolid_Wastelclalseptagelforms%Pumper Vehicles Cetification.doc

DE ��� North Carolina Department of Environmental Quality
Division of Waste Management
"'�'"�''� Solid Waste Section INVOICE
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
phone: [phone] fax: [phone]
email: [e-mail]
Description
Septage-Annual:
Goldston's Concrete and Septic Tanks, Inc. (NCS-00321)
PO Box 737
Ramseur, NC 27316
Number of Trucks: 1
To: Larry L. Goldston
Goldston's Concrete and Septic Tanks, Inc.
PO Box 737
Ramseur, NC 27316
Date: 09/20/2021
Invoice #: NCS-00321-2022 Y
i
Amount Due 6
I'
$550.00
i
Total Amount Due $550.00
Date Due 12/15/2021 I
Payment O tip ons:
E-check - Available online at http://go.nedenr.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.
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.]
Explanation of Invoice Amount is Based on Facilites Current Permit Status:
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.
Solid Waste Connects:
Billing process:
Alby Alexander [phone]
Regufaati&i s and Technical Assistance.
Adam Ulishney [phone] Septage Management Firms, Land Application Sites, Detention Facilities
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/aboutidivisionswwaste-managementlelectronics-management
North Carolina Septage Program - https:/Ideq.nc.gov/about/divisions/waste-managementtwaste-management-rules/septage
NC Solid Waste Invoice Form 1-2016

PAID
FIRM NAME: Goldston's concrete and Septic tanks, Inc.
PERMIT #: NCS-00321
AMOUNT: $550
PAID BY: Check
DATE: 11/19/2021
Adam Ulishney