NCS00393_2022Permit_Initial

2022
Permit and Registration
Parks Septic Tank Cleaning Service
is hereby issued a Septage Management Firm Permit,
tszArr of
"� Permit Number NCS-00393
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o and registered as a e:-e D.E CIA�
NORTH CAROLINA Q
` � a= Septage Management Firm Department ofEnvironmental Quality
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. Septage Detention or Treatment Facility, SDTF-98-08
2. Septage Detention or Treatment Facility, SDTF-96-01
3. Septage Land Application Site, SLAS-96-05
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 20:25:36
-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*
PARKS SEPTIC TANK CLEANING SERVICE
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00393
Enter the five digits following the NCS #
Street address of office*
Street Address
798 parkstown road
Address Line 2
city
State / Province / Region
lagrange
NC
Postal / Zip Code
Country
28551
United States
County*
Wayne
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
9197780264
Email*
[e-mail]
Owner Info
Firm owner's name*
chris parks
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9197385834
Operator Info
Firm operator's name* Firm operator's title
chris parks7
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
9197780264
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 700,000
Portable Toilet Waste 0
Grease (Restaurant) 250,000
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation}
List each county you plan to do business in: *
wayne,greene,wilson,johnston,lenoir,duplin
Vehicle Info^j
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
cod
Date*
12/31/2021
Title*
owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage*
License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage
YA-105271 1HTSCAAN3XH674500 2,000
Domestic Septage
YA- 003432 1HTSDAAN4XH611810 2,500
Septage Disposal Method �^
For each method, indicate whether you plan to use it by checking yes or no.

Approved wastewater treatment plant*
Yes • No
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-96-05 5/24/2023
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-96-01 12/26/2023
SDTF-96-13 5/24/2022
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed^
Date* Hours*
10/19/2021 4
Location*
burmill park greensboro,nc
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
10/19/2021 3
Location
burmill park greensboro,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
12/31/2021
03:39:40 PM
Print Name* Title*
chris parks owner

AU I HURILA I iON 10 DISCHARGE SENT AGE AT A SEP TAGE TREATMENT T OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission has been given to a permitted
Septage Management Firm to discharge septage into the permit holders detention or treatment facility.)
Damei L Newsome
441 Buck Newsome Rd. Fremont, NC 27830 (Facility Operator)
do hereby authorize:
Parks Septic Tank Cleaning Service
(Name of Septage Management Firm)
798 Parkstown Rd. LaGrange, NC 28551
(Operator Address)
Cnris Parks
(Owner of Septage Management Firm)
00393
NCS #
(Address of Septage Management Firm)
98-08
to utilize septage detention or treatment facility #
in 2022
Date:
for the treatment or storage of septage *
The facility will be operated in accordance with the Septage Management Rules **.
Signed
Operator)
* As defined in G.S. 130A-290(a)(32)
** As defined in 15A NCAC 13B .0800
Return the properly completed form to:
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

PAID
FIRM NAME: Parks Septic Tank Cleaning Service
PERMIT #: NCS-00393
AMOUNT: $800
PAID BY: E-Check
DATE: 12/31/2021
Adam Ulishney