NCS00667_2022Permit_Initial

2022
Permit and Registration
Pro Service Septic
is hereby issued a Septage Management Firm Permit,
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Permit Number NCS-00667
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o and registered as a
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a= Septage Management Firm OORTHeCAROLIN nmentalQuality
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E#f 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. City of Forest WWTP, Forest NC
2. Town of Spindale, Spindale 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
20:29:24-04'00'
Perry Sugg, Environmental Compliance Branch Head

APPIJCATtW FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
WWN OF WASTE HAM OWNT • SOUD WASTE SECTION- ISU WL SERy10ECENrEk RALEIGN, NC 278➢6111,I6
If.) Firm name: all Tlrmm ca'moetb►g ss R is shown on9rour soh ele(s)j
4
Sh®d address of
W&q address (d ciften):
EAU.
C-lY FirmpemitmLrnba: NCS/ Q©W� !
(Z) Firm owners mire: 1 f t n
IAaitrg address {d GAererd).
pY Stale: 7<
Phone: Fax
r
(3.) Finn cpaalWsnare: 1 opaafds title:
maimadd�ss (d
CtY• State: L;
Ph".. Fax _
K) Type(s) ofseptage pumped: (Example: Domes#c:50,000).
Damste Portable TaietWaste Gmwe Mestarany Tmahrmt Pkdd� ,IMrstrulrCummeidell
_.,.. ( �
f4 N.C. Cambes of Opardon: 1J
PM -wh Me0b)- wrMbetrad m ee bwlmu+M
N Total NrrOer of PwWVdvdes Opxaled: i
Nurribausedbr: DommkSeplap I maselm sarq:
Mum. PorMle ToW Waste:
Velddekdumatiar (usea&WmWpaper dneeded)
,�.+ Tap i1 h1%aNde kkrxkBcadon# --7art�t.Sapi�- —
4
4. J
5.
,APPLICATION CONTINUED ON PAGE 2
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 7i
R4 Do you Wan to operate pumper vehicles? (check one) ( Yes( ) m.
Nyou checked yes above, you mot atbsl to tre fdbadng slatmrexel bebre a pwwA may be Issued.
I Ge". xnder perety dfaw. Drat the purgerWide Orvehiclas kslod b the sr6mieed permt appkabon meets the
requremards lor sane and salary as spata6m d sepmge as requred by 15A NCAC 13B.0835(a) and vehide levmehg
as reaahrad by 15A NCAC.0835(b), Futwmore, I also cerldyOW a lug is madanad ofeach seplage W*ng evert as
required by I5A NCAC 13B.0836(a),I an aware tut thae are sogicart penalties for false cWcabDn kxkdkxg tha
pormbliry d Fme xmd imprisorrrenL'
Do you adesibthe statemerdabove? ( )yes I,)no hhWjLS_Date
(t) SePtage Dopogal MOW., (clack one)
a)Aq—VdvmeoavaWb-lff-tptad:( ✓(yes()m.tYes, 2M,atWaskevralerTmMawdMinizaEwhfor each
plats, as kdc*d in Subpa lyaph.0Ci4(c)(14) d theSeplage Maroganat Ruled
b) Septage LaWAppkabm Ste(SLAS)PenNNwbms:(uwadgmWshwbireededt
MSC: Expiakan Date: SLAS#: Fapirabon Date:
c)Sepfage Ookfi n mTragkmtFaciq (SOTF) P=dNwnbers: (use add'tluxal sheet dreeded)
SOTF#: ExpirabonDab: SDTF#: ExpkamBele:
(t.) Soptage USAWnerd Firm Opemla Tramm;; Camp /,'"PP0-y" r^
Bob: Locator - liars: rS
Tralmny. Sporamsd or Pro idedby. �U - S r )4
(It.) sePtayeas Sde Opd alaTrasdng abom kd:
Dow
Lecakon: Hours:
Tmmsrg Sponsored or Proaded by:
III-)Repstrakntypem esled:CN.ECNONE
Ragscaed Ponade Sa tabon FmM
P,eystamdSeptapManarmedFirm: ✓
p� 0-14"CarWaxYna Qe—WnrrmrnfF -
https://edocs.deq.nc.gov/WasteManagement/DocView.aspx?id=1485715&dbid=0&repo=WasteManagement&cr=1 11/1/21, 7:57 PM
Page 2 of 2

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, Jacob Hodge Biological WW41002183 Town of Forest City Wastewater Treatment
Plant (Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
PO Box 728, 397 Riverside Drive, Forest City NC, 28043
(Address)
(828) 248-S217 do hereby authorize Kirk Smith
(Phone Number) (Owner/Operator of Septage Management Firm)
of Pro Service Septic [phone] NCS # 00667
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage , from
Rutherford County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Septage receiving station prior to influent screen. Screen to be raked and screenings placed in dumpster
by septage operator.
(Location)
between the hours of 8:00 am - 4:00 pm Monday - Friday
Reintroducing partially treated liquid into a grease trap is acceptable X Yes No
This authorization shall be valid until December 31 2022
(Usually December 31, Year)
Signed Date
(Face ity Operator)
Subscribed and affirmed before me this day of G r 20.2L
My Commission expires:
(Notgry Public) \�0byN S ��4 I
Flq L ` z
PUBLIC �=
Note: Falsification of this document by the septage management firm shall lead to permit��1NbY1
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

AUTI-JORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
`f
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,.� �c'� ° Town of Spindale
(Plant Operator in Responsible Charge ORC), ORC License Number, Name of Plant)
327 Ecology Street, Spindale, NC, 28160
(Address)
828-286-3407 do hereby authorize
(Phone Number) (Owner/Operator of Septage Management Firm)
of
NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage XXX , portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
Rutherford County, Cleveland County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
The influent distribution box inside the plant
(Location)
between the hours of 8:00 AM & 3:00 PM No weekends or Holidays
Reintroducing partially treated liquid into a grease trap is acceptable Yes xxx No
This authorization shall be valid until 1 4?, 2 L
(Usually December 31, Year)
Signed - ').7 -
(Facility Operator)
Subscribed and a !p ed b ore me this
(Notary Public)
Date i, A A4 1
�I V144..
day of - i'v 20
My Commission expires: _M �t4't /S 2a2
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

PAID
FIRM NAME: Pro Service Septic
PERMIT #: NCS-00667
AMOUNT: $550
PAID BY: Check
DATE: 11/18/2021
Adam Ulishney