NCS01222_2022Permit_Initial

2022
Permit and Registration
Lewis Farms
is hereby issued a Septage Management Firm Permit,
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Permit Number NCS-01222
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o and registered as a e:,e D:;.�EQ2�
` 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-71-08
2. Septage Land Application Site, SLAS-71-08
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
20:35:42-04'00'
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*
Lewis Farms
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01222
Enter the five digits following the NCS #
Street address of office*
Street Address
8155 Malpass Corner Road
Address Line 2
City
State / Province / Region
Currie
NC
Postal / Zip Code
Country
28435
United States
County*
Pender
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9102839823
Email*
[e-mail]
Owner Info
Firm owner's name*
Lewis Farms and Liquid Waste Inc
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9102839823
Operator Info
Firm operator's name* Firm operator's title
Wesley Wooten Owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
9102839823
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 300,000
Portable Toilet Waste 200,000
Grease (Restaurant) 300,000
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
New Hanover, Pender, Duplin, Onslow, Brunswick, Columbus, Bladen, Sampson
Vehicle Info 16- 1
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*
12/15/2021
Title*
owner
Choose how to add vehicle descriptions*
Add vehicles individually • Upload List
Upload vehicle list*
You can upload a file with a list of vehicles to be used. Please be sure to include the following information for each vehicle on your upload: Usage, License Tag #, Vehicle
Identification #, and Tank Capacity.
Pages from Septage Renewal Lewis Farms.pdf 45.22KB
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-71-08 2/20/2018
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-71-08 3/3/2019
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed
Date* Hours*
4/7/2021 4
Location*
Shallotte
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed^
Date Hours
0
Location
Training Sponsored or Provided by
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

(6.) Total Number of Pumper Vehicles Operated: �J
Number used for: Domestic Septage: S Grease (restaurant}:
Other. Portable Toilet Waste: S
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
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2N Y, M H 2r1 Xo 5
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2MA
10 9
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140oo
3
I S37
10 KD XN —J 3t 51 9
Soo
4
126835
U D we 1 "v6 I
I to Do©
5
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1 2N LPJ0 X LYCMl 0
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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
12/15/2021
03:48:03 AM
Print Name* Title*
Wesley Wooten Owner

PAID
FIRM NAME: Lewis Farms
PERMIT #:
NCS-01222
AMOUNT:
$800
PAID BY:
E-Check
DATE:
12/17/2021
Adam Ulishney