NCS01275_2022Permit_Initial

NORTH CAROLINA
Environmental Quality
2022
Permit and Registration
JW Septic Service LLC
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01275
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. Mount Airy WWTP, Mount Airy NC
2. Septage Detention or Treatment Facility, SDTF-34-06 & 60-09
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
20:37:48-04'00'
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*
JW Septic Service LLC
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01275
Enter the five digits following the NCS #
Street address of office*
Street Address
402 North Franklin Rd
Address Line 2
city State / Province / Region
Mt. Airy NC
Postal / Zip Code Country
27030 us
County*
Surry
Mailing address same as street address of office?*
• Yes No
Phone* Fax
336-325-0899
Email*
[e-mail]
Owner Info
Firm owner's name*
Jeremy Williamson
Mailing address same as street address of office?*
• Yes No
Phone* Fax
336-325-0899
Operator Info
Firm operator's name* Firm operator's title
Jeremy Williamson Owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
336-325-0899
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 1 68, 000
Portable Toilet Waste 0
Grease (Restaurant) 29,000
Treatment Plant 58,000
Industrial/Commercial 158,500
North Carolina counties of operation}
List each county you plan to do business in: *
Surry, stokes, Yadkin, Wilkes, Forsyth,
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
Date*
12/30/2021
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage EK-1229 1GDJ6H1J8TJ510292 2,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
0 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*
Mt. Airy waste water treatment plant
Liquid environmental solutions
Septage Land Application Sites (SLAS)*
Yes • No
Septage Detention or Treatment Facility (SDTF)*
Yes • No
Expiration Date* Authorization
12/31/2022 image.jpg 2.14MB
12/31/2022 image.3pg 1.85MB
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed
Date* Hours*
6/9/2021 6
Location*
Clemons
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
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
12/30/2021
05:28:50 AM
Print Name* Title*
Jeremy Williamson Owner

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,
of
RC oftl
A�
(Plant Operator' in Responsible Charge (ORC), ORC
•
• � - ter• - �
(Address)
- '1U�O '.3� do hereby authorize
(Phone Number) (Owner/O
W c�1 I'� CGQ t oGdz
Number,, Name of Plant)
V\ut A
I c' Z4 a 30
of Septage Management Firm)
Septage Management Firm Name and NCS number)
to dispose of: domestic Septage portable toilet waste
grease septage (grease trap pumpings)
sw
commercial/industrial septage , from
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of
�%C, /I+ l
Reintroducing partially treated liquid into a grease trap is acceptable Yes ✓No
This authorization sh be valid until .Jae mil, Z02z-
zo '�/J (Usually December 31, Year)
Signed
(Facility Operator)
Date /d//r//,?
Subscribed and affirmed before me the day of 20
ry Public)
My Commission expires:
NOTARY PU
HRISTOPHER I WALLACE
North Carolina
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2016 Firm Application/WWTP Authorization Form 2016

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT 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.)
1, Liquid Environmental Solutions
(Facility Operator)
Place, Charlotte, NC 28216 and at 750 Pa
(Operator Address)
do hereby authorize: Jeremy Williamson
(Owner of Septage Management Firm)
107
_ JW Septic Service NCS # 01275
(flame of Septage Management Firm)
402 N Franklin ST MT Airy, NC 27030
(Address of Septage Management Firm)
to utilize septage detention or treatment facility # STDF 34-06 & STDF 60-09 for the treatment or
storage of septage *
in 2021-2022 . The facility will be operated in accordance with the Septage Management Rules **
f
Date: 11 /30/21 Signed
Mayberry, Processing Facility Manager
* As defined in G.S.130A490(a)(32)
** As defined in 15A NCAC 138.0800
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: JW Septic Service LLC
PERMIT #: NCS-01275
AMOUNT: $550
PAID BY: E-Card
DATE: 12/31/2021
Adam Ulishney