NCS01279_2022Permit_Initial

NORTH CAROLINA
Environmental Quality
2022
Permit and Registration
George Bros.
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01279
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
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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. Johnnie Mosley Regional WRF, Kinston 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
20:39:14-04'00'
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 "Firm name" must be ex� as it is shown on your vehicle(s)).
&e-or, ros,
Street address of office: So 1� 0 on e_ `1Z cl
City: Lv'p— 10ck State: kC. Zip: ? 5 3 a
Mailing address (if different):
City: State: Zip
Phone: '� 5a - (, 7 5 — p y 3 y Fax: 2 Sa - AIv 7 -
E-Mail: r o r, aA oo . caw.
County: C rkL.,Jer) Septage Mana ement F' 79
(2.)
(2.) Firm owner's name: lZ aw to w 4-
Mailing address (if different):
City:
g irm permit number. NCS * O l.2
State: Zip
Phone: Fax:
(3.) Firm operator's name: �Rrnr 10 U,1 (Te d` c- Firm operators title: ±�fn e�
Mailing address (if different):
City:
State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Me in the number of gallo_ n�urmoed in last 92 months (Example: Domestic: 50,000).
(5.) N.C. Counties of Operation: Cc-� feve.f C,rave-^ }Paw,; I L a
(6.)
(List each county you are authorized to do business in)
Total Number of Pumper Vehicles Operated: 1
Number used for: Domestic Septage: /
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
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? (/_ ✓.1 yes ( ) no Initial Date o� -
(8.) Septage Disposal Method: (check one)
_ �_QL
a) Approved wastewater treatment plant:( ,/) yes ( ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of theSeptage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: Expiration Date: 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 Managgtnen�Fi Operator Training Completed:
Date: 77 / Location: Hours: 6
Training Sponsored or Provided by: A/C S TA
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
01.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
Hours:
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.
�Q�
Signature (Signature of �Compa�nyoffidal require
D►r jot ' Ge-o ✓� cL
Print Name
Other Comments:
Date
Title
),,')- "18-.2/
PAGE 2
Rev. 04-26-2021

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehide(s)
Septage Firm Permit #: NCS-O IX7 9
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 (sign �compp�anyynffit�i,/.,,�i..4i Date
%?6Wjo t.-I 'rev r ev-frier
Print Name Title
S.1Solid_WastelclalseptageVormSTumper Vehicles Cetification.doc

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, Kenneth R. Stevens. Jr.- Wastewater License #21198 Johnnie Mosley Recional Water Reclamation Facility
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
0 Drawer 339, Kinston NC 28502
(Address)
252-939-3375 do hereby authorize Rarlow George
(Phone Number) (Owner/Operator of Septage Management Firm)
of George Brothers NCS # 01279
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage _ X portable toilet waste X
grease septage (grease trap pumpings) - commercial/industrial septage from
Lenoir and su ounding counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Johnnie Mosley Regional Water Reclamation Facility- 2101 Becton Farm Road
Bdery Run Lift Station- Hiahwav 55 East
(Location)
between the hours of 8:00 a.m. to 4:00 n.m. Monda thru Frida
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31 2022
Signed Date / 3
(Facility Operator
Sworn to and subscribed before me
(Notary Public)
day of 1 20
My Commission expires:
Note: Falsification of this document by the septage management firm shall lead to permit revoca
S:/Solid Waste/CLA/SEPTAGE/FORMS/2013 Firm ApplicationMfWTP Authorization Form 20
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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:
George Bros. (NCS-01279)
250 Boone Rd
Havelock, NC 28532
Number of Trucks: 1
To: Rarlow George Wulie George
George Bros.
250 Boone Rd
Havelock, NC 28532
Date: 09/20/2021
Invoice #: NCS-01279-2022
Amount Due
�$550.00
Total Amount Due 1 $550.00
Date Due 12/15/2021
Payment Options:
E-check - Available online at http://go.ncdenr.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 Facilitv's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay feels) based on your solid waste management activities. The fee(s)
shall be used to support the septage management program.
Solid Waste Contacts:
Billing process:
Alby Alexander [phone]
Regulations 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/about/divisions/waste-managementielectronics-management
North Carolina Septage Program - https://deq.nc.gov/aboutidivisions/waste-management/waste-management-rules/septage
NC Solid Waste Invoice Form 1-2016

PAID
FIRM NAME: George Bros.
PERMIT #: NCS-01279
AMOUNT: $550
PAID BY: Check
DATE: 12/13/2021
Adam Ulishney