NCS01281_2022Permit_Initial

2022
Permit and Registration
A Countywide Septic
is hereby issued a Septage Management Firm Permit,
i!51'ArE of
Permit Number NCS-01281
"= 0
o and registered as a
e: EQ
NORTH CAROLINA
` a= Septage Management Firm Department nmentalQuality
!^nvL z n�
EueQIIiN
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-78-22
2. Septage Land Application Site, SLAS-78-23
3. City of Lumberton WWTP
4. Central Johnston County Regional WWTP
5. Cross Creek WRF
6. West Brunswick Regional WWTP
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
_65,
Perry Sugg
Date: 2022.10.02
20:39:51-04'00'
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*
A county wide Septic tank service 0
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01281
Enter the five digits following the NCS #
Street address of office*
Street Address
373 Swift Creek rd
Address Line 2
City
State / Province / Region
Raeford
North Carolina
Postal / Zip Code
Country
28376
USA
County*
Hoke
Mailing address same as street address of office?*
• Yes No
Phone* Fax
910624-2587 910875-1777
Email*
[e-mail]
Owner Info
Firm owner's name*
Belton Wayne Jones
Mailing address same as street address of office?*
• Yes No
Phone* Fax
910-712-4091
Operator Info
Firm operator's name* Firm operator's title
Belton Wayne Jones Owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
910712-4091
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic
30,000
Portable Toilet Waste
0
Grease (Restaurant)
0
Treatment Plant
0
Industrial/Commercial
0
North Carolina counties of operation
List each county you plan to do business in: *
Hoke, Cumberland, Brunswick, Lumberton, Harnett, Bladen, Moore, Sampson,
Columbus, Lee, Johnson
Vehicle Info
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
g dJlr ]'io
Date*
6/30/2022
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA103857 1HTMKAAN13H569542 20,000
Domestic Septage YA132942 2NP2HN7X8AM110101 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
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*
Beltons
Expiration Date* Authorization
1/27/2023
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 #*
SLAS-78-23
Expiration Date*
6/30/2023
Authorization
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 #*
SDTF#78-22
Other disposal method*
Yes • No
Expiration Date*
6/30/2023
Authorization
Septage Management Firm Operator Training Completed
Date* Hours*
1/27/2022 6
Location*
NC Septic Tank ASS.
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
1/27/2022 6
Location
NC Septic tank service

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
Certif cation 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
6/30/2022
11:38:55 AM
Print Name* Title*
Belton Wayne Jones Owner

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.
HenryHarper: ORC WW# 1008147 _ City of Lumberton Waste Treatment
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
700 Lafayette Street. Lumberton NC_28358__ Contact: Tam— Smith 910-671-3858
(Address) (Contact / Phone Number)
do hereby authorize
Wavne Jones-
(Owner/operator of Septage Management Firm)
of A Count Wide Se tic Tank Service NCS # 01281
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage Yes , portable toilet waste Yes
grease septage (grease trap pumpings) NO commercial/industrial septage Yes , from
Robeson and Surrounding Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
The Influent Basin at 700 Lafayette Street Lumberton, NC 28358 _
(Location)
between the hours of.- 7 am to 4 pm Monday — Friday. No weekends or Holidays _
Reintroducing partially treated liquid into a grease trap is acceptable Yes X,No
This authorization shall be valid until __
December 31" 2022
(Usually December 31, Year)
Signed N&
Date i!4�f
�acfflty Operator)
4. day of G L,
it ed before me this
Y �---
r,
My Commission expires: &"k&x__ f 9 &2r
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid Waste/CLA/SEPTAGE/FORMS/2014 Firm Application/WWTP Authorization Form 2014
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AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste,150, Raleigh, N.C. 27605
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.
1, John D. Wall Central Johnston County
al Wastewater
s� atej Treatment Plant
ant operators aa of
Post Office Box 2263 Smithfield North Carolina 27577
(Address)
do hereby authorize ��� �1 ��- ✓'L AC- NCS#_1281
919 9$ -- (Owner/Operator of septage Management F
(PPhonehone umber} inn)
N
of A Coun -de 5e tic bervices mu. or o o-11i —un--
(Septage Management Firm Name and address)
to dispose of: domestic septage X , portable toilet waste X
Johnston County does not accept grease traps and pumpings.
Johnston County. North Carolina (County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of 8:00 A.M. thru 4:45 P.M: Monda thmu h Frida .
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be Valid until riot 31; 2022
(usuaity December 31, Year)
Signed ��—
LG .J Date���
John D. Wal (Facility Operator)
Sworn to and subscribed before me this
day of 2o ,R.
My Commission expires:
Nancy House (Notary Public)
*Waste generated in other counties will not be accepted.
All waste must be generated in Johnston county.
Note: Falsification of this document by the septage management firm
shall lead to permit revocation.
(OFFICIAL SEAL)
NANCY HOUSE
NOTARY PUBLIC {
JOHNSTON COUNTY, N.0 • i
My commission Expires 41-2123•

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, N.C. 27699-1646
Fee assessments and waste determinations will be required atthe
discretion
wastes to the water tg atment
facility. The facility has the ultimate prerogative to deny discharges Y
wastewater stream -
Scott McCov #24382 _ Cross Creek WRF ! Rockfish Creek WRF _
I'_ (Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
p.0. gOxjo89 Fa etteville NC 28302.1089 (Address)
do hereby authorize Wa ne Jones
�910 223.4700 (ownerloperator of Septage Management Firm)
(Phone Number) NCS# 01281
Of
(Septage Management Firm Name and
to dispose of: domestic septage X �, portable toilet waste .�,
grease septage (grease trap pumpings)
commercialfiindustrial septage _ _, from
Cumberland & surroundin countiesCounty or other Geographic Area}
at the above named wastewater treatment facility. Septage shall be discharged at:
Facilit Influent Pum Station
(Location)
between the hours of Sunrise to Sunset
Reintroducing partially treated liquid into a grease trap is acceptable Yes —A-NO
This authorization hall be valid until December 31 2022
Date—[ t 2 1
Signed (Facility 0 r) —
Subscribed and affirmed before me this
day of
My Commission expires: Au ust 15 2024
7'4� (Notary Public �•I. ry We
�, AL SEAt�'�
TAIL
Ka r
No
te: Falsification of this document by the septage management firm shall lead to permit revocatborr' ftKIC
olid WastelCLAISEPS12022 Firm ApplicationlWWTP Authorization Form 2022 /��'•�, •••'' • • •' ••• �.•'�i'
sJS _ TAGFJFORM,�����r��u�n►���,,,

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
er
Fee assessments and waste determinations ibe required at the discretion of the wastewatprerogat a to deny discharges of any wastes to the
treatment facility. The facility has
' incoming wastewater stream.
1, Tim Webb_ # 21200. West 13rurtsw1cx nG ►�► •• �..•--•---_
(Plant operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
of
235 Grey Water Road, Supply, NC 28462
[phone] do hereby authorize
Wayne Jones
(Phone Number) (Owner/Operator of Septage Management Firm)
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage -- x — portable toilet waste.
rease tra um ins commercial/industrial septage
from
grease Septage (g p P p g) ��
Brunswick Coun
—� (County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
West Brunswick
Wastewater Treatment Facility, 235 Grey Water Road, Su ly, NC
(Location)
between the hours of Monde -#ride 8 a.m. - 6 n.m.• Weekends & Holidays 9 a.m.
Reintroducing partially treated liquid into a grease trap is acceptable
Yes X No
December 31 2022
This authorization shall be valid until (usually December 31, Year)
Signed
(Facility Operator)
Tim Webb personally known to MP -
Subscribed and affirmed before me this
My Commission expires: ai al0
(Notary Public)
DateZ2L
day of 20 Q1
LAUREN E. MILLER
Notary PutOFRMIC
Srunawick County
My C miasi rL,Expirea
Note: Falsification of this ocu 20 s Fibyy Application g/w P manaAuthogement
firm
m oa lead to permit revocation-
Note:
Waste/CLA/SEPTA /

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE LAND APPLICATION
SITE PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a land application site permit holder to indicate that permission has been
given to a permitted Septage Management Firm to land apply septage on the permit holders
land application site.) RECEIVED
P o
do hereby authorize:
�e
(Name of Sel
by Z�S
(Site Operator)
s d .306
(Operator Address)
UY
Owner of Septage Management Firm)
ge Management Firm)
(Septage Management Firm Address)
JAN 12 2022
NCS#�
SECTION
to use septage disposal site # -A� for the disposal of. gallons of septage* in 20�
Date: Dl 0 Od�2 Signed
(Site Operator)
* As defined in G.S. 130-A-290(a)(32). The site will be operated in accordance with 15A NCAC 13B
.0800 - Septage Management Rules
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

kHrom4ac.0 ufEwin4n:R;:nf.+1 Q,i;6;`�a �'=-A'j r
■
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:
A Countywide Septic (NCS-01281)
373 Swift Creek Rd
Raeford, NC 28376
Number of Trucks: 2
INVOICE
To: Belton Wayne Jones
A Countywide Septic
373 Swift Creek Rd
Raeford, NC 28376
Date: 09/20/2021
invoice #: NCS-01281-2022
Total Amount Due
Date Due
Amount Due
$800.00
$800.00
12/15/2021
Payment Options*
E-Check - Available online at httpJ/go.nodenr.gov/swpay
Requires bank account and routing information. You will need to use the tip 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.nodenr.govlswpay
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. 26-3-606: A $26.00 processing fee will be charged on all returned checks.]
Exolanatloo of Invoice Amount Is Based on Facllitws Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay fee(s) 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 Wilable on the web:
North Carolina Department of Environmental Quality (DEQ) - http://deq.no.gov
North Carolina Solid Waste Program - httpl/deq.nc.gov/abouVdMsions/waste-managemenVsolid-waste-section
North Carolina Electronics Management Program - http!/deq.nc.gov/abouVdivisionstwaste-managemenVele&onics-manage
North Carolina Septage Program - https:/Ideq.nc.gov/sboutldivisbnstwaste-managementtwaste-management-rulesiseptage
NC Solid Waste Invoice Form 1-2016

PAID
FIRM NAME: A County Wide Septic
PERMIT #: NCS-01281
AMOUNT: $800
PAID BY: Check
DATE: 12/16/2021
Adam Ulishney