NCS01292_2022Permit_Initial

2022
Permit and Registration
Loose Ends Repair and Septic Tank Services
is hereby issued a Septage Management Firm Permit,
tszArr of
Permit Number NCS-01292
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o and registered as a e:,e DE
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A Q
` a= Septage Management Firm Department ofEnvironmental Quality
44 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. Septage Land Application Site, SLAS-12-03
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. 11 -1 b
Digita y signe y
Wm Perry Sugg
Date: 2022.10.02
20:41:06-04'00'
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*
Loose Ends Repair and Septic Tank Services
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01292
Enter the five digits following the NCS #
Street address of office*
Street Address
6499 George Hildebran School Road
Address Line 2
City
State / Province / Region
Hickory
NC
Postal / Zip Code
Country
28602
USA
County*
Burke
Mailing address same as street address of office?*
• Yes No
Phone* Fax
8282174138
Email*
[e-mail]
Owner Info
Firm owner's name*
Brandon Martin
Mailing address same as street address of office?*
• Yes No
Phone* Fax
8282174138
Operator Info
Firm operator's name* Firm operator's title
Brandon Martin owner/operator
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
8282174138
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 200,000
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: *
Burke, Catawba, Caldwell, Alexander
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
fftexe" W"I*:e
Date*
12/13/2021
Title*
Owner/Operator
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Domestic Septage
YA165101
2NK-HHM7X-7-NM481993
2,500
Domestic Septage
YA155966
2NPNHD7X73M809388
2,500
Domestic Septage
YA116351
1HTSDAAN4YH247227
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
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-12-03 12/31/2022 Scanned 981KB
Document
11.pdf
Septage Detention or Treatment Facility (SDTF)*
Yes • No
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed
Date* Hours*
3/29/2021 4
Location*
HICKORY INC
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
12/13/2021
08:35:21 PM
Print Name*
Brandon Martin
Title*
owner/operator

L q
• "-stir'-' - -�� _'---��+_�,• __-�
AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention c,r treatment facility perwIt JjL)jd("j tk) In&L' ate that �wrmission
has been given to a permitted Septage Management Firm to ; into the permit
RP
holders detention Or ti L--,0.1t [110 nt facility,.)
(Facility opt.,r-,itor)
(operator Address)
1-
tea hereby authori��: ��*'�' v P/;*&Tr
-�--
-.--
(Ownei- of Septzi-ge Management Firm}
Coast �,"nf EF Arg
(Name of Septage
?WK W.),twiT
anagement Firm)
64 Nil ! Foz&& / N.�c[�EC/✓4'`> �L�a'L
(Address of Septage
Ns # 0,292
i�lcof�
anagement Firm)
. -0
facilit# for the treatment or storage of
to utilize septage detention otreatmenty
septage
in 20 The f�dlhtv tivil
Date:
be operated m accordance with the Septage
As defined in G.S. 13OA-290(a)(32)
'"• As defined in SSA NCAC 13B.0800
anagement Rules **.
Signed /-` �. `-- - ' + VillL
(Facility Operator)
Return the properly co«ipleted form to:
Noi th, Carolina Department of EnvironmentA QUality
Division of Waste NILinagement
tiOhd Wdste So- etian
1646 M,-,Iil Service Center
Raleigh, NC 27699-1646
k
[a

PAID
FIRM NAME: Loose Ends Repair and Septic Tank Service
PERMIT #: NCS-01292
AMOUNT: $800
PAID BY: E-Check
DATE: 12/15/2021
Adam Ulishney