NCS01580_2022Permit_Initial

2022
Permit and Registration
Harris & Sons Septic LLC
is hereby issued a Septage Management Firm Permit,
tszArr of
Permit Number NCS-01580
0
o and registered as a e:le D
` 7
NORTH CAROLINA
a= Septage Management Firm Department ofEnvironmental Quality
E#f 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. City of Roxboro WWTP, Roxboro, 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. D; N-n i l S; ned b
�13 Y �g Y
Wm Perry Sugg
Date: 2022.10.02
20:58:53-04'00'
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*
Harris & Sons Septic LLC
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01580
Enter the five digits following the NCS #
Street address of office*
Street Address
127 Harris Morris Rd
Address Line 2
City State / Province / Region
roxboro nc
Postal / Zip Code Country
27574 USA
County*
Person
Mailing address same as street address of office?*
• Yes No
Phone* Fax
3365048398
Email*
[e-mail]
Owner Info
Firm owner's name*
Megan Throckmorton
Mailing address same as street address of office?*
• Yes No
Phone* Fax
3365048398
Operator Info
Firm operator's name* Firm operator's title
Megan Throckmorton
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
3365048398
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 6,000
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:
person
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
(�-�!r�'rr�jfa��anrfeae
Date*
12/9/2021
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA164627 3HAMMAAL8EL767704 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* Expiration Date* Authorization
City of Roxboro WWTP 12/31/2022 Dec 9, Doc 289.28...
l.pdf
Septage Land Application Sites (SLAS)*
Yes • No
Septage Detention or Treatment Facility (SDTF)*
Yes • No
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed �^
Date* Hours*
1/12/2021 6
Location*
Virtual
Training Sponsored or Provided by*
NC DEQ - New Operator Training
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
12/9/2021
09:33:52 AM
Print Name* Title*
Megan Ryane Throckmorton Owner

PAID
FIRM NAME: Harris & Sons Septic, LLC
PERMIT #: NCS-01580
AMOUNT: $550
PAID BY: E-Check
DATE: 12/13/2021
Adam Ulishney

AUTH011DUION 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, Derek Clayton, SRC #9264 for the City of Roxboro WVVTP 0000�
(Plant Operator in Responsible Charge (011C)., SRC license Number, Name of Plant]
902 Cave] -Chub Lake Rd. Roxboro NC 27574 (NCO021024)
(Address)
3365998232
(Phone Number)
of f4p, crt 5
do hereby authorize
+-- SAP&,f!F 5
+} C_
WC
V+16.,f
Aerator of Septage Management Firm)
Sa�rJ��e.,
(Septage Management Firm Name and NGS number)
to dispose of: domestic septage s portably toilet waste nr a
CS # 0 1
grease t rase trap pumpings)1110 commercial/industrial septa , from
Person County NC (anly!) Domestic Septage (Only!) -
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Septic Dumping t do n at the head of the Roxboro U'1 TP located at 902 Gavel -Chub Lake Rd.
(Location)
between the hours f 6 30arn-II 30arm & 12 30pm-Gprn (Inter by permission on]y)
llntrdu*inrtiall treated liquid into a grease trap i acceptable
This authorization shall be valid until
Signed
(Facility Operitar)
Subscrdoed and affirmed before me this
ma) e-1-C, 4LW6,-%,7 C-e- 31
Yes
?,XD Z Z
X No
(Usually December 31, Years
Date k 7- in
My Commission a pit I.
%6**4nVWn M1
0 00
(Notery Public) ##i
C)
RIO*
• + •
imp
i f
do r ■ �*
d
' � ++*
Note- Falsification of this document by the s eta a management firm shall lead to perm s * I
./Sol id_V a st-e/CUVS C P TA E/FORM S/ 2018 h rM Ap pl Ication/1 1 Tp Authoriz 31 ion Form 2C 1 & oft, F 111111101 %