NCS00008_2023Permit_Initial

2023
Permit and Registration
Rowan Septic Tank & Ditching Co Inc
is hereby issued a Septage Management Firm Permit,
sTArE� _ Permit Number NCS-00008
oand registered as a e:,e D Qi�
NORTH
A%L 12 t
-�� Septage Management Firm�� �� w� ��nffii�utr
4sr
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 80-02
2. Septage Detention or Treatment Facility, SDTF 80-01
3. Town Creek WWTP, East Spencer, 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, 2023.
"���12/12/2022
Perry Sugg, En ' onmenta ompliance 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 exactly as it is shown on your vehicle(s)).
Street address of office: 7 5a1_ O LD W CtS U.E
City: J
Mailing address (if different):
State. — —le— Zip: AS144
City: State: Zip
Phone: IOLl LQ33 a) I a Fax: r! 0Lj33 a- H
E-Mail: C_o m
County: �io1.taA�t.] Septage Management Firm permit number: NCS #
(2.) Firm owner's name:_�i C.k
Mailing address (if different): g351 OLD fmy—s Ji )Ze, PO - City: State: N�zip 9 810-
Phone: '114 a4 510Fax: 904 (o33 J4a-
(3.) Firm operator's name: 1 ) PV t tQ kAe-Y-DA O CK Firm operator's title: VP
Mailing address (if different): q 3� O7R-t:� Lr 1,
City: csoiti g State: to L ip: a $ I `q
Phone: q 04 90a- I q 9 (P Fax: q 1) q- (033 aL Wa
(4.) Type(s) of septage pumped: Write in the number of 0a/Ions numoed in last 12 months (Example: Domestic: 50,000).
Domestic Portable Toilet Waste I Grease (Restaurant) Treatment Plant Industrial/Commercial
(5.) N.C. Counties of Operation:
you are authorized to
(6.) Total Number of Pumper Vehicles Operated: 8
Number used for: Domestic Septage: �k Grease (restaurant):
Other: Portable Toilet Waste: Cp
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
1
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (X) 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? ( ) yes ( ) no Initial1:�,e Date 1/ 1--16 — 2 2
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: () yes ( ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: -0A Expiration Date: 31 17Ae SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: 80 - 01 Expiration Date: 3 3 SDTF#: Expiration Date: _
(9.) Septage Management Firm Operator Training Co pleted:
Date: I I VB 2-2 Location: (" Hours:
Training Sponsored or Provided by:
(10.) Septage Land Application Site Operator Training Comple ed:
Date: Location: Hours: LQ
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm: X
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.
gignaturetSignature of 6ompanyofficial required)
C-%m L gIRA"Yj CL
Print Name
Other Comments:
-ld-22
Date
Ip.
Title
Rev. 04-26-2021
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NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- 00008
Number of Pumper Vehicles:
0
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."
`/-ik - a
Signature ( nature of company official required) Date
George Kirkpatrick
Print Name
President
Title
S:lSolid WastelclalseptagelformslPumper Vehicles Cetification.doc

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AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mai) 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.
Charles Wood of Town Creek WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
704-638-5377
(Phone Number)
850 Heiligtown Rd, East Spencer, NC 28039
(Address)
do hereby authorize George Kirkpatrick
(Owner/Operator of Septage Management Firm)
of Rowan Septic Tank & Ditching Co Inc. NCS # 00008
(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 No from
ROWAN COUNTY ONLY
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
_Town Creek WWTP - Influent Installation
(Location)
between the hours of lam to 5pm Monday -Friday
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2023
(Usually December 31, Year)
Signed `v,.l... - Date ) ( a
(F a c i`iitq-Oper 'rr o r ) �k
S scribed and affirmed me this day of��
r %
My Commission expires:
(Notary Public) •��„�wrtinp„_
*I k . ISEl���
s
G p� ��� V
Note: Falsification of this document by the septage management firm shall lead to pe it t'+rvocatiIItT. 2
5:/5olid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018 ��'�►�� .`

I •-
North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
RV RTH ftWWA 1QVfl Solid Waste Section
Envfronmentar (bvolffy
Division of Waste Management To: George H Kirkpatrick
Solid Waste Section Rowan Septic Tank & Ditching Co Inc
1646 Mail Service Center 7321 Old Mocksville Road
Raleigh, NC 27699-1646 Salisbury, NC 281441255
Phone/Fax: [phone]
Email: [e-mail] PA I D
CK. NO.
DATE {J 2 22 Date: 09/27/2022
$ Qa. OD Invoice #: NCS-00008-2023
Septage - Annual:
Rowan Septic Tank & Ditching Co Inc (NCS-00008)
7321 Old Mocksville Road $800.00
Salisbury, NC 281441255
Number of Trucks: 8
Date Due: 12/15/2022
LATE FEES: In accordance with NC General Statutes GS 130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted by January 1, 2023.
Payment Options:
E-check Available online at httos://deq.nc.gov/sway
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 https://deg.nc.aov/sw)aay
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.]
EEMlanation of Invoice Amount is Based on Firm's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 )Ipu are required to pay fee(s) based on your solid waste management
activities. The fee(s) shall be used to support the septage rNi anagement program.
For questions regarding
Billing
Regulations or Technical Assistance
Jared Wilson [phone]
Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - httos.//deq.nc.gov
North Carolina Solid Waste Program - httos://dec.nc.gov/abouYdivisionVwaste-manacement'solid-waste-section
North Carolina Septage Management Program - httos:'idea.nc.gov/aboutidivisionsiwaste-management/solid-waste-sectionlspecia l-wastes-and-alternative
handling/septage