NCS00027_2023Permit_Initial

2023
Permit and Registration
Mike's Septic
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00027
o and registered as a
e:,e D
NORTH
EQ�J
%L 12. 9*
-�� Septage Management Firm�� �� w� ��nffii�utr
E� Q m
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, Tide 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. French Broad River WRF, MSD of Buncombe County, Asheville, 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.
Wm Perry
Sugg
Digitally signed by
Wm Perry Sugg
Date: 2023.02.01
15:47:00-05'00'
Perry Sugg, Environmental Compliance Branch Head

12/6/22, 2:36 PM
New Submission
State of North Carolina Application for Permit to operate
Environmental Quality
Waste Management a S e pt a g e Management Firm
For questions regarding this form or the online application process, please contact Jeffrey Bullard (http://mailto:
[e-mail])(919-707-8285) or Chester Cobb (http://mail to:[e-mail])(919-707-8283).
Firm Info
Firm name*
Mike's Septic Service Inc
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
�NCS-
Enter the five digits following the NCS #
Street address of office*
Street Address
10636 NC 63 Hwy
Address Line 2
City
Leicester
Postal / Zip Code
�28748
County*
;Madison
I
CK ivo.
2
DATE
- 22
bob•oo
State / Province / Region
NORTH CAROLINA
Country
United States
Mailing address same as street address of office?*
o Yes 0 No
https:Hedoes.deq.nc.gov/Forms/wm_septagefirm 1 /6

12/6122, 2:36 PM
New Submission
Mailing Address*
Street Address
�P 0 Box 968
Address Line 2
Dwner Info
City State / Province / Region
C—
Postal / Zip Code Country
https://edocs.deq.nc.gov/Forms/wm_septagefiirm 2/6

12/6/22, 2:36 PM
New Submission
Phone*
_ .... ... _..
Operator Info
Phone*
Fax
Firm operator's title
Fax
Type and amount of septage pumped in the last 12 months
Domestic
Portable Toilet Waste
Grease (Restaurant)
141
https://edocs.deq.nc.gov/Forms/wm_septagefiirm 3/6

12/6/22, 2:36 PM
New Submission
Treatment Plant
Industrial/Commercial
[North Carolina counties of operation
List each county you plan to do business in:*
�JWlC, M' 6 Hmm waC'%) �jeN e-30t"-?Mo-aIsQr- 1 �C.Wc.uG`1/ � S�C�%CA I 1'w'
t�tortlI—T(-ar'.Sy)ale�';N. I-/Qr.CV
Vehicle Info
Do you plan to operate pumper vehicles?
0 Yes 0 No
yq 136014 yV-1 so ALTFS"RR?7.'11'11 340OS 4-
Yfl �3`132't '1Fi}{�C70fl9st1N9"1211y 23�o3a)lon
�1 R I'Do rlo 1 XP F�29X(0 yN 192230 3400'Sa
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
+6 Yes O No
Septage Land Application Sites (SLAS) *
O Yes 0 No
Septage Detention or Treatment Facility (SDTF)
® Yes # No
Other disposal method*
0 Yes # No
https://eciocs.deq.ne.gov/Forms/wm_septagefirm 4/6

12/6122, 2:36 PM
New Submission
Septage Management Firm Operator Training Completed
Hours*
v!i
Septage Land Application Site Operator Training Completed
Date Hours
kn
0
Location
Training Sponsored or Provided by
Registration Type
Select one*
O Registered Portable Sanitation Firm
40 Registered Septage Management Firm
0 Registered Portable Sanitation and Septage Management Firm
https://edocs.deq.nc.gov/Forms/wm_septagefirm 5/6

12/6/22, 2:36 PM
New Submission
[Comments and Notes
Comments or notes
Certification Statement
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
12/6/2022
02 : 32 : 25 11 AM v
Print Name*
Submit Save as Draft
Title*
https://edoes.deq.nc.gov/Forms/wm_septagefirm 6/6

NC SE PTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #:
Number of Pumper Vehicles:
NCS- C)a0,2
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 (Signature of company official required)
Print Name
-71zz
Date j
E.�JC�'erl'
Title
S:1Solid WastelclalseptagelformslPumper 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, N.C. 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.
Bart Farmer (991328), French Broad River Water Reclamation Facility (MSD of Buncombe County. NC)
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
2028 Riverside
828-225-8224
do hereby authorize
(Phone Number)
of Mikes Septic
North Carolina 28804
(Address)
Michael Lusk, Jr
(Owner/Operator of Septage Management Firm)
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage Yes , portable toilet waste No
N CS#
00027
grease septage (grease trap pumpings) No commercial/industrial septage No , from
Buncombe, Haywood, Henderson, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania & Yancey Co.
(County or other Geographic Area)
at the above -named wastewater treatment facility. Septage shall be discharged at:
MSD's Septage Receiving Station at 2110 Riverside Drive; Asheville, North Carolina 28804
(Location)
Between the hours of 24 hours a day / 7 days per week
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until
Signed
�lity Operator)
December 31, 2023
Usually December 31, Year)
Date /O 3 I %2 Z---
Subscribed and affirmed before me this ' I day ofWtbe4, , 20os�_
My Commission expires
Gf (Notary Public)
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2015 Firm Application/WWrP Authorization Form 2018