NCS00047_2023Permit_Initial

2023
Permit and Registration
Lloyds Portable Toilet Rentals & Septic Tank Pumping
is hereby issued a Septage Management Firm Permit,
STATE,, Permit Number NCS-00045
Nnr 0.i�
= o and registered as a e:,e D
EQ
-�� Septage Management Firm awnen� f� wrnmenta�lty
NORTH CAROLlNA (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. Mason Farm WWTP, Chapel Hill, NC
2. East Burlington WWTP, Burlington, 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. Digitally signed by
Wm Perry Wm Perry Sugg
Sugg Date: 2023.02.02
11:41:23-05'00'
Perry Sugg, Environmental Compliance 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 vehkle(s)).
Street address of office: +
i ' -- r%
I
City: - /`
State: j] Zip:_ r�
Mailing address (if different): -540*
City:
State: Zip
Phone:.3.34,- -5-A� ^d
Fax:
E-Mail: L 10 ILo /'
County: tlL'l rA4AA 'e
Septage Management Firm permit number: NCS # 400
(2.) Firm owner's name: tf
a
Mailing address (if different): 5�71/tf
City:
State: .Zip
Phone:
Fax:
i
(3.) Firm operator's name:_ �� A L.��Ii
Firm operator's title: 0 Lvo e'
Mailing address (if different):
City:
State: Zip:_
Phone:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons mooed in last 12 months (Example: Domestic: 50,000).
Portable Toilet Waste Grease (Restaurant) I Treatment Plant Industrial/Commercial
(5.) N. . Counties of Operation: ?qf 4/P -Cc. Gt 14n - �'�yra�^ efts Lv -
Iki
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: Grease (restaurant):
Other: -- Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
• (CONTINU7yes
M PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) ( ) 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." �1
Do you attest to the statement above? (/yes ) no Initial Date /,�2 " D�
(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 theSeptage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#:. _Expiration Date: SLAS#: __Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: Expiration Date: SDTF#: Expiration Date:
(9.) Septage Management Firm Operator Training Completed:
Date: /�.� °a� Location: r f Hours:
Training Sponsored or Provided by: n C, ,Sbo
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
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:
Certification Statement
Hours:
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.
r�
C � _'/� -
Signature (Signature of companyofficial required)
ejo% )- ice
Print Name
Other Comments:
Date
Title
Rev. 04-26-2021
PAGE 2

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
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, Travis Rich Certification #999730 OWASA-Mason Farm WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
170 Old Mason Farm Rd, Chanel Hill, NC 27517
(Address)
919-537-4354 do hereby authorize Keith Lloyd
(Phone Number) (Owner/Operator of Septage Management Firm)
of Lloyd's Portable Toilet Rentals & Septic Tank Pumpin,,� NCS # 00047
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X _ portable toilet waste X _
grease septage (grease trap pumpings) commercial/industrial septage , from
Orange and surrounding counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
170 Old Mason Farm Rd, Chapel Hill NC
(Location)
Monday -Friday 08:OOAM-4:00 PM
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
(Facility Operator)
Subscribed and affirmed before me this
(Notary Public)
KELLY H. BELCHER
Notary Public, North Carolina
Alamance County
My o, mission Expires
_� -
Date—. `` / Z I Z zuzZ
dayof'beCf'rK'LW,20 Ad
My Commission expires: _'__A�,' ).GJL5
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

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.
(,_Damn Allred. Chief Operator of the East Burlin ton Wastewater Treatment Plant
(Plant Operator and Name of Plant)
225 Stone Quarry Rd. Burlington, NC 27217
(Address)
336 � 578-0515 _ do hereby authorize --Keith Llovd _
(Phone Number) (Owner/Operator of Septage Management Firm)
Of Lloyd's Sentic Tank Cleanio, NCS #S00047
Septag (e Management Firm Name and NCS number)
to dispose of: domestic septage X _ portable toilet waste _ X
grease septage (grease trap pumpings) N/A commercial/industrial septage N/A ,
from Alamance Coun�ly Tat the above named wastewater treatment facility.
(County or other Geographic Area)
Septage shall be discharged at: The Influent Se to a dump it of the East Burlington Wastewater Treatment Plant.
(Location)
between the hours of 8:00 —11:30 am / 12.00 - 5:00 pm Monday — Saturday
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
Thi uthorization shall be valid until December 31 2023
(Usually December 31, Year)
ozl
Signed Q--- Date � — 2
( agility Operal
Swom to and subscribed before me this 0 _ _ day of _ M 20 2�
i . . C �'"�Y My Commission expires:2-
(Notary Public)
(OFFIC v C.r
W NOTARY
Note: Falsification of this document by the septage management firm shall lead to permit revocation. PUBLIC
H:CUVFORMS/2009 Finn Application/WWrPAuthorizationForm2010 LL COse"'

NCB SEMANAGEMENT I RM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- C D
Number of Pumper Vehicles: -
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 o 2 required)
r-% Z, /0//10
Print Name
Date
Ld Y) ram'
Title
SASolid_WastelclalseptagelformslP um per Vehicles Cetification.doc

North Carolina Depa tment or Environmental Quality
wy '' Division of Waste Nill- iagem��nt INVOICE
r:eFt?;: ua.Rot.inn
FnvtroronentalQuattty Solid Waste Section
Division of Waste Management To: Keith Lloyd
Solid Waste Section Lloyds Portable Toilet Rentals & Septic Tank Pumping
1646 Mail Service Center 3748 South NC 87
Raleigh, NC 27699-1646 Graham, NC 27253
Phone/Fax: [phone]
Email: [e-mail] P A D
CK No. s�?9
DATE 12- "2S - Z'+�� Date: 09/27/2022
Soo.6 Invoice #: NCS-00047-2023
Septage - Annual:
Lloyds Portable Toilet Rentals & Septic Tank Pumping (NCS-00047)
3748 South NC 87 $800.00
Graham, NC 27253
Number of Trucks: 2
Date Due: 1211512022
LATE FEES: N
Payment Options:
E-check Available online at
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
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.]
Explanation of Invoice Amount is Based on Firm's 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.
For.Questions re,garding..
Billing Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - ___;!' i•
North Carolina Solid Waste Program =_ „-
North Carolina Septage Management Program -