NCS00052_2023Permit_Initial

2023
Permit and Registration
Sprinkle Septic Tank
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00052
o and registered as a
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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. Archie Elledge WWTF, Winston-Salem, NC
2. Septage Detention or Treatment Facility, SDTF 34-01, SDTF 60-09, SDTF 34-06
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: 2023.02.02
11:43:00-05'00'
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*
Sprinkle Septic Tank
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00052
Enter the five digits following the NCS #
Street address of office*
Street Address
4900 Murray Rd.
Address Line 2
City
State / Province / Region
Winston-Salem
NC
Postal / Zip Code
Country
27106
Merica
County*
Forsyth
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
P.O. Box 37
Address Line 2
City
State / Province / Region
Rural Hall
NC
Postal / Zip Code
Country
27045
Merica
Phone* Fax
336-924-8677
Email*
[e-mail]
Owner Info
Firm owner's name*
Michael Sprinkle
Mailing address same as street address of office?*
• Yes No
Phone* Fax
336-924-8677

Operator Info
^J
Firm operator's name* Firm operator's title
Michael Sprinkle Owner
Mailing address same as street address of office?*
Yes • No
Mailing address*
Street Address
PO Box 37
Address Line 2
City State / Province / Region
Rural Hall North Carolina
Postal / Zip Code Country
27045 U.S.A.
Phone* Fax
3368160704
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 430,000
Portable Toilet Waste 0
Grease (Restaurant) 15,000
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
Forsyth, Stokes, Davie, Yadkin, & Davidson
Vehicle Info
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
80�aq) "I -
Date *
12/7/2022

Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA 004494 lfv6hjaa9yh664284 2,000
Grease (restaurant) same same 2,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
• 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*
Archie Elledge Wastewater Facility
Liquid Environmental Solutions
Septage Land Application Sites (SLAS) *
Expiration Date* Authorization
12/31/2023 12072201.PDF 169.71...
12/31/2023 12072202.PDF 117.67...
Yes • No
Septage Detention or Treatment Facility (SDTF)
• Yes No
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.
SDTF #* Expiration Date* Authorization
SDTF-34-01 12/20/2022 12072203.PDF 145.81...
Other disposal method*
Yes �* No
Septage Management Firm Operator Training Completed
Date* Hours*
1/28/2022 6

Location*
Hickory, NC
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
Certif cation 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
�&&qj )M�I-
Date
12/7/2022
08:37:59 AM
Print Name* Title*
Michael J Sprinkle Owner

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, 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, Matthew Lavigne- WW##997822 -Archie Elledge Wastewater Facility
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
2801 Griffith Rd. Winston-Salem NC 27103
(Address)
336-765-0130 do hereby authorize Michael Sprinkle
(Phone Number) (Owner/Operator of Septage Management Firm)
of Sprinkle Septic NCS # 00052_
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage X , portable toilet waste
grease septage (grease trap pumpings) NO commercial/industrial septage from
Winston-Salem/Forsyth County and Adjacent Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Archie Elled e Wastewater Facility
(Location)
between the hours of 6:00 am until 6:00 pm Monday Through Saturday
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 3
(Usually December 31, Year)
Signed ;/, /ef Date
(5afiirity Operator)
Subscribed and affirmed before me this Cal day of ©cJober' 20 aa'
My Commission expires: 31 a3 r' 9-u a1
(Notary Public)
MARY G. BROWN
Notary Public, North Carolina (OFFICIAL SEAL)
Forsyth County
b y MY Co mis�sl n Expires
....d
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/solid_waste/CLA/SEPTA6F/FORMS/2D18 Firm Application/WWTP Authorization Farm 2018

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission has been given to a permitted
Septage Management Firm to discharge septage into the permit holders detention or treatment fadl y )
I, Li uid Environmental Solutions
(Faality operator}
Offices at 4826 Worth Placz Charfotte, NC 28216 and at 750 Palmer Lane, Winston-Salem. NC 27107
Operator Address)
do hereby authorize: Michael S rinkle
(pwner of Septage Managernerit Firm)
S tinkle Septic Tank NCS # 00052
(Name of Septage Management Firm)
PO Box 37 Rural Hali NC 27045
(Address of Septage Management Firm)
to utilize septage detention or treatment facility # STDF 34-06 & STDF 60-09 for the treatment or
storage of septage
in 2022-2023 . The facility will be operated in accordance with the Septage Management Rules'*
Date: 12-06-2022 f
Signed
�` {Facility CA, ator)
Joe Mayg, Processing Faci'fity Manager
* As defined in G.S. 130A-290(a)(32)
�* As defined in 15A NCAC 13B .0800
Return the properly completed form to:
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646