NCS00070_2023Permit_Initial

2023
Permit and Registration
Skipper Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,, _ Permit Number NCS-00070
oand registered as a
NORTH
A%L 12. rim
-�� 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. Wallace Regional WWTP, Wallace, NC
2. Johnnie Mosley Regional WRF, Kinston, NC
3. James A. Loughlin WWTP, Wilmington, 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. DI Ita11 SI ned b
Wm Perry
Sugg
g Y g Y
Wm Perry Sugg
Date: 2023.02.02
11:46:46-05'00'
Perry Sugg, Environmental Compliance Branch Head

Application for Permit to Operate a
Septage Manager ent 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*
The "Firm name" must be exa111lctly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
Coon 0
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
2 6 0,Y1e'--o\,(,ee, rCA,
Address Line 2
City �O'il
Postal / Zip Code
2119 L� 09
County*
Nu l'-VAIIov r v
Mailing address same as street address of office?*
yes 0 No
State / Province / Region
Country 9�
VS
PAI
CK. N0.
. 17-1 .---
DATE
17 - 29 - 72-
F"&5DO.00
N C,

Mailing Address*
Street Address
--Z Z 5_ _0,-6-ro 1tc e `'tr► CC,1
Address Line 2
City
Postal / Zip Code
2�S 4 o q
Phone*
q I is `-1 C(
Email*
C�►1no-�- � q2� �
Owner Info
a.6o y cv ►gin,
Firm owner's name*
0c(-\ Wa�-'r
Mailing address same as street address of office?*
U Yes O No
Mailing Address*
Street Address
`ZZ 0,V-Pn-0,6,e a,I
Address Line 2
city
Postal / Zip Code J
11%HOci
Phone*
g1o)-gl &K
Operator Info
State / Province / Region �V
Country
u S*
Fax
State / Province / Region
N C
Country
V 5 A -
Fax

Firm operator's name* Firm operator's title
RCn \4- VA- 0 w n&V-
M,a/iling address same as street address of office?*
@ Yes Q No
Mailing address*
Street Address
ro \), ce �rc� ► i
Address Line 2
City State / Province / Region
,W PVC
Postal / Zip Codde(� Countjry]
ASS Li vc V S A
Phone* Fax
qID-t)ci qLIP�
Type and amount of septage pumped in the last 12 months
Domestic
Portable Toilet Waste
Grease (Restaurant)
Treatment Plant
Industrial/Commercial
Amount in gallons *
0 H�3,10oL-)
0 —�
0
0
North Carolina counties of operation

List each county you plan to do business in:*
6L' �61-tivver , S�Irvns W CAC
� '��'�ne pry ��s 1►r1� ��5
131rtAe(\ %UUM6S
Vehicle Info
Do you plan to operate pumper vehicles?*
Yes O No
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
)J Yes O No
Septage Land Application Sites (SLAS)*
O Yes W No
Septage Detention or Treatment Facility (SDTF)*
O Yes 6 No
Other disposal method*
O Yes No
Septage Management Firm Operator Training Completed
Date* �U ne -,7C5, '2C Hours* `j
0
Location *
Training Sponsored or Provided by*
PVC 11rtx.�,p
Se
Septage Land Application Site Operator Training Completed
Date
Hours
0

Location
Training Sponsored or Provided by
v
Registration Type
Select one*
O Registered Portable Sanitation Firm
Registered Septage Management Firm
O Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
-D �` L �u b DG Y D ateF �Ct8 CGre v
"`�`2 �- 1- 'I W3 1 u�OS3
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 hermit and that there are criminal penalties for knowingly making a false statement, representation, or certification.
Signature* �1°�
4t�
Sign
Date
12/17/2022 r
09:36:20 AM
Print Naame*& 0 , `
Su bm it Save as Draft
Title*
D Lj-)(V,-.Y"

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section f /
1646 Mail Service Center, Raleigh, NC 27699-1646 v
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.
Lisa Cottle, 994036, Wallace Regional WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
851 Old Wilminton Road, Wallace NC,28466
(Address)
910-665-2091 do hereby authorize Ben Holt
(Phone Number) (Owner/Operator of Septage Management Firm)
of Skipper Septic Tank NCS k___Dg070
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage ___Les , portable toilet waste no
grease septage (grease trap pumpings) nO commercial/industrial septage no from
Duplin County and surrounding counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Manhole #1
(Location)
between the hours of 6am-6pm Sunday -Saturday
Reintroducing partially treated liquid into a grease trap is acceptable Yes no No
This authorization shall be valid until December 31,2023
(Usually December 31, Year)
Signed —4n 'tfqX _ Date_ to - -�
(Facility Operator) I
Ird� a oZ
scribed and affirmed before me this .� day o 20
My Commission,expl esomM Expires Octob r27,2tV4
(N ary Public)
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2016 Firm Application/WWTP Authorization Form 2016

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, Kenneth R. Stevens. Jr.- Wastewater License #21198 Johnnie Mosley Regional Water Reclamation Facility
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
252-939-3375
(Phone Number)
of
to dispose of: domestic septage
P. 0 Drawer 339. Kinston NC 28502
(Address)
do hereby authorize Ben Hott
(Owner/Operator of Septage Management Firm)
Skii: ; er Septic Tank Service
(Septage Management Firm Name and NCS number)
X , portable toilet waste X -,
grease septage (grease trap pumpings) commercial/industrial septage
_ Lenoir and surroundini counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
NCS # 00070
from
Johnnie Mosle Re Tonal Water Reclamation Facilit - 2101 Becton Farm Road
Brie Run Lift Station- Hi hwa 55 East
(Location)
between the hours of 8:00 a.m. to 4:00 p.m. Monday thru Friday)
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until
Signed
(Facility Operator)
Sworn to and subscribed before me this j '
December 31, 2023
Date ]/-/d -? ?-
day ofIV,-J 20 2 2
7 �
My Commission expires:
(Notary Public) — �.�►'� ® . - F
0 ( DIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revoation;
00
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2013 Firm Application/WWTP Authorization Form 20� '.
ale
t f E6 f/EEN%�

Permit To Discharge Wastewater Under the
Industrial Pretreatment Program
In compliance with the Cape Fear Public Utility Authority's Sewer Use Ordinance and Industrial Pretreatment
Program, North Carolina General Statute 143-215.1, 162A, and applicable federal categorical pretreatment
regulations, and other lawful standards and regulations promulgated and adopted by the North Carolina
Environmental Management Commission and the Cape Fear Public Utility Authority (CFPUA),
Skipper Septic Tank Service
is hereby authorized to discharge wastewater collected from residential septic tanks located within the
CFPUA Service Area
into the designated disposal site at the CFPUA's James A. Loughlin Wastewater Treatment Plant (NPDES Permit
NC0023965) herein written "NSWWTP", in accordance with effluent limitations, monitoring requirements, and
all other conditions set forth in Parts I, II, and III of this Permit.
This permit will become effective on July 1, 2020. This permit and the authorization to discharge shall expire at
midnight June 30, 2025.
Signed this the 12/20/2019.
`t
S ure
By Authority of the Cape Fear Public Utility Authority
Forms 4: ESCCA-0010.446C Corresponding Procedure: ESCCA-0010.446
Revision Date: 6/1/15 Revision #: 2
Effective Date: V25/15 Page 1 of6

NC SEPTAG.E MANAGEMENT FIRM
Decertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS. VVO M0
Number of Pumper Vehicles: Z
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)
1�-i -3 _� +
Print Name
fZ — (7— 2 0 Z'Z--
Date
CCVo&V-
Title
S:1Solid Wastelcla%septagelformsSPumper Vehicles Cetification.doc

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