NCS00076_2023Permit_Initial

2023
Permit and Registration
Don Jordan's Septic Tank Cleaning & Portable Toilet Rental
is hereby issued a Septage Management Firm Permit,
STATE� Permit Number NCS-00076
oand registered as a e:de
NORTH
A%L 12 t
-�� 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, 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. Cross Creek WRF/Rockfish Creek WRF, Fayetteville, NC
2. Septage Detention or Treatment Facility, SDTF-82-04
3. Septage Land Application Site, SLAS-82-19
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
Wm Perry Perry Sugg
S u g g Date:
023.02.02 11:53:26
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*
Don Jordan's Septic Tank Service
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00076
Enter the five digits following the NCS #
Street address of office*
Street Address
260 Beulah Rd
Address Line 2
City
State / Province / Region
Clinton
North Carolina
Postal / Zip Code
Country
28329
United States
County*
Sampson
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
PO Box 1889
Address Line 2
City
State / Province / Region
Clinton
North Carolina
Postal / Zip Code
Country
28329
Sampson
Phone* Fax
910-249-3131
Email*
[e-mail]
Owner Info
Firm owner's name*
Donald Ray Jordan
Mailing address same as street address of office?*
Yes 0 No

Mailing Address*
Street Address
PO Box 1889
Address Line 2
City
Clinton
Postal / Zip Code
28329
Phone*
910-249-3131
Operator Info
State / Province / Region
North Carolina
Country
Sampson
Fax
Firm operator's name*
Firm operator's title
Donald Ray Jordan
owner/operator
Mailing address same as street address of office?*
Yes • No
Mailing address*
Street Address
PO Box 1889
Address Line 2
City
State / Province / Region
Clinton
North Carolina
Postal / Zip Code
Country
28329
Sampson
Phone* Fax
910-249-3131
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 60,000
Portable Toilet Waste 6,000
Grease (Restaurant) 31 000
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in:
Sampson, Bladen, Duplin
Vehicle Info
Do you plan to operate pumper vehicles?*
0 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
a�osaaerP�x1� c%/iid
Date*
11/28/2022
Title*
owner/operator
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA132675 1HTMMALXAH1664438 2,500
Grease (restaurant) KD3321 1HTSLAAM5XH680032 1,500
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*
Cross Creek WRF
Expiration Date* Authorization
11/8/2022
Septage Land Application Sites (SLAS)*
• Yes No
If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site.
SLAS #* Expiration Date* Authorization
SLAS- 7/9/2031
Septage Detention or Treatment Facility (SDTF)
Yes 0 No

Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed^
Date* Hours*
2/19/2022 4
Location*
Raleigh
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
Date Hours
2/19/2022 3
Location
Raleigh
Training Sponsored or Provided by
NC Pumper Group & NC Portable Toilet Group
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
rs��� �tstrl�
Date
11/28/2022
08:49:13 AM
Print Name* Title*
Donald Ray Jordan owner/operator

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
Mr. Donald Ray Jordan
Don Jordan's Septic Tank Cleaning
PO Box 1889
Clinton, NC 28329
RE: SDTF-82-04 Permit Renewal
Don Jordan's Septic Tank Cleaning
SR 1214 in Sampson County
Dear Mr. Jordan:
NORTH CAROLINA
Environmental Quality
August 3, 2021
The NC Division of Waste Management has reviewed your application to renew Septage Detention and
Treatment Facility permit, SDTF-82-04, in Sampson County. Your application has been approved in
accordance with NC Septage Management Rules and your permit, SDTF-82-04, is enclosed. This facility
consists of six (6) above ground steel tanks for a total storage capacity of 32,000 gallons. The Permit
covers the use of the six (6) tanks for the storage of domestic septage, portable toilet waste, and grease
septage. This permit shall expire on July9, 2031.
Please readthe permit conditions carefully. When communicating to the Division about this permit, refer
to it as "SDTF-82-04." Failure to operate the septage detention facility in accordance with NC Septage
Management Rules and the enclosed permit could subject you to administrative penalties of up to
$15,000 per violation per day. If you have questions concerning this permit or septage in general, please
do not hesitate tocontact me at919-707-8283.
Sincerely,
Digitally signed by Chester R, Cobb
c cn=Chester R. Cobb, o=Solid Waste
Se
Section, ou=DW M,
email=chester,cobb@ncdencgov, c=US
Date: 2021.08M S 2:0928-04'00'
Chester R. Cobb, Environmental Program Consultant
Division of Waste Management. NCDEQ
Enclosures
copies: Central File
John Farnell, Environmental Specialist 11, Wl
Sampson County Health Department
DEQ
North Carolina Department of Environmental Quality I Division of Waste Management
e:��-,— 217 West Jones Street 11646 Mall Service Center } Raleigh, North Carolina 27699-1646
N�PTri :N:C�I1�M
o.,.ranrne �r snwmnmr,ruum, r919.707.8200

ROY COOPER
G<nnAev
EUZASETH S. BfSER
$e'vew)
MICHAEL SCOTT
aftIr <x
Facility Permit No.: SDTF-82-04
Don Jordan's Septic Tank Cleaning
Permit to Operate
July 9, 2021
Page 1 of 3
NOR I H 4,&RG;j .A
6r+tran+nM401 Quaiy
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WASTE MANAGEMENT
SOLID WASTE SECTION
PERMIT TO OPERATE A SEPTAGE DETENTION
AND TREATMENT FACILITY
Don Jordan's Septic Tank Cleaning
Donald Ray Jordan
PO Box 1889
Clinton, NC 28329
is hereby permitted to operate Septage Detention and Treatment Facility with permit # SDTF-82-04 located on
SR 1214 in Sampson County at approximate position 34.9661 ° N latitude and-78.3619' E longitude. This site is
permitted only for operations that are conducted in accordance with the representations made in the approved
application, with all conditions attached to this permit, and with all of the provisions of 15A NCAC 136.0800 --
Septage Management. 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 facility is subject to periodic inspection, as deemed necessary by the Division of Waste Management, to
determine if the facility is in compliance with this permit. This permit is subject to review at least annually, or
more often if deemed necessary by the Division of Waste Management, to determine if the operations
permitted are consistent with the Septage Management Rules in effect at the time of the review. Modifications
to the conditions of this permit may be made where necessary to make this permit conform to the requirements
of rules in effect at the time of'the review.
Digitally signed by
Adam
Adam Ulishney
Date: 20
Ulishney 14:0430204'00'g
Adam Ulishney
Environmental Compliance Branch
Solid Waste Section
Division of Waste Management, NCDEQ
D North Carolina Department of Environmental Quality I Div uion of Waste 6lanagemenl
217 West ]ones Street ' 1646 Mail Service Center I Raleigh. North Carolina 27699 164b
Qq�
91(1.707.8200

{ 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, N,C, 27699-1646
Fee assessments and waste determinations witl 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, Scott McCoy #24382 Cross Creek WRF 1 Rockfish Creek WRF
(Plant Operator in Responsible Charge (CRC), ORC License Number, Name of Plant)
p,0. Box 1089 Fayetteville, NC 28302-1089
(Address)
[phone] do hereby authorize Don Jordan
(Phone Number) (Owner/Operator of Septage Management Firm)
of Don Jordan's Portable Toilets & Septic Tank Cleaning NCS# 00076
(Septage Management Firm Name and NOS number)
to dispose of: domestic septage X , portable toilet waste X ,
grease septage (grease trap pumpings) commercial/industrial septage , from
Cumberland & surroundina counties
(County or other Geographic Area)
at the above named wastewater treatment facility, Septage shall be discharged at:
Facility Influent Pump Station
(Location)
between the hours of Sunrise to Sunset
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2023
Signed it ` Date (0 It 11ZZ
(Facility Op rator)
on
Subscribed and affirmed before me this / [f''h day of 20 oZ4 o2
My Commission expires: _/. �20;ZF
(Notary Public) *4-9-4-
(OFFAL
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
�0
S:lSolid_WastelCLAISEPTAGElFORMS12023 Firm ApplicationlWWTP Authorization Form 2023

RCY COOPER
C _, rr n<r
F-UZABETH S. BISER
S;r,rr4ar$
MICHAEL SCOT I
A'nrsir
Facility Permit No.: SDTF-82-04
Don Jordan's Septic Tank Cleaning
Permit to Operate
July 9, 2021
Page 1 of 3
NORTH CA;?G;_0*A
Frrrtro�rtrn�f QuQifty
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WASTE MANAGEMENT
SOLID WASTE SECTION
PERMIT TO OPERATE A SEPTAGE DETENTION
AND TREATMENT FACILITY
Don Jordan's Septic Tank Cleaning
Donald Ray Jordan
PO Box 1889
Clinton, NC 28329
is hereby permitted to operate Septage Detention and Treatment Facility with permit # SDTF-82-04 located on
SR 1214 in Sampson County at approximate position 34.9661 ° N latitude and-78.3619' E longitude. This site is
permitted only for operations that are conducted in accordance with the representations made in the approved
application, with all conditions attached to this permit, and with all of the provisions of 15A NCAC 1313.0800 --
Septage Management. Failure to operate as permitted may result in the Department suspending or revolting 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 facility is subject to periodic inspection, as deemed necessary by the Division of Waste Management, to
determine if the facility is in compliance with this permit. This permit is subject to review at least annually, or
more often if deemed necessary by the Division of Waste Management, to determine if the operations
permitted are consistent with the Septage Management Rules in effect at the time of the review. Modifications
to the conditions of this permit may be made where necessary to make this permit conform to the requirements
of rules in effect at the time of the review.
Digitally signed by
Adam
Adam Ulishney
Ulishney Date:2021.07.09
4:04:30-04'00'
Adam Ulishney
Environmental Compliance Branch
Solid Waste Section
Division of Waste Management, NCDEQ
North C:droliria Department or Environmental Quality I Division of Waste Management
D- E Q./ 217 West Jones Street 1 1646 Mail Service center I rtalelgh. North Carolina 27699 i646

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) ( ;) yes ( ) nc-
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 1 SA 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 Initial Date
(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 Mules.
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: '=' Location: Hours: -
Training Sponsored or Proviaea m .
(10.) Septage Land Application Site Operator Training Completed:
r?ate: _ - Location: Hours:
Training Sponsored or Provided by:ram xr T
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:.
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm:
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.
Signature (Signatur of companyofFcial required) Date
Print Name Title
Other Comments:
Rev. 04-26-2021
PAGE 2

North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NORTH CARo'!N
E,. ronmawwo,,a4 Solid Waste Section
Division of Waste Management
To:
Donald R Jordan
Solid Waste Section
Don Jordan's Septic Tank Cleaning & Portable Toilet
1646 Mail Service Center
Rental
Raleigh, NC 27699-1646
PO Box 1889
Phone/Fax: [phone]
Email: [e-mail]
PA
1
NC 283291889
D,
CK NO.
f Z 06 f 2
DATI~
/ I ZZ
Date: 09/27/2022
;�$OD, 00
Invoice #: NCS-00076-2023
Septage - Annual. -
Don Jordan's Septic Tank Cleaning & Portable Toilet Rental (NCS-00076)
PO Box 1889 $800.00
Clinton, NC 283291889
Number of Trucks: 2
Date Due: 12/15/2022
LATE FEES: 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 https://deg.nc.aov/swpaa,
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://deq.nc.gov/swpay
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 regardincr
Billing Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on thr- wi:b:
North Carolina Department of Environmental Quality (DEQ - __i,2s://ate....cgov
North Carolina Solid Waste Program - .- _ __ ,ut/divisions�wast -m oemen solid-wast -section
North Carolina Septage Management Program - httc:s- ,de:� nc Gov/about+divisions,waste-manJement/sol id -waste -section ispecial -wastes -and -alternative-
handling/septaae