NCS00092_2023Permit_Initial

2023
Permit and Registration
Lyons Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00092
o and registered as a
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NORTH
EQ
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-�� Septage Management Firm�� �� w� ��nffii�utr
E4 ()'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. North and South Durham WRF, Durham, NC
2. Septage Detention or Treatment Facility, SDTF-92-12
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 Digitally signed by
Wm Perry Sugg
Date: 2023.02.02
Suqq 11:55:44-05'00'
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 gXjG& as it is shown on your vehicle(s)).
Street address of office: kjs j-
City: State: uL Zip: `Y-2!�;-roG
Mailing address (if different):
City:
State: Zip
Phone: Fax:
E-Mail: b s4e ,ti - trn •►1 r d c5_ Yc�,CCU..
County: Septage Management Firm permit number: NCS #03j a
(2.) Firm owner's name: C•-rr
Mailing address (if different):
City: State: Zip
Phone: Fax:
(3.) Firm operator's name: Firm operator's title: _
Mailing address (if different):
City: State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons oumned in last 12, months (Example: Domestic: 50,000).
I Domestic ' Portable Toilet Waste I Grease (Restaurant) 1 Treatment Plant I Industrial/Commercial
(5.) N.C. Counties of Operation: \'3C'A C r 1 ' ��.cw. , lah^3 ,� ��r i ;
L��i :. 6,rr-, _
(List each county you are authorized to do business in)
(6.)
Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage:
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License Tag #
Vehicle Identification #
Tank Capacity
.�
= �� �� x
' 2e o
2P�
t
-�
3
4
5
APPLICATION CONTINUED ON PAGE 2
RECEIVED
JAN 0 4 2023
SOLID WASTE SECTION

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) ( ) yes ( ) 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."
Do you attest to the statement above? ( -Ifyes ( ) no Initial Date Wl&0.4Da
(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: i ,Y),- Location: v. c—, q Hours: Li
Training Sponsored or Provided by: �u
(10.) Septage Land Application Site Operator Training Completed:
Date: ID jI I ` D- Location: Gw 1-\gc �3,?�1b Hours:
Training Sponsored or Provided by: 4c- �Iftqe -c- % �❑
(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
crimin#penalties fyr knowingly making a false statement, representation, or certification.
required)
� L �
Print Name
t � /2
Date
Title
Other Comments::
W01113 r'6- 4:,"CC-c r L.M . T— Eli Ct&.t� SU1�r:,`r_
Rev. 04-26-2021
PAGE 2

NC SEP T AGE MANAGEMENT. FIRYi
Recertification of Pumper Vehicle(s)
Septage Firm Permit #:
Number of Pumper Vehicles:
NCS-
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 possibilitypf fine and imprisonment."
nature((#ghat6re of company official required)
Print Na e
Date
C ]►,Rem
Title
S:1Solid WastelcialseptagelfonnslPumper Vehicles Cetification.doc

s
DURHAM
POIl;ti e±rlt01!.t M W-Itm- mall.1110rt ono
l voit+ SvpHi► 'l'aitk_tirrviev
llewlr►' is Utz►t►te11 l+C'n►►tti4t►+n to tl►se•liar,e• �l+,nu titw se l,tage waste init, Pity of 1►urhau►i's
Not ill and N*outl► Wnter Re'C 1amatit'll 1,16lit ie%. 'I'll Is kIiscllarge shill 1 11C between 11►e hollIN
t,f 11;►.in.:1e1tl •1;00 l+.ni., ti►c•+1:►►• ;► ►►erl.. 1'e•ri►►issio►► to tlisrl►:ugr i, veslrictcd to
waste collooM in the State of Not-th Cavoliimt The ma-kiti►utat tlisdial- ► plume nfe:teh
loa.i is 1 WO gallons.
l,► t,t►x SepticTank- tii r► iee sl►:►ll rt►i►►l+ly ►► ith till l►m► isit,t►s Or City e,l' lhirluui►'S
SoNvel. Use Onlim►lwe, Ifany provision nt'the C it►•'s Swwer Use Ordinance is ►'ie,Iatod.
tl►is atithe,riltltie,n ►►tan he lctti►it►:►teei.
Fee a•sessillent and ► rite detenninanoti may t►e required tit the discretion of the City of
Dui-han►. Dcpattinent trt'Water Managemea►t.
Z"Eiis authori.:ation shall be valid rrom aatutary 1. 2023 until December 31. 2 02 3.
1e+lin ❑t►{ltil►iti
Nor i Durham Witter Reclatitlilt itiri Fneilily
1900 Fast Club Boule►'arel
Darh,am, North Cairolina 277(M
C harlic Cocker - Dane
tie,ulh Durham Waiter lice la minion lta►cility
[1605 FtIlTit►4te,l► 1201lel
Chapel I Ii11, North Can,lina 27517
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AUTHOR17ATION 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 facility.)
DO
do hereby authorize:
(Facility operator)
�(�O�erat r Acldress)
ire
iOwnV of Sephgi
Management Firm)
0
` (Name of Septage Management Firm) "T
-(�Aorc-L-S�7�A� a&;�2/5 vic/L. A
(Address of Septage Management Firm)
to utilize septage detention or treatment facility # for the treatment or storage os
septage
in 20-1;�3,. The facility will be operated in accordance with the Septage Management Rules'#.
Rate: - (`-20,7 Signe
(Facility Operator)
' As defined in GS.130A-290ia)(321
" As defined in LSA NCAC 138.08M
Return the properly completed form to:
North Carolina Department of Environmental quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, I4C 27699.1646
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PAI
CK NO. 36S3-
DATE
L- Lion-s- �\Llse" coe., N CS-000<zoo,06)
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