NCS00147_2023Permit_Initial

2023
Permit and Registration
Lentz Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00147
o and registered as a
e:,e D
NORTH
EQ
A%L i2. ��
-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r 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. Septage Land Application Site, SLAS 49-02
2. Septage Detention or Treatment Facility, SDTF 49-02
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.
(,{,yy /D, 7,12/01 /2022
Perry Sugg, En ' nmental 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 exact/v as it is shown on your vehicle(s)).
Street address
'ofroffice:'
City: �, s ' " State: c Zip:
Mailing address (if different):
City: Phone: j �4— 'iKt?
tt
E-Mail: a, 1
County:
(2.) Firm owner's name:
Mailing address (if different):
State: Zip
City: State: Zip
(3.) Firm operator's
-1I
number: NCS#
operator's title:
oy VvAejjdo4
Mailing address (if different):
City: State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons numned in last 12 months (Example: Domestic: 50,000).
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrial/Commercial
(5.) N.C. Counties of ration: S- WC 1�Ail�AIIACII I
[�
(List eacWcounfy 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)
.�
..
to- K, _ 6'2_7Y7 1V vv -11X1+(6L K aby' q1 ' tn�-UO
APPLICATION CONTINUA ON PAGE 2
PAGE 1 PAI
L'�C. e . e
DATE /U/11/2tz�
Ab 00. o-v

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED F OM 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? (Vj'yes ( ) no Initial J"'ie,C. Date 0
(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 nd Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: Expiration Date: 1,9—(6 -2 SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility► SDTFI Permit Numbers: (use additional sheets if needed)
SDTF#:Expiration Date: 3�_ SDTF#: Expiration Date:
(9.) Septage Management irm er�or Training Completed:
Date: Location:
Training Sponsored or Provided by: L � " 4.
Hours: r f
(10.) Septage Land Iicatil n Site Operator Training Completed:
Ap
Date: Location: Hours:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm: --k_
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 then: are
criminal penalties for knowingly making a false statement, representation, or certification.
(� N� � , -
Y` .4z�
Sign (Signatum of companyofiic al required)
son e /'P()4�
Print Name
Other Comments:
/0 /d
Date
(' =
Titre
Rev.04-26-2021

NC SEPTAGI MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- 000 ( 7
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 icial required)
�Q�Gn z,-
Print Name
Date
Title
S:lSolid_WastelclalseptagelformslPumper Vehicles Cetification.doc

.WNW
NORTH CAROLINA
Environmental Quality
rya
Solid Waste ePayments Receipts
ePayments - Online Payments
WARNING: Do not click on your browser's back button! Doing so may cause
another payment to be processed!
Thank you for your payment.
Payment Type: VISA
Amount Paid: 1$821.20
Date Paid: 10/11/2022
Confirmation number: 22101140741539
Authorization Code: 011076
Disclaimer: The ePayments System will not be updated immediately with your
payment transaction until the next business day. Therefore, paid invoices
will continue showing outstanding in the system until 1 business day or 24 hours
after the transaction was made.
Would you like to pay another invoice?
Pay another invoice

d
Ow
Ell A !z �4
z
o
Poll 0, C IT
W Z4 �v
�..� IQ
�r �� r
z
e
a�
LA
o rm
p �
m LIB
MI