NCS00153_2023Permit_Initial

2023
Permit and Registration
Singletary Septic Tank Service
is hereby issued a Septage Management Firm Permit,
sTArE� _ Permit Number NCS-00153
oand registered as a e:,e D Qi�
NORTH
A%L 12 t
-�� 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. Septage Land Application Site, SLAS 09-07
2. Septage Detention or Treatment Facility, SDTF 09-07
3. City of Lumberton WWTP, Lumberton, 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.
Wm Perry Digitally signed by Wm Perry
Su
S u g g a 00 023.02.02 12:17:06
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 "Finn name" must be exactly as it is shown on your vehicle(s)).
r. . 4 C . . . r.
r
Street address of odce: '
City: l%1-'� W )a\,0 -0 Stateju-c_Zp::cS za(j
Mailing address (if different): . i 1
City: -a State:KI C _Zip c2,cs Z.-;� a
Phone: q 0l Fax:_3 WS - (b 0%
--
County: Septage Management Firm permit number: NCS # D3
(2.) Firm owners name: r�,3 rr„
Mailing address (if different):
0
City: State: ()C Zip Qs 3a)
Phone: Fax:
v.
(3.) Firm operators name: _ Firm operators title: o N
Mailing address (if different):
City: `' IV State: �(� Zip: 0? g �a U 9 �
APhone: 10 T � -�®� Fax: `� I 6 �a� - 6 � Zi 1
o
(4.) Type(s) of septage pumped: Write in the number of Gallons numned in last 12 months (Example: Domestic: 50,000).
(5.) N.C. Counties of Operation: T2,k.a 1���r��r,,� CON Cv�he.r1.� n� _ 1�►�
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: rr Grease (restaurant): _
Other: Portable Toilet Waste: E
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
1YA
66 L I
i _
2
A - ,r
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) Oyes ( ) 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? 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 theSeptage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: W-07 Expiration Date:-SLAS#: Expiration Date: - o•
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:QeGs,—Vv.r 3 �aaLocation: 4.;C Hours:
J
Training Sponsored or Provided by: zr ��
y-
(10.) Septage Land Application Site Operator Training Completed:
Date: b o c e?-q;r::A Location: Hours:
J
Training Sponsored or Provided by:
(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 %Ring a false statement, representation, or certification.
Other Comments:
Rev. 04-26-2021
PAGE 2

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE LAND APPLICATION
SITE PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a land application site permit holder to indicate that permission has been
given to a permitted Septage Management Firm to land apply septage on the permit holders
land application site.)
l 6i
(Site Operator)
do hereby authorize:
(Name
(Operator Address)
cnf 9
(Owner of
Management Firm)
�A- aWk0'\-)47
(Septage Management
Firm)
WC
Address)
NCS# 0 bV
to use septage disposal site # 69-07 for the disposal of gallons of septage* in 201P-9
Date: De, vm 6x R da-922 Signed /C I t fl _ .,lw�
(Site Operator)
* As defined in G.S.130-A-290(a)(32). The site will be operated in accordance with 15A NCAC 13B
.0800 - Septage Management Rules
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

NC SF PTAG 1=-4'j' MANAGEMENT F111M
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: _ NCS- ho l 5
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 arjq imprisoppent."
r
iture (Signature of c official required) Date
�� rTa '�/1©l /� {'coh
Name Title
S:18olid_WastelclaWeptagelformslPumper Vehicles Cetification.doc

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.
Henry Harper; ORC # 1008147_ City of Lumberton Waste Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
700 Lafayette Street, Lumberton, NC 28358 Tammy Smith 910-671-3858
(Address) (Contact / Phone Number)
do hereby authorize
(Owner/Operator of Septage Management Firm)
of Singletary Septic PO Box 782 Bladenboro, NC 28320 NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage Yes portable toilet waste . ,
grease septage (grease trap pumpings) commercial/industrial septage , from
Robeson and Surrounding COL
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
The Influent Basin at 700 Lafayette Street Lumberton, NC 28358
(Location)
between the hours of 7 am to 4 pm Monday — Fridas No weekends or Holidays
Reintroducing partially treated liquid into a grease trap is acceptable Yes X_No
This authorization shall be valid until December 315t 2023
(Usually December 31, Year)
Signed Date NN
0 ' (Facility Operator)
Subscribed and affirmed before me this day of 20-,L,
My Commission expires: ID !9 &2-1 _
(Kota ublic)
TAMMY L SMITH
(OFFICIAL SEAL) NOTARY PUBLIC
BLADEN COUNTY, NC
My Commission Expires 10-19-2025
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2014 Firm Application/WWTP Authorization Form 2014

z;K
nL
ua
cn
rn 0
�z
�-1
> z
�
a>
Cz
T O n z M TT
z
n
°C: O
>m z
>M
� � � A >
"U
�;0 'n _ 0 Q
T z — m
m z T u > O U}
0
O
w m — Z ,� ,.� r-
..
°wmo N �A m ;a > O
_.
�. 0
CN0m W (> to C M
z�z `� � r"Q ro `� ►�
�Z"4 m ��
v T
z �• O �
=mC 0 r�
zz� �p
na >
T PO.
Oam
c z
6)

zx
r),L.
�a
cn
M D
E 1�
on z
an O
PT Z
m = z N
0� o O N
j;u-r > ~�
-4 Z �o =
� M ;u ( 0
>0 n Z
M M
shim r on 0
m3g0 r� 0 O z d 2Wo z
m z 0 CA (A > C:
0. O
0 Ln xwz Lnara N > "a
�
ONZ
c Ou c wM 3 �' C d rz
i�l1N�> >-� W
r v' ;u X
r Z > v �--
>o o r
z0> �0
�? O Ma
z Now
Ma z
G)

North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NORTHCAROUNA Solid Waste Section
Enytronmentalq�glfry
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
Septage - Annual:
Singletary Septic Tank Service (NCS-00153)
PO Box 782
Bladenboro, NC 28320
Number of Trucks: 2
To: Furnie Singletary Jr
Singletary Septic Tank Service
PO Box 782
Bladenboro, NC 28320
Date: 09/27/2022
Invoice #: NCS-00153-2023
Date Due: I 12/1S/2022
LATE FEES: 'n 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://dea.nc.aov/swpav
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 htti)s://deg.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.]
Exolanation 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 regarding:
Billing
Regulations or Technical Assistance
Jared Wilson [phone]
Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - https://deo.nc-cic
North Carolina Solid Waste Program - tti s:_dee-.nc.e:ov abou � idivisions?.waste-m nag emen +solid -waste -section
North Carolina Septage Management Program - httus::' deu.nc.uov;abou, divisions.waste-manauemenVsolid-waste-sectioWsuecia I -wastes -and-alternative-
handlina/septage