NCS00205_2023Permit_Initial

2023
Permit and Registration
Appalachian Outhouses Inc.
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-00205
o and registered as a
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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. Corpening Creek WWTP, Marion, 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.
" A � 12/14/2022
Perry Sugg,1E, mental 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*
Appalachian Outhouses, Inc.
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00205
Enter the five digits following the NCS #
Street address of office*
Street Address
85 Lester Hollifield Rd.
Address Line 2
City
State / Province / Region
Marion
NC
Postal / Zip Code
Country
28752
United States
County*
McDowell
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
P.O. Box 96
Address Line 2
City
State / Province / Region
Marion
NC
Postal / Zip Code
Country
28752
United States
Phone* Fax
828-756-7268
Email*
[e-mail]
Owner Info
Firm owner's name*
Mario B. Smith
Mailing address same as street address of office?*
Yes 0 No

Mailing Address*
Street Address
P.O. Box 96
Address Line 2
City
Marion
Postal / Zip Code
28752
Phone*
828-756-7268
Operator Info
State / Province / Region
NC
Country
United States
Fax
Firm operator's name*
Firm operator's title
Mario B. Smith
Owner
Mailing address same as street address of office?*
Yes • No
Mailing address*
Street Address
P.O. Box 96
Address Line 2
City
State / Province / Region
Marion
NC
Postal / Zip Code
Country
28752
United States
Phone* Fax
828-756-7268
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 0
Portable Toilet Waste 93,893
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
McDowell, Avery, Burke, Mitchell, Rutherford and Yancey
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
Date*
11/14/2022
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Portable
Toilet
Waste
HX7519
JALE5W161G7300854
525
Portable
Toilet
Waste
EV7969
J813C41316767006353
300
Portable
Toilet
Waste
JZ6385
5PVNV8JV5L4559791
1,000
Portable
Toilet
Waste
KT6944
JALES=5W162N7302240
800
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* Expiration Date* Authorization
McDowell Corpening Creek WWTP 12/31/2023 McDWTFExp202... 395.38...
Septage Land Application Sites (SLAS)
Yes �) No
Septage Detention or Treatment Facility (SDTF)
Yes • No
Other disposal method*
Yes 0 No

Septage Management Firm Operator Training Completed
Date* Hours*
8/13/2022 4
Location*
Morganton, NC
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
Date Hours
0
Location
Training Sponsored or Provided by
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
alt�
Date
11/14/2022
11:00:00 AM
Print Name* Title*
Mario Brian Smith [e-mail]

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, Tim Horton 1008211 Cor enin Creels W1 'T
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
PO Drawer 700 Marion NC 28752
(Address)
828-652-8943 do hereby authorize Mario B. Smith
(Phone Number) (Owner/operator of Septage Management Firm)
of Appalachian Outhouses Inc. NC# 00205
(Septage Management Firm Name and NCS number)
to dispose of. domestic septage �� portable toilet waste X
grease Septage (grease trap pumpings) commercial/industrial septage , from
McDowell Ave Burke Mitchell Rutherford and Yancey Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Public Works Facility 94 Shop Drive Marion N.C. 28752
(Location)
between the hours of 8:00 Am through 5:00Pm Monday thru Friday (Excludes Holiday
Reintroducing partially treated liquid into a grease trap is acceptable Yes —X_No
This authorization shall be valid until December, 31 2023
(Usually December 31, Year)
Signed 4i0p'erator)
Date(F
Subscribed and affirmed before me this _
)'PC, day oft? 20-
My Commission expires:
(Notary Public)
"'O"ItIol loop,
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Note: Falsification of this document by the septage management firm shall lead to @rmit revocation. -
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