NCS00210_2023Permit_Initial

2023
Permit and Registration
Hoffman Septic Tank Pumping
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00210
oand registered as a e:,e D
NORTH CAROLINA
EQ�J
-�� Septage Management Firm awnen� f� wrnmenta�lty
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. Ray Rogerson WWTP, Elizabeth City, NC
2. Septage Land Application Site, SLAS 27-11
3. Septage Detention or Treatment Facilities, SDTF 27-11, SDTF, 70-02
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.
" �' 12/01 /2022
Perry Sugg, EnviznmentH tompliance 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*
Hoffman Septic Tank Pumping
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-210
Enter the five digits following the NCS #
Street address of office*
Street Address
110 Enterprise Dr
Address Line 2
City State / Province / Region
Elizabeth City NC
Postal / Zip Code Country
27909 Pasquotank
County*
Pasquotank
Mailing address same as street address of office?*
• Yes No
Phone* Fax
2523394900
Email*
[e-mail]
Owner Info
Firm owner's name*
PaulHoffman
Mailing address same as street address of office?*
• Yes No
Phone* Fax
2523394900
Operator Info
Firm operator's name* Firm operator's title
Paul Hoffman owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
2523394900
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 529,950
Portable Toilet Waste 3,500
Grease (Restaurant) 8,100
Treatment Plant 9,000
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
Eastern North Carolina counties.
Vehicle Info
Do you plan to operate pumper vehicles?*
• 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*
11/8/2022
Title*
owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage Ya146088 1htmsaar45j000621 3,600
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
0 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
Ray Rogerson Wastewater Plant 12/31/2023 ncs210 wt.pdf 109.42...
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-27-11 5/28/2020
Septage Detention or Treatment Facility (SDTF)
• Yes No
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.
SDTF #* Expiration Date* Authorization
SDTF 27-11 12/1/2023
SDTF-70-02 4/1/2023
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed
Date* Hours*
9/7/2022 4
Location*
Kill Devil Hills
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
9/7/2022 3
Location
Kill Devil Hills

Training Sponsored or Provided by
NC Septic Tank Association
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
Date
11/8/2022
01:55:08 AM
Print Name* Title*
Paul G Hoffman owner

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, 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.
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
��0
` (Address)
�9-33 7-611�6 do hereby authorizeAmc')L cr t> fit/
(Phone Number) (Owner Operator of Septage Management Firm)
(Sept -age Management Firm Name and A1CS number))
to dispose of: domestic septage Y , portable toilet waste ` 1
grease septage (grease trap pumpings) commercial/industrial septage A-"/ , from
o0q5at,4,44,6 e. Q
(C unty or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of b % f op
Reintroducing partially treated liquid into a grease trap is acceptable Yes _X'No
This authorization shall be valid until OPCeyL,6- er 3/6,2o-2_3
(Usually December 31, Year)
Signed Date,��
(Facility Operator)
Subscr' ed a d affir ed fore me this 3f day of_Ak20 'I
AAA
My Commission expires:
(No ary Public)
M1 .
.�. 4(61PFICIAL SEA ); .'
Note: Falsification of this document by the septage management firm shall lead t"q permit rh_'gT6 aj1ibn.
S;/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018 ^-