NCS00271_2023Permit_Initial

2023
Permit and Registration
C & C Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00271
o and registered as a
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NORTH
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-�� Septage Management Firm�� �� w� ��nffii�utr
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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. Septage Land Application Site, SLAS 82-14
2. Septage Detention or Treatment Facility, SDTF 82-14
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.
"/'Z aff 12/12/2022
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FILM
DIVISION OF WASTE MANAGEMENT - SOUD WASTE SECTION - IM MAIL SERVICE CENTER, RAtLEtGH, NC 2 OO-1046
(1.) Flrm name: (Tire "Rrm name" m It be exact) "It is shown on your vshkle(s).
street ag raw of office: / T Wie
CRY: 1110reorho *&
Mailing address (if different): '94W
�e
Phhone:9lo- 3�'= o _ ax Fed= 3,r.��1= � -
County;..vr7!' 0 Septeae Management Firm pe number NCS # �
(2.) Firm ownees name:AA A sI_ � 2K +,� i i / °7i ,/j�.�+•+� %
Mailln iddress (if differenQ: /v4? SS City:
State' - Zip: of
Phone&, O - i��.?'O Fax:
(3.) Firm operator's na A Arrf la"'�'I!f Firm operator's title:
Mailing address (if different): _
City; 5rWstate: __ Zip:
Phone: ---Fax:
(4.) Type(s) of septage pumped: tNrhe In the number of gifts pympeaf In (Example. Dotr►estic: 50,004).
Portable Toilet Waste
Industrial/Commercial
(5.) N.C. of Operation:.VPaa
(LM each county you do businus In)
(6.) Total Number of Pumper Vehicles Ope . 4#0
Number used for. Domestic Septage:�! Grease (restaurant): �d
Other: Portable Toilet Waste:
Vehicle Infonration: (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A'SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(I.) Septage Qlsposal Method: (check one)
a) Approved wastewater Treatment plant ( ) yes ( ) no, if yes, submit Wastewater Treaftnt Authorization
for each plant, as IndkaW in Subparagraph .08M(c}(14) of the Septage Management Rules.
b) Septage Apt Site (SLAS �mii yu : (use additlonat shoals if needed)
SLAS#: pkation Q �+C� SLAS#: Expiration Date:
c) Septageik Treabrreni Facility DTFem�lt Numbers: (use additional sheeis if needed)
SDTF#k %_ Expiration tote SDTF#: — - _ Expiration Date:
(8.) Septage Ma�at nt F! perator Training Completad
Date:/ a " �,�,' _ Hours,
Trains S red or Provided by: M__- d er
(8.) Septage A. atio �' C+petatar Training Comp d: Hours:,,
Date:y'
_ tars:
Training Sponsored or Provided by:
(10.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm: _
Registered Septage Management Firm: „�.�, �,.►
Registered Portable Sanitation and Septage Management Firm:
Certification Stement
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 suspndsd or revoked upon a finding that Its
Issuance was b*W upon incorrect or Inadequate inbrmadan that matsd* atfwAW the dechton to laws the
permit and that theire are criminal penalties for knowingly making a false stateanent, representatim, or u-v;6,mAlon.
Sirgnst re (, n&Wm of company offiWa l regrrlred)� pate _
4
Print Name
Title
Other Comments:
5! 0W W0*XLA "aEPTAGFORM=13 FW ApNcWoMFkWwmVV0oel wW13
PAGE 2

SEPTA E MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #:._ _ NCS- 04.2 %1
Number of Pumper Vehicles: IAe
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."
IOiAw 0, '0" -
Signature (Signature of company official requfretO
Print name
� �lA.a52 rn�'e
Y)
/"�^ �-C'i
Date
Title
' %e-re- ire FWD�--
Q k'VA0V Wayne Cahr,a
a NYVnur D�l�o n Cahn dd
cK No. 4�f�2s
DATE
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