NCS00304_2023Permit_Initial

2023
Permit and Registration
Stay Clean
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00304
o and registered as a
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NORTH
EQ�j
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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. Central Johnston County Regional WWTP, Smithfield, NC
2. ORC North Harnett Regional WWTP, Lillington, NC
3. Septage Detention or Treatment Facility, SDTF-51-03
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.
Gf,4'x- A&4,4�' 12/01 /2022
Perry Sugg, En onmental 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*
STAY CLEAN
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00304
Enter the five digits following the NCS #
Street address of office*
Street Address
670 WIGGINS RD
Address Line 2
City
State / Province / Region
ANGIER
NC
Postal / Zip Code
Country
27501
United States
County*
Johnston
Mailing address same as street address of office?*
• Yes No
Phone* Fax
919-427-1623 919-639-1091
Email*
[e-mail]
Owner Info]
Firm owner's name*
GENE STEPHENSON
Mailing address same as street address of office?*
• Yes No
Phone* Fax
919-427-1623 919-639-1091
Operator Info
Firm operator's name* Firm operator's title
BRIAN DIXOM MANAGER
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
919-427-1623 919-639-1091
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 15,000
Portable Toilet Waste 325,000
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in:
JOHNSTON, WAKE, HARNETT
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
off' f NO/
Date*
11/29/2022
Title*
MANAGER
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Portable
Toilet Waste
YA171953
2FZAAHCT31AJ38713
1,700
Portable
Toilet Waste
YA162184
2FZACFCS95AU20O74
1,700
Portable
Toilet Waste
AB-3220
1HTKHPVK8LH414723
1,300
Portable
Toilet Waste
NR1179
1GBKC34FXJ103770
100
Domestic
Septage
YA130876
1HTSCAAN51H348O88
2,100

Portable Toilet Waste YA120657 1HISCAAL2WH563515 950
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*
Bill J. Thomas (Grade IV WW #
995445), ORC of NHRWWTP (NPDES #
0021636
Central Johnston County Regional
Wasterwater treatment Plant
Septage Land Application Sites (SLAS)
Yes • No
Expiration Date* Authorization
12/31/2023 Scan2022-11- 427.9KB
29_085159.jpg
12/31/2023 Scan2022-11- 441.81...
29_085330.jpg
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-51-03 1/1/2025 Scan2022-11- 542.5KB
29_085951.jpg
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed^
Date* Hours*
12/4/2021 4
Location*
NC STATE FAIR GROUNDS, JIM MARTIN BUILDING
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
Date
11/29/2022
09:02:00 AM
Print Name*
Brian E. Dixon
Title*
[e-mail]

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.
I, Billy J. Thomas Grade IV WW # 995445 ORC North Harnett Regional WWTP
NPDES # NCO021636
607 Edwards Brothers Drive Lillington NC 27546 910-893-2424
do hereby authorize �_�_1 l j>
of N CS #
to dispose of: domestic septage and/or portable toilet wastes at the above named WWTP-
Septage shall be discharged at: Septage Receiving Station at NHRWWTP
between the hours of 7 AM-5 PM
0
This authorization shall be valid until 12-31-23
Signed _tj Date
(Facility Operator)'
ubscribed and affirmed before me this day of 2022
My Commission expires. FEB 10 2024
(OFFICIAL SEAL)
•. OFFICIAL SEAT.
Notary Public, Now Carolina
1 County of Hamett
Carolyn K. Murayama
Note: falsification of this document by the septage managementfirm shall lead to permit revocation.
5-/Solid Waste/CLA/SEPTAGE/FORMS/2oi6 Firm Application/WW7 Authorization form 2017

� AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605
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.
1, John D. Wai[ Central Johnston County Regional Wastewater Treatment Plant
(Alan! Operator and Name of Plan[)
Post Office Box 2263, Smithfield. North Carolina 27577
(Address)
[phone] do hereby authorize
(Phone Number) (Owner/Operator of Sept age Management Firm)
of _7_T�r�t & 7c.)
(septage nagemeni Firm Name and address)
Email Address: fccc� � G.— vL ;i V<Zec
to dispose of; domestic septage ___X portable toilet waste
Johnston County does not accept grease traps and pumpings.
Johnston County, Forth Carolina
(County or o?her Geographic Area)
at the above named wastewater treatment facility. 5eptage shall be discharged at:
Johnston County Sludge Handling Fa0ity, 680 County Home Road, Smithfield North Carolina
Locauori
between the hours of 100 A.M. thru 44.5 P.M. -Monday through Frlday.
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
John D. Wall (Facility Operator)
Sworn to and subscribed before me this
Nancy House (Notary Public)
Date
day of _
My Commission expires:
'Waste generated in other counties will not be accepted. All waste must be
generated in Johnston County.
Note: Falsification of this document by the septage management firm
shall lead to permit revocation.
4.1-2023
(OFFICIAL SEAL)

RECEIVED
SEP 14 2023
9EaF4y5rM1rW ROKWI 0"-"
Landowrner's Authorization to Operate a Septage Detention or
Treatment Facility
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
n
1, (name of site owner) hereby certify that i am the owner of
r
acres of land located and
identified by CJ (book and page of recorded deed or fax map parcel) and
that I agree to allow (SDTF permit applicant) to use
said land for a septage detention or treatment facility for a period of (length
of time)beginning y 2,0 (give date) and that I have read the North Carolina
Septage Management Rules''. I further understand that no septage may be stored or treated on the land
until the Division. of Waste Management hay=issued a permit for a detention or treatment facility, Thee above
described property is owned sole€ by me or jointly with sid
(names of all co -owners, or state none).
3ionature of landowner 1,07/II Nte
- S &U
Signature of landowner Date
Sworn to and subscribed before me this Jr� h da of 20 � D
Y
1�o��A ❑x0�
1�ifiJJ.
= {OFFICiA� SEAL}
(Notary Public) = 't4oYP+RY
PUBLIC z_�
My Commission expires: - — oy
15A N.C. Admin, Code 13B Section .0800
Rev. 41-07-16