NCS00314_2023Permit_Initial

2023
Permit and Registration
Cannons Septic Tank Service, Inc.
is hereby issued a Septage Management Firm Permit,
STATE,, _ Permit Number NCS-00314
oand registered as a e:,e D
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. Greenville Utilities WWTP, Greenville, NC
2. Septage Detention or Treatment Facility, SDTF-98-08, SDTF-74-13
3. Septage Land Application Site, SLAS-74-13, SLAS-74-17, SLAS-74-08, SLAS-74-15
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
Y Wm Perry Sugg
0
Sugg 113:06 03-05''00'2
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 "Firm name" must be exactly as it is shown on your vehicle(s)).
Street address of office: 4-?)5) (M-c rai 4, _
City: 6 ri.�k ., State: 1�-c Zip: 0�5--_)o
Mailing address (if different): Pe I�J�X [� `2
City: (,vj �fyw State: NC- Zip J S 5 iL
Phone:_ 5,-)-r,)'dq-t4 Fax: a53-`5-44 33L�Ka
E-Mail: CcLnn6-ns . sg4tic x cO • C4V�
County: ,P ii _ Septage Management Firm permit number: NCS # 2 14
(2.) Firm owner's name: C •1Ei' &,, at)il;-y, L
Mailing address (if different): 5 CL.N1r1k ro rz,49,.w. .
State: Zip
Phone: Fax:
(3.) Firm operator's name: ae i'tt c, rn n M �.5,� "Firm op rator's title:
Mailing address (if different): `7 (_� ryd Q ` Ot,{!hS1 _
City: State:_ _Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons in last 12 months (Example: Domestic: 50,000).
Domestic Portable_ Toilet Waste Grease (Res
l *D6 J u101.19.�b
(5.) N.C. Counties of Operation: I.atb1Y, FfYl1M�. CXCuaP
(6.)
Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage:
Other:
Vehicle Information: (use additional paper if needed)
�3
you are
I reatment Plant i Industrial/Commercial
do
Grease (restaurant): 3
Portable Toilet Waste: -ter
i
License Tag #
Vehicle Identification #
Tank Capacity
1
1J16 1
N, - `7 0 Ub
3 5Lt -. Aj
2
t� SjcjCjLj
Mr" dv&L.. 199 LA-?3
LDGAP
3
iJN 3
1LU a r, If _3;01ll4
Lu 7
41
5
APPLICATION CONTINUED ON PAGE 2 RECEIVED
PAGE
JA N 0 4 2023
SOLID WASTE SECTION

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (t,,�yes ( ) 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? (L/yes ( ) no Initial —& Date I D- a�V -:4,
(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#:` 14-1 Expiration Date: j_SLAS#: I -1-1 Expiration Date: U-i - 3
1b-14; gj
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: -1q-I Expiration Date:_ SDTF#: Expiration Date:
(9.) Septage Management Firm Operator Training Completed:
Date: Location: 0444mv
Training Sponsored or Provided by: IIJ C 7
(10.) Septage Land Application Site Operator Training Completed: -
Date: C1 `6 ' a a- Location: W r 1.
Training Sponsored or Provided by: P C-
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm: ✓
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
Hours: W
Hours:
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 (Signature of companyofficial required) Date
G lend 4 ( nnerw 5colt (c) r au - 01
Print Name Title
Other Comments:
5LAI� - -
5 L w 5 — - I LI — ©'c6 — E7 �Yt — 1w �t
Rev. 04-26-2021
PAGE 2

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #:
Number of Pumper Vehicles:
NCS- ob Jlu
3
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."
Signature (Signature of company official required
6 61 & Cca)ilm 5r D-H h�lG rPrc��!
Print Name
yam`
Date
!0 Lk)f\Q--y
Title
S:1Solid_Wastelclalseptagelforms\Pumper Vehicles Cetification. doc

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission has been given to a permitted
Septage Management Firm to discharge septage into the permit holders detention or treatment facility.)
441 Buck Newsome Rd. Fremont, NC 27830
do hereby authorize:
Cannon's Septic Tank Ser
(Name of Septage Management Firm)
PO Box 65 Grifton, NC 28530
Daniel L Newsome
(Facility Operator)
(Operator Address)
Alton Cannon
(Owner of Septage Management Firm)
NCS #
(Address of Septage Management Firm)
(00953)
98-08
to utilize septage detention or treatment facility #
00314
for the treatment or storage of septage *
in 2023._The facility will be operated in accordance with the Septage Management Rules **.
Date:
11-01-22
Signed
acility Aerator)
* As defined in G.S. 130A•290(a)(321
** As defined in 15A NCAC 136.0806
Return the properly completed form to:
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

`7
Greenville
e
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.
M. Jason Mannino, WW415210. Greenville Utilities VMW
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
240 Aqua Lane PO Box 1847 Greenville, NC 27835
(Address)
252 551-1546 — do hereby authorize Alton Cannon
(Phone Number) (Owner/Operator of Septage Management Firm)
Of Cannons Septic Tank Service. Inc. NCS # 00314 _
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage 1/ -portable toilet wasteV
grease septage (grease trap pumpings) .commerciaVindustrial septage _ from
Pitt County and Surrounding Areas
(County or other Geographic Area)
at the above -named wastewater treatment facility. Septage shall be discharged at:
Greenville Utilities WWiP
(Location)
between the hours of 8:30 AM - 4.30 PM, Manda�through Frrday_
Reintroducing partially treated liquid into a grease trap is acceptable Yes d No
This authorization shall be valid until
Signed,,-,'.. _
December 31, 2023
NG GtlA* (Usually December 31, Year)
Date /C�
Note: Falsifit{on of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CL /SEPTAGEIFORMS/2018 Firm Application/WWTP Authorization Forth 2018
Canected fb You Post Office Box 1847 1 Greenville, North Carolina 27835-1847 1 guc.com 1 252-752-7166

NORTH CAROLINA
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Payment Type: VISA
Amount Paid: $821.20
Date Paid: 12 29 2022
Confirmation number: 22122954680538
Authorization Code: 029438._.._. ____.._._._.._....._ __�
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