NCS00320_2023Permit_Initial

2023
Permit and Registration
Millers Septic Service
is hereby issued a Septage Management Firm Permit,
STATE,, _ Permit Number NCS-00320
oand registered as a
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. Taylorsville WWTP, Taylorsville, NC
2. Septage Land Application Site, SLAS 02-05
3. Septage Detention or Treatment Facility, SDTF 02-05
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.
12/12/2022
Perry Sugg, Environmental 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*
Millers Septic Service
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00320
Enter the five digits following the NCS #
Street address of office*
Street Address
80W main ave
Address Line 2
City
State / Province / Region
Taylorsville
NC
Postal / Zip Code
Country
28681
United States
County*
Alexander
Mailing address same as street address of office?*
• Yes No
Phone* Fax
828-632-0788
Email*
[e-mail]
Owner Info
Firm owner's name*
Warren Miller/Darren Weaver
Mailing address same as street address of office?*
• Yes No
Phone* Fax
[phone]/455-
5086
Operator Info}
Firm operator's name* Firm operator's title
Warren Miller/ Darren Weaver owner/owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
18284555566/82845550
86
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 52,000
Portable Toilet Waste 0
Grease (Restaurant) 12,750
Treatment Plant 6,000
Industrial/Commercial 0
North Carolina counties of operation}
List each county you plan to do business in: *
Alexander, Iredell, Catawba, Caldwell, Wilkes
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*
11/21/2022
Title*
owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA99064 4VLVDRDF6MN642124 2,000
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
Town of Taylorsville WWTP 12/31/2023 2023 WWTP.pdf 652.5KB
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 # *
SLAS-02-05
Expiration Date*
10/28/2024
Authorization
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 #*
SDTF-02-05
Other disposal method*
Yes � No
Expiration Date*
10/28/2024
Authorization
Septage Management Firm Operator Training Completed
Date* Hours*
1/27/2022 6
Location*
Hickory North Carolina
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
1/27/2022 6
Location
Hickory North Carolina
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
11/21/2022
04:00:00 PM
Print Name* Title*
Warren Miller/ Darren Weaver Owner/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)
-1--`L 2!E691
(Address)
5241:b do hereby authorize m. trey e
(Phone Number) (ownerloperator of Septage Management Firm)
of jM: d 4e#'-g 5 e p 4.r 5&—,r& `Ge NCS # 0'0 3 Zb
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage ) portable toilet waste G
grease septage (grease trap pumpings) Alt>— commercial/industrial septage V/r 04 from
ft leKaJs.:::L rylell Caliir..J af . tftj& CKn�
(County or other Geogr phic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
C,.3 t,.j% � /flan
(Location)
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable Yes C----No
This authorization shall be valid until _ I Z/311 ZO Z3
(Usually December 31, Year)
Signed Date I)Z1 &-VL—
(1`3-ci lity Operator)
S� � 1
Subscribed and affirmed before me this day of ! O V 20
lc� My Commission expires;
(Notary Public) �� r•+�? ll
r`.
(4FF1CIAL''SEAL),, `.ti
i 41,�� • � r: l l i ' ','
Note: Falsification of this document by the septage management firm shall lead to'petrrit revacatian:,\
S:/Solld_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/MVPAuthorization Form 2D18 r r` d; 1
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