NCS00336_2023Permit_Initial

NORTH CAROLINA
Environmental Quality
2023
Permit and Registration
Powell's Septic Tank Service
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00336
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
NORTH CAROLINA �EQ
W/11
Department at Environmental quality
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. Roanoke River WWTP, Weldon, NC
2. Septage Land Application Site, SLAS 42-04
3. Septage Treatment or Detention Facility, SDTF 42-04
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.
" 6z�A� �, 12/01 /2022
Perry Sugg, En ' onmenta tornpliance 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*
POWELL'S SEPTIC TANK SERVICE
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
00336
Enter the five digits following the NCS #
Street address of office*
Street Address
3296 hwy 48
Address Line 2
po box 395
city
State / Province / Region
ROANOKE RAPIDS
NC
Postal / Zip Code
Country
27870
United States
County*
Halifax
Mailing address same as street address of office?*
• Yes No
Phone* Fax
2525372450 2525354907
Email*
[e-mail]
Owner Info;
Firm owner's name*
ALLIE M POWELL III
Mailing address same as street address of office?*
• Yes No
Phone* Fax
2525372450 2525354907
Operator Info
Firm operator's name* Firm operator's title
ALLIE M POWELL III OWNER
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
2525372450 2525354907
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 60,000
Portable Toilet Waste 0
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation}
List each county you plan to do business in:
HALIFAX, NORTHAMPTON, WARREN
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*
9/27/2022
Title*
OWNER
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage AP2636 1HT5DNSL4MH377183 1,800
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
ROANOKE RAPIDS SANITARY DISTRICT 12/31/2023
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-42-04
Expiration Date*
12/1/2025
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-42-04
Other disposal method*
Yes • No
Expiration Date*
12/1/2025
Authorization
Septage Management Firm Operator Training Completed
Date* Hours*
1/28/2022 4
Location*
HICKORY NC
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed^
Date Hours
1/28/2022 2
Location
HICKORY NC
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
alle !.� �vr�ef! 111
Date
9/27/2022
09:52:15 AM
Print Name* Title*
ALLIE M POWELL III OWNER

NC SLPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- W33(,f)
Number of Pumper Vehicles: I
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."
�\v L
Signature (Signature of company official required)
V1i1 a a
Print Name
Date
Title
S:1Solid_Wastelclalseptagelforms\Pumper Vehicles Cetification.doc

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, Roanoke River Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
135 Aqueduct Rd, Weldon, NC 2890
(Address)
252-536-4884 do hereby authorize Allie M Powell
(Phone Number) (Owner/Operator of Septage Management Firm)
of Powell's Septic Tank Sales and Service NCS # 0036
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage x , portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
Halifax and Northampton Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
135 Aqueduct Rd, Weldon, NC 2890
(Location)
between the hours of 8am - 5pm
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 .4_ _ _ Date. 9/28/2022
(Facili y Operator)
Subscribed and affirmed before me this
(Notary Public)
28th
day of September 20 22
My Commission expires: 12/06/2022
y BRIn NEY MOSELEY (OFFICIAL SEAL)
I NOTARY PUBUC
I HALIFAX COUNTY, NC
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2016 Firm Application/WWTP Authorization Form 2017

a
7�
North Carolina Department of. Environmental Quality
Division of Waste Management INVOICE
R7H N6CAROLINA
e„wronn,enwt Solid Waste Section
Division of Waste Management To: Allie M Powell III
Solid Waste Section Powell's Septic Tank Service
1646 Mail Service Center PO Box 395
Raleigh, NC 27699-1646 Roanoke Rapids, NC 27870
Phone/Fax: [phone]
Email: [e-mail]
Date: 09/27/2022
Invoice #: NCS-00336-2023
Septage - Annual:
Powell's Septic Tank Service (NCS-00336)
PO Box 395 $550.00
Roanoke Rapids, NC 27870
Number of Trucks: 1
Date Due: 12/15/2022
LATE FEES: if, accordam-e wlrl l NC GL-iural Statutes GS 130A-291.1(e2), a late fee will be applied to any annual pel gat fees not submitted by January 1, ?023-
Payment Options:
E-check Available online at
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card Available online at hf, r?s:-7dco.rc.,a
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number shown
on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
[*Convenience Fee of 2.65% added to amount invoiced.]
Paper check Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number on
check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy of this
invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Ex lanation of Invoice Amount is Based on Firm's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay fee(s) based on your solid waste management
activities. The fee(s) shall be used to support the septage management program.
For questions regarding_
Billing Jared Wilson [phone] A L3
Regulations or Technical Assistance Chester -
g C es er Cobb 919 707 2 8 83 IMP
Jeffrey Bullard [phone] CK. NO. 2a 162
DATE (f/Y 22 _
More information available on the web)�o, a� `
North Carolina Department of Environmental Quality (DEQ) - i tt;> _! ;:i :rc .ni:.00V
North Carolina Solid Waste Program
North Carolina septage Management Program anj :a tr rnative
no