NCS00361_2023Permit_Initial

2023
Permit and Registration
Delk Septic Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00361
o and registered as a
e:,e D
NORTH
EQ
%L 12. 9*
-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r Q'M
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. City of Asheboro WWTP, Randelman, NC
2. Denton WWTP, Denton, NC
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.
(.BYTE A�� g �fff 12/01 /2022
Perry Sugg, EnvWonmentl tompliance 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 exac Iv as it is shown on your vehicle(s)).
Street address of office: �i o ESL e 2 C,hfri L 2c(
City: State: nl c- Zip: a? 2- 11
Mailing address (if different):
City:.
Phone: 3 3 L 3 o X— Xa 42
State:_ --Zip
Fax:
E-Mail: k-, et, e-t is 0- 2Tnn L.&r E T
County: R, A„ r Qc L Q H Septage Management Finn permit number: NCS # c a3- 3 6 l
(2.) Firm owner's name: 4{e-v P4 T. l7 EL 14
Mailing address (if different):
City:.
State:
F
(3.) Firm operator's name: ,� • T�o ELk Firm operator's title:
Mailing address (if different):
City:
Phone:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of igglionsgumaed in last 12 months (Example: Domestic: 50,000).
f Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant
5C/o , 000 1 30, 000 1 /ego, 000
(5.) N.C. Counties of Operation: Z &, 1 0 01- T R av L (D so ..1
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: 1
Number used for: Domestic Septage:_ L _ Grease (restaurant):
Other. _ Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
ndustnallCommercial
License Tag #
Vehicle Identification #
Tank Capacity
1
1436-7
oaQV'A RS7 cjj M 1Wq-715
a-5o0
2-
3
4
-
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGUAENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) ( 4yes ( ) 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? ( Vfyes ( ) no Initial 1L5 O Dates l— '?— a—�,
(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 the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: .Expiration Date: _ _ SLAS#:_ _ __ Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: Expiration Date: _ SDTF#:_. Expiration Date: _
(9.) Septage Management Firm Operator Training Completed:
Date: r® 8 ao Location: �C',r«.� , f bm.� L Hours:��
Training Sponsored or Provided by: _ r� --t-t. C.��(�N �r S �, TA-.k Brae-"A-h'0.a
(10.) Septage Land Application Site Operator Training Completed:
Date: _ Location:._ Hours:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm:
Certification 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.
Si nature (Signatu
re of coompanyofcial requirao
Ke;VAf45-1-H 7 ELK
Name
Other Comments:
1--7 - 2-a-
Date
Title
PAGE 2
Rev. 04-26-2021

N
Q
z
0
cp-
tA
m
r)
z
A
0
z
CL
a.
M.
to

NC SEPTAGE MANAGEMENT FIRM
Recertification of dumper Vehicle(s)
Septage Firm Permit #: NCS- o b 3-
Number of Pumper Vehicles: A.
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."
Si gr1QW'(S1g'na`tVe of company official requireco
Print Name
a:
Date
W "i E-K
Title
S:lSolid WastelcialseptagelformslPumper Vehicles Cetification.doc

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
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, Michael R. Wiseman ORC, WW4#987680,_ City of Asheboro Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
1032 Bonkeme er Drive Randleman NC 27317
(Address)
336-672-0892 do hereby authorize
(Phone Number)
Kenneth Delk
(Owner/Operator of Septage Management Firm)
of Delk Septic Service NCS# 00361
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage _ X portable toilet waste
grease septage (grease trap pumpings) X commercial/industrial septage from
Randolph Count
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
1032 Bonkemever Drive, Randleman, NC 27317
(Location)
between the hours of 7:00 a.m. to 5:00 ;.m. Mondav -Friday Only
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 s
(Facility Operator)
Date O
4 �C��ti

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.
W --i-
star M RespandNe merge (ORq, ORC license Number, Name of Plant)
(Address)
(-3302�S g- q(Q hereby authorize s— ��•� k
(Phone Number) (Owner/Operator of Septaga Management firm)
of ? Lit S C 9 ` - 1 CL Sc AV i L r✓ C7f� - 3 (a I
- -_ .._GCS i _,..
(5ept3ge Management Firm Name and NCS number)
to dispose of: domestic septege } ✓� portable toilet waste
grease septage (grease trap purnpings) commercialfindustrial septage _,, from
i (County or other Geographic Area) ~� -
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
pardaliy treated Nquid into a grow trap is acceptable ,_,_Yn _a/, No
This authorization shall be valid until
Signed
(Facility Operator)
(Usually December 31, Year)
Subscribed and affirmed before me this ao day of 20
i
My Commission expires: S alp
Notary Pubik)
(OFFICIAL SEAL)
NOW. FalsiRcation of this document by the sapterga maneprrrent firm shall wid to permit ravoeStlon.
SAdid„wa&a1G.A/WTAWF0RMSjMS Firm APP11=fi VWWTP AUftwha Wn Fwm 2018

VANorth Carolina Department of Environmental Quality
Division of Waste Management
NORTH CAROLINA INVOICE
EhvlronmentW Qualify Solid Waste Section
Division of Waste Management To: Kenneth 1 Delk
Solid Waste Section Delk Septic Service
1646 Mail Service Center ad
Raleigh, NC 27699-1646 Trinihi Tyo
Phone/Fax: [phone] rAj
Email: [e-mail] /1e w '77� �3 escr2�� �L
q�ltSJ I> `
Date: 09/27/2022
Invoice #: NCS-00361-2023
Septage - Annual:
Delk Septic Service (NCS-00361)
2918 Ross Wood Road $550.00
Trinity, NC 27370
Number of Trucks:1
Date Due: 12/15/2022
LATE FEES: lccordance with NC General Statutes r r, 1:%nA-2A11(e2), a late fee will be applied to any annual permit fees not submitted by )anuary 1, 2023.
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
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--4anation 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
Regulations or Technical Assistance
Jared Wilson [phone]
Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) -
North Carolina Solid Waste Program -
North Carolina Septage Management Program -
PAID
CK. NO.
DATE`._�Yt`� 2'L