NCS00388_2023Permit_Initial

NORTH CAROLINA
Environmental Quality
2023
Permit and Registration
Dudley's Septic Tank Service
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00388
and registered as a e:.x5fDE 2�
NORTH CAROLINA :.�
Septage Management Firm Department ofEnvironmentalQuality
(PUMPER)
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.seg.,
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. Septage Detention or Treatment Facility, SDTF 54-01
2. Johnnie Mosley Regional WRF, Kinston, NC
This permit does not entitle the permit holder to operate a Septage Land Application Site, a Septage Detention or Treatment F acility, 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.
"_� 12/14/2022
Perry Sugg, E41ronmetirtaTCompliance 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
u M as N is shown on your Whicie(s)).
(1.) Firm name: (The Firm name must be L r-- 5 � c-
Street address of office: d'
C'rty:
t
Mailing address (if different): G
City:
State:.Zip
tiEZ��
Phone: I a- JrX3-Y !f y Fax:
E-Mall: GOr;
County: Septage Management Firm permit number. NCS # , d'
(2.) Firm owner's name:
Mailing address (if different).
`�
City:_
Phone:oZ 5-2 -SLj f G 3 Y Fax:
(3.) Firm operator's name:_
����, a 1��,— Firm operator's title: d u✓/Ue r
Mailing address (if different): -
City:---- - - State: Trp:.
Phone: Fax:
(Example: Domestic: 50,000).
(4.) Type(s) of septage pumped: NO in the number of -
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industnalluommeru+e
t L dD v. II
(5.) N.C. CountieA of Operation:
Et9 P o'r� CG M G r1Ct�
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage:_ Grease (restaurant):
O#W _ Portable Toilet Waste:
Vehicle information (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APP UCATION FOR PERM 4- TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (s yes ( ) no be issued.
ff you checked yes above, you must attest to the following statement before a permit may application meets the
°i certify, under penalty of law, that the pumper vehicle or vehicles listed
tquired by e s submiNCAtted
138 .0835(a) and vehicle letten►g
requirements for safe and sanitary transportation of Septage astheatt a 1 is maintained of each septage pumping event as
as required by 15A NCAC .0835(b). Furthermore, I also cerMy o9
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." _ z
? es no Initial
Do you attest to the statement above? ( - ( )
(a.) Septage Disposal Method: (check one) lion for each
a) Approved wastewater treatment purr ( ) yes ( ) no. If yes, submit Wastewater Treatrrierit Au#lor+za
plant, as indicated in Subparagraph .0834(cx14) of the Septage Management Rules.
b) Septage Land Application Site ($LAS) Permit Numbers: (use additional sheets if needed) --
iration Date:_— - SLAS#:�_� Expiration Date:-
—.
SLAS#: _Exp — --
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets
ee RDe needed)
SDTF# �y_0/ E)iration Date _G /i"dQ.t �� SDTF#:.p
9. Septage Management Firm Operator Training Completed:
() ,LS- v Location: e�'� ti C Hours:�L---
Date: k — /�
Training Sponsored or Provided by: �w�"
(10.) Septage Land Application Site Operator Training Completed: Hours:
Date: _-- _ — Location:
Training Sponsored or Provided by: - --
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Finn:
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.
__ —
Signature (—S n8tw9 of mpanyofffcm1 mgrrlm4
Print Name
Other Comments:
Date -� -
Titre
PAGE 2
Rev. 04-2&2021

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
NC --
Septage Firm Permit #:.
Number of Pumper Vehicles:
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 signicat t penalties for false certification including
the possibility of fine and imprisonmen"
- - - - - Date
Signatu4(signaturie ome ny ofiicial requiredf)
Print Name Title
S.%Solid_Waste\cla\septage\forms\Pumper 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, Kenneth R. Stevens Jr.- Wastewater License #21198 Johnnie Mosley Rggional Water Reclamation Facility
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
P. 0 Drawer 339. Kinston NC 28502 -
(Address)
252-939-3375 do hereby authorize Allen Dudle
(Phone Number) (Owner/Operator of Septage Management Firm)
of Dudley's Se. -tic Tank Service NCS # 388
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste X
grease septage (grease trap pumpings) commercial/industrial septage from
Lenoir and surrounding counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
_ Johnnie Mosley Regional Water Reclamation Facility- 2101 Becton Farm Road
Briery Run Lift S_ tation- Hi hwa 55 East
- (Location)
between the hours of 8:00 a.m. to 4:00 o.m. Monday thru Friday,:
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until
Signed -
(Facility Operator)
Sworn to and subscribed before me this
December 31. 2023
Date
//--A f;X�
day of 20
My Commission expires:
(Notary Public)
Note: Falsification of this document by the septage management firm shall lead to permit revocati
S:/Solid Waste/CLA/SEPTAGE/FORMS/2013 Firm Application/WWTP Authorization Form 2018

a
'
us'
e . North Carolina Department of Environmental Quality
'�-��` Division of Waste Management INVOICE
NORTH CAROLINA EffYhWU eetarQua7ry Solid Waste Section
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email [e-mail]
Seotac,,e - Annual:
Dudley's Septic Tank Service (NCS-00388)
2852 Hsvy 258 Sol^
Kinston, NC 23504
t�lurnber of Tmc!<s: 1
LATE FEES:
To: Allen Dudley
Dudley's Septic Tank Service
2852 Hwy 258 South
Kinston NC 28504
PAI
CK.NO._
DATE tt122 2� Date: 09/27/2022
• a Invoice #: NCS-00388-2023
$550.00
Date Due: 1 1211512022
Payment Options:
E-check Available online at ,hens //dea ncaov/swpav
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 https-//dea.nc.gov/swpav
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.]
Exijlanation of Invoice Amount is Based on Firm's CiJrrent 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 auestions reaardina:
Billing - Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on thew b:
North Carolina Department of Environmental Quality (DEQ) - htt ."Ldeo.nc.aov
North Carolina Solid Waste Program - httnt //dg nc aov/about/d i vaste-manaaement/solid-waste-section
North Carolina Septage Management Program - htt� ///dome S,aov/a ut/divisions/waste managPmPnt/solid waste section/special wastes end alternative
handling/septage