NCS00393_2023Permit_Initial

2023
Permit and Registration
Parks Septic Tank Cleaning Service
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-00393
o and registered as a
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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. Septage Land Application Site, SLAS 96-05
2. Septage Detention or Treatment Facility, SDTF 96-13, SDTF 96-01, SDTF 98-08
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.
Digitally signed
Wm PerrybyWmPerry
Sugg
Sugg Date: 2023.02.02
13:09:37-05'00'
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*
PARKS SEPTIC TANK CLEANING SERVICE
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00393
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
1161-B Parkstown Road
Address Line 2
City
La Grange
Postal / Zip Code
28551
County*
Wayne
Mailing address same as street address of office?*
• Yes No
Phone*
9197780264
Email*
[e-mail]
Owner Info
State / Province / Region
NC - North Carolina
Country
United States
Fax
Firm owner's name*
CHRIS PARKS
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9197780264
Operator Info
Firm operator's name* Firm operator's title
CHRIS PARKS OWNER
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
9197780264
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 725,000
Portable Toilet Waste 0
Grease (Restaurant) 17,500
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
WAYNE,GREENE,LENOIR,WILSON,JOHNSTON,DUPLIN
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
eiu'e/arfr
Date*
12/31/2022
Title*
OWNER
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage SUGERBUS 1HTLDTVN7HH512412 2,000
Domestic Septage YA166451 1HTSCAAN3XH674500 2,000
Domestic Septage YA174431 1HTSDAAN4XH611810 2,500
Septage Disposal Method^
For each method, indicate whether you plan to use it by checking yes or no.

Approved wastewater treatment plant*
Yes • No
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.
Permit Verification
✓ I certify that I AM the permit holder for this SLAS.
If unchecked, please attach a signed land application authorization form for each site.
SLAS #* Expiration Date*
SLAS-96-05 5/24/2022
Septage Detention or Treatment Facility (SDTF) *
• Yes No
Permit Verification
✓ I certify that I AM the permit holder for this SDTF.
If unchecked, please attach a signed detention/treatment authorization form for each site.
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 #*
Expiration Date*
SDTF-96-13 5/24/2022
SDTF-96-01 12/26/2023
Other disposal method*
• Yes No
Description * Authorization
D&D SEPTIC D&D.pdf 400.39...
Septage Management Firm Operator Training Completed
Date* Hours*
10/18/2022 4
Location*
BURMILL PARK GREENSBORO,NC
Training Sponsored or Provided by*
INC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
10/18/2022 3
Location
BURMILL PARK GREENSBORO,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
Date
12/31/2022
05:49:24 PM
Print Name* Title*
CHRIS PARKS OWNER

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
Uaniel L Newsome
(Facility Operator)
(Operator Address)
Chris Parks
do hereby authorize!
(Owner of Septage Management Firm)
Parks Septic Tank Cleaning Service
(Name of Septage Management Firm)
798 Parkstown Rd, LaGrange, NC 28551
NCS #
(Address of 5ep€age Management Firm)
98-08
to utilize septage detention or treatment facility #
00393
for the treatment or storage of septage'
in 2023. The facility will be operated in accordance with the Septage Management Rules **
11-01-22
Date:
* As defined in G.S. 130A•290(a1(321
** As defined in 15A NCAC 13B .0800
r
_g Signed
acility Operator)
Return the properly completed form to:
North Carolina Department of Environment and Natural Resources
Uivislon of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646