NCS00465_2023Permit_Initial

2023
Permit and Registration
V & S Septic Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00465
o and registered as a
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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. Mount Airy WWTP, Mount Airy WWTP
2. Septage Detention or Treatment Facility, SDTF-86-11
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.
Wm PerrY Digitally signed by
Wm Perry Sugg
2023.02.02
Sugg 113 12 35-05''00?
Perry Sugg, Environmental Compliance Branch Head

State of North Carolina Application for Permit to Operate a
Environmental Quality
Waste Management Septage Management Firm
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*
V&S Septic Service
The "Fvm name" must be mactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00465
Enter the five dimes following the NCS 9
Street address of office*
Street Address
1401 West Pine Street
Address Line 2
City
Mt. Airy
Postal /zip Code
27030
County*
Surry
Mailing address same as street address of office?*
+� Yes No
Phone*
336-786-2402
Email *
[e-mail]
Owner Info
Firm owner's name*
Bennett Lynn and John Edward Stamper
State I Province / Region
NC
Country
US
Fax
336-789-5274
O�C..12 2p�.2
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Mailing address same as street address of office?*
Yes . No
Phone*
336-786-2402
Operator Info
Firm operator's name*
Bennett and John Stamper
Mailing address same as street address of office?*
I Yes No
Phone*
336-786-2402
Fax
336-789-5274
Firm operator's title
President and Sec./Tres.
Fax
336-789-5274
Type and amount of septage pumped in the last 12 months
Amount in gallons
Domestic 679,900
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:
Surry and Stokes
Vehicle Info
Do you plan to operate pumper vehicles?*
b. 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 .083E(a). 1 am aware that
there significant penalties for false certification including the possibility of fine and imprisonment"
Signature *
.r•:�%��� � ,ter ��s ��� F
Date *
11/17/2022
Title *
President and Sec./Tres.
Choose how to add vehicle descriptions*
��) Add vehicles individually Upload List
Pumper Vehicles
Usage*
Ucense Tag #*
Vehicle Identification #*
Tank Capacity*
Domestic Septage
YA-96928
2HSFHEMR2PC072062
2,500
Domestic Septage
DX-5238
1FDNF60HlFVA29978
1,000
Domestic Septage
EW-8055
1HTSLNPM7N406506
1,000
Septage Disposal Method
For each method, indicate whether you plan to use it by ctteclmig yes or no.
Approved wastewater treatment plant*
&- 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 •W33(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEG
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name* Expiration Date* Authorization

Mount Airy Waste Water Treatment 12/31/2022
Plant
Septage Land Application Sites (SLAS)
Yes i No
Septage Detention or Treatment Facility (SDTF)
6` 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-86-11
Other disposal method*
Yes �� No
Expiration Date*
6/25/2026
Authorization
Septage Management Firm Operator Training Completed
Date* Hours
1/27/2022 6
Location *
Hickory Metro Convention Center
Training Sponsored or Provided by*
NC Septic Tank Association
Septage _Land Application Site Operator Training Completed
Date Hours
0
Location
Training Sponsored or Provided by
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
Certification Statement
I1 certify that the information and representations in #w application for a permit are true, cornplete, and accurate to ttie 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 irKx rrect or irwkpata information that materi* affected the decision to issue
the permit and that there are cri ux t penabes for imowiroy making a Use statement representation, or certification_
Signature*
Date
11/17/2022
11:46:13 AM
Print Name*
Title*
Bennett Stamper and John Stamper President and Sec./Tres

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- 00*5
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 significant penalties for false certification including
the possibility of fine and imprisonment."
Signature (Sigma y ofthd ►eq+rr4
Print Name
36 E.
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Date
9&R )
Title
Se c -r.�QuSu
s:lsolid wastelclalseptagelfortns%Pwnper vehicles CeLrication.aoc

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.
09C 61( 44
(Plant Operator in Responsible Charge (ORC), ORC
319 (,cAS t,�ler t'rr ?'a4d
(Phone Number)
(Address)
w w-TP (ce't * /d 6o20
acAse Number, Name of Plant)
(hoc�n-f Kl i <c, N C. 23o3 o
do hereby authorize t aon's- �k� S ?�
_ `per
(Owner/Ope for of septage Management Firm)
of S + C C i
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage , portable toilet waste
NCS # 00t{&�_
grease septage (grease trap pumpings) commercial/industrial septage , from
JI(itl 4 S+o kes
d ' 1(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
S
between the hours of 75an —
(Location)
—nro Nob day S
u
Reintroducing partially treated liquid into a grease` trap is acceptable Yes __ZNo
This authorizati n shall be valid until _R1 ZUZ3
MOA613 (Usually December 31, Year)
Signed Date IO-Z-2L _
(Facility Operator)
ed and affirmed before me this - ` day of d 260 t!�,20
My Commission expires:
(Nwiry Public)
NOTARY PUBLIC
CHRISTOPHER I WALLACE (OFFICIAL SEAL)
Csnnty, North !Molina
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid Waste/CWSEPTAGE/FORMS/2018 Firm Appliration/WWTP Authoraadon Form 2018

AUTHORIZAVON TO OWDO E SEFTAGE AT A SEFTASE 7MTMENT OR
sawk FAcuff Pomum TQ sbmEota oTm THAN YOU
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North Carolina Department of Environmental Quality
Division of Waste Management
NORINVOICE
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mwQuaw Solid Waste Section
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
Septage - Annual:
V & S Septic Service (NCS-00465)
1401 W Pine Street
Mt Airy, NC 27030
Number of Trucks: 3
To: Bennett Stamper John Stamper II
V & S Septic Service
1401 W Pine Street
Mt Airy, NC 27030
Date: 09/27/2022
Invoice #: NCS-00465-2023
i;�i$800.00 ) '
o0Q �'�„eCk 101' as
Date Due: j 11 12/15/2022
LATE FEES: nn —Anince with NC General Statutes GS 130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted by January 1, 2023.
Payment Options:
E•check Available online at https://deq.nc.gov/swjay
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://de%nc. oq v/swpay
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.)
Explanation 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]
RECEIVE[)
DEC 12 2022
More information available on the web: SOLID WASTE SECTION
North Carolina Department of Environmental Quality (DEQ) - https://deg.nc.gov
North Carolina Solid Waste Program - htts:l/d .nc. ov aabou division wwaste-man emen 'solid -waste -section
North Carolina Septage Management Program - h s://d .nc. owabout/division waste -manaement/solid-waste-sectic, i. s yecia, o-altemative-
handling/septagee

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