NCS00259_2023Permit_Initial

2023
Permit and Registration
Hall's Septic Tank Cleaning Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00259
o and registered as aD E
-�� Septage Management Firm ��en� f� w� nmental Ouallty
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-31-11
2. Septage Detention or Treatment Facility, SDTF-31-11
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.
Digitally signed by Wm Perry
Wm Perry Sugg Sugg
Date: 2023.02.02 12:27:57
-05'00'
Perry Sugg, Environmental Compliance Branch Head

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North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NORTH CAROLINA
LnWronmaddQ,a. 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:
Hall's Septic Tank Cleaning Service (NCS-00259)
297 Durwood Evans Rd
Beulaville, NC 28518
Number of Trucks: 1
To: Emmett G. Hall
Hall's Septic Tank Cleaning Service
297 Durwood Evans Rd
Beulaville, NC 28518
Date: 09/27/2022
Invoice #: NCS-00259-2023
$550.00
Date Due: 1 12/15/2022
LATE FEES: accordance with NC General Statutes GS 130A-291.1(e2), a late fee voU be applied to any annual permit fees not submitted by January 1, 2023.
Payment Options:
E-check Available online at httos://deq.nc.gov/sway
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 htts:/p /deq.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 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]
PAI
D
Regulations or Technical Assistance
Chester Cobb [phone]
Jeffrey Bullard [phone]
O. NO .
9') 4
QA�
� �' 2° • 'la 2'L
More information available on the web:
North Carolina Department of Environmental Quality
(DEQ) - https://deq.nc.ciov
North Carolina Solid Waste Program - silldeg.ncyouvrabouldivisions'waste-managemenv
solid -waste -section
North Carolina Septage Management Program - hups./ideg.nc.00v/abouy
divisions/waste -ma nag emenVsolid -waste-sectionfsoecial-wastes-and-alternative
handling/septaoe

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 exact! as it is shown on your vehicle(s)).
�7� ��� ►7� r� � �L n iC Lam[ Earl �n a, _ -ef U r' Q
Street address of office: :� 9 r7 ' ur woo'd 1--_7r/ca0s egad
City:.9.e11/a I//'f`� State: Zip: i} h'
Mailing address (if different):
City: State: Zip
Phone: 9/0 ,&_S-m _Oww
5?
E-Mail: / AG l e / 7q 6 Z - C6
County: Ocia %f n Septage Management Firm permit number: NCS # ©QA i q
(2.) Firm owner's name: I—C-rn m e
Mailing address (if different): -29 7 V c.c iu1 opet ter, 4 kt,n_
City: ,0u f U i // __�P__ State: ac Zip 0:2 S19,
Phone'/& So -9/ts crf3 wV&' Fax:
(3.) Firm operators name: 56 rn-e, _Firm operator's title:�-
Mailing address (if different): � G/ Me,
City:
State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons numoed in last 12 months (Example: Domestic: 50,000).
Domestic I Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrial/Commercial
�?n"DD
(5.) N.C. Counties of Operation: ,r R��[ P o 51n U )
(List each county you are authorized to do business in)
(6.)
Total Number of Pumper Vehicles Operated: /
Number used for: Domestic Septage:_ /
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License Tag #
Vehicle Identification #
tiTj 0 ri1 N S
Tank Capacity
D O
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

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APPLICATION FOERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE1
r vehicles?
b) Septage La d Application Site (SEAS
SEAS#: 3�l Expiration DateEEEEEEEWM===��
(7.) Do you plan to operate pumpe
check one) I XvAs (ANeno,
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 -as of septage � required by 945A NCAC--I'�3B .0835(a) andVehicle lettering
as required bv 15A NCAC �0835(b). Furthermore, I al$o ce�ifyc that a log is maintained of each septage pumping event as
required by 15A NCAC 13B .0836(a). I am aware that t
possibility of fine and imprisonment, n
Do you attest to the statement above?.
here are signff'icantpenalties for false certification inciua�ng u�C0
n
Or
yes ( ) no Initial., Date
M&
LJ
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( )yes (ti/j no. If yes, submit WastewaLe� Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of theSeptage Management Rules.
do
Permit Numbers: (use additional sheets if needed)
l-�,z.. SEAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permi
SDTF#:.,,,. Expiration Date: C-3l -z 2-
(9.) Septage Management Firm Operator Training Completed:
Date: %'-sS_ �, 2 Location:
Training Sponsored or Provided by:
Numbers: (use additional sheets if needed)
SDTF#: Expiration Date:
90.Septage Land Application Site Operator Training CompletedIe
Date: -j S_ � Location:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
L �
Registered Portable Sanitation Firm:
Registered Septage Management Firm: �/Registered Portable Sanitation and Septage Management Firm.
Hours:
l-�
Hours: hi!ha
MENOMONEE
CertificationStatement
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, orcertification.
ignature (Signature of companyofficNEW- ialrequired)
Print Name
er Comments:
Date
C& " V k6h� (I .0.0�
Rev. 04-26-i
PAGE 2

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