NCS00347_2023Permit_Initial

2023
Permit and Registration
Roberts Septic Tank Cleaners
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00347
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. Septage Land Application Site, SLAS 35-01
2. Septage Detention or Treatment Facility, 35-01
3. Louisburg WRF, Louisburg, 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.
Wm Perr Digitally signed by
PerryWm Perry Sugg
Date: 2023.02.02
Sugg 13:08:15-05'00'
Perry Sugg, Environmental Compliance 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 ex� as it is shown on your vehicle(s)).
Il r C-- ) c - .- �'- /
Street address of office: E .
City►� State: /Ii Cr Zp: (50 530
Mailing address (if different):
City: — State: Zip
Phone: 1O/ I Fax:
E-Mail: A1r ) tJ c,-.
County: 1 !r-1 i
(2.) Firm owners name:—_tL
Mailing address (if different):
State: Zip
�J�LL 14r% Y- Fax:
a
(3.) Firm operators name: +l /0 iSG 9 Firm operators title:
Mailing address (if different): C_ t15 19— -
City: State: Zip:
Phone:—,?[,?- [,? — _Fax:
(4.) Type(s) of septage pumped: Write in the number of gabris o •cooed in last 12 months (Example: Domestic: 50,000).
uomesuc Portable Toilet Waste Grease (Restaurant) I Treatment Plant 1 Industrial/Commercial i
F a —
(5.) N.C. ties of 0 ation:oru
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: a
Number used for. Domestic Septage: - Grease (restaurant):
Other. Portable Toilet Waste.
Vehicle Information: (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (�s ( ) 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? ( Vj"yes ( ) no Initial Date 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) Papit Nutnee,,s: (use additional sheets if needed)
SLAS# Expiration Date: l f SLAS# Expiration Date:
c) Septage Detention or Treatment Facility (S TF)W Numbers: (use additional sheets if needed)
SDTF#Expiration Date: i7 it
SQTF#. Expiration Date:
(9.) Septage Manageme Fi Operator Training Come : r
Date: _ , Location: zv c- Hours:
Training Sponsored or Provided by: Ind cc,
(10.) Septage Land Ap licati n Site Operator Training Complet y�
Date: Location: N C Hours:
Training Sponsored or Provided by: A GAimkt'-
(111.)d
Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Finn:
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.
a Lt, /� " i�'- �
Signature (Signature of compan o7"'
l required)
f?
E rt1 (�L- E �� ■ %
Print Name
Other Comments:
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Date I f
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Title
PAGE 2
Rev. 04-26-2021

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605
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.
a ame of Plant) ) - _
(Address) J
�do hereby authorize 'N 5e_
(Phone Number) (OwnerlOperator of Se toe Managent Firm
Of i O a E t �c-- 7o4k, NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage f portable toilet waste /c
grease septage (grease trap pumpings) commercial/industrial septage
_ //z/ 0 from
yf r-rowv'Coj,,
(County or other Geographic Area)
at the above named wastewater treatment facility Se tage shall Pe discarged, at:
„-�/i,, (ter/ 5 �, I ;sue
-
between the hours of
Reintroducing partially treated liquid into a grease trap its acceptable Yes No
This authorization shall be alid until !� f Y/ �04V
(Usually December 31, Year)
Signed Date %0 _ — AV
lidfli Operator)
N
',be r et �Ir (Oct
day of 20 CLIg
My Commission expires:
(Notary Public)
Note: Falsification of this document by the septage management firm shall lead to permit
h:cla/septagefforms/authoriz/alW4lwwtp auth-2006
�9vy�
Y�l

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS-
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."
'CSC / f /.,
Signat re (fgnafure of company official required)
Print Name
/,.) I-o,
Date
qklcl
Title
S.XSolid_Waste%cla1septageWormslPumper Vehicles Cetification.doc

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a
. North Carolina Department of Environmental Quality
Division of Waste Management
NORLINA INVOICE
TH
Solid Waste Section
Division of Waste Management
To:
Denise R. Roberts
Solid Waste Section
Roberts Septic Tank Cleaners
1646 Mail Service Center
431 South Cheatham Street
Raleigh, NC 27699-1646
Franklinton, NC 27525
Phone/Fax: [phone]
Email: [e-mail]
PAI
CK.NO.
CC-oIV26S
DATE
l 2 - 12 — 2-L-
8 nb . 0o
Date: 09/27/2022
Invoice #: NCS-00347-2023
Septage - Annual:
Roberts Septic Tank Cleaners (NCS-00347)
431 South Cheatham Street $800.00
Franklinton, NC 27525
Number of Trucks: 2
Date Due: 12/15/2022
LATE FEES: accordance 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)/deg.nc.aov/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://deq.nc.gov/swDaay
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]
Exolanation 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.
Foestions resgarding;
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) - https://deq.nc.gov
North Carolina Solid Waste Program - Ws:;ldea.nc.00v, about/divisions/waste-manat}ementrsolid-waste-section
North Carolina Septage Management Program - h s d .nc. ov abou divisionslwaste-managemenysolid-waste-sec*ionispecial-wastes-and-alternative-
handlin_/septaae