NCS01575_2023Permit_Initial

2023
Permit and Registration
County Septic Repair
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01575
o and registered as a
e:,e D
NORTH
EQ�J
%L 12. 9*
-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r Q'M
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. McAlpine Creek WWTP, Charlotte, 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.
(,f�m � 12/14/2022
Perry Sugg, Envir nmental Compliance Branch Head

04
9 North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
d ORT]iLAROL r,1QU Y:,
EnrSolid Waste 5ecilor'
hnnmenraf Qind7irr
Division of Waste Management
-Tci Waste Section
%A41vlail Service Center
°aleioh. NC 27699-1646
Phone/Fax: [phone]
Email: jared.wilsonPncoenr,00N
Septage - Annual:
County Septic Repair (NCS-01575)
134 Spring Wyatt Drive
Gastonia, NC 28056
Number of Trucks: 1
To: Gary Bradlev
Countv 5eotic Repair
134 Slorina Wvatt Drive
Gastonia, NC 28056
-.ate: 09/2712022
nvoice #- NCS-01575--2023
$ 550.00
Date Due: 1 12/15/2022
LATE FEES. In acrordance with NC General Statutes GS 130A-291 1(e2), a late fee will be applied to ary annual perme fees not submitted by January 1, 202'
Pavment Ootior-
F-check Available online at ritrrS:IMe .nL.atv:; v,-i-IV
-•_'dues oanK account and routino information. You will need to use the zie code in the descriotion box and the invoice number
shown on this invoice to access Your account. If a zio code is not listed. use the code: 99999 along with the invoice number.
Credit Card Available online at :,n .�; a-u.nC cx,r :,' .
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
--.-anience Fee of 2.65% added to amount invoiced.}
Raoer 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 varn vour oavrn,-.-
[G.S. 25-3-506: A $25.00 processing fee will be charged on all retumed checKs.J
--oianation of Invoice Amount is Based on Firm's Current Permit Status:
,,suant to North Carolina General Statute 130A-291.1 you are reouired to pay fee(s) based an your solid waste management
activities. The fee(s) shall be used to support the septage management program.
For questions regaroiny_
Billing
Regulations or Technical Assistance
Jared Wilson [phone]
Chester Cobb [phone]
f�ffrev Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (Dt.�i - n:,c
North Carolina Solid Waste Program - llus: deu.n:.r�r das��Lrldivrsinn rwaste car oer,entisoi r� ?-,—�
North Carolina Septage Management Program - httvslideflrcurjWabout/dry,sic0n VM3fe-F,ar �r��nt .=.alit- was�-sAai-nrsQg-:�jar-+vase; ant, -a, -,Pr,.=
r-ann„rr ��s�--

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 eac#1 as it is shown on your veftle(s)).
Street address 611office: _ 1,3ir�
City: state: C. Tip: 6 `6
Mailing address (if different):
City: State: zip,
Phone:
E-Mail:
County: Septage Management Firm permit number: NCS #
(2.) Firm owners name: -f- c
lk
Mailing address (if different):
City: State: Zip
Fax:
(3.) Firm operators name: P M 13 124 8 i At"" P. Firm operator's title:
Mailing address (if different):
Co., State: zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in last 12 months (Example: Domestic: 60,000).
Domestic Portable Toilet Waste Grease (Restaurant) ITreatmentPlant Industrial/Commercial
(5.) N.C. Counties of Operation: G A �-) i, :, -M C-_ C_ k 4 : w t 1,1 C 1 -� " i 4* C 4 " P. tr_j
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: Q n e- -:1 _
Number used for: Domestic Septage: - Grease (restaurant):
Other. Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
C1
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Da you plan to operate pumper vehicles? (check one) {✓) yes ( ) 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 NCAG 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? (L,�yes ] no Initial 6-- M Date 41 Al L)
(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) Permit Numbers: (use additional sheets if needed)
SLAS#: Expiration Date: SLAS# Expiration Date-
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: Expiration Date: SDTF#: Expiration Date: _
(9.) Septage Management Firm Operator Training Completed;
Date. --: 14Py G 2 Location: H i c- fh g� t - Hours. '
Training Sponsored or Provided by 5
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(11.) Registration type requested' CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm -
Certification Statement
Hours:
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.
$ignatu nature of companyofficial fequireo9
Print Name
Other Comments:
Cate
OLV Al
Title
Rev 04-26-2021
PAGE 2

CHARLOTTE
W6TER
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT
FACILITY
I, Bill Gintert 1 Environmental Compliance Manager
Charlotte Water- System Protection (CLTVllater- SP)
4222 Westmont Drive Charlotte. NC 28217 704-336-4407
Do hereby authorize Gary Bradley
(Authorized Representative)
Of
County Septic
(Septage Management Firm Name)
To dispose of Septage x Portable Toilet Waste x
Note: 1) Grease trap waste is not allowed at the disposal sites.
2) Re - introducing partially treated liquid into a grease trap is not allowed in the
Charlotte Water system.
From: Mecklenburg County and Surrounding Areas;
(County or other Geographic Area)
At the below named Wastewater Treatment Facility; Septage shall be discharged;
McAlpine Creek Wastewater Treatment Plant (MCWWTP) Septage Receiving Station
Between the hours of 7:30 a.m. until 11:00 a.m and 12:06 n_m until 3:45 n.rn. Mon. -Fri.
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.
This authorization will be effective: January 15' 2023
This authorization shaft be valid until; December 31St 2023
Signed: Date: 0 2-7 .2 z
(Environment I Compliance Manager)
Note: Falsification of this document by the Septage management firm shall lead to permit revocation.

10I31I22. 3:18 PM
New Submission
For questions regarding this form or the online application process, please contact Jeffrey Bullard (httoWmaitic
[e-mail])(9R9-707-6285) or Chester Cobb (http://mail to:[e-mail])(919-707-8283 .
=rmInfo
Firm nary-' C ic) , n
oe Firm name' must he exactiy as it is shown on your venive(s),
-eiatacie Management Firm permit number (NCS #}'�
art C)
Enter the five digits tollowino the ivy
-treet address of oficex
�treeS Address�--
Address L!r,,.
_ ,. G4 s.) , n : if
Postal I Lo Code 2- (5� D 5 `6
Cour- - b
', address same as street address of office?*
�' fes 0 No
State I Provinre 1 Reaion ti /
Caun,
https:lledocs.deq.nc.govIVormslwm_septagefiirTn gl:.

10/31/22. 318 PM
New Submission
Maiiina Addre S
Street Aaor c, A I, t V e—
address Line 2
Clty C-i AS)0 j State I Province i kea+:. )Vf ' jr,�L a f-1
Pastas 1 Zio Code I rc* Gountry j" vl
at Fax
Ema i x V k 'C-
Nner Into
Firm owner's nary:=' C—#&/ 47 B ) 4
�ilina address same as street address of office?
es -,i No
Maiiina Addresr�-' n
Street Hoer:
actress Line 2
ON "5) A ; State / Province i Regic A J C
Postal I Zip Codeey �r cowltry
A E 3 - Fax
Qoeramr inr--
�ittos:lledocs.deq.nc.gov/Formslwm_septagefirm 215

10131/22. 3:18 PM
New Submission
Firm operator's name*
Firm ooerator's ttt:- 0 " ff e A'-
"Railing address same as street address of office?*
es 0 No
Maifina addresw� n Streei Hoc J S ► ► r /5/ I✓ 4— , v
a(iriress Line 2
Postal � Zio Code } 9 0--.�— j
,Ong, 00 r�,�
State 1 Province i neck- AJC
Country L G� Y1
Fax
Type and amount of septage pumped in the last 12- monT-r.-
� i7orrlestiG�
Portable Toilet ►lvasu
Grease (Restaurant)
Treatment Plan,
-mount in oaiions
C) 6C,
Industrial/Commercial
North Carolina counties of operation
nttos:lledocs.deq.nc.govJForm slwm_septagefirm 33/5

10131/22, 3:18 PM
New Submission
List each county you plan to do business i -. r (� n 5. f o n C jQ L-' C. I t. H / 'C Q7 a w4A 1- j"o c cl n Mc',)-,
venlcie
❑Ian to operate pumper vehicles?'�
'es0 Iio
Seutacle Disposal Method
For each method. indicate whether you plan to use it by cheMn9 ves or n:_
Aporoved wastewater treatment ola; -
Yes N
Septage Land Application Sites (SLAS)
La Yes 0 No
Septage Detention or Treatment Facility (SDTF)
C) Yes U Nc
Other disposal method*
.� Yes 0 No
Septage Management Firm OperaTor 1 raining Comic: L;
lace t -3 AAl Hours''
Location ` j�C p 1•� ° _
Trainina Sponsored or Provided bv* Iv, C - 5 e�
Septage Land Application Site Operator Training Comoieieo
vate Hours
https-.//edccs.deq.nc-goy/Forms/wm_septaaefirm 4/5

10/31/22, 3:18 PM New Submission
LCC3T! Inc, f:j 1 C
� rainina 5nonsored or Provided by y + i /� ,
N C , N %� r tG It �i I SSb [ - ♦ 4 r 40 14
kegisuation _l_yr`
.'art one's
1 R istered Portable Sanitation Firm
CH Registered Seotage Manaffemenr fir,
Cj Registered Portable Sanitation and Septage Management Firm
,.ommenzs and Notes
t:ommenzs or n-..
�-erilTicaT-ioTatemen-r
i cernty that the information and representations in this application for a permit are true. complete. and accurate to the best of my knowledoe and belief, i am aware
i:�i-2a-rg mar be susnended or revoKed upon a tondIno Ma Its issuance was base upon incorrect or inaaeauate imormat+on that matenanv arrectea the o4xz ,r)
to issue the permit and that there are criminal penalties for knowingly making a false statement, representation. or certifieabon
5ianatl+-�=
i sig;: T
Date Lf ---
10/31/2022
03:17:1rA
Print Name* j /4
aKA
/W . 94,4&,e�k
Save as Dra;-
Title * 0 W fl e- A —
https:lledocs.deq.nc-gov/Forms/wm_septagefirm 515