NCS00433_2023Permit_Initial

2023
Permit and Registration
Clean Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00433
o and registered as a
e:,e D
E� M
-�� Septage Management Firm ��en� f� w� nmenta�llry
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. North and South Durham WRF, Durham, 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 PerryDigitally signed by Wm
Perry Sugg
Sugg Date: 2023.02.16 10:25:39
-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*
Clean Septic Tank Service
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
00433
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
1048 Jacks Trail
Address Line 2
City State / Province / Region
Hillsborough NC
Postal / Zip Code Country
27278 Orange
County*
Orange
Mailing address same as street address of office?*
• Yes No
Phone* Fax
919-291-6412
Email*
[e-mail]
Owner Info
Firm owner's name*
Jeff Dixon
Mailing address same as street address of office?*
• Yes No
Phone* Fax
919-291-6412
Operator Info
Firm operator's name* Firm operator's title
Jeff Dixon Owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
919-291-6412
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 62,400
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: *
Durham,Orange,Granville,Person,Wake,Chatham
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."
Date*
2/2/2023
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA118357 1HSZAGTNlGHB2157 2,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
0 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 .0833(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*
City of Durham
Septage Land Application Sites (SLAS)
Yes • No
Septage Detention or Treatment Facility (SDTF)
Yes • No
Other disposal method*
Yes • No
Expiration Date* Authorization *
12/31/2023 BOA10335- 1.81MB
OD32-461D-
9A0B-
D490374C5A26...
Septage Management Firm Operator Training Completed
Date* Hours*
1/27/2022 6
Location*
Hickory NC
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
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
` fly � .1
Date
2/2/2023
12:18:46 AM
Print Name* Title*
Jeff Dixon Owner

CITY OF
DURHAM
i
Department o f Water Ma
t
a9ement
AUTHORIZATION TO DISCHARGE
Clean Septic Tank Service
hereby is granted permission to discharge domestic septage waste into City of Durham's
North and South Water Reclamation Facilities. This discharge sha11b e between the hours
ot'7:30 a.m. and 4800 pem., five days a week.
waste collected 1*n the state of North CaroIina.
load is 1600 gallons.
Permission to d10 ischarge is restricted to
The maximum discharge volume of each
Clean Septic Tank Service shall comply with all provisions of City of Durham's Sewer
Use Ordinance. If any provision of the City 9 s Sewer Use Ordinance is violated, this
authorization maybe terminated.
Fee assessment and waste determination may be required at the discretion of the City of
Durham, Department of Water Management.
This It sha
11 be valid from January I , 2023 until December 31, 2023 .9
i
Z�
John Dodson — ate
North urham Water Reclamation Facility
1900 East Club Boulevard
Durham, North Carolina 27704
(919) 560ffin�4384
Charles Cocker - Date
South Durham Water Reclamation Facility
6605 Farrington Road
Chapel Hill, North Carolina 27517
(919
) 560-4386