NCS00672_2023Permit_Initial

2023
Permit and Registration
Triple A Sanitation
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00672
o and registered as a
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NORTH
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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. City of Columbus WWTP, Columbus, 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 Perry Digitally signed by
Wm Perry Sugg
Sugg 110:33 08-05''00'6
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*
Stacey Price
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00672
Enter the five digits following the NCS #
Street address of office*
Street Address
475 Short Creek Drive
Address Line 2
City
State / Province / Region
Mill Spring
NC
Postal / Zip Code
Country
28756
United States
County*
Polk
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
PO Box219
Address Line 2
City
State / Province / Region
Mill Spring
N.C.
Postal / Zip Code
Country
28756
United States
Phone*
Fax
8288948603
Email*
[e-mail]
Owner Info
Firm owner's name*
Stacey Price
Mailing address same as street address of office?*
Yes 0 No

Mailing Address*
Street Address
P.O. Box 219
Address Line 2
City
Mill Spring
Postal / Zip Code
28756
State / Province / Region
North Carolina
Country
United States
Phone* Fax
8288948603
Operator Info
Firm operator's name* Firm operator's title
Stacey Price Owner
Mailing address same as street address of office?*
Yes • No
Mailing address*
Street Address
P.O. Box 219
Address Line 2
City
State / Province / Region
Mill Spring
North Carolina
Postal / Zip Code
Country
28756
United States
Phone* Fax
8288948603
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 5,000
Portable Toilet Waste 160,000
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in:
Polk
Vehicle Info
Do you plan to operate pumper vehicles?*
0 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."
Signature
Date*
12/15/2022
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA000599 2NKMH07X81M870022 2,000
Portable Toilet Waste JP4758 3D6WD66A08G214523 500
Portable Toilet Waste JP4787 1FDUF5HTXKDA22462 1,100
Septage Disposal Method
For each method, indicate whether you plan to use it by checking 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 .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* Expiration Date* Authorization
Columbus WWTP 12/31/2023 IMG_0002.pdf 462.52...
Septage Land Application Sites (SLAS)
Yes • No
Septage Detention or Treatment Facility (SDTF)
Yes • No
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed ^

Date* Hours*
10/14/2022 4
Location*
Franklin, N.C.
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
a��
Date
12/15/2022
09:01:37 PM
Print Name* Title*
Stacey E. Price Owner

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.
I, Ck, s�vpkj_,r C6c kt,,,— dad SIyT 710
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
355 e- o d Ca i,,�A2
(Address)
V Y `-t 7 9 2-0 LI do hereby authorize 4 _'�11 rC4C� r
(Phone Number) n e^ ` _ _ (Owner/Operato f 5eptage Management Firm) ,�/
of fir, o I e Y� nl t #'tit , a� IT n; f _ N CS I#
(5eptage Management Firm Name and NC5 number)
to dispose of domestic septage '1___ portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage , from
k
(County or other Geographic Area)
at the above named wastewater treatment facility. 5eptage shall be discharged at:
Le4dA-1,rr I<. gh P.e.�'+
(Location)
between the hours of 7: VV
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
- This authorization shall be valid until 3 ( 20 Z :S
�% (Usually December 31, Year)
SignedZzz_ G�4 Date / 2 ` 2 — 7— Z
17 (Facility Operator)
Subsc ' d and affirmed before me this
(Notary Public)
2,4"h day of ]_[.e,n m .20
My Commission expires: 'Sj 30I zoz.-"-
Note: Falsification of this document by the septage management firm shall lead to perm
5'/5oil d_WaSte/CLA/SEPTA GE/FORMS/2018 Firm Application/W WTP Authorization Form 2018
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