NCS00675_2023Permit_Initial

2023
Permit and Registration
Lassiter's Portable Toilets
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00675
o and registered as aD E
-�� Septage Management Firm ��en� f� w� nmenta�llty
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 Ahoskie WWTP, Ahoskie, 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. Digitally signed by
Wm PerrywmPerrySugg
Sugg 10:33:40— 05''00'6
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 exactly as it is shown on your vehicle(s)).
La ss) -i ors Por+-able l s
Street address of office: Q-7 3 b �J C. 4vv 9 S S. City: 0—o le t-air" State: lk� Zip: 01,7q auu_T
Mailing address (if different): �- Box i L'
City:C_o f e.r0-1 v> _State: [�c— Zip a-i 9,;L4
Phone: 251- 3 56 Z$ 36 Fax:
E-Mail: (A—) Amy (. ccm
County: 44 ,a Septage Management Firm permit number: NCS # O�Io�S
(2.) Firm owner's name: C '
Mailing address (if different):
.City:
Phone:
State:
Zip
(3.) Firm operator's name:_ Cct1; L>aJ i'S Firm operator's title: O lA t-jef
Mailing address (if different):
City:
Phone:
State: ____Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in last 12 months (Example: Domestic: 50,000).
Domestic Portable Toi
!c 51 000
(6.)
Treatment Plant
Industrial/Commercial
l0.�--vo0
N.C. Counties of Operation: H erorj, 6GY`�1 r . CtnOWa n � � a.-i-eS. IJ Dr-)� q m,&#1
11 K j e ru, t rv► s, W asL► ►�-,a-[-c nnc�r�-�'r� . r rrc.
% (List each cou ty you are authorize o do busi ess in)
Total Number of Pumper Vehicles Operated: A
Number used for: Domestic Septage: 42� Grease (restaurant):
Other: Portable Toilet Waste: MR
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
1
Tv3 B 3
3 C-ILW DMCit~ 3 C.c,25 9a
1000
z
KL
4E"
3
4
--
5
APPLICATION CONTINUED ON PAGE 2
PAGE

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (fyes ( ) 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? V ) yes ( ) no Initial CR N_Date i I — I -7 - 2.0'Z►2
(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 theSeptage 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: , r
Date: 5 %±. 7. 2ozZ. Location: N a4 4C.&A , !I C- Hours: `7"
Training Sponsored or Provided by: _ G5
(10.) Septage Land Application Site Operator Training Completed:
Date: Location: Hours:
Training Sponsored or Provided by: _
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm: V/
Registered Septage Management Firm:
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.
Signature (Signature of companyofficial required)
Ccc i i 1�)61 ✓15
Print Name
Other Comments:
Date
// — / 7— aoaa
aoa�-
Rev.04-26-2021
PAGE 2

NC SEPTAG14� MANAGIZMENT FIRM.
Recertification of bumper Vehicle(s)
Septage Firm Permit #:
Number of Pumper Vehicles:
NCS- 00 (9-7S-
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."
Signature (Signature of company official required)
C 1PC1,l /3• 7Do V,-
Print Name
H - 18 - a Od 2,
Date
0 wirer
Title
S:1Solid_Waste\clalseptagelformslPumper Vehicles Cetification.doc

11 /23/22, 9:58 AM
NC DEQ Solid Waste ePayment - Payment Results
Payment Results
Merchant: NDENR-Sotid Waste
Merchant City/State: Raleigh, North Carolina
Payment Status: Payment Success
Payment Date: 11/23/2022
Confirmation Number: 22112348596894
Bitting Address: Loria Parker
220 8 Elks Road
Winton, NC 27986
[phone]
E-Mail Address: lassiterportabletoitets-gmaii.com
Total Amount: 800.00 USD
Account #. x4546
Routing #: 053000219
Account Type: Checking
Reference information: NCS-00675.2023,27924,Lassiter''s Portable Toitets,PO
Box 14,Coterain,NC,NCS-00675,$800.00
Disclaimer: No convenience fee is charged for using the eCheck
payment method. However, a processing fee of $25.00
or 10% of the amount of the eCheck, whichever is
greater, wilt be charged for an eCheck returned due
to insufficient funds. Payments are null and void if
payment is made with an eCheck that is returned
unpaid by the bank.
Er:it
tiC il£fj i;+ris�cst of °Nance f�anayemrnL, Soii,7 Y.as:+ :e ..iL:i
:-i[Og Ali ie:S: Tom% sufcr; n(Fi•,agYr. �., Zr(.� •t`
�..'.)!3ne- R'f f:t,�
https://www.thepaypiace.com/neosc/ncdenreep/solidwaste/paymentcomplete.aspx 1/1

R
v
d
d
top
-404
rA
LM
V
V
W
z
Z
0
z
N
O
N
J
�
a
�fl
�
rA
'
O
q
to
IT
o
�
o
�
V
�
A
N
OAvsa��o
z
z
a
0
I
r-2
4

f
North Carolina Department of Environmental Quality
Division of Waste Management
INVOICE
-NOR I CAROLINAant
Erovironmantnl Quror+;}'�
,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:
Lassiter's Portable Toilets (NCS-00675)
PO Box 14
Colerain, NC 27924
Number of Trucks: 2
To: Cecil Davis
Lassiter's Portable Toilets
PO Box 14
Colerain, NC 27924
Date: 09/27/2022
Invoice #: NCS-00675-2023
�C, online_
11I_31Z''-
Date Due: 1 12/15/2022
LATE FEES: i't :iC, 7r;b3! t` : [ ail Gene_;.3! tat I: S U'• I_Y!;t1- 9
Payment Options:
E-check Available online at rt ;c r;_".r.Ct_Z—�'•;
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 tit us:7c-'?ct.r.c.cto.i/c,; �-,aV
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 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.
For questions regardin� RECEIVED
Billing Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone] NO V'-3, 0 2022
Jeffrey Bullard [phone]
More information available on the web: SOLID WASTE SECTION .
North Carolina Department of Environmental Quality (DEQ) - httr�s:!;dt .nc.,OV
North Carolina Solid Waste Program - Y ;,%1d fr .q,,3vi_A-c1is: r_ tti, to -ma naclern.�a °�_s i n
North Carolina Septage Management Program - I?iyti f .�._:._ r _r.__ 9 a rl... i S ..3:.__.._.._i.," rn f t. o.lri-.. , tt ��c ! rr p.':.ig.._1: ,5�. -id- :tc._nl .

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.
1, r---,nn�hnn
(Plant Operato Responsible Charge (ORC), ORC License Number, Name of Plant)
Pw �). BIDS iV7 NC rX79 t D
�r �t hereby authorize
(Phone Number)
(Addr"s)
C,eC,Z V, s
(Owner/Operator of Septage Management Firm)
ofIkcV'S P0rVC-06C OT, CA's NCS#000
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage portable toilet waste '°/
grease Septage (grease trap pumpings) NA commercial/industrial septage from
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
%wm J\ree.,�
(Location)
between the hours of :00 am j', 00��.MoncAar --- �)4ijrc'\a`I
—r—
Reintroducing partially treated liquid into a grease trap is acceptable Yes �/ No
This authorization shall be valid untilCerY�b�r
(Usually December 31, Year)
Signed , Date 10 - V - 2 'Z
(Facili(y Operator)
.F^
S bscribed and affirmed before me this day of 20 17-
Q My Commission expires: iif `
(Notary Public) ���•�p� ��,�
gTAq>' NX
(OgAL SEAL)
C MISSION EXPIRES
b v
Note: Falsification of this document by the septage management firm shall lead to
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/W WTP Authorization Form 2018