NCS00772_2023Permit_Initial

2023
Permit and Registration
Piedmont Septic Tank Inc
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00772
oand registered as a e:,e D
NORTH CAROLINA
EQ�J
-�� Septage Management Firm awnen� f� wrnmenta�lty
4sr
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, Tide 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. Rocky River Regional WWTP, Concord, 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
Sugg
Digitally signed by Wm
Perry Sugg
Date: 2023.02.17
14:13:02-05'00'
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*
Piedmont Septic Tank
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00772
Enter the five digits following the NCS #
Street address of office*
Street Address
213 North Main St Suite G
Address Line 2
City
State / Province / Region
China Grove NC
North Carolina
Postal / Zip Code
Country
28023
United States
County*
Rowan
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
PO Box 8126
Address Line 2
City
State / Province / Region
Landis
NC
Postal / Zip Code
Country
28088
United States
Phone* Fax
7048576426
Email*
[e-mail]
Owner Info
Firm owner's name*
Randy Melton
Mailing address same as street address of office?*
Yes 0 No

Mailing Address*
Street Address
633 Hunter Oak Dr
Address Line 2
City
Kannapolis
Postal / Zip Code
28083
Phone*
7048576426
Operator Info
State / Province / Region
NC
Country
United States
Fax
Firm operator's name*
Firm operator's title
Randy Melton
President
Mailing address same as street address of office?*
Yes • No
Mailing address*
Street Address
633 Hunter Oak Dr
Address Line 2
City
State / Province / Region
Kannapolis
NC
Postal / Zip Code
Country
28083
United States
Phone*
Fax
7042020370
Type and amount of septage pumped
in the last 12 months
Amount in gallons*
Domestic
250,000
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:
Cabarrus, Rowan
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
IZFIlewz�w
Date*
11/25/2022
Title*
President
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA79364 1MA13YXSWO54334 3,500
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*
Rocky River Regional WWTP
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
Septage Management Firm Operator Training Completed
Date* Hours*
10/19/2022 6

Location*
5834 Bur -Mil Club Rd Greensboro
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
I41
Date
11/25/2022
11:54:32 AM
Print Name*
Randy Melton
Title*
[e-mail]

�:. North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
CAROL!NA Solid Waste Section
Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
Septage - Annual:
Piedmont Septic Tank Inc (NCS-00772)
PO Box 8126
Landis, NC 28088
Number of Trucks: 1
To:
Randy Melton
Piedmont Septic Tank Inc
PO Box 8126
Landis, NC 28088
PAI
CK NO.
/V W
DATE._ _�lL?rz''-
Date: 09/27/2022
�S od
Invoice #: NCS-00772-2023
$550.00
Date Due: 1 12/15/2022
LATE FEES: In 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.ric.gov/swpay
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 httpsT,',deq.nc.gov/swp_y
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 StatuL.
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 regarding
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) - littgs://deci.nc.gov
North Carolina Solid Waste Program - httos:i' der.;.nc.gov/about'divisionsAwaste-maragement/solid-waste-section
North Carolina Septage Management Program - httcs: 7de .nc. ov'abou divisions/Uva e-man em nt oli -waste -section /sc ecial-wastes-and-alternativ
handling/se . tag e

NC SEPrI,AG E MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- on
Number of Pumper Vehicles: _ l ore)
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)
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Print Name
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Date
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Title
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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, NC27699-1646
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, James Christian Sims, #999309, Rocky River Regional Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
6400 Breezy Lane, Concord, North Carolina 28025
(Address)
704-788-4164 x114 do hereby authorize Randy Melton (704-857-6426)
(Phone Number) (Owner/Operator of Septage Management Firm)
of Piedmont Septic Tank NCS # 00772
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage YES , portable toilet waste YES ,
grease septage (grease trap pumpings) NO commercial/industrial septage NO from
Cabarrus and surrounding counties.
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
6400 Breezy Lane, Concord, NC 28025
(Location)
between the hours of 7AM and 7PM Monday -Saturday: Sunday upon request.
Reintroducing partially treated liquid into a grease trap is acceptable Yes d No
This authorization shall be valid until December 31, 2023
(Usually December 31, Year)
Signed Date October 18, 2022
James Christian Sims, Facility ORC
Subscribed and affirmed before methis
Angela Hill, Notary Public
18th
day of October 120 22
My Commission expires: May 15, 2025
K.
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off:. `A \� ••Q�-,
OW, c�
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018