NCS00817_2023Permit_Initial

2023
Permit and Registration
Mueller Septic Services
is hereby issued a Septage Management Firm Permit,
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Permit Number NCS-00817
o and registered as a
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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. Mebane Bridge WWTP, Eden, 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 114:17 09—7 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*
Mueller Septic Services
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00817
Enter the five digits following the NCS #
Street address of office*
Street Address
1901 US 311 Hwy N
Address Line 2
City
State / Province / Region
Walnut Cove
North Carolina
Postal / Zip Code
Country
27052
USA
County*
Stokes
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
336-362-5112
Email*
[e-mail]
Owner Info
Firm owner's name*
Donna Mueller and Christopher Mueller
Mailing address same as street address of office?*
• Yes No
Phone* Fax
336-362-5112
Operator Info
Firm operator's name* Firm operator's title
Mike Mueller
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
336-362-5112
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 260,000
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: *
Stokes, Guilford, Forsyth, Rockingham
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."
Signature
Date*
12/2/2022
Title*
Owners
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA147870 1FDZU90L9KVA07041 3,000
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*
Mebane Bridge Wastewater Treatment
Plant
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 2022 Eden 2.59MB
paperwork.png
Septage Management Firm Operator Training Completed^
Date* Hours*
10/18/2022 6
Location*
Greensboro, 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
Mawr liryrwPFr/f ��rr✓rana6.r ljt
Date
12/2/2022
09:45:53 AM
Print Name* Title*
Donna Mueller/Christopher Mueller owners

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste. 150, Raleigh; N.C. 27605
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; Chris Powell -- City of Eden Wastewater Treatment Plant Chief Operator I ORC
(Plant Operator and Name of Plant)
204 Mebane Bridge Road -- Eden. NC 27288
(Address)
336-627-1009 ext. 130 do hereby authorize Michael A. Mueller
(Phone Number) (Owner/Operator or Septage Management Firm)
of Mueller Septic NCS#
iSeptage Management Firm Name and NCS number}
to dispose of: domestic septage X
grease septage (grease trap pumpings) N/A
portable toilet waste X
corn merciaUindustrial septage NIA , from
Rockin ham County and surrounding counties
{County or other Geographic Area}
at the above named wastewater treatment facility. Septage shall be discharged at:
Mebane Bridge Wastewater Treatment Plant -- 204 Mebane Bride Road Eden NC 27288
(Location)
between the hours of 7:00 a.m. — 4:00 pm. Monday — Friday -- Septage will be accepted after hours by appt, only
After hours & emergencies call: 336-627.1009 ext. 4
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31. 2023
Signed Date
(Fact ' Operalor)
S n to and subscribed before me this day of OdOLer 20 2 2-
My Commission expires: ?-z 27
(Notary Public) ��� ri+I,��.r
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Nate: Falsification of this document by the septage management firm shall lead to permit revocation. . �. PUB : �4e