NCS00852_2023Permit_Initial

2023
Permit and Registration
Chatham Portables
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-00852
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, 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. Town of Siler City WWTP, Siler City, 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
14:23:11-05'00'
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*
Chatham Portables
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00852
Enter the five digits following the NCS #
Street address of office*
Street Address
5115 AIRPORT RD
Address Line 2
City
State / Province / Region
Siler City
North Carolina
Postal / Zip Code
Country
27344
CHATHAM
County*
Chatham
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9197427300
Email*
[e-mail]
Owner Info
Firm owner's name*
patricia austin
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
po box 274
Address Line 2
City State / Province / Region
Siler City nc
Postal / Zip Code Country
27344 chatham
Phone* Fax
9197427300

Operator Info ^�
Firm operator's name* Firm operator's title
PATRICIA AUSTIN OWNER
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9197427300
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 0
Portable Toilet Waste 41 , 625
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in:
CHATHAM CO
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*
12/15/2022
Title*
OFFICE MANG
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*

Portable Toilet Waste HF3722 1FDAF56F11ED62785 500
Portable
Toilet
Waste
DF7211
1FDXF47F92EB92969
500
Portable
Toilet
Waste
JZ5604
3FRWF65H76V339822
800
Portable
Toilet
Waste
JR2217
JALE5B16367903599
300
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
HEADWORKS 12/31/2023
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*
12/2/2022 4
Location*
RALEIGH NC
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
Date Hours
12/3/2022 4
Location
RALEIGH NC
Training Sponsored or Provided by
NC Pumper Group & NC Portable Toilet Group
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
I WILL HAVE TO SEND THE NOTORIZED AUTHORIZATION SEPARATELY. I CANT SEND FROM
THIS COMPUTER
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
Date
12/15/2022
09:15:43 AM
Print Name*
SHEILA HAMMER
Title*
OFFICE MANAGER

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 decay discharges of any wastes to the
incoming wastewater stream.
Brittany York, 1007288, Town of Siler City
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
PO Box 769, Siler City, NC 27344
(Address)
919 742-4581 do hereby authorize Patrica Austin
(Phone Number) (Owner/operator of Septage Management Firm)
of Chatham Eortablg25 NC5 #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage x J portable toilet waste X
grease septage (grease trap pumpings) No commercial/industrial septage No from
Chatham County
(County or other Geographic Area)
at the above named wastewater treatment facility. septage shall be discharged at:
Headworks
(Location)
between the hours of Mon - Fri 7:00 am - 4 0 pm
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until Dec. 31, 2023
(Usually December 31, Year)
Signed Date l0 1Z R 1 Z Z
(Facility �Operatof)
Subs i d and affirmed before me this day of 0
My Commission expires:
(NotaryPublic) ',,ati r►��
,t°S�':
AUgC�CI
Note: Falsification of this document by the septage management firm shall lead to p$ s�vttrj�Ar' �V
5./Sohd_Waste/CLA/SEPTAGE/FORMS/2018 Firm Applicavon/WWTP Authoruation Form 2018 v � `���
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