NCS00853_2023Permit_Initial

2023
Permit and Registration
Five County Waste
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00853
o and registered as a
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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, 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. Louisburg WRF, Louisburg, 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: 2023.02.20
09:36:48-05'00'
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*
Five County Waste
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00853
Enter the five digits following the NCS #
Street address of office*
Street Address
57
Address Line 2
Berry Williams Rd
City
State / Province / Region
Zebulon
NC
Postal / Zip Code
Country
27597
United States
County*
Franklin
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9193690028
Email*
[e-mail]
Owner Info
Firm owner's name*
Hugh C. Williams
Mailing address same as street address of office?*
• Yes No
Phone* Fax
9193690028
Operator Info}
Firm operator's name* Firm operator's title
Hugh C. Williams Owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
9193690028
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 1,458
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: *
Wake,Franklin,Wilson,Johnston,Nash
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
61wmwa
Date*
12/14/2022
Title*
Owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage DR3937 1HTSCRF8ZLH252329 1,800
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*
Louisburg WFR
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 8430187D- 1.89MB
7C5B-43A9-
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Septage Management Firm Operator Training Completed
Date* Hours*
10/18/2022 6
Location*
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
I have not run my Portable Toilet truck in 2022 No help, but want to keep my
registration in case I can find someone to operate it.and will pay additional
fee for second vehicle.
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
g4,90 rwmzl�
Date
12/14/2022
08:21:44 AM
Print Name* Title*
Hugh C. Williams Owner

AUTHC�RIZATIC?N T� DISCHAR-GE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
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