NCS00865_2023Permit_Initial

2023
Permit and Registration
Blue Ridge Pumping
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-00865
o and registered as a
e:,e D
NORTH
EQ�J
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-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r Q'M
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. Cub Creek WWTP, Wilkesboro, 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 Perr Digitally signed by
PerryWm Perry Sugg
Sugg Date: 2023.02.20
09:38:37-05'00'
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).
Street address of office:
City:
State:, Zip: X / 5
Mailing address (if different):
City: ��� o�i °lay State: ip:�C
Phone: t — �w — (� Fax: f j
E-Mail:
County: eptage Management Firm permit number: NCS #�
(2.) Firm owner's name:
Mailing address (if different):
City:
Phone:
(3.) Firm operator's name.
Mailing address (if different):
City:
Phone:
State: Zip:
Fax:
Firm operator's title:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of -gallons pumped in2 - Example: Domestic: 50,000).
Domestic 1 Portable Toilet Waste . Grease
(5.) N.C. Counties of Operation:
Treatment Plant InduslPiavCommercial
(List each county you do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: 0
WE Grease (restaurant): —�'b
Other: 6&IVEI Portable Toilet Waste: Wpffp_,�
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capach
1
2
3
4
-
-
5
--
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: (M yesQC4)
no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagrap .0833 of the Septage 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#: _ Expipation Date: SDTF#: Expiration Date:
(8.) Septage Management Firm 0 erator Training Completed:
Date: 6a Location: `WHours:
Training Sponsored or Provided by: N ff 76 : i V, [1.n�
(9.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsoped or Provided by:
(10.) Registration type requested: CHECK ON
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
Hours:
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.
A
Sig�athe(Sign re of company officia quimd)
Print Name
Other Comments:
�� I • �1a W.0W,0 mom
SJSolid_WasteJCLA/SEPTAGE/FORMS/2016 FPm Application/FpmPermitApplication2016
PAGE 2

MOTOR CARRIER OPERATOR
I �-G e- 9
ADDRESS
/ o 7
CITY,
ZIP CODE
OTRAC R ❑
❑ (OTHER)
ANNUAL VEHICLE INSPECTION REPORT
VEHICLE HiSTORY RECORD
REPORT
NUMBER FLEET UNIT NUMBER •
�m
DATyt
�U
INSPECTOR'S NAME (PRINT OR TYPE)
) Vkmr -5eiPc Lk)vA W
THIS IN CTOR MEETS THEQUALIFICATION REQUIREMENTS IN SECTION 396.19.
ES
VEHICLE IDENTIFICATION (✓ AND COMPLETE) ❑ LIC. PLATE NO. ❑ VIN ❑ OTHER
jet TRUCK ❑ BUS INSPECTION AGENCY ATION (OPTIONAL)
EC
I .6
REPAIRED ITEM
DATE
OK NEEDS R DATED
ITEM
I BRAKE SYSTEM
I 0
.
a. Service Brakes
a. Part(s) of vehicle or
b. Parking Brake System
condition of loading such
c. Brake Drums or Rotors
that the spare tire or any
d. Brake Hose
part of the load or dunnage
e. Brake Tubing
can fall onto the roadway.
f. Low Pressure Warning
b. Protection against shifting
Device
cargo.
g. Tractor Protection Valve
c. Container securement
h. Air Compressor
devices on intermodal
i. Electric Brakes
equipment.
j. Hydraulic Brakes
k. Vacuum Systems
�"
a. Steering Wheel Free Play
I. Antilock Brake System
b. Steering Column
m. Automatic Brake Adjusters
c. Front Axle Beam and All
COUPLING2. DEVICES
Steering Components
Other Than Steering
Column
d. Steering Gear Box
e. Pitman Arm
f. Power Steering
g. Ball and Socket Joints
a. Fifth Wheels
b. Pintee Hooks
c. Drawbar/Towbar Eye
d. Drawbar/Towbar Tongue
e. Safety Devices
f. Saddle -Mounts
h. Tie Rods and Drag Links
a. Exhaust system leaking
t/
i. Nuts
forward of or directly below
,r
j, Steering System
the driver/sleeper
compartment.
b. Bus exhaust system
a. Any U-bolt(s), spring
leaking or discharging in
hanger(s), or other axle
violation of standard.
c. Exhaust system likely to
positioning part(s) cracked,
broken, loose or missing
burn, char, or damage the
resulting in shifting of an
electrical wiring, fuel supply,
axle from its normal position.
or any combustible part of
b. Spring Assembly
the motor vehicle.
c. Torque, Radius or Tracking
a. Visible leak.
b. Fuel tank filler cap missing.
c. Fuel tank securely attachec
All lighting devices and
reflectors required by Part 393
shall be operable.
INSTRUCTIONS: MARK COLUMN ENTRIES TO VERIFY
CERTIFICATION: THIS VEHICLE HAS PASSED ALL
ACCORDANCE WITH 49 CFR PART 396.
Copyright 2016 J. J. Keller & Associates, Inc.
Neenah, WI • JJKeller.cam - [phone]
Printed in the USA
a. Frame Members
_ b. Tire and Wheel Clearance
c. Adjustable Axle
Assemblies (Sliding
Subframes)
✓ OK. x rvcrua REPAIR, Nw (IF IT'
REPAIRED I DAITEM
TE
a. Tires on any steering axle
of a power unit.
b. All other tires.
c. Installation of speed -
restricted tires unless
specifically designated by
motor carrier.
a. Lock or Side Ring
b. Wheels and Rims
c. Fasteners
d. Welds
Requirements and exceptions
as stated pertaining to any
crack, discoloration or vision
reducing matter (reference
393.60 for exceptions).
Any power unit that has an
inoperative wiper, or missing
or damaged parts that render
it ineffective.
Any passenger seat that is
not securely fastened to the
vehicle structure.
List any other condition(s)
which may prevent safe
operation of this vehicle.
REP -ED DATE
THE INSPECTION ITEMS FOR THE ANNUAL VEHICLE INSPECTION IN
ORIGINAL
3128
(Rev. 8/16)

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
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.
I, Dustin Colburn., WW4 #10002188 of Town of Wilkesboro Cub Creek WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
700 Snyder Street Wilkesboro North Carolina 28697
(Address)
336-981-1078 do hereby authorize Jeff Wyatt
(Phone Number) (Owner/Operator of Septage Management Firm)
of Blue Ridge Purnoin-q NCS #00865
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste X -,
grease septage (grease trap pumpings) commercial/industrial septage. X from
Northwestern North Carolina _
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
700 Snyder Street Wilkesboro, North Carolina 28697
(Location)
between the hours of 8:00 am and 5.00 m
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31 2023
(Usually December 31, Year)
Signed '
(Facility Operator)
Date 14 %t= ¢�
Subscribed and affirmed before me this _Q&Oa� — day of �� . 20 c9Q
My Commission expires: Ll
(Notary Public) --
I ~ Amber H Garwood
NOTARY PUBI &FICIAL SEAL)
Wilkes Coun
North Carolina
My Commission mmision Expires 12-02-20,Z3
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CtA/SEPTAGE/FORMS/2014 Firm Application/WWTP Authorization Form 2014

INVOICE
Divisiti-Ld aft,4."'agement Jeffery D. Wyatt
Solid Waste Section Blue Ridge Pumping
1646 Mail Service Center 10-16-De l
Raleigh, NC 27699-1646
phone: [phone] fax: [phone]
email: [e-mail] __ __._ __.__.. _
! gl'r`t `�Do��L
�. � i� 5 \'" � NCS'00865- a
Septage-Annual: $550.00
Blue Ridge Pumping (NCS-00865)
l� O zk� '�q
('i
umber of Trucks:.Q.,
CK. NO. %i�� Total Amount Due $550.00
DATE t s —/ ' L2 Date Due 12/15/,q0
ojr3—S'6. ob
Payment Options:
E-check - Available online at http:/igo.ncdenr.goviswpay
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 vour account. If a zip code is not listed. use the code: 99999 along with the invoice number.
Credit Card available online at http:h`go_ncdenr.gov/swpay
riGceotS 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 invni—,'t L '% j 4 r G1 l..Lu,�%)I�`�' " -a
t Paper check - Make checks payable to N.C. Division of Waste Management, Soli Waste Section, me ude 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
n �y of this invoice with your payment. "� J
iG.S_ 25-3-506: A 525.00 processing fee will be charged on all returned chi-nks.l
WEx. lanation of Invoice Amount -s Based on t-actnt s �urre r rern��� ��acu�.
t.r (JY Pursuant to North Carolina General Statute 130A-291.1 you are required to pay [eels) based on your snuri vas _ .,,u_,gemeni auly ��-The teeist
5 CIO hall be used to support the septage management program_
Q
Soli Waste Contacts -
Billing process:
Mary H. Johnson [phone]
Regulations and Technical Assistance
Chester Cobb [phone] Septage Management Firms. Land Application Sites. Detention Facilities
Adam Ulishney (9191707-8210
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - http-l/deq.nC.gov
North Carolina Solid Waste Program - http://deq.nc.gov/abouUdivisions/waste-managemenUsolid-waste-section
North Carolina Electronics Management Program - http:ildeq.nc.gov/about/divisions/waste-management/electronics-management
Form 1-2016
NC Solid Waste Invoice

SEPTAGE MANAGEMENT FIRM PERMIT APPLICATION CHECKLIST
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
Complete all questions on both pages of the application, including:
r Contact information, including email
4b Estimate of gallons pumped within the calendar year
Enclose all disposal authorizations for wastewater treatment plants (WWTP), Septage
Land Application Sites (SLAS), Septage Detention or Treatment Facilities (SDTF), compost
facilities, or landfills where you plan to dispose of waste.
Be sure any Wastewater Treatment Plant Authorization forms included are signed,
notarized original documents.
Make check payable to: DIVISION OF WASTE MANAGEMENT
a $550 if you operate one truck
o $800 if you operate two or more trucks
M/To pay online with a credit card, debit card, o checking account, you will need the
j invoice for instructions.
® Remember to include the "Recertification of Pumper Vehicle(s)" form enclosed for
/ compliance certification of all pumper vehicles previously inspected by the Division.
® Mail payment (unless you are paying online) and all application materials to:
Division of Waste Management, Solid Waste Section
Attn: Septage Management Program
1646 Mail Service Center
Raleigh, NC 27699-1646
D If you have any questions, we are here to help! Call or email us:
Environmental Compliance Branch, Septage Management Program Staff
Raleigh Central Office
Chester Cobb [phone] [e-mail]
Jeffrey Bullard [phone] [e-mail]
Fayetteville Regional Office
Connie Wylie [phone] [e-mail]
Asheville Regional Office
Troy Harrison [phone] [e-mail]
Wilmington Regional Office
John Farnell [phone] john.farnell@ncdenr.
A copy of the NC Septage Management Rules and program forms are available at:
httos://deg.nc.govlabout/divisions/waste-managei,ient/waste-management-ruleslseotage