NCS00883_2023Permit_Initial

2023
Permit and Registration
Ray's
is hereby issued a Septage Management Firm Permit,
ZNti STATE ,, Permit Number NCS-00883
o and registered as a
EQ�J
i2. ��
-�� Septage Management Firm �� fEnvironmental utr
NORTH CAROLlNA (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. Septage Detention or Treatment Facility, SDTF-36-12, SDTF-34-06, SDTF-60- 3. City of Hickory WWTP, Hickory, NC
09, SDTF-26-05 4. McAlpine Creek WWTP, Charlotte, NC
2. Clark Creek WWTP, Newton, NC 5. City of Dallas WWTP, Dallas, 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
09:42:16-05'00'
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 " ' name" must be exactly as it is shown on your vehicle(s).
Street address of office: L2�. 1 � C I r-, J I -, �!n
City' I State: C_
I� Zip: Z8v1 "'I
Mailing address (if different): '4 , 5S
City: 0 C -S State:P.
Phone: '-i oQ - QZ Z . SSSS` Fax: ti P kj
E-Mail: r� e.l o-r�o1 -ofSAo-P-14, • C�
County: Septage Management Firm permit number: NCS # d &&I&S
(2.) Firm owner's name:
Mailing address (if different): 9--
Ciry: State:
Zip:
Phone: �u Ci I 2 g �Ll Fax: #,-,1 n
(3.) Firm operator's name:
Firm operator's title:
Mailing address (if different):
City: State:
Zip:
Phone: Fax:
K) Type(s) of septage pumped: Wine in the number of alto is Pam -Pod in 2015 (Example: Domestic: 50,000).
Domestic _ _ Portable Toilet Waste Grease Restaurant Treatment Plant lnd�us!tda%/Comry
(5.) N.C. Counties of Operation:
(List each county you do business in)
(6.) Total Number of Pumper Vehicles Operated: "-I _
Number used for: Domestic Septage:—= Grease (restaurant):
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License Tag # Vehicle Identification #
C Tank Ca ad
2 iJ u o �o
3 -1 1L S5S
vin
5 1
4 � ` v �V � Z1 �.
Il l C Z9 'lS Z1,'2
CoK-1 05 /u 1�1 I P I I-{ V F _tv
APPLICATION CONTINUED ON PAGE -2
�? 1 J 14 - - 2Zv I r�-�Z �nl i9+�-1 US U-,&4 v2.'a
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: v yes no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagrap .0833 cc 4) of the Septage Management Rules.
ules.
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#: Expiration Date:
SDTF#: _ Expiration Date:
(8.) Septage Management Firm Operator Training Completed:
Date: I Location: lC�v
Training Sponsored or Provided by: luc, Hours:
(9.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by: Hours:
(10.) Registration type requested: CHECK ON
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
11
Registered Portable Sanitation and Septage Management Firm:
Certification 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 (Signature of company clalrequirea)
Print Name
Other Comments:
1r1Z61ZZ
SJSolid_Waste:/CWSEPTAGE/FORMS/2016 Firm Appliicafon/FirmPermitAPplication2016
Date
Title
PAGE 2

NC SEPTAGE MANAGEMENT FIRM -
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- �>O-
Number of Pumper Vehicles:
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."
Signa ure (Signature ofcom fficiat required) Date -
Print Name
Title
S:ISolid_WastelclalseptagelformslPumper Vehicles Cetification.doc

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 deny discharges of any wastes to the
incoming wastewater stream.
S #1d2t7��
(Plant Operator in Responsible
16 7 me-
Cl C�e�
.e PRO, ORC License Number, Name of Plant)
i2 kc 21w5
(Address)
Olt '05—T 7?b do hereby authorize
(Phone Number) (Owner/Operator of Septage Management Firm)
of
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage, portable toilet waste
21�
grease septage (grease trap pumpings) commercial/industrial septage from
` � 5-f� n � (., r �'l eel � �Lt-c.. (e r1d i►-r
(County or other Geographic Area)r-tdt
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of '`7 - cm" -r- r7: VO P " "Orl��
Reintroducing partially treated liquid into a grease trap is acceptable Yes 1 No
This authorization shall be valid until 1 ��
(Usually December 31, Year)
Signed Date 2�
(Faci Operator)
Subscribed and affirmed before this
(Notary Public)
day of G' c./►'/6o, 20 c 2
My Commission expires: 54- , c?&Z
RONALD L INGRAM
NOTARYPUBLIC (OFFI(IALSEAL)
Catawba County
North Carolina
My Commission Expires May 8, 2027
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
5:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

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.
Shawn Pennell, C
(Plant Operator and Name of Plant)
(Address)
828-32 - one
PRobert A Ra
(Phone Number) do hereby authorize
(Owner/Operator of Septage Management Firm)
Of _ Ray's Well anrt Cpn+it-
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage _, portable toilet waste
grease septage (grease trap pumpings)
commercial/industrial septage --------- ,from
at the above named wastewater treatment facility.tyor otherSeptage shallphic be discharged at:
Old Brookford Plant
between the hours of
(Location)
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 -a - D a
(Facility Operator) Date
Swo n to and su scribed before me this U
%day of 20
Z
(Notary Public) MY Commission expires: A�U- 4
(OFFI` I` �Bff 11ry10�
�. S Ery
Note: Falsification of this document by the septage management firm shall lead to permit revocation. `` �••• ••��,��
? �tii �,pTagy •? �'
=ta-
-n• s2—
do % _ 'OUBI \O }
. BOG_ �' �'.
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1111111C/I

CHARLOTTE
W TES
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT
FACILITY
I, Bill Gintert / Environmental Compliance Manager
Charlotte Water - System Protection CLTWater - SP)
4222 Westmont Drive Charlotte NC 28217 704-336-4407
Do hereby authorize _Robert A Ray
(Authorized Representative)
Of Rays
(Septage Management Firm Name)
To dispose of Septage_ x _Portable Toilet Waste X
Note: 1) Grease trap waste is not allowed at the disposal sites.
2) Re - introducing partially treated liquid into a grease trap is not allowed in the
Charlotte Water system.
From: Mecklenbur Count and Surrounding Areas;
(County or other Geographic Area)
At the below named Wastewater Treatment Facility; Septage shall be discharged;
McAlpine Creek Wastewater Treatment Plant MCWWTP Septa -gig! Receivin Station
Between the hours of 7:30 a.m. until 11:00 a.m. and 12Q0 p m until 3:45 M. Mon . -Fri.
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.
This authorization will be effective: January 1s' 2023
This authorization shall be valid until: December 31st 2023
"NASigned: _ Date: Z%— 26Z—,,,
(Environmental Compliance Manager)
Note: Falsification of this document by the Septage management firm shall lead to permit revocation.

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission
has been given to a permitted Septage Management Firm to discharge septage into the permit
holders detention or treatment facility.)
1, _4IVtt d-
eC -e_
�eA �I — 00- fL--V, 5-
(Facility Operator)
Ch--[a
(Operator Address)
do hereby authorize: _ _ I j q 4
(owner of Septage Management Fi
r �T
- 'i- -- NCS #
(Name of Septage Management Firm)
(Address of Septage Management Firm)
75-D
F-74
to utilize Septage detention or treatment facili # c�Dg` 51- (�D-D� -©->
Septage
tY for the treatment or storage of
in 20 13 . The facility will be operated in accordance with the Septage Management Rules **
Date:-27-Z1�
* As defined in G.S.13OA-29Q(a)(32)
** As defined in 15A NCAC 138.0800
Signed ii✓�
(Facility Operator)
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

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 deny discharges of any wastes to the
incoming wastewater stream.
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
(Address)
fk
.,
do hereby authorize oI -4
(Phone Number) (Owner/Operator of Septage Management Firm
of - S rt• NCS # a $
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage _ portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage _ from
(County or other Geographic Area) 1�1r�• ! —�,� t
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable Yes —.4—No
This authorization shall be valid until
(Usually December 31, Year)
Signed-Aa 5
Datei
(Faciii Op or)
S scribed and affirmed before me this _ day of �i O�e�lber 20
My Commission expires:
(Notary Public)
LISA HULLENDER HARRIS
Notary Publlpf opmCg> onp
Gaston County
My Commission Expires Sep 25, 2026
Note. Falsification of this document by the Septage management firm shall lead to permit revocation.
s:/solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/W WTP Authorization Form 2018

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�`- North Carolina Department of Environmental Quality
Division of Waste Management
> n"~RTH wr``W INVOICE
Solid Waste Section
Division of Waste Management To: Robert A Ray Jr
Solid Waste Section Ray's
1646 Mail Service Center PO Box 53
Raleigh, NC 27699-1646 High Shoals, NC 28077
Phone/Fax: [phone]
Email:[e-mail] >>} E.
CK. NO. % 1 8U7
DATE It -3 D/2z Date: 09/27/2022
�Od. 00 Invoice#: NCS-00883-2023
Septage - Annual:
Rays
(NCS-00883)
PO Box 53
High Shoals, NC 28077 $800.00
Number of Trucks: 6
Date Due: 12/15/2022
LATE FEES: i � F iYli [ l !L (;? al. S:atuies.✓s5 t3rJA e'�l.l �f lat2:.f�e:..'uH� ,1,Y++1.� lrooIiP:1 fU 'l'7y Fet?ti nvC <,iJtilY?It:"PQ by iar`.i;avi 1, .�U:.
Payment Options:
E-check Available online at f .CWjs: /deq nc govy_ _ v spay
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 ht rs//deo n-1-117 nw
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.]
x I nati n f nvoice moun is Bas don Firm's Current Permit Status;
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 euestl_ ions regardino-
Billing Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - f;ttps:ir`derc o;,v
North Carolina Solid Waste Program - Li:ti cy� J=,o:it:divi ons'4vaste aanerienLiso =w�a ir- �� inn
North Carolina Septage Management Program - Fitps,f[rl_c,rc,ggy;divi;ionsiwastr
3n nng;sef:�E --� tioni:p rr __t3t s n-�;ten_ati(e_.

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:
o Contact information, including email
o 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
o $550 if you operate one truck
o $800 if you operate two or more trucks
❑ To pay online with a credit card, debit card, or checking account, you will need the
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
❑ 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]
Jeffrey Bullard
[e-mail]
[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]
— _ _. — _ _ —
[e-mail]
A copy of the NC Septage Management Rules and program forms are available at:
htt s: de C1.nc. ov abou divisions waste -man emen waste -mans 1ement-rules se to e