NCS00886_2023Permit_Initial

2023
Permit and Registration
AAA Portable Toilets
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00886
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, 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. City of Asheboro WWTP, Randleman, 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
Digitally signed
by Wm Perry
Perry
Sugg
Sugg
Date: 2023.02.20
09:42:44-05'00'
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
(�_ d''`
Street addres of office: 1 ,,
City: t�IJd Iro
Mailing address (if different):
as it is shown on your vehicle(s).
State:. Zip:_ aP Qvl&
City: State: _ 2 Zip:
Ll
Phone: �� �� Fax: "] ,3� e c�a 3'7
E-Mail: U C
County: Q Se2tage Management irm permit number: NCS # 1p
(2.) Firm owner's name: I'
Mailing address (if different):
City: _ State: Zip:
Phone: Fax:
(3.) Firm operator's name: tj,5c4 r t Q _ _ Firm operator's title: Owyl -00
Mailing address (if different): --
City:
State: Zip:
Phone: rax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in 2015 (Example: Domestic: 50,000).
Domestic I Portable Toilet Waste I Grease
(5.) N.C. Counties of Operation:
Restaurant Treatment Plant IndustriallCommercial
(List each county you do business in)
(6.) Total Number of Pumper Vehicles Operated: an
Number used for: Domestic Septage: Grease (restaurant):
Other: Portable Toilet Waste: eu
Vehicle Information: (use additional paper if needed)
License Tao # , Vehicle Identification #
Tank
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: Nap yes FI no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subpara.0833 c 4) 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#: Expiration Date: SDTF# Expiration Date:
(8.) Septage Management Firm Operator Training Completed:
Date: Location: Hours:
Training Sponsored or Provided by:
(9.) Septage Land Application Site Operator Training Compl ed:
Date: I17 l 01V Location: r,e�e - �- Hours:
Training Sponsored or Provided by:
(10.) Registration type requested: CHECK ON
IX
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm: F
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.
g ature (Signature �oof company official required)
Print Name
Other Comments:
Date
Title
S:/Solid_Waste:/GLA/SEPTAGEIFORMS/2016 Firm Application/FirmPermitApplicabon20l6
PAGE 2

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, Michael_R. Wiseman., ORC, WW4#987680. Citv of Asheboro Wastewater Treatment Plant
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
1032 Bonkerneyer Drive, Randleman_, NC 27317
(Address)
336-672-0892
(Phone Number)
do hereby authorize Susan Delk
(Owner/Operator of Septage Management Firm)
of AAA Portable Toilets NCS# 00886
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage portable toilet waste _. X
grease septage (grease trap pumpings) commercial/industrial septage from
Randolph County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
1032 Bonkemever Drive. Randleman, NC 27317
(Location)
between the hours of 7:00 a.m. to 5:00 o.m. Monday - Friday Oniv
.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, 4el RDate / / Z Z
(Facility Operator)
Subscribed and affirmed before me this 2 _ _ day of _ ��k'--� 20 2Z
C) 1dJWV\Ak-"' My Commission expires:
( )ary Public) ,`�ttllllll►��`i
T SAf!,0
U.W `- t� �.`� ICIAL SEAL) F9 y
� S �aTAgy
U"
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Note: Falsification of this document by the septage management firm shall lead to per fiyocation.�.�
5:/Solid_Waste/CLA/SEPTAGE/FORMS/2019 Firm Application/WWTP Authorization Form 2019 ''�,PH �CO`i�``

NC SEF AG_E, TNIANAGLMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS-
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."
S ature (Signature of company official required)
fJe1k
Print Name
Date
Title
SASoIld WastelcWseptagelformslPumper Vehicles Cetification.doc

,3
North Carolina Department of Environmental Quality
''=•�'"' Division of Waste Management INVOICE
NORTH CAROLINA Solid Waste Section
[nvhonrmentalQNdby
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
Septage - Annual:
AAA Portable Toilets (NCS-00886)
3023 Highway 64 West
Asheboro, NC 27205
Number of Trucks: 2
To: Susan Delk
AAA Portable Toilets
3023 Highway 64 West
Asheboro, NC 27205
CK. NO. 3141
DATE It 'T/11-
$ Date: 05T27/26
Invoice #: NCS-00886-2023
$800.00
4
Date Due: 12/15/2022
LATE FEES: In accordance with NC General Statutes C-5130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted by January 1, 2023.
Payment Options:
E-check Available online at https://deq.nc.ciov/swi2a
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 https://deg.nc. ov/swpaa
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.
rConvenience 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.]
Explanation of Invoice Amount is Based on Firi_m_'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 questions regarding:
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) - https://deq.nc.gov
North Carolina Solid Waste Program - hits de .nc.govrabput+division.,�waste-management.'solid-waste-section
North Carolina Septage Management Program - https://deo.ngAov/aboul2divisions!waste-managementisolid-waste-section special-wastes-and-alternative-
handlina/septage