NCS00889_2023Permit_Initial

2023
Permit and Registration
Farmers Rentals
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-00889
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. Town of Boone WWTP, Boone, 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
Y Wm Perry Sugg
Sugg 09:43 20— 05''00 0
Perry Sugg, Environmental Compliance Branch Head

r
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 276994646
(1.) Firm name: (The "Firm name" must be exactly as it is shown on your vehicle(s).
r4owS "rwLl ---
Street address of office: ? S W o .r 4
City: .9 or> w e State: [lc, Zip: Z S 6 0"7
Mailing address (if different):
City: State: Zip:
Phone: $L 4 Z 66, Y Fax: !�2 S • Z G L• elez / `l
E-Mail: 7'cv6 %eR4'l4<s RI-- ArrX cs , & a Alf
County: ^W.A
(2.) Firm owner's name
Mailing address (if different):
Septage Management Firm permit number: NCS # 0 o g$ 9
5; L—kr.
City: 'V.,-o15-AJ6 State: Ale,zi 99 6• 07
Phone: ;'Z 8 • 24-- 60VV _Fax: gZ 8 • ZG l02! 9
(3.) Firm operator's name: Firm operator's title:
Mailing address (if different):
City:
Phone:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in 2095 (Example: Domestic: 50,000).
Domestic
�!
Portable Toilet Waste Grease Restaurant Treatment Plant Industrial/Commercial
S'oo
(5.) N.C. Counties of.Operation: M*F alQsi S A AfOC
IK
(List each county you do business in)
Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage:
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License TN #
Vehicle Identification #
Tank Capa 't
1
F- 3 r; o
l ri2F.!;' 'f? sad Lizz ?(4
L.
2
3
4
5
A
r 4
� h
ADDI 'CATION r'OWIN' IIED ON DASD 7
r.1 I LIVr\I1V1� VV1� 111\VLV1\ 1 111VL 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: (, yesPC4)
no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagraph .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#: Expiration Date: SDTF#: Expiration Date:
(B.) Septage Management Firm Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
c4m v,tz ?b 4 t',&Ajr7. Gva -t. dip"Pe-trp
Hours: 1Gycp '7;FkS flG'aR .
(9.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(10.) Registration type requested: CHECK ON
Registered Portable Sanitation Firm:
Registered Septage Management Firm: 12
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.
Signature (Signature of company official required)
Print Name
Other Comments:
Date
OGvat/t�
Title
S:ISolid Waste:lCLAISEPTAGEIFORMSl2016 Firm ApplicationlFirmPermitApplication2o16
PAGE 2

` 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
iliThe facility has the ultimate prerogative to deny discharges of any wastes to the
treatment facty.
Sm
incoming wastewater stream.
i
r`�.
- (Plant Operator in
of
II ' 2-LIt�4' 1) C, - -s,A
Y�
ible Charge (ORC), ORC License Number, Name of Plant)
- - --
o�
(Address) �r /
do hereby authorize
(owner/Operator of Septage Management Firm)
(Phone Number)
iucs# ov 8S9
I ev„."-.ZS
to dispose of:
(Septage Management Firm Name and NCS number) �.
toportable toilet waste
domestic sep ge
um ins •
grease septage- (grease trap p � P g ? ��-
commercial/industrial septagefrom
A.Ie, ,gluey L l
t` L'
/ (County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
�� JJ ii l• � s� �,-.
(Lo
between the hours of __j 0
Reintroducing partially treated liquid into a grease trap is acceptable
Yes ono
�c rnt�� .31, ���
This authorization shall be valid untir / � n (Usually December 31, year)
n � O
(Facility Operator)
Subscribed and affirmed before me this
(Notary Public)
-Shanno741saaos
NotawatsuNorth �,
.3�4yCommission
Date 12 - 2't- a 2-
day of ccrr i7er 20-�'
My Commission expires:
(OFFICIAL SEAL)
e management firm shall lead to permit revocation.
Note: Falsification of this document by the septag
s:/soiia_waste/CWSEPTAGE/FORMS/2018 Firm Appiication/WvP Ahorization Form 2018