NCS00906_2023Permit_Initial

2023
Permit and Registration
Lassiter's Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00906
o and registered as a
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NORTH
EQ�J
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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 Ahoskie WWTP, Ahoskie, NC
2. Town of Windsor WWTP, Windsor, 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
Date: 2023.02.22
Sugg 115:05:47— 05'00?
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OP2RATE ASEPTA GE MANAGEMENT FIRM
'D`W -Z SECTION- 164691-j 'SERACECENTEEP, RALEIGH, NC27601646
-7,.,m name.'01 (The "F"FlueMme" must be exac ils it is shown on your v9hiclef8j),
1
Street address of'office.,
city:,- State:
-zg�c-
Mang aikiress (d dfferer ): ns..e '12 J11
City: State: Zip
Phowe: lt�-4UU fl—
E-Mait. I ek & S i4(/-
Counry
SWI-age V anagement Firms oc---k rvmber-. NCS 01,s
12.) FIvmowrvsnarne.-
wne
Maig address If different): A
aty: --fte— -- Zip __
Ph": Fax.
(3.) Firrr opwat3es name:
n o Ly's ue
MWg address jl diff0eq)
City: Stale,,- Zip.
ftw Fax.
(4.) Type(sl, of septage wumped: Mite ihihg numbar of as tens jZ"MgL%d in last 12 manth-i (r-
i-xamp!e. ocmesti.-: rK Co).
L;Omesvc Payable Tbilet vvaste
--qMse (Reslawan') Treatment Plan, I InduWaliCommercial
115.) NX. Counties of Opn#icn: J&Art
kuwl earn -.0uni"Ou am aumonred to dq*usinns in
M) ToWNumber of Pun-perVehicles operated:_ �
Number tamed fcr: Comeslic Septage.� Grease (restaurant):
Mer. 10 Ponabie Toilet Waste -
Vehicle Informa5t: iluse addiboral paper 7 iw-e—e;
License Tag.
4
i A 5939
12 a5;;
'-3 --
'elucle ldeMFicato
I wk Capacity
PSL- S- D X g e)b I g 9 4,& Lj L/ 26b
.0 .
APPLICATION CONTINUED ON PAGE 2

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACIL
ITY
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.
charge (ORC), ORC License Number, Name of Plant)
NC
(Address)
1 4- '0 do hereby authorize ti ll sr
(Phone Number) (Owner/Operat r of Septage Management Firm)
(Plant operator
(Septage Management Firm Name and NCS number)
1"nCa
to dispose of- domestic Septage portable toilet waste
Al' il('&UJA only
grease Septage (grease trap pumpings) VAN commercial/industrial Septage from
r-I/y� 1!_
(County or other Geographic Area) .sl ice?"`.Oi , wi f y
at the above named waste water treatment facility. Septage shall be discharged at:
between the hours of '' `. (Location)
«", — ; C'Ocrn
SciA-u r6
Reintroducing partially treated liquid into a grease trap is acceptable yes ✓ No
This authorization shall be valid until -C.e l�l�pt;Y � i r , '
q (Usually December 31, Year)
Signed ` Date ( - 31- z z
(Facility Operator)
S bscribed and affirmed before me this
1
(Notary Public)
ii
day of 1, `1 e"L . 207,
My Commission expires:
Note: Falsification of this document by the septage management firm shall lead to
s:/solid waste/CLA/SEPTAGE/FORMS/2018 Firm Application/wwTP Authorization Form 2018
.9MMIS8ION EXPIRES
�,. pUBLIG ,-k`,;

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.
I, 5
(Plant Operator in Responsible Charge (ORC), ORC license Number, Nano of Plant)
f r ti -n Cm '
(Address)
6, -1 C1 4 ` y0! 15 do hereby authorize 1 k4
(Phone Number
(Owner/OPeratdr ofSeptage Management Firm)
Of
7- r
Management Firm Name and NCS number)
to dispose of: domestic septage _' portabletoilet waste Le`
grease septage (grease trap pumpings) commercial/industrial septage _ i-� from
w
(County o other tieog raphic Area) Ui r j5
at the above named wastewater treatment facility. Septage shall be discharged at:
P C-Drnn1 r c.
(Location)
between the hours of -'
Reintroducing partially treated liquid into a grease trap is acceptable Yes _p---,No
This authorization shall be valid until 9 r 3 �
(Usually December 31, Year)
Signed i 5 4Cc :� _ Date_ I_Z
(Facility Operator)
Subscribed and affirmed before me this day ofl�fp , y- 20
My Commission expires: "� Q�
otary Pu
CALLIE C. MIZELLE
NOTARY PUBLIC (OFFICIAL SEAL)
Berrie County
North Carolina tt
My Commisslon Expires ' l�G
Nate: Falsification of this document by the septage management firm shall lead to permit rewcation.
s•./8o w Waae/aA(SEPTAciVFORW/2018 Finn Aw awn/Wwrr/ Autfiorrza bn Forth 2018

NC SEPTAGE MANAGEMENT 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."
Sig ture (Signature of company official required)
print Name
J '� -- [6r '; G 9-1—
Date
' 6-1�
Title
S:%Solid_WastelclalseptageVormslPumper Vehicles Cetification.doc