NCS00909_2023Permit_Initial

2023
Permit and Registration
Powell Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00909
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. Lower Creek WWTP, Lenoir, 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 Date: 2023.02.22
15:06:21-05'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE, MANAGEMENT FIRM
iDlVIStON OF WASTI=MANAGEMENT -SOLID WASTE SECTION —1646 MAIL SERVICE CENTER, RALEIGH, NC 276,99-1646
(I.) Firm name: -(ft "Fft m t anw, trust be as it is`s'homm on yow vehicfe(s).
Street address of office:
City: _�a 2 State: L • C Zip: .I t?6 'F1
Mailing ad ress 01' different) -
City:
State: Zip:
-Phone: F/ 5�— 63.2 — ! 71 / Fax:
E-Mail: led
County:
-(3.) Rm owner's -name:
Mailing address (if different)-
-City:
State:
Phone: fax:
Zip:
0.) firm operators name. L di I ,'e /Ja► /e Z Id a r _ _ Firm operator's tide: 0a r% ee-
Mailing address (ifdifferent); 5'e7 & 3 AlC /%,..,r /6 S!QC-4A
City: 1orsu, lit State: ,r/L Zip: 2S&Y,
0 Nd
Np
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Q E
Phone: -30.2 - 7 Fax: z EEJ
(4) Type(s) of septage pumped; Write in the rumor of aallons pumped in 2015 (Example: Domestic: 50,000). U a
Domestic Portable Toilet Waste Grease Restaurant Treatment Plant Industrial/Commercial
7 a
(5.) N.C. Counties of Operation:
(List each county you do Nsiness in)
(6) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage.��_,%1•rease (restaurant):
Other: Portable Toilet Waste:
Vehicle information: (use additional paper if needed)
jN
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now
APPLICATION CONTINUED ON RAGE 2

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
fCONTINtiM FROM PAGE 1)
Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: yes no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagrap .083 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 streets if needed)
SDTF#: Expiration Date: SDTF#: Expiration Date: ,
(8.) Septage Managemer� firm Operator Training Completed:
Date: D� 1l Lotion: LC
Training Sponsored or Provided by: 1t/�4
(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:
Registered Portable Sanitation and Septage Management firm:
CertificationStatement
Hours:
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 maybe 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 fs*wwm
Name,
other Comments:
}�ny dlicw mw#4 Hate
T91e
Sr,-,& Waste ICLAISEPTAGMRNfSiZoi6f'wmAp*alicxi hd:lecrrulFippft a00016
PAIGE 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
treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the
incoming wastewater stream.
I, Donnie R. Hawkins. ORC WWTP Ouerator 4 9876925 ; Citv of Lenoir - Lower Creek WWTP (NC0023981
(Plant Operator in Responsible Charge jORC), ORC License Number, Name of Plant)
1905 Broadland Road. Lenoir. NC 28645 f P.C. Box 958. Lenoir NC 28645�
(Address)
82& 757-2198 _ do hereby authorize Kevin Powell
(Phone Number) (Owner/Operator of Septage Management Firm)
of Powell Septic Tank Service NCS # 00909
(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 , from
Caldwell. Catawba. Alexander and Iredell Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Seritaue Receiving Station �@ Lower Creek WWTP
(Location)
between the hours of 7:00 a.m. until 7:00 :.m.. Monday throueh Saturda,
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)
f C
Signed—�LDate_ _� y_1 ,)-
(Facility Operator)
Subscribed and affirmed before me this
day of eyh 61y' , 20 ?—Z
zLlo C�,,rc_ My Commission expires: ae 2FJ23
(Notary Public)
�'it�iilftffj�f
♦`�, � CSC
(CF: EAL)
•
ram- NOTARY
Note: Falsification of this document by the septage management firm shall lead to permit revocation. PUBLIC
S-./Solid Waste/CLA1SEPTAGEIFORMS/2016 Firm ApplicationANVVTP Authorization Form 2016

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- 00 22
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."
i
Signature (Signature of company official required}
4U, k 1 LA-�% V a c..0 E L(
Print Name
Date
Title
RECEIVED
FEB 4 9 2023
SOLID WASTE SECTION
S:1Solid_WastelclalseptagetformslPumper Vehicles Cetification.doc