NCS00104_2023Permit_Initial

2023
Permit and Registration
Taylorsville Precast Molds, Inc.
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-00104
o and registered as a
e:,e D
E� M
-�� Septage Management Firm ��en� f� w� nmenta�llry
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. Septage Land Application Site, SLAS-02-04
2. Septage Detention or Treatment Facility, SDTF-02-04
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 Perry Digitally signed by Wm
Y Perry Sugg
S u g g Date: 2023.02.16
10:23:56-05'00'
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 exactly as it is shown on your vehic/e(s)).
Taylorsville Precast Molds, Inc
Street address of office: 128 Taylorsville Precast Mold-. Lric
City: Taylorsville State: NC Zip: 28681
Mailing address (if different):
City: State: Zip
Phone: [phone] Fax: [phone]
E-Mail:
County: Alexander
(2.) Firm owner's name:
Septage Management Firm permit number: NCS # 00104
David R. Mecimore
Mailing address (if different): Same as above
City: State: Zip
Phone:
(3.) Firm operator's name: David R. Mecimore Firm operator's title:
Mailing address (if different): Same as above
City:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in last 12 month (Example: Domestic: 50,000).
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrial/Commercial
62,000 15,000
(5.) N.C. Counties of Operation:
Alexander
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: one
Number used for: Domestic Septage: 3/4 Grease (restaurant): 1 /4
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
1
AM7107
1 HTSCAANXSH212041
2000 gallons
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (x) yes ( ) no.
If you checked yes above, you must attest to the following statement before a permit may be issued.
"I certify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meets the
requirements for safe and sanitary transportation of septage as required by 15A NCAC 13B .0835(a) and vehicle lettering
as required by 15A NCAC .0835(b). Furthermore, I also certify that a log is maintained of each septage pumping event as
required by 15A NCAC 13B .0836(a). I am aware that there are significant penalties for false certification including the
possibility of fine and imprisonment."
Do you attest to the statement above? (x ) yes ( ) no Initial
Date
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( ) yes ( x ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: 0204 Expiration Date: 9-22-23 SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: 02-04 Expiration Date: SDTF#: Expiration Date: _
(9.) Septage Management Firm Operator Training Completed:
Date: 8-13-22 Location: Morganton, NC Hours:
Training Sponsored or Provided by:
NC Pumper Group
4
(10.) Septage Land Application Site Operator Training Completed:
Date: 8-13-22 Location: Morganton Hours:
Training Sponsored or Provided by: _ NC Pumper Group
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm: x
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 (Si4ni&re of companyofficial requires? ----Date
Print Name Title
Other Comments:
Rev. 04-26-2021
PAGE 2

a
North Carolina Department of Environmental Quality
-'' Division of Waste Management INVOICE
NORTH CAROLINA
m�uy Solid Waste Section
Division of Waste Management
To: David R Mecimore
Solid Waste Section
Taylorsville Precast Molds, Inc.
1646 Mail Service Center
128 Taylorsville Mfg Road
Raleigh, NC 27699-1646
Taylorsville, NC 28681
Phone/Fax: [phone]"'
Email: [e-mail]
P
A
CKNa-
DATE
2 . b . ,
Date: 01/24/2023
Z�s Ivy
Invoice #: NCS-00104-2023LF
Septage - Penalty:
Taylorsville Precast Molds, Inc. (NCS-00104)
128 Taylorsville Mfg Road $275.00
Taylorsville, NC 28681
Number of Trucks:1
Date Due: 02/24/2023
LATE FEES: Vance with NC General Statutes GS 130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted ay January 1, 2023.
Payment Options:
E-check Available online at https://deg.nc.aov/swraY
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://dea.nc.aov/sw)aay
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.
i*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.]
Explanation of Invoice Amount is Based on 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 r uestions re: ardinr _
Billing
Regulations or Technical Assistance
Jared Wilson [phone]
Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - https://deg..nc.aov
North Carolina Solid Waste Program - httrss:Udeg.nc,gov/abou*Jdivisions/waste-ma nag ement/solid-waste-section
North Carolina Septage Management Program - b=y/deq.ncgovlabout/divisions!waste-manag ement/solid-waste-sections special-wastes-and-alternative-
handling/septaoe

North Carolina Department of Environmental Quality
;"i- $
Division of Waste Management INVOICE
NORTH CAROLINA
terQ=W Solid Waste Section
Division of Waste Management
To:
David R Mecimore
Solid Waste Section
Taylorsville Precast Molds, Inc.
1646 Mail Service Center
128 Taylorsville Mfg Road
Raleigh, NC 27699-1646
Taylorsville, NC 28681
Phone/Fax: [phone]
Email: [e-mail]
PAI
CK NO.
2
DAIS
2 " &. 1p 2z3
1 Date: 09/27/2022
d
Invoice #: NCS-00104-2023
Description
Amount Due
Septage - Annual:
Taylorsville Precast Molds, Inc. (NCS-00104)
128 Taylorsville Mfg Road
$550.00
Taylorsville, NC 28681
Number of Trucks:1
Date Due:
12/15/2022
LATE FEES: • ' +rce with NC General Statutes GS 130A-291.1(e2), a late fee will be applied m any annual permit fees not submitted by lartuary 1 2023
Payment Options:
E-check Available online at his://deq.nc.00v/swn_ay
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://dep.nc.aovlswn_ay
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 S2ction, 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 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 questions regardinU.
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 - ,_y -_ . t!aboutldivisions/waste-management/solid-waste-section
North Carolina Septage Management Program - htt: dec nc.gov/about/divisions/waste-manaaemenJsolid-waste-section special -wastes -and -alternative
handling/septaae