NCS00611_2023Permit_Initial

2023
Permit and Registration
Robersonville Ice & Coal Inc.
is hereby issued a Septage Management Firm Permit,
Py�4,NTAr,,��� Permit Number NCS-00611
oand registered as a
NORTH
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-�� Septage Management Firm�� �� w� ��nffii�utr
4sr
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-59-03
2. Septage Detention or Treatment Facility, SDTF-59-03
3. Robersonville WWTP, Robersonville, 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 Perry
Sugg
Digitally signed by
Wm Perry Sugg
Date: 2023.02.16
10:29:11-05'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT -SOLID TASTE SECTION - I M6 MAIL. SERVICE CENTER RALEIGH, NC 27699-I GM
(t.) Firm name: (The "Firm name" must be gXV& as f is shown on your wefrrclos ).
Street address of office: L.; ►r v .C_
City: u -e-C.5 ayi ut State: C-Zip: Z8 7 l
Mailing address (,i different): � � � u � i U � �✓1 a h v c � t � Y �� J 17A C
Clay: r i� V State'.- A) C Zip'
Phase: 2 5 2 Fax:
County: , ►' - Septage Management Firm permit number: NCS # U
1
(2.) Firm aomei's name: C - I � i t
Mailing address (if different) --
'City. t, +_ v I State-- Zip
Phone: �- 5 7 9.5 - � 7 9:1 f ax:
L-
(3.) Fin operator's name: r I ■ } (,✓ L r --✓S � Fin operators title: ?YeS i
Mailing address fif different):, r2' Q - D 1
City: State: ._zips: 2-2
Phone: �- 52 " 9015 - -4 St z Fax:
(4.) Type(s)of Septage pumped: lN& IU tgallMbg ¢i gAitons 12=jged;n ,fast 12 nxmths "Example: Domestic: 50,0C%
i DorneSbc Portable Toilet Waste I Grease(Restaurant) Treatment Plant
6-
(5.) N-C. Cgnti:44 of Operation: C..✓ �t� 12,
.--Ht
steach county you are authorized to
(6.) Total Number of Pumper Vehicles Operated: �;7 ;?-
Number used for, Domestic Septage; Grease (restaurant):
Other. Portable Tcilet 'Alaste:
Vehicle Information; (use additional paper if needed)
License Tag # VeNcle Identification# Tank Capacity
JrID L1 f= S_L T Y 'PE ?_f. !ai _
3 Z K r7 5 a -1 Cs-���,._3 44 X of _-Z93' 1 U 0 53 S�
5 dry r y ti r- G iv-9 r1i r= v Sy s 13 050
APPLICATION CONTINUED ON PAGE 2
IndusfriallCorn menial
PAGE I PA I
8aa•oa

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE'1)
(7.} Do you plan to operate pumper vehicles? 1check arse) (V) 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 lain. that the pumper vehicle or vehicles listed in the submitted permit application meets the
requirements for safe and sanitary transportation of se,ptage as required by 15A NCAC 13B .0835(a) and vehicle lettering
as required by 15A NCAG _0835(b). Furthermore, I also certify that a lag 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." ,o
Do you attest to the statement above? �,�es ( � no initial e�. � Date_ 0�-
(13.} Septage Disposal Method: (check one).
a) Approved wast&xater treatment plant ✓yes no. If yes. submit 'Naste Aster Treatment Aufhaorizatiar,for each
plant, as indicated in Subparagraph .083 Ic)i 14) of theSeptage Management Rules.
b) Septage Land Appf+cation Site {SLAS) Permit Numbers: (use additional sheets if needed)
SLAS# •-o 3 Expiration Date-1 "1Y1'i SLAS# Expiration Gate:
ca Septage D tenp ticn or Treatment Facility ,' TFt Pen -nit. Numbers: (use additional sheets if needed)
SDTF#: 41 SZl 4 7 Expiration Date:` `? - 1-5 Z,9- SDTF#fA_'rt-&j Expiration ate:
f ib T F A$q -a -7 EYI,t• s•.� a '7 .1 'S � Z� =
(9.) Septage Mana4ment Firm 4peratot Training C•ompletetd 2
Date: - -Z'z LocationW n3 `. �-�.. Hours:
Training Sponsored or Provided by: _ /i/cf- )4
(10.1 Septage Land Application Site Operator Training Completed: Ca v
Date: -2-1 Location:IdC444t-.S,as, Cti Hours: Z
Training Sponsored or Provided by: NC S-t-Ij
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation anJ Septage Management Firm:
Certification Statement
I certify thatthe information and representations in this application for a permit are true, corrglete, 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, materlall� affected the decision to issue the permit and that there are
criminal penalties for knowingly making a false statement, representation, or certification.
Z� -211
d'
Signature Sigrratureoicompary4fcia#mW#ed)
C- (n
Print name
Other Comments:
l�&� Z.V - 2-
Date
cA0,1 c✓
Title
PAGE 2
.ev. 04-=°._2Li2

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.
r � '
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
I� St.rJa..s� 1?4 LA a "vl
(Address) y� f
do hereby authorize _ �._ ! ' l(! �/" I-�Jl
(Phone) Number) (Owner/Operator of Septage Management Firm)
of 20 L t./ j a ti..rJ. ) I I t- t1= v p✓ nc- NCS # B
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location) -
between the hours of �!4-M 5 IFM " rrl
Reintroducing partially treated liquid into a grease trap is acceptable _Yes No
This authorization shall be valid until _ -t,, d23
(Usually December 31, Year)
Signed ? Date
(Facility Operator)
Subs ibed and affirmed efore me this A day of (.Q 20
-L '� 10 �1 '
My Commission expires: _ (D -A
Aj#� (Notary Public)
WYNESHA CRANAELL (OFFICIAL SEAL)
Notary Public, North Carolina
Martin County
My C m fission Expires
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

NC SEPTAGE MANAGEMENT F I RM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: N_CS- 6) G (0 1
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."
Signature (Signature of company official requi )
(..� P f i V ✓� �� l,� Y S
Print Name
Date
Title
ja -ems -zz
,-,9 w 1-1 t✓ -
S:1Solid WastelclalseptagelformslPumper Vehicles Cetification.doc