NCS00709_2023Permit_Initial

2023
Permit and Registration
WILSON
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00709
o and registered as a
e:,e D
NORTH
EQ�J
%L 12. 9*
-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r Q'M
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 Spindale WWTP, Spindale, 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 Digitally signed by
Wm Perry Sugg
Sugg 110:36 46- 050'00'6
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 vehicle(s)).
WN D
Street address of office: o D `T-►�-C r i S
e
C_- Zip:,OC43
Mailing address (if different): , \ mL> �� SN
City: C__�A V _State: 0 G Zip 04 3
=Pm �tiWW�;Y�
E-Mail:
County:�kA�a"I z>yA Septage Management Firm permit number: NCS #A2427,041
(2.) Firm owner's name: S -IL 'e W A% 6''-1
Mailing address (if different):
City:,
State: Zip
Phone: Fax:
(3.) Firm operator's name: S -,ire-- M '% 5` Firm operator's title: 0 01r\ P4_r4A CC -
Mailing address (if different):
City:_
Phone:
State:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons punned in last 92 months (Example: Domestic: 50,000).
Domestic
040
Waste i Grease
-- 1
(5.) N.C. Counties of Operation: __?_�_���'� or
Plant Industrial/Commercial
(List each county you are authorized to do business in)
(6.) 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 Tag #
Vehicle Identification #
I Tank Capacity
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) ( I '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? (vl'yes ( ) no Initial —'5.- W • Date L Z to
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: yes ( ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of theSeptage 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:
(9.) Septage Management Firm Operator Training Complete
Date:..��-r�� aGuta Location: r� Hours: t _
Training Sponsored or Provided by:
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
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.
M. GV.
Signature (Signature of companyofficial required)
Print Name
Other Comments:
Date
Title
PAGE 2
Rev.04-26-2021

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #:
Number of Pumper Vehicles:
NCS-
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."
4;2--
Signature (Signature of company official required)
Tev-G
Print Name
Date
Title
S:%Solid WastelcialseptagelfonnslPumper Vehicles Cetification.doc

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.
sP ,� 9
(Plant operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
(Addre )
do hereby authorize `^-'
(Phone Number) (Owner/Operator of Septage Management Firm)
of _ .1 \S V r� t C C,2
(Septag Management Firm Name and NCS number)
to dispose of: domestic septage portable toilet waste
.V
# C,�
grease septage (grease trap pumpings) commercial/industrial septage , from
G [C 1��'bh G � ✓�I� iYE'�
(County or other Geographic Area)
at the
��above named wastewater treatment facility. Septage shall be discharged at:
�r,- l : 8-r S["
(Location)
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
This authorization shall be valid until
Signed
(Facility Operator)
Subscrib and affirmed before me this
oG ��G✓L"
(Notary Public)
(Usually December 31, Year)
Date z f6�t Z
day of ► ec'^I" . 20 11'
My Commission expires: L[
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CWSEPTAGE/FORMS/2018 Firm Application/WWR Authorization Form 2018

is-�-aa aK�a3i9
North Carolina Department of Environmental Quality
Division of Waste Management
NORTH Wr&wn& &Qua Solid Waste Section
INVOICE
8+vtrone�mMrQuaUry
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email:[e-mail]
Septage - Annual:
WILSON (NCS-00709)
131 Ramona Str
Forest City, NC 28043
Number of Trucks:1
To: Steve Wilson
WILSON
131 Ramona Str
Forest City, NC 28043
CK. NO. 2
DATE.
Date Due:
Date: 09/27/2022
Invoice #: NCS-00709-2023
$550.00
LATE FEES: In accordance with NC General Statutes GS 130A-291.1(e2), a late fee A01 be applied to any annual permit fees not submitted bs January 1, 2023.
Payment Options:
E-check Available online at https://deo.nc. oq v/swpay
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 httos://deq.nc.gov/sway
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.
[*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 retumed 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 rQaarding:
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://deg.nc.gov
North Carolina Solid Waste Program - httr,si/dea.nc.Qov-abou+ division waste -ma nag emenysolid-waste-section
North Carolina Septage Management Program - httas:/: deq_nc.aov/about'divisions/waste-ma napementUsolid-waste jectiowsvecial-wastes-and-alternative-
handling septaae