NCS00714_2023Permit_Initial

2023
Permit and Registration
Tim's Septic Tank
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00714
o and registered as a
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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. Anson County Regional WWTP, Wadesboro, 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.
Digitally signed by
Wm PervywmPerrySugg
Sugg 10:3759-050'00'6
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,
(1.) Firm name: (The "R hm name" must be exa as it is shown on your vehicle(s)).
I imS .Sen4�r. -frfnK
Street address of office: (Q _ Yr l,�! k. Cart Y) rNCA
City: e—slzm Statel(f'—Zip:
Mailing address (if different):
City: G1 If State: Zip
Phone:-7 C) �' / 4 " 0,� Q � __ _ Fax:
E-Mail: OL VI A2 QA S43 n Q 1 tQ&I 1_ I • CbIM
County:Anson _Septage Management Firm permit number: NCS #
(2.) Firm owner's name:_
Mailing address (if different):
City: State: Zip
Phone: Fax:
(3.) Firm operator's name: iYiU 4i ( re. Firm operators title: ki .
Mailing address (if different): (( me- 0
City: 1( State: Zip:
Phone:_104 — l 94 - 0 309' Fax:
(4.) Type(s) of septage pumped: Write in the number of gai gns numned in last 92 months (Example: Domestic: 50,000).
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrial/Commercial
(5.) N.C. Counties of Operation: _&ts On
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: __ I
Number used for: Domestic Septage: I Grease (restaurant):
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
5'
License Tag # I Vehicle Identification #
1 C0'+-Z3 X ID 9`1,�� l�l 25— ' C
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (611'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 A835(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? (✓S yes ( ) no Initial jr4 Date L- % � - �QojA
(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 the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#. Expiration Date:-SLASM. 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 Completed:
Date: Location:
Training Sponsored or Provided by:
(10.) Septage Land Application Site Operator Training Complet d:
Date: � 1$ ROA 2. Location: grczAy bor u Hours: (0
Training Sponsored or Provided by: NC S .`%
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
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 (SignatVIe of companyoff dWtegtituq
`T ► A Ofuj 4('[d Ve_f
Print Name
Other Comments:
Data
Title
Rev. 04-26-2021

Anson County
Regional Wastewater Treatment Plant
P.O. Box 553
1360 Hollywood Road
Wadesboro, NC 28170
Phone: [phone]
Fax: [phone]
October 5, 2022
To: All Septic Waste Pumpers
From: Gary Garrison, Plant Superintendent )"
RE: AUTHORIZATION TO DISCHARGE SEPTAGE WASTE RENEWALS
The state of North Carolina requires that your authorization to discharge be renewed
annually. The required renewal form and gallons pumped (through September 2022) is
enclosed. It is your responsibility to mail this form, together with any other paperwork
the State requires from you. Please submit your reports to Raleigh at your earliest
convenience to avoid fees/fines for late submission.

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, GARY GARRISON 990415 ANSON COUNTY REGIONAL WASTEWATER TREATMENT PLANT
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
POST OFFICE BOX 553 WADESBORO, NC 28170
(Address)
[phone]_ do hereby authorize TIMOTHY L. HILDRETH
(Phone Number) (Owner/Operator of Septage Management Firm)
of TIM'S SEPTIC TANK NCS # NCS00714
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage IXI , portable toilet waste _ Xl
grease septage (grease trap pumpings) commercial/industrial Septage , from
ANSON COUNTY
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
THE MAIN LIFT — WWTP SITE —1360 HOLLYWOOD ROAD WADESBORO NC
(Location)
between the hours of 7:30am & 4:30pm Monday — Saturday
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)
Signed _ o.�,, o �,,.^ _ _ . Date 10105/2022
( cility Operator)
Subscribed and affirmed before me this 5th day of October. 2022
,A I My Commission expires: _ May 12 2024
(Notary Public)
A. qb-
(OFFICIAL SEAL)My
COivlMISSION
Exr,Rts
To_ v �•
Note: Falsification of this document by the septage management firm shall lead to permit revocation. 'is°�y< ee0 i;'I4,v'`��
S:/Solid Waste/CWSEPTAGE/FORMS/2016 Firm Application/WWTP Authorization Form 2016

Tim
HILDRETH
2022
Gallons
Discharged
January
8,000
February
8,000
March
4,000
April
12,000
May
4,000
June
4,000
July
6,000
August
September
Total Gallons
Billed
46,0Q(3

/ North Carolina Department of Environmental Quality
division of Waste Management INVOICE
NOR, '"l CA'"`s"& Solid Waste Section
Gn�rt+smurstrz(�r�r
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
GK. NO.
DATE
Septage - Annual:
Tim's Septic Tank (NCS-00714)
76 McLaurin Road
To: Timothy Hildreth
Tim's Septic Tank
76 McLaurin Road
Wadesboro, NC 28170
t /Z 2'1- Date: 09/27/2022
�$ rSo . dV Invoice #: NCS-007W2023
$550.00
Wadesboro, NC 28170
Number of Trucks: 1
Date Due: 12/15/2022
LATE FEES:--nrdance with NC General Statutes GS 130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted by January 1, 2023.
Payment Options:
E-check Available online at.httI2s://deQ.nc.gc)y/swWa
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://deQ.nc.Qovlswpay
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 flee will be charged on all returned chedcsj
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 regarding:
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) - littl2s://deo.nc.gov
North Carolina Solid Waste Program - hit[is:.. dej.nc.gov about: divisions.'waste-management'solid-waste-section
North Carolina Septage Management Program - https:_ _ deu.nc.rJov about divisi; ins: waste -management solid -waste -section, special -wastes -and -alternative -
handling/ septacde