NCS00765_2023Permit_Initial

2023
Permit and Registration
Anderson Septic Tank Cleaning Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00765
o and registered as a
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NORTH
EQ�J
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-�� Septage Management Firm�� �� w� ��nffii�utr
E� 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. Septage Land Application Site, SLAS-12-03
2. Septage Detention or Treatment Facility, SDTF-12-03, SDTF-36-15
3. Catawba Water Pollution Control Facility, Morganton, NC
4. 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. Digitally signed by
Wm PerrywmPerrySugg
Sugg Date: 2023.02.17
14:12:34-05'00'
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 rAame: (The "Firm name" must be exactly as it is shown on your vehicle(s)).
r1c40e_, (A Clk44e4k46. 5F—iL
Street address of office: Z a 4CI
City: UA� State: C - Zip: ayAb
ar
Mailing address (if different): Cr_ � _._
city: State: Zip
Phone: -- `- Jt-' (`� Fax:
E-Mail:
County, cur
(2.) Firm owner's name:
Management Firm permit number: NCS # ��
Mailing address (if different):
City:
Phone:
(3.) Firm operator's
Mailing address (if different):
City:
Phone:
State: Zip
Fax:
State: Zip:
operator's title:
F ib(L ,
(4.) Type(s) of septage pumped: Waite in the number of gallons numngd ja jUt 12 months (Example: Domestic: 50,000),
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Ind ustriallCommercial
II }
(5.) N.C. Counties of Operation: Cal 13e1 C3 ._6 , s
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
N umber used for. Domestic Septage:
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant):.
Portable Toilet Waste:
License Tag #
Vehicle tdenti5catioo #
Tank Capacity
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED OM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) yes ( ) no.
If you checked yes above, you must attest to the following statement before a permit may be issued.
"1 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."
❑o you attest to the statement above?( ) yes ( ) no Initial 1 , '. Date
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( V 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#:A_03 Expiration Date: SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: l5t-0--3 Expiration Date: SDTF#:Expiration Date:
(9.) Septage Manag nt Fir Operator Training Completed:
Dater off. Location:Q(Ad�eirl'.n 5 mLti � "4,hG
ours:
Training Sponsored or Provided by: i4 r C , P(-;�Pev 0 vc�u 0
(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 Finn:
Certification Statement
IM.r#"&
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.
OWL�v d�
SignaturetSignafure of comp yofficial require
1d} LISI
Print Name
Other Comments:
I �1 a o �.
Date
Title
Rev. 04-26-2021
PAGE 2

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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,
Elisha, Self 1002187 Catawba Water Pollution Control Facility
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
1000 Vine Arden Rd / P.O Box 3448 Morganton, NC 28655
(Address)
828-438-5285 do hereby authorize William Harvey Anderson
(Phone Number) (Owner/Operator of Septage Management Firm)
Anderson Septic Tank Cleaning Services
of NCS # 00765
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
Burke County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Catawba River Water Pollution Facility
(Location)
between the hours of 7:00 AM - 7.00 PM
X
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
This authorization shall be valid until December 31, 2023
(Usually December 31, Year)
Signed 66--� &eA� Date
(Facility Operator)
Y �
Subscribed and affirmed before me this s , day of ffa U - 20 ;k�,
My Commission expires:
IV (Notary Public)
(OFFiCIALSEAL)- — -
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
5:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Farm 2018

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT
OR STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission
has given to a permitted Septage Management Firm to discharge septage into the permit
holders' detention or treatment facility.)
351 Colt Thornburp.Road, Dallas _NC 28034
(Facility Operator) (operation Address)
do hereby authorizeA_cWk�i� - I�.�k4`�}� Si~rt, „GCS# CC_�
(Name of Septage Management Firm)
(Address of Septage Management Firm)
to utilize septage detention or treatment facility #-�)-V_T for the treatment of septage*
in 20_U. The facility will be operated in accordance with the Septage Management Rules**
Date;. �. ... }.
* As defined in G.S. 130A-290(a)(32)
** As defined in 15A NCAC 13B .0800
Return property completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
164 Mail Service Center
Raleigh, NC 27699-1646
(F cility Operator)

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 Operator 4 987625 City of Lenoir - Lower Creek WWTP NC0023981
(Plant Operator in Responsible Charge (oRC), ORC License Number, Name of Plant)
1905 Broadland Road Lenoir NC 28645 P.Q. Box 958 Lenoir NC 28645
(Address)
[phone] do hereby authorize William Harvey Anderson
(Phone Number) (Owner/Operator of Septage Management Firm)
of Anderson Septic Tank Cle aning Service NCS # 00765
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
Burke Caldwell Catawba and Surrounding Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Septage Receiving Station @ Lower Creek WWTP
(Location)
between the hours of 7:00 a.m. until 7:00 ,m. Monday through 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)
f r
Signed Date C� "
(Facility Operator)
Subscribed and affirmed before me this l off" day of tQ-eX�6er , 20
L h k,
(Notary Public)
My Commission expires: COW ZoZ5
(OFFI� SEAL)
NOTARY
Note: Falsification of this document by the septage management firm shall lead to permit revocation. ri PUBLIC ®-
S:ISolid_Waste/CLA/SEPTAGE/FORMS/2o16 Firm ApplicationNVV TP Authorization Form 2016

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE LAND APPLICATION
SITE PERMITTED TO SOMEONE OTHER THAN YOURSEL
(This form is used by a land application site permit holder to indicate that permission has been
given to a permitted Septage Management Firm to land apply septage on the permit holders
land application site.)
do hereby authorize: 0-11 tA 11,
(Site Operator)
(Operator Address)
(Owner of Septage M
t Firm)
NCS#�
(Name of Septage Management Firm )
CA,C.
(Septage Management Firm Address)
it G Oc-
to use septage disposal site # Z'U7 for the disposal of gallons of septage* in 20 2-7
Date: ! - 2 rr27— ffl-!�
Signed
(Site Operator)
* As defined in G.S. 130-A-290(a)(32). The site will be operated in accordance with 15A NCAC 13B
.0800 - Septage Management Rules
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by as -'detention or treatment facility permit holder to indicate that permission
has been given to a permitted Septage Management Firm to discharge septage into the permit
holders detention or treatment facility.)
6b I C_ k-.., tA-d1f C- �
(Facility Operator)
Cl JJ G. Y.--� IZ-1 /�/ &
(Operator Address)
do hereby authorize:
D
4 h.` T l c 4Z �4--4-43i!-AAU
(Owner of Septage Management Firm)
t►Cf...���i�� NCS#�� l
(Name of Septage Management Firm)
to utilize septage detention or treatment facility #
septage *
Management Firm)
f Z-07
for the treatment or storage of
in 20 Z- . The facility will be operated in accordance with the Septage Management Rules **
Date: 1 /- 2,# L
* As defined in G.S. 130A-290(a)(32)
** As defined in 15A NCAC 13B .0800
Signed 4 �
(Facility Operator)
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

,qSTAif ,_
North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
AV( nFr nft1QUNH Solid Waste Section
En�tranmcntarQuarrry
. sNision of Waste Manaaernent
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax-- [phone]
Email: [e-mail]
Septage - Annual:
Anderson Septic Tank Cleaning Service (NCS-00765)
3249 Flat Gap Road
Valdese, NC 28690
Number of Trucks 1
To: William H Anderson
Anderson Septic Tank Cleaning Service
3249 Flat Gap Road
Valdese, NC 28690
Date Due:
Date: 09/2712022
Invoice #: NCS-00765-2023
$550.00
5/2022
LATE FEES: xcordance with NC General Statutes GS 136A 91 i 0.4 a late fern -'nll be applied Ui any awival perrmt fees not %Omitted by January S,
Payment Options:
r-rheck Available onfine at
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 I P I
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 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 re,cgarding:
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) - t?t
North Carolina Solid Waste Program-ht+•ps:/ifieq.,_ cwla luiai4_ilvrs�or.�rfLvast� IJ�,�nagF�rrint!;,oilri ti+,asto seitinn
North Carolina Septage Management Program - ht{us.3ni7- Ate_rri,atlLr_-
Fyrt�

112022, 6:23 PM
Yahoo Mail - Payment Confirmation
Payment Confirmation
From. do_not-,[e-mail]
To: [e-mail]
Date: Friday, December 2, 2022 at 06:20 PM EST
Thank you for your recent payment to NC DEQ Solid Waste.
Payment Application: NC DEQ Solid Waste ePayment
Payment Status: Payment completed successfully,
Confirmation Number: 22120250155155
Payment Date: 1210212022
Billing Address: William H. Anderson
3249 Flat Gap Rd,
Valdese, NC 28690
8288745005
Account Number: x8581
Routing Number: 053100300
Account Type: Checking
Payment Amount: 550.00 USD
Total Amount, 550.00 USD
Reference Information: NCS-00765-2023,28690,Anderson Septic Tank Cleaning Service,3249 Flat Gap
Road,Valdese, NC,NCS-00765,$550.00
DO NOT REPLY DIRECTLY TO THIS EMAIL.

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicles)
Septage Firm Permit #: NCS- 0 09 �(S
Number of Pumper Vehicles: I
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). l am aware that there are significant penalties for false certification including
the possibility of fine and imprisonment."
Signature` (Signature of company official required)
Print Name
Date
Title
S:ISoiid WastelcialseptagelformslPumper Vehicles Cetification.doc