NCS00984_2023Permit_Initial

2023
Permit and Registration
Ben Harrelson DBA Rudolph Inman Septic Tank Service
is hereby issued a Septage Management Firm Permit,
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0 _ Permit Number NCS-00984
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oand registered as a e:,e D Q:>
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-�� Septage Management Firm�� �� w� ��nffii�utr
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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. Septage Detention or Treatment Facility, SDTF-24-07
2. Septage Land Application Site, SLAS-24-07
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
Wm Perry by Wm Perry
1 Sugg
Sugg Date: 2023.02.23
13:49:45-05'00'
Perry Sugg, Environmental Compliance Branch Head

3
North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NORTH CAROLiP7ii fmRau�nivlQuSolid Waste Section
apty
Division of Waste Management
To:
Ben Harrelson
Solid Waste Section
Ben Harrelson DBA Rudolph Inman Septic Tank
1646 Mail Service Center
Service
Raleigh, NC 27699-1646
Phone/Fax: [phone]
PAI
5 mes B White Hwy S
to , NC 28472
Email: [e-mail]
CK. NO.
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DATE- -
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--- Date: 09/27/2022
Invoice #: NCS-00984-2023
Septage - Annual:
Ben Harrelson DBA Rudolph Inman Septic Tank Service (NCS-00984)
5454 James B White Hwy S $550.00
Whiteville, NC 28472
Number of Trucks:1
Date Due: 12/15/2022
LATE FEES: In accordance with NC General Statutes ',)S 130A-291.1(e2), a late fee wui be applied to any annual permit fees not submitted by January1, 20?3
Payment Options:
E-check Available online at https://deq.nc.gov/swg_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://deg.nc.gov/swpay
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 Stat rc�
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 cluestions regarding
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.aov
North Carolina Solid Waste Program - hit Gs�.deco ncgoviabout div_isionsiwaste-management/solid-waste-section
North Carolina Septage Management Program - httj s deq, ncin oWabou division waste-mana ement�solid-waste-sectio ! so ecial-wa es-and-alternative-
handlina/septage

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 ex� as it is shown on your vehicle(s)).
Street address of office: e.
city:.iii' 4 Je v)i tle Stater NL Zip: z Ft�7Z
Mailing address (if different):
City:
Q State: Zip.
Phone: —1 10 — (0 4 a--7 (4 S I Fax:
E-Mail: '
County: c) I U, rn b U.S Septage Management Firm permit number: NCS # 0 0 9�T
(2.) Firm owner's name: GL ( S d
Mailing address (if different):
City:
Phone:
State: Zip
(3.) Firm operator's name: Ike r1 0-f—reA S1) tJ Firm operator's title: 10 (A) A)
Mailing address (if different):
City:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons oumoed in last 12 months (Example: Domestic: 50,000).
Domestic I Portable Toilet Waste I Grease
Treatment Plant
Industrial/Commercial
(5.) N.C. Counties of Operation: i 61 tJlio—b ws �Laden, Robe [ p,,Aas ick.
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: I
Number used for: Domestic Septage:_Grease (restaurant): I
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
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) (Vloyes ( ) 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? (V�`yes ( ) no Initial Date it, 3 (D—Z 2--
(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#:.Z4-0 7 Expiration Date: SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: —07 Expiration Date: SDTF#: Expiration Date: _
(9.) Septage Management Firm Operator Training Completed:
Date: 27— Z Z Location: 'G Hours:
r
Training Sponsored or Provided by: AG S T�
(10.) Septage Land Application Site Operator Training Complete
Date: Location: Hours: Z
Training Sponsored or Provided by: A/C ST,q
01.) 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 (Signature of companyofgcial requirea7
Print Name
Other Comments:
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Date
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Title
PAGE 2
Rev. 04-26-2021

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NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- DO
Number of Pumper Vehicles: 3'
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."
/I-30—z2.
Signature (Signature of company official required)
Date
6WN6A-
Print Name
Title
S:lSolid_WastelclalseptagelformslPumper Vehicles Cetification.doc