NCS01400_2023Permit_Initial

2023
Permit and Registration
Allen Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01400
o and registered as a
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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. Louisburg WRF, Louisburg, NC
2. Warren County WWTP, Warrenton, 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 Perr Digitally signed by
PerryWm Perry Sugg
Sugg 112:3303-050'00'7
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)).
Street address of office:
City: a c°S tJ { n C State: n C Zip -? 7 S- q
Mailing address (if different):
City:
State: Zip:
Phone: 't I C/ - t(17 Ll - ' 1 G 6 C( Fax:
E-Mail:
County: Septage Management Firm permit number: NCS # 6 1 t-I0 c?
(2.) Firm owner's name:_ L ey b o r\- r) k2_ e ;A _
(3.)
Mailing address (if different):
City: 1� State:
Phone: (� r 14C, 6 tf Fax:
Firm operator's name:
Mailing address (if different):
City:
Zip:
Firm operator's title: ® •,; [�
State: Zip:
Phone: Fax:
v0
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in last 12 Monihs (Example: Domestm �
�,�) 1 .0
Domestic I Portable Toilet Waste I Grease (Restaurant) 1 Treatment Plant I IndustrialICor{imircialRA
(5.) N.C. Counties of Operation: f s � Q- 1\ ✓ rt G ' �� I" ia� 1
(List each county you are authorized to do business in) a
(6.) Total Number of Pumper Vehicles Operated: ( $ 2
Number used for: Domestic Septage: 1 Grease (restaurant):
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
2
3
_
4
5
APPLICATION CONTINUED ON PAGE 2

e-
PAGE 1
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( b-1 'yes ( ) no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagraph .0833(c)(14) of the Septage 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: _
(8.) Septage Management Firm Operator Training Con
Date: 9 2 Location:
Training Sponsored or Provided by:
(9.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
Hours: �-
Hours:
(10.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm: _Lz�f
Registered Portable Sanitation and Septage Management Firm:
iS W �� �i 5 rc v2,-- Fi �� oc, t- C
Certification Statement � S �� t -
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 company official required)
Print Name
Other Comments:
- 11 "
Date
C 4"
Title
S:/Solid_waste:/CLA/SEPTAGEIFORMS/2018 Firm Application/FirmPermitApplication2018
PAGE 2

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS-
Number of Pumper Vehicles: 1
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."
W O-X-
Signature (Signature of company official required)
Print Name
Date
Title
S:lSolid_WastelclalseptagelformslPumper Vehicles Cetification.doc

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
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.
William R. Perkinson ORC License Number 987831
(Plant Operator in Responsible Charge (ORC) and ORC License Number)
Warren Countti, WWTR 738 US Hwy 401 S.. PO BOX 281. Warrenton NC 27589
(Address)
252-257-1776 do hereby authorize Ruben Allen
(Phone Number) (Owner/Operator of Septage Management Firm)
of Allen Septic Tank Services NCS #01400
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste X ,
grease septage (grease trap pumpings) _ commercial/industrial septage from
Warren Vance Granville and surroundinu counties
(County or other Geographic Area)
at the above -named wastewater treatment facility. Septage shall be discharged at:
Influent works
(Location)
between the hours of _ 8:00 AM - 3:30 PM Monday - Friday
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31 2023
WV/
(Usually December 31, Year)
Signed � � Date Av/•_ Z Z_
(Facility Operator)
1
Sworn to and subscribed before me this
day of OC40 20
'i tAa _C'L I i ul l_ My Commission expires:��,,
(Notary Public) 0`1 VAVAZ/Fe 4� ICIAL SEAL)
rn
Note: Falsification of this document by the septage management firm shall lead to permit revocatioiy !� ,p
UBL%C' V
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2013 Firm Application/WWTP Authorization Form 2013 �.�
tt

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AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605
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.V
(Plant Operator and ame of Plant)
O5"! 0 :,it (' & 'I)r
(Address)
(j q t ��� �do hereby authorize _ 1/0
to .•�
Phone Number) ) (Owner/Operator of Septage Management Firm)
of e A 5,00ew c q'i NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage portable toilet waste
grease septage (grease trap pumpings) a commercial/industrial septage 0 from
01
(County or other Geographic Area)
at the above named wastewater treatment facility. Se tage shall ¢e disc�f a
( ;ration)
between the hours of 7 PM. _ J c re
at:�j
I S+ `)
Reintroducing partially treated liquid into a grease trap is acceptable -Yes No
This authorization shall be lid until !
(Usually December31, Year)
Signed Date
(Notary ruouc)
day of . 20 .
My Commission expires:
KC6
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Note: Falsification of this document by the septage management firm shall lead to permit revocation.` l
h:cia/septage/formslauthorizlall-041wwtp auth-2006
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