NCS00990_2023Permit_Initial

2023
Permit and Registration
Bullard Septic Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00990
- o and registered as a
D EQ�J
e:,e
NORTH CAROLINA
-�� Septage Management Firm Department }Enulr nmentalllty
Esr,�,,.
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, Tide 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. Big Buffalo WWTP, Sanford, NC
2. North Harnett Regional WWTP, Lillington, 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
Y Wm Perry Sugg
Sugg 113:50:48-05003
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)).
-ILL AAJ S - Vie-- C
Street address of office: /// 2 &1A
City:_ 5 State:' Zip: .22fY.2
Mailing address (if different):
City:
State: Zip
Phone: i 19 Y_Qg-141010 Fax:
E-Mail: -AV Li- 4 r, A oi. . cle'7_
County: -e Septage Management Firm permit number: NCS # 0 D
(2.) Firm owner's name: 2c) v j Q U L.1_A r&A- j A - _ _Y
Mailing address (if different):
City:
State: Zip
Phone: Fax:
(3.) Firm operator's name: :5 12 Li a ,•, /3 y L- l- AaA Firm operator's title:
Mailing address (if different):
City: State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons Wined in last 12 months (Example: Domestic: 50,000).
Domestic
Portable Toilet Waste
Grease (Restaurant)
Treatment Plant Industrial/Commercial
0
ly, oo v
(5.) N.C. Counties of Operation:
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: X_
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant): /
Portable Toilet Waste:
License Tag #
A A
Vehicle Identification #
1�13m-7 L5 7
Tank Capacity
1
o®
2
Yi416 Ob?
/KM P112
o"
3'_
o 00
4
5
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) (✓jyes ( ) 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? (✓jyes ( ) no Initial ,i Date /941/m?o.2. z ,
(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: 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 Completed:
Date:. b i /a &�2 2 Location: ` 1, Hours:
Training Sponsored or Provided by: _/V � ?a A 6 ea,
(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: i, '
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.
Sign re ('nature of co onyofcialrequired)
�vLC Print Name
Other Comments:
Date
Title
PAGE 2
Rev. 04-26-2021

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- on 99c)
Number of Pumper Vehicles: --7
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."
S71g*m= 94nature of comps fficiai required)
Print Name
A211
Date
0
Title
S:1Solid_WastelolalseptagelformslPumper 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
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, Scott Siletzkv B_iy Buffalo Waste Water Treatment Plant _
(Plant Operator and Name of Plant)
5327 Iron Fumace Rd., Sanford. NC 27330
(Address)
9�19)775-8305 do hereby authorize Julian Bullard
(Phone Number) (Owner/Operator of Septage Management Firm)
Of Bullard Septic NCS00990
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage x , portable toilet waste x ,
grease septage (grease trap pumpings) commercialfindustrial septage , from
Lee County " Only
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
5327 Iron Furnace Road
(Location)
between the hours of 7am-7pm Monday -Sunday
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until
Signed
(Facility
(Usually December31, Year)
Date t1 36 2
Sworn to and subscribed before me this day of I�20 AR
�j My Commission expires: <5 (y - 0 0 -.90Q �
(Nobry Public
vo ,,-d —I.� (OFFICIAL SEAL),,
I+u�
Note: Falsification of this document by the septage management firm shall lead to permit revocation. �= ° • . ©T'•�'
a � 23
0c , Z --
•• c5�41
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f��f�1NIiN11U1O

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, Billy J. Thomas Grade IV WW # 995445 ORC North Harnett Regional WWTP
NPDES # NCO021636
607 Edwards Brothers Drive Lillington NC 27546 910-893-2424
ii do Oereby authorize k"_ uday_'d
of I `a rd '6ero-fita'410 Ocz NCS # 064� I
(this will also include duly a000inted drivers of the comoanv)
to dispose of: domestic septage and/or portable toilet wastes at the above named WWTP.
Septage shall be discharged at: Septage Receiving Station at NHRWWTP
between the hours of 7 AM-5 PM Nov -Mar and 7 AM-6 PM
a
This authorization shall be valid until 12-31-23
Signed At-�lDate 0
( acility Operator) {
ubscribed and affirmed before me thisQk k� DA \1 N k
lS
day of 1y �V .2022
My Commission expires: FEB 1 0 2024
(OFFICIAL SEAL)
_ OFFICIAL SEAL
Notary Public, North Carolina
County of Hamett
Carolyn K. Murayama
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2016 Firm Application/WWTP Authorization Form 2017

North Carolina Department of Environmental Quality
INVOICE
Division of Waste Management
NAWOFOTR1Mi MArURfGQLuI NA
ally Solid Waste Section
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
Septage - Annual:
Bullard Septic Service (NCS-00990)
1117 Walker Road
Sanford, NC 27332
Number of Trucks: 3
To: Boyd J Bullard Jr
Bullard Septic Service
1117 Walker Road
Sanford, NC 27332
PA
I
CK NM
1 �61
DATE
I2-30. Z2
;5 800- - 0 C;'
Date Due:
Date: 0912712022
Invoice #: NCS-00990-2023
022
j ,
LATE FEES: �1,i 1., 1:11
Payment Options:
E-check Available online 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 1 d
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 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 Frivironmental Quality (DF Lij_t'.'
North Carolina Solid Waste Program -
North Carolina Septage Management Program - V:"n I
ij.
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