NCS01010_2023Permit_Initial

2023
Permit and Registration
Pumpmasters Pumping
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01010
o and registered as a
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NORTH
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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. Archie Elledge WWTP, Winston-Salem, 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
Wm Perry by Wm Perry
Sugg
Sugg Date: 2023.02.23
13:54:54-05'00'
Perry Sugg, Environmental Compliance Branch Head

For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-707-
8283).
Firm Info
Firm name*
Pumpmasters Pumping
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)*
NCS-01010
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
8695 Baux Mountain Rd
Address Line 2
City
Germanton
Postal / Zip Code
27019
County*
Forsyth
Mailing address same as street address of office?*
0 Yes No
Mailing Address*
Street Address
PO Box 11773
Address Line 2
City
Winston Salem
Postal / Zip Code
27116
Phone*
3367886339
Email*
[e-mail]
Owner Info
Firm owner's name*
Kevin Stanberry
Mailing address same as street address of office?*
0 Yes * No
State / Province / Region
North Carolina
Country
United States
State / Province / Region
NC
Country
US
Fax

Mailing Address*
Street Address
PO Box 11773
Address Line 2
City
State / Province / Region
Winston Salem
NC
Postal / Zip Code
Country
27116
US
Phone*
Fax
3367886339
Operator Info
�^
Firm operator's name*
Firm operator's title
Kevin Stanberry
Owner
Mailing address same as street address of office?*
0 Yes O No
Phone*
Fax
3367886339
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic
10,200
Portable Toilet Waste
0
Grease (Restaurant)
90,500
Treatment Plant
0
Industrial/Commercial
0
North Carolina counties of operation^'
List each county you plan to do business in: *
Forsyth, Stokes, Davie, Guilford,
Vehicle Info
Do you plan to operate pumper vehicles?*
J Yes O No
"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 significant penalties for false certification including the possibility of fine and imprisonment."
Signature

Date *
2/10/2023
Title*
Owner
Choose how to add vehicle descriptions*
Add vehicles individually O Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA-93786 1HTSDAAN11H363422 2,500
Septage Disposal Method^
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
Yes No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
subparagraph .0833(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*
Archie Elledge Wastewater
Facility
Septage Land Application Sites (SLAS)*
Yes No
Septage Detention or Treatment Facility (SDTF)
Yes No
Other disposal method*
Yes No
Expiration Date* Authorization*
12/31/2023 image. jpg 3.13...
Septage Management Firm Operator Training Completed^
Date * Hours*
10/19/2022 4
Location *
Greensboro, NC
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
0

Location
Training Sponsored or Provided by
Registration Type
Select one*
O Registered Portable Sanitation Firm
0 Registered Septage Management Firm
D Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
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
Date
2/10/2023
07:41:01 PM
Print Name* Title*
Kevin Stanberry Owner

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of WasLe Management,, Solid Waste Section
1646 Mall Service Center, Raleigh, NC 27699-1646
Fee assessments and waste determinations will be required at the discretion of the wastewater to the
trpeitmpnt facility. The facility has the ultimate prerogative to deny discharges of any
incoming
wastewater
stream.
I, Matt
of
hew Lavine 0-0
WW#997822- Archie Elledge Wastewater raci-lit
(Plant OneratorDRC), ORC License Number, Name of Plant)
in Responsible Charge
qpni Griffith Rd. Winston-Salem
336-765-013-0
(Phone Number)
Pijmnma-qtPr-q
NC 27103
hm
Address)
do hereby authorize
(Owner/Operator of Se
ins& Plum(Septage Ma
Kevin Stanberr
ptage Management rirm)
NCS # 01010
nagement FiE�m Name and NCS number)
to dispose of: domestic septage X , portable toilet wasteX
grease septage (grease trap purnpings)
UVins#-nn-SaIPrnIFnrsvt
W .V.,._,.-;_-__--___,- -
h Cnunt
commercial/industrial septage , from
,and Adjacent Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be dis
Archie E!ledee Wastewater Facilit
between the hours of 6:00 am until
(Location)
6:00 om Monday Throu
h Saturda
charged at:
Reintroducing partially treated liquid into a grease trap is acceptable0. Yes X No--Nmftnm�
This autharization shall be valid until f�ecember 31,2023Usually December 31, Year)
Signed
Fa ' y Operator
Subscribed and affirmed before me
(Notary Public)
this
�W Date
9 pm- -T eraft A 00
day of (�*t�et� ,20
My Commission expires:
A. MARY G. BRQWN
Notary Public, North Corolina
� `� � � Forsyth Ct�unty
�'My Cor�7mi fon Expires
Note; Falsification of this document by the septage management firm steal(S:/SoNd Waste/CLE1/SEPTAGE/FORMS/2018 Firm Application/WWTP Authoflr.atiott Form 201$
(OFFICIAL SEMI.)
e�d tea permik r�
vacation.
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