NCS01099_2023Permit_Initial

2023
Permit and Registration
Scott Robbins Septic Tank
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-01099
o and registered as a
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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. Town of Denton WWTP, Denton, 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
23
Sugg 114:32 12-0.020.0'
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*
Scott Robbins Septic Tank
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01099
Enter the five digits following the NCS #
Street address of office*
Street Address
1064 Garner Rd
Address Line 2
City
State / Province / Region
Denton
North Carolina
Postal / Zip Code
Country
27239
United States
County*
Davidson
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
3368800859
Email*
[e-mail]
Owner Info
Firm owner's name*
Scott Robbins
Mailing address same as street address of office?*
• Yes No
Phone* Fax
3368800859
Operator Info
Firm operator's name* Firm operator's title
Scott Robbins
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
3368800859
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 40,000
Portable Toilet Waste 0
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in:
Davidson
Vehicle Info
Do you plan to operate pumper vehicles?*
• Yes 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
Rc�l.4�G�CCt
Date*
12/12/2022
Title*
Owner/Operator
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage YA158352 1HTSDAAN61H388872 2,200
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
0 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* Expiration Date* Authorization
Town of Denton WWTP 12/31/2023
Septage Land Application Sites (SLAS)
Yes • No
Septage Detention or Treatment Facility (SDTF)
Yes • No
Other disposal method*
Yes • No
Septage Management Firm Operator Training Completed
Date* Hours*
10/18/2022 6
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*
Registered Portable Sanitation Firm
• Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes^
Comments or notes
Certif cation 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
Rc�l.4�G�CCt
Date
12/12/2022
05:53:47 AM
Print Name*
Scott Robbins
Title*
Owner/Operator

S!iTi
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I'? ` North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NOROLM
TH
y 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:
Scott Robbins Septic Tank (NCS-01099)
1064 Garner Road
Denton, NC 27239
Number of Trucks.1
LATE FEES:
To. Scott Robbins
CK. NO. PAI
7
DATE
Scott Robbins Septic Tank
1064 Garner Road
Denton, NC 27239
Date Due:
Date: 09/27/2022
Invoice #. NCS-MO99-2023
$550-00
Payment Options:
E-check Available online at htt�fdeq.rc.gev/swoav
Requires bank account and routing information. You wilt 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 baps:/fdeQ.nc.gov/vroay
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 xW1 be charged on all returned checks.]
Ex Ian ton 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 Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone]
Jeffrey Bullard [phone]
More infor abon available on the web:
North Carolina Department of Environmental Quality (DEQ) - httosZl j .nc.go,
North Carolina Solid Waste Program - https•//deq nc.00vf=b^utfdivisionsfwaste-manacmen* solid -waste -se ton
North Carolina Septage Management Program - htt:. s_/ deo.nc, ov: about'divisions/waste-mana .emen__solid-waste-section sLecial-wastes-and-aitemative-
handling/segigg

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, 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.
(Plant Operator and Name of Plant)
t.
� 3 ,A 11 f q:L160 do hereby authorize S C O D - —
(Phone Number) (Owner/Operator of Septage Management Firm)
-_D , IC ._,L N S#
(Septage M `.: agement Firm Name and NCS Number)
to dispose of; domestic septage__ . portable toilet waste
grease septage (grease trap pumpings).
A
commercial/industrial septage, from
(County or Other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of —1 Ay, -
Reintroducing partially treated liquid into a grease trap is acceptable
Signed
This au�orization shall be valid
l (Facr`lity Operator)
Yes _ No
limber 31, Year)
Date 1 2�. -
Sworn to and subscribed before me this —1 _ . -day of "-I)2 C _ � 20AF.
My Commission expires' Cza (p
�(Nota�rybli�c)��__
Note: Fafsificaion of this do=ymt by the s~ fsm sha111=dto permit MVocateom

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