NCS01143_2023Permit_Initial

2023
Permit and Registration
Salmons Septic
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01143
o and registered as a
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NORTH
EQ
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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 PerrybyWmPerry
Sugg
S u g g Date: 2023.02.23
14:37:23-05'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRS!
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(4.) Ty*s) of f & fhemmpbwgfgallons aump.2d in List 12 movib, (Exampk Donleft 50,00).
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(5.) RQ Cartes of
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Lie Tag #
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APPLICATION CONTINUED ON PANE 2
PAGE I

APPLIrATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CO1nNUED RM PAGE 1)
(7•) Do you PIM to Wrdie WW vexes? (check ore) (Vf yes ( ) no.
K you diedied yss above% you t attest fo the isft+w ing stdmmt before a perM nw be imed.
'# cry, under penatty of Yaw, that ft puqw vaWe or v wed in thesubmftdpwm1appkahw meets the
feWikeffmo forsafe and sank" ftupon cdsep"e as ie**W by 15A WCAL 138.08Wa)
as reqLdred by UA NCAC fl83ft Fudhercmce€ I also M a log is mnbned of each septage pumpmg event ss
by 15A NMC 138 OMa) l am awamtW#me are soffmt penarm bt Me cwgcagm mduft the
posses► of sne and kpbmnent.
Do you ailest to Medakment _ above? (V i t w ( � nomdflS ire
a) Appmuedwaskwater treamnit ( ( ) no- g ymsubutVftWmatff TreabneniAuftfizEffion for each
as Mmated in S0parcqraPh .0834(cX14) of D*Sepwp Maugmed Wes.
c) She DeWnson or Try FaGdky (SDTF) Pemdf Nwnbem (use addaW dab d ed)
SDTF# Exkabm Dabam-- - - -- - - - — SW# E)Oigm Dam
(9-) 5 w@Nned FkmT CwVW8d
Try � orPftiMby. -- iv C -S
(10) Septage Land Amkabm Site t)peraw Tm" COVOW
Dam Low -
Trig Sponsored or Pfo"d by. - -
l certify thatthe bft nand rosinrids aporplim for pewaretm% comOsta, and ac cwafeto the best
of nq bwwwfteand hdief. I am ametluda mmit am be suspe &d or resod upm a inftg Old fts ieseaRm was
bated upon umrect o,- icy won that n /aft the decisim to issue the pemdt and that t me are
p� b+r u : owingtar a fie or .
.:7
11tk1 t:- 1
Date
We
PAGE 2
Rev 04-2tr=

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.
I, Matthew Lavigne- WW#997822-Archie Elledi;e Wastewater Facility
(Plant operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
_ 2801 Griffith Rd. Winston Salem NC 27103
(Address)
336-765-0130 do hereby authorize Darrell Salmons
(Phone Number) (Owner/Operator of Septage Management Firm)
of Salmons ons Septic NCS # 01143
(septage Management Firm Name and NCS number)
to dispose of: domestic septage._ __ X J portable toilet waste _ X
grease septage (grease trap pumpings) NO commercial/industrial septage _ from
Winston-SalemlForsyth Coun and Ad'acent Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Archie Elled a Wastewater Facili
(Location)
between the hours of 6:00 am until 6.00 Pm Monday Through Sat
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31 2023
(Usually December 31, Year)
011
Signed .
(F rity Operator)
Subscribed and affirmed before me this 3 CC)
ti (Notary Public)
Date 4' ^ I — ;LP
day of Cic-6 b--r 120 7"9'
My Commission expires: 3 3�
,. MARY G. BROWN
Notary Public. North Carolina
Forsyth County
�.� My f I 2%a3 ires
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management Cron shall lead to permit revocation.
5:/Solid VYa5te/CI1y/SEPTAGE/F0RMS/2018 firm Applimation/UVWTPAuthorization form 2018

uwEnsmn-Salem / Forsyth Co"
'- t lip I lipties
1Nater + Waserwater • Sam VlFaste
Wastewater Division, 2799 GriftittL Road, Winston-Salem, NC 27103
O: 336-727-WW, F: 336-659-4320, wsktAilities-org
SEPTAGE DISCHARGE PERMIT
* THERE SHALL BE NO GREASE DISCHARGED AT ELLEDGE WASTEWATER TREATMENT PLANT *
Permit # 38-23
Is issued in compliance with the provisions of the City of Winston-Salem Sewer Use
Resolution, subsequent revisions thereof, and any other applicable rules and regulations of
the City of Winston-Salem.
Salmons Septic -
6509 US 601 Hwy
Yadkinville, NC 27055
is hereby authorized to discharge Domestic Septage into the designated disposal site
located at the
Elledge Wastewater Treatment Plant
2801 Griffith Road
Winston-Salem, NC 27103
NPDES # NCO037834
in accordance with the limitations and conditions as set forth in this Septage Discharge
Permit.
This permit and the authorization to.discharge shall become effective January 1, 2023.
This permit and the authorization to discharge shall expire at midnight on
. December 31, 2023.
�4 I
Signed this day of U�� , 2022.
Michael Gearren
City/County Utilities
City, of Winston-Salem
North Carolina
Permit Number 38-23
City CowrcR: Mayorklen loins; Denise D. Adams, Mayor ProTempore, North Ward; Dan Besse, Southwest Ward; Robert C Clark, West Ward; John C Larson, South
Ward; Jeff Madntash, Northwest Ward; Annette Sdppio, East Ward; James Taylor, Jr., Southeast Ward; City Manager. Lee D. Garrity
County CeromTssbr . David R. Plyler, ChatrDo. Martin, Nee Chaff; Fleni ft EM ft Ted Kaplan, Richard V. Linville, Tonya M.Danlel, Glad. D. WMsennhunt; County
Call 311 or336-7274M Manager-DudleyWatts,Jr.
Wlr-r5atdR/F-vACountyUtftConienbsibaRatdAS.`aft.ChairLWesleyCurftlr.,VimChairtlaroldE.Dar;TanGditWwneKtikes;DuaneL-C
dt}11mkf�. CftV0fWS:0r9 Hugh W.Jean;a.P.*,JamesRufftDonald R.Stwwart;AN.Younger

NC SEPTAGE MAANAGEAMNZ' FIRM
Recertification of Pumper. Vehicle(s)
SepMge Firer# Permit #: „ NCs- �71
Number of Pumper Veh'des: v
CERTIFICATION
i :t ( - :--ri-tt -h-:E t !:- 't :-. T, - ti.R !k' .[�..t;f.t: •T r
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North Carolina Department of Environmental Quality
MMTHCAROUNA Division of Waste Management INVOICE
_e�Wuafty Solid Waste Section
- NNNNNWMI�7
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax [phone]
Emaii:[e-mail]
Septage - Annual:
SalmonsSeptic (NCS-01143)
6509 US 601 Hwy
Yadkinvift NC 27055
Number of Trucks;:&
at-T
v A�A
CK NO.
DATE— -
4,8 00
To: Darrell Salmons
Salmons Septic
6509 US 601 Hwy
Yadkinville, NC 27055
Date Due:
Date- 09/27/2022
Invoice *-- NCS-01143-2023
12/15/2022
E-check Available ongne at.h,,,
Requires bank account and routing information You val need to use the zip code in the descriptior; box and the invoice number
shown on this invoice to access your account N a zip code is not listed, use the code. 99999 along with the invoice number.
Credit Card Available ordine at https.//dea.rc.
Accepts MasterCard. Visa, and Discamr cards. You will reed to use the zip code in the dmcnpbm box and the invoice nurnber shown
on this invoice W access your account. ff a zip code is nut listed, use the code: 99999 along with the invoice number
Konvergence Fee of 2.65% added to amount invoiced-1
Paper check make checks payable to N.C_ Division of Waste Managemerit; Solid Waste Section include Permit Number and invoice number on
check. ff you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy of this
invoice with your payment
Ki-S, 253-505: A $25.00 processing fee will be dwr Ad on all reftmied 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 feels) based on your solid waste management
activities. The fee(s) shall be used to support the septage management program.
for gug5fms regarding
Billing
Regulations or Technical Assistance
Jared Wilson (M) 707-8298
Chester Cobb [phone]
Jeffrey Bullard [phone]
More information available on the web:
North Carofina Department of Enviinctmental Quality (DEQ) - https.,/1derjjpc.wt
North Carolina Sold Waste Prognim, - h!+,,7,K/Vde:4
North Cawkv Septage Management Program -
_Spe ial-waM-and-afternathe-
handlino/_,,,prace