NCS01153_2023Permit_Initial

2023
Permit and Registration
ECLP Co.
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01153
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. Septage Land Application Site, SLAS-71-08
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
Digitally signed
by Wm Perry
Perry
Sugg
Sugg
Date: 2023.02.23
14:38:21
-05'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRS'
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 276W1646
(1.) Firm name: (The "Firm name" must be MV& as it is shown on your vehicle(s)).
�cIt P
Street address of office: 1 o l r C A A)AL O e
City: Cfifi011AAq HeRCN State: NC Zip: a��d
Mailing address (if different): D 60Y 213 /
City: C0R04)&)e deacp State: NC Zip o?E' Iv -a 00-
Phone:_ Wo - 3,5W- 7a 9 % Fax: 1710
E-Mail: Wg✓e1r-7 QQ CS- 0014
County: kew
0 ✓e 9
Septage Management Firm permit number: NCS # 0/1.33
(2.) Firm owner's name: fyrllo �z , _
Mailing address (if different):
City:- —
State: Zip.
Phone: Fax:
(3.) Firm operator's name: &T901JI 0 . L. 0 Rc-%) Firm operator's title: © w v e
Mailing address (if different):
City:
Phone:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of aal., ions pugWW in last 12, months (Example: Domestic: 50,000).
Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrial/Commercial
(,5000 j 1 y-a do
(5.) N.C. Counties of Operation: Aj e w H aN c re e Pe v D.e R 11 ORVA)S O i c K"
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: -7
Number used for. Domestic Septage:___. Grease (restaurant)-. 77,) Q
Other._ Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification #
Tank Capacity
0?5 "
I Cr O J- 70/C" ,5-1 ,?93 i
a 0
2
1A10 R,?
/FU/Aj Z HeARKL ?,6- 7/9uf
1/a0
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(1.) Do you plan to operate pumper vehicles? (check one) (, a ) yes ( ) 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? ( ) yes ( ) no Initial6Wf Date�,
(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: c, x6 zv Location: E'W 0e ea N G Hours: �f
Training Sponsored or Provided by: S61-i O zins,re S'ec=rio o o F pe,) R Ijo_ PoMPeR G Rov P
(10.) Septage Land Application Site Operator Training Completed:
Date: Location: _ _ Hours:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management
Registered Portable Sanitation and Septage Management Firm:
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.
nature ( re of companyofiicia! required) Date
A17- /u
Print Name Title
Other Comments:
Rev.04-26-2021
PAGE 2

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE LAND APPLICATION
SITE PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a land application site permit holder to indicate that permission has been
given to a permitted Septage Management Firm to land apply septage on the permit holders
land application site.)
(Site Operator)
s Co aeR RD, CUJ?/fje 11 NC
(Operator Address)
do hereby authorize: &7W ._W 40 h'e7-1
(Owner of Septage Management Firm)
ICY- /° Co, NCS # 00 1,53
(Name of Septage Management Firm)
Jail 0,4wA1. O 00 dox 91SI . CfiR6410A _ k,,4CN 0C F-
(Septage Management Firm Address)
to use septage disposal site # %f-cis for the disposal of ;6'0 00 o _ gallons of septage* in 20 a3
Date: la t o?02 Signed 'f
(Site Operator)
* As defined in G.S.130-A-290(a)(32). The site will be operated in accordance with 1SA NCAC 13B
.0800 - Septage Management Rules
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

NC SEPTAGE MANAGEMENT FIRM
1ecertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS. O11.53
Number of Pumper Vehicles: LN0
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."
Signature ature of cmpany oflrciai required
Print Name
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Date
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S:1Solid__Wastelcialseptagelforms%Pumper Vehicles Cetiflcation.doc

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INVOICE
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NCS-01'53-2C23
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?a/-?Pnt rvtions:
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