NCS01181_2023Permit_Initial

2023
Permit and Registration
G.S.M.R.
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01181
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. Tuckaseigee Water and Sewer Authority, Sylva, 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 Perryby Wm Perry
Sugg
Sugg Date: 2023.02.23
14:42:56-05'00'
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*
GSMR
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01181
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
225 Everett St, Suite G&H
Address Line 2
City
State / Province / Region
Bryson City
NC
Postal / Zip Code
Country
28713
United States
County*
Swain
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
PO Box 1490
Address Line 2
City
State / Province / Region
Bryson City
NC
Postal / Zip Code
Country
28713
United States
Phone* Fax
8283420935
Email*
[e-mail]
Owner Info
Firm owner's name*
Al Harper
Mailing address same as street address of office?*
• Yes No
Phone* Fax
828-488-7008

Operator Info
^J
Firm operator's name*
Teddy Crawford
Mailing address same as street address of office?*
• Yes No
Firm operator's title
Coach and Property Maintenance
Manager
Phone* Fax
828-342-0935
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 0
Portable Toilet Waste 70,000
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
Jackson County and Swain County
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
Date*
12/29/2022
Title*
Coach and Property Maintenance Manager
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*

Portable Toilet Waste 06EJ39 1FDOW5HT3FEC65058 525
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* Expiration Date* Authorization
Tuckaseigee Water And Sewer Authority 12/31/2023 2023 177.07...
Authorization
Form.pdf
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*
12/3/2022 4
Location*
Raleigh,NC
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group
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
Date
12/29/2022
01:00:00 PM
Print Name*
Teddy Crawford
Title*
Coach and Property Maintenance
Manager

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.
0S,yLsp�� —
(Plant Qperator in Responsible Charge
o tJ df—C . e" Li
ORC License Number, Name of Plant)
V1 ✓ AC �R, 7
(Address)
hereby authorize �C�
(Phone Number) (owner/Open r of Septage Management Firm)
of 0--� " � � NGS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage) portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
c
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at,
-/
(Location)
between the hours of r'" - Lie
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
This authorization shall be valid until ► NA +� ' 1 1-
(Usuallyll December 31, Year)
Signed Date 1 ' 4 --
(Facility Operator)
Subscribed and affirmed before me this
I/44,
day of 20 -Z
-V"��aQ My Commission expires: 3Ir!&2-3
(N ary Public) 64."'Ja' juoift 2 Cw/
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S;/Solid_Waste/GLA/SEPTAGE/FORMS/2018 Firm Appiication/WWTP Authorization Form 2018