NCS01188_2023Permit_Initial

2023
Permit and Registration
Haynes
is hereby issued a Septage Management Firm Permit,
STATE,, _ Permit Number NCS-01188
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. Mount Airy WWTP, Mount Airy, NC
2. Septage Detention or Treatment Facility, SDTF-03-04
3. Septage Land Application Site, SLAS-03-04
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
Y Wm Perry Sugg
Sugg 114:45 34— 3
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*
HAYNES
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01188
Enter the five digits following the NCS #
Street address of office*
Street Address
305 SHAW STREET
Address Line 2
City
State / Province / Region
GALAX
VA
Postal / Zip Code
Country
24333
United States
County*
Out -of -State
Mailing address same as street address of office?*
• Yes No
Phone* Fax
276-228-3548 276-228-7685
Email*
[e-mail]
Owner Info
Firm owner's name*
William Aaron Robinson / R & R
Enterprises, Inc.
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
3572 PEPPERS FERRY ROAD
Address Line 2
City
WYTHEVILLE
Postal / Zip Code
24382
State / Province / Region
VA
Country
UNITED STATES

Phone* Fax
276-228-3548 276-228-7685
Operator Info
Firm operator's name* Firm operator's title
William Aaron Robinson President
Mailing address same as street address of office?*
• Yes No
Phone* Fax
276-620-0533 276-228-7685
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 172,500
Portable Toilet Waste 61 , 725
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business in: *
Ashe, Alleghany, Surry, Stokes, Wilkes, Yadkin, Forsyth, Davie
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
1�1.U,4�k a�,¢�-,dhff�tl�lrJa�GAf
Date*
11/10/2022
Title*
President
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles

Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage UB20913 3C7WRNBL8MG526238 1,300
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
MOUNT AIRY WASTEWATER TREATMENT PLANT 12/31/2023 Scan 2022111... 288.03...
Septage Land Application Sites (SLAS)
• Yes No
If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site.
SLAS # *
SLAS-0304
Expiration Date*
3/10/2027
Authorization
Septage Detention or Treatment Facility (SDTF)
• Yes No
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.
SDTF #*
SDTF-0304
Other disposal method*
Yes • No
Expiration Date*
3/10/2027
Authorization
Septage Management Firm Operator Training Completed ^.
Date* Hours*
8/13/2022 4
Location*
MORGANTON, NC
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group

Septage Land Application Site Operator Training Completed —�T]
Date Hours
8/13/2022 3
Location
MORGANTON, NC
Training Sponsored or Provided by
NC Pumper Group & NC Portable Toilet Group
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
11/10/2022
11:13:33 AM
Print Name* Title*
William Aaron Robinson President / Owner

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - 5oiid 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
QC C4- u,
(Plant operator in Responsible Charge (ORC), ORC License N
(Ph no Number)
of
ZIV,) -
(Address)
Name of Plant)
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do hereby authorize%-&'kb5
(Owner/Operator of Septage Management Firm)
(Septage Management Firm fume and NCS number)
to dispose of; domestic septage portable toilet waste
grease septage (grease trap pumpings) commercia)/industrial septage , from
s w- t ^A
( ounty or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at;
(Location
between the hours of 3?A . — i-n
CV
V a
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
Th73Z
valid until@{5'�"
(Usually December 31, Year)
Signed�u.� Date
(Facility Operator)
i 0 .%
Subscribed and affirmed before me this / day of /6'V42p
11
My Commission expires:c. "Z'L23
ublic) I
WO'TAR r PLOW
N—PR P_ S11 CHRISTOPHER I WALLACE (OFFiCIAI SEAL) S Wn , %orth Cardins
Note. Falsification of this document by the septage management firm shall lead to permit revocation.
5:/Solid_Waste/CI,A/5EPTA GF/FORMS/2018 Firm Application/WWTPAuthorizatlon Form 2018