NCS01267_2023Permit_Initial

2023
Permit and Registration
Beck's Septic
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01267
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. Mount Airy WWTP, Mount Airy, NC
2. Carolina Compost 2911-COMPOST, Thomasville, 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
Y Wm Perry Sugg
Sugg Date: 2023.02.23
15:16:29-05'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL,SERVICE CENTER, RALEIGH, NC 27699.1646
(1.) Firm name: (The "Firm name" must be end& as it is shown on your vehicle(s)).
Street address of office: � 9 00A
City: State:�c _Zip: Q I M I
Mailing address (if different):
City: State: Zip
Phone: 33 D - 3JJ2 ' Fax:
E-Mail: L,ll-3ttV.1lG��']�, �C� � ,I p a) . ["_ onc)
County: v" 0rr�� �''Septage Management Firm permit number: NCS # d
(2.) Firm owner's name:_D2Q j DG l
Mailing address (if different):
City: State: Zip
Phone:..�()L-AjOO Fax:
(3.) Firm operator's name: QDCa6 &L L 'TV - Firm operator's title:
Mailing address (if different):
City: State: Zip:
Phone: 3aD- S53 ` o Fax:1 (4.) Type(s) of septage pumped: Write in the number of joUgns 12umDed in last 12 months (Example: Domestic: 50,000 .
Domestic r Portable Toilet Waste Grease (Restaurant) j Treatment Plant IndustriallCommercial I
(5.) N.C. Counties of Operation:(
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: 1
Other: _
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License Tag #
Vehicle Identification #
Tank Capacity
l "
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) ( t-1"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? (vj 'yes ( ) no Initia&k5 Date &D
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( �es ( ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of theSeptage 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#:,, ,l 1 i4AtExpiration Dater SDTF#: Expiration Date: __
(9.) Septage Management Firm Operator Training Completed:
Date: tD -1Yx0A'J Location: 1 Hours:
Training Sponsored or Provided by:
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm:
Registered Septage Management Firm: L,
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
Hours:
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 two are
criminal penalties for knowingly making a false statement, representation, or certification.
Other Comments:
of companyoffrcial requk" Date
Title
PAGE 2
Rev. 04-2&2021

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS-
Number of Pumper Vehicles: i
CERTIFICAI
"I certify, under in the
submitted pem
transportation i ,hicle
lettering as rec .i , % x , is
maintained of I� ; 3B .0839
(a). I am away N Ant � �,'�'��� . ��aP ncluding
the possibility
gnature (Signa5r of
Print Name
S:lSolid Wastelcialseptagelforms%Pumper Vehides CeMeation doc

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.
(Plant Operator in Responsible Charge (ORC), ORC Lic
3!
Name of Plant)
(Address) j U
&o-39f -3S75Q7 do hereby authorize (t7 �r
(Phone Number) �/ C� (owner/Operator of Septage Management Firm)
of l �oYl (plc �4P`I- I C_ —<�e.r-o-C2 NCS # O X 417
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage_portable toilet waste _
grease septage (grease trap pumpings) commercial/industrial Septage _ from
5 AJU�j CJL J,
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
betwef
Reintroducing partially treated liquid into a grease trap is acceptable Yes J�No
This authorization sh I be valid until COI 31 z O Z3
/'� 0 (Usually December 31, Year)
Signed __ Date . • Z/�
(Facility operator) ,,,1,1
Subscribe) and affirmed before me this day of �_� 20
01
My Commission expires: s2 4.J
uER �' (OFFICIAL SEAL)
wall W`!1ka
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission
has been given to a permitted Septage Management Firm to discharge septage into the permit
holders detention or treatment facility.)
t, Jason Gibson
588 Free
(Facility Operator)
Church Rd. Thomasvilte, NC 27360
(Operator Address)
do hereby authorize:
Donald Beck Jr.
(Owner of Septage Management Firm)
Beck's Se tic NCS #
(dame of Septage Management Firm)
419 Ash Hill Road, Ararat, NC 27007
(Address of Septage Management Firm)
267
to utilize septage detention or treatment facility 4 SWCD-29-10 for the treatment or storage of
septage *
in Zo 23 The faeieity will be operated in accordance with the Septage M2nagernent Rule-s
Date:
12/19/22
As defined in G.5.130A 290(a)(32)
*" As defined in 15A NCAC 13B .0800
Signed
Return the property completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Jason Gibson
(Facility Operator)