NCS01275_2023Permit_Initial

2023
Permit and Registration
JW Septic Service LLC
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01275
o and registered as a
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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. Mt Airy WWTP, Mt. Airy, 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 11519:20— 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*
JW Septic Service LLC
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01275
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
402 North Franklin Rd.
Address Line 2
City
State / Province / Region
Mt. Airy
NC
Postal / Zip Code
Country
27030
us
County*
Surry
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
336-325-0899
Email*
[e-mail]
Owner Info
Firm owner's name*
Jeremy Robert Williamson
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
336-325-0899
Operator Info
Firm operator's name*
Firm operator's title
Jeremy Williamson
Owner
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
336-325-0899
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 168,000
Portable Toilet Waste 0
Grease (Restaurant)
30,000
Treatment Plant
60,000
Industrial/Commercial
158,500
North Carolina counties of operation
List each county you plan to do business in: *
SURRY-STOKES-YADKIN-WILKES-FORSYTH
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
,TDB-CJq}1 )? 4UICLIAMM ON
Date*
12/31/2022
Title*
OWNER
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage EK-1229 1GDJ6H1J8TJ510292 2,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
0 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 *
Mt. Airy WWTP
Septage Land Application Sites (SLAS)
Yes • No
Septage Detention or Treatment Facility (SDTF)
Yes • No
Other disposal method*
Yes • No
12/31/2023 image.jpg 2.39MB
Septage Management Firm Operator Training Completed
Date* Hours*
1/28/2022 6
Location*
Hickory
Training Sponsored or Provided by*
NC Septic Tank Association
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
,TOCM}l R !U}CL1�41 UM
Date
12/31/2022
02:47:25 PM
Print Name* Title*
Jeremy R. Williamson Owner

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