NCS01279_2023Permit_Initial

2023
Permit and Registration
George Bros.
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01279
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. Johnnie Mosley Regional WRF, Kinston, 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
Date: 2023.02.23
Sugg 15:20:18-05'00'
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 "Finn name" must be g�(y as it is shown on your vehicle(s)).
l7" <2' 0 YG <7_ 13 r0 s,
Street address of office: ® O 0 n e-
City: # Cw e' 10 Cr 1 C - State: AIAL Zip: �2 8 �5 3.;�
Mailing address (if different):
City:
State:
Phone: Q S,,� -& 7 S-y V 3` _Fax:
E-Mail: lo 1I o ci a- o aA oo , CO *n
County: Y k v e A Septage Management Firm permit number. NCS # 01.27 5'
(2.) Firm owner's name: l.(J 1 r� 4- "KeA Y 0 1-,;1 e.,
Mailing address (if different):
City:_
Phone:
State:
(3.) Firm operator's name: 7<C�,Y 16 t,v C-e0 r (Z. Firm operator's title: ?0'v7r)er
Mailing address (if different):
City:
State:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons numoed in last 12 months (Example: Domestic: 50,000).
Domestic Portable Toilet Waste
/ao 00o f
Treatment Plant I Industrial/Commercial
(5.) N.C. Counties of Operation: cLl­ �'/C 0
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for. Domestic Septage: i Grease (restaurant):
Other Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2
PAGE

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) Oyes ( ) 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? ( Lyes ( ) no Initial %L 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: — %) — - oA Location: r►'1 ore%eli�% L'� Hours
Training Sponsored or Provided by:
(10.) Septage Land Application Site Operator Training Completed:
Date:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Location:
Registered Portable Sanitation Firm:
Registered Septage Management Firm: A,,' -
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
2
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 there are
criminal penalties for knowingly making a false statement, representation, or certification.
Signature(Signaturecompanyo�cialrequired)
/� Gil o 14/ V"¢ or
Print Name
Other Comments:
/,.2 — la — �2o2
Date
Rev. 04-26-2021
PAGE 2

NC SEPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle (s)
Septage Firm Permit #:
Number of Pumper Vehicles
NCS. 0 i-2 � 7
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 byl 5A 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
`(Signature
oot companyoficialrequired? Date
�" i ° k1 (reo Y,. e—
Print Name Title
S:lSolid_WastelcialseptagelfotmslPumper Vehicles Cetification.doc

Note: Falsification of this document by the septage management firm shall lead to permit
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2013 Firm Application/WWTP Authorization Form 2018
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
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.
I, Kenneth R. Stevens Jr.- Wastewater License #21198 Johnnie Mosley Regional Water Reclamation Facilit
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
of
P. 0 Drawer 339 Kinston NC 28502
(Address)
252-939-3375 do hereby authorize _
(Phone Number)
Rarlow George
(Owner/Operator of Septage Management Firm)
Geo_me Brothers NCS # 01279
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X
grease septage (grease trap pumpings)
, portable toilet waste X
commercial/industrial septage __ _ , from
Lenoir and surrounding counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Johnnie Mosley Regional Water Reclamation Facilitv- 2101 Becton Farm Road
Brie Run Lift Station- Highway 55 East
(Location)
between the hours of 8:00 a.m. to 4:00 p.m.(Monday thru Friday)
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorizatio shall be valid until_ December 31 2023
7,
Signed � DateZ2—
(Facility Operator)
Sworn to and subscribed before mePs�6day of
AMy Commission expires:
(Notary Public)
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20 22

5 .
North Carolina Department of Environmental Quality
Division of Waste Management
NORTH CAROLING. INVOICE
EmdrMMfta(QUaW Solid Waste Section
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Phone/Fax: [phone]
Email: [e-mail]
CK. N0,PAI
7
DATE lZ- 6.ZI,.
Y,D- 6 7c,
To: Rarlow George Wulie George
George Bros.
250 Boone Rd
Havelock, NC 28532
Date: 09/27/2022
Invoice #: NCS-01279-2023
Description o Due
Septage - Annual:
George Bros. (NCS-01279)
250 Boone Rd $550.00
Havelock, NC 28532
Number of Trucks: 1
Date Due: 12/15/2022
LATE FEES: accordance with NC General Statutes GS 130A-291,1(e2), a late fee will be applied to any annual permit fees not submitted by January 1, 2023.
Payment Options:
E-check Available online at htt ss:/l /deq.nc.aov/swoav
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card Available online at https://deq.nc.gov/swpax
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number shown
on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
[*Convenience Fee of 2.65% added to amount invoiced.]
Paper check Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number on
check. If you are paying by electronic transfer, include the invoice number with your electronic transfer, Please return a copy of this
invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.)
Ex lanation of Invoice Amount is Based on Firm's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay fee(s) based on your solid waste management
activities. The fee(s) shall be used to support the septage management program.
For questions regarding:
Billing
Regulations or Technical Assistance
Jared Wilson [phone]
Chester Cobb [phone]
Jeffrey Bullard [phone]
More information .available on the web -
North Carolina Department of Environmental Quality (DEQ) - https://deQ.nc.aov
North Carolina Solid Waste Program -,https:/Idea nc gov/about/divisions/waste-management/solid-waste-section
North Carolina Septage Management Program - ti s:/idea nc gov/about/divisions/waste-managgmpnt/solid-waste-section/special-wastes and alternative
handling septage