NCS01281_2023Permit_Initial

2023
Permit and Registration
A Countywide Septic
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-01281
o and registered as a
e:,e D
NORTH
EQ�j
%L 12. 9*
-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r Q'M
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. Septage Land Application Site, SLAS-78-23
2. Cross Creek WRF/Rockfish Creek WRF, Fayetteville, NC
3. City of Lumberton WWTP, Lumberton, NC
4. Central Johnston County WWTP, Smithfield, NC
5. West Brunswick Regional WWTP, Supply, 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 Perry Digitallysigned by
Wm Perry Sugg
Sugg 115:2119-005'003
Perry Sugg, Environmental Compliance Branch Head

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�v.� j'. F � : $ � 3 4 t1r c �i � r.�':irm
For questions regarding this form or the online application process, please contact Jeffrey Bullard (http:llmailto:
Jeffrey.Bullardgncdenr.gov)(919-707-8285) or Chester Cobb (http:l/mail to:Chester.cobb@ncdenr-gov)(919-707-8283).
s
E Firm Info
Firm name'
A COUNTYWIDE SEPTIC TANK SERVICE INC.
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS t#)*
1281
Please enter the complete N c S #, including the 5 end digits [NCS-XXXXX,'
Street address of office*
Street Address
373 SWIFT CREEK RD
Address Line 2
City
State I Province I Region
RAEFORD
NORTHCAROLINA
Postal I Zip Code
Country
28376
USA
County*
Hoke NO
Mailing address same as street address of office?*
Yes No
Phone* Fax
910624-2587 910-875-1777
Email*
[e-mail]

Owner Info
---------------- -
Firm owner's name*
BELTON WAYNE JONES
Mailing address same as street address of office?*
* Yes 0 No
Phone*
Fax
910-624-2587
910 -875-1777
I Operator Info
Firrn operator's name*
Firm operator's title
BELTON WAYNE JONES
OWNER
Mailing address same as street address of office?*
OW Yes C) No
Phone*
Fax
910 624-2587
910-875-1777
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic
146, 000
Portable Toilet Waste
0
Grease (Restaurant)
0
Treatment Plant
0
Industrial/Commercial
0
. ..... --------
North Carolina counties of operation

List each county you plan to do business in:*
HOKE, CUMBERLAND, BRUNSWICK, LUMBERTON, HARNETT, BLADEN, MOORE, SAMPSON,
COLUMBUS, LEE, JOHNSON,
Vehicle info
Do you plan to operate pumper vehicles?*
(:, Ye s Q No
" i certify, under penalty of law, that the pumper vehicle or vehicles listed in the subrnitted 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, 1 also certify that a log is maintained of each septa ge pumping event as required by 15A NCAC 13B .0836(a). I am aware that
there significant penalties for false certitEcation including the possibility of fine and imprisonment."
Signature*
x
Date*
Date will be captured on form submission
Title*
OWNER
Choose how to add vehicle descriptions*
Add vehicles individually ❑ Upload List
Pumper Vehicles
Usage *
Domestic Septage
Domestic Septage
+ Add more vehicles
License Tag #*
v YA103857
YA132942
Vehicle identification # *
I HTMKAAN13H553542
2NP2HN7X8AM110101
Septage Disposal Method
For each method, indicate whether you plan to use it by ohecking yes 0r no. _ _---_.-._--- __.--
Tan4 Capacity*
2,500

Approved wastewater treatment plant*
G Yes 0 No
If yes, list the facilities below and upload or suhmit by mail a copy of Wastewater Treatment Authorization
(https:/Ifiies.nc.gov/ncdeq/DWM/SW/Composting°/02520and%252OLand%252OApplicationfMTP°/a2OAuthorization.pdf) 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
1645 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name` Expiration Date* Authorization
BELTON'S 2/23/2026 Upload
Value is required.
+ Add another WWTP
Septage Land Application Sites (SLAS)*
0 Yes 0 No
If you are not the permit holder for the septage land application site, you must have a signed land application authorization form
(https:itfiles.nc.govincdeglDWMISW/Composting°/o2520and❑/❑2520Land❑/`252DApplir,ation/SLAS°/o2OAuthorization.pdf) for each site.
Permit Verification
0 1 certify that 1 AM the permit holder for this SLAS.
If unchecked, please attach a signed land application authorization forrn for each site.
SLAS #'� Expiration Date* Authorization'
SLAS-78-23 n �ipi h
Value is required. Value is required.
SLAS-78-22 p- Upload X
Value is required. Value is required.
+ Add another SLAS

Septage Detention or Treatment Facility (SDTF)*
(*:) Yes C) No
Permit Verification
0 1 certify that I AM the permit holder for this SDTF.
if u rchecked, please attach a signed dete n tion/trea im ent a u thoniZ360n form for each site.
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detentionitreatment authorization form
(https-lifiles.nr,.govtncdeq/DWMISW/Composting�/�2520and�/�2520Land�/o2520APplicationISDTF°/�2OAuthorizaton.pdg for each site.
SDTF ft Expiration Date Authorization
woad
SDTF-24382
Value is required- Value is required.
+ Add another SDTF
other disposal method*
0 yes n No
Value is required.
Septage Management Firm operator Training Completed..__- - ---- - ------
Date Hours*
1/27/2023 f 6
Location*
HICKORY CONVENTION CENTER
Training Sponsored or Provided by*
Value is required.
- -------- --
Septage Land Application Site Operator Training Completed
Date Hours
1/27/2023 4
Location
HICKORY CONVENTION

Training Sponsored orProvided bv
NC Septic Tank ASS0Ci8tiOD ^'
------------ --'------------------
| [) '�t t' Type
. \/p8
`— '-------'--------------'------...... --------
Select one*
[} Registered Portable Sanitation Firm
* Registered SeptaQe Management Finn
0 Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
Certification Statement
I c,�Aify that th e i nfo rm ation a nd re presentations �n Nr� appi !cation fo r a p ermit are true, complete, and a cc u rate to th e best of my knowledge and bell ef- I am awa re
that a permit m ay be suspended or revoked upo n a find ing that its issue nce �va s based upon incorril�c t or i nadequ ate in.Formation that materially affected th e decisio n
to issue th e pe r rn it and th at there are crim inal penal U as for knowingly ma king a false statement, represe nta tion. or cerfification.
Signature*
Date
2/6/2023
10:22:32 AM*'
Print Noma* Title��
BELTON WAYNE JONE3 OWNER
Save as Draft

�y
North Carolina Dep
artment of Environmental Quality
NORTH CARO LkNA Division of Waste Management INVOICE
Envrranmenral Qudtry 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. NO. 3
DATE
�
Septage - Annual:
A Countywide Septic (NCS-01281)
373 Swift Creek Rd
Raeford, NC 28376
Number of Trucks: 2
To: Belton Wayne Jones
A Countywide Septic
373 Swift Creek Rd
Raeford, NC 28376
Date Due:
Date: 09/27/2022
Invoice #: NCS-01281-2023
$800.00
12/15/2022
LATE FEES: In 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 https://deci.nc. oc ov/sw)aav
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
Paper check
Available online at httips:Hdeci.nc.gov/swpay
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.]
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 retumed checks.]
Explanation of Invoice Amount is Based on FirmlCurrent 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.gov
North Carolina Solid Waste Program - htt s: de ..nc. ov about divisionsiwaste-mana emenI-solid -waste-section
North,Carolina Septage Management Program - htt s: de-j-nc.,,ov abou divisions. waste-manauement. solid-waste-sectionisFecial-wastes-and-alternative-
handlina/septage

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE LAND APPLICATION
I SITE PERMITTED TO SOMEONE OTHER THAN YOURSELF
(phis form is used by a land application site permit holder to indicate that permission has been
given to a permitted Septage Management Firm to land apply septage on the permit holders
land application site.)
i Y
(Site Operator)
I (Operator A dress)
L
hereby authorize:
�Lam.�S
(Owner of Septage Management Firm)
(Name of Septage Management Firm)
(Septage Management Firm Address)
-!74,45
to use septage disposal site # for the disposal of
NCS # Y I
gallons of septage* in 2023
Date: Signed �~
perator)
E
*!As defined in G.S. 130-A-290(a)(32). The site will be operated in accordance with 1SA NCAC 138
.9800 - Septage Management Rules
Rlturn the properly completed form to:
North Carolina Department of Environmental Quality
a
Division of Waste Management
Solid Waste Section
4
1P46 Mail Service Center
Raleigh, NC 27699-1646

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, N.C. 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.
1, Scott McCoy #24382 Cross Creek WRF / Rockfish Creek WRF
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
P.O. Box 1089 Fa etteville NC 28302-1089
(Address)
[phone] do hereby authorize Wayne Jones
(Phone Number) (Owner/Operator of Septage Management Firm)
of -. A Countywide Septic Tank Service. _ _ _ _ _ NCS# 01281
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage from
Cumberland & surrounding counties _
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Facility Influent Pump Station
(Location)
between the hours of Sunrise to Sunset
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This autho ' tion shall be valid until ---December 31 2023 _
Signed "
(Facili Operator)
Subscribed and affirmed before me this
Date t o i I t J; Z
4A day of&AY4.1020
My Commission expires: /�i_aow/
�.nuq�y
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:1Solid_WastelCLA/SEPTAGEIFORMS12023 Firm ApplicationlWWTP Authorization Form 2023
T' T14 •may.
pikRY
�. :z=
�' pUBL%G

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, HenryHarper; ORC WW# 1008147 City of Lumberton Waste Treatment _
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
700 Lafayette Street, Lumberton, NC 28358 Contact: Tammy Smith 910-671-3858
(Address) (Contact/ Phone Number)
do hereby authorize Wayne Jones
(Owner/Operator of Septage Management Firm)
Of A County Wide Septic Tank Service NCS # 01281
(septage Management Firm Name and NCS number)
to dispose of: domestic septage Ye5___ _ . portable toilet waste Yes
grease septage (grease trap pumpings) _NO
Robeson and Surrounding.Counties
(County or other Geographic Area)
commercial/industrial septage Yes , from
at the above named wastewater treatment facility. Septage shall be discharged at:
The Influent Basin at 700 Lafayette Street Lumberton NC 28358
(Location)
between the hours of 7 am to 4_pm Monda__— Friday. No weekends or Holidays
Reintroducing partially treated liquid into a grease trap is acceptable Yes _ X No
This authorization shall be valid until _ December 315L 2023
(Usually December 31, Year)
Signed Date,
V,J(Facilit)/ Operator)
Subscribed and affirmed before me this day of MOYPfV7 L20
My Commission expires:
(Notary P )
TAMMY L SMITH
(OFFICIAL SEAL) NOTARY PUBLIC
BCADEN COUNTY, NC
Note: Falsification of this document by the septage management firm shall lead to permit revocation. Canrnf�ton trim
4
S:/Solid_WasteXLA/SEPTAGE/FORMS/2014 Firm Application/WWTP Authorization Form 2014

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.
I, Matthew Henry,#998880 West Brunswick Regional Wastewater Treatment Facili
(Plant Operator in Responsible Charge (ORC), ❑RC License Number, Name of Plant)
235 Grey Water Road, Supply, NC 28462
(Address)
[phone] do hereby authorize Wayne Jones
(Phone Number) (owner/Operator of Septage Management Firm)
of A Countywide Septic Service Inc. NCS # 128I
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste
grease septage (grease trap pumpings) commercial/industrial Septage from
Brunswick County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
West Brunswick Regional Wastewater Treatment Facility, 235 Grey Water Road, Supply, NC
(Location)
between the hours of -Monday-Friday 8 a.m. - 6 .m.• Weekends & Holidays 9 a.m. - 5 p.m.
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31. 2023
A (Usually December 31, Year)
Signed Date l2 ^ 8 ~ ,2.2
(facility Operator)
Matthew Henry personally known to me
Subscribed and affirmed before me this day of '2C,@XY►W, 20 9A
My Commission expires: `6 Q01 I c1to
(Notary Public)
WIAUIFI(EN E. MILLER
g@Ayorth Carolina
Brunswick County
Com issi aExpires
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 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.
1, Matthew HeM, 9998880 West Brunswick Regional Wastewater Treatment Facility
(Plant Operator in Responsible Charge JORC), ORC License Number, Name of Plant)
235 Grey Water Road, Supply, NC 28462
(Address)
[phone] do hereby authorize Wayne ]ones
(Phone Number) (Owner/Operator of Septage Management Firm)
of A Countywide Septic Service, Inc_ INCS # 1281_.
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste _
grease septage (grease trap pumpings) commercial/industrial septage _ , from
Brunswick County
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
West Brunswick Regional Wastewater Treatment Facility, 235 Grey Water Road, Supply, NC
(Location)
between the hours of Monday -Friday 8 a.m. - 6 p.m.; Weekends & Holidays 9 a.m. - 5 p.m.
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2023 _
A (Usually December 331, Year)
Signed ` ` `�`'� Date ! 2 —'r
(Facility Operator)
Matthew Henry personally known to me
Subscribed and affirmed before me this day of ])AC.,¢flrnle• , 2O as
My Commission expires: a°l ato
(Notary Public)
WLAtUREN E. MILLER
6;pAUorth Carolina
swickCounty
issi gE4xpires
Note: Falsification of this document by the Septage management firm shall lead to permit revocation.
S./Soii[t_Waste/CLA/SEPTAGE/FORM S/2018 Firm App1ication/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
401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605
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, John D. Wall Central Johnston County Regional Wastewater Treatment Plant
(Plant Operator and Name of Plant)
Post Office Box 2263 Smithfield, North Carolina 27577
(Address)
9190 989-5075 do hereby authorize Ael 717NCS# % �!
(Phone Number) (Owner/Operatof of Septage Management Firm)
of
(Septage Management Firyfti Name and address)
L
Email Address: A _ znta5 ,t-3qq S- 0 a `_ cD
to dispose of: domestic septage , portable toilet waste
Johnston County does not accept grease traps and pumpings.
L,
Johnston County, North Carolina
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Johnston County Sludge Handling Facility, 680 County Home Road, Smithfield. North Carolina
(Location)
between the hours of 8:00 A.M. thru 4:45 P.M. -Monday through Friday.
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2023 _
(Usually December31, Year)
Signed C C �.��`7 _ Date
John D. Wall e facility Operator)
Sworn to and subscribed before me this _ day of (� �; ' �ju{ ac)
A_�r,^V*\ �•,c J`.-Jp My Commission expires: 4-1-2023
Nancy House (Notary Public)
(OFFICIAL SEAL,. -
*
Waste generated in other counties will not be accepted. All waste must be i NANCY HOUSE
generated in Johnston County. E NOTARY PUBLIC I
Note: Falsification of this document by the septage management firm JOHNSTON COUNT(, N.C.
shall lead to permit revocation.
\,Iy Commission Expires 4-1-2023.