NCS01286_2023Permit_Initial

2023
Permit and Registration
MDM Septic Services
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01286
oand registered as a e:,e D
NORTH CAROLINA
EQ�J
-�� Septage Management Firm awnen� f� wrnmenta�lty
4sr
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:
Elizabeth City WWTP, Elizabeth City, NC
Hampton Roads (HRSD), Virginia Beach, VA
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 Digitally signed by
Wm Perry Sugg
23
Sugg 115:22 42-0.020.0'
Perry Sugg, Environmental Compliance Branch Head

State of North Carolina
Environmental Quality
Waste Management
Application for Permit to Operate a
Septage Management Firm
For questions regarding this form or the online application process, please contact Jeffrey Bullard (httpJ/maifto:
[e-mail])(919-707-8285) or Chester Cobb (http-.//mail to:chester.cobb@ncdencgov)(919-707-8283).
Firm Info
Firm name*
MDM SEPTIC SERVICES INC
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)*
NCS-01286
Enter the five digits following the NCS #
Street address of office*
Street Address
937 Fentress Airfield Road
Address Line 2
City
Chesapeake
Postal / Zip Code
23322
County*
Currituck
Mailing address same as street address of office?*
O Yes O No
Phone*
7574260511
Email*
[e-mail]
State / Province / Region
VA
Country
United States
Fax
I7574265957

Owner info
Firm owner's name*
David R. Thieman
Mailing address same as street address of office?*
i- Yes O No
Phone* Fax
7574260511 7574265957
Operator Info
Firm operator's name* Firm operator's title
David R. Thieman Vice President/Secretary
Mailing address same as street address of office?*
® Yes O No
Phone* Fax
7574260511 7574265957
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 750,000
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:*
Currituck, Moyock, Elizabeth City, Knotts Islarid, and South Mills
Vehicle Info
Do you plan to operate pumper vehicles?*
(]/ Yes 0 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*
Date*
Date will be captured on form submission
Title*
President
Choose how to add vehicle descriptions*
Add vehicles individually O Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity's
Domestic
Septage
V 45518P
2FZXEWYBlYAGO4865
3,300 x
Domestic
Septage
v 45-543P
2FZSAZCV77AX81733
4,800 x
Domestic
Septage
V 61853P
1M2AW02C58N002279
4,500 x
Domestic
Septage
v 72068P
1FUY3MCB2XLA21435
3,800 x

+ Add more vehicles
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
Yes O No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization
(https://files.nc.gov/ncdeq/DWM/SW/Composting%2520and%252OLand%252OApplication/WWTP%20AUthorization.pclt) 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*
HRSD, PO Box 5902, Virginia Beach, I
Elizabeth City Wastewater Plant, 45(
+ Add another WWTP
Expiration Date* Authorization
12/31/2023 p Upload x
HRSD AUTHOR... 53.8... X
12/31/2023 n Upload X
ELIZABETH C... 65KB X
Septage Land Application Sites (SLAS)*
O Yes * No
Septage Detention or Treatment Facility (SDTF)*
O Yes Q No
Other disposal method*
O Yes Q No
i Septage Management Firm Operator Training Completed

Date* Hours*
9/7/2022 4
Location*
Hilton Garden Inn - Pier House 5353 N Virginia Dare Trail Roa
Training Sponsored or Provided bye`
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
0
Location
Training Sponsored or Provided by
i�lj
Registration Type
Select one*
O Registered Portable Sanitation Firm
O Registered Septage Management Firm
^. Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
We are located in Chesapeake (moved in September this is a new address
change) which is a City. Won't let me leave blank so I chose Currituck.
Certification 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
10/25/2022 F7
03:17:07 AM Y
Print Name*
Kimberly M. Thieman
Submit Save as Draft
Title*
President

NC SEPTAG E MANAGEMENT FIRM
Recertification of Pumper Vehide(s)
Septage Firm Permit #
Number of Pumper Vehicles:
NCS- 61 ' �-
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 by15A NCAC 13B .0844 (a) and vehicle
lettering as required by 15A NCAC 13B .0844 (b). I also certify that a log is
mai ed of each septage pumping event as required by 15A NCAC 13B .0839
(a). I a aware that there are significant penalties for false certification including
the pos bility of fine and imprisonment."
a
(Signature o ompany official required) Date
Print Name
Title
S:1Solid WastelclalseptagelformslPumper Vehicles Cetification.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.
1,
9-f'S-V
ej s IeO6 391
(Plant operator AResponsible Charge (ORC), ORC License Number, Name
C;4y
d 79cf
`Addr s)
t do hereby authorize y ,ifs tf i rg•".-) 19t : ' -_'
(Phone Number) (Owner/Operator of Septage Management Firm)
Of , "`� i) k4 • �c 0, v t C t' S A-10. NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage ^' portable toilet waste iJ
grease septage (grease trap pumpings) commercial/industrial septage - , from
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
SD b% :-Y-)hh S
-- t f- 4 .-.Jr ,
(location)
between the hours of 0-? o ' j q 00
Reintroducing partially treated liquid into a grease trap is acceptable Yes 1peo No
This authorization shall be valid until _ ] C F d'�1 t: L9D �-Z3
(Usually December 31, Year)
Signed : Date
(Facility Operator)
Subscribe and affirmed before me this
(Notary P blic)
-,-9 9-aa
2-4?- day of 20 22.
My Commission expires: ='S
(OFFl,E1A�FNC+'
0 T A,,�.�.
Note: Falsification of this document by the septage management firm shall lead to permit rA'caiPC s L I(, ; U
SVSolidwaste%EA/SEPTAGE/FORMS/2018 Firm ApplicationAMP Authorization Form 2018 �3
rr�HIII I u 11 U����p

MVnnoI
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 License Number, Name of Plant)
(Address)
'-160-?V q--� do hereby authorize Ms. ,trI f-rk;,,A. J?f,.sr e,11/0wive.^
(Phone Number) (Owner/Operator of Septage Management Firm)
of MDrA Se_ p c. eryic-ex . Ywc.. NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage . portable toilet waste
grease Septage (grease trap pumpings) _ y commercial/industrial septage �Jlh , from
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of 6 ArA & -7 PAA e m
Reintroducing partially treated liquid into a grease trap is acceptable Yes ✓ No
This authorization shall be valid until Der ens n e /' 3 eZ0
(Usually December 31, Year)
Signed Date /6/ /z Z
(Fa cili perator)
Sub cribed and affirrT�ecl efore me this day of 20
1
My Commission expires: ✓�
ic)
TV"C. SPMS
NotaryrPublic (OFFICIAL SEAL)
Reg. # mT7w
Common "M of Vtrgbft
MY CommhWon Explrea: August 31, IM
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

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North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
+vosrH caaourua
EnvrronuamrQ�tary Solid Waste Section
Division of Waste Management To: °David Thieman
Solid Waste Section MDM Septic Services
1646 Mail Service Center 1400 Campbells Landing Rd
Raleigh, NC 27699-1646 Virginia Beach, VA 23457
Phone/Fax: [phone]
Email: [e-mail]
Date: 09/27/2022
Invoice #: NCS-01286-2023
Septage - Annual:
MDM Septic Services (NCS-01286)
1400 Campbells Landing Rd $800.00
Virginia Beach, VA 23457
Number of Trucks: 4
Date Due: 12/15/2022
m-
LATE FEES. {n accv daVcp witrt NC General„ Statutes , ,13QA-251.1Se2), , Igte fie wilt be applied co any annual pe(mit fees,nat submitted by January1, 023.
Payment Options:
E-check Available online at https://deo.nc-nov/swpaay
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/swpav
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 Jared Wilson [phone]
Regulations or Technical Assistance Chester Cobb [phone] PA I
Jeffrey Bullard [phone] CK 140. 2. 12o7
More information available n the web: DATE I IDI% ?!vz
North Carolina Department of Environmental Quality (DEQ) - https://deq.nc.aov $ $D0 o0
North Carolina Solid Waste Program-httr.s:�!de:.nc.:ovrabou •division waste-mana ement. solid -waste -section
North Carolina Septage Management Program - httos:; idea, nc.,,ov/about,divisions waste-manap-men .'solid-waste-section/zecial-wastes-and-alternative-
handling/septtaae —