NCS01321_2023Permit_Initial

2023
Permit and Registration
Artis Septic Tank Service
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01321
o and registered as a
e:,e D
NORTH
EQ�J
A%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:
Hampton Roads Sanitation District, Hampton Roads, 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.
Digitally signed
Wm Perry by Wm Perry
Perry
Sugg
Sugg Date: 2023.02.27
12:12:28-05'00'
Perry Sugg, Environmental Compliance Branch Head

115123, 8:50 PN1
Resume Submission
For questions regarding this form or the online application process. please contact Jeffrey Bullard (htfp:llmailto:
Jeffrey. Bullard @ncdenr. gov)(919-707-8285) or Chester Cobb (http:Ilmail to:[e-mail])(919-707-8283).
I._irrr info
Firm name*
Art:is Septic Tank Service
i nP "Firm name" mast ne exacli,, as it is shown on your vehicie(s}.
Septage Management Firm permit number (NCS
NCS-01321
Pi(,ase enter the carndeie NOS 4, including the 5 end digits (NCS-XXXXXj
Street address of office*
S-ee[,A fd-95s
1821 ansemond Parkway
Address Line 2
City Stato 1 Province / Region
Sufffolk VA
f✓ostal i pis Crde Country
23434 USA
County
Out -of -State "
Mailing address same as street address of office?*
0 Yes ® %
https://edocs.deq.nc.gov/Formsiform/resume/203/293754 117

1/5123, 8:50 PM Resume Submission
Mailing Address'
St€eet Address
P.0. Box 21
.Addt9SS J112 _.
City State! Province, i Region
Carro=ton VA
Zip Code
23314 USA
Plhcne* Fax
557-285-8800
Email
zartissetic:@yahoo.com
Firm owner's name*
Zebedee Artis
Mailing address same as street address € f office?*
0 Yes * No
Mailing Address
,Street ,Qddr�Ss
P.O. Box 21
Add -ass Lsrc 2
City
Carrollton
Pasta;, Zip cods
2334
Phone*
?572858800
S;Ate I Province 1 F;egicn
VA
country
United States of America
Fax
https:lfedocs.deq,nc.gov/Forms/form/resume/203/293754 217

115123, 8:50 PM
Resume Submission
Making address same as street address of office?*
Yes 00 No
Mailing address*
P. 0. Box 21,
Address I-Ine 2
St2ta I Province 1" Reciarc
VA
Pos�pl." ZIP crx"E; Go:, In V�
23314 USA
Phone* Fax
7572858800
type and amount of septage pumped in the last 12 months
Amount in galluns*
Domestic 125,000
Portable Toilet Waste 0
G-ease (Pestaurant) 0
Treatrrent Plant 0
0
https://edocs.deq.nc.gov/Forms/formtresume/2031293754 3/7

115/23, 8:50 PM Resume Submission
North Carolina counties of operation
List each county you plan to do lousiness in:
GaLCS
Elizabeth City
Camden
sunbui'y
Vehicle Info
Do you plan to operate pumper vehicles?*
a Yes 0 No
"i certify, UT -,der 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 .0635(a) and vehicle lettering as required by 15A NCAC .0835(b)).
3 urthermore, I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 'I3B .0836(a). i am awe re that
there significant penalties for false certification including the possibility of line and imprisonment."
Signature's
x
Date
Date wili be captured on form submission
Title*
Owner
Choose how to add vehicle descriptions'
CW Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #*
Domestic Septage � 42141P
Domestic Septage 42143P
+ Add more vehicles
Vehicle identification #*
R10707
1 HTMSAAR87H411935
Tank Capacity*
3.000 x
3,200 x
https:lledocs.(Ieq. nc.govf Forms/formlresume/203/293754
4/7

1/5123, 8:50 PM
Resume Submission
Septage Disposal Method
For each rre['nod, indicate vv -Iher you PEar to use i' by checkh,g yes ar ro.
.Approved wastewater treatment plant*
Yes 0 No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization
(https:l/files.no.gov/ncdeg/DWMISW/Composting%2520and%252OLand%252DApplication/WWTP%2OAuthorization.pdf) for each plant as
indicated in su°'nparacgraph .0833(c)(14) of the Septage Management Rules,
forms to:
NC DEQ
Div;sion of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facikty Name Expiration Date* Authorization`
HRSD ; 2/31 /2023 i I(?aC
p
J 1 uis I reC
+ Add another WWTP
Septage Land Application Sites (SLAS)*
i � Yes ® No
Septage Detention or Treatment Facility (SDTF)
[' Yes 0 No
other disposal method*
?Yes ® No
Sepl age Management- Firm Operator Training Completed
Date's Hours*
6/25/2022 4
Location*
https:lledocs.deq nc goy/Pormslformlresumel203/293754 i17

115/23, 8:50 PM Resume Submission
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet G v
Septage Land Application Site Operator Training Completed
Date Hours
.............. . ...__
Location
New Bern
Training Sponsored or Provided by
Registration Type
Select one*
O Registered Portable Sanitation Firm
Q Registered Septage Management Firm
O Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
............ .........
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*
X
hips://edocs.deq.nc.gov/Formsitorm/resume/203/293754 6/7

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.
Ke v rV ,/. IJ" !4Z �a..i S 14k5
(Plant Operator in Resp+ nsible Charge (ORC), ORC License Number, Name of Plant)
O. Uo, 5-7©,9. be_a.ck. VA 93q?1 -O go
(Address)
?37- Wo- 70y2. do hereby authorize Mr. ?-P-69ct: A r-h' Jr. OwNrr•
(Phone Number) (Owner/Operator of Septage Management Firm)
of -2. AAii 5-o1,c —/.-k C.15arv;c- NCS# 61,ToZI
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage vo`� portable toilet waste ✓
grease septage (grease trap pumpings) ✓ commercial/industrial septage Y,/ A , from
IVoALf_C,tle/ A) N C
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
All �Avio ieJ Ym
(Location)
between the hours of /iM t� ?FRA J,r Jwe`k
Reintroducing partially treated liquid into a grease trap is acceptable Yes V- No
This authorization shall be valid until 21-iccM 6,o- 31 o;,,3
l(Usually December 31, Year)
Signed �Y Date �d
(Facili operator)
Su}5scribed and affirm, d be re me this day of
IX— 0 �
ry
My Commission expires:
'hammy 0. spasm
(0=)
OMWa "th of ftheFt
My Commist; m Expirm August 31, 2025
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solld_Waste/CLA/SEPTAGE/FORMS/2018 firm Application/WWTP Authorization Form 2018