NCS01341_2023Permit_Initial

2023
Permit and Registration
Shorties Pot O' Gold
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01341
oand registered as a
NORTH
EQ
i2. ��
-�� Septage Management Firm�� �� w� ��nffii�utr
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. Warren County WWTP, Warrenton, 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. Digitally signed by
Wm Perry Wm Perry Sugg
Sugg 112 18 26-050'00'7
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*
Shorties Pot 0 Gold
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01341
Enter the five digits following the NCS #
Street address of office*
Street Address
961 Fleming Mill Rd
Address Line 2
City
State / Province / Region
Macon
NC
Postal / Zip Code
Country
27551
United States
County*
Warren
Mailing address same as street address of office?*
Yes • No
Mailing Address*
Street Address
PO Box 1049
Address Line 2
City
State / Province / Region
Littleton
NC
Postal / Zip Code
Country
27850
United States
Phone* Fax
2525862256
Email*
[e-mail]
Owner Info
Firm owner's name*
Daniel Long
Mailing address same as street address of office?*
Yes 0 No

Mailing Address*
Street Address
PO Box 1049
Address Line 2
City
Littleton
Postal / Zip Code
27850
Phone*
2525862256
Operator Info
State / Province / Region
NC
Country
United States
Fax
Firm operator's name* Firm operator's title
Daniel Long owner
Mailing address same as street address of office?*
Yes • No
Mailing address*
Street Address
PO Box 1049
Address Line 2
City
State / Province / Region
Littleton
NC
Postal / Zip Code
Country
27850
USA
Phone* Fax
252 578 5424
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 31 7, 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: *
Warren,Halifax,Northampton,Vance,
In VA Brunswick and Mecklenburg
Vehicle Info
Do you plan to operate pumper vehicles?*
0 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
Date*
12/9/2022
Title*
owner
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage* License Tag #* Vehicle Identification #* Tank Capacity*
Domestic Septage fb9930 1HTLDUXP3GHA13144 2,300
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
• 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*
Warren County WWTP
Septage Land Application Sites (SLAS)
Yes • No
Septage Detention or Treatment Facility (SDTF)
Yes •) No
Other disposal method*
Yes 0 No
Expiration Date* Authorization
12/31/2023 2023 325.22...
Completed
Authorization
to Discharge
Permits.pdf

Septage Management Firm Operator Training Completed
Date* Hours*
12/3/2022 4
Location*
NC State Fairgrounds
Training Sponsored or Provided by*
NC Pumper Group & NC Portable Toilet Group
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
Z�-Iu \�41
Date
12/9/2022
08:38:16 AM
Print Name* Title*
Daniel Long Owner

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, William R. Perkinson, ❑RC License Number 987831
(Plant Operator in Responsible Charge (CRC) and ORC License Number)
Warren County WWTP, 738 US Hwy 401 S„ PO BOX 281, Warrenton, NC 27589
(Address)
252-257-1776 do hereby authorize Daniel Lon
(Phone Number) (OwnerlOperator of Septage Management Firm)
of Shorties Pot of Gold NCS #01341
(septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste X
grease septage (grease trap pumpings) commercialtindustrial septage . from
Warren. Vance. Granville and surrounding counties
(County or other Geographic Area)
at the above -named wastewater treatment facility. septage shall be discharged at:
Influent works
(Location)
between the hours of 8:00 AM - 3:30 PM Mondav - Fridav
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2023
(Usually December 31. Year)
Signed �r� /� 1 Date Za -
{Facility Qperator)
Sworn to and subscribed before me this 1
yf
day of L _ i�l ,' 20
My Commission expires: ^ �6 )(_ .4r
( otary ub ic)
ve
. =:
�U 40TAl�i- Z
Note: Falsification or this document by the septage management Finn shall lead to permit revocation. M
SJSolid_Waste/CLA/SEPTAGE/FORMS12013 Firm ApplicationNVWTP Authorization Farm 2013Ile
• N N0.

North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NORTH CAROLINA
o9,rerueY Solid Waste Section
Division of Waste Management
To:
Daniel Long
Solid Waste Section
Shorties Pot O' Gold
1646 Mail Service Center
PO Box 1049
Raleigh, NC 27699-1646
Littleton, NC 27850
Phone/Fax: [phone]
Email: [e-mail]
PAI
CK NO.
DATE
12--/3-22
Date: 09/27/2022
1). e v
Invoice #: NCS-01341-2023
Septage - Annual:
Shorties Pot O' Gold (NCS-01341)
PO Box 1049 $550.00
Littleton, NC 27850
Number of Trucks:1
Date Due: 12/15/2022
LATE FEES: In accordance with NC General Statutes G5130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted by January 3. ?023.
Payment Options:
E-check Available online at https://deq.nc.gov/swp_ay
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/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.]
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.]
Explanation 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.00v
North Carolina Solid Waste Program - https://dgq.ng.gov/about/divisions/waste-management/solid-waste-section
North Carolina Septage Management Program - htts:/p_ /deu.nc.aov/about/ ivi ions/waste-managemg_ny5olid-waste-section/sr)ecial-wastes-and-alternative-
handlin 2Vtaoe

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