NCS01354_2023Permit_Initial

2023
Permit and Registration
Tarboro Septic Tank NC LLC
is hereby issued a Septage Management Firm Permit,
STATE,, _ Permit Number NCS-01354
oand registered as a e:,e D Qi�
NORTH
A%L 12. rim
-�� Septage Management Firm�� �� w� ��nffii�utr
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:
1. Septage Detention or Treatment Facility, SDTF-74-18, SDTF-98-08
2. Septage Land Application Site, SLAS-74-18
3. Tar River Regional WWTP, Rocky Mount, 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
Wm Perryby Wm Perry
Sugg
Sugg Date: 2023.02.27
12:20:29-05'00'
Perry Sugg, Environmental Compliance Branch Head

DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646
(i.) Firm name: (The "Rim name" musf be jU as it is shown on your vehlcte(s)).
��2� � G7 1� ��� J C
Street address of office: 96/"!- / P,_d
City: ;�v�� j �c�i State: /V C Zip: _Q 1%8 4.
Mailing address (if different): u 3
City: r - 9d State: L`C, Zip 3793 ?f
Phone: S J o Fax:
E-Mail:C�,
County:Septage Management Firm permit number: NCS #
(2.) Firm owner's name:
Mailing address (if different):
City: r i? �i' State: Zip
Phone: Fax:
(3.) Firm operator's name:Firm operator's title —
Mailing address (if different): % �ql 5'0 e ejl 2A
City: {-10 ? J State. A/ G Zip: o-� -7 8
Phone: ����5�r`�(Y� iL Fax:
a •- • -• ;•- • r-• i ':i' r ��' r.1�.'' � r .'- 'J ��,r1[.���, t - 71 •��.t • - �• - 1 11i
Domestic
Portable Toilet Waste
Grease (Restaurant)
Treant Plant
lndustriaVCammercial
�
(5.) N.C. Counties of Operation: ' e%� � ,' l i e ilr r IV w; k,E"-1
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: I
Number used for: Domestic Septage: 1 Grease (restaurant): j
Other: Portable Tort Waste:
Vehicle Information: (use additional paper if )
License Tag #
Vehicle identification #
Tank Capacity
n
2
3
4
5

(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? (A) yes ( ) no Initial Rf Date )d Z - J
(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 theSepfage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLASP �7 q -! �3 Expiration Date: SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF# 5 Expiration Date: SDTF#: Expiration Date: _
(9.) Septage Management Firm Operator Training Completed:
Date: 1 � -3 - Location: 1�. c�L o tac it: �u L Hours:
Training Sponsored or Provided byUU^Y�
(10.) Septage Land Application Site Operator Training Completed:
Date: Location: r'_cl"<.ti1. f Hours:
Training Sponsored or Provided by: r", C Pism(>� s�rp
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
Print Name
Date
0wA c
Tale
am
Rev.04-26-2021

Site Operator: 4c'tt
SLAS Permit #:
Site Location:
(street address for the site or latitude and longitude)
Number of acres permitted: 1,0
Permitted application rate: V
(gallons septage per acre per year)
Crop(s):_ C�Lf
Crop nitrogen requirement(s): '?
(pounds nitrogen per acre)
"I certify, under penalty of law, that the pathogen requirements in (insert either
503.32 (c)(1) or 503.32 (c)(2)) and the vector attraction reduction requirements in
(insert 503.33 (b)(9), 503.33 (b)(10) or 503.33 (b)(12)) have been met. This
determination has been made under my direction and supervision in accordance
with the system designed to ensure that qualified personnel properly gather and
evaluate the information used to determine that the pathogen requirements and
vector attraction reduction requirements have been met. I am aware that there
are significant penalties for false certification including the possibility of fine and
imprisonment."
(signature) (date)
S:\Solid—Waste\clakseptage\forms\SLAS-Application & Authorization12011 SLAS Log.doc

Landowner's Authorization to Operate a Septage Detention or
Treatment Facility
{�ati,� ll�mn-5
C�s-1yo� �cm�-s
North Carolina Department of Environmental Quality
Division of Waste Management- Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
(name of site owner) hereby certify that I am the owner of
0 acres of land located PfCK-, on dP-PXVif"ti)L-N a�- 19elX64 IJ�)1,Qj and
identified by de's-- 1 Z-I "j bi (book and page of recorded deed or tax map parcel) and
that I agree to allow -3.4r",:+ (SDTF permit applicant) to use
said land for a septage detention or treatment facility for a period of ) (length
of time), beginning 1 a- IS —Oa — ) Z-)S-Z3 (give date) and that I have read the North Carolina
Septage Management Rules *. I further understand that no septage may be stored or treated on the land
until the Division of Waste Management has issued a permit for a detention or treatment facility. The above
described property is owned solely by me orjointly with 6ZU4, l snGs i lJ�vA i`k crs
J
�c. r l j" `f6v\j�5 (names of all co -owners, or state none).
C�JO Date / Q--�-
� L. f
Signature of landowner 711 D�W !-z—
L i2Z
Sworn to and subscribed before me this day of r 20
(Notary Pub c)
My Commission expires: "n G-'�
* 15A N.C. Admin. Code 13B Section .0800
t� N qu
0 T4�g�- .��
U IC
OUNT°f + a
Rev. 01-07-16

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TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management — Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Operator and Facility Information
Applicant
Address
Phone
2. Contact person for site operation (if different from applicant):
Title or position V ew i -i- v,- �--&; Phone
Address
3. Landowner
Address c?' u C 9,ox jl. Ll3 C.'t'V;li
L'; v ��d1� + ;� j..7? � a.,} �'� dJ; : �t;�i��.k?; •kri�iC i°�Jv- i� I
4. Site Location: County Ff iT 0-D State Road Number
Directions to site:_.
5. Is the location on a permitted Septage Land Application Site? 8es
If yes, give the site permit number here: .S LNI
6. Indicate whether project is: new renewal modification
For a permit renewal or modification, indicate the existing permit number rSt!`- and the
permit expiration date
7. Attach written, notarized landowner authorization to operate a septage storage or treatment facility
form signed by the landowner (if the permit applicant does not solely own the property). /f a
corporation owns the land use a corporate landowner authorization form. If Limited Liability
Company owns the land, use a limited liability company landowner authorization form,
8. Aerial photograph scale 1 inch = 400 feet with site property lines accurately located on the photograph
must be enclosed (if 1 inch = 400 feet is not available, 1 inch = 660 feet may be substituted).
9. Vicinity map (county road map showing site location).
10. Land application site or wastewater treatment plant to be used after treatment or storage:
(over)

lL Facility Information: the following information shall be included with the application form.
1. Facility to be used for. Storage
V/
Treatment
2. Types of septage to be stored or treated,
Domestic Septage Grease Trap Pumpings
Portable Toilet Waste Commercial/Industrial Septage
Types of treatment to be provided: pH Adjustment (lime stabilization) V
Screening Other (attach explanation if other)
4. A description of the proposed detention or treatment facility including the size, type, and number of
structures to be used and how those structures will be constructed or installed (use additional
paper to explain, if n,acessary
� s
6. An explanation of how septage will be discharged into and removed from the facility (use
additional paper to explain, if necessary):
6. An explanation of how any leaks or spills at the facility will be cleaned and how odors will be
controlled use additional paper to explain, if necessary):
F n
III. Certification
I hereby certify that
1. The information provided on this application is true, complete, and correct to the best of my
knowledge, and
2. I have read and understand the N.C. Septage Management Rules.
3. l am aware of the potential consequences, including penalties and permit revocation, for
failing to follow all applicable rules and the conditions of a Septage Detention or Treatment
Facility permit
Signature (Signature of company oific iairequired!) Date/
Print name Title
Note: This application will not be accepted for review until all parts of the application are complete.
S:Solid_Waste\ctalseptage\foms\SDTF-Application & AuthorizationlSDTF Permit Application -Jan 2016.docx
Rev 01-07-16

� � „ !. a. 1, f.. s .... � � � f s 4 1 ...,. i. .►, .., ' F � h: f � ► � '. ,.
North Carolina Department of Environmental Quality
Division of Waste Management — Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Site and Operator Information
1. Applicant
Address
Phone
Contact person for site operation (if different from applicant):
Title or position Phone
Address ,
3. Landowner
Address
4, Site Location: County State Road Number
Directions to site:
5. Indicate whether request is: new renewal ✓ modification
For a permit renewal or modification, provide the following information:
Existing site permit number: '�H 11 permit expiration date:
6. Number of acres meeting the requirements of the N.C. Septage Management Rules: P acres.
7. Substances other an septage or grease trap pumpings previously disposed of on the site:
(a) None , or (b) Attach a list indicating other substances, the amounts discharged,
and the dates of discharge.
8. Attach written, notarized landowner authorization to operate a septage disposal site signed by the
landowner (if the permit applicant does not own the property). If a corporation owns the land
use a corporate landowner authorization form. if Limited Liability Company owns the land,
use a limited liability company landowner authorization form.
9. Attach site evaluation report, including aerial photograph and soil analysis with metals results,
unless the Division prepared the report.
10. Attach a vicinity map (county road map showing site location).
(over)

11. Site Management Information:
1. The following information shall be included with the application form:
(a) Nutrient Management Plan
(b) Soil Erosion and Runoff Control Plan
2. Alternative plan for disposal (detention facility permit number or wastewater treatment plant
authorization): '?Lj -1 '�) C1.A'; i rU"9w— I- C( —
3. Types of septage proposed to be discharged at the site (check all that apply):
(a) Domestic septage pumped from septic tanks
(b) Grease trap pumpings
(c) Portable toilet waste
(d) Commercial / Industrial septage
4. Proposed treatment method of each type of septage to be land applied (use additional paper to
explain if necessary):
5. Proposed method of applying septage to land, including septage distribution plan if required * (use
additional paper to explain if necessary):
6. Demonstration from the appropriate state or federal government agency that the land application
site complies with the Endangered Species Law ** or if any part of the site specified is not
agricultural land (use additional paper to explain if necessary):
Ill. Certification
I hereby certify that:
1. The information provided on this application is true, complete, and correct to the best of my
knowledge.
2. 1 have read and understand the N.C. Septage Management Rules, and
3. 1 am aware of the potential consequences, including penalties and permit revocation, for failing
to follow all applicable rules and the conditions of a Septage Land Application Site permit.
iLf ' ( KUIJA�I
Signature (Signature of company official required) Date
V,e,l e 1N kAQe I-e r
Print name Title
Note: This application will not be reviewed until all parts of the application are complete.
* Refer to Section .0837(e) of the W.C. septage Management Rules.
' Refer to Section .0837(g) of the M.C. Septage Management Rules.
S_Solid WastelclalseptagelfomislSLAS Application & AuthorizationlSLAS Permit Application -Jan 2016.docx
Rev 01-07-16

AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
(This form is used by a detention or treatment facility permit holder to indicate that permission has been given to a permitted
Septage Management Firm to discharge septage into the permit holders detention or treatment facility.)
441 Buck Newsome Rd. Fremont, NC 27830
do hereby authorize:
Tarboro Septic Tank of NC, LLC
Daniel L Newsome
(Facility Operator)
(Operator Address)
Keliie Wheeler
(Owner of Septage Management Firm)
NCS #
01354
(Name of Septage Management Firm)
PO Box 203 Speed, NC 27881 252-544-0596
(Address of Septage Management Firm)
(009553)
98-08
to utilize septage detention or treatment facility #
for the treatment or storage of septage *
in 2023._The facility will be operated in accordance with the Septage Management Rules **.
11-01-22
Date:
* As defined in G.S.130A-290(a)(32)
** As defined in 15A NCAC 13B .0800
Signed
a sty Operator)
Return the properly completed form to:
North Carolina Department of Environment and Natural Resources
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

9.
ROCKY MOUNT
WATER RESOURCES
THE CENTER OF IT ALL
SEPTAGE DISPOSAL PERMIT (SDP)
Tarboro Septic Tank NC, LLC
P.O. Box 203
Speed, NC 27881
CRM-01354
Permit Number
N/A
40 CFR Category
The City of Rocky Mount (City) agrees to allow the discharge of septage wastewaters collected
as described in Part I, D, into the Tar River Regional Wastewater Treatment Facility; herein
"WWTP", at the designated disposal site:
Tar River Regional WWTP
3031 Treatment Plant Rd
P.O. Box 1180
Rocky Mount, NC 27802-1180
Edgecombe County
NPDES Number: NCO030317
Effective date, this permit and the authorization to discharge shall become effective at midnight
on this date:
January 1, 2023
Expiration date, this permit and the authorization to discharge shall expire at midnight on this
date:
December 31, 2023
s Costello, Wastewater Superintendent Date
City of Rocky Mount
1��
Subscribed and affirmed before me this �-- day
— 1
My Commission Expires: v E%
(Notary Public)
Beverly Anne Harrelson Ricks
NOTARY PUBLIC
Nash County= NC [OFFICIAL SEAL]