NCS01671_2023Permit_Initial

2023
Permit and Registration
Lago Vista Septic
is hereby issued a Septage Management Firm Permit,
STATE
_ Permit Number NCS-01671
o and registered as a
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EQ�J
ILL i2�ti�
-�� Septage Management Firm �� w� omeotal�llty
aunrt
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. Rocky River Regional WWTP, Concord NC
This pen -nit does not entitle the permit holder to operate a Septage Land Application Site, a Septage Detention orTreatment Facility, or any other solid waste management facility
not specified herein.
Failure to operate as permitted mayresultin the Department suspending orrevoking thispermit, 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 Perr Digitally signed by
PerryWm Perry Sugg
ate: 2023.05.18
Sugg D012:20-04'00$
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646
(1.) Firm name: (The "Firm name" must be exactly as it is shown on your vehicle(s)).
Street address of office:
City V State: C
Mailing address (if different): _
City:
Phone: Z-� 2.'"'
E-Mail: 00,Y
County: - tn�
(2.) Firm owners name:__ 1 lW9
.State: Zip
Fax:
• 0-n[`li'l
Septage Management Firm permit number: NCS # 0 r�1
t
y
1 1 7ptfC� Kam. _ l [ \1 �� o-_
Mailing address (if different): _[aptS -
City any State: _C. Zip
Phone: hU4 J tLtT �` Q 7- Fax:
(3.) Firm operators name: A C,r1 CriV �� Finn operator's title:
Mailing address (if different):6oA 4,�.Nv
City: State- V Zip: Z. Z
Phone: 10_i
) 14k -b Fax:
Imo,
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zw
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(4.) Type(s) of septage pumped: Write in the number of gallons pined in last 12 months (Example: Domestic: 50,000).
1 Domestic Portable Toilet Waste Grease (Restaurant) Treatment Plant Industrianommercial
(5.) N.C. Counties of Operation: t ltnl tAky vx kAh nvu a I Sk GAVI
county you are authorized to do business
(6.) Total Number of Pumper Vehides Operated:
Number used for. Domestic Septage:__,L.
Other. 2—
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License Tag # I Vehicle Identification # j Tank Capacity
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (,/) yes ( ) 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? ( ) yes ( ) no Initial Date
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: (d) yes ( ) no. If yes, submit Wastewater Treatment Authorization for each
plant, as indicated in Subparagraph .0834(c)(14) of the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: Expiration Date: SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
SDTF#: Expiration Date: SDTF#: Expiration Date:
(9.) Septage Management Firm Operator Training Completed:
Date: L_ Location: (Yi��2rJte— Hours:f --
Training Sponsored or Provided by: _ ) A [)F- a
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm: /
Registered Septage Management Firm: �/
Registered Portable Sanitation and Septage Management Firm:
Certification Statement
Hours:
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.
%4Lteas✓ 106 14?'Dcj
Signature (Signature of companyofiicial required)
Pn'n Name
Q^
oytm 1 MIA.,
Other Comments:
2
Date
Du3Dc!c
Title
Rev. 04-26-2021

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, NC27699-1646
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,. James Christian Sims, 0999309, Rocky River Regional Wastewater Treatment Plant
(Plant operator in Responsible Charge (pRC), ORC License Number, Name of Plant)
6400 Breezy Lane, Concord, North Carolina 28025
704-788-4184 x114 do hereby authorize Wanuei Alcauter (704-242-3402)
(Owner/Operator of Septage Management Firm)
of Lago Vista Landscaping R Septa
NCS # 01 ia71
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage YES , portable toilet waste YES
grease septage (grease trap pumpings) NO commercial/industrial septage NO , from
Cabarrus and surrounding counties. _
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
6400 Breezy Lane, Concord, NC 28025
(Location)
between the hours of 7AM and 7PM Monday -Saturday: Sunday upon request.
Reintroducing partially treated liquid into a grease trap is acceptable Yes d No
This authorization shall be valid until December 31, 2023
(Usually December 31, Year)
4
Signed Date May 15, 2023
James Christian Sims, Facility ORC
Subscribed and affirmed before me this
Angela Hill, Notary Public
15th
day of May 20 23
My Commission expires:
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_W2ste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorizatlon Form 2018

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
Sent via Email
Mr. Juan Carlos Rocha Villa
Lago Vista Landscaping & Septic
2517 Pageland Hwy
Monroe, NC 28112
NORTH CAROLINA
En vironmen (a I Quality
March 22, 2023
Re: New Firm — Assignment of Permit Number (NCS#)
Lago Vista Landscaping & Septic NCS-01671
Dear Mr. Rocha Villa:
We have received an Application for Permit to Operate a Septage Management Firm and a permit fee
payment in the amount of $800. Also, we have record of your attendance at the New Operator Class on
March 9, 2023. However, your Application for Permit to Operate a Septage Management Firm will
not be processed until at least one disposal authorization has been received, and the vehicle(s)
have been inspected for compliance with the rules and approved by the Division. When the Permit
to Operate a Septage Management Firm is issued, the Firm Permit Number will be NCS-01671. Please
note that this letter is not a permit.
Requirements for the pumper vehicle(s) can be found within 15A NCAC 13B .0835 of the Septage
Management Rules. As noted within Rule .0835 (b), the firm name, town name, phone number, and
permit number, NCS-01671, must be visible and permanently attached on both sides of the pumper
vehicle. Each letter must be at least 3 inches in height. When the required lettering has been completed,
please contact me at 919-707-8283 or by email at chester.cobb(C_ncdenr.gov to request a truck
inspection.
This letter shall not be considered as a permit to operate a Septage Management Firm. Please
note that you may not legally operate a septage management firm in North Carolina without a
permit. General Statutes, GS 130A-291.1 (c) states in part "A septage management firm that
commences operation without first having obtained a permit shall cease to operate until the firm obtains a
permit under this section." You are hereby advised that, pursuant to N.C.G.S. 130A-22, an administrative
penalty of up to $15,000 per day may be assessed for each violation of the Solid Waste Statute or
Regulations. If you have any questions, feel free to contact me at 919-707-8283.
Sincerely,
Digitally signed by Chester Cobb
DN: cn=Chester Cobb, o=NC DEC, ou=Division of Waste
Management, email=[e-mail], c=US
i Date: 2023.03.22 14:59:27-04'00'
Chester R. Cobb, Environmental Program Consultant
Division of Waste Management, NCDEQ
owr
�� North Carolina Department of Envirunmentai Quality I Division of Waste Management
z.,-DEf
217 West Jones Street 1 1646 Mai Service Center I Raleigh, North Carolina 27699.1646
919.707.8200