NCS01692_2023Permit_Initial

2023
Permit and Registration
Gerald Temple Septic Service, LLC
is hereby issued a Septage Management Firm Permit,
STATE
_ Permit Number NCS-01692
o and registered as a
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NORTH
EQ�J
ILL i2�ti�
-�� Septage Management Firm�� �� w� �nffii�utr
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. North Harnett Regional WW'I"P, Lillington 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
Y Wm Perry Sugg
Date: 2023.06.01
Sugg 13:11:31-04'00'
Perry Sugg, Environmental Compliance Branch Head

APPLIC TION FOR P MIT 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, as it is shown on your yehicis(s)).
_ rjh o, _- 5eptl G '(Py14P� L. L. C.
Street address of office:
City: y I !rc 1 State: ��.� 6 Zp: 7 F Z 7
Mailing address (if different):
City: State: Zip
Phone: 3 F4� .z �} _
ax: f
E-mail: h L 17 LAW
Courtly: 6t P - Septage Management Firm permit number. NCS # _ VF V
(2.) Firm owner's name: 1 a h rr f- �yA A � �
Mailing address (if ftmnt):
City:
State: zp
Phone. 2 r 0- IH-75 13 Fax
(3.) Firm operator's name.. Firm operator's title.
Mailing address (if different): �-
Phone.
State: 4p:
Fax;
K) Type(s) of septage pumped: YYrf[4e in the number of aggons BUMBUMBed 1
kU 2
,�,1. , (Example: Domestic: 50,000),
Toilet
(5.) N.C. Counties of Operation:
Treatment Plant
(List each county you arse autlfonxed to do us ness m}
(6.) Total Number of Pumper Vehicles Operated:
Number used far Domestic Septage:��� Grease (restaurant):
Other. Portable Toilet Waste: `
Vehicle Information: (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(T.) 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? (oyes ( } no Initial_ ^ .Date
(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 theSeptage 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: 5 -11 2,3 _ Location: c h i' 1 Hours:
Training Sponsored or Provided by. !)/C 9
(10.) Septage Land Application Site Operator Training Completed:
Date: Location: Hours:
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: V11"
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 penattles for knowingly making a false Statemment, representation, or cerfificatron.
Signature (Signature of,companyo- requ#ed)
4 k
Print Name
Other Comments:
-• 31
Date
" h
Title
DAr:F 7
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, 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, Billy J. Thomas (Grade IV VM # 995445). ORC North Harnett Regional VWVTP
NPDES # NCO021636
607 Edwards Brothers Drive Lillington NC 27546 910-893-2424
do hereby authorize Hunter Johnson and/or Gerald Temple
of Gerald Temple Septic Service, LLC NCS # 01692
(this will also include duly appointed drivers of the company)
to dispose of: domestic septage at the above named WWTP.
Septage shall be discharged at: Septage Receiving Station at NHRWWTP
between the hours of
This authorization shall be valid until 12-31-23
Signed-�
(Facility Operator)
r-Oct
Date 5-2 ao s
Subscribed and affirmed before me this dAZday of 2023
My Commission expires: ofZ aka
(OFFICIAL SEAL)
OFFICIAL SEAL
Notary Public; North C2rolina
County of Hamett
Carolyn K.Eurayama
J
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2016 Firm Application/WWTPAuthorization Form 2017

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
Sent via Email
Mr. Hunter Johnson
Gerald Temple Septic Service, LLC
1896 Temple Road
Bunnlevel, NC 28323
NORTH CAROLINA
En vironmen (a I Quality
May 24, 2023
Re: New Firm — Assignment of Permit Number (NCS#)
Gerald Temple Septic Service, LLC NCS-01692
Dear Mr. Johnson:
We have received an Application for Permit to Operate a Septage Management Firm and payment of the
$550 permit fee. 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 bythe Division. When the Permit
to Operate a Septage Management Firm is issued, the Firm Permit Number will be NCS-01692. 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-01692, 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 email at Chester. Cobb(a-)d eq. nc. gov to request a truck inspection.
This lettershall 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: Chester Cobb, o=NC DEQ, ou=Division of
Waste
Management,
email—[e-mail], c=US
r Date: 2023.05.24 16:00:07-04'00'
Chester R. Cobb, Environmental Program Consultant
Division of Waste Management, NCDEQ
owr
�� North Carolina Department of Environmentai Quality I Division of Waste Management
z.,-DEf
217 West Jones Street 1 1646 Mail Service Center I Raleigh, North Carolina 27699.1646
919.707.8200