NCS01692_2023Permit_Modify

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
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-�� Septage Management Firm�� �� w� �nffii�utr
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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 WWTP, Lillington NC
3. Rockfish Creek WRF, Fayetteville NC
2. Cross Creek WRF, Fayetteville NC
4. Septage Detention or Treatment Facility, SDTF-92-12
This permit does not entitle the permit holder to operate a Septage Land Application Site, a Septage Detention orTreatment Facility, orany other solid waste management facility
not specified herein.
Failure to operate as permitted mayresult in theDepartment suspending orrevoking thispennit, 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 Perry Digitallysigned by
Wm Perry Sugg
Date: 2023.07.12
Sugg 115:16 177-04'00?
Perry Sugg, Environmental Compliance Branch Head

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, N.C. 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, Scott McCoy #24382 Cross Creek WRF / Rockfish Creek WRF
(Plant Operator In Responsible Charge (ORC), ORC License Number, Name of Plant)
P.O. Box 1089 Fayetteville, NC 28302.1089
(Address)
[phone] do hereby authorize Gerald Temple
(Phone Number) (Owner/Operator of Septage Management Firm)
of Gerald Temple Septic Tank Service _ NCS# 01692
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste X ,
grease septage (grease trap pumpings) commercialAndustrial septage , from
Cumberland, Sampson, Johnston & Harnett counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Facility Influent Pump Station
-- (Location)
between the hours of Sunrise to Sunset
Reintroducing partially treated liquid Into a grease trap is acceptable Yes X No
This authoriza 'on shall be valid until December 31, 2023
Signed G Date_ �%i.2
(Fadii yOperator)
Subscribed and affirmed before me this &sz
pp
Gx. r �Gtlit,�
-(Notary Public)
day of
20 a 3
My Commission expires: t o - jj4 - 0-0 ato
Note, Falsification of this document by the septage management firm shall lead to permit revocation.
S;ISolid_Waste/CLAISEPTAGEIFORMSl2023 Firm AppiicationlWWrP Authorization Form 2023
00"IyIf!
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(OFFICIAL ���5',�'�•
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= PUBI.�� �.

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 intoWIRWR
holders detention or treatment facility.)
JUL 2023
V �� G_ I _SOLID WASTE SECTION
(Facility Operator)
2-7603
(Operator Address)
do hereby authorize: Gc4 K] ( /46yn ' ] �b 5 •1
(Owner of Septage Management Firm) ^
I -ems l,t..�' S� vt'r..e "CS # 0 1 a
(Name of Septage Management Firm)
l(3(o TeW, (zoo- L' I a Allf
(Address 6f Septage Management Fi )
to utilize septage detention or treatment facility # �C"^ r'_ _ for the treatment or storage of
septage
in 20 } The facility will be operated in accordance with the Septage Management Rules **.
Date:V✓1 Sign rl
(Facility Operator)
* As defined in G.5.130A-290(a)(32)
As defined in 15A NCAC 13B .0800
Return the properly completed form to:
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646