NCS01696_2023Permit_Initial

NORTH CAROLINA
Environmental Quality
2023
Permit and Registration
Mountain View Septic LLC
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01696
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
NORTH CAROLINA �EQ
W/11
Department at Environmental quality
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. Archie Elledge WWTP, Winston-Salem 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.
Wm Perry "I"'llysigned byWrn
Perry Sugg
Date: 20
Sugg i13:3638-04'00'1
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)).
f'10cin�-a;0 L'LG
Street address of office: 5 a.Lro f -p w 11 roN�
City: G e rlNlofl lon State:_p(f _Zip:
Mailing address (if different):
City:
55— V
State: Zip
E-Mail: (hQW1f-h-rViC►a6ed J'G P pMOI`j •COM
County: i-45 Septage Management Firm permit number: NCS #
(2.) Firm owner's name: Gh r i6 kcm 3o 6n bcwi S
Mailing address (if different):
City: State: Zip
Phone: Fax:
(3.) Firm operator's name: G hr;SiYan „ )2�n '1)Wi`5 Firm operator's title: ouner
Mailing address (if different):
City: State: Zip:
Phone: Fax:
M 0
.ON
ro�
0
(4.) Type(s) of septage pumped: Write in the number of Uallons,Rumned in last 12 months (Example: Domestic: 50,000).
I Domestic I Portable Toilet Waste I Grease (Restaurant) I Treatment Plant I Industrial/Commercial I
(5.) N.C. Counties of Operation: &0+ x f h
(6.)
(List each county you are authorized to do business in)
Total Number of Pumper Vehicles Operated:
Number used for. Domestic Septage:
Other.
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste:
License Tag #
Vehicle Identification #
Tank Capacity
- ©
5 G U `t
16 0.
--tG--- t;blfof6-
2
1200 Gallons
3
IRB 8/1/2023
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION FOR PER?' ff TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) X 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? K yes ( ) no Initial Cb Date
(8.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( ) yes (x ) 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 Appication Site (SLA.S) 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 Figs Operator Tr* ing Completed:
Date: y3 Location: OnI"fe Hours: "r
Training Sponsored or Provided by: Je )�w1�Qr
(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:
I certify that the information and representations in this appiicafion 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 (Signature of companyoiitciai required7
t✓hrris+-;aj
Print Name
Other Comments:
Date
Title
/)-1 /4
PAGE 2
Rev. 04-26-2021

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, Matthew Lavigne- W W#997822-Archie Elledge Wastewater Facility
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
2801 Griffith Rd. Winston-Salem, NC 27103
(Address)
336-765-0130 do hereby authorize Christian Davis
(Phone Number) (Owner/Operator of Septage Management Firm)
of Mountain View Septic LLC NCS # 01696
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X portable toilet waste
grease septage (grease trap pumpings) NO commercial/industrial Septage , from
Winston-Salem/Forsyth County and Adjacent Counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Archie Elledge Wastewater Facility
(Location)
between the hours of 6:00 am until 6:00 pm Monday Through Saturday
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 �(/ �� Date a3
(Faci' erator)
F�
Subscribed and affirmed before me this ( 0
(Notary Public)
day of J u-A 1 , 20 a3
My Commission expires: `J I a 3 f "�-o 3-1
Notary Public, North Carotins
Forsyth County (OFFICIAL SEAL)
My C,pmmipa(on Expires
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CWSEPTAGE/FORMS/2018 Firm Application/W WTP Authorization Form 2018

ROY COOPER V
Governor OELIZABETH S. BISERSecretary
MICHAEL SCOTT NORTH CAROLINA
Director Environmental Quality
July 6, 2023
Sent via Email
Mr. Christian Davis
Mountain View Septic LLC
1550 Sauratown Road
Germanton, NC 27019
Re: New Firm — Assignment of Permit Number (NCS#)
Mountain View Septic LLC NCS-01696
Dear Mr. Davis:
We have received an Application for Permit to Operate a Septage Management Firm and payment of
$550 for the permit fee. 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 submitted to this Office 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-
01696. 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
Dermit number. NCS-01696. must be visible and Dermanently attached on both sides of the DumDer
vehicle. Each letter must be at least 3 inches in height. When the required lettering has been completed,
please contact Ms. Stephanie Williams, Environmental Specialist II in the Asheville Regional Office at
[phone] or email at stephanie.williams(a)deq.nc.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, ail=Destou=Division n
49 Waste Management, email=[e-mail],
C=US
Date: 2023.07.06 15:27:18-04'00'
Chester R. Cobb, Environmental Program Consultant
Division of Waste Management, NCDEQ
copied: Stephanie Williams, Environmental Specialist II, Asheville Regional Office
D E Q�� North Carolina Department of Environmental Quality I Division of Waste Management
217 West Jones Street 11646 Mail Service Center I Raleigh, North Carolina 27699-1646
NORTH CAROHNA -
oepaememorEnvimnmenGlaaality /"� 919.707.8200