NCS01635_2024Permit_Initial

NORTH CAROLINA
.Environmental Quality
2024
Permit and Registration
DWRG Septic Services
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01635
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
Q:>
NORTH CAROLINA �E
Department of 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. Elizabeth City WWTP
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 this registration expire on December 31, 2024.
Sugg
W m Perry S u g g Datea202 lly 01.11b1 52 Perry
2 r 5'00'
Perry Sugg, Environmental Compliance Branch Head

l 1 e�tl O 2ra40 C'
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT, SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646
50
(1.) Firm name: (The "Firm name" must be exactly as it is shown on your vehicle(s).
�i• irk . rT i cis: o �a''!t'> ,'srI`.�
Street address of office: Za l l3G�r�/, / / 7✓ ,
City: , 4" 4101, C. 'L,] State: AJ, G. Zip: 'Z7 709
Mailing address (if different):
City: State: Zip:
Phone: 2 52' 35�-'� Fax:
E-Mail: /1/0 vc- &V, .rl s ele,?rl,
County: �n < nt,P(�`i �J-n1 - Septage Management Firm permit number: NCS #
(2.) Firm owner's name:r-;
Mailing address (if different):
City: State: Zip:
Phone: '� 39 Fax:
(3.) Firm operator's name: IJr. ., 7)4/0 4ra.7 Firm operator's tiit�tle:.��✓���
Mailing address (if different):
City:
State: Zip:
Phone: Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in 2015 (Example: Domestic: 50,000).
Domestic
R
Portable Toilet Waste I Grease (Restaurant) 1 Treatment Plant I Industrial/Commercial
o I o o I 0
(5.) N.C. Counties of Operation: zs2y-Y.1v..���,y,_..s �-•�!�/! ���
(List each county you do business in)
(6.) Total Number of Pumper Vehicles Operated: 00
Number used for: Domestic Septage: Grease (restaurant): p Ja
Other: Portable Toilet Waste: 1
Vehicle Information: (use additional paper if needed) CSC �r 10 2bZy
I I License Taa # i Vehicle Identification # I Tank Capacity A-`� %-' - ' " I
JRB 10/31/23
. J
APPLICATION CONTINUED ON PAGE 2
Paid $250.00 1/5/2024 for total of $800.00 for
PAGE 1 2024 Permit fee.

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: yes no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagrap .0833 c 4) 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: _
Septage Management Firm Operator Training Completed:
Date: Location: Hours:
Training Spnnrnrpri or Provided by: _'L�c /- L/IC i
(9.) Septage Land Application Site Operator Training Completed:
Date: Location: Hours:
Training Sponsored or Provided by: _
(10.) Registration type requested: CHECK ON
Registered Portable Sanitation Firm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm: F
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 penalties for knowingly making a false statement, representation, or certification.
Print Name
Other Comments:
Truck passed inspection on10/27/2023 JRB 1/10/2024
�1111 2�z2
Oat'e
Title
SJSolid_waste:ICLA/SEPTAGE/FORMS/2016 Firm Application/Firm PermitApplication2016
PAGE 2

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.
" 4 v74-6 Vj � �tou -'-L / om �3 s/ �
e �wo)�—
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant) I
(Address)
t" ?c n 7 (01`cago hereby authorize
(Phone Number) (Owner/Operator of Septage Management Firm)
of
T
(SeptAe Management Firm Name and NCS number)
to dispose of: domestic septage portable toilet waste
NCS #
grease septage (grease trap pumpings) commercial/industrial septage ; from
Of
(County or other Geographic Area) _
at the above named wastewater treatment facility. Septage shall be discharged at:
in�� CY O 7,wL-
catiq�)
between the hours of
Co-3 �—/
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
This authorization shall beyaAid until -e-CemL 3 /f 2-o Z-y
/ (Usually December 31, Year)
Signed L» -� Date_/ z — Z Z - Z3
(Facility Operator)
Subscribed and affirm before me this day of(,��� l� J
L My Cornission expires:
(Notary Public) KAUq/
m
"' am 4O (OFFICIAL SEAL)
J �
w NOTARY ; m
v ; PUBLIC c�
Note: Falsification of this document by the septage mgg T6/6049`,*1 J�ad to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Ad#1,or�ztF(}f� Q,1$�
i���„I W O",