NCS00860_2024Permit_Initial

2024
Permit and Registration
Village of BHI Utilities Dept.
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00860
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. Bald Head Island WWTP, Bald Head Island, 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, 2024.
Digitally signed by Wm Perry
Wm Perry S u g g Dagte: 2024.02.05 11:42:25-05'00'
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)).
Nji\\a4ekRA6 uk� ,kke-4
Street address of office: .25 (o 6Ata10'e b ex� , Y
City: ePL4 Stater C.Zip: 2 L(. to (
Mailing address (if different): Q . 1?>QA 3 00
City: 11r1 'J4 tangy State: 14(, -Zip
Phone: - Ll Sri R "? 0 Fax:` — LI 5"7
E-Mail -o v k cwv, 1' . �Y'
County:a V h �W t (. Y1. y Septage
(2.) Firm owner's name:
Firm permit number: NCS # (�0
5-�- k4k
Mailing address (if different):
V �- 0 . %pl( socq
city:— �Qp.a _146
State: NN-
Zip 28Lf (Q
Phone: 4 5
Fax: Q t� '
q Sr7 — + 74 3
(3.) Firm operator's name:
0FV ► L�
Q . R�2.
1
Firm operator's title: 04
Mailing address (if different):
�� 0 �
$OX 106q
City: �eR1.0 �b
r -
State:_�Zip: 28L4 &I
Phone: qW -
Fax. CL o ''
�� ✓ �u�3
(4.) Type(s) of septage pumped:
Write in the
number of gallons pumped
in last 12 month (Example: Domestic: 50,000).
Domestic I Portable Toilet Waste j Grease
0
Treatment Plant I Industrial/Commercial
(5.) N.C. Counties of Operation: t`VA
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: 1�
Number used for. Domestic Septage:_y Grease (restaurant):
Other: &&aI _ 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 FR OM 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 QK Date 1D � 23
(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 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 Competed:
Date: —53^ %L� 2)>23 Location: lti Ok r Hours:
Training Sponsored or Provided by: _ N 'Vj6`n QT "*-1?
(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 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.
. ", ?, -h P wt �-
Signatvr (Sig Lure of companyofficiai required)
Print Name
Other Comments:
Date \ \
Title
r
Rev. 04-26-2021
PAGE 2

NC S.EPTAGE MANAGEMENT FIRTNI
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS- W$('C> _
Number of Pumper Vehicles. _
CERTIFICATION:
"I certify, under penalty of law, that the pumper vehicle or vehicles listed in the
submitted permit application meet the requirements for safe and sanitary
transportation of septage as required by15A NCAC 13B .0844 (a) and vehicle
lettering as required by 15A NCAC 13B .0844 (b). I also certify that a log is
maintained of each septage pumping event as required by 15A NCAC 13B .0839
(a). I am aware that there are significant penalties for false certification including
the possibility of fine and imprisonment."
Signature (Signature of company ofci 1 uired)
not Name
l O - 6 — 2-6 2?�.
Date
Title
S:lSolid_WastelclalseptagelformslPumper Vehicles Cetification.doc

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Received 12/8/2023 JRB
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.
r,, 1-_ � C- 166 3
(Plant Operator in RJsplansible 42f rarge JORC), ORC License Number, NaYhe of Plant)
S olsq Z S`C a FdFWOTA
(Address)
ql> - 2-610� - 51 �� do hereby authorize QLL- "� <' G- 0'
(Phone Number) (0wner/OpLYator of Septage Management Firm)
"(Septage Management Firm Name and NCS number)
to dispose of: domestic septage V portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage —0 , from
�
(Countyl�r other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
1N
-j (Lo tion)
1
between the hours of .S tl,� Q1 0-1--� ca %r-
Reintroducing partially treated liquid into a grease trap is acceptable Yes -V No
This authorization shall be valid until = C,9-rti r Si � -�PLf All —
(Usually December 31, Year)
Signed Dated Z 2,1
(Facility Operator)
S bscribed and affirmed before me this day of L-J, 20
G � �►t+ ;�n�Eniu+rrahr y ��
s, fMy Commission expires:
(Notary Public) �Ci Q ��'A
(0�tjtg L) Q)
Note: Falsification of this document by the septage management firm shall lead to
s:/solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

4 ..
North Carolina Department of Environmental Quality
NORTH are
'TcCARor.sNA Division of Waste Management INVOICEEnuimm"niniQualm, Solid Waste Section
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
To: J. P. McCann
Village of BHI Utilities Dept
PO Box 3009
Bald Head Island, NC 28461
Date: 10/03/2023
Invoice #: NCS-00860-2024
Septage - Annual:
Village of BHI Utilities Dept (NCS-00860)
PO Box 3009
Bald Head Island, NC 2W1$800.00
Annual Fee 2024 - Pumper/Number of Trucks: 1 Annual Fee 2024 - Annual Fee
2024 - Pumper/Number of Trucks: 1
Date Due: 1211512023
LATE FEES: In accordance vvith NC Genera; S atu.es GS '30A 291, r(e2). a iate ee wil; be append to any annuai perry it tees no: submitted t;y Jan; ary 202z.
Payment Options:
E-check Available online at lot.?<: %;r,,,� •j;_{ Y,c ;�;::;,, ;:,,_,.n .,r; , , ; sirnl r.�.._ _ .._._: _._......
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card Available online at httris: e. a;y.dcq.rr-.anv/svV-rt avr ;-t,r_01*n11
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number shown
on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
[*Convenience Fee of 2.65% added to amount invoiced.]
Paper check Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number on
check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy of this
invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
planation of Invoice Amount is Based on Firm's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay fee(s) based on your solid waste management
activities. The fee(s) shall be used to support the septage management program.
Staff Contacts:
Connie Wylie [phone] or [e-mail]
Chester Cobb [phone] or [e-mail]
Jeffrey Bullard [phone] or [e-mail]
s
More information available on the web: �Qo•-
North Carolina Department of Environmental Quality (DEQ) - It: �`,.; ,:.o;. ,,
North Carolina Solid Waste Program - cis_+ q
North Carolina Septage Management Program I_ tJ.s e o cx.,c _..'., r!: r L,..._._ cg rn=i r so' >t... ?

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