NCS00704_2024Permit_Initial

NORTH CAROLINA
Environmental Quality
2024
Permit and Registration
Davidson County Schools
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00704
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
CIA�
PIORTH CAROLINA
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. Lexington Regional WWTP, Lexington 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.
Perry iSlusigned byWm
Wm Perry
99
Date: 024.02.20 13:48:23
S u g g OS
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(Pumpers)
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC
27699.1646 (1.) Fir. i; name: (The "Firm name" must be ex��acflyy as it is shown
J ] A v 1, (mil ® ✓l C
Street address of office: -� I g- B c U Un SC A Dd l 2
City:16 fv V) _ State: NC- Zip: Q 7agR
Mailing address (if different): Pb S-7
City: Lu I tit State: Zip
Phone: 33 b . c q . Co 70 q- Fax: �J 3 iP . a
S!rl x LQU
df rlc--bUS
County: v OLAU —Id SCrI� Septage Management Firm permit number: NCS # -7 4—
(2.) Firm owner's name:_ -fib C� v t �S 0q Cf) U�1 _kl IS-C11-N) 16
Mailing address (if different): _ c� OG 7
City: �7 G' f7J�_ State: Aj Zip `a __7 ac a
Phone: 3 _ 'mil - 6 _7 /q Farx::_3 h - c ' Q - Z ,Ci. r� I -
(3.) Firm operator's name:_ %� I C hQ -C ( q1 i�- Firm operators title: w a_6 (�c�r�-lef-
Mailing address (if different): — ) 101. I
City: 16 A
�t rr'' State: A) L Zip:
�6 l�
Phone: - �-7`f' 0 Fax: 133& `a J
(4.) Type(s) of septage pumped: NVrite in.(ie number of alg Ions numned in last 12 months (Example: Domestic: 50,000).
Domestic I Portable Toilet Waste I Grease (Restaurant) Treatment Plant
(5.) N.C. Counties of Operalion: sWL_
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: I
Number used for: Domestic Septage:_ Grease (restaurant):
Other: -` Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
PAGE 1 of 2

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(7.) Do you plan to operate pumpE!r 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." 2 2
Do you attest to the statement above? ( ) yes ( ) no Initial3
_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 the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#: __ E=xpiration 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 Trainin�_I Completed:
Date: r I — I -- l 6. - Location: N Hours:
Training Sponsored or Provided by: ___ --�t ► `c, Civ , \L- k6v,
(10.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(11.) Registration type requested: CHECK ONE
Registered Portable Sanitaton Firm: _.
Registered Septage Manacement 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.
SignAdre (Signature of company offichlr d)
Print Vame
Other Comments:
_�_ 2p2
Date
Title
Rev. 04-26-2021
PAGE 2

NC SEPTAGIJ NIANAGEN ENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #:
Number of Pumper Vehicles:
NCS. 0�--
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."
(/L , �( n- '"NaiLL\
Signature (ignature of mpan official required)
Print Name
Date
-'l rtcAbf L & Al 0. i n �1QhUL.
Title
SASolid_Waste\clalseptageWormsWumper Vehicles Cetification.doc

Y �
� bTHORIZATION 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.
99 9 30c
(Plant Operator in Responsible Charge (ORCj, License Num ,Name of Plant) W W 3
(Address)
a C-Zdo hereby authorize
(Phone Number) (Owner/Operator of Septage Management Firm)
Of ___ �I .c <_ ;� `, _ C�q l.� • s Ao-aLs NCS # 7
(Septage Man ment Firm Name and NCS number)
to dispose of: domestic septage / . portable toilet waste
grease septage (grease trap pumpings) commercial/industrial Septage from
C� V,k' Cl�
(County or of Geographic Ar )
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable
Yes _V_No
This authorization shall be valid until .2 13 % _
(Usually December 31, Year)
Signed Date-'Z
(Facility Operator)
1�
Subscribed and affirmed before me this A)oV- a
day of 20
My Commission expires:
(Notary Public)
�a (� Ar eman (OFFICIAL SEAL)
'Votary Pubiie
Davidson Coun , NC
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
kvir H dQua f Solid Waste Section
LINA
Fnvhonmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Septage - Annual:
Davidson County Schools (NCS-00704)
PO Box 2057
Lexington, NC 27293-2057
Annual Fee 2024 - Pumper/Number of Trucks:1
To: Joe Tysinger
Davidson County Schools
PO Box 2057
Lexington, NC 27293-2057
Date: 10/03/2023
Invoice #: NCS-00704-2024
Date Due: 1 12/1
LATE FEES: In accordance with NC General Statutes GS 130A-291.1(e2), a late fee will be applied to any annual permit fees not submitted by January > 2024
Payment Options:
E-check Available online at.https://epay.dec.nc.gov/sw-epayrnents.htmi
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 https://epay.deq.nc.gov/sw-epayments.html
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.]
Explanation 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]
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - https://deg.nc.gov
North Carolina Solid Waste Program - https./deo.nc.coy/abouVdivisions/waste-managemenlsoIid-waste-section
North Carolina Septage Management Program - httcs: 'deu.nc. ov abou divisions/waste-rnanacemen solid -waste -section ecial-wastes-and-alternative
handling/septage

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