NCS01103_2024Permit_Initial

NORTH CAROLINA
Environmental Quality
2024
Permit and Registration
Providence Environmental, Inc.
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01103
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
NORTH CAROLINA
W/11
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, Tide 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. Cross Creek WRF / Rockfish Creek WRF, Fayetteville NC
2. Spears Creek WWTP, Permit # SC0043451, Elgin SC
3. Septage Detention or Treatment Facilities, SDTF-26-05, SDTF-34-06, and SDTF-60-09
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 oSUO 024.02.20 15:51:49
Perry Sugg, Environmental Compliance Branch Head

For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-707-
8283).
Firm Info
Firm name*
Providence Environmental Inc
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)*
NCS-01103
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
312 Sharpe Rd.
Address Line 2
City
State / Province / Region
Columbia
South Carolina
Postal / Zip Code
Country
29203
United States
County*
Out —of —State
Mailing address same as street address of office?*
0 Yes 0 No
Mailing Address*
Street Address
PO Box 3216
Address Line 2
City
State / Province / Region
Columbia
South Carolina
Postal / Zip Code
Country
29230
United States
Phone*
Fax
803-754-1175
Email *
rachel@providenceenvironmental.
com
Owner Info
Firm owner's name*
Providence Environmental Concepts
and Services, LLC
Mailing address same as street address of office?*
0 Yes * No

Mailing Address*
Street Address
PO Box 3216
Address Line 2
City
Columbia
Postal / Zip Code
29230
State / Province / Region
South Carolina
Country
United States
Phone* Fax
803-754-1175
Operator Info
Firm operator's name*
Michael D. Cannon
Mailing address same as street address of office?*
O Yes * No
Mailing address*
Street Address
Po Box 3216
Address Line 2
City
Columbia
Postal / Zip Code
29230
Firm operator's title
Managing Member
State / Province / Region
South Carolina
Country
United States
Phone* Fax
803-754-1175
Type and amount of septage pumped in the last 12 months^'
Amount in gallons*
Domestic 278,202
Portable Toilet Waste 0
Grease (Restaurant) 308,361
Treatment Plant 0
Industrial/Commercial 0
North Carolina counties of operation
List each county you plan to do business irl
State Wide
Vehicle Info
Do you plan to operate pumper vehicles?*
Yes No

"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 significant penalties for false certification including the possibility of fine and imprisonment."
Signature
6 //[/i9ldPF4l lZltIrell!
Date *
12/20/2023
Title*
Managing Member
Choose how to add vehicle descriptions *
0 Add vehicles individually * Upload List
Upload vehicle list*
You can upload a file with a list of vehicles to be used. Please be sure to include the following information for each vehicle on your upload: Usage, License Tag #, Vehicle
Identification #, and Tank Capacity.
Truck list.xlsx 13.6KB
Septage Disposal Method �^
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
* Yes O No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
subparagraph .0833(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*
Cross Creek WRF/Rockfish WRF
Septage Land Application Sites (SLAS)*
❑ Yes * No
Septage Detention or Treatment Facility (SDTF) *
J Yes No
Expiration Date* Authorization*
12/31/2024 Authorizat... 454....
to
Discharge
Cross Creek
2024.pdf
Permit Verification
❑ I certify that I AM the permit holder for this SDTF.
If unchecked, please attach a signed detention/treatment authorization form for each site.
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.

SDTF # * Expiration Date* Authorization *
SDTF-60-09 12/31/2024 Authorizat... 76.1...
discharge
Liquid
Environmen...
2024.pdf
SDTF-34-06 12/31/2024 Authorizat... 76.1...
discharge
Liquid
Environmen...
2024.pdf
SDTF-26-05 12/31/2024 Authorizat... 76.1...
discharge
Liquid
Environmen...
2024.pdf
SCO043451 12/31/2024 Authorizat... 307....
to
Discharge
Spears
Creek
2024.pdf
Other disposal method*
Yes 9) No
Septage Management Firm Operator Training Completed
Date * Hours*
1/27/2023 4
Location *
Hickory, NC
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
Location
Training Sponsored or Provided by
Registration Type ^

Select one*
O Registered Portable Sanitation Firm
Registered Septage Management Firm
O Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Comments or notes
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.
Signature
Ci "ZIe"O. O&AW&
Date
12/20/2023
10:43:33 AM
Print Name* Title*
Michael D. Cannon Managing Member

Make/Year
Truck ID
Gallon
Capacity
License Plate
#
VIN #
Use
2005 International
V007
2700
P762377
I HTWXSAT95JO47039
Grease (Restaurant)
2017 International
V009
3200
P762378
1HTWNTATOHH576614
Grease (Restaurant)
2020 International
VO11
3200
P779223
3HAEKTAT5LL440678
Grease (Restaurant)
2012 International
V006
3000
A002149
1HTWNAZT6CJ127190
Grease (Restaurant)
2023 International
V016
3200
P781186
3HAEKTAT4PLO60592
Grease (Restaurant)
2024 Hino
V019
1800
P861778
5PVNJ7AJ7R5T50065
Grease (Restaurant)
2021 Hino
V014
1800
P692536
5PVNJ8AV9M5T50179
Grease (Restaurant)
2021 Freightliner
V015
2700
P766747
1FVHG5FE2MHMP6129
Grease (Restaurant)
1992 Polar Tanker
V005
5500
PV46513
IPMS44227NIO11674
Grease (Restaurant)
2004 Dragon Tanker
V008
6300
8922PT
IUNST42244LO23905
Grease (Restaurant)
2006 Dragon Tanker
V017
6300
69143PT
IUNST42266LO45553
Grease (Restaurant)
2006 Dragon Tanker
V018
6300
82268PT
IUNST422X6LO45491
Grease (Restaurant)
2011 Freightliner
TR06
Power Unit
P760509
1FUJGLDR6BLBB7004
Grease (Restaurant)
2007 Freightliner
TR07
Power Unit
P760504
1FUJA6CK17LY50044
Grease (Restaurant)
2009 Freightliner
TR08
Power Unit
P777764
IFUJGEDR29LAH6229
Grease (Restaurant)
2013 Freightliner
TR09
Power Unit
P778739
1FUJGEBG5DLBS8497
Grease (Restaurant)

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 Michael D. Cannon
(Phone Number) (Owner/Operator of Septage Management Firm)
of Providence Environmental Concepts NCS# 01103
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste
grease septage (grease trap pumpings) commercial/industrial septage , from
Cumberland and surroundings counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
Facil
Sunrise to Sunset
Influent Pump Station
(Location)
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2024
Signed IA�1r'! �® Date 1d -1,9
(Facility Operator)
Subscribed and affirmed before me this I 0 day of Jobt-r 20 c�3
—L� t 3 My Commission expires:
(Notary Pub' )
Note: Falsification of this document by the septage management firm shall lead to permit revocation
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2023 Firm Application/WWTP Authorization Form 2023
(0 - I4-aoa(0
(OFFICIAL SEAL�."��Na
NOTARY
PUBUG

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 into the permit
holders detention or treatment facility.)
SG wU C
h Y�r�=h �P�� J?Zl S
1SD 6r17z4-;'`l L1� �,
(Facility Operator)
(Operator Address)
do hereby authorize: N� i c h of I 'b . an Yl (7 n
(Owner of Septage Management Firm)
pf-D�'% 6nce n\J: roe, rn'0 VVA*1 , �&l C NCS # ©I I O 3
(Name of Septage Management Firm)
1 a S hoar pe tLn-� b: c,, S cc')- 9 a c) 3
(Address of Septage Management Firm)
to utilize septage detention or treatment facility #1 for the treatment or storage of
septage *
in 20The facility will be operated in accordance with the Septage Management Rules **.
Date: S— Signed
(Facility Operator)
* As defined in G.S. 130A-290(a)(32)
** As defined in 15A NCAC 13B .0800 C—yP45e f�� ly9s
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

National Pollutant Discharge
Elimination System Permit
(for Discharge to Surface wacea)
This NPDES Permit Authorizes
PALMETTO UTILITIES, INC.
Spears Creek WWTP
to discharge from a facility located
about 113 mile WNW of Highway Church Road bridge over 1-20
at the dead end of Brarzell Lane, about 3 miles S. of Elgin in
Kershaw County
to receiving waters named
Wateree River
in accordance with limitations, monitoring requirements and other conditions set forth herein.
This permit is issued in accordance with the provisions of the Pollution Control Act of South
Carolina (S.C. Code Sections 48-1-10 etseq.,1976), Regulation 61-9 and with the provisions of the
Federal Clean Water Act (PL 92-500), as amended, 33 U.S.C.1251 etseq., the "Act."
► yrt
Issue Date: July 17, 2017
eBess on ., Director
Facilities Permitting Division
Effective Date: September 1, 2017
Expiration Date': August 31, 2022
Permit Number: SC0043451
This permit will continue to be in effect beyond the expiration date if a complete timely re -application is received
pursuant to Regulation 61-9.122.6 and signed per Regulation 61-99.122.22.
0
TOdhec
S.C. Department of Health and
Environmental Control

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 into the permit
holders detention or treatment facility-)
(Facility, Operator)
(Operator Address)
do hereby authorize: 1 C- h a-e— 1 1) . C-cun Y--� 0 V1
(Owner of Septage Management Firm)
Cn C'E NL, j' ron M'e an C- NCS #
(Name of Septage Management Firm)
M
(Address of Septage Management Firm)
to utilize septage detention or treatment facility # for thetreatment or storage of
septage *
in 2DA4--- The facility will be operated in accordance with the Septage Management Rules
Date:
As defined in G-S. 130A-290(a)(32)
As defined in 15A NCAC 13B.0800
Signed
(Facility Operator)
Return the property completed form to --
North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646