NCS01757_2024Permit_Initial

2024
Permit and Registration
Shady Knoll Septic Service, LLC
is hereby issued a Septage Management Firm Permit,
Py�4,NTAr���� Permit Number NCS-01757
- o and registered as a
--�� Septage Management Firm �� fEnvironmental �EQ�J
Itr
Esr,�,,.
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. 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 this registration expire on December 31, 2024.
Digitally signed byWmPerry
Wm Perry Sug
S u g g Date: 2024.06.0412:33:30
04'00'
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.) Fk name: (,the "Finn name" must be exec as rt is shown on your vehicle(s).
ril
Street address of office:
CRY: �'1[ZC 14 J )i Ile State: A/6- Zip:
Mailing address (If dRferent):
CRY: State: Zip:
Phone: Fax:
E-Mail:
County: _
(2.) Firm owner's
Septage Management Firm permit number: NCS #
Mailing address (If different): : a Vu_ # a .
City: State: Zip:
Phone: Fax:
(3.) Firm operator's name:
Mailing address (If different):
CRY:
Firm operator's title:
State: Zip:
Phone: Fax.
(4.) Type(s) of septage pumped: Write in the number of oallons pumped in 2915 (Example: Domestic: 50,000).
Domestic Portable Toilet Waste I Grease Restaurant Treatment Plant IndustdaVCommerclal
(5.) N.C. Counties of Operation:
(List each county you do business in)
(6.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: I Grease (restaurant): _
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper If needed)
License Tag #
Vehicle Idemlflcatlon #
Tank Capacity
1
!
y 2
15-0
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

APPLICATION[ FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Septage Disposal Method: (check one)
(8.)
a) Approved wastewater tfeatment pant "yes no. If yes, submit Wastewater Treatment Authorization
for each plant, as Indicated In Subparagrap 083 (c 4) of the Septage Management Rules.
b) Septage Land Application Site (SLAS) PerrmIt Numbers: (use additional sheets If needed)
SLAS#.- Expiratlon Date: SLAS#: Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets 9 needed)
SDTF#: Expiration Date: SDTF#: Expiration Date:
Septage Management Fkm Operator Training Completed:
Date: _ Ek- 2 3 Location: Q n- Un e
Training Sponsored or Provided by:
(9.) Septage Land Application Site Operator Training Completed:
Date: Location:
Training Sponsored or Provided by:
(10.) Registration type requested: CHECK ON
Registered Portable Sanitation Firm. .
Registered Septage Management Flom:
la
Registered Portable Sanitation and Septage Management FlFrn: F
Certification Statement
Hours:
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.
o.dw,'. aug/1-
Signature (Signature of conwa# ofi'rciai required)
Aalw,
Print Name
Other Comments:
C?_
Date
. e.
Titre
SAoIN WastelCIA/SEPTAGE/FORMSd2016 FMm App1cat10n/FMmPWWp*atlon2016
PAGE 2

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
I
ncoming wastewater stream.
1, Kristopher Heath Petree- WW#1006819 - 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 Andrew Jarrett Daywalt
(Phone Number) (Owner/Operator of Septage Management Firm)
of Shady Knoll Septic Service LI-C NCS # 01757
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage X , portable toilet waste
grease septage (grease trap pumpings)
from
NO
commercial/industrial septage ,
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 Elled e 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 2024
(Usually December31, Year)
Signed Date`-1 7—t Z�Z
(Facility Aerator)
Subscribed and affirmed before me this day of M ('A20 0
My Commission expires:
(Notary Public)
a ICIAVY&k)3• BROWN
} Notary Public, North Carolina
Forsyth County
My Co c,�ission Explrsa
4��,
Note. Falsification of this document by the septage management firm shall lead t
S:/Solid_Waste/CIA/SEPTAGE/FOR MS/2018 Firm Application/WWTP Authorization Form 2018

F
t
ston-Salem / Forsyth County
totilities
Water • Wastewater • Solid Waste
Wastewater Division, 2799 Griffith Road, Winston-Salem, NC 27103
0: 336-727-8000, F: 336-659-4320, wskutilities.org
SEPTAGE DISCHARGE PERMIT
Permit # 77-24
Is issued in compliance with the provisions of the City of Winston-Salem Sewer Use
Resolution, subsequent revisions thereof, and any other applicable rules and regulations of
the City of Winston-Salem.
Shady Knoll Septic Service LLC
213 Shady Knoll Lane
Mocksville, NC 27028
is hereby authorized to discharge Domestic Septage into the designated disposal site
located at the
Elledge Wastewater Treatment Plant
2801 Griffith Road
Winston-Salem, NC 27103
NPDES # NCO037834
in accordance with the limitations and conditions as set forth in this Septage Discharge
Permit.
This permit and the authorization to discharge shall become effective January 1, 2024.
This permit and the authorization to discharge shall expire at midnight on
December 31, 2024.
Signed this 2151 day of May , 2024.
Michael Gearre
City/County Utilities
City of Winston-Salem
North Carolina
Permit Number 77-24
City Council: Mayor Allen Joines; Denise D, Adams, Mayor Pro Tem pore, North Ward; Ban Besse, Southwest Ward; Robert C. Clark, West Ward; John C. Larson, South
Ward; Jeff Macintosh, Northwest Ward; Annette Scippio, East Ward; James Taylor, Jr., Southeast Ward; Clty Manager: Lee D. Garrity
County Commissioners: David R. Plyler, Chair; Don Martin, Vice Chair; Fleming El -Amin; Ted Kaplan; Richard V. Linville; Tonya McDaniel; Gloria D. Whisenhunt; County
Calf 311 or 336.727-8000 Manager: Dudley Watts, Jr.
�"
Winston/Forsyth -Salem County Utility Commission: Randall S. Tuttle, Chair; L. Wesley Curtis, Jr., Vice Chair; Harold E. Day; Tom Grim; Yvonne H. Hines; Duane Long;
Gitylirik9( dtyOfVVS.Or9 Hugh W.Jemigan; Chris Parker; James Ruffin; Donald R. Stewart; Allan Younger

ROY COOPER
Governor
ELIZABETH S. BISEP,
Secretary
MICHAEL SCOTT
Director
Sent via Email
NORTH CAROLINA
Environmental Quality
May 20, 2024
Mr. Andrew Daywalt
213 Shady Knoll Ln
Mocksville, NC, 27028
Re: New Firm — Assignment of Permit Number (NCS#)
Shady Knoll Septic Service, LLC NCS-01757
Dear Mr. Andrew Daywalt:
You have been assigned the Septage Management Firm Permit Number of NCS-01757 based upon the
receipt of an Application for a Permit to Operate a Septage Management Firm and a permit fee payment
in the amount of $800. Also, we have a record of your attendance at the New Operator Class on
November 16t", 2023. However, a Permit to Operate a Septage Management Firm will not be issued until:
1) Submission of the disposal authorizations to cover the type(s) of septage you plan to pump and the
area you plan to serve. Authorizations can also be scanned and emailed to me at
lee. sorrel l(a_deg.nc.gov.
2) Inspection of the pumper vehicle(s) for compliance with the Septage Management Rules and
approved by the Division. 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 permit number, NCS-01757, must be visible and permanently attached on
both sides of the pumper 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 Stephan ie.Williams(a)deg.Inc. 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,
Lee Sorrell, Environmental Specialist II
Division of Waste Management, NCDEQ
copied: Stephanie Williams, Environmental Specialist II, Asheville Regional Office
�� NOTth Carolina Department of Environmenta Quality I Division of Waste Management
,/-,�-D Et
217 West Jones Street 1 1646 Mail Service Center I Raleigh, North Carolina 27699 -16 46
919.707.8200