NCS01754_2024Permit_Initial

2024
Permit and Registration
Cooke Rentals Inc.
is hereby issued a Septage Management Firm Permit,
ZNti STATE ,, Permit Number NCS-01754
o and registered as a
e:,e D E
-�� Septage Management Firm �rtmen� �� w� nmentai�iltq
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. Clark Creek WWTP, Newton 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 by Wm Perry
Wm Perry S u g g Sugg
Date: 2024.05.31 15:21:43-04'00'
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.) Firm name: (The "Firm name" must be exact as it is shown on your vehicle(s).
"C
Street address of office: 517 q� iuj ij t�r
City: aAtEL State: c_ zip: %
Mailing address (If different): C)'Be' 1 �a i�r C_
City: State: _L L —zip:��
Phone: fy-� -��3 2i� Fax:
E-Mail: �h V C
f�f`en�a�1 S, Lmrrt
'
County: 0"t, Aa Septage Management Firm permit number: NCS #
'
2. Firm owners name:
�I
Mailing address (If different):x�L
City:
State:
Zip:
Phone:
Fax:
tY
(3.) Firm operator's name:
Firm operator's title:
Mailing address (If different):
Vic- ► _
r
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 Portable
Toilet Waste Grease (Restaurant)
Treatment Plant
Industrial/Commercial
j
(5.) N.C. Counties of Operation:
2 Llj� i (101CL
GeZ5 0 . t i t ec Y � en
_
(List each county you do business in)
Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage:
Other:
Vehicle Information: (use additional paper if needed)
Grease (restaurant):
Portable Toilet Waste
License Ta #
Vehicle Identification #
Tank Capacity
1
/n . 2
©M G
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)
a) Approved wastewater treatment plant: yesPC4)
no. If yes, submit Wastewater Treatment Authorization
for each plant, as Indicated In Subparagrap .083 of the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets If needed)
SLAS#: Explration Date: SLAS#: Expiratlon Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets If needed)
SDTF#: Expiration Date: SDTF#: Explration Date:
(8.) Septage Manage n Flrm Operator Training Completed:
Date: J 2,4 Location:
Training Sponsored or Provlded by:
(9.) Septage Land Application Site Operator Training Completed:
Date: Location:
Tralning Sponsored or Provided by:
(10.) Registration type requested: CHECK ON
Registered Portable Sanitation Arm:
Registered Septage Management Firm:
Registered Portable Sanitation and Septage Management Firm: 17
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.
(Signature of company official required)
Cep Kz—
Print Name
Other Comments:
5 a. �;�oa�
Title
S: Solid_WasteJCLA1SEPTAGE/FORMS/2016 FMm AppllcatloNFMmPermMppOcaton2o16
PAGE 2

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of I-nvironrnental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, ftalelgh, 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.
(Plant �05pera�tori)n Responsible Charge (ORC), ❑RC License Number, Name of Plant)
y ib : (zl 5- { y7()
(Phone Number)
of 0 n�
o7 ►C-Ao
(!24
Address)
do hereby authorize t -a1 a d LOOLE
(Owner/Operator of septage Management Firm)
(Septage
Name and NCS number)
to dispose of: domestic septage. portable toilet waste
grease septage {grease trap pumpings) Lcommercial/industrial septage _ c- , from
C
(County or other Geographic Area) -`1
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
t7 Itira�
_5
VC ? �I
Reintroducing partially treated liquid into a grease trap is acceptable Yes V-."No
This authorization shall be valid until I e /-P A 6e-/
(Usually December 31, Year)
Signed date
(Fa" ity Operator)
Sulascr ed and affirmed before me this day of c, 20 '24
XJMy Commission expires:
(Notary Public)
RONALD L INGRAM
NOTARY PUBLIC (OFFICIAL SEAL)
Catawba County
North Carolina
My Commission Expires May 8, 2027
Mote: Falsification of this document by the septage management firm shall lead to permit revocation.
S:jSolid_Waste/C[A/SEPTAGE/FaRMS/2016 Firm Application/WWTP Authorization Form 2016
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