NCS01761_2024Permit_Initial

2024
Permit and Registration
Only Septic and Utilities
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-01761
- o and registered as a
--�� Septage Management FirmCAROL] � �nffi��NOR ity
i2. ��
LULAH
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. Warren County WWTP, Warrenton, 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
Sugg
W m Perry S u 99
Date: 2024.07.01 10:42:42-04'00'
Perry Sugg, Environmental Compliance Branch Head

New PFOOTT
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)).
Street address of office: Nu 14 Tkcj �'a(
City: State: 111 C Zip: Z 7-ra
Mailing address (if different):
City:
Phone:
G ] Onts , 1% yhtr)- e �
State:
IT C a /h
Zip
County: WQ(CC✓- Septage Management Firm permit number: NCS #
(2.) Firm owner's name: �`b/h �1 Ck'," �o4 4er- gd^e1
Mailing address (if different):
City:
State: Zi
Fax:
(3.) Firm operator's name: I ,4*-I f Firm operator's title: LU cr
Mailing address (if different):
City:
State: Zip:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons uummged in last 12 months (Example: Domestic: 50,000).
Domestic I Portable Toilet Waste I Grease (Restaurant) I Treatment Plant I Industrial/Commercial
(5.) N.C. Counties of Operation: / /�h 40 a a c r c-f c i t �✓ a /� e- l -",4 % r { /IJ<s 414
you are
(6.) Total Number of Pumper Vehicles Operated: dl
Number used for: Domestic Septage: Grease (restaurant):
Other: Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
License Tag #
Vehicle Identification # Tank Capacity
1
-y rx?
IJF $C S-Al 114 7 4.2 .7
1 IrUd IC / A, f
2
3
4
5
APPLICATION CONTINUED ON PAGE 2
PAGE 1

A6/ei AF,eA i � -/�
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Do you plan to operate pumper vehicles? (check one) (J) 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 .0844(a) and vehicle lettering
as required by 15A NCAC .0844(b). Furthermore, 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."
Do you attest to the statement above? (-*") yes ( ) no Initial TC 7
Date f " 2 Y
(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 .0833(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 Completed:
Date: S - y - Il Location: (J , I,'�
Hours:
Training Sponsored or Provided by: Al CD E' N C h d YA je-(�r,e�d
(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.
Z .
Signature (Signature of cco ;a-nyofficial required)
Print Name
Other Comments: ,(!� PV 4170 /C fjdN
Date
041A
Title
Rev.10-27-2020
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, Raieigh, 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,
I, 1111iiliam R. F'erkinsan, DRC License Number 9$7831
{Plant Operator in Responsible Charge (ORC) and ORC License Number)
Warren Coun WVIlTP, 73$ L]S F# 401 S. PO BOX 281 Warrenton NC 27589
(Address)
252-257-1776 do hereby authorize _ Thomas Christopher Jones (Chris,
(Phone Number) (Owner/Operator of Septage Management Firm)
of ❑nl Se tic and Utilities NCS #01761
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage X , portable toilet waste x
grease septage (grease trap pumpings) commerclallindustrial septage , from
Warren Vance GranviNe and surroundin counties
(County or other Geographic Area)
at the above -named wastewater treatment facility. Septage shall be discharged at
Influent works
( Location)
between the hours of 8:0n AM - 3:30 PM Maeda - Frida
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31 2024
f(Usua1;y Decemher 31, Year)
Signed �L�I .� � _ _
­,,—.2y
Date
(Facility pera#or}
Sworn to and subscribed before me this day of JLk 20 d
My Commission expires: - 5f - dC- s
(Notary Public)
!
IT
AL
Note- Falsification of this document by the septage management firm shall lead to permit revocZ
S:/Solid Waste/CLA/5EPTAGETCRMS/2013 Firm Application/WW rP Authorization Form 2fl1i �'6�a! IC m
P � �

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MICHAEL SCOTT
Director
NORTH CAROLINA
Environmental Quality
June 05, 2024
Sent via Email
Mr. Thomas Jones
Only Septic & Utility
122 Hugh Jones Rd
Warrenton, NC 27589
Re: New Firm — Assignment of Permit Number (NCS#)
Only Septic & Utility NCS-01761
Dear Mr. Thomas Jones:
You have been assigned the Septage Management Firm Permit Number of NCS-01761 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 May 91", 2024. 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 [e-mail].
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-01761, must be visible and permanently attached on both sides of the pumper
vehicle. Each letter must be at least 3 inches in height. When ready to schedule an
inspection, please contact Mr. Chester Cobb, Environmental Program Consultant in
the Raleigh Office at [phone] or email at [e-mail] .
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 919-707-8292.
Sincerely,
Lee Sorrell, Environmental Specialist II,
Division of Waste Management, NCDEQ
copied: Chester Cobb, Environmental Program Consultant, Raleigh 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