SDTF-43-07_PERMIT_RENEWAL_APPLICATION_20240903

APPLICATION FOR A PERMIT TO OPERATE A SEPTAGE DETENTION OR
TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
Operator and Fac
1. Applicant
Address
Phone
2. Contact person for site
Title or position IDV
Address 121
3. Landowner
Address
(if different from applicant): Ge, f -kWes &OCS)
>onatf'ar Phone gtq -5;.0 -4;Z(09.
4. Site Location: County 14&(yI&(- State Road Number
Directions to site:
5. Is the location on a permitted Septage Land Application Site? i1D
If yes, give the site permit number here:
6. Indicate whether project is: new renewal ✓ modification _
For a permit renewal or modification, indicate the existing permit number 3 a6nd the
permit expiration date 11931 - , 9
7. Attach written, notarized landowner authorization to operate a septage storage or treatment facility
form signed by the landowner (if the permit applicant does not solely own the property). If a -
corporation owns the land use a corporate landowner authorization form. If Limited Liability
Company owns the land, use a limited liability company landowner authorization form.
8. Aerial photograph scale 1 inch = 400 feet with site property lines accurately located on the photograph
must be enclosed (if 1 inch = 400 feet is not available, 1 inch = 660 feet may be substituted).
9. Vicinity map (county road map showing site location). f*aLWA
10. Land application site or wastewater treatment plant to be used after treatment or storage:
(over)

11. Facility Information: the following information shall be included with the application form.
1. Facility to be used for: Storage ). Treatment
2. Types of septage to be stored or treated:
Domestic Septage �� Grease Trap Pumpings
Portable Toilet Waste Commercial/Industrial Septage
3. Types of treatment to be provided: pH Adjustment (lime stabilization) A .Crr SP' i1$ Ny " 3�
Screening Other (attach explanation if other)
4. A description of the proposed detention or treatment facility including the size, type, and number of
structures to be used and how those structures will be constructed or installed (use additional
paper to explain, if necessary): fl k Q,C�1Gu'a-C�
5. An explanation of how septage will be discharged into and removed from the facility (use
additional paper to explain, if necessary):
PLA dr1 iP
6. An explanation of how any leaks or spills at the facility will be cleaned and how odors will be
controlled (use additional paper to explain, if necessary): U�" f1r1f •ce
rct-rJ tt /tZCS
zeJ
III. Certification
I hereby certify that
1. The information provided on this application is true, complete, and correct to the best of my
knowledge, and
2. 1 have read and understand the N.C. Septage Management Rules.
3. 1 am aware of the potential consequences, including penalties and permit revocation, for
failing to follow all applicable rules and the conditions of a Septage Detention or Treatment
Facility pe i
w , LL
Signatu ignamm of company official required Date
w=�1•� w: l I:S S`�G4-tV�`� St eirr�cut�
Print name J Title
Note: This application will not be accepted for review until all parts of the application are complete.
S:Solid WastelGa\septage\forms\SDTF-Application & Authorization\SDTF Permit Application -Jan 2016.docx
Rev 01-07-16

Harnett
®5urraunding County
c o U N r Y
{ Boundaries
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County Boundary
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Warnett.org/GIS ° Address Numbers
August 19, 2024 Parcels Feet
0 40

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
incoming wastewater stream.
I Billy J. Thomas (Grade IV WW # 995445), ORC North Harnett Regional Waste
Water Treatment Plant NPDES # NCO021636
607 Edwards Brothers Drive Lillineton NC 27546
910-893-2424
do hereby authorize
of
M=W
will also include duly appointed&*ers of the company)
to dispose of: domestic septage from Harnett County and Service Areas
at the above named wastewater treatment facility. Septage shall be discharged at:
Septal;e Receiving Station at NHRWWTP
between the hours of 7AM-513M (Nov -Mar) and 7 AM-6 PM (Apr -Oct)
Mon -Fri (except Holidays)
This authorization shall be valid until 12-31-24
Signed 7-Lyy'-C:�Date
acility Operator) 44 �C
Subscribed and affirmed before me this�ti1 day of 2023
My Commission expires: FEB 10 2024
(Notary P li
OFFICIAL -
Notary Public, North Carolina (OFFICIAL SEAL)
County of Harnett
Carolyn K. Murayama
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid waste/CLA/SEPTAGE/FORMS/2014 Firm Application/WWTP Authorization Form 2014