Disposal Authorization Forms

AUTHORIZATION TO DISCHARGE SEPTAGE
-WASTE WATER TREATMENT FACILITY/PLANT-
North Carolina Department of Environmental Quality
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,
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
(Address)
do hereby authorize
(Phone Number) (Owner/Operator of Septage Management Firm)
of NCS #
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage , portable toilet waste
grease Septage (grease trap pumpings) commercial/industrial Septage , from
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
(Location)
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable Yes No
This authorization shall be valid until
Signed
(Facility Operator)
Subscribed and affirmed before me this
(Notary Public)
(Usually December 31, Year)
Date
day of 20
My Commission expires:
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
Revised: 09/25/2024

AUTHORIZATION TO DISCHARGE SEPTAGE
-SEPTAGE TREATMENT OR STORAGE FACILITY -
(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.)
I
do hereby authorize:
(Facility Operator)
(Operator Address)
(Owner of Septage Management Firm)
NCS #
(Name of Septage Management Firm)
(Address of Septage Management Firm)
to utilize septage detention or treatment facility # for the treatment or storage of
septage *
in 20 The facility will be operated in accordance with the Septage Management Rules **.
Date:
Signed
(Facility Operator)
* As defined in G.S. 130A-290(a)(32)
** As defined in 15A NCAC 13B .0800
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
Revised: 09/25/2024

AUTHORIZATION TO DISCHARGE SEPTAGE
-SEPTAGE LAND APPLICATION SITE -
(This form is used by a land application site permit holder to indicate that permission has been
given to a permitted Septage Management Firm to land apply septage on the permit holders
land application site.)
do hereby authorize:
(Site Operator)
(Operator Address)
(Owner of Septage Management Firm)
NCS #
(Name of Septage Management Firm )
(Septage Management Firm Address)
to use Septage disposal site # for the disposal of gallons of septage* in 20
Date:
Signed
(Site Operator)
* As defined in G.S. 130-A-290(a)(32). The site will be operated in accordance with 15A NCAC 13B
.0800 - Septage Management Rules
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
Revised: 09/25/2024