NCS00169_2019Permit_Initial

2019
Permit and Registration

McMahan Septic Tank
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00169
And by virtue of completing the annual training
requirements is hereby registered as a Septage Management Firm
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. City of Lexington Regional WWTP
2. Archie Elledge Wastewater Facility, 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 registration expires on December 31, 2019.

__________________________________________________
Adam Ulishney, Environmental Compliance Branch Head
State of North Carolina
Environmental Quality
Waste Management
Application for Permit to Operate a
Septage Management Firm
For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-
707-8283).
Firm name**
Septage Management Firm permit number (NCS #)**
Street address of office**
County**
Mailing address same as street address of office?**
Phone**Fax
Email**
Firm owner's name**
Mailing address same as street address of office?**
Phone**Fax
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
Phone**Fax
Firm Info
McMahan Septic Tank Inc
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00169
Enter the five digits following the NCS #
City
Lexington
State / Province / Region
NC
Postal / Zip Code
27295
Country
United States
Street Address
10 Paddington Drive
Address Line 2
Davidson
Yes No
3362486575 3363007590
[e-mail]
Owner Info
Brett McMahan & Bobby McMahan
Yes No
3362486575 3363007590
Operator Info
Brett McMahan President
Yes No
3362486575 3363007590
Amount in gallons*
DomesticDomestic
Portable Toilet WastePortable Toilet Waste
Grease (Restaurant)Grease (Restaurant)
Treatment PlantTreatment Plant
Industrial/CommercialIndustrial/Commercial
List each county you plan to do business in:**
Do you plan to operate pumper vehicles?**
"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 significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date**
Title**
Choose how to add vehicle descriptions**
Pumper Vehicles
Usage*License Tag #*Vehicle Identification #*Tank Capacity*
Approved wastewater treatment plant**
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
Type and amount of septage pumped in the last 12 months
216,000
0
8,000
0
0
North Carolina counties of operation
Davidson, Davie, Forsyth, Rowan, Guilford, Randolph
Vehicle Info
Yes No
11/9/2018
President/Owner
Add vehicles
individually
Upload List
Domestic Septage YA003555 1HTSDAAN8TH314646 2,500
Grease (restaurant)YA003556 1HTSDAANXTH275686 2,300
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
subparagraph .0833(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*Expiration Date*Authorization
Septage Land Application Sites (SLAS)**
Septage Detention or Treatment Facility (SDTF)**
Other disposal method**
Date**Hours**
Location**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Select one**
City of Lexington 12/31/2019 City of
Lexington
Permit
Form.pdf
179.31…
City of Winston 12/31/2019 City of
Winston
Permit
Form.pdf
107KB
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
2/1/2018 6
Hickory NC
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Registration Type
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments or notes
Signature
Date
Print Name**Title**
Comments and Notes
Certification Statement
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.
11/9/2018
06:24:00 PM
Brett McMahan President
PayPoint
Payment Receipt
Application: Solid Waste Credit
Merchant: NDENR-Solid Waste Credit
Merchant City/State: Raleigh, North Carolina
Merchant Location Code: 00001
Payment Status: Settled
Result Message: Payment completed and settled successfully.
Payment Date: 11/09/2018
Posting Date: 11/09/2018
Billing Information: MCMAHAN SEPTIC TANK 10 Paddington Drive Lexington, NC 27295 3364911558 [e-mail]
Payment Amount: 800.00 USD
Method: Not Present
Page 1 of 1
Reference Information: NCS-00169-2019,27295,McMahan Septic Tank, 10 Paddington Drive,Lexington,NC,NCS-00169,$800.00
Disclaimer: A convenience fee is charged by a third-party provider for all online payments made by a credit or debit card. DEQ does not receive any portion of these fees associated with this service. The fee is currently 2.65% of the amount paid on all credit and debit card transactions, except for VISA debit, which has a flat fee of $3.95 per transaction. Your card will not be charged until after you have accepted the convenience fee amount. If you choose not to pay the fee, you may cancel the transaction and pay by another method. If you accept the convenience fee and elect to continue, your credit card statement will show two charges -one for the amount due to DEQ, and one for the convenience fee. The convenience fee is not refundable.
;L/.J 7)
https ://ad.min. thepayplace.com/epayad.min/paymentreceipt.aspx 11/13/2018