NCS00304_Permit2019_Initial

2019
Permit and Registration

Stay Clean
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00304
And by virtue of completing the annual training
requirements is hereby registered as a Portable Sanitation &
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. Neuse River Resource Recovery Facility
2. Central Johnston County Regional WWTP
3. North Harnett Regional WWTP
4. Septage Detention or Treatment Facility SDTF-51-03

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
STAY CLEAN
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00304
Enter the five digits following the NCS #
City
ANGIER
State / Province / Region
NC
Postal / Zip Code
27501
Country
US
Street Address
670 WIGGINS RD
Address Line 2
Johnston
Yes No
919-427-1623 919-639-1091
[e-mail]
Owner Info
GENE STEPHENSON
Yes No
9194271623 919-639-1091
Operator Info
BRIAN DIXON MANAGER
Yes No
9194271623 919-693-1091
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*
Type and amount of septage pumped in the last 12 months
75,000
218,000
0
0
0
North Carolina counties of operation
JOHNSTON, HARNETT, WAKE, WAYNE
Vehicle Info
Yes No
11/15/2018
Manager 11-15-18
Add vehicles
individually
Upload List
Portable Toilet Waste AB-3220 1GBJC33US1F185502 100
Portable Toilet Waste AB-9020 1HTSDAAL91H335808 750
Portable Toilet Waste AB-3223 1HTSCAALSV475878 950
Portable Toilet Waste EA-3218 1HTSLAAM2SH643707 850
Portable Toilet Waste AB-3222 3FENF80C3KMA00425 900
Domestic Septage YA130876 1HTSCAAN51H348088 2,100
Date Hours
Location
Training Sponsored or Provided by
Select one**
Comments or notes
Signature
Date
Print Name**Title**
Septage Land Application Site Operator Training Completed
0
Registration Type
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
ON THE LIST OF VEHICLES YOU WILL NOTICE THAT THERE ARE 9 VEHICLES LISTED, I
LISTED ONE TRUCK TWICE BECAUSE IT CAN BE USED FOR PORTABLE TOILETS AND
SEPTIC. I PUT ONE LINE AS PORTABLE TOILET AND ONE LINE AS SEPTIC, BUT IT'S
THE SAME TRUCK.
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.
11/15/2018
03:49:27 PM
Brian Dixon Manager
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER

TREATMENT FACILITY

North Carolina Department of Environment and Natural Resources

Division of Waste Manqgement -Solid Waste Section

401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605

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, John D. Wall -Central Johnston County Regional Wastewater Treatment Plant
(Plant Operator and Name of Plant)
Post Office Box 2263, Smithfield, North Carolina 27577
(Address)
....l:(9"-!1-"-9)L-'.9=8.!:...9--"-50=7...!<5______do hereby authorize Gene C. Stephenson [phone]
(Phone Number) (Owner/Operator of Septage Management Firm)
of Stay Clean Inc., 448 Wiggins Road, Angier, North Carolina 27501 NCS# 00304
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage _---'X--'---__, portable toilet waste __..!..CX'------__
grease septage (grease trap pumpings) _..:....:N...::;O___ commercial/industrial septage * , from
'Requires pre-approval from Johnston County
Johnston County, North Carolina
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Johnston County Sludge Handling Facility, 680 County Home Road, Smithfield, North Carolina 27577
(Location)
between the hours of 8:00 A.M. thru 4:45 P.M.-Monday through Friday
Reintroducing partially treated liquid into a grease trap is acceptable __Yes _X_No
This authorization shall be valid until .=;D"""ecp:ec:..:.m:..::.b.::..:er"",,3:....:..11...:'2:.,::0-'-'19"-----c-___--:----:----:---:--________---4=& i ~ (;Jc--J"'''Y o.oemoo, 31, Yea,)
Signed C ~::-. ~ Date: December 28, 2018
John D. Wall (Facility Operator)
Sworn to and subscribed before me this -3 ~~ 1 day of 3OO0A \ \\ +d..O\q --)'
My Commission expires: December 14, 2023
NANCY HOUS~OFFICI LSEAL)
NOTARY PUBLIC
JOHNSTON COUNTY, N.C. I
'i ommissjon Expir~s 4-1-2u23. Note: Falsification of this document by the septage management firm sUIJ.~LJQ.j~~~~Ift--_-J
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: 11/15/2018
Posting Date: 11/15/2018
Billing Information: BRIAN E DIXON 670 WIGGINS RD ANGIER, NC 27501 9194271623 [e-mail]
Payment Amount: 800.00 USD
Method: Not Present
Reference Information: NCS-00304-2019,27501,Stay Clean,670 Wiggins Road,Angier,NC,NCS-00304,$800.00
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