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HomeMy WebLinkAboutNCS00636_2019Permit_Initial 2019 Permit and Registration East Coast Resources is hereby issued a Septage Management Firm Permit, Permit Number NCS-00636 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. Septage Detention or Treatment Facility: SDTF-19-02 2. Septage Land Application Site: SLAS-19-02 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?** Mailing Address** Phone**Fax Email** Firm owner's name** Mailing address same as street address of office?** Mailing Address** Firm Info East Coast Resources The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00636 Enter the five digits following the NCS # City FUQUAY VARINA State / Province / Region NC Postal / Zip Code 27526 Country US Street Address 51 Buttonwood Court Address Line 2 Harnett Yes No City FUQUAY VARINA State / Province / Region NC Postal / Zip Code 27526 Country US Street Address PO Box 1127 Address Line 2 919-577-1995 ecrww@yahoo.com Owner Info Wallace Woodall Yes No Phone**Fax Firm operator's name**Firm operator's title Mailing address same as street address of office?** Mailing address** Phone**Fax 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 City FUQUAY VARINA State / Province / Region NC Postal / Zip Code 27526 Country US Street Address PO Box 1127 Address Line 2 919-577-1995 Operator Info Wallace Woodall President Yes No City FUQUAY VARINA State / Province / Region NC Postal / Zip Code 27526 Country US Street Address PO Box 1127 Address Line 2 919-577-1995 Type and amount of septage pumped in the last 12 months 0 0 1,450,000 0 0 North Carolina counties of operation Wake,Durham,Orange,Johnston,Lee,Harnett Vehicle Info Yes No 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** Septage Land Application Sites (SLAS)** If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site. SLAS #*Expiration Date*Authorization Septage Detention or Treatment Facility (SDTF)** If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for each site. SDTF #*Expiration Date*Authorization Other disposal method** Date**Hours** 11/15/2018 President Add vehicles individually Upload List Grease (restaurant)BY-6378 #3FRNF75R17V402330 2,100 Grease (restaurant)AZ77521 #1XPHD49X88N755666 7,200 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Yes No SLAS-19-02 9/7/2019 Yes No SDTF-19-02 1/15/2020 Yes No Septage Management Firm Operator Training Completed 12/6/2017 4 Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** Raleigh NC NC Pumper Group & NC Portable Toilet Group Septage Land Application Site Operator Training Completed 12/6/2017 3 Raleigh NC NC Pumper Group & NC Portable Toilet Group Registration Type Registered Portable Sanitation Firm Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm 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. 11/15/2018 08:11:48 PM Wallace Woodall President