NCS00834_Permit2019_Initial

2019
Permit and Registration
Rachel Locklear Porta John
Service
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00834
And by virtue of completing the annual training
requirements is hereby registered as a Portable Sanitation 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 Lumberton Wastewater Plant
2.Septage Land Application Site SLAS-78-19
3.Septage Detention or Treatment Facility SDTF-78-19
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
Rachel Locklear Porta Jon Service
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00834
Enter the five digits following the NCS #
City
Pembroke
State / Province / Region
NC
Postal / Zip Code
28372
Country
United States
Street Address
2161 Evergreen Church Road
Address Line 2
Robeson
Yes No
910-734-1759 910-521-9310
[e-mail]
Owner Info
Rachel Locklear
Yes No
910-734-1759 910-521-9310
Operator Info
Rachel Locklear Owner
Yes No
910-734-1759 910-521-9310
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**
Type and amount of septage pumped in the last 12 months
0
100,000
0
0
0
North Carolina counties of operation
Robeson, Cumberland, Columbus, Scotland
Vehicle Info
Yes No
11/30/2018
Owner
Add vehicles
individually
Upload List
Portable Toilet Waste CF2216 1HTSDAAM71H314108 1,000
Portable Toilet Waste YA126328 1HTMMAAN57H407221 2,500
Portable Toilet Waste HJ2043 3C7WRMBLGG377724 1,200
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
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)**
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**
Location**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Yes No
Lumberton WWTP 12/31/2019
Lumberton WWTP 12/31/2019
Yes No
SLAS-78-19 1/6/2020
Yes No
SDTF-78-19 1/6/2020
Yes No
Septage Management Firm Operator Training Completed
1/6/2018 4
Gov. Martin Building, State Fairgrounds 1025 Blue Ridge Road
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
1/6/2018 3
Gov. Martin Building, State Fairgrounds 1025 Blue Ridge Road
Select one**
Comments or notes
Signature
Date
Print Name**Title**
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.
11/30/2018
03:04:05 PM
Rachel Locklear Owner
PAID
FIRM NAME: Rachel Locklear Porta John Service
PERMIT #: NCS-00834
AMOUNT: $800
PAID BY: e-check (R&D Associates of Pembroke,Inc.)
DATE: 12/03/2018

Chester Cobb