NCS00986_Permit2019_Initial

2019
Permit and Registration

Forever Clean
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00986
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. Neuse River Resource Recovery Facility
2. Central Johnston County Regional WWTP 3. North Harnett Regional WWTP
4. North Durham Water Reclamation Facility 5. South Durham Water Reclamation Facility

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
ForeverClean
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00986
Enter the five digits following the NCS #
City
Fuquay Varina
State / Province / Region
NC
Postal / Zip Code
27526
Country
US
Street Address
116 W Academy St
Address Line 2
Wake
Yes No
9195520200
[e-mail]
Owner Info
Scott Tart
Yes No
919-669-6006
Operator Info
Scott Tart President
Yes No
9196696006
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
0
1,961,880
0
0
0
North Carolina counties of operation
Wake Harnett Johnston Durham
Vehicle Info
Yes No
12/31/2018
President
Add vehicles
individually
Upload List
Portable Toilet Waste FF-2518 1FDUF5GT2GEA 600
Portable Toilet Waste FB-8996 5VPNJ8JV64S59623 1,100
Portable Toilet Waste HT-2535 5PVNJ8JTXJ4S58174 1,550
Portable Toilet Waste FB-8959 3C7WRMBL5FG610272 800
Portable Toilet Waste EY-9563 1FDUF5GTXCED00399 1,100
Portable Toilet Waste HV-7451 3C7WRMDL2HG728098 900
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
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**
Portable Toilet Waste JE-5867 3C7WRMBLXJG255723 900
Portable Toilet Waste CH-2856 JALE5B16877301282 1,000
Portable Toilet Waste HN-6474 3C7WRMDL7HG680890 900
Portable Toilet Waste HW-2071 1FDUF5GT6DEA41797 1,100
Portable Toilet Waste HY-2890 3C7WRMDL9HG674914 1,100
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
City of Durham 12/31/2019 City of
Durham.pdf
266.15…
Central Johnston County Regional
Wastewater
12/31/2019 Central
Johnston.pdf
340.54…
N Harnett Regional WWTP 12/31/2019 N.
Harnett.pdf
349.33…
City of Raleigh/ Neuse River Resource 12/31/2019 City of
Raleigh.pdf
345.89…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
12/8/2018 4
Raleigh NC
NC Pumper Group & NC Portable Toilet Group
Date Hours
Location
Training Sponsored or Provided by
Select one**
Comments or notes
Signature
Date
Print Name**Title**
NC Pumper Group & NC Portable Toilet Group
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
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.
12/12/2018
11:53:13 AM
Scott Tart President