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HomeMy WebLinkAboutNCS01000_Permit2019_Initial 2019 Permit and Registration Braxton Septic Tank Service is hereby issued a Septage Management Firm Permit, Permit Number NCS-01000 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. Septage Land Application Site, SLAS-25-10 2. Septage Detention or Treatment Facility, SDTF-25-10 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 Braxton Septic Tank Service The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01000 Enter the five digits following the NCS # City Vanceboro State / Province / Region NC Postal / Zip Code 28586 Country US Street Address 9900 US HWY 17 N Address Line 2 Craven Yes No 252-244-0713 braxton.brandon@gmail.com Owner Info Michael Braxton Yes No 252-244-0713 Operator Info Brandon Braxton owner operator Yes No 252-229-0483 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** Septage Land Application Sites (SLAS)** Type and amount of septage pumped in the last 12 months 289,700 0 32,850 0 0 North Carolina counties of operation Craven, Beaufort, Pamlico, Pitt, Carteret, Onslow, Jones Vehicle Info Yes No 12/25/2018 owner operator Add vehicles individually Upload List Domestic Septage YA136589 1fvhcybs09ham6697 3,550 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Yes No 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 Select one** Comments or notes SLAS-2510 6/8/2020 Yes No SDTF-2510 6/8/2020 Yes No Septage Management Firm Operator Training Completed 12/8/2018 4 Raleigh NC Pumper Group & NC Portable Toilet Group Septage Land Application Site Operator Training Completed 12/8/2018 3 Raleigh 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 I'm unsure on the expiration date of the SLAS and SDTF; however, I DO know they're not expired. 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. Signature Date Print Name**Title** 12/25/2018 08:45:50 PM brandon braxton owner operator PAID FIRM NAME: Braxton Septic Tank Service PERMIT #: NCS-01000 AMOUNT: $550 PAID BY: e-card DATE: 12/25/18 Chester Cobb