NCS01251_Permit2019_Initial

2019
Permit and Registration

A&A Atlantic
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01251
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. Town of Columbia WWTP
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?**
Phone**Fax
Firm Info
A&A Atlantic
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01251
Enter the five digits following the NCS #
City
Manteo
State / Province / Region
NC
Postal / Zip Code
27954
Country
USA
Street Address
211 S California Lane
Address Line 2
Dare
Yes No
City
Manteo
State / Province / Region
NC
Postal / Zip Code
27954
Country
USA
Street Address
PO Box 966
Address Line 2
2524735160 2523048409
[e-mail]
Owner Info
Heath Burkhart
Yes No
2524230747
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
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
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*
Operator Info
Heath Burkhart owner
Yes No
2524230747
Type and amount of septage pumped in the last 12 months
0
74,600
0
0
0
North Carolina counties of operation
Dare, Currituck, Hyde, Tyrrell, Camden
Vehicle Info
Yes No
12/12/2018
Operator Owner
Add vehicles
individually
Upload List
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**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Portable Toilet Waste YA117531 2np2hm6x5hm414119 1,100
Portable Toilet Waste AC-18962 4t0fb24213000289 2,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Town of Columbia 12/26/2019
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
1/13/2018 4
Raleigh Fair Grounds
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
0
Registration Type
Comments or notes
Signature
Date
Print Name**Title**
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
03:05:46 AM
Heath Burkhart owner operator
PAID
FIRM NAME: A&A Atlantic
PERMIT #: NCS-01251
AMOUNT: $800
PAID BY: e-Check
DATE: 12/12/2018

Chester Cobb