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Home My WebLink AboutNCS01286_2019Permit_Initial2019 Permit and Registration MDM Septic Services is hereby issued a Septage Management Firm Permit, Permit Number NCS-01286 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.Hampton Roads Sanitation District WWTP (Virginia Beach, VA) 2.Elizabeth City 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). 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 Firm name** MDM Septic Services The "Firm name" must be exactly as it is shown on your vehicle(s). Septage Management Firm permit number (NCS #)** NCS-01286 Enter the five digits following the NCS # City Virginia Beach State / Province / Region VA Postal / Zip Code 23457 Country US Street Address 1400 Campbells Landing Road Address Line 2 Currituck Yes No 7574260511 7574265957 kim@mdmseptic.com Owner Info David R. Thieman Yes No 7574260511 7574265957 Operator Info David R. Thieman President/Owner Yes No 7574260511 757426-5957 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 52,700 0 0 0 0 North Carolina counties of operation Currituck and Camden Vehicle Info Yes No 11/13/2018 President/Owner Add vehicles individually Upload List Domestic Septage 70-059 2000 Sterling Teal Blue 3,900 Domestic Septage 45-543P 2007 Sterling Blue 5,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Comments or notes Signature Date Print Name**Title** Comments and Notes We are located in the City of Virginia Beach, we are not a county - you could not leave it blank that is why I put Currituck. 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. 11/13/2018 03:00:00 AM David R. Thieman President/Owner PayPoint Payment Receipt Application: Solid Waste Credit Merchant: NDENR-Solid Waste Credit Merchant City/State: Raleigh, North Carolina Merchant Location Code: 00001 Payment Status: Settled Result Message: Payment completed and settled successfully. Payment Date: 11/13/2018 Posting Date: 11/13/2018 Billing Information: MDM Septic Services, Inc. 1400 Campbells Landing Road Virginia Beach, VA 23457 7574260511 kim@mdmseptic.com Payment Amount: 800.00 USD Method: Not Present Page 1 of 1 Reference Information: NCS-01286-2019,23457,MDM Septic Services,1400 Campbells Landing Rd,Virginia Beach,VA,NCS-01286,$800.00 Disclaimer: A convenience fee is charged by a third-party provider for all online payments made by a credit or debit card. DEQ does not receive any portion of these fees associated with this service. The fee is currently 2.65% of the amount paid on all credit and debit card transactions, except for VISA debit, which has a flat fee of $3.95 per transaction. Your card will not be charged until after you have accepted the convenience fee amount. If you choose not to pay the fee, you may cancel the transaction and pay by another method. If you accept the convenience fee and elect to continue, your credit card statement will show two charges -one for the amount due to DEQ, and one for the convenience fee. The convenience fee Is not refundable. https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 11/14/2018