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Home My WebLink AboutNCS01281_Permit2019_Initial 2019 Permit and Registration A Countywide Septic is hereby issued a Septage Management Firm Permit, Permit Number NCS-01281 And by virtue of completing the annual training requirements is hereby registered as a 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. Cross Creek Water Reclamation Facility, Fayetteville NC 2. City of Lumberton Wastewater Plant 3. Septage Land Application Site SLAS-78-23 4. Septage Detention or Treatment Facility SDTF-78-22 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 A COUNTYWIDE SEPTIC SERVICES INC. The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01281 Enter the five digits following the NCS # City RAEFORD State / Province / Region NORTH CAROLINA Postal / Zip Code 28376 Country United States Street Address 373 SWIFT CREEK ROAD Address Line 2 Hoke Yes No 910-875-7616 910-875-1777 VICKIECPR@AOL.COM Owner Info BELTON WAYNE JONES Yes No 910-875-7616 910-875-1777 Operator Info B. WAYNE JONES OWNER Yes No 910-862-3119 910-875-1777 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** If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in Type and amount of septage pumped in the last 12 months 412,807 0 26,000 0 0 North Carolina counties of operation Cumberland, Hoke, Sampson, Bladen, Moore, Harnett, Columbus Vehicle Info Yes No 1/15/2019 Owner Add vehicles individually Upload List Grease (restaurant)YA103857 1HTMKAAN13H569542 2,500 Domestic Septage YA132942 2NP2HN7X8AM110101 2,500 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No 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)** Other disposal method** Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location PUBLIC WORKS COMMISSION 12/31/2019 PWC AUTHORIZATION 001.tif 91.34KB CITY OF LUMBERTON WASTE TREATMENT 12/31/2019 LUMBERTON AUTHORIZATION 001.tif 75.04KB ENVIRO-CHOICE 12/31/2019 ENVIRO-CHOICE 001.tif 51.78KB Yes No SLAS-78-23 12/31/2019 MAXINE JONES 001.tif 41.83KB Yes No Yes No Septage Management Firm Operator Training Completed 1/25/2018 6 HICKORY CONVENTION CENTER NC Septic Tank Association Septage Land Application Site Operator Training Completed 0 Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** 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. 1/15/2019 12:51:37 PM Vickie Cooper Secretary/Bookkeeper PAID FIRM NAME: A Countywide Septic PERMIT #: NCS-01281 AMOUNT: $800 PAID BY: e-check DATE: 12/21/18 Chester Cobb