NCS01304_2019Permit_Initial

2019
Permit and Registration

Septic Blue NC L.L.C.
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01304
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. Rocky River Regional 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

there significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date*
11/19/2018
Title*
Manager
Choose how to add vehicle descriptions*
r: Add vehicles
individually
<" Upload List
License Tag#* Tank Capacity*
Pumper Vehicles
Usage*
Domestic Septage YA121014
Vehicle Identification # *
5pvnv8jm1h4s5115 2,500
I Seotage Disposal �ethod ��ch method, indicatev.hether),QU plan to use it by checW __ ·n_,g,_,ye_s_or_n_o_. ---��----------------�-------
Approved wastewater treatment plant*
r: Yes <" No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment A.ilhorization for each plant as indicated in
subparagraph .0833(c)(14) of the Septage Mmagement Rules.
11/eil forms to:
NCDEQ
Division of Waste 11/enagement-Solid Waste Section
1646 11/eil Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*
Rocky River treatment plant
Septage Land Application Sites (SLAS) *
Expiration Date*
-4 2/31 /20+9,.
12/31/2019
A.ilhorization
-treatment ,.
�lant Flalei§R
-nc aatl, •
�19.pdf
Rocky River
Teatment
plant concord
NC auth
2019.pdf
215.@4
301. 24 ...
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**
Comments or notes
Signature
Date
Print Name**Title**
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
11/5/2018 4
Smoky Mountain Center for the Performing Arts. Franklin NC
NC Septic Tank Association
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
New truck being added sometime within the next couple of weeks.
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.
11/19/2018
03:17:00 PM
William Dyer Manager/Agent
PayPoint
Payment Receipt
Application: Solid Waste
Merchant: NDENR-Solid Waste
Merchant City/State: Raleigh, North Carolina
Payment Status: Settled
Result Message: Payment completed and settled successfully.
Payment Date: 11/01/2018
Posting Date: 11/01/2018
Billing Information: SEPTIC BLUE NORTH CAROLINA LLC P.O. BOX 2049 715 BUSH STREET ROSWELL, GA 30077 7706401125 [e-mail]
Payment Amount: 800.00 USO
Page 1 of 1
Reference Information: NCS-01304-2019,30077,Septic Blue of North Carolina L.L.C.,PO Box 2049,Roswell,GA,NCS-01304,$800.00
Disclaimer: No convenience fee is charged for using the eCheck payment method. However, a processing fee of $25.00 or 10% of the amount of the eCheck, whichever is greater, will be charged for an eCheck returned due to insufficient funds. Payments are null and void if payment is made with an eCheck that is returned unpaid by the bank.
https :// admin. thepayplace.com/epayadmin/paymentreceipt.aspx 11/2/2018