NCS01437_2019Permit_Initial

2019
Permit and Registration

Hulin Septic Tank
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01437
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. Denton 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?**
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
Hulin Septic Tank
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01437
Enter the five digits following the NCS #
City
Lexington
State / Province / Region
NC
Postal / Zip Code
27292
Country
USA
Street Address
1494 Wright Rd
Address Line 2
Davidson
Yes No
[phone]
[e-mail]
Owner Info
Paul Allen Hulin
Yes No
[phone]
Operator Info
Paul Allen Hulin Owner
Yes No
[phone]
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
subparagraph .0833(c)(14) of the Septage Management Rules.
Type and amount of septage pumped in the last 12 months
17,000
0
0
0
0
North Carolina counties of operation
Davidson
Vehicle Info
Yes No
11/13/2018
Owner
Add vehicles
individually
Upload List
Domestic Septage YA141904 2FZAAKBV31AH62952 3,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Date
Print Name**Title**
11/13/2018
08:21:18 AM
Paul Allen Hulin Owner
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: 11/13/2018
Posting Date: 11/13/2018
Billlng Information: Paul A Hulin 1494 WRIGHT RD LEXINGTON, NC 27292 3364422360
[e-mail]
Payment Amount: 550.00 USO
Page 1 of 1
Reference Information: NCS-01437-2019,27292,Hulin Septic Tank,1494 Wright Road,Lexington,NC,NCS-01437,$550.00
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 11/14/2018