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Home My WebLink AboutNCS01172_Permit2019_Initial 2019 Permit and Registration Triad 24 Pumping is hereby issued a Septage Management Firm Permit, Permit Number NCS-01172 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. Lexington Regional WWTP 2. Septage Detention or Treatment Facilities: SDTF-34-02, SDTF-34-06 and SDTF-60-09 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 Triad 24 Pumping, LLC The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01172 Enter the five digits following the NCS # City lexington State / Province / Region NC Postal / Zip Code 27295 Country USA Street Address 177 canoe ln Address Line 2 Davidson Yes No City lexington State / Province / Region NC Postal / Zip Code 27293 Country USA Street Address p.o. box 421 Address Line 2 3368301858 henryyork@msn.com Owner Info Henry York Yes No 3368301858 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 Henry York owner Yes No 3368301858 Type and amount of septage pumped in the last 12 months 0 0 600,000 0 0 North Carolina counties of operation ALL Vehicle Info Yes No 1/1/2019 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)** If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for each site. SDTF #*Expiration Date*Authorization Other disposal method** Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Grease (restaurant)YA021820 2fzhawdc07ay57606 3,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Lexington Regional WWTP 999300ww3 12/31/2019 2019septic.pd…1.18MB Yes No Yes No SDTF-34-06 12/31/2019 SDTF-34-02 12/31/2019 2019septic.pd…1.18MB Yes No Septage Management Firm Operator Training Completed 10/25/2018 4 Clemmons, NC 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 Authorization to discharge at Liquid environmental Winston Salem was sent in by them. 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. 1/1/2019 09:36:44 AM Henry York owner AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environmental euality Division of Waste Management - Solid Waste Section 1546 Mail Service Center, Raleigh, NC 27699-1,646 Fee assessments and waste determinations will be required at the discretion of the wastewater treatrnent facility. The facility has the ultimate prerogative to deny discharges of any wastes to the incoming wastewater stream. txlvrl",t,-/tA- (Plant Operator in Responsible Charge (ORC),License , Name of Plant) U,l t^lYP Ito dispose of: domestic septage portable toilet waste t ./' , grease septage (grease trap pumpin gs) V" commercial/industrialseptage , from q? g Joowh/3 , NC *+L<1,2* of do hereby authorize 5ov id (County or ot Geographic at the above named wastewater treatment facility.Septage shall be discharged at: between the hours of Reintroducing partially treated liquid into a grease trap is acceptable yes tI f*f o (Usually December 31, Year) .t rhis authorization shal be vatid untit t2.. lZ t I XO I q Signed (Facility Operator) Subscribed and affirmed before me this Firm Name and NCS number) ox" to I n) lQ Jamie Freeman Notary Public Davidson Countv. NC My commission expires , Nl&ll5D$ orvor 0Cl ,20 lt (oFFtctAL sEAL) Note: Falsification of this document by the septage management firm shall lead to permit revocation. s:/Solid-waste/cLA/SEPTAGE/FoRMs/2018 Firm Application/wwrp Authorization Form 2018 (Notary Public) AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF (This form is used by a detention or treatment facility permit holder to indicate that permission has been given to a permitted Septage Management Firm to disciarge septage into the permit holders detention or treatrnent facility.) l, Rodney Sides (Environmental Relief Technoloqy. lnc. (Facility Operator) 617 Wauqhtown Street. Buildinq 350. Winston-Salem NC 27107 do hereby authorize: (Operator Address) John York (Owner of Septage Management Firm) Triad24 NCS# 01172 (Name of Septage Management Firm) P0 Box421 Lexinoton. NC 27293 to utilize septage detention or treatment facility # U-02 for the treatment or storage of septage * in 2019 . The facility will be operated in accordance with the Septage Management Rules *. $* #-#^Date: 1211118 Signed * As defined in G.S. 130A.290(a)(32)* As defined in 15A NCAC 138.0800 Retum the properly completed form to: North Carolina Department of Environment and Natural Resources Division of Waste Management Solid Waste Section 1646 Mail Service Center Raleigh, NC 27699-1646 (Facility Operator) lr rn fi r} { D xo:N -|T& n mAJ *r x }',urn '[ =n { x I/\ >urfifinff { *x T AvFl\-)oFl EJ -.f.t F3H7HTI 8.o I Itrbrf I Ilr AtsRil i+ Ft.EZb' !eat FtLrla6 Hl-rtJIt.a ooE a-+Fi; olra *.8ciFt / oY-)ohr-b E'\- Y)PCc-| il.F| t4 Ed sFrHt3lJ FrA tJi6R FU E.B9A)oH)(+og wx FZZtal OOE -O23 Y'{xE a'o iEE S5'=giH 3 H; EIHiL ='{ ;5ql L:<3 g. ESEie g HF!rl) 4 FUoaAvoo U)-i IJalrFt Foo ,^tvr-oFl !e{-}oFt g H I FUo FDHo _(Dzo(./) '-j r-.to@a CDp -I r.t p XtD(Dr5 U) D' u) teF leor! E t (.) leFl|o(a !sFtr! F} .s? D9 te o FpaF}z !eEH)o a oa o+ \ t\\b\\)\ 1\| \, t i tr\\, I t1 Ji h lr i\x\\( t\I \\l \\i\l I I I RPAID FIRM NAME: Triad 24 Pumping PERMIT #: NCS‐01172 AMOUNT: $550 PAID BY: e‐check DATE: 12/31/2018 Chester Cobb