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Home My WebLink AboutNCS00217_Permit2019_Initial 2019 Permit and Registration Jefferson Rent-All is hereby issued a Septage Management Firm Permit, Permit Number NCS-00217 And by virtue of completing the annual training requirements is hereby registered as a Portable Sanitation 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. Town of Boone WWTP 2. Jefferson 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 Jefferson Rent-All The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00217 Enter the five digits following the NCS # City Jefferson State / Province / Region North Carolina Postal / Zip Code 28640 Country USA Street Address 427 South Main Street Address Line 2 Ashe Yes No 336-846-8136 336-846-8137 kpc@jeffersonrentall.com Owner Info Samuel B. Church Yes No 336-846-8136 336-846-8137 Operator Info Samuel B. Church Owner Yes No 336-846-8136 336-846-8137 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 0 73,576 0 0 0 North Carolina counties of operation Ashe, Watauga, Avery, Wilkes, Alleghany Vehicle Info Yes No 11/21/2018 Owner Add vehicles individually Upload List Portable Toilet Waste BY-2833 1GBE4C3267F410855 400 Portable Toilet Waste AH-4959 1GDE4C3206F402305 400 Portable Toilet Waste AH-4960 1GB3KYCY8JF156572 450 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. 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)** Other disposal method** Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Yes No Jefferson Wastewater Treatment Facility 12/31/2019 JWWTP.PDF 86.5KB Town of Boone Wastewater Treatment Plant 12/31/2019 BWWTP.PDF 91.46KB Yes No Yes No Yes No Septage Management Firm Operator Training Completed 3/17/2018 4 Morganton, North Carolina NC Pumper Group & NC Portable Toilet Group 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 Signature Date Print Name**Title** 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. 11/21/2018 03:22:00 PM Samuel B. Church Owner AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environmental Quality Division of Waste Management - Solid Waste Section 1646 Mailservice Center, Raleigh, NC 27699-1645 Fee assessments and waste determinations will be required at the discretion of the wastewater treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the incoming wastewater stream. ,'A I (plant operator in Responsible charge (oRc), oRc License Number, Name of Plantl Tor, .t 'ilon,' L:LJTP Zat C,, su atq /UC 2kCa'l (Ahdress) (Yz Aztr?-t,71t do hereby authorize ''; I J ?t,;/;1te (Phone Number)(Owner/Operator of Septage Management Firm) or Je'C[" vso ,./t/^,t0Zl"7 (Septage Management f irm Name and NCS number) to dispose of: domestic seprage , portable toilet waste ''/-" grease septage (grease trap pumpings) commercial/industrial septage from Q. I Huaa lt'lle d,lA n ,/ llv+r (Co/nty or Geograi:Kic Area) at the above named wastewater treatment facility, Septage shall be discharged at: , Ls)JLSe (Locatiol) 1:utt A,M - 7 'oa 'fu-lbetwee.n the hours of Reintroducing partially treated liquid into a trease trap is acceptable -Yes ' 'l{;" This authorization shallbe valid ,n itQecen Le, 3 | d: 2o t ? (Facility Operator) /8 (Notary Public) (Usually December 31, Year) / 8/h day or f[O U' ,o MyGommission expires: D I - /,t' / 7 ("'il,tl$u+ftqf North Carolina Ashe Gsun ) Note: Falsification of this document by the septage management firm shall lead to permit revocation, 5:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Appllcation/WWTP Authorization Form 2018 AUIIHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environmental euality Division of Waste Management - Solid Waste Section 1545 Mail Service Center, Raleigh, NC 27699_1646 Fee assessments and waste determinations will be required at the discretion of the waster,t,latertreratment facility. The facility has the ultimate prerogative to deny discharges of any wastqs to theincomrng wastewater stream. gA Z\b/ 65 do hereby autho'ze (Phone Number)(Owner/Operator of Septage Management Firm.t *PJ€ l-f a ,5Or-l I <tzwzz (Septage Management Firm Name and NCS number) to dispose of : domestic septage portable toilet waste grease septage (grease trap pumpings) commercial/industrial septage . from --]-- uj '//;n he-u.Aq.-et/ k/ (County oiother GeogYaphic Area) at the above named wastewater treatment facility. Septage shall be discharged at: Reintroducing partially treated liquid into a grease trap is acceptable _ yes This authorization shall be valid until Sipnod acility Operator) Sub:;cribed and affirmeo fore me this day of 20 /E (Notary Public) Note: Falsification of this document by the septage management firm shall lead to permit revocatiofr.S:/5olid_Waste/CLA/SEPTAGE/FoRMs/zo1G Firm Application/wwrp Authorization Fo m zo17 / (Plant operator in Responsibre charge (oRc), oRc License Number, Name of prant) (Address) between the hours of sually December 31, year) My Commission expires , 0/ - /, KAREN Notary PAID FIRM NAME: Jefferson Rent-All PERMIT #: NCS-00217 AMOUNT: $800 PAID BY: e-check DATE: 12/03/2018 Chester Cobb