NCS00997_Permit2019_Initial

2019
Permit and Registration

Affordable Septic & Grease
Pumping
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00997
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. Archie Elledge WWTP, Winston-Salem NC
2. Septage Detention or Treatment Facility SDTF 34-02
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
Affordable Septic and Grease Pumping
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00997
Enter the five digits following the NCS #
City
Rural Hall
State / Province / Region
NC
Postal / Zip Code
27045
Country
US
Street Address
260 Grade Street
Address Line 2
Forsyth
Yes No
3364626228
[e-mail]
Owner Info
Tommy Neal
Yes No
3364626228
Operator Info
Tommy Neal
Yes No
3364626228
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
730,000
0
102,000
0
0
North Carolina counties of operation
Alamance, Forsyth, Guilford, Stokes, Surry, Davidson, Randolph
Vehicle Info
Yes No
12/31/2018
Owner
Add vehicles
individually
Upload List
Domestic Septage YA135709 1Fvacxdc67hy75446 2,500
Grease (restaurant)FC1563 1htscabp4h486131 1,500
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)**
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
Archie Elledge Wastewater Facility 12/31/2019 AffordableSep…
Authorization…
806.52…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
12/8/2018 4
Raleigh, NC
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
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
Signature
Date
Print Name**Title**
the decision to issue the permit and that there are criminal penalties for knowingly making a false statement, representation, or certification.
12/31/2018
11:28:32 AM
Tommy Neal Owner
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 discharge septage into the permit holders detention or treatment facility.) I, Rodney Sides (Environmental Relief Technology, Inc. (Facility Operator) 617 Waughtown Street, Building 350, Winston-Salem NC 27107 (Operator Address) do hereby authorize: Tommy Neal (Owner of Septage Management Firm) Affordable Septic & Grease Pumping LLC NCS # 00997 (Name of Septage Management Firm) 260 Grade Street, Rural Hall, NC 27045
(Address of Septage Management Firm) to utilize septage detention or treatment facility # 34-02 for the treatment or storage of septage * in 2019 . The facility will be operated in accordance with the Septage Management Rules **.
Date: 12/1/18 Signed (Facility Operator) * As defined in G.S. 130A-290(a)(32) ** As defined in 15A NCAC 13B .0800 Return 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

PAID
FIRM NAME: Affordable Septic & Grease Pumping
PERMIT #: NCS-00997
AMOUNT: $800
PAID BY: e-check
DATE: 12/26/18

Chester Cobb