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Home My WebLink AboutNCS01391_2019Permit_Initial 2019 Permit and Registration CAC Potty House is hereby issued a Septage Management Firm Permit, Permit Number NCS-01391 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. Town Creek WWTP, Spencer NC 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 CAC POTTY HOUSE The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01391 Enter the five digits following the NCS # City Salisbury State / Province / Region NC Postal / Zip Code 28146 Country US Street Address 407 S Salisbury GQ Ave Address Line 2 Rowan Yes No City Granite Quarry State / Province / Region NC Postal / Zip Code 28072 Country US Street Address P.O. Box 1015 Address Line 2 7042783719 cac_plumbing@yahoo.com Owner Info Cedric A Cuthbertson Yes No 7047971314 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 Cedric A Cuthbertson Yes No 7042783719 Type and amount of septage pumped in the last 12 months 0 28,200 0 0 0 North Carolina counties of operation Rowan Vehicle Info Yes No 8/16/2019 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)** Other disposal method** Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Portable Toilet Waste AE93267 5W0FA1726GL001119 800 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Town Creek Wastewater Treatment Plant 12/31/2019 Town Creek WWTP.pdf 36.47KB Yes No Yes No Yes No Septage Management Firm Operator Training Completed 9/17/2019 6 Mooresville NC NC Septic Tank Association Septage Land Application Site Operator Training Completed 0 Registration Type Comments or notes Signature Date Print Name**Title** Registered Portable Sanitation Firm Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm Comments and Notes Will attend 2 classes in 2019 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. 8/16/2019 09:25:24 AM Cedric A Cuthbertson Owner PAID FIRM NAME: CAC Potty House PERMIT #: NCS-01391 AMOUNT: $550 PAID BY: E-check DATE: 08/16/2019 PAID (late) FIRM NAME: CAC Potty House PERMIT #: NCS-01391 AMOUNT: $275 PAID BY: E-check DATE: 08/16/2019 Chester Cobb