NCS01497_Permit2019_Initial

2019
Permit and Registration

Russel & Son’s Septic
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01497
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. Ahoskie 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

Truck passed inspection 9/4/2019 JB 9/6/2019
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(7.) Septage Disposal Method: (check one)
a)Approved wastewater treatment plant: ,r::7(' yes n no. If yes, submit Wastewater Treatment Authorizationfor each plant, as indicated in Subpara� .0833tcITT4) of the Septage Management Rules.
b)Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets If needed) SLAS#: N / A Expiration Date:____ SLAS#: ___ Expiration Date: ___ _
c)Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use addittonal sheets if needed)
SDTF#: �/A Expiration Date:____ SDTF#: ___ Expiration Date: ___ _
(8.) Septage Management Firm Operator Training Completed: \ 11 Date: '7 / I I( I 9 Location: Eiqt:,+\-vi \ e tNG Hours: .=i.._ .. Training Sponsored or Provided by: NC Jx{2L of ½QV\ v:ocroeo bJ l'.>) \ iOJ 1bj
(9.) Septage Land Appllcatton Site Operator Training Completed: Date: bl { e Location:-------Hours:Training Sponsored or Provided by: ___________________ _
(10.) Registration type requested: CHECK ONth Registered Portable Sanitation Firm: Registered Septage Management Firm: Q_ Registered Portable Sanitation and Septage Management Firm:
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.
Signature (Signature of compan official required)Date Gt -Ru00el Print Name Q\00012.\0\lf'IM.tPR Tit
Other Comments: 1'" \:2LlCk'.- is ii'\ � l_)'fOlR¼ Ot 'oe,il"0 ?'J£-':,\r\etsd � f)icJLd
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S:/Solid_ Waste:/CLAIS EPTAG E/FORMS/2016 Fi'm AppUcatton/Fi'mPerml!Applicatton2016
PAGE2
X Discharge Authorization allows for both
JB 9/6/2019