NCS01374_2020Permit_Initial

2020
Permit and Registration

Stanley Environmental
Solutions (Durham)
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01374
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. Septage Detention or Treatment Facility, SDTF-32-03
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, 2020.

__________________________________________________ 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?**
Mailing Address**
Firm Info
Stanley Enviormental Solutions
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01374
Enter the five digits following the NCS #
City
Durham
State / Province / Region
North Carolina
Postal / Zip Code
27701
Country
United States
Street Address
140 Angier Ave
Address Line 2
Durham
Yes No
City
Stanley
State / Province / Region
North Carolina
Postal / Zip Code
28164
Country
United States
Street Address
PO Box 184
Address Line 2
704-263-8186
[e-mail]
Owner Info
Wind River Environmental
Yes No
Phone**Fax
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
Mailing address**
Phone**Fax
Amount in gallons *
DomesticDomestic
Portable Toilet WastePortable To ilet Waste
Grease (Restaurant)Grease (R estaurant)
Treatment PlantTreatment Plant
Industrial/CommercialIndustrial/Co mmercial
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
City
Marlborough
State / Province / Region
MASSACHUSETTS
Postal / Zip Code
01752
Country
United States
Street Address
46 Lizotte Dr
Address Line 2
7042638186
Operator Info
Nathan Wooten Site Supervisor
Yes No
City
Stanley
State / Province / Region
North Carolina
Postal / Zip Code
28164
Country
United States
Street Address
131 Mariposa Rd
Address Line 2
7042638186
Type and amount of septage pumped in the last 12 months
0
0
7,668,509
0
0
North Carolina counties of operation
All Counties
Vehicle Info
Yes No
there significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date**
Title**
Choose how to add vehicle descriptions**
Upload vehicle list**
Approved wastewater treatment plant **
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
11/12/2019
11/12/19
Add vehicles
individually
Upload List
You can upload a file with a list of vehicles to be used. Please be sure to include the following information for each vehicle on your upload: Usage, License Tag
#, Vehicle Identification #, and Tank Capacity.
Durham Trucks.xlsx.pdf 15.12KB
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Yes No
Yes No
SDTF-32-02 12/31/2019
Yes No
Septage Management Firm Operator Training Completed
1/24/2019 6
Hickory, 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
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.
11/12/2019
02:53:02 PM
Nate Wooten Operations Supervisor