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Home My WebLink AboutNCS00168_2020Permit_Initial 2020 Permit and Registration A Sani-Can is hereby issued a Septage Management Firm Permit, Permit Number NCS-00168 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. T Z Osborne WRF, Mcleansville NC 2. Septage Detention or Treatment Facility, SDTF-41-06 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?** Phone**Fax Firm Info A Sani-Can The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-168 Enter the five digits following the NCS # City Greensboro State / Province / Region NC Postal / Zip Code 27405 Country USA Street Address 2316 Joe Brown Drive Address Line 2 Guilford Yes No City Denver State / Province / Region NC Postal / Zip Code 28037 Country USA Street Address 8151 Webbs Road Address Line 2 7044835641 7044838481 neeley@asanican.com Owner Info Gary & Virginia Dellinger Yes No 7044835641 7044838481 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 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 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** Operator Info Gary Dellinger Seceraty Yes No 7044835641 7044838481 Type and amount of septage pumped in the last 12 months 0 396,480 0 0 0 North Carolina counties of operation Guilford,Davidson,Randolph,Forsyth,Stokes,Moore,Rockingham, Chatham,Orange,Durham,Wake,Alamance,Franklin Vehicle Info Yes No 11/18/2019 Treasurer 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** Description*Authorization Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by 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. Truck List for Permits.xls 84KB Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Wil Mail In 12/31/2019 Yes No Yes No Yes No Onsite into the county Septage Management Firm Operator Training Completed 9/17/2019 8 Mooresville, NC NC Septic Tank Association Septage Land Application Site Operator Training Completed 1/25/2019 6 Hickory, NC NC Septic Tank Association Registration Type Select one** 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 For the truck list use the list under the tab GB State 2020 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. 11/18/2019 10:38:53 AM Neeley Robinson Treasurer TRUCKS A SANI-CAN SERVICE Greensboro TRUCK #YEAR MAKE/MODEL VIN#TAG#TANK CAPACITY 22 2000 Ford F-650 3FDWF65H4YMA06981 EK6019 1000 Gallons 26 2002 Freightliner 1FVABPAK82HI85835 FB1027 1000 Gallons 27 2003 International 1HTWAAAN83J062562 AY7778 1000 Gallons 80 2004 Freightliner 1FVACWCS44HN17342 AY7781 1000 Gallons 203 2006 Freightliner 1FVACWCSX6HW99454 CV2548 1000 Gallons 300 2006 UD 2300 JNALC80HX6AK55141 AW3239 250 Gallons 301 2006 Freightliner M2106 1FVACWCS86HW99453 AY8562 1000 Gallons 305 2007 Kenworth T300 2NKMHY6X27M207367 AE7149 1000 Gallons 215 2014 Hino 338 5PVNV8JJ0E4S50092 EL1152 1000 Gallons 219 2013 Hino 338 5PVNV8JT0D4S53090 YA126024 300 Gallons 307 2016 Hino 338 5PVNV8JJ1G4S50296 FJ5180 1000 Gallons 308 2017 Hino 338 5PVNV8JV6J4S57707 JA1002 300 Gallons 309 2018 Hino 338 5PVNV8JL4J4S50432 JF8995 1200 Gallons 310 2019 Hino 338 5PVNV8JV6K4S58311 JL1709 1200 Gallons 311 2019 Hino 338 5PVNV8JT4K4S55289 JP2709 300 Gallons PayPoint Payment Receipt Application: Solid Waste Credit Merchant: NDENR-Solid Waste Credit Merchant City/State: Raleigh, North Carolina Merchant Locatiol! Code: 00001 Payment Status: Settled Result Message: Payment completed and settled successfully. Confirmation Number: 19111853539666 Payment Date: 11/18/2019 Posting Date: 11/18/2019 Billing Information: A Sani-Can 8151 Webbs Road Denver, NC 28037 7044835641 neeley@asanican.com Payment Amount: 800.00 USD Card Type: VISA Method: Not Present Reference Information: NCS-00168-2020,27405,A Sani-Can,2316 Joe Brown Dr,Greensboro,NC,NCS-00168,$800.00 Page 1 of 1 Disclaimer: A convenience fee is charged by a third-party provider for all online payments made by a credit or debit card. DEQ does not receive any portion of these fees associated with this service. The fee is currently 2.65% of the amount paid on all credit and debit card transactions, except for VISA debit, which has a flat fee of $3.95 per transaction. Your card will not be charged until after you have accepted the convenience fee amount. If you choose not to pay the fee, you may cancel the transaction and pay by another method. If you accept the convenience fee and elect to continue, your credit card statement will show two charges -one for the amount due to DEQ, and one for the convenience fee. The convenience fee is not refundable. https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 11/19/2019