NCS00121_2020Permit_Initial

2020
Permit and Registration
Waste Management of
Wilmington
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00121
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.Septage Detention or Treatment Facilities: SDTF-65-01, and SDTF-67-01
2.Septage Land Application Site, SLAS-24-08 (Inactive)
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?**
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
Waste Management of Wilmington
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00121
Enter the five digits following the NCS #
City
Wilmington
State / Province / Region
NC
Postal / Zip Code
28412
Country
United States
Street Address
3920 River Rd
Address Line 2
New Hanover
Yes No
9109159040
[e-mail]
Owner Info
Waste Management of Wilmington
Yes No
9109159040
Operator Info
David Greer District Operations Manager
Yes No
9109159040
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**
Pumper Vehicles
Usage*License Tag #*Vehicle Identification #*Tank Capacity*
Type and amount of septage pumped in the last 12 months
579,000
152,500
3,053,650
0
0
North Carolina counties of operation
New Hanover, Pender, Onslow, Carteret, Jones, Duplin, Sampson, Bladen,
Columbus, Brunswick, Craven, Pamilico
Vehicle Info
Yes No
12/11/2019
District Operations Manager
Add vehicles
individually
Upload List
Domestic Septage NC-YA30971 4V2JCBMDXRR825599 3,500
Grease (restaurant)NC-YA97392 1M2AG11C16M035500 3,500
Grease (restaurant)NC-YA008461 1M2AG11C37M065907 4,200
Portable Toilet Waste NC-YA81518 1FVACXCS74HN12612 1,500
Portable Toilet Waste NC-YA81517 1FVACXCS94HN12613 1,500
Portable Toilet Waste NC-LX3167 15VACXCS45HU32430 1,500
Approved wastewater treatment plant **
Septage Land Application Sites (SLAS)**
If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each
site.
SLAS #*Expiration Date*Authorization
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
Training Sponsored or Provided by
Other NC-YA94015 1M2AA05Y8LW002429 0
Other NC-LP7795 3WKDDU9XXYF850438 0
Other NC-AY31311 10BGX5210KF0A1600 5,500
Other NC-AH31307 10GBU6216FF007620 6,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Yes No
SLAS-24-08 5/4/2020
Yes No
SDTF-65-01 6/11/2018
SDTF-67-01 8/30/2022
Yes No
Septage Management Firm Operator Training Completed
1/24/2019 4
Hickory NC
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
1/25/2019 3
Hickory NC
NC Septic Tank Association
Select one**
Comments or notes
Signature
Date
Print Name**Title**
NC Septic Tank Association
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.
12/11/2019
09:18:26 AM
David Greer District Operations Manager
PayPoint
Payment Receipt
Application: Solid Waste Credit
Merchant: NDENR-Solid Waste Credit
Merchant City/State: Raleigh, North Carolina
Merchant Location Code: 00001
Payment Status: Settled
Result Message: Payment completed and settled successfully.
Confirmation Number: 19121658561372
Payment Date: 12/16/2019
Posting Date: 12/16/2019
Billing Information: Cathy Barnes 3001 S Pioneer Dr Smyrna, GA 30082 4044690166 [e-mail]
Payment Amount: 800.00 USD
Card Type: MC
Method: Not Present
Page 1 of 1
Reference Information: NCS-00121-2020,28412,Waste Management of Wilmington,3920 River Road,Wilmington,NC,NCS-00121,$800.00
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https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 12/17/2019