NCS01367_2020Permit_Initial

2020
Permit and Registration

Septic System Solutions
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01367
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. North Durham WRF, Durham NC 2. South Durham WRF, Chapel Hill 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, 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
Septic System Solutions
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01367
Enter the five digits following the NCS #
City
Wake Forest
State / Province / Region
North Carolina
Postal / Zip Code
27587
Country
USA
Street Address
2021 Sandy Plains Rd.
Address Line 2
Wake
Yes No
919-451-5377
[e-mail]
Owner Info
Jack B Durham Jr
Yes No
919-451-5377
Operator Info
Jack B Durham Jr President
Yes No
919-451-5377
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
72,000
0
0
0
0
North Carolina counties of operation
Wake
Granville
Durham
Franklin
Johnston
Nash
Alamance
Orange
Chatham
Vehicle Info
Yes No
11/21/2019
President
Add vehicles
individually
Upload List
Domestic Septage YA149758 2NKHHM6X4LM386032 1,583
Approved wastewater treatment plant **
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**
Comments or notes
Signature
Date
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
1/30/2019 6
Hickory, NC
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
0
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.
11/21/2019
Print Name**Title**
11/21/2019
10:48:35 AM
Jack B Durham Jr President
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.
Confir111atlon Number. 19112154162936
Payment Date: 11/21/2019
Posting Date: 11/21/2019
Bllllng Information: Jack B Durham 2021 Sandy Plains Rd. Wake Forest, NC 27587 9194515377 [e-mail]
Payment Amount: 550.00 USD
Method: Not Present
Reference Information: NCS-01367-2020,27587,Septic System Solutions,2021 Sandy Plains Rd,Wake Forest,NC,NCS-01367,$550.00
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