HomeMy WebLinkAboutNCS00188_2020Permit_Initial 2020
Permit and Registration
Cumberland Septic
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00188
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. Cross Creek WRF, Fayetteville, NC
2. Spring Lake Regional WWTP
3. Moore County Water Pollution Control Plant
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
Cumberland Septic
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00188
Enter the five digits following the NCS #
City
Fayetteville
State / Province / Region
NC
Postal / Zip Code
28303
Country
USA
Street Address
319 Mike St
Address Line 2
Cumberland
Yes No
City
Fayetteville
State / Province / Region
NC
Postal / Zip Code
28303
Country
USA
Street Address
PO Box 35192
Address Line 2
9108683830 9108679044
cumberlandseptic@aol.com
Owner Info
Audrey Stancil
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
Fayetteville
State / Province / Region
NC
Postal / Zip Code
28303
Country
USA
Street Address
PO Box 35192
Address Line 2
9108683830 9108679044
Operator Info
Mike Stancil Vice President
Yes No
City
Fayetteville
State / Province / Region
NC
Postal / Zip Code
28303
Country
USA
Street Address
PO Box 35192
Address Line 2
9108683830 9108679044
Type and amount of septage pumped in the last 12 months
130,912
852,741
0
0
0
North Carolina counties of operation
CUMBERLAND, LEE, HOKE, HARNETT, SCOTLAND, SAMPSON, MOORE, ROBESON, BLADEN
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 **
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**
Date**Hours**
12/16/2019
President
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.
Septage.jpg 1.16MB
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Cross Creek 12/31/2020 CCWWTP.jpg 704.13…
Moore County WPCP 12/31/2020 MooreWWTP.jpg 738.08…
Spring Lake Regional Waste Water 12/31/2020 SLWWTP.jpg 623.52…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
1/12/2019 4
Location**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Comments or notes
Signature
Date
Print Name**Title**
Raleigh NC
NC Pumper Group & NC Portable Toilet Group
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.
12/16/2019
09:25:07 AM
Audrey Stancil 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.
Confirmation Number: 19121658498547
Payment Date: 12/16/2019
Posting Date: 12/16/2019
Billing Information: Cumberland Septic Service Inc Po Box 35192 Fayetteville, NC 28303 9108683830 cumberlandseptic@aol .com
Payment Amount: 800.00 USD
Card Type: VISA
Method: Not Present
Page 1 of 1
Reference Information: ncs-00188-2020,28303,Cumberland Septic,PO Box 35192,Fayetteville,NC,NCS-00188,$800.00
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https://admin. thepayplace.com/epayadmin/paymentreceipt.aspx 12/17/2019