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Home My WebLink AboutNCS00873_2020Permit_Initial 2020 Permit and Registration Owensby's Septic Tank Pumping is hereby issued a Septage Management Firm Permit, Permit Number NCS-00873 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. Town of Columbia, Columbia 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?** Mailing Address** Phone**Fax Email** Firm owner's name** Mailing address same as street address of office?** Mailing Address** Firm Info Owensby's Septic Tank Pumping The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00873 Enter the five digits following the NCS # City Mill Spring State / Province / Region North Carolina Postal / Zip Code 28756 Country United States Street Address 49 School Road Address Line 2 PO Box 26 Polk Yes No City Mill Spring State / Province / Region North Carolina Postal / Zip Code 28756 Country United States Street Address PO Box 26 Address Line 2 8288990274 arledgetracy@gmail.com Owner Info John L Owensby 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 Mill Spring State / Province / Region North Carolina Postal / Zip Code 28756 Country United States Street Address PO Box 26 Address Line 2 8288990274 Operator Info John L Owensby Owner/Operator Yes No City Mill Spring State / Province / Region North Carolina Postal / Zip Code 28756 Country United States Street Address PO Box 26 Address Line 2 8288990274 Type and amount of septage pumped in the last 12 months 6,000 0 0 0 0 North Carolina counties of operation Polk,Rutherfordton,Henderson. 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** Pumper Vehicles Usage*License Tag #*Vehicle Identification #*Tank Capacity* 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** Location** 12/30/2019 Owner/Operator Add vehicles individually Upload List Domestic Septage YA127307 1FTXR90L9LVA45979 2,300 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Town of Columbus Wastewater Treatment Plant 12/31/2021 Scan_20191230…6.42MB Yes No Yes No Yes No Septage Management Firm Operator Training Completed 10/29/2019 4 Greensboro, NC Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** 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. 12/30/2019 02:53:26 PM John L Owensby Owner/Operator PayPoint Payment Receipt Application: Solid Waste Merchant: NDENR-Solid Waste Merchant City/State: Raleigh, North Carolina Payment Status: Settled Result Message: Payment completed and settled successfully. Confirmation Number: 19123060958506 Payment Date: 12/30/2019 Posting Date: 12/30/2019 Billing Information: John L Owensby 49 School Road PO Box 26 Mill Spring, NC 28756 8288990274 arledgetracy@gmail.com Payment Amount: 550.00 USD Page 1 of 1 Account Type: Checking Reference Information: NCS-00873-2020,28756,Owensby's Septic Tank Pumping,PO Box 26,Mill Spring,NC,NCS-00873,$550.00 Disclaimer: No convenience fee is charged for using the eCheck payment method. However, a processing fee of $25.00 or 10% of the amount of the eCheck, whichever is greater, will be charged for an eCheck returned due to insufficient funds. Payments are null and void if payment is made with an eCheck that is returned unpaid by the bank. https:/ / admin. thepayplace.com/epayadmin/paymentreceipt.aspx 12/31/2019