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Home My WebLink AboutNCS01473_2020Permit_Initial 2020 Permit and Registration Wayne County Facility Services is hereby issued a Septage Management Firm Permit, Permit Number NCS-01473 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. Septage Detention or Treatment Facility SDTF-98-08 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 Wayne County Facility Services The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01473 Enter the five digits following the NCS # City Goldsboro State / Province / Region NC Postal / Zip Code 27534 Country US Street Address 804 C Corporate Drive Address Line 2 Wayne Yes No 919-731-1168 919-731-1166 facilities@waynegov.com Owner Info Wayne County (Kendall Lee) Yes No 919-731-1168 919-731-1166 Operator Info Robbie Blanton ORC Yes No 919-920-2630 919-731-1166 Amount in gallons * DomesticDomestic Portable Toilet WastePortable Toilet Waste Grease (Restaurant)Grease (Restaurant) Treatment PlantTreatment Plant Industrial/CommercialIndustrial/Commercial 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* Approved wastewater treatment plant ** Type and amount of septage pumped in the last 12 months 0 0 0 0 0 North Carolina counties of operation Wayne Vehicle Info Yes No 10/25/2019 ORC Add vehicles individually Upload List Domestic Septage 75988V 1HTMMAAL47H470437 1,550 Grease (restaurant)75988V 1HTMMAAL47H470437 1,550 Other 75988V 1HTMMAAL47H470437 1,550 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Septage Land Application Sites (SLAS)** 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** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Yes No Yes No Yes No 98-08 0095 12/31/2019 Yes No Septage Management Firm Operator Training Completed 412/7/2020 Location** Raleigh NC Training Sponsored or Provided by **NC Pumper 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. Changed from new operator training to current JRB 1/9/2020 Date Print Name**Title** 10/24/2019 02:08:27 AM Kendall Lee Facility Services Director ÅU丁的RさZ珊削T⑱朗SCHARGE S押丁AG臣AT A S脚TAGE T駈ATM醐丁OR S丁ORAG臣的Clし町Y P輔肌町ED TO SOMEON悟①T鵬R珊AN YO眠S軋F (This form is used by a deterItion or treatment fac冊y permit holder to indicate that permission has been given to a permitted Septage Management Fi「m to discharge septage into the permit hoIders detention or treatment fac冊y.) 二毒叢輩≡し: 生晩一えをオーろ了引 do hereby authorize: 闇萱萱雪国国璽閣圏語呂聖萱画調 d雄一ク8 三豊芋Ptagedetentionort「eatmen圃ity#　Ot,的　forthetreatmentorstorageof 掌　As defined in G.S. 1亀0A-290(a)(32) 蕪As de軸ed i調15A NCAC 13B.0800 Return the properly completed form to: North Carolina Department of Environmentai Qualitγ Division of Waste Management Solid Waste Section 1646 Mail Service Cente「 Ra(eigh, NC 27699-1646 みて8参る