NCS01051_2020Permit_Initial

2020
Permit and Registration
Carolina Grease Trap
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01051
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
Carolina Grease Trap
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01051
Enter the five digits following the NCS #
City
Durham
State / Province / Region
Nc
Postal / Zip Code
27703
Country
Us
Street Address
3305 Venus dr
Address Line 2
Durham
Yes No
919-201-5474 919-957-9701
[e-mail]
Owner Info
Preston williams
Yes No
919-812-8423
Operator Info
Preston Williams Owner
Yes No
9198124873
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 **
Septage Land Application Sites (SLAS)**
Type and amount of septage pumped in the last 12 months
0
0
150,000
0
0
North Carolina counties of operation
Durham,Granville,Wake,Forsyth
Vehicle Info
Yes No
12/31/2019
Owner
Add vehicles
individually
Upload List
Grease (restaurant)Ya108080 2hsfbgur2kc022896 3,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Yes No
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
Print Name**Title**
Yes No
Yes No
Septage Management Firm Operator Training Completed
12/7/2019 5
Raleigh
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.
12/31/2019
09:35:54 AM
Preston williams Owner
Septage Detention or Treatment Facility SDTF-98-08X
AUTHORIZA丁!ON TO DISCHARGE SEP丁AGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PER脚TTED TO SOMEONE OTHER THAN YOJRSELF
(This form is used by a detention or froatmentfac掴ty permit hoIder to刷cate that permission has bee[ given to a pe「mitted
Septage Ma[agement Fi「m to discha「ge septage into the pe「mit holders dete[fron or treatme[t fac岬y)
Daniel L Newsome
(Fac岬y Ope「ato「)
441 Buck Newsome Rd, Fremont, NC 27830
(Ope「ato「 Add「ess)
P「eston W冊ams
do hereby autho「ize:
Caro“na Grease T「ap
(Owne「 of Septage Management Fi「m)
NCS#
(Name of Septage Management Fi「m)
3305Venus Dr. Du巾am, NC 27703
(Address of Septage Ma[agement Fi「m)
(00953)
98-08
to u帥ze septage detention or treatment fac岬#for the t「eatment o「 StO「age Of septage *
in 2020_. The fac冊y w冊e ope「ated in accordance with the Septage Management Ruies th.
10-25-19
Date:
’ As defined in G,S, 130A-290(a)(32)
柵As defined in 15A NCAC 13B.0800
(Fac岬y Ope「ato「)
Retum the p「OPerIy completed form to:
No輔Caro"na Department of Envi「onment and Natu「aI Resou「ces
Division of Waste Management
So=d Waste Section
1646 Ma= Service Cente「
Raleigh, NC 27699-1646
Received by email from Laura Newsome 6/23/2020 JRB
PayPoint
Payment Receipt
Application: Solid Waste
Merchant: NDENR-Solid Waste
Merchant City/State: Raleigh, North Carolina
Payment Status: Success
Result Message: Success
Confirmation Number: 19123161089068
Payment Date: 12/31/2019
Posting Date: 12/31/2019
Billing Information: Preston E Williams 3305 Venus Dr Durham, NC 27703 9192015474 [e-mail]
Payment Amount: 550.00 USD
Account Type: Checking
Reference Information: Ncs-01051-2020,27703,Carolina Grease Trap,3305 Venus Dr,Durham,NC,NCS-01051,$550.00
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https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 12/31/2019