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Home My WebLink AboutNCS01286_2020Permit_Initial 2020 Permit and Registration MDM Septic Services, Inc. is hereby issued a Septage Management Firm Permit, Permit Number NCS-01286 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. Hampton Roads Sanitation District WWTP (Virginia Beach, VA) 2. Elizabeth City WWTP 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 MDM SEPTIC SERVICES, INC. The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01286 Enter the five digits following the NCS # City virginia beach State / Province / Region VA Postal / Zip Code 23457 Country United States Street Address 1400 Campbells Landing Road Address Line 2 Currituck Yes No 7574260511 7574265957 pvta@cox.net Owner Info Kimberly M. Thieman Yes No 7576891884 Operator Info David R. Thieman Vice President Yes No 7574260511 757426-5957 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* Approved wastewater treatment plant ** Type and amount of septage pumped in the last 12 months 475,500 0 0 0 0 North Carolina counties of operation Currituck and Camden Vehicle Info Yes No 11/1/2019 President/Owner Add vehicles individually Upload List Domestic Septage 70-059 2FZXEWYB1YAGO4865 3,900 Domestic Septage 45-543P 2FZSAZCV77AX81733 5,000 Domestic Septage CXUX13 1M2AWO2C58N002279 4,500 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. 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** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Yes No HRSD PO Box 5902, Virginia Beach, VA 23471 12/31/2019 hrsd authorization to discharge_000… 59.19KB Elizabeth City Waste WAter Treatment Plant, PO Box 347, Elizabeth City, NC 27909 12/31/2019 elizabeth city authorization to discharge_000… 68.17KB Yes No Yes No Yes No Septage Management Firm Operator Training Completed 5/13/2019 4 Jeanette's Pier, 7223 S. Virginia Dare Trail, Nags Head, NC 27959 NC Septic Tank Association Septage Land Application Site Operator Training Completed 0 Registration Type Select one** Comments or notes Signature Date Print Name**Title** Registered Portable Sanitation Firm Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm Comments and Notes We are located in the City of Virginia Beach, we are not a county - you could not leave blank so I used Currituck. 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. 10/22/2019 02:29:45 AM Kimberly M. Thieman President 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: 19102248984000 Payment Date: 10/22/2019 Posting Date: 10/22/2019 Billing Information: Kimberly M Thieman 1400 campbells landing rd virginia beach, VA 23457 7574260511 pvta@cox.net Payment Amount: 800.00 USD Account #: Page 1 of 1 Reference Information: NCS-01286-2020,23457,MDM Septic Services,1400 Campbells Landing Rd,Vlrginia Beach,VA,NCS-01286,$800.00 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 10/23/2019