HomeMy WebLinkAboutNCS00310_2020Permit_Initial2020
Permit and Registration
Pee Wee's Septic Tank Cleaning
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00310
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.East Burlington WWTP2.Town of Siler City WWTP3.Old Mason Farm WWTP, Chapel Hill NC
4.Septage Detention or Treatment Facility SDTF-34-02
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?**
Mailing Address**
Phone**Fax
Firm Info
Pee Wee’s Septic Tank Cleaning
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00310
Enter the five digits following the NCS #
City
Graham
State / Province / Region
NC
Postal / Zip Code
27253
Country
USA
Street Address
1830 Almond Ln
Address Line 2
Alamance
Yes No
3362260329
mhill611@gmail.com
Owner Info
William Matthew Hill
Yes No
City
Graham
State / Province / Region
NC
Postal / Zip Code
27253
Country
USA
Street Address
1837 Swepsonville Rd
Address Line 2
3362147967
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
there significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date**
Operator Info
William Matthew Hill Owner/operator
Yes No
City
Graham
State / Province / Region
NC
Postal / Zip Code
27253
Country
USA
Street Address
1837 Swepsonville Rd
Address Line 2
3362147967
Type and amount of septage pumped in the last 12 months
130,000
0
30,000
0
0
North Carolina counties of operation
Alamance
Orange
Chatham
Vehicle Info
Yes No
12/31/2019
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)**
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.
12/31/2019
Owner/operator
Add vehicles
individually
Upload List
Domestic Septage PUMPNP00 3FEXF8014XMA17497 2,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Town of Siler City WWTP 12/31/2020 08689F1E-
FD85-4DAC-
893A-
C16C1162405F.…
3.53MB
East Burlington WWTP 12/31/2020 53D1E453-
3694-4F93-
B4CF-
A5F4F89EDD5F.…
3.45MB
OWASA-Old Mason Farm Plant 12/31/2020 788B63D1-
DC85-469B-
BDB2-
E76F1DECE4DC.…
545.93…
Yes No
Yes No
SDTF #*Expiration Date*Authorization
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
SDTF-34-02 12/31/2020 95395352-
F10B-4643-
9659-
1E978DCBBD51.…
3.44MB
Yes No
Septage Management Firm Operator Training Completed
1/12/2019 4
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
04:30:13 PM
Print Name**Title**
William Matthew Hill Owner/operator
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: 19123161158867
Payment Date: 12/31/2019
Posting Date: 12/31/2019
Billing Information: William M Hill 1837 Swepsonville Rd Graham, NC 27253 3362147967 Mhi11611@gmail.com
Payment Amount: 550.00 USO
Card Type: VISA
Method: Not Present
Reference Information: NCS-00310-2020,27253,Pee Wees Septic Tank Cleaning,1830 Almond Lane,Graham,NC,NCS-00310,$550.00
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