HomeMy WebLinkAboutNCS00909_2020Permit_Initial 2020
Permit and Registration
Powell Septic Tank Service
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00909
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. Lower Creek WWTP, Lenoir NC
2. Taylorsville 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
Powell Septic Tank Service
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00909
Enter the five digits following the NCS #
City
Taylorsville
State / Province / Region
NC
Postal / Zip Code
28681-8426
Country
United States
Street Address
360 Powell Rd
Address Line 2
Alexander
Yes No
8286321791
kpowell57@gmail.com
Owner Info
Kevin Powell
Yes No
828-632-1791
Operator Info
Kevin Powell
Yes No
8286321791
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*
Type and amount of septage pumped in the last 12 months
536,000
1,000
0
0
0
North Carolina counties of operation
Alexander,Catawba,Caldwell,Iredell
Vehicle Info
Yes No
12/30/2019
owner
Add vehicles
individually
Upload List
Domestic Septage YA011516 1htsdaanoyh230960 2,500
Domestic Septage YA-77216 1hsscaanxsh667766 2,500
Domestic Septage YA-122151 1xpcdr8x3sn378258 4,400
Domestic Septage YA156084 2NP2HM7X1BM110596 2,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
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**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Yes No
Lower Creek WWTP (NC0023981)12/31/2020 lenoir dump
1.jpeg
79.03KB
Taylorsville WWTP 12/31/2020 lenoir
dump.jpeg
73.3KB
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
1/24/2019 6
Hickory Nc
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 FirmX
JRB 8/10/2020
Comments or notes
Signature
Date
Print Name**Title**
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
10:48:00 AM
Kevin Powell Owner
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: 19123060902282
Payment Date: 12/30/2019
Posting Date: 12/30/2019
Billing Information: Kevin Powell 360 Powell Rd Taylorsville, NC 286818426 8286321791 kpowell57@gmail.com
Payment Amount: 800.00 USD
Card Type: MC
Method: Not Present
Page 1 of 1
Reference Information: NCS-00909-2019,28681,Powell Septic Tank Service,360 Powell Road,Taylorsville,NC,NCS-00909,$800.00
Disclaimer: A convenience fee is charged by a third-party provider for all online payments made by a credit or debit card. DEQ does not receive any portion of these fees associated with this service. The fee is currently 2.65% of the amount paid on all credit and debit card transactions, except for VISA debit, which has a flat fee of $3.95 per transaction. Your card will not be charged until after you have accepted the convenience fee amount. If you choose not to pay the fee, you may cancel the transaction and pay by another method. If you accept the convenience fee and elect to continue, your credit card statement will show two charges -one for the amount due to DEQ, and one for the convenience fee. The convenience fee is not refundable.
https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 12/31/2019