NCS00093_APPLICATION2020

AF'PLICATION FOR PEFIMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
TIIVISION OF WASTE MANAGEMENT. SOLID WASTE SECTION - 1646 MAIL SERVICE CENTER, RALEIGH, NC 27699'1646
(1.) Firm name . (The "Firm name" musf be exactlv ars if is sha,wn on your vehicle(s)).
i) [.-i-Li L;r:l: Jr.):;.1. r-i-')L:r'V 1CC
Streetaddressofoffice: 7 I3Z Hidden !'a.lley lt'rail
City: barner State: i,lC 7;p;27 529
Mailing address (if different):
fitate:
--Zp
City:
Phone: 919-779-r074 Fax: 91lJ-779-1018 (ca11 tst)
E_Marl: stal l ings sept ics Gbe11s;outh - net
County: Wake Septaqe Management Firm permit number:
(2.) Firm owner's name: Bobby iiiay Sta11 ings\,
Mailing address (if different):
City:zip'.
Phone:
(3.r Firm operator's name: Bobbl' Ray Sta.t. 1 ings
tl Firm operator's title: owne r
Mailing address (if different):
City:zip:
Phone:
Wake, John:ston, Hsrilett
NCS# 00093
State:
Fax:
State:
Fax:
(4. r Type(s) of septage pumped: Wrtte in the number of qallons pumped in last 12 Months (Example: Domestic:
50, )00),
fOornesta --fPortable Toilet Waste lcreasitnestaurantl Tfreatment pUnt -TlndustrialjJommercd lEqq;9';L, i -_'14--f-as<,
--T -- f - ----__l
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehiclers Operated:
Number used for: Domestic Septage: Z Grease (restaurant):
Other.Portable Toilet Waste:
Vehicle Information: (use additional paper if needed)
'lIt-
3
4
A
_License Tag #
YAi 318 9 2
Vehicle ldentification iT
1 ti TMKAAI.mT 1T; 0 S Z I 7'F'V5Htrfc4vlll'55-{56 galrons-Yr-sfi€r
APPL.ICATION C,ONTINUED ON PAGE 2
PAGE 1
APPLICATION FOR PEiIIMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(coNTtNUED FROM PAGE 1)
(7 | Septage Drsposal Method: (check one)
a) Approved wastewater treatment plant: ( ,"4yes ( ) no lf yes, submit Wastewater TreatmentAuthorization
foreach plant, as indicahd in Subparagrilph.0S33(cX14) of the Septage Management Rules,
b) Septage loapd Applicatrorr Site (SLAS) Reruit\qmbers: (use additional sheets if needed)
sLAS#: r't-u/ ExpirationDatel ur4/LU sLAS#: ExpirationDate:
Septage Manpgenrpnt Firm Operator Training C;ompleted:
Date: Y/rLiLY Locati.n$hallotte, NC
c) Septage Detention or Treiatment Facility {SDIF) Permit Numbers: (use additional sheets if needed)
SDTF#: 9,2-07 ExpirationDate: 5/Z/23 SDTF#:Expiration Date:
Training Sponsored or Provided by: t\ C STA
(9,1r Septage Land Application Site 0cerator Trainirrc Completed:
Date: 9 / \f ,/ 19 Location: Shallotte
Training Sponsored or Provided by N C S f A
(1t ,) Registration type requested: CFIECK ONE
Registered Portable Sanitatrcn Firm:
--_Reg istered Septage Manag,:rm ent F tr7r7'
Registered Portable Sanitatitn and Septage, Management Firm:
Ce rtification Statement
I cri,rtify that the information and re;rresentations in this application for a permit are true, complete, and accurate to
thr best of my knowledge and belir:rf. I am aware that a permit may be suspended or revoked upon a finding that its
iss;lance was based upon incorrec't 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.
LZ/L6/rs
S:r'S rlid_Wasle:/CLASEPTAGE/FORMSi2018 Frrnr Apolicatron/F rnrPernr tApDlrcatror20l8
(8)
Hours. 4
NC Hours: 3
J +,r=rl=r..1 l.l...l t , t..
Prirrt Name I
Otl,rer Comments:
PAGE 2
NC SEPT,,I\GE, IlI I\NA GEME,NT FIRM
Rer:ertifiication of Pumper Vehicle(s)
Septage Firm Permit #:hlCS' C;C;(--q 3
Number of Pumper \/ehicles:_,)
?-
CERTIFICATION:
"l certify, under penalty <lf law, that ther pumper vehicle or vehicles listed in the
submitted perrnit applici'rtion meet the requirements for safe and sanitary
transportation of septagr3 as requirerd by15A l{CAC 138 .0844 (a) and vehicle
lettering as required by 15A NCAC X 38 ,0844.(b) | also certify that a log is
maintained of each septage pumpirrg BVent as required by 15A NCAC 138 .0839(a). I am aware that there are signiiicant penialties for false certification including
the possibility of fine and imprisonnrent."
2;,:";'o/Vi '..,--.)
Siglnature (
Title
\Lc,\i -(
s :\s olid-waste\cla\septage\forms\Pum per Vehicles cet ification.doc
AUTHORIZATION TO DISCHI\RGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolirra Departmeni of Environnrent and Natural Resources
Division of Waste l\,liinagement - Solid Waste Section
401 Oberlin Rd Ste 150, Raleigh, N,C 27605
F€rl assessments ancl waste detetrminations will ber required at the discretion of the wastewater treatment
facility The facility has the ultrmerte prerogatrve to deny discharges of any wastes to the incoming
wa stewater stream
l, l\athan Howell; City of Raleigh / NeLrse Biver Resource Recoverv Facilitv (NRRRF)
(Plant C,pe'al,lr dnd Namr: of Plant)
8500 Battle Bridge Road, Raleiqh, NC 276'10 (P 0. Box 590, Raleiqh, NC 27602)
(Address)
i91 9) 996-3700 do hereby'authorize Bobbv R Stallinqs
(Phoner Number)
of Stallinqs Septic Seruice
(OwnerlOperator of Septage Management Firm)
NCS00093
iSeptage Manag,:rnent Firm Name and NCS number)
to r ispose of: domestic septage
-)( , prlflable toilet waste
gr€ ase septage (grease trap pumpings) _ N/A commercial/industrial septage N/A
Wake County
from
(Countv o'otner Geographic Area)
at rte above named wastewater treal:ment facility Sieptage shall be discharged at:
8500 Battle Bridge Road Raleigh NC j]910
(l-ocalion)
bei rveen the hours of _ Bam - 4pm Monday -llrru Friday (Except Holidays)
Re ntroducing paftially treated liqr.rid into a grease trap is acceptable _Yes
This authorization shall be valicl until Der:ember 31,2020
i
I
\l r ,]l,. iL.
(Usually December 31 Year)
(Facility Op,rrator)
.1 i'
t.,') .ttl,{Y:Qirrrpdv,ri ,vv Date ,
holrn to and s
L
blic}
Sw
\-\
day of L{20J9_
4.,,)
(oFFrcrAL SEAL)
ANGELA L YOUNG
NOTARY PUBLIC
Wake County
North Carolina
My Commission expires: >2
Not l: Falsification of this document by thr:r septage managemetrt firm shall lead to permit revocation.
XNo
Commission Expires February .t, ZOZa i%_J
AUTHORIZATION II'O DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Departmenl of Environment and Natural Resources
Division of waste l\4irnagement - Soiid waste section
40'l Oberlin Rd Ste 150, Rateigh N C 2T605
Fei) assessments and waste determrnations will be required at the discretion of the wastewater treatment
facrility The facility has the ultimzrte prerogative to deny discharges of any wastes to the incoming
wa stewater stream,
l, John D Wall -Central Johnston Countv_Regional Wastewater Treatment plan t
(Plant Ctpe,atrtr and Name of Plant)
Po,;t Office Box 2263, Smithfield, No-rth Carqlin a 2T:iT7
(Address)
Co hereby authorize Bobby Stallinqs
(Owner/Operator of Septage Management Firm)
of Stallings Septic Service, 7132 Hidden Vallev lgail, Garner, North Carolina 2752g NCS# 00093
t'Septage Managenent Firm Name and NCS number)
to r lispose of domestic septage _ X , poftable toilet waste
greilse septage (grease trap pumpinus) NO commercial/industrial septage *, from-Requires pre-approval from Johnston County
J ,rhnston County, North Carolina
(Phone Number)
(County or other Geographic Area)
at t te above named wastewater treatment facility. Sieptage shall be discharged at:
Joi tston Countv Sludge Handlinq Fi,rcilitv, 680 CorlllaHome Road Smithfield North Carolina
(L-ocatron )
bet,veen the hours of B;00 A.M. thru_Ut P_h|\/lq4lay throuqh Friday
Reirrtroducing padially treated liquid into a greasie trap is acceptable .--Yes X No
This authorization shall be valicl until December 31,2020
Swt, rn to and subscribed before me this day of
201 I
4t1t23
(OF =ICIAL SEAL)I"IOTAR'{ PUTJLIC)
. -\..., i-\; t l^ A' ' t r'rr' l' | {r
.lOriNS i ON !.Utl')','. 'l;i
Nott, Falsification of this document by
'r \Jr rlr*' ' - --
'ires'1-1 '2023'fl y Commis.ion j1t_*--...--
& nEPUBLTSoza, SERyTCES. tNC.
Republic Services, lnc.
Allied Way
t__
ll. ti;pecial Waste Department Decision:
Marrrrgement Method(s): iy' uandfrll
Prol.rlematic Special Waste according to Republic?
lf ye r . which one? i
App"oved by Special Waste Review Committ,:e?
l Approved Rejected
Broremediettion ; iTransferFacility
Yes y' No
\r('s 'No id not Applicable
S ohdi{ication
Prer:autions, Condltions or Limitations on Approval
Spec al Waste Analyst Signature:
Date:'1i18l2019
lll. I acility Decision:
Name (Printed): KEITH D|AMANTI
Approved iRejected
Precautions, Conditions or Limitations on Approval
By sil:ning below the Gerreral Manager or Desigr-ee agrees that a fully executecj Special Waste Service Agreement is cn file for this profile and that thespec,,rl waste file rs complete
Genlal Manager or Designee:
Date 111812019
Name (Printed):
Phoenrx, AZ 85054
INVOICE
ND
Division of Waste Management
Solid Was;te Section
1646 Marl Service Center
Raleigh,'JC 27699-1646
phone: (!,r1 9) 707 -8236 fax [phone]')_36
emaiI [e-mail]
Bobby R Stallings Wallace Moore
S;tallings Septic Service
7132 Hidden Valley Trail
Clarner. NC 27529
, a!',,'':'.
i : ' t' .1..a. i,
10t15t2019
NCS-00093-2020
Amount DueSescnr ptilct rl I
Septage-,\nnual: $800.00
Stallings ieptic Service (NCS-00093)
7132 Hld(jen Valley Trail
Garner, l,C 27529
Numbel rrrucks g ), (lU.li- t-lqc
Tntal amnr nt FLro $800.0l),/
Date Due 1111412019
Payment lptions: tai rt* | t ti
E-ch 3Ck - Avarlabie online at http://go.ncdenf.gov/swpay
Requrres bank account and routing informa|on YoJ will need to use the zip code in the (lescrrption box and the invoice number
shown on this invoice to access your account. f a zp code is not listed, use the code 99999 along wrth the invorce number.
Credit C ard - Available online al http://go.ncdenr.gov/swpay
Accepts Master(lafd Visa, and Discover cards. voL w J need lo use the zip code in lhe descrplion box and the nvoice number
shown on this invoice to access your account. lf a z p code is not listed. use the code: 99999 along with the invoice number.''Convenrence Fee of 2.65% added to amounl invoiced l
Paper ch:ck - N/ake checks payable to N.C. D vision of Waste [4anagemenl, So|d Waste Section, include Permit Numbef and lnvoice number
on check. lf yo! are paying bt electronic kansfer, rnclLrde lhe invo ce number with your eleckonrc transfer. Please return a copy
of this invoice with your paym€,nt.
[G.S 25-3-506: A $25.00 processing fee w]ll be charged on all returned checks.l
Exolanatiorr of Invoice Amount is Based on Facilitv's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291 1 you are required lo pay fee(s) based on your solid wasle management activities. The fee(s)
shall be useJ to support the septage managemeni prograrn.
Solid Wasto Contacts:
Bil ng proc(ss:
lvlary H J,hnson (919)707'8236
Regulations and Technical Assistance:
Chester Crbb (91S)707-8283 Seplage Man.gement Firn s. ..nd /\pplcation Sites. Detention Facilities
Adam Ulrshney (919) 707'8210
lllore intormation available on the web
North Carolir a Department of Envirolmenial Qualily (DEQ) - http:/,deq.oc.gov
North Carolir a Solid Waste Program - http r/deq . nc. gov/a bou Vd v s ons/wasie'managemonl/solid-\,laste_section
Norlh Carolir a Electronrcs Management Program - hltp.//deq nc.gov/abouVdrv srons/wasle managemenVelectronros'managemsnt
NC Solid W,,tste lnvotce Form l-2016