NCS01392_2020Permit_Initial

2020
Permit and Registration

Stallings Rock Store Bar-B-Que
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01392
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. Material removed from an interior point-of-use grease interceptor is treated to remove any free liquids, bagged, and placed into a dumpster. Solid Waste Management Rule 15A NCAC 13B .1626(9)(c)(i) defines “free liquids” as determined by Method 9095 (Paint Filter Liquids Test) S. W. 846.
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
Restaurant Septage (Grease)
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?**
Mailing Address**
Phone**Fax
Email**
Firm owner's name**
Mailing address same as street address of office?**
Mailing Address**
Firm Info
Stalling Rock Store Bar-B-Que
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01392
Enter the five digits following the NCS #
City
Stallings
State / Province / Region
NC
Postal / Zip Code
28104
Country
US
Street Address
3116 Old Monroe Road
Address Line 2
Union
Yes No
City
Indian Trail
State / Province / Region
NC
Postal / Zip Code
28079
Country
US
Street Address
P O Box 1603
Address Line 2
704-200-028-
[e-mail]
Owner Info
Jack Chavis
Yes No
Phone**Fax
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
Mailing address**
Phone**Fax
Approximate amount of Grease Septage managed within the last 12 months
Amount in gallons *
Grease (Septage)Grease (Septage)
List each county you plan to do business in:**
Do you plan to operate pumper vehicles?**
Note: Interceptor must be cleaned when the sinks are not being used and no food preparation is taking place. Do not VIOLATE any
Health Department Regulations.
1. Obtain proper tools to open the interceptor.
2. Place plastic trash bags (or any disposable item) on floor to protect floor from contamination.
3. Remove lid from interceptor and place upside down on floor protection item.
4. Skim grease from top of interceptor and place in a container lined with two strong disposable bags.
5. Scrape walls of the interceptor with a wide putty knife or similar item to remove solids and grease that have accumulated on the
City
Indian Trail
State / Province / Region
NC
Postal / Zip Code
28079
Country
US
Street Address
PO Box 1603
Address Line 2
704-200-0281
Operator Info
Jack Chavis Vice President
Yes No
City
Indian Trail
State / Province / Region
NC
Postal / Zip Code
28079
Country
US
Street Address
PO Box 1603
Address Line 2
704-200-02819
800
North Carolina counties of operation
Union
Vehicle Info
Yes No
Procedure to Clean an Interior Point-Of-Use Grease Interceptor
Please read the following procedure and and check the box acknowledging you have read the procedures.
walls.
6. Remove solids from the bottom of the interceptor and place in the same container with the grease skimmings.
7. Inspect the trap for any equipment deficiencies and make repairs.
8. Place lid on interceptor carefully. Make sure lid is sealed properly or odors will be released.
9. Place floor covering item in the trash dumpster.
10. Remove container with grease and solids from the food preparation area.
11. Solidify contents with an absorbent material such as kitty litter. Make sure all contents are solidified. This may take several
minutes for the material to absorb all of the liquid.
12. Tie bags together securely.
13. Inspect bag for leaks and re-bag if needed.
14. Place bag in trash dumpster.
15. Clean the area and sanitize all surfaces in the areas as prescribed by the Health Department.
Acknowledgement**
Indicate which type of training you have completed.**
Date**Hours**
Location**
Training Sponsored or Provided by**
Select one**
Comments or notes
Signature
Date
I acknowledge I have read the procedure to clean an interior point-of-use grease interceptor.
Septage Management Operator Training
In-person training Online training
In-person Training
3/15/2017 8
Fayetteville NC
NC DEQ - New Operator Training
Registration Type
Registered Septage Management Firm
Comments and Notes
I had the classroom train back in 2018 in Fayetteville can’t remember the
exact date. I now do the online training class each year. Please call me if
you have questions. Thanks Jack 704-200-0281. We are a small restaurant and
only service our own grease trap. No others.
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.
10/17/2019
04:50:40 AM
X See comments and notes below JRB 8/12/2020
-----------------------------------------------
Print Name**Title**
Jack Chavis, Jr VP
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: 19101748091097
Payment Date: 10/17/2019
Posting Date: 10/17/2019
BIiiing Information: Chavis Mondock Services Inc. PO Box 1654 Indian Trail, NC 28079 7042000281 [e-mail]
Payment Amount: 550.00 USD
Page 1 of 1
Account Type: Checking
Reference Information: NCS-01392-2020,28079,Stallings Rock Store Bar-B-Que,PO Box 1603,Indian Trail,NC,NCS-01392,$550.00
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 12/9/2019