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Home My WebLink AboutNCS00023_2020Permit_Initial 2020 Permit and Registration Grimes Septic Tank Pumping is hereby issued a Septage Management Firm Permit, Permit Number NCS-00023 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. Archie Elledge WWTP, Winston Salem NC 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 Grimes septic tank pumping The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00023 Enter the five digits following the NCS # City Boonville State / Province / Region Nc Postal / Zip Code 27011 Country Yadkin Street Address 1536 Richmond hill ch rd Address Line 2 Yadkin Yes No 3364699710 jgrimes90@yahoo.com Owner Info Jody grimes Yes No 3364699710 Operator Info Jody grimes Owner Yes No 3364699710 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 ** If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in Type and amount of septage pumped in the last 12 months 300,000 0 0 0 0 North Carolina counties of operation Yadkin. Wilkes. Surry. Stokes. Davie. Davidson. Forsyth. Vehicle Info Yes No 11/16/2019 Owner Add vehicles individually Upload List Domestic Septage Ya104013 1FVACWDC46HW25888 2,500 Domestic Septage YA147646 2NP3LJ0X9LM668404 4,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No 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** Comments or notes Archie elledge 1/1/2020 Yes No Yes No Yes No Septage Management Firm Operator Training Completed 10/28/2019 4 Greensboro 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 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. Signature Date Print Name**Title** 11/16/2019 04:33:37 PM Jody grimes Owner Received 8/20/2020 JRB Received 8/20/2020 JRB PayPoint Payment Receipt Application: Solid Waste Credit Merchant: NDENR-Solid Waste Credit Merchant City/State: Raleigh, North Carolina Merchant Location Code: 00001 Payment Status: Success Result Message: Success Confirmation Number: 19121758793096 Payment Date: 12/17/2019 Posting Date: 12/17/2019 Billing Information: Jody G Grimes 1536 Richmond hill ch rd Boonville, NC 27011 3364699710 Jhrimes90@yahoo.com Payment Amount: 800.00 USD Card Type: AMEX Method: Not Present Page 1 of 1 Reference Information: Ncs-00023-2020,27011,Grimes Septic Tank Pumping,1536 Richmond Hill Church Rd,Boonville,NC,NCS-00023,$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 fiat 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 12/18/2019