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Home My WebLink AboutNCS00756_2020Permit_Initial2020 Permit and Registration Preferred Rent-A-Jon is hereby issued a Septage Management Firm Permit, Permit Number NCS-00756 And by virtue of completing the annual training requirements is hereby registered as a Portable Sanitation 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). 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 Firm name** Preferred Rent-A-Jon The "Firm name" must be exactly as it is shown on your vehicle(s). Septage Management Firm permit number (NCS #)** NCS-00756 Enter the five digits following the NCS # City Advance State / Province / Region NC Postal / Zip Code 27006 Country USA Street Address 147 Aviara Dr. Address Line 2 Forsyth Yes No City Clemmons State / Province / Region NC Postal / Zip Code 27012 Country USA Street Address PO Box 414 Address Line 2 336-345-4392 preferreddisposal@outlook.com Owner Info Allen Snider Yes No Removed "Inc." to match firm name on record JRB 8/20/2020 Phone**Fax 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 Toilet Waste Grease (Restaurant)Grease (Restaurant) Treatment PlantTreatment Plant Industrial/CommercialIndustrial/Commercial 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 City Clemmons State / Province / Region NC Postal / Zip Code 27012 Country USA Street Address PO Box 414 Address Line 2 336-345-4392 Operator Info Allen Snider President Yes No City Clemmons State / Province / Region NC Postal / Zip Code 27012 Country USA Street Address PO Box 414 Address Line 2 336-345-4392 Type and amount of septage pumped in the last 12 months 0 93,600 0 0 0 North Carolina counties of operation Forsyth Vehicle Info Yes No 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 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** 4/19/2020 President Add vehicles individually Upload List Portable Toilet Waste KA-7302 JALB4B143X7006241 900 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Elledge Wastewater Treatment Plant 1/1/2021 Yes No Yes No Yes No Septage Management Firm Operator Training Completed 12/7/2019 4 Raleigh NC NC Pumper Group & NC Portable Toilet Group Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** 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. 4/19/2020 01:46:57 PM Allen Snider President X--------------------------------- JRB 8/20/2020 Received 8/20/2020 JRB AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environment and Natural Resources Division of Waste Management -Solid Waste Section 1646 Mail Service Center, Raleigh, NC 27699-1646 Fee assessments and waste determinations will be required at the discretion of the wastewatertreatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to theincoming wastewater stream. I, J. Frank Crump-WW#10047-Archie Elledge Wastewater Facility (Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant) 2801 Griffith Rd. Winston-Salem NC 27103(Address) __ _e3c,3.,,_6-...,7_,,6c,5c,-Oe.e1ee3e,O _______ do hereby authorize c,Accl lescn=Sncei_,,_descrc._ _________ _(Phone Number) (Owner/Operator of Septage Management Firm) Of Preferred Rent-A-Jon NCS # 00756(Septage Management Firm Name and NCS number) to dispose of: domestic septage ---� portable toilet waste ----"'X,..__� grease septage (grease trap pumpings) ____ commercial/industrial septage ---� from Winston-Salem/Forsyth County and Adjacent Counties (County or other Geographic Area)at the above named wastewater treatment facility. Septage shall be discharged at: Archie Elledge Wastewater Facility (Location)between the hours of 6:00 am until 6:00 pm Monday Through Saturday Reintroducing partially treated liquid into a grease trap is acceptable __ Yes _X_No This authorization shall be valid until "'D-"e"'ce"-'m=be"'r�3'-'1"---"2-"'02"'0"--------------(Usually December 31, Year) Signed __ .... ;:Z"'"-·---'.'--j,,,..,'.-fo��"'Fa"'-ci -lit-y�-.,,_e=r�;(=Lor_) ________ _ Subscribed and affirmed b�fore me this ___ �_,__ ____ day of Q()\/€Q'J00!; 20 1'3 Ob o�y��-�\ My Commission expires: Y l I l J,.o� (OFFICIAL SEAL) NOTARY PUBLIC CHERYL TILLEY Note: Falsification of this document by the septage management firm shall lead to permi revoOOWtill'f OF FORSYTH, �C S:/Solid_Waste/ClA/SEPTAGE/FORMS/2016 Firm AP.plication/WWTP Authorization Form 2018 M'f COMMISSION EXPIRES '--I )I /a&::<1 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: Settled Result Message: Payment completed and settled successfully. Confirmation Number: 20042080239970 Payment Date: 04/20/2020 Posting Date: 04/20/2020 Billing Information: Allen Snider PO Box 414 Clemmons, NC 27012 3363454392 allen@alpha-disposal.com Payment Amount: 550.00 USD Card Type: VISA Method: Not Present Page 1 of 1 Reference Information: NCS-00756-2020,27012,Preferred Rent-A-Jon Inc.,PO Box 414,Clemmons,NC,NCS-00756,$550.00 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 4/22/2020 Payi>oint 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: 20042080239213 Payment Date: 04/20/2020 Posting Date: 04/20/2020 Billing Information: Allen Snider PO Box 414 Clemmons, NC 27012 3363454392 allen@alpha-disposal.com Payment Amount: 275.00 USD Card Type: VISA Method: Not Present Page 1 of 1 Reference Information: NCS-00756-2020LF,27012,Preferred Rent-A-Jon Inc.,PO Box 414,Clemmons,NC,NCS-00756,$275.00 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 4/22/2020