NCS01115_2020Permit_Initial

2020
Permit and Registration

Long's Septic Pumping
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01115
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. West Brunswick Regional Wastewater Treatment Facility

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
LONGS SEPTIC SERVICE
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01115
Enter the five digits following the NCS #
City
SUPPLY
State / Province / Region
NC
Postal / Zip Code
28462
Country
BRUNSWICK
Street Address
1935 OYSTER HARBOUR PARKWAY
Address Line 2
Brunswick
Yes No
910 540 3139 910 287 5779
[e-mail]
Owner Info
DANIEL LONG
Yes No
910 287 5778 2287 5779
Operator Info
DANIEL LONG OWNER
Yes No
910 540 3139 910 287 5779
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
subparagraph .0833(c)(14) of the Septage Management Rules.
Type and amount of septage pumped in the last 12 months
1,500,000
0
0
0
0
North Carolina counties of operation
BRUNSW2ICK COUNTY NC
Vehicle Info
Yes No
1/27/2020
OWNER
Add vehicles
individually
Upload List
Domestic Septage YA151268 NOT SHORE 4,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
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
Signature
BRUNSWICK COUTY WASTE WATER PLANT 12/31/2020
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
6/10/2020 4
SHALLOTTE 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 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.
Date
Print Name**Title**
1/27/2020
07:22:17 PM
DANIEL LONG OWNER
$550.00 permit fee
$275.00 late fee
Paid 09/17/2020
JRB 10/23/2020
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality 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 wastewater treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the incoming wastewater stream.
I, Michael J._{iarri #1002810 West Brunswick Re ional Wastewater Trea .(Plant Operator in Responsible Charge (ORC), ORC License Number, Name'o
235 Grey Water Road, Supply, NC 28462
(Address)
[phone] do hereby authorize ________ D_an_1_· e_l _L_on....::g"---------(Phone Number) (Owner/Operator of Septage Management Firm)
of ________ -=L=o=ng.._'--s=S.c.Jep"""t_ic'-Pum-==p._i=n.,_g....._ ___________ ...,N=CS......_#.,.,0....,1 .... 11 ... 5'-(Septage Management Firm Name and NCS number)
to dispose of: domestic septage _X ____ _, portable toilet waste _____ _,
grease septage (grease trap pumpings) commercial/industrial septage from ---------
Brunswick County (County or other Geographic Area) at the above named wastewater treatment facility. Septage shall be discharged at:
West Brunswick Regional Wastewater Treatment Facility, 235 Grey Water Road, Supply NC
(Location) between the hours of Monday-Friday 8 a.m. -6 p.m.; Weekends & Holidays 9 a.m. -5 p.m.
Reintroducing partially treated liquid into a grease trap is acceptable __ Yes --2£._No
-fhis authorization shall be valid until __________ D __ e __ c __ em ........ b __ e __ r __ 3 __ 1,...,2 __ 0 __ 2 __ 0 ________ _
Signed .Lb1:,..., 11�/ �
(Usually December 31, Year)
7 (F� Operator) Date \ [ 'o / f).o ;;;.o
Michael J. Garrity personally own to me
Subscribed and affirmed before me this ____ tf ___ --l_J.. _____ day of
��� ff.#;;,, My Commission expires: (Not;f Public) ------------KATHY H. WALTERS
NOTARY PUBLIC Bnnwlck COunty, CaRJllna My commission expires 1/'I � l-.
LJZ,u,ry. 20 :J. 0
(J '1 II o /6 o -l 1..r ,
(OFFICIAL SEAL)
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Appllcatlon/WWTP Authorization Form 2018
Received 10/23/2020 from BRWWTF JRB 10/23/2020