NCS00772_2021Permit_Initial

2021
Permit and Registration
Piedmont Septic Tank Inc
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00772
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. Rocky River Regional WWTP, Concord 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, 2021.
__________________________________________________ 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?**
Mailing address**
Firm Info
Piedmont septic Tank
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00772
Enter the five digits following the NCS #
City
China Crove
State / Province / Region
NC
Postal / Zip Code
28023
Country
USA
Street Address
213 N Main St
Address Line 2
Rowan
Yes No
704-857-6426
[e-mail]
Owner Info
Randy Melton
Yes No
704-857-6426
Operator Info
Randy Melton
Yes No
Inc. JRB 2/9/2021
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
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*
City
Kannapolis
State / Province / Region
NC
Postal / Zip Code
28083
Country
USA
Street Address
633 Hunter Oak Dr
Address Line 2
704-202-0370
Type and amount of septage pumped in the last 12 months
400,000
0
0
0
0
North Carolina counties of operation
Rowan, Cabarrus, Mecklenburg, Iredell, Davidson
Vehicle Info
Yes No
12/31/2020
Owner, Operator
Add vehicles
individually
Upload List
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**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Domestic Septage YA79364 1MAA13YXSWO54334 3,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
WASACC of Cabarrus Co.12/31/2021
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
9/22/2020 4
Stony Point Birch Lodge
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 or notes
Signature
Date
Print Name**Title**
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.
12/31/2020
04:08:23 PM
Randy L Melton Owner, Operator