NCS01016_2021Permit_Initial

2021
Permit and Registration

J & B Septic Service Portable Toilets
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01016
And by virtue of completing the annual training
requirements is hereby registered as a Portable Sanitation &
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. Neuse River Resource Recovery Facility, Raleigh NC
2. South Durham WRF, Chapel Hill NC
3. North Durham WRF, Durham NC
4. Septage Detention or Treatment Facility, SDTF-39-02
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?**
Phone**Fax
Firm Info
J & B SEPTIC SERVICE PORTABLE TOILETS
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01016
Enter the five digits following the NCS #
City
Creedmoor
State / Province / Region
North Carolina
Postal / Zip Code
27522
Country
United States
Street Address
2622 Chloe Ln
Address Line 2
Granville
Yes No
9195284422
[e-mail]
Owner Info
Michael Dickerson
Yes No
9195284422
Operator Info
Michael Dickerson owner
Yes No
9195284422
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
60,000
40,000
0
0
0
North Carolina counties of operation
Granville,Durham, Wake
Vehicle Info
Yes No
12/15/2020
owner
Add vehicles
individually
Upload List
Domestic Septage HJ-4574 1GBJ6C1315F526675 1,200
Portable Toilet Waste JJ-9739 1GD6C2BKXAF127277 450
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)**
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.
SDTF #*Expiration Date*Authorization
Other disposal method**
Date**Hours**
Location**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
North Durham Water Reclamation
Facility
12/31/2020 CITY OF
DURHAM
AUTHORIZATION
2021.pdf
824.45…
NEUSE RIVER RESOURCE RECOVERY
FACILITY
12/31/2020 CITY OF
RALEIGH
2021.pdf
980.98…
Yes No
Yes No
39-02.6/4/2025
Yes No
Septage Management Firm Operator Training Completed
1/11/2020 4
RALEIGH,N.C.
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
0
Registration Type
Select one**
Comments or notes
Signature
Date
Print Name**Title**
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.
12/15/2020
04:57:44 PM
Michael Dickerson OWNER
PAID
INVOICE #: NCS‐01016‐2021 
PERMIT #: NCS‐01016 
AMOUNT: $800 
PAYMENT METHOD: e‐card 
DATE: 12/16/2020 

Chester Cobb