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Home My WebLink AboutNCS00914_2021Permit_Initial 2021 Permit and Registration Albemarle Septic Service is hereby issued a Septage Management Firm Permit, Permit Number NCS-00914 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. Rogerson Wastewater Treatment Facility, Elizabeth City NC 2. Ahoskie WWTP, Ahoskie 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?** Phone**Fax Firm Info Albemarle Septic Service LLC The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00914 Enter the five digits following the NCS # City Camden State / Province / Region North Carolina Postal / Zip Code 27921 Country USA Street Address 134 Belcross Rd Address Line 2 Camden Yes No 252-202-9969 albsepticservice@centurylink.net Owner Info Joseph M Russell Yes No 252-202-9969 252-335-0089 Operator Info Joseph M Russell owner/operator Yes No 252-202-9969 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** Upload vehicle 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 Type and amount of septage pumped in the last 12 months 300,000 15,000 50,000 100,000 10,000 North Carolina counties of operation Camden Pasquotank Currituck Dare Perquimans Chowan Gates Vehicle Info Yes No 12/9/2020 Owner Add vehicles individually Upload List You can upload a file with a list of vehicles to be used. Please be sure to include the following information for each vehicle on your upload: Usage, License Tag #, Vehicle Identification #, and Tank Capacity. BRW2C6FC95EE060_001106.pdf 250.69KB Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No 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)** If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site. SLAS #*Expiration Date*Authorization 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 Select one** Elizabeth City Waste Water Treatment Plant 12/31/2021 BRW2C6FC95EE0…471.08… Town of Ahoskia 12/31/2021 BRW2C6FC95EE0…471.08… Yes No SLAS-1502 4/30/2019 Yes No SDTF-1502 4/30/2019 Yes No Septage Management Firm Operator Training Completed 10/8/2020 6 Nags Head NC NC Septic Tank Association Septage Land Application Site Operator Training Completed 10/8/2020 3 Nags Head NC NC Septic Tank Association Registration Type 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 please see attache recertification of pumper vehicles 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. 12/9/2020 06:39:02 PM Joseph M Russell owner PAID INVOICE #: NCS‐00914‐2021 PERMIT #: NCS‐00914 AMOUNT: $800 PAYMENT METHOD: e‐card DATE: 12/11/2020 Chester Cobb