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Home My WebLink AboutNCS01163_2021Permit_Initial2021 Permit and Registration Premium Tanks & Stone is hereby issued a Septage Management Firm Permit, Permit Number NCS-01163 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.City of Roxboro WWTP, Roxboro NC 2.Septage Detention or Treatment Facility SDTF-73-01 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). 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** PREMIUM TANKS & STONE, INC The "Firm name" must be exactly as it is shown on your vehicle(s). Septage Management Firm permit number (NCS #)** NCS-01163 Enter the five digits following the NCS # City ROXBORO State / Province / Region NC Postal / Zip Code 27573 Country USA Street Address 120 BURCH AVE Address Line 2 Person Yes No City ROXBORO State / Province / Region NC Postal / Zip Code 27573 Country USA Street Address PO BOX 1037 Address Line 2 336-597-2005 336-597-3215 PREMIUMTANKS1@EMBARQMAIL.COM Owner Info KIPPY BLANKS Yes No ------- Inc. removed to match firm name on DWM records JRB 2/19/2021 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 ROXBORO State / Province / Region NC Postal / Zip Code 27573 Country USA Street Address 120 BURCH AVE Address Line 2 336-597-2005 336-597-3215 Operator Info KIPPY BLANKS PRESIDENT Yes No City ROXBORO State / Province / Region NC Postal / Zip Code 27573 Country USA Street Address PO BOX 1037 Address Line 2 336-597-2005 336-597-3215 Type and amount of septage pumped in the last 12 months 0 33,000 0 0 0 North Carolina counties of operation PERSON, DURHAM, ORANGE, GRANVILLE 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** 12/15/2020 PRESIDENT Add vehicles individually Upload List Portable Toilet Waste JT 4316 3C7WRMBL0DG518984 800 Portable Toilet Waste JT 5397 3C7WRMCL8JG391993 1,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No ROXBORO WASTEWATER TREATMENT PLANT 12/31/2021 DUMP.pdf 406.03… Yes No Yes No Yes No Septage Management Firm Operator Training Completed 11/17/2020 4 ONLINE, ZOOM SDTF-73-01 Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** ONLINE, ZOOM 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. 12/2/2020 09:25:52 AM KIPPY BLANKS PRESIDENT