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Home My WebLink AboutNCS01473_2021Permit_Initial 2021 Permit and Registration Wayne County Facility Services is hereby issued a Septage Management Firm Permit, Permit Number NCS-01473 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. Septage Detention or Treatment Facility, SDTF-98-08 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 Wayne County Facility Services The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01473 Enter the five digits following the NCS # City Goldsboro State / Province / Region NC Postal / Zip Code 27534 Country USA Street Address 804C Corporate Drive Address Line 2 Wayne Yes No 919-731-1168 919-731-1166 facilities@waynegov.com Owner Info Wayne County (Kendall Lee) Yes No 919-731-1168 919-731-1166 Operator Info Robbie Blanton ORC Yes No 919-920-2630 919-731-1168 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 ** Type and amount of septage pumped in the last 12 months 0 0 0 0 0 North Carolina counties of operation Wayne Vehicle Info Yes No 9/24/2020 ORC Add vehicles individually Upload List Domestic Septage 75988V 1HTMMAAL47H470437 1,550 Grease (restaurant)75988V 1HTMMAAL47H470437 1,550 Other 75988V 1HTMMAAL47H470437 1,550 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No 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 Select one** Comments or notes Signature Yes No Yes No 980800953 12/31/2021 Septic.pdf 523.53… Yes No Septage Management Firm Operator Training Completed 9/10/2020 4 Morganton NC NC Pumper Group & NC Portable Toilet Group 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** 9/24/2020 09:01:04 AM Kendall Lee Facility Services Director 餓軸餓舗銅の輔弼館距離軸謳館鱒蝋誰配賦肝翻 §蛾醍醐珊瑚晴即の§㊨艦鵜胸囲醐閏舗㊨鵬的臣 nThis form is used by a detention or treatme鴫栂y permit hc咽er to indicate that permissjon has been given to a permitted Septage Manageme刷m to djscharge §ePtage into the permit 輔ers detention or treatment faci“ty.) do he「ebv authori独 (栂a周e of sep量るge 置芸詳時ge Management Firm) 三>も「V、\ 帝可硝」叱一時) 蔓遡上-塞 tO ut醇eptage detenti唖的ent fadity #曲輸for the treatment or storag。。f SePtageを壌」曝凋e軸姉・Se瑚A・輔輝瑚鞠的即納e摘縄脆賦G量鈍さ0800 Return the properiy completed form to: No軸的航さDepa軸en亡of富画「onm摘- Q嘩 D廟sjon o唖as書e煽れagem帥 So栂Was年e sec亡i。n 1646 Maiはervice Center ㈲eigh′ NC 27699-1646 みて日参3 PAID INVOICE #: NCS‐01473‐2021 PERMIT #: NCS‐01473 AMOUNT: $550 PAYMENT METHOD: Paper DATE: 10/2/2020 Chester Cobb