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Home My WebLink AboutNCS01103_2021Permit_Initial 2021 Permit and Registration Providence Environmental, Inc. is hereby issued a Septage Management Firm Permit, Permit Number NCS-01103 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. Spring Lake Regional WWTP, Spring Lake NC 2. Cross Creek WRF/Rockfish Creek WRF, Fayetteville NC 3. Septage Detention or Treatment Facility, SDTF-26-05, SDTF-34-06, SDTF 60-09 & SDTF-36-15 4. Storms Farm Waste to Energy Digester Facilities (AWI090025), Bladenboro NC 5. 5. Greenway Disposal, Irmo, SC (SCDHEC Permit Number 19389-IW) 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?** Mailing Address** Phone**Fax Email** Firm owner's name** Mailing address same as street address of office?** Mailing Address** Firm Info Providence Environmental Inc. The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01103 Enter the five digits following the NCS # City Columbia State / Province / Region South Carolina Postal / Zip Code 29203 Country United States Street Address 312 Sharpe Rd. Address Line 2 Out-of-State Yes No City Columbia State / Province / Region South Carolina Postal / Zip Code 29230 Country United States Street Address PO Box 3216 Address Line 2 8037541175 8037540687 JULIE@PROVIDENCEENVIRONMENTAL.COM Owner Info Providence Environmental Concepts and Services, LLC Yes No 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 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 City Columbia State / Province / Region South Carolina Postal / Zip Code 29230 Country United States Street Address PO Box 3216 Address Line 2 8037541175 8037540687 Operator Info Michael D. Cannon Managing Member Yes No City Columbia State / Province / Region South Carolina Postal / Zip Code 29230 Country United States Street Address PO Box 3216 Address Line 2 8037541175 8037540687 Type and amount of septage pumped in the last 12 months 187,644 0 233,760 0 0 North Carolina counties of operation State Wide 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)** 12/2/2020 Managing Member Add vehicles individually Upload List Grease (restaurant)P760505 1HTWNAZT6CJ127190 3,000 Grease (restaurant)P760502 1HTWXSAT95J047039 2,700 Grease (restaurant)P760508 1HTWNTAT0HH576614 3,800 Grease (restaurant)PV46513 1PMS44227N1011674 5,500 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Spring Lake Regional Wastewater Treatment Facility 12/31/2021 Spring Lake Regional Wastewater Treatment Facility.pdf 363.74… Cross Creek WRF / Rockfish WRF 12/31/2021 Cross Creek WRF - Rockfish WRF.pdf 388.01… 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 Yes No Yes No SDTF-36-15 12/31/2021 SDTF-36- 15.pdf 344.36… SDTF-26-05 12/31/2021 SDTF-26- 05.pdf 336.09… SDTF-34-05 12/31/2021 SDTF-34- 05.pdf 336.53… SDTF-60-09 12/31/2021 SDTF-60- 09.pdf 335.61… 19389IW 12/31/2021 SCDHEC Permit Number 19389- IW.pdf 273.48… ND0088889 12/31/2021 SCDHEC Permit Number ND0088889 Belger Farms Co., Inc..pdf 298.13… Yes No Septage Management Firm Operator Training Completed 1/30/2020 4 Hickory Metro Convention Center Hickory, NC NC Septic Tank Association Septage Land Application Site Operator Training Completed NC Septic Tank Association Select one** Comments or notes Signature Date Print Name**Title** 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 03:00:00 PM Michael D. Cannon Managing Member PAID INVOICE #: NCS-01103-2021 PERMIT #: NCS-01103 AMOUNT: $800 PAYMENT METHOD: e-card DATE: 12/3/2020 Chester Cobb