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Home My WebLink AboutNCS01441_2021Permit_Initial2021 Permit and Registration Lee Septic & Land is hereby issued a Septage Management Firm Permit, Permit Number NCS-01441 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.Septage Detention or Treatment Facilities, SDTF-27-24 2.Septage Land Application Site SLAS-27-24 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 Lee Septic & Land The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01441 Enter the five digits following the NCS # City Kitty Hawk State / Province / Region NC Postal / Zip Code 27949 Country USA Street Address 3908 Poor Ridge Road Address Line 2 Dare Yes No 252-261-3073 lee@septicandland.com Owner Info Roy L. Etheridge, Jr. Yes No 252-261-3073 Operator Info Roy L. Etheridge, Jr.Owner Yes No 252-261-3073 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 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 #* Approved wastewater treatment plant ** Septage Land Application Sites (SLAS)** Type and amount of septage pumped in the last 12 months 343,350 0 0 0 0 North Carolina counties of operation Dare, Currituck, Camden, Pasquotank Vehicle Info Yes No 10/30/2020 Consultant for Lee Septic & Land Add vehicles individually Upload List Domestic Septage YA141448 1FVHA6CV46LW64565 Domestic Septage YA145932 1HTWJADT54J021611 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Portable Toilet OBX94881 1FTNX21FXYED73576 Portable Toilet OBX97332 1FDAF57PO6EC85874 Tank Capacity* 4,200 3,500 200 ---------- 300 -----------Added 3/5/2021 JRB 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** Comments or notes Yes No SLAS-27-24 11/1/2021 Yes No SDTF-27-24 11/1/2021 Yes No Septage Management Firm Operator Training Completed 10/8/2020 6 Ramada Inn, Kill Devil Hills, NC NC Septic Tank Association Septage Land Application Site Operator Training Completed 10/8/2020 3 Ramada Inn, Kill Devil Hills, NC NC Septic Tank Association Registration Type Registered Portable Sanitation Firm Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm Comments and Notes Training certificates emailed to NCDEQ DWM Chester Cobb 10-30-20. 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. ----------Expired 11/1/2020 renewal received JRB 3/10/2020 Expired 11/1/2020 renewal received JRB 3/10/2020--------------- Signature Date Print Name**Title** 10/30/2020 05:27:28 AM Kenneth Elliott Consultant for Lee Septic & Land PAID INVOICE #: NCS-01441 FIRM NAME: Lee Septic & Land PERMIT #: NCS-01441 AMOUNT: $800 PAYMENT METHOD: Paper Check – Check # 2355 DATE: 11/03/2020 Chester Cobb