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Home My WebLink AboutNCS00168_2021Permit_Initial2021 Permit and Registration A Sani-Can is hereby issued a Septage Management Firm Permit, Permit Number NCS-00168 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.T Z Osborne WRF, Mcleansville NC 2.Septage Detention or Treatment Facility, SDTF-41-06 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 A Sani-Can The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00168 Enter the five digits following the NCS # City Greensboro State / Province / Region North Carolina Postal / Zip Code 27405 Country United States Street Address 2316 Joe Brown Drive Address Line 2 Guilford Yes No City Denver State / Province / Region North Carolina Postal / Zip Code 28037 Country United States Street Address 8151 Webbs Road Address Line 2 7044835641 7044838481 neeley@asanican.com Owner Info Gary & Virginia Dellinger 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). City Denver State / Province / Region North Carolina Postal / Zip Code 28037 Country United States Street Address 8151 Webbs Road Address Line 2 7044835641 7044838481 Operator Info Gary Dellinger Secertary Yes No City Denver State / Province / Region North Carolina Postal / Zip Code 28037 Country United States Street Address 8151 Webbs Road Address Line 2 7044835641 7044838481 Type and amount of septage pumped in the last 12 months 0 382,956 0 0 0 North Carolina counties of operation Guilford,Davidson,Randolph,Forsyth,Stokes,Moore,Rockingham,Chatham,Orange,Dur ham,Wake,Alamance,Franklin Vehicle Info Yes No 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 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** Description*Authorization 11/6/2020 Treasurer 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. 2021 Greensboro Trucks.pdf 38.62KB Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No ORC-TZ Osborne Water Reclamation 12/31/2021 2021 ORC-TZ Osborne Discharge.pdf 306.82… Yes No Yes No Yes No Onsite into the county Septage Management Firm Operator Training Completed SDTF-41-06 06/01/2023X JRB 3/16/2021 Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** 1/30/2020 12 Hickory, NC NC Septic Tank Association Septage Land Application Site Operator Training Completed 1/31/2020 6 Hickory, 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 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. 11/6/2020 11:01:57 AM Neeley Robinson Treasurer ---------------------------------------------- X TZO Authorization to Discharge only allows disposal of potable toilet waste. JRB 3/17/2021 PayPoint Payment Receipt Application: Solid Waste Credit Merchant: NDENR-Solid Waste Credit Merchant City/State: Raleigh, North Carolina Merchant Location Code: 00001 Payment Status: Settled Result Message: Payment completed and settled successfully. Confirmation Number: 20110612361301 Payment Date: 11/06/2020 Posting Date: 11/06/2020 Billing Information: A Sani Can Service Inc 8151 Webbs Road Denver, NC 28037 7044835641 neeley@asanican.com Payment Amount: 800.00 USD Card Type: VISA Method: Not Present Reference Information: NCS-00168-2021,27405,A Sani-Can,2316 Joe Brown Dr,Greensboro,NC,NCS-00168,$800.00 Page 1 of 1 Disclaimer: A convenience fee is charged by a third-party provider for all online payments made by a credit or debit card. DEQ does not receive any portion of these fees associated with this service. The fee is currently 2.65% of the amount paid on all credit and debit card transactions, except for VISA debit, which has a flat fee of $3.95 per transaction. Your card will not be charged until after you have accepted the convenience fee amount. If you choose not to pay the fee, you may cancel the transaction and pay by another method. If you accept the convenience fee and elect to continue, your credit card statement will show two charges -one for the amount due to DEQ, and one for the convenience fee. The convenience fee is not refundable. https://admin.thepayplace.com/epayadmin/paymentreceipt.aspx 11/9/2020