NCS01511_2021Permit_Initial

2021
Permit and Registration

United Site Services (Monroe)
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01511
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 Monroe WWTP 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?**
Mailing Address**
Phone**Fax
Firm Info
United Site Services
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01511
Enter the five digits following the NCS #
City
Monroe
State / Province / Region
North Carolina
Postal / Zip Code
28110
Country
United States
Street Address
3213 Union Power Way
Address Line 2
Union
Yes No
980-285-2587
[e-mail]
Owner Info
United Site Services
Yes No
City
Westborough
State / Province / Region
Massachusetts
Postal / Zip Code
01581
Country
United States
Street Address
118 Flanders Rd
Address Line 2
1-800-864-5387
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
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
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**
Operator Info
Charles Boyd Field Operations Supervisor
Yes No
980-285-2587
Type and amount of septage pumped in the last 12 months
0
1,137,800
0
0
0
North Carolina counties of operation
Union, Mecklenburg, Cabarrus
Vehicle Info
Yes No
3/4/2021
Area Manager
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.
Monroe Permit Fleet List 03.03.21.xlsx 10.71KB
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**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
City of Monroe 12/31/2021 United Site
Services
Authorization
to Discharge
2021 City of
Monroe.pdf
312.62…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
11/17/2020 4
Online with Dylan Friedenberg
NC DEQ - New Operator Training
Septage Land Application Site Operator Training Completed
Registration Type
Comments or notes
Signature
Date
Print Name**Title**
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.
3/3/2021
03:09:11 AM
Marty Poole Area Manager
2021 Permitted truck information
169829 5PVNJ8JV4H4S66525 JC1310 1100
169830 5PVNJ8JV3H4S66452 JC1318 1100
169828 5PVNJ8JV0H4S66523 JC1317 1100
159784 5PVNJ8JL7F4S51822 JC1315 1100
S50771 5PVNJ8JJXK4S50771 JC2936 1100
S50812 5PVNJ8JJ9K4S50812 JH4426 1100
196029 5PVNJ8JJ7J4S50631 JC1313 110
S50774 5PVNJ8JJ5K4S50774 JC2955 1100
S50779 5PVNJ8JJ4K4S50779 JC2985 1100
S50813 5PVNJ8JJ0K4S50813 JC2987 1100