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Home My WebLink AboutNCS01365_2021Permit_Initial 2021 Permit and Registration New Bern Grand Marina Yacht Club is hereby issued a Septage Management Firm Permit, Permit Number NCS-01365 And by virtue of completing the annual training requirements is hereby registered as a Portable Sanitation 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. On-Site Wastewater Disposal System (City of New Bern, New Bern NC) 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 New Bern Grand Marina Yacht Club The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01365 Enter the five digits following the NCS # City New Bern State / Province / Region NC Postal / Zip Code 28560 Country United States Street Address 134 Craven Street Address Line 2 Craven Yes No 2526380318 jeremy@newberngrand.com Owner Info Marina Ventures 223 LLC Yes No City San Clemente State / Province / Region CA Postal / Zip Code 92672 Country United States Street Address 143 Avenida Caballeros Address Line 2 252-638-0318 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 there significant penalties for false certification including the possibility of fine and imprisonment." Signature Date** Title** Operator Info Jeremy McConnell Dock Master Yes No City New Bern State / Province / Region NC Postal / Zip Code 28560 Country United States Street Address 134 Craven Street Address Line 2 2526380318 Type and amount of septage pumped in the last 12 months 0 39,500 0 0 0 North Carolina counties of operation Craven Vehicle Info Yes No 12/8/2020 Dock Master Choose how to add vehicle descriptions** Pumper Vehicles Usage*License Tag #*Vehicle Identification #*Tank Capacity* Approved wastewater treatment plant ** 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 Dock Master Add vehicles individually Upload List Portable Toilet Waste EC 4210 22 ft Pontoon 95 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Yes No Yes No SDTF-12/31/2021 New Bern Grand Marina 2021 City of NB septage letter.pdf 136.28… Yes No Septage Management Firm Operator Training Completed 11/11/2020 4 New Bern NC Septic Tank Association Septage Land Application Site Operator Training Completed 0 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 Both classes completed, NC state Webex and onsite renewal. 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. 12/8/2020 02:22:26 AM Jeremy McConnell Dock Master PAID Permit Fee INVOICE #: NCS‐01365‐2021 PERMIT #: NCS‐01365 AMOUNT: $550 PAYMENT METHOD: e‐card DATE: 2/12/2021 Chester Cobb