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Home My WebLink AboutNCS01398_2021Permit_Initial2021 Permit and Registration United Site Services (Gastonia) is hereby issued a Septage Management Firm Permit, Permit Number NCS-01398 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.Long Creek WWTP, Dallas 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 United Site Services The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01398 Enter the five digits following the NCS # City Gastonia State / Province / Region NC Postal / Zip Code 28052 Country United States of America Street Address 212 Bulb Ave Address Line 2 Gaston Yes No 7048421854 marty.poole@unitedsiteservices.com Owner Info United Site Services Yes No City Westborough State / Province / Region Massachusettes Postal / Zip Code 01581 Country United States of America Street Address 118 Flanders Rd Address Line 2 18008645387 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 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 .0835(a) and vehicle lettering as required by 15A NCAC .0835(b). Furthermore, I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 13B .0836(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 Marty Poole Area Manager Yes No 7048421854 Type and amount of septage pumped in the last 12 months 0 2,350,800 0 0 0 North Carolina counties of operation Gaston, Mecklenburg, Cabarrus, Iredell, Lincoln, Vehicle Info Yes No 4/22/2021 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. Fleet List for Application Gastonia 2020.xlsx 10.19KB 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 Two Rivers 12/31/2021 2021 Authorization to Discharge Form.pdf 422.35… Yes No Yes No Yes No Septage Management Firm Operator Training Completed 11/17/2020 4 Online NC Pumper Group & NC Portable Toilet Group Septage Land Application Site Operator Training Completed 0 Registration Type Long Creek Wastewater Treatment Plant -------------- JRB 4/28/2021 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. 4/22/2021 04:32:14 AM Marty Poole Area Manager AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environmental Quality Division of Waste Management -Solid Waste Section 1646 Mail Service Center,Raleigh,NC 27699—1646 Fee assessments and waste determinations will be required at the discretion of the wastewater treatment facility.The facility has the ultimate prerogative to deny discharges of any wastes to the incoming wastewater stream. I,Mourice K.Brothers,#993739,Long Creek Wastewater Treatment Plant (Plant Operator in Responsible Charge (ORC),ORC License Number,Name of Plant) 3000 Old Spencer Mountain Rd,Dallas,NC 28034 (Address) (704)9224086 do hereby authorize Marty POOIG (Phone Number)(Owner/Operator of Septage Management Firm) of United Site Services NCS #01398 (Septage Management Firm Name and NCS number) to dispose of:domestic septage ,portable toilet waste X Only , grease septage (grease trap pumpings)commercial/industrial septage ,from loe NC (County or other Geographic Area) at the above named wastewater treatment facility.Septage shall be discharged at: 212 Bulb Avenue,Gastonia,NC 28052 _(Location) between the hours of AnytIme Reintroducing partially treated liquid into a grease trap is acceptable Yes X No This authorization shall be valid until December 31.2021 (Usually December 31,(Year) Signed jg )M S ,MQQWAB Date [4‘@Z 3 (Facility Operator)w Subscribed and affirmed before me this 4 day ofl I SS M(R ),ZOQI C 2 Q1 W4 \Q.El X at a 2 My Commission expires:4 (Notary Public)\u Ia“\.a"I\b \SP\84 I”,emawrgI” w‘q|lilhll'lll I '55 ‘3’,o -§Note:Falsification of this document bythe septage management rm shall lead parénit Mbglon$9 a}? S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018 ’d?,3?I!"fCOUN‘VII you.,va,’4‘ a r %”‘nIEIHH’I‘I Truck # Vin # Plate # Tank Capacity 5460 5PVNJ8JV2E4S56571 FC1037 1500 Gallons 169825 5PVNJ8JV3H4S66466 HK9853 1100 Gallons 169830 5PVNJ8JV3H4S66452 JC1318 1100 Gallons 196027 5PVNJ8JJ5J4S50627 JC1321 1100 Gallons 196028 5PVNJ8JJ9J4S50629 JC1320 1100 Gallons 196035 5PVNJ8JR9J4S51494 JC1314 695 Gallons 196036 5PVNJ8JR0J4S51495 HT1033 695 Gallons S50773 5PVNJ8JJ3K4S50773 JC2956 1100 Gallons S50776 5PVNJ8JJ9K4S50776 JC2982 1100 Gallons S50777 5PVNJ8JJ0K4S50777 JC2983 1100 Gallons S50778 5PVNJ8JJ2K4S50778 JC2984 1100 Gallons S50779 5PVNJ8JJ4K4S50779 JC2985 1100 Gallons S50814 5PVNJ8JJ2K4S50814 JC2988 1100 Gallons S50920 5PVNJ8JM0J4S50920 JA2393 695 Gallons S50921 5PVNJ8JM2J4S50921 JA2378 695 Gallons S50922 5PVNJ8JM4J4S50922 JA2376 695 Gallons S50923 5PVNJ8JM6J4S50923 JA2394 695 Gallons S50924 5PVNJ8JM8J4S50924 JA2392 695 Gallons S51523 5PVNJ8JR1J4S51523 JA2391 695 Gallons A77549 1FDUF5GT9FEA77549 JT4053 650 Gallons 483507 3FRWF7FJ2CV483507 JT4071 2000 Gallons Fleet List for Application Gastonia 2020. PAID INVOICE #: NCS‐01398‐2021 PERMIT #: NCS‐01398 AMOUNT: $800 PAYMENT METHOD: Paper DATE: 10/13/2020 Chester Cobb