NCS00220_2021Permit_Initial

2021
Permit and Registration
B & B Concrete Products Inc.
is hereby issued a Septage Management Firm Permit, Permit Number NCS-00220
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 Facility, SDTF-57-01
2.Septage Land Application Site, SLAS-57-04
3.Town of Franklin WWTP, Franklin 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
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT . SOLID WASTE SECTION - 1646 MAIL SERVICE CENTER, RALEIGH, NC 27699.1646
(1.) Firm name: fhe "Firm name" musf be exactly as if is shown on your vehicle(s)).
State. Zip
tsqlc
City:State:
Fax:
Zp
Phone:
(3.) Firm operato/s nam operato/s tite.. (lcc-rt<cq<(
Mailing address (if d
State: Zip:
Fax:
(a.)Type(s)of septage pumped: (Example: Domestic: 50,000),
(6,) Total Number of Pumper Vehicles Operated.
Number used for: Domestic Septage: -f Crrase lrestaurant): S
Vehicle Information: (use additional paper if needed)
c ty:
Other:Portable Toilet Waste: -S
Streetaddressofoffice: | 6 8 l, Ge o rgt a- R.4
cttv, {rctnL(l 14 state: A/C zip: )-8/}Ll
Mailing address (if different):Sa-r-'te-
City:
Phone{&Lt) 5 \t-l -(Ll 83 Fax,
E-Mail:
County: //ld-C Q4 SeptageManagementFirmpermitnumber: NCS#OO>\O
(2.) Firm owne/s name:
Mailing address (if different):Szurma,
N,C. Counties of Operation:
License Taq #Vehicle ldentification #Tank Capac
1 /VD - q X R)l7 2-
z A/fl) - I A ?a IA li€oo?NO- tOx6 2^6 '/ >-, R6n
4 Al F - 4< 14 6 >^--s'o oIVK - S;>-\E \o 2_,3c|cl
APPLICATION CONTINUED ON PAGE 2
PAGE 1
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(coNTtNUED FROM PAGE 1)
(7,) Do you plan to operate pumper vehicles? (check one) (X) yes ( ) no.
lf you checked yes above, you must attest to thdfollowing statement before a permit may be issued.
"l ceftify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meets therequirements for_safe and sanitary transportation of septage as required by 15A NC a) and vehicle letteringas required UV ]?l\9n9 0835(b) Furthermore, I also certify that a log is maintain tage pumping event asrequired by 15A NCAC 138 '0836(a). I am aware that there are significint penalties cation including thepossibility of fine and imprisonment.,'
Do vou attest to the statement above? F) ym ( ) no tnitiat = /U D oate 7/ /S/ > I
(8.) Septage Disposal Method: (check one)
a)Appgve! w.gstew.atefreatment plant (r,( ) yes ( ) no. lf yes, submit Wastewater Treatment Authorization for eachplant, as indicated in subparagraph .O$a(c)(ia) of theseptage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
S[-AS#: 5/- O 1 Expiration Oate.THz I SmS+,_Exprat6n bate:
c) Septage Detention or Treatment Facility (SDIF) Permit Numbers: (use additional sheets if needed)SDTF#:-57-d/ Expiration oateig/21/z<sDTF#: ExpirationDate:_
(9.) Septage Management Firm Operator Training Completed:
Date'. lr/ 3O1>O Location:Hours: 6
Training Sponsored or Provided OV.. M C_S T 4
(10,) Septage La or Training Completed:Date: Location: HtCKor/f AtC Hours: 3
Training Sponsored or provided OV: N ( SYt
(11.)Registrationtyperequested:cHEcKoNEUPd,'-leJ+,
Registered Portable sanitation Firm: For a cl- o be( >oti
Registered Septage Management Firm: _
Registered Portable Sanitation and Septage Management Firm: _V(
Certification Statement
I certify that the information and representations in this application for a permit are true, complete, and accurate to the bestof my knowledge and belief' I am aware that a permit may be suspended or revoked upon a finding that its issuance wasbased upon incorrect or inadequate information that materially affected the decision to issue the p-ermit and that there arecriminal penalties for knowingly making a false statement, representation, or certification.
/ - / S^Z- 2-(
Date(Signature ofiompany oiEht requtred)
OtherComments: 7- |
:. (e,rng Dec(c/ rTl<t nug<.(
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'
70 6rn at kt
(PlantOperatorinResponsiORC),ORCLiceseNumber'NameofPlant)
to dispose of: domestic septage / ' portable toilet waste x
grease septage (grease trap pumpings) y commercial/industrial septage ' from
flXSU- Zg tt do herebv authorize
(Phone Number)
t'
of Name and NCS number)
'{})tu (.-('litt
(County or other GeograPhic Area)
at the ailve named wastlwater treatment facility. Septage shall be discharged at:
between the hours of
Reintroducing partially treated liquid into a grease trap is acceptable
-YesThis authorization shall be valid until
ecember 31, Year)
L7-day or NnV 20 7-D
Mv Commission exPires:
signed ou" ilf tzlzozo
(oFFl
Note: Falsification of this document by the septage management firm shall lead to permit
S:/Solid-Waste/CLA/SEPTAGE/FORM5/201S Firm Application/WWTP Authorization Form 2018
OZ.,-
PAID
INVOICE #: NCS‐00220‐2021 
PERMIT #: NCS‐00220 
AMOUNT: $800 
PAYMENT METHOD: Paper 
DATE: 10/2/2020 

Chester Cobb