NCS01286_2022Permit_Initial

2022
Permit and Registration
MDM Septic Services

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01286
and registered as a Septage Management Firm
(PUMPER)
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. Hampton Roads Sanitation District, Virginia Beach VA 2. Elizabeth City WWTP, Elizabeth City 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, 2022.

__________________________________________________ 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 oce*
County*
Mailing address same as street address of oce?*
Phone*Fax
Email*
Firm owner's name*
Mailing address same as street address of oce?*
Phone*Fax
Firm operator's name*Firm operator's title
Mailing address same as street address of oce?*
Firm Info
MDM Septic Services Inc.
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01286
Enter the five digits following the NCS #
City
VIRGINIA BEACH
State / Province / Region
VA
Postal / Zip Code
23457
Country
United States
Street Address
1400 Campbells Landing Road
Address Line 2
Currituck
Yes No
757-426-0511 757-426-5957
[e-mail]
Owner Info
David R. Thieman
Yes No
757-426-0511 757-426-5957
Operator Info
David R. Thieman Vice President
Yes No
Phone*Fax
Amount in gallons*
Domestic
Portable Toilet Waste
Grease (Restaurant)
Treatment Plant
Industrial/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*
Pumper Vehicles
Usage*License Tag #*Vehicle Identification #*Tank Capacity*
757-426-0511 757-426-5957
Type and amount of septage pumped in the last 12 months
750,000
0
0
0
0
North Carolina counties of operation
Currituck, Moyock, Elizabeth City, Knotts Island, and South Mills
Vehicle Info
Yes No
11/10/2021
President
Add vehicles individually Upload List
Domestic Septage 45518P 2FZXEWYB1YAGO4865 3,300
Domestic Septage 45-543P 2FZSAZCV77AX81733 4,800
Domestic Septage 61853P 1M2AWO2C58N002279 4,500
Domestic Septage 72068P 1FUY3MCB2XLA21435 3,800
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
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
HRSD PO Box 5902 Virginia Beach, VA
23471
12/31/2022 HRSDDischarg…289.4KB
Elizabeth City Waste Water Treatment
Plant, PO Box 347 Elizabeth City, NC
27909
12/31/2022 Elizabethcit…305.69…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
5/11/2021 4
Jeanette's Pier 7223 S. Virginia Dare Trail Nags Head, NC
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
0
Registration Type
Select one*
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
We are located in the city of Virginia Beach, we are not a county. Selected
Currituck as county as it would not allow option to remain blank.
Certication 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.
11/10/2021
12:58:00 PM
Kimberly M. Thieman President
PAID
FIRM NAME: MDM Septic Services
PERMIT #: NCS-01286
AMOUNT: $800
PAID BY: Check
DATE: 11/15/2021

Adam Ulishney