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Home My WebLink AboutNCS00758_2022Permit_Initial2022 Permit and Registration K. T. Moore Septic Tank Service is hereby issued a Septage Management Firm Permit, Permit Number NCS-00758 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. Warren County WWTP, Warren NC 2. Town of Louisburg WRF, Louisburg 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 PAID FIRM NAME: K.T. Moore Septic Tank Service PERMIT #: NCS-00758 AMOUNT: $800 PAID BY: E-Check DATE: 11/1/2021 Adam Ulishney 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 KT Moore Septic Tank Service The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00758 Enter the five digits following the NCS # City Kittrell State / Province / Region NC Postal / Zip Code 27544 Country USA Street Address 712 N . Chavis RD Address Line 2 Vance Yes No 252-432-1859 440.ktmoore@gmail.com Owner Info Stephen & Michael Dickerson Yes No 252-425-0320 Operator Info Stephen & Michael Dickerson 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* 252-432-1859 Type and amount of septage pumped in the last 12 months 550,000 0 0 0 0 North Carolina counties of operation Vance, Warren, Wake, Franklin, Granville Vehicle Info Yes No 10/28/2021 President Add vehicles individually Upload List Domestic Septage BM-8169 3FDNF6563YMA19411 1,250 Domestic Septage KF-5357 1FVACWDTOEHFH2197 2,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. 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)* If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site. SLAS #*Expiration Date *Authorization Septage Detention or Treatment Facility (SDTF)* Other disposal method* Date*Hours * Location * Training Sponsored or Provided by* Date Hours Yes No Louisburg WRF 12/31/2022 8CB3ED48- FC39-4FE5- 8B94- 299E07E0FBC9… 2.67MB Warren County WWTP 12/31/2022 56D9EF49- B50A-44A9- 840C- FCECC798D5E3… 2.58MB Yes No SLAS-91-04 12/31/2025 Yes No Yes No Septage Management Firm Operator Training Completed 5/12/2021 4 Outer BANKS NC NC Septic Tank Association Septage Land Application Site Operator Training Completed 5/13/2021 3 Location Training Sponsored or Provided by Select one* Comments or notes Signature Date Print Name*Title* Outer banks nc NC Septic Tank Association Registration Type Registered Portable Sanitation Firm Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm Comments and Notes 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. 10/28/2021 01:23:59 PM Stephen Dickerson President