NCS01456_2022Permit_Initial

2022
Permit and Registration
Fresh and Clean LLC, DBA Straight Flush Septic

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01456
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. Rocky River Regional WWTP, Concord 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?*
Mailing Address*
Firm Info
Straight Flush Septic
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01456
Enter the five digits following the NCS #
City
Winston Salem
State / Province / Region
NC
Postal / Zip Code
27106
Country
United States
Street Address
1959 N Peace Haven Rd.
Address Line 2
Suite 171
Forsyth
Yes No
336-970-0502
[e-mail]
Owner Info
David Welch
Yes No
City
Winston Salem
State / Province / Region
NC
Postal / Zip Code
27106
Country
United States
Street Address
957 Kenleigh Cir
Address Line 2
Phone*Fax
Firm operator's name*Firm operator's title
Mailing address same as street address of oce?*
Mailing address*
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
336-970-0502
Operator Info
David Welch Managing Member
Yes No
City
Winston Salem
State / Province / Region
NC
Postal / Zip Code
27106
Country
United States
Street Address
957 Kenleigh Cir
Address Line 2
336-970-0502
Type and amount of septage pumped in the last 12 months
711,000
0
0
0
0
North Carolina counties of operation
Forsyth, Surry Stokes, Davidson, Davie, Rowan, Cabarrus, Iredell,
Mecklenburg, Yadkin, Guilford
Vehicle Info
Yes No
Date*
Title*
Choose how to add vehicle descriptions*
Pumper Vehicles
Usage*License Tag #*Vehicle Identification #*Tank Capacity*
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*
11/28/2021
Managing Member
Add vehicles individually Upload List
Domestic Septage YA1461771 1HTMMAAN2BH323656 2,000
Domestic Septage JK-2732 JALC4B14737013711 1,000
Domestic Septage KH6577 5PVNJ8AV9M5T51171 1,400
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Archie Elledge Wastwater Facility 12/31/2021
Rocky RIver Regional Wastewater
Treatment Plant
12/31/2022 WSACC
Authorization
to
discharge.pdf
962.09…
McAlpine Creek Wastewater Treatment
Plant
12/31/2021
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
Date*Hours *
Location *
Training Sponsored or Provided by*
Date Hours
Location
Training Sponsored or Provided by
Select one*
Comments or notes
Signature
Date
Print Name*Title*
9/16/2021 16
Asheville, NC
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
0
Registration Type
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
McAlpine and Archie Elledge have not sent in the updated authorizations to
discharge. Archie Elledge requires me to send my 2022 permit to them first so
I will update that one after receiving your permit and submitting to Archie
Elledge. McAlpine has just not sent theirs yet, but I have taken the required
training. My permit will be updated after receiving both of these from the
respective plants.
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.
11/28/2021
03:08:48 PM
David Welch Member Manager
PAID
FIRM NAME: Fresh and Clean LLC, DBA Straight Flush Septic
PERMIT #: NCS-01456
AMOUNT: $800
PAID BY: E-Check
DATE: 12/1/2021

Adam Ulishney