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Home My WebLink AboutNCS01103_2022Permit_Initial2022 Permit and Registration Providence Environmental, Inc. is hereby issued a Septage Management Firm Permit, Permit Number NCS-01103 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. Cross Creek WRF/Rockfish Creek WRF, Fayetteville NC 2. Septage Detention or Treatment Facility, SDTF-26-05, SDTF-34-06, & SDTF 60-09 3. Greenway Disposal, Ridgeway, SC (SCDHEC Permit Number 19389-IW) 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?* Mailing Address* Phone*Fax Email* Firm owner's name* Mailing address same as street address of oce?* Firm Info Providence Environmental Inc. The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01103 Enter the five digits following the NCS # City Columbia State / Province / Region South Carolina Postal / Zip Code 29203 Country United States Street Address 312 Sharpe Rd. Address Line 2 Out-of-State Yes No City Columbia State / Province / Region South Carolina Postal / Zip Code 29230 Country United States Street Address PO Box 3216 Address Line 2 (803)754-1175 (803) 754-0687 julie@providenceenvironmental.com Owner Info Providence Environmental Concepts and Services, LLC Yes No Mailing Address* 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?* City Columbia State / Province / Region South Carolina Postal / Zip Code 29230 Country United States Street Address PO Box 3216 Address Line 2 (803) 754-1175 (803) 754-0687 Operator Info Michael D. Cannon Managing Member Yes No City Columbia State / Province / Region South Carolina Postal / Zip Code 29230 Country United States Street Address PO Box 3216 Address Line 2 (803) 754-1175 (803) 754-0687 Type and amount of septage pumped in the last 12 months 194,940 0 244,245 0 0 North Carolina counties of operation State Wide Vehicle Info Yes No "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* 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)* 11/23/2021 Managing Member Add vehicles individually Upload List Grease (restaurant)P770155 1HTWNAZT6CJ127190 3,000 Grease (restaurant)P762377 1HTWXSAT95J047039 3,000 Grease (restaurant)P762378 1HTWNTAT0HH576614 3,800 Grease (restaurant)P766747 1FVHG5FE2MHMP6129 2,700 Grease (restaurant)8922PT 1UNST42244LO23905 6,300 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Cross Creek WRF / Rockfish WRF 12/31/2022 Cross Creek WRF - Rockfish WRF.pdf 337.08… Yes No Septage Detention or Treatment Facility (SDTF)* If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for each site. SDTF #*Expiration Date *Authorization Other disposal method* Date*Hours * Location * Yes No SDTF-34-05 12/31/2022 Liquid Environmental SDTF-34-05 SDTF-60-09 SDTF-26- 05.pdf 268.13… SDTF-60-09 12/31/2022 Liquid Environmental SDTF-34-05 SDTF-60-09 SDTF-26- 05.pdf 268.13… SDTF-26-05 12/31/2022 Liquid Environmental SDTF-34-05 SDTF-60-09 SDTF-26- 05.pdf 268.13… ND0088889 12/31/2022 SCDHEC Permit Number ND0088889 Belger Farms Co., Inc..pdf 212.3KB 7 12/31/2022 Greenway Disposal #7.pdf 264.22… Yes No Septage Management Firm Operator Training Completed 4/22/2021 4 Online Division of Waste Management Training Sponsored or Provided by* Date Hours Location Training Sponsored or Provided by Select one* Comments or notes Signature Date Print Name*Title* 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 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. 11/23/2021 01:45:27 PM Michael D. Cannon Managing Member PAID FIRM NAME: Providence Environmental, Inc. PERMIT #: NCS-01103 AMOUNT: $800 PAID BY: E-Check DATE: 11/29/2021 Adam Ulishney