NCS00009_2022Permit_Initial

2022
Permit and Registration
Bryant & Lassiter Septic Tank Service, Inc.

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00009
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. City of Ahoskie WWTP 2. Town of Woodland WWTP 3. Roanoke River WWTP
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?*
Phone*Fax
Firm Info
Bryant and Lassiter Septic Tank Service, Inc
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00009
Enter the five digits following the NCS #
City
Woodland
State / Province / Region
NC
Postal / Zip Code
27897
Country
United States
Street Address
3047 NC 35 Hwy
Address Line 2
Northampton
Yes No
City
Potecasi
State / Province / Region
North Carolina
Postal / Zip Code
27867
Country
United States
Street Address
PO Box 157
Address Line 2
252-587-4321
[e-mail]
Owner Info
David and Felicia Cooper
Yes No
252-587-4321
Firm operator's name*Firm operator's title
Mailing address same as street address of oce?*
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*
Operator Info
David Cooper
Yes No
252-587-4321
Type and amount of septage pumped in the last 12 months
845,000
475
80,200
0
227,300
North Carolina counties of operation
Northampton, Hertford, Bertie, Gates, Halifax
Vehicle Info
Yes No
11/24/2021
President
Add vehicles individually Upload List
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*
Domestic Septage NE-4669 1HTMMAAN18H552533 2,400
Domestic Septage BN-3695 1HTSCAAM4VH479008 1,500
Domestic Septage NE-4670 1HTMMAAN22H542925 2,500
Domestic Septage NE-4671 1HTMMAAN07H357327 2,500
Domestic Septage NE-4672 1HTMMAAN67H443449 2,500
Domestic Septage NH-8860 1HTMKAZN27H402827 2,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Town of Woodland 12/31/2022 Woodland
WWTP.pdf
590.42…
Town of Ahoskie 12/31/2022 Ahoskie
WWTP.pdf
585.78…
Roanoke River WWTP 12/31/2022 RRWWTP.pdf 542.83…
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
3/29/2021 6
Hickory, NC
NC Septic Tank Association
Date Hours
Location
Training Sponsored or Provided by
Select one*
Comments or notes
Signature
Date
Print Name*Title*
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.
11/24/2021
04:05:34 AM
David Cooper President
PAID
FIRM NAME: Bryant & Lassiter Septic Tank Service, Inc.
PERMIT #: NCS-00009
AMOUNT: $800
PAID BY: Check
DATE: 12/1/2021

Adam Ulishney