NCS01268_2022Permit_Initial

2022
Permit and Registration
Shorty's

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01268
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. Anson County Regional WWTP, Wadesboro 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?*
Mailing Address*
Phone*Fax
Email*
Firm owner's name*
Mailing address same as street address of oce?*
Firm Info
Shorty's
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01268
Enter the five digits following the NCS #
City
Rockingham
State / Province / Region
NC
Postal / Zip Code
28379
Country
USA
Street Address
232 County Home rd
Address Line 2
Richmond
Yes No
City
Rockingham
State / Province / Region
NC
Postal / Zip Code
28380
Country
USA
Street Address
PO Box 1691
Address Line 2
910-995-9040
[e-mail]
Owner Info
James Shingleton,Jennifer Shingleton
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
Rockingham
State / Province / Region
NC
Postal / Zip Code
28380
Country
USA
Street Address
PO Box 1691
Address Line 2
910-995-8859
Operator Info
James Shingleton Owner/Partner
Yes No
City
Rockingham
State / Province / Region
NC
Postal / Zip Code
28380
Country
USA
Street Address
PO Box 1691
Address Line 2
910-995-8859
Type and amount of septage pumped in the last 12 months
393,500
197,000
0
0
0
North Carolina counties of operation
Anson,Richmond,Scotland,Moore,Montgomery
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)*
Septage Detention or Treatment Facility (SDTF)*
1/31/2022
Owner/Partner
Add vehicles individually Upload List
Portable Toilet Waste JP8093 1FDUF4HY7HEB37724 700
Portable Toilet Waste KV5736 1FDOW5HT1KED01212 700
Portable Toilet Waste KC2626 1FDUF4GT9CEC62559 400
Domestic Septage YA128341 1HTMMAANX5H100690 2,500
Domestic Septage YA161930 2NP3LJOX7MM765912 4,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
ANSON COUNTY WASTEWATER TREATMENT
PLANT
12/31/2022
Yes No
Yes No
Other disposal method*
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*
Yes No
Septage Management Firm Operator Training Completed
10/7/2021 6
Hickory,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
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.
1/31/2022
11:18:54 AM
James Shingleton Owner/Partner
PAID
FIRM NAME: Shorty’s
PERMIT #: NCS-01268
AMOUNT: $800
PAID BY: Check
DATE: 12/16/2021

Adam Ulishney