NCS01489_2022Permit_Modify

2022
Permit and Registration
Septics-R-Us

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01489
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. T Z Osborne WRF, Mcleansville NC
2. North & South Durham WRR, Durham NC
3. Archie Elledge WWTP, Winston-Salem NC
4. Central Johnston County Regional WWTP, Smithfield 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?*
Phone*Fax
Firm operator's name*Firm operator's title
Mailing address same as street address of oce?*
Firm Info
Septics-R-US
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01489
Enter the five digits following the NCS #
City
Milton
State / Province / Region
NC
Postal / Zip Code
27305
Country
United States
Street Address
480 Rock Creek Drive
Address Line 2
Caswell
Yes No
434-770-3460
[e-mail]
Owner Info
Seth Robinson
Yes No
434-770-3460
Operator Info
Gary Gisclair Forman
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*
919-638-2087
Type and amount of septage pumped in the last 12 months
432,600
0
0
0
0
North Carolina counties of operation
Caswell, Person, Vance, Granville, Alamance, Orange, Durham, Franklin,
Chatham, Lee, Harnett, Johnston, Guilford, Rockingham
Vehicle Info
Yes No
10/19/2021
Owner
Add vehicles individually Upload List
Domestic Septage YA154616 2NKHHM7X3BM285867 1,500
Domestic Septage JZ-5122 JALC4B16667007582 1,200
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)*
Septage Detention or Treatment Facility (SDTF)*
Other disposal method*
Date*Hours *
Location *
Training Sponsored or Provided by*
Date Hours
Location
Training Sponsored or Provided by
Yes No
Durham's North And South Water
Reclaimation Facilities
12/31/2022
City Of Winston Salem 12/31/2022
Johnston County 12/31/2022 Johnston
County .pdf
33.71KB
Yes No
Yes No
Yes No
Septage Management Firm Operator Training Completed
10/19/2021 4
Bur-Mil Park Greensboro NC
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
0
Registration Type
Select one*
Comments or notes
Signature *
Date
Print Name*Title*
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Still Waiting for 2022 Authorizations To Discharge form from Durham And
Winston Salem. But Wanted to get my application out ASAP. Thanks Seth
Robinson
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.
10/19/2021
02:29:20 AM
Seth Robinson [e-mail]
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management -Solid Waste Section
401 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605
Fee assessments and waste detenninations will be required at the discretion of the wastewater treatment
facility. The facility has the ultimate prerogative lo deny discharges of any wastes to the incoming
wastewater stream.
I, John D. Wall Central Johnston County Regional Wastewater Treatment Plant
(Plant Operator and Name of Plant)
Post Office Box 2263 Smithfield North Carolina 27577
(Address)
/919) 989-5075 do hereby authoriZe _5e_,ll RD b\A5on, NCS# _ 1489
(Phone Number) (ONn"l{O~or of Septage M"j'agement Furn)
of SepticR-Us, 480 Rock Creek Drive, Milton. NC 27305 _;§dJ,, ~
(Sep!aga Management Ann Name and address)
to dispose ot domestic septage -~X _ _, portable toilet waste __ ..cX,_ _ _,
<
Johnston County does not accept grease traps and pumplngs.
Johnston County. North Garolina
(Coonty °' other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at
Johnston County Sludge Handling Facility. 680 County Home Road. Smithfield. North Carolina
(l.ocalion)
between the hours of 8:00 A.M. thru 4:45 P.M.-Monday through Friday.
Reintroducing partially treated liquid into a grease trap is acceptable __ Yes X No
Date f(J -I I· z../
(Facirity Opera!()()
Sworn to and subscribed before me this \ d-¥\--.__ day of a d ch..A ;;lO d I
UC>CX\ >, ~(0\Q.P
Nancy House ($ (Notary Public)
My Commission expires: ~ -I -d{) d 3
'Waste generated In other countles will not be accepted.
All waste must be generated In Johnston County.
Nole: FalslHcaUon ol this document by the septage management finn
shall lead lo pennll revocation.
(OFFICIAL SEAL)
NANCY HOUSE
NOTARY PUBLIC
JOHNSTON COUNTY, N.C.
My Commission Expires 4-1-2023.
PAID
FIRM NAME: Septics-R-US
PERMIT #: NCS-01489
AMOUNT: $800
PAID BY: E-Check
DATE: 9/29/2021

Adam Ulishney