NCS00039_2022Permit_Initial

2022
Permit and Registration
Roanoke Porta-Johns

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00039
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 2. Roanoke Rapids Sanitary District, Roanoke Rapids 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.

__________________________________________________ Perry Sugg, 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
ROANOKE PORTA-JOHNS
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00039
Enter the five digits following the NCS #
City
GARYSBURG
State / Province / Region
NORTH CAROLINA
Postal / Zip Code
27831
Country
UNITED STATES
Street Address
1717 LEBANON CHURCH RD.
Address Line 2
Northampton
Yes No
City
ROANOKE RAPIDS
State / Province / Region
NORTHD CAROLINA
Postal / Zip Code
27870
Country
United States
Street Address
PO BOX 1123
Address Line 2
252-537-2338 252-537-0281
[e-mail]
Owner Info
EUGENE ST CLAIR
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
ROANOKE RAPIDS
State / Province / Region
NORTH CAROLINA
Postal / Zip Code
27870
Country
United States
Street Address
PO BOX 1123
Address Line 2
252-537-2338 252-537-0281
Operator Info
EUGENE ST CLAIR PRESIDENT
Yes No
City
ROANOKE RAPIDS
State / Province / Region
NORTH CAROLINA
Postal / Zip Code
27870
Country
UNITED STATES
Street Address
PO BOX 1123
Address Line 2
252-537-2338 252-537-0281
Type and amount of septage pumped in the last 12 months
0
235,000
0
0
0
North Carolina counties of operation
HALIFAX, NORTHAMPTON, WARREN, HERTFORD, BERTIE, EDGECOMB, NASH, FRANKLIN,
VANCE, GRANVILLE
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)*
4/25/2022
PRESIDENT
Add vehicles individually Upload List
Portable Toilet Waste CZ7759 1FDUF5GTXCEC14901 700
Portable Toilet Waste KB4480 3C7WRMLB7KG646717 700
Portable Toilet Waste JR4305 1HTBUMML9KH164909 1,000
Portable Toilet Waste JJ5440 1HTAMM6624378321 1,000
Portable Toilet Waste OUT OF
SERVICE
1HTSCABN34H244000 1,000
Portable Toilet Waste BU23456 NC-5858-AY 100
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
ROANOKE RAPIDS SANITARY DISTRICT 12/31/2022
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 *
Training Sponsored or Provided by*
Date Hours
Location
Training Sponsored or Provided by
Select one*
Comments or notes
Signature
Yes No
SDTF-12/31/2022
Yes No
Septage Management Firm Operator Training Completed
2/19/2022 4
RALEIGH
NC Pumper Group & NC Portable Toilet Group
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.
Date
Print Name*Title*
12/9/2021
09:01:58 AM
EUGENE ST.CLAIR PRESIDENT
PAID
FIRM NAME: Roanoke Porta-Johns
PERMIT #: NCS-00039
AMOUNT: $800
PAID BY: Check
DATE: 10/4/2021

Adam Ulishney