NCS00834_2022Permit_Initial

2022
Permit and Registration
Rachel Locklear Porta John Service

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-00834
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 Lumberton WWTP, Lumberton NC
2. Septage Detention or Treatment Facility, SDTF-78-19
3. Septage Land Application Site, SLAS-78-19

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?*
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
Rachel Locklear Porta Jon Service
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-00834
Enter the five digits following the NCS #
City
Pembroke
State / Province / Region
NC
Postal / Zip Code
28372
Country
United States
Street Address
2161 Evergreen Church Rd
Address Line 2
Robeson
Yes No
9107341759 9105219310
[e-mail]
Owner Info
Rachel Locklear
Yes No
9107341759 9105219310
Operator Info
Rachel Locklear Owner
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*
910-734-1759 9105219310
Type and amount of septage pumped in the last 12 months
0
100,000
0
0
0
North Carolina counties of operation
Robeson, Cumberland, Columbus, Scotland
Vehicle Info
Yes No
12/7/2021
Owner
Add vehicles individually Upload List
Portable Toilet Waste CF2216 1HTSDAAM71H314108 1,000
Portable Toilet Waste HJ2043 3C7WRMBL7GG377724 1,200
Portable Toilet Waste JM2589 5PVNJ8JL4K4S52243 1,600
Portable Toilet Waste FA1375 3C7WRMCLXKG646712 1,250
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)*
If you are not the permit holder for the septage land application site, you must have a signed land application authorization form for each site.
SLAS #*Expiration Date *Authorization
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*
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Lumberton WWTP 12/31/2022 Lumberton
WWTP
Authorization
2022.pdf
916.26…
Yes No
SLAS-78-19 1/6/2023
Yes No
SDTF-78-19 1/6/2023
Yes No
Septage Management Firm Operator Training Completed
8/28/2021 4
Quality Inn 2400 S Sterling St, Morganton, NC 28655
NC Pumper Group & NC Portable Toilet Group
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
8/28/2021 3
Quality Inn 2400 S Sterling St, Morganton, NC 28655
NC Pumper Group & NC Portable Toilet Group
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.
12/7/2021
09:40:00 AM
Rachel Locklear [e-mail]
PAID
FIRM NAME: Rachel Locklear Porta John Service
PERMIT #: NCS-00834
AMOUNT: $800
PAID BY: E-Check
DATE: 11/4/2021

Adam Ulishney