NCS01182_2022Permit_Initial

2022
Permit and Registration
Blu Site Solutions of North Carolina, Inc.

is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01182
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. Cross Creek WRF/Rockfish Creek WFR, Fayetteville NC 2. Septage Detention or Treatment Facility, SDTF-67-10
3. Septage Land Application Sites, SLAS-67-09 and SLAS-67-10
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?*
Mailing Address*
Phone*Fax
Firm Info
BluSite Solutions
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01182
Enter the five digits following the NCS #
City
Jacksonville
State / Province / Region
North Carolina
Postal / Zip Code
28540
Country
United States
Street Address
5680 Richlands HWY
Address Line 2
Onslow
Yes No
941-544-7019
[e-mail]
Owner Info
Adco Holdings
Yes No
City
Charlotte
State / Province / Region
North Carolina
Postal / Zip Code
28269
Country
United States
Street Address
4250 Trailer Dr
Address Line 2
570-396-2013
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*
Operator Info
Derrick Jackson General Manager
Yes No
941-544-7019
Type and amount of septage pumped in the last 12 months
0
920,150
0
0
0
North Carolina counties of operation
Onslow, Pender, Brunswick, Dare, Wilson, Edgecombe, Pitt, Jones, Beaufort,
Pamlico, New Hanover, Duplin, Sampson, Lenoir, Carteret
Vehicle Info
Yes No
5/23/2022
Director
Add vehicles individually Upload List
Upload vehicle 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)*
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)*
Other disposal method*
Date*Hours *
Location *
Training Sponsored or Provided by*
Date Hours
You can upload a file with a list of vehicles to be used. Please be sure to include the following information for each vehicle on your upload: Usage, License Tag #, Vehicle
Identification #, and Tank Capacity.
jaxvehicles.pdf 171.76KB
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
M. Jason Manning 12/31/2021 jaxpermits.p…1.41MB
John D. Wall-Central Johnston County 12/31/2021 jaxpermits.p…1.41MB
Yes No
SLAS-67-09 10/17/2022 jaxslas.pdf 239.88…
Yes No
Yes No
Septage Management Firm Operator Training Completed
6/13/2021 8
Online
NC DEQ - New Operator Training
Septage Land Application Site Operator Training Completed
6/13/2021 8
Location
Training Sponsored or Provided by
Select one*
Comments or notes
Signature
Date
Print Name*Title*
Online
NC DEQ - New Operator Training
Registration Type
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
We are working on adding WWTP and the certificates will be emailed to Chester
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.
5/23/2022
08:40:07 AM
Johnny Roach Director
PAID
INVOICE #: NCS‐01182‐2022 
PERMIT #: NCS‐01182 
AMOUNT: $800 
PAYMENT METHOD: Credit Card 
DATE: 03/10/2022 
Chester Cobb 
Permit Fee
PAID
INVOICE #: NCS‐01182‐2022LF 
PERMIT #: NCS‐01182 
AMOUNT: $400
PAYMENT METHOD: Credit Card 
DATE: 05/20/2022
Late Fee