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Home My WebLink AboutNCS00758_2023Permit_Initial2023 Permit and Registration K. T. Moore Septic Tank Service is hereby issued a Septage Management Firm Permit, STATE,, Permit Number NCS-00758 o and registered as a e:,e D NORTH EQ A%L 12. 9* -�� Septage Management Firm�� w� ��nffii�utr E,%r Q'M NORTH CAROLINA (PUMPER) Environmental Quality 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. Septage Land Application Site, SLAS-91-04 2. Warren County WWTP, Warrenton, NC 3. Louisburg WRF, Louisburg, 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, 2023. Wm Perry Sugg Digitally signed by Wm Perry Sugg Date: 2023.02.17 14:11:24-05'00' Perry Sugg, Environmental Compliance Branch Head For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-707- 8283). Firm Info Firm name* KT Moore Septic Tank Service The "Firm name" must be exactly as it is shown on your vehicle(s). Septage Management Firm permit number (NCS #) NCS-00758 Enter the five digits following the NCS # Street address of office* Street Address 712 N. Chavis rd Address Line 2 City State / Province / Region Kittrell NC Postal / Zip Code Country 27544 USA County* Vance Mailing address same as street address of office?* • Yes No Phone* Fax 252-432-1859 Email* bacca911@yahoo.com Owner Info Firm owner's name* Michael and Stephen Dickerson Mailing address same as street address of office?* • Yes No Phone* Fax 252-432-1859 Operator Info Firm operator's name* Firm operator's title Michael and Stephen Dickerson Mailing address same as street address of office?* 0 Yes No Phone* Fax 252-432-1859 Type and amount of septage pumped in the last 12 months Amount in gallons* Domestic 550,000 Portable Toilet Waste 0 Grease (Restaurant) 0 Treatment Plant 0 Industrial/Commercial 0 North Carolina counties of operation List each county you plan to do business in: * Vance. Franklin, warren,Granville, wake Vehicle Info Do you plan to operate pumper vehicles?* • 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* 10/27/2022 Title* President Choose how to add vehicle descriptions* • Add vehicles individually Upload List Pumper Vehicles Usage* License Tag #* Vehicle Identification #* Tank Capacity* Domestic Septage BM-8168 3FDNF6563YMA19411 1,250 Domestic Septage KF-5357 1FVACWDTOEHFH2197 2,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Approved wastewater treatment plant* • Yes No 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 Warren county WWTP 12/31/2023 image.jpg 2.6MB Louisburg WRF 12/31/2023 image.3pg 2.31MB Septage Land Application Sites (SLAS)* • Yes No 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 # * SLAS-9104 Septage Detention or Treatment Facility (SDTF) Yes • No Other disposal method* Yes • No Expiration Date* 12/31/2022 Authorization Septage Management Firm Operator Training Completed Date* Hours* 1/26/2022 4 Location* Hickory NC Training Sponsored or Provided by* NC Septic Tank Association Septage Land Application Site Operator Training Completed Date Hours 1/27/2022 3 Location Hickory NC Training Sponsored or Provided by NC Septic Tank Association Registration Type Select one* Registered Portable Sanitation Firm • Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm Comments and Notes Comments or notes Certif cation 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. Signature Date 10/27/2022 04:50:47 PM Print Name* Title* Stephen Dickerson President 4 7 • %a 49 — - %. It. - 0 n AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environment and Natural Resources Division of Waste Management - Solid Waste Section 1 Oberlin Rd., Ste. 150, Raleigh, N.C. 27605 Fee ssessr'�ents and %waste determinations will be required at the discretion of the wastewater treatment fa0l#tY. The fadli r has the ultimate prerogative to deny discharges of anywastes to the inmmin Wastewar stream. lant r t r n a of Ply �1V, (Address)C77 �do hereb # Yauthorizem Ale �rv),on t) j ex f 6, fft*ne kunber) X41 I 0j ; I r soel2lFL 44�mt?' <4f111.r rune/{ rator of4j'Se-Vage Management Fan) ,-�416 0 to ispose domestic epge portable toilet waste0 grew sep a (grease hmp pu pi 0commercialfindustrial septage fromrr7P r.) co 1) r � (County or other Geographic Area) at the above named wastewater treatmentxSe tage shall Pe disc ir=ion t be� the hours f �Mtm` w, Reintroducing partially treated liquid into a grease trap is acceptable Yes No � This authorizaban shaft valid until � (Usually December 31 ,Year) i Signed � Date 2 '1iry oo G.�n d me this5dayof � 24Swo 49 "to and sub'rQ i ill C7 a My Commission ex ices: P Notary Public) s � ` (0 � No Note.- Falsification of this document by the septage management fiRn shall lead to permit revvcatia'n. Z . ; a s ptage/fc>rrns/ rLzJi�4X +wtp auth-2006 --W.- i.. - _ r�r — w —� _ IN 1b G ti 41C Q� UNTN 1"4111t �NG x qi ff AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environment and Natural Resources Division of Waste Management - Solid Waste Section 1646 Mail Service Center, Raleigh, NC 27699-1646 Fee assessments and waste determinations will be required at the discretion of the wastewater treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the incoming wastewater stream. �f William R. Perkinson, ORC License Number 987831 (Plant Operator in Responsible Charge (ORC) and QRC License Number) Warren Coup WWTP, 738 US Hwv 401 S. PO BOX 2$1 Warrenton, NC 27589 (Address) 252-257-1776 (Phone Number) do hereby authorize Mike Dickerson (Owner/Operator of Septage Management Firm) of K. T. Moore Septic Tank Service (Septage Management Firm Name and NCS number) NGS to dispose of: domestic septage x , portable toilet waste x , grease septage (grease trap pumpings) commercial/industrial septage ,from Warren, Vance, Granville and surrounding counties (County or other Geographic Area) at the above -named wastewater treatment facility. Septage steall be discharged at: Influent works (Location) between the hours of 8:00 AM - 3:30 PM Mondav - Fridav Reintroducing partially treated liquid into a grease trap is acceptable Yes X No This authorization shall be valid until December 31, 2023 (Usually December 31, Year) Signed 11 (Facility Operat6r) Sworn to and subscribed before me this (Notary Public) Rote: Falsification of th Date /Q .` //.W.. 2'... zo.-I t_EMEEEEEPE&Vh� __ __ day of My Commission expires: H -r6 - dC)a5 20 c)a. �\111111lfI/��' (o is document by the septage management firm shall lead to permit revocations 441 = W ? mp S:lSolid Waste/CLA/SEPTAGE/FORMS/2013 Firm Application/WVVTP Authorization Form 2013 am lop 40 P dOP U15\ 40 /Zop *4%6 r%4 *1 eN GOJ�`�. e-, emu 161 + -WSO e ' " ■ N