The URL can be used to link to this page

Home My WebLink AboutNCS01061_2023Permit_Initial2023 Permit and Registration Take -A -Break Portables, Inc. is hereby issued a Septage Management Firm Permit, STATE,, Permit Number NCS-01061 oand registered as a e:,e D NORTH CAROLINA EQ�J -�� Septage Management Firm awnen� f� wrnmenta�lty 4sr 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, Tide 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. Clay County WWTP, Hayesville, 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: 2023.02.23 14:22:44-05'00' 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* Take -A -Break Portables, Inc. The "Firm name" must be exactly as it is shown on your vehicle(s). Septage Management Firm permit number (NCS #) NCS-01061 Enter the five digits following the NCS # Street address of office* Street Address 3126 NC HWY 69 Address Line 2 Suite A city Hayesville Postal / Zip Code 28904 County* Clay Mailing address same as street address of office?* Yes • No Mailing Address* Street Address PO Box 95 Address Line 2 City Hayesville Postal / Zip Code 28904 Phone* 8283894001 Email* cindya@takeabreakportables.com Owner Info Firm owner's name* Sherry A Rodriguez Mailing address same as street address of office?* Yes 0 No State / Province / Region NC Country United States State / Province / Region North Carolina Country United States Fax 8283894499 Mailing Address* Street Address PO Box 95 Address Line 2 City Hayesville Postal / Zip Code 28904 State / Province / Region North Carolina Country USA Phone* Fax 8283894001 883894499 Operator Info Firm operator's name* Sherry A Rodriguez Mailing address same as street address of office?* Yes • No Mailing address* Street Address PO Box 95 Address Line 2 City Hayesville Postal / Zip Code 28904 Firm operator's title Owner/President State / Province / Region North Carolina Country USA Phone* Fax 8283894001 8283894499 Type and amount of septage pumped in the last 12 months Amount in gallons* Domestic 0 Portable Toilet Waste 143,000 Grease (Restaurant) 0 Treatment Plant 0 Industrial/Commercial 0 North Carolina counties of operation List each county you plan to do business in: * Clay, Cherokee, Macon, & All Surrounding Areas Vehicle Info Do you plan to operate pumper vehicles?* 0 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 u `�ke��rd2�r'-ieyrrxs� Date* 12/6/2022 Title* Owner/President Choose how to add vehicle descriptions* • Add vehicles individually Upload List Pumper Vehicles Usage* License Tag #* Vehicle Identification #* Tank Capacity* Portable Toilet Waste JW4891 1FDWF37F62EA25104 300 Portable Toilet Waste HE2239 3C7WRCAL766700153 400 Portable Toilet Waste JT3026 3C7WRLAL4KC752240 300 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 Clay County Waste Water Treatment 12/31/2023 T-A-B 2022 393.79... Plant AUTH TO DISCHARGE FORM.pdf Septage Land Application Sites (SLAS) Yes • No Septage Detention or Treatment Facility (SDTF) Yes 0 No Other disposal method* Yes • No Septage Management Firm Operator Training Completed^ Date* Hours* 8/13/2022 4 Location* Morganton, North Carolina Training Sponsored or Provided by* NC Pumper Group & NC Portable Toilet Group Septage Land Application Site Operator Training Completed Date Hours 0 Location Training Sponsored or Provided by 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 "Recertification of Pumper Vehicles" form is mailed with the payment. 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 12/6/2022 11:38:00 AM Print Name* Title* Sherry A Rodriguez Owner/President NC S E]" :,AGE MANAGEMENT FIRM Recertification of Pumper Vehicle(s) Septage Firm Permit #: NCS- 0 1 Number of Pumper Vehicles: 3 CERTIFICATION: "I certify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meet the requirements for safe and sanitary transportation of septage as required by15A NCAC 13B .0844 (a) and vehicle lettering as required by 15A NCAC 13B .0844 (b). I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 13B .0839 (a). I am aware that there are significant penalties for false certification including the possibility of fine and imprisonment." Date L Title S:1Solid WastelclalseptagelformslPumper Vehicles Cetification.doc &AUTHORIZATION TO DISCHARGE SEPTAGE.TO A WASTEWATER TREATMENT FACILITY North Carolina Department of Environmental Quality Division of Waste Management- Solid Waste Section 1646 Mail Service Center, Raleigh; NC 27699-1646 Fee assessments and waste determinations will he 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. (Plant 01#�- / C) 5P C in Kesponsible Charge (OR£), CIRC License Number, Name of Plant) �y 3 (Address) �Y /1 _do herebyauthorize. ja�z'of (Phone Number) (Owner/Operator of Septage Management Firm) of --i-o-k-o- - A - (Septage Management Firm Name and fVCS number) to dispose of: domestic septage , portable toilet waste grease septage (grease trap pumpings) NCS M# commercial/industrial septage from a LIM aUWV= Ila-IIMU VVaaLCYY0LC3 M CQLI 11O1IL 10 �ljm J]G La FjG allu" - ml V.,,al:b- - Plant Co u Vya- r e Se.ke.r ci- Wa sf�H�AAd (Location) between the hours of _ • M Reintroducing partially treated liquid into a grease trap is acceptable Yes _YNo This authorization shall be valid until_ C� -c-r 31 -"2-.oa 3 (Usually December 31, rYear) Signed - Date (Facility Opera r) Sub ibed a affirmed before me this day of 20� My Commission expires: 05,11 � —0 (Notary public) ,,,, ��r,`;,�.• ' ....... I, 0,0'rARY W a s Note: Falsification of this document by the septage management firm shall lead to perm7{��,,,,..�'�' Sr 5:/Solid_Waste/CLA/SEPTAGE/FORMS/2016 firm Application/WWTP Authorization Form 2016 +.,�3'••�y �• �� Coo ..�.