Firm New Pumper Vehicle

SEPTAGE MANAGEMENT FIRM
NEW PUMPER VEHICLE(S)
(1.) Septage Management Firm permit number: NCS #
(2.) Physical location where vehicles are kept:
Address:
City: State: Zip:
(3.) Total Number of New Pumper Vehicles Operated: If more than 5 vehicles, put all vehicles on additional paper:
License Tag #
Vehicle Identification #
Tank Capacity
(in gallons)
Select one or more of the following
Domestic
Septage
Portable
Toilet
Grease
Other
1
2
3
4
5
*Firms must notify the Department within 10 days of getting a new pumper truck. Firms must make new pumper vehicles available
for Department to complete inspections. Firms may use pumper trucks prior to inspection if they meet all requirements and fees
have been paid. (G.S. 130A-291.1(hl) & 15A NCAC 1313.0835(a)/(f))
Certification Statement
I certify, under penalty of law, that the pumper vehicle(s) listed above meet the requirements for safe and sanitary
transportation of septage as required by 15A NCAC 13B .0835(a) and vehicle lettering is on both sides of the trailer, with
the firm name, town name, phone number, and NCS permit number, at least 3 inches in height, legible, distinguishable
from the background, not obstructed from view, and not removable (i.e., magnetic), 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 are significant penalties for false certification including the possibility of fine and
imprisonment.
Signature (Signature of company official required) Date
Print Name
Title
Revised: 10/16/2025