Approved List of Grease Haulers/Pumpers Application
This annual application must be completed and submitted to Charlotte Water at 4222 Westmont Drive., Charlotte,
NC 28217 by December 1st of each year to be included on the Charlotte Water Approved List of Grease
Haulers/Pumpers. In addition to providing the following information, Please include proof of yearly training by NC
State Permitting Division.
(1.) Firm name: (The “Firm name” must be exactly as it is shown on your vehicle(s).
_______________________________________________________________________________________________
Street address of office: ____________________________________________________________________________
Mailing address (if different):
Phone:
Email:
FAX Phone: _______________________________________
County:
State permit number: N.C.S #______________________________________
(2.) Firm owner's/ operator's name (list all):
Email(s):
(3.) Type(s) of septage pumped: Write in the number of gallons (not check marks) of each type pumped yearly.
Domestic:
Portable Toilet Waste:
Treatment Plant:
Grease (restaurant):_______________________
Industrial/Commercial: _____________________________________
(4.) N.C. Counties of Operation:_____________________________________________________________________
(List each county)
(5.) Total Number of Pumper Vehicles Operated:
Number used for: Domestic Septage: ___________ Grease (restaurant): ____________
Other: ____________________ Portable Toilet Waste: __________
Vehicle Information: (use additional paper if needed)
Photos of each vehicle used to pump grease is required showing company logo and tag #
License Tag #:__________________________________
Vehicle Identification #:___________________________Tank Capacity: _________________________________
CHARLOTTE WATER
System Protection
Revised 1/2/15
4222 Westmont Drive
Charlotte, NC 28217
Ph: 704/336-4946
Fax: 704-632-8355
(6.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: ( ) yes ( ) no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagraph .0817(d) (11) of the Septage Management Rules. (use additional sheets if needed)
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
SLAS#:
Expiration Date:
SLAS#:
Expiration Date:
c) Septage Detention or Treatment Facility (SDTF) Permit Numbers: (use additional sheets if needed)
Name_____________________________________________________________________________________________
SDTF#:
Expiration Date:
(7) Septage Management Firm Operator Training Completed:
Date: _________________
Location: _______________________
Training Sponsored or Provided by: _______________________________________________________________________
Hours for Septage Management: ______
Hours for Portable Sanitation: _____
All area grease pumpers/haulers included on the Approved Charlotte Water List of Grease Pumpers/Haulers will abide by the
following City of Charlotte Sewer Use Ordinance:
Article III: Wastewater Discharge Restrictions
Section 23-80 (d) Wastewater, grease, grit and other materials removed in any manner from facilities required by this section or
other applicable law shall be disposed of in accordance with applicable law and shall not be discharged directly or indirectly into
the POTW or otherwise placed back into such facilities under any circumstances.
(f) Grease interceptors, oil/water separators, grit interceptors and other approved facilities required by this section or other
applicable law shall be cleaned, maintained and repaired regularly, as needed, by the user at its expense. The user shall
maintain records in conformance with section 23-91(o) of this article concerning the dates and manner of its inspection,
maintenance and repair of such facilities; and of its disposal of all wastewater, grease, oil, grit and other materials removed from
such facilities in accordance with applicable law.
Charlotte Water Wastewater Treatment Facilities and Collection System DO Not accept grease trap waste.
Upon submission of this application, you and your staff maybe required to attend a training course conducted by Charlotte
Water. Check the box if in agreement.
CERTIFICATION
I have personally examined and am familiar with the information submitted in this document and attachments. Based upon my
inquiry of those individuals immediately responsible for obtaining the information reported herein, I believe that the submitted
information is true, accurate and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of a fine and/or imprisonment.
Signature:
CHARLOTTE WATER
System Protection
Revised 1/2/15
Date:
4222 Westmont Drive
Charlotte, NC 28217
Ph: 704/336-4946
Fax: 704-632-8355