Monroe County Municipal Waste 2023 Waste Hauler Permit Application

Monroe County Municipal Waste Management Authority
183 Commercal Blvd.
Blakeslee, PA 18610
Telephone: (570) 643-6100 | Fax: (570) 643-6112
www.thewasteauthority.com

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Monroe County Municipal Septage Hauler Permit Application

CALENDAR YEAR 2023

The Monroe County Municipal Waste Management Authority (the Waste Authority) is the Implementing and enforcement agency of the Monroe County Municipal Waste Management Plan (the Plan), the Monroe County Municipal Waste Management Ordinance (the Ordinance) and the Monroe County Municipal Waste Management Rules and Regulations (the Rules and Regulations). All Septage waste haulers are required to register and obtain a permit from the Waste Authority for the collection and transportation of Septage Waste. The permit shall be affixed onto your vehicle as to identify you as a Monroe County Septage Waste hauler. All transporters of Septage Waste must comply and remain in compliance with the requirements of Act 97, Act 101, Act 537, the County Ordinance and the Waste Authority Rules and Regulations. These laws are enforced to ensure, maintain and protect the health and safety of the general public and the environment.
Application Date:*
Type of Application:*

NEW APPLICATIONRENEWAL APPLICATION
Septic Hauler Number:
Company Name:*
Mailing Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Business Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Information:*

First NameLast Name
Telephone Number:*
Please enter a valid phone number.
Fax Number:
Please enter a valid fax number.
Cell Phone Number:
Please enter a valid cell phone number.
Email (REQUIRED):*
example@example.com

Federal Employer ID Number or Social Security Number:
Ownership Type:*

Sole ProprietorshipPartnershipCorporationLimited LiabilityMunicipality
APPLICANT OWNERSHIP INFORMATION:

If the Applicant is a partnership or corporate entity, please list all individuals and/or parent corporate entities. (If neccessary, please list additional individuals on a separate document and upload the completed document(s) below OR you can take a clear, high quality photo of the completed document(s) and upload the photo(s) below).
1. Name:

First NameLast Name
Residential Address:

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth:

MonthDayYear
Percentage of Ownership:
Please upload any Additional Ownership Information below including name, residential address, date of birth and percentage of ownership:

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INSURANCE COVERAGE INFORMATION:
All persons applying, maintaining or renewing a permit to collect and transport Septage Waste in Monroe County MUST obtain and maintain the following insurance coverage. Certificate of Insurance Forms are required for the insurances below.

(A) Commercial Automobile Liability Insurance as required by The DEP and Pennsylvania State law and/or regulations; with a minimum coverage of $100,000.00.

(B) Commercial Liability Insurance with a minimum coverage of $1,000,000.00.

(C) Workers' Compensation Insurance as required by Pennsylvania State law and/or regulations. PLEASE NOTE: If you do NOT have Workers' Compensation Insurance, please check the box at the bottom of this page where indicated.

PLEASE NOTE: Monroe County Municipal Waste Management Authority MUST be listed as the Certificate Holder on ALL Certificate of Insurance Forms. Also, please do NOT submit a copy of your Insurance Declaration's Page and/or your Insurance Card(s).
If you do NOT have Workers' Compensation Insurance, please check the box below.
Please scan & upload a copy of ALL required Certificate of Insurance Form(s) OR you may take a clear, high quality photo of the completed document(s) and upload the photo(s) below.

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FEE SCHEDULE:

Fees are $100.00 per Septage Waste Hauler vehicle. Registration permits are not transferrable and shall be issued for one calendar year.

In addition to all other provisions/terms/language of this application, notice is
hereby given to the Applicant concerning the following:

Note 1: Permits are NOT transferrable and must be assigned to a vehicle. If any
registered vehicle is sold or in any way transferred by the applicant, notice must be provided to the Waste Authority within five (5) days of such sale or transfer. Further, all permits received from the Waste Authority must be removed prior to any sale or transfer of a registered vehicle.

Note 2: To add vehicles and request additional permits, complete page number 5 and submit it to the Monroe County Waste Authority by email or fax.

Note 3: Any registration and/or permit issued by the Waste Authority is subject to
immediate revocation by the Waste Authority for any violation of the terms of this application.

Note 4: If this application is approved, the applicant agrees to provide a full and complete list of all its customers within the geographic boundaries of Monroe County, Pennsylvania upon issuance of such a request by the Waste Authority. Applicant agrees to provide a full and complete response to a request for a customer list from the Waste Authority within five (5) days from the date the request is issued by the Waste Authority.

Disposal Sites for Septage Haulers:

Greater Hazleton Joint Sewer Authority
500 Oscar Thomas Road
West Hazleton, PA 18202

Lehigh County Authority
7676 Industrial Boulevard
Allentown, PA 18106

Lackawanna County River Basin Authority
145 Boulevard Avenue
Throop, PA 19464

Pottstown WWTP
Industrial Hwy & Moser Road
Pottstown, PA 19464

Roerre-Honesdale
416 Adams Pond Road
Honesdale, PA

Pond Hollow Ag
5167 Berry Hollow Road
Bangor, PA 18013

Hartfield
3200 Advance Lane
Colmar, PA 18915

Annville WWTP
675 West Main Street
Annville, PA 17003

Derry WWTP
670 Clearwater Road
Hershey, PA 17030

Land Application J.R. Borger, Inc.
RR1
Saylorsburg, PA 18353 (Disposed on Multiple farms)

Finken Farm (Lawson)
1018 Benders Church Road
Pen Argyl, PA 18072

Wyoming Valley Sewer Authority
PO Box 33A
Wilkes-Barre, PA 18703

Delcora
100 E.5th Street
Chester, PA 19016

Sile Bay Farm (Koberlein)
2809 Eastern Turnpike (Rt. 296)
Waymart, PA 18472

Henry Yeska Farm
821 Georgetown Road
Nazareth, PA 18064

Middlesex County Utilities Authority
2571 Main Street
Sayreville, NJ 08772

Commonwealth Disposal (Hartponce Farm)
Yostville Road (Route 2018)
Moscow, PA 18444

FLEET INFORMATION FORM:
Click here to download our Septic Hauler Fleet Information Form
Please print & complete the Waste Hauler Fleet Information Form. Next, scan and upload the completed document(s) below OR you may take a clear, high quality photo of the completed document(s) and upload the photo(s) below.

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NOTARIZATION:
Click here to download our Notary Form.
Please print, complete and have the Notary Form notarized by a licensed Notary. Next, scan and upload the completed document(s) below OR you may take a clear, high quality photo of the completed document(s) and upload the photo(s) below.

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My Products

2023 Septic Hauler PermitOnline Payment Option

$100.00 Quantity

USPS Priority Mail with TRACKING Product Image

USPS Priority Mail with TRACKINGMonroe County Municipal Waste Management Authority will MAIL your approved 2023 septic hauler permits to the MAILING ADDRESS provided on your submitted permit application using the United States Postal Service's PRIORITY MAIL with TRACKING option. If you would like to pick-up your approved 2023 septic hauler permits, please see the FREE Permit Pick-Up Option BELOW. ** PLEASE NOTE: If you ordered more than 50 septic hauler permits, you MUST pick up your septic hauler permits at our Blakeslee facility, please see the FREE Permit Pick-Up Option BELOW.

$20.00

FREE Permit Pick-Up OptionThis option is for any septic haulers who plan to pick-up their approved 2023 septic hauler permits at our Blakeslee facility. Our Blakeslee facility is located at183 Commercial Blvd. in Blakeslee, PA, 18610. Our Blakeslee Facility Office Hours are Monday thru Friday from 8AM to 4PM except during HOLIDAYS. If inclement weather is predicted, please call our Blakeslee Facility at (570)643-6100 before picking up your permits as our office hours may be compressed.

$ Free

Total

$0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

PLEASE ALLOW 30 DAYS FOR APPLICATION PROCESSING.

In order for any application to be processed, it MUST be fully completed, notarized and accompanied by ALL necessary documents.

** PLEASE NOTE ** Permits will NOT be issued if application is incomplete and/or missing any requested information.
Signature:*

Clear
Date Signed:

MonthDayYear

MinutesAM/PM Option
Should be Empty: