NCS01162_2021Permit_Initial

2021
Permit and Registration

A & D Environmental Service,
Inc.
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01162
And by virtue of completing the annual training
requirements is hereby registered as a Septage Management Firm
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 Detention or Treatment Facility, SDTF-34-02
2. Waste Management Facility – Great Oak Landfill, Randleman 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, 2021.

__________________________________________________
Adam Ulishney, Environmental Compliance Branch Head
State of North Carolina
Environmental Quality
Waste Management
Application for Permit to Operate a
Septage Management Firm
For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-
707-8283).
Firm name**
Septage Management Firm permit number (NCS #)**
Street address of office**
County**
Mailing address same as street address of office?**
Phone**Fax
Email**
Firm owner's name**
Mailing address same as street address of office?**
Phone**Fax
Firm operator's name**Firm operator's title
Mailing address same as street address of office?**
Phone**Fax
Firm Info
A&D Environmental Service Inc.
The "Firm name" must be exactly as it is shown on your vehicle(s).
NCS-01162
Enter the five digits following the NCS #
City
Archdale
State / Province / Region
North Carolina (NC)
Postal / Zip Code
27263
Country
USA
Street Address
2718 Uwharrie Road
Address Line 2
Randolph
Yes No
336-434-7750 336-417-5544
[e-mail]
Owner Info
A&D Holdings, Inc.
Yes No
336-434-7750 336-417-5544
Operator Info
Travis Clapp Resource Manager
Yes No
336-434-7750 336-417-5544
Amount in gallons *
DomesticDomestic
Portable Toilet WastePortable To ilet Waste
Grease (Restaurant)Grease (R estaurant)
Treatment PlantTreatment Plant
Industrial/CommercialIndustrial/Co mmercial
List each county you plan to do business in:**
Do you plan to operate pumper vehicles?**
"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 .0844(a) and vehicle lettering as required by 15A NCAC .0844(b).
Furthermore, 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 significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date**
Title**
Choose how to add vehicle descriptions**
Pumper Vehicles
Usage*License Tag #*Vehicle Identification #*Tank Capacity*
Approved wastewater treatment plant **
Septage Land Application Sites (SLAS)**
Type and amount of septage pumped in the last 12 months
0
0
1,201
0
45,430
North Carolina counties of operation
All Counties
Vehicle Info
Yes No
12/7/2020
Fleet Manager
Add vehicles
individually
Upload List
Grease (restaurant)NL6403 1NPTL40X9FD262005 3,500
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Yes No
Yes No
Septage Detention or Treatment Facility (SDTF)**
If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for
each site.
SDTF #*Expiration Date*Authorization
Other disposal method**
Description*Authorization
Date**Hours**
Location**
Training Sponsored or Provided by**
Date Hours
Location
Training Sponsored or Provided by
Select one**
Comments or notes
Signature
Yes No
SDTF-34-02 12/31/2020
Yes No
Solidified Material sent to Landfill12 Waste
Management, Great Oak Landfill
Septage Management Firm Operator Training Completed
9/10/2020 4
Morganton, NC
NC Pumper Group & NC Portable Toilet Group
Septage Land Application Site Operator Training Completed
0
Registration Type
Registered Portable Sanitation Firm
Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes
Certification 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.
Date
Print Name**Title**
12/7/2020
12:18:57 AM
Arthur Campbell Fleet Manager
1
Cobb, Chester
From:Cobb, Chester
Sent:Thursday, January 21, 2021 5:24 PM
To:Arthur Campbell
Subject:RE: [External] A&D Septage Permit Renewal Application
Hello Arthur, 

On the application for the 2021 Permit you listed the Firm name as A & D Environmental Service, Inc.  On the application 
for the 2020, the Firm name was listed as A & D Environmental.  Whatever is on the first line of the application for the 
Firm name, we expect to be on both sides of the pump trucks.  Each letter of the Firm name must be at least 3 inches in 
height.  Along with the Firm name, the phone number, town, and permit number is required to be on both sides of the 
pump truck.  As with the Firm name, each letter of the required information is required to be at least 3 inches in 
height.  The lettering on the pump trucks is one of the things we look for when we conduct a truck inspection.  Please let 
me know which name to go by, whether A & D Environmental Service, Inc. or A & D Environmental.   

Thanks, 

Chester 

From: Arthur Campbell <[e-mail]>  
Sent: Thursday, January 21, 2021 2:45 PM 
To: Cobb, Chester <[e-mail]> 
Cc: Arthur Campbell <[e-mail]> 
Subject: FW: [External] A&D Septage Permit Renewal Application 

CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to 
Report Spam. 

Hi Chester 

   Its Arthur Campbell with A&D and I’m trying to get an update on our Septage Permit for 2021, I submitted it a month 
ago and was checking its status. Also we would like to add 4  additional trucks to this permit, can you help me with this 
as well please? 

Thanks 
 Chester Cobb
Environmental Program Consultant
Division of Waste Management, Solid Waste Section
North Carolina Department of Environment Quality
919.707.8283 (Office)
[e-mail]
PAID
INVOICE #: NCS‐01162‐2021 
PERMIT #: NCS‐01162 
AMOUNT: $550 
PAYMENT METHOD: Paper 
DATE: 10/6/2020 

Chester Cobb