NCS01162_2023Permit_Initial

2023
Permit and Registration
A & D Environmental Service, Inc.
is hereby issued a Septage Management Firm Permit,
ZNti STATE
Permit Number NCS-01162
o and registered as a
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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, 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. City of High Point Eastside WWTP, Jamestown, NC
2. Waste Management Great Oak Landfill, Randleman, NC
3. OWASA-Old Mason Farm Plant, Chapel Hill, 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 Perr Digitally signed by
Y Wm Perry Sugg
Sugg 114:39:48-005'003
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*
A&D Environmental Service Inc.
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-01162
Enter the five digits following the NCS #
Street address of office*
Street Address
2718 Uwharrie Road
Address Line 2
City
Archdale
Postal / Zip Code
27263
County*
Randolph
Mailing address same as street address of office?*
• Yes No
Phone*
336-434-7750
Email*
[e-mail]
Owner Info
State / Province / Region
NC
Country
United States
Fax
336-417-5544
Firm owner's name*
A&D Holding, Inc
Mailing address same as street address of office?*
• Yes No
Phone* Fax
336-434-7750 336-417-5544
Operator Info}
Firm operator's name* Firm operator's title
Travis Clapp Resource Manager
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
336-434-7750 336-417-5544
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 0
Portable Toilet Waste 0
Grease (Restaurant) 5,626
Treatment Plant 0
Industrial/Commercial 2,170
North Carolina counties of operation
List each county you plan to do business in:
All Counties
Vehicle Info
Do you plan to operate pumper vehicles?*
• 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
Date*
10/5/2022
Title*
Fleet Manager
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Grease
(restaurant)
NL6403
1NPTL40X9FD262005
3,500
Grease
(restaurant)
MX6642
1NPTL40X4ED218850
3,500
Grease
(restaurant)
AM42088
10BGS6217SFOA5175
6,000
Grease
(restaurant)
AM42080
1HLK1B7BOL9D40439
6,000

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*
Piedmont Triad Area; Eastside WWTP
Septage Receiving Station
Orange And Surrounding Counties
Septage Land Application Sites (SLAS) *
Expiration Date* Authorization
12/31/2022 AD.WWTP Doc 154.46...
.pdf
12/31/2022 AD. WWTP 193.82...
II.pdf
Yes • No
Septage Detention or Treatment Facility (SDTF)
• Yes No
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
SDTF-34-02 12/31/2022 AD.SDTF-34- 97.43KB
02.pdf
Other disposal method*
• Yes No
Description * Authorization
Solidified Material sent to Landfill12 Waste AD.SMTL .pdf 80.33KB
Management, Great Oak Landfill
Septage Management Firm Operator Training Completed
Date* Hours*
1/27/2022 4
Location*
Hickory, North Carolina

Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed^
Date Hours
0
Location
Training Sponsored or Provided by
Registration Type `�j
Select one*
Registered Portable Sanitation Firm
• Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes^
Comments or notes
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
10/5/2022
03:43:09 AM
Print Name*
Arthur Campbell
Title*
Fleet Manager

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 be 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.
John Thomas Certification # 1000478 City of High Point Eastside WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
5898 Riverdale Drive Jamestown NC 27282
(Address)
336-822-4730 do hereby authorize
(Phone Number)
Arthur Campbell
(Owner/Operator of Septage Management Firm)
of A&D Enviromental NCS # 01162
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage Yes , portable toilet waste No
grease septage (grease trap pumpings) No commercial/industrial septage Yes from
Piedmont Triad Area
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Eastside WWTP Septage Receiving Station
(Location)
between the hours of 7:00 AM - 5:00 PM Monday - Sunday
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31, 2023
(Usually December 31, Year)
Signed Date lc% Z 5 1 .y Z
i (Facility Operator)
�J
Subscribed and affirmedbefore me this Z day of 20 ZZ
�413
My Commission expires:
(N (ary P blic) F�
(OFFICIAL SEAL)
4 'OUg�\G V
Note: Falsification of this document by the septage management firm shall lead to permit �id 24Q v1���`
S:/Solid_ Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

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 be 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.
I, Travis Rich, Certification #999730, OWASA-Mason Farm WWTP
(Plant Operator in Responsible Charge (ORC), ORC License Number, Name of Plant)
919-537-4354
(Phone Number)
170 Old Mason Farm Rd, Chapel Hill, NC 27517
(Address)
do hereby authorize Arthur Campbell
(Owner/Operator of Septage Management Firm)
of A&D Environmental Services NCS # 01162
(Septage Management Firm Name and NCS number)
to dispose of: domestic Septage X , portable toilet waste
grease septage (grease trap pumpings) commercial/industrial Septage , from
Orange and surrounding counties
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
between the hours of
170 Old Mason Farm Rd, Chapel Hill NC
(Location)
Monday -Friday 08:OOAM-4:00 PM
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until
ber 31. 2023
(Usually December 31, Year)
Signed �il.�.-� / _ Date H s , . 2
(Facility Operator)
Subscribed and affirmed before me this
'Vk I � " (fl - & � j2j:�j
(Notary Public)
1 15+h
day of Novembe,620 as
My Commission expires: 11- a3 - aoa-3
[*:::]Ala
ELLY H. BELCHERPublic. North Carohna mance Co �r� ���Cl L SEAL)
m I on r���-
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018

W Non -Hazardous WAM Approval
WASTE MANAGEMENT
Requested Management Facility: Great Oak Landfill
Profile Number:100597NC Waste Acceptance Expiration Date: 02/12/2024
Common Name: WASTE PROCESSING SOLIDS (WM025A) WM Regulatory Volume Limit: U✓ NA
APPROVAL DETAILS
Approval Decision: U Approved ❑ Not Approved
Management Method: Direct Landfill
Generator Name: A&D ENVIRONMENTAL
Profile Expiration Date:02/12/2024
Periodic Testing Due Date: Fb NA
Other Due Date: CA NA (Specify) _—
Management Facility Precautions, Special Handling Procedures or Limitation on approval:
Generator Conditions
- Shall not contain free liquids.
- Waste manifest or applicable shipping document must accompany load.
- The waste profile number must appear on the shipping papers.
Customer provides periodic requirements.
WM Authorization Name: Sara Adams
WM Authorization Signature: --. r,r«
Agency Authorization (if Required):
Profile Renewal: 1A Yes LINO
Title: Waste Approval Manager
Date:11/30/2020
Date:
Last Revised January 25, 2018
THINK GREEN! QUESTIONS? CALL 800 963 4776 FOR ASSISTANCE ©2018 Waste Management

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From:
Arthur Campbell
To:
Wilson, Jared C
Cc:
Arthur Campbell
Subject:
RE: [External] FW: AD Disposal Authorizations
Date:
Thursday, January 26, 2023 10:57:44 AM
Attachments:
imaae001.Dna
image002.pnno
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Jared
I have spoken to my CEO & GM, and they have informed me that we will not being using that
facility any longer, so please process our packet eliminating them from our list.
If I need to submit any additional documents, please let me know and I will gladly get it to you.
Thanks
From: Wilson, Jared C <[e-mail]>
Sent: Tuesday, January 24, 2023 12:14 PM
To: Arthur Campbell <[e-mail]>
Subject: RE: [External] FW: AD Disposal Authorizations
Received, thank you!
One thing I will need before I can complete it is the Disposal Authorization for Liquid Environmental
Solutions, the SDTF that is listed on the applicatio
signed, I'll need a copy of the SDTF authorization.
need to be completed for that to this email.
Have a nice day!
Jared C. Wilson
Environmental Senior Specialist
Division of Waste Management
North Carolina Department of Environmental Quality
Office Phone: [phone]
iared.wilson&ncdenr.gov
n
. I won't be able to use the agreement that was
I've attached a copy of the document that would
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be
disclosed to third parties.

no�art�n�nt vl BiH�u�wienla[ purl
From: Arthur Campbell <acampbell(@adenviro.com>
Sent: Tuesday, January 24, 2023 12:09 PM
To: Wilson, Jared C <iared.wilson(@ncdenr.gov>
Cc: Arthur Campbell <acampbell(@adenviro.com>
Subject: [External] FW: AD Disposal Authorizations
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Here you go Jared, please confirm that you received this email.
Thanks
From: Arthur Campbell <acampbell(@adenviro.com>
Sent: Wednesday, January 18, 2023 12:30 PM
To: iared.wilson(�ncdenr.gov
Cc: Arthur Campbell <acampbell(@adenviro.com>
Subject: AD Disposal Authorizations
Hi Jared
Here are the Authorization for our disposal permit application for 2023, also included is our
contract with LES for the Winston-Salem Septage Detention or Treatment Facility # 34-02.
if anything, else is needed please let me know
'%ficcr/d
Arthur Campbell
Fleet Manager
A&D Environmental Services
2718 Uwharrie Road Archdale, NC 27263
D: [phone] 1 C: [phone]
acaMDbell(@adenviro.com
AID Environmental Services