NCS01162_2024Permit_Initial

2024
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
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-�� Septage Management Firm�� �� w� ��nffii�utr
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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, Randelman, 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, 2024.
Digitally signed by Wm Perry
Wm Perry Sugg Sugg
Date: 2024.02.05 11:42:49-05'00'
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 Services Inc.
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)*
NCS-01162
Please enter the complete NCS #, including the 5 end digits (NCS-XXXXX)
Street address of office*
Street Address
2718 Uwharrie Road
Address Line 2
City
State / Province / Region
Archdale
NC
Postal / Zip Code
Country
27263
United States
County*
Randolph
Mailing address same as street address of office?*
0 Yes O No
Phone* Fax
336-434-7750 336-417-5544
Email *
[e-mail]
Owner Info 1, '
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*
Travis Clapp
Mailing address same as street address of office?*
Firm operator's title
Resource Manager
Yes No
Phone* Fax
336-434-7750 336-417-5544

Type and amount of septage pumped in the last 12 months
Domestic
Portable Toilet Waste
Grease (Restaurant)
Amount in gallons*
0
0
9,407
Treatment Plant 0
Industrial/Commercial 637
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?*
6
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
1�cif
Date *
10/5/2023
Title*
Fleet Manager
Choose how to add vehicle descriptions*
0 Add vehicles individually 0 Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Grease
(restaurant)
AM42080
1HLK1B7BOL9D40439
6,000
Grease
(restaurant)
AM42088
10BGS6217SFOA5175
6,000
Grease
(restaurant)
NL6403
1NPTL40X9FD262005
3,500
Grease
(restaurant)
MX6642
1NPTL40X4ED218850
3,500
Septage Disposal Method �^
For each method, indicate whether you plan to use it by checking yes or no.

Approved wastewater treatment plant*
0 Yes 0 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
Orange and Surrounding
Counties OWASA-Mason Farm WWTP
Septage Land Application Sites (SLAS)*
Yes No
Septage Detention or Treatment Facility (SDTF)
Yes No
Other disposal method*
Yes 0 No
Description *
Expiration Date*
12/31/2023
12/31/2023
Solidified Material sent to Landfill @
Waste Management Great Oak Landfile
Authorization *
Eastside 148....
WWTP.pdf
OWASA-Mason 145....
Farm
WWTP.pdf
Authorization *
Great Oak 71.3...
Landfill .p...
Septage Management Firm Operator Training Completed Q
Date * Hours
1/27/2023 4
Location *
Raleigh, NC
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

LRegistration Type
Select one*
O Registered Portable Sanitation Firm
OD Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes^
Comments or notes
Corey McMahan took 4-hour Septage Firm Management Course
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.
Signature
06%G l
Date
10/5/2023
08:26:55 AM
Print Name*
Dennis Winter
Title*
Fleet Manager

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
I
North Carolina!Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Seice Center, Raleigh, INC 27699-1646
Fee assessments and waste cleterminatic ns 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.
Travis Rich, Certificat
(Plant Operator in
919-537-4354
(Phone Number)
170 Old
Charge (ORC), ORC License Number, Name of Plant)
Farm Rd, Ch.
(Address)
Hill, NC 27517
do hereby aut prize Arthur Campbell
(Owner/Operator of Septage Management Firm)
of A&D Environmental Services NCS it 01162
(Septage Mar agement Firm Name and NCS number)
to dispose of: domestic septage x portable toilet waste x
grease septage (grease trap pumpings) 1 N A commercial/industrial septage N/A , from
Orange and surrounding counties
(CoUInty or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
I
170 Old Mason Farm Rd, Chapel Hill INC
(Location)
between the hours of Monday -Friday 08:OOAM-4:00 PM
i
Reintroducing partially treated liquid into a grease trap is acceptable Yes x No
This authorization shall be valid unt I December 31 2024
(Usually December 31, Year)
Signed � � / L Date e Z
(Facility Operator)!
Subscribed and affirmed before me this
day of _ •DeCCAJXr. 20 D--')
My Commission expires: f `,)`3 -o1u) S
(No4ary Public) R��
Al 3rf,9Ik 0 -" k- Li JISiV (OFFICIAL SEAL)
nnsrs -rnrs F-r es
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
5:/Solid_Waste/CLA/SEPTAGEjF0RM5/2018 Firm Appii[ation/WWTP Authorization Form 2018

AUTHORIZATION TO DISCHARGE SEPTAG£ 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, 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 Arthur Campbell
(Phone Number) (Owner/Operator of Septage Management Firm)
of A&D Environmental
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage Yes portable toilet waste Yes ,
01162
grease septage (grease trap pumpings) No commercial/industrial septage Yes from
Gullford,Randolph, Davidson, Forsyth
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Eastside WWTP Septage Receiving Station
(Location)
hetween 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, 2024
(Usually December 31, Year)
Signed Date 6 !1 I I Z
(Facility Operator)
I` l
Subs rlbed and affirmed b fore me this day of 120 2-3
My Commission expires:
(Kota Pu (ic) DA G 8 ' 'or
,XFFICIALSEAL) kN -10
Note: Falsification of this document by the septage management firm shall lead to frejwbrevocation. A_�`
5:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm Application/WWTP Authorization Form 2018 10` 61 COV��11`�`

W
e WAWM MANAG[MIJT
Requested Management Facility: Great oak Landfill
Non -Hazardous WAM Approval
Profile Number: 100597NC _ Waste Acceptance Expiration Date: 11/14/2024
Common Name: WASTE PROCESSING SOLIDS (WM025A) WM Regulatory Volume Limit: d NA
APPROVAL DETAILS
Approval Decision: a Approved 0 Not Approved
Management Method: Direct Landfill
Generator Name: A&D ENVIRONMENTAL
Profile Expiration Date: 11/14/2024
Periodic Testing Due Date: d NA
Other Due Date: [A 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.
WM Authorization Name: Daniel Patrick
WM Authorization Signature:
Agency Authorization (if Required):
Profile Renewal: a Yes ❑ No
Title: Waste Approval Manager
Date: 11/ 14 / 2 02 3
Date:
Last Revised January 25, 2018
THINK GREEN: QUESTIONS? CALL $00 963 4776 FOR ASSISTANCE 02018 Waste Management

Aa.�w T�r--
lt�"-
;"i North Carolina Department of Environmental Quality
Division of Waste Management INVOICE
NORTH CAROLINA
Environmental Quality Solid Waste Section
Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Septage - Annual:
A & D Environmental Service, Inc. (NCS-01162)
2718 Uwharrie Road
Archdale, NC 27263
Annual Fee 2024 - Pumper/Number of Trucks: 4
To: Dennis Winter
A & D Environmental Service, Inc.
PO Box 484
High Point, NC 27261
Date Due:
Date: 10/03/2023
Invoice #: NCS-01162-2024
$1,500.00
LATE FEES: in accordanc:, with NC Generai Statutes ,a 'i. r 291 Ir,-:'; a !ate• fee -�' be applied to any .! inual . fees not s,;bmitted by January 1, 2024
Payment Options:
E-check Available online at _
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card Available online at
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number shown
on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
[*Convenience Fee of 2.65% added to amount invoiced.]
Paper check Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number on
check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy of this
invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Explanation of Invoice Amount is Based on Firm's Current Permit Status:
Pursuant to North Carolina General Statute 130A-291.1 you are required to pay fee(s) based on your solid waste management
activities. The fee(s) shall be used to support the septage management program.
Staff Contacts:
Connie Wylie [phone] or [e-mail]
Chester Cobb [phone] or [e-mail]
Jeffrey Bullard [phone] or [e-mail]
PCK. OATEE AW
More information available on the web:
North Carolina Department of Environmental Quality (DEQ)
North Carolina Solid Waste Program .' d
North Carolina Septage Management Program -