NC0005762_Operator Designation Forms_20130404

WESTPOINT
HOME
April 4, 2013
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Water Pollution Control System Operators Certification Commission
1618 Mail Service Center
Raleigh, NC 27699-1618
Re: WestPoint Home — Wagram, Scotland. County, NC Facility
NPDES Permit No. NC0005762 - ORC Designation Form
DENR-FRO
APR 2 3 2013
MVO
Dear Sir or Madam:
WestPoint Home (WPH) currently owns and operates a Grade IV wastewater treatment plant in
Wagram, NC under NPDES Permit No. NC0005762. The plant's current ORC is Ronald
Locklear and the back-up ORC is Fred Locklear. On the attached form we are requesting the
addition of a second back-up ORC — Donovan Dennis. Mr. Dennis holds a Grade IV license.
If you have any questions about these designations, please give me a call at 334-756-5541.
Please note that the form also reflects a change of address and phone number for me as the
permittee officer.
Sincerely,
L. E. Lanier, PE
Director — Environmental Department
C: Ms. Belinda Henson
NCDENR Fayetteville Regional Office
225 Green Street
Suite 714
Fayetteville, NC 28301-5043
Environmental Dept, 523 Fob James Drive, Valley, AL 36854, Phone: [phone], Fax [phone]

WEST Po IN
H—I0ME
INTEROFFICE COMMUNICATION
From: Eddie Lanier Date: April 4, 2013
To: Mr. Tony Perry
Subject: Back-up ORC for Wastewater
Treatment Plant — Wagram
Attached is a letter and Operator Designation Form to have Donovan Dennis added as a back-up
ORC for the wastewater treatment plant. Please have Ronald, Fred, and Donovan sign the form
in the appropriate places (in blue ink), and send the letter and completed form on to the State,
with a copy to Belinda Henson. Please send me a scanned copy of the letter and completed form.
Eddie Lanier
Director — Environmental Department
Enclosure
Environmental Dept, 3300 23`I Drive, Valley, Alabama 36854-3101, Phone: [phone], Fax: [phone]

Water Pollution Control System Operator Designation Form
wPCsocc
NCAC 15A 8G .0201
Permittee Owner/Officer Name: WestPoint Home LLC L.E. Lanier — Director Env Dept
Mailing Address: 523 Fob . James Drive
City: Valley
Email address:
Signature,
State:. AL Zip: 36854 - Phone #: ( 334) 756-5541
[e-mail]
Date: V"/
Facility Name:
Wagram Facility WWTP
Permit #: WQ0008764
SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM!
Facility Type/Grade:
Biological WWTP
Physical/Chemical
Collection System
IV
Surface Irrigation
Land Application
4
Operator in Responsible Charge (ORC)
Print Full Name: Ronald Gene Locklear
Certificate TypeGrade / Number:
Biological
Work Phone #: f 910 369—' 392
Signature: `' �t ,! Date: 4/`
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: Fred Locklear
Biological
Certificate Type / Grade / Number: Grade III #993462
Work Phone #: [phone]
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge fd
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A
Disciplinary Actions by the Water Pollution Control System Operators Certification Cod
WPCSOCC, 1618 Mail Service Center, Ra'f
EmailleCertadmi(a?nedenr aov
Mail, fax or email the
original to:
Mail or fax a copy to the
appropriate Regional Office:
Asheville
2090 US Hwy 70
Swannanoa 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq Mall
Washington 27889
Fax: [phone]
Phone: [phone]
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-504_`
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr
Wilmington 28405-2845
Fax: [phone]
Phone: [phone]

Facility Name: Wagram Facility WWTP Permit #: WQ0008764
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: Donovan Dennis
Biological
Certificate Type / 4rade / Number: 4 OR 4 #989 700 Work Phone #: [phone]
Signature: 491241 twGlf.A- j{l/4€4,144 Date: Y////ii
"I certify that I agreto my designation a!; a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name:
Certificate Type / Grade / Number: Work Phone #: ( )
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name:
Certificate Type / Grade / Number: Work Phone #: ( )
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name:
Certificate Type / Grade / Number: Work Phone #: ( )
Signature: Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Revised 02-2013