NC0024571_ORC Designation Form_20010508

North Carolina
Department of Environment and Natural Resources
Water Pollution Control System Operator Certification Commission
Michael F. Easley, Governor
William G. Ross Jr.; Secretary
Coleen H. Sullins, Chairman
March 07, 2001
Town of Lumberton
Mr. Todd Powell
PO Box 1388
Lumberton, North Carolina 28359-1388
ATA
NCDENR K
ECEIVED
LIAR 8 2001
�n�'�TiEvr�
REG. OFFICE
Subject: Operator in Responsible Charge/Back-Up Operator Designation
NPDES: NC0024571
Robeson County
Dear Mr. Powell:
The' Water Pollution Control System Operators .Certification Commission hereby classifies the
subject facility as a Class 4 Biological Water Pollution Control Treatment System.
The Water Pollution Control System Operators Certification Commission received a letter dated
March 02, 2001 concerning the vacancy of Mr. Raymond Deese's position, as the Back-up
Operator in Responsible Charge for the listed facility. According to 15A NCAC 8G Section
.0202, an Operator in Responsible Charge or Back-up Operator must be designated within 120
calendar days following a vacancy in the position. Upon the vacancy of the Operator in
Responsible Charge, the owner of the system must notify the appropriate regional office within
10 working days of the vacancy. Please complete the enclosed designation form or contact this
office concerning steps to acquire a new certified Operator in Responsible Charge or Back-up
Operator by April 07, 2001.
If you have any questions concerning this matter, please contact me at 919/733-0026 ext. 315.
Sincerely,
Tony old, Water Pollution Control Systems Consultant
Tech ical Assistance and Certification
1618 Mail Service Center, Raleigh, North Carolina 27699-1618
Phone: [phone] \ FAX: 919 — 733-1338
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED / 10% POST CONSUMER PAPER

Enclosure
cc: Central Files
Fayetteville Regional Office
TAC Files

Water Pollution Control System Designation Form
WPCSOCC
NCAC 15A:08G .0201
General Information:
Permittee Owner/Officer Name:
Mailing Address:
City: State: Zip: -
Telephone Number: ( )
Signature: Date:
Facility Information:
Facility:
Permit Number: County:
! SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM !
Mark.(X) Type of Facility Class (1 — 4) Class
Wastewater Plant Spray Irrigation N/A
Physical/Chemical Land Application N/A
Collection System Subsurface N/A
Operator in Responsible Charge:
Print Name: Social Security # :
Certificate Type and Grade: Certificate #:
Work Telephone: ( ) Signature:
Back -Up Operator in Responsible Charge:
Print Name: Social Security # :
Certificate Type and Grade: Certificate #:
Work Telephone: () Signature:
Mail or Fax to:
WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
Revised 10/2000

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FAX TRANSMITTAL COVER
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Remarks:

05/09/2001 14:33 19106713932 LUMBERTON LAB
PAGE 02
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VLPIK IrA I LA WALITY PAW 02
Water Pollution Control System Designation Form
wPCSOCC ,
NCAC 1SA:08G .0201
w.T0dd wl i C t4ti
Pcrenittee Owner/Ofl:cic Name: C t.4 0 P
Mailing Address: P.D. 1 28
city: L _ , , _ r.., r , State:
General Information:
Telephone Nu
Signatuca:
(
Faciliq Information:
Facility: C. s 4-1 D 1 )--4) ►.% os. -fi.y W 4p
Permit Number: NI C,Qo 2.1 r1 L County: ®Is e
0
SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM
Mork CXI Tr* of Facility Qui (1— 4) CIVI
Waatewste: Plant Spry Irrigation bitie
Physical/Chemical Lam! Applicetiou j�(g
Collection System _�.. Subsurface I
Operator in Responsible Charge:
PrintName: C Soc. Security # • ca y- i 3 " 3O-5"7
Certificate Type and Grade: l_Qrtd_NIA Car}c 0 wl Cetr4iwe 0: 1 fri Z
Work Telephone: C4l'0)�,-t l -3151 ' sipaturec
Back -Up Operator In Responsible Charge: Pant Name: of Cl ij
s Social Security # - 2 1yr.-.- g q r 7 11
Certificate Type and Oracle/IJ4Ji*: I.A
t C1 A
Work Telephone: ('jI tr )121:-.2.13S3 Sigaare:
Mail RE Fax to: WPCSOC C
1618 Mali Service Center
RalalQ�, N.C. 276994618
Ftua 919/^.33-1338
Revised 1W200U

U4/18/2001 13:22 19106713932. LUMBERTON LAB •
PAGE 02
Lu
Permittee Owner/Officer Name: (k) P CA) -I2
Mailing Address: P. ,
City: L
State: INLC_ Zip: 3 ?
Telephone Number: A „II CQ
Off :Wier.
Signature:
Facility Information:
Facility: C
Permit Number: N. C 0 0 I?. 6 - 1 County: RO 7Q:). a •
! SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM'
Mark (X) Type of Facility. ' Class (1 -- 4)
4 fc.k% Savilf-c bl RVQ a/04_ s
Wastewater Plant
Physical/Chemical
Collection System
Spray Irrigation
Land Application
Subsurface
U.1,6
N/A
N/A
Operator in Responsible Charge:
Print Name: 1-i oway-ei 2r2u
Water Pollution Control System Designation Form
WPCSOCC
NCAC 15A:08G .0201
General Information:
Social Security #
Certificate Type and Grade: 1011..-kabaso-2.17`20,init0:40wire
Work Telephone: (j'(0 ) 67/- 3 F-S Signature-
4
#:
;2.
OU3i
Back -Up Operator in Responsible Charge:
Print Name: E 6 LOW/7 Social Security # 'la.- al -4v2iis
Certificate Type and Grade: WALfie. 04
Work Telephone:
(910 C )1 -.2,6517
Signature:
Mail gE Fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
Certificate #: `1.3 ab

To: Kitty Kramer
From: Belinda Henson
Date: April 18, 2001
Subject: ORC Information
Howard Revels called from the City of Lumberton today with the following information:
City of Lumberton Water Treatment Plant - Howard Revels - .Grade IV . ORC
Eugene Lowry - Grade I - Backup Operator
**The application form has been submitted to our Training and Certification Unit and the above
named ORC and Backup Operator are effective as of April 1, 2001.
***Howard also addressed the DMR report for the Water Plant. He will begin sending DMRs to
Central Files beginning with the month of April.
**An application will be submitted to our Training and Certification Unit by next week with the
following information:
City of Lumberton Wastewater Treatment Plant - John Locldear - Grade IV - ORC
Howard Revels - Grade IV - Backup Operator
**Copies of the applications will be faxed to our office.
Thanks.
/bsh