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Home My WebLink AboutNC0026921_Inspection_20191001ROY COOPER Gow-m r K41CHAEL S. REGAN seere«y LINDA CULPEPPER Drrff for Al McMillan, Mayor Town of Parkton PO Box 55 Parkton, NC 28371 SUBJECT: Compliance Inspection Report Parkton WWTP NORTH CAROLINA €nvironmenml Quality October 01, 2019 NPDES WW Permit No. NCO026921 Robeson County Dear Permittee: The North Carolina Division of Water Resources conducted an inspection of the Parkton WWTP on 9/23/2019. This inspection was conducted to verify that the facility is operating in compliance with the conditions and limitations specified in NPDES WW Permit No. NC0026921. The findings and comments noted during this inspection are provided in the enclosed copy of the inspection report entitled "Compliance Inspection Report". Please respond in writing to this office within 30 days of your receipt of this letter regarding your plans or measures to be taken to address the following issues: • The previous year's annual report has not been completed and submitted to the Division. . The effluent sample storage unit is not keeping the wastewater samples at the correct temperature. • The Division of Water Resources records currently indicate that the Town of Parktown's WWTP does not have an ORC and only lists Roy Lowder as the Back-up ORC. The Fayetteville Regional Office understands that Roy Lowder has been in the ORC role since that position was vacated by Tim Littler on September 4, 2018. Please complete the enclosed ORC/ Back-up ORC form and submit it to the address listed as soon as possible. Please refer to the enclosed inspection report for further comments regarding these issues. ,EQ2�iN-DrtF.�rD.r.a6epsrtmentofEPvr-Dnir.er.ta:QLa-ty I D:vs*r.ofWaterRes]Lrsa j.�L - Fayenev e F,eg:ora: Wre 1 t.25 Greer, Street, Sate 714 1 Fay;etter;:e, NortF 5r-3 �a 2SSD1 ° �� $1C: 422-2,200 If you should have any questions, please do not hesitate to contact Hughie White or myself with the Water Quality Regional Operations Section in the Fayetteville Regional Office at 910-433-3300. Sincerely, EDocuSigned by: ✓MIAR "I E4E1A9691DB248E— Mark Brantley, Asst. Regional Supervisor Water Quality Regional Operations Section Fayetteville Regional Office Division of Water Resources, NCDEQ ATTACHMENTS Cc: WQS Fayetteville Regional Office (HW) Roy Lowder, ORC Nort6CaroliasDepartinentofEirvlrortmeirtaiQoa!ity I DiulsioirofWater Resouroes Fayettevige Regioirai W:ce 1 225 Green Street, Suite 7A I Fayetteville, North Carofma 25301 '.mq T 910-433--4WO United States Environmental Protection Agency Form Approved. EPA Washington, D.C. 20460 OMB No. 2040-0057 Water Compliance Inspection Report Approval expires 8-31-98 Section A: National Data System Coding (i.e., PCS) Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type 1 IN 1 2 15 I 3 I NCO026921 111 12 I 19/09/23 I17 18 I S J 19 L G] 201 I 211111 I I I I I I II I I I I I I I I I I I I I I I I I I I I I I I II I I I I I f6 Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA ---------------------- Reserved ------------------- 671 70 I I 71 I I 72 I r I 73 I I 174 751 I I I I I I I80 u ty I I i Section B: Facility Data Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include Entry Time/Date Permit Effective Date POTW name and NPDES oermit Number) 01:00PM 19/09/23 15/02/01 Parkton WWTP Loop Rd Exit Time/Date Permit Expiration Date Parkton NC 28371 02:45PM 19/09/23 19/07/31 Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data Roy Lemuel Lowder/ORC/910-827-7953/ Name, Address of Responsible Official/Title/Phone and Fax Number Contacted Timothy E Little,NCSR 1724 Saint Pauls NC 28384/Public Works Director/910-474-6616/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Permit 0 Flow Measurement Operations & Maintenance Records/Reports Self -Monitoring Program 0 Facility Site Review Effluent/Receiving Waters Laboratory Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date Hughie White DWR/FRO WQ/910-433-3300 Ext.708/ Signature of M bQ,�¢. bV.eviewer Agency/Office/Phone and Fax Numbers Date Mark BraFtled"�1/v DWR/FRO WQ/910-433-3300 Ext.727/ 10/7/2019 EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete. Page# NPDES yr/mo/day Inspection Type (Cont.) NCO026921 I11 121 19/09/23 117 18 JCJ Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary) All records and log books appeared to be very well organized and maintained. A copy of the NPDES permit was available for review. The ORC visitation log appeared to be complete and current. Calibration records appeared to be properly documented. Laboratory data was reviewed and all data appeared to be correct, as reported on the DMR's. The annual report for 2018 has not been submitted. It was recommended, during this inspection, to complete and submit the previous year's annual report, even though it will be late. Also, as noted in this inspection checklist, the effluent sampler storage unit was not keeping the sample at the proper temperature. At the time of the inspection, the temperature inside the unit was reading 15 degrees C, when it should be kept at no more than 6 degrees C. The sample storage unit either needs to be repaired or replaced in order to ensure proper sample storage. The Division of Water Resources records currently indicate that the Town of Parktown's WWTP does not have an ORC and only lists Roy Lowder as the Back-up ORC. The Fayetteville Regional Office understands that Roy Lowder has been in the ORC role since that position was vacated by Tim Littler on September 4, 2018. Please complete the enclosed ORC/ Back-up ORC form and submit it to the address listed as soon as possible. Page# Permit: NCO026921 Owner - Facility: Parkton WWTP Inspection Date: 09/23/2019 Inspection Type: Compliance Evaluation Operations & Maintenance Yes No NA NE Is the plant generally clean with acceptable housekeeping? 0 ❑ ❑ ❑ Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable ❑ ❑ ❑ Solids, pH, DO, Sludge Judge, and other that are applicable? Comment: Permit Yes No NA NE (If the present permit expires in 6 months or less). Has the permittee submitted a new 0 ❑ ❑ ❑ application? Is the facility as described in the permit? 0 ❑ ❑ ❑ # Are there any special conditions for the permit? ❑ ❑ 0 ❑ Is access to the plant site restricted to the general public? 0 ❑ ❑ ❑ Is the inspector granted access to all areas for inspection? 0 ❑ ❑ ❑ Comment: Record Keeping Yes No NA NE Are records kept and maintained as required by the permit? 0 ❑ ❑ ❑ Is all required information readily available, complete and current? 0 ❑ ❑ ❑ Are all records maintained for 3 years (lab. reg. required 5 years)? 0 ❑ ❑ ❑ Are analytical results consistent with data reported on DMRs? 0 ❑ ❑ ❑ Is the chain -of -custody complete? 0 ❑ ❑ ❑ Dates, times and location of sampling Name of individual performing the sampling Results of analysis and calibration Dates of analysis Name of person performing analyses Transported COCs Are DMRs complete: do they include all permit parameters? ❑ ❑ ❑ Has the facility submitted its annual compliance report to users and DWQ? ❑ ❑ ❑ (If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator ❑ ❑ ❑ on each shift? Is the ORC visitation log available and current? ❑ ❑ ❑ Is the ORC certified at grade equal to or higher than the facility classification? ❑ ❑ ❑ Is the backup operator certified at one grade less or greater than the facility classification? ❑ ❑ ❑ Is a copy of the current NPDES permit available on site? ❑ ❑ ❑ Page# 3 Permit: NCO026921 Inspection Date: 09/23/2019 Record Keeping Facility has copy of previous year's Annual Report on file for review? Owner - Facility: Parkton WWTP Inspection Type: Compliance Evaluation Yes No NA NE ❑ ■ ❑ ❑ Comment: The previous year's annual report has not been done. It was recommended to the ORC that the annual report needs to be completed even though it will be submitted late. Bar Screens Yes No NA NE Type of bar screen a.Manual b.Mechanical Are the bars adequately screening debris? 0 ❑ ❑ ❑ Is the screen free of excessive debris? 0 ❑ ❑ ❑ Is disposal of screening in compliance? 0 ❑ ❑ ❑ Is the unit in good condition? 0 ❑ ❑ ❑ Comment: Grit Removal Yes No NA NE Type of grit removal a.Manual ❑ b.Mechanical Is the grit free of excessive organic matter? 0 ❑ ❑ ❑ Is the grit free of excessive odor? 0 ❑ ❑ ❑ # Is disposal of grit in compliance? 0 ❑ ❑ ❑ Comment: Oxidation Ditches Yes No NA NE Are the aerators operational? 0 ❑ ❑ ❑ Are the aerators free of excessive solids build up? 0 ❑ ❑ ❑ # Is the foam the proper color for the treatment process? 0 ❑ ❑ ❑ Does the foam cover less than 25% of the basin's surface? 0 ❑ ❑ ❑ Is the DO level acceptable? ❑ ❑ ❑ Are settleometer results acceptable (> 30 minutes)? ❑ ❑ ❑ Is the DO level acceptable?(1.0 to 3.0 mg/1) ❑ ❑ ❑ Are settelometer results acceptable?(400 to 800 ml/I in 30 minutes) ❑ ❑ ❑ Comment: Page# 4 Permit: NCO026921 Owner - Facility: Inspection Date: 09/23/2019 Inspection Type: Parkton WWTP Compliance Evaluation Secondary Clarifier Yes No NA NE Is the clarifier free of black and odorous wastewater? 0 ❑ ❑ ❑ Is the site free of excessive buildup of solids in center well of circular clarifier? 0 ❑ ❑ ❑ Are weirs level? 0 ❑ ❑ ❑ Is the site free of weir blockage? 0 ❑ ❑ ❑ Is the site free of evidence of short-circuiting? 0 ❑ ❑ ❑ Is scum removal adequate? 0 ❑ ❑ ❑ Is the site free of excessive floating sludge? 0 ❑ ❑ ❑ Is the drive unit operational? ❑ ❑ 0 ❑ Is the return rate acceptable (low turbulence)? 0 ❑ ❑ ❑ Is the overflow clear of excessive solids/pin floc? 0 ❑ ❑ ❑ Is the sludge blanket level acceptable? (Approximately'/4 of the sidewall depth) ❑ ❑ ❑ Comment: Disinfection -Gas Yes No NA NE Are cylinders secured adequately? 0 ❑ ❑ ❑ Are cylinders protected from direct sunlight? 0 ❑ ❑ ❑ Is there adequate reserve supply of disinfectant? 0 ❑ ❑ ❑ Is the level of chlorine residual acceptable? 0 ❑ ❑ ❑ Is the contact chamber free of growth, or sludge buildup? 0 ❑ ❑ ❑ Is there chlorine residual prior to de -chlorination? 0 ❑ ❑ ❑ Does the Stationary Source have more than 2500 Ibs of Chlorine (CAS No. 7782-50-5)? ❑ ❑ 0 ❑ If yes, then is there a Risk Management Plan on site? ❑ ❑ 0 ❑ If yes, then what is the EPA twelve digit ID Number? (1000- If yes, then when was the RMP last updated? Comment: De -chlorination Yes No NA NE Type of system ? Liquid Is the feed ratio proportional to chlorine amount (1 to 1)? 0 ❑ ❑ ❑ Is storage appropriate for cylinders? 0 ❑ ❑ ❑ # Is de -chlorination substance stored away from chlorine containers? 0 ❑ ❑ ❑ Comment: Are the tablets the proper size and type? ❑ ❑ 0 ❑ Page# 5 Permit: NCO026921 Owner - Facility: Parkton WWTP Inspection Date: 09/23/2019 Inspection Type: Compliance Evaluation De -chlorination Yes No NA NE Are tablet de -chlorinators operational? ❑ ❑ 0 ❑ Number of tubes in use? Comment: Flow Measurement - Effluent Yes No NA NE # Is flow meter used for reporting? 0 ❑ ❑ ❑ Is flow meter calibrated annually? 0 ❑ ❑ ❑ Is the flow meter operational? 0 ❑ ❑ ❑ (If units are separated) Does the chart recorder match the flow meter? ❑ ❑ 0 ❑ Comment: Standby Power Yes No NA NE Is automatically activated standby power available? 0 ❑ ❑ ❑ Is the generator tested by interrupting primary power source? 0 ❑ ❑ ❑ Is the generator tested under load? 0 ❑ ❑ ❑ Was generator tested & operational during the inspection? ❑ ❑ ❑ Do the generator(s) have adequate capacity to operate the entire wastewater site? 0 ❑ ❑ ❑ Is there an emergency agreement with a fuel vendor for extended run on back-up power? ❑ ❑ ❑ Is the generator fuel level monitored? 0 ❑ ❑ ❑ Comment: Influent Sampling Yes No NA NE # Is composite sampling flow proportional? ❑ ❑ 0 ❑ Is sample collected above side streams? 0 ❑ ❑ ❑ Is proper volume collected? 0 ❑ ❑ ❑ Is the tubing clean? 0 ❑ ❑ ❑ # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees ❑ ❑ ❑ Celsius)? Is sampling performed according to the permit? 0 ❑ ❑ ❑ Comment: Effluent Sampling Yes No NA NE Is composite sampling flow proportional? ❑ ❑ 0 ❑ Is sample collected below all treatment units? 0 ❑ ❑ ❑ Page# 6 Permit: NCO026921 Inspection Date: 09/23/2019 Effluent Sampling Owner - Facility: Parkton WWTP Inspection Type: Compliance Evaluation Is proper volume collected? Is the tubing clean? # Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)? Is the facility sampling performed as required by the permit (frequency, sampling type representative)? Yes No NA NE ■ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ■ ❑ ❑ ■ ❑ ❑ ❑ Comment: The sample storage unit does not appear to be cooling properly. At the time of the inspection, the temperature in the unit was reading 15.0 degress C. It appears that the unit either needs to be repaired or replaced. Page# 7 Mayor Al McMillan Commissioners Robin Hill Tony McVickers David Register Nathaniel Solomon Doris Underwood Attorney Garris Neil Yarborough October 29, 2019 Mark Brantley North Carolina Department of Environmental Quality 228 Green Street, Suite 714 Fayetteville, NC 28301 • Re: Parkton WWTP Robeson County NPDES WW Permit No.: NC0026921 Compliance Inspection Report Dear Mr. Brantley: Town Clerk/Finance Officer Marjorie S. Memoli Chief of Police Sam May Public Works Director 1 Code Enforc o -- es � t #ffiLer DEOMNRm OCT 31 2019 V,VQ,ROS :rAYETTFV113,. ?EG;Q 4ALOFF(CE We received your Compliance Inspection Report dated October 1, 2019. The report referenced three (3) items which require responses. • The previous year's annual report has not been completed and submitted to the Division. Response: The Town of Parkton's Performance AnnualReportfor 2018 is attached hereto. • The effluent sample storage unit is not keeping the wastewater samples at the correct temperature. Response: An additional cooling unit has been incorporated into the system to keep the wastewater samples at the correct temperature. • The Division of Water Resources records currently indicate that the Town of Parkton's WWTP does not have an ORC and only lists Roy Lowder as the Back-up ORC. Response: Attached please find two (2) fully executed Water Pollution Control System Operator Designation Forms regarding Biological and Collection.. Parkton Town Hall • 28 W David Parnell Street • P.O. Box 55 • Parkton • North Carolina • 28371 Telephone (910) 858-3360 • Facsimile (910) 858-9808 October 28, 2019 Re: Compliance Inspection Report Page 2 Should you have any questions or should you require anything further, please do not hesitate to contact our office. Thank you for your consideration in this matter. Sincerely, Al McMillan Mayor AM/msm Enclosures I. General Information: Facility / System Name: Responsible Entity: Person in Charge /Contact: Applicable Permit(s): Town of Parkton Performance Annual Report Parkton Wastewater Treatment Plant Town of Parkton Roy L. Lowder (910)-858-3360 NC0026921 Description of Collection System or Treatment Process: Operation of a 0.2 MGD wastewater treatment facility consisting of a manual bar screen, two oxidation ditches operated in parallel treatment trains, two clarifiers with flow directed to a Partial flume and flow meter, step down post aeration, aerated sludge digester with sludge drying beds, and post chlorination. This facility is located at the Parkton WWTP, on NC SR 1724 southeast of Parkton in Robeson County. The wastewater collection system consists of 2 miles of gravity flow sewer mains and 1.5 miles of force mains. We have two lift stations one that pumps waste water to different location in the collection system. Lift station # 2 pumps sewer water to the wastewater treatment plant. II. Performance: Text summary of System for Calendar Year 2018: 8 - Permit Violations 0 - Notice of Violation 3 - Sanitary Sewer Overflow 0 - Notice of Deficiency The 3 sanitary sewer overflows were caused by I&I due to excessive rainfall amounts. All of the sanitary sewer overflows were due to Hurricane Florence. The 8 Permit Violations were due to oversight, low chlorine, holiday and flow. We exceeded at the WWTP in the months of March, June, November and December. The 8 Permit Violations were as follows, sanitary sewer overflow, total mercury, total nitrogen, total phosphorus, fecal and excessive flow at WWTP. III. Notification: A copy of this report can be obtained at the Parkton Town Hall. IV. Certification I certify under penalty of law that this report is complete and accurate to the best of my knowledge. I further certify that this report has been made available to the users or customers of the named system at Parkton Town Hall. Remy 1' 400deden October 28, 2019 Roy L. Lowder Date ORC Town of Parkton ar6) al9aet-QA9i9 Al McMillan Mayor Town of Parkton Date WASTEWATER SPILL REPORTED AT THE TOWN OF PARKTON Parkton, NC September 15, 2018 - Parkton's wastewater collection system experienced a wastewater overflow at 3 locations on September 15, 2018, at approximately 8:00 AM. According to Public Works, the spill of an estimated 12,672 gallons at 353 McNeill St., an estimated 10,824 gallons at McNeil St. and an estimated 5,412 gallons Church St. occurred when the manhole began overflowing into Dunn's Marsh. The gravity line carrying the wastewater exceeded its capacity due to inflow and infiltration from excessive rainfall amounts. The Town found no evidence that the spill impacted surface waters in the Lumber River Basin. However, as required, The Town notified the state Division of Water Quality and the agency is reviewing the matter. Public Works operates the wastewater system, providing services to the Town of Parkton. North Carolina General Statutes Article 21 Chapter 143.215.0 requires this notice. Water Pollution Control System Operator Designation Form WPCSOCC NCAC 15A 8G .0201 Permittee Owner/Officer Name: n b- Po Ackok Mailing Address-7f. a . 13(1 .SS State: &C. Zipd$a'7 I - Phone #:'l!b— 8Sg - 33(o Email address: Gl;{Ka 4-euyt\of epr.2 Signature: Date: 019(Sie/l g j I Facility Name of n n \r \n County - J 5o Permit #: /VG 00.3 9a,i SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM! Facility Type/Grade (CHECK ONLY ONE): Collection Physical/Chemical Surface Irrigation Land Application Operator in Responsible Charge (ORC) Print Full Name: A) L Email: Certificate Type /9ade / Number: L) l4.3 2. 2 7'1') 1 Signature: rel, I • Oon Work Phone #: j 1$ Y 1 I S— AO/Z1.)t q Date: "I certify that gree 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: W /Sam Caoty MC'tJe' l) Email: Cod y.lvtcn G,"/I Li}/g _two• Co I'lA Certificate Type / Grade / Number: (. 5 160 a, S 4 Work Phone #: coo 6 7 /1 5 G /3 Date: 1 J ) 17 Signature: 41 "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." Mail, fax or email the original to: Mail or fax a copy to the appropriate Regional Office: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 Email: certadmin(�ncdenr.gov Asheville 2090 US Hwy 70 Swannanoa 28778 Fax: 828.299.7043 Phone: 828.296.4500 Washington 943 Washington Sq Mall Washington 27889 Fax: 252.946.9215 Phone: 252.946.6481 Fayetteville 225 Green St Suite 714 Fayetteville 28301-5043 Fax: 910.486.0707 Phone: 910.433.3300 Wilmington 127 Cardinal Dr Wilmington 28405-2845 Fax: 910.350.2004 Phone: 910.796.7215 Fax: 919.715.2726 Mooresville 610 E Center Ave Suite 301 Mooresville 28115 Fax: 704.663.6040 Phone: 704.663.1699 Winston-Salem 450 W. Hanes Mall Rd Winston-Salem 27105 Fax: 336.776.9797 Phone: 336.776.9800 Raleigh 3800 Barrett Dr Raleigh 27609 Fax: 919.571.4718 Phone:919.791.4200 Revised 05-2015 WPCSOCC Operator Designation Form, cont. Facility Name: Permit #: Back -Up Operator, in Responsible Charge (BU ORC) Print Full Name: Email: 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: Email: 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 spt forth in 15A NCAC 086 10205 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: Email: 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: Email: 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 05-2015 Print Full Name: Permittee Owner/Officer Name: Mailing Address: D. Bn&5�s Water Pollution Control System Operator Designation Form WPCSOCC NCAC 15A 8G .0201 O-F PaAC ' City h,r y4 k State: x1 C. Zip: aza`Z ! - Phone #: i i -$S8 —33 da d Email address: Signature: G ka4/4_ 1of.nrZ Date: `(Y , -O(? Facility Name: kin c•. \AVV Permit #: ikk..06a(D`jai County: Biological SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM! ility Type/Grade (CHECK ONLY ONE): Physical/Chemical Surface Irrigation Land Application Operator in Responsible Charge (ORC) L L-toL- Email: r r Certificate Type / Grade / Number. �� 2 11 L/57J Work Phone #: 1 1..D 9 6 Lfl ) Date: (.J/L2 11 Signature: "I certify that I agree tcdesignation 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: Ll//Sc)Cl CArly mCAI(•'`) Email:C dt1,mc-i1k..► tl }3 c� k(th Certificate Type / Grade / Number: , S / 1 3 d 9 5 Signature: ./7( Work Phone #: �t/0c7L! S��3 Date: I� "aZS- "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." Mail, fax or email the original to: Mail or fax a copy to the appropriate Regional Office: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 Fax: 919.715.2726 EinaiI certadniiiiancdenr Eov Asheville 2090 US Hwy 70 Swannanoa 28778 Fax: 828.299.7043 Phone: 828.296.4500 Washington 943 Washington Sq Mall Washington 27889 Fax: 252.946.9215 Phone: 252.946.6481 Fayetteville 225 Green St Suite 714 Fayetteville 28301-5043 Fax: 910.486.0707 Phone: 910.433.3300 Wilmington 127 Cardinal Dr Wilmington 28405-2845 Fax: 910.350.2004 Phone: 910.796.7215 Mooresville 610 E Center Ave Suite 301 Mooresville 28115 Fax: 704.663.6040 Phone: 704.663.1699 Winston-Salem 450 W. Hanes Mall Rd Winston-Salem 27105 Fax: 336.776.9797 Phone: 336.776.9800 Raleigh 3800 Barrett Dr Raleigh 27609 Fax: 919.571.4718 Phone:919.791.4200 Revised 05-2015 WPCSOCC Operator Designation Form, cont. Facility Name: Permit #: Back -Up Operator in Responsible Charge (BU ORC) Print Full Name: Email: 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 Resp- - g ,, ge (BU ORC) Print Full Name: Email: Certificate Type / Grade / Number: Work Phone #: Signature: Date: "I certify that I agree to my designation as a Back-up Operator in Responsible.Chvg,,e-for the facility noted. I understand and will abide by the rules and'regulatioos pertaining to the responsibilities of the BU ORC asset forth fry f5A 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: Email: 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: Email: 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 05-2015