NC0039446_Operator Designation Form_20211208

WATER l'OLLUTION CONTROL SYSTEM (iPE:. rUR DESIGNA ON FORM (WPCSOCC)
NCAC 15A 8G .0201
Press TAB t; .itermatior,
Permittee Owner/Officer Name; Alan Burcheill
Email Address:
Permittee Signature:
alaratinviltegolfclub.com
tinviP.e Resorts VVWTP
SUBMIT A SEPARATE FORM FOR EACH SYSTEM CLASSIFICATION: VONA
Print Full Name! Robert G. Rowe
:..-2rtificate Type: V\i'Vv' Certificate Grace:
Permit #
ORC - OPERATOR IN RESPONSIBLE CHARGE
Erna!! Address:
Signature:
[e-mail]
•iAiork.
Certificate
Aic9-04,4
Effective Date:
N C0039446
{828! 25-1900
1010082
10/15/2021
' certify that agree 10my cie.cianation ac the Operator in Resoonsible Charge ,ror !-ne facility noted. underana and MP abide by the-
7u/es dna regulations pertaining to the respoasibilities of ho ORC a ser forth ;r? ISA NCAC 083 .0204 .inci tailing to ao c.on.n
Disciplinary Ac-Lions by the Water Po!lution ntrot System Operators •forrrnission.'
Print Pull mp: Reber P. Barr
CPrt.ticate W‘iki
ET,Idli Address: rbarl—Zi)rpiT)sysiorris.com
nature: •
BACKUP ORC
Work Phone. [phone]
Cel•ficate Gracie: Certificate
8928
Effective Date: 10/15/2021
corify that agree to my designation as a Back-up Operator in Responsibie (horpe for the facilit'y' noted. 1 understand and will abide by
wec dna regulations pertaining to the responjbliiiies of the CRC as set fo'tn in 25A NCAC 08G .0204 and failing t do se can reSWE
4ction5 by he Water Pollbtin Tontrol SysteniOperator,. Certificatior Commission."'
•-• !a.:
ORIGINAL. tc: Email: • • • . • • • Fax: 91(2,7.1.
VIIPCcOCC: 1512 mail• sei's•Le NE 27699 151.8
or L7A COPY to: Asheville
2090 US Hwy 7C
Swan,lanoa. NC 7877S
Fax: [phone]
Phone: S?..:S 296-4500
Washington
Washir!gton, NC 2/889
Fax: 2-3716
Phone: [phone]
Fayetteville
(-)res.,r; 4
Fayetteville. NC 2830' 504'
Fax: 9:0-326-0727
Phone: [phone];00
Wilmington
127 C,F7-iTiiri3! Dr.
Wiln...ing-Ion, NC 28405, 2845
Fax: [phone]
Phone: [phone]
Mooresville
510 E. Center Ayc.... Suite 3C1
Mooresyilie, NC 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
ar; W. a.ar es Rd.
Wrnslon-Salem., NC. 27105
Fax: [phone]/‘?.../ Phone:
336-776 9800
Raleigh
3800 Bari -en:
Raleigh, NC 2750.
Fax: [phone].
Phone: [phone]C;

Page 2
Facility Name: Linville Resorts WWTP Permit#: NC0039446
BACKUPORC
Print Full Name: Tony D Metcalf Work Phone: [phone]
Certificate #: 997885
-----------------------
Ce rt if i cat e Type: 'WW Certificate Grade: I -----------------
Em a i I Address:
Signature:
"I certify that I agree to my d gnatian as a Back-up Ope tor 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 foiling to do so can result in
Disciplinary Actions by the Water Pollution Contra/ System Operators Ce-tification Commission.·
BACKUPORC
Print Full Name: ------------------------Work Phone: ----------
Ce rt if i cat e Type: Select Certificate Grade: Select Ce rt i fi cat e #:
Email Address:
Signature:
------------------
Effective Date:
----------
----------------------------------
"/ certify that I agree ra 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 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."
BACKUPORC
Print Full Name: -----------------------Work Phone: ----------
Ce rt if i cat e Type: Select Certificate Grade: Select Ce rt i fi cat e #:
Email Address:
Signature:
-----------------
Effective Date: -----------------------------------
"I certify that I agree ro my designation as o 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 ORC as set forth in 15A NCAC OBG .0204 and foiling to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUPORC
Print Full Name: Work Phone: ---------------------------------
Ce rt i fi cat e Type: Select Certificate Grade: Select Ce rt i fi cat e #:
Email Address:
Signature:
-----------------
Effective Date: ----------------------------------
"I certify that I agree to my designation as a Back-up Operator in Respomible Charge for the facility noted. I understand and will abide by
the rules and regulations pertaining ta the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and foiling to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commi55ion."
Re-vised 11/2020