NC0060755_Operator Designator Form_20220324

Per
e Owner/Officer Na
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MtIan o o System Operator Des
wPCSQCC
'CAC 15A NG .0201
CarotinWater Service of NC
Mailing Address: 4.)44 Parkwa , PiaZa 131 AMC. 3
City: Charlotte
Stale
address: tone.konsucarolinawaterse
2$217
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at o
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RECEIVED/NCDEQ/DMIR
MAR 24 7022
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MOORESVILLE REGIONAL OFFICE
575-7990
ZI6.w W'vSm eJKC,PCiW [.w.
Tony Konsul
Dille_
Saddlewood
SUB
Facility Type/Grade:T
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Physical C- lieinical
Collection System
permit : NC0060755
ITT A SEPARATE FORM FOR EACH TYPE SYSTEM!
Operator in Responsible Charge (ORO'
Print Full Nan : Kenneth Knopf
Surface iii
Land Applic:lion
VW 2 - 994883
t rti c ntType ;' Grade ' Number:
.0.,.....atty 0,0001
4* US, C=CarcknaWaII0Serese of NC, C.10000001 0000.
f
Si %Irian
Kenneth Knop
Plic�;ln�
Date: 3/14/22
in RsNpo
Control y tein r r i ors (7ertifiration CommL
Back -Up Operator in Responsible Charge (BU ORC)
Pi.t Fitli Name: Mark R. Haver
11
7 ) 361-4377
no 11
and
Work Puerile
k-up i=rprait
ari the 1U ORC as
-0645
hid
"PC CC,. t 3 Mail enice Center. Raleigh. NC 2276 -161 Fax: [phone]
(l c rtadmin
I copy ra the Asheville
ilppr(+Cure Regional lOj ke 209+ i 1 S '. Sy:=rt IC
Ss;`-snn 6c a -0,1177.g
Fax: 8 299. io-fir
Phone: [phone]
SVii hingiorn
.r E: 252.946_9215
Phone: 252_946.4481
116.070
_433.3300
Wilmington
127 (3rilaral D
1-.ax: 9111.351),291k
.7 6_7215
Suiic 01
l606.66111 `N 115
Fax: [phone]
Phtme: 70- 663.1699
instfn i-SalciFa
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t°ax: 336 ` 11-4 3i
Phone: [phone]
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3:SO411366660 Dr
Raki h 27E--9
Fr 919571_4718
1Shrr t:i:91 . 91.4?1)zi

Certificate
addle vetni
Back -Up Operator n Responsible Charge ORC)
Pr`sntttilatn=a: Larry Henry
Certificate ILL
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Per
NC0060755
7
Number: if 2 7
Back -Up Operator in Responsible Charge (BU ORC)
Print Full 'tine: Tommy Capps
Cc it'icatc Type Grade
Back -Up Operator €e Responsible Charge (BU ORC)
Pries Full Name:
Number
Phone
04) 361-0641
inr the f any nolc E33xi e:r ..
15 'S,. ''t G JJ2O5 and ad`di
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Signature: 3 a
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Back --Up Operator in Responsible Cha
Prig[ t€ Naine:
Celli J cafe Type l G Number:
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Revised