NC0084565_Operator Designator Form_20220324

Wafer Pollution Control System Operator
WPCSQCC
NCA,C t&k 8C . 2201
Pert ttee Owner/Ofcer Name Carr aterSet ce NC
Mailing Address: 4944 Parkway Plaza Blvd.. suite 375
City: Charlotte
signation " g t VED/NCDEQ/DWR
MAR`442022
MO©RESVILWQROS
LE REGIONAL OFFICE
State: NC Zi 78217 Phone #: [phone]
Email address: totry_ltonsultcarolinawatc
attire Tony Konsul
cenc_eottr.
,.serame,C.CW,l,K,.
Amy. lea igalxing OsErmsal
Date:
Facility Name! Tl e Harbour Wells [ and 2 Permit : NC0084565
SUBMIT A SEPARATE FOR. FOR EACH T E SYSTEM
Facility Type/Grade:
Biological WWTP
Physical/Chemical
Collection System.
Operator in Responsible Charge (ORC)
Print Full Name: Mark R. Haver
Surface Irrigation
Land Application
•
Certificate Type < Grade i umber: PC 1 994053
Signature:
Work Phone "it: (704 l36 [-0645
Date: c--
"1 certify that 1 agree to nay desigttati n as the Operator in Responsible Charge for the Facility noted. [ understand and will abide by the rules
and regulations pertaining to the reapunsibi[ t es of the ORC as set fo€tlt In ISA 1,ICAC 08G _0204 and fairing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Coinnvssion_'
•
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: Tony onsu[
Certificate Type f Grade f Number: PC
sgylature: Tony Konsul
1 - 985369
NC
Work Phone #: ( 704
76-1685
Date:
"1 certify that agree tt my design at urt as a Rack. -up Operator in Responsible Charge for tftc be [it
rules and regulations pertaining to the responsibilities oldie BO ORC as set forth itt 15A NCAC 0
Disciplinary Actions by the Water Pollution Control Sy tetnOperators Certification Cornmission:
understand and will abide by the
end failing to do so can result in
Hail, fax or entail the WPCSOCCa 1.61.8 Mali Service Center, Raleigh, NC 276994618
original try:
ri=fail or fax a copy to the
appropriate Regional Office:
Asheville
2090 US 1Iwy 711
Sw.nnnanoa 2€1778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sal tfal
Washington._78589
Fax: [phone]
Phone: [phone].
Fayetteville
22S Green St
Suite 714
Fayetteville 2830 1 -S0.13
Fax: [phone]
Phone: [phone]'
Wilmington
127 Cardinal Dr
Wilt00111100 28405-2845
Fax: [phone]
Phone: [phone]
Fax: 919
Maoresille
610 E Center Ave
Suite 301
Mooresville 28 t IS
Fax: [phone]
Phone: [phone]
Winston -Salmi
585 Waughtown St
Wins -Ma -Salem 27107
Fax: [phone]
Phone: [phone]
7,6492
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]
Revised 02-2t113