NC0037508_Operator Designation_20031205

Water Pollution Control System ORC Designation. Form
wPCSOCC
NCAC 15A:08G .0201
General Information:
Permittee Owner/Officer Name: Phillip Boles - Public Works Director'
Mailing Address: 703 Pinehurst Avenue PO Box 756
City: Carthage _ State: NC Zip: 28327
RECEIVED
DEC 05 2003
DENR - FAYETII IIILLE REGIONAL OR3CI
Telephone Number: (_910_) 947-2301
Signature: C i�, �,� ' Date: / z/.S/o3
Facility Information: 0
Facility: _Moore County Water Pollution Control Plant
Permit Number: NC0037508 County: Moore County
! SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM !
Mark (X) Type of Facility Class (1 - 4) Class
Wastewater Plant X 4 Spray Irrigation
Physical/Chemical Land Application
Collection System Subsurface
N/A
N/A
N/A
Operator in Responsible Charge:
Print Name: James D. Frye- Superintendent Social Security # : �- 4/ d34 - '/ 33
Certificate Type and Grade: Wastewater IV Certificate #:
Work Telephone: ( 910 ) 997-6275 Signature: r 41k,, -
9831
Back -Up Operator in Responsible Charge:
Print Name: Jeffery W. Corder Social Security # : 237-27-3533
Certificate Type and Grade: Wastewater IV Certificate, #:! 16856
Work Telephone: ( 910 ) 281-5456 Signature:

Back -Up Operator in Responsible Charge:
Print Name: Bruce A. Turner
Certificate Type and Grade: Wastewater IV
Social Security #: 353 `58-5074
Work Telephone: ( 910_) 281-3913 Signature:
Back -Up Operator in Responsible Charge:
Print Name: Joseph A. McGrath
Certificate Type and Grade: Wastewater III Certificate #: 27321.
Work Telephone: L910J _947-4866 Signature:
ificate #: 19193
Social Security # : 579-74-9896
Mail or Fax to:
WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
Revised 10/2000