WQ0015052_ORC Designation Form_20230113

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FOI RM (WPCSOCC)
NCAC 15A 8G .0201
OPERATOR IN RESPONSIBLE CHARGE (ORC)
Work Phone: [phone]
Certificate Grade: IV _ Certificate #: 26526
Email Address: [e-mail]
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Signature: _Effective Date:
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"1 certify that 1 agree 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."
Print Full Name: Michelle Pharr
Certificate Type: WW
Press TAB to enter information
Permittee Owner/Officer Name: William Freed
Mailing Address: P.Q. Box 92
City: Harbinger state:
Email Address: [e-mail]
Signature:
Facility Name: Village at Ocean Hill WWTP
County: Currituck
Phone: [phone]
NC zip: 27941
— — Date:
Permit # WQ0015052
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
EFacility Type: r
y Grade:
Print Full Name: David Pharr
Certificate Type: WW
BACKUP ORC
Work Phone: [phone]
Certificate #: 1008158
Email Address: [e-mail]
Signature: -
Effective Date: /21z"le�
"1 certify that I agree to my'designotion as a Back-up Operator in Responsible Charge for the facility noted. 1 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."
Mail, fax or email WPCSOCC, 1618 Mail Service Center, Fax: [phone]
ORIGINAL to: Raleigh, NC 27699-1618 Email: [e-mail]
Mail or Fax Asheville
a COPY to: 2090 US Hwy 70
Swannanoa, NC 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq. Mall
Washington, NC 27889
Fax: [phone]
Phone: [phone]
Certificate Grade: IV
Fayetteville
225 Green St., Suite 714
Fayetteville, NC 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr.
Wilmington, NC 28405-2845
Fax: [phone]
Phone:[phone]
Mooresville
Raleigh
610 E. Center Ave., Suite 301
3800 Barrett Dr.
Mooresville, NC 28115
Raleigh, NC 27609
Fax: [phone]
Fax: [phone]
Phone:[phone]
Phone:[phone]
Winston-Salem
45 W. Hanes Mall Rd.
Winston-Salem, NC 27105
Fax: [phone]
Phone: [phone]
Revised ar>naa