NC0075701_Operator Designation_20180330

03-29-'18 10:53 FROM -
Date: March 30, 2018
Letter of Transmittal
To:
WPCSOCC
610 E. Center Ave.
Suite 301
Mooresville, NC 28115
ATN: Certification Administrator
(via Fax - 704-663-60401
T-098 P0001/0003 F-437
.
La
ALBEMARLE
NORTH CAROLINA
W ter-; v-, Land, I%pport«a/t�
From:
Michael Leonas
Albemarle Public Utilities Department
PO Box 190
Albemarle, NC 28002.190
704.984.9605
m leonas(Dalbemarlenc. eov
Attached please find a copy of the completed WPCS Operator Designation Forms for the following facilities:
• Tuckertown Water Treatment Plant - Land Application System (W00000759)
Tuckertown Water Treatment Plant - Waste Treatment System (NC0075701)
Being submitted to officially designate the change in ()RC$ f9r (hg rgfgrgggq0 facillties,
Please advise if there is any additional information needed or if there are any questions concerning the
enclosed information.
Thank You
Mike Leonas

03-29-'18 10:53 FROM -
T-098 P0002/0003 F-437
WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G.0201
Press TAB to enter information
Permittee Owner/Officer Name: City of Albemarle / Michael L. Leonas
MallingAddress: 144 North Second Street PO Box 190
city: Albemarle
Email Address:
Signature:
Facility Name: Tuckertown Water Treatment Plant
County: Staniy
state: NC
Phone: [phone]
zip: 28002-0190
Date: .3.W.15
Permit# W00000759
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
Facility Type:
I LA
Facilit Grade:
Select
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..CS.f�1" `R6XAS6Y4i�
Print Full Name: Todd Franklin.Robin5on. Work Phone: [phone]
Certificate Type: LA Certificate Grade: Select
Email Address: robinson0784@bellsouth-net
Certificate If: 998969
Signature: Effective Date: 3I p 01/1 1;
'1 certify that/ agree to my designation as the 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 25A NCAC 080.0204 and falling to do so can result in
Disciplinary Actions by the Water pollution Control System Operators Certification Commission."
Print Full Name: (No change to the Backup ORC) Work Phone:
Certificate Type: Select Certificate Grade: SeleCt Certificate tt:
Email Address:
Signature: Effective Date:
certify that I agree to my designation 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."
Mall, fax or email WPCSOCC, 1618 Mail Service Center, Fax: [phone].. 'fiNAWYM
ORIGINAL to: Raleigh, NC 27599-1618
Mail or Fax Asheville
a COPY to: 2090 US Hwy 70
Swannanoa, NC 28778
Fax; 828-299-7043
Phone: [phone]
Fayetteville
225 Green St., Suite 714
Fayetteville, NC 28301-5043
Fax: [phone]
Phone: [phone]
Mooresville
610 E. Center Ave., Suite 301
Mooresville, NC 28115
Fax: [phone]
Phone: [phone]
Washington Wilmington Winston-Salem
943 Washington Sq. Mall 127 Cardinal Dr. 45 W. Hanes Mall Rd.
Washington, NC 27889 Wilmington, NC 28405-2845 Winston-Salem, NC 27105
Fax; 252-946-9215 Fax: [phone] Fax: [phone]
Phone: [phone] Phone: [phone]S Phone; 336-776-9800
Raleigh
38DD Barrett Dr.
Raleigh, NC 27609
Fax: [phone]
Phone: [phone]
Rc&dd 412010

03-29—'18 10:55 FROM— T-098 P0003/0003 F-437
WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
Im:T�fif:Lcl6FbFl
Press rA6 to enter Information
Permittee owner/officer Name: City of Albemarle / Michael L. Leonas
Mailing Address: 144 North Second Street PO Box 190 Phone: [phone]
city: Albemarle
Email Address:
Signature:
Facility Name: Tuckertown Water Treatment Plant
County:
state: NO Zip: 28002-0190
Date: �,0• (�7
Permit# NCO075701
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
t
it T pe: PCity Grade: I
i `1 sax fvY' 'wy xyr ,Ic rR .pfi �� `9j�ti1.'turaixr"Cat"�5, `la vx/;Y•'4H" Or
Tiny' '9: '*i' + W.
Print Full Name: Thomas David Johnson Work Phone: [phone]
Certificate Type: PC Certificate Grade: 11 Certificate #: 988361
Email Address: tjohnsc n@envlrollnklnc. m
Signature: Effective Date:
"1 certify that I ague to my aesignotlon as toe Opemlor In Re3pulWIlle Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responslbliitles 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."
9'2K 36,
Print Full Name: (No Change in Backup ORC) Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Email Address: [e-mail]
Signature: Effective Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge far 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 NC4CO8G .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] aili..a
ORIGINAL to: Raleigh, NC 27699-1618
Mail or Fax Asheville
Fayetteville
Mooresville
Raleigh
a COPY to: 2090 US Hwy 70
225 Green St., Suite 714
610 E. Center Ave., Suite 301
3800 Barrett Dr.
Swannanoa, NC 28778
Fayetteville, NC 28301.5043
Mooresville, NC 28115
Raleigh, NC 27609
Fax: [phone]
Fax; 910.486-0707
Fax: [phone]
Fax: [phone]
Phone; 828-296-4500
Phone; 910-433-3300
Phone; 704-653-1599
Phone: [phone]
Washington Wilmington Winston-Salem
943 Washington Sq. Mall 127 Cardinal Dr. 45 W. Hanes Mall Rd,
Washington, NC 27889 Wilmington, NC 28405-2845 Winston-Salem, NC 27105
Fax: [phone] Fox:910-350.2004 Fax: [phone]
Phone: [phone] Phone: [phone] Phone: [phone] REVk9d42018