WQ0031831_Sewer Extension Permit Status Update_20191119

Public Works Director/City Engineer 704 878 3551
CITY of40
tat Assistant Public Works Director 704 878-3567
Assistant City Engineer 704 878-3552
En
ering
e Off eeManager Tech
704 878-3562
PUBLIC WORKS Garage Superintendent 704 878-3563
7048783420
Sanitation Superintendent 704 878-3415
Street Superintendent 704 878-3414
P.O. Box 1111,Statesville, NC 28687-1111 Water/Sewer Mtn Superintendent 704 878-3417
19 November 2019
RECEIVED
DEC 0 2 2019
North Carolina Department of Environmental Quality NCDEQ/DWRINPDES
PERCS Unit
Attn: Mr. Nyle Hothem
1617 Mail Service Center
Raleigh NC 27699-1617
Subject: Sewer Extension Permit Status Update ICO WQ0031831
Enclosure: Sewer Extension Permit Status Update, Permit Rescission Request
Dear Mr. Hothem:
Please find enclosed the subject rescission request. Point of contact is the undersigned at
phone [phone] or email [e-mail].
Sincerely,
k/---_____,s("1—A----..._.._______i
William E. Vaughan, PE
Public Utilities Director

(or Engineering Certification Date of Letter: August 9,2019
Sewer Extension Permit Status Update
ease complete the applicable portion of this form for each permit and return to the Division by the delivery method below and
within 30 days of the date of this letter:
NCDEQ/DWR
WQPS—PERCS UNIT
By U.S. Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothem
Raleigh, NC 27699-1617 Raleigh, NC 27604 [e-mail]
***********************************************************/*******************j****************************
Permit No.: W( C�O31 B Sl Permittee: C;�j U 1c 3 erbrSV
Project Name: \/270Ce PO r&J62,7ei'n`(
**********************************************************************************************************
Project Status (Check appropriate box to indicate Permittee's response and complete&sign below)
❑ Permit to Remain Open: The Permittee certifies that the permitted project has not been constructed but shall be constructed in
the future in conformity with the approved Permit, project plans,specifications,and supporting documents.The Permittee
understands that the appropriate certification documents will need to be forwarded to the Division prior to operation. Subject
permit shall be maintained in Active status.
❑ The Permitted project has been constructed and the required Engineer's Certification and supporting documents will be
submitted to the Division with this form. Permittee understands that failure to submit required certification documents for an
active,in-service system may result in enforcement action.
❑ Request Extension: Permittee requests extension to reply to this letter not to exceed 60 days of the date of this letter.
Name&Title(print):
Signature: Date:
Comments:
***********************************************************************************************************
Permit Rescission Request
The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall
not be constructed nor made operational.We understand that, in the future,should we wish to operate a non-discharge sewer
system,we shall apply for and receive a new Wastewater Collection System Permit.
Name&Title(Print): v P
Signature: Date: << 2 (
R'
Comments: 7j < Under 74)j5 p t'r(7717/` I70T} 61.(/ /- -
**********************************************************************************************************
Contact Information Updates
Updated Contact Person:
Updated Mailing Address:
Updated Email: