WQ0022965_Sewer Extension Permit Status Update_20191203 (2)

RECEIVED
DEC 0 3 2019
NCDEQ/DVVR/lPDE
TO: Christyn L. Fertenbaugh (
Environmental Engineer
1617 Mail Service Center
Raleigh,NC 27699-1617
In Response to the letter on Requested Certifications
WQ0022965 Coffin woods subdivision
Certification included
WQ0021680 Deep River Haven Industrial Park
Request Extension
We have contacted the Engineer and they are unable to Find
? Is the number Correct ?
Arnold Allred
336-736-4185
[e-mail]
Public Works Director 11-26-19
cc: Jeff Bryan (Environmental Engineer)

•
Request for Engineering Certiflca •n Date of Letter: October 22,2019
Sewer Extension Permit Status Update
Please complete the appli ble portion of this form for each permit and return this form and supporting documents to the attention
of Nyle Hothem at the Divi 'on's PERCS Unit by the delivery method below and within 30 days of the date •die.hie jet :l V0 E
# NCDEQ/DWR ��+++
WQPS—PERCS UNIT DEC 0 3 2019
By U.S.Postal Servic- By Courier/Special Delivery: By Email:
1617 Mail Service Ce er 512 N.Salisbury St.Suite 925 Nyle Hothem NCDEQIDWRINPDES
Raleigh,NC 27699-1 7 Raleigh,NC 27604 [e-mail]
Permit No.: (d0 0 0' 42 414iC Permittee: Town of Franklinville
Project Name: i P,'4J L. viS &.64iii).S/ell
Project Stat - (Check appropriate box to indicate Permittee's response and complete&,sign below)
0 Permit to Remain Op: : The Perm ittee certifies that the permitted project has not been constructed but shall be constructed In _
the future in conform with the approved Permit,project plans,specifications,and supporting documents.The Permittee
understands that the:ppropriate certification documents will need to be forwarded to the Division prior to operation. Subject
- .ermit shall be maintined in Active status.
A►: e Permitted proje has been constructed and the required Engineer's Certification and supporting documents will be
submitted to the Divi A on with this form. Permittee understands that failure to submit required certification documents for an
active,in-service systi m may result In enforcement action.
❑ Request Extension: rmittee requests extension to reply to this letter not to exceed 60 days of the date of this letter.
❑ Ownership/Name Ch Pi
The Permittee requests information to apply for ownership or name change. Please provide email
and phone number b low for follow-up.
Name&Title(print):
Signature: Date:
Comments:
Permit Rescission Request
The Permittee requests t at the subject permit be rescinded and certifies that the permitted sewer system has not been and shall
not be constructed nor n de 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):
Signature: Date:
Comments: .
Contact Information Updates for Current Owner
Updated Contact Perso Title(Print):
Updated Mailing Addre :
Updated Email: Updated Phone: