WQ0021960_Sewer Extension Permit Status Update_20200113

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ROY COOPER 14- li',� c ,i,.
Governor 1 �' g;,
MICHAEL S.REGAN ;, %
Secretary °'
LINDA CULPEPPER NORTH CAROLINA RECEIVED
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Director Environmental Quality
December 17,2019 AN 1
2020
Walter McDaniel NCDEQ/DWR/NPDES
Town of Polkton
113 W Polk St
Polkton, NC 28135
Subject: Engineering Certification
Town of Polkton
Anson County
Dear Permittee:
Based on a review of our records for permits issued during the period of 2002 through 2006, it appears that
the Division of Water Resources (Division) has not yet received a final engineering certification in accordance
with 15A NCAC 02T.0116,as well as the standard conditions of the permit,for the Wastewater Collection
System Extension Permit(s) listed below.
• Permit No. WQ0021960:Woodland Ridge Subdivision issued on 11/18/2002
If the permitted facility,or any portion of the facility, has been constructed and is in operation,a complete
and final engineering certification is required to be submitted prior to placing the system into service. It
should be noted that failure to certify a non-discharge sewer extension permit appropriately in accordance
with the provisions of 15A NCAC 02T.0116 may result in enforcement action.
Recognizing that the required certification documents may not be readily available for the permits issued
between 2002 and 2006(i.e., lost,destroyed,etc.),the Division will accept a statement from the Permittee,
in lieu of the Engineer's Certification, attesting to the construction,operation and maintenance of the
permitted system. (See Status Update form on back for response options.) If the permitted facility has not
been constructed and will not be constructed,the Permittee may request to have the permit rescinded by
returning the attached Status Update form. If the Permittee no longer owns the facility or the Permittee's
name has changed, please return the attached Status Update requesting information for ownership/name
change. Please note that Permits are not automatically transferable in the event the project site is now
owned by others.
The Division requests a response from the Permittee by January 20, 2020. The Status Update form on the
back of this letter should be completed and included with all submittals.
If you have any questions regarding this outreach program, please contact Nyle Hothem via e-mail at
[e-mail]. Alternatively,voice mail messages can be left at(919)707-9130.
Sincerely, ` "g— t
Christyn L. Fertenbaugh, P.E., Environmental Engineer
PERCS Unit, Division of Water Resources
cc: Fayetteville Regional Office,Water Quality Section Regional Operations [electronic]
PERCS[electronic copy]/163
D E
�.,. North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617
NORTH GARO1INA
b o e*^��MvI�� /°d 919.707.9000

Request for Engineering Certification Date of Letter: December 17,2019
Sewer Extension Permit Status Update
Please complete the applicable portion of this form for each permit and return this form and supporting documents by January 20,
2020 to the attention of Nyle Hothem at the Division's PERCS Unit by the delivery method below:
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]
Permit No.:WQ0021960 Permittee: Town of Polkton
Project Name:Woodland Ridge Subdivision
Project Status (Check appropriate box to indicate Permittee's response and complete&sign below)
SEWER NOT CONSTRUCTED
❑ 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. NOTE: If sewer will never be built,please complete Permit Rescission Request section below.
SEWER/ HAS BEEN CONSTRUCTED [Check one]
t9� Permittee's Certification:The Permitted project has been constructed and the required Engineer's Certification and supporting
documents are not available. However,the undersigned agent for the Permittee hereby states that to the best of[his/her]
knowledge,this project has been constructed pursuant to the applicable standards&requirements of the Permit issued for the
above named project and the Permittee is presently operating and maintaining the wastewater collection system in accordance
with the conditions of the Permit. The permitted system was placed into service in [insert month&year].
❑ Engineer's Certification: The Permitted project has been constructed and the required Engineer's Certification and supporting
documents are being submitted to the Division with this form.
OWNERSHIP/NAME CHANGE
❑ The Permittee requests information to apply for ownership or name change. Please provide email and phone number below for
follow-up. Q 10c ` (�
Name&Title(print): fie
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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):
Signature: Date:
Comments:
Contact Information Updates for Current Owner
Updated Contact Person&Title(Print):
Updated Mailing Address:
Updated Email: Updated Phone: