WQ0038452_Sewer Extension Permit Status Update_20210715

ONWASA
LETTER OF TRANSMITTAL onwasa corn
228 Georgetown Rd
Jacksonville, NC 28540
TO:
Collin Geersen
Municipal Permitting Unit
Division of Water Resources\Department of Environmental QualiI
1617 Mail Service Center VED
Raleigh, NC 27699-1617 JUL i 5 2021
NCDE /DVVFi/NpJJE
FROM: Wynne M. Ray, Development Services Supervisor
DATE July 13, 2021
RE: Engineering Certification Request
CONTENT:
1 — Completed Project Status Update form and asbuilt for WQ0033507,
Maidstone Park
1 — Final Certification and asbuilt for WQ0036207, Watercrest Landing
1 — Final Certification and asbuilt for WQ0033132, Shadow Creek Estates
1 — Final Certification and asbuilt for WQ0038590, New Beginnings Liberty
Christian Academy Expansion (Main)
1 — Request for permit extension for WQ0038342, Grants Creek Farms
1— Request for permit extension for WQ0038452, 4228 Richlands Highway
COMMENTS:
METHOD OF TRANSMITTAL:
NUS MAIL ❑FEDEX ❑UPS ❑FAX ❑EMAIL ❑PICK UP
/1/////kA
Wynne M. Ray
Development Services Supervisor

Request for Engineering Certification Date of Letter: June 15,2021
Sewer Extension Permit Status Update
Please complete the applicable portion of this form for each permit and return this form and supporting documents by July 14,2021
to the attention of Collin Geersen at the Division's Municipal Permitting Unit by the delivery method below:
NCDEQ/DWR
WQPS—Municipal Permitting Unit
By U.S. Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Collin Geersen
Raleigh, NC 27699-1617 Raleigh, NC 27604 [e-mail]
Project Status (Complete Signature&Date section below. Check appropriate box[v'to indicate Permittee's response.)
Name&Title(prin • I'') i pt. /"tohrPE , e
Signature: 7 _Date: D 7/13/2—E0 Z I
Comments: )a r7Q3 9SD q aag c.hlQr�Ps
SEWER NOT YET 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 •
❑ Engineer's Certification: The Permitted project has been constructed and the required Certification page 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.
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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. By signing below,we acknowledge that should we wish to operate a non-discharge sewer
system in the future,we shall apply for and receive a new Wastewater Collection System Permit.
Name&Title(Print):
Signature: _ Date:
Comments:
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Contact Information Updates for Permittee
Updated Contact Person&Title(Print): _ s
Updated Mailing Address:_ !\4 __
Updated Email: Updated Phone: JUL ?O21
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