WQ0038590_Sewer Extension Permit Status Update_20210715

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[ 'to indicate Permittee's response.)
Name&Title(print): ''Ce U�J� /`�. /t'(o c -- P C.1Ak`e� 0c� �`or,s c2Cs;ce v __
Signature: '-_./ C: _Date: 07AA 7—®Z-1
Comments: LU 6/ OO?&q O iUew �rvrlkrrr4S / ,1oe
C xpC`i r_ ion (it-iaLi> v J
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.
ESIENCIEMEP
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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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:
Contact Information Updates for Permittee
Updated Contact Person&Title(Print):
Updated Mailing Address:
Updated Email: Updated Phone:
RECEIVED
JUL 15 Z021
NCDEQ/DWRINPDES

ENGINEERING CERTIFICATION
Permittee: Onslow Water and Sewer Authority Issue Date:August 3,2016
Permit No: WQ0038590 County: Onslow
Project: New Beginnings Liberty Christian Academy Expansion
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of this permit
until the Division has received this Certification and all required supporting documentation,which includes:
® One copy of the project construction record drawings(plan &profile views of sewer lines&force mains)
of the wastewater collection system extension. Final record drawings should be clear on the plans or on
digital media (CD or DVD disk) and are defined as the design drawings that are marked up or annotated
with after construction information and show required buffers, separation distances, material changes,
etc.
Permit modifications are required for any changes resulting in non-compliance with this permit. A detailed
description for partial certifications should be attached to this form along with any certification comments.
Certification should be submitted in a manner that documents the Division's receipt. The Permittee is responsible
for tracking all partial certifications up until a final certification is received.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant to the
applicable standards&requirements,the Professional Engineer below has provided applicable design/construction
information to the Permittee, and the Permittee is prepared to operate & maintain the wastewater collection
system permitted herein or portions thereof.
I'Dew M./cjohf 96
(Doe(-r.\onS o r:(er , /4 fE 06 Z 202/ •
Printed Nam ,Title ignature / Da e
ENGINEER'S CERTIFICATION
I, Michelle S.Clements , as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (® periodically, ❑ weekly, ❑full time) the construction of the project name and
location as referenced above for the above Permittee hereby state that,to the best of my abilities,due care and
diligence was used in the observation of the following construction: approximately 9S linear feet of 2-inch force
main to serve two modular units housing 90 students each as part of the New Beginnings Liberty Christian
Academy Expansion project, and in conformity with the project plans,specifications, supporting documents,and
design criteria subsequently filed and approved. I certify that the construction of the above referenced project
was observed to be built within substantial compliance and intent of the approved plans and specifications.
North Carolina Professional Engineer's Seal w/signature&date: ���CTMN/0
_�•o`s • ESS/0 i4'f:
Final ❑Partial(include description) •
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•a SEAL
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Send the Completed Form&Supporting Documentation to the Following Address:
DWR WATER QUALITY PERMITTING SECTION
WASTEWATER BRANCH—PERCS UNIT
1617 Mail Service Center
Raleigh,NC 27699