WQ0031255_Sewer Extension Permit Status Update_20190827

Request for Engineering Certification Date of Letter: August 16,2019
Sewer Extension Permit Status Update
Please 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 117ECEIVED/NODEQ/DWR
WQPS-PERCS UNIT 1
By U.S. Postal Service: By Courier/Special Delivery: By Email: AUG 2 7 2019
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothemg -••-
Raleigh, NC 27699 1617 Raleigh, NC 27604 Nyle.Hothem@ncden Water Quality
?e`�nitting Section
Permit No.: Lo Cs oO;i i 5 Permittee: 4-re eft,
1��1' tL.i f s
Project Name: IY t�"i"C t I-'- ip — 1 o'- & J I r4 12/-44--rE SE- Q
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Project Status (Check appropriate box to indicate Permittee's response and complete &sign below)
VPermit to Remain Open: The Permittee certifies that the permitted project has not been c.��`-ucted 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(prin : 1 krE Pfti�t-G s �`6-r ntimiC )
Signature:
Date: S «-19
Comments: I.-VT 1 -rnra-i1r1S 4A-GA7.,I-r Ln-C IS o.,1 Peg- CS7R-(e- t-4r1KE-r g- sine
'FP V'ci-a spe c7f,,e 1 Yh& 6 v)► oe-g p
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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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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.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:
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Contact Information Updates
Updated Contact Person: 061-Y►qe- 11
Updated Mailing Address: S (� �LT t'Doe 0. y-rd , I,t✓ - s7 7
Updated Email: P3 - t+1 LL 1es c t", ( 6,m