WQ0034291_Sewer Extension Permit Status Update_20190829

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Request for Engineering Certification Date of Letter: August 9,2019
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
W
By U.S.Postal Service: By Courier/SpecialDelPveryS UNIT By Email: MCEIVEDjNCDEQjD\NR
1617 Mail Service Center 512 N.Salisbury St.'Suite 925 Nyle Hothem mis c,9 'L
Raleigh,NC 27699-1617 Raleigh,NC 27604 [e-mail]
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�( Permitting
Permit No.: W R DO 3 (ZR( Permittee: t�v✓► �...�c(C CO vt�t.T
Project Name: S+. u..aw.gc �t t"���t a,,. _ �rorc� w Pb-e .rvC
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Project Status (Check appropriate box to indicate Permittee's response and complete&sign below)
Permit to Remain Open. 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.
❑ 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 uests extension to reply to this letter not to exceed 60 days of the date of this letter.
Name&Title(print: I.-. >i E. vs \o t' a btee.►-,
Signature: U• Date: jzzJvoi•
Comments: -AI 5 `A�oe_Gt IncS +&b� Lid I2.ecutn
f7.v11Stvcdlc e44 I LA. -Ev+ir r-P . 4 (ea- l f CoLve- At-a�act vt
status I �I
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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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: i I (i a un L. -)r+1k►.���.• l +n��fov d� a ale i
Updated Mailing Address: !• 0. -gox �t(1 1'�01 I v � !�C Z e'(•
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Updated Email: LA" tt�a�. }fit IAA d ✓

North Carolina Department of Environmental Quality
Division of Water Resources
r: WQ0034291 Version: 1.0 Issued Date: 1/7/2010
pe: Gravity Sewer Extension,Puma Stations,&Pressure Sewer Extensions
Facility Name: St.James Plantation-Tract W Pressure Sewer
Facility County: Brunswick Latitude: Longitude:
Facility Region: Wilmington
Owner Information Details:
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ifit,;:op ,!tie.,:'0AfpctrispiEr:,lega!1y;:teronobt01ciw.11Clire:fofr;"PerTit 00,erskitolpplf,C11#1.0:f?raiglj,':T:t4,#,:44,tj,:--.,I;;,
Owner Name: Brunswick County
Owner Affiliation: *lohn Nichols Title: Utilities Director
Addressl: PO Box 249
Address2:
City,State&Zip: Bolivia,NC 28422-0249
Work Phone: [phone] Fax: [phone]
Email Address: John.Nichols(ftrunswickcountync.gov
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Rome Organization Name Mune Imail
Event Description Date Comment
Permit issued 1/7/2010 construction and operation of a low pressure sewer system extension consisting
of approximately 170 linear feet of 2-inch pressure sewer and three(3)simplex
pump stations with on-site audible and visual high water alarms to serve three(3)
3-bedroom single family residential units as a part of St.James Plantation
Subdivision Tract W,and the additional discharge of 630 GPO of collected
wastewater Into the Brunswick County West Regional WWTF(Permit No.
NC0023693)
Permit Comments 411,0iloiziers19,00P, '-',:;;I:-,:'''T
Date Comment Text Version
1.00
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8/15/2019 Page 1

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: W00034291 Version: 1.0 Issued Date: 1/7/2010
Permit Type: Gravity Sewer Extension,Pump Stations,&Pressure Sewer Extensions
Facility Name: St.James Plantation-Tract W Pressure Sewer
Facility County: Brunswick Latitude: Longitude:
Facility Region: Wilmington
Owner Information Details:
a. ai"" �,,;�-� 3 ma-' ,.„ " ,�a,g�.t„;v dS �..»- ak�sa. �' ,^7d a .,,,�„ ?
flit^ 49:6 �^ �i� S b i lei i Oininership l i1 a hange A to Q Et th ake n ,cfiange to i i (i rt rsinfornta io
Note that;the r ble�g l ilesponsible et1 ,a c r r a#1 1'r i a et e,r "`ar ata) ;
Owner Name: Brunswick County
Owner Affiliation: John Nichols Title: Utilities Director
Addressl: PO Box 249
Address2:
City,State&Zip: Bolivia,NC 28422-0249
Work Phone: [phone] Fax: [phone]
Email Address: John.NicholsObrunswickcountync.00v
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f1r !# via ,,
Name Organization Name Phone Email
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- - � �� � t�,;���.a�a�, `�°",a�r��w,�? �+m� �„',n��,,." �.
Event Description Date Comment
Permit issued 1/7/2010 construction and operation of a low pressure sewer system extension consisting
of approximately 170 linear feet of 2-inch pressure sewer and three(3)simplex
pump stations with on-site audible and visual high water alarms to serve three(3)
3-bedroom single family residential units as a part of St.James Plantation
Subdivision Tract W,and the additional discharge of 630 GPD of collected
wastewater into the Brunswick County West Regional WWTF(Permit No.
NC0023693)
v�.
Re it Co m , ts, 0-1,14 all. rior"Vears1ons : „; l,aN,,
Date Comment Text Version
1.00
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8/15/2019 Page 1