WQ0033939_Sewer Extension Permit Status Update_20190829

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
WQPS—PERCS UNIT RECEIVED/NCDEQ/DWR
By U.S.Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothem AUG r 9 me
Raleigh,NC 27699-1617 Raleigh,NC 27604 [e-mail] a
Permit No.: 104of)334137 Permittee: y'ut4SwcGg. CouH 1r,,
Project Name: $e((a 'Po ed— St.J 6,VCV+S l o k% f?ressu✓e SGwe`
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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 riot 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 requests extension to reply to this letter not to exceed 60 days of the date of this letter.
Name&Title(print): W;t l i0..in4 L• r Put i x. 7 ^•
4
Signature: � � •1 Date: ZZ 9
1 II r
Comments:} 1.IS �t.o jec* rC,c Gtn� Ltei �j�euet tpu't w ( t
C cl,t.S 1 Ircr r'f'e t N �� I u'f'ta v •e45s J l e V.e e 2Gt l h
0 -et& StA tiS .
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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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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: I/U + ( [w el,,k L. + r. 0. t 1rector
Updated Mailing Address: P.D . -gex 2-Li' 161 t V i a t Me_ 2-kLI c�
Updated Email: IN It .-"--. pt p g_co +AL - dV

North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: W00033939 Version: 1.0 Issued Date: 8/31/2009
Permit Type: Gravity Sewer Extension,Puma Stations,&Pressure Sewer Extensions
Facility Name: Bella Point Subdivision Pressure Sewer
Facility County: Brunswick Latitude: Longitude:
Facility Region: Wilmington
Owner Information Details:
w " Submit a Permit Ownership I Name ta,inake.ehihatiges,ta thispweer inforination. „„ • -
1:qP, Note that the'owner lathe 1 responsibleI-k for'Pe kOwn 011110m Cfraii-qel,'Perin) —
legally --,1,c,—„efFf "
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.Nichols(abrunswickcountync.00v
PerMit;EngineeriEnviipia» Consultantm„,;„ — 7"-^ ,-"mr7 70`,p2,77V-7,77771
„ " ° A
&MR Organization Name Phone Email
Jeffrey Boyd Malpass Malpass Engineering and Surveying PC 910-392-5243 [e-mail]
Permit Events
Event Description Date Comment
Permit issued 8/31/2009 construction and operation of a sewer extension system consisting of:
approximately 259 linear feet of 1.5-inch pressure sewer pipe;approximately 783
linear feet of 2-inch pressure sewer pipe;approximately 34 linear feet of 3-inch
pressure sewer pipe;20 simplex gnnder pump stations with on-site audible and
visual high water alarms serving 20 3-bedroom single family residential homes as a
part of Bella Pointe Subdivision,and the discharge of 4,200 GPD of collected
wastewater into the West Brunswick Regional WWTF(WQ0023693)
• 7,477P1,172 :1::-''4," ,
Date Comment Text Version
1.00
t„. , „ 4 4 , „ ' -, ,y,"q•:"X,
Receiplt otanAngtneering Certiticatian(Partial and or Ana redpr or to ope ation ottne many.
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