WQ0033699_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 RECEIVED/NCJEQ/[
WQPS—PERCS UNIT
AUG 2 9 2019
By U.S.Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothem Water Quality
Raleigh,NC 27699-1617 Raleigh,NC 27604 [e-mail] Permitting Sectioi
Permit No.: IA) iD 0 3 3 47,g er Permittee: p f G CO✓K�"t
Project Name: v�•e_4,A P t stuveS ?(et Cia -CV Intrk ✓bS1 atit Ps ,re Se.I-see-
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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 requests extension to reply to this letter not to exceed 60 days of the date of this letter.
Name&Title(print): W ((idles.. 1-. 7 t`X 7. C. h!Nye c.to&— as L1 4E-ear l
Signature: W ��--.-P) -� . Date: <6c‘,.p,..? 1�0 15
Comments: 1E' / p►-pj.eCt IlAS kdt �e1- he, Lj at L.ir
('6Yt StVc.t 't e Gl / ✓l ( u2 �v�V✓P P194 S2J I e4 V.e p fr6J eef [ K
_' ? s'f'afVS.
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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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: kb L tr Glt1. L• �&kt(X p. �tV.ec'fdr- of��'Le/Keene4
Updated Mailing Address: P.O. 'go?: 2--`f of tt Vct r
Updated Email: L.i.t �gat.... tr..NtX 9tolevK.S,... 4 cor.K kC. iov

,
North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: W00033699 Version: 1,0 Issued Date: 5/12/2009
Permit Type: Gravity Sewer Extension,Pumo Stations,&Pressure Sewer Extensions
Facility Name: Green Pastures Place Subdivision Pressure Sewer
Facility County: Brunswick Latitude: Longitude:
Facility Region: Wilmington
Owner Information Details:
-E: ,40k Submit al'Permit Owner`ship/'NamegChange forin_ito,DWRto„make any changes,1ta this Owne;ir grinatioh °Aa g .; ka�,„ ,."
1,0,v,., ,;, F , Note,,that the ovuner is th `legally respone e siblntity.:.(CJ(ck H re for"Permit Own'erk Barge Cho "Fnrm', "
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(ibrunswickcountvnc.gov
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Name Organization Name Phone Email
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Event Description Date Comment
Permit issued 5/12/2009 construction and operation of a sewer extension system consisting of:
approximately 43 linear feet of 1.5-inch pressure sewer;approximately 3,454
linear feet of 2-inch pressure sewer; 13 simplex pump stations with on-site
audible and visual high water alarms to serve 13 3-bedroom single family
residential units as a part of the Green Pastures Place Subdivision,and the
discharge of 2,730 GPD of collected wastewater into the Brunswick County
Carolina Shores WWTF(WQ0006878)pursuant to the permit application received
on December 15,2008,and subsequent additional information received by the
Division,and in conformity with the project plans,specifications,and other
supporting data subsequently filed and approved by the Department of
Environment and Natural Resources and considered a part of this permit.
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permit commeni~;(�n udrngtiall�p 1., versw�s)�s N., ,, ". ,,` a.�'d q' „ .— e "'ll„ p _ . t
Date Comment Text Version
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'`` !NOTEf RecerPttit'an,=Eng1,neeringJCeftificatiPWtPertrat nndiSPOkiaty,'is ei iretivprgc�r;to.aperatiort ofbthe,,fpcility;, tia'i f�z�o', g f„,,,,:,„`,i
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