WQ0033133_Sewer Extension Permit Status Update_20190828

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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
WQPS—PERCS UNIT
By U.S.Postal Service: By Courier/Special Delivery: By Email: RECEIVED/IVCDEQ/DWR
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothem
Raleigh,NC 27699-1617 Raleigh, NC 27604 [e-mail] 2 9 2019
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Water Quality
Permitting Section
Permit No.: WO ell)3 s (3 Permittee: vu K S w G CO u of�c.
Project Name: Sop s 1 a.k s 2[.✓e v
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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):
Signature: Date:
Comments:
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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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): let l f v l a o E .2
Signature: /V/+,/lr� %V e Date:
Comments: 'Hen s,e_- re S c i kv4 ih.i s -n jt. c� r-e r dt1 i
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Contact Information Updates
Updated Contact Person: 41 i(i ttn L. 7ikIA 141 x f.E _ `,t I-ec-fo , +ti-eevi kn
Updated Mailing Address: p.O. a OK 21(1 fjn L,En'a 1'J c Z&( Z Z
Updated Email: Lk)t t )c e fruv_s .,c _ca„Kt, 1,ti • 54!/

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North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: W00033133 Version: 1.0 Issued Date: 6/27/2008
Permit Type: Gravity Sewer Extension,Pump Stations.&Pressure Sewer Extensions
Facility Name: Sunset Lakes Sewer
Facility County: Brunswick Latitude: Longitude:
Facility Region: Wilmington
Owner Information Details:
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t, .,,;u ;ry, a, ,,,' a„I ,m Submit;a--Peritt,Own_ �, „,. , 1; 6',,*t:", or,,,i. 'irt�c-;,,,' w >„, .,,r 1,R ',v;,�a,,,,,p:t., a rr `,
"'t-, , -;NoteOtathe gwneristlle sgalyePflisI ®ny. ,(CickHee for-"fe°1ftOffle-1Q(91- ggii,fg F.a9;,
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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.NicholsCla brunswickcountync.gov
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Name Organization Name Phone Email
David B Bowman Bowman Design&Engineering Services 910-755-6526 [e-mail]
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Event Description Date Comment
Permit issued 6/27/2008
F . ;ems, w _ <
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Date Comment Text Version
6/24/2008 force main in DOT r-o-w construction only 1.00
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