WQ0032599_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
WQPS—PERCS UNIT
By U.S.Postal Service: By Courier/Special Delivery: By Email:
1617 Mail Service Center 512 N.Salisbury St.Suite 925 Nyle Hothem iVEDltact0EGOVIR
Raleigh,NC 27699-1617 Raleigh,NC 27604 [e-mail]
Permit No.: W Q(oY 2,Sqq Permittee: vvkSt..�r ality
•� T `,� �atie�
Project Name: j rt er at Ks r�ij I i c, rO 1 e-9 144,r vt em c�t€rtltttn9 Section
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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
60 days of the date of
this letter.
Name&Title(print) wt(�1 . �—. ?►KKtCCx t P•E• +-� veLfv►- r L "Kt,vir�
Signature: i2 � ? . Date: Z.../0/0
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Comments:_- 11 t S pko jP Gl t& N Of tje+ 1 II 4eeu►.l 1 of L ( � foe
oe
Cm t S I ecer,+41 t l LQ f jf-t,r... leave__e__ V(,Ki+ pl
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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The Permittee requests that the subject permit be rescinded and certifies that the permitted sewer system has not been and shall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: ,AJ t t w w. L IAlt x r lam•E• 1_r r2 tiezvrit.p
Updated Mailing Address: P.0,. O)C 2— q ' o I t vi2 RCs. 3-
Updated Email: (Ai. t t alit . ( t v\H t'x , b hurt,$w tL�Gd c�vt ft c• _ sd V

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North Carolina Department of Environmental Quality
Division of Water Resources
Permit Number: W00032599 Version: 1.0 Issued Date: 2/15/2008
Permit Type: Gravity Sewer Extension,Pump Stations,&Pressure Sewer Extensions
Facility Name: Inlet Oaks Public Force Main
Facility County: Brunswick Latitude: Longitude:
Facility Region: Wilmington
Owner Information Details:
;, "Wo. V:N., of ,, , t.. :tea? ,, ,. „ . . i, t ° . �d,oin:;` '.:',
.a,, _ Sutiiitit a PermitV,Owherslip/A Name�Char+ge form to DWR^tai.makia�ail�'f!'cbenges<ta�this s0orneti�inf�ot7riatioiOM'�,L.r�;,,.A�°�„�"�;t e�,� !,, „;
.'-';-:!`_ .,.:h:;,':",= Notettiatthey'owner_Lethelegally�r,eSponsibleNentity.,.(CfickHerefor,"PermitOwnerhhip/Name Change"•Formj 4' _„„,, `e,, ,
Owner Name: Brunswick County
Owner Affiliation: John Nichols Title: Utilities Director
Addressl: p0 Box 249
Address2:
City,State&Zip: Bolivia,NC 28422-0249
Work Phone: [phone] Fax: [phone]
Email Address: [e-mail]
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,Nermi�t�Epginger/Environmntal Co�hsuftant: ��.,�� ��� �'�°� � �,�� � .-.� � , -"��-�,� � .y " ���.°�.�;° ��°�„ s,
Name Organization Nam@ Phi !"mail
Paul R Shivers Highfill Infrastructure Engineering PC 910-313-1516 [e-mail]
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Event Description Date Comment
Permit Issued 2/15/2008
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