UNIONVILLE_COMPLETE FILE - HISTORICAL_20110831

STORMWATER DIVISION CODING SHEET
Municipalities NOT MS4
PERMIT NO.
NC50000_
DOC TYPE
D COMPLETE FILE -HISTORICAL
MOST RECENT
�v L � O
❑ V
DATE
YYYYMMDD

Town of Unionville
August 31, 2011
Mr. Mike Randall
N C Department of Natural Resources
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Mr, Randall:
sEr ,i 2011
Ow-mmam-P
ft7LMMNO=MTMWACjj
Thank you for your recent email response to my question regarding the Phase II Stormwater
program in Town of Unionville.
Enclosed please find our community's completed stormwater non-ownership/non-operation
certification form. Town of Unionville does not operate any storm drain systems, nor do we provide
maintenance for any roads within the Town limits. We do not have any staff or operations people to
meet with you. I am the only employee of the Town. Please consider this information when
determining Unionville's water quality.
If I can be of further assistance, please feel free to call.
/swg
Enclosure
Regards,
':"-
Sonya Gaddy
Clerk/Tax Collector/Land Use Administrator
1102 Unionville Church Rd. • Monroe, NC 28110
Phone: [phone] • Fax: [phone]
Website: www.unionvillenc.com
Email: [e-mail]

State of North Carolina
Department of Environment & Natural Resources
Division of Water Quality
J.sfih'OFFIC USE'ONLY 5 astir
Date Rec'd
BIMS
Cert. Number
STORMWATER NON -OWNERSHIP / NON -OPERATION CERTIFICATION FORM
This form is for use by Regulated Public Entities (RPE), pursuant to Title 15A North Carolina Administrative Code
2H .0126, to certify that they do not own or operate a small MS4.
I. APPLICANT STATUS INFORMATION
Name of Regulated Public Entity
Status (federal, state, public, or
other)
i-rn1( Ct PAS V
Type of Public Entity (city, town,
county, prison, school etc.
County(s)
310�j
RPE Jurisdictional Area in square
miles
II. OPTIONAL PERMITTING OPPORTUNITIES
Are you exercising your option to apply for a NPDES Stormwater Discharge
Permit? If yes, submit this form along with a complete application package (Form ❑ Yes ONO
SWU-264 and a Comprehensive Stormwater Mana ement Pro ram Report).
Are exercising your option to apply for Permit by Rule status? If yes, submit this ❑ Yes D<No
form along with a completed form SWU-267
III. SIGNING OFFICIAL'S STATEMENT
I certify, under penalty of law, that the Regulated Public Body listed in Section I of this document does not
currently own or operate a small municipal separate storm sewer system, as defined in 40 CFR 122. I further
certify that this document and all attachments were prepared under my direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief,
true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations.
Signature
Print Name
Title
COD a0 [-kAL> (,tSZ Dlvt t nti i VTR A1T0 [� -
Street Address
l0
10 0 V l W Pits
PO Box
city
State
Zip
CP9 I to
Telephone
-70t.
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Fax
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E-Mail
W'\
u.n1onV i{(e Co) do 1. care
SWU-266-103102