WQ0024756_Modification_1_20210607

Initial Review
Reviewer Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0024756
Applicant/Permittee FMB at The Grove, LLC
Applicant/Permittee Address 2231 Nash St. NW, Suite D, Wilson, NC 27896
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Organization
Facility Name The Grove WWTP
County Carteret
Fee Category Major
Is this a complete
application?*
r Yes r No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount $0
Complete App Date 06/07/2021
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Reese provide information on the person to be contacted by NM Staff
Name * Ronald D. Cullipher
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ ......... ....................................................................................................................................... .
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
252-773-0090
O Modification - Minor
C Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
r Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WO0024756
Fbs Current Existing permt number
Applicant/Permittee *
FMB at The Grove, LLC
Applicant/Permittee Address*
2231 Nash St. NW, Suite D, Wilson, NC 27896
Facility Name *
The Grove WWTP
Please provide comments/notes
on your current submittal below.
I have been working with Eric Saunders
on this submittal
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Rans, Spec'rfications, Calculations, Rc.)
Binder1.pdf 46.1 MB
upload only 1 RCF docurrent (less than 250 NS). IvL@iple documents nest be conrUned into one RDF file unless file is larger than
upload limit.
* W By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature
0- &-4-4-t
Submission Date 6/7/2021

Ic
THE CULLIPHER GROUP, P.A.
ENGINEERING & SURVEYING SERVICES
March 20, 2021
Mr. Erickson G. Saunders
NC Department of Environmental Quality
Division of Water Resources
Water Quality Section
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Vertical Buffer Request- The Grove WWTP- WQ0024756, Atlantic Beach, Carteret County, North
Carolina
Dear Mr. Saunders,
We appreciate your time working with us on our earlier discussions to construct a parking
deck over the drip field at The Grove WWTP. Based on your guidance please find the enclosed
application package.
The original retaining wall around the drip field was constructed approximately 28" higher
than the drip field itself. The purpose of this additional wall height was to allow for storage of
rainwater from major rain events such as hurricanes and tropical storms. This storage volume, if you
will, was a safety precaution that was recommended during the original project permitting discussions.
The installation of a parking deck over this drip field will shield the drip field from direct impacts from
these major weather events. The parking deck will also provide cover from normal rain events which
will reduce the infiltration requirements of the soils to only treated wastewater effluent.
Since this is a parking deck, fluorescent lighting will be provided throughout the ceiling of the
first parking level to provide security lighting for the parking customers. This lighting will continue over
the drip field to allow proper illumination for maintenance personnel and inspection purposes.
We recently replaced the drip field and when that was done a mini excavator was used to
clear the unwanted vegetated growth and to remove and replace the drip field. We determined in that
operation that a minimum of 8' clearance was needed for this equipment to operate. With that said,
our proposal is to seek a vertical clearance(buffer) over the drip field for the parking deck structure of
8'. This 8' will be to the bottom of structural girders expected to be 30" deep or more. In between
girders there would be additional clearance as well.
The drip field retaining wall currently has signage posted around its perimeter indicating "No
Trespassing Authorized Personnel Only: Area contains Wastewater Effluent Drip Irrigation Disposal
Fields" and it continues to provide contact information. There have been no known issues with
improper access and is not secured other than the signage. We do not anticipate access problems with
the parking deck construction and as such we would propose to keep the signage as notification and a
HESTRON PLAZA TWO
151-A NC HWY 24
MOREHEAD CITY, NC 28557
[phone]

deterrent to un-authorized access.
The proposed parking deck is a concrete deck with steel supports and will sheet flow
stormwater down the ramp away from the drip field. Once a final site design is completed a modified
state stormwater permit will be required to be submitted to the WiRo which will show dispersal of
stormwater in accordance with the current stormwater permit requirements.
Included with this submittal are the following:
1) This cover letter
2) NC Secretary of State Corporate Search indicating FMB at the Grove, LLC is an active
company
3) Gis map showing FMB at the Grove,LLC as owner of the property
4) Copy of current active permit WQ0024756
5) HRIS 06-16 forms
6) Overall Site Plan with Compliance Boundaries and Proposed Vertical Buffer.
If I can provide any further information or assistance during your review of this package,
please do not hesitate to contact me.
rely,
o H AR % ��
? OFESS�o .!�j,%,; Ro ald D. Cullipher, P.E.
Cc: ' �. • SEAL �9<9
Fred Bunn = 13343=
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iurrrnu nun;N�

.o My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print an Amended a
%nnual Report form
Limited Liability Company
_egal Name
=MB at the Grove, LLC
Information
3osld: 1246237
Status: Current -Active (D
)ate Formed: 2/27/2012
citizenship: Domestic
4nnual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Robbins, Larry E
Addresses
Mailing
2231 Nash Street NW, Suite D
Wilson, NC 27896
Reg Mailing
PO Drawer 17803
Raleigh, NC 27619-7803
;ompany Officials
Principal Office
2231 Nash Street NW, Suite D
Wilson, NC 27896
Reg Office
4101 Lake Boone Trail, Suite 300
Raleigh, NC 27607
NII LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Fred M. Bunn
2231 Nash Street N.W., Suite D
Wilson NC 27896

Tax Parcel Information: C a r t e r e t C o u n t y N. C
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The information displayed by this website is prepared forthe inventory of real property found within this jurisdiction and is compiled from recorded deeds, plats, and other public records and data. Users of this information are hereby notified that the aforementioned public; primary
information sources should be consulted for verification of the information contained on this site. Carteret County assumes no legal responsibifity for the information contained on this site. Carteret County does not guarantee that the data and map services wit be available to users
Wthoutinterru otionor error. Furthermore, Carteret Countymay modifyorremove map services and access methods at wil.

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
FRED M. B UNN —MANAGER
FMB AT THE GROVE, LLC
2331 NASH STREET NW — SUITED
WILSON, NORTH CAROLINA, 27896
Dear Mr. Bunn:
NORTH CAROLINA
Environmental Quality
October 28, 2019
Subject: Permit No. WQ0024756
The Grove WWTP
High -Rate Infiltration System
Carteret County
In accordance with your permit renewal request received December 3, 2018, and subsequent
additional information received April 1, 2019, May 24, 2019, and September 3, 2019, we are forwarding
herewith Permit No. WQ0024756 dated October 28, 2019, to FMB at the Grove, LLC for the continued
operation of the subject wastewater treatment and high -rate infiltration facilities.
The following modifications to the subject permit are as follows:
• The Town of Atlantic Beach has been removed as a Permittee.
• The original permitted flow and field area have been reestablished. The June 5, 2017 permit allowed
for the continued use of the originally permitted field area until the abandonment of the field was
completed. The abandonment of the field never occurred, so the reduction of permitted flow can be
disregarded.
• The compliance boundary has been changed from previous permit issuances to be in accordance with
15A NCAC 02L .0107.
• Landscape cloth overlaid on the infiltration area has replaced the filter fabric and tire chip cover from
the previous permit.
This permit shall be effective from the date of issuance through June 30, 2025, shall void Permit
No. WQ0024756 issued June 5, 2017, and shall be subject to the conditions and limitations therein. The
Permittee shall submit a renewal application no later than January 1, 2025.
Please pay attention to the monitoring requirements listed Attachments A, B, and C for they may
differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
D� North Carolina Department of Environmental Quality I Division of Water Resources
_ 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

Mr. Fred M. Bunn
October 28, 2019
Page 2 of 3
The Division has removed the following permit conditions since the last permit issuance dated
June 5, 2017:
➢ Old Condition 1.2. — Condition has been removed.
➢ Old Condition II.7. —Green area requirements have been removed.
➢ Old Condition II.8. — Green area requirements have been removed.
➢ Old Condition III.3. — This condition has been removed.
➢ Old Condition VI.2. — This condition has been removed because the permit is not voidable.
The following permit conditions are new since the last permit issuance dated June 5, 2017:
➢ Condition 1.1. — The Permittee shall raise the drip lines to the surface and establish the
landscaping cloth cover prior to April 1, 2020 and notify the Wilmington Regional Office upon
completion of these activities.
➢ Condition 11.12. — All setbacks applicable to 15A NCAC 02H .02190) have been added.
➢ Condition 111.11. — The treatment units are partially located in the 100-year floodplain, so the
treatment facilities must either be watertight or two feet from the 100-year flood elevation.
➢ Condition 111,12, — A protective vegetative cover shall be maintained on all earthen
embankments.
➢ Condition 111,13. — Metering equipment shall be tested and calibrated annually.
➢ Condition II1.15. — Infiltration areas must be cleaned once per permit cycle, and records of
maintenance must be kept for 5 years. The Wilmington Regional Office shall be notified prior
to each cleaning.
➢ Condition IV.8.b. — Infiltration equipment calibration dates must be recorded.
➢ Condition VI.10. — This condition states that the permit will not be renewed if the annual fee
is not paid.
➢ Attachment A — Sampling frequencies have been updated for some of the parameters to match
the Non -Discharge Effluent Monitoring policy.
➢ Attachment B — The delineation of the compliance and review boundary has been changed
from previous permit issuances as dictated by an easement with the Town of Atlantic Beach.
If any parts, requirements, or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Otherwise, this permit shall be final and binding.

Mr. Fred M. Bunn
October 28, 2019
Page 3 of 3
If you need additional information concerning this permit, please contact Erick Saunders at (919)
707-3659 orcrickson.saunders,ti)ncdenr.gov.
Sincerely,
',,Linda Culpepper, Director
(J Division of Water Resources
cc: Carteret County Health Department (Electronic Copy)
Wilmington Regional Office, Water Quality Regional Operations Section (Electronic Copy)
David R. Walker — Town of Atlantic Beach (Electronic Copy)
Ronald D. Cullipher, PE — The Cullipher Group, P.A.
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

'II"HJIS PAGE BLANK

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
HIGH -RATE INFILTRATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
FMB at the Grove, LLC
Carteret County
FOR THE
continued operation of a 120,000 gallon per day (GPD) wastewater treatment and high -rate infiltration
facility consisting of: .
a manually -cleaned bar screen; a 36,346 gallon flow equalization basin with dual 125 gallon per minute
(GPM) pumps and a 7.5 horsepower (hp) aerator; a flow splitter box; two 58,643 gallon aeration tanks with
dual 140 GPM pumps and three 15 hp aerators; two 13,100 gallon clarifiers each with dual 27 GPM waste
sludge pumps and a I I I GPM return sludge pump; a 29,930 gallon sludge holding basin with a 10 GPM
pump and three 15 hp aerators; a tertiary sand filter with a 3 hp air scour blower; a 3,360 clearwell with
dual 336 GPM pumps; a 5,446 mudwell with dual 50 GPM pumps; ultraviolet (UV) disinfection; a 11,440
gallon irrigation pump tank with a 152 GPM pump and audible/ visual high-water alarms; a permanent
auxiliary power source with an automatic transfer switch capable of powering all essential units; a 0.56 acre
(24,258 ftz) drip line dosed high -rate infiltration area overlaid with a landscape cloth cover; and all
associated piping, valves, controls, and appurtenances
to serve The Grove WWTP, with no discharge of wastes to surface waters, pursuant to the application
received December 3, 2018, subsequent additional information received April 1, 2019, May 24, 2019, and
September 3, 2019, and in conformity with the Division -approved plans and specifications considered a
part of this permit.
This permit shall be effective from the date of issuance through June 30, 2025, shall void Permit No.
WQ0024756 issued June 5, 2017, and shall be subject to the following conditions and limitations:
I. SCHEDULES
Prior to April 1, 2020, the Permittee shall raise the drip infiltration lines to the land surface, and a
landscape cloth cover shall be installed in the infiltration area. The Permittee shall notify the
Wilmington Regional Office in writing when these activities have been completed so that the
infiltration area can be inspected. [15A NCAC 02T .0108(b)(1)(B)]
2. The Permittee shall request renewal of this permit on Division -approved forms no later than January 1,
2025. [15A NCAC 02T .0105(b), 02T .0109]
WQ0024756 Version 3.0 Shell Version 180901 Pagel of 9

U. PERFORMANCE STANDARDS
The Permittee shall maintain and operate the subject non -discharge facilities so there is no discharge to
surface waters, nor any contravention of groundwater or surface water standards. In the event the
facilities fail to perform satisfactorily, including the creation of nuisance conditions due to improper
operation and maintenance, or failure of the infiltration areas to assimilate the effluent, the Permittee
shall take immediate corrective actions, including Division required actions, such as the construction
of additional or replacement wastewater treatment or disposal facilities. [15A NCAC 02T
.0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02T .0108(b)(1)(A)]
3. Groundwater monitoring wells shall be constructed in accordance with 15A NCAC 02C .0108
(Standards of Construction for Wells Other than Water Supply), and any other jurisdictional laws and
regulations pertaining to well construction. [15A NCAC 02C .0108]
4. Effluent quality shall not exceed the limitations specified in Attachment A. [15A NCAC 02T
.0108(b)(1)(A)]
5. Application rates, whether hydraulic, nutrient, or other pollutant, shall not exceed those specified in
Attachment B. [15A NCAC 02T .0705(m)]
6. The attached Operational Agreement shall be a condition of this permit. Noncompliance with the terms
of the Operational Agreement shall subject the Permittee to all sanctions under G.S. 143-215.6A, G.S.
143-215.613, and G.S. 143-215.6C for violation of or failure to act in accordance with the terms and
conditions of this permit. [15A NCAC 02T .0115]
High -rate infiltration sites permitted on or after December 30, 1983 have a compliance boundary that
is either 250 feet from the infiltration area, or 50 feet within the property boundary, whichever is closest
to the infiltration area. Any exceedance of groundwater standards at or beyond the compliance
boundary shall require corrective action. Division -approved relocation of the compliance boundary
shall be noted in Attachment B. Multiple contiguous properties under common ownership and
permitted for use as a disposal system shall be treated as a single property with regard to determination
of a compliance boundary. [15A NCAC 02L .0106(d)(2), 02L .0107(b), 02T .0105(h), G.S. 143-
215.1(i), G.S. 143-215.1(k)]
8. The review boundary is midway between the compliance boundary and the infiltration area. Any
exceedance of groundwater standards at or beyond the review boundary shall require preventative
action. [15A NCAC 02L .0106(d)(1), 02L .0108]
9. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of property affecting a compliance boundary (i.e., parcel subdivision). [15A NCAC
02L .0107(c)]
10. No wells, excluding Division -approved monitoring wells, shall be constructed within the compliance
boundary except as provided for in 15A NCAC 02L .0107(g). [15A NCAC 02L .0107]
11. Except as provided for in 15A NCAC 02L .0107(g), the Permittee shall ensure any landowner who is
not the Permittee and owns land within the compliance boundary shall execute and file with the Carteret
County Register of Deeds an easement running with the land containing the following items:
a. A notice of the permit and number or other description as allowed in 15A NCAC 02L .0107(f)(1);
b. Prohibits construction and operation of water supply wells within the compliance boundary; and
c. Reserves the right of the Permittee or the State to enter the property within the compliance boundary
for purposes related to the permit.
WQ0024756 Version 3.0 Shell Version 180901 Page 2 of 9

The Director may terminate the easement when its purpose has been fulfilled or is no longer needed.
[15A NCAC 02L .0107(f)]
12. The facilities herein were permitted per the following setbacks:
a. The infiltration sites were originally permitted April 27, 2005. The setbacks for infiltration sites
originally permitted or modified from February 1, 1993 to September 1, 2006 are as follows (all
distances in feet):
i. Each private or public water supply source:
100
I Surface waters:
200
iii. Groundwater lowering ditches:
200
iv. Surface water diversions (upslope):
200
v. Surface water diversions (downslope):
200
vi. Each well with exception of monitoring wells:
100
vii. Each property line:
50 1,2
viii. Top of slope of embankments or cuts of two feet or more in vertical height:
100
ix. Each water line:
10
x. Each swimming pool:
100
xi. Public right of way:
50 3
xii. Nitrification field:
20
xiii. Each building foundation or basement:
15
xiv. Each impounded public surface water supply:
500
xv. Each public shallow ground water supply (less than 50 feet deep):
500,
1 Setbacks to property lines are not applicable when the Permittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
2 Per setback waivers recorded in the Carteret County Register of Deeds, reduced setbacks from
the wetted area to any property line are as follows:
Parcel No.
Deed Book / Page
Setback
Easement
637516934000000
1571 / 188
0 feet
50 feet
637516935111000
1571 / 189
0 feet
50 feet
637516936014000
1571 / 190
0 feet
50 feet
637516935111000
1571 / 267
0 feet
50 feet
3 Per setback waivers recorded in the Carteret County Register of Deeds, reduced setbacks from
the wetted area to any public right of way are as follows:
Street Name
Deed Book / Page
East Drive
1460 / 004
West Drive
1460 / 004
a There is a public water supply well (PWS ID # 0416035) located within 250 feet of the
infiltration area. The well is listed as being 225 feet deep, therefore the 500 foot setback does
not apply.
[15A NCAC 02H .0404(g), 02H .02190)(5)]
WQ0024756 Version 3.0 Shell Version 180901 Page 3 of 9

b. The storage and treatment units were originally permitted April 7, 2005. The setbacks for storage
and treatment units originally permitted or modified from February 1, 1993 to September 1, 2006
are as follows (all distances in feet):
i. Each habitable residence or place of assembly under separate ownership: 1001
ii. Each private or public water supply source: 100
iii. Surface waters: 50
iv. Each well with exception of monitoring wells: 100
v. Each property line: 50 2,3
vi. Nitrification field: 20
' Habitable residences or places of assembly under separate ownership constructed after the
facilities herein were originally permitted or subsequently modified are exempt from this
setback.
2 Setbacks to property lines are not applicable when the Permittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
3 Per a setback waiver recorded in the Carteret County Register of Deeds, reduced setbacks from
the storage and treatment units to any property line / public right of way are as follows:
Street
Deed Book / Page
Setback
Easement
Bogue Boulevard West
1460 / 004
10 feet
40 feet
[15A NCAC 02H .02190)(5)]
OPERATION AND MAINTENANCE REQUIREMENTS
1. The Permittee shall operate and maintain the subject facilities as a non -discharge system. [15A NCAC
02T .0700]
2. The Permittee shall maintain an Operation and Maintenance Plan, which shall include operational
functions, maintenance schedules, safety measures, and a spill response plan. [15A NCAC 02T
.0707(a)]
3. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, the Permittee shall designate and employ a certified
operator in responsible charge (ORC), and one or more certified operators as back-up ORCs. The ORC
or their back-up shall operate and visit the facilities as required by the WPCSOCC. [15A NCAC 02T
.0117]
4. The Permittee shall take measures to prevent effluent ponding in or runoff from the infiltration sites
listed in Attachment B. [15A NCAC 02T .0707(c)]
5. Infiltration equipment shall be tested and calibrated once per permit cycle. [15ANCAC 02T .0707(d)]
6. Only treated effluent from The Grove WWTP shall be infiltrated on the sites listed in Attachment B.
[15A NCAC 02T .0701]
7. The Permittee shall not allow vehicles or heavy machinery on the infiltration area, except during
equipment installation or maintenance activities. [15A NCAC 02T .0707(e)]
8. The Permittee shall prohibit public access to the wastewater treatment, storage, and infiltration
facilities. [15A NCAC 02T .0705(p)]
9. The Permittee shall dispose or utilize generated residuals in a Division -approved manner. [15A NCAC
02T .0708, 02T .1100].
WQ0024756 Version 3.0 Shell Version 180901 Page 4 of 9

10. The Permittee shall not divert or bypass untreated or partially treated wastewater from the subject
facilities. [15A NCAC 02T .0705(i)]
11. The Permittee shall provide a water -tight seal on all treatment and storage units, or provide two feet
protection from the 100-year flood plain elevation. [15A NCAC 02T .0705(1)]
12. A protective vegetative cover shall be established and maintained on all berms, pipe runs, erosion
control areas, surface water diversions, and earthen embankments (i.e., outside toe of embankment to
maximum allowable temporary storage elevation on the inside of the embankment). Trees, shrubs, and
other woody vegetation shall not be allowed to grow on the earthen dikes or embankments. Earthen
embankments shall be kept mowed or otherwise controlled and accessible. [15A NCAC 02T .0707(g)]
13. Metering equipment shall be tested and calibrated annually. [15A NCAC 02T ,0707(d)]
14. An automatically activated standby power source capable of powering all essential treatment units shall
be on site and operational at all times. If a generator is employed as an alternate power supply, it shall
be tested weekly by interrupting the primary power source. [15A NCAC 02T .0705(k)]
15. The infiltration areas shall be cleaned at least once per permit cycle to remove deposited materials that
may impede the infiltration process. Cleaning records shall be maintained at the facility for five years,
and shall be made available to the Division upon request. The Wilmington Regional Office, telephone
number [phone], shall be notified prior to each cleaning. [15A NCAC 02T .0707(h)]
IV. MONITORING AND REPORTING REQUIUPX, M ENTS
1. The Permittee shall conduct and report any Division required monitoring necessary to evaluate this
facility's impact on groundwater and surface water. [15A NCAC 02T .0108(c)]
2. A Division -certified laboratory shall conduct all analyses for the required effluent, groundwater, and
surface water parameters. [15A NCAC 02H .0800]
3. Flow through the treatment facility shall be continuously monitored, and daily flow values shall be
reported on Form NDMR. Facilities with a permitted flow less than 10,000 GPD may estimate their
flow from water usage records provided the water source is metered. [15A NCAC 02T .0105(k), 02T
.0108(c)]
4. The Permittee shall monitor the treated effluent at the frequencies and locations for the parameters
specified in Attachment A. [15A NCAC 02T .0108(c)]
5. The Permittee shall maintain records tracking the amount of effluent infiltrated. These records shall
include the following information for each infiltration site listed in Attachment B:
a. Date of infiltration;
b. Volume of effluent infiltrated;
c. Site infiltrated;
d. Length of time site is infiltrated;
e. Loading rates to each infiltration site listed in Attachment B; and
f. Weather conditions.
[15A NCAC 02T .0108(c)]
WQ0024756 Version 3.0 Shell Version 180901 Page 5 of 9

6. Three copies of all monitoring data (as specified in Conditions IV.3. and IVA.) on Form NDMR for
each PPI and three copies of all operation and disposal records (as specified in Condition IV.5.) on
Form NDAR-2 for every site in Attachment B shall be submitted on or before the last day of the
following month. If no activities occurred during the monitoring month, monitoring reports are still
required documenting the absence of the activity. All information shall be submitted to the following
address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[15A NCAC 02T .0105(1)]
7. The Permittee shall maintain a record of all residuals removed from this facility. This record shall be
maintained for five years, and shall be made available to the Division upon request. This record shall
include:
a. Name of the residuals hauler;
b. Non -Discharge permit number authorizing the residuals disposal, or a letter from a municipality
agreeing to accept the residuals;
c. Date the residuals were hauled; and
d. Volume of residuals removed.
[15A NCAC 02T .0708(b)]
8. A maintenance log shall be kept at this facility. This log shall be maintained for five years, and shall
be made available to the Division upon request. This log shall include:
a. Date of flow measurement device calibration;
b. Date of infiltration equipment calibration;
c, Date and results of power interruption testing on alternate power supply;
d. Visual observations of the plant and plant site; and
c. Record of preventative maintenance (e.g., changing of equipment, adjustments, testing, inspections
and cleanings, etc.).
[15A NCAC 02T .0707(i)]
9. Monitoring wells MW-1, MW-2, and MW-3 shall be sampled at the frequencies and for the parameters
specified in Attachment C. All mapping, well construction forms, well abandonment forms and
monitoring data shall refer to the permit number and the well nomenclature as provided in Attachment
C and Fi gure l . [15A NCAC 02T .0105(m)]
10. Two copies of the monitoring well sampling and analysis results shall be submitted on a Compliance
Monitoring Form (GW-59), along with attached copies of laboratory analyses, on or before the last
working day of the month following the sampling month. The Compliance Monitoring Form (GW-59)
shall include this permit number, the appropriate well identification number, and one GW-59a
certification form shall be submitted with each set of sampling results. All information shall be
submitted to the following address:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[15A NCAC 02T .0105(m)]
WQ0024756 Version 3.0 Shell Version 180901 Page 6 of 9

11. Noncompliance Notification:
The Permittee shalt report to the Wilmington Regional Office, telephone number [phone],
within 24 hours of first knowledge of the following:
a. Treatment of wastes abnormal in quantity or characteristic, including the known passage of a
hazardous substance.
b. Any process unit failure (e.g., mechanical, electrical, etc.) rendering the facility incapable of
adequate wastewater treatment.
c. Any facility failure resulting in a discharge to surface waters.
d. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
e. Ponding in or runoff from the infiltration sites.
Emergencies requiring reporting outside normal business hours shall call the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. All
noncompliance notifications shall file a written report to the Wilmington Regional Office within five
days of first knowledge of the occurrence, and this report shall outline the actions proposed or taken to
ensure the problem does not recur. [15A NCAC 02T .0108(b)(1)(A)]
V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the wastewater
treatment and infiltration facilities. [15A NCAC 02T .07070)]
2. The Permittee shall inspect the wastewater treatment and infiltration facilities to prevent malfunctions,
facility deterioration, and operator errors that may result in discharges of wastes to the environment,
threats to human health, or public nuisances. The Permittee shall maintain an inspection log that
includes the date and time of inspection, observations made, and maintenance, repairs, or corrective
actions taken. The Permittee shall maintain this inspection log for a period of five years from the date
of the inspection, and this log shall be made available to the Division upon request. [15A NCAC 02T
.0707(i), 02T .07070)]
3. Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the wastewater treatment and infiltration facilities permitted
herein at any reasonable time for determining compliance with this permit. Division authorized
representatives may inspect or copy records maintained under the terms and conditions of this permit,
and may collect groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
WQ0024756 Version 3.0 Shell Version 180901 Page 7 of 9

VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to a
Division enforcement action. [G.S. 143-215.6A, 143-215.613, 143-215.6C]
2. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, and Division -approved plans and specifications. [G.S. 143-215,I(d)]
3. Unless specifically requested and approved in this permit, there are no variances to administrative codes
or general statutes governing the construction or operation of the facilities permitted herein. [15A
NCAC 02T .0105(n)]
4. The issuance of this permit does not exempt the Permittee from complying with all statutes, rules,
regulations, or ordinances that other jurisdictional government agencies (e.g., local, state, and federal)
may require. [15A NCAC 02T .0105(c)(6)]
5. If the permitted facilities change ownership, or the Permittee changes their name, the Permittee shall
submit a permit modification request on Division -approved forms. The Permittee shall comply with
all terms and conditions of this permit until the permit is transferred to the successor -owner. [G.S. 143-
215.1(d3)]
6. The Permittee shall retain a set of Division -approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0105(o)]
7. The Permittee shall maintain this permit until the proper closure of all facilities permitted herein, or
until the facilities permitted herein are permitted by another authority. [15A NCAC 02T .01050)]
8. This permit is subject to revocation or modification upon 60-day notice from the Division Director, in
whole or part for:
a. violation of any terms or conditions of this permit or Administrative Code Title 15A Subchapter
02T;
b, obtaining a permit by misrepresentation or failure to disclose all relevant facts;
c. the Permittee's refusal to allow authorized Department employees upon presentation of credentials:
i. to enter the Permittee's premises where a system is located or where any records are required
to be kept;
ii. to have access to any permit required documents and records;
iii. to inspect any monitoring equipment or method as required in this permit; or
iv. to sample any pollutants;
d. the Permittee's failure to pay the annual fee for administering and compliance monitoring; or
e. a Division determination that the conditions of this permit are in conflict with North Carolina
Administrative Code or General Statutes.
[15A NCAC 02T .0110]
WQ0024756 Version 3.0 Shell Version 180901 Page 8 of 9

9. Unless the Division Director grants a variance, expansion of the facilities permitted herein shall not
occur if any of the following apply:
a. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has been convicted of
environmental crimes under G.S. 143-215.6B, or under Federal law that would otherwise be
prosecuted under G.S. 143-215.6B, and all appeals of this conviction have been abandoned or
exhausted.
b. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has previously abandoned
a wastewater treatment facility without properly closing the facility.
c. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid a civil
penalty, and all appeals of this penalty have been abandoned or exhausted.
d. The Permittee or any parent, subsidiary, or other affiliate of the Permittee is currently not compliant
with any compliance schedule in a permit, settlement agreement, or order.
e. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid an annual
fee.
[ 15A NCAC 02T .0120(b), 02T .0120(d)]
10. This permit shall not be renewed if the Permittee or any affiliation has not paid the required annual fee.
[ 15A NCAC 02T .0120(c)]
Permit issued this the 28" day of October 2019
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
--
nda Culpepper, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0024756
WQ0024756 Version 3.0 Shell Version 180901 Page 9 of 9

THIS PAGE BILAI\\IK

ATTACHMENT A — LIMITATIONS AND MONITORING REQUIREMENTS
PPI 001— WWTP Effluent
Permit Number: WQ0024756 Version: 3.0
EFFLUENT CHARACTERISTICS EFFLUENT LIMITS
MONITORING REQUIREMENTS
PCS
Code
Parameter Description
Units of
Measure
Monthly
Average
Monthly
Geometric Mean
Daily Minimum
Daily Maximum
Measurement
Frequency
Sample
Type
00310
BOD, 5-Day (20 °C)
mg/L
10
Weekly' / 2 x Month 2
Composite
00940
Chloride (as Cl)
mg/L
3 x Year 3
Composite
31616
Coliform, Fecal MF, M-FC Broth, 44.5 °C
#/100 mL
14
43
Weekly 1 / 2 x Month 2
Grab
50050
Flow, in Conduit or thru Treatment Plant
GPD
120,000
Continuous
Recorder
00610
Nitrogen, Ammonia Total (as N)
mg/L
4
Weekly 1 / 2 x Month 2
Composite
00625
Nitrogen, Kjeldahl, Total (as N)
mg/L
Weekly' / 2 x Month 2
Composite
00620
Nitrogen, Nitrate Total (as N)
mg/L
10
Weekly' / 2 x Month 2
Composite
00600
Nitrogen, Total (as N)
mg/L
Weekly 1 / 2 x Month 2
Composite
00400
pH
su
5 x Week
Grab
00665
Phosphorus, Total (as P)
mg/L
Weekly 1 / 2 x Month 2
Composite
70300
Solids, Total Dissolved —180 °C
mg/L
3 x Year 3
Composite
00530
Solids, Total Suspended
mg/L
20
Weekly 1 / 2 x Month 2
Composite
1. Weekly sampling shall be conducted from May 11 through August 311t.
2. 2 x Month sampling shall be conducted from September 11 through April 301h.
3. 3 x Year sampling shall be conducted in February, June and October.
WQ0024756 Version 3.0 Attachment A Page 1 of 1

THIS PAGE BLANK

ATTACHMENT B — APPROVED LAND APPLICATION SITES AND LINIITATIONS
FMB at the Grove, LLC — The Grove WWTP
Permit Number: WQ0024756 Version: 3.0
INFILTRATION AREA INFORMATION
APPLICATION LIMITATIONS
site
Owner
County
Latitude
Longitude
Net
Acreage
Dominant
Soil Series
Parameter
Rate
Units
A
FMB at the Grove, LLC
Carteret
34.6989940
-76.7386790
0.56
Corolla
01284 — Non -Discharge Application Rate
4.95 GPD/ft2
Totals
0.56
Note: The compliance boundary has been extended as shown on Figure I by an easement granted by the Town of Atlantic Beach. This easement is granted in the Carteret County Register of Deeds
(Book: 1647 Page: 379).
WQ0024756 Version 3.0 Attachment B Page 1 of 1

THIS PAGE BLANK

ATTACHMENT C — GROUNDWATER MONITORING AND LD41TATIONS
Monitoring Wells: MW-1, MW-2, and MW-3
Permit Number: WQ0024756 Version: 3.0
GROUNDWATER CHARACTERISTICS GROUNDWATER STANDARDS MONITORING REQUIREMENTS
PCS Code Parameter Description
Daily Maximum
Frequency Measurement
Sample Type Footnotes
00680
Carbon, Tot Organic (TOC)
mg/L
3 x Year
Grab 1,6
00940
Chloride (as Cl)
250
mg/L
3 x Year
Grab
1
31616
Coliform, Fecal MF, M-FC Broth, 44.5 °C
#/100 mL
3 x Year
Grab
1
00610
Nitrogen, Ammonia Total (as N)
1.5
mg/L
3 x Year
Grab
1
00620
Nitrogen, Nitrate Total (as N)
10
mg/L
3 x Year
Grab
1
00400
pH
6.5-8.5
su 3 x Year
Grab
1,2
00665
Phosphorus, Total (as P)
mg/L 3 x Year
Grab
1
70300
j Solids, Total Dissolved - 180 °C
500
mg/L 3 x Year
Grab 1
GWVOC
Volatile Compounds (GW)
Present: Yes/No
Annually
Grab 1, 4, 5
82546 Water Level, Distance from measuring point
feet
-
3 x Year
-
Calculated 1, 2, 3
i
1. 3 x Year monitoring shall be conducted in February, June, and October; Annual monitoring shall be conducted October.
2. The measurement of water levels shall be made prior to purging the wells. The depth to water in each well shall be measured from the surveyed point on the top of the casing. The measurement of
pH shall be made after purging and prior to sampling for the remaining parameters.
3. The measuring points (top of well casing) of all monitoring wells shall be surveyed to provide the relative elevation of the measuring point for each monitoring well. The measuring points (top of
casing) of all monitoring wells shall be surveyed relative to a common datum.
4. Volatile Organic Compounds (VOC) - In October only, analyze by one of the following methods:
a. Standard Method 6230D, PQL at 0.5 µg/L or less
b. Standard Method 6210D, PQL at 0.5 µg/L or less
C. EPA Method 8021, Low Concentration, PQL at 0.5 µg/L or less
d. EPA Method 8260, Low Concentration, PQL at 0.5 µg/L or less
e. Another method with prior approval by the Water Quality Permitting Section Chief
Any method used shall meet the following qualifications:
a. A laboratory shall be DWR certified to run any method used.
b. The method used shall include all the constituents listed in Table VIII of Standard Method 6230D.
C. The method used shall provide a PQL of 0.5 µg/L or less that shall be supported by laboratory proficiency studies as required by the DWR Laboratory Certification Unit. Any constituents
detected above the MDL but below the PQL of 0.5 µg/L shall be qualified (estimated) and reported.
5. If any volatile organic compounds (VOC) are detected as a result of monitoring as provided in Attachment C, then the Wilmington Regional Office supervisor, telephone number [phone],
shall be contacted immediately for further instructions regarding any additional follow-up analyses required.
6. If TOC concentrations greater than 10 mg/L are detected in any downgradient monitoring well, additional sampling and analysis shall be conducted to identify the individual constituents comprising
this TOC concentration. If the TOC concentration as measured in the background monitor well exceeds 10 mg/L, this concentration will be taken to represent the naturally occurring TOC
concentration. Any exceedances of this naturally occurring TOC concentration in the downgradient wells shall be subject to the additional sampling and analysis as described above.
7. Monitoring wells shall be reported consistent with the nomenclature and location information provided in Figure 1 and this attachment.
WQ0024756 Version 3.0 Attachment C Page 1 of 1

WQ0024756 Site Map
r
A ,u�
it
i
LegendIV
�, t
Monitoring Weiis +
Treatment Plant r
Revlew Boundary r>
Compliance Boundary
l:
Drip Field 4
QParcel Boundaries —
` 1'
oil,
= ��r
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L
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FOR REGISTRATION REGISTER OF DEEDS
Karen S Hardesty
AugusCarteret County. NC
l 28, 2019 0241:05 P11
ANNA ESMT 6 P
FEE, $26.00
FILE # 1647379
Prepared by: Kirkman, Whitford, Brady, Berryman & Gordon, P.A.
STATE OF NORTH CAROLINA
EASEMENT
COUNTY OF CARTERET
THIS EASEMENT is made th' day of%� <<! 2019, by and between the
Town of Atlantic Beach, a North Carolina body politic (hereinafter referred to as "Town") and FMB
at the Grove, LLC, a North Carolina limited liability company (hereinafter referred to as "FMB").
STATEMENT OF EXPLANATION
FMB has been issued a high -rate infiltration system permit from the State of North Carolina
Department of Environmental Quality, Division of Water Resources for operation of a wastewater
treatment and disposal system in the Town of Atlantic Beach, Permit #WQ0024756 (herein "Permit").
The North Carolina Division of Water Resources contact information is as follows: 512 North
Salisbury Street, 1617 Mail Service Center, Raleigh, NC 27699-1617, and 919-707-9000,
15A NCAC 02L.0107 requires a compliance boundary of "250 feet from the waste boundary,
or 50 feet within the property boundary, whichever point is closer to the source." The compliance
boundary and perimeter boundary for the Permit includes the right of way of East Drive and West
Drive, which are municipal streets under the control and jurisdiction of the Town of Atlantic Beach
as more particularly shown on the attached Exhibit A.
FMB has requested that Town grant an easement to FMB in order to comply with State
regulations and Town as agreed to grant the same.

-2-
STATEMENT OF AGREEMENT
For good and valuable consideration, including FMB's commitment to allow the Town to
connect its Municipal and Public Safety building facilities to the FMB wastewater treatment and
disposal facilities with a maximum flow of no more than 550 gallons per day, the receipt of which is
hereby acknowledged, Town does hereby give, grant, bargain and convey unto FMB, its successors
and assigns an easement as follows:
In the Town of Atlantic Beach, Carteret County, North Carolina, and being a perpetual non-
exclusive easement over the right of ways of East Drive and West Drive, which are adjacent to 110
Atlantic Boulevard, Carteret County Tax Parcel #637516934000000, and 100 Atlantic Boulevard,
Carteret County Tax Parcel 637516936014000, for purposes of establishing the required boundaries
as set forth in 15A NCAC 02L.0107. Said easement extends from the common boundary line of the
eastern right of way of West Drive and 110 Atlantic Boulevard to the western boundary of the right
of way of West Drive and the common boundary line of the western right of way of East Drive and
100 Atlantic Boulevard to the eastern boundary of the right of way of East Drive to establish a
perimeter boundary for the wastewater disposal system as shown on the attached Exhibit A.
Withui the above described area, Town shall not be permitted to construct or operate any
water supply wells. FMB and the State of North Carolina shall have the right to enter into the property
within the compliance boundary for groundwater monitoring and remediation purposes. This
Easement shall be limited to purposes of meeting the required compliance boundary and grants no
additional rights to either FMB or the State of North Carolina.
This is a non-exclusive easement and Town reserves the right to grant easements and use the
property in any manner that is not inconsistent with the same being used as a compliance boundary.
FMB, its successors and/or assigns shall promptly repair any damage to any of Town's
improvements and/or infrastructure within the easement areas granted herein, occurring as a result of
use of this easement, returning such improvements and/or infrastructure to the same or better

-3-
condition that existed just prior to such damage.
FMB may transfer, convey, or assign this easement only upon written consent of the Town
and such consent shall not be unreasonably withheld. The Town's consent will be predicated upon
any proposed successor or assignee having and providing the Town with proof of sufficient financial
strength and liquidity to assume the responsibilities of FMB hereunder.
This easement may be terminated by the State of North Carolina when its purpose has been
fulfilled or the need for the easement no longer exists. Under these conditions, the Director of the
Division of Water Resources, Department of Environmental Quality, or the designee therefore shall,
upon request by the Town, file a document terminating the easement in the Register of Deeds of
Carteret County.
TO HAVE AND TO HOLD said easement with all rights.and privileges appurtenant thereto
belonging unto Town, its successors and assigns, to its use and behoof forever.
IN TESTIMONY WHEREOF, the parties hereto have signed this instrument as of the day
and year first above written.
SIGNATURE PAGES ARE ATTACHED

-4-
SIGNATURE PAGE TO EASEMENT BY AND BE,
THE TOWN OFATLANTIC BEACHAND FMB AT THE GROVE, LLC
To i IF Atla tic,Sach
i ' / 1'
�a �-
Title: / D+A) fP ' C.
(Town Seal)
ATTEST:
Town Clerk
STATE OF NORTH CAROLINA
COUNTY OF aAY4
I, a�� rNotary Public f r the County and State aforesaid, certify that
U&M �- YV �/ , as n of the Town of Atlantic Beach
personally appeared efore me this day and ackn�the execution of the foregoing
instrument, and that k CL I W , ' Town Clerk attested the same and caused
the Town Seal to be placed hereon, al y authority duly given.
WITNESS my hand and official stamp (or seal), this the (2k_ day of ,
2019.
UCMD
�ignat of Notary Public
My Commission Expires Yl N .W'3 = OSSION4,-0'�,,,
m�
s to APRIL 9N �
n� 200061
���,,,1,111W„��,

-5-
SIGNATURE PAGE TO EASEMENT BYAND BETWEEN
THE TOWN OFATLANTIC BEACHAND FMB AT THE GROVE, LLC
FMB at the Grove, LLC
Fred M. Bunn, Manager
STATE OF NORTH C( UAROLINA
COUNTY OF
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated: Fred M. Bunn.
,�.
N
Date:O
Signature of Ndlary Public %0�'�
=0 NOTARY
PUBLIC
My commission expires;�1�
�6y'1ViV-ry
�/Iflllllll����

This map may not be a certified survey and has
not been reviewed by a local government agency `
for compliance with any applicable land
development regulations and has not been
reviewed for compliance with recording '
requirements for plats.
i
e
G i

STATE OF NORTH CAROLINA
COUNTY OF Permit No. 1)Q 00?-+:75 (o
OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (d1) and entered into this i day
of
1A G,, ( CA) Z,L1 _, by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
F M R Al i Ht- 6 rzo06 1 LV— , a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
I. The DEVELOPER is the owner of the certain lands lying in C'Il ,--T County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
as 7 L�e - (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to
serve the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C of the North Carolina General Statutes.
The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, the (Unit Owners' Association) Rn) Lte 0 t- A �'�(agpljc8(1-1 C �r� (hereinafter
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the
State of North Carolina, for the purpose, among others, of handling the property, affairs and business of
the Development; of operating, maintaining, re -constructing and repairing the common elements of the
lands and improvements subject to unit ownership, including the Disposal System; and of collecting dues
and assessments to provide funds for such operation, maintenance, re -construction and repair.
The COMMISSION desires to assure that the Disposal System of the Development is properly
constructed, maintained and operated in accordance with law and permit provisions in order to protect the
quality of the waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions and law.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility
for the operation and maintenance of its Disposal System until a permit has been reissued to the
DEVELOPER's successor.
FORM: DEV 11-17 Page 1 of 2

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element, which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available
to repair, maintain or construct the Disposal System, beyond the routine operation and maintenance
expenses, the Declaration and Association Bylaws shall provide that a fund be created out of the common
expenses. Such fund shall be separate from the routine maintenance funds allocated for the facility and
shall be part of the yearly budget.
6. In the event the common expense allocation and separate fund are not adequate for the construction,
repair, and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for
special assessments to cover such necessary costs. There shall be no limit on the amount of such
assessments, and the Declaration and Bylaws shall provide that such special assessments can be made as
necessary at any time.
7. If a wastewater collection system and, wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary casements as the
governmental unit may require -as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the
continued proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall
provide in the Association Bylaws that the Association shall not enter into voluntary dissolution without
first having transferred its said system and facilities to some person, corporation or other entity acceptable
to and approved by the COMMISSION by the issuance of a permit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration
is filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of
the Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL Fr e'd M . i� u n f) )::Ks s F1 i 1h Goo(-, )-LC-
MANAGEMENT COMMISSION Name of DEVELOPR
<=� BV:
nda Culpepper, In+erim Director (Signature)
" Division of Water Resources
(ed_M. I�L)nme
Print Name and Title
/a/Za l/9
(Date)
-3 .;_>, L�
(Date)
FORM: DEV 11-17 Page 2 of 2

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
BUFFER WAIVER FORM
(THIS FORM,bL4 ), BE PI-1OTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality (Division) will not consider this attachment form to be complete unless
all the instructions are followed. Failure to follow the instructions or to submit all of the required
items will lead to additional processing and review time for the application.
For more information or for on electronic version of this form, visit our web site at:
htip.-Ah2o. enr, state. ne.us/ndpsr/
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓Do not submit this attachment form for revien without a corresponding surface irrigation application
form (Form SIA or Form SFR-S1A).
✓ Any changes to this attachment form will result in the application package being returned.
✓Any other buffers required by 15A NCAC 2H .0219 0)(5), other than those referenced below, cannot be
waived through execution of this fora►.
✓A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE THE BUFFER REQUIRED BY
15A NCAC 211.0219 0)(5)(A)(i) or 15A NCAC 21H .0219 (j)(5)(J)(i) or (ii) or (iv)
The undersigned property owner hereby permits:
Applicant's name: _ FMB of Atlantic Beach, L.L.C. —
Complete mailing address of applicant: 2231-D West Nast St.. Suite D _ —
City. Wilson _ State: NC __ Zip: 27896 _
Telephone number: ( 252_) 291-9000 ext 23 Facsimile number: [phone]
hereinafter referred to as the Permittee, to (check all that apply):
® Irrigate wastewater within 50 feet (cannot be less than 50 feet) of the property line,
❑ Irrigate wastewater within feet (cannot be less than 200 feet) of the
identified residence,
® Construct wastewater treatment units within 10 of the property line,
as shown on the attached map and located at the following:
Location address of property: — Street r lit -of --ways of East & West Drives, Boaue
B1vd.West --
City: Atlantic Beach State: NC Zip:._ 28570
(� I certify that I am a deeded property owner of above -referenced property and am authorized
to make decisions regarding this property on behalf of other deeded property owners
Furthermore, I certify that I have read and understand this Agreement and do hereby grant
permission to the Permittee to irrigated wastewater or construct wastewater treatment units as
specified herein. I further wee that upon i suance of a permit by the Division for the
wastewater irrigation system I will record this waiver form with the Apopriate Resister of
Deeds and provide the Permittee with documentation of such.
Property owner na le: Town 7f Atlantic Beacom__ _
�
Signature:--�� 4VL__
t
Date:
Title: —,7a- GU/t,/ _
`. A
GE
FORM: BWF 09-02

Philip A. Collier
North Carolina
Carteret Count
I,
t
a -A
t 1
hAI 1 1
ereby certify that,
Q- fgr ool-
a Notary Public for the said County and State do
this day and acknowledge the due execution of the foregoing instrument.
Ily appeared before me
Witness my hand and official seal, this the day of
�JU(
Comm. E p:
I Notary
u 0
U RY
Pu Bol [`
B00vt AGE

NORTH CAROLINA, CARTERET COUNTY FILE # 1511198
This Instrument and this certificate ore duly tiled at
the date and time and In the Book and Page shown
onthe first page hereof.
FOR REGISTRATION REGISTER OF DEEDS
Jer T. ardesty, fie sl�art
Deeds arter T. Hardesty
Ceret County. NC
ey n Deputy, ftegls(er of Deeds March 29, 2017 04 :20: 05 Phi
TRAVIS WAIVER 2 P
FEE: $26.00
FILE 110188
`l State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
1, Fred M. Bunn
Address: 110 AtlantiaBlvd.
certify that I am a deeded owner of the property located at:
Parcel No.: 637616934000000
City: ___ Atlantic Beach state: NC Zip Code: 28512 County: Carteret
Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby
agree that the setback distances cited below be granted to the Applicant/Pern:dttee listed on the following
page.
® I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, 'I consent to a reduced setback from 60 feet to 0 feet, thereby allowing the
application of wastewater effluent as near as o feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback *om feet to feet, thereby allowing the
application of wastewater effluent as near as feet from my residence.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as _ feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, �1 consent to a reduced setback from feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as feet from my residence.
Signature: ji'� /' � N - Date: 31" 'VI %
FORM: NDWSW 03-17 Page 1 of
BOOK 1S`1( pA(3E!gg

Applicant/Peimittee: FMB at fhe Grove, LLC
Address: N/A
City:
Atlantic Beach
Parcel No.: 637516935111000
State: NC Zip Code: 28612 _ County: Carteret
NORTH CAROLINA, P.ny fP7/P COUNTY
I, I a i iyen R . a Notary Public for OCjk � County, North Carolina,
do hereby certify that 1)U n Yl personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official: seat, this the 2` I day of mn }f (`,�i , �•
,00lli l//t,
SEAL
�0TARy 0�
--Q X=
_.J PUBLIG
M
1
Signature of Notary Public
My commission expires ' I I I Le 126))
Once notarized, this form shall be recorded at the Register of Deeds in the county or
counties in which the described properties are located. A copy of the recorded
waiver shall be sent to the following address:
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 BOOK FAGS Ige Page 2 of

NORTH CAROLINA, CARTERET COUNTY
This Instrument and this cerllnoWa are duly filed at
the date and time and In th6 Book and Page shown
on the first pane hereof. jjam�((
R99
ds
-�afCDeputy. Reg�eler of Daede
FOR REGISTRAI[ON REGISTER OF DEEDS
Jerry T. Hardesty
Carteret County, NG
March 29, 2017 09:20:06 N
TRAVIS WAIVER 2 P
FEE- $26.00
FILE # 1571189
State of North Carolina
"t a. Department of Environmental Quality
Skt°� Division of Water Resources
NON -DISCHARGE WASTWATER SYSTEM WAIVER
AGREEMENT TO 'WANE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
I, Fred M. Bunn
Address: -N/A
City: Atlantic Beach
certify that I am a deeded owner of the property located at:
Parcel No.: 637516935111000
State: NC Zip Code: 28512 County: Carteret
Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby
agree that the setback distances cited below be granted to the Applicant/Permittee listed on the following
page.
❑X I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from 50 feet to 0 feet, thereby allowing the
application ofwastewater effluent as near as o feet from my property lime.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
application of wastewater effluent as near as feet from my residence.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from. feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as feet from my residence.
Signature: qaz-&- jDate: 3 � j-� _
FORM: NDWSW 03-17
Page 1 of 2
BOOK 15'1 t pA6E �

Applicant(Pennittee: FMB at The Grove, LLC
Address:
110 Atlantic Blvd.
City: Atlantic Beach
Parcel No,: 637516934000000
State: NC Zip Code: 28512 Comity: Carteret
NORTH CA.ROLr7INA, 0(-) Vn[ ff COUNTY l
a Notary Public for LC L f (V CJ County, North Carolina,
do hereby certify that Ty-e6 M - 3U nn personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the'N day of MO P)n ,W,-'.
SEAL �� R ¢ 0 8�/,i
�a �OTAR y q''':.
1� PUBOQ
i
J
Signature offolary Public
My commission expires ( I I I O
Once notarized, this form shall be recorded at the Register of Deeds in the county or
counties in which the described properties are located. A copy of the recorded
waiver shall be sent to the following address:
FORM: NDWSW 03-17
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Page 2 of
BOOK 1511 PAGE I �<'I

NORTH CAROLINA, CARTEMT COUNTY
This Instrument and this cerfiticute are duly fled at
the the and time and
page hereof, the Book and Page shown
on Is
aVqgAR'61"I�e� ��,o s
FOR REGISTRRATION REGISIERyOF DEEDS
Hardes
Carte�Irn17 C r n0,
(larch 29Kc
, LUU 0420
TRAL�JVIS WpIV�R rn,'� r
FEE. $26.00
FILE 0 1571190
State of North Carolina
9�c ,
Department of Environmental Quality
5AcV4 Division of Water Resources
NUN -DISCHARGE WASTWATER SYSTEM WAIVER
AG12EE11MNT TO WAIVE SETBACKS AS REQUIPX( D BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
I, Fred M. Bunn certify that I am a deeded owner of the property located at:
Address: 100 Atlantic Blvd.
City:
Atlantic Beach
Parcel No.: 637516936014000
_ State: NC Zip Code: 28512 County; Carteret
Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby
agree that the setback distances cited below be granted to the Applicant/Permittee listed on the following
page.
® I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from 50 feet to 0 feet, thereby allowing the
application of wastewater effluent as near as o feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
application of wastewater effluent as near as feet from my residence.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as _feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as feet from my residence.
Signature:�r' -- _ bate:
FORM: NDWSW 03-17
Page 1 of 2
BOOK '- �Lsm E
L x 2-ILG _jaCj_ D9

Applicant/Pertnittee: FMB at The Grove, LLC
Address: NIA
City: Atlantic Beach
Parcel No.: 637516935111000
_ State: NC Zip Code: 28512
County: Carteret
NORTH CAROLINA, _00.V i�P_Vef COUNTY
i, . n l � Vf'_n (�f l • Uvd a Notary .Public for r(— County, North Carolina,
do hereby certify that F-Yed M. b1.IYln personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 2q day of _ ff)(iY0,V)
SEAL ����d►'a Ott
i
�pIA-R Y o=
PUBLIO
&16 Q4�) 3&h 11
Signature of Notary Public
My commission expires l l I l9 2 ill
Once notarized, this form shall be recorded at the Register of Deeds in the county or
counties in which the described properties are located. A copy of the recorded
waiver shall be sent to the following address:
FORM: NDWSW 03-17
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Page 2 of 2
�3.0 0K �r1 L PAGED

NORTH CAROLINA. CARTERET COUNTY
This instrument and this cadfleats are duly filed at
the date and time and In the Book and Page shown
on the first page heroof. _
FOR REGISTRATION REGISTER OF DEEDS
,ferry T. ardeat�
Carteret C.I C ,
Rarch 30, 2017 04:22:37 PR
TRAVIS EVER 2 P
FEE: M-00
FILE 1t 10267
S�'foAtiAeT-
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIIM BY
15A NCAC 02T .0506(a), .0506(b), ,0606(2), .0706(a) AND .1006(a)
I, Fred M: Bunn certify that I am a deeded owner of the property located at:
Address: N/A Parcel No.: 637516935111000
City: Atlantic Beach State: NC Zip Code: 26512 County; Carteret
Furthermore, I certify that I am authorized to make decisions regarding this property, and that I do hereby
agree that the setback distances cited below be granted to the Applicant/Permittee listed on the following
page.
® I understand the setback requirements set forth In 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from 5o feet to o feet, thereby allowing the
application ofwastewater effluent as near as o feet from my property line.
❑ I understand the setback requirements set forth In 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from _ feet to _ feet, thereby allowing the
application of wastewater effluent as near as _ feet from my residence.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from _ feet to _ feet, thereby allowing the
construction of wastewater treatment and storage units as near as_ feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from _ feet to _ feet, thereby allowing the
i construction of wastewater treatment and storage units as near as i feet from my residence.
Signature:.'/1 i ✓.^ _ _ Date: 3 7 D
FORM:NDWSW 03-17 Page 1 of2
BOOK CLA PAGE ��`1

Applicant/Permittee: FMB at The Grove, LLC
Address: 100 Atlantic Blvd.
City: Atlantic Beach
Parcel No.: 637616936014000
State: NC Zip Code: 28512 County: Carteret
NORTH•CAROLINA, 0 M t(TC COUNTY
x, Lft 1C ym R. FDS{rMX, a Notary P' ublic for MV fUe. County, North Carolina,
do hereby certify that r ye-6 ff) • -A3x xn I personally appeared before me this day
and acknowledged the due execution of the foregoing instrument
Witness my hand and official seal, this the day of ((` yo-h OIl.
`0%11111i1//�
s p P08h-,j��"i �nlitnor� t(. PQI�J�
N O T A a r l '::o Signature ofNotmy Public
P U B Ltc My commisslon expires l l
jVT G0 j��
''r'�ttlfNlltl�t ��
Once notarized, this form shall be recorded at the Register of Deeds in the county or
counties in which the described properties are located. A copy of the recorded
waiver shall be sent to the following address: ,
FORM: NDWSW 03-17
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
000K.PA►GE_D �o I
Page 2 of 2

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0700 — HIGH -RATE INFILTRATION SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION
Plans, specifications and supporting documents shall be prepared in accordance with 15A NCAC 02H .0400 (if necessary), 15A
NCAC 02L .010% 15A NCAC 02T .0100, 15A NCAC 02T .0700, Division Policies and good engineering practices. Failure to
submit all required items will necessitate additional processing and review time.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
General — When submitting an application to the Water Quality Permitting Section's Non -Discharge Permitting Unit, please use the
following instructions as a checklist in order to ensure all required items are submitted. Adherence to these instructions and checking
the provided boxes will help produce a quicker review time and reduce the amount of requested additional information.
Unless otherwise noted the Applicant shall submit one original and two copies of the application and supporting documentation.
A. Cover Letter (All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
B. Application Fee (All New and Major Modification Application Packages):
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ). The appropriate fee amount for new and major modification applications may be found at: Standard Review
Project Fees.
C. High -Rate Infiltration Systems (FORM: HRIS 06-16) Application (All Application Packages):
❑ Submit the completed and appropriately executed High -Rate Infiltration Systems (FORM: HRIS 06-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or due
to space restrictions, attachments to the application may be made, as long as the attachments are numbered to correspond to the
section and item to'which they refer.
® If the Applicant Type in Item 1.2. is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2. is a partnership or d/bla, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The facility name in Item I1.1. shall be consistent with the facility name on the plans, specifications, agreements, etc.
® The Professional Engineer's Certification on Page 13 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 13 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person maybe designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
❑ If this project is for a renewal without modification, use the Non -Discharge System Renewal (FORM: NDSR) application.
D. Property Ownership Documentation (All Application Packages):
➢ Per 15A NCAC 02T .0704(fl, the Applicant shall demonstrate they are the owner of all property containing the wastewater
treatment and high -rate infiltration facilities:
® Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
® Provide all agreements, easements, setback waivers, etc. that have a direct impact on the wastewater treatment, conveyance,
storage and high -rate infiltration facilities.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 1 of 6

E. Soil Evaluation (All Application Packages that include new high -rate infiltration sites):
❑ Per 15A NCAC 02T .0704(b) and the Soil Scientist Evaluation Policy, submit a detailed soil evaluation that has been signed,
sealed and dated by a North Carolina Licensed Soil Scientist and includes at a minimum:
❑ The report shall identify all the basins/fields with project name, location, and include a statement that the basins/fields
were recommended for the proposed land application activity.
❑ Field delineated detailed soils map meeting all of the requirements of the Soil Scientist Evaluation Policy.
❑ Soil profile descriptions meeting all of the requirements of the Soil Scientist Evaluation Policy.
❑ Provide 11 soil boring logs performed at the site.
❑ For non-b standard soil fertility analysis conducted no more than one year prior to permit application for each map
unit in the�soap legend for the following parameters:
❑ Acidity ❑ Exchangeable sodium percentage (by calculation) El Phosphorus
❑ Base saturation calculation) ❑ Magnesium ❑ Potassium
❑ Calcium ❑ Manganese ❑ Sodium
❑ Cation exchange capa 'ty ❑ Percept humic matter ❑ Zinc
❑ Copper VHSaturated hydraulic conductivi KsAT) d ttshall include at a minimum:
❑ A minimum of three KsAT test hall educted in the most restrictive horizon for each soil series in the soil map.
❑ All KsAT tests shall be conducted ' areas representative of the site.
❑ All KSAT tests shall be run until stea -state equilibrium has been achieved.
❑ All collected KsAT data shall be submi d, including copies of field worksheets showing all collected readings.
❑ Submit a soil profile description for e ch AT data point that shall extend at least one foot below the tested horizon.
➢ Soil evaluation recommendations shall ' ude a minimum:
❑ A brief summary of each map uniftation
its comp ition and identification of minor contrasting soils.
❑ For non -basins, maximum precipi rate (in/hr or each soil/map unit within the proposed infiltration areas.
❑ Seasonal infiltration restrictions, if appropriate.
❑ Identification of areas not suitable for high -rate infiltrat
❑ Recommended geometric mean KsAT rate to be used in th water balance for each soil/map unit based upon in -situ
measurement of the saturated hydraulic conductivity from th ost restrictive horizon.
❑ Recommended drainage coefficient to be used in the water bala a based upon comprehensive site evaluation, review
of collected onsite data, minor amounts of contrasting soils and th ature of the wastewater to be applied.
❑ For non -basins, recommended annual hydraulic loading rate (in/ for each soil/map unit within the proposed
infiltration areas based upon in -situ KsAT measurements form the most strictive soil horizon.
❑ For basins, recommended hydraulic loading rate (GPD/ft2) for each soiUmap unit within the proposed infiltration areas
based upon in -situ KsAT measurements form the most restrictive soil horizon.
NOTE — If the soil evaluation was performed more than one year prior to the submittal of this application package, a statement shall
be included indicating that the site has not changed since the original investigation.
F. Agronomist Evaluation (All Application Packages that include new infiltration sites with cover crops or new crops for existing
infiltration sites):
❑ Per I SA NCAC 02T .0704(i), submi agronomist evaluation that has been signed, sealed and dated by a qualified professional
and includes at a minimum:
❑ Proposed nutrient uptake values for each c r ased upon each field's dominant soil series and percent slope.
❑ Plant available nitrogen calculations for each c er crop using the designed effluent concentrations in Application Item
V.1. and proposed mineralization and volatilizati s.
❑ Historical site consideration, soil binding and t upta f phosphorus.
❑ Seasonal infiltration restrictions, if appropriat .
❑ A clear and reproducible map showing all areas investigated and it relation to proposed fields and crops.
❑ Maintenance and management plan for all specified crops.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 2 of 6

G. Hydrogeologic Report (All Application Packages treating industrial waste or having a design flow over 25,000 GPD):
❑ Per 15A NCAC 02T .0704(e), the Hydrogeologic Investigation and Reporting Policy, the Groundwater Modeling Policy and
the Performance and Analysis of Aquifer Slug Tests and Pumping Tests Policy, submit a detailed hydrogeologic description
that has been signed, sealed and dated by a qualified professional and includes at a minimum:
❑ A hydrogeologic description to a depth of 20 feet below land surface or bedrock, whichever is less. A greater depth of
investigation is required if the respecti a de is used in predictive calculations.
❑ Representative borings within theh'ifli atio areas and all proposed earthen impoundments.
❑ A description of the regional andyeisting
gy and hydrogeology.
❑ A description, based on field obsethe site, of the site topographic setting, streams, springs and other groundwater
discharge features, drainage featuresand abandoned wells, rock outcrops, and other features that may affect the
movement of the contaminant plume wastewater.
❑ Changes in lithology underlying the ❑ Depth to bedrock and occurrence ofk tcrops.
❑ The hydraulic conductivity and transmissivity of the affected aquifer(s).
❑ Depth to the seasonal high water table (SHWT).
❑ A discussion of the relationship between the affected aquifers of the site to local and regional geologic and hydrogeologic
features.
❑ A discussion of the groundwater flow regime of the site prior to operation of the proposed facility and post operation of
the proposed facility focusing on the relationship of the system to groundwater receptors, groundwater discharge features,
and groundwater flow media.
❑ If the SHWT is within six feet of the surface, a mounding analysis to predict the level of the SHWT after wastewater
application.
H. Water Balance (All Application Packages that include new or modified infiltration sites, changes in flow or changes in storage):
❑ Per the Water Balance Calculation Policy, submit information clearly demonstrating that the effluent can be assimilated
regardless of precipitation events or temperature, and there are no crop or equipment maintenance issues that would necessitate
storage.
OR
❑ Per 15A NCAC 02T .0704(k) and the Water Balance Calculation Policy, submit a water balance that has been signed, sealed
and dated by a qualified professional andyru
at a minimum:
❑ At least a two-year iteration of data cn that considers precipitation into and evaporation from all open atmosphere
storage impoundments, and uses mber of days per month.
❑ Precipitation based on the 801 pe c a minimum of 30 years of observed data.
❑ Potential Evapotranspiration (PET) Thornthwaite method, or another approved methodology, using a minimum
of 30 years of observed temperatur
❑ Soil drainage based on the geometric the in -situ KsAr tests in the most restrictive horizon and a drainage coefficient
ranging from 4 to 10% (unless otherwise technically documented).
➢ Other factors that may restrict the hydraulic loading rate when determining a water balance include:
❑ Depth to the SHWT and groundwater lateral movement that may result in groundwater mounding.
❑ Nutrient limitations and seasonal application times to ensure high -rate infiltration does not exceed agronomic rates.
❑ Crop management activities resulting in cessation of infiltration for crop removal.
NOTE — High -Rate Infiltration Systems serving residential facilities shall have a minimum of 14 days of wet weather storage.
I. Engineering Plans (All Application Packages):
® Per 15A NCAC 02T .0704(c)(1), submit standard size and 11 x 17-inch plan sets that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer, and shall include at a minimum:
® Table of contents with each sheet numbered.
® A general location map with at least two geographic references and a vicinity map.
❑ A process and instrumentation diagram showing all flow, recycle/return, aeration, chemical, electrical and wasting paths.
❑ Plan and profile views of all treatment and storage units, including their piping, valves, and equipment (i.e., pumps,
blowers, mixers, diffusers, flow meters, etc.), as well as their dimensions and elevations.
❑ Details of all piping, valves, pumps, blowers, mixers, diffusers, recording devices, fencing, auxiliary power, etc.
❑ A hydraulic profile from the treatment plant headworks to the highest infiltration point.
❑ The high -rate infiltration area with an overlay of the suitable infiltration areas depicted in the Soil Evaluation.
❑ For non -basins, each nozzle/emitter and its wetted area influence and each infiltration zone labeled as it will be operated.
❑ For non -basins, locations within the infiltration system of air releases, drains, control valves, highest infiltration
nozzle/emitter, etc.
❑ For non -basin automated infiltration systems, provide the location and details of the precipitation/soil moisture sensor.
® Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 3 of 6

J. Specifications (All Application Packages):
❑ Per 15A NCAC 02T .0704(c)(2), submit specifications that have been signed, sealed and dated by a North Carolina licensed
Professional Engineer, and shall include at a minimum:
❑ Table of contents with each secUion/age umbered❑ Detailed specifications for ea me storage/infiltration unit, as well as all piping, valves, equipment (i.e., pumps,
blowers, mixers, diffusers, et s, etc.), nozzles/emitters, precipitation/soil moisture sensor (if applicable),
audible/visual high water alarms, linevm4re4ial, etc.
❑ Site Work (i.e., earthwork, clearineteel,
, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
El Materials (i.e., concrete, masonry, ' ting, method of construction, etc.)
❑ Electrical (i.e., control panels, transfer switches, automatically activated standby power source, etc.)
❑ Means for ensuring quality and integrity of the finished product, including leakage, pressure and liner testing.
❑ Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
K. Engineering Calculations (All Application Packages):
❑ Per 15A NCAC 02T .0704(c)(3), submit engineering calculations that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer, and shall include at a minimum:
❑ Hydraulic and pollutant oading calculations for each treatment unit demonstrating how the designed effluent
concentrations in April Item V. were determined.
❑ Sizing criteria for each treatme unit d a sociated equipment (i.e., blowers, mixers, flow meters, pumps, etc.).
❑ Total and effective storage calcul 'on o each storage unit.
❑ Friction/total dynamic head calculat s and system curve analysis for each pump used.
❑ Manufacturer's information for all trea ent units, pumps, blowers, mixers, diffusers, flow meters, etc.
❑ Flotation calculations for all trea an torage units constructed partially or entirely below grade.
❑ For non -basins, a demonstration�i the d igned maximum precipitation and annual loading rates do not exceed the
recommended rates.
❑ For basins, a demonstration that the designed loading rate (GPD/ftz) does not exceed the recommended rate.
❑ A demonstration that the specified auxiliary power source is capable of powering all essential treatment units.
L. Site Map (All Application Packages):
® Per 15A NCAC 02T .0704(d), submit standard size and 11 x 17-inch site maps that have been signed, sealed and dated by a
North Carolina licensed Professional Engineer and/or Professional Land Surveyor, and shall include at a minimum:
® A scaled map of the site with topographic contour intervals not exceeding 10 feet or 25 percent of total site relief and
showing all facility -related structures and fences within the wastewater treatment, storage and infiltration areas.
❑ Soil mapping units shown on all infiltration sites.
® The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of all wastewater treatment, storage
and infiltration sites.
® Delineation of the compliance and review boundaries per 15A NCAC 02L .0107 and .0108.
® Setbacks as required by 15A NCAC 02T .0706.
® Site property boundaries within 500 feet of all wastewater treatment, storage and infiltration sites.
® All habitable residences or places of public assembly within 500 feet of all treatment, storage and infiltration sites.
NOTE — For clarity, multiple site maps of the facility with cut sheet annotations may be submitted.
M. Power Reliability Plan (All Application Packages):
❑ Per 15A NCAC 02T .0705(k), submit documentation of power reliability that shall consist of at a minimum:
❑ An automatically activated standby /npotential
pply onsite that is capable of powering all essential treatment units under
design conditions, OR
➢ Approval from the Director that th
[I Serves a private water distributionhat has automatic shut-off during power failures and has no elevated water
storage tanks, 11
❑ Has sufficient storage capacity that for overflow exists, and
❑ Can tolerate septic wastewater due to prolonged detention.
INSTRUCTIONS FOR FORM: MS 06-16 & SUPPORTING DOCUMENTATION Page 4 of 6

N. Operation and Maintenance Plan (All Application Packages):
® Per 15A NCAC 02T .0707, submit an operation and maintenance (O&M) plan encompassing all wastewater treatment, storage
and infiltration systems that shall include at a minimum a description of:
❑ Operation of the wastewater treatment, storage and infiltration systems in sufficient detail to show what operations are
necessary for the system to function and by whom the functions are to be conducted.
❑ Anticipated maintenance of the wastewater treatment, storage and infiltration systems.
❑ Safety measures, including restriction of access to the site and equipment.
❑ Spill prevention provisions such as response to upsets and bypasses, including how to control, contain and remediate.
❑ Contact information for plant personnel, emergency responders and regulatory agencies.
NOTE — A final O&M Plan shall be submitted with the partial and/or final Engineering Certification required under 15A NCAC
02T .0116, however, a preliminary O&M Plan shall be submitted with each application package.
O. Residuals Management Plan (All Application Packages with new, expanding or replacement wastewater treatment systems):
❑ Per 15A NCAC 02T .0704(D and .0708, submit a Residuals Management Plan that shall include at a minimum:
❑ A detailed explanation of howgenprat d residuals (including trash, sediment and grit) will be collected, handled, processed,
stored, treated, and disposed.
❑ An evaluation of the treatme cili A,.
duals storage requirements based upon the maximum anticipated residuals
production rate and ability to emove es.
❑ A permit for residuals utilization or commitment to the Applicant from a Permittee of a Department approved
residuals disposal/utilization progra that has adequate permitted capacity to accept the residuals or has submitted a
residuals/utilization program application.
❑ If oil/grease removal and collection are a designed unit process, submit an oil/grease disposal plan detailing how the
oil/grease will be collected, handled, processed, stored and disposed.
NOTE — Per 15A NCAC 02T .0705(n), a minimum of 30 days of residual storage shall be provided.
NOTE — Per 15A NCAC 02T .0704(i), a written commitment to the Applicant from a Permittee of a Department approved residuals
disposal/utilization program is not required at the time of this application, however, it shall be provided prior to operation of any
permitted facilities herein.
NOTE — If an on -site restaurant or other business with food preparation is contributing wastewater to this system, an oil/grease
disposal plan shall be submitted.
P. Additional Documentation:
➢ Certificate of Public Convenience and Necessity (All p ication Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T.0 115(aNll and .0704 , p v' e t e ertificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating p is t is authorized to hold the utility franchise for the area to be
served by the wastewater treatment and high-r e ' fi a system, or
❑ Provide a letter from the North Carolina Utilities ommission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and th the service area is contiguous to an existing franchised area or that
franchise approval is expected.
➢ Existing Permit (All Modification Packages):
® Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit modification
(i.e., compliance schedules, permit description, monitoring, permit conditions, etc.).
➢ Final Environmental Document (All Application Packages using public monies or lands subject to the North Carolina
Environmental Policy Act under 15A NCAC 0 1 C .0100 to .0400):
❑ Per 15A NCAC 02T .0105(c)(4), submit one copy of the environmental assessment and three copies of the final
environmental document (i.e., Finding of No Significant Impact or Record of Decision).
❑ Include information on any mitigating factors from the Environmental Assessment that impact the design and/or
construction of the wastewater treatment and high -rate infiltration system.
➢ Floodway Regulation Compliance (All Application Packages where any portion of the wastewater treatment, storage and
infiltration system is located within the 100-year floodplain):
❑ Per 15A NCAC 02T .0105(c)(8), provide written documentation from all local governing entities that the facility is in
compliance with all local ordinances regarding construction or operation of wastewater treatment and/or disposal facilities
within the floodplain.
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION Page 5 of 6

P. Additional Documentation (continued):
➢ Operational Agreements (All Application Packages for Home/Property Owners' Associations and Developers of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), subPthp ly executed Operational Agreement (FORM: HOA).
❑ Per 15ANCAC 02T.0115(c), subp o ed or approved Articles of Incorporation, Declarations and By-laws.
➢ Developers of lots to be sold
Per 15A NCAC 02T.0115(b), subr perly executed Operational Agreement (FORM: DEV).
➢ Threatened or Endangered Aquatic Species Documentation (All Application Packages):
❑ Per 15A NCAC 02T .0105(c)(10), submit documentation from the Department's Natural Heritage Program demonstrating
the presence or absence of threatened r endangered aquatic species within the boundary of the wastewater treatment,
storage and infiltration facilities.
❑ If the facility directly impacts such p i s, documentation shall provide information on the need for permit conditions
pursuant to 15A NCAC 02B .0110.
➢ Wastewater Chemical Analysis (All Application Packages treating Industrial Waste):
❑ Per 15A NCAC 02T .0704(h), provide a complete Division certified laboratory chemical analysis of the effluent to be
infiltrated for the following parameters (For ew facilities, an analysis from a similar facility's effluent is acceptable):
❑ Ammonia Nitrogen (NH3-N) ❑ Nitrate Nitrogen (NO3-N) ❑ Total Organic Carbon
❑ Calcium ❑ pH ❑ Total Phosphorus
❑ Chemical Oxygen Demand (CO ❑ Phenol ❑ Total Trihalomethanes
❑ Chloride ❑ Sodium ❑ Total Volatile Organic Compounds
❑ Fecal Coliform ❑ Sodium Adsorption Ratio (SAR) ❑ Toxicity Test Parameters
❑ 5-day Biochemical Oxygen Demand (BOD5) ❑ Total Dissolved Solids
❑ Magnesium ❑ Total Kjeldahl Nitrogen (TKN)
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: HRIS 06-16 & SUPPORTING DOCUMENTATION
Page 6 of 6

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0700 — HIGH -RATE INFILTRATION SYSTEMS
Division of Water Resources FORM: HRIS 06-16
I. APPLICANT INFORMATION:
1. Applicant's name: FMB at the Grove, LLC
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
3. Signature authority's name: Fred M. Bunn per 15A NCAC 02T .0106(b) Title: Manager
4. Applicant's mailing address: 2231 Nash Street NW, Suite D
City: Wilson State: NC Zip: 27896-
5. Applicant's contact information:
Phone number: 252) 399-1617 Email Address: fredbunnna,finb-inc,com
II. FACILITY INFORMATION:
1. Facility name: The Grove
2. Facility status: Existing
3. Facility type: Major > 10,000 GPD or> 300 disposal acres)
4. Facility's physical address: 100 & 110 Atlantic Blvd
City: Atlantic Beach State: NC Zip: 28512- County: Carteret
5. Wastewater Treatment Facility Coordinates (Decimal Degrees): Latitude: 34.699' Longitude:-76.739'
Datum: NAD83 Level of accuracy: Nearest 10 seconds Method of measurement: Zip Code centroid
6. USGS Map Name:
HI. CONSULTANT INFORMATION:
1. Professional Engineer: Ronald D. Cullipher
P.A.
Mailing address: 151A Hwy 24
License Number: 13343 Firm: The Cullipher Group,
City: Morehead City State: NC Zip: 28557-
Phone number: 252)173-0090 Email Address: [e-mail]
2. Soil Scientist: na License Number: Firm:
Mailing address:
City: State:
Zip: -
Phone number: (_) _-
Email Address: _
3. Geologist: na
License Number:
Mailing address:
City: State:
Zip: -
Phone number: (_) _-
Email Address: _
4. Agronomist: na
Firm:
Mailing address:
City: State:
Zip: -
Phone number: (_) _-
Email Address: _
Firm:
FORM: HRIS 06-16
Page 1 of 13

IV. GENERAL REQUIREMENTS —15A NCAC 02T .0100:
1. Application type: ❑ New ❑ Major Modification r�1 Minor Modification
If a modification, provide the existing permit number: WQ077 a most recent issuance date: i Z a I!
2. Application fee: $0 - Standard - Minor Modification
3. Does this project utilize public monies or lands? ❑ Yes or ® No
If yes, was an Environmental Assessment required under 15A NCAC OIC? ❑ Yes or ❑ No
If yes, which final environmental document is submitted? ❑ Finding of No Significant Impact or ❑ Record of Decision
Briefly describe any mitigating factors from the Environmental Assessment that may impact this facility:
4. What is the status of the following permits/certifications applicable to the subject facility?
Permit/Certification
Date
Submitted
Date
Approved
Permit/Certification
Number
Agency Reviewer
g y
Collection System (O > 200,000 GPD)
Dam Safety
Erosion & Sedimentation Control Plan
Nationwide 12 / Section 404
Pretreatment
Sewer System
Stormwater Management Plan
Wetlands 401
Other:
5. What is the wastewater type? ® Domestic or Industrial (See 15A NCAC 02T .0103(20))
Is there a Pretreatment Program in effect? ❑ Yes or ❑ No
Has a wastewater chemical analysis been submitted? ❑ Yes or ❑ No
6. Wastewater flow: 120000 GPD
Limited by: ® Treatment, ❑ Storage, ❑ Field/Basin Hydraulics, ❑ Field Agronomics or ® Groundwater Mounding
7. Explain how the wastewater flow was determined: ® 15A NCAC 02T .0114 or ❑ Representative Data
Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes or ® No
Establishment Type
Daily Design Flow'
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
FORM: HRIS 06-16 Page 2 of 13

IV. GENERAL REQUIREMENTS —15A NCAC 02T .0100 (continued):
8. What is the nearest 100-year flood elevation to the facility? AE11 feet mean sea level. Source: GIS
Are any treatment, storage or infiltration facilities located within the 100-year flood plain? ® Yes or ❑ No
If yes, which facilities are affected and what measures are being taken to protect them against flooding? RETAINING
If yes, has the Applicant submitted written documentation of compliance with & 143 Article 21 Part 6? ❑ Yes or ® No
9. Has the Applicant provided documentation of the presence or absence of threatened or endangered aquatic species utilizing
information provided by the Department's Natural Heritage Program? ❑ Yes or ❑ No
10. Does the facility have a proposed or existing groundwater monitoring well network? ® Yes or ❑ No
If no, provide an explanation as to why a groundwater monitoring well network is not proposed:
If yes, complete the following table (NOTE — This table may be expanded for additional wells):
Well Name t
Status
Latitude °
Longitude a
Gradient
Location
Active
- °
Select
Select
Active
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
Select
0-
Select
Select
a Provide the following latitude and longitude coordinate determination information:
Datum: NAD83 Level of accuracy: Nearest 10 seconds Method of measurement:
Cadastral survey
11. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
❑ Yes, ❑No or ®N/A
12. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been submitted?
® Yes, ❑No or ❑N/A
13. If the Applicant is a Home/Property Owners' Association, has an Association Operational Agreement (FORM: HOA) been
submitted? ❑ Yes, ❑No or ®N/A
14. Demonstration of historical consideration for permit approval — 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.613? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or ® No
FORM: HRIS 06-16 Page 3 of 13

V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA —15A NCAC 02T .0705:
1. For the following parameters, provide the estimated influent concentrations and designed effluent concentrations as
determined in the Engineering Calculations, and utilized in the Agronomic Evaluation and Groundwater Modeling (if
applicable):
Parameter
Estimated Influent Concentration
Designed Effluent Concentration
monthl average)
Ammonia Nitrogen (NH3-N)
mg/L
mg/L
Biochemical Oxygen Demand (BOD5)
mg/L
mg/L
Fecal Coliforms
per 100 mL
Nitrate Nitrogen (NO3-N)
g1L
mg/L
Nitrite Nitrogen (NO2-N)
mg/L
mg/L
Total Kjeldahl Nitrogen
mg/L
Total Nitrogen
mg/L
mg/l,
Total Phosphorus
mg/L
mg/L
Total Suspended Solids (TSS)
mg/L
mg/L
2. Is flow equalization of at least 25% of the aver a daily flow provided? ❑ Yes or ❑ No
3. Does the treatment facility include any bypass r overflow lines? ❑ Yes or ❑ No
If yes, describe what treatment units are bypa'sed, why this is necessary, and where the bypass discharges:
4. Are multiple pumps provided wherever pu ps are used? ❑ YM or ❑ No
If no, how does the Applicant intend on/omplying with
5. Check the appropriate box describing/how power ri
❑ Automatically activated standb power supply
❑ Approval from the Director that the facility:
be provided in accordance with 15A NCAC 02T .0705(k):
of powering all essential treatment units; or
➢ Has a private water supply that automatically shuts off during power failures and does not contain elevated water
storage tanks;
➢ Has sufficient storage capacity that no potential for overflow exists; and
➢ Can tolerate septic wastewater due to prolonged detention.
6. If the wastewater treatment system is located within the 100-year flood plain, are there water -tight seals on all treatment units
or a minimum of two feet protection from the 100-year flood plain elevation? ❑ Yes, ❑ No or ❑ N/A
7. In accordance with 15A NCAC 02T .0705(n), how many days of residuals storage are provided?
8. How does the Applicant propose to prohibit public access to the wastewater treatment and storage facilities?
9. If an influent pump station is part of the proposed facility (i.e., within the wastewater treatment plant boundary), does the
influent pump station meet the design criteria in 15A NCAC 02T .0305(h)? ❑ Yes, ❑ No, ❑ N/A — To be permitted
separately, or ❑ N/A — Gravity fed
10. If septic tanks are part of the wastewater treatment facility, do the septic tanks adhere to the standards in 15A NCAC 18A
.1900? ❑ Yes, ❑ No or ❑ N/A
FORM: HRIS 06-16 Page 4 of 13

V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA —15A NCAC 02T .0705 (continued):
11. Provide the requested treatment unit and mechanical equipment information:
a. PRELIMINARY / PRIMARY TREATMENT (i.e., physical removal operations and flow equalization):
Treatment Unit
No. of
Units
Manufacturer or
Material
Dimensions (ft) /
Spacings in(gallons)
Volume
Plan Sheet
Reference
Ispecification
Reference
Select
Select
Select
Select
Select
b. SECONDARY / TERTIARY TREATMENT ge., b f ilogic/l and chemical processes to remove organics and nutrients)
Treatment Unit
No. of
Units
Manufact r o
Mater a
Dimensions (ft)
Volume
allons
Plan Sheet
Reference I
Specification
Reference
Select
Select
Select
Select
Select
Select
Select
Select
c. DISINFECTION
No. of
Manufacturer or
Volume
Plan Sheet
Specification
Treatment Unit
Units
Material
Dimensions (ft)
allons
Reference
I Reference
Select
Select
➢ If chlorination is the proposed method of disinfection, specify detention time provided: minutes (NOTE — 30
minutes minimum required), and indicate what treatment unit chlorine contact occurs:
➢ If ultraviolet (UV) light is the proposed method of disinfection, specify the number of banks: , number of lamps
per bank: and maximum disinfection capacity: GPM.
d. RESIDUAL TREATMENT
No. of
Manufacturer or
Volume
Plan Sheet
Specification
Treatment Unit
Units
Material
Dimensions (ft)
(gallons)
I Reference
I Reference
Select
Select
FORM: HRIS 06-16 Page 5 of 13

V. WASTEWATER TREATMENT FACILITY DESIGN CRITERIA — 15A NCAC 02T .0705 (continued):
e. PUMPS
Location
No. of
Pum s
Purpose
Manufacturer /
Type
Ca acit
Plan Sheet
Reference
Specification
Reference
GPM
TDH
f. BLOWERS /
Location
No. of
Blowers
Units Sery
Manufacturer /
T e
Capacity
(CF
Plan Sheet
Reference
Specification
Reference
g. MIXERS
Location
No. of
Mixers
Units Served
Manufacturer /
Type
Power
h
Plan Sheet
Reference
Specification
Reference
h. RECORDING DEVICES & RELIABILITY
Device
No. of
Units
Location
Manufacturer
Maximum
Capacity
Plan Sheet
Reference
Specification
Reference
Select
Select
Select
Select
i. EFFLUENT PUMP / DOSING TANK (IF APPLICABLE):
Plan Sheet
Reference
Specification
Reference
Internal dimensions (L x W x H or y x H)
ft
ft
ft
Total volume
ft3
gallons
Dosing volume
ft3
gallons
Audible & visual alarms
Equipment to prevent infiltration during rain
events if applicable)
FORM: HRIS 06-16 Page 6 of 13

VI.
EARTHEN STORAGE IMPOUNDMENT DESIGN CRITERIA —15A NCAC 02T .0705:
IF MORE THAN ONE IMPOUNDMENT PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. What is the earthen impoundment type? Select
2. Storage Impoundment Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
Datum: Select Level of accuracy: Select M thod of measurement: Select
3. Do any impoundments include a discharge IAint ipe, pillway, etc)? ❑ Yes or ❑ No
4. Are subsurface drains present beneath or a o nd e ' poundment to control groundwater elevation? El Yes or El No
5. Is the impoundment designed to receive s r ru ffj j4 Yes or ❑ No
If yes, what is the drainage area? W, and s unoff incorporated into the water balance? ❑ Yes or ❑ No
6. If a liner is present, how will it be protected fr d d iven wave action?:
7. Will the earthen impoundment water be pla d d' ectly into or in contact with GA classified groundwater? ❑ Yes or ❑ No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not result in a
contravention of GA groundwater standards? ❑ Yes or ❑ No
8. What is the depth to bedrock from the earthen impoundment bottom elevation? ft
If the depth to bedrock is less than four feet, has the Applicant provided a liner with a hydraulic conductivity no greater than
1 x 10.1 cm/s? ❑ Yes, F1 No or ❑ N/A
Has the Applicant provided predictive calculations or modeling demonstrating that surface
water or groundwater standards will not be contravened? ❑ Yes or ❑ No
If the earthen impoundment is excavated into bedrock, has the Applicant provided predictive calculations or modeling
demonstrating that surface water or groundwater standards will not be contravened? ❑ Yes, ❑ No or ❑ N/A
9. If the earthen impoundment is lined and the mean seasonal high water table is higher than the impoundment bottom
elevation, how will the liner be protected (e.g., bubbling, groundwater infiltration, etc.)?
10. If applicable, provide the specification page references for the liner installation and testing requirements:
11. If the earthen impoundment is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No
12. Provide the requested earthen impoundment design elements and dimensions:
Earthen Impoundment Design Elements
Earthen Impoundment Dimensions
Liner type:
❑ Clay
❑ Synthetic
Top of embankment elevation:
ft
❑ Other
10 Unlined
Liner hydraulic conductivity:
x cm/s
Freeboard elevation:
ft
Hazard class:
Select
Toe of slope elevation:
ft
Designed freeboard:
ft
Impoundment bottom elevation:
ft
Total volume:
ft3
gallons
Mean seasonal high water table depth:
ft
Effective volume:
ft,
gallons
Embankment slope:
Effective storage time:
days
Top of dam water surface area:
ft2
Plan Sheet Reference:
Freeboard elevation water surface area:
ft2
Specification Section:
Bottom of impoundment surface area:
ft2
NOTE — The effective volume shall be the volume between the two foot freeboard elevation and the: (1) pump intake pipe
elevation; (2) impoundment bottom elevation or (3) mean seasonal high water table, whichever is closest to the two foot
freeboard elevation.
FORM: HRIS 06-16
Page 7 of 13

VH. INFILTRATION SYSTEM DESIGN CRITERIA —15A NCAC 02T .0705:
1. Provide the minimum depth to the seasonal high water table within the infiltration area:
NOTE — The vertical separation between the seasonal high water table and the ground surface shall be at least one foot.
2. Are there any artificial drainage or water movement structures (e.g., surface water or groundwater) within 200 feet of the
infiltration area? ❑ Yes or ❑ No
If yes, were these structures addressed in the Soil Evaluation and/or Hydrogeologic Report, and are these structures to be
maintained or modified?
3. Soil Evaluation recommended loading rates (NOTE — This table may be expanded for additional soil series):
Soil Series
Basins/Fields
within Soil
Series
Recommended
g R to
Logi/hr
ecommended
Loading Rate
in/ r
Recommended
Loading Rate
GPD/ft2
Annual /
Seasonal
Loading
If Seasonal, list
appropriate
months
Select
Select
Select
Select
Select
Select
4. Are the designed loading rates less than or equal to Soil Evaluation recommended loading rates? ❑ Yes or ❑ No
If no, how does the Applicant intend on complying with 15A NCAC 02T .0705(m)?
5. How does the Applicant propose to prohibit public access to the infiltration facilities?
6. Has the infiltration system been equipped with a flow meter to accurately determine the volume of effluent applied to each
basin/field as listed in VILE.? ❑ Yes or ❑ No
If no, how does the Applicant intend on determining the amount of effluent applied to each basin/field?
7. For non -basins, provide the required cover crop information and demonstrate the effluent will be applied at or below
agronomic rates:
Cover Crop
Soil Series
% Slope
Nitrogen Uptake Rate
lbs/ac r
Phosphorus Uptake
Rate lbs/ac rF_
a. Specify where the nitrogen and phosphorus uptake rates for each cover crop were obtained:
b. Proposed nitrogen mineralization rate:
c. Proposed nitrogen volatilization rate:
d. Minimum infiltration area from the Agronomist Evaluation's nitrogen balance: ft2
e. Minimum infiltration area from the Agronomist Evaluation's phosphorus balance: ft2
f. Minimum infiltration area from the water balance: ft2
FORM: HRIS 06-16 Page 8 of 13

VII. INFILTRATION SYSTEM DESIGN CRITERIA —15A NCAC 02T .0705 (continued):
8. Basin/Field Information (NOTE — This table may be expanded for additional fields):
Basin/
Field
Area
(acres)
acres
Dominant
Soil Series
Designed
Loading
Rate
in/hr
Designed
Loading
Rate
in/ r
Designed
Loading
Rate
GPD/ft'
Latitude a
a
Longitude
Waterbody
Stream
Index No. b
Classification
O
o
O
o
O
o
O
O
O
O
o
O
o
O
0
0
o
O
o
O
O
O
o
O
0
0
O
O
O
O
O
O
O
O
O
O
Total
a Provide the following latitude and longitude coordinate determination information:
Datum: Select Level of accuracy: Select Method of measurement: Select
b For assistance determining the waterbody stream index number and its associated classification, instructions may be
downloaded at: http•//dea nc pov/about/divisions/water-resources/planninp-lclassification-standards/classifications
9. High -Rate Infiltration System design criteria:
a. Infiltration Fields:
Spray Infiltration Design Elements
Drip Infiltration Design Elements
Nozzle wetted diameter:
ft
Emitter wetted area:
ft2
Nozzle wetted area: I
ft2
Distance between laterals:
ft
Nozzle capacity:
GPM
Distance between emitters:
ft
Nozzle manufacturer/model:
/
Emitter capacity:
GPH
Elevation of highest nozzle:
ft
Emitter manufacturer/model:
/
Specification Section:
Elevation of highest emitter:
ft
Specification Section:
FORM: HRIS 06-16 Page 9 of 13

VII. INFILTRATION SYSTEM DESIGN CRITERIA —15A NCAC 02T .0705 (continued):
b. Infiltration Basins:
IF MORE THAN TWO BASINS, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
Infiltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
Top of embankment elevation:
ft
Hazard class:
elect
Freeboard elevation:
ft
Designed freeboard:
ft
Toe of slope elevation:
ft
Total volume:
ft3
Impoundment bottom elevation:
ft
Infiltrative surface area:
ft2
Mean seasonal high water table depth:
ft
Daily infiltrative capacity:
GPD
Embankment slope:
Plan Sheet Reference:
Top of dam water surface area:
ft2
Specification Section:
Freeboard elevation water surface area:
ft2
Bottom of impoundment surface area:
ft2
i. Does this basin include a discharge point (pipe, spillway, etc)? ❑ Yes or ❑ No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ❑ Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ❑ No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ❑ No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain ?levation) been provided? ❑ Yes or ❑ No
Infiltration Basin Design Elements
Infiltration Basin Dimensions
Basin Name:
rTop
of embankment elevation:
ft
Hazard class:
Se ect
Freeboard elevation:
ft
Designed freeboard:
ft
Toe of slope elevation:
ft
Total volume:
ft3
Impoundment bottom elevation:
ft
Infiltrative surface area:
ft2
Mean seasonal high water table depth:
ft
Daily infiltrative capacity:
GPD
Embankment slope:
Plan Sheet Reference:
Top of dam water surface area:
ft2
Specification Section:
Freeboard elevation water surface area:
ft2
Bottom of impoundment surface area:
ft2
i. Does this basin include a discharge point (pipe, spillway, etc)? ❑ Yes or ❑ No
ii. Are subsurface drains present around the impoundment to control groundwater elevation? ❑ Yes or ❑ No
iii. Is the basin designed to receive surface runoff? ❑ Yes or ❑ No
If yes, what is the drainage area? ft2, and was this runoff incorporated into the loading rate? ❑ Yes or ❑ No
iv. Will the effluent be placed directly into or in contact with GA classified groundwater? ❑ Yes or ❑ No
If yes, has the Applicant provided predictive calculations or modeling demonstrating that such placement will not
result in a contravention of GA groundwater standards? ❑ Yes or ❑ No
v. If the infiltration basin is located within the 100-year flood plain, has a minimum of two feet of protection (i.e., top of
embankment elevation to 100-year flood plain elevation) been provided? ❑ Yes or ❑ No
FORM: HRIS 06-16 Page 10 of 13

VIU. SETBACKS —15A NCAC 02T .0706:
1. Does the project comply with all setbacks found in the river basin rules (15A NCAC 02B .0200)?X Yes or ❑ No
If no, list non -compliant setbacks:
2. Have any setback waivers been obtained in order to comply with 15A NCAC 02T .706(a) and .0706WL9�9 Yes or ❑ No
If yes, h these waivers been written, notarized and signed by all parties involved and recorded with the County Register of
Deeds? Yes or ❑ No
3. Provide the minimum field observed distances (ft) for each setback parameter to the infiltration system and treatment/storage
units (NOTE — Distances greater than 500 feet may be marked N/A):
Setback Parameter
Infiltration
System
Treatment /
Ptorage Unit
Any habitable residence or place of assembly under separate ownership or not to be
maintained as part of the project site
Any habitable residence or place of assembly owned by the Permittee to be maintained as
art of the project site
Any private or public water supply source
Surface waters (streams —intermittent and re ial, erennial waterbodies, and wetlands)
Groundwater lowering ditches (where t m f the d'tch intersects the SHWT)
Subsurface groundwater lowering drainage sy ems
Surface water diversions (ephemeral strea , wa rw)s, ditches)
Any well with exception of monitoring wells
Any property line
Top of slope of embankments or cuts of two feet or more in vertical height
Any water line from a disposal system
Any swimming pool
Public right of way
Nitrification field
Any building foundation or basement
Impounded public water supplies
Public shallow groundwater supply (less than 50 feet deep)
4. Does the Applicant intend on complying with either
If yes, what are the designed Total Nitrog a To
5. Does the Applicant intend on complyin it the i
If yes, verify the following informatio
✓ Are the most stringent effluent
❑ Yes or ❑ No
❑ Yes or ❑ No
Phosphorus effluent concentrations? TN: _ mg/L TP: _ mg/L
issued October 27, 2006? ❑ Yes or ❑ No
15A NCAC 02T .0705(b) and 15A NCAC 02U .0301(b) met?
✓ Is duality provided for all treatment wits per 15A NCAC 02U .0402(c)? ❑ Yes or ❑ No
✓ Continuous online monitoring and recording of effluent for turbidity? ❑ Yes or ❑ No
✓ A lined 5-day upset pond is provided? ❑ Yes or ❑ No
✓ The 5-day upset pond has restricted access? ❑ Yes or ❑ No
✓ A certified operator of a grade equal or greater than the facility classification is on call 24 hrs/day? ❑ Yes or ❑ No
FORM: HRIS 06-16 Page 11 of 13

IX. COASTAL WASTE TREATMENT DISPOSAL REQUIREMENTS —15A NCAC 02H .0400:
1. Is this facility located in a Coastal Area as defined per 15A NCAC 02H .0403? ® Yes or ❑ No
For assistance determining if the facility is located within the Coastal Area, a reference map may be downloaded at: Coastal
Areas Boundary.
2. Is this an Interim Treatment and Disposal Facility per 15A NCAC 02H .0404(g)? ❑ Yes or ® No
NOTE — Interim facilities do not include County and Municipal area -wide collection and treatment systems.
IF ANSWERED YES TO ITEMS IX.1. AND IX.2., THEN COMPLETE ITEMS IX.3. THROUGH IX.16.
3. Is equalization of at least 25% of the average daily flow provided? ® Yes or ❑ No
4. How will noise and odor be controlled?
5. Is an automatically activated standby power source provided? ® Yes or ❑ No
6. Are all essential treatment units provided in duplicate? ® Yes or ❑ No
NOTE — Per 15A NCAC 02T .010306), essential treatment units are defined as any unit associated with the wastewater
treatment process whose loss would likely render the facility incapable of meeting the required performance criteria, including
aeration units or other main treatment units, clarification equipment, filters, disinfection equipment, pumps and blowers.
7. Are the disposal units (i.e., infiltration basins/fields) provided in duplicate? ® Yes or ❑ No
8. Is there an impounded public surface water supply within 500 feet of the infiltration area? ❑ Yes or ® No
9. Is there a public shallow groundwater supply (less than 50 feet deep) within 500 feet of the infiltration area? ❑ Yes or ® No
10. Is there a private groundwater supply within 100 feet of the infiltration area? ❑ Yes or ® No
11. Are there any SA classified waters within 100 feet of the infiltration area? ❑ Yes or ® No
12. Are there any non -SA classified waters within 50 feet of the infiltration area? ❑ Yes or ® No
13. Are there any surface water diversions (i.e., drainage ditches) within 25 feet of the infiltration area? ❑ Yes or ® No
14. Per the requirements in 15A NCAC 02H .0404(a)(7), how much green area is provided? 0 ft'
15. Is the green area clearly delineated on the plans? ❑ Yes or ® No
16. Is the sprU infiltration wetted area within 200 feet of any adjoining properties? ❑ Yes, ❑ No or ® N/A
X. GROUNDWATER LOWERING SYSTEM DESIGN:
1. Does this project utilize a groundwater
2. Is the groundwater lowering system: [
? ❑ Yes or ❑ No (If yes, complete Items X.2. through X.4.)
(i.e., pumped) or ❑ gravity fed?
3. Where does the groundwater loweri ain ge s s m disc rge?
If the system mechanically lowers rou w r d d7th
es directly or indirectly (i.e., pond overflow) to surface waters,
wetlands and/or stormwater structures, pro de e dapplicant obtained written confirmation from the Water Quality
Regional Operations Section that operat' n of the grter lowering drainage system will not adversely affect surface
waters of the State. Submitted: & Received:
4. Groundwater lowering system design criteria:
Groundwater Lowering System Design
Pipe diameter:
in
Discharge rate:
GPD
Pipe material:
Method to measure discharge rate:
Pipe depth:
ft
Number of pumps:
Pipe length:
ft
Pump capacity:
GPM
TDH
Pipe slope (gravity -fed):
%
Plan Sheet Reference:
Trench backfill material:
Specification Section:
FORM: HRIS 06-16 Page 12 of 13

Professional Engineer's Certification:
(Professional
11t2 1
s name from Apt
Item III.1.)
(Facility name from Application Item II.1.)
that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications, engineering
calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the
proposed design has been prepared in accordance with this application package and its instructions, as well as all applicable regulations
and statutes. Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
under my signature and seal signifies that I have reviewed this material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
�0\%II I l I I I IIII//p/
.o�`` H CARO''iii,,
`10 FF.SS/OIL/�9
1 343
01 $NGINE��Q`���
�51'D14 iiCU\�\'��.
Applicant's Certification per 15A NCAC 02T .0106(b):
-rw 14- 13bl\%N 14.04f&EA M X ^11J6,F Jk attest that this application for
(Signature Authority's name & title from Application Item I.3.)
(Facility name from Application Item II.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that any discharge of wastewater
from this non -discharge system to surface waters or the land will result in an immediate enforcement action that may include civil
penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if all required
supporting information and attachments are not included, this application package will be returned to me as incomplete. I further certify
that the Applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without
proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any
active compliance schedule, and do not have any overdue annual fees per 15A NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penaltie up to $25,000 per violation.
Signature: -I- • r y 14� Date: 20Z 1
FORM: HRIS 06-16 Page 13 of 13

BOGUE SOUND
ATLANTIC OCEAN
SHEET # C1 OF 2
PROJECT #: PM339-12
DESIGN FILE #:339/CIRCLE/VERTICAL CLEARANCE/C1_COVERSHEET.DGN
19�
CA 9�
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SEAL :*=
13343
REVISIONS:

107 W BOGUE BLVD
UNIT
PROPERTY OWNER
NC PIN
107-1
HEINZMAN.JOHN K ETUX PAMELA L
637516933358000
107-2
GONZALEZ.EDUARDO ETUX KELLIE
637516933452000
107-3
BLACK WATCH PROPERTIES LLC
637516933472000
107-4
VARNER-DAVID TRUSTEE
637516933492000
107-5
KLUCZYKOWSKI.JUDY ETVIR MICHAE
637516934422000
107-6
PAUL.SCOTT A ETUX DOREEN A
637516934442000
107-7
NGUYEN.HIEN THIEN ETUX HANNAH
637516934324000
107-8
ANDERSON.SAMUEL ETUX BONN ETAL
637516933394000
107-9
SLK RENTALS LLC
637516933374000
107-10
PARKER.ALTON P JR ETUX TRACEY
637516933344000
106 WEST DR
UNIT
PROPERTY OWNER
NC PIN
106-A
ROBERSON.SHER1 LEA
637516934482000
106-B
CORY HOLDINGS LLC
637516934492000
108 WEST DR
UNIT
PROPERTY OWNER
NC PIN
108-A
GREEN.ALYCE EVERETTE
637516934481000
108-B
GARY GAULDEN LLC
637516934388000
110 WEST DR
UNIT
PROPERTY OWNER
NC PIN
110-A
110 WEST DRIVE LLC
637516934357000
110-B
110 WEST DRIVE LLC
637516934366000
112 WEST DR
UNIT
PROPERTY OWNER
NC PIN
112-A
WEST DRIVE INVESTMENTS LLC
637516934355000
112-B
POP-ELATO LLC
637516934353000
114 WEST DR
UNIT
PROPERTY OWNER
NC PIN
114-A
102 WEST DRIVE RESIDENTIAL LLC
637516934209000
114-B
102 WEST DRIVE RETAIL LLC
637516934229000
116 WEST DR
UNIT
PROPERTY OWNER
NC PIN
116-A
MOORE.JENNIFER ETVIR JESSE IV
637516934207000
116-B
MOORE.JENNIFER ETVIR JESSE IV
637516934205000
118 WEST DR
UNIT
PROPERTY OWNER
NC PIN
118-A
LOOKOUT 22 LLC
637516933283000
118-B
LOOKOUT 22 LLC
637516933293000
FLOURESCENT LIGHTING. TYP.
CLEARANCE TO
TRUCTURAL COLUMN
PILE CAPS
PILES-,,--,
NOTE: SITE SURVEY AND PRELIMINARY SITE PLAN PROVIDED BY:
Herring -Sutton & Associates. P.A.
Engineers - Surveyors - Planners
2201 Nash Street NW. Wilson. North Carolina 27896 [phone]
MOD NO.
03-XL-ISSBA
w
U
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a
a
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a
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LOWER LEVEL PARKING DECK Z
15 ,
CD
------------------------
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DRIP FIELD RETAINING WALL
PILE CAP
NOTES:
1. ALL EXISTING FEATURES. TOPOGRAPHY AND BOUNDARY
SURVEYED BY HERRING-SUTTON & ASSOCIATES. P.A..
2201 NASH STREET NW. WILSON. NC 27896.
ENTITLED REFLECTIONS ON THE CIRCLE TOPOGRAPHIC
MAP. MAP NO. 03-XL-1868A. DATED JANUARY 16. 2004.
2. FLOOD ZONES ARE APPROXIMATE AND TAKEN FROM
NC FIRM PANEL 6375 J. MAP NUMBER 3720637500J.
DATED 7/16/03.
5 � HORIZONTAL CLEARANCE TO
VERTICAL STRUCTURAL COLUMN
PILES"
MONITORING WELL #1
LATITUDE: N 34041'54"
LONGITUDE:W 76044'17"
TOP CASING ELV.= 11.04'(NAVD 88)
VERTICAL CLEARANCE
SCHEMATIC
TOETOP6OF CASING 4.40
GGRADE RADE
STATIC WATER ELEV (2.8' PER MARKINGS)
SCALE: 1 "=20'
MONITORING WELL #2
LATITUDE: N 34°41'58"
LONGITUDE: W 76044'19"
TOP CASING ELV.= 9.80' (NAVD 88)
GRADE TO TOP OF CASING 4.43
GRADE ELEV. 5.37
STATIC WATER ELEV (2.8' PER MARKINGS)
MONITORING WELL #3
LATITUDE: N 34041'58"
LONGITUDE: W 76044'17"
TOP CASING ELV.= 9.55' (NAVD 88)
GRADE TO TOP OF CASING 4.28
GRADE ELEV. 5.27
STATIC WATER ELEV (2.8' PER MARKINGS)
r
ATLANTIC BLVD
o: F
-
UNIT
PROPERTY OWNER
NC PIN
SOIL
105-1
105-4 EAST ATLANTIC BLVD LLC
637516929904000
UNI T-COROLLA =
3
105-2
NAVARRE-WILLIAM J JR ETUX CYNT
637516929907000
'
C L I ANCE
F 1ELD A /
105-3
ZARICK.JOHN PAUL ETUX DIANE M
637516939000000
/J
�BULJNDARY
'
105-4
105-4 EAST ATLANTIC BLVD LLC
637516938083000
105-5
BUNN.TURNER B III ETUX SARAH W
637516938043000
7
105-6
MCLEOD-WAYNE A ETUX LEIGH L
637516938020000
co
ARCHITECT RENDERING PLAN VIEW
REVIEW
105-7
NEWELL.HAROLD J ETAL L ISA WOOD
637516928927000
_
nnl Inlr'� n nv
/5
105-8
105-8 EAST ATLANTIC BLVD LLC
637516928924000
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ARCHITECT RENDERING ELEV VIEW
SHEET 1 OF 2
PROJECT # PM339-12-001
DESIGN FILE: PM339-12-002/PM339-12-002 THE GROVE DRIP DISPOSAL SITE MAP.dgn
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BEFORE YOU DIG'
NC ONE CALL
(TOLL FREE)
FA0o0fl
(OR 1-800-632-4949)
IT'S THE LAW!
REVISIONS: