WQ0030775_Additional Information Response incl Setback Waivers_20210812

Sharon Lear Willoughby
',ender County Register of Deeds
Howard Holly Building
300 E. Fremont St.
P.O. Box 43
Burgaw, NC 28425
Phone: [phone]
I -Z OR =--P a
Cashier: ON TEACHEY Receipt Started: 08/11/2021 02:01:22 PM
Receipt #: 20210811140122-4
STROUD ENGINEERING, PA
WILMINGTON, NC
WAIVER
Party 1: RENYE, KEITH EDWARD Downloaded 8/12/2021
Book / Page: 4761 / 1031 - 2 Page(s)
Time: 08/11/2021 02:05:57 PM
Recording Fee: $26.00
Excise Tax: $0.00
SUBTOTAL: $26.00
WAIVER
Party 1: ONDISH, AMBER LEE DOWNLOADED 08/12/2021
Book / Page: 4761 / 1033 - 2 Page(s)
Time: 08/11/2021 02:05:58 PM
Recording Fee: $26.00
Excise Tax: $0.00
SUBTOTAL: $26.00
WAIVER
Party 1: TUCKER, KRISTOPHER DOWNLOADED 8/12/2021
Book / Page: 4761 / 1035 - 2 Page(s)
Time: 08/11/2021 02:05:59 PM
Recording Fee: $26.00
Excise Tax: $0.00
SUBTOTAL: $26.00
WAIVER
Party 1: JOHNSTON, MICHAEL R DOWNLOADED 08/12/2021
Book / Page: 4761 / 1037 - 2 Page(s)
Time: 08/11/2021 02:06:00 PM
Recording Fee: $26.00
Excise Tax: $0.00

SUBTOTAL: $26.00
WAIVER
Party 1: JONES, ERIN L. DOWNLOADED 8/12/2021
Book / Page: 4761 / 1039 - 2 Page(s)
Time: 08/11/2021 02:06:01 PM
Recording Fee: $26.00
Excise Tax: $0.00
SUBTOTAL: $26.00
WAIVER
Party 1: RIOS, CHRISTIAN ERNESTO DOWNLOADED 08/12/2021
Book / Page: 4761 / 1041 - 2 Page(s)
Time: 08/11/2021 02:06:02 PM
Recording Fee: $26.00
Excise Tax: $0.00
Check:
Check # 2287 - $156.00
•
SUBTOTAL: $26.00
Thank • for • the Pender • Register • I--• Office.
Please visit our website and take our performance survey.
www.pendercountync.govlrod

STROUD ENGINEERING, PA
WILMINGTON, NC
Doc No: 20088481
Recorded: 08/11/2021 02:05:57 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
BK 4761 PG 1031 - 1032 (2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
I, KEITH EDWARD RENYE (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 109 ST LAWRENCE DR Parcel No.: 3273-06-8057-0000
City: ROCKY POINT State: NC Zip Code: 28457 County: Pender
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 the following reduced setbacks:
❑ Wastewater Irrigation/Infiltration Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
❑ Wastewater Irri2ation/Infiltration Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my residence(s) or place(s) of assembly.
❑X Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of 50 feet is reduced to 20 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 20 feet from my property line.
❑ Wastewater Treatment and Storage Unit Setback to PIaces of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my residence or place of
assembly. Signature: Date: loe)l d (%,`-I
FORM: NDWSW 02-19 Pagel of 2
►©

Applicant/Permittee: AQUA NORTH CAROLINA INC
Permit No.: WQ0030775
Bk 4761
pg 1032
Address: 4408 NC-210 Parcel No.: PIN-3273-16-1144-0000
City: Rocky Point State: NC Zip Code: 28457 County:
NORTH CAROLINA, Jj Q-J "ANZVQR COUNTY
Pender
I, —T—y-c..c�A L .
, a Notary Public for
Mtj �k%o icr- County, North Carolina,
do hereby certify that
_ ���� ��
,�r� 3 e r\!J -P .
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
SEAL
s
�{)TA Signature of Notary Public
U My commission expires M, S o i
Z/��) PU$1.�C.r 2
yaA._.._W% G
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
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 Page 2 of

Doc No: 20088482
Recorded: 08/11/2021 02:05:58 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
BK 4761 PG 1033 - 1034 (2)
STROUD ENGINEERING, PA Q�
WILMINGTON, NC
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .050M(b), .0606(a), .0706(a) AND .1006(a)
1, AMBER LEE ONDISN (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 87 ST LAWRENCE DR Parcel No.: 3273-06-8231-0000
City: ROCKY POINT
State: NC Zip Code: 28457
County: PENDER
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 the following reduced setbacks:
❑ Wastewater Irrieation/Infiltration Setback to Property Line
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
❑ Wastewater Irrigation/Infiltration Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my residence(s) or place(s) of assembly.
❑ Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of 50 feet is reduced to 20 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 20 feet from my property line.
�1
Wastewater Treatment and Storage Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my residence or place of
assembly. n
Signature:
FORM: NDWSW 02-19
Date: 25A 12-1
Page 1 of 2
M

Bk 4761
Pg 1034
Applicant/Permittee: AQUA NORTH CAROLINA, INC Permit No.: WQ0030775
Address: 4408 NC HWY 210 Parcel No.: 3273-16-1144-0000
City: ROCKY POINT State: NC Zip Code: 28457
NORTH CAROLINA, N� \-�AgoV E.. COUNTY
County: FENDER
I, —7me t L . LcL--)t— , a Notary Public for 'Nei.,-) k-6moV-W County, North Carolina,
do hereby certify that Sh personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the day off
`���pcuNfisNt�e
SEAL t°4®��Q►G �'�y� O ���, -•
�C3T�► R y Signature of Notary Public
2 PLi ��G �U My commission expireso� (jT�
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
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 Page 2 of 2

Doc No: 20088483
Recorded: 08/11/2021 02:05:59 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
BK 4761 PG 1035 - 1036 (2)
STROUD ENGINEERING, PA
WILMINGTON, NC
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
I, KRISTOPHER TUCKER (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 59 ST LAWRENCE DR Parcel No.: 3273-06-8315-0000
City: ROCKY POINT State: NC Zip Code: 28457 County: Pender
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 the following reduced setbacks:
❑ Wastewater Irri2ation/Infiltration Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
❑ Wastewater Irri2ation/Infiltration Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my residence(s) or place(s) of assembly.
❑X Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of 50 feet is reduced to 20 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 20 feet from my property line.
❑ Wastewater Treatment and Storaze Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my residence or place of
assembly. /
Signature.Date:
FORM: NDWSW 02-19
Page 1 of 2
_a,

Applicant/Permittee: AQUA NORTH CAROLINA INC
Permit No.: W00030775
Bk 4761
pg 1036
Address: 4408 NC-210 Parcel No.: PIN-3273-16-1144-0000
City: Rocky Point State: NC Zip Code: 28457 County:
NORTH CAROLINA, N6IJ �A9gj-oYEa_ COUNTY
Pender
I, \ MC L. Lie. , a Notary Public for County, North Carolina,
do hereby certify that ri(- A5�e personally appeared before me this day
11
and acknowledged the due execution of the foregoing instrument.
1
Witness my hand and official seal, this the � day of � goat
SEAL ``,.���PGY L �lyr`�<rp ` ,�4
--
OTAFj
r Signature of Notary Public
My commission expires
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
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 Page 2 of 2

STROUD ENGINEERING, PA
WILMINGTON, NC
Doc No: 20088484
Recorded: 08/11/2021 02:06-00 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
BK 4761 PG 1037 - 1038 (2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
I, NucHAEL R JOHNSTON (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 95 ST LAWRENCE DR Parcel No.: 3273-06-8144-0000
City: ROCKY POINT State: NC Zip Code: 28457 County: Pender
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 the following reduced setbacks:
❑ Wastewater Irrigation/Infiltration Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
❑ Wastewater Irrigation/Infiltration Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my residence(s) or place(s) of assembly,
❑X Wastewater Treatment and Storage Unit Setback to Pronertv Lines
The required Setback of 50 feet is reduced to 20 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 20 feet from my property line.
❑ Wastewater Treatment and Storage Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage no closer than feet from my residence or place of
assembly.
Signature:
FORM: NDWSW 02-19
Date: 2b'pl-�
Pagel of 2

Sk 4761
Pg 1038
Applicant/Permittee: AQUA NORTH CAROLINA INC Permit No.: WQ0030775
Address: 4408 N -210 Parcel No.: 1'IN-3273-16-1144-0000
City: Rocky Point State: NC Zip Code: 28457 County: Pender
NORTH CAROLINA, 1�6 ,UQ COUNTY
11 . , a Notary Public for NE9County, North Carolina,
nw�rv„kn
do hereby certify that VR personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
4
Witness my hand and official seal, this the day of
SEAL 0���'�'�i
��'.P
0 A J4 P Signature o fNota Public
Y �
y pC) My commission expires Mcu, 1� 2
II, � `4ati
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
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 Page 2 of 2

Doc No: 20088485
Recorded: 08/11/2021 02:06:01 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
6K 4761 PG 1039 - 1040 (2)
STROUD ENGINEERING, PA
WILMINGTON, NC
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
1, E R I N L. J O N ES (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 43 ST. LAWRENCE DRIVE Parcel No.: 3273-06-8412-0000
City: ROCKY POINT
State: NC Zip Code: 28457
County: PENDER
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 the following reduced setbacks:
❑ Wastewater Irrieation/Infiltration Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
❑ Wastewater Irriaation/Infiltration Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my residence(s) or place(s) of assembly.
❑X Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of 50 feet is reduced to 20 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 20 feet from my property line.
❑ Wastewater Treatment and Stora a Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my residence or place of
assembly. _
Signature:
Date: -7 13D l o� l
FORM: NDWSW 02-19
Pagel of 2
al

Applicant/Permittee: AQUA NORTH CAROLINA, INC
Address: 4408 NC H WY 210
City: ROCKY POINT
State: N C
Bk 4761
Pg 1040
Permit No.: WQ0030775
Parcel No.: 3273-16-1144-0000
Zip Code: 28457 County: PENDER
NORTH CAROLINA, N 6,j 4Aw oyea- COUNTY
I, c QkA -•-c�t.�t- , a Notary Public for IA-e'o V�. County, North Carolina,
do hereby certify that (-TI\A `,._ , QNES personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
+Lk
Witness my hand and official seal, this the day of 7:Su.i 202
``,```i���st11llffl/���,,'
SEAL .GY, l; 00
IOTA /QSignature of Jary Public
08y p 0G �� My commission expiresc-� 2D24
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
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 Page 2 of 2

Doc No: 20088486
Recorded: 08l1112021 02:06:02 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
BK 4761 PG 1041 - 1042 (2)
STROUD ENGINEERING, PA /
WILMINGTON, NC
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE WASTEWATER SYSTEM WAIVER
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T .0506(a), .0506(b), .0606(a), .0706(a) AND .1006(a)
I CHRISTIAN ERNESTO RIOS (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 73 ST. LAWRENCE DRIVE Parcel No.: 3273-06-8228-0000
City: ROCKY POINT State: NC Zip Code: 28457 County: PENDER
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 the following reduced setbacks:
❑ Wastewater Irrigation/Infiltration Setback to Property Lines
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my property line.
❑ Wastewater Irrigation/Infiltration Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than feet from my residence(s) or place(s) of assembly.
❑X Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of 50 feet is reduced to 20 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 20 feet from my property line.
❑ Wastewater Treatment and Storage Unit Setback to Places of Assembly
The required setback of feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than feet from my residence or place of
assembly.
Signature: Date: 0� Q
FORM: NDWSW 02-19 Page 1 of

Applicant/Permittee: AQUA NORTH CAROLINA, INC Permit No
Address: 4408 NC HWY 210
City: ROCKY POINT
Bk 4761
Pg 1042
WQ0030775
Parcel No.: 3273-16-1144-0000
State: NC Zip Code: 28457 County: PENDER
NORTH CAROLINA, t V 1 O'-,) COUNTY
I, 1aAXA �J. Notary Public for pr'1alo­) County, North Carolina,
do hereby certify that C 1215\ i At-'*, G • a O.SS personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the36 day of ,
sjka Y Rodriguez
NOTARY PUBLIC
On$low Counl/, NO Signature of Notary Public
47 My commission expires
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
Non -Discharge Branch
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
FORM: NDWSW 03-17 Page 2 of 2