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Home My WebLink AboutWQ0038087_More Information Received_20211122Initial Review Reviewer Thornburg, Nathaniel D Is this submittal an application? (Excluding additional information.) * Yes No If not an application what is the submittal type?* Annual Report Residual Annual Report Additional Information Other Permit Number (IR) * WQ0038087 Applicant/Permittee Terra Renewal Services, Inc Email Notifications ....... ........ ......... ........... Does this need review by the hydrogeologist? * Yes No Regional Office CO Reviewer Admin Reviewer Submittal Form Project Contact Information Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence. ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ Name* Terra Renewal Services, Inc Email Address* david.coyle@terrarenewal.com Project Information Application/Document Type* New (Fee Required) Modification - Major (Fee Required) Renewal with Major Modification (Fee Required) Annual Report Additional Information Other Phone Number* 479-747-8192 Modification - Minor Renewal GW-59, NDMR, NDMLR, NDAR-1, N DAR-2 Residual Annual Report 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. hftps://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report Perm it Type:* Wastewater Irrigation High -Rate Infiltration Other Wastewater Reclaimed Water Closed -Loop Recycle Residuals Single -Family Residence Wastewater Other Irrigation Permit Number: * WQ0038087 Has Current Existing permit number Applicant/Permittee Address* P.O. Box 1746 Watkinsville, GA 30677 Facility Name* Terra Renewal Services Class B Residuals Program Please provide comments/notes on your current submittal below. This is additional information pertaining to the recently submitted application for modification of RLAP Permit WQ0038087. It is the scanned copies of the property line setback waiver forms for the proposed land application sites (corresponding to fields MRF-13, MRF-14, and MRF- 15). Please contact me if there are any complications or questions. Thank you. David Coyle Senior Environmental Manager Terra Renewal 479-747-8192 At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg at nathaniel.thornburg@ncdenr.gov. Please attach all information required or requested for this submittal to be reviewed here. * (Application Form, Engineering Plans, Specifications, Calculations, Etc.) NC—WQ0038087—Setback Waiver Forms_2021 Mod.pdf 2.95MB Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger than upload limit. * 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 Submission Date 11/22/2021 FILED WILKES COUNTY MISTY M. SMITHEY REGISTER OF DEEDS FILED Nov 18, 2021 AT 08:50:48 am BOOK 01343 PAGE 0199 INSTRUMENT # 09628 EXCISE TAX (None) State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER FOR THE APPLICATION OF CLASS B RESIDUALS AGREEMENT TO WAIVE SETBACKS PURSUANT TO 15A NCAC 02T .1108(c) I, Luke Mathis , certify that I represent Mathis Properties LLC which is the deeded owner of the property located 11: Ad sMATF!1 615 MATHIS FARM RD Zip�olaeR`ER, AC 2866 bounCity: State: ty+''. Wilkes A . ♦ . • . A .. • . ♦ • Parcel No.: .. • ♦ . • ..... • ®t a ®$ t I 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. dFor the parcel identified above, I consent to a reduced setback from 50 feet to 0 feet, thereby allowing the application of Class B residuals as near as 0 feet from my propertyline. ❑ For the parcel identified above, I consent to a reduced setback from _ feet to _ feet, thereby allowing the application of Class B residuals as near as _ feet from my residence "THIS WAIVER SHALL BE Signature: FORM: NDRMPNr-LAS 11-IS UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED" ze Page 1 of 2 Permittee: Terra Renewal Services Inc. Address: Post Office Box 1746 Permit No.: W00038087 City: Watkinsville State: GA Zip Code: 30677 County: N/A NORTH CAROLINA, � K1 j� Y43 COUNTY I OU✓1A,t m. r1a a Notary Public for W'k u j County, North Carolina, do hereby certify that ma� s personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal, this the bay of :( 6 SEAL <iss�ccF'Q(P' •ti ��' AOTARyVI.ber AS, OZ PUSOCI i-,r''�� • .............. U.. Signature of Notary Public My commission expires t � — klp —05,7 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 _?AC2cEL- 0100aII FORM: NDRMPW-LAS 11-18 Page 2 of FILED WILKES COUNTY MISTY M. SMITHEY REGISTER OF DEEDS FILED Nov 18, 2021 AT 08:50:49 am BOOK 01343 PAGE 0200 INSTRUMENT # 09629 EXCISE TAX (None) State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER 17 T FOR THE APPLICATION OF CLASS B RESIDUALS AGREEMENT TO WAIVE SETBACKS PURSUANT TO 15A NCAC 02T .1108(c) I, Stephen C. Motsinger , certify that I am a deeded owner of the property located at: Address: Old 60 Parcel No.: 0100282 City: Roaring River State: NC Zip Code: 28669 County: Wilkes 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. El"For the parcel identified above, I consent to a reduced setback from 50 feet to 0 feet, thereby allowing the application of Class B residuals as near as 0 feet from my property line. ® For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the application of Class B residuals as near as feet from my residence. **THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED** Si FORM: NDRMPW-LAS 11-18 Si�eC-- ZS Z Pagel of 2 Permittee: Terra Renewal Services Inc. Address: Post Office Box 1746 Permit No.: W00038087 City: Watkinsville State: GA Zip Code: 30677 County: N/A NORTH CAROLINA, COUNTY I ��`� � �- >( S (\ , a Notary Public for 1 V-0-. County, North Carolina, do hereby certify thatC�Q . �s �It1t�Pf personally appeared before me this day and acknowledged the due execution of the foregoing instrument. Witness my hand and official seal, this theSS�tday of .l l jye� ak y M ..!D�,Q o SEAL c � o"-oss n 'cam•.' cS0 . •.y PUBOG r2. 'kefibet 16 S. COv0011 �°�,, Signature of Notary Public My commission expires N k — � �o - as: _ 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 1?aR(-eL, _rr : 0100 20-2-- FORM: NDRMPW-LAS 11-18 Page 2 of 2 FILED WILKES COUNTY MISTY M. SMITHEY REGISTER OF DEEDS FILED Nov 18, 2021 AT 08:50:47 am BOOK 01343 PAGE 0198 INSTRUMENT # 09627 EXCISE TAX (None) State of North Carolina Department of Environmental Quality Division of Water Resources NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER P 97... r /I FOR THE APPLICATION OF CLASS B RESIDUALS AGREEMENT TO WAIVE SETBACKS PURSUANT TO 15A NCAC 02T .1108(c) Ja d�tk►-la-Beale � Yt�f van certifp that a deeded owner of the property located at: Address: Dr Beale Farm Rd Parcel No.: 0100020 City:_ Roaring River State: NC Zip Code: 28669 County: Wilkes 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. For the parcel identified above, I consent to a reduced setback from 50 feet to 0 feet, thereby allowing the application of Class B residuals as near as 0 feet from my propertyline. For the parcel identified above, I consent to a reduced setback from feet to feet, thereby allowing the application of Class B residuals as near as feet from my residence. "THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED" Signature Date: FORM: NDRMPW-LAS 11-18 Page] of 2 Permittee: Terra Renewal Services Inc. Address: Post Office Box 1746 Permit No.: W00038087 City: Watkinsville State: GA Zip Code: 30677 County: N/A NORTH CAROIL,INA, W&tMct e,,- COUNTY I, i?tll/2 fni A V t,� c u , a Notary Public forAsi1_e_ County, North Carolina, do hereby certify that n p.r if- S r A Y 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 4 )J I SEAL Notary Public 9� Ashe _ County My Comm. Exp 2 07-20-2023 T C Ado Signature of Notary Public My commission expires 7 ,7?d 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 �Aa_cr"_- ' 0 lao® 20 FORM: NDRMPW-LAS 11-18 Page of