WQ0024756_More Information (Received)_20211130

FOR REGISTRATION REGISTER OF DEEDS
Karen S. Hardesty
Carteret County, NC
November 30, 2021 01:16 PM
BWC AGMT 2 P
FEE: $26.00
FILE # 1748123
FILE # 1748123
State of North Carolina
Department of Environmental Quality
COX 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), AND .0706(a)
I F red 6A, 'RV RA (printed name), certify that I am a deeded owner or an
authorized agent of the property located at: f 3151(pg3"0O06p
II,� �I_ ^� 4,115 1613S ► % 1 O0a
Address: ) 00 � L I 0 A�-'lQ �'�, Fjq JI6I)Qmd Parcel No.: 43151k93fp 014000
City: 141 QM71/(, LRemjA-, State: k)C Zip Code: ZSSI'Z County: C" 4
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/Inflltration 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 IS 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 feet is reduced to feet, thereby allowing the construction of
wastewater treatment and storage units no closer than 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:
t411- i 541�
Date: //h <.J /
FORM: NDWSW 12-20 Page 1 of 2 0

Applicant/Permittee: fGeOVC,LLC. Permit No.: 0 0OM-7$(o
6,37s Ib539.0000o0
Address: Baal r4sN Sri -'SDI?� ParcelNo.: G3 51foo355111O0Ot7
City: 1, &n State: Zip Code: Q�q County: W 1 1 SC Y�
NORTH CAROLINA, l MTERET COUNTY
I, Uuyeln Qktcdut , a Notary Public for ny to ear County, North Carolina,
do hereby certify that Red M • 1 Junf1 personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 30 day of W w exYlheV , W "•
N
1��1F0�� �.0
SEAL �4 *OTAR y ct
PUBl1G
Signature of Notaq Public
My eonunission expires 1 ltzoko'
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 12-20 Page 2 of 2