WQ0000884_More Information Received_20220603

Deviib i Dewberry Engineers Inc. 919.981.9999
Ji aJ 2610 Wyclif f Road. Suite 410 919.8131.9923 Fax
Raleigh, NC 27607-9079 voiviAr.dewliterry.tom
June 3, 2022
North Carolina Division of Water Resources
Water Quality Permitting Section
Non-Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Response to Request for Additional Information
Butterball Permit Renewal
WQ0000884
Dear Ms. Raup-Plummer,
Butterball and Dewberry received the request for additional information dated June 2, 2022 for the
renewal application for permit WQ0000884. The additional information and clarifications are provided
herein:
Attachment H —Affiliations:
1. Please confirm the following changes to the WQ0000884 affiliations:
a. Craig Leviner is the current complex manager, and it appears that the intent is for Mr. Leviner
to have permit signature authority. In order to process this request, an executed Signature
Authority Delegation Letter is required.
Craig Leviner is the Complex General Manager and an executed Signature Authority
Delegation Letter is attached.
b. Steve Swan has changed roles from complex manager to plant manager (Mr. Swan has
previously been granted signature authority).
Steve Swan is the Senior Plant Manager for Further Processing and is included on the
attached Signature Authority Delegation Letter.
c. Bill Folk's current role is Vice President of Operations and needs to be added as an owner-
level contact person. This action will be reflected on all DWR permits held by Butterball, LLC.
Correct, Bill Folk is the Vice President of Operations.
d. Jeffry Shamblin has changed roles from Plant Manager to Plant Engineering Manager(Mr.
Shamblin has previously been granted signature authority).
Jeffry Shamblin is the Maintenance Manager for Facilities and Wastewater and is included on
the attached Signature Authority Delegation Letter.
e. Terry Mercer and Keith Shoemaker were not included on the provided Attachment H
document. Our records have them listed as owner-level contact persons. Are they no longer
employed by Butterball, LLC? Owner-level affiliations for Butterball, LLC may apply to other
DEQ permits that are not maintained by the Non-Discharge Branch.
Terry Mercer is still employed by Butterball but does not work at the Mt Olive facility and is
not nor ever was an Owner-level employee. Keith Shoemaker is no longer employed at
Butterball.
f. Michael D. Bliss was not included on the provided Attachment H document. Mr. Bliss is listed
as having signatory authority for the WQ0000884 permit. Is he no longer employed by
Butterball, LLC, and does he need to be removed from the affiliations list for this facility?
Michael Bliss is no longer employed by Butterball and should be removed from the affiliations
list.
Page 1 of 2

Ms. Raup-Plummer
June 3,2022
Attachment L—Setback Waivers:
1. The provided setback waivers do not appear to have been fully notarized (the seal is absent from
the provided waivers). It is also unclear as to whether these waivers were recorded with Duplin
County Register of Deeds. Please review your records and confirm that the notarized waivers
were recorded with the Duplin County Register of Deeds. Please also provide the associated
deed books and pages for each waiver.
The setback waivers provided with the permit renewal application were not the same waivers that
were recorded with the Register of Deeds. Attached are the correct copies of the waivers that are
sealed and show deed book pages.
Additional Documentation:
Existing Permit:
a. Within the existing permit, there are several schedules regarding the modifications to the
facility. Our office received a Partial Final Engineering Certification on May 7, 2019 for the
pretreatment facility and effluent pump station; however, we could not find a document for the
proposed irrigation fields (Fields 15A, 15B, 17A, 17B, 17C, and 17D). Please confirm that the
proposed irrigation fields have not been constructed. If the facilities have been constructed,
please provide a certification as required in Condition 1.1 of the existing permit.
Fields 15A, 158, 17A, 178, 17C, and 17D have not been constructed.
b. Condition 1.3 of the existing permit requires that the existing 100,000 GPD domestic
wastewater pretreatment facility be decommissioned from the site within one year of the
startup of the replacement 100,000 GPD pretreatment facility (certified May 7, 2019). Has the
aged pretreatment facility been decommissioned? Please provide additional information. If
the facility has been decommissioned, then please provide documentation that this condition
has been met.
The old domestic wastewater pretreatment facility was decommissioned in accordance with
the approved plans prior to the engineering certification dated May 3, 2019. Photos of the old
package plant and the same area following decommissioning are attached.
c. It is unclear whether Fields 17A and 17C have been constructed. Please note that Condition
1.5 requires that upon completion of construction and prior to irrigation, a soil scientist
evaluation shall be completed for all areas where fill material is placed within the permitted
irrigation areas (i.e., Fields 17A and 17C). Please provide additional information.
Fields 17A and 17C have not been constructed.
If you have any questions regarding the information provided please contact me at 919.424.3764 or
[e-mail].
Sincerely,
4944 Ov•-1 Da)--45
Leigh-Ann Dudley, PE
Associate, Sr Project Manager
_:1 Dewberry
Page 2 of 2

ROY COOPER ,i' 1 -'E
tnx Gewerr
MICHAEL S.REGAN
secretary
S. DANIEL SMITH NORTH CAROLINA
aired& Environmental Quality
June 2,2022
Division of Water Resources
Non-Discharge Branch
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Subject: Permit No. WQ0000884
Signature Authority Designation
Butterball-Mt. Olive WWTF
Wastewater Irrigation System
Duplin County
To Whom It May Concern: r� ¡
As an appropriate signing official for l iu t*f-e 4, 11 L-¿ C- (cityltown or
business name)as designated by 1SA NCAC 2T.010 ,I hereby delegate authority to sign and certify all
permit applications,reports or other permit related documents to the following staff for the following
permit types(sewer, spray, land application)and/or permit numbers:
Person Permit Type
Position Currently in or Permit
¡ yyyy�� (Position Number
C,,,,^ Ic K. l6enrr`., 014,0 ,q e�� llrr-- .J Le.l.'ri rir 4 Q17üQ4 `` ,
y��y� �y —... R.I. ¡jJ ,y re * frt.,J C, (-vJ,íj1 n ewe.. 0 Q co TS
Pir,.n4irvt�1 .. _iiiPAcn c- c,l-114,1 hiPt Y11-H- _171ci gIl'rj hig,12co�i I If you have any questions,please contact me at the following:
Permittee/Applicant name(please print): 9 u}},er Ib . I-L Ilf� 111
Title: r c Ertl . C Mln r awd V ` a .Jr., ^ UC J
Complete mailing address: r. w L J
City: Gt.(r+er State: NC. Zip: 2,75.2 1
Telephone number: ( 91 9 )255 90ú Facsimile number; ( )
lr 4 1 ell
Sincere!
signature
North Carolina DepartmenT of Er eironmentaf Qun1iry I ❑iwlgtort of Waper R urces
5l2 Nort[u 9lisóury Street lÓl7 Mall Service Center RaI Igh,lvor;h Carerllr�a 27b99 lbl7
D
:vr;�w
wganner bv,iSr wwr4.nh 919.7073 000

v ;
Doc No 10013123 '1 .
Recorded: 06/26/2017 10:40:36 AM
Fee Amt. $26.00 Page 1 of 2 n(
} e gate
Dublin County North Carolina age shown on iheliiNge
Davis H.Brinson,Register of Deeds al,and is being returned r
BK 1862 PG 496-496(2) ;t your sateteephry
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORA9 MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or for an electronic version of this form,visit our web site al:
Into- aortal.ncclenr.ors NI eb irg dos lnn anplicalions.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Permitting Unit application form.
V. Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by I5A NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicant's name: Butterball,LLC
Complete mailing address of applicant: PO BOX 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (919 ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
Non-Discharge disposal of wastewater effluent within 0 feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
❑ C• onstruct treatment and storage units within feet of the property line,
❑ C• onstruct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-16 Page I oft

Book 1852
Page 496
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 296 Willie Best Road(PIN 351100732815)
City: Mount Olive State: NC Zip: 28365
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 dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that I will record this waiver form with the
appropriate Register of Deeds and provide the Permittee and Division of Water Resources with documentation of
such. tt �¿
Property owner(s)name(s): cine�.( 1:15 11 A otOetako.'13 — &Mre> I( LL L
Signature: f�`'' ",e� Date: et
Signature: Date:
NORRTHn¡CAROLINA, (,)C)LL COUNTY
I,— t,00(, KA/ /(141d ,a Notary Public for Wait., County,North Carolina,
do hereby certify that {, Cell AJ,Lia) personally appeared before me this day and
acknowledged the due execution of the foregoing instrument.
Witness my band and official seal this the 2 Z day of (%(� , u%/l .
o% &t.90 y,•,, lardL
LJ
'4',y ,!<y Signature of Notary Public
L
ATM` 2/Z /202-f
�`G My commission expires _
FORM:NDWSW 10-16 Page 2 of 2

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:r your salekeepipp.Doc10013129NIIIIIIIIIIN1IIIIIIIII A
No: �
Recorded. 06126/2017 10:40:42 AM
Fee Amt: 526.00 Page 1 of 2 6rtrtltblbt[ltltrMt)iºtpt"
Duplin County North Carolina
Davis H.Brinson,Register of Deeds
BK 1862 PG 607-508(2) �n�¡`(
V �j)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM A/9PBE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or for an electronic version of this form,visit our web site al:
bon:-portaLncdenr.or1 web nip amlint applications.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Permitting Unit application form.
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by I5A NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicant's name: Butterball,LLC
Complete mailing address of applicant: PO Box 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (919 ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
Non-Discharge disposal of wastewater effluent within 0 feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-tb Page 1 of2

Book 1852
Page 508
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 1501 Whitfield Road(PIN 352100448348)
City: Mount Olive State: NC Zip: 28365
1 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, 1 certify that 1 have read and
understand this Agreement and do hereby grant permission to the Permittee to dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that I will record this waiver form with the
appropriate Register of Deeds and provide the Pennittee and Division of Water Resources with documentation of
such. // p
Property owner(s)name(s): �o h�t %_5 1/ 170erw�+'�� t7✓#f/6+�� L L,L.
Signature: % Date: 6 7-
Signature: t Date:
NORTH CAROLINA, Lk/11)U— COUNTY
I, 1/- 01> ,a Notary Public for L� — County,North Carolina,
do hereby certify that`2.A ,04 11 t1 t, . G "» personally appeared before me this day and
acknowledged the due execution of the foregoing instrument. I/�'
Witness my hand and official seal this the �2 �y,day of r , 2O
1{II{I1111//4�� �GY /J� jo,i6 Az,<./
yJ5 (% Signature of Notary Public
46)TA9r J
= My commission expires /- 2 G L I
tisr0N COA,
EH MOO
FORM:NDWSW 10-16 Page 2 of 2

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shown on h
Doc No 10013125 I,and is being retuneØ Inc
Recorded: 06/26/2017 10:40.38 AM `c%i 1,o your safekeeping. 14
Fee Amt: 826.00 Page 1 of 2
94.0(
Duplin County North Carolina
Davis H.Brinson,Register of Deeds »400
BK 1862 PG 499-600(2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information afar an electronic version of this,form,visit our web site a!:
hop. porial.ncclenr.ory web rice erns'Ian applications.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Permitting Unit application form.
V Any changes to this form will result in the application package being returned.
V Any other setbacks required by I SA NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
V A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicants name: Butterball, LLC
Complete mailing address of applicant: PO Box 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (919 ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
❑ Non-Discharge disposal of wastewater effluent within ° feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-16 Page I oft

Book 1852
Page 500
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 1528 Whitfield(PIN 352100152405)
City: Mount Olive State: NC Zip: 28365
err 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 dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that 1 will record this waiver form with the
appropriate Register of Deeds and provide the Permittee and Division of Water Resources with documentation of
such. �9
Property owner(s)name(s): t { LNDa 0i1 /[S! V 4 i(*4 ynJ - DJ L�1•/'
Signature: �"p1 u�1 Date: iJ2.2- !
Signature: Date:
NORTH CAROLINA, 1/UAa COUNTY
12S r 5�(r� �Í��Í tit 2Li d ,a Notary Public for txja kQ._ County,North Carolina,
do hereby certify that 1MJ£,L¿ ¡Lis! personally appeared before me this day and
acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this the 2 Z day of JarO - 2.0 j7.
�� SAL ti% � ,ilwl laid A.t-
4pTAg5, Signature of Notary PPTblic
yCJ��+ My commission expires 21 2132 / _
.,TON CO'E:••%
""
FORM:NDWSW 10-16 Page 2 of 2

„NoRI11
III IIIIIIIIIIIIII'"''IIIIII'”
Doe No 10013124 'the Dah;
Recorded: 06/26/2017 10:40:37 AM ape shown on the
Fee Amt: $26.00 Page 1 of 2 04 1,and is being retome{py
your safekeeping.
DuoItn County North Carolina v4,.
Davis H.Brinson,Register of Deeds ir
BK 1862 pG 497-498(2) t
ae‘v
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For snore information or for an electronic version of thisfornt,visit our web site at:
hltp portal nedmr urnz web uy ups lent upplicatioru•.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Pennitting•Unit application form.
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by I NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicant's name: Butterball, LLC
Complete mailing address of applicant: PO Box 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (º1 º ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
■❑ Non-Discharge disposal of wastewater effluent within 0 feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-16 Page 1 of 2

Book 1852
Page 498
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 1528 Whitfield Road(PIN 351100830382)
City: Mount Olive State: NC Zip: 28365
V(1 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 dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that 1 will record this waiver form with the
appropriate Register of Deeds and provide the Permittee and Division of Water Resources with documentation of
such.
Property owner(s)name(s): ifrate. �!J/1 vP e/'.14V")
Signature: Date: ZZ
Signature: Date:
NORTH CAROLINA,, COUNTY I
1, Aug '�},�Catf (ji ,a Notary Public for 1A County,North Carolina,
¡
JJ�� n
do hereby certify that %LtiG/2QkQ I6L �.] personally appeared before me this day and
acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this the 2 2- day of Sill ,0011111104
1,L0Yp
:•� i tii�'�� l( CC�
q �TAJTh Signature of Notary Public
c AllB4�G Z My commission expires 21 Z J 20Z
=0
"ION CO�```,`�.
FORM:NDWSW 10-16 Page 2of2

III IIIIIIINIIIIIIINIIIIIIIII III r .
Doc No: 10013126 tr¡ghi.111MbpienkVeº trerup
Recorded: 06/26/2017 10.40:39 AM men the Dale,11404iit ,,
Fee Amt: $26.00 Page 1 of 2 Btleli t$Page shown on the
tt ,and is being returns, '
Duplin County North Carolina your safekeeping.
Davis H.Brinson,Register of Deeds
BK 1862 PG 501-602 121 103 At
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or for an electronic version of this form,visit ow web site at:
bivp: portal nedem.org web rip ups icm applications.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Permitting Unit application form.
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by I NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicant's name: Butterball,LLC
Complete mailing address of applicant: PO Box 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (919 ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
❑■ Non-Discharge disposal of wastewater effluent within 0 feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-16 Page I oft

Book 1852
Page 502
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 1528 Whitfield Road(PIN 352100349992)
City: Mount Olive State: NC Zip: 28365
[ 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 dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that I will record this waiver form with the
appropriate Register of Deeds and provide the Permittee and Division of Water Resources with documentation of
such.
Property owner(s)name(s): /Of V ra •y^f ' 4✓ 4'« LL
Signature: Date: % 2 x
Signature: Date:
NO�RTH�CAROLINNA, /V COUNTY
[, 01 110 J'ail- ,as Notary�) Public for W County,North Carolina,
do hereby certify that Uj Waif
/ iL4. personally appeared before me this day and
acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this the Z Z day of U%ti , Z b f.
.01111111//,�/
LLO kp ,,
SEAL �' 'ly,c n 91)Ú�l!,t .C.i.L
eo p1A . Signature of Notary Public
O �°ueU� 2 my commission expires 2 I7 Iw Z _
1►1111
FORM:NDWSW 10-16 Page 2 of2

411M11/fOftili
III IIIIIIIIIIIINIIIIIIIIIIIIIIIII �:,,' r ,
Doc No. 10013128
Recorded: 06/26/2017 10 40:41 AM the Dale ',
Fee Amt: $26.00 Page 1 of 2Page shown on the
th end is helee retorrro� `".._rr.
Duptn County North Carolina your safekeeping.
Davis H.Brinson,Register of Deeds
BK 1852 PG 606-506(2)
e
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or for an electronic version of this form, visit our web site at:
lipE ,hortalncrlenr.orc web WC(ape Ian applications-
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Permitting Unit application form.
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by 15A NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicant's name: Butterball,LLC
Complete mailing address of applicant: PO Box 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (919 ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
Non-Discharge disposal of wastewater effluent within 0 feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
❑ Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-16 Page 1 of2

Book 1852
Page 506
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 1528 Whitfield Road(PIN 352100368454)
City: Mount Olive State: NC Zip: 28365
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 dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that I will record this waiver form with the
appropriate Register of Deeds and provide the Permittee and Division of Water Resources with documentation of
such. / b
Property owner(s name(s): M.atlAe.. /,I'jt ✓P 0Ptr-.4"i - 1,14A Lc—
Signature: oft6ta-e" / Date: 47z2/17
Signature: Date:
NORTH CAROLINA, tc)C COUNTY / �j
I, a c kid / C(�/ ,a Notary Public for Ll¿/C_ County,North Carolina,
do hereby certify that`%i�L1\(ha ki /jLcL2 personally appeared before me this day and
acknowledged the due execution of the foregoing�77 instrument. - � 1
Witness my hand and official seal this the 2L day of rJ(LJl_2' , 2 n I
"Ylifilhc (Aid
ppT40� r Signature of Notary Public
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FORM:NDWSW 10-16 Page 2 of 2

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Recorded: 06/26/2017 10 40:40 AM ! Iltirthe Oale,fga Ih,1*
Fee Amt. $26.00 Page 1 of 2 fladlrÑd Pape shown on the Pfultflot
Duplin County North Carolina trot,and is being returned*
Davis H.Brinson,Register of Deeds your safekeeping. ,q
BK 1862 PG 503-604 121 4'
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State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON-DISCHARGE WASTEWATER SYSTEM WAIVER
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Resources will not consider this form complete unless all instructions are followed. Failure
to follow instructions or to submit all required items will lead to additional processing and review time.
For more information or,for an electronic version of this form,visit our web site at:
htin puiicdncclenr ork web irk up.s tau applications.
INSTRUCTIONS TO THE APPLICANT:
✓ Do not submit this form for review without a corresponding Non-Discharge Permitting Unit application form.
✓ Any changes to this form will result in the application package being returned.
✓ Any other setbacks required by 15A NCAC Subchapter 02T other than those referenced below, cannot be waived
through execution of this form.
/ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE SETBACKS AS REQUIRED BY
15A NCAC 02T.0506(a),.0506(b),.0606(a),.0706(a)and.1006(a)
The undersigned property owner(s)hereby permits:
Applicant's name: Butterball,LLC
Complete mailing address of applicant: PO Box 589
City: Mount Olive State: NC Zip: 28365
Telephone number: (919 ) 658-6743 Facsimile number:(919 ) 658-4419
Hereinafter referred to as the Permittee,to(check all that apply):
11 Non-Discharge disposal of wastewater effluent within l) feet of the property line,
❑ Non-Discharge disposal of wastewater effluent within feet of the identified residence,
LI Construct treatment and storage units within feet of the property line,
❑ Construct treatment and storage units within feet of the identified residence.
FORM:NDWSW 10-16 Page 1 of2

Book 1852
Page 504
The waived setbacks apply as shown on the attached map and located at the following:
Location address of property: 1529 Whitfield Road(PIN 352100360453)
City: Mount Olive State: NC Zip: 28365
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 Pennittee to dispose of wastewater effluent or
construct wastewater treatment units as specified herein. I further agree that l will record this waiver form with the
appropriate Register of Deeds and provide the Permittee and Division of Water Resources with documentation of
such. Jj .. �,J
Property owner(s)name(s): 114 rJ Jf �P r9.,1) t t'rrL if LLC_
Signature: Date:
Signature: Date:
NORTH, %ll�/CAROLINA, i�(�Ctk-�- COUNTY /�
I r ;/1 I( ( ,id a Notary Public for W County,North Carolina,
do hereby certify that /lÍl((had iI personally appeared before me this day and
acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this the 2 Z day of (c/t.t� , ZO .
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FORM:NDWSW ]0-16 Page 2 of 2

Photos of Old Package Plant Area
Transformer is a point of reference in both photos.
Photo 1 (November 9, 2017). Old package sanitary plant
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Photo 2 (March 17, 2019).Area following removal of the old package domestic wastewater plant taken.
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Non-Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnvI,,! M&I Q,thty
Version 2-Revised June 23,2020
Initial 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)* WQ0000884
Applicant/Permittee Butterball,LLC
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* Leigh-Ann Dudley
Email Address* Phone Number*
[e-mail] 9194243764
Project Information
Application/Document Type* New(Fee Required) Modification-Minor
Modification-Major(Fee Required) Renewal
Renewal with Major Modification(Fee GW-59, NDMR,NDMLR, NDAR-1,
Required) NDAR-2
Annual Report Residual Annual Report
Additional Information Change of Ownership
Other
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:* Wastewater Irrigation High-Rate Infiltration
Other Wastewater Reclaimed Water
Closed-Loop Recycle Residuals
Single-Family Residence Wastewater Other
Irrigation
Permit Number:* WQ0000884
Has Current Existing permit number
Applicant/Permittee Address* One Butterball Lane,Garner,NC 27529
Facility Name* Butterball-Mt.Olive WWTF
Please provide comments/notes on your current submittal below.
The submittal is a response to a request for additional information for the renewal application
of permit WQ0000884.Please direct this document to Lauren Raup-Plummer.
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 Plans,Specifications,Calculations,Etc.)
2022.06.03 Response to RFI WQ0000884.pdf 637.25KB
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 6/3/2022