WQ0044731_More Information (Received)_20240402

BK 2377 PG 0811
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FILED
CHATHAM COUNTY NC
LUNDAY A. RIGGSBEE
REGISTER OF DEEDS
FILED Aug 23, 2023
AT 11:28:54 am
BOOK 02377
START PAGE
0811
END PAGE
0812
INSTRUMENT #
07423
EXCISE TAX
(None)
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, Joel Carpenter (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: 187 Marthas Vineyard Dr (Marthas Vineyard Lot 4) Parcel No.: 85292
City: Apex State: NC Zip Code: 27523 County:
Chatham
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 Irrii!ation/Infiltration Setback to Property Lines
The required setback of 50 feet is reduced to 25 feet, thereby allowing wastewater effluent
irrigation or infiltration no closer than 25 feet from my property line.
❑ Wastewater Irrii!ation/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 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. K\ n A
Signature:
FORM: NDWSW
Date: �/Z2�Lo2�
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Page 1 of 2

BK 2377 PG 0812
Applicant/Permittee: Joel Carpenter Permit No.:
Address: 189 Marthas Vineyard Dr. (Marthas Vineyard Lot 4A) Parcel No.: 96072
City: Apex State: NC Zip Code: 27523 County: Chatham
NORTH CAROLINA, VJ c�a�,er COUNTY
a Notary Public for W CL-K"r. County, North Carolina,
do hereby certify that Spy` C Ck cr personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the _2U day of
SEAL
w
0 REVA SUTTON
Notary Public, North Carolina
Wake County Signature of Notary Public
My Commission Expires
May 07, 2025 My commission expires 5 _ 07 ` a 5
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