WQ0024301_Final Permit_20190201

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
THOMAS J. GILBERT, JR.
11500 LAKEVIEw LANE WEST
MINNETONKA, MINNESOTA 55305
Dear Mr. Gilbert:
NORTH CAROLINA
Environmental Quality
February 1, 2019
Subject: Permit No. WQ0024301
152 Hickory Flats Rd. SFR
Single -Family Residence
Wastewater Irrigation System
Caswell County
In accordance with your permit renewal request received December 3, 2018, we are forwarding
herewith Permit No. WQ0024301 dated February 1, 2019, to Thomas J. Gilbert, Jr. for the continued
operation of the subject single-family residence wastewater treatment and irrigation facilities.
This permit shall be effective from the date of issuance through February 29, 2024, shall void
Permit No. WQ0024301 issued September 26, 2013, and shall be subject to the conditions and limitations
therein. The Permittee shall submit a renewal application no later than September 2, 2023.
Please pay attention to the operation and maintenance requirements listed in Section III for they
may differ from the previous permit issuance. Failure to establish an adequate system for collecting and
maintaining the required operational information shall result in future compliance problems.
The Division has removed the following permit condition since the last permit issuance dated
September 26, 2013:
➢ Old Condition VI.2. — This condition has been removed because the permit is not voidable.
The following permit conditions are new since the last permit issuance dated September 26,
2013:
➢ Condition II.10. —The setback conditions have been updated as per 15A NCAC 02H .02190).
➢ Condition I11.12 — Metering equipment shall be tested and calibrated annually.
➢ Condition VI.3. — This condition states that unless specifically requested and approved in the
permit, there are no variances to administrative codes or general statutes governing the
construction or operation of the permitted facilities.
➢ Condition VI.10. —The permit cannot be renewed if the annual fee has not been remitted.
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
NORrHCARQUNA
919.707.9000

Mr. Thomas J. Gilbert Jr.
February 1, 2019
Page 2 of 2
If any parts, requirements, or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Otherwise, this permit shall be final and binding.
If you need additional information concerning this permit, please contact Ranveer Katyal at (919)
707-3661 or ranveer.katvalgncdenr.gov.
Sincerely,
?Linda Culpepper, Director
Division of Water Resources
cc: Caswell County Health Department (Electronic Copy)
Winston-Salem Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Thomas J. Gilbert, Jr.
Caswell County
FOR THE
continued operation of a 480 gallon per day (GPD) single-family residence wastewater treatment and
irrigation facility consisting of:
a 1,500 gallon baffled septic tank with an effluent filter; a splitter box; two 210 square foot (fl) subsurface
sand filters in parallel; a tablet chlorinator; a chlorine contact chamber; a 1,200 gallon storage tank; a 6 foot
diameter pump manhole (with floats set to provide a minimum net storage of 2,400 gallons) with a 20 gallon
per minute (GPM) pump, and audio/visual high-water alarms; an automatic rain shut off device and soil
moisture monitoring device; a 0.19 acre spray irrigation area with four 1.22 GPM sprinklers that have an
effective diameter of 52 feet; and all associated piping, valves, controls, and appurtenances
to serve the single-family residence at 152 Hickory Flats Rd., Leasburg, NC 27291, with no discharge of
wastes to surface waters, pursuant to the application received December 3, 2018, and in conformity with
the Division -approved plans and specifications considered a part of this permit.
This permit shall be effective from the date of issuance through February 29, 2024, shall void Permit No.
WQ0024301 issued September 26, 2013, and shall be subject to the following conditions and limitations:
I. SCHEDULES
1. The Permittee shall request renewal of this permit on Division -approved forms no later than September
2, 2023. [15A NCAC 02T .0105(b), 02T .0109]
2. If a public or community sewage system is or becomes available, the Permittee shall connect to this
system, and shall request rescission of the single-family residence wastewater treatment and irrigation
facilities permitted herein. [15A NCAC 02T .0607]
WQ0024301 Version 2.0 Shell Version 181105 Page 1 of 7

II. PERFORMANCE STANDARDS
The Permittee shall maintain and operate the subject non -discharge facilities so there is no discharge to
surface waters, nor any contravention of groundwater or surface water standards. In the event the
facilities fail to perform satisfactorily, including the creation of nuisance conditions due to improper
operation and maintenance, or failure of the irrigation areas to assimilate the effluent, the Permittee
shall take immediate corrective actions, including Division required actions, such as the construction
of additional or replacement wastewater treatment or disposal facilities. [15A NCAC 02T
.0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02T .0108(b)(1)(A)]
3. The Permittee shall apply treated wastewater effluent at or below the following rates:
TABLE 1— APPLICATION LIMITATIONS
Field
Parameter
Hourly Rate
Yearly Max
Units
1
01284 — Non -Discharge Application Rate
0.53
33.25
inches
[15A NCAC 02T .06050)]
4. The Permittee shall only apply treated wastewater effluent to the following:
TABLE 2 — IRRIGATION AREA INFORMATION
Field
Owner
County
Latitude
Longitude
Net
Dominant
AcreaLwe
Soil Series
1
Timothy S. and Tammy S.
Gilbert
Caswell
36.3541310
-79.1739780
0.19
N/A
[15A NCAC 02T .0I08(b)(1)(A)]
The attached Operation and Maintenance Agreement shall be a condition of this permit.
Noncompliance with the terms of the Operation and Maintenance Agreement shall subject the Permittee
to all sanctions under G. S. 143-215.6A, G.S. 143-215.613, and G.S. 143-215.6C for violation of or
failure to act in accordance with the terms and conditions of this permit. [ 15A NCAC 02T .0604(h)]
6. The Permittee shall connect the irrigation system to a rain or moisture sensor designed to prevent
irrigation during precipitation events or wet conditions. [ 15A NCAC 02T .0605(o)]
The compliance boundary is the property boundary. Any exceedance of groundwater standards at or
beyond the compliance boundary shall require corrective action. Division -approved relocation of the
compliance boundary shall be noted in Condition I1.4. Multiple contiguous properties under common
ownership and permitted for use as a disposal system shall be treated as a single property with regard
to determination of a compliance boundary. [ 15A NCAC 02L .0106(d)(2), 02L .0107(i), 02T .0105(h),
G.S. 143-215.l(i), G.S. 143-215.l(k)]
8. The review boundary is midway between the compliance boundary and the effluent disposal area. Any
exceedance of groundwater standards at or beyond the review boundary shall require preventative
action. [15A NCAC 02L .0108]
9. The Permittee shall apply for a permit modification to establish a new compliance boundary prior to
any sale or transfer of property affecting a compliance boundary (i.e., parcel subdivision). [15A NCAC
02L .0107(c)]
WQ0024301 Version 2.0 Shell Version 181105 Page 2 of 7

10. The facilities herein were permitted per the following setbacks:
a. The irrigation sites were originally permitted January 3, 2005. The setbacks for spray irrigation
sites originally permitted or modified from February 1, 1993 to August 31, 2006 are as follows (all
distances in feet):
i. Each habitable residence or place of assembly under separate ownership:
4001
ii. Each private or public water supply source:
100
iii. Surface waters:
100
iv. Groundwater lowering ditches:
100
v. Surface water diversions (upslope):
100
vi. Surface water diversions (downslope):
100
vii. Each well with exception of monitoring wells:
100
viii. Each property line:
150 2> 3
ix. Top of slope of embankments or cuts of two feet or more in vertical height:
15
x. Each water line:
10
xi. Each swimming pool:
100
xii. Public right of way:
50
xiii. Nitrification field:
20
xiv. Each building foundation or basement:
15
' Habitable residences or places of assembly under separate ownership constructed after the
facilities herein were originally permitted or subsequently modified are exempt from this
setback.
2 Setbacks to property lines are not applicable when the Permittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
3 Per easements recorded in the Caswell County Register of Deeds, the Permittee can convey
and irrigate treated wastewater through and onto an adjacent property under separate
ownership. The details of this easement are as follows:
Parcel No.
Deed Book / Page
Easement
0130 032
466 / 120
20 feet
0130 032
477 / 209
20 feet
[15A NCAC 02H .02190)(5)]
b. The storage and treatment units were originally permitted January 3, 2005. The setbacks for storage
and treatment units originally permitted or modified from February 1, 1993 to August 31, 2006 are
as follows (all distances in feet):
i. Each habitable residence or place of assembly under separate ownership (only 1001
applicable to surface sand filters):
ii. Each private or public water supply source: 100
iii. Surface waters: 50
iv. Each well with exception of monitoring wells: 100
v. Each property line: 50 2
vi. Nitrification field: 20
1 Habitable residences or places of assembly under separate ownership constructed after the
facilities herein were originally permitted or subsequently modified are exempt from this
setback.
WQ0024301 Version 2.0 Shell Version 181105 Page 3 of 7

2 Setbacks to property lines are not applicable when the Permittee, or the entity from which the
Permittee is leasing, owns both parcels separated by the property line.
[15A NCAC 02H .02190)(5)]
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The Permittee shall operate and maintain the subject facilities as a non -discharge system. [15A NCAC
02T .0600]
2. Upon the Water Pollution Control System Operators Certification Commission's (WPCSOCC)
classification of the subject non -discharge facilities, the Permittee shall designate and employ a certified
operator in responsible charge (ORC), and one or more certified operators as back-up ORCs. The ORC
or their back-up shall operate and visit the facilities as required by the WPCSOCC. [15A NCAC 02T
.0117]
3. The Permittee shall maintain vegetative cover on the irrigation sites, such that crop health is optimal,
allows even effluent distribution, and allows inspection of the irrigation system. [15A NCAC 02T
.0608(a)]
4. The Permittee shall take measures to prevent effluent ponding in or runoff from the irrigation sites
listed in Condition I1.4. [15A NCAC 02T .0608(b)]
5. The Permittee shall not irrigate treated effluent during inclement weather, or when the soil is in a
condition that will cause ponding or runoff. [15A NCAC 02T .0605(o)]
6. The Permittee shall only irrigate treated effluent from the single-family residence at 152 Hickory Flats
Rd, Leasburg, NC 27291 on the sites listed in Condition I1.4. [15A NCAC 02T .0601]
7. The Permittee shall not allow vehicles or heavy machinery on the irrigation area, except during
equipment installation or maintenance activities. [ 15A NCAC 02T .0608(d)]
8. The Permittee shall prohibit public access to the wastewater treatment and irrigation facilities through
lockable treatment units, and fencing around the irrigation sites. [15A NCAC 02T .0605(i)]
9. The Permittee shall dispose or utilize generated residuals in a Division -approved manner. [15A NCAC
02T I100].
10. The Permittee shall not divert or bypass untreated or partially treated wastewater from the subject
facilities. [15A NCAC 02T .0605(f)]
11. Pump tanks shall have audible and visual alarms external to any structure. [15A NCAC 02T .0605(n)]
12. Metering equipment shall be tested and calibrated annually. [ 15A NCAC 02T .0608(c)]
WQ0024301 Version 2.0 Shell Version 181105 Page 4 of 7

13. The Permittee is responsible for the operation and maintenance of the wastewater treatment and
irrigation system including the following:
a. Inspect the septic tank annually, and pump out solids as needed. Inspect and clean the septic tank
effluent filter annually.
b. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium
hypochlorite) as needed. Swimming pool grade chlorine tablets are not acceptable.
c. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all
pump/storage tanks when pumping the septic tank solids out.
d. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there
are no leaks; that vegetative growth does not obstruct the spray heads; that the irrigated wastewater
is not ponding in or running off the designated irrigation area; and that there are no objectionable
odors.
[15A NCAC 02T .0608]
IV. MONITORING AND REPORTING REQUIREMENTS
1. The Permittee shall conduct and report any Division required monitoring necessary to evaluate this
facility's impact on groundwater and surface water. [15A NCAC 02T .0108(c)]
2. Noncompliance Notification:
The Permittee shall report to the Winston-Salem Regional Office, telephone number [phone],
within 24 hours of first knowledge of the following:
a. Any process unit failure (e.g., mechanical, electrical, etc.) rendering the facility incapable of
adequate wastewater treatment.
b. Any facility failure resulting in a discharge to surface waters.
c. Any time self -monitoring indicates the facility has gone out of compliance with its permit
limitations.
d. Ponding in or runoff from the irrigation sites.
Emergencies requiring reporting outside normal business hours shall call the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. All
noncompliance notifications shall file a written report to the Winston-Salem Regional Office within
five days of first knowledge of the occurrence, and this report shall outline the actions proposed or
taken to ensure the problem does not recur. [15A NCAC 02T .0108(b)(1)(A)]
WQ0024301 Version 2.0 Shell Version 181105 Page 5 of 7

V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the wastewater
treatment and irrigation facilities. [15A NCAC 02T .0608(f)]
2. The Permittee shall inspect the wastewater treatment and irrigation facilities to prevent malfunctions,
facility deterioration, and operator errors that may result in discharges of wastes to the environment,
threats to human health, or public nuisances. The Permittee shall maintain an inspection log that
includes the date and time of inspection, observations made, and maintenance, repairs, or corrective
actions taken. The Permittee shall maintain this inspection log for a period of five years from the date
of the inspection, and this log shall be made available to the Division upon request. [15A NCAC 02T
.0608(e), 02T .0608(f)]
3. Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the wastewater treatment and irrigation facilities permitted herein
at any reasonable time for determining compliance with this permit. Division authorized
representatives may inspect or copy records maintained under the terms and conditions of this permit,
and may collect groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to a
Division enforcement action. [G.S. 143-215.6A, 143-215.613, 143-215.6C]
2. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, and Division -approved plans and specifications. [G.S. 143-215.1(d)]
3. Unless specifically requested and approved in this permit, there are no variances to administrative codes
or general statutes governing the construction or operation of the facilities permitted herein. [15A
NCAC 02T .0105(n)]
4. The issuance of this permit does not exempt the Permittee from complying with all statutes, rules,
regulations, or ordinances that other jurisdictional government agencies (e.g., local, state, and federal)
may require. [15A NCAC 02T .0105(c)(6)]
5. If the permitted facilities change ownership, or the Permittee changes their name, the Permittee shall
submit a permit modification request on Division -approved forms. The Permittee shall comply with
all terms and conditions of this permit until the permit is transferred to the successor -owner. [G.S. 143-
215.1(0)]
6. The Permittee shall retain a set of Division -approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0105(o)]
7. The Permittee shall maintain this permit until the proper closure of all facilities permitted herein, or
until the facilities permitted herein are permitted by another authority. [15A NCAC 02T .01050)]
WQ0024301 Version 2.0 Shell Version 181105 Page 6 of 7

8. This permit is subject to revocation or modification upon 60-day notice from the Division Director, in
whole or part for:
a. violation of any terms or conditions of this permit or Administrative Code Title 15A Subchapter
02T;
b. obtaining a permit by misrepresentation or failure to disclose all relevant facts;
c. the Permittee's refusal to allow authorized Department employees upon presentation of credentials:
i. to enter the Permittee's premises where a system is located or where any records are required
to be kept;
ii. to have access to any permit required documents and records;
iii. to inspect any monitoring equipment or method as required in this permit; or
iv. to sample any pollutants;
d. the Permittee's failure to pay the annual fee for administering and compliance monitoring; or
e. a Division determination that the conditions of this permit are in conflict with North Carolina
Administrative Code or General Statutes.
[ 15A NCAC 02T .0110]
9. Unless the Division Director grants a variance, expansion of the facilities permitted herein shall not
occur if any of the following apply:
a. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has been convicted of
environmental crimes under G.S. 143-215.6B, or under Federal law that would otherwise be
prosecuted under G.S. 143-215.613, and all appeals of this conviction have been abandoned or
exhausted.
b. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has previously abandoned
a wastewater treatment facility without properly closing the facility.
c. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid a civil
penalty, and all appeals of this penalty have been abandoned or exhausted.
d. The Permittee or any parent, subsidiary, or other affiliate of the Permittee is currently not compliant
with any compliance schedule in a permit, settlement agreement, or order.
e. The Permittee or any parent, subsidiary, or other affiliate of the Permittee has not paid an annual
fee.
[ 15A NCAC 02T .0120(b), 02T .0120(d)]
10. This permit shall not be renewed if the Permittee or any affiliation has not paid the required annual fee.
[I 5A NCAC 02T .0120(c)]
Permit issued this the lst day of February 2019
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
"
�mda Culpepper, Director
Division of Water Resources 0
By Authority of the Environmental Management Commission
Permit Number WQ0024301
WQ0024301 Version 2.0 Shell Version 181105 Page 7 of 7

DWR
Division of Water Resources
Permit No. WQ0024301
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM
OPERATION AND MAINTENANCE AGREEMENT
FORM: SFRWWIS-O&M 09-18
Permittee: Thomas J. and Valerie Gilbert Jr. (i.e., all deeded property owners)
County: Caswell
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
l . Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (if applicable)
3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets (e.g., calcium hypochlorite) as needed.
Swimming pool grade chlorine tablets are not acceptable. (if applicable)
4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if
applicable)
5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks
when pumping the septic tank solids out.
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks;
that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running
off the designated irrigation area; and that there are no objectionable odors. (if applicable)
7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that
vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not ponding in or running off
the designated irrigation area; and that there are no objectionable odors. (if applicable)
8. Maintain a set of Division -approved engineering plans and specifications.
9. Pay the required annual fee.
10. Request renewal of this permit on Division -approved forms no later than 180 days prior to expiration.
11. Sign and provide a Change of Ownershi.p a lication to any future owner of the single-family residence wastewater
treatment and irrigation system for their completion and submission to the Division of Water Resources.
We understand the above requirements a d agree to these terms as part of the issued permit.
Signature: 7/Date: OI
Signature
Signature
Signature:
Date: f)"?S^yQJ1
Date:
Date:
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRWWIS-O&M 09-18 Page i of 1

Unofficial Document Unofficial Document
•� CLL NC
Nov 00 =4 a W. ph
FEMSMMo1�
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NORTH CAROLINA DECLARATION OF SEWER EASEMENT
CASWELL COUNTY
THIS DECLARATION OF SEWER EASEMENT made this the t—�t day ofNovember, 2004, by Timothy
Scott Gilbert, and Wife, Tammy Stewart Gilbert, their heirs, successors and assigns, hereinafter referred to as
"parties of the first part"; their heirs, successors and assigns in Title to any part of the lands hereinafter described,
hereinafter referred to as "parties of the second part';
WITNESSETH:
THAT WHEREAS the parties of the first part are seized in fee simple absolute and are presently in
possession of two (2) tracts of land lying and being in Leasburg Township, Caswell County, North Carolina, which
tracts of land adjoin each other and one tract of land being more particularly described in Deed duly recorded in
Deed Book 298 on Page 706 of the Caswell County, N.C. Registry hereinafter referred to as Tract 1, containing
26.06 acres t and the other tract of land being more particularly described in Deed duly recorded in Deed Book 415
on Page 78 of the Caswell County, N.C. Registry hereinafter referred to as Tract 2, containing 8.53 acres f;
AND WHEREAS, the parties of the first part intend to convey Tract 2 and hereby agree to dedicate and
establish a permanent and perpetual sewer easement of right of way across a portion of Tract 1 for the benefit of
Tract 2, by providing off site sewer for Tract 2;
NOW, THEREFORE, in order that Tract 2 may be conveyed and used for residential purposes with offsite
sewer, the parties of the first part hereby dedicate and establish a permanent and perpetual sewer easement ofright of
way for the purposes of constructing, repairing and maintaining a sanitary septic tank and/or sewer system over and
upon Tract 1 for the benefit of Tract 2 with said sewer easements being described as follows;
Being that permanent and perpetual twenty foot (20') sewer easement of right of way and that 0.32
acrest sewer easement of right of way, running with the land to serve Tract 2 for the purposes of
constructing, repairing and maintaining a sanitary septic sand and/or sewer system. Said sewer
easements extends over and upon Tract 1, that is located in Leasburg Township, Caswell County, N. C.
and being situated to the east of and adjoining Tract 2. Said sewer easements are more particularly
described and depicted on plat of survey entitled "Plat of Survey for Harold D. Goff', dated June 21,
2004 made William Conway Moorefield, P.L.S., Said plat duly recorded in the Caswell County, N.C.
Registry in Plat Book /S on Page q62 is incorporated herein and made an integral part of this
description by express reference thereto.
IN TESTIMONY WHEREOF, said parties have hereunto set their hand and seals the day wherein first
above written.
(4-A A 4 -4*-? � -11 (SWL)
' TIMO`1W SCOTT GILBERT
i44A% 4 Ct—ZahA-CrQ V+ (SEAL)
TAMMY STEWART GILBERT

Unofficial Document Unofficial Document
NORTH CAROLINA $ 4M PAM 121
CASWELLCOUNTY
], t�GtPsz lIV 1 �rat4U2l , a Notary Public for said County and State, do hereby certify
that i ersonally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the�day of November, 2004.
o iry Public
1, &Ph%. / , a Notary Public for said County and State, do hereby certify
that At 5t' dr e i/LIrt personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
l and official seal, this therN—'—' day of Novemb , 2004.
Public
COUNTY
The foregoing certificate(s)of Karen W. Daniel
Notary Public of Caswell County, North Carolina is certified to be correct. Filed for registration in
the Caswell County Register of Deeds Office at 2: 4g : 25wm./p.m. on the 8th day ofNov.
2004, and recorded in Deed Book 466 page 1 O .
Delores S. Dameron
REGISTER OF DEEDS Caswell County
r
Tammy W. Riggs - Assistant
H:\Docwn W\REALP\G\Gilbmt FavcmenLdw

Unofficial Document Unofficial Document
FUM h CASML GuM% NC
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NORTH CAROLINA GENERAL WARRANTY DEED
Kloomments%REA KWarranty oeedslGH-1.AG1bed to Gilbert.4-19-
05.doc
Excise Tax $00.00 Racordin Time, Book and Peg e
Tax Map No.
Verified by
by
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Mail after recording to
Parcel Identifier No. 0042 (Portion M_
vCounty on the day of
This instrument was prepared by William H. Daniel, Attoiney at Law, P.O. Box 417, Yanceyvill% North Car olina, 27379
Brief description for the Index 1.35 Acres t, Leesburg Township
THIS DEED made this 18 day of May , 2005 ,by and between
GRANTOR
TIMOTHY SCOTT GILBERT
THOMAS JOSEPH GILBERT, JR., Married
And Spouse,
154 Hickory Flats Road
TAMMY STEWART GILBERT Leesburg, NC 27291
Enter In appropriate block for each party: name, address, and, If appropriate, character of enflty, e.q. corporation
or partnership.
The designation Grantor and Grantee as used herein shall include said parties, glair heirs, successors, and assigns, and
shall include singular, plural, masculine, feminine or neuter as required by context.
W ITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that
certain lot or parcel of land situated in the City of Leasburp Township,
Caswell County, North Carolina and more particularly described as follows:
All that certain parcel or tract of land lying and being in Leesburg Township, Caswell County, North Carolina,
being Lot 1-A , containing 1.35 acres f as shown on a plat of survey entitled "Plat of Survey for Timothy Scott
Gilbert, made by W. C. Moorefield, P.L.S. dated March 15, 2005, Said plat duly recorded in the Caswell
County, N.C. Registry in Plat Book 15 page 564 and is by express reference thereto incorporated herein as an
integral part of this description for the purpose of augmentation.
All that certain lot or parcel of land lying and being in Leasburg Township, Caswell County, North Carolina, being Lot 1-A ,
containing 135 acres f as shown on a plat of survey entitled "Plat of Survey for Timothy Scott Gilbert, made by W. C. Moorefield,
P.L.S. dated March 15, 2005. Said plat duly recorded in the Caswell County, N.C. Registry in Plat Book 15 on Page 564 and is by
express reference thereto incorporated herein as an integral part of this description for the purpose of augmentation.
In addition to the above described lot or parcel of land, the Grantors convey unto the Grantee a permanent and perpetual 20' sewer
easement of right-of-way across and upon land of the Grantors, running with the land for the purposes of constructing, repairing and
maintaining an underground sewer line for a sanitary septic/sewer system. Said sewer casement extends from the common boundary
line of the above described property in a Southeastemly and Eastemly direction over and upon land of the Grantors (Lot 1) as more
particularly shown and depicted on the above referenced Plat of Survey. The Grantors also convey unto the Grantee, for the purposes
of constructing, repairing and maintaining an underground sewer tine for a sanitary septic/sewer system, that connecting 20' sewer
casement of right-of-way to the above described easement and that 0.32 acres} sewer easement of right-of-way (being perpetual and
running with the land herein conveyed) as more particularly shown and depicted on Plat of Survey duly recorded in Plat Book 15 on
page 458 and described in deed duly recorded in Deed Book 466 on Page 120 of the Caswell County, N.C. Registry.
TITLE NOT EXAMINED

Unofficial Document Unofficial Document
8OO1L 177 PAGE 21O
The property hereinabove described was acquired by Grantor by instrument recorded in Book 415 on Page 78
Caswell County, NC Repislry
A map showing the above described property is recorded in Plat Book page
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to
the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey
the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and
defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
a) Any and all recorded and unrecorded easements and right of ways over and across subject property, including
those for public utilities and highways and restrictive covenants, if any.
b) Any and all defects of property environmental or otherwise which may be revealed by property investigation
and/or on site inspection.
c) Any and all valid recorded and unrecorded leases applicable to property, which would postpone possession by
Grantee as well as any and all filed and un-filed claims of lien by materialmen or laborers applicable to subject property.
d) Any inaccuracies and discrepancies which an up4o-date survey may reveal.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused this
instrument to be signed in its corporate name by its duly authorized officers and its seal to be hereunto affixed by authority
of its Board of Directors, the day and year first above written.
USE BLACK ONLY
iWi i rOURN 93 ,
Sr r e Name TIMOTHY S OTT GILBERT
(S)
By in 39101the1977 M' �
Sire,
NOMCrO urnstitan /Nil r�9�
�.tiZ subcy;ta and 1Mt
ATTEST: hm bew paid 68 Yd/�
rate Seal)
TAMMY EWART GILBERT (SEAL)
(SEAL)
(SEAL)
NORTH CAROLINA, CASWELL County.
a Notary Public of the County and State aforesaid, certify that
hIMOTHY SCOTT GILBERT and TAMMY STEWART GILBERT Grantor,
)brsonally appeared before me this day and acknowledged the execution of the foregoing
instrument. Witness my hand and official stamp or seal, this day of
2005
My commission expires:
Public
SEAL -STAMP NORTH CAROLINA, County.
I, a Notary Public of the County and State aforesaid, certify that personally came before me this day and acknowledged that —he is Secretary of
a North Carolina corporation, and that by authority
duly given and as the act of the corporation, the foregoing instrument was signed in its name by
President, sealed with its corporate seal and attested by
as Secretary.
Witness my hand and official stamp or seat, this day of
My commission expires:
The foregoing Certificate(s) of nary. u .
Notary Public
is/are certified to be correct. This instrument and this certificate are duly registered at the date and time and in the Book
and Page shown on first page hereof.
Delores S. Dameron REGISTER OF DEEDS FOR Caswell County
By Deputy/Aaek to — Register of Dead.

c
HAROLD D. GOFF
DB. 303\419, MB. 12\252
TIM 130\37
1-A
1.35 ACS +N-
CARL BOOTHBY 8 ETAL
DB. 415\715
TIM 130\39
LEASBURG, TWSP.
CASWELL,COUNTY, NC
PLAT OFSURVEY FOR
TIMOTHYSCOTT GILBERT
3N 15,02 SCALE 1-- 100'
NOTE: LOT SURVEYED 312110
,Y*4 . RCccas a Lo* 1-q if.
pcovUd i 4y eascwA w+s
lt4esae�bal to 08.3ASPS�tt, 4 a.:� IWa...
Mo. la,Pg. FOa am ai(B:tJ� .pi I I •'"
IO.m IIICASiCLt 1Calmly. 1 m
r 1D 7DI A LON All
SM 15 PAGE 564
W.C. MOOREFIELD
P.O. BOX 69
YANCEYVILLE N.C. 27379
I. WILL IAM CONWAY MOOREFIELD CERTIFY THAT
THIS PLAT WAS DRAWN UNDER MY SUPERVISION FROM AN ACTUAL
SURVEY MADE UNDER MY SUPERVISION (DEED DESCRIP-
TION RECORDED IN BOOK ?a____.PAGE 41B _.ETC.)
(OTHER): THAT THE BOUNDARIES NOT SURVEYED ARE CLEARLY
INDICATED AS DRAWN FOR INFORMATION FOUND IN BOOK
Y4 12 ,PAGE __=.--:THAT THE RATIO OF PRECISION AS CALCULATED
IS Ii 10000t:THAT THIS PLAT WAS PREPARED IN ACCORDANCE
WITH G.S. 47-30 AS AMENDED.WITNESS MY ORIGINAL
SIGNATURE.REGISTRATION NUMBER AND SEAL THIS
' DA
Y
OF ja�_. A. D. j [Bf .
PtN��O
ro "440' L
T Fes_ a r o 0
SURVEYOR L-1213 a '12f5 . o
\y0 6 SURY.•, ,
NORTH CAROL INA, CASWELL,COUNTY
Filed for registration in the office of Register of Deeds of
of M. on the day of
20 and recorded in book page
egister or Ileeds
„IAI E OF NORTH CAROIYM
COUNTY OF CASINEtL
1 CERTIFY THAT THEMAPOR"
TO VVIiICH THIS CERTFFICATIOM
A E OR
REQUIREMENTS STATUTOFty
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TIM 130\10
CARL R. ANDERSON- DB. 340\324,MB. 11 \750, 10,343
PARENT TRACT
TAX MAPN ( --IN—) PARCEL#
SEE MB. 151456
LEGEND
O EXISTING IRON
11ori��$M�bjW ^�
O IRON PLACED
❑ STONE FOUND
• MATHEMATICAL PT.
^�. CREEK DRAIN OR RD.
CNPL OVERHEAD POWER LINE
THIS SURVEY HAS BEEN PREPARED WITHOUT
ON OVERHEAD TELEPHONE LINE
P.P. POWER POLE
THE BENEFIT OF A TITLE REPORT
W.V. WATER VALVE
F. H. FIRE HYDRANT
AND DOES NOT THEREFORE NECESSARILY INDICATE
TN TAX MAP B PAGE
ALL ENCUMBRANCE ON SAID PROPERTY.
AREA BY COORDINATES
100 0 100 200 300
T., pw <vapt f�ISPYmiri�ir 4ltirro
GRAPHIC SCALE - FEET Y..aLm1. v w 32le V�
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FILE SNAKE SCREEN FILE T-GaBER Siveos
� %WO /.o YLS mow•% is •.... .
" ,L�ecptiA6iY�.N3FY'on"
By: I.W.C.MDOREFIELD DO CERTIFY THAT THIS MOP IS ONE OF THE
Assistant/Deputy FOLLOWING.AS INDICATED.
-- (A) THIS SURVEY DOES CREATE A SUBDIVISION AS DEFINED BY COUNTY ORDINANCE:
(0) THIS PARCEL IS LOCATED IN A UNREGULATED PORTION OF COUNTY ORLUNICIPALITY:
__ (C) THIS SURVEY IS OF AN EXISTING PARCEL OR PARCELS OF LAND:
(D) THIS SURVEY IS ONE OF THE FOLLOWING:
1 RECCI.B INATION OF EXISTING PARCELS.
2 A CCURT-ORDERED SURVEY.
_r 3 OTHER EXCEPTION TO THE DEFINITION OF SUBDIVISION ADD ON i� *_ '
_<E) I AM UNABLE TO HAKE A DETERMINATION TO THE BEST OF MY PROFESSIONAL
�ABIL ITY AS TO PROV IS I DNS CONTAINED IN (A) THROUGH (D) ABOVE.
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