WQ0001664_More Information Received_20191216

Initial Review
INITIAL REVIEW
Reviewer Thornburg, Nathaniel
Is this submital an
application?*
r Yes r No
Is this a complete
application?* Complete App Date
r Yes r No
Project Number* WQ0001664
Applicant/Permittee Carolina Water Service Inc. of North Carolina
Applicant/Permittee P.O. Box240908
Address
Is the owner in BIMS? Is the facility in BIMS?
r Yes r No r Yes r No
Owner Type
Facility Name Belvedere Plantation WWTF
County
Fee Category
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if
non -application)
Email Notifications
Does this need O Yes
review by the r No
hydrogeologist? *
Regional Office Wilmington
Fee Amount

CO Reviewer Tessa Monday: eads\trmonday
Admin Reviewer
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notification
Comments for Kendall
Comments for RO
Comments for Reviewer
Comments for Applicant

Submitted Form
Project Contact Information
Rease provide inforrration on the person to be contacted by MB Staff regarding electronic subnittal, confirmation of receipt, and other issues.
........................................................................................................................................................................................................................................................................................................................................................................
Name * Brent Milliron
Email Address*
Brent. [e-mail]
Project Information
.........................................................................................
Submittal Type* r New Permit Application
r Renewal
r Annual Report
Permit Type * r Wastewater Irrigation
r Other Wastewater
r Closed -Loop Recycle
r Single -Family Residence
Wastewater Irrigation
Is a paper copy of the application being submitted?*
r Yes r Nor N/A
Permit Number* WQ0001664
Phone Number*
704-319-0504
Applicant\Permittee * Carolina Water Service Inc. of North Carolina
Applicant/Permittee P.O. Box240908
Address*
Facility Name * Belvedere Plantation WWTF
r Modification (Major or Minor)
r Additional Information
r Other
r High -Rate Infiltration
r Reclaimed Water
r Residuals
r Other
Please provide comments/notes on your current submittal below.
Please attach all information required or requested for this submittal to be review here.
Application Form Engineering Rans, Specifications, Calculations, Etc.)
WQ0001664 Additional Information Packet
489.64KB
12122019.pdf
upload only 1 RJF document. Nlaltiple documents must be corrbined into one RJF file.

For new and modification permit applications, a paper copy may be required. If you have any questions
about what is required, please contactthe reviewer or Tessa Monday. If a paper --polka*-ion is required,
be advised, applications accepted' far pre -review until both the paper and eIect-c-,i_ co1)ies nave been
received. The paper copy shall include the following:
o Application Form
o All relevant attachments (calcs, soils report, specs, etc.)
o One full-size engineering plan set
o One 11x17" engineering plan set
o One extra set of specifications
o Fee (if required)
MallinE address:
❑iuision of Water Resources1 Division of Water Resources
Non -Discharge Branch I Non -Discharge Branch
1617 Mail Service Center 1 Aft: Nathaniel Thornburg, 91° Floor, Cfice #942W
----------------------------------------------------------- -----------------------------------------
Raleih, NC 27699-1617 512 N. Salisbury St.
Far questions or problems contact Tessa Monday [e-mail] or 919.707.3560.
* W By checking this box I acknowledge that I understand the application will not be accepted
for pre -review until the paper copy (if required) and fee (if required) have been received by
the Non -Discharge Branch. 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).
Signature
Submission Date 12/12/2019

Carolina Water Service
of North Carolina'"
December 12, 2019
Tessa Monday
Environmental Engineer
Division of Water Resources
512 N Salisbury Street
Raleigh, NC 27604
Re: Additional Information Request; Application No. WQ0001664 Belvedere Plantation WWTF
Ms. Monday,
The additional information that you have requested for our Belvedere Plantation WWTF
(WQ0001664) application has been attached.
1. Agreement for Disposal of Treated Effluent.
2. Map showing the reclaimed water irrigation.
3. Setback waiver for the treatment unit.
4. Within the "Agreement for Disposal of Treated Effluent", additional wording has
been put in to comply with 15A NCAC 02L .0107(f)
We appreciate your assistance that you have provided while we worked through this process.
If you have any further questions, please do not hesitate to reach out to Dana Hill (704) 269-
2540 or myself [phone].
Sincerely,
Brent Milliron
Regulatory Compliance Manager
Carolina Water Service of North Carolina
• 4944 Parkway Plaza Blvd. Suite 375 • Charlotte, North Carolina 28217 9800-525-7990

1. Agreement for Disposal of Treated Effluent
Prepared By and Return to:
Chris Ayers
301 Fayetteville St.
Suite 1900
Raleigh, NC 27601
STATE OF NORTH CAROLINA
COUNTY OF PENDER
Agreement for Disposal of Treated Effluent
This Agreement for Disposal of Treated Effluent (the "Agreement") is made by and between
Carolina Water Service, Inc. of North Carolina ("CWSNC") and DMB Belvedere, LLC ("Owner"), effective
January 1, 2013 (the "Effective Date").
WHEREAS, CWSNC as successor to Belvedere Utility Development, LLC and Owner as successor
to Bridgewater Golf Properties, Inc. are successor parties to a certain Easement and Maintenance
Agreement dated March 5, 2004 and recorded with the Pender County Register of Deeds at Book 2336,
Page 155 (the "Easement"); and
WHEREAS, CWSNC succeeded to the interests of Belvedere Utility Development, U.0 in and to
the Easement via a Bill of Sale and Assignment of Easement and Maintenance Agreement, dated
October 6, 2009 and recorded with the Pender County Register of Deeds at Book 3703, Page 0018 (the
"Bill of Sale"; and
WHEREAS, CWSNC operates a wastewater treatment facility that disposes treated wastewater
through effluent disposal facilities as more fully described and defined in the Easement as the "Effluent
Disposal Facilities" located on the Belvedere Golf Course (the "Golf Course") more particularly described
in that certain deed recorded in Book 3872 at Page 226, Pender County Registry;
WHEREAS, CWSNC owns the Effluent Disposal Facilities up to and including the effluent
irrigation pump(s);

WHEREAS, Owner owns and operates the Golf Course and Owner operates that portion of the
Effluent Disposal Facilities that disposes treated wastewater onto the Golf Course from the point that
the effluent leaves the holding pond effluent pump (herein the "Effluent Irrigation System");
WHEREAS, Owner incurs certain costs in connection with its operation and maintenance of the
Effluent Irrigation System and seeks reimbursements of such costs from CWSNC;
WHEREAS, CWSNC agrees to establish a compensation arrangement with Owner for the regular
operation of the Effluent Disposal of treated wastewater via the Effluent Irrigation System;
NOW THEREFOR, In consideration of the sum of ten dollars ($10.00) and other good and
valuable consideration recited herein, CWSNC and Owner agree as follows:
1. (a) Owner shall regularly dispose of treated wastewater from the Effluent Disposal
Facilities on the Golf Course using the Effluent Irrigation System in compliance with the
requirements contain in NCDENR Permit No. WQ0001664 issued to CWSNC on October
3, 2007 and as amended or renewed from time to time by the appropriate regulatory
authority (the "Permit'). Owner shall maintain the Effluent Irrigation System and the
Golf Course in a manner that allows regular disposal of treated wastewater in
compliance with the Permit. CWSNC shall maintain its portion of the Effluent Disposal
Facilities in compliance with the Permit.
(b) Owner shall at all times comply with the following provisions of the Permit. Section I,
Paragraphs 9 and 10; Section II, Paragraphs 4, 5, and 6; Section III, Paragraph 4. CWSNC
shall at all times comply with all other provisions of the Permit.
(c) Owner shall monitor the level of the 20-day effluent holding pond located adjacent
to the driving range on the Golf Course to ensure compliance with the Permit and
ensure that the treated wastewater is disposed of in accordance with all local, state and
federal requirements. Owner will dispose of treated wastewater and operate the
Effluent Irrigation System in a manner that will maintain a freeboard level of greater
than 2 feet at all times, subject to the conditions in section 1(d) below.
(d) Owner shall not be required to dispose of treated wastewater on the Golf Course
during a weather event involving precipitation; when the ground is in a condition that
will cause runoff; or when in the reasonable opinion of the Owner disposal may violate
the Permit.
(e) In the event Owner is unable to dispose of treated wastewater on the Golf Course
for more than a 72 hour period pursuant to section 1(d) above, Owner will make
reasonable efforts to notify CWSNC of the inability to spray, but Owner shall incur no
liability in the event it fails to provide notification.
(f) No water suppiv wells shall be constructed or operated within the compliance
boundary of the Permit and CWSNC and the North Carolina Department of
Environmental Quality Division of Water Resources shall at all times have the right to
enter onto the property within the compliance boundary for purposes of groundwater
monitoring and remediation

2. (a) CWSNC pay Owner $0.006 per gallon of treated wastewater that is disposed on the
Gold Course via the Effluent Irrigation System measured by the meter at the pump
located at the outtake of the 20-day effluent holding pond. Each year, on the
anniversary date of this agreement, the per gallon fee shall be adjusted equal to the
previous year's inflation as measured by the U.S. Bureau of Labor Consumer Price Index.
(b) CWSNC and Owner shall each record the meter readings monthly. Owner will submit
a monthly invoice to CWSNC and CWSNC agrees to render payment to Owner within 30
days of each invoice (the "Monthly Charge").
(c) CWSNC shall not be obligated to make any additional payment to Owner beyond the
Monthly Charge for the operation or maintenance of the Effluent Irrigation System.
Including, but not limited to, any payments that would have otherwise been due and
payable under the Easement.
3. Upon request of CWSNC, Owner agrees to provide documentation of all expenses
incurred related to the operation, maintenance and repair of the Effluent Facilities.
Owner agrees to cooperate with CWSNC in providing such expenses to the extent
required by the North Carolina Utilities Commission or the North Carolina Utilities
Commission Public Staff.
4. Except for losses, damages, or claims arising solely out of the negligent acts or omissions
or willful misconduct of CWSNC, its agents, contractors or employees, Owner agrees to
indemnify or defend at CWSNC's sole option) CWNNC, its successors and signs, and hold
it harmless against any loss, damage, liability, penalties, expenses or cost, including
reasonable attorneys' fees, resulting from or arising out of Owner's use and operation of
the Effluent Irrigation System or any breach by Owner's of its obligation under this
Agreement. Except for losses, damages or claims arising solely out of the negligent acts
or omissions or willful misconduct of Owner, its agents, contractors or employees,
CWSNC agrees to indemnify (or defend at Owner's sole option) Owner, its successors
and assigns, and hold it harmless against any loss, damage, liability, penalties, expense
or cost, including reasonable attorney's fees, resulting from or arising out of CWSNC's
use and operation of the Effluent Disposal Facilities (other than the Effluent Irrigation
System) or any breach by CWSNC's of its obligations under this Agreement.
5. The initial term of this Agreement shall be two (2) years from the Effective Date and
shall automatically renew for subsequent one (1) year terms unless either party
provides written notice to the other party at least thirty (30) days prior to the end of the
initial term or any renewal term, as the case may be.
6. Unless otherwise explicitly amended herein, this Agreement does not modify the rights
or obligations of the parties under the Easement or the Bill of Sale, the terms of which
are hereby ratified and confirmed.

7. The Agreement shall be governed as to all matters by, and shall be construed and
enforced in accordance with, the laws of the State of North Carolina, without regard to
principles of choice of law.
8. This Agreement may be executed in any number of counterparts, each of which shall be
deemed an original, but all of which together shall constitute one and the same
instrument.
9. If any provision of this Agreement or the application thereof to any person or
circumstance shall be invalid, illegal or unenforceable to any extent, the remainder of
the Agreement and the application thereof shall not be affected and shall be
enforceable to the fullest extent permitted by law.
10. This Agreement shall be binding upon and inure to the benefit of the parties hereto and
their respective successors and signs. In the event the Golf Course is conveyed by Owner
to a third party, this Agreement and the obligations described herein shall run with the
land and be binding on the subsequent owner of the Golf Course.
11. All notices given pursuant to this Agreement, or required by related matters between
the parties shall be deemed made when addressed to the proper party and sent by
certified mail, facsimile or electronic mail to the following addresses:
If to Owner: Jack Broadbridge
DMB Belvedere, LLC
2368 Country Club Road
Hampstead, NC 28443
If to CWSNC: Brent Milliron, Compliance Director
Carolina Water Service, Inc. of North Carolina
PO Box 240900
Charlotte, NC 28224-0908

IN WITNESS WHEREOF, the parties hereto have executed this Agreement through their duly
authorized officers or member/manager as of the Effective Date.
DMB Belvedere, LLC
By:
N a rn eV I,e /+V 13R0 4-/7ty tneLf
Title: jJ' 11110
Carolina W r Krvice, Inc. o North rol'
By: 2
Name: SgQe a Mewdef i o4L L.
Title: DO of QPurltaweS

STATE OF NORTH CAROLINA
COUNTYOF
I certify that the following person(s) personally appeared before me this day, each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated therein and in the
capacity indicated: ].d of DMB Belvedere, LLC.
Date: A, � day of I , , 2019.
Official Signature of Notary: � ��
Notary's Printed or Typed Name: p — 0.11 Notary Public
My Commission Expires: Zs f&S j,0v3
(Official Seal)
DANA HILL
NOTARY PUBLIC
GREENE COUNTY, NC
My Comnission Expires 02-25- 19t 6
STATE OF NORTH CAROLINA
COUNTYOF
I certify that the following person(s) personally appeared before me this day, each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated therein and in the
capacity indicated: ]. d,_.. Cl. �. ~.�i of Carolina Water Service, Inc. of
North Carolina.
Date: 1 4"` day of .. 2019.
Official Signature of Notary:
Notary's Printed or Typed Name:-)..-- 0:11 , Notary Public
My Commission Expires: 25
(Official Seal)
DANA HILL
NOTARY PUBLIC
GREENE COUNTY, NC
My Commission Expires 02-25- 2�

2. Map of Reclaimed Water Irrigation
3. Setback Waiver
Doc No: 20056914
Recorded: 12/04/201912:54.02 PM
Fee Amt: $26.00 Page 1 of 2
Pender County North Carolina
Sharon Lear Willoughby, Register of Deeds
BK 4699 PG 362 - 363 (2)
"/DANA HILL
CAROLINA WATER SERVICES
State of North Carolina
Department of Environmental Quality
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), .0706(a) AND .1006(a)
I, L„� (printed name), certify that I am a deeded owner or an
authorized agent of the property located at:
Address: —Parcel No.: V2 03.1 7 • VI Rf • 0000
City: State: N Zip Code: 2Sggs County: A-J"
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/Infiltration 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 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.
E' f Wastewater Treatment and Storage Unit Setback to Property Lines
The required setback of So feet is reduced to 5 feet, thereby allowing the construction of
wastewater treatment and storage units no closer than _T 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.
.n
Signature: /Ind 6 4"4 PU t" , , ,,Date: l�
FORM: h}UWSW 02-19 Page 1 of 2

Bk 4&%
P9 363
Applicant/Permittee: (�..o I r. W.1<. 5.. ,;. <g N c Permit No.: Wq oco i t,.g
Address: IZ6 a.,,�„� �,;,,� Parcel No.: N2o;.IL- yg2--1 - 0000
City: State: TAc Zip Code: 9v3 County: P(,4,,
NORTH CAROLINA, COUNTY
I, -1 a. .. i :i l 4, , a Notary Public for Cr<,.. County, North Carolina,
do hereby certify that 1,.�C 1� fo.�1 b,: �., personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 3,1 day of , 1.,1
SEAL
DANA HILL Signature of Notary Public
NOTARY PUBLIC
GREENE COUNTY, NC My commission expires 2-25 - a3
M�ksionF.z�eso2-z� toaa
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

4. See #1 for addition of 15A NCAC 02L .0107(f)