WQ0035809_Setback Waiver_20190925

Type: CONSOLIDATED REAL PROPERTY
Recorded: 2/26/2018 4:36:24 PM
Fee Amt: $26.00 Page 1 of 5
Onslow County, NC
Rebecca L. Pollard Reg. of Deeds
BK 4742 VU 479 - 483
a . ° � 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), Neu06(a) AND .1006(a) ON I
I, The Board of Trustees of the Endowment Fund'of.North Carolina State Lfniversity at Raleigh, an entity
created and existing pursuant to N.C.G.S. § 116-3o of the laws of the State of North Carolina, certify that I
am a deeded owner of the property located at,
Address: 105 Forestry Center. Circle =Parcel No.: 44810.0404531
City: Maysville State: NC Zip Code; 28555 County: Onslow
I, NC State Natural Resources Foi ndation % Inc., a North Carolina non-profit corporation, .certify that hold
a reversionary interest in the property located at: E
Address: 105 Forestry Center Circle Parcel No.: 448100404531VON : ' • ;;
ON
City. Maysville State, NC Zip Code: 28555 County: Onslow
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 ApplicantJPermittee listed on the following
page•
® I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from 100 feet to 50 feet, thereby allowing the application of
wastewater effluent as near as 50 feet from my property line.
�U00260591) FORM: NDWSW 03-
17 Page 2 of 2
RALEIGH 519140,1
submitted electronically by "zanier,
in compliance with North Carolina
Fountain & ceruzzi"
statutes governing
recordable
documents
and the terms
of the submitter agreement
with the
onslow County
Register of Deeds.
Book: 4742 Page: 479 Page 1 of 5

❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
application of wastewater effluent as near as feet from my residence.
I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from. feet to -.feet, thereby allowing the construction
of wastewater treatment and storage units as near as _ feet from my property line.
❑ I understand the setback requirements set forth in 15A NCAC 02T. For the parcel identified
above, I consent to a reduced setback from feet to feet, thereby allowing the
construction of wastewater treatment and storage units as near as feet from my residence.
Signature:
Date:
On behalf of The Board of Trustees of the Endowment Fund of North Carolina State University at Raleigh
NORTH CAROLINA,
COUNTY
I, 1, iL�(�0���� �• r'' 1-Vw Notary Public for Vy County, North Carolina,
to hereby certify that 5� �personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness m hand and official seal, this the day of
y A
MARGARET A DAVIS
NOTARY PUBLIC
WAKE COUNTY, NC
My Commission Expires S-1 •201l
(N0026059.1J
Signature of Natary Public I (��
My commission expires I `"` o U
Book: 4742 Page: 479 Page 2 of 5

Signature:
On behalf of NC State Natural Resources Foundation, Inc.
f
Date:
NORTH UA�ROLINA, W A i Ne, COUNTY
1, Vi G IS , /ta d ey a Notary Public for / Iq �
�V County, North Carolina,
do hereby certify that _ �� S P of -�a r personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the /,3 day of r 2017.
SEAL
�L{'+► aVB41G
(N002fi059.1)
�; Signature of Notary Public
r
My commission expires 6 old
Book: 4742 Page: 479 Page 3 of 5

Applican[/Pei7nittee: OId North State Water (amx�any. LLC
AdcJress: 4700 Homewood Ct.. Ste. 108
City; Ralei h State: NC7.,ip Code: 27609 County: Wake
Signature;
Un behalf of Uld North State Vb'ater Comptuiy, LLC
NORTH CAROI,INA1 0 W
- GOUN'1'Y
(, �Aw_l 1 a IACI &4 Notary Public for County; North Carolina,
do hereby certify that 1 11 �1J11f1VJ personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the Mnday of , 2017.
Notary Public
Wake d
County
My Comm. Exp.
2 10-29-2022
%0'QTh CAWO�'�aP�`
Sigita�i�re of No�ar�� Public
My commission cepires
Once notarized, this fof'6`l'�1ia11 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
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, North Carolina 276994617
1N0026059.1�
Book: 4742 Page: 479 Page 4 of 5

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This map may not be a certified survey and has
been reviewed by a local government agency for '
compliance with any applicable land development regulations
and has not been reviewed for compliance with recording
requirements for plats.
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