WQ0012475_Application_20210106

Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0012475
Applicant/Permittee Michael F. and Kimberly R. Tenoever
Applicant/Permittee Address 6225 Wake Forest Hwy, Durham, NC 27703
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Individual
Facility Name 5903 Wake Forest Hwy. SFR
County Durham
Fee Category Single -Family Residence
Is this a complete
application?*
c Yes r No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount $0
Complete App Date 01/06/2021
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff
Name * Michael F. Tenoever
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ ......... ....................................................................................................................................... .
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
9192263737
O Modification - Minor
C Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
c Change of Ownership
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:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
r Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WQ0012475
Fbs Current Existing permt number
Applicant/Permittee *
Michael F. and Kimberly R. Tenoever
Applicant/Permittee Address*
6225 Wake Forest Hwy, Durham, NC 27703
Facility Name *
5903 Wake Forest Hwy. SFR
Please provide comments/notes
on your current submittal below.
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 Fans, Spec'rfications, Calculations, Rc.)
DWR Septic Transfer - Clements to Tenoever 1.pdf 2.56MB
Upload only 1 FDFdocurrent (less than 250 M3). IvL@iple documents nest be corrbined into one FDFfile unless file is larger than
upload limit.
* W 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 01-06-2021
Is filled in autorratically once subrritted.

State of North Carolina
Department of Environmental Quality
Kim
DW Division of Water Resources
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION
This form is for ownership changes or name changes of a non -discharge system permit. Please note that "Permittee"
references the existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
A. Non -Discharge Permit Ownership/Name Change (FORM: NDPONC 06-16) Application (All Applications):
❑ Submit an original completed and appropriately executed Non -Discharge Permit Ownership/Name Change (FORM: NDPONC
06-16) application.
❑ The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106 b . Per ISA NCAC 02T
.0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106 b . Per 151A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (Alt Applications):
❑ Submit a copy of the most recently issued permit.
C. Property Ownership Documentation (All Applications):
➢ Per 15A NCAC 02T .0504 , 1SA NCAC 02T .0604(e), 15A NCAC 02T .0704(f), 15A NCAC 02T .0804, 15A NCAC 02T
.1004(d), 15A NCAC 02T. I 104(d)(7), 15A NCAC 02T .l 104(e)(5), 15A NCAC 02U .0201 e or 15A NCAC 02U .0202 ,
the Applicant shall demonstrate they are the owner of all property containing the non -discharge system facilities:
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Written notarized lease agreement that specifically indicates the intended use of the property and has been signed by both
parties, as well as a plat or survey map. Lease agreements shall adhere to the requirements of 15A NCAC 02L .0107.
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the. Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (All Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to
be sold):
➢ Home/Pronertv Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agree entFORM: HOA .
❑ Per 15A NCAC 02T .01 15c , submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b, submit an original of the properly executed Operational Agreement FORM: DEV .
F. Operation and Maintenance Agreement (All Applications for Single -Family Wastewater Irrigation Systems):
❑ Per 15A NCAC 02T .0604(h), submit an original of a notarized Operation and Maintenance Agreement (FORM: SFRWWIS
O&M) that has been signed and dated by all deeded property owners.
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone] FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: NDPONC 06-16 & SUPPORTING DOCUMENTATION Page 1 of I

Water Resources
ENvtNONMENTAL QUALITY
DRAFT
MERRICK R. AND PEGGY CLEMENTS
5903 WAKE FOREST Hwy.
DURHAM, NORTH CAROLINA 27703
Dear Mr. and Mrs. Clements:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Permit No. WQ0012475
5903 Wake Forest Hwy. SFR
Single -Family Residence
Wastewater Irrigation System
Durham County
I.n accordance with your permit renewal request received on April 4, 2018, we are forwarding
herewith Permit No. WQ0012475 dated DATE OF PERMIT, to Merrick R. and Peggy Clements for the
continued operation of the subject single-family residence wastewater treatment and irrigation facilities.
Please note that this renewed permit shall become effective on February 1, 2019 (i.e. the day after the
expiration date of the existing permit).
This permit shall be effective from February 1, 2019 until EXPIRATION DATE, and shall be
subject to the conditions and limitations as specified therein. An extension shall be requested at least six
months prior to the expiration of this permit. Upon receipt of the request, the Commission will review
the adequacy of the facility described therein and, if warranted, will extend the permit for such period of
time and under such conditions and limitations as it may deem appropriate.
Please pay particular attention to the operation and maintenance requirements listed in Section 111.
Failure to establish an adequate system for collecting and maintaining the required operational information
shall result in future compliance problems. Also note that Condition VI.6. requires the Permittee to retain
a set of Division approved plans and specifications for the life of the facilities permitted herein.
Please note the following permit conditions have been removed since the last permit issuance
dated September 9, 2013:
➢ Old Condition 9.a.vi — The setback for irrigation sites from any subsurface groundwater
lowering drainage systems has been eliminated.
y Old Condition 9.b.i — The setback for storage and treatment units from any private or public
water supply source has been eliminated.
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
'Nothing Compares -,
State of North Carolina I Environmental Quality I Water Resources I Water Quality Permitting I Non -Discharge Permitting
1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919-807-6332

Mr. and Mrs. Clements
DATE OF PERMIT
Page 0 of 0
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall he final and binding.
If you need additional information concerning this permit, please contact Alice M. Wessner at (919)
807-6425 or alice.wessner&cdenr,gov.
Sincerely,
Linda Culpepper, Interim Director
Division t ' a Resources
cc: Durham County Health. Department (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic 'Copy)
Digital Permit Archive (Electronic Copy)
Central Files

NORTH CAROLINA
ROY COOPER Environmental Quality
Gw"Or
MICHAEL S. REGAN
3mreaury
LINDA CULPEPPER
rnteam Director
July 20, 2018
MRS. PEGGY CLEMENTS
5903 WAKE FOREST HWY.
DURHAM, NORTH CAROLINA 27703
Subject: Permit No. WQ0012475
Request to Review Draft Permit
5903 Wake Forest Hwy. SFR
Single -Family Residence
Wastewater Irrigation System
Durham County
Dear Mrs. Clements:
Please see the enclosed DRAFT permit for your review. This draft permit is a result of your request to
have your permit renewed and the inspection by Ms. Jane Bernard of our Raleigh Regional office.
We routinely send the DRAFT permit to the Permittee to review prior to the final permit so the
Permittee can see what the new permit looks like and have a chance to ask questions. If there are conditions
that have been added or deleted since the last permit it will be mentioned in the cover letter.
Please review the permit by the close of business August 3, 2018 or sooner so we may continue
with the permitting process. You can send you comments to Nathaniel Thornburg at
[e-mail] and by phone at 919-807-6453.
Sincerely,
Alice M. Wessner, Environmental
Engineer
Division of Water Resources
Enclosure: DRAFT permit
cc: Raleigh Regional Office, Water Quality Regional Operations Section
Laserfiche Files
Central Files
DEQ
North Carolina Department of Environmental Quality I Division of Water Resources I Non -Discharge Branch
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.807.6332

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
Merrick R. and Peggy Clements
DURHAM County
FOR THE
continued operation of a 360 gallon per day (GPD) single-family residence wastewater treatment and
irrigation facility consisting of: a 1,000 gallon baffled septic tank, a 360 square -foot (W) subsurface sand
filter, a tablet chlorinator, two 1,200 gallon interconnected storage/pump tanks with a 9.2 gallon per minute
pump, and a 0.2 acre spray irrigation area and all associated piping, controls, valves and appurtenances;
to serve the single-family residence at 5903 Wake Forest Hwy., Durham, NC 27703 with no discharge of
wastes to surface waters, pursuant to the application received on April 4, 2018, and in conformity with the
project plans, specifications, and other supporting data subsequently filed and approved by the Department
of Environmental Quality and considered a part of this permit.
This permit shall be effective from February 1, 2019 until EXPIRATION DATE, and shall be subject to
the following specified conditions and limitations:
I. SCHEDULES
No later than six months prior to the expiration of this permit, the Permittee shall request renewal of
this permit on official Division forms. Upon receipt of the request, the Division will review the
adequacy of the facilities described therein, and if warranted, will renew the permit for such period of
time and under such conditions and limitations as it may deem appropriate. Please note Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal application.
[15A NCAC 02T .0105, 02T .0109.02T .0115(c)]
2. If a public or community sewage system is or becomes available, the subject single-family residence
wastewater treatment and irrigation facilities shall be closed and all wastewater shall be discharged into
the public or community sewage system within 180 days of its availability. Prior to the initiation of
these connection activities, appropriate Division approval shall be received. [ 15A NCAC 02T .0607]
WQ0012475 Version 4.0 Shell Version 171 103 Page 1 of

H. PERFORMANCE STANDARDS
1. The subject non -discharge facilities shall be effectively maintained and operated at all times 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 adequately 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)(l )]
2. This permit shall not relieve the Permittee of their responsibility for darnagea't6'groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02B .029p 02L .0100]
3. Application rates, whether hydraulic, nutrient or other pollutant, shall tiof d those specified in the
following table:
TABLE 1—APPLICATION LANITATiONS
Field
Parameter
Hourly Rate
Yearly nitx
Units
1
01284 — Non -Discharge Application Rate
0.5
26
inches
[15A NCAC 02T .06050)]
4. The subject facility has been approved to land apply wastewater effluent on the following fields:
TABLE 2 — IMUGATION AREA INFORMATION
Field
Owner
County
Latitude
Longitude.,
Net
Dominant
Acreage
Soli Series
Merrick R. and Peggy
wsC — white
t
Clements
Durham
35.9795W
-78.7Q651°
0.2
Store sandy loam
6-10% slopes
[G.S_ 143-215.1]
5: The Operation and Maintenance Agreement (attached) between the Permittee and the Division of Water
Resources is incorporated herein by reference and shall be a condition of this permit. Noncompliance
with the terms of the Opemtion and Maintenance Agreement shall subject the Permittee to all sanctions
provided by North Carolina General Statutes §143-215.6A to §143-215.6C for violation of or failure
to act in accordance with the terms and conditions of this permit. [15A NCAC 02T .0115 (2)]
6: The compliance boundary is established at the property boundary. Any exceedance of standards at the
Compliance boundary shell require action in accordance with 1 SA NCAC 02L .0106. [15A NCAC 02L
.0107(i)]
7. The review boundary is established midway between the compliance boundary and the effluent disposal
area. Any, exceedance of groundwater standards at the review boundary shall require action in
accordance with 15A NCAC 02L .0106. [15A NCAC 02L .0108]
8. 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. [ 15A NCAC 02L .0107(c)]
9. The facilities permitted herein shall be constructed according to the following setbacks:
a. The setbacks for irrigation sites permitted under 15A NCAC 02H .0200 shall be as follows (all
distances in feet):
WQb012475 Version 4.0 Shell Version 171 103 Page 2 of 8

i. Any habitable residence or place of public assembly under separate ownership: 400
ii. Any private or public water supply source:
100
iii. Surface waters:
too
iv. Any well with exception of monitoring wells:
100
v. Any property line:
150'
vi. Public right of way.
50
'Per setback waivers recorded in the Durham County Register of Deeds, reduced setbacks from the
wetted area to any property line are as follows:
Parcel No.
0871-03-01-5891
Deed Book / Page
777
Setback Easement
8466 / 341-342
1S0. 0
[15A NCAC 02H .02190)] :.
b. The setbacks for storage and treatment units permits ii der 15A NCAC 000 shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wellaf; 100
ii. Any property line: 50
[15A NCAC 02H .02196)]
III. OPERATION AND MAINTENANCE R bVMK TENTS
1. The facilities shall be properly maintained told operaw- 4411 times. The ilities shall be effectively
maintained and operated as a non -discharge system to pmve* toe discharge of any wastewater resulting
from the operation of this facility. The Permittee shall mainthtu an'Operation and Maintenance Plan
pursuant to 15A NCAG:OZT, 0604(f). [15A NCAC 02T .0604(o]>
2. Upon the Water .Pollution Control System Operators Certification Commission's (WPCSOCC)
classification`of th6 subject no"ischarge facilities,. in accordance with 15A NCAC 08G .0200 the
Permittee shall designate and employ a certified operator in responsible charge (ORC) and one or more
certified operator(s) as twk�o ORC(a),i s. otherwise stated in 15A NCAC 08G .0304. The ORC
or the baolt ttp shall visit the facilities in accwdance with I SA NCAC 08G .0200, and shall comply
with all other conditions speeied in the previously cited rules. [ 15A NCAC 02T .0117]
3: A suitable year routtdrvegetative cover shall be maintained at all times, such that crop health is
Optimized, allows for evert distribution of effluent and allows inspection of the irrigation system. [I 5A
NCAC 02T .0108(b)(1)]
4. Adequhmeasures shall be taken to prevent effluent ponding in or runoff from the irrigation sites listed
in Conditloo 114. [15A NCAC 02T .0605(o)]
5. Irrigation shall not'be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff. [15A NCAC 02T .0605(o)]
6. Only effluent from the single-family residence at 5903 Wake Forest Hwy., Durham NC 27703 shall be
irrigated on the sites listed in Condition IIA. [G.S. 143-215.1]
7. No automobiles or machinery shall be allowed on the irrigation sites except during equipment
installation or while maintenance is being performed. [15A NCAC 02T .0108(b)(l)]
8. Public access to the irrigation sites and wastewater treatment facilities shall be prohibited. Fencing
shall be provided to prevent access to the irrigation site (minimum 2-strand wire) and treatment units
shall be secured with locks on all tank accesses and control panels. [15A NCAC 02T .0605(i)]
WQ0012475 Version 4.0 Shell Version 171103 Page 3 of 8

9. The residuals generated from the wastewater treatment facilities shall he disposed or utilized in
accordance with 15A NCAC 02T .1100. [15A NCAC 02T .11001.
10. Diversion or bypassing of untreated or partially treated wastewater from the treatment facilities is
prohibited. [15A NCAC 02T .0605(f)]
11. Pump/dosing tanks shall have audible and visual alarms external to any structure. [I SA NCAC 02T
.0605(n)]
12. The Permittee is responsible for the operation and maintenance of the entire treatment and disposal
system including, but not limited to, the following items:
a. The septic tank shall be checked annually and pumped out as needed,. 7be septic tank effluent filter
shall be checked and cleaned at the same frequency as the septic tank. [I 5A NCAC 18A .1900,
02T .0605]
b. The tablet chlorinator shall be checked weekly. Wastewater grade chlorine tablets (calcium
hypochlorite) shall be added as needed to provide proper chlorination. Pool chlorine tablets shall
not be used. [15A NCAC 02T .0605(1)]
c. The storage, pump, and alarm systems shall be inspected monthly. The scum layer shall be removed
at the same interval as the septic tank is cleaned out. [15A NCAC 02T .0108(b)(1)]
d. The system shall be inspected monthly to make certain of the proper operation of the spray heads,
that the system is free of leaks, that the vegetative growth allows a proper spray pattern, that the
soil is assimilating the disposed treated wastewater with no surface runoff, and that no objectionable
odors are being generated. [15A NCAC 02T .0108(b)(1)]
IV. MONITORING AND REPORTING REOUIREMENTS.
1. Any Division required monitoring (including groundwater, plant tissue, soil and surface water analyses)
necessary to ensure groundwater and surface water protection shall be established, and an acceptable
sampling reporting schedule shall be followed. [15A NCAC 02T .0108(c)]
2. Noncompliance Notification:
The Penn ittee shall report by telephone to the Raleigh Regional Office, telephone number (919) 791-
4200, #&.gM_g§,possible, but in no case more than 24 hours, or on the next working day following the
occurrence or first knowledge of the occurrence of any of the following:
a. Any process unit failure (e.g., mechanical, electrical, etc.), due to known or unknown reasons,
rendering the facility incapable of adequate wastewater treatment.
b. Any facility failure resulting in a by-pass directly to receiving 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.
Any emergency requiring immediate reporting (e.g., discharges to surface waters, imminent failure of
a storage structure, etc.) outside normal business hours shall be reported to the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in letter form within five days
following first knowledge of the occurrence. This report shall outline the actions taken or proposed to
betaken to ensure the problem does not recur. [15A NCAC 02T .0105(1)]
WQ0012475 Version 4.0 Shell Version 171103 Page 4 of 8

1IA
1. The Permittee shall provide adequate inspection and maintenance to ensure proper operation of the
wastewater treatment and irrigation facilities. [15A NCAC 02T .0108(b)]
2. The Permittee or their designee shall inspect the wastewater treatment and irrigation facilities to prevent
malfunctions, facility deterioration and operator errors resulting in discharges, which may cause the
release of wastes to the environment, a threat to human health or a public nuisance. The Permittee shall
maintain an inspection log that includes, at a minimum, the date and time of inspection, observations
made, and any 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, :0#444 log shall be made
available to the Division upon request. [15A NCAC 02T .0108(b)]
3. Any duly authorized Division representative may, upon presentattc*46f ettials, enter and inspect
any property, premises or place on or related to the wastewa"treatm ' irrigation facilities
m
permitted herein at any reasonable time for the purpose of determining coma pt with this permit;
may inspector copy any records required to be maintained prtdorthe terms and con tl ,s ofthis 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 )Mein may subject the Permittee to an
enforcement action by the Division in accordance with North Cablina General Statutes 143-215.6A to
143-215.6C. [G.S. 143-215.6A to 143.215,6C]
2. This permit shall become voidable if the po miftd facilities are not cones in accordance with the
conditions of this permit, the Division approved Plins and specifications, and other supporting
documentation. [15A NCAC 02T .0110]
3. This permit is effective :only with respect to the nature and volume of wastes described in the permit
application, Division approved plans and specifications, and other supporting documentation. No
variances to apcable rules governing the construction or operation of the permitted facilities are
granted, unless specifically requested and approved in this permit pursuant to 15A NCAC 02T .0105(n).
[G.S. 14.-215.1 ]
4. The issuance of this permit does not exetpt tho'Permittee from complying with any and all statutes,
rules, regulatlons; or ordinances, which may be imposed by other jurisdictional government agencies
(e.g., local, state, and federal). Of particular concern to the Division are applicable river buffer rules in
15A NCAC 02B .0200; erosion and sedimentation control requirements in 15A NCAC Chapter 4 and
under General Permit NCGO10000; any requirements pertaining to wetlands under 15A NCAC 02B
.0200 and 02H .0500; and documentation of compliance with Article 21 Part 6 of Chapter 143 of the
GeneralStatutes. [15A NCAC 02T .0105(c)(6)]
5. In the event, the permitted facilities change ownership or the Permittee changes their name, a formal
permit modifi ion. request shall be submitted to the Division. This request shall be made on official
Division forms, and, shall include appropriate property ownership documentation and other supporting
documentation as necessary. The Permittee of record shall remain fully responsible for maintaining
and operating the facilities permitted herein until a permit is issued to the new owner. [15A NCAC
02T .0104]
6. The Permittee shall retain a set of Division approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0108(b)(1)]
7. The Permittee shall maintain this permit until all permitted facilities herein are properly closed or
permitted under another permit issued by the appropriate permitting authority. [15A NCAC 02T
.01050)]
WQ0012475 Version 4.0 Shell Version 171103 Page 5 of 8

8. This permit is subject to revocation or unilateral modification upon 60 days' notice from the Division
Director, in whole or part for the requirements listed in 15A NCAC 02T .0110. [ 15A NCAC 02T .0110]
9. Unless the Division Director grants a variance, expansion of the permitted facilities contained herein
shall not be granted if the Permittee exemplifies any of the criteria in 15A NCAC 02T .0120(b). [15A
NCAC 02T .0120]
10. The Permittee shall pay the annual fee within 30 days after being billed by the Division. Failure to pay
the annual fee accordingly shall be cause for the Division to revoke this permit_ [15A NCAC 02T
Permit issued this the # day of May 2018
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Linda Culpepper, Interim Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0012475
WQ0012475 Version 4.0 Shell Version 171103 Page 6 of 8

OFFER TO PURCHASE AND CONTRACT
For valuable consideration, the receipt and legal sufficiency of which are hereby acknowledged, Buyer offers to purchase and Seller
upon acceptance agrees to sell and convey the Property on the terms and conditions of this Offer To Purchase and Contract and any
addendum or modification made in accordance with its terms (together the "Contract").
1. TERMS AND DEFINITIONS: The terms listed below shall have the respective meaning given them as set forth adjacent to each
term.
(a) "Seller": Merrick and Peggy Clements
(b) "Buyer": Michael F. Tenoever and Kimberly R. Tenoever
(c) "Property": The Property shall include all that real estate described below together with all appurtenances thereto including the
improvements located thereon and the fixtures and personal property listed in Paragraphs 2 and 3 below. NOTE: If the Property
will include a manufactured (mobile) home(s), Buyer and Seller should consider including the Manufactured (Mobile) Home
provision in the Additional Provisions Addendum (Standard Form 2A11-T) with this offer.
Street Address: 5903 Wake Forest Rd, Durham NC 27703
NOTE: Governmental authority over taxes, zoning, school districts, utilities and mail delivery may differ from address shown,
Legal Description: (Complete ALL applicable)
Plat Reference: Lot/Unit Block/Section, Subdivision/Condominium
, as shown on Plat Book 00142 at Page(s) 00123
The PIN/PID or other identification number of the Property is: PARCEL ID: 193799 PIN: 0861-03-91-8783
Other description: The offer to purchase is for a 1.69 acre portion of the parcel noted. See Attached Map that roughly outlines the
lines the portion of the parcel that is being proposed for purchase.
Some or all of the Property may be described in Deed Book at Page
(d) "Purchase Price":
$ 634,000,00
$ 0.00
paid in U.S. Dollars upon the following terms:
BY DUE DILIGENCE FEE trade payable to Seller by the Effective Date
BY INITIAL EARNEST MONEY DEPOSIT made payable to Escrow Agent named
in Paragraph 1(f) ❑ with this offer OR ❑ delivered within five (5) days of the
Effective Date of this Contract by ❑ cash ❑ personal check ❑ official bank check
❑ wire transfer
BY (ADDITIONAL) EARNEST MONEY DEPOSIT made payable to Escrow
Agent named in Paragraph l(I) by cash or immediately available funds such as
official bank check or wire transfer to be delivered to Escrow Agent no later than
_.. , TIME
BEING OF THE ESSENCE with regard to said date.
$ BY ASSUMPTION of the unpaid principal balance and all obligations of Seller on
the existing loan(s) secured by a deed of trust on the Property in accordance with the
attached Loan Assumption Addendum (Standard Form 2A6-T).
$ BY SELLER FINANCING in accordance with the attached Seller Financing
Addendum (Standard Form 2A5-T).
$ BY BUILDING DEPOSIT in accordance with the attached New Construction
Addendum (Standard Form 2A3-T).
$634,000,00 BALANCE of the Purchase Price in cash at Settlement (some or all of which may be
paid with the proceeds of a new loan)
Should Buyer fail to deliver either the Due Diligence Fee or arry Initial Earnest Money Deposit by their due dates, or should any
check or other funds paid by Buyer be dishonored, for any reason, by the institution upon which the payment is drawn, Buyer shall
have one (1) banking day after written notice to deliver cash or immediately available funds to the payee. In the event Buyer does
Page 1 of 11
Buyer initials � Seller initials &ef
NC Bar Association Form No. 2T © Revised 2007, 2008, 1/2011, 7/2011, 1/2012, 7/2012, 7/2013 This standard form has been approved jointly by:
Printed by Agreement with the NC Bar Association Noah Carolina Bar Association - NC Bar Form No. 2T
North Carolina Association of Realtors*, Inc. - Standard Form 2T

not timely deliver cash or immediately available funds, Seller shall have the right to terminate this Contract upon written notice to
Buyer.
(e) "Earnest Money Deposit": The Initial Earnest Money Deposit, the Additional Earnest Money Deposit and any other earnest
monies paid in connection with this transaction, hereinafter collectively referred to as "Earnest Money Deposit", shall be deposited
and held in escrow by Escrow Agent until Closing, at which time it will be credited to Buyer, or until this Contract is otherwise
terminated. In the event: (1) this offer is not accepted; or (2) a condition of any resulting contract is not satisfied, then the Earnest
Money Deposit shall be refunded to Buyer. In the event of breach of this Contract by Seller, the Earnest Money Deposit shall be
refunded to Buyer upon Buyer's request, but such return shall not affect any other remedies available to Buyer for such breach. In
the event of breach of this Contract by Buyer, the Farnest Money Deposit shall be paid to Seller upon Seller's request ng liquidated
damages and as Seller's sole and exclusive remedy for such breach, but without limiting Seller's rights under Paragraphs 4(d) and
4(e) for damage to the Property or Seller's right to retain the Due Diligence Fee. It is acknowledged by the parties that payment of
the Earnest Money Deposit to Seller in the event of a breach of this Contract by Buyer is compensatory and not punitive, such
amount being a reasonable estimation of the actual loss that Seller would incur as a result of such breach. The payment of the
Earnest Money Deposit to Seller shall not constitute a penalty or forfeiture but actual compensation for Seller's anticipated loss,
both parties acknowledging the difficulty determining Seller's actual damages for such breach If legal proceedings are brought by
Buyer or Seller against the other to recover the Earnest Money Deposit, the prevailing party in the proceeding shall be entitled to
recover from the non -prevailing party reasonable attorney fees and court costs incurred in connection with the proceeding.
(f) "Escrow Agent" (insert name): N/A
NOTE: In the event of a dispute between Seller and Buyer over the disposition of the Earnest Money Deposit held in escrow, a
licensed real estate broker ("Broker") is required by state law (and Escrow Agent, if not a Broker, hereby agrees) to retain the
Earnest Money Deposit in the Escrow Agent's trust or escrow account until Escrow Agent has obtained a written release from the
parties consenting to its disposition or until disbursement is ordered by a court of competent jurisdiction. Alternatively, if a
Broker or an attorney licensed to practice law in North Carolina ("Attorney") is holding the Earnest Money Deposit, the Broker or
Attorney may deposit the disputed monies with the appropriate clerk of court in accordance with the provisions of N.C.G, S. §93A-
12.
THE PARTIES AGREE THAT A REAL ESTATE BROKERAGE FIRM ACTING AS ESCROW AGENT MAY PLACE THE
EARNEST MONEY DEPOSIT IN AN INTEREST BEARING TRUST ACCOUNT AND THAT ANY INTEREST EARNED
THEREON SHALL BE DISBURSED TO THE ESCROW AGENT MONTHLY IN CONSIDERATION OF THE EXPENSES
INCURRED BY MAINTAINING SUCH ACCOUNT AND RECORDS ASSOCIATED THEREWITH.
(g) "Effective Date": The date that: (1) the last one of Buyer and Seller has signed or initialed this offer or the final counteroffer, if
any, and (2) such signing or initialing is communicated to the parry making the offer or counteroffer, as the case may be.
(h) "Due Diligence"; Buyer's opportunity during the Due Diligence Period to investigate the Property and the transaction
contemplated by this Contract, including but not necessarily limited to the matters described in Paragraph 4 below, to decide
whether Buyer, in Buyer's sole discretion, will proceed with or terminate the transaction.
(i) `Due Diligence Fee": A negotiated amount, if any, paid by Buyer to Seller with this Contract for Buyer's right to conduct Due
Diligence during the Due Diligence Period. It shall be the property of Seller upon the Effective Date and shall be a credit to Buyer
at Closing. The Due Diligence Fee shall be non-refundable except in the event of a material breach of this Contract by Seller, or if
this Contract is terminated under Paragraph S(l) or Paragraph 12, or as otherwise provided in any addendum hereto. Buyer and
Seller each expressly waive any right that they may have to deny the right to conduct Due Diligence or to assert any defense as to
the enforceability of this Contract based on the absence or alleged insufficiency of any Due Diligence Fee, it being the intent of the
parties to create a legally binding contract for the purchase and sale of the Property without regard to the existence or amount of
any Due Diligence Fee.
0) "Due Diligence Period": The period beginning on the Effective Date and extending through 5:00 p.m. on June 9, 2015 TIME
BEING OF THE ESSENCE with regard to said date.
Page 2 of 11
/S Buyer initials � eller initials h , '/ f 1I' ("n, �
NC Bar Association Form No. 2T e Revised 2007, 2008, 1/2011, 7i2011, 1/2012, 7/2012, 7/2013 This standard form has been approved jointly by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association — NC Bar Form No. 2T
North Carolina Association of Realtors®, Inc. — Standard Form 2T

(k) "Settlement": The proper execution and delivery to the closing attorney of all documents necessary to complete the transaction
contemplated by this Contract, including the deed, settlement statement, deed of trust and other loan or conveyance documents,
and the closing attorney's receipt of all funds necessary to complete such transaction.
(1) "Settlement Date": The parties agree that Settlement will take place on June 9, 2015 (the "Settlement Date"), unless otherwise
agreed in writing, at a time and place designated by Buyer.
(m) "Closing": The completion of the legal process which results in the transfer of title to the Property from Seller to Buyer, which
includes the following steps: (1) the Settlement (defined above); (2) the completion of a satisfactory title update to the Property
following the Settlement; (3) the closing attorney's receipt of authorization to disburse all necessary funds; and (4) recordation in
the appropriate county registry of the deed(s) and deed(s) of trust, if any, which shall take place as soon as reasonably possible for
the closing attorney after Settlement. Upon Closing, the proceeds of sale shall be disbursed by the closing attorney in accordance
with the settlement statement and the provisions of Chapter 45A of the North Carolina General Statutes. If the title update should
reveal unexpected liens, encumbrances or other title defects, or if the closing attorney is not authorized to disburse all necessary
funds, then the Closing shall be suspended and the Settlement deemed delayed under Paragraph 13 (Delay in Settlement/Closing).
WARNING: The North Carolina State Bar has determined that the performance of most acts and services required for a closing
constitutes the practice of law and must be performed only by an attorney licensed to practice law in North Carolina, State law
prohibits unlicensed individuals or firms from rendering legal services or advice. Although non -attorney settlement agents may
perform limited services in connection with a closing, they may not perform all the acts and services required to complete a
closing. A closing involves significant legal issues that should be handled by an attorney. Accordingly it is the position of the
North Carolina Bar Association and the North Carolina Association of REALTORS' that all buyers should hire an attorney
licensed in North Carolina to perform a closing.
(n) "Special Assessments": A charge against the Property by a governmental authority in addition to ad valorem taxes and
recurring governmental service fees levied with such taxes, or by an owners' association in addition to any regular assessment
(dues), either of which may be a lien against the Property. A Special Assessment may be either proposed or confirmed.
"Proposed Special Assessment": A Special Assessment that is under formal consideration but which has not been approved prior
to Settlement.
"Confirmed Special Assessment": A Special Assessment that has been approved prior to Settlement whether or not it is fully
payable at time of Settlement.
2. FIXTURES: The following items, if any, are deemed fixtures and are included in the Purchase Price free of liens:
range/stove/oven, any built-in appliances, light fixtures, ceiling fans, attached floor coverings, blinds, shades, drapery rods and curtain
rods, brackets and all related hardware, window and door screens, storm windows, combination doors, awnings, antennas, satellite
dishes and receivers, burglar/fire/smoke/carbon monoxide/alarms, pool and spa equipment, solar energy systems, attached fireplace
screens, gas logs, fireplace inserts, electric garage door openers with controls, outdoor plants and trees (other than in movable
containers), basketball goals, storage sheds, mailboxes, attached wall and/or door mirrors, fuel tank(s) whether attached or buried and
including contents, if any, as of Settlement, landscape and/or foundation lighting, invisible fencing including all related equipment,
lawn irrigation systems and all related equipment, water softener/conditioner and filter equipment and any other items attached or
affixed to the Property, EXCEPT the following items which are leased or not owned by Seller or which Seller does not intend to
convey: NIA
Seller shall repair any damage caused by removal of any items excepted above.
(NOTE: Seller and Buyer should confirm whether fuel tanks, antennas, satellite dishes and receivers, alarm systems, and other items
listed above are leased or not owned by Seller and should be entered in the blank above. FUEL TANKS AND ANY FUEL IN THEM
WHICH ARE NOT TO CONVEY SHOULD BE NOTED IN THE BLANK ABOVE.)
3. PERSONAL PROPERTY: The following personal property shall be transferred to Buyer at no value at Closing: none
(NOTE: Buyer is advised to consult with Buyer's lender to assure that the Personal Property items listed above can be included in this
Contract.)
Page 3 of 11
Buyer initials �tiTseller initials � r
NC Bar Association Form No. 2T © Revised 20 7, 2008, 1/2011, 7,12011, 1/2012, 7/2012, 7/2013 This standard form has been approved jointly by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association — NC Bar Form No. 2T
North Carolina Association of Realtors®, Inc. — Standard Form 2T

4. BUYER'S DUE DILIGENCE PROCESS:
(a) Loan: During the Due Diligence Period, Buyer, at Buyer's expense, shall be entitled to pursue qualification for and approval of
the Loan if any.
NOTE: Buyer is advised to consult with Buyer's lender prior to signing this offer to assure that the Due Diligence Period allows
sufficient time for the appraisal to be completed and for Buyer's lender to provide Buyer sufficient information to decide whether
to proceed with or terminate the transaction since the Loan is not a condition of the Contract.
(b) Property Investigation: During the Due Diligence Period, Buyer or Buyer's agents or representatives, at Buyer's expense,
shall be entitled to conduct all degired tests, surveys, appraisals, investigation, examination and inspections of the Property ag
Buyer deems appropriate, including but NOT limited to the following:
(i) Inspections: inspections to determine the condition of any improvements on the Property, the presence of unusual drainage
conditions or evidence of excessive moisture adversely affecting any improvements on the Property, the presence of asbestos
or existing environmental contamination, evidence of wood -destroying insects or damage therefrom, and the presence and
level of radon gas on the Property.
(ii) Review of Documents: Review of the Declaration of Restrictive Covenants, Bylaws, Articles of Incorporation, Rules and
Regulations, and other governing documents of any applicable owners' association and/or subdivision. If the Property is
subject to regulation by an owners' association., it is recommended that Buyer review the completed Residential Property and
Owners' Association Disclosure Statement provided by Seller prior to signing this offer.
(iii) Insurance: Investigation of the availability and cost of insurance for the Property.
(iv) Appraisals: An appraisal of the Property.
(v) Survey: A survey to determine whether the property is suitable for Buyer's intended use and the location of easements,
setbacks, property boundaries and other issues which may or may not constitute title defects.
(vi) Zoning and Governmental Regulation: Investigation of current or proposed zoning or other governmental regulation
that may affect Buyer's intended use of the Property, adjacent land uses, planned or proposed road construction, and school
attendance zones.
(vii) Flood Hazard: Investigation of potential flood hazards on the Property, and/or any requirement to purchase flood
insurance in order to obtain the Loan.
(viii) Utilities and Access: Availability, quality, and obligations for maintenance of roads and utilities including water, sewer,
electric, gas, communication services, stonnwater management, and means of access to the Property and amenities.
(ix) Fuel Tank: Inspections to determine the existence, type and ownership of any fuel tank located on the Property.
(NOTE: Buyer is advised to consult with the owner of any leased fuel tank regarding the terms under which Buyer may lease
the tank and obtain fuel.)
(c) Repair/Improvement Negotiations/Agreement: Buyer acknowledges and understands that unless the parties agree
otherwise, THE PROPERTY IS BEING SOLD IN ITS CURRENT CONDITION. Buyer and Seller acknowledge and
understand that they may, but are not required to, engage in negotiations for repairs/improvements to the Property. Buyer is
advised to make any repair/improvement requests in sufficient time to allow repair/improvement negotiations to be concluded prior
to the expiration of the Due Diligence Period. Arry agreement that the parties may reach with respect to repairs/improvements
shall be considered an obligation of the parties and is an addition to this Contract and as such, must be in writing and signed by the
parties in accordance with Paragraph 20.
(NOTE: See Paragraph 8(b) Access to Property/Walk-Through Inspection and Paragraph 8(k) Negotiated RepairsAmprovements.)
(d) Buyer's Obligation to Repair Damage: Buyer shall, at Buyer's expense, promptly repair any damage to the Property resulting
from any activities of Buyer and Buyer's agents and contractors, but Buyer shall not be responsible for ally damage caused by
accepted practices either approved by the N.C. Home Inspector Licensure Board or applicable to any other N.C. licensed
professional performing reasonable appraisals, tests, surveys, examinations and inspections of the Property. This repair obligation
shall survive any termination of this Contract.
(e) Indemnity: Buyer will indemnify and hold Seller harmless front all loss, damage, claims, suits or costs, which shall arise out of
any contract, agreement, or injury to any person or property as a result of any activities of Buyer and Buyer's agents and
contractors relating to the Property except for any loss, damage, claim, suit or cost arising out of pre-existing conditions of the
y� Page 4 of 11
Buyer initials � setter initials p—/-J
��cr
NC Bar Association Form No. 2T C° Revised 2007, 2008, 112200111, 7/2011, 1/2012, 7/2012, 7/2013 This standard form has been approved jointly by:
Printed by Agreement with the NC Par Association North Carolina Bar Association — NC Bar Form No. 2T
North Carolina Association of Realtorsa), Inc. — Standard Form 2T

Property and/or out of Seller's negligence or willful acts or omissions, This indemnity shall survive this Contract and any
termination hereof.
(f) Buyer's Right to Terminate: Buyer shall have the right to terminate this Contract for any reason or no reason, by delivering to
Seller written notice of termination (the "Termination Notice") during the Due Diligence Period (or any agreed -upon written
extension of the Due Diligence Period), TIME BEING OF THE ESSENCE. If Buyer timely delivers the Termination Notice, this
Contract shall be terminated and the Earnest Money Deposit shall be refunded to Buyer,
WARNING: If Buyer is not satisfied with the results or progress of Buyer's Due Diligence, Buyer should terminate this Contract,
prior to the expiration of the Due Diligence Period, unless Buyer can obtain a written extension from Seller. SELLER IS NOT
OBLIGATED TO GRANT AN EXTENSION. Although Buyer may continue to investigate the Property following the expiration
of the Due Diligence Period, Buyer's failure to deliver a Termination Notice to Seller prior to the expiration of the Due Diligence
Period shall constitute a waiver by Buyer of any right to terminate this Contract based on any matter relating to Buyer's Due
Diligence. Provided however, following the Due Diligence Period, Buyer may still exercise a right to terminate if Seller fails to
materially comply with any of Seller's obligations under Paragraph 8 of this Contract or for any other reason permitted under the
terms of this Contract or North Carolina law.
(g) CLOSING SHALL CONSTITUTE ACCEPTANCE OF THE PROPERTY IN ITS THEN EXISTING CONDITION
UNLESS PROVISION IS OTHERWISE MADE IN WRITING.
5. BUYER REPRESgnATIONS:
(a) Loan: Buyer 0 does ❑ does not have to obtain a new loan in order to purchase the Property. If Buyer is obtaining a ne loan,
Buyer intends to obtain a loan as follows: ❑ FHA ❑ VA (attach FHA/VA Financing Addendum) ❑ Conventional E fOther:
loan at a ❑ Fixed Rate ❑ Adjustable Rate in the principal amount of
plus any financed VA Funding Fee or FHA MIP for a term of year(s), at an initial
interest rate not to exceed % per annum (the "Loan").
NOTE: Buyer's obligations under this Contract are not conditioned upon obtaining or closing any loan If Buyer represents that
Buyer does not have to obtain a new loan in order to purchase the Property, Seller is advised, prior to signing this offer, to obtain
documentation from Buyer which demonstrates that Buyer will be able to close on the Property without the necessity of obtaining
a new loan.
(b) Other Property: Buyer ❑ does IZ does not have to sell or lease other real property in order to qualify for a new loan or to
complete purchase.
(NOTE: This Contract is not conditioned upon the sale of Buyer's property unless a contingent sale addendum such as Standard
Form 2A2-T is made a part of this Contract.)
(c) Performance of Buyer's Financial Obligations: To the best of Buyer's knowledge, there are no other circumstances or
conditions existing as of the date of this offer that would prohibit Buyer from performing Buyer's financial obligations in
accordance with this Contract, except as may be specifically set forth herein.
(d operty Disclosure (check only one):
0 Buyer has received a signed copy of the N.C. Residential Property and Owners' Association Disclosure Statement prior to the
signing of this offer.
❑ Buyer has NOT received a signed copy of the N.C. Residential Property and Owners' Association Disclosure Statement prior to
the signing of this offer and shall have the right to terminate or withdraw this Contract without penalty (including a refund of
any Due Diligence Fee) prior to WHICHEVER OF THE FOLLOWING EVENTS OCCURS FIRST. (1) the end of the third
calendar day following receipt of the Disclosure Statement; (2) the end of the third calendar day following the date the Contract
was made; or (3) Settlement or occupancy by Buyer in the case of a sale or exchange.
❑ Exempt from N.C. Residential Property and Owners' Association Disclosure Statement because (SEE GUIDELINES):
6. BUYER OBLIGATIONS:
� Page 5 of 11
Buyer initials Seller initials —N,C ;
NC Bar Association Form No. 2T CCU Revised 2007, 2008, 1/2011, 7/201 I, 1/2012, 7/2012, 7/2013 This standard form has been approved jointly by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association - NC Bar Form No. 2T
North Carolina Association of Realtors®, Inc. — Standard Form 2T

(a) Owners' Association Fees/Charges: Buyer shall pay any fees required for confirming account payment information on
owners' association dues or assessments for payment or proration and any charge made by the owners' association in connection
with the disposition of the Property to Buyer, including any transfer and/or document fee imposed by the owners' association.
Buyer shall not be responsible for fees incurred by Seller in completing the Residential Property and Owners' Association
Disclosure Statement.
(b) Responsibility for Proposed Special Assessments: Buyer shall take title subject to all Proposed Special Assessments.
(c) Responsibility for Certain Costs: Buyer shall be responsible for all costs with respect to any loan obtained by Buyer,
appraisal, title search, title insurance, recording the deed and for preparation and recording of all instruments required to secure the
balance of the Purchase Price unpaid at Settlement.
7. SELLER REPRESENTATIONS:
(a) Ownership: Seller represents that Seller:
❑ has owned the Property for at least one year.
❑ has owned the Property for less than one year.
❑ does not yet own the Property.
(b) Primary Residence: Seller represents that the Property ❑ is or ❑ is not Seller's primary residence.
(c) Lead -Based Paint (check if applicable):
❑ The Property is residential and was built prior to 1978 (Attach Lead -Based Paint or Lead -Based Paint Hazards Disclosure
Addendum (Standard Form 2A9-T)).
(d) Assessments: To the best of Seller's knowledge there are no Proposed Special Assessments except as follows (Insert "None" or
the identification of such assessments, if any):
Seller warrants that there are no Confirmed Special Assessments except as follows (Insert "None" or the identification of such
assessments, if any):
(e) Owners' Association(s) and Dues: Seller authorizes and directs any owners' association, any management company of the
owners' association, any insurance company and any attorney who has previously represented the Seller to release to Buyer,
Buyer's agents, representative, or lender true and accurate copies of the following items affecting the Property, including any
amendments:
• master insurance policy showing the coverage provided and the deductible amount
• Declaration and Restrictive Covenants
• Rules and Regulations
• Articles of Incorporation
• Bylaws of the owners' association
• current financial statement and budget of the owners' association
• parking restrictions and information
• architectural guidelines
The name, address and telephone number of the president of the owners' association or the association manager
is:
Owners' association website address, if any
The name, address and telephone number of the president of the owners' association or the association manager
is:
Owners' association website address, if any:
(f) OIL AND GAS RIGHTS DISCLOSURE:
Oil and gas rights can be severed from the title to real property by conveyance (deed) of the oil and gas rights from the
owner or by reservation of the oil and gas rights by the owner. If oil and gas rights are or will be severed from the
/jam Page 6 of I 1
Buyer initials Seller initials _h ` __W_V, U ,
NC Bar Association Form No. 2T C Revised 2007, 2008, 112011, 7l2011, 1/2012, 7/2012, 7/2013 "Ibis standard form has been approved jointly by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association - NC Bar Form No. 2T
North Carolina Association of Realtors®, Inc. - Standard Form 2T

property, the owner of those rights may have the perpetual right to drill, mine, explore, and remove any of the subsurface
oil or gas resources on or from the property either directly from the surface of the property or from a nearby location.
With regard to the severance of oil and gas rights, Seller makes the following disclosures:
1. Oil and gas rights were severed from the property
Yes
❑
No No Representation
❑
Buyer Initials
by a previous owner.
Yes
No
2. Seller has severed the oil and gas rights from the
❑
Buyer Initials
property.
Yes
No
beJ -Ak—
3. Setter intends to sever the oil and gas rights from
❑
uyer Initials
the property prior to transfer of title to Buyer.
This disclosure does not modify or limit the obligations of Seller under Paragraph 8(f) of this Contract and shall not constitute the
assumption or approval by Buyer of any severance of oil and gas rights, except as may be assumed or specifically approved by Buyer
in writing.
(NOTE: The parties are advised to consult with a NC attorney prior to signing this Contract if severance of oil and gas rights has
occurred or is intended.)
SELLER OBLIGATIONS:
(a) Evidence of Title: Seller agrees to use best efforts to deliver to Buyer as soon as reasonably possible after the Effective Date,
copies of all title information in possession of or available to Seller, including but not limited to: title insurance policies, attorney's
opinions on tide, surveys, covenants, deeds, notes and deeds of trust, leases, and easements relating to the Property. Seller
authorizes: (1) any attorney presently or previously representing Seller to release and disclose any title insurance policy in such
attorney's file to Buyer and both Buyer's and Seller's agents and attorneys; and (2) the Property's title insurer or its agent to release
and disclose all materials in the Property's title insurer's (or title insurer's agent's) file to Buyer and both Buyer's and Seller's agents
and attorneys.
(b) Access to Property/Walk-Through Inspection: Seller shall provide reasonable access to the Property (including working,
existing utilities) through the earlier of Closing or possession by Buyer, including, but not limited to, allowing Buyer an
opportunity to conduct a final walk-through inspection of the Property.
(c) Removal of Seller's Property: Seller shall remove, by the date possession is made available to Buyer, all personal property
which is not a part of the purchase and all garbage and debris from the Property.
(d) Affidavit and Indemnification Agreement: Seller shall furnish at Settlement an affidavit(s) and indemnification agreement(s)
in form satisfactory to Buyer and Buyer's title insurer, if any, executed by Seller and any person or entity who has performed or
furnished labor, services, materials or rental equipment to the Property within 120 days prior to the date of Settlement and who
may be entitled to claim a lien against the Property as described in N.C. G.S. §44A-8 verifying that each such person or entity has
been paid in full and agreeing to indemnify Buyer, Buyer's lender(s) and Buyer's title insurer against all loss from any cause or
claim arising therefrom.
(e) Designation of Lien Agent, Payment and Satisfaction of Liens: If required by N.C.G.S. §44A-11.1, Seller shall have
designated a Lien Agent, and Seller shall deliver to Buyer as soon as reasonably possible a copy of the appointment of Lien Agent.
All deeds of trust, deferred ad valorem taxes, liens and other charges against the Property, not assumed by Buyer, must be paid and
satisfied by Seller prior to or at Settlement such that cancellation may be promptly obtained following Closing. Seller shall remain
obligated to obtain any such cancellations following Closing.
(f) Good Title, Legal Access: Seller shall execute and deliver a GENERAL WARRANTY DEED for the Property in recordable
form no later than Settlement, which shall convey fee simple marketable and insurable tide. without exception for mechanics'
liens, and free of any other liens, encumbrances or defects, including those which would be revealed by a current and accurate
survey of the Property, except; ad valorem taxes for the current year (prorated through the date of Settlement); utility easements
Page 7 of I 1
Buyer initials _7eller initials 14-1-1
NC Bar Association Form No. 2'1' C� Revised 20
2t)0$, 112011, 7 2011, 1)'2012, 7l2012, 7/2013 This standard form has been approved jointly by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association - NC Bar Form No. 2T
North Carolina Association of RealtorsT. Inc. - Standard Form 2T

and unviolated covenants. conditions or restrictions that do not materially affect the value of the Property; and such other liens,
encumbrances or defects as may be assumed or specifically approved by Buyer in writing. The Property must have legal access to a
public right of way.
(NOTE: Buyer's failure to terminate this Contract prior to the expiration of the Due Diligence Period as a result of any
encumbrance or defect that is or would have been revealed by a title examination of the Property or a current and accurate survey
shall not relieve Seller of any obligation raider this subparagraph.)
(NOTE: If any sale of the Property may be a "short sale," consideration should be given to attaching a Short Sale Addendum
(Standard Form 2A14-T) as an addendum to this Contract)
(g) Deed, Excise Taxes: Seller shall pay for preparation of a deed and all other documents necessary to perform Seller's
obligations under this Contract, and for state and county excise taxes required by law. The deed is to be made to: Michael F.
Tenoever and wife. Kimberlv R. Tenoever.
(h) Agreement to Pay Buyer Expenses: N/A
NOTE: Examples of Buyer's expenses associated with the purchase of the Property include, but are not limited to, discount points,
loan origination fees, appraisal fees, attorney's fees, inspection fees, and "pre-paids" (taxes, insurance, owners' association dues,
etc.).
(i) Payment of Confirmed Special Assessments: Seller shall pay all Confirmed Special Assessments, if any, provided that the
amount thereof can be reasonably determined or estimated.
0) Late Listing Penalties: All property tax late listing penalties, if any, shall be paid by Seller.
(k) Negotiated Repairs/Improvements: Negotiated repairs/improvements shall be made in a good and workmanlike manner and
Buyer shall have the right to verify same prior to Settlement.
(1) Seller's Failure to Comply or Breach: If Seller fails to materially comply with arty of Seller's obligations under this Paragraph
8 or Seller materially breaches this Contract, and Buyer elects to terminate this Contract as a result of such failure or breach, then
the Earnest Money Deposit and the Due Diligence Fee shall be refunded to Buyer and Seller shall reimburse to Buyer the
reasonable costs actually incurred by Buyer in connection with Buyer's Due Diligence without affecting any other remedies. If
legal proceedings are brought by Buyer against Seller to recover the Earnest Money Deposit, the Due Diligence Fee and/or the
reasonable costs actually incurred by Buyer in connection with Buyer's Due Diligence, the prevailing party in the proceeding shall
be entitled to recover from the non -prevailing party reasonable attorney fees and court costs incurred in connection with the
proceeding.
9. PROBATIONS AND ADJUSTMENTS: Unless otherwise provided, the following items shall be prorated through the date of
Settlement and either adjusted between the parties or paid at Settlement:
(a) Taxes on Real Property: Ad valorem taxes and recurring governmental service fees levied with such taxes on real property
shall be prorated on a calendar year basis;
(b) Taxes on Personal Property: Ad valorem taxes on personal property for the entire year shall be paid by Seller unless the
personal property is conveyed to Buyer, in which case, the personal property taxes shall be prorated on a calendar year basis;
(c) Rents: Rents, if any, for the Property;
(d) Dues: Owners' association regular assessments (dues) and other like charges.
10. 119ME WARRANTY: Select one of the following:
No home warranty is to be provided by Seller.
© Buyer may obtain a one-year home warranty at a cost not to exceed S
© Seller leas obtained and will provide a one-year home warranty from
at a cost of S and will pay for it at Settlement.
�n Page 8 of 11
Buyer initials Seller initials //n, C
NC Bar Association Form No. 2T V- Revised 2007, 2008, 1/2011, 7/2011, 1 /2012, 7,2012, 7/2013
Printed by Agreement with the NC Bar Association
and Seller agrees to pay for it at Settlement.
This standard form has been approved jointly by:
North Carolina Bar Association — NC Bar Form No. 2T
North Carolina Association of RealtorsX, Inc. - Standard Form 2T

(NOTE: Home warranties typically have limitations on and conditions to coverage. Refer specific questions to the home warranty
company.)
11. CONDITION OF PROPERTY AT CLOSING: Buyer's obligation to complete the transaction contemplated by this Contract
shall be contingent upon the Property being in substantially the same or better condition at Closing as on the date of this offer,
reasonable wear and tear excepted.
12. RISK OF LOSS: The risk of loss or damage by fire or other casualty prior to Closing shall be upon Seller. If the improvements on
the Property are destroyed or materially damaged prior to Closing, Buyer may terminate this Contract by written notice delivered to
Seller or Seller's agent and the Eamest Money Deposit and any Due Diligence Fee shall be refunded to Buyer. In the event Buyer does
NOT elect to terminate this Contract, Buyer shall be entitled to receive, in addition to the Property, any of Seller's insurance proceeds
payable on account of the damage or destruction applicable to the Property being purchased. Seller is advised not to cancel existing
insurance on the Property until after confirming recordation of the deed.
13. DELAY IN SETTLEMENT/CLOSING: Absent agreement to the contrary in this Contract or any subsequent modification
thereto, if a party is unable to complete Settlement by the Settlement Date but intends to complete the transaction and is acting in good
faith and with reasonable diligence to proceed to Settlement ('Delaying Party"), and if the other party is ready, willing and able to
complete Settlement on the Settlement Date ("Non -Delaying Party") then the Delaying Party shall give as much notice as possible to
the Non -Delaying Party and closing attorney and shall be entitled to a delay in Settlement. If the parties fail to complete Settlement
and Closing within fourteen (14) days of the Settlement Date (including any amended Settlement Date agreed to in writing by the
parties) or to otherwise extend the Settlement Date by written agreement, then the Delaying Party shall be in breach and the Non -
Delaying Parry may terminate this Contract and shall be entitled to enforce any remedies available to such party under this Contract
for the breach.
14. POSSESSION: Possession, including all means of access to the Property (keys, codes, garage door openers, etc.), shall be
delivered upon Closing as defined in Paragraph 1(m) unless otherwise provided below:
❑ A Buyer Possession Before Closing Agreement is attached (Standard Form 2A7-T)
❑ A Seller Possession After Closing Agreement is attached (Standard Form 2A8-T)
❑ Possession is subject to rights of tenant(s) (NOTE: Consider attaching Additional Provisions Addendum (Form 2A-11-T) or
Vacation Rental Addendum (Form 2A 13-T))
15. OTHER PROVISIONS AND CONDITIONS: CHECK ALL STANDARD ADDENDA THAT MAY BE A PART OF THIS
CONTRACT, IF ANY, AND ATTACH HERETO. ITEMIZE ALL OTHER ADDENDA TO THIS CONTRACT, IF ANY, AND
ATTACH HERETO. NOTE: UNDER NORTH CAROLINA LAW, REAL ESTATE BROKERS ARE NOT PERMITTED TO
DRAFT CONDITIONS OR CONTINGENCIES TO THIS CONTRACT.
❑ Additional Provisions Addendum (Form 2A11-T)
❑ Bask -Up Contract Addendum (Form 2A1-T)
❑ Contingent Sale Addendum (Form 2A2-T)
❑ FHA/VA Financing Addendum (Form 2A4-T)
❑ Lead -Based Paint Or Lead -Based Paint Hazard
Adendum (Fo A9-T)
OTIIER, Car /� s'e Ic r
❑ Loan Assumption Addendum (Form 2A6-T)
❑ New Construction Addendum (Form 2A3-T)
❑ Seller Financing Addendum (Foram 2A5-T)
❑ Short Sale Addendum (Form 2A14-T)
❑ Vacation Rental Addendum (Form 2AI3-T)
-J' C-/3 Se _ /Y,-)
16. ASSIGNMENTS: This Contract may not be assigned without the written consent of all parties except in connection with a tax -
deferred exchange, but if assigned by agreement, then this Contract shall be binding on the assignee and assignee's heirs and
successors.
17. TAX -DEFERRED EXCHANGE: In the event Buyer or Seller desires to effect a tax -deferred exchange in connection with the
conveyance of the Property, Buyer and Seller agree to cooperate in effecting such exchange; provided, however, that the exchanging
party shall be responsible for all additional costs associated with such exchange, and provided further, that a non -exchanging party
shall not assume any additional liability with respect to such tax -deferred exchange. Buyer and Seller shall execute such additional
Page 9 of 11
Buyer initials —yt--r Seller initials J2
NC Bar Association Form No. 2T C Revised 200 , 2008, 112011, 712011, 1/2012, 7/2012, 7/2013 This standard form has been approved jointly by.
Printed by Agreement with the NC Bar Association North Carolina Bar Association — NC Bar Form No. 2T
North Carolina .Association of Realtors®, Inc. - Standard Form 2T

documents, including assignment of this Contract in connection therewith, at no cost to the non -exchanging party, as shall be required
to give effect to this provision.
18. PARTIES: This Contract shall be binding upon and shall inure to the benefit of Buyer and Seller and their respective heirs,
successors and assigns. As used herein, words in the singular include the plural and the masculine includes the feminine and neuter
genders, as appropriate.
19. SURVIVAL: If any provision herein contained which by its nature and effect is required to be observed, kept or performed after
the Closing, it shall survive the Closing and remain binding upon and for the benefit of the parties hereto until fully observed, kept or
performed.
20. ENTIRE AGREEMENT: This Contract contains the entire agreement of the parties and there are no representations,
inducements or other provisions other than those expressed herein. All changes, additions or deletions hereto must be in writing and
signed by all parties. Nothing contained herein shall alter any agreement between a REALTOR' or broker and Seller or Buyer as
contained in any listing agreement, buyer agency agreement, or any other agency agreement between them.
21. NOTICE: Any notice or communication to be given to a party herein may be given to the party or to such parry's agent. Any
written notice or communication in connection with the transaction contemplated by this Contract may be given to a party or a party's
agent by sending or transmitting it to any mailing address, e-mail address or fax number set forth in the "Notice Information" section
below. Seller and Buyer agree that the "Notice Information" and "Escrow Acknowledgment" sections below shall not constitute a
material part of this Contract, and that the addition or modification of any information therein shall not constitute a rejection of an
offer or the creation of a counteroffer.
22. EXECUTION: This Contract may be signed in multiple originals or counterparts, all of which together constitute one and the
same instrument, and the parties adopt as their seals the word "SEAL" beside their signatures below.
23. COMPUTATION OF DAYS: Unless otherwise provided, for purposes of this Contract, the term "days" shall mean consecutive
calendar days, including Saturdays, Sundays, and holidays, whether federal, state, local or religious. For the purposes of calculating
days, the count of "days" shall begin on the day following the day upon which any act or notice as provided in this Contract was
required to be performed or made.
THE NORTH CAROLINA ASSOCIATION OF REALTORS®, INC. AND THE NORTH CAROLINA BAR ASSOCIATION
MAKE NO REPRESENTATION AS TO THE LEGAL VALIDITY OR ADEQUACY OF ANY PROVISION OF THIS FORM IN
ANY SPECIFIC TRANSACTION. IF YOU DO NOT UNDERSTAND THIS FORM OR FEEL THAT IT DOES NOT PROVIDE
FOR YOUR LEGAL.. NEEDS, YOU SHOULD CONSULT A NORTH CAROLINA REAL ESTATE ATTORNEY BEFORE YOU
SIGN IT.
This offer shall become ja binding contract on the Effective Date,
Date: Z Z Z v Date:
Buyer (SEAL) Seller %L , �y, (SEAL)
Date: Date: /2 d
Buyer (SEAL) Seller (SEAL)
Date: Date:
Buyer (SEAL) Seller (SEAL)
Page 10 of I l
Buyer initials eller initials C
�
NC Bar Association Form No. 2T C Revised 20072008, 1/2011, 7/2011, 1/2012, 7/2012, 7/2013
Printed by Agreement with the NC Bar Association
This standard form has been approved jointly by:
North Carolina Bar Association — NC Bar Form No. 2T
North Carolina Association of Realtors®, Inc. -- Standard Form 2T

NOTICE INFORMATION
NOTE: INSERT THE ADDRESS AND/OR ELECTRONIC DELIVERY ADDRESS EACH PARTY AND AGENT APPROVES
FOR THE RECEIPT OF ANY NOTICE CONTEMPLATED BY THIS CONTRACT. INSERT "N/A' FOR ANY WHICH ARE
NOT APPROVED.
BUYER NOTICE ADDRESS:
Mailing Address: 6225 Wake Forest Hwy, Durham, NC 27703
Buyer Fa.c*: _
Buyer E-mail:
SELLING AGENT NOTICE ADDRESS:
Firm Name:
Acting as ❑ Buyer's Agent
Mailing Address:
SELLER NOTICE ADDRESS:
Mailing Address: 5903 Wake Forest Rd, Durham NC
27703
Seller Fax#:_
Seller E-mail:
LISTING AGENT NOTICE ADDRESS:
Firm Name:
Seller's (sub)Agent ❑ Dual Agent Acting as 13 Seller's Agent ❑ Dual Agent
Mailing Address:
Individual Selling Agent:
❑ Acting as a Designated Dual Agent (check only if applicable)
License #: ..
Selling Agent Phonek
Selling Agent Fax#:
Selling Agent E-mail:
EARCEL ID: 193799
STTE ADDRF- 5903 Wake Forest Rd. Durh m. NC 27703
OWNER CITY- Durham
OWNER STATE: NC
OWNER ZIP: 27703
LAND IJSE: 211
T,AND USE. DFSC: AG/1-Family>
LAND VALUE:
BU I.DING VALUE:_
TOTAL VALUE
DEED PACE_ 000911
PLAT BOOK: 000135
PLAT PAGF: 000062
DATE. SOLD:
SALE PRICE: $634,000.00
SITM ACRES: 18,335
Individual Listing Agent:
❑ Acting as a Designated Dual Agent (check only if applicable)
T.iraneA i:'
Listing Agent Phone#:
Listing Agent Fax#:
Listing Agent E-mail:
Page 11 of 11
Buyer initials L _! Seller initials Ar
ll This standard form has been approved jointly by:
NC Bar Association Form No, 2T C0 Revised 2007, 2008, 1/2011, 7/2011, 112012, 7/2012, 7/2013 PP
Printed by Agreement with the NC Bar Association North Carolina Bar Association — NC Bar Form No. 2T
North Carolina Association of Realtors®, Inc. - Standard Form 2T

Existing Permittee's Certification per 15A
11
(Signature A4hority's name & title from Application Item 1.2.)
(Facility name from Application Item II.I.)
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. 1 will make no claim against the
Division of Water Resources should a condition of the existing permit be violated. I also understand that if all required parts of this
application package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned as incomplete. I further certify that the existing Permittee or any affiliate has not been convicted of an
environmental crime, has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where
all appeals have been exhausted or abandoned, are compliant with any active compliance schedule, and do not have any overdue annual
fees per 15A NCAC 02T .0105(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed S 10,000 as well as civil penalties up to $25,000 per violation.
Signature: ;� 1--2 Id Date: Zzo 0
Applicant's Certification per 15A NCAC 02T .0106(b):
1 attest that this application for
(Signature Authority's name & title from Application Item IV.2.)
�C
from Application Item It.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after reissuance of the permit
into the Applicant's name, any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as incomplete. I further certify that the Applicant or any affiliate has not been convicted of an environmental
crime, has not abandoned a wastewater facility without proper closure, does not have an outstanding civil penalty where all appeals have
beenexhausted or abandoneLT are-enmpliant with any ucii-vv eompitanee schedule, and du not have any overdue-anntud ices pet 15A
NCAC 02T .0I05(e).
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed S 10,000 as well as civil penalties up to $25,000 per violation.
�J-7 �d Z
'Signature: � U �-� Date:
FORM: NDPONC 06-16 Page 2 of 2

State of North Carolina
Department of Environmental Quality
r1w Division of Water Resources
jb&VF JW 1W IR
NON -DISCHARGE PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources FORM: NDPONC 06-16
1. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: 10erpck le
J
2. Signature authority's name: per 15A NCAC 02T .0106(b) Title: i)' cAm er
3. Permittee's mailing address: 57go 3 ke rzoj-pg l- !i wt/
City: 7)UAOm State: ,&& Zip: v� 7%lD3
4. Permittee's contact information: Phone number: (Z'_.lv% Email Address: Db('�Pi�f'»(U)c�a��• t
5. Demonstration of historical consideration for permit approval - 15A NCAC 02T ,0120:
Has the Permittee or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or ['io
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ❑15-o
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or RNo-
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or 0-No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(c)(2)? ❑ Yes or [gf4o
11. FACILITY INFORMATION: 1. Facilityname: oe•Y'/ j1 j R.,,v-t )�oRo Gl "X��I,,7 _r
2. Facility's physical address: 110-3 We_ kr^_2� City: Our Aq W, State: NC Zip:Z?ZO3 _ County: Select Dgr4fv1,7
III. PERMIT INFORMATION: q
1. Existing permit number: WQ00 aid most recent issuance date:
2. Existing permit type: Select
3. Reason for the permit application: Select
4. Has the facility been constructed? ❑Yes or ❑'fl;o
IV. APPLICANT INFORMATION:
y
1. Applicant's name: ! - i rlwel IC 4. �r
2. Signature authority's name: L�w_/Se iI�JJ
per 15A NCAC 02T .0106(b) Title: OLr nef_
3. Applicant's mauling address; 6 L CO i'V0 e a/ U
City: awro4m State:Zip:Z2W.
4. Applicant's contact information: Phone number: (%�}-� Email Address: 1�/%(�7�Z/ ' • �1�'j7
5. Demonstration of historical consideration for permit approval - 15A NCAC 02T .0120:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or RIN'o
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or To
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or 10
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or Q N
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or Io
FORM: NDPONC 06-16 Page I of 2