WQ0021826_More Information (Received)_20210729

III 1111111111111111111111111111111
Doc No 395185
Recorded: 07/27/2021 11:23:19 AM
Fee Amt: $26.00 Page 1 of 2
Person County North Carolina
Tonya R. Wilson, Register of Deeds
BK 1087 PG 660 - 661 (2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
I, I iENR`! Vim' 1-4,1M011 N1 , certify that I am a deeded owner of the property located at:
Address: S 6`.1 G n fv;' /2 o 2jo
City: (2..0)(go -i2
Parcel No.:
23q//
State: N 1. Zip Code Z 57 y County: /9E7251::11/4)
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.
❑ For the parcel identified above, I consent to a reduced setback from feet to feet,
thereby allowing the application of Class B residuals as near as feet from my property line.
Ell'or the parcel identified above, I consent to a reduced setback from VD() feet to / °y' feet,
thereby allowing the application of Class B residuals as near as I00 feet from my residence.
**THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED**
A
Signature:
FORM: NDRMPW-LAS 11-18
Page 1 of 2

Applicant/Permittee: Err( O( gk'(3c2
Address: / O S S M114 S ei
Parcel No.:
City: Yi-0iG°/2-c-, State: /r� Gip Code: 275-73 county: PEnsdv
NORTH CAROLINA, Scv COUNTY
C,Pe. vo , a Notary Public for AMA County, North Carolina,
do hereby certify that I /ENP''1 W%"I(tvi M 7;J personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 22PD day of AL'( , ZoZI .
SEAL
-1111•J Cop.,
•0 /;�, s Signature of Notary Public
RY, ; U -7ii b12u7t'i
it•9 �1_,+; , z ? My commission expires
's<', �,��,:
y�1-y ,,i J 1r �,ti
Once notarized, thisfortn 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
1.617 Mail Service Center
Raleigh, North. Carolina 27699-1617
Document shows proof /acknowledgement before
officer authorized to take proof /acknowledgement;
acknowledgement includes officer's signature,
com(/r�}�s_ron ex irat'on dial seal, if required.
TonyaR:Wilson, Person County Register o eds
FORM: NDRMPW-LAS 11-18 Page 2 of 2

III 111111111111IIIIU111111IIII IU
Doc No: 395186
Recorded: 07/27/2021 11:23:20 AM
Fee Amt: $26.00 Page 1 of 2
Person County North Carolina
Tonya R. Wilson, Register of Deeds
BK 1087 PG 662 - 663 (2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
I, Si Ev 1 1",
Address: 2360
City: o.No12-0 State: Zip Code: 2� S. 7q County: %''72So''
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.
, certify that I am a deeded owner of the property located at:
(MO Parcel No.: si 0
❑ For the parcel identified above, I consent to a reduced setback from feet to feet,
thereby allowing the application of Class B residuals as near as feet from my property line.
[ For the parcel identified above, I consent to a reduced setback from a feet to /t)c' feet,
thereby allowing the application of Class B residuals as near as NO feet from my residence.
**THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED**
Signature:
FORM: NDRMPW-LAS 11-18
Date:
Page 1 of 2

Applicant/Permittee: Cjn/ G F P04130aD
Address: 105 cS 1144 -
Parcel No.:
City: w5(0 State: AL Zip Code:17 57 3 County: f egc2^)
NORTH CAROLINA, rL2S0,i COUNTY
I, g\fAiJ LOf e1fk,M , a Notary Public for AtAMilt-I :r; County, North Carolina,
do hereby certify that . TEV0J f f i i personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 2('' I4 day of In-Y , Zo21 .
1
g*to P
Signature of Notary Public
My commission expires N1) 1-1D2-4
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
Document shows proof /acknowledgement before
officer authorized to take proof/acknowledgement;
acknowledgement includes officer's signature,
comm ict exp atio d o icja2 seal, if required.
Tonya ilson, Person County Register of Deeds
FORM: NDRMPW-LAS 11-18 Page 2 of2

111111111111110111111111111111
Doc Noy 395187
Recorded: 07/27/2021 11:23:21 AM
Fee Amt: $26.00 Page 1 of 2
Person County North Carolina
Tonya R. Wilson, Register of Deeds
BK 1087 PG 664 - 665 (2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
i, L 'VOL AN)(\) &ENTV'Y , certify that I am a deeded owner of the property located at:
Address: yZt CA U ('- l/3Ri1 P-,oe0
City: Z°46�r
Parcel No.:
State: NC Zip Code: Z75 75 County: 1)82-5-vN
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.
❑ For the parcel identified above, I consent to a reduced setback from feet to feet,
thereby allowing the application of Class B residuals as near as feet from my property line.
[(For the parcel identified above, I consent to a reduced setback from 1460 feet to I 00 feet,
thereby allowing the application of Class B residuals as near as Its© feet from my residence.
**THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED**
FORM: NDRMPW-LAS 11-18
Date: / - 2 (p
Page 1 of 2

Applicant/Permittee:
Cis OF )(6o0-)
Address: OS S LIM ftf 2
City: V-W60P-0 State: I c- Zip Code: Z7573 County: 1E0u'J
Parcel No.:
NORTH CAROLINA, Peq-Sor.•► COUNTY
I, (ZIAly COP , a Notary Public for t.3114ryNC,County, North Carolina,
do hereby certify that 1 i"1 N'J & tJr1 ' personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the 2C' }t day of , 2v2t ,
``,``,,,,,,l1111/,,,,,,,,''
,GOP-4 "''--
NOTARY ; II
D PUBLIC ' 2 Signature of Notary Public
✓ -- 2tJ"�,�'` My commission expires '7%`' tIZZ�
SCE CGS
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
Document shows proof/acknowledgement before
officer authorized to take proof/acknowledgement;
acknowledgement includes officer's signature,
comm)pn expiration dat)official seal, if required.
Tonya ifsorsontyegist re of Deeds
FORM: NDRMPW-LAS 11-18 Page 2 of 2

ift)
III IIIIIIIIIIIIIIIIIIIIIIIIIIII III
Doc No: 395188
Recorded: 07/27/2021 11:23:22 AM
Fee Amt: $26.00 Page 1 of 2
Person County North Carolina
Tonya R. Wilson, Register of Deeds
BK 1087 PG 666 - 667 (2)
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NON -DISCHARGE RESIDUALS MANAGEMENT PROGRAM WAIVER
FOR THE APPLICATION OF CLASS B RESIDUALS
AGREEMENT TO WAIVE SETBACKS PURSUANT TO
15A NCAC 02T .1108(c)
1. 5; huEt\-) R 6 .1
, certify that I am a deeded owner of the property located at:
Address: 22-! 'lL1}(0cop f;fi/`Ey 11-0 Parcel No.: 57 1/2
City: ra6o2k2 State: ATL Zip Code: Z7$7County: Priv!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.
❑ For the parcel identified above, I consent to a reduced setback from feet to feet,
thereby allowing the application of Class B residuals as near as feet from my property, line.
ErFor the parcel identified above, I consent to a reduced setback from C100 feet to /OO feet,
thereby allowing the application of Class B residuals as near as /00 feet from my residence.
**THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED**
Signature:
FORM: NDRMPW-LAS 11-18
Date: a/
Page 1 of 2

Applicant/Permittee:
(..iTY 122-r6oR
Address: (1?S 5 L04PrR- 5nztr
Parcel No.:
City: ( t(30R-U State: 1\5C- Zip Code: 2575 County: Pe-PicA)
NORTH CAROLINA, Qe ter'' COUNTY
I, 'FAO L W) , a Notary Public for AtAmtVJ
County, North Carolina,
do hereby certify that ST Eue(%) f &ILO personally appeared before me this day
and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal, this the''I day of ��;,� , 2;y2r
•
C O P
`,,,,,,,1,„I,,,,,,I
c �°''o�''.
U ,1 E ___kill• (06(A0
1
: NOTARY ; =
= D 1 PUBLUC ' U
47 Z II
S :!,16,, 2`0 . "� .`1
Signature of Notary Public
My commission expires 114202y
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
Document shows proof/acknowledgement before
officer authorized to take proof/acknowledgement;
acknowledgement includes officer's signature,
commis expirati da ei i ial seal, if required.
Tonya Gilson, Person County Register of Deeds
FORM: NDRMPW-LAS 11-18 Page 2 of 2