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Home My WebLink AboutWQ0000672_More Information Received_20231002Initial Review Reviewer nathaniel.thorn burg Is this submittal an application? (Excluding additional information.) * Yes No If not an application what is the submittal type?* Annual Report Residual Annual Report Additional Information Other Permit Number (IR) * WQ0000672 Applicant/Permittee City of Lumberton Email Notifications Does this need review by the hydrogeologist? * Yes No Regional Office CO Reviewer Admin Reviewer Submittal Form Project Contact Information Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence. Name* Enviro-Choice Recycling, LLC Email Address* envirochoicenc@gmail.com Project Information ......................... Application/Document Type* New (Fee Required) Modification - Major (Fee Required) Renewal with Major Modification (Fee Required) Annual Report Additional Information Other Phone Number* 9107385311 Modification - Minor Renewal GW-59, NDMR, NDMLR, NDAR-1, N DAR-2 Residual Annual Report 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://edoes.deq.nc.gov/Forms/NonDischarge_Monitoring_Report Permit Type:* Wastewater Irrigation High -Rate Infiltration Other Wastewater Reclaimed Water Closed -Loop Recycle Residuals Single -Family Residence Wastewater Other Irrigation Permit Number:* WQ0000672 Has Current Existing permit number Applicant/Permittee Address* 700 Lafayette Street Facility Name* City of Lumberton Class B Residuals Program Please provide comments/notes on your current submittal below. Setback waiver for Mark Bullard. At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg at nathaniel.thornburg@ncdenr.gov. Please attach all information required or requested for this submittal to be reviewed here. (Application Form, Engineering Plans, Specifications, Calculations, Etc.) Mark Bullard.pdf 808.52KB Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless file is larger than upload limit. * 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 ��ni��`�er✓Y� yyt�ilrG Submission Date 10/2/2023 2023009215 ROBESON CO, NC FEE $26.00 PRESENTED & RECORDED. 09-28-2023 12:21:38 PM VICKI L LOCKLEAR REGISTER OF DEEDS s BY: CHISA WAINWRIGHT-LOCKLEAR SENIOR DEPUTY BK: D 2425 PG: 501-502 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. Mark Bullard Address: 4169 %V Unv Road City: Rowland certify that I am a deeded owner of the property located at: Parcel No.: 27150102002 State: No Zip Code: 2x383 County: Robeson Furthermore, I certify that I am authorized to snake 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 tine. ❑ For the parcel identified above, I consent to a reduced setback from 400 feet to 150 feet, thereby allowing the application of Class B residuals as near as 150 feet from my residence. "THIS WAIVER SHALL BE TERMINATED UPON CHANGE OF OWNERSHIP OF ANY PARTIES INVOLVED" Signature: \ Date: FORM: NDRMPW-LAS 11-18 Page 1 of ApplicantlPermittee: (_1 tj,y JV (yn) j(t(M Address: >t 3li4�/ Parcel No.: en v�o t 61061 City: b ,la y:)2) P cfo n State: t"JI Zip Code: rD,3 jg County:LL?b NORTH CAROLINA, . �� P COUNTY 1+ W1 1il��t, a Notary Public for z,t'Yl County, North Carolina, do hereby certify thatt O46CK 3n�,np personally appeared before me this day and acknowledged the due execution of the fore instrument. Witness my hand and official seat, this the 1 ay of SQ Vk1&6LA- SEA ```�ttttttttirri ,� .• �s �pTAgY •••� S1$11ature of Notary Public Mp co►nmissian erpiresMY iN Cpv Once notarized, this form shall be recorded at the Register of Deeds in the county or counties in which the described properties are located. A copy of the recorded waiver shall be sent to the following address: Division of Water Resources Non -Discharge Branch 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDRMPW-LAS 11-18 Page 2 of 2