WQ0000819_Correction_20090612

NCDENk
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Paves Perdue Colleen H. Sullins
Governor Director
June 12, 2009
George Radford, Director
Plantation Harbor Property Owner's Association, Inc,
200 Antebellum Drive
Havelock, North Carolina 28532
Dear Mr. Radford:
Dee Freeman
Secretary
Subject: Permit No. WQ0000819
Plantation Harbor
Wastewater irrigation System
Craven County
In accordance your email request (enclosed) received June 1, 2009, we are forwarding herewith a
corrected Permit No. WQ0000819, dated May 12, 2009. The purpose of this action is to correct the
following items as described below:
• The recalculation of the authorized connections as 332 using the new adjusted daily flow
rate of 80 gpd/bedroom.
• The replacements of the gas feed chlorination system with liquid feed chlorination system
and the 15 acres spray irrigation field to 49.62 acres in the permit description.
• Copies of the original waivers are included in this permit correction.
• The setback of 150 feet to any property line from the irrigation site has been changed to 50
feet.
• Based on 15A NCAC 02T .0505(1)(2), the requirement for the automatically activated
standby power has been deleted from the permit.
• To clarify, the State requires 12 months prior to the time that you submit your permit for
renewal of data of the actual (measured) monthly average amount of wastewater
contributed per unit (GPD/br). The permittee shall re-evaluate the approved value using the
methodology used to determine the approved flow rate of 80 GPD/br and submit this
information eighteen months following the submittal of the renewal.
AQUIFER PROTECTION SEC TION
1636 Priail Service Center, Raleigh. North Caro€ins 27699 -163 --
Location. 2728 Caoital Boulevard Raieigh, Nortn Carolina 27604
Phone: [phone] FA' 1: 919-715-0588: FA), 2: 919-715-604E, l customer 5er.ice: ,,-67= 23 6748
interne'.: wwwncwatergualily.orq
, ' EC ial Jar i , Affirmative A^ employ,
Nole
zthCarol;na

Mr. Radford
June 12, 2009
Page 2 of 2
6 The effluent limits listed on Attachment A page 2 for PPL:
o BOD has been changed from 30 mg/l to 60 mg/l.
o Total Suspended Solids (TSS) has been changed from 30 mg/l to 90 mg/1.
This change was as a result of utilizing Rule 15A NCAC 02T .0505 (b)(3) for
expanding facilities with lagoon treatment systems.
Please replace the existing Permit No. WQ0000819 with this corrected Permit No. WQ0000819,
issued May 12, 2009. If you need additional information concerning this matter, please contact Alice M.
Wessner at [phone] or [e-mail].
Sincerely,
/oleen H. Sullins
cc: Craven County Health Department
Washington Regional Office, Aquifer Protection Section
John G. Thomas, PE, Thomas Engineering, PA 309 Metcalf Street, PO Box 1309
New Bern, NC 28563
APS Central Files
LAU Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
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 HERESY GRANTED TO
Plantation Harbor Property Owner's Association, Inc.
Craven County
FOR THE
continued operation of a 79,710 gallon per day (GPD) wastewater treatment and surface irrigation
disposal facility consisting of 332 individual septic tank effluent pump systems, each consisting of a
1,200 gallon baffled septic tank, a 44 gallon pump tank with a 10 GPM submersible pump and a high
water alarm, and approximately 11,655 linear feet of 2 inch, 2.5 inches and 3 inch force main, a 2.6
million gallon treatment lagoon, a 3.8 million gallon storage lagoon, a pump station for the spray
irrigation system consisting; of dual 225 GPM pumps with high water alarms, a liquid feed chlorination
system with dual contact chambers a 30 minutes of detention time, a 49.62 acre spray irrigation field, and
all associated piping, valves, and appurtenances to serve Plantation Harbor, with no discharge of wastes to
the surface waters, pursuant to the modification and renewal applications received January 29, 2009 and
April 1, 2009 respectively, and in conformity with the project plan, specifications, and other supporting
data subsequently filed and approved by the Department of Environment and Natural Resources and
considered a part of this permit.
This permit shall be effective from the date of issuance until March 30, 2014, shall void Permit No.
WQ0000819 issued October 14, 2004, 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 that Rule 15A
NCAC 02T .0105(d) requires an updated site map to be submitted with the permit renewal
application. The Permittee shall submit a copy of the declarations and bylaws that documents
compliance with the attached Operational Agreement in accordance with Rule 15A NCAC 02T.01 15.
2. The subject wastewater treatment and disposal facilities shall be connected to an operational publicly
owned wastewater collection system, within 180 days of its availability to the subject facilities, if the
subject wastewater treatment or disposal facilities are in noncompliance with the terms and conditions
of this non -discharge permit or the governing statutes or regulations. Prior to the initiation of these
connection activities, appropriate approval must be received from this Division.
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U. PERFORMANCE STANDARDS
The surface irrigation facilities shall be effectively maintained and operated at all times so that there
is no discharge to the surface waters, nor any contravention of groundwater or surface water
standards. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions due to improper operation and maintenance, or failure of the irrigation area to
adequately assimilate the wastewater, the Permittee shall take immediate corrective actions including
those actions that may be required by the Division, such as the construction of additional or
replacement wastewater treatment and disposal facilities.
2. The issuance of this permit shall not relieve the Permittee of the responsibility for damages to ground
or surface waters resulting from the operation of this facility.
All wells that are constructed for purposes of groundwater monitoring shall be constructed in
accordance with 15A NCAC 02C .0108 (Standards of Construction for Wells Other than Water
Supply) and any other state and local laws and regulations pertaining to well construction.
4. Effluent limitations shall not exceed those specified in Attachment A.
5. Application rates, whether hydraulic, nutrient, or other pollutant shall not exceed those specified in
Attachment B.
6. The compliance boundary for the disposal system is specified by rules in 15A NCAC 02L,
Groundwater Classifications and Standards. This disposal system was individually permitted on or
after December 30, 1983; therefore, the compliance boundary is established at either 250 feet from
the waste disposal area, or 50 feet within the property boundary, whichever is closest to the waste
disposal area. An exceedance of groundwater standards at or beyond the compliance boundary is
subject to remediation action according to 15A NCAC 02L .0106(d)(2) as well as enforcement
actions in accordance with North Carolina General Statute 143-215.6A through 143-215.6C.
7. The Permittee shall apply for a permit modification prior to any sale or transfer .of property that
affects a compliance boundary to establish a new compliance boundary.
S. In accordance with 15A NCAC 02L .0107(d), .no wells, other than monitoring wells, shall be
constructed within the compliance boundary except as provided by 15A NCAC 02L .0107(g).
9. The review boundary is established around the disposal systems midway between the compliance
boundary and the perimeter of the waste disposal area. Any exceedance of standards at the review
boundary shall require action in accordance with 15A NCAC 02L.0106.
10. The facilities permitted herein must be constructed according to the following setbacks:
a. The setbacks for irrigation Sites permitted prior to September 1, 2006 shall be as follows (all
distances in feet):
i. Any habitable residence or place of public assembly under separate ownership: 4004
ii. Surface waters: 100
iii. Any well with exception of monitoring wells: 100
iv. Any property line: 504
v. Public right of way: 50
'The setback waivers (attached) signed by George Radford and Frank Marmarose respectively,
dated December 3, 2008 allows irrigation of treated wastewater within 200 feet of the identified
residences with tax parcel ids as follows: Plantation Harbor Property Owners Association 5-013-4-
004A & 5-013-4-004C and The Links at Plantation Harbor 5-013-4-021 & 5-013-4-020. A setback
waiver (attached) signed by Frank Marmarose dated December 3, 2008 allows irrigation of treated
WQ0000819 Version 3.0 Shell Version 090415 Page 2 of 8

wastewater within 200 feet of the identified place of public assembly located at 1886 Adams Creek
Road, Havelock, NC 28532. The Setback Waiver Form shall be recorded with the Craven County
Register of Deeds within ninety (90) days of issuance of this permit.
b. The setbacks for Treatment and Storage Units permitted prior to September 1, 2006 shall be as
follows (all distances in feet):
i. Any well with exception of monitoring wells: 100
ii. Any property line: 50
11. The Operational Agreement (Attached) between the Permittee and the Environmental Management
Commission is incorporated herein by reference and shall be a condition of this permit.
Noncompliance with the terms of the Operational 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.
M. OPERATION AND MAINTENANCE REQUIREMENTS
1. The facilities shall be properly maintained and operated at all times. The facilities shall be effectively
maintained and operated as a non -discharge system to prevent the discharge of any wastewater
resulting from the operation of this facility. The Permittee shall maintain an Operation and
Maintenance Plan pursuant to 15A NCAC 02T .0507 including operational functions, maintenance
schedules, safety measures, and a spill response plan,
2. Upon classification of the wastewater treatment and irrigation facilities by the Water Pollution
Control System Operators Certification Commission (WPCSOCC), the Permittee shall designate and
employ a certified operator to be in responsible charge (ORC) and one or more certified operator(s) to
be back-up ORC(s) of the facilities in accordance with 15A NCAC 08G .0200. The ORC shall visit
the facilities in accordance with 15A NCAC 08G .0200 or as specified in this permit and shall comply
with all other conditions specified in these rules.
3. A suitable year round vegetative cover shall be maintained such that crop health is optimized, allows
for even distribution of effluent, and allows inspection of the irrigation system.
4. Adequate measures shall be taken to prevent wastewater ponding or runoff from the irrigation field.
5. Irrigation shall not be performed during inclement weather or when the ground is in a condition that
will cause ponding or runoff.
6. All waste application equipment must be tested and calibrated at least once per permit cycle. Records
of the calibration must be maintained for five years.
7. No type of wastewater other than that from Plantation Harbor shall be irrigated onto the irrigation
area.
S. No traffic or equipment shall be allowed on the disposal area except while installation occurs or while
normal maintenance is being performed.
9. Public access to the land application sites shall be controlled during active use. Such controls may
include the posting of signs showing the activities being conducted at each site.
10. The residuals generated from these treatment facilities must be disposed 1 utilized in accordance with
15A NCAC 02T .1100. The Permittee shall maintain a residual management plan pursuant to 15A
NCAC 02T.0508.
11. Diversion or bypassing of the untreated wastewater from the treatment facilities is prohibited.
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12. Freeboard in the treatment and storage lagoons shall not be less than two feet at any time.
13. A waste -level gauge to monitor waste levels in the treatment and storage lagoons shall be provided.
This gauge shall have readily visible permanent markings indicating the maximum liquid level at the
top of the temporary liquid storage volume, minimum liquid level at the bottom of the temporary
liquid storage volume, and the lowest point on top of the dam elevations.
14. A protective vegetative cover shall be established and maintained on all earthen basin embankments
(outside toe of embankment to maximum allowable temporary storage elevation on the inside of the
embankment), berms, pipe runs, erosion control areas, and surface water diversions. Trees, shrubs,
and other woody vegetation shall not be allowed to grow on the earthen basin dikes or embankments,
Earthen basin embankment areas shall be kept mowed or otherwise controlled and accessible.
IV. MONITORING AND REPORTING REQUIREMENTS
Any monitoring (including groundwater, surface water, soil or plant tissue analyses) deemed
necessary by the Division to ensure surface and ground water protection will be established and an
acceptable sampling reporting schedule shall be followed.
2. All laboratory analyses for effluent, ground waters, or surface waters shall be made by a laboratory
certified by the Division for the required parameter(s) under 15A NCAC 02H.0800.
Flow through the treatment facility shall be continuously monitored and daily flow values shall be
reported on Form NDMR.
The Permittee shall install and maintain an appropriate flow measurement device consistent with
approved engineering and scientific practices to ensure the accuracy and reliability of flow
measurement. Flow measurement devices selected shall be capable of measuring flows with a
maximum deviation of less than 10 percent from true flow, accurately calibrated at a minimum of
once per year, and maintained to ensure that the accuracy of the measurements is consistent with the
accepted capability of that type of device. The Permittee shall keep records of flow measurement
device calibration on file for a period of at least three years. At a minimum, data to be included in
this documentation shall be:
a. Date of flow measurement device calibration,
b. Name of person performing calibration, and
c. Percent from true flow.
4. The effluent from the subject facilities shall be monitored by the Permittee at the frequencies and
locations for the parameters specified in Attachment A.
5. The Permittee tracking the amount of wastewater disposed shall maintain adequate records. These
records shall include, but are not necessarily limited to, the following information:
a. Date of irrigation,
b. Volume of wastewater irrigated,
c. Field irrigated,
d. Length of time field is irrigated,
e. Continuous weekly, monthly, and year-to-date hydraulic (inches/acre) loadings for each field,
£ Continuous monthly and year-to-date loadings for any non -hydraulic parameter specifically
limited in Attachment B for each field,
g. Weather conditions, and
h. Maintenance of cover crops.
Freeboard (waste level to the lowest elevation on the top of the embankment) in the treatment and
storage lagoons shall be recorded weekly.
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7
01
A record shall be maintained of all residuals removed from this facility. This record shall include the
naive of the hauler, permit authorizing the disposal or a letter from. a municipality agreeing to accept
the residuals, date the residuals were hauled, and volume of residuals removed.
A maintenance log shall be maintained at this facility including but not limited to the following items:
a. Visual observations of the plant and plant site.
b. Record of preventative maintenance (i.e., changing of equipment, adjustments, testing,
inspections and cleanings, etc.).
e. Date of calibration of flow measurement device.
9. Monitoring wells MW -1, MW -2, MW -3, MW -4, and MW -5 shall have their wellheads remain
secured in such a way as to prevent access by hand. This restriction of access may be accomplished
by utilizing a padlock,, which would secure a protective wellcap to the protective casing, or by some
other means acceptable to the Groundwater Section,
10. Any additional groundwater quality monitoring, as deemed necessary by the Division, shall be
provided. The permittee shall contact the Washington Regional Office of the Aquifer Protection
Section when the average influent flow reaches 20,000 gallons per day so that a groundwater
monitoring and reporting program can be considered.
11. Three (3) copies of all monitoring data [as specified in Conditions N.3. and IVA.] on Foran NDMR
for each PPI and three (3) copies of all operation and disposal records [as specified in Conditions 1V.5
and N.6.] on Form NDAR-1 for every field shall be submitted on or before the last day of the
following month. If no activities occurred during the monitoring month, monitoring reports are still
required documenting the absence of the activity. All information shall be submitted to the following
address:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
12. An annual representative soils analysis (Standard Soil Fertility Analysis) shall be conducted on each
irrigation field and the results maintained on file by the Permittee for a minimum of five years. The
Standard Soil Fertility Analysis shall include, but is not necessarily limited to, the following
parameters:
Acidity
Manganese
Potassium
Calcium
Percent Humic Matter
Sodium
Copper
pH
Zinc
Magnesium
Base Saturation (by calculation)
Phosphorus
Cation Exchange Capacity
Exchangeable Sodium Percentage
13. Noncompliance Notification:
The Permittee shall report by telephone to the Washington Regional Office, telephone number 252-
946-6481, as soon as 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 occurrence at the wastewater treatment facility which results in the treatment of significant
amounts of wastes which are abnormal in quantity or characteristic, such as the dumping of the
contents of a sludge digester; the known passage of a slug of hazardous substance through the
facility; or any other unusual circumstances including ponding in the irrigation field or runoff
from the irrigation fields.
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b. Any process unit failure, due to known or unknown reasons, that render the facility incapable of
adequate wastewater treatment such as mechanical or electrical failures of pumps, aerators,
compressors, etc.
c. Any failure of disposal system resulting in a by-pass directly to receiving waters.
d. Any time that self-monitoring information indicates that the facility has gone out of compliance
with its permit limitations including, but not limited to, freeboard measurements, effluent
limitations, exceedances of groundwater standards, or overloading of any field.
For any emergency that requires immediate reporting (e.g., discharges to surface waters, irrlminent
failure of a storage structure, etc.) outside normal business hours must be reported to the Division's
Emergency Response personnel at telephone number [phone], [phone], or (919) 733-
3300. Persons reporting such occurrences by telephone shall also file a written report in letter form
within five (5) days following first knowledge of the occurrence. This report must outline the actions
taken or proposed to be taken to ensure that the problem does not recur.
V. INSPECTIONS
1. Adequate inspection and maintenance shall be provided by the Permittee to ensure proper operation
of the subject facilities.
2. The Permittee or his designee shall inspect the wastewater treatment and disposal facilities to prevent
malfunctions and deterioration, operator errors and discharges which may cause or lead to the release
of wastes to the environment, a threat to human health, or a nuisance. The Permittee shall keep an
inspection log or summary including at least the date and time of inspection, observations made, and
any maintenance, repairs, or corrective actions taken by the Permittee. This log of inspections shall
be maitltained by the Pcrmittee for a period of five years from the date of the inspection and shall be
made available upon request to the Division or other permitting authority.
3. Any duly authorized officer, employee, or representative of the Division may, upon presentation of
credentials, enter and inspect any property, premises or place on or related to the disposal site or
facility at any reasonable time for the purpose of determining compliance with this permit; may
inspect or copy any records that must be maintained under the terms and conditions of this permit,
and may obtain samples of groundwater, surface water, or leachate.
VI. GENERAL CONDITIONS
I. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee
to an enforcement action by the Division in accordance with North Carolina General Statute 143-
215.6A to 143-215.6C.
This permit shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other supporting data.
This permit is effective only with respect to the nature and volume of wastes described in the
application and other supporting data. No variances to applicable rules governing the construction
and i or operation of the permitted facilities are granted unless specifically requested and granted in
this permit.
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4. The Division accepts the data -based design flow rate of 80 gallons per. day per bedroom (gpdpb) for
the community served by this system. Regardless of the adjusted design daily wastewater flow rate,
at no time shall the wastewater flows exceed the limits defined in this permit for the subject facility or
exceed the capacity of the sewers downstream of any new sewer extension or service connection(s).
The Permittee shall report the actual (measured) monthly average amount of wastewater flow
contributed per unit {GPD/br) for the 12 months prior to renewal. If any of these values are within
twenty percent of the approved value, the Permittee shall re-evaluate the approved value using the
methodology used to determine the approved flow rate of 80 gpdpb and submit this information
within eighteen months following the renewal, The Division may change the design flow rate for
connections to the system at that time, and upon each renewal cycle, pending an evaluation of the
submitted flow information.
The issuance of this permit does not exempt the Peri ittee from complying with any and all statutes,
rules, regulations, or ordinances, which may be imposed by other government agencies (local, state,
and federal) that have jurisdiction. 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 the Division's General Permit NCG010000, and any requirements pertaining'to
wetlands under 15A NCAC 02B .0200 and 02H .0500.
b. In the event there is a desire for the facilities to change ownership, or there is a name change of the
Permittee, a formal permit request must be submitted to the Division on official Division form(s),
documentation from the parties involved, and other supporting materials as may be appropriate. The
approval of this request will be considered on its merits and may or may not be approved. The
Permittee of record shall remain fully responsible for compliance until a permit is issued to the new
owner.
7. The Permittee shall retain a set of approved plans and specifications for the life of the facilities
permitted herein.
S. Tlhe Permittee shall maintain this permit until all, permitted facilities herein are properly closed or
permitted under another permit issued by the appropriate permitting authority.
The Permittee must pay the annual fee within thirty (30) days after being billed by the Division.
Failure to pay the fee accordingly may cause the Division to initiate action to revoke this permit
pursuant to 15A NCAC 02T .0105(e).
Permit issued this the 12th of May, 2009
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
J,1,2 A 11-�-
,!;�r Ween H. ins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0000819
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WQ0000819 Version 3.0 Shell Version 090415 Page 8 of 8

ATTACHMENT A - LIMITATIONS AND MONITORING REQUIREMENTS
PPI 001 — WWTF Influent
Perinit Nurnbei•: WQ0000819 Version: 3.0
PPI 002 — WWTF Effluent
E1+FLUENT CIIARACTERIS11CS
EFFLUENT LIMITS
AIONITORING
INFLUENT CIIARACTERISTICS
INFLUENT LIPIITS
REQUIRE51EN-FS
Parameter Description - PCS Code
Monthly Average
Monthly Geometric
Mean
Daily Minimum
Daily Maximum
Measurement
Frequency
Sample
Type
Flotiv, iti Conduit or that Treatment Plant - 50050
79710
gpd
4 x year
Grab
Continuous
Recording
PPI 002 — WWTF Effluent
E1+FLUENT CIIARACTERIS11CS
EFFLUENT LIMITS
MONITORING
REQUIREMENTS
Parameter Description - PCS Code
Monthly Average
Monthly Geometric
Mean
Daily Minimum
Daily Maximum
Measurement
Frequency`
Sample
Type
Coliform. Fecal MIs, M -FC Brotli,44.5C - 31616
200
4/100hul
4 x year
Grab
BOD, 5 -Day (20 Deg. C) - 00310
60
Ingl
4 x year
Grab
Nitrogen, Kjeldahl, Total (as N) - 00625
4 x year
Grab
Nitrite ploy Nitrate Total I DET. (as N) - 00630
4 x year
Grab
Solids, Total Suspended - 00530
90
rug[
4 x year
Grab
Nitrogen, Ammonia Total (as N) - 00610
15
tngl
4 x year
Grab
Phosphorus, 'total (as P) - 00665
4 x year
Grab
pH --- 00400
4 x year
Grab
Monthly averages for all but total coliform shall be the arithmetic meati of all samples collected during the reporting period.
I Monthly average for total coliform shall be the geometric mean of all samples collected during the repotting period
`4 x year niouitoring shall be conducted in March, June, September and November.
WQ0000819 Version 3.0 .Attachment A Page I of 2

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WQ00008 � , Version 3.0 Attachment A ge 2 of 2

ATTACHMENT 13- APPROVED LAND APPLICATION SITES AND LIMITATIONS Permit Number: WQ0000819 Version: 3.0
Plantation Harbor Property Owner's Association, Inc — Plantation Harbor Wastewater Irrigation System
IRRIGATION AREA INFORMATION
APPLICATION LIMITATIONS
F1eld/
Owner
Count y
Latitude
Lon itude
g
Net
Dominant
P erarneter
Hourly
Rate
Yearly
Max
[hits
Zone
Acreage
Soil Series
01
Plantation Harbor POA
Craven
34052'52"
76045'04'
23.92
Tomo0ey
01284 - A lication Surface lrri ation
0.25
22
inches
02
Plantation Harbor POA
Craven
34052'52"
76045'22"
14.47
Augusta
01284 - App lication Surface Itri ation
0.25
27.9
inches
03
Plantation harbor POA
Craven
34°52'55"
76°44'53"
11.23
49.62
Tornotley
01284 - Application Surface Irrigation
0.25
19.5
inches
Totals
WQ0000819 Version 3.0 Attaclunent B Page I of 2

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WQOOOO8 , , Version 3.4 Attachment B 'age 2 of 2

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
SETBACK WAINTR FORD ORIGINLL
(THIS FORMMAIr BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality will not consider this attachment form to be complete unless all the
instructions are followed. Failure to follow the instructions or to submit all of the required items
will lead to additional processing and review time for the application.
For more information or for an electronic version of this_form, visit our web site at:
http: //h2o.eny-.state. nc.us/lau/applications.html
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for review without a corresponding Land Application Unit
application form.
✓ Any changes to this attachment form will result in the application package being returned.
✓ Any other setbacks required by 15A NCAC2T ,0506 and .0606 other than those referenced below, cannot
be waived through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WANE THE SETBACK REQUIRED BY
15A NCAC 2T .0506(a), .0506(b) and .0606(x)
The undersigned property owner(s) hereby permits:
Applicant's name; Plantation Harbor Proiaerty Owners Association, Inc,
Complete mailing address of applicant: PHPOA Attn: Mr. George Radford,Director,• 202 Sumter Ct.
City: Havelock State: North Carolina Zip: 28532
Telephone number: 5252) 463-0547 Facsimile number: na
hereinafter referred to as the Permittee, to (check all that apply):
X Irrigate wastewater within 50 feet (cannot be less than 50 feet) of the property line,
X Irrigate wastewater within 200 feet (cannot be less than 200 feet) of the identified residence,
❑ Construct wastewater treatment units within feet of the property line,
as shown on the attached map and located at the following:
Location address of property: Plantation Harbor Property Owners Association S rav Irrigation Site
County: Craven State: North Carolina Zip: 28532
X I certify that I am a deeded property owner of above -referenced property and am authorized to make
decisions regarding this property on behalf of other deeded property owners. Furthermore, I certify
that I have read and understand this Agreement and do hereby grant permission to the Permittee to
irrigated wastewater or construct wastewater treatment units as specified herein. I further a ee that
upon issuance of a permit by the Division for the wastewater irritation system I will record this
waiver form with thea ra nate Register of Deeds and providr, the Permittee with documentation of
such.
Property owner(s) narae(s): Plantation Harbor _Property- Owners Association. Inc. George
Signature:
FORM: SWF 09-06
Date:

i.l-_Y:3UT
http://gismaps. cravencounty.com/maps/map_print.asp?pid= 8-lminX=2671254.15 543 701 &,m... 81$1"2007

State of North Carolina
Department of Environment and Natural Resources
Division of mater Quality
SETBACK WAIVER FORM �0,
�:
(THIS FORM MAI' BE PHOTOCOPIED FOR USE AS AN ORIGINAL)
The Division of Water Quality will not consider this attachment form to be complete unless all the
instructions are followed. Failure to follow the instructions or to submit all of the required items
will lead to additional processing and review time for the application.
For more irzformation or for an electronic version of this form, visit our web site at;
http: //h2 o. enr. state. nc, us/lauiapplications. h rml
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ Do not submit this attachment form for review without a corresponding Land Application Unit
application form.
✓ Any changes to this attachment form will result in the application package being returned.
✓ Any other setbacks required by 15A NCAC2T .0506 and .0606 other than those referenced below, cannot
be waived through execution of this form.
✓ A copy of the completed and appropriately executed form must be provided to the property owner.
AGREEMENT TO WAIVE THE SETBACK REQUIRED RY
15A NCAC 2T .0506(a), .0506(b) and .0606(a)
The undersigned property owner(s) hereby permits:
Applicant's name: Plantation. Harbor Property Owners Association, Inc.
Complete mailing address of applicant: PHPOA Attn. Mr. George Radford, Director: 202 Sumter Ct.
City: Havelock State: North Carolina Zip: 28532
Telephone number: 252 463-0547 Facsimile number: na
hereinafter referred to as the Permittee, to (check all that apply):
X Irrigate wastewater within 50 feet (cannot be less than 50 feet) of the property line,
• Irrigate wastewater within 20_0 feet (cannot be less than 200 feet) of the identified residence,
X Irrigate wastewater within 200 feet (cannot be less than 200 feet) of the identified place of
public assembly
❑ Construct wastewater treatment units within feet of the property line,
as shown on the attached map and located at the following:
Location address of property: The Links at Plantation Harbor
County: Craven State: North Carolina Zip: 28532
X I certify that I am a deeded property owner of above -referenced property and am authorized to make decisions
regarding this property on behalf of other deeded property owners. Furthermore, I certify that I have read and
understand this Agreement and do hereby grant permission to the Permittee to irrigated wastewater or construct
wastewater treatment units as specified herein. I further a ree that upon issuance of a permit by the Division for
the wastewater irritation system I will record this waiver form with the amropriate Register„ of Deeds and
provide the Permittee with documentation of such.
Property owner(.$) name(s): The Links at Plantation Harbor. LLC; Dr. Frank Marmarose Mana er
Signature: _V: ' '!.';��?'�e%ix....e✓�. Date:
Signature: Date:
FORM: SWF 09-06

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