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Home My WebLink AboutWQ0039297_Application_20210401I DWR State North Carolina Department of Environmental Quality Division of Water Resources Division of Water Resources ISA NCAC 02T.0600-SINGLE-FAMILY RESIDENCE WASTEWATER IRRIGATION SYSTEM -CHANGE. OF OWNERSHIP FORM: SFR W W I.S-CO 03-21 Pursuant to ISA NCAC 02T.0107(bl, If the application do" not Include all required Information and the necessary supporting documentation, the application shall be returned. The application and attachments shall be prepared in accordance with ISA NCAC 02T.0100, ISA NCAC 02T 0600, and Division Pollcles. For more Information, visit the Water Quality Permitting Section's Non -Discharge Branch website. The Applicant shall submit an electronic copy of the application and attachments uploaded as a single Portable Document Format (PDF) file to httos://Cdocs,deu.nc aov/Far /N D' h• ee-R h-S b itt (- Form -Vert, or entailed to Non -Discharge R rtswn de ¢u If less than 20 megabytes (MR). r SECTION I - APPLICANT INFORMATION —. _ _ I. Applicant James S. Boyer -- -- - _ 2. Permit No.: W00039297 3. Signature authority: S L� Title: 4. Mailing address: 51% OPP0571oa1 WAS( cit),: WilKF Fo1165 Stan tVC. Zip Z77-0-7 S. Contact Person. JAMIF $OYflt Email: J A r'+•1 f E Fo y ErQ@ A 0 L. . Cowl Primary phone number: (911)(r01- 6kjjPlect Secondary phone number: ( ) - Select 6. Secondary Comamperson: CRAVE,5 Boy ErC Email: CjgdVE513o7E)94aC7M4jL.(,, Priman phone number: ftj Z13-OW(Select Secondary phone number: ) Select SECTION 11-FACILITY INFORMATION L Physical address: 3701 Quarry Road County: Wake City: Wake Forest State: NC. Zip: 27587- OPP05) -BILLING INFORMATION State: N1C 7ip:Zl SECTION IV- DEED INFORMATION Has a deed been executed and recorded in the County Register of Deeds pursuant to 15A NCAC 02T 0604(e)(1)? ® Yes - Complete Ilems I through 4 below. ❑ No - See Attachment B on Page 3. I. Parcel No.: 0096793 2. Date of Purchase: October 16, 2017 3- Deed Book: 016939 4. Deed Page Nos.: 02594 - 02596 FORM: SFRW WIS-CO 03-21 PA¢P I nF1 SECTION V —OPERATION AND MAINTENANCE AGREEMENT Permit No.: W00039297 County: Wake Permitme: James S. Boyer (i.e., all deeded property owners) The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as follows: I. Inspect the septic tank annually, and pump out solids as needed. 2. Inspect and clean the septic lank effluent fiherannually. (ifapplicahle) 3. Inspect the tablet chlorinator weekly. Add wastewater grade chlorine tablets(e.g., calcium hypochlorite) as needed. Swimming pool grade chlorine tablets are not acceptable. (if applicable) 4. Inspect the ultraviolet disinfection unit weekly. Clean or replace the lamps and quartz sleeves as needed. (if appbcaMe) 5. Inspect all storage tanks, pumps, and alarms monthly. Remove the floating scum layer in all pump/storage tanks when pumping the septic tank solids out. 6. Inspect the spray irrigation system monthly to verify: proper operation of the spray heads; that there are no leaks; that vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not ponding in or running off the designated irrigation area; and that there are no objectionable odors. (if applicable) 7. Inspect the drip irrigation system monthly to verify: proper operation of the drip lines; that there are no leaks; that vegetative growth does not obstruct the drip emitters; that the irrigated wastewater is not pending in or running off the designated irrigation area; and that there are no objectionable odors. (ifopplicable) 8. Maintain a set of Division -approved engineering plans and specifications. 9. Pay the required annual fee. 10. Request renewal of this permit on Division -approved forms no later than 180 days prior to expiration. 11. Sign and provide a Change of Ownership application to any future owner of the single-family residence wastewater treatment and irrigation system for their completion and submission to the Division of Water Resources. I/We understand the above requirements and agree to these terms as part of the issued permit. Signature: ' Date: 3 -31- 7041 Signature: Signature: Signature: Date: Date: Date: All deeded property owners shall sign this Operation and Maintenance Agreemeat FORM: SFRW WIS-CO 03-21 Page'_ of 3 I ATTACHMENT A -SIGNATURE AUTHORITY DELEGATION 1 Does the signature authority in Section 1, Item 3 meet the requirements pursuant to 15A NCAC 02T 0106(b)? Q Yes — Skip Attachment A. ❑ No —Submit a d lele a� pursuant to 15A NCAC 02T 0106(c) authorizing the signature authority to sign. ATTACHMENT a- PROPERTY OWNERSHIP DOCUMENTATION Hm a deed been executed and recorded in the County Register of I)ccds pursuant to 15A NCAC 02T 0604(D(I)? ®Yes -Complete hems I lhmugh 4 in Section IV on I'agc I. ❑ No [:]Submit a written nomnzed intent to purchase agreement sign by both panics with a plat or survey map pursuant to 15A NCAC Qy'J_Q6(14L, Q. or ❑ Submit a xnuan notarized lease agreement that specifically indicates the intended use of the property and has been signed by both panms. as well as a plat or survey ntap pursumn to 15A NCAC 0 1 0604(c)(3 t Lease agreements shall adhere to the mgmremcnbaf lSA NCAC 021.. 0107. APPLICANT'S CERTIFICATION JAM& 5 S C O'r 13oy E(L attest that this application (Signature authority's name as noted in Section 1, Item 3) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this application package arc 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 pursuant to 15A NCAC 02T 01201hi, that the applicant, or any parent- subsidiary. or other affiliate of the applicant has: not been convicted of environmental crimes under. not previously abandoned a wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance schedule in a permit, settlement agreement, or order; not paid an annual fee. Note: The Applicants Certification shall be signed pursuant to 15A NCAC 02T 0I06(bl. An alternate person may be delegated as the signing official if a letter is provided pursuant to 15A NCAC 02T .0106(c). Pursuant to § 143-21 i6A and § 143-215.6B, any person who knowingly m es any false statement, representation, orcenification in any application package shall be guilty ofa Class 2 misdemeanor, which y inglade a fine o exceed $10,000 as well as civil penalties up to $25,000 per violation. Station: \'� Date: 3.3 t— Z o z l It THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA: Email: Non-Discharee.Reoorts(a).nedenceov Laserftche Upload: https://edoesdeg.ncgov/Fornis[N nDis ha 2e-Branch- Submittal-Form-Vert FORM: SFRW WIS-CO 03-21 Page 3 of 3