WQ0021351_Application_20220114

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
15A NCAC 02T .0600 — SINGLE-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM — CHANGE OF OWNERSHIP
FORM: SFRWWIS-CO 03-21
Pursuant to 15A NCAC 02T .0107(b), if the application does 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 15A
NCAC 02T .0100, 15A NCAC 02T .0600, and Division Policies. 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 https://edocs.deq.nc.gov/Forms/NonDischarge-Branch-Submittal-
Form-Ver2, or emailed to Non-Discharge.Reports(uncdenr.gov if less than 20 megabytes (MB).
SECTION I — APPLICANT INFORMATION
1.
Applicant: Waltonwood Oberlin Reston, LLC
2.
Permit No.: WQ0021351
3.
Signature authority: Avi Grewal
Title: Manager
4.
Mailing address: 2601 Weston Parkway, Suite 203
City: Cary
State: NC Zip: 27513-
5.
Contact person: Matt Berberick
Primary phone number: [phone] Cell
Email: matthew.berberickgsinghmail.com
Secondary phone number: ( ) -
Select
6.
Secondary Contact person: Jacob Shermer
Primary phone number: (919) 961-953 Cell
Email: [e-mail]
Secondary phone number: ( ) -
Select
1. Physical address: 105 Holly Creek Road
City: Morrisville
County: Wake
State: NC
Zip: 27560-
1. Billing address: 2601 Weston Parkway, 203
City: Cary
State: NC
Zip: 27513-
SECTION IV 1 EED INFORMATION
Has a deed been executed and recorded in the County Register of Deeds pursuant to 15A NCAC 02T .0604(e)(1)?
® Yes — Complete Items 1 through 4 below.
❑ No — See Attachment B on Page 3.
1. Parcel No.: 745441543
2. Date of Purchase: January 11, 2022
3. Deed Book: 188877
4. Deed Page Nos.: 1476 - 1477
FORM: SFRWWIS-CO 03-21
Page 1 of 3

SECTION V — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0021351
Permittee: Waltonwood Oberlin Reston, LLC (i.e., all deeded property owners)
The Permittee agrees to operate and maintain the single-family residence wastewater treatment and irrigation system as
follows:
1. Inspect the septic tank annually, and pump out solids as needed.
2. Inspect and clean the septic tank effluent filter annually. (if applicable)
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
applicable)
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.
County: Wake
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 ponding in or running off
the designated irrigation area; and that there are no objectionable odors. (if applicable)
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:
Signature: Date:
Signature: Date:
Signature: Date:
1/14/2022
All deeded property owners shall sign this Operation and Maintenance Agreement
FORM: SFRWWIS-CO 03-21
Page 2 of 3

ATTACHMENT A — SIGNATURE AUTHORITY DELEGATION
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106(b)?
® Yes — Skip Attachment A.
❑ No — Submit a delegation letter pursuant to 15A NCAC 02T .0106(c) authorizing the signature authority to sign.
■
ATTACHMENT B — PROPERTY OWNERSHIP DOCUMENTATION
Has a deed been executed and recorded in the County Register of Deeds pursuant to 15A NCAC 02T .0604(f)(1)?
® Yes — Complete Items 1 through 4 in Section IV on Page 1.
❑ No
❑ Submit a written notarized intent to purchase agreement sign by both parties with a plat or survey map pursuant to 15A NCAC
02T .0604(e)(2); or
❑ Submit a 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 pursuant to 15A NCAC 02T .0604(e)(3). Lease agreements shall adhere to the
requirements of 15A NCAC 02L .0107.
Avtar S. Grewal attest that this application
(Signature authority's name as noted in Section I, 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 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 pursuant to 15A NCAC 02T .0120(b), 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 Applicant's Certification shall be signed pursuant to 15A NCAC 02T .0106(b). An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15A NCAC 02T .0106(c). Pursuant to § 143-215.6A 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 ' i ' cl • e _�f ' - - : to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: / Date: 1/14/2022
THE COMPLETED APPLICATION AND ATTACHMENTS SHALL BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email:
Non-Discharge.Reports(u)ncdenr. gov
Laserfiche Upload:
https://edocs.deq.nc.gov/Forms/NonDischarge-Br anch-
Submittal-Form-Ver2
FORM: SFRWWIS-CO 03-21 Page 3 of 3

BK018877PG01476
WAKE COUNTY, NC
TAMMY L. BRUNNER
REGISTER OF DEEDS
PRESENTED & RECORDED ON
01-11-2022 AT 09:24:19
STATE OF NC REAL ESTATE
EXCISE TAX: $4,256.00
BOOK: 018877 PAGE: 01476 - 01477
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax: $4,256.00
Parcel Identifier No. 0111831 Verified by
County on the day of , 20
By:
Mail/Box to: Grantee
This instrument was prepared by: Hervey and Hervey P.A. (without title examination)
Brief description for the Index: Lot 2 Morris West Subdivision BM 1979, Page 673
THIS DEED made this 7th day of January 2022 by and between
GRANTOR
Mark Alan Kloefkorn and Karen Elizabeth Kloetkorn,
a married couple
105 Holly Creek Road
Morrisville, NC 27560
GRANTEE
Waltonwood Reston Oberlin, LLC
a Michigan limited liability company
7125 Orchard Lake Road, Suite 200
West Bloomfield, MI 48322
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged,
has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot or parcel of land
situated in Wake County, North Carolina and more particularly described as follows:
BEING ALL OF LOT NO.2 OF MORRIS WEST SUBDIVISION CONTAINING 5.01 ACRES ACCORDING TO
MAP ENTITLED "MORRIS WEST" BYWILLIAM O. YATES, R.L.& DATED JU'LY 17, 1979 AND RECORDED
IN BOOK OF- MAPS 1979; 673 PAGE WAKE COUNTY REGISTRY_
The property hereinabove described was acquired by Grantor by instrument recorded in Book page
All or a portion of the property herein conveyed XX includes or does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Book of Maps 1979, Page 673.
Submitted electronically by Adams, Howell, Sizemore &Adams, Y.A. in compliance with North Carolina statutes governing
recordable documents and the terms of the submitter agreement with the Wake County Register of Deeds.
NC Bar Association Form No. 6 © 1/1/2010
Printed by Agreement with the NC Bar Association

BK018877PG01477
My Commission Expires:
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the
Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and Grantor
will warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, other than the
following exceptions:
1) Ad Valorem taxes for the current year and subsequent years.
2) All easements, covenants, and restrictions of record.
3) Zoning regulations and ordinances.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
Mark Alan Kloefkorn
Karen Elizabeth Kloefkom
State off
County of (eA
I, the undersigned Notary Public of the County of \Ce-• and State aforesaid, certify that Mark Alan
Kloefkorn personally appeared before me this day and acknowledged the due ex�eion of the foregoing instrument for the
pupo, es ttl�erein expressed. Witness my hand and Notarialaff Q str seal this '� ..ay of January 2022.
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41ffr,c Seal)
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State of 9 , C--
County of lid AV -
I, the undersigned Notary Public of the County of LAJA,KR,, and State aforesaid, certify that Karen Elizabeth
Kloefkom personally appeared before me this day and acknowledged the due execution of the foregoing instrument for the
pxrposes herein expressed. Witness my hand and Notarial stamp or seal this day of January 2022.
Notary Public's Printed Name
My Commission Expires: A C /j'Z'?