WQ0020814_Application_20230922

State of North Carolina
Department of Environmental Quality
Division or Water Resources
15A NCAC 02T .0600 — SINGLF-FAMILY RESIDENCE
WASTEWATER IRRIGATION SYSTEM — C'IIANGE OF OWNERSFW
FORM: SFRW W IS -CO 03-21
Pursuant to I5A NCAC 02T.010, 7 , if the application does not include all required information and the necessary supporting
documentation, the application shall be returned. The application and attachments shall he prepared lu accordance with SSA
N1�0 1 SA NCAC OZ f .06� and Division Policies. For more information, visit the Water Quality Permitting
CAC OZT .0
Section's Non -Discharge Branch websitc. The Applicant shall submit an electronic copy of the application and attachments
uploaded as a single Portable Document Format (PDF) Tile to htt s:lle0 d� c5•de4� ov/FormslNonl7ischa►gr8ranch-
SuhmittaT-Form-Vey or emailed to Non-DIscharge.Reports rr7ncdenr.go-v if less than 20 megabytes (MB)•
SECTION II — FACILITY INFORMATION
1. Physical address: 149 Perfect Moment Dr. County- Chatham
City: Durham State: N ip: 27713-
SECTION III — BILLING INFORMATION
1. Billing address: 1 1-k
CityI 10fate: Zip: p�
SECTION IV -- DEED INFORMATION
Ilas a deed been executed and recorded in the County Register of Deeds pursuant to I SA NCAC 02T .060-4fe)(11?
Yes — Complete Items t through 4 below.
No — See Attachment 13 on Page 3.
1. Parcel No.: 79798 2. Date of Purchase: October 3, 2022
3. Deed Book: 2329 4. Deed Page Nos.: 820 - 821
SECTION V — OPERATION AND MAINTENANCE AGREEMENT
Permit No.: WQ0020814
Permittee: Pooja Aga and Anshooman Aga (i.e., all deeded property owners)
County: Chatham
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.
Z. 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 hypocblorite) as needed.
Swimming pool grade chlorine tablets arc 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 pumplsterage tanks
when pumping the septic tank solids out
6. Inspect the spray irrigation system monthly to verify: proper operation of the spray beads; that there are no leaks; that
vegetative growth does not obstruct the spray heads; that the irrigated wastewater is not pending in or running off
the designated irrigation area; and that there are a 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 objecbonable 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.
IIWe understand the a e require cuts and agree to these terms as part of the issued permit.
f Signature: —
2a Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
All deeded property owners shalt sign this Operation and Maintenance Agreement
ATTACHMENT A — SIGNATURE AUTHORITY DELEGATION _ _J
Does the signature authority in Section I, Item 3 meet the requirements pursuant to 15A NCAC 02T .0106 bj?
Yes — Skip Attachment A.
No — Submit a dclg ation Ietter pursuant to 15A N C A C 0 2 T -0106 c) authorizing the signature authority to sign.
ATTACHMENT B —PROPERTY OWNERSHIP DOCUMENTATION
Has a deed been exccured and recorded in the County Register of Deeds pursuant to 15A NCAC 02T � 0 604 1D(ll?
Yes — Complete Itcros I through 4 in Section N on Page I .
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 c 2l; 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 1 SA N C A C 02T -0604 a 31. Lease agreements shall adhere to the
requirements of 15A NCAC 021.-0.107.

1 APPLICANT'S CERTIFICATION
I I, attest that this a
I PPlication
{Signature authority's name as poled in Scction 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 carts of thL,
application package are not completed, and that if all required supporting information and attachments are not included fru,
application package will be returned as incomplete. I further certify pursuant to Z, that the applicant. or am
parent, subsidiary, or other affiliate of the applicant has: not been convicted of environmental crimes under, not previously abandoned
4 wastewater treatment facility without properly closing the facility; not paid a civil penalty; not been compliant with any compliance
schedule in a permit, settlement agrcernent, or order; not paid an annual fee.
Note: The Applicant's Certification shall be signed pursuant to 15A NCAC 02T .0106(bl. An alternate person may be delegated as
the signing official if a letter is provided pursuant to 15 02 . 1 g). Pursuant to § 143-215.6A and § 143-215.66 any
person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class
2 misdcrr(�uor, whi h may include a fmc not to exceed 510,000 as well as civil penaIties up to $25,000 per violation.
Signatum: Date:
("`I 929 `3
THE COMPLETED APPLICATION AND ATTACHIAENTS SHALL, BE SUBMITTED AS A SINGLE PDF FILE VIA:
Email: Laserficbe Upload:
iVon-Disrha e.Re ports a ncdenr, ay h-
Submittal-Forrn-Ver7.
u mittal-F rm-V r
FORM: SFRWWIS-CO 03-21 Page I of