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Notice of Transfer of Ownership For Onsite Wastewater Treatment Facility (Septic System)
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This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Transfer Information
This section is complete
This section is incomplete
2.
Inspection Information
This section is complete
This section is incomplete
3.
Form Submittal Information
This section is complete
This section is incomplete
Transfer Information
Additional Information
Notice of Transfer of Ownership Website
Want to submit it by mail or email?
Notice of Transfer Application Fillable PDF
For questions, assistance, or feedback, please call (602) 506-6666 or email us at
SepticQuestions@mail.maricopa.gov
1. Property Information
Address
*
City
*
Zip Code
*
County
*
Parcel #
*
Property Type
*
Residential
Non-residential
2. Transferor/Seller/Former Owner of Property
Name
*
Mailing Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Fax Number
Email Address
*
3. Transferee /Buyer/New Owner of Property
Name
*
Mailing Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Fax Number
Email Address
*
Inspection Exemption Criteria
Transferee/Buyer must check this box if the On-site Wastewater Treatment Facility is exempted from inspection
An inspection is not required if both of the following conditions apply (Buyer shall check applicable boxes to affirm that these conditions are met, provide the file number and authorization date, then skip directly to Item 8 before submitting this form):
Inspection Exemption Condition #1
A Discharge Authorization was issued by ADEQ or its delegated county agency, Maricopa County, to operate the facility.
(See Inspection Exemption Criteria Above)
Discharge Authorization File No.
(See Inspection Exemption Condition #1 Above)
Discharge Authorization Date
Discharge Authorization Date
(See Inspection Exemption Condition #1 Above)
Inspection Exemption Condition #2
The facility has never been put into service before this property transfer.
(See Inspection Exemption Criteria Above)
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Inspection Information
4. Inspector Information
Inspector Name
*
NAWT Inspector Number
*
Company Name
*
Address
*
City
*
State
*
Zip Code
*
Phone Number
*
Fax Number
Email Address
*
5. Date of Facility Construction (Copy form either Item 7A or 7B of the REPORT OF INSPECTION form)
Before January 1, 2001, or
On or after January 1, 2001 as authorized by ADEQ or its delegated county agency, Maricopa County
6. Facility Type (Refer to Item 7 of the REPORT OF INSPECTION form)
Conventional septic tank/disposal system (very common—any system consisting of a septic tank that disposes effluent to trench, bed, chamber technology, or seepage pit), or
Alternative on-site system (not common—any system using an alternative technology for treatment or disposal)
7. Inspection Information (Copy all required information from the REPORT OF INSPECTION form)
Date of Inspection (from Item 13 of REPORT OF INSPECTION form):
Date of Inspection (from Item 13 of REPORT OF INSPECTION form):
Design flow of facility (from Item 6E of REPORT OF INSPECTION form):
gallons per day
Please indicate any file number/dates as indicated in Item 5 of REPORT OF INSPECTION form:
Discharge Authorization issued on or after January 1, 2001 (Item 5A of REPORT OF INSPECTION form):
Approval of Construction or other permitting document issued by ADEQ or Maricopa County before January 1, 2001 (Item 5B or REPORT OF INSPECTION form):
File No.
Date issued:
Date issued:
Please indicate the number of septic tanks in use on this property:
Was the septic tank(s) pumped as part of inspection (Item 8A of REPORT OF INSPECTION form)?
Yes
No
If the answer is No above, please indicate why the septic tank(s) were not pumped:
The septic tank was put into service less than 12 months before inspection, or
Pumping or servicing was not necessary at the time of inspection based on manufacturers written operation and maintenance instructions (applicable only to alternative technologies), or
No accumulation of floating or settled waste was present in the septic tank (may be applicable to certain remote or seasonal systems with little use).
Were repairs made as part of the inspection (Item 8Q of REPORT OF INSPECTION form)?
Yes
No
Continue to Form Submittal Information
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Form Submittal Information
8. Form Submittal and Buyer/Transferee Advisory
Date of property transfer (closing date):
*
Date of property transfer (closing date):
Date of submittal of this NOTICE OF TRANSFER form:
*
Date of submittal of this NOTICE OF TRANSFER form:
Fee Confirmation
*
Check this box to confirm the $50 filing fee is being submitted with this NOTICE OF TRANSFER form
Please Select who is submitting this Notice of Transfer Form
*
Buyer/Transferee, or
A person submitting this form on behalf of the Buyer/Transferee (Please complete the required information below)
Name of Submitter
Company
Address
City
State
Zip Code
Phone Number
Email
Telephone Contact
Escrow Officer/Title Company, or
Other (indicate below)
Please specify if you chose Other
Relationship of submitter
Certification/Signature
*
I, as the Buyer/Transferee, certify that I have received a Report of Inspection from the Seller/Transferor or their representative, and that I have accurately completed this Notice of Transfer form
I, as a person submitting this form on behalf of the Buyer/Transferee, certify that the information provided in this Notice of Transfer form is complete and accurate to the best of my knowledge
Electronic Signature
*
Date
*
Date
Once the submittal has been processed by the Department, you will receive an email with instructions and options for payment of the Notice of Transfer $50 filing fee. The Notice of Transfer will be complete when payment has been made. Checks must be made payable to Maricopa County Environmental Services Department (M.C.E.S.D.).
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
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