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Home My WebLink AboutNCG550175_Owner (Name Change)_20221103 ROY COOPER Aol, , Governor ELIZABETH S.BISER 0, Secretary ;Q" °" S.DANIEL SMITH NORTH CAROLINA Director Environmental Quality i NPDES Certificate of Coverage (CoC) , 1 NCG550000 OWNERSHIP CHANGE FORM I. Please enter the CoC number for which the change is requested. Certificate of Coverage N C G '5 5 0 I '7X II. Please provide the following for the requested ange(revised CoC). a. Request for change is a result of: Change in ownership of the residence/property 0 Name change of the facility or owner If other please explain: b. CoC will be issued to(person's name • or company name,if applicable): c. Owner: person legally responsible for CoC: 0-1 in rh LL Q f 0 toLi Fit MI Last 0 LO rJ 1 ft-- Title �,S7 1'yfi ilnfr,,t"w ��'ftr�4 /� Permit Holder Meiling Addrss City State Zip ( 33(') ''(PG/ - S 7& Phone E-mail Address d. Facility name(if applicable): e. Facility address: 5 (9$ ,C=Q-e e- , �7 Address /(./,z1K v - /Iva- •72??s— City State Zip f. Facility contact person: _ [if different from Owner] First MI Last ( ) Phone E-mail Address III. Contact person i from the person legally responsible for the CoC) First MI Last Title Mailing Address City State Zip ( ) Phone E-mail Address �p North Carolina Department of Environmental Quality I Division of Water Resources 1 . JJ D E�� 512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617 NORTH CAROLINA v uw,. un.a,A E,+um GIAWI e.' 919.707.9000 Iffis NCG550000 OWNERSHIP CHANGE FORM Page 2 of 2 IV. Will this permitted facility continue to discharge the same volume and type of wastewater as priorpgopkithis ownership or name change? Yes ❑ No(please explain) V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE INCOMPLETE OR MISSING: ❑ This completed application is required for both facility-name change and/or facility ownership mange requests. Legal documentation of the transfer of ownership(such as a property deed,relevant pages of a contract,or a bill of sale)is required for an ownership change request The certifications below must be completed and signed by the new applicant in the case of an ownership change request. APPLICANT CERTIFICATION I, ,attest that this application for a name/ownership change has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not completed and that if all required supporting information is not included,this application package will be returned as incomplete. v�-P� d)�� - a a oa Signature Date PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: Mr. Charles H. Weaver NC DEQ/DWR/NPDES 1617 Mail Service Center Raleigh,NC 27699-1617 , ._ ._ _._ charles.weaver@ncdenr.gov . r 1 fe - • NORTH CAP OLLNA GENERAL WARRANTY DEED EXCISE TAX: $60.00 NO TITLE SEARCH/NO CLOSING -Parcel Identifier No. Verified by County on the_ day of ,2021. BY: _ Mail/Box to: GRANTEE(a See Address Below This instrument was prepared by H. Dwight Nelson,Attorney At Law P.O.Box 902,Rural Hall NC 27045 Brief description for the index: '2 Tracts,MCGee Road,Walkertown, NC THIS DEED made this the 24th day of March,2021 by and between: - GRANTOR GRANTEE JOB:CE,Executor and the Estate .J0.R1lTNY:PAIJIJ I TEMRIC:,, . al- UFUS`I ANIEL''JOYCE ' n - _. DA.NIELRUFUS JOYCE :.JIMMY LEE OVERBY - I : 3409 Shiloh Church Road 4572 Mountain Spring Road Winston-Salem,North Carolina 27105 Germanton,North Carolina 27105 • The designation.Grantor and Grantee as used herein shall included 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 Forsyth County,North Carolina and more particularly described as follows: SEE ATTACHED EXHIBIT"A"FOR FULL LEGAL DESCRIPTION Forsyth County Tax Pin:6858-24:-295.5.000: : PROPERTY ADDRESS: 5450 McGee Road,.Walker town,North Carolina 27051' - ' ' • As per NCGS § 105-317.2 t &foregoing,property does not include the primary residence=of the Grantor(s). The property herein above=deseribedxwas acquired-by-Grantor by instrument recorded,-in Deed 2Book 1.823;Page 3565 in the Forsyth County,Regish,y. "': ;, ? ,.1•"•‘ • y`y . • The 2020 taxes have been paid;in full: , "': • - I O RAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee simple. c • • • And the Grantor covenants with the Grantee,that Grantor is seized of the premises in fee simple,has the right to convey the same in fee simple,that title is marketable and free and clear of all encumbrances,and that Grantor will warrant and defend the title against the lawful claims of all persons whomsoever, other than the following exceptions: ANY EASEMENTS AND RESTRICTIONS OF RECORD. IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written. - (SEAL) BILI, .JOY E, +zee or'o�tJe Estate of RUFUS 1DANIEL JOYCE Seal-Stamp State of -County of -C.)' I, Oi l hroj 3C:bl'))Lthe undersigned Notary Public of 7 .(e,7 County and State aforesaid,certify that BILLY R.JOYCE,Executor of the Estate of RUFUS DANIEL JOYCE,personally came before me this day and voluntarily acknowledged the foregoing instrument in its name on its behalf as its act and KAREN S. � dee . Witness my hand and Notarial stamp or seal,this the Stokes Coun {, NC o day of jrY1a.lrCh ,2021.ommission Expires`-1-i 6-aC•�3 7 loll A &rtile,o-n4-5L Notad Public J fi My Commission Expires: J-_/b—pO93 • • EXHIBIT"A" TRACT# 1, BEGINING at an iron in the West margin of McGee Road,the southeast corner of the Paul Ellis Tract described in Deed Book 1334, Page 1022, Forsyth County Registry; thence from said BEGINNING POINT,North 85 deg, 15 min 48 sec. West 192.27 feet to an iron in the east line of Alene B. Gravitt, Deed Book 856,Page 27;thence with Gravitt's line,North 07 deg. 51 min. 41 sec. East 130 feet to an iron; thence South 82 deg. 16 min. 56 sec. East 191.61 Feet to an iron in the West margin of McGee Road; thence with the margin of said road, South 07 deg. 40 min. 54 sec. West 120 feet to an iron,the point and place of BEGINNING and containing 0.5504 acre, more or less according to a survey by Danny L. Comer on July 7th, 1981. TRACT# 2. BEGINNING at an iron in the West margin of McGee Road, said iron lying North 07 deg, 40 min. 54 sec. East 120 feet from an iron which marks the southeast corner of the Paul Ellis tract described in Deed Book 1334, Page 1022, Forsyth County Registry;thence from said BEGINNING point North 82 deg, 16 min. 56 sec. West 191.61 feet to an iron in the East line of Alene B. Gravitt, Deed Book 855,page 27; thence with Gravitt's line,North 07 deg. 51 min. 41 sec. East 120 feet to an iron, thence South 82 deg. 16 min. 56 sec. East 191.23 feet to an iron in the West margin of McGee Road, thence with the margin of said road, South 07 deg. 40 min. 54 sec. West 120 feet to an iron,the point and place of BEGINNING, and containing 0.5273 acre, more or less, according to a survey by Danny Corner, dated July 7, 1981. Both Tract#1 and Tract#2 herein are conveyed subject to a 25 foot wide easement reserved by the grantors therein, said easement running 25 feet from the parallel to the entire West side of both parcels. This easement shall be for the purpose of access to and from the adjoining parcels of land, and for sewer and water outfall. The grantees may not make any use of the land within this easement which would hinder these uses of said easement. Grantors reserve the uses of this easement in, on, over and through said 25 feet strip, and beneath the surface thereof. Further subject to any portion of either tract which lies within the boundaries of McGee Road, which the prior grantors have conveyed to the North Carolina Department of Transportation. •