NCG551010_Owner (Name Change)_20221121

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JOHN NICHOLSON
Intmm Se+rre mr) •��""�•
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: .NCOO / / / / or NCGS5/1/C)/ 1 /0
1. Facility Name:
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change i~a result of:
/a. Change in ownership of property/company
b. Name change only
c. Other(please explain):
2. New owner's name(name to be put on permit):
(t/1 t• (-1-i PJ--
3.
New owner's or signing official's name and title: IAA i 1 -Iri t -Vet: 'Pic(A , )
(Person legally responsible for permit)
O Lt vl-.v
(Title)
4. Mailing address: pe, e,,,,, I/2- City: l,'3Q j,L ck
State:CIA Zip Code: 3 i 1 q(Q Phone: (221) 21(42 ' Ca 33(a.
E-mail address: rib o of_;91 ivll c't; I • C Uvyl
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF
THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership(such as a property deed, articles of incorporation,
or sales agreement)
[see reverse side of this page for signature requirements]
D E ,) North512North Carolina
Salisbury DepartmentStreet1 of1617 EnvironmentalMilService Center I Raleigh.Quality I Division of WaterNorthCaro Resouli27rces
ana 699-1617
`401M-10,Ra NA
oeovetrnl a¢n.Itaw.tar au+nr 0.0.1 919.707.9000

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
YV Pa-ivck
! t -c�Yl , 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 and attachments are not included,this application package will be returned as
incomplete.
Signature: Date: I — 1`JZZ
THE COMPLETED APPLICATION PACKAGE,INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ/DWR/NPDES
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Version 11/2020

0513
0455 BK:00513 PG:0455 FILED
SWAIN COUNTY NC
DIANA WILLIAMSON KIRKLAND
REGISTER OF DEEDS
FILED Oct 05,2022
AT 03:36:27 pm
BOOK 00513
SVVAiN COUNTY TAX OFFiic START PAGE 0455
Date (0.5-Z,022 P �.� END PAGE 0462
INSTRUMENT# 02297
PIN (�(do20(o3'13�'1'I
Signature tCtrnC EXCISE TAX $60.00
(ALL TAXES PAID ON THIS PARCEL ONLY.)
NORTH CAROLINA GENERAL WARRANTY DEED
Prepared by:Jonathan C.Mattox,a licensed North Carolina attorney.
Brief description for the Index:0:76 acres,Lower Alarka
Parcel Number:6662.06.37.3677
Excise Tax$60.00
Does not include the primary residence of at least one of the Grantors.(NC GS§ 105-317.2)
TITLE TO THE WITHIN DESCRIBED LANDS IS NOT CERTIFIED BY JONATHAN C.MATTOX OR
BRIGHAM&MATTOX,PLLC UNLESS A WRITTEN TITLE OPINION IS RENDERED.
THIS DEED made this 4th day of October,2022 by and between:
GRANTOR: GRANTEE:
David Keough and Michael Keough, Milton Patrick,Jr.and Tina M.'Patrick,
Trustees of the Duane A.Keough and husband and wife
Patricia A.Keough Trust dated
February 2,2009.
435 Cold Springs Road PO Box 212
Bryson City,North Carolina 28713 Warwick,GA 31796
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 the Charleston
Township,Swain County,North Carolina and more particularly described as follows:
See Exhibit A attached hereto and incorporated herein by express reference.

0513
0456 BK:00513 PG:0456
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 is seized of said premises in fee simple
and 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 except for the exceptions hereinafter stated.
Title to the property conveyed is subject to the following exceptions.Easements,restrictions and
rights of way of record and utility lines and rights of way in existence over,under or upon the
property conveyed by this deed and exceptions set forth herein.
Signatures appear on following pages.

0513
0457
BK:00513 PG:0457
IN WITNESS WHEREOF,the Grantor has hereunto set his hand and seal,the day and year first
above written.
Ls/ (SEAL)
Das'id Keough,Trustee of uane A.Keough and Patricia A.Keough Trust dated February 2,
2009
County of MA,/ o r
State of Pi cr
I,a notary public,certify that the following person(s)personally appeared before me this day,
each acknowledging to me that he or she voluntarily'signed the foregoing document for the purpose stated
therein and in the capacity indicated:David Keough,Trustee of the Duane A.Keough and Patricia A.
Keough Trust dated February 2,2009.
Witness my d
and official seal,this - day of �Y ,2022.
Affix Notary Seal:
it otary Signature(Must Match Name on Seal Exactly)
AN ((-):k rl ROB9RAtTMAN
Notary rinted Name(Must Match Name on Seal Exactly) 6474tsYCOMi11351ON#M#i t
' ` EXPIRES A47uR 77,2025
A(J& V-7 �:J'9
5 i ^ 6mddibuNa`yp
Date ssion E,pires

0513
0458
BK:00513 PG:0458
IN WITNESS WHEREOF,the Grantor has hereunto set his hand and seal,the day and year first
above written.
/11At-40,/ - (SEAL)
Michael Keough,Trustee of the Duane A.Keough and Patricia A.Keough Trust dated February
2,2009
County of 0 � A
State of,
I,a notary public,certify that the following person(s)personally appeared before me this day,
each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated
therein and in the capacity indicated:Michael Keough,Trustee of the Duane A.Keough and Patricia
A.Keough Trust dated February 2,2009.
W nr s Tay r.,n and o icial ,this*fp_day of ,2022.
1
Affix Notary Seal:
eta ly)
'Lary Signature(Must Match Name on Seal Exact
K.(.S ? _
Notary Printed Name(Must Match Name on Seal Exactly) t pu DORIS 0.MAW RA
It Dro .rsd: NoCo publk•State 0 Florida 6
I �i+. e�• Commission R HH 100056
My(omen.Expires Mar 9,2025
Date Commission Expires

0513
0459
BK:00513 PG:0459
Exhibit A
Lying and being in the Alarka Creek Community, Charleston Township, Swain County,
North Carolina.
BEGINNING on a nail and cap in the centerline of a bridge where Old U.S.Highway#19
crosses Alarka Creek and runs thence with the centerline of Old U.S. Highway#19,N. 45-29 E.
36.15 feet; N. 58-42-10 E. 55.72 feet; and S. 88-28-10 E. 113.32 feet; thence leaving Old U.S.
Highway#19,N.06-51-30 E.51.66 feet,passing iron pins at 23.63 feet and at 51.05 feet to a point
in the Railroad right of way; thence with the railroad right of way, S. 82-40-30 E. 185.90 feet;
thence leaving the Railroad right of way S.06-46-20 W. 124.68 feet passing iron pins at 80.90 feet
and 106.67 feet to the centerline of Alarka Creek; thence down and with the centerline of said
creek,N.$2-56 W.365.30 feet to the BEGINNING,and containing.76 acre,more or less.
There is also conveyed a right of way and easement to obtain water from a spring located
upon the adjoining property now or formerly owned by Marguerite Tatum and George Tatum,et
al.,for a one single family dwelling,together with.the right to lay and maintain water lines over
and across the said property to connect the above described property with the said spring.
This conveyance is made subject to rights of way for Old U.S. Highway #19 and the
Southern Railway.
Being the same property described in the deed from Brooks Michael Anderson and
Margaret H.Dieckelman to Duane A.Keough and Patricia A.Keough,dated September 23,
1997 and recorded in Book 208,page 404,Swain County Registry. See also deed recorded in
Book 370,page 213,Swain Coynty Registry.
(SEAL)
ba6d Keough,'I'nistee of t4e Duane A.Keough and Patricia A.Keough Trust dated February 2,
2009 v
(SEAL)
Mike Keough,Trustee of the Duane A.Keough and Patricia A.Keough Trust dated February 2,
2009

0513
0460 BK:00513 PG:0460
Exhibit A
Lying and being in the Alarka Creek Community, Charleston Township, Swain County,
North Carolina.
BEGINNING on a nail and cap in the centerline of a bridge where Old U.S.Highway#19
crosses Alarka Creek and runs thence with the centerline of Old U.S.Highway#19,N.45-29 E.
36.15 feet; N. 58-42-10 E. 55.72 feet; and S. 88-28-10 E. 113.32 feet; thence leaving Old U.S.
Highway#19,N.06-51-30 E.51.66 feet,passing iron pins at 23.63 feet and at 51.05 feet to a point
in the Railroad right of way; thence with the railroad right of way, S. 82-40-30 E. 185.90 feet;
thence leaving the Railroad right of way S.06-46-20 W. 124.68 feet passing iron pins at 80.90 feet
and 106.67 feet to the centerline of Alarka Creek; thence down and with the centerline of said
creek,N,82-56 W.365.30 feet to the BEGINNING,and containing.76 acre,more or less.
There is also conveyed aright of way and easement to obtain water from a spring located
upon the adjoining property now or formerly owned by Marguerite Tatum and George Tatum,et
al.,for a one single family dwelling,together with the right to lay and maintain water lines over
and across the said property to connect the above described property with the said spring.
This conveyance is made subject to rights of way for Old U.S. Highway #19 and the
Southern Railway.
Being the same property described in the deed from Brooks Michael Anderson and
Margaret H.Dieckelman to Duane A.Keough and Patricia A.Keough,dated September 23,
1997 and recorded in Book 208,page 404,Swain County Registry.See also deed recorded in
Book 370,page 213,Swain County Registry.
(SEAL)
David Keough,Trustee of the Duane A.Keough and Patricia A.Keough T a •Y
2009 �'e'r DORIS D.MAIE rr#
• Notary Pu6Ns-State of Fonda
�•!/�/M
/ ,4 SEAL •?• Commission a HH 100056
f (SEAL) a My Comm.Expires Mu 9,2025
Michael Keough,Trustee of the Duane A.Keough and Patricia A.Keough T -
2,2009 /1 1 , I

0513
0461
BK:00513 PG:0461
EXHIBIT B
CERTIFICATE OF TRUST
NOW COMES,the undersigned,pursuant to NCGS 36C-10-1013 and acknowledges and
says as follows:
I. That the name of the trust is The Duane A.Keough and Patricia A.Keough Trust dated
February 2 /009("the Trust").
2. Duane A.Keough and Patricia A.Keough were the seniors of the Trust.
3. David,and Mike Keough are the currently acting Trustees of the Trust.
4. That said trust gives the trustee the powers to sell real property belonging to the Trust located
in Swain County,North Carolina.
5. That the trust is irrevocable.
6. That the above named Trustees have authority to convey the real property belonging to the
Trust and the above named Trustees have authority to execute a deed for the real property
belonging to the Trust.
7. That the federal identification number of said Trust has been or will be supplied to the
Buyer's closing attorney prior to or at closing for said real property.
8. That the trust property was conveyed to the Trustees by deed referred to herein.
9. That the Trust has not been revoked,modified,or amended in any manner that would cause
the representations contained in this certification of trust to be incorrect.
Signed this the -0 8 44day of -(1 ,2022.
/
j :, (SEAL)
vid Keough,Trastee of th.,e_ tne A.Keough and Patricia A.Keough Trust dated February 2,
2009
(SEAL)
Mike Keough,Trustee of the Duane A.Keough and Patricia A.Keough Trust dated February 2,
2009

0513
0462
BK:00513 PG:0462
EXHIBIT B
CERTIFICATE OF TRUST
NOW COMES the undersigned,pursuant to NCGS 36C-10-1013 and acknowledges and
says as follows:
1. That the name of the trust is The Duane A.Keough and Patricia A.Keough Trust dated
February 2,2009("the Trust").
2. Duane A.Keough and Patricia A.Keough were the seniors of the Trust.
3. David and Mike Keough are the currently acting Trustees of the Trust.
4. That said trust gives the trustee the powers to sell real property belonging to the Trust located
in Swain Cc,,.rty,North Carolina.
5. That the trust is irrevocable.
6. That the above named Trustees have authority to convey the real property belonging to the
Trust and the above named Trustees have authority to execute a deed for the real property
belonging to the Trust.
7. That the federal identification number of said Trust has been or will be supplied to the
Buyer's closing attorney prior to or at closing for said real property.
8. That the trust property was conveyed to the Trustees by deed referred to herein.
9. That the Trust has not been revoked,modified,or amended in any manner that would cause
the representations contained in this certification of trust to be incorrect.
Signed this the -day of 064 +2-& ,2022.
(SEAL)
David Keough,Trustee of the Duane A.Keough and Patricia A.Keough Tr a._ - .
2009 Or Si,. DORIS D.MAIETTA
p, ,..
Notify Public-State of Florida
,/�j �ygt.��d('.: Commission a HH 100054
/.f�y}�! �l y (SEAL) '`x" My Comm.Expires Mar t,2025
Michael eough,Trustee of the Duane A.Keough and Patricia A.Keough P .,
2,2009