HomeMy WebLinkAboutNCG550906_Owner (Affiliation Change)_20230130 ri
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory John E.Skvarla,Ill
Governor WATER QUALITY PERMITTING SECTION Secretary
PERMIT NAME/OWNERSHIP CHANGE REQUEST
This form is for omnership changes or name changes of NPDES astewater permits.
▪ "Permittce"references the eeistin t permit holder
✓ "Applicant"references the entity appkinc for the ownership name dialyze.
I. NPDES Permit No.(for which the change is requested): L NCOO
or
Certificate of Coverage#: •
N C G 5'5.09019
II. E.isting Permittee Information:
a. Permit issued to(company name);
I' nd.1 o '' bermit:
i
Firs Mil Last
JAN 3 0 2023 Title
Pe. it Holder Mailing Ad ess
NCDE /D R/NPDES City State Zip
PI .ite F.
c. Facility name:
d. Facility's physical address:
Ad_• ss
'ty State Zip
e. Facility contact person: ( )
First .' MI Last Phone
itoi,c-4 h EC e...
HI. Applicant Information:
a. Request for change is a result of: ►l Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to(company name):
c. Person legally responsible for permit:
First MI Last
�+ I Title l
Permit Holder Mailing Address
City State Zip
_9tci !7a0 5!7oi j k9 , Co�'i
Phone E-mail Address
d. Facility name: -� 1q 3 o J I.,�1in- ..
t ------ _ _ _-
e. Facility's physical address: .a9- �0,)'k-6_9D, I r` —
Addres
S�tneiQmac. N3 a'?S _______
City State Zip
f. Facility contact person: t�-&1 o v\l " ��_-__l ��e'�
First MI Last
0 v t.,
Title �1
P 19)'Go-�r10 ( "+'oc diD-e- !!_� inCO.LOP
Phone E-mail Address
IV. Will the permitted facility continue to conduct the same commercial/industrial activities conducted prior to
this ownership or name change?
Yens ,
0 No(please explain)
If applicable,the applicant shall submit a major permit modification request to DWR. A major modification shall be
defined as one that increases the volume,increases the pollutant load,results in a significant relocation of the
discharge point,or results in a change in the characteristics of the waste generated.
V. Required Items: TINS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
1. This completed application is required for both name change and or ownership change requests.
2. Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,or a bill of sale)is
required,for an ownership change request. Articles of incorporation are not sufficient for an ownership change.
Applicable regulations:40 CFR 122.41,40 CFR 122.61 and 15A NCAC 02H .0114
The certifications below must be completed and signed by both the permit holder prior to the change(Permittee),and the
new applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification
is sufficient.
PERMITTEE CERTIFICATION(Permit holder prior to ownership change):
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 arc not completed and that if all required
supporting information is not included,this application package will be returned as incomplete.
-----:-/'('-' '-')`- — - --'6-e---g,e;.-.)-42-X-Q.---,
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ate
APPLICANT CERTIFICATION ,
I, ,attest that this application for a nameownership 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
porting information is not included,this application package will be returned as incomplete.�J
or e-A.."---A..-0- D . (34 jaeA._
t_Zeicz__ _
Signature Date
**************************
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
BK 1125 PG 28 - 30 (3) DOC# 401440
Document# Jun/06/2022 14:13 PM This Document eRecorded: 06/06/2022 02:28:51 PM
18354 Fee: $26.00 DocType: DEED Tax: $1,620.00
FILED Person County, North Carolina
Person County Tonya R. Wilson, Register of Deeds
Russell Jones
Tax Administrator
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $1620.00 Parcel Identifier No: A14 58
Prepared By: Lance A. Wootton
Return to : Grantee
The property transferred herein ® includes ❑ does not include the primary residence of the grantor.
THIS DEED made this 1 day of June, 2022, by and between:
GRANTOR GRANTEE
PAUL R.LAVOIE and wife, WENDY S. LAVOIE TODD PEELER and wife, SHEILA PEELER
3110 Little River Church Rd., Hurdle Mills,NC 27541 6506 Joshua Tree Lane, Hurdle Mills,NC 27541
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 State of North Carolina, more particularly described as
follows:
See Exhibit A
1
submitted electronically by "Lance A. Wootton Attorney"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Person County Register of Deeds.
BK 1125 PG 29 DOC# 401440
The Property hereinabove described was acquired by Grantor by instrument recorded in Book 1017 at Page 101.
A map showing the above described property is recorded in Plat Book Cabinet 1, Page 85.
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 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 except for the exceptions
,hereinafter stated. Title to the property hereinabove described is subject to the following exceptions:
Easements and restrictions of record.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal,or if corporate,has caused
this instrument to be signed in its corporate name by its duly authorized officers and its seal to be
hereunto affixed by authority of its Board of Directors,the day and year first above written.
IN TESTIMONY WHEREOF, the said Grantor has hereunto set his hand and seal, the day and year
shown in notary acknowledgment. /��
�'-� , .. �� (SEAL)
PAUL . LAVOIE
r ryc7 tWez n (SEAL)
WENDY S.LAV�IE
(SEAL)
(SEAL)
State ofAy2g 4-644/4. I County of f 64
I certify that the following person(s)personally appeared before me this day, each acknowledging to me that he
or she signed the foregoing document: PAUL R.LAVOIE and WENDY S.L OIE. W' ess my nd and
official stamp or seal this (1:2 day of June,2022.
My Commission Expires: 1G19-teivi (p
(SEAL- STAMP) Notary Public
JAMES JEFFERSON
NOTARY PUBLIC
CUMBERLAND COUNTY
NORTH CAROLINA
MY COMMISSION EXPIRES 1/10/2026
2
BK 1125 PG 30 DOC# 401440
Exhibit A— Peeler
BEING that certain lot or parcel of land lying in Cunningham Township,
Person County, North Carolina and being shown, depicted and described
as Lot "7", containing "0.89 ac." on plat of survey entitled "DUNAWAY
LANDING SECTION ONE', surveyed and prepared by Phillip J. Hall
and Associates, Surveyors, dated August 1978; which plat, of record in
Plat Cabinet 1, Hanger 85, Person County Registry, is hereby referenced
for greater accuracy as to metes and bounds, courses and distances.
There is also conveyed herewith a perpetual right of easement for
ingress and egress over and along that certain sixty foot roadway
described on plat of survey entitled "PROPERTY OF T.O. PASS", dated
August 1978 and recorded in Plat Cabinet 1, Hanger 87, Person County
Registry, which plat is incorporated by reference.