NCG550780_owner (name change)_20240129

ROY COOPER
Govtmm,
ELIZABETH S. BISER
tic�^rrtun�
RICHARD E. ROGERS, JI,
0Irri'Mr
NOR r1 i C:AP01 INA
It, ir<rnrnrntul Qrr<rlitt
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
1. Please enter the. CoC number for which the change is requested.
Certificate of Coverage
N I C G 5 15 10 1 ? U
II. Please provide the following for the requested change (revised CoC).
a. Request for change is a result of: Change in ownership of the residence/property
❑ 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:
d. Facility name (if applicable):
e. Facility address:
f. Facility contact person:
[if different from Owner]
�t 's
Sto ke h
First MI Last
Title
9/0-7 Old �!C 9Le
I- Permit Holder Mailing Address
nYl l /l o Al ,-11 fi C . o . -7 S
City State Zip
(��9) 923'o37s r�hckah.yai s-cy�q,,�v►a.�l . �o�►�,.
Phone E-mail Address o
Address
city State Zip
First MI Last
Phone
E-mail Address
III. Contact person (if different from the person legally responsible for the CoC)
First MI
Title
Mailing Address
City State
Last
Phone E-mail Address
-� North Carolina Department of Environmental Qualky I Division of Water Resources
..�.��� 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolura 27699-1617
rnal�"al. Mrune�wOca� 919.707.9000
Zip

Page 2 of 2
Will this permitted facility continue to discharge the same volume and type of wastewater as
IV. prior to this ownership or name change?
Yes
❑ No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
V. INCOMPLETE OR MISSING:
This completed application is required for both facility -name change and/or facility ownership
change 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, Stt a ttest that this application for a name/ownership change has been reviewed and is accurate and
co p e 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.
Signature
7
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(gdeq. nc. gov

BK 6662 PG 1519 - 1521 (3) DOC# 30022926
This Document eRecorded: 06/12/2020 12.35.28 PM
Fee: $26.00 Tax: $1,070.00
�7 V Orange County, North Carolina
MARK CHILTON, Register of Deeds by JAMES A. BARTOW
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $ 1 j % rn ,
Parcel Identifier No. 988023-2145 Verged by County on the day of , 20
This instrument was prepared by: BAGWELL HOLT SMITH P.A.
Grantee's address (return to): 8107 Old NC 86, Chapel Hill, NC 27518
o THIS DEED is made this Odayof 2020, by and between
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GRANTOR
JASON THOMAS and spouse,
EDITH GETTES
GRANTEE
REBEKAH VAISEY and spouse,
STEPHEN VAISEY
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 Orange County, North Carolina and more particularly described as follows:
See attached Exhibit A.
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.
{00054464DOC}NC Ber Association Form No. 3 0 1976, Revised ®1977, 2002
Printed by Agreement with the NC Bar Association -1981
C C
V)•r ro

BK 6662 PG 1520
DOC# 30022926
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, excepting ad valorem taxes for the current year, restrictive covenants of record
affecting the property, utility easements and rights of way of record, of all persons whomsoever.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
(SEAL) Address: S WGl,co- �n1 094 f U!�j
JA N THOMAS ,le- c T
C�4 [ (SEAL_)
EDITH GE ES
Address: LE dA AJ-
Pursuant to N.C.G.S. §105-317.2, the Seller/Grantor states as follows:
The property conveyed herein'lkkclude It�de (initial one) the primary residence of one or more of the
Grantors. Each Grantor's address is provid d above.
County, North Carolina
hereby certify that the following person(s) p
that he or she voluntarily signed the foregc
indicated: JASON THOMAS
Date: LIE w-;—v
(Official Seal)
1Y1A,yJ. 4- County, North Carolina
My commission expires: 57fg/ Zo2 —
I hereby 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: EDITH GETTES
D
6%/���
Date: WI&
� GANNQ��i,�
Notary PublLf0 y� �0
Print d Name of Notary Public ` �'jARM
(Official Seal) My commission expires: 1AZZ2, 7- S
.,may J,.111811111110
{00054464.DOC}NC Bar Association Form No. 3 ® 1976, Revised © 1977, 2002
Printed by Agreement with the NC Bar Association - 1981

BK 6662 PG 1521 DOC# 30022926
EXHIBIT A
BEGINNING at an iron (the control corner) in the southern line of the right-of-way of a 60-
foot private easement as shown on those plats recorded in Plat Book 52, Page 99 and Plat
Book 72, Page 168, Orange County Registry, said iron also being located at the
intersection of the western line of Robert Ayers' lot with the southern line of said right-of-
way, and running thence from the place of BEGINNING with Ayers' line South 24° 00' 18"
West 316.87 feet to an iron, a common corner with John Boyle and Mary Ayers; running
thence with Boyle's line North 850 28' 56" West 241.70 feet to an iron, the southeast corner
of K. H. Dudley; running thence with Dudley's line North 05° 56' 42" East 307.03 feet to an
iron in the southern line of the aforesaid 60-foot private right-of-way; running thence with
the line of said right-of-way South 840 05' 47" East 339.86 feet to the point and place of
BEGINNING, according to that survey by Ayers Surveying dated September 9, 1995,
entitled "Lyell C. Cash, Jr. and wife, J. Laurel Cash," and being the same real property
conveyed to Harold M. Harris and wife, Rebecca Harris, by deed recorded in Book 197,
Page 865, Orange County Registry.
PIN: 9860-73-2145