NC0090166_Owner (Name Change)_20240209

ROY COOPER
MICHAEL S. REGAN
LINDA CULPEPPER
Water Resources
ENVIRONMENTAL OUAUTY
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
:���FrvFQ
,.pN 16 202�
Permit Number: NC00 q / 0 / / 6 / i:� or NCG5_/
1. Facility Name: AI&Ka-A Lz6c>
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
a. Change in ownership of property/company
b. Name change only
c. Other (please
2. New owners name (name to be put on permit):
64 M F go EI1�770��5o L1—C-
3. New owners or signing official's name and title: (`e 64-f— l 0 o KS
(Person legally responsible for permit)
V'`Ce Pf'sided f-
(Title)
4. Mailing address: Aso � (A ez VV oo6 9�,'60"City:
State: Zip Code: 2 Phone:(0-5 )%ot - S'606
E-mail address: ''z>k, W%'F)(.CoWL*o\ 6.1nr\6 . L'C tV^
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]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https:lldeq.nc.govlabouttdivisionslwater-resourceslwater-resources-permitslwastewater-branchhipdes-wastewater-pemiits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
i, K0 bEr I i3r'0 0 ks 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: < <<
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 1112017

State of North Carolina
N
" Water Resources Department of Environmental Quality
INVMdINlNt11L WALIT.
Division of Water Resources
EDMR REGISTRATION FORM
INSTRUCTIONS AND SUPPORTING DOCUMENTATION
This form is used to register NPDES wastewater permittees to use NCDWR's eDMR system for the purpose of
electronically submitting required monthly monitoring reports.
For more information on the eDMR system, visit the Division of Water Resources' eDMR website.
General — When submitting an application to the NCDWR's Information Processing Unit, please use the
following instructions as a checklist to ensure all required items are submitted. Adherence to these instructions
and checking the provided boxes will help produce a quicker review time and reduce the amount of requested
additional information.
eDMR Registration Application [FORM: NC eDMR Registration Form (Revision 4.1)1:
❑ Submit the completed and appropriately executed eDMR registration application form [FORM: NC
eDMR Registration Form (Revision 4.1)).
❑ Part A: Permit/Facility Information. Provide a permit number and the associated facility
information. Only a single permit number is needed for registration. If the Owner holds
multiple NPDES wastewater permits, then the permit number provided on the application
will be used to identify the Owner and all associated permits. All permits issued to the
Owner will be automatically registered for eDMR. NOTE: Owner is also known as the
Permittee and may be an individual or organization.
❑ Part B: Owner User Information. Provide the Owner/Responsible Official information that
will be used to create the Facility Owner in eDMR. The Owner is the legal entity to which
the permit(s) have been issued and may be an individual or organization. For an
organization, the information provided for the Owner should be the designated Responsible
Official or the person with delegated signatory authority for the Owner as specified in Part
II, Section B.11 of the Standard Conditions for NPDES Permits and 40 CFR 122.22.
❑ Part C: User Account Information. Provide the user details for each individual who will be
assigned Facility Administrators permission and/or Submitters permission.
1. Facility Administrator Permission. The Facility Administrator is the person
responsible for managing user information for the facility/permit. The Facility
Administrator user permission can be assigned by the Owner or can be assigned at
the time of registration by the NCDWR eDMR Administrator. If someone other than
the Owner will be responsible for managing facility users within eDMR and you
would like NCDWR to set up the permission at the time of registration, then provide
the user details for the individual who will need the user permission. Note: If this
person will be responsible for submitting eDMR reports, then you will also need to
request Submitter permission for this user.
2. Submitter Permission. The Submitter is the person who submits the electronic
report. This person may be the Owner or other delegated person that has signatory
authority for the permit. The Submitter user permission can only be assigned by the
NCDWR eDMR Administrator. The Owner specified within the application will be
given full eDMR permissions including Submitter user permission.
NC eDMR Registration Form (Revision 4.1) Instructions i

The Submitter is equivalent to the individual who signs the certification statement on
the back of the Discharge Monitoring Report. In most cases, the Submitter will be
the Owner but may be other delegated individuals. The Submitter must be an
individual with delegated signatory authority. If individuals other than the duly
authorized person for the Owner have been delegated signatory authority, the
Division of Water Resources must be notified in writing of such delegations as
specified in the signatory requirements in Part II, Section B.11 of the Standard
Conditions for NPDES Permits and 40 CFR 122.22. A delegation of authority form is
available from the eDMR website.
❑ Responsible Official Authorization. Complete the Responsible Official Authorization and
identify the individual duly authorized to sign applications or reports for the Owner.
❑ Registration Certification. Complete and sign the Registration Certification in accordance
with Part II, Section B.11 of the Standard Conditions for NPDES Permits and 40 CFR 122.22.
An alternate person may be designated as the responsible official if written authorization
(see paragraph III below) is provided from a person who meets the criteria in Part II, Section
B.11 of the Standard Conditions for NPDES Permits and 40.CFR 122.22.
II. eDMR Owner Verification Report:
❑ Submit the eDMR Owner Verification Report verifying the facility permit information. Should the Owner
name, Facility information, or ORC Designation be incorrect, the Owner must notify the appropriate
NCDWR contact to resolve any discrepancies before continuing with the registration process. The report
is accessed using the Registration Verification link located on the eDMR User Registration web page.
The permit information related to all NPDES wastewater permits issued to the Owner will be returned in
a PDF report format. If the Owner has multiple NPDES permits, the Owner should verify that all permits
are returned in the report. If there are permits missing from the report, the Owner should conduct a
search for each missing permit and verify the Owner Name. Any discrepancies detected must be
resolved before registration.
III. Delegation of Signature Authority:
❑ Complete and submit the Delegation of Signature Authority form (located on the eDMR Forms and
Reports web page) for each individual who has been authorized, as described in paragraph I above, to
sign reports for the Owner. This includes each individual who will be given Submitters permission. If a
delegation letter has been previously submitted to NCDWR, then include a copy with your application
package.
THE COMPLETED REGISTRATION FORM AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED TO THE
NORTH CAROLINA DIVISION OF WATER RESOURCES
Fax: or Email: or US Postal Mail:
[phone] [e-mail] Information Processing Unit
Attn: eDMR Registration
1617 Mail Service Center
Raleigh, NC 27699-1617
NC eDMR Registration Form (Revision 4. I) Instructions ii

B37644 - P 107
For Registration
Fredrick Smith
Register of Deeds
Mecklenburg County, NC
Electronically Recorded
2022 Sep 14 04:05 PM RE Excise Tax: $ 22500.00
Book: 37644 Page: 107 - 113 Fee: $ 26.00
Instrument Number: 2022130550
C� Lu. �k
Excise Tax: $22,500.00 Tax Parcel ID #: 14705111, 14705112 & 14705124
This instrument was prepared by Harry J. Stathopoulos, Esq., P.O. Box 78056, Charlotte, NC 28271
After recording return to Alston & Bird LLP, 1201 West Peachtree Street, Atlanta, GA 3 03 09, Attn:
Jason Howard. Esa.
Brief description for the Index: 3305 & 3309 South Boulevard, Charlotte, NC, and 121, 127, 133 &
139 Hartford Avenue, Charlotte, NC
NORTH CAROLINA SPECIAL WARRANTY DEED
is made as of this 14th day of September, 2022, by and between
GRANTOR
FOURB'S PROPERTIES LLC,
a North Carolina limited liability company,
F/K/A FourB's Partnership,
a North Carolina general partnership, holding
a 3/4 interest as tenant in common
and
TERESA BALLAS MELETIOU, AKA
TERESA BALLAS (married, spouse Demetrios
S. Meletiou), an individual holding a 1/4 interest
as tenant in common
16732 Belle Isle Drive
Cornelius, North Carolina 28031
GRANTEE
CH MF BTH IUJCHARLOTTE LOSO, L.L.C.,
a Delaware limited liability company
4509 Creedmoor Road, Suite 308
Raleigh, North Carolina 27612
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.
submitted electronically by "Ragsdale Liggett PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Mecklenburg County Register of Deeds.

WITNESSETH, that Grantor, for a valuable consideration paid by Grantee, the receipt of which is
hereby acknowledged, has and by these presents does hereby grant, bargain, sell and convey unto Grantee
in fee simple, all that certain lot or parcel of land situated in Mecklenburg County, North Carolina and
more particularly described on Exhibit "A" attached hereto and made a part hereof (the "Property"):
The Property was acquired by Grantor by instruments recorded in Book 05363, Page 0587-0588;
Book 07484, Page 0697-0699; and Book 08921, Page 0109-0110, Book 37635, Page 277-281 and Book
37635, Page 282-287 in the Mecklenburg County Registry.
THE PROPERTY CONVEYED HEREIN DOES NOT CONSTITUTE THE PRIMARY
RESIDENCE OF THE GRANTOR.
TO HAVE AND TO HOLD the aforesaid lots or parcels of land and all privileges and
appurtenances thereto belonging to the Grantee in fee simple.
And Grantor covenants with Grantee, that Grantor has done nothing to impair such title as Grantor
received, and Grantor will warrant and defend the title against the lawful claims of all persons claiming by,
under or through Grantor, except for the exceptions hereinafter stated.
Title to the property hereinabove described is subject to the following exceptions:
See Exhibit B attached hereto and incorporated herein by reference.
Demetrios S. Meletiou, spouse of Teresa Ballas Meletiou AKA Teresa Ballas, joins in this
conveyance for the sole purpose of conveying any marital interest he may have in the Property and does
not join in any warranties or representations contained herein.
[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]

IN WITNESS WIIEREOF, Grantor has caused this instrument to be signed as of the
day and year first above written.
GRANTOR:
FOURB'S PROPERTIES LLC,
a North Carolina limited liability company,
F/K/A FourB's Partnership,
a North Carolina general partnership
By: N ckoIO4. Ballas
Title: Man er
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
I, the undersigned Notary Public of the County and State aforesaid, certify that Nickolas J.
Ballas, Manager of FourB's Properties LLC, a North Carolina limited liability company, F/KIA
FourB's Partnership, a North Carolina general partnership, personally c efore me this day
and acknowledged that he signed the foregoing instrument as his eed olun act and deed.
Date: September 12, 2022
[Notarial Seal/Stamp
Harr J. Statho oulos
Print Name
z My Commission Expires: August 7, 2027
4

GRANTOR:
FOURB'S PROPERTIES LLC,
a North Carolina limited liability company,
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
I, Harry J. Stathopoulos, a Notary Public of aforesaid County and State, certify that John J. Ballas
personally appeared before me this day and acknowledged that he is a Manager of FourB's Properties
LLC, a North Carolina limited liability company, F/K/A FourB's Partnership, a North Carolina general
partnership, and that as such Manager he, being authorized to do so, executed the foregoing instrument on
behalf of the limited liability company.
Witness my hand and official seal, this tl
`7A
Print Name
My Commission Expires: August 7, 2027
4

IN WITNESS WHEREOF, Grantor has caused this instrument to be signed as of the
day and year first above written.
GRANTOR:
DEMETRIOS S. MELETIOU
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
I, the undersigned Notary Public of the County and State aforesaid, certify that Teresa Ballas
Meletiou AKA Teresa Ballas personally came before me this day and acknowledged that she
signed the foregoing instrument as her free a
Date:
n
STATE OF NORTH CAROLINA
COUNTY OF MECKLENBURG
HgpM J. Stathopoulos
Print Name
My Commission Expires: August 7, 2027
I, the undersigned Notary Public of the County and State aforesaid, certify that Demetrios S.
Meletiou personally came before me this day and acknowledged thathe, signed the foregoing
instrument as his free and voluntary act and deed. ., A A n
Date: September 12, 2022
Harry J. Stathopoulos
Print Name
My Commission Expires: August 7, 2027

EXHIBIT A
DESCRIPTION OF PROPERTY
Tract 1:
BEGINNING at a found #4 rebar located on the northeasterly margin of the 50-foot right -of- way of
Hartford Avenue, said #4 rebar also being located at the common comer of Lot 1 and Lot 3 of CEDAR
PARK subdivision, as shown on map recorded in Map Book 5 at Page 251 of the Mecklenburg County
Public Registry (the "Cedar Park Map"); running thence along the northeasterly margin of the aforesaid
right-of-way of Hartford Avenue N. 50-58-55 W, a distance of 236.15 feet to a point of curvature located at
the intersection of the northeasterly margin of the aforesaid right-of-way of Hartford Avenue and the
southeasterly margin of the variable right-of-way of South Boulevard; running thence with the arc of a
circular curve to the right having a radius of 15.00 feet, an arc length of 20.02 feet (said are being
subtended by a chord having a bearing and distance of N. 12-43-33 W. 18.57 feet) to the point of
tangency located on the southeasterly margin of the aforesaid right -of --way of South Boulevard; running
thence with the southeasterly margin of the aforesaid right-of-way of South Boulevard the following two (2)
courses and distances: (1) N. 25.30-27 E. a distance of 96.79 feet to a point, and (2) with the are of a
circular curve to the right having a radius of 474.88 feet, an arc distance of 94.26 feet (said arc being
subtended by a chord having a bearing and distance of N. 31-11-38 E. 94.11 feet) to a nail in walk located
on the southerly boundary line of that property owned by Center Associates (now or formerly) as described
in that instrument recorded In Book 4770 at Page 904. aforesaid Registry; running thence along a portion
of the southerly boundary line of the aforesaid property owned by Center Associates S. 50-19-00 E. a
distance of 285.28 feet to a set #4 rebar located at the common comer of Lot 2 and Lot 3 of CEDAR
PARK subdivision, as shown on the Cedar Park Map; running thence along the common boundary lines of
Lot 2 and Lot 3 and Lot 1 and Lot 3 of CEDAR PARK subdivision, as shown on the Cedar Park Map, S.
313-45-21 W. a distance of 195.53 feet to the point or plane of BEGINNING, and containing 1.220 acres, or
53,165 square feet, more or less, as shown on that certain Boundary & Physical Survey of 3309 South
Boulevard dated September 15, 1993, revised September 24, 1993 and prepared by Lucas -Forman
Incorporated, reference m which survey is hereby made for a particular description.
Tract 2:
Being all of lots 3, 4, and 5 of Block 5 of Cedar Park as shown on a map thereof recorded in Map Book 5
at Page 251 of the Mecklenburg County, North Carolina Public Registry,

EXHIBIT B
1. Taxes and assessments for the year 2023, and subsequent years, not yet due or payable.
2. Any right, easement, setback, interest, claim, encroachment, encumbrance, violation,
variations or other adverse circumstance affecting the Title disclosed by plat(s) recorded
in Map Book 27, page 158, shown on SLIT -Vey; and boundary and property lines reflected
on Map Book 5, Page 251, shown on Survey.
The following matters disclosed by survey entitled "ALTA/NSPS Land Title Survey of
3305 South Blvd & 3309 South Blvd; 121, 127, 133, & 139 Hartford Ave" by Seth F.
Martin, P.L.S., with GPI, dated November 30, 2021, last revised September 13, 2022 (the
"Survey"):
a. Service utilities, and
b. Fence encroachments.
4. Right of Way Agreement recorded in Book 2925, page 292, and shown on Survey.
5. All easements, conditions, restrictions, rights of way and other matters of record.
6. Matters which a current, accurate ALTA/NSPS survey would show.