NCG550099_Owner (Name Change)_20240502

NORTH CAROLINA
Envlranmental Quality
NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
Laserfiche WATER QUALITY PERMITTING SECTION
NPDES PERMITTING
PERMIT NAME/OWNERSHIP CHANGE FORM RECEIVED
I. CURRENT PERMIT INFORMATION:
Permit Number: NC00����_ or NCGSs5 /!aj�J_2jH MAY 0 1 L "11
1. Facility Name: 306.0 Cede, Cr¢ek NCDEQ/DWR/NPDES
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 explain):
2. NeZowner's name (name to be put on permit):
3. New owner's or signing official's name and title: ks y , n t 1-, 4 �2,,,
(Person legally responsible for permit)
(Title)
4. Mailing address: '6�G Cecia� C'ree� �r��eCity: Yein1zr��. IIf
state: NL Zip Code: 2 �o��"f Phone: ( �3b) yC�� - ►�y5
E-mail address: f c . rnp.,,i — kev, n 6" yahoo • c c,.^
III. FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same as under the previous owner? Yes ©-1q`o ❑
2. Will the treatment system and discharge location remain the same? Yes E2- 'No O
"No Responses"
If either or both of these questions are answered 'No" then more information will be needed to review the
request. Please attach documentation to describe and explain the changes to the facility activities, waste
stream, treatment process oroutfall location. The Division may not be able to process the Permit
Name/Ownership Change request and may require that the new owner file a new permit applica tion.
_D I N North Carolina Department of Environmental Quality I Division of Water Quality
0 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
TMCAP
�"�` 919.707.9000

Final Settlement Statement
Your Order Summary
FILE # FLIPPIN-ERVIN
PROPERTYADDRESS 3060 Cedar Creek Drive LOAN #
715029354
Kernersville, INC 27284
PREPARED 04/27/2020
TITLE BY
Stegall & Clifford, PLLC
BUYER Kevin Neal Flippin
SETTLEMENT 04/27/2020
445 Dolley Madison Road
Patricia Ann Lawson Ervin OURADDRESS
Suite 102
DISBURSEMENT 04/27/2020
SELLER 3060 Cedar Creek Drive
Kemersville, NC 27284
Greensboro, NC
27410
SETTLEMENT LOCATION 445 Dolley Madison Road OUR PHONE #
Fairway Independent
[phone]
Suite 102
Greensboro, NC 27410 Mortgage Corporation CD CONTACT
LENDER ISAO /ATIMA
Laurie Stegall
4201 Marsh Lane
Carrollton. TX 75007
Charges
SELLER DEBIT SELLER CREDIT
PRIMARY CHARGES & CREDITS
BUYER DEBIT
BUYER CREDIT
$168.500.00
Sales Price of Property
$168,500.00
Deposit
$800.00
Loan Amount
$168,686.00
NCHFA DPA
$8,000.00
SELLER DEBIT SELLER CREDIT
PRORATIONS/ADJUSTMENTS
BUYER DEBIT
BUYER CREDIT
$385.82
County Taxes 01/01/2020 to 04/27/2020
5385.82
$800.00
Due Diligence Fee
$800.00
SELLER DEBIT SELLER CREDIT
LOAN CHARGES
BUYER DEBIT
BUYER CREDIT
Commitment Fee to Fairway Independent Mortgage Corporation
$965.00
ISAOA/ATIMA
Origination Fee to Fairway Independent Mortgage Corporation
$1.686.86
ISAOA/ATIMA
Appraisal Admin Fee to Fairway Independent Mortgage Corporation
$10000
ISAOA/ATIMA
Appraisal Fee to Fairway Independent Mortgage Corporation
$425.00
ISAOA/ATIMA
Credit Report Fee to Fairway Independent Mortgage Corporation
$48.50
ISAOA/ATIMA
Document Preparation Fee to Fairway Independent Mortgage
$110.00
Corporation ISAOA/ATIMA
Final Inspection to Fairway Independent Mortgage Corporation
$125.00
ISAOA/ATIMA
Flood Certification Fee to Fairway Independent Mortgage Corporation
$10.25
ISAOA/ATIMA
Guarantee Fee to Fairway Independent Mortgage Corporation
$1,686.87
ISAOA/ATIMA
USDA Technology Fee to Fairway Independent Mortgage Corporation
$2500
ISAOA/ATIMA
Prepaid Interest ($16.18 per day from 04/27/2020 to 05/01/2020)
$64.72
SELLER DEBIT SELLER CREDIT
IMPOUNDS
BUYER DEBIT
BUYER CREDIT
Homeowner's insurance $76.75 per month for 3 mo.
$230.25
Property taxes $100.89 per month for 11 mo.
$1,109.79
Aggregate adjustment
$453.31

NPDES Name and Ownership Change
Page 2 of 2
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)
3. Information to document facility, waste stream, treatment system or outfall changes as noted in
item III above (if appropriate)
Applicant's Certification:
I, 4�F V J A �C, n0, n , 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. I understand that Permit Name/Ownership Change can only take place through action
taken by the Division of Water Resources and that no actions on my part or the part of my company
result in the automatic transfer of permit coverage.
Signature: Date: irW, L71 �2a
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
INC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 07/2021
Feb 1 , 2024 8:05:38 P,