NCG550094_Permit (Correction)_20171016

ROY COOPER
Governor
a MICHAEL S. REGAN
Secrelaty
S. JAY ZIMMERMAN
Water Resources Director
ENVIRONMENTAL QUALITY
October 16, 2017
Zack 85 Lauren Locklear
187 Marajo Court
Winston-Salem, NC 27127
Subject: NPDES General Permit NCG550000
Transfer of NCG550094
187 Marajo Court
Davidson County
Dear Permittees:
The Division hereby transmits Certificate of Coverage (CoC) NCG550094, issued under
NPDES General Permit NCG550000. This action is taken to show that you are now the
owner of the subject facility. This CoC is issued pursuant to the requirements of North
Carolina General Statute 143-215.1 and the Memorandum of Agreement between North
Carolina and the U.S. Environmental Protection Agency dated October 15, 2007 (or as
subsequently amended).
If any parts, measurement frequencies or sampling requirements contained in the
General Permit are unacceptable to you, you have the right to request an individual NPDES
permit upon written request within thirty (30) days following receipt of this letter. Unless
such a request is made, this transfer of the subject CoC shall be final and binding.
This CoC is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the CoC. This permit does not affect the
legal requirements to obtain other permits which may be required by any other Federal,
state, or local government. If you have any questions concerning this matter, please contact
Emily Phillips at [phone] or via e-mail [[e-mail]].
ncerely,
G-
S. Jay Zimmerm, G.
Director
cc: Winston-Salem Regional Office
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://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

,
-1
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
•
CERTIFICATE OF COVERAGE NCG550094
Under GENERAL. PERMIT NCG550000
TO DISCHARGE 100%-DOMESTIC AND SIMILAR WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
(NPDES)
In compliance with the provisions of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Zack & Lauren Locklear
are hereby authorized to operate a wastewater treatment facility with a discharge of<1000
gallons per day); discharging from
' 187 Marajo Court
Winston-Salem
Davidson County
to receiving waters designated as an unnamed tributary (UT) to Miller Creek [stream segment
12-94-14], a waterbody currently classified C located within subbasin
03-07-04 of the Yadkin Pee-Dee River Basin, in accordance with the effluent limitations,
monitoring requirements, and other conditions set forth in Parts I, II, and III of General
Permit NCG550000 as attached.
This certificate of coverage shall become effective October 16, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 16, 2017. /2
(/-7ZA_. //42-,--2,4,9*
"/ay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission
v

PAT MCCRORY
DONALD R. VAN DER VAART
.
tljcxterResources S. JAY ZIMMERMAN
ENVIRONMENTAL QUAL'1Y 1)i,'e,to,
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NC00 / / / / or NCG5_5_/_0_/_0_/_ _/46_
1. Facility Name: 187 Maraio Ct(Residence) CoC NCG550094
II. NEW OWNER/NAME INFORMATION: RECEIVED/NCDEQ/DWR -
1. This request fora name change is a result of: SEP 2 9 2017
_X_a. Change in ownership of property/company
Water Quality
b. Name change only Permitting Section
c. Other(please explain):
2. New owner's name (name to be put on permit):
2a k- d t.ovr.eh 1,o ckfeu'
3. New owner's or signing official's name and title:
(Person legally responsible for permit)
Q,h , (Title)
4. Mailing address: I�� !V1 I 0 c,y ^/
• City: Y V i 1�sk5 l' L cal eh
State: AJC Zip Code: , '7)e9�' Phone: ( 33(, /�
) "l'/7- 30'1'5
E-mail address: Lag /i gy Corn
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://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

• NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
I, LaU,'&'t 1 1,O tk. i e C4V , 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 AAA{, p Date: q/Z0
THE CO LETED APP CATION 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 7/2016

FILED DAVIDSON COUNTY, NC DAVID T. RICKARD, REGISTER OF DEEDS 9/20/2017 2:15:00
PM , BOOK 2285 PAGE 1265 — 1266 INSTRUMENT #2017000020198 Recording:$26.00
Excise Tax:$280.00 Deputy: ERECORD
•
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $280.00
Parcel Identifier No.1,J )4"L2-1p1-b i y I Verified by County on the day of ,20_
By:
Mail/Box to: Goins Law, 3723 Apple Orchard Cove, High Point, NC 27265
This instrument was prepared by: Goins Law, 3723 Apple Orchard Cove, High Point, NC 27265
Brief description for the Index: LOT 32, SEC 3, Whispering Trails
THIS DEED made this day of ,20��l,by and between
GRANTOR GRANTEE
Jeffrey S. Everett and wife, Jennifer W Everett Lauren Gilley Locklear and husband, Zachery William Locklear
191 Mendenhall Dr I87 Marajo Ct.
Winston Salem, NC 27127 Winston Salem, NC 27127
Enter in appropriate block for each Grantor and Grantee: name,mailing address,and,if appropriate,character of entity,e.g.
corporation or partnership.
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,parcel of land or condominium unit
situated in the City of Winston Salem , Township, Davidson County.
North Carolina and more particularly described as follows:
Being known and designated as Lot 32, Map of Whispering Trails, Section 3, recorded in Plat Book 16 at Page 50, in the
Office of the Register of Deeds of Davidson County, North Carolina, reference to which is hereby made for a more particular
description.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 1976 page 1617
All or a portion of the property herein conveyed includes or X does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book 16 page 50
Page 1 of 2
NC Bar Association Form No 3©1976.Revised©1977,2002,2013 This standard form has been approved by:
Pnnted by Agreement with the NC Bar Association•-1981 North Carolina Bar Association—NC Bar Form No.3
submitted electronically by "Goins Law"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Davidson County Register of Deeds.

BK: 2285 PG: 1266
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,other than the following exceptions:
Restrictive covenants recorded in Book 506, Page 148, and Book 513, Page 504, and Book 568, Page 523, Davidson County
Registry. Easements and Restrictions of record. 2018 ad valorem taxes.
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
�If e-c (SEAL)
(Entity Name) 'n Na e: Jeffrey
By: t
(SEAL)
Print/Type Name&Title: Pri Type Na ' Jennifer W Everett
By: (SEAL)
Print/Type Name&Title: Print/Type Name:
By: (SEAL)
Print/Type Name&Title: Print/Type Name:
State of North Carolina -County or City of ,5-I-(')
I,the undersigned Notary Public of the County or City of_,S 44 0 and State aforesaid,certify that
Jeffrey S. Everett and wife, Jennifer W Everett personally appeared before me this day and acknowled ed the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this j LI day of
_ ' ,20\}.
JENNIFER ANNETTE JOHNSO •
My Commission Expires:_�e O (`( p 6`1 p1L���� PUBLIC �, r�No ary Public
(Affix Seal) STOKESOKES COUNTY,NC
My Commission Expires September 9,2N0 's Printed or Typed Name
State of -County or City of
I,the undersigned Notary Public of the County or City of and State aforesaid,certify that
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this day of
,20 _
My Commission Expires: Notary Public
(Affix Seal) Notary's Printed or Typed Name
State of -County or City of
I,the undersigned Notary Public of the County or City of and State aforesaid,certify that
personally came before me this day and acknowledged that
_he is the of ,a North Carolina or
corporation/limited liability company/general partnership/limited partnership(strike through the
inapplicable),and that by authority duly given and as the act of such entity,_he signed the foregoing instrument in its name on its
behalf as its act and deed. Witness my hand and Notarial stamp or seal,this day of ,20 .
My Commission Expires: Notary Public
(Affix Seal) Notary's Printed or Typed Name
Page 2 of 2
NC Bar Association Form No. 3©1976.Revised©1977,2002,2013 This standard form has been approved by.
Printed by Agreement with the NC Bar Association—1981 North Carolina Bar Association—NC Bar Form No.3