HomeMy WebLinkAboutNCG550127_Permit (Issuance)_20090610 ArgC.11A
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality _
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
June 10, 2009
CHRISTOPHER K KIMSEY .
ERICA S KIMSEY
2162 UPPER LAKE ROAD
THOMASVTT.L E NC 27360
Subject:NPDES Permit Modification-Name and/or Ownership Change
Christopher K.Kimsey&Erica S.Kimsey-Residence
Formerly Zachary T.Harris-Residence
Certificate of Coverage NCG550127
Davidson County
Dear Mr. and Ms.Kimsey:
Division personnel have reviewed and approved your request for ownership change of the subject certificate of coverage
received on June 10,2009. This permit modification documents the change of ownership of the above reference facility.
Please find enclosed the revised certificate of coverage. All other terms and conditions contained in the original certificate
remain unchanged and in full effect. This modification is issued under the requirements of North Carolina General Statutes
143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.Environmental Protection Agency.
If you have any questions concerning this permit modification,please contact the Point Source Branch at(919) 807-6304.
Sincerely,
r/ Coleen H. Sullins
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cc: Central Files
Winston-Salem Regional Office, Surface Water Protection -
MI �: Vilna
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 .
Location:512 N.Salisbury St.Raleigh,North Carolina 27604 One
Phone:919-807-63001 FAX:919-807-64921 Customer Service:1-877-623-6748 North Carolina
Internet:www.ncwaterquality.org s,r���Je,
An Equal Opportunity\Affirmative Action Employer Natl�6
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550127
DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND
OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE •
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision 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,
Christopher K. Kimsey and Erica S. Kimsey
is hereby authorized to discharge domestic wastewater [450 GPD] from a facility located at .
2162 Upper Lake Road
Davidson County
to receiving waters designated as an unnamed tributary to Hamby Creek in subbasin 03-07-07 of
the Yadkin River Basin in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV hereof.
This certificate of coverage shall become effective June 11, 2009.
This Certificate of Coverage shall expire on July 31, 2012.
Signed this day June 11, 2009.
for , een H. Sullins, Director
Division of Water Quality 3
By Authority of the Environmental Management Commission
NA7
Beverly Eaves Perdue,Governor
tir
:- J Dee Freeman,Secretary
3 :' North Carolina Department of Environment and Natural Resources
Ca" —
Coleen H.Sullins,Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION -1
PERMITf NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C 0 0 N 'C G 5 5 O I a ?7
II. Permit status prior to status change.
a. Permit issued to(company name): _
b. Person legally responsible for permit: OJT' 7 �•a i vi
}h k , First 1 MI Last
t
am, • ,' . (Pr( 0tabuJNi�C�
1
;' Title
aliDa UPPER LRikil, ?d
J U N 1 0 2009 Permit Holder Mailing Address
—117\0m2- Nl r 11-Q- N Q_ a13 Lc,0
City State Zip
LII
DENR - WATER QUALITY >Phoneika'17(0 Fax
POINT SOU RC_a_I scharge): Nizi Ns'e k
d. Facility address: a l b A PiUt LA
Address
City State LL,, Zip
e. Facility contact person: 2:VIP/N \-�.rtn5 (��7 C 111Q
First /MIV Last Phone
III. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: VI 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: hr5 k i r1f1 iL,L(
irst MI Lust
a I to ,a l� Title
, P>d
Permit Holder Mailing Address
-116 t'Y1Otb V + ( k. N Zl lQ 0
City State Zip
: -3Le) 3S® U U 3'1
Phone E-mail Address
d. Facility name(discharge): FIR 00 b �,f
e. Facility address: `a I lc,a I R y
Address
. 1 homQejt 11-Q__ lJ& `a'13 L2 0
City i State Zip
f. Facility contact person: 6.,Ilr i,b+c L 1- i ONS,ems,
Firs MILast
tom ') SSG 44 ' {1 1
Phone E-mail Address
Revised 112009 EiV 1 LA 1 v-Y-, eAj gSo q 0 a
PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information(if different fr m the perso legally responsible for the permit)
Permit contact: V\1rl 5 0p j (Y
First MI ) Last
Q3
i �� Title
—�-� Mailing ddress t ^���
1'Yl�i��i 1 t� `^'1�
City SS CD 4-Stat -1 Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
1�4 Yes C+er�
❑ No(please explain) S( 0.5T'i al WO NdL&c \ Q(.r t\) t +i QS
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
This completed application is required for both name change and/or ownership change
requests.
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. �►; L J/
The certifications below must be completed and signed by both the permit holder prior to the change,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 are not
completed and that if all required supporting information is not included,this application package will be
returned as incomplete.
4709
/7/74--Signature Date
APP ANT CERTIFICATION
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 are not
completed and that if all required supporting information is not included,this application package will be
returned as ' omplete.
Signa Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 1/2009
•
NORTH CAROLINA
GENERAL WARRANTY DEED
Excise Tax: S220.00 Recording Time, Book and Page:
Tax Map No. Parcel Identifier No: 16-340-F-000-0015
Mail after recording to: GRANTEE: 2162 UPPER LAKE ROAD,THOMASVILLE,NC 27360
This instrument was prepared by: MARK L. MCGUIRE,ATTORNEY AT LAW,THOMASVILLE, NC(NO TITLE
SEARCH PERFORMED OR REQUESTED)
THIS DEED made this 17th day of April , 2009 by and between
GRANTOR
Zachary Todd Harris and wife,Ashley Hulin Harris
GRANTEE
Christopher K. Kimsey and wife, Erica S.Kimsey
Property Address: 2162 Upper Lake Road,Thomasville,NC 27360
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
and more particularly described as follows:
BEING: Lot No. 15 of CHARTER OAKS, according to the plat thereof,which is duly recorded in Plat Book 16, Page 51,in
the Office of the Register of Deeds for Davidson County,North Carolina.
All or a portion of the property hereinabove described was acquired by Grantor by instrument recorded in Book 1717 , Page
1236 , Davidson County Registry.
A map showing the above described property is recorded in Plat Book 16 , Page 51 ,and referenced within this instrument.
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:
Power,telephone and utility easements of record or those visible upon the ground,if any.
Any and all 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 officer(s),the day and year first above written.
/ ,,,„4 - (SEAL)
(Entity Name) ha odd Harris
By: ( EAL)
Ash ey Hul n Harris
Title:
By: (SEAL)
Title:
(SEAL)
NORTH CAROLINA a1.ta 111 COUNTY
I certify that the following person(s)personally appeared before me this day,each acknowledging to me that h e or she signed the
foregoing document: Zachary Todd Harris and wife,Ashley Hulin Harris .Witness my hand and official stamp or seal,
this the 11-ii/1 day of ___ 4 �,0____a®aooa__ , f..)(0Gi I 1
P41,,t...-\(---
My Commission Expires: �q ��; ATI �� 4 s '�� , �`',tLA/1 /.1I1:16vfr
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=� t', ' I 1:a Notary Public
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1 (l., ' 1' Notary AÜICia IJIu e iJU+ki,i
=�° '2;� 0`' ? PrintNota Name:
)
Via,
.� J e
NORTH CAROLINA COUNTY
I certify that the following person(s)personally appeared before me this day,each acknowledging to me that h e or she signed the
foregoing document: , .Witness my hand and official
stamp or seal,this the day of
My Commission Expires:
Notary Public
Print Notary Name: