NCG550133_Owner (Name Change)_20161026

PAT MCCRORY
DONALD R. VAN DER VAART
Secretary
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Director
October 26, 2016
Mr. Tommie Stanley
142 Cedar Run
Reidsville, NC 27320
Subject: General Permit NCG550000
142 Cedar Run Drive
Certificate of Coverage NCG550133
Rockingham County
Dear Permittee:
The Division has received and approved your request to transfer ownership of the subject Certificate
of Coverage (CoC)under General Permit NCG550000. As a result,the Division hereby reissues NCG550133.
This CoC is issued pursuant to the requirements of North Carolina General Statue 143-215.1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated
October 15, 2007 [or as subsequently amended]. Please provide a copy of the deed as soon as possible for our
records.
If any parts, measurement frequencies or sampling requirements contained in this General Permit
are unacceptable to you,you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, the certificate of coverage shall be final and binding.
Please take notice that this Certificate of Coverage is not transferable except after notice to the
Division. The Division may require modification or revocation and reissuance of the certificate of coverage.
Contact the Winston-Salem Regional Office prior to any sale or transfer of the permitted facility.
Regional Office staff will assist you in documenting the transfer of this CoC.
This permit does not affect the legal requirements to obtain any other State, Federal, or Local
governmental permit that may be required. If you have any questions concerning the requirements of the
General Permit, please contact Brianna Young of the NPDES staff[919-807-6388 or
[e-mail]].
ely,
orS.Jay Zimmerman, P. .
Director, Division of Water Resources
cc: Winston-Salem Regional Office
NPDES File
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

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550133
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,
Tommie Stanley
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
142 Cedar Run Drive
Reidsville
Rockingham County
to receiving waters designated as an unnamed tributary to Wolf Island Creek, a class C stream in
subbasin 03-02-03 of the Roanoke 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 takes effect October 26, 2016.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day October 26, 2016.
for ay Zimmerman, P.G.
Director, Division of Water Resources
By Authority of the Environmental Management Commission

PERMIT NAME/OWNERSHIP CHANGE FORM
I• CURRENT PERMIT INFORMATION:
Permit Number: NCOO / / / / or NCGS /D/ / /
1. Facility Name:_ C.4 E.L — n.,,J•.-51w� or- t.. lte f" 9-41-lotme tS
II. NEW OWNER/NAME INFORMATION:
1 This request for a name change Is a result of:
Y a. Change in ownership of properlylcornpany
b. Name change only
c. Other(please explain):
2. New owners name(name to be put on permit):
3. New owners or signing official's name and title:
permit) erson legally respon t for
Mt .
(Title)
4. Mailing address: \� � C.,&ctc c City: .�� �\4
State: js( Zip Code: a---1 3 .Q Phone: ( 33(..) (o Lk55- \ -1
E-mail address: -1C-r,.4 ,_,n,t;c N2aLc\(ei c —.\ . LA1,41
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]
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Filed
Rockingham County, NC
Amy Lee Simpson, Register of Deeds
09/01/2016 01:13:45 PM
Fee Amt:$26.00 NC Excise Tax:$355.00
CATINIA E.WINCHESTER
NORTH CAROLINA GENERAL WARRANTY DEED
,3SS, Recording Fee:S26.00
Excise Tax
Parcel Identi
: fier No.1l46200 Verified by County on the day of ,2016
By:
Mail/Box to:GRANTEE
This instrument was prepared by:James It.Walker,Attorney-Walker,Melvin&Woodall,LLP.P.U.Box 528,Eden,NC 27289
Brief description for the Index: 142 Cedar Run,Reidsville,NC
THIS DEED made this �9 day of September,3016,by and between
GRANTOR GRANTEE
DALE H.SMITH &wife, TOMMY WAYNE STANLEY,JR.
PATRICIA D.SMITH
142 Cedar Run 04 —872DAIC'/U4at-&-
Reidsville, NC 27320 TAT- itAt Ry r\lC _D-1030
Notice per NCGS§ 105-317-2: The above mentioned property IS a primary residence of the Grantor.
Enter in appropriate block for each party: name,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 or parcel of land situated in the
City of ,Wentworth Township,Rockingham County,North Carolina and more particularly described as
follows:
SEE ATTACHED EXHIBIT "A"
"TITLE NOT EXAMINED BY PREPARER OF THIS DEED"
NC Bar Association Form No.3 O 1976,Revised© 1977,2002
Printed by Agreement with the NC Bar Association- 1981 -Chicago Title Insurance Company
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The property hereinabove described was acquired by Grantor by instrument recorded in Book— page
A map showing the above described property is recorded in Plat[look page
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:
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day at year first above written.
1— — (SF-AI)
DALE II.SMITH
PATRICIA D.SMITH
State of North Carolina-County of Rockingham
I, the undersigned Notary Public of the County and State aforesaid,certify that DALfi 11.SMCI ll
PATRICIA D. SMITH 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'September,2016.
My Commission Expires. ll -/C
ary l ublic
SCOT . S MORE
NOTARY PUBLIC
ROCKINGHAM COUNTY.NC
NC Bar Association Form No.3© 1976.Revised© 1977,2002 an
Printed by Agreement with the NC Bar Association—1981—Chicago Title Insurance Cop any
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EXHIBIT "A"
142 Cedar Run
Reidsville, NC
Pa reel H 146200
BEGINNING at an iron located on the West right-of-way line of Cedar Run, said iron
marking the Northeast corner of I,ot 15, Section D. Windemere Subdivision thence from
said beginning point on the North line of Lot 15. North 30° 57' West 200.0 feet to an on:
thence North 59° 03' East 100.0 feet to an iron; thence North 30° (K,' West 127.1 t feel too an
iron: thence South 76° 00'to an iron; thence North 89° 22' East East 109.15 feet to an iron: thence South •1')" 49' Fast 101.')') feet
107.81 feet to an iron on the West right-of-way line of
Cedar Run, said iron being North 6° 49' West 174.43 feet from the Southeast corner of Lot
7, Section D; thence along the West line of Cedar Run, South 6° 49' East 27.79 feet to an
iron; thence along the West right-of-way line of Cedar Run as it curves in a Southwesterly
direction to an iron, a chord distance and bearing of South 36° 13' \Vest 135.78 feet; thence
South 59° 03' West 179.94 feet to an iron. THE POINT OF I3FGINNING and being all of
Lot 14, Section D, Windemere and an adjoining tract containing 0.869 acres. This
description as per plat of survey for Mitchell B. Wilson by C. E. Robertson and Associates.
R.L.S., dated August 16, 1977 and revised May 30, 1979. A copy of said plat being recorded
with Deed of Trust from Mitchell B. Wilson and wife, Dorothy S. Wilson to Cntc City
Savings and Loan Association dated 1979. SUBJECT to restrictions as recorded in Book
678, Page 937, Rockingham County Registry. (WMW kcf 114979)
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