NC0074110_owner name change_20000107

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
January 7, 2000
Ms. Cathey Childrey, President
Mizpah Healthcare, Inc.
P.O. Box 999
Mountain Home, North Carolina 28758
f
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: NPDES Permit Modification - Ownership Change
Permit NCO074110
Mountain View Assisted Living
Henderson County
Dear Ms. Childrey:
In accordance with your request received December 15, 1999, the Division is forwarding the subject
permit modification. This modification documents the change in ownership at the subject facility. All other terms
and conditions in the original permit remain unchanged and in full effect. This permit modification is issued
under 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 December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit modification
are unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30)
days following receipt of this letter. This request must be a written petition conforming to Chapter 150B of the
North Carolina General Statutes, filed with the Office of Administrative Hearings, Post Office Drawer 27447,
Raleigh, North Carolina 27611-7447. Unless such demand is made, this decision shall be final and binding.
This permit does not affect the legal requirement to obtain other permits which may be required by the
Division of Water Quality, the Division of Land Resources, Coastal Area Management Act, or any other Federal or
Local government permit that may be required. If you have any questions concerning this permit, please contact
Christie Jackson at the telephone number or address listed below.
Sincerely, ,
rr T. Stevens
cc: Central Files
Asheville Regional Office, Water Quality Section
NPDES Unit
Point Source Compliance Enforcement Unit
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 733-5083, extension 538 (fax) 919 733-0719
VISIT US ON THE INTERNET@ hftp://h2o.enr.state.nc.us/NPDES [e-mail]

Permit NCO074110
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER 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,
Mizpah Healthcare, Inc.
is hereby authorized to discharge wastewater from a facility located at the
Mountain View Plant
on NCSR 1528
north of Balfour
Henderson County
to receiving waters designated as an unnamed tributary to Featherstone Creek in the
French Broad River Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective January 7, 2000.
This permit and authorization to discharge shall expire at midnight on November 30, 2000.
Signed this day January 7, 2000.
c
A -
�rr T. Stevens, Director (/
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0074110
SUPPLEMENT TO PERMIT COVER SHEET
Mizpah Healthcare Inc., is hereby authorized to:
1. Continue to operate an existing 0.005 MGD wastewater treatment facility with the
following components:
♦ Grease trap
♦ Bar screen
♦ Aeration basin
♦ Clarifier
♦ Sludge holding tank
♦ Dual blowers
♦ Tertiary filter
♦ Chlorine contact chamber
♦ Tablet chlorinator
♦ Post aeration tank
The facility is located at Mountain View Assisted Living, on NCSR 1528, north of
Balfour in Henderson County.
2. Discharge from said treatment works at the location specified on the attached map
into an unnamed tributary to Featherstone Creek, classified C waters in the
French Broad River Basin.

N+IZDENR
JAMES B. HUNTJR.
GOVERNOR
1
MEMORANDUM
TO:
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
ASHEVILLE REGIONAL OFFICE
WATER QUALITY SECTION
December 17, 1999
Dave Goodrich
FROM: Roy Davis
SUBJECT: Permit Name Change
Mountain View Rest Home
NPDES Permit Number NCO074110
Henderson County
Attached is a Permit Name/Ownership Change form
submitted by the new owners of the Mountain View Rest Home
along with a Deed of Trust relating to the same property.
Please do not hesitate to call if I may be of assistance in
this matter.
INTERCHANGE BUILDING, 59 WOODFIN PLACE, ASHEVILLE, NC 28801-2414
PHONE [phone] FAX [phone]
AN EQUAL OPPORTUNITY / AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED/10% POST -CONSUMER PAPER
OW..

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holm��{{��, Secretary
Kerr T. Si�vehs, Director
l�.
I.
AV%"A_aW,A
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
PERMIT NAME/OWNERSHIP CHANGE FORM
wr I
CURRENT PERMIT INFORMATION:
Permit Number: NC00
1. Permit holder's name: rrc
2. Permit's signing official's name and title: _
(Person le ally responsible for permit)
3. Mailing address: gj�ozcity:
E-mail address:
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. New owner's name (name to be put on permit):
New owner's or signing official's name and tit
(Person Ie(gally responsible f* pE
p (Title)
4. Mailing address: City:?.�I�
State:4� Zip Code J Phone:
E-mail address:
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled / 10% post -consumer paper

PERMIT NAME / OWNERSHIP CHANGE FORM
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF WATER
QUALITY UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUD
WITH THE SUBMITTAL.
rl
REQUIRED ITEMS:19992 0
1. This completed application form
2. Legal documentation of the transfer of ownership rs B9 un
g p (such as a cont ct, de,,�'��s�p�NcN
incorporation) S
For changes of ownership, this. form must be completed and signed by both the current permit
holder and the new owner of'the facility.
For name change only, the current permit holder must complete and sign the Applicant's
Certification.
Current Permittee's Certifcation:
attest that this application for
name/owners p 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: 8Date:
Applicant's Certification:
attest that this application for a
name/owners6ip 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
`fall required supporting information and attachments are not included, this application
package will be returned as incomplete:
Sig
Date:
THE COMPLETED A-PLICATION PACKKGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD'BE SENT TO THE FOLLOWING ADDDRESS:
NC DENR / DWQ
NPDES Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 9-99

SATISFACTION: The debt secured by this Deed of Trust, as evidenced by
the note or other document secured tluueby, has been satisfied in full. This
the day of
Signed:
Mail after recording to:
Lex H. Veaze
210 North Main Street
Hendersonville NC 28792
This instrument was prepared by:
Lex H. Vea*zey, Attorney
Recording: Time, Book and Page
NORTH CAROLINA (FUTURE ADVANCE) DEED OF TRUST
(Collateral is or Includes Fixtures)
THIS DEED OF TRUST AND SECURITY AGREEMENT ("Deed of Trust") is made as of this 23rd
day of February 1999 by and between:
GRANTOR (Include Address)
TRUSTEE
AIIZPAH PROPERTIES, LLC, a North Carolina Limited Liability Compariymng,it resident ofNorth Carolina
BENEFICIARY
BRANCH BANKING AND TRUST COMPANY, a
North Carolina state banking corporation
El 1F BOX CHECKED, THIS DEED OF TRUST SECURES AN OBLIGATION INCURRED P.O. Box 1255, Winston-Salem, NC 27102-1255
FOR THE CONSTRUCTION OF AN IMPROVEMENT ON LAND.
THE FOLLOWING IIVFORMATION APPLIES TO TH1S DEED OF TRUST:
1. The maximum principal amount of the Debt (defined below), including present and future advances, secured by Ibis Deed of Trust is
Seven Hundred Sixty Thousand Dollars & 00/100
( 760 000.00 ) Dollars.
2. The Debt, on the date hereof, is evidenced by a Note and/or other Document described by name, parties, dollar amount and date as follows:
Note dated February 23 1999 in the amount of $ 760, 000. 00
executedby Miz ah Properties, LLC
and may be evidenced by and shall be at all times deemed to include, any and all other notes or other Documents now or hereafter evidencing any debt whatsoever
incurred by Grantor and payable to Beneficiary, the terms of which are incorporated herein by reference.
3. Pursuant to the provisions of Sections 45-67 et seq., of the North Carolina General Statutes, this Deed of Trust secures the payment of the Debt,
including present and future advances.
4. The current principal amount of the Debt advanced on the date hereof (including any outstanding amounts advanced previously) by Beneficiary is
$ 760 000.00 (if none, so state).
5. No execution of a written instrument or notation shall be necessary to evidence or secure any future advances made hereunder. The period within which
future advances are to be made shall be the fifteen year period beginning on the date of this Deed of Trust.
6. The real property which is the subject of this Deed of Trust is located in or near the City of Hendersonville
the Township of Hoopers Creek ' 1°
in the County of Henderson , in the
State of North Carolina, and the legal description and the chain of title referencc of the real property are set forth as follows:
OT.+ ,mm...,...,.. .--------

B0 CERTIFICATE OF CORPORATE RESOLUTIONS
And Authorization To Borrow
100 HEREBY CERTIFY to Branch Banking and Trust Company (herein "Bank") that I am the duly elected and qualified
Secretary of MIZPAH HEALTHCARE INC •
a corporation organized and existing under the laws of the State of NORTH CAROLINA , having its principal place of business in the City c
HENDERSONVILLE State of NC (herein "Corporation"), that the taxpayer identificatio
number. of the Corporation is 56.1982403 ; that I am the keeper of the records and the corporate seal of the Corporation
that the following is a true and correct copy of resolutions duly adopted at a meeting of the Board of Directors of the Corporation held ii
accordance with its bylaws and the laws of said state at ROUTE 11 BOX 238 HENDERSONVILLE NC 28792
23 y February 1999 on the
de of as taken and transcribed by me from the minutes of fait
meeting and compered by me with the original of said resolutions recorded In said minutes; and that thesame have not in any way beer
modified, repealed, or rescinded but remain in full force and effect:
COPY OF RESOLUTIONS
BE IT RESOLVED that the following officers of this Corporation, President _
or any one or more of them unlass otherwise limited below, are hereby authorized, empowered,
and directed to perform the following acts and deeds in the name of and on behalf of this Corporation:
(a) To negotiate and procure loans from the Bank up to an amount not exceeding (if there is no limit, so indicate)
8 Unlinutcd in the aggregate at any one time
outstanding on such terms and conditions as said officer or agent deems proper; and
(b) To negotiate and procure loans from Bank on BB&T Business Cards under such terms and conditions as contained in the BB&T
Business Card Plan Agreement; and
(c) To enter into and execute on behalf of MIZPAH PROPERTIES LLC herein "Borrower"), who/which
is a Partnership of NC any one or more of the following: security agreement, deed of trust, guaranty
)Redden of ate%, Corpwation or Pe"MrSNp of state)
agreement, mortgage or other writing (herein Documents) in favor of Bank on such terms, in such form, and pledging as security
such Collators l owned by the CCorporation, as such officer deems adwsafle and appropriate ,to guarantee payment and secure
performanoe of all obligations of Borrower to Bank, whether direct or indirect, absolute or contingent, or now existing or hereafter
arising, Corporation acknowledges that it has an economic interest in said Borrower and that the funds, credit, or financial
assistance desired by said Borrower from Bank will only be extended upon the promise of Corporation to guarantee and secure all
obligations of Borrower as set forth in the Documents; and
(d) To give security for any liabilities of the Corporation to Bank,. by pledge, mortgage, assignmont, security interest, or other. ion upon
any real or personal property, tangs le or intangible, of the Corporation, end to execute --aft
such a form es may be required �y the
BII i aU notes and other evidences of such loans, ell in
of pledge, mortgage, assignment, security interosr or other lien,
financing and other agreements with Bank relating to the terms end conditions upon wftich any such loans may be obtained and
to the security to be furnshed b this Corporation therefore, provided, however, that tha andorsement of commercial or other
business paper discounted may bye effected by any one of them; and
(a) To discount with spill Bank, commercial or other business paper belonging to this Corporation, made or drawn by or upon third
parties;. without limit as to amount; and
(f) To modify, supplement or amend such agreements, guarantees, notes or other writings, any such terms or conditions thereof, and
any such security; and
(a) To pledge assign, guarantee, mortga a, cosign, grant security, interests in and otherwise transfer to Bank additional security and
Coll toral fC
and
or any and all debts and obligations of either this orporation or of Borrower to Bank, whenever and however ansing;
(h) To do and performall other acts and things deemed by any such officer or agent necessary, convenient, or proper to carry out any
of
do in contents
of those resolutions; hereby ratifying, approving, and confirming all that any such officers or agents have done or
RESOLVED FURTHER, that the following officers, are hereb�r
authorized to enter into and execute on behalf of the Corporation foreign exchange transactions and wire transfers through the bank to shill
from accounts of the Corporation in accordanoe with the Bank's procedures and requirements, and suoh officers are hereby' authorized and
directed to do and perform all necessary and proper acts to carry out such authority; and
RESOLVED FURTHER, that any officer, employee ,or person designated hereunder is authorized to sign, endorse and negotiate: any
Convenience Checks Issued to the Corporation in connection with the BB&T Business Card. The Bank is authorized to honor receive and pay
all Convenience Checks even though drown or endorsed to the order of any person sighing the same or tendered by him for cashing, or in
payment of the individual obligation of such persons, or for deposit to his personal acgpunts, and the Bank shall not be required or be under
any obligation to inquire as to the circumstances of issuance, use or disposition of any Convenience Checks; and
RESOLVED FURTHER, that the Sacretogy or Assistant Secretary of this Corporation shall certify to said Bank the names and signatures
of the persons who: are at present authorize to act on behalf of this Corporation under the foregoing resolutions and shall from time to time
hereafter as changes in the personnel of said gfficers and em loyees are made, immediately certify such changes to said Bank, and said Bank
shall be {ully protected In relying on such Cortiticatione of the Secretary or Assistant Secretary and shall be inchryinified and saved harmless in
any claims, demands, expenses, loss, or damage resulting from or growing out of honoring the signature of any officer or amployse so
cortified; and
RESOLVED FURTHER, that the .fore oing resolutions shall remain in full force and effect until written. notice 9f their amendment or re-
scission shall have bQ2n repaired by said nk, and that rageipt of such notice shall not affect any action taken by said Bank prior thereto; and
RESOLVED FURTHER that the Secretary and/or Assist itt Secretary of the Corporation are hereby authorized and directed to attest the
signatures of he above authwrized officers as may be required from time to time by the Bank: and
RESOLVED FURTHER, that all transactions by any of the officers or employees of this Corporation on its behalf and in its name, with
Bank prior to the delivery to Bank of a certified copy of the foregoing resolutions are, in all respects, hereby ratified, confirmed, approved, and
adopted; and
RESOLVED FURTHER, that
RESOLVEDFURTHER, that the following LIMITATIONS to the above apply, if any:
ONLY THE PRESIDENT CAN SIGN ON BEHALF OF THE CORPORATION.
I HEREBY CERTIFY that neither these resolutions nor any action to be taken pursuant hereto are or will ba in contravention of any
prevision of the articles of incorporation, bylaws or any agreement, indenture, or other instrument to which such Corporation is a party,.end
that no consent by shareholders is required to authorize the actions taken by this resotution, and that the actions authorized hereby are not in
contravention of any applicable law or statute.
I HEREBY FURTHER CERTIFY that the followin named per;ions have been duly elected to the offices set opposite their respective
names, that they continue to hold these offices at t%c present time, and that the signatures appearing hereon are the genuine, original
signatures of each respectively:
(PLEASE SUPPLY GENUINE SIGNATURES HEREUNDER)
ti—AIM a President
Vica President
Treasurer
t�asture Asst. Treasurer