NCG020125_Rescission_20150214

72i
NCDENR
NORTH CAHOON. DCPARTMCNT Of
CNV4RONMCHT .NO NnuR•L RCUOUNCC1
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year Month Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or)
Certificate of Coverage
G
0
2
0
1
2
5
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name John F. Lavden /John F. Lavden Mine
Facility Contact John F. Lavden (Permit Contact: Ken Elliott, 252-339-9021, [e-mail]
Street Address 305 Dances Bay Road
City Elizabeth City State NC ZIP Code 27909
County Pasquotank E-mail Address [e-mail]
Telephone No. � 252-330-4929 Fax:
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on Spring 2015. All industrial activities have ceased such that no discharges
of stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to
on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
1, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature
Date February 14, 2015
t t :b i E.tt, ).v, 0.4Dex.,_1A 144- .1;1, F. t
Print or type name of Berson signing above le
Please return this completed rescission request form to:
NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
An Equal Opportunity \ Affirmative Action Employer

VIVID NV. LDU"L-U265 It
A
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
SETTLEMENT STATEMENT
B. TYPE OF LOAN:
1.
FHA 2.
FmHA 3.
©CONV. UNINS. 4.
VA 5.
CONV. INS.
6. FILE NUMBER:
LNGSWMP.13630
7. LOAN NUMBER:
400390900
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked (POCJ° were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 9/98(WGSWMP..13630.PFDMIGSWMP.1363621)
D. NAME AND ADDRESS OF BORROWER: .
LONG SWAMP HUNT CLUB, LLC
A North Carolina Limited Liability Company
769 Pitts Chapel Road
Elizabeth City, NC 27909
E. NAMEAND ADDRESS OF SELLER:
JOHNNY F. LAYDEN unmarried
305 Dances Bay Road
Elizabeth City, NC 27909
F. NAMEAND ADDRESS OF LENDER:
Select Bank & Trust Company
3600 Charles Boulevard
Greenville, NC 27858
G. PROPERTY LOCATION:
Sand Pit Road
Elizabeth City, NC 27909
H. SETTLEMENT AGENT: 26-3090419
G. E. Small, P.C.
I. SETTLEMENT DATE:
M
J. SUMMARY OF BORROWER'S TRANSACTION
K SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price
20,000.00
401. Contract Sales Price
20,000.00
102. Personal Property
402. Personal Property
103. Settlement Charges to Borrower (Line 1400)
1,472.95
403.
104.
404.
105.
405.
Adjustments For Items Paid By Seller in advance
Adjustments For Items Paid By Seller in advance
106. City Taxes to
406. City Taxes to
107. 2014 County Taxes to
407. 2014 County Taxes to
108. Assessments to
408. Assessments to
109.
409.
110.
410.
111.
411.
112.
412.
120. GROSS AMOUNT DUE FROM BORROWER
21,472.95
420. GROSS AMOUNT DUE TO SELLER
20,000.00
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money
501. Excess Deposit (See Instructions)
202. PrindpalAmount of New Loan(s)
28,500.00
502. Settlement Charges to Seller (Line 1400)
203. Existing loan(s) taken subject to
503. Existing loan(s) taken subject to
204.
504. Payoff of first Mortgage
205.
505. Payoff of second Mortgage
206.
506.
207.
507.
208.
508.
209.
509.
Adjustments For Items Unpaid By Seller
Adjustments For Items Unpaid By Seller
210. City Taxes to
510. City Taxes to
211. 2014 County Taxes 01/01/14 to 05/16/14
82.86
511. 2014 County Taxes 01/01/14 to 05/16/14
82.86
212. Assessments to
512. Assessments to
213.
513.
214.
514.
215.
515.
216.
516.
217.
517.
218.
518.
219.
519.
220. TOTAL PAID BY/FOR BORROWER
28,582.86
520. TOTAL REDUCTION AMOUNT DUE SELLER
82.86
300. CASH AT SETTLEMENT FROMITO BORROWER:
600. CASH AT SETTLEMENT TOIFROM SELLER:
301. GrossAmount Due From Borrower (Line 120)
21,472.95
601. GrossAmount Due To Seller (Line 420)
20,000.00
302. LessAmount Paid By/For Borrower (Line 220)
( 28,582.86)
602. Less Reductions Due Seller (Line 520)
( 82.86)
303. CASH ( FROM) ( X TO) BORROWER
7,109.91
603. CASH ( X TO) ( FROM) SELLER
19,917.14

L: SETTLEMENT CHARGES
rage z
700. TOTAL COMMISSION Based on Price $ @
%
PAID FROM
BORROWERS
FUNDSAT
SETTLEMENT
MID FROM
SELLERS
FUNDSAT
SETTLEMENT
Division of Commission (line 700) as Follows:
701. $ t0
702. $ to
-
703. Commission Paid at Settlement
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee 0.3509 % to Select Bank & Trust Company
100.00
802. Loan Discount % to •
803. Appraisal Fee to
804. Credit Report to
805. Flood Cert Fee to
806. Wire Fee to Select Bank & Trust Company
19.00
807. UCC Recording Fee to Select Bank & Trust Company
64.00
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 05/16/14 to 06/01/14 © $ /day (
16 days
%)
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to
904. Flood Insurance Premium 1.0 years
905.
I7nnn_ RFSFRVPR nl=Dncrrcn wnru I eunro
.1.01.111 al I1R montns ( $ per month
1002. Mortgage Insurance months © $ per month
1003. City Taxes months © $ per month
1004. 2014 County Taxes months @ $ per month
1005. Assessments months © $ per month
1006. Flood Insurance Premium months © $ per month
1007. months © $ per month
1008. Aggregate Adjustment months © $ per month
1100. TITLE CHARGES
1101. Settlement or Closing Fee to G. E. Small, P.C.
500.00
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation • to G. E. Small, P.C.
250.00
1106. UPS Mafl Fees to
1107. Attorneys Fees to
(includes above item numbers: )
1108. Title Insurance to Fidelity National Title Co. 14MT036393
153.95
(includes above item numbers:
)
1109. Lender's Coverage . $ 28,500.00
1110. Owner's Coverage $ 28,500.00
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 26.00; Mortgage $ 56.00; Releases $
1202.
82.00
City/County Tax/Stamps: 1% Land Transfer 200.00; Mortgage
200.00
1203. State Tax/Stamps: Revenue Stamps 40.00; Mortgage
40.00
1
1204. to Pasquotank County Register of Deeds
64.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303.
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K)
1,472.95
ert ed to be a true copy.

i
ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT
Borrower:
Seller:
Lender:
Settlement Agent:
Place of Settlement:
Settlement Date:
Property Location:
LONG SWAMP HUNT CLUB, LLC A North Carolina Limited Liability Company
JOHNNY F. LAYDEN unmarried
Select Bank & Trust Company
G. E. Small, P.C.
[phone]
607 E. Main Street
Elizabeth City, NC 27907-0069
May 16, 2014
Sand Pit Road
Elizabeth City, NC 27909
Pasquotank County, North Carolina
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further
certify that I have received a copy of the HUD-1 Settlement Statement.
LONG SWAMP HUNT CLUB, LLC/A North Carolina
Limited Liability Company
BY:
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account
of the funds which were received and have been or will be disbursed by the undersigned as part otthe settlement of
this transaction.
. Elvin Small, III, Attorney at Law
Settlement Agent