NCG550843_owner name change_20210927

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
Shannon Leigh Morgan
114 Jasmine Place
Durham, NC 27712
Dear Permittee:
NORTH CAROLINA
Environmental Quality
September 27, 2021
Subject: General Permit NCG550000
Certificate of Coverage (CoC) NCG550843
114 Jasmine Place
Durham County
The Division has approved your request to transfer coverage under the subject General Permit.
Accordingly, the Division hereby issues you a revised version of NCG550843, along with a copy of
NCG550000. Discard any earlier versions of the permit and use this version until further notice. 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 NOTE: Your facility discharges to a class WS-II HQW NSW waterbody. Therefore, you will
use the limits and monitoring frequencies found in Part I, section C. (3.) of NCG550000.
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.
This CoC is not transferable except after notice to the Division. The Division may require
modification or revocation and reissuance of the CoC. Contact the Raleigh 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 Derek Denard of the NPDES staff [[e-mail]].
cc: NPDES file
NORT
Department of Environmental Dual
Sincerely,
for S. Daniel Smith
Director, Division of Water Resources
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.707.9000

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
GENERAL PERMIT NCG550000
CERTIFICATE OF COVERAGE NCG550843
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,
Shannon Leigh Morgan
is hereby authorized to discharge <1000 gallons per day of domestic wastewater from a
facility located at
114 Jasmine Place
Durham
Durham County
to receiving waters designated as an unnamed tributary to the Little River, currently a class WS-II
HQW NSW stream in subbasin 03-04-01 of the Neuse River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, and III hereof.
This certificate of coverage takes effect 9/27/2021.
This Certificate of Coverage shall remain valid for the duration of the General Permit.
Signed this day 9/27/2021
ii 144
for S. Daniel Smith
Director, Division of Water Resources
By Authority of the Environmental Management Commission

ROY COOPER
Governor
ELIZABETH S. B1SER
Secretary
S. DANIEL SMITH
Director
NOR H CAROLINA
Envlrohmental Qualfty
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
I. Please enter the CoC number for which the change is requested.
Certificate of Coverage
C,G
5
5
0
3
II. Please provide the following for the requested change (revised CaC).
a. Request for change is a result of: ® Change in ownership of the residence/property
❑ Name change of the facility or owner
If other please explain:
b. CoC will be issued to (person's name
or company name, if applicable):
c. Owner: person legally responsible for
CoC:
d. Facility name (if applicable):
e. Facility address:
f. Facility contact person:
[if different from Owner]
gAoJAvtov l ei o In Mo
First t Las
l
\\L . STitASKNO0 01610,
Permit Holder Mailing Address
b uV-titr M 2.11v2.-
City State Zip
(°11�1) (42q%-1603P) C. tivtitlaA1.1 A
Phone E-mail Address \J P0, (,, 1
Address
City
State Zip
First
MI Last
Phone E-mail Address
III. Contact person (if different from the person legally responsible for the CoC)
First
MI Last
Title
Mailing Address
City State Zip
(
Phone E-mail Address
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1617 Mail Service Center E Raleigh, North Carolina 27699-1b17
919707.9000

NCC-- G000 OWNERSHIP CHANGE FORM
Page 2 of 2
IV Will this permitted facility continue to discharge the same vc':me and type of wastewater as
prior to this ownership or name change?
Yes
❑ No (please explain)
V.
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
'C This completed application is required for both facility -name change and/or facility ownership
change requests.
Legal documentation of the transfer of ownership (such as , property deed, relevant pages of a
contract, or a bill of sale) is required for an ownership change request.
.3iYh� -
The certifications below must be completed and signed by the new applicant in the case of an ownership
change request.
APPLICANT 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
return-, as incomplete.
1\171\7/02.1
ignature - Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Mr. Charles H. Weaver
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
[e-mail]

Book9151 - Page 594 Page 1 of 3
For Registration Sharon A, Davis
Register of Deeds
Durham County, NC
Electronically Recorded
2020 Nov 30 02:47 PM
Book: 9151 Page: 594
NC Rev Stamp: $ 530.00 Fee: $ 26.00
Instrument Number: 2020052615
DEED
Excise Tax: $530.00 PARCEL ID: 187532
Mail after recording to: GRANTEE
This instrument prepared by: DUANE R. HALL 11, a licensed North Carolina attorney.
Delinquent taxes, if any, to be paid by the closing attorney to the county tax collector
upon distribution of closing proceeds
NORTH CAROLINA GENERAL WARRANTY DEED
This Deed made this the 19TH day of NOVEMBER, MO, by and between GRANTOR:
Peter C. Jorgensen, widower, whose mailing address is 41 BALSAM VIEW RD
FRANKLIN, NC 28734 (herein referred to collectively as Grantor) and GRANTEE:
Shannon Morgan, unmarried, whose mailing address is 114 Jasmine Place. Durham,
NC 27712 (herein referred to collectively as Grantee).
WITNESSETH, For valuable consideration from Grantee to Grantor, the receipt and
sufficiency of which is hereby acknowledged, Grantor hereby gives, grants, bargains, sells and
conveys unto Grantee in fee simple, subject to the Exceptions and Reservations hereinafter
provided, if any, the following described property located in the City of Durham, County of
Durham, State of North Carolina, more particularly described as follows:
submitted electronically by "Law offices of Duane R. Hall II, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Durham County Register of Deeds.

Book9151 - Page 595 Page 2 of 3
Lying on Jasmine Place and BEING all of Lot 13 in Block C of
NORTH PARK DEVELOPMENT, Section 2-3. as per plat and survey
thereof on file in the Office of the Register of Deeds of
Durham County in Plat Book 67 at page 3, to which reference
is hereby made for a more particular description.
This conveyance is made subject to Restrictive Covenants
recorded in Deed Book 371 at page SO.
Said property having been previously conveyed to Grantor by instrument(s) recorded in
Book 1257, Page 240, DURHAM COUNTY REGISTRY.
All or a portion of the property herein conveyed does include the primary residence of a
Grantor
PROPERTY STREET ADDRESS: 114 Jasmine Place, Durham, NC 27712
TO HAVE AND TO HOLD unto Grantee, together with all privileges and appurtenances
thereunto belonging, in fee simple, subject to the Exceptions and Reservations
hereinafter and hereinabove provided, if any.
And Grantor hereby warrants that Grantor is seized of the premises in fee and has the
right to convey same in fee simple, that title is marketable and is free and clear of
encumbrances other than as set forth herein, and that Grantor will forever warrant and
defend the title against the lawful claims of all persons or entities whomsoever.
This conveyance is made subject to the following Exceptions and Reservations:
1) Ad valorem taxes for the current year, 2) Easements and rights of way of record,
if any; and 3) Restrictions of record, together with amendments, if any.
All references to Grantor and Grantee as used herein shall include the parties as well as
their heirs, successors and assigns, and shall include the singular, plural, masculine,
feminine or neuter as required by context.

Book9151 - Page 596 Page 3 of 3
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year
first above written.
By: (Seal)
eetensen
STATE OF kl %Q-'- -M"'
COUNTY OF �JU‹i�ra..
I ul�t1 C 5 a Notary Public of the County and State aforesaid,
certify that the following person(s) personally appeared before me this day, each acknowledging
to me that he or she signed the foregoing document:
Peter C. Jorgensen
Date: NOVEMBER . 2020
Notary Pu
My Commission Expires:-7-?Oc2
SEAL
JULIE H. SOLES
Notary Public
North Carolina
Durham County