NCG550679_owner name change_20100611

TrA.
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 11, 2010
MARIT NELSON
100 BRIAR PATCH LANE
CHAPEL HILL NC 27516
Subject NPDES Permit Modification- Name and/or Ownership Change
100 Briar Patch Lane - Marit Nelson — Residence
Formerly — 100 Briar Patch Lane - Bate Crudup — Residence
Certificate of Coverage NCG550679
Chatham County
Dear Ms. Nelson:
Division personnel have reviewed and approved your request for ownership change of the subject certificate of
coverage received on June 10, 2010. This permit modification documents the change of ownership of the above
referenced 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
cc: Central Files
Raleigh Regional Office, Surface Water Protection
NPDES Unit File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] \ Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity ; Affirmative Action Employer
NorthCarolina
Natural!&

05/12/2010 16:37 9197887159
. r
NCDWQRRO
PAGE 02/03
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
North Carolina Department of Environment and Natural Resources
Cotten H. Sullins, Director
Division of Water Quality
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
c
0
A
II. Permit status prior to status change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility name (discharge):
d. Facility address:
e, Facility contact person:
III. Please provide the following for the requ
a. Request for change is a result of:
Xf other please explain:
b, Permit issued to (company name):
c. Person legally responsible for permit:
ll
JUN 10 2010
DENR- IA"i ER QUALITY
POINT SOURCE BRANCH
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
1P
s-
0
l9
First
Crvd uroc
MI T,ast
Title
/00 &Y-. a r pa -Eck L h .
Permit Holder Mailing Address
C .t el e 1 F-/,1( )J C 21- 57
City State Zip
) ( )
Phone Fax
/O ' '.ei-c-Gk Z. h .
Address
CGc .1, Q ((-(r (( it/_ 215—f CF
City State Zip
( )
First / 3VII / Last
ed change (revised permit).
Change in ownership of the facility
Name change of the facility or owner
Phone
Bari A- Ne[se;
First MI Last
Title
/t; 7 ri•r 74-Eck LA.
Permit Holder Mailing Address
C& are( F I( ' AJC- 2757(Q
City State Zip
(R f' ) 21a0-(Z1"1- wl Lci' I". 4044 • Ili(snyl�filotil -CCM
Phone E-mail Address ✓
706 Briar Vs+c14 Gh-
Address
CIA v t-{ ivc 2 4Sl_0_____
City State Zip
N R r: ii kit i6 A
First MI Lest
(gib d -12 fl ivl,Kt. 4r910- viZIsnvl 0944a -re wk
. Phone E-mail Address
Revised 1/2009

05/12/2010 16:37 9197887159 NCDWQRRO PAGE 83/03
PERMIT" NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
TV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: s
V.
VI.
First
Mt Fast
Title
Mailing Address
City State Zip
i )
Phone E-mail Address
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
Xcs
❑ No (please explain)
Required Items: THIS APPLICAfTON WILL BE RETURNED UNPROCESSED IF ITEMS
INCOMPLETE OR MISSING:
This completed application is required for both name change andfor 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.
The certifications below roust 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):
, 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. ((` or J ,if_
d QQC t c)
Signature Date
APPLICANT CERTIFICATION
i, Mid , 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.
Signature Date
PLEASE SEND '>r.'itCC COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section.
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 1/2009

BOOKl509PAGEO900
FILED
CHATHAM COUNTY NC
TREVA B. SEAGROVES
REGISTER OF DEEDS
FILED Apr 27, 2010
AT 12:33:45 pm
BOOK 01509
START PAGE 0900
END PAGE 0901
INSTRUMENT # 03676
;EXCISE TAX $254.00
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $2(4.00
Parcel Identifier No.0061720; Verified By County on the day of , 20
By:
Mail/Box to: Grantee
This instrument was prepared by: Richard Bircher, Attorney at Law
Brief description for the Index:
THIS DEED made April 26, 2010
GRANTOR
BATE TOMS CRUDUP (unmarried)
MAR`TT A. NELSON
100 Briar Patch Lane
Chapel Hill, NC 27516
GRANTEE
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 to them 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 of that certain lot or
parcel of land situated in Chatham County, North Carolina and more particularly described as follows:
BEING all of Lot N. 100, Phase 11 and III of CHATHAM SUBDIVSION, according to the plat and survey thereof recorded in Plat
Eook 15, Page 63, Chatham County Registry, to which plat reference is hereby made for a more particular description of same.
Said pi oper_
CLC pr na y t7S1, i1Cje oGrantors.
Me properly her ei aahir've wee-4 ac,0-nsiet
Dy Ufai73o= b
:.P __3 Book 675, Page 7 i6.
:, =.i showing f.v ...e...rriLed pro reel dell ill Piat £.'`o",n3._ _, -

•
BOOK 13 0 9 PAGE 0 9 01.
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 that the 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: All easements, rights -of -way and restrictive covenants
of record, and Ad Valorem Property Taxes for 2010 and subsequent years.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
(Entity Name)
By:
By:
Title:
By:
Title:
s
a
No hRY
P 11StA G
�f t t t 1t11A��
USE BLACK INK 0
Bate Toms Crudup
State of North Carolina, County of Orange
1, the undersigned Notary Public, hereby certify that Bate Toms Crudup personally
appeared before me on this date and acknowledged the execution of the foregoing
instrument.
This x 2-7day of x , 2010.
(SEAL)
Notary Publi
My Commission Expires: x " 2f
(SEAL)
(SEAL)
(SEAL)
(SEAL)
II; INK ONLY
State of North Carolina, County of Orange
I, the undersigned Notary Public of the County and State aforesaid, certify that the following
person(s) personally appeared before me on this date and acknowledged that he/she executed the
foregoing instrument for the purposes stated therein and in the B capacity indicated:
This
(SEAL)
Notary Public
My Commission Expires: 9_28_2014