NCG551333_Owner (Name Change)_20211228

ROY COOPER
Governor
tt MICHAEL S. REGAN
r `�'� �`tr4 Secretary
!r • RECEIVED S. DANIEL SMITH
Director
..,a,,,s• I L 8 2021
NORTH CAROLINA
Environmental Quality NCDEQ/DWR/NPDES
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
1. Please enter the CoC number for which the change is requested.
Certificate of Coverage
5 A 3 3 3
II. Please provide the following for the requested change(revised CoC).
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): Qco cpA—k ie S 4 U I
c. Owner: person legally responsible for
CoC:
First MI Last
Title
Permit Holder Mailing Address
City State Zip
c )
Phone E-mail Address
d. Facility name(if applicable):
e. Facility address:
Address
City State Zip
f. Facility contact person:
[if different from Owner] First MI Last
c )
Phone E-mail Address
III. Contact person (if different from the person legally responsible for the CoC)
Ma,u4.Ii i.) , 0 (1 c1.v1 a
First MI Last
Title C., 1DifjA141'M
(o0 - e.04a,nf -
Mailing Address
City State Zip
( l ) o l—01{b 9 i rope,ir e.5v e9rna I.corn
Phone E-mail Address
Revised 12/2018

NCG550000 OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Will this permitted facility continue to discharge the same volume 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:
El This completed application is required for both facility-name change and/or facility ownership
change requests.
RI Legal documentation of the transfer of ownership(such as a property deed,relevant pages of a
contract,or a bill of sale) is required for an ownership change request.
The certifications below must be completed and signed by the new applicant in the case of an ownership
change request.
APPLICANT CERTIFICATION
I,RAvi,(1 ttest 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 THE COMPLETE APPLICATION PACKAGE TO:
Mr. Charles H. Weaver
NC DEQ/DWR/NPDES
1617 Mail Service Center
Raleigh,NC 27699-1617
Revised 4/2020

Book9557 - Page 823 Page 1 of 3
For Regtstrabon Sharon A Davis
Register of Deeds
Durham County NC
E onIcalty Recorded
2021 Dec 13 11:52 AM
Book: 9557 Page:823
NC Reti „amp S 35000 Fee S 2600
Instrument Number 2021053255
DEED
GENERAL WARRANTY DEED
This instrument prepared by Michael d Daumen, a licensed North Carolina attorney.
Delinquent taxes,if any,to be paid by the closing attorney to the county tax collector upon
disbursement of closing proceeds. No advice given regarding tax consequences of this deed.
Return To Michael J Daumen,9017 Miranda Drive,Raleigh NC 27817
Brief Description for Index: Lot 56 Rosebriar proeprty
Stamps: $350.00 ID No.: 177403
THIS DEED, made this A th day of >1.-e ev, , 2021, by and between
Donna Page f/k/a Donna P Wright & spouse, Robert Earl Page,
hereinafter referred to as Grantor(s),
whose address is 1k o&& 4 n6it rAftnue hu( am W . 27703 ; and
Properties4U, LLC, hereinafter referred to as Grantee(s),
whose address is 602 Pleasant Drive in Durham, NC 27703;
WITNESSETH.that the Grantor(s), for a valuable consideration paid by the Grantee(.$),
the receipt of which is hereby acknowledged, do grant, bargain. eels and convey unto
the Grantee(s) in fee simple all that certain tract or parcel of land situate, lying and
being in the City of Durham, County of Durham and State of North Carolina, and
more particularly described as follows:
Submitted electronically by 'Michael J. Dawn, Attorney at tar'
in compliance with North Csro'1na statutes mover-nine recordable &dents
and the terms of the *atwitter Agreement with the Durham Coemty aa>iister of Deeds.

Book9557 - Page 824 Page 2 of 3
BEGINNING at a stake on the north side of Rosewood Circle,said stake
being the southwest corner of Lot 57,and running thence along and with
the north side of said Rosewood Circle.
North 86° 32' West 51.27 feet to a stake; thence continuing with the
North side of Rosewood Circle in a general westerly direction along a
curve having a radius of 550.85 feet, a distance of 48,73 feet to a stake,
the southeast corner of Lot 55 of said plat; thence
North 0° 15' 30" West. 199.63 feet to a stake; thence
South 86° 30'20" East 112 to a stake; thence
South 3° 12' 20" West 197 feet to a stake, the point and place of
BEGINNING, and being Lot 56 of the Rosebriar property of C V Brown
and wife as per plat and survey thereof now on file in the Office of the
Register of Deeds of Durham County in Plat Book 52 at Page 16, to
which plat reference is hereby made for a more particular description of
same.
Property address: 3034 Rosewood Drive, Durham NC.
The property described above was acquired by Grantor(s) by instrument
recorded in Book 424, Page 841, Durham County Registry.
To HAVE AND To HOLD this tract or parcel of land and all privileges and
appurtenances thereunto belonging to the Grantee(s)in fee simple forever.
And the Grantor(s)covenant with the Grantee(s),that Grantor(s)are seized of
the premises in fee simple,have the right to convey the same in fee simple,that title is
marketable and free and clear of all encumbrances,and that Grantor(s)will warrant
and defend the title against the lawful claims of all persons whomsoever except for the
exceptions hereinafter stated:
Easements and Restrictions of record;
Ad valorem taxes for 2021 and subsequent years, not yet due &payable.
If initialed, the property includes the primary residence of at least one of the
Grantor(s) (see NCGS S1O5.317.2).
The designations Grantor(s) and Grantee(A) as used herein shall include the
parties hereto, their heirs, succeseears, assigns and legal smiler personal
representatives,

Book9557 - Page 825 Page 3 of 3
IN WITNESS WHEREOF, the Grantor(s)have set their hand or seal the day and year first
above written.
(SEAL) EAL)
DONNA PAGE OB JRT L PAGE G S
Ella DONNA P WRIGHT
STATE OF IJQ(ZT il. C4Ro t,t^/A
COUNTY OF Wa K.8'
I, the undersigned, a Notary Public of the county and state aforesaid, certify
that Donna Page fi'k/a Donna P Wright & Robert Earl Page, Grantor(s), personally
appeared before me this day and acknowledged the due and voluntary execution of the
foregoing instrument. I further state that I have personal knowledge of the identity of
the Grantor(s)or satisfactory evidence of the identity of the Grantor(s)in the form of
WITNESS my hand and notarial stamp or seal this the _2_th day of
Nb.eeec r^her , 20 2.l
MICHAlwk J. DAUMEN
r csTommi4TF
N� TA C pY�I
uy3NA P is
2{SFA
Notary Public
My commission expires: