WQCSD0694_Change of Ownership_20220107

State of North Carolina
Department of Environmental Quality
DWDivision of Water Resources
,,R SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permtttee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
❑ Submit an original completed and appropriately executed application (PNOCF 01-16).
❑ The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0I06(b).
B. Existing Permit (All Applications):
❑ Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
❑ Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/PropgM Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Package Submitted in Duplicate
❑ Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ - DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

DW
,wR
Division of Water Resources
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: RUTHERFORD COUNTY
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
2. Signature authority's name: STEVE GARRISON per 15A NCAC 02T .0106(b)
3. Signature authority's title: COUNTY MANAGER
4. Permittee's mailing address: 289 N. MAIN STREET
City: RUTHERFORDTON State: NC Zip: 28139-
5. Permittee's contact information: Phone number: 8( 28) 287-6060 Fax Number (_)
Email Address: steve.panisongrutherfordcountync.gov
II. APPLICANT INFORMATION:
1. Applicant's name: CHIMNEY ROCK VILLAGE
2. Signature authority's name: PETER O'LEARY per 15A NCAC 02T .0106(b)
3. Signature authority's title: MAYOR
4. Applicant's mailing address: PO Box 300
City: CHIMNEY ROCK State: NC Zip: 28720-
5. Applicant's contact information: Phone number: 8(� 545-1243 Fax Number (_) _-
Email Address: bubbaolearysnbellsouth.net
6. Representative's name: Stephen Duncan
7. Representative's title: Village Administrator
8. Representative's contact information Phone number: [phone] Fax Number (_) _-
Email Address: [e-mail]
III. PERMIT INFORMATION:
1. Existing permit number: WQ0016943 and most recent issuance date: October 6, 2020
2. Reason for the permit application: Change of Ownership If other, attach detailed explanation
3. Has the facility been constructed? ® Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ® Yes or ❑ No
FORM: PNOCF 01-16 Pagel of 2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, Steve Garrison, Rutherford Coun Manager attest that this application
(Signature Authority's name & title from Application Item I.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certificat' in any a lication package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as c i enalties% to $25,000 per jolation. / l
Signature: Date: !/>
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Peter O'Leary, Mayor Chimney Rock Village attest that this application
(Signature Authority's name & title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated.
I also understand that if all required parts of this application package are not completed and that if all required supporting information
and attachments are not included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well 'vil penaItie up to $2
5.?F per violation.
Signature: Date:
FORM: PNOCF 01-16 Page 2 of 2

State of North Carolina
Department of Environmental Quality
D-W,R Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
Division of Water Resources INSTRUCTIONS FOR FORM: PNOCF 01-16
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permtttee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting's website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
❑ Submit an original completed and appropriately executed application (PNOCF 01-16).
❑ The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106 c , an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications):
❑ Submit a copy of the most recently issued permit and certification.
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities:
❑ Legal documentation of ownership (i.e., G1S, deed, article of incorporation, or contract), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately -Owned Public Utility):
❑ Per 15A NCAC 02T .01 15(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV).
F. Package Submitted in Duplicate
❑ Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ - DWR
Water Quality Permitting Section
PERCS Unit
By U.S. Postal Service: By Courier/Special Delivery:
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925
RALEIGH, NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

DW
,R
Division of Water Resources
1. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: RUTHERFORD COUNTY
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
INSTRUCTIONS FOR FORM: PNOCF 01-16
2. Signature authority's name: STEVE GARRISON per 15A NCAC 02T .0106(b)
3. Signature authority's title: COUNTY MANAGER
4. Permittee's mailing address: 289 N. MAIN STREET
City: RUTHERFORDTON State: NC Zip: 28139-
5. Permittee's contact information: Phone number: ( 8) 287-6060 Fax Number
Email Address: Steve. arrison@a,rutherfordcountync.gov
II. APPLICANT INFORMATION:
1. Applicant's name: CHIMNEY ROCK VILLAGE
2. Signature authority's name: PETER O'LEARY per 15A NCAC 02T .0106(b)
3. Signature authority's title: MAYOR
4. Applicant's mailing address: PO Box 300
City: CHIMNEY ROCK State: NC Zip: 28720-
5. Applicant's contact information: Phone number: [phone] Fax Number (� _-
Email Address: bubbaolearvskbellsouth.net
6. Representative's name: Stephen Duncan
7. Representative's title: Village Administrator
8. Representative's contact information Phone number: [phone] Fax Number
Email Address: tevieridesp_aol.com
III. PERMIT INFORMATION:
1. Existing permit number: WOCSD0694 and most recent issuance date: October 6, 2020
2. Reason for the permit application: Change of Ownership If other, attach detailed explanation
3. Has the facility been constructed? ® Yes or ❑ No
4. Has the facility been certified per 15A NCAC 02T .0116? ® Yes or ❑ No
FORM: PNOCF 01-16 Page 1 of 2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
I, Steve Garrison, Rutherford County Manager attest that this application
(Signature Authority's name & title from Application Item I.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me as incomplete.
NOTE — In accordance with General Statut 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification ' any applica ' n package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil lties up to 25,000 per violation. / L
Signature: ` Date:
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Peter O'Learv, Mayor Chimney Rock Village attest that this application
(Signature Authority's name & title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated.
I also understand that if all required parts of this application package are not completed and that if all required supporting information
and attachments are not included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any ap lication package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as w . pen ties up to $ 0 per violation. /
Signature: Date:
FORM: PNOCF 01-16 Page 2 of 2

Doc ID: 006780500005 Type: CRP
Recorded: 01/07/2022 at 12:38:29 PM
Fee Amt: $26.00 Paqe 1 of 5
Rutherford County, NC
Rachel Thomas Reqister of Deeds
BK2055 PG4633-4637
STATE OF NORTH CAROLINA
COUNTY OF RUTHERFORD
ASSIGNMENT AND INTERLOCAL AGREEMENT
THIS ASSIGNMENT AND INTERLOCAL AGREEMENT, made and entered into this
the 4th day of January, 2022, by and between COUNTY OF RUTHERFORD, A North Carolina
Body Politic, hereinafter referred to as the "County", and CHIMNEY ROCK VILLAGE, a North
Carolina Municipal Corporation, hereinafter referred to as the "Village";
WITNESSETH:
WHEREAS, the County is the owner of a gravity sewer main which provides sewer
service to portions of the Village and areas to the west of the Village along US 64/74 toward and
to the general location of the Esmeralda Inn (the "Sewer Main'). The Sewer Main is more than
50-years old and is in a good and acceptable state of repair and serves the area without significant
problems, and
WHEREAS, the County entered into an agreement with the Town of Lake Lure dated May
5, 1970 which outlines criteria for the acceptance and treatment of sewer from the Sewer Main
serving the Village area by the Town of Lake Lure and permits a flow of 27,500 gallons per day
(GPD) to the Lake Lure sewer system; and
WHEREAS, the County periodically expends funds to address and correct problems with
the Sewer Main and the County does not charge and collect user fees for those customers served
by the Sewer Main and requires review and approval of connections to the Sewer Main upon
application from new users; and
WHEREAS, the County desires to transfer ownership of the Chimney Rock Village Sewer
Main to the Village and to transfer to the Village the responsibility for the future operation and
maintenance of the Sewer Main; and
WHEREAS, the Village recognizes the importance of providing sanitary sewer service for
the area served by the Village including areas outside the corporate, and that this service helps to
protect the health of the citizens of Chimney Rock Village and protects the natural environment,
and therefore the Village desires to accept the transfer of ownership of the Sewer Main into the
assets of the Village and to incorporate those assets into the Villages utility system which includes
the potable water supply and distribution system, and the Village will assume the responsibility

for the future operation and maintenance of the Sewer Main subject to the terms and conditions
contained herein, and
WHEREAS, the County agrees to make this transfer of ownership at no cost to the Village,
and the transfer includes all components of the Sewer Main including any documented or
prescriptive easements and property rights associated with the Sewer System Main, and any
permits issued for the Sewer Main from the North Carolina Department of Environmental
Quality, North Carolina Department of Transportation or other regulatory agencies; and
WHEREAS Chimney Rock Village agrees to accept this transfer of Ownership and the
assets of the Sewer Main at no cost and Chimney Rock Village hereby agrees to the transfer of the
Sewer Main including all components of the Sewer Main including any documented or
prescriptive easements and property rights associated with the Sewer Main, and any permits
issued for the Sewer Main from the North Carolina Department of Environmental Quality, North
Carolina Department of Transportation or other regulatory agencies; and
WHEREAS, Part 1 of Article 20 of Chapter §160A of the North Carolina General Statutes
authorizes the County and the Village to enter into interlocal agreements in order to execute any
undertaking on behalf of one another
NOW, THEREFORE, in consideration of the mutual covenants set forth herein the parties
do agree as follows:
ASSIGNMENT AND DEDICATION. That the County hereby assigns, gives, grants and
conveys to the Village all County's interest in and to the gravity Sewer Main which
provides sewer service to portions of the Village and areas to the west of the Village along
US 64/74 toward and to the general location of the Esmeralda Inn, same as being
described herein as the "Sewer Main". This assignment, gift, grant and conveyance
specifically includes the assignment of all of the County's interest in any rights of way or
easements, permits issued for the Sewer Main from the North Carolina Department of
Environmental Quality, North Carolina Department of Transportation or other regulatory
agencies, and expected grant funds associated with the conveyed Sewer Main in existence
at the time of the recording of this document. County makes no warranty, express or
implied, as to the title of the property hereby conveyed.
2. MAINTENANCE PROVISION. The Village agrees to accept the conveyed Sewer Main in
"as is" condition. The County expressly makes no warranty as to the condition of the
Sewer Main conveyed hereby, nor any part thereof. As part of the consideration of this
agreement, the County agrees to pay fifty percent (50%) of any necessary repair work to
said Sewer Main which exceeds one -thousand dollars ($1,000.00) for a period of five (5)
years following the execution of this agreement arising as a result of ordinary failure or
casualty as determined by the Village's Engineer subject to the County's right to confirm.
In the event the Village's Engineer makes such a determination, County shall have the
right to retain a professional engineer to confirm the determination by the Village's
Engineer. The intent of this agreement is for the County to assist the Village in repairing
the Sewer Main to a reasonable level of service in the event of any failure of the Sewer
Main itself, whether as a result of casualty, ordinary wear and tear, or otherwise, not to
assist the Village in improvements of the Sewer Main beyond its present capacity, nor to
assist in ordinary maintenance. The Village acknowledges that any maintenance,
replacement or repair of the Sewer Main as constructed after said five-year period shall

be the sole responsibility of the Village. In addition, the Village acknowledges that the
County shall have no further liability, for maintenance or otherwise, for the Sewer Main
or any part thereof conveyed pursuant to this Agreement from and after said five-year
period. The repair obligation as stated herein for the five-year period shall be only for
such repairs and maintenance necessary to maintain a reasonable level of service as
determined by the Village's Engineer, subject to the County's right to seek confirmation
through retaining its own engineer as set forth hereinabove, and shall not imply any
obligation by the County to pay for improvements or replacement of the Sewer Main or
any part of the sewer system of which the Sewer Main is apart other than the Sewer Main
itself unless required to maintain reasonable level of service of the Sewer Main.
3. The Village and County shall each use its best efforts in a timely, but fiscally prudent,
manner to transfer or obtain all permits and approvals, as relevant, required by this
agreement and to comply with all laws and regulations.
4. The parties hereto acknowledge that environmental and other applicable laws pertaining
to the acceptance, treatment, and discharge of sewage are ever changing and becoming
more restrictive. The parties, therefore, agree to use their best efforts to fairly and
equitably modify, amend, or change the terms and conditions of this agreement from time
to time as applicable laws or requirements change, and unforeseen circumstances occur,
in order to perpetuate this agreement within the term herein set out and to maintain
appropriate fiscal responsibility and good environmental practices.
5. In the event that any notice needs to be sent to either party hereto, it shall be sent to:
Notices to County:
Notices to Village:
County of Rutherford
Attn: County Manager
289 N. Main St.
Rutherfordton, NC 28139
Chimney Rock Village
Attn: Mayor
PO Box 300
Chimney Rock, NC 28720
6. Nothing set forth herein is intended nor shall be construed as a waiver of any immunity
available to the County or the Village, their governing boards, officers, employees, agents
or anyone else having immunity due to their relationship with the County or the Village.
7. This Assignment and Interlocal Agreement contains the entire agreement and
understanding between each of the parties hereto and there are no verbal or other written
terms of any kind which constitute a part of this Interlocal Agreement.
8. Each of the parties hereto confirms that the person executing this Interlocal Agreement
on its behalf has been duly authorized by its official governing body to execute it on behalf
of such party and that such authority is reflected in the official minutes of the proceedings
of each such party.

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CP
9. The terms of this Agreement may only be modified by a written mutual agreement signed
by the parties and attached hereto.
10. No waiver of any default by any party hereto of any of the terms, covenants or conditions
hereof to be performed, kept and observed shall be construed to be a waiver of any
subsequent default.
IN WITNESS WHEREOF, the parties have hereunto caused this instrument to be executed
by their respective appropriate officers and caused their respective seals to be hereunto affixed
the day and year first above written.
THE COUNTY OF RUTHERFORD,
A North Carolina Body Politic
B
:' •• �¢ t n .King
Chairman County
a� -
s�'•. * *, • A EST:
•CA 9t 6 -
Hazel S. Haynes, Clerk
CHIMNEY ROCK VILLAGE
A Municip rporation
By: - --
Pe 'Lea
Mayor
ATTEST:
r
tephen Duncan, Clerk

STATE OF NORTH CAROLINA
COUNTY OF RUTHERFORD
a Notary Public of the County and Sate
aforesaid, certify that Br*n A. King personally appeared before me this day and acknowledged
that he is the Chairman of the County Commissioners of the County of Rutherford, a body
politic, and that by authority duly given and as the act of the same, the foregoing instrument
was signed in its name by its Chairman, sealed with its corporate seal and attested by its Clerk,
Hazel S. Haynes.
Witness my hand and official stamp or seal, this day of
Notary Public � S7Cp issr° %
O�
C3' •
My Commission Expires: 3�::t %�JOTg9� m =
lox
STATE OF NORTH CAROLINA03 •''C����
COUNTY OF RUTHERFORD �OR
D CO,, ���
I, i in 6az L T, ► a Notary Public of the County and Sate
aforesaid, certify that Pete O'Leary personglly appeared before me this day and acknowledged
that he is the Mayor of Chimney Rock Village, a municipality, and that by authority duly given
and as the act of the same, the foregoing instrument was signed in its name by its Mayor, sealed
with its corporate seal and attested by its Town Clerk, Stephen Duncan.
Witness my hand and official stamp or seal, this day of 2022.
Notary Iyublic
,%
My Commission Expires:
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FORD G�
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