NCG551153_Owner (Name Change)_20220317

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NPDES PERMITTING
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NCO() / / / / or NCG55I I/1/j/
1. Facility Name:
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
/a. Change in ownership of property/company
RECENED
b. Name change only MAR 17 2022
c. Other(please explain): NCDEQIDWRINP®ES
•
2.New owner's name(name to be put on permit):
Je565 &crardo etUGzaria-Moncle_Z
3. New owner's or signing official's name and title: v�z��
U-
esus (der-Cl�do Q NIPS 67'
(Perssopon legally responsibler for permit) /� ,� N'��
aLi &OraIr l0 aUQ, U- 1'�,U Ldei
(Title)
4. Mailing address: City: Chapei I r11C
State: i V C Zip Code: 9.1 5 I b Phone: el l 612-2- J16 t U
E-mail address: ) r )s G�►�(��d o rnc(� o cr
cJ
III. FACILITY AND DISCHARGE INFORMATION

1.Will the waste stream for the facility remain the same as under the previous owner? No•
2.Will the treatment system and discharge location remain the same? oyes
No •
"No Responses"
If either or both of these questions are answered"No"then more information will be needed to review the
request. Please attach documentation to describe and explain the changes to the facility activities,waste
stream,treatment process or outfall location. The Division may not be able to process the Permit
Name/Ownership Change request and may require that the new owner file a new permit application.
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DWISION UNLESS
ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE
SUBMITTAL.
REQUIRED ITEMS:
1.This completed application form
2.Legal documentation of the transfer of ownership(such as property dee articles of incorporation,or
sales agreement)
3.Information to document facility,waste stream,treatment system or outfall changes as noted in item III
above(if appropriate)
Applicant's Certification:
3 escis 6 xa ru O UI,Uoa —iu(u"t^(. -t ,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 and attachments are not included,this application package will be returned as
incomplete. I understand that Permit Name/Ownership Change can only take place through action taken
by the Division of Water Resources and that no actions on my part or the part of my company result in the
automatic transfer of permit coverage.
Signature: RW,C Date: d_00/202-
[HE COMPLETED APPLICATION PACKAGE,INCLUDING ALL SUPPORTING
INFORMATION&MATERIALS,SHOULD BE SENT TO [HE FOLLOWING ADDDRESS:
NC DEQ/DWR/NPDES
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
North Carolina Department of Environmental Quality 1 Division of Water Quality
512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617
919.707.9000

BK 1866 PG 0023
FILED ELECTRONICALLY
CHATHAM COUNTY NC
LUNDAY A. RIGGSBEE
REGISTER OF DEEDS
FILED Jun 30, 2016
AT 01:53:53 PM
BOOK 01866
START PAGE 0023
END PAGE 0024
INSTRUMENT # 06202
EXCISE TAX $378.00
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $378.00
Parcel Identifier No. 0002289 Verified by County on the day of , 20_
This instrument was prepared by: BAGWELL HOLT SMITH P.A.
Grantee's address (return to): 140 Loblolly Lane, Chapel Hill, NC 27516
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THIS DEED is made this 30th day of June, 2016, by and between °
LA 1-
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GRANTOR GRANTEE v VI
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LAURA COMLEY, Unmarried JESUS G.QUEZADA-MENDEZ
And, 0
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ERMA STEPPE, UnmarriedCZ 0
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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.
I--N 4-1
WITNESSETH, that the Grantor, for a valuable consideration paid 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 that ;171,v
certain lot or parcel of land situated in the Chatham County, North Carolina and more particularly described as follows: m r
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BEING all of Lot 140 as shown on the Plat of"CHATHAM,Phase 2", prepared by Harold M.Harris,Surveyor,
April, 1973 and recorded at Plat Book 15, Page 6, Chatham County Registry, reference to which is hereby asa
made for a more particular description of same.
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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. a)cU E
Fdv
C•r 1-+
{00054464.DOC}NC Bar Association Form No. 3©1976,Revised©1977,2002 4-1 e)
Printed by Agreement with the NC Bar Association-1981 •E 31'
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BK 1866 PG Q924
And the Grantor covenants with the Grantee,that Grantor is seized of the premises in ee 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, excepting ad valorem taxes for the current year, restrictive covenants of record
affecting the property, utility easements and rights of way of record, of all persons whomsoever.
WITN SS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
(SEAL) Address: /5-34 5/t4'1'1 ( (a&.--c ,,
LAURA COMLEY V. c /.4,,u /(le:,
‘16 1'7 .S.—/A
1v��� '1- (SEAL) Address: IS;r-( 9�A1 1,44 -�
ERMA STEPPE �'1 C,l -P M -e_JL mc.
z---7. /,
(SEAL) Address:
Pursuant to N.C.G.S. §105-317.2, the Seller/Grantor states as follows:
The property conveyed herein includes t/ does not include(initial one)the primary residence of one or more of the
Grantors. Each Grantor's address is provided above.
04 "te--e County, North Carolina
I hereby certify that the following person(s)personally appeared before me this day, each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity
indicated: LAURA COMLEY
Date: 61%o1
IAO6 • , Notary Public
THOMAS R. HOLT Printed Name of Notary P I), -
( fficiaWgilRy PUBLIC My commission expires: (_
ORANGE COUNTY, NC .
County, North Carolina
I hereby certify that the following person(s)personally appeared before me this day,each acknowledging to me
that he or she voluntarily signed the foregoing document for the purpose stated therein and in the capacity
indicated: ERMA STEPPE ,.
ilDate: te 17.'0 )s---2.015,0 _/ �t
rto R!J4 Notary Public
THOMAS R. HOLT Printed Name of Notary Pu.lic
(O icial SAl TARY PUBLIC ORANGE COUNTY, NC My commission expires: °I � M
{00054464.DOC}NC Bar Association Form No. 3 C 1976,Revised©1977,2002
Printed by Agreement with the NC Bar Association-1981