NC0041220_Owner (Name Change)_20220425

Alt
a t R A', NC DEPARTMENT OF ENVIRONMENTAL QUALITY
kl l 4.4aV"" , "i? DIVISION OF WATER RESOURCES
e.,,, > WATER QUALITY PERMITTING SECTION
NORTH CAROLINA NPDES PERMITTING ,,
Environmental Quality
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NC00 4 /_1_j_2_j2 /_0_ or NCG5_-/_f /__/_
1. Facility Name: Oak Hill Charter School
II. NEW OWNER/NAME INFORMATION: RECEIVED
1. This request for a name change is a result of:
I?R 2 2 2022
X a. Change in ownership of property/company
NCDEQ/DWR/NpDES
b. Name change only
c. Other(please explain):
2. New owner's name(name to be put on permit):
Oak Hill Development Corporation
3. New owner's or signing official's name and title: Greg White
(Person legally responsible for permit)
President(year 2022)
(Title)
4. Mailing address: 4603 Oak Hill School Road City: Lenoir,
State: NC Zip Code: 28645 Phone: (828) 754-7104
E-mail address: [e-mail]
III. FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same as under the previous owner? Yes X No 0
2. Will the treatment system and discharge location remain the same? Yes X No 0
"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.
Q rtliem Quality I W Quality
D :r/)) 512No Northh Caro Salinasbury StreetDepartm 1 nt161of7 MailEnviron Service Centerental I Raleigh,NorthDivision Caroofli aterna 27699-1617
NORTH C+1AOUNA
Department at Fmtmmnental 11:21;Mpi' 919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION 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 a property deed,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:
I, Greg White ,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.
r
Signature: � �/I,P��.c,aCaa o`Htac. 20o2a Date: Ora l cy 2.6;1,9,
THE COMPLETED APPLICATION PACKAGE,INCLUDING ALL SUPPORTING INFORMATION&MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ/DWR/NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 07/2021

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This document presented and filed:
08/27/2021 08:13:13 AM
Fee$26.00 Excise Tax:$753.00
IIIII1ffhlIIIIIH 111111
10061893
Caldwell County North Carolina
Wayne L. Rash, Register of Deeds
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $753.00
Parcel Identifier No.07 14 1 9 Verified by County on the day of ,20_
By: f
Mail/Box to: Bruce W.Vanderbloemen,Vanderbloemen&White,PA,P.O.Drawer 1320,Lenoir,North Carolina 28645
This instrument was prepared by: Vanderbloemen&White.PA.P.O.Drawer 1320,Lenoir,North Carolina 28645
Brief description for the Index:
THIS DEED made this 26th day of August ,2021 ,by and between
GRANTOR GRANTEE
Oak Hill Development Corp
Caldwell County Board of Education 4607 Oak Hill School Rd
Lenoir,NC 28645
Enter in appropriate block for each Grantor and Grantee: name,mailing 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 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 certain lot,parcel of land or condominium unit
situated in the City of , Little River Township, Caldwell County,
North Carolina and more particularly described as follows:
See Attached Exhibit"A"incorporated herein by reference as if fully set out herein.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 247 page 216
All or a portion of the property herein conveyed includes or J{ does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book 36 page 324
Page 1 of 2
NC Bar Association Form No. 3©1976,Revised©1977,2002,2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association—1981 North Carolina Bar Association—NC Bar Form No.3
3

BK 2032 PG 012 DOC# 10061893
.A
�r 4.
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 with the Grantee,that 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:
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
Caldwell/ ty Board of Education (SEAL1
i ntity a ) Print/Type Name:
By: IP /, :%r��a�l
Print/Type Name&Title: Darrell Pennell (SEAL)
yp Print/Type Name:
Chairman
By: (SEAL)
Print/Type Name&Title: Print/Type Name:
By: (SEAL).
Print/Type Name&Title: Print/Type Name:
State of ti.l i -County or City of CCA ' '
� I,,,the nunder igned No�Public of the County or City of • ) ► and State aforesaid,certify that
—�-GQ Kx 2 h' "� 0 1111 l 1//Ii, personally appeared before me this day and acknowledged e due
� �TCRF
execution of the foregoing instrument for the purpos, tl$ n exprt ! Witness my hand and Notarial stamp or seal this , a y of
1
My Commission Expires: Z P U B�,\�' U` P :=� jr[ ;Ar, Notary Public
(Affix Seal) *".i P ?\ No . *s Printed or Typed Name
"i`'9T ``
State of -County or City w�/o 1111101���
I,the undersigned Notary Public of the County or City of and State aforesaid,certify that
personally appeared before me this day and acknowledged the due
execution of the foregoing instrument for the purposes therein expressed. Witness my hand and Notarial stamp or seal this day of
,20_
My Commission Expires: Notary Public
(Affix Seal) Notary's Printed or Typed Name
State of North Carolina -County or City of Caldwell
I,the undersigned Notary Public of the County or City of Caldwell and State aforesaid,certify that
Darrell Pennell personally came before me this day and acknowledged that
_he is the Chairman of Caldwell CountyBoanl of Education ,a North Carolina or
corporation/limited liability company/general partnership/limited partnership(strike through the
inapplicable),and that by authority duly given and as the act of such entity,__he signed the foregoing instrument in its name on its
behalf as its act and deed. Witness my hand and Notarial stamp or seal,this 26th day of August ,2021 .
My Commission Expires: Notary Public
(Affix Seal) Notary's Printed or Typed Name
Page 2 of 2
NC Bar Association Form No. 3 O 1976,Revised O 1977,2002,2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association—1981 North Carolina Bar Association—NC Bar Form No.3

BK 2032 PG 013 DOC# 10061893
y `4 .
EXHIBIT "A"
BEING ALL OF THAT 30.455 acres gross as shown on that Plat entitled"Boundary&Location
Survey of the Property of Caldwell County Board of Education", surveyed by Western Carolina
Surveyors, PA, on 1/28/2021 and recorded in Plat Book 36,Page 324, Caldwell County Registry.

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