NCG020762_Ownership Change_20220304

LaserFiche
RECEIVED/NCDEO/DWR
MAR - 4 2022
GROUP
To Whom it may concern,
WOROS
REGIONAL OFFICE
Enclosed in this packet you will find a completed Name/Ownership Change form signed by NJR Group
Inc. President Nathan Russell for permit number NCG020762 (Riley Street Borrow Pit) previously
operated by JT Russell and Sons, Inc. In addition to the change form, I have included a copy of the new
deed showing NJR Group Inc. has now purchased the property containing the Riley Street Borrow Pit.
Ben Speight✓��
A-
EHS Manager
NJR Group Inc.
Cell- 704-985-5285
Email- [e-mail]
Seacoast Medical
w .sseeat—coost�tmmeedidicca/1A.=m
10913 Olive street f Omaha. NE 68128
1ou ME 1-800-732-2115
Item N Z13 F": [phone] A51 A 38670

Water Resources
ENVIRONMENTAL OUALITY
ROY COOPER
Gnremor
MICHAEL S. REGAN
Secrelnrp
LINDA CULPEPPER
/rshrim
Ulrechrr
RECEIVED/NCDEO/DWR
PERMIT NAME/OWNERSHIP CHANGE FORM MAR -4 2022
CURRENT PERMIT INFORMATION: WORDS
MOORESVILLE REGIONAL OFFICE
Permit Number: NC00 / / / / or NCG 0 / Z/O / 7/ b /2
1. Facility Name: KJe,v Stree-+ borrow P +-
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
a. Change in ownership of property/company
b. Name change only
c. Other (please explain):
2. New owner's name (name to be put on permit):
/JTtZ Gr�j 1,n�..
3. New owner's or signing official's name and title: / cAm R�Sseal
(Person legally responsible for permit)
Pres-,aw--
(Title)
4. Mailing address: PO BoX 92V City: f>`Iherhav/e
State: N(- Zip Code: 7_6;m2 Phone:( 900 ) 501 - 8/oZ
E-mail address: >1f�SSe11C�rCor� nG,Go✓it
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)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https:Hdeq. ne.gov/abouVdiv isions/water-resources/water-resources-pertnits/wastewater-branch/npdes-wastewater-permits

0
NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
I, , 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.
Signature:
Date:
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 1112017

BOOK 1772 PAGE 660 4 442574
}
Faed 01/20/2022 03:53.42 PM
Suzwine W. Lowder. Rehr of Deeds
Scanty County, NC
.nh� 1kTA••►
REAL ESTATE EXCISE TAX: $1,000.00
Parcel No.: 654901360344
Return to: NJR Group, Inc.
1017 Belvedere Drive
This Instrument is Prepared By John W. Webster, A
Albemarle, NC 28001
Licensed N.C. Attorney. Delinquent Taxes, If Any, To
Be Paid By The Closing Attorney To County Tax
Prepared by: John W. Webster
Collector Upon Disbursement of Closing Proceeds.
Attorney at Law
Albemarle, NC 28001
Stamps: $1,000.00
Brief description for the index: Vacant Riley Street (Lots 11/13 & 16) Albemarle, NC 28001
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this b day of December, 2021, by and
between:
GRANTOR
GRANTEE
TRIPLE R PROPERTIES & RENTALS, INC.
NJR Group, Inc.
1721 US 52 HWY N
1017 Belvedere Drive
Albemarle, NC 28001
Albemarle, NC 28001
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, hereby
acknowledged, has and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all
that certain lot or parcel of land situated in bemarle Township, Staniv County, North Carolina, and more
particularly described as follows:
SEE EXHIBIT A OR LEGAL DESCRIPTION ATTACHED HERETO AND INCORPORATED HEREIN, AS WELL AS ANY AND
ALL OTHER EXHIBITS, ADDENDUMS, OR ATTACHMENTS REFERENCE TO ALL OF WHICH BEING HEREBY MADE.

BK 1772 PG 661 DOC# 442574
The property hereinabove described was acquired by Grantor by instrument recorded in Book 266, Page 625, Staniv
County Registry.
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 dear of all encumbrances, and that Grantor will
warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions
hereinafter stated. Title to the property hereinabove described is subject to the following exceptions:
This conveyance Is made subject to all restrictive covenants, set -backs, easements, and restrictions of record affecting
the title to sold real estate and all easements or rights -of -way visible upon the property, as well as Grantee's pro-
rated share of the current year's ad valorem taxes, if any.
IN WITNESS WHEREOF, The Grantor has hereunto set his hand and seal, or if corporate, has caused this instrument
to be signed in its corporate name by its duly authorized officers and it seal to be hereunto affixed by authority of it
Board of Directors, the day and year first above written.
TRIPLE R PROPERTIES & RENTALS, INC.
(Entity Name)
BY: `71V'.Ak
Angela R. Blalock, President
By: Z' 1A I lfwlil
Vivian R. Turbeville, / & 4,
By.
Robert Russell. SCare

BK 1772 PG 662 DOC# 442574
State of North Carolina, County of Stanly
�FR/c'''.
��,•�y ..••/r '�.,� I, the undersigned Notary
�.�`��`; •. Public aforesaid, certify that ANGELA R. BLALOCK, President of Triple R Properties and
01 AR j� `� tentals, Inc., personally appeared before me this day and acknowledged that she is
jested with full authority to bind said Company by her signature hereon, and further
SEAL -STAID Scknowledged the due execution of the foregoing Instrument for the purposes therein
AUg1.
� 'ZiSexpressed.
�. [Y CO • Witness m hand and Notarial stamp or seal this 1� day of December, 2021.
''�ffuffru�uN�+��` Y P , Y
My Commission Expires: _ G-�'a�—ajj�t� .
Notary Public
State of North Carolina, County of Stanly
I, &04 P1. Gil the undersigned Notary
.+�F�R f�''''••,,� Public aforesaid, certify that VIVIAN R. TURBEVILLE, Ulrl ftd; zoo of Triple R
y ,,••-'••�',� 40,$ Properties and Rentals, Inc.. personally appeared before me this day and acknowledged
�,• •� 6 that she Is vested with full authority to bind said Company by her signature hereon, and
C�E�1�.-S7dMP; = further acknowledged the due execution of the foregoing instrument for the purposes
' E therein expressed.
5
A vx • �:
00, S •. ,•,�•.� Witness my hand and Notarial stamp or seal, this day of December, 2021.
q O�
My Commission Expires: "0�3-2LA,
Notary Public
State of North Carolina, County of Stanly
FRI�
H . tr the undersigned Notary
Ic'%
•'---•.,�'''�,, Public aforesaid, certify that ROBERT RUSSELL, ^ of Triple R
O.� AR `.` is Properties and Rentals, Inc.. personally appeared before me this day and acknowledged
that she is vested with full authority to bind said Company by her signature hereon, and
s ; SEAL STAIAP = further acknowledged the due execution of the foregoing instrument for the purposes
JpQ therein expressed.
*40;�� Y CO J►+`���`��, Witness my hand and Notarial stamp or seal, this 0 day of u , 81 L.
'fffff/lillU++ �.
My Commission Expires: vj j��� 3 C/k-
Notary Public

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