NCG550289_Owner (Name Change)_20221024

ROY COOPER °!g r' `` g.
Governor TFl o`
ELIZABETH S.BISER may` '5` k,,;'- r .
Secretary -.
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCOO / / / / or NCG55/0/2/g/j
S ."-?J A-E. e A ful-X-LilP.E.' O-iCE
1. Facility Name: g0C.`T-tr4 ithikk COI 2_1-3 MGJA PE CC,,Ag.r��'+.-
II. NEW OWNER/NAME INFORMATION: C `)`°'° (Li)
1. This request for a name change is a result of: 1 ` i .'D
a. Change in ownership of property rry-, 20z�
OCT 2`
b. Name change only
1�!C�+D�1Ec�((�' ` ES
c. Other(please explain): ,'lV1aG�"+
2. New owner's name(name to be put on permit):
ilik-I-A4 1 C V4F%I-1.i) VkiN IDJli,
3. New owner's or signing official's name and title: `I e.-7 EJ E.bWNa c' t410.a>. ou
(Person legally responsible for permit)
0 Ne1•
(Title)
4. Mailing address: 22-3 Mir JOT c"il. t C. c-kwkkity: gi, q = - J
(.10
State: 64 C Zip Code: 1-'"B"3'Z.Ct Phone: (3°3 ) 4 0 4 •- G q iq
E-mail address: ‘r154"a e:.et . 42„.• ‘ncor 60 r. e 5 +4:4 k , c c.o.,
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]
DE ---. North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617
NORTH CAROutvq
o.n.m.atofEmo-ontoonmounntY� eb" 919.707.9000

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
I, 13,ft:X•P acivithlt To,v9,50 g_ , 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: 102 f L a'2_`Z
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, NC 27699-1617
Version 7/2016

BOOK 1572 PAGE 2449 (3)
595210 111111111110 I I 11111
•
Filed
Rockingham County, NC
Benjamin J. Curtis, Register of Deeds
02/07/2020 11:41:53 AM
Fee Amt:$26.00 NC Excise Tax:$140.00
MITZI M. EVANS
NORTH CAROLINA GENERAL WARRANTY DEED
✓Excise Tax: 11-113°() l ecor +ra Vea, g .013
Parcel Identifier No.159124 J r._Verified by County on the�.,day of ,20
By:
Mail/Box to: Seth M. Woodall, Seth M. Woodall.Walker.Melvin&Woodall.LLP.640 Fagg Drive.Eden.NC 27288
, -This instrument was prepared by: Seth M. Woodall_Walker_Melvin&Woodall. I.LP. 640 Fagg Drive,Eden.NC 27288
Brief description for the Index: . 223 Mt Carmel Church Rd Ruffin,NC 27326,
THIS DEED made this 7]Li__day of February ,20_i,by and between
GRANTOR GRANTEE
Melissa Ellington Brian E. Harbour
Jack Ellington 114 Triangle Station Road
3100 Gurreant Springs Road Ruffin,NC 27326
Ruffin,NC 27326
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 ____ . _ _Ku ff in Township, Rockingham County,
North Carolina and more particularly described as follows:
Seed ` -kkac hed
Page 1 01.2
NC Bar Association farm No. 3 0 1976.Revised 52 1977.2002,2013 'this standard form has been approved by:
Printed by Aynement with the NC Aar Association 1981 North Carotin Bar Association—NC Bar Fame No.3
THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT REPRODUCTION
OR ABSTRACT OF THE OFFICIAL RECORD FILED IN THE OFFICE OF THE
REGISTER OF DEEDS OF ROCKINGHAM COUNTY,NORTH CAROLINA,IN
BOOK 1512- ,PAGE ZANY ALTERATION OR ERASURE VOIDS THIS ne?, J J. C�
CERTIFICATE. ,- .. •-'r].
WITNESS MY HAND AND OFFICIAL SEAL,THIS THE /9 DAY OF ;rL• r� "
0CJbbcr 2 02 2
BENJ CURTIS,RE IJR OF DEEDS ' C C COU N rN
e ?i•'1
Vf
=
BY: a-C-t
Deputy/ eeister of Deeds ;OCKiUC •
`Ste v ''• I I111111 y1

BK 1572 PG 2450 DOC# 595210
The property hereinabove described was acquired by Grantor by instrument recorded in Book_ page .
All or a portion of the property herein conveyed__..includes or. ,does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book— page .
TO HAVE AND TO HOLD the aforesaid lot or parcel ofland 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:
A. 2019 Ad Valorem Taxes
B. Any easements or rights-of-way heretofore granted for alleys, roads and public utilities as may affect the subject premises.
C. Zoning and subdivision ordinances, if any.
IN WITNESS WHEREOF,the Grantor has duly executed the foregoing as of the day and year first above written.
Mal.ZYJAC).. lis Ell L`X> ( EAL)
(Entity Name) Print/Type Name: Melissaa Ellin
By:
J
(SEAL)
Print/Type Name&Title: 'nt/Type Name: Jack E neon
By: (SEAL)
Print/Type Name&Title: Print/Type Name:
By: (SEAL)
Print/Type Name&Title: Print/Type Name:
State 4 ' ,? arolina -County or City of Rockingham
Bch;, •, '•ned Notary Public of the County or City of Rockingham and State aforesaid,certify that
• sa Ellin: o-°t`•`); usband,Jack Ellington personally appeared before rite this day and acknowledged the
tfde a ,•F 'alit f• •;-ing�i instrument for the purposes therei expressed Witness myh'nd and Notarial s or seal this 7th day of
0-.itate ot�of • y�.
.. rite on .� y�
. •' /J� p— f 11 ''�l 1-a' S Notary Public
i-1 � a� Notaty unty Notary Primed or Typed Name
tisiumuml
Star\iti tfrGH'�M COJ rs
County or City f
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 .County or City of
I,the undersigned Notary Public of the County or City of and State aforesaid,certify that
personally came before me this day and acknowledged that
—he is the of ,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 day of ,20_ ,
My Commission Expires: Notary Public
(Affix Seal) Notary's Printed or Typed Name
Page 2 of 2 •
NC Bar Association Form No. 3 0 1976,Revised 0 1977,2002.2013 This standard Conn has been approved by:
Printed by Agrorment with the NC Bar Asetcintion 1981 North Carolina Bar Association—NC Bar Faint No,3

BK 1572 PG 2451 DOC# 595210
4
EXHIBIT"A"
223 Mt.Carmel Church Road, Ruffin,NC 27326—Parcel#159124
BEGINNING at an iron stake on the north edge of the paved road leading from Oregon Hill to Harrison's
Cross Road,said stake marking a corner between Joe G. Kennon and Jack Ellington(formerly apart of
the John Ellington lands):thence in a northerly direction with the line between Joe G. Kennon and Jack
Ellington 152 feet; thence a new line in an easterly direction parallel with the said road leading from
Oregon Hill to Harrison's Cross Road, 100 feet to a stake; thence a new line in a southerly direction
parallel with the Kennon-Ellington line, 152 feet to a point in the north edge of said Oregon Hilt-
Harrison's Cross Road:thence with said road in a westerly direction 100 feet to the point of beginning.
containing approximately 15,200 square feet. Being the same property as described in Deed Book 812,
page 921, Rockingham County Registry.For further reference,see Book 675,page 32 and Book 653,
page 507, Rockingham County Registry.(YAM kef 116250)
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