NC0086223_Permit (Modification)_20080118

O�OF W ATF9c
) Michael F.Easley,Governor
rWilliam G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Coleen H.Sullins.Director
Division of Water Quality
January 18, 2008
DEBORAH WHITMIRE
COO PRESIDENT
HEADWATERS OUTFITTERS ADVENTURE VILLAGE
PO BOX 1057
ROSMAN NC 28772
Subject:NPDES Permit Modification-Name&Ownership Change
Adventure Village WWTP
Formerly D&D Catfish Resort
Certificate of Coverage NC0086223
Transylvania County
Dear Ms.Whitmire:
Division personnel have reviewed and approved your request for name/ownership change of the subject
certificate of coverage received on January 10,2008. This permit modification documents the change of ownership of
the above reference facility.
Please find enclosed the revised certificate of coverage. All other terms and conditions contained in the original
certificate remain unchanged and in full effect. This modification is issued under the requirements of North Carolina
General Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions concerning this permit modification,please contact the Point Source Branch at(919)
733-5083,extension 350.
Sincerely,
Laurie Singleton
NCDENR Point Source Branch
cc: Central Files
Asheville Office,Surface Water Protection
Fran McPherson,NCDENR,DWQ,Budget
NPDES Unit File NC0086223
No hCarolina
,Naturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh,NC 27699-1617 Phone[phone] Customer Service
Internet: h2o.enr.state.nc.us 512 N.Salisbury St. Raleigh,NC 27604 FAX [phone] 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper

Permit NC0086223
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Headwaters Outfitters Adventure Village
is hereby authorized to discharge wastewater from a facility located at the
Adventure Village WWTP
129 Israel Road
Brevard
Transylvania County
to receiving waters designated as Peter Weaver Creek in the French Broad River
Basin
in accordance with effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective January 18, 2008.
This permit and authorization to discharge shall expire at midnight on September 30, 2010.
Signed this day January 18, 2008.
oleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

0, WA? Michael F.Easley,Governor
r William G.Ross Jr.,Secretary
r North Carolina Department of Environment and Natural Resources
0 Alan W.Klimek,P.E.Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit ,n (or) Certificate of Coverage
N C 6 , O 5. ,C, 7 Z.. 3 cri t,,200 N C G
II. Permit status prior to status change.
a. Permit issued to(company name): Ooubke Pq Co-A-`=3h,,I) 4- RV Ike SDr`fi
b. Person legally responsible for permit: Oak Owe&1
. J ii !� L_- J ,t First / MI / Last
(- Title
!1 JAN 10 Zoos f'-'" 121 ISrcei iesmd
Permit Holder Mailing Address
, (3r4-v..rei Nc 2g712
...._.LF ,R 11Tr ,iir,� 1 " City State Zip
. - (r ) �b Z Sof Il ( )
Phone Fax
c. Facility name(discharge): 54,,.c a cub o vL
d. Facility address: Sa.r.c as alop et_
Address
5:,.,..e ag ct,64vL
City State Zip
e. Facility contact person: (itvc,r C. NlC eiL rt n ( 824) 69 I -Mil
First / MI / Last Phone
III. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: !✓� Change in ownership of the facility
II Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): I-64Awr,lierc O41 Nees itk elver+v u%llw
c. Person legally responsible for permit: 0 e.10; Pr L k, vv-t: e Q
First / MI / Last
C 0O — Q c es;cier.-1-
Title
P,0 • Li. ibS7
Permit Holder Mailing Address
KoSOlaA "kJ C... 237-72-
City State Zip
( $2.1c)862- )4l\
Phone E-mail Address
d. Facility name(discharge): Ael von tort Vu q, zu LO L)1 lP
e. Facility address: 12.1 I s rvka(
Address
13 rtijaA NC 28-712.
City State Zip
f. Facility contact person: Lira,#-- C. 1t'1c Wynn
First / MI / Last
(cZt ) 61 1 -7I`1 i
Phone E-mail Address
Revised 7/2005

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information: (if different from the person legally responsible for the permit)
Permit contact: Irtvor C ekcIN:nr%
First / MI / Last
Ofe ►r
Title
20 Zo �w•�.e� C-. tetxuA
Mailing Address
der2's.eN V.1 I t wC 2Y7q
City State Zip
($Z$ ) G°11 —711
Phone E-mail Address
V. Will the permitted facility continue to conduct the samedustrial activities conducted prior to
this ownership or name change?
Yes
O No(please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
This completed application is required for both name change and/or ownership change requests.
gLegal documentation of the transfer of ownership(such as relevant pages of a contract deed, or a bill
of sale) is required for an ownership change request. Articles of incorporation are not sufficient for
an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and the new
applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification
is sufficient.
PERMITTEE CERTIFICATION(Permit holder prior to ownership change):
I, Pe.k. 0Wel\ , 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 is not included, this
application package will be returned as incomplete.
O
Signature to
APPLICANT CERTIFICATION: •
I, ,(�pt ii \A-k- n,`, c .1 , attest that this application for a name/ownership
change has been revie.ved 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 is not included, this
application package will be returned as incomplete.
. W� J� - al 0200 '1
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 7/2005

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.
' (SEAL)
AUBREY DALE OWEN
State of North Carolina-County of 1310311011/1 Henderson
• I,the undersigned Notary Public of the State and County aforesaid,certify that AUBREY DALE OWEN(a divorced and
unremarried man)personally appeared before me this day and acknowledged the due execution of the foregoing instrument for the
• purposes therein expressed.
WilpissotaiNlAuutand Notarial stamp or seal this 30th day of October ,2007.
GTA R•r.,• •
. ; = Signature of Notary Public
My t h u : 6-2009 Janice M
. .R Bowers
4/4t.'''!... •'.0 • typed /Notary Public
Prig/ed or td name o
9T/20'd 0602 S88 8Z8 ed 'lltilid QNti A3SWtid EZ:SI L00Z-OE-D3Q

, '; ,1/ JAN 1 0 2008 1 t : ;
STATE OF NORTH CAROLINA,
i
1 r _..DcNP, -urrjFo J/JA�Ji`'._
COUNTY OF TRANSYLVANIA. --
ASSIGNMENT OF OWNERSHIP INTEREST
NOW COMES AUBREY DALE OWEN and says:
i
1. I am the sole owner of the limited liability company
known as DOUBLE D'S RV & CATFISHING RESORT, LLC.
2 . For a good and valuable consideration in hand received,
I have agreed to convey a 514 undivided interest in the LLC to
CONFLUENCE ENTERPRISES, INC.
3 . I hereby represent to CONFLUENCE ENTERPRISES, INC. , that
I am the sole owner of the interest being conveyed, that there
are no liens or encumbrances or clouds on my title, that I have
the right to convey the same free of any claims by any third
parties and that I hereby warrant to CONFLUENCE ENTERPRISES,
INC. , that the interest conveyed shall be free and clear of the
claims of any other person, and that it shall be a fee simple
interest in the limited liability company known as DOUBLE D'S RV
• 6g, CATFISHING RESORT, LLC,
NOW, THEREFORE, I hereby bargain, sell, assign and convey a
514 undivided interest in the limited liability company known as
DOUBLE D' S RV & CATFISHING RESORT, LLC, to CONFLUENCE
ENTERPRISES, INC.
WITNESS MY HAND AND SEAL, this 30th day of October, 2007 .
((A� (SEAL)
UBREY DALE OWEN
9T/S0'd 17602 S88 828 ed 'lltidd GNU A3SWUd 0:ST L002-02-J3Q

•
JAN 1 0 2008
STATE OF NORTH CAROLINA,
COUNTY OF XEMEMOUUMOMM. HENDERSON
I, a Notary Public of said State and County, do 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: AUBREY DALE OWEN.
WITNESS my hand and Notarial Seal, this the lOrh day of
Oc toh*r 2007 .
• 91e)agelidr) . 421111
Signature of Notary Public
• ' iAni r• M MAWAra
, .. • Printed or typed name of Notary Public
My commission expires: 16_2nng
• F:Norma\Pratt\owentoConfluenceAssignmentofownershipInterest(DoubleD•5)
•
9i/90'd P6bz S88 8Ze
rid 'l1tiZ{d QNti A3SWti8 MST L002-0z-D3Q