NCG550992_owner (name change)_20230621

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ELIZABETH S. BISER
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S. DANIEL SMITH
NOWT I -I CAROLINA
Di!Fcfor
Environmental Quality
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
Please enter the CoC number for which the change is requested.
Certificate of Coverage
N I C I G 15 1 5 10 19 1 q I a.
11. Please provide the following for the requested change (revised CoC).
a. Request for change is a result of: Change in ownership of the residence/property
❑ Natne change of the facility or owner
!f other please ei:plain:
b. CoC will be issued to (person's name
or company name, if applicable):
c. Owner: person legally responsible for
CoC:
11EC4d V 5 0 A CJh C z Y R P V 013 Pe dal q
First MI Last
Title
3 N Kc
m RA
Permit Holder Mailing Address
pr•tt'#1�
- --- vA 9115
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City
State
Zip
(5 9) 90
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c eg 19 e,
Phone
E-matl Address
g i�net t r to W,
d. Facility name (if applicable):
i-15 Q Co yY�n
n Itx A00Ld
e. Facility address:
</ S 0 (e
j'1' o n ni )c
Address
pU c hax. N C- a
7 009
City
State
Zip
f. Facility contact person:
if of dy
5 cL
rc h a
[if different from Owner]'First
Ml Last
Phone
E-mail Address
II1. Contact person (if different from the person legally responsible
for the CoC)
YY\
b] aV
First
Ml Last
Title
Mailing Address
City State Zip
Phone F-mail Address
North Carolina Department of Envin,nmenial Quality I Division of Water Resources
517 Not Salishcrry S[ieet 11617 h.lall So tied latter I R: leiyh. , €ut lh Carolin:l Z7090 lGt!

NCG550000 OWNERSHIP CHANGE FORM
Page 2 of 2
IV Will this permitted facility continue to discharge the same volume and type of wastewater as
prior to this ownership or name change?
Yes
❑ No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
V. ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both facility -name change and/or facility ownership
change requests.
❑ Legal documentation of the transfer of ownership (such as a property deed, relevant pages of a
contract, or a bill of sale) is required for an ownership change request.
...................................................................................................................
The certifications below must be completed and signed by the new applicant in the case of an ownership
change request_
ALV
1, a es tt i?mP TION p g
I, , a es i lication for a name::ownershi change has been reviewed and is accurate and
complete to the best of my knowledge. 1 understand that if all required parts of this application are not
completed and that if d supporting information is not included, this application package will be
returned as incom ete.
Signature Date
....................................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Mr. Charles H. Weaver
NC DEQ DWR - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
charles.weaver(fr: ncdenr.gov
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s
Register of Deeds
Sharon A. Davis
purham County, NC
0410412023 0113:40M es: 2
gT; OPR B: 9891 P: 886 Pa9
DEED - DEED
Fee: $26•oo Excls ENT 02023057263
INSTRUM
gpril Carrington
QUIT(:LAIM DEED
Prepared 8}>, Rec•urd and Return ta:
Melissa Rosado, Esq#.*
TI- angle Property Law, PC
1051 Pemberton Hill Road, Suite 102
Apex, NC 27502
(Without Title Gxarninarion or Tax Advict)
STATE OF NORTH CAROLINA
COUNTY OF DURHAM
nEVENUG: $u.00
EXCISE TALC: %00 '
PARCEL IDENTIFIER: 170349,170372,170373
!t
THIS DEED made this 31st _day of March 2023 by and between Better Life Group
Investment, LLC, A North Carolina Limited Liability Company, whose address is 505 Sutter
Gate Ln, Morrisville, NC 27560 as Grantor and Eddy Esthertin Sanchez Tineo and spouse,
Revna Lisbeth Peralta Marte, whose address is 309 Kemper Rd Danville, VA 24541, as
Grantees.
The designation Grantor anrantee as used herein shall include said parties, their heirs,
1ura j c u'in ferninine or neuter as
p , ma_c
successors, and assigns, and shall include singular,
required by context.
«'ITNESSETH, that the Grantors, for a valuable consideration paid by the Grantee, the
receipt of which is hereby acknowledged, have and by these presents do remise, release, convey,
and forever quitctaim unto the Grantee its heirs successors and assigns, all right, title, claim and
interest of the Grantor in and to that certain lot or parcel of land situate in The City of DURHAM
County of DURHAM, State of North Carolina and more particularly described as follows:
submitted electronically by "Triangle Property haw, Pc"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Durham county Register of Deeds.