NCG551535_Owner (Name Change)_20230703 (2)

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RECEIVED
Jam_
, a ��31
�.02_.,
S. DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
NCDEO/DWR/NPDES
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
I. Please enter the CoC number for which the change is requested.
Certificate of Coverage
N I C I G 1 S 1 5
II. 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
Name change of the facility or owner
If other please explain:
b. CoC will be issued to (person's name
or company name, if applicable):
c. Owner: person legally responsible for
p
CoC:
First MI Last
Title
Permit Holder Mailing Address
City State Zip
( )
Phone E-mail Address
d. Facility name (if applicable):
e. Facility address:
Address
City State Zip
f. Facility contact person:
[if different from Owner]
First MI Last
Phone E-mail Address
III. Contact person (if different from the person legally responsible for the CoC)
t
First MI Last
Title
M0-f C4,,e
Mail' g AdHress
r)C
City State Zip
(ill) Cgs 55`A3
Phone E-mail Address
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
919.7079000

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?
R Yes
❑ No (please explain)
V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
0 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.
APPLICANT 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 is not included, this application package will be
returned as incomplete.
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(a-),ncdenr.gov

Register of Deeds
Sharon A. Davis
Durham County, NC
04/18/2023 02:50:20PM
BT: OPR B: 9899 P: 926 Pages: 3
DEED -DEED
Fee: $715.00 Excise Tax: $689.00
INSTRUMENT #2023068707
April Carrington
NORTH CAROLINA GENERAL WARRANTY DEED
Excise tax $689.00
Real Estate Tax ID #: 211291
Mail after recording to GRANTEE
This instrument was prepared by: Crosby Law Firm. PA. 8480 Honeycutt Rd. #200 Raleigh, NC 27615
Brief description for the Index: Lot 2 Pope Sub
itniN 1)rh1) made this day of 4/18/2023 , by and between
GRANTORS Gn A NTFF.0
Estate of Charles Edwin Cash
by Leigh Ann Hobgood, Administrator
whose mailing address is
1455 Medlin Rd, Clayton, NC 27527
(herein referred to collectively as Grantor)
All or a portion o9ke property herein conveyed
does or . V does not include the primary
residence of a Grantor. (Seller to check one)
Pah Kue, a married woman, and
Bu Reh, a married man
whose mailing address is
6917 Kemp Rd, Raleigh, NC 27613
(herein referred to collectively as Grantee)
ine aesignanon vrantor ana 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 buy these piesents does grant, bargain, seii, and convey unto
the Grantee in fee simple, all that certain lot or parcel of land situated in Durham County, North
Carolina and more particularly described as follows:
Being all of Lot 2, Containing 2.0 Acres, more or Less, as per plat and survey thereof entitled
Final Plat Pope Subdivision, Property of Willie E. Pope, Jr. and Emma T. Pope Living Trust,
said plat is raja. . �'A-i -m `�'- =A-"=-- -_ ---- , y..........
11� !i1 ddl i. isa - VVYu,,� ldd 1 •AL LV�-z
183, Page 248, to which plat reference is hereby made for a more particular description of
same.
r.-overry atreet Aadress: 6917 Kemp Rd. Raleigh. NC 27713
—itamirted eiectronicaily by Crosbv Law Firm in compliance with North Carolina statutes eovernine recordable documents and

?n7AMR707 BT: OPR B: 9899 P: 926
04/18/2023 02:50:20 PM Page 2 of 3
The property hereinabove described was acquired by the Grantor by instrument recorded in BOOK
61%9? PeCF Izn n.."hom CnrTNTY RErfCmnv. - u ;rc also 22SP827DurhamCounty Clerk
m ouuci aw %,uuri im, %n uer s.tuninning glue OI Keal rrooerty: ana see also ZZE1027 Durham
County Clerk of Suuerior Court for Estate of Charles Edward Cash.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
And the Grantor covenants with the Grantee that Grantor is seized of the premises in fee simple,
that title is marketable and free of all encumbrances and that the Grantor will warrant and defend the
title apsinct the. lawful claimc of all narcnne Iaihnmcnavar
Title to the property heremabove described is subject to the following exceptions:
1. ad valorem taxes for the current year (prorated through the date of Settlement), -
and
2. utility easements and unviolated covenants, conditions or restrictions that do not
materially affect the value of the Property

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v$i iaicu23 62:56:265 Fivi raye a ui a
IN WITNESS WHEREOF, the Grantor, having been duly sworn, has hereunto set his/her hand
mid seal the day anti year above written.
i n Estate of Charles Edwin Cash
$4 0 t4.4
rev;/rj
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A l .�11' twOr !.1
I, the undersigned ivotary rubiic, eel iiiai ine oiiowing person(s) personally appeared before me
ulis clay, each acknowieuprig tome that he or she voinntanly. c,onm the +nrs-aninr ;in......, ..,� F.� a
. . - _-' - cr ---- ----a----a ...,...,,.,....,,. thz
............... ........ .............�. _..,.............,. �..._ ._^ ._. /J, vJ ',N•// %!ice � �w
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t'l ttn rvnrw.ry ... .. ...,. .•.. .I,o,ti 't_
RECEIVED
NCDEQ/ WR/IMP
®ES