NCG550988_Owner (Name Change)_20230721

RECEIVEDNC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
JUL 2 1 ?023 WATER QUALITY PERMITTING SECTION
NPDES PERMITTING
NORTH CAROLINA
Environmental Quality PERNQQk"AW WI)14NGE FORM
I. CURRENT PERMIT INFORMATION:
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Permit Number: NC00_/__J__/__/ or NCG5_::/
1. Facility Name: t,-1Xd ­7 A�, /-xy0► -a 11 0 /CK
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
i/ 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):
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3. New owner's or signing official's name and title: Q k-CL-A2ALb
(Person legally responsible for per it)
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(Title)
4. Mailing address: 7c-- ✓,f m i'Q QY, City: C 61 a &I %t
State: A/ C Zip Code: Phone: ( � � �) �q / � 3 -� a2
E-mail address: -r , ,���'�p%f t> •lr t ���
Ill. FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same as under the previous owner? Yes VNo ❑
2. Will the treatment system and discharge location remain the same? Yes V No ❑
"No Responses"
If either or both of these questions are answered "No" then more information will be needed to review the
request. Please attach documentation to describe and explain the changes to the facility activities, waste
stream, treatment process or outfall location. The Division may not be able to process the Permit
Name/Ownership Change request and may require that the new owner file a new permit application.
DE Q North Carolina Department of Environmental Quality I Division of Water Quality
�, 512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
fv�T4 CAR.'?.Y4
""'N 919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
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)
3. Information to document facility, waste stream, treatment system or outfall changes as noted in
item III above (if appropriate)
Applicant's Certification:
I, `N�Qa `Z, )Z,LQ 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. I understand that Permit Name/Ownership Change can only take place through action
taken by the Division of Water Resources and that no actions on my part or the part of my company
result in the automatic transfer of permit coverage.
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
RECEIVED
j... I ,,-,
JV- s x L'1;_J
NCDEQ/DWR/NPDES
Version 07/2021

BK 2340 PG 0839
FILED ELECTRONICALLY
CHATHAM COUNTY NC
LUNDAY A. RIGGSBEE
REGISTER OF DEEDS
RECEIVED
JUL 21 2J213
NCDEQ/DWR/NPDES
FILED Dec 16, 2022
AT 03:56:37 PM
BOOK 02340
START PAGE 0839
END PAGE 0841
INSTRUMENT # 14031
EXCISE TAX $476.00
Excise Tax: $476.00
Mail after recording to: Grantee c/o Chatham Habitat for Humanity, P.O. Box 883, Pittsboro, NC 27312
This instrument was prepared by: Paul S. Messick, Jr., Gunn & Messick, PLLC, P.O. Box 880, Pittsboro, NC 27312
All or a portion of the property herein conveyed includes or _ �_ does not include the primary residence of a Grantor
(NCGS § 105-317.2)
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED, made this 15 day of December, 2022 between CHATHAM HABITAT FOR HUMANITY, a
North Carolina non-profit corporation, P.Q. Box 883, Pittsboro, NC 27312; hereinafter referred to as GRANTOR; and
BERNADETTE TAYLOR, 696 Jeremiah Drive, Chapel Hill, NC 27517; hereinafter referred to as GRANTEE. The
designation Grantor and Grantee as used herein shall include parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH
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 or parcel of
land situated in Williams Township, Chatham County, North Carolina and more particularly described as follows:
BEING ALL of Lot #6, containing 1.076 acres, more or less, as shown on a Plat entitled, "Final Plat -
Major Subdivision and Recombination of a Portion of the Hero Stone Bunker Estate Hero Stone Bunker
Subdivision," dated June 22, 1998, and revised October 26, 1998, prepared by Absolute Land Surveying
and Mapping, P.C., and recorded in Plat Slide 98, Page 391, Chatham County Registry, reference to
which is hereby made for greater certainty of description.
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 except for the exceptions hereinafter
stated.
Title to the property hereinabove described is subject to the following exceptions:
1. See Exhibit A attached hereto and incorporated herein by reference.
2. Easements and restrictions of record.
submitted electronically by "Gunn & Messick, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the chatham county Register of Deeds.

BK 2340 PG 0840
IN WITNESS WHEREOF, the Grantor has hereunto caused this instrument to be executed on the day and year
first above written.
CHATHAM HABITAT FOR HUMANITY,
a North Carolina non-profit corporation
By:
Name�rn
Title:
STATE OF NORTH CAROLINA
COUNTY OF CHATHAM
I, a Notary Public of ej&a x County and the State aforesaid, do hereby certify that c_,,a id 04aV'r&.
personally came before me this day and acknowledged that he/she is i;x. 61 cec:�X of Chatham Habitat for Humanity, a
North Carolina non-profit corporation, and that he/she as Fy, N re akyr being authorized to do so, executed the
foregoing on behalf of the corporation.
Witness my hand and official seal or stamp, this the Ib1 day of December, 2022.
My Commission Expires: 16
Printed Name. rL, -`
Notary Public
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