NCG551027_owner (name change)_20230926

ROY COOPER
comff a.r
EUZABETH S. BISER
seaw-V
S. DANIEL SM17M
Z;i i-
NORTH CAROLINA
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
1. Please enter the CDC number for which the change is requested.
Certificate of Coverage
N I C I G 15 1 5
]l. 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
I- f other please explain:
b. CDC will be issued to (person's name
or company name, if applicable): 0 �i(� �(� l e S (i ,1.� (jI
c. Owner: person legally responsible for
First MI Last
G cX �3
Pe it Holder Mailing Address
u City Mate zin
.23M I (1-7 1
Phone E-marl Address
d. Facility name (if applicable):
e. Facility address: I ( ct e-, h L
Address
City state Zip
e
� M t L-
[if different from Owner] p First MI Last
Phone E-mail Address ne-4
lll. Contact person (if different from the person legally responsible for the CDC)
Fist Ml Last
Title
Mailing Address
City State Zip
( )
Phone E-mail Address
North Carolina Department of Environmental Quality i Division of Water Resources
512 North Salisbury Street i 1617 Mail Service Center j Raleigh. North Carolina 27699 1617
919.707.90Oo

NCG550000 OWNERSHIP CHANGE FORM
Page 2 of 2
1V Will this permitted facility continue to discharge the same volume and type of wastewater as
prior to this ownership or name change?
❑ Yes I,,
No (please explain) W L n(\ U
Shou_lcl 64__ 1 �s
V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
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' owwnership change request.
...................................................................................................................
The certifications below must be completed and signed by the new applicant in the case of an ownership
rhancrP o-Pn���c4
APPLICANT CERTIFICATION
1, L W, attest that this application for a name/ownership 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 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 R. Weaver
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
[e-mail]

III�p�Y'�NI�IINIiII
2022006656
TRANSYLVANIA CO, NC FEE S64.00
PRESENTED RECORDED.
10-21-2022 04:07:50 PM
BETH C LANDRETH
REGISTER OF DEEDS
By D REE MCCALL
DEPUTY REGISTER OF DEEDS
BK: DOC 1057
PO: 638-642
NORTH CAROLINA DEED OF TRUST
Mail/Box to: Donald E. Jordan
This instrument was prepared by: Donald E. Jordan, Attorney at Law
Brief description for the Index: 1.9919 acres, Lime Kiln Lane
THIS DEED of TRUST made this 20' day of October, 2022, by and between:
GRANTOR
JCM PROPERTIES OF
BREVARD, LLC,
a North Carolina limited liability
company
TRUSTEE
DONALD E. JORDAN
BENEFICIARY
DOYLE ASSOCIATES, LLC,
a Michigan limited liability
company
The designation Grantor, Trustee, and Beneficiary 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 whereas the Grantor is indebted to the Beneficiary in the principal sum of FIVE
HUNDRED FORTY THOUSAND and 00/100 DOLLARS ($540,000.00 ), as evidenced by a Promissory
Note of even date herewith, the terms of which are incorporated herein by reference. The final due date for
payments of said Promissory Note, if not sooner paid, is October 20, 2032.
NOW, THEREFORE, as security for said indebtedness, advancements and other sums expended by
Beneficiary pursuant to this Deed of Trust and costs of collection (including attorneys fees as provided in
the Promissory Note) and other valuable consideration, the receipt of which is hereby acknowledged, the
Grantor has bargained, sold, given and conveyed and does by these presents bargain, sell, give, grant and
convey to said Trustee, his heirs, or successors, and assigns, the parcel(s) of land situated in Boyd Township,
Transylvania County, North Carolina, (the "Premises") and more particularly described as follows:
as described in EXHIBIT A attached
TO HAVE AND TO HOLD said Premises with all privileges and appurtenances thereunto belonging, to said
Trustee, his heirs, successors, and assigns forever, upon the trusts, terms and conditions, and for the uses
hereinafter set forth.