NCG550990_Owner (Name Change)_20231027

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
I"
NCDEQ/fsWR
2 7 O C T 2023
Non -Discharge
Permitting Unit
NPDES Certificate of Coverage (CoC)
NCG550000 OWNERSHIP CHANGE FORM
I. Please enter the CoC number for which the change is requested.
Certificate of Coverage
FNJ C I G 15 1 5 1 0 1 9 19 0
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
CoC:
Emilie A Williams
First Ml Last
Property Co —Owner
Title
222 W. 15th St. Apt 1C
Permit Holder Mailing Address
New York NY 10011
City State Zip
[phone] [e-mail]
Phone E-mail Address
d. Facility name (if applicable):
e. Facility address:
500 Jeremiah Dr
Address
Chapel Hill NC 27517
City State Zip
f. Facility contact person:
Alice & Jim Williams
[if different from Owner]
First Ml Last
( 919) 889-7180 [e-mail]
}+•^^illia®gmail com
Phone (Mobile phone) E-mail Address
III. Contact person (if different from the person legally responsible for the CoC)
Alice & Jim Williams
First MI Last
Property Co —Owners (...and Parents)
Title
721 Hogan Farm Road
Mailing Address
Apex NC 27523
City State Zip
( 919) 362-1794 [e-mail]
3imwi11ia0gma+1 com
Phone (Home phone) E-mail Address
DE QNorth 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
oR:n;j.F.v m o�»�•i a,nn\ r 919.707.9000

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)
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, Emilie Williams, 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 ackage ill bereturned as incomplete.
October 17th, 2023
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
[e-mail]

BK 2384 PG 1028
This document has been
Electronically recorded.
iseTax: $ q30 NORTH CAROLINA GENERAL WARRANTY DEED
FILED ELECTRONICALLY
CHATHAM COUNTY NC
LUNDAY A. RIGGSBEE
REGISTER OF DEEDS
FILED Oct 11, 2023
AT 02:51:10 PM
BOOK 02384
START PAGE 1028
END PAGE 1029
INSTRUMENT # 08923
EXCISE TAX $430.00
Parcel Identifier No. 0074955 Verified by County on the day of By: .20
Mail/Box to: Grantee
This instrument was prepared by: Arnette Law Offices PLLC 3131 Rdu Center Drive Suite 120 Morriwtlle N( 27560
Brief description for the Index: Lot 1. Hero Stone Bunker Est to Hero Stone Bunk Subdivision
THIS DEED made this _� day of
- _90POPkIAMM"P._tr , 20n by and between
UKANTOR
Toni G. Constant a/k/a Toni George Constant, an unmarried
individual
300 Meadowlands Drive
Hillsborough, NC 27278
Enter in appropriate block for each Grantor and Grantee: name, mai
or partnership.
GRANTEE
Emilie Williams, an unmarried individual and
Alice Williams and spouse,
Jimmy Williams
as joint tenants with right of survivorship
Property Address: 500 Jeremiah Drive
Chapel Hill, NC 27517
Mailing Address: 1410 Broadway
New York, NY 10018
ling address, and, if appropriate, character of entity, e.g. corporation
The designation Grantor and Grantee as used herein shall include said parties, their heirs, success
singular, plural, masculine, feminine or neuter as required by context. ors, and assigns, and shall include
WITNESSETH, that 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, parcel of land or
condominium unit situated in or near the City/Town of Chapel Hill, Township, Chatham County, North Carolina and
more particularly described as follows:
BEING all of Lot #1, containing 3.208 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, prepared by Absolute Land Surneying and Ma recorded in Plat Slide 98-391, Chatham County Registry, to which plat r%rence is hereby mad fping, p or
a
more particular description of same.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2365, Page 1013.
All or a portion of the property herein conveyed _ includes or X does not include the primary residence of a Grantor.
A map showing the above -described property is recorded in Plat Slide 98-391.
mitted
cally
InbcompliancecwithiNorth CarolinatstatutesfgoverningLLrecordable documents
and the terms of the submitter agreement with the Chatham county Register of Deeds.

NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: $ `l � C)
Parcel Identifier No. 0074955 Verified by _ County on the day of __ ___. 20__
By: _
Mail/Box to: Grantee
This instrument was prepared by: Arnette Law Offices PLLC 3131 Rdu Center Drive, Suite 120, Morrisville, NC 2_" Cni
Brief description for the Index: Lot 1 Hero Stone Bunker Estate Hero Stone Bunker Subdivision
THIS DEED made this _7' day of Cr , 20X3 by and between
GRANTOR
Toni G. Constant a/k/a Toni George Constant, an unmarried
individual
300 Meadowlands Drive
Hillsborough, NC 27278
Enter in appropriate block for each Grantor and Grantee: name, ma
or partnership.
GRANTEE
Emilie Williams, an unmarried individual and
Alice Williams and spouse,
Jimmy Williams
as joint tenants with right of survivorship
Property Address: 500 Jeremiah Drive
Chapel Hill, NC 27517
Mailing Address: 1410 Broadway
New York, NY 10018
iling address, and, if appropriate, character of entity c irporation
The designation Grantor and Grantee as used herein shall include said parties, their heirs. successor, and assigns, and IiAl.l 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 ackii, L dged, has
and by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot, par,, I ,f land or
condominium unit situated in or near the City/Town of Chapel Hill. Township, Chatham County, North olina and
more particularly described as follows:
BEING all of Lot #1, containing 3.208 acres, more or less, as shown on a plat entitled "Final Plat,
Subdivision and Recombination oJ' a portion of the Hero Stare Bunker Estate, Hero Stone BiwA,
,Subdivision, " dated June 22, 1998, prepared by Absolute Land Sun�eying and Mapping, P.0 cr) ,
recalled in Plat Slide 98-391, Chatham County Registry, to which plat reverence is hereby made Iw
more particular description of same.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2365, Page 1013.
All or a portion of the property herein conveyed ` includes or X does not include the primary residence of a Grantor.
A map showing the above -described property is recorded in Plat Slide 98-391.

...... ..... . to fee si-Ple, has the ri I ght 10 "'j, ey the lilIlle in
and that (i,aritor will warrant and defend tile tills"f- all
"'d CXCCPtjonN:
Ita.ntsa�Cvcr. Vtf,,r than
the fi•Il+taa'ntgurrent year and subsequent years.
Ad valorem taws for the c
2. Easements, restrictions and other matters of record affecting title 10 the '41blect IM ollel-1%
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing and %cai I \11( I,! I
S LA L)
Toni G. Constant aYz/a Toni George Constant hN
Ann Theresa Murphy a k a Ann I heresa (Terri) Murphy.
Attorney -in -Fact
State
1, the undersigned Notary Public oi, the I "OLUM 01- (40V of Xld
aforesaid, do hereby certify that \nn - I liciv ' sa,Nluiph\ 'a k a Anil I lici c,,i I �,-i I I) ui 1,1 k! I I
for Toni G. Constant a/k)'aTopI..G ( C Constant , Jj)j1CJIk'd 1)(AOIC W� till" 'Ll, tlid
-,S-Lrg- Constant -- llctomllh
being by me duly ~wont says that I,,)he executed the lolc'-'ol III III h'I ,wd 111
Toni G. Constant ivkia Toni GcPrge ('onstant and tlui( the AL111101 M 10 (11C III,! t, 1,1l'-% 1, (1,
S
........... A said instrument is contained in ;in instrument dtji,. eXeCUI[Cd. A-kno\k 1� (Lcd uid I c-,i dc, I III t 11�
,r OTA A* Ch North Cai0hiia. III kook -' I tt I
P Office of the Register of Deeds alliam County, Not
and that this instrument was executed under and by VIII-111C 01 111C 11,1111011t\ nrn 1', Jld
Z
MY comm. Exp.
12-18-2027. € instrument granting Powerol'Attorney: and that the said Ann I here,,a I k a
tJ
(Terri) Mu!ph acknowledged the due execution of the forc,-,oing IIINIMI)Icill fol 01c
0 *- z I
;�, C) r' therein expressed forand in behalfol-l'oni G. Constant a k- it I ()III (Jcoi=-,c on,uw iliw— w
V'�U B 0. -"' --- r ---
i ......... . . . .. .... 4, hand and Notarial stamp or seal this
",%""ON C 0\3 -00
..0
v
;T
�ota Pub(c
:
a
t
My Commission Expires:17!�.j
(Affix Notary Seal) Notary's Prinfed or I r"d "-illic

THIS IS TO CERTIFY THAT ON THE _ �3F0 DAY OF lfil$isjSL___ 201u_ AN ACTUAL
SURVEY WAS DONE UNDER MY SUPERVISION OF THE PROPERTY SHOWN HEREON, THIS MAP IS NOT INTENDED
TO MEET CS 47-30 RECORDING REQUIREMENTS.
A•```L111I urgrFaF
C_
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SIGNED _ : SEAL
{ L-4679 L
DEAN M. RHOADS. PLS (L-4679) :�7 y�'!
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RHO`.� SNAT
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I AREA IN R/W 4.757 S.F
I
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1
ADJACENT PROPEIITT' LOWS
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NOTES
��
WilliamsFLF-SCreek Township. Chatham Countv. North Carolina
-ALL DISTANCES SHOW+ ARE HORIZONTAL u7ROUNO OISTANCES
D1 i ('�
LAND SERVICES, PLLC.
PROPERTY OF: EMILIE B ALICE WILLIAMS
60 R'W
-AREAS COMPUTED BY COORDINATE MEM00
-PROPERTY SUBACT TO ALL EASEMENTS AND RESTRICTIONS D
MAP BOOK 98 PAGE 391 DEED REFERENCE 1094 PAGE 11'2@_
-NO HORIZONTAL CONTROL FOUND Wr IN 2000 FEET OF WWII
-9D11DARY PREDICATED ON EXISTING MONUMEN TA TIO/ FOUND N IE.
r. Natty l.a'amu
-TWS PRmERrY' MAY BE SUBiCT TO ANY AND ALL APPUCAIAE
Phon9 (919) 376-9J16
3"
RESDRCTIONS. EASEMENTS. RIGHT-OF-WAY UTILITIES AID
FKTn LlcenAe 4 P-OR73
DRAWN BY: D SURVEYED BY: AW CHECKED BY: DWT DATE: AUGUST 23. 2023
RESTRICTIVE COVENANTS WHICH MAY BE O RLCORO OR
L.

dottoop signature verificatron
w A- Settlement Statement (HUD-1)
IYi
9oRN a2JE�
R T 41-
OMB Approval No. 2502-0265
1. ❑ FHA 2. ❑ RHS 3. ❑ Conv Unins. 6.
4. ❑ VA 5. ❑ Conv. Ins. 202309623-WILLIAMS
File Number
7. Loan Number
8. Mortgage Insurance Case Number
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "(po. c)"were paid outside the Dosing; they are shown here for informational purposes and are not included in the totals
0. Name and Address of Buyer.
Emilie Williams and
Alice Williams
222 W. 15th Street #1 C
New York, NY 10011
E. Name and Address of Seller
Toni G. Constant, an unmarred individual
300 Meadowlands Drive
Hillsborough, NC 27278
F. Name and Address of Lender
G. Property Location.
500 Jeremiah Drive
Chapel Hill, NC 27517
Chatham County, North Carolina
H. Settlement Agent:
Amette Law Offices, PLLC
3131 RDU Center Drive, Suite 120
Monisvile, NC 27560 Ph. [phone]
I. Settlement Date:
October 11. 2023
Place of Settlement:
3131 RDU Center Drive, Suite 120
Morrisville, NC 27560
J. Slnlmary of Buyer's transaction
K. Summary of Seller's transaction
100. Gross Amount Due from Buyer
400. Gross Amount Due to Seller.
101. Contract sales price
215,000.00
401. Contract sales Price
215,000.00
102. Personal property
402. Personal pro rt
103. Settlement Charges to Buyer Line 1400
2,872.45
403.
104.
404.
105,
405.
Adustmenits for items paid by Seller in advance
Aclustirnents for items paid by Seller in advance
106. City/Town Taxes to
406. Cit (Town Taxes to
107. County Taxes 10/12/23 to 01/01/24
209.95
407. County Taxes to
108. Assessments to
408. Assessments to
109.
409.
110.
410.
ill.
411.
112.
412.
120. Gross Amount Due from Buyer
218,082A0
420. Gross ArrlouH Due to Seller
215,DD0.00
200. Amounts Paid by or in Behalf of Buyer
600. Reductions in Arrant Due Seller:
201. Deposit or earnest money
501. Excess deposit see instructions
202. Principal amount of new bans
502. Settlement charges to Seller Line 1400
12,012.50
203. Existing bans taken subject to
503. Existing bans taken subject to
204.
504. Payoff First Mortgage
205.
505. Payoff Second Mortgage
206.
506.
207.
507.
208. Due Diligence Fee
15 000.00
508. Due Diligence Fee
15.000.00
209. Seller Pd Closing Costs
509. Seller Pd Closing Costs
Adjustments for items unpaid by Seller
Aclustronts for items unpaid by Seller
210. Cit(Town Taxes to
510. Cit[Town Taxes to
211. County Taxes to
511. Count Taxes 01/01/23 to 10/12/23
736.14
212. Assessments to
512. Assessments to
213.
513.
214.
514.
215.
515.
216.
516.
217.
517.
218.
518.
219.
519.
220. Total Paid byttor Buyer
15,000.00
520. Total Reduction Amant Due Seller
27.748.64
300. Cash at Settlement frorrYtD Buyer
600. Cash at settlement to from Seller
301, Gross amount due from Buyer line 120
218,082.40
601. Gross amount due to Seller fine 420
215,000.00
302. Less amount paid by/for Buyer (line 220)
( 15,000.00
602. Less reductions due Seller (line 520)
( 27.748.64
303. Cash O From To Buyer
203,082.40
603. Cash E] To From Seller
187,251.36
Pad odade d d-rg w ba.wene, wensle.aenu. a imopany,
The undersigned hereacknowledge receipt of a completed copy of this statement & any attachments referred to herein
Buyer Banter
ilie Williams Toni G. Constant
Ql�u7//cllRn+ra oiosvaK
Mice Williams
TO THE BEST OF MYKN0WI.EDGE, THE HUD1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED 6 ATRUEANDACCURATE ACCOUNT OF THE FUNDS WHICH WERE
RECENED AND HAVE BEEN OR WILL BE DISBURSED BYTHE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS TRANSACTION.
ArnaGe Law 011ices, PL-C, SedementAgent
WARNING: IT ISA CRMETO KNOWINGLYMAKE FALSE STATEMENTSTO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDEA
FINE AND IMPRISONMENT FOR DETAILS SEE TITLE 18 U.S. CODE SECTION 1001&SECTION 1010.
The PL&k Rep"V &r den fa tb cdecuon d MamaOon s ..need at % mLt% per re pace fm cdecbg m wffg and mpoftV the fyta Ths apenq ma/ not clod ft MamMm and yw are rwt myed to cardete tlr tam, uiaes t
dapptc a Curero* vdd OF5 cabd nmba. Nn cvf dwt* 6 ascued d'f dsdosue 6 maidetay TFc 6 desigiedto po.itle tl.e parbas to a f�SFle. cwasdlmrsacEm with Homeeon dmg the sdtenwt pmcuss.
Page 1 of 3 HUD-1
(202309623-W ILLIAMS. PFD/202309623-WILLIAMS/13)

700. Total Real Estate Broker Fees $ 11,287.50
Paid From
Buyers
Paid From
Sellers
Division of commission (line 700) as follows:
701. $ 5,912.50 to Weaver Street Realty
Funds at
Funds at
702. $ 5,375.00 to Keller Williams Realty Cary
Seaernerd
Sedlernent
703. Commission paid at settlement
11 287.50
704.
705. Transaction/Brokerage Fee
800. Items Payable in Connection with Loan
801. Our origination charge $
from GFE #1
802. Your credit or charge(points) for the specific interest rate chosen
from GFE #2
803. Your adiusted origination charges to
from GFE #A
0.00
804. Appraisal fee to
from GFE #3
805. Credit Report to
from GFE #3
806. Tax service to
from GFE #3
807. Flood certification to
from GFE #3
808.
from GFE #3
809
from GFE #3
810.
from GFE #3
900. Items Required by Lander to Be Paid in Advance
901. Daily interest charges from to $/da
from GFE #10
902. MIP Tot Ins. for Life of Loan months to
(from GFE #3)
903. Homeowners insurance for yearsto
(from GFE #11)
904
(from GFE #11)
905
(from GFE #11)
1000. Reserves Deposited with Lender
1001. Initial deposit for your escrow account
(from GFE #9)
1002. Homeowners insurance months @ $ per month
$
1003. Mortgage insurance months CED $ per month
$
1004. Property taxes
$
1005.
1006. County Taxes months @ $ per month
$
1007. months @ $ per month
$
1008.
$
1009. Aggregate Adjustment
$
1100. Tine Charges
1101. Title services and lenders title insurance
(from GFE #4)
899.75
1102. Settlement or closing fee to Annette Law Offices, PLLC
$ 899.75
1103. Owners title insurance to
(from GFE #5)
496.70
1104. Lenders title insurance to
$
1105. Lenders title policy limit $
1106. Owners title policy limit $
1107. Agent's portion of the total title insurance premium to Attorneys Title
$
496.70
1108. Underwriters portion of the total title insurance premium
$
1109. Seller Docs to Amette Law Offices, PLLC
$
250.00
1110. Courier Fee to Annette Law Offices, PLLC
$
25.00
1111. Lien Cancellation Require
$
1112.
$
1113.
$
1200. Govemrrnent Recording and Transfer Charges
1201. Government recording charges to Annette Law Offices Recording Account
from GFE #7
26.00
1202. Deed $ 26.00 Mortgage $ Releases $
Other $
1203. Transfer taxes
(from GFE #8)
1204. Cit/Count tax/stam s Deed $ Deed of Trust $
1205. State tax/stamps Deed $ 430.00 Deed of Trust $
430.00
1206.
1207,
1300. Additional Settlement Charges
1301. Required services that you can shop for
(from GFE #6)
1302. Survey to Residential Land Services
$
23-10773
1,450.00
1303. Document Retrieval to Abstracting Services, LLC
$
5049
20.00
1304.
$
1305.
$
400. 1Total Settlement Charges (enter an lines 103, Section J and 502, Section K)
2,872.45
12,012.50
Poe« ackArgq'1, +iB), se4(SL Ie XWQ arm)
By sgng pa¢ t d do seals , the sgreGaes aclmoNeQ7e weg d a targeted caw d page 2 8 3 ar Ins Mh pa¢ stalerrwt
Certified to be a true copy.
Annette Law Offices, PLLC, Settlement Agent
Page 2 of 3 HUD-1
(202309623-W ILLIAMS.PFD/202309623-W ILLIAMS/13)

dotloop signature verification:
ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT
Buyer: Emilie Williams and Alice Williams
Seller: Toni G. Constant, an unmarried individual
Settlement Agent: Annette Law Offices, PLLC
[phone]
Place of Settlement: 3131 RDU Center Drive, Suite 120
Morrisville, NC 27560
Settlement Date: October 11, 2023
Property Location: 500 Jeremiah Drive
Chapel Hill, NC 27517
Chatham County, North Carolina
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate
statement of all receipts and disbursements made on my account or by mein this transaction. 1 further certify that I have received a
copy of the HUD-1 Settlement Statement.
' "2 %piled
c"
0/1 12'.28 PM EDT
Lam- W%OQ_SQ-SiFJ-ME..QE,.
Toni G. Constant
tlotioop ve�
0/1t P t00PM EDT
%SPA-L2PW-assO-0PGa
Alice Williams
To the best of my knowledge, the H UD-1 Settlement Statement which I have prepared is a true and accurate account of the funds
which were received and have been or will be disbursed by the undersigned as part of the settlement of this transaction.
Annette Law Offices, PLLC
SettlementAgent
VWNING: It is a crime to knowingly make false statements to the United States on this or any similar form Penalties upon conviction can include a
fine and imprisonment For details see: Title 18 U.S. Code Section 1001 and Section 1010.
(202309623-WILLIAMS.PFDI202309623 WILLIAMS113)