NCG550063_Permit (Issuance)_20130515

1) `!'•
RECEIVED
Wr
TWAN.C.Dept.of EN'R Beverly Eaves Perdue,Governor MAR 15 2013 Dee Freeman,Secretary
] North Carolina Department of Environment and Natural Resources 0
Winston-Salem
Regional Office Coleen H.Sullins,Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
L Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
a a 8 0 __j tl 0 6 5" 5- -a - -6..
II. Permit status prior to requested change. 6-5 0 c Co 3
a. Permit issued to(company name):
b. Person legally responsible for permit: NI 1 C.( AFL, T .1 LV(NS_
First MI Last
Title
Lf l 2 CASCADE D4 i v g
Permit Holder Mailing Address
-I4IG4 PoIir /QC 21215
City State Zip
(33O 848—8384 ( )
Phone Fax
c. Facility name(discharge):
d. Facility address:
Address
City State Zip
e. Facility contact person: ( )
First /MI/Last Phone
III. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: ✓V Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to(company name):
c. Person legally responsible for permit: FARE F f P cytvc5
First MI Last
D ��17�
�t f � ' Title
T------------� d 12. CASCADE DRIVE
��a D e Permit Holder Mailing Address
R :., , �Oi3 �1GE-f /NT NC 2'7265
D NR a U ATF City State Zip
La.f�rlde K QU,Lln, (334) 6439 2124 -Ppdav is e n4 r-fh 5--a .nQf
��wate
Phone E-mail Address
d. Facility name(discharge):
e. Facility address:
Address
City State Zip
f. Facility contact person:
First MI Last
( )
Phone E-mail Address
Revised 8/2008

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
• IV. Permit contact information(if different from the person legally responsible for the permit)
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
( )
Phone E-mail Address
Will the permitted facility continue to conduct the same industrial activities conducted
V. to this ownership or name change? prior
Er Yes
❑ No(please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,
or a bill of sale)is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
•
The certifications below must be completed and signed by both the permit holder prior to the change,and
the new applicant in the case of an ownership change request. For a name change request,the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION(Permit holder prior to ownership change):
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 thattf 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
APPLICANT CERTIFICATION
I, FAR LEY P JAr/{J ,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 wi be returned as incomplete.
- 1 ` ?o (3
217457"65 ignature Date
PLEASE SEND THE COMPLETE APPLICATIONL PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
Revised 512012

OMB Approval No.2502-0265
111111
• <`I1I0III*= A. Settlement Statement (HUD-1)
B. Type of Loan
1.❑FHA 2.❑RHS 3. Cony.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.OVA 5.D Cony.Ins. 36583/64546 1301016349
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"(p.o.e.)"were paid outside the closing;they are shown here for informational purposes and are not included in the
D. Name an rA&ess of Borrower: E. Name and Address of Seller: F. Name and Address of Lender:
Farley P.Davis and spouse, Michael T.Bivins New Bridge Bank
Sharon L.Davis 2337 Addison Boulevard ISAOAATIMA
412 Cascade Drive High Point,NC 27262 100 N.Cherry Street,Suite 400
High Point,NC 27265 Winston-Salem,NC 27101
G. Property Location: H. Settlement Agent: I. Settlement Date:
412 Cascade Drive Wyatt Early Harris Wheeler LLP
High Point,NC 27265 1912 Eastchester Drive Ste 400 February 12,2013
Davidson County,North Carolina High Point,NC 27265 Ph. [phone]
Lots 279&280,Map No.7 Place of Settlement:
Willow Creek Subdivision 1912 Eastchester Drive Ste 400
Plat Book 15 Page 18 High Point,NC 27265
J. Summary of Borrower's transaction K. Summary of Seller's transaction
100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller:
101. Contract sales price 425,000.00 401. Contract sales price 425,000.00
102. Personal property 402. Personal property
103. Settlement Charges to Borrower(Line 1400) 4,676.66 403.
104. 404.
105. 405.
Adjustments for items paid by Seller in advance Adjustments for items paid by Seller in advance
106. City/Town Taxes to 406.City/Town Taxes to
107. County Taxes to 407.County Taxes to
108. Assessments to 408.Assessments to
109. 409.
110. 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 429,676.66 420.Gross Amount Due to Seller 425,000.00
200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller:
201. Deposit or earnest money 2,500.00 501. Excess deposit(see instructions)
202. Principal amount of new loan(s) 180,000.00 502. Settlement charges to Seller(Line 1400) 24,447.12
203. Existing loan(s)taken subject to 503. Existing loan(s)taken subject to
204. 504.Payoff First Mortgage to BB&T Mortgage 171,983.92
205. Credit for Credit Report 3.40 505.Payoff Second Mortgage
206. 506.Dep.retained($2,500.00) 2,500.00
207. 507.
208. 508.
209. Due diligence fee 500.00 509.Due diligence fee 500.00
Adjustments for Items unpaid by Seller Adjustments for items unpaid by Seller
210. City/Town Taxes to 510.City/Town Taxes to
211. County Taxes 01/01/13 to 02/13/13 380.64 511. County Taxes 01/01/13 to 02/13/13 380.64
212. Assessments to 512.Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid by/for Borrower 183,384.04 520. Total Reduction Amount Due Seller 199,811.68
300. Cash at Settlement from/to Borrower 600. Cash at settlement to/from Seller
301. Gross amount due from Borrower(line 120) 429,676.66 601. Gross amount due to Seller(line 420) I 425,000.00
302. Less amount paid by/for Borrower(line 220) ( 183,384.04) 602. Less reductions due Seller(line 520) i( 199,811.68)
303. Cash X❑From ❑ To Borrower 246,292.62 603. Cash l To El From Seller 225,188.32
•Paid outside of dosing by borrower(B),seller(S),lender(L),or
trffelliiiiiisigned hereby acknowledge a i pt of_a completed copy of this statement&any attachments referred to•- in
Borrower 1113��Avs Seller 1
a y . ate,,// / • Micha I T.Bivins
/tLL103L i��
$�7aron L.Davis
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and reporting the data.This agency may not collect this information,and you are
not required to complete this form,unless itdisplaysa currently valid OMB control number.No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to a RESPu covered
transaction with information during the settlement process.
Page 1 of 3 HUD-1
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•
'L. Settlement Charges
700.Total Real Estate Broker Fees S 25.500.00 Paid From Paid From
Division of commission(line 700)as follows Borrowers Sellers
• 701 S 25.500-00 to Coldwell Banker Triad Realtors Funds at Funds at
702.S to Settlement Settlement
703.Commission paid at settlement 23,000.00
704. Deposit Ret'd By Listing Agent to Coldwell Banker Triad Realtors 52500.00(POC)
705
800.Items Payable in Connection with Loan •
801.Our origination charge $ 1.400.00 (from GFE#1)
802.Your credit or charge(points)for the specific interest rate chosen S (from GFE#2)
803.Your adjusted origination charges (from GFE#A) 1,400.00
804.Appraisal fee to Southern Appraisal Grouo.Inc. (from GFE#31 P.O.C.S410.00(B)•
805.Credit Report to Old Republic (from GFE#3) P.O.C.518.60(Br
806.Tax service to (from GFE#3)
807_Flood certification to LPS National Flood (from GFE#3) 9.00
808.LQI Pre-Closing Credit I to New Bridge Bank ISAOAATIMA (from GFE#3) 18 60
809.Employment Verification (from GFE#3)
810_ (from GFE#3)
811. (from GFE#3)
900.Items Required by Lender to Be Paid in Advance .
901.Daily interest charges from 02/12/13 to 03/01/13 17 @ $14.375000/dy (from GFE#10) 244.38
902.Mortgage insurance premium for months to (from GFE#3)
903.Homeowner's insurance for 1.0 years to Nationwide Insurance (from GFE#11) 1,141.00
904. (from GFE#11)
905. (from GFE#11)
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account (from GFE#9)
1002.Homeowner's insurance months @ $ per month $
1003.Mortgage insurance months @ $ per month $
1004.Property taxes S
County Taxes months @ $ per month
1005. $
1006. months @ S per month $
1007. months @ S per month $
1008. $
1009.Aggregate Accounting Adj. $
1100.Title Charges . - -
1101. Title services and lender's title insurance (from GFE#4) 989.50
1102. Settlement or closing fee to Wyatt Early Harris Wheeler LLP $ 685.00
1103. Owner's title insurance to North Carolina Title Center,LLC (from GFE#5) 413.30
1104. Lender's title insurance to North Carolina Title Center,LLC $ 304.50
1105. Lender's title policy limit S 180,000.00
1106. Owner's title policy limit S 425,000.00
1107. Agent's portion of the total title insurance premium $
1108. Underwriter's portion of the total title insurance premium to North Carolina Title Center,LLC 5 717.80
1109. CourierNYire Fee to Wyatt Early Harris Wheeler LLP $ 50.00
1110. $
1111. S
1112. $
1113. $
1200.Government Recording and Transfer Charges . • •- - , •
1201.Government recording charges to Register of Deeds (from GFE#7) 108.00
1202.Deed $ 26.00 Mortgage 5 56.00 Releases $ Other $ 26.00
1203.Transfer taxes (from GFE#8)
1204.City/County tax/stamps $ $
1205.State tax/stamps $ 850.00 $ 850.00
1206. •
1207.
1300.Additional Settlement Charges - °sii - • - -
1301.Required services that you can shop for (from GFE#6)
1302. $
1303. Home Warranty to Home Security of America $ 500.00
1304. 2012 HOA Dues to Willow Creek Homeowers Assoc. $ 352.88 47.12
1305. $
1400.Total Settlement Charges.(enter on lines 103,Section J and 502,Section K) - - • •4,676.66 24,447.12
•Paid outside of dosing by borrower(B),seller($),lender(L).or third-party(T)
By signing pager of des statement Co signatories acknowledge receipt of a completed copy of page 283 of this//,/��(t�,e pa •statement
Wyatt EaT1y Harris Wheeler LLP ttlement
Agent
Page 2 of 3 HUD-1
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•
Comparison of Good Faith Estimate(GFE)and HUD-1 Charges Good Faith Estimate HUD-1
Charges That Cannot Increase HUD-1 Line Number
Our origination charge # 801 1,400.00 1,400.00
Your adjusted origination charges # 803 1,400.00 1.400.00
Charges That in Total Cannot Increase More than 10% Good Faith Estimate HUD-1
Government recording charges #1201 100.00 108.00
Appraisal fee # 804 410.00 410.00
Credit report # 805 22.00 18.60
Tax service # 806 87.00 0.00
• Flood certification # 807 9.00 9.00
LQI Pre-Closing Credit Report # 808 18.60 18.60
Employment Vkrification # 809 14.00 0.00
Title services and lender's title insurance #1101 960.00 989.50
Owner's title insurance to North Carolina Title Center,LLC #1103 360.00 413.30
Total 1,980.60 I 1,967.00
Increase between GFE and HUD-1 Charges $ -13.60 or -0.69%
Charges That Can Change Good Faith Estimate HUD-1
Initial deposit for your escrow account #1001 0.00 0.00
Daily interest charges #901 $ 14.375000/day 158.13 244.38
Homeowner's insurance # 903 _ 1,560.00 1,141.00
Loan Terms
Your initial loan amount is $180,000.00
Your loan term is 15.00 years
Your initial interest rate is 2.8750%
Your initial monthly amount owed for principal,interest and S 1,232.25 includes
any mortgage insurance is 0 Principal
E Interest
❑ Mortgage Insurance
Can your interest rate rise? ❑X No ❑ Yes,it can rise to a maximum of %. The first
change will be on and can change again every_months after
. Every change date,your interest rate can increase or decrease
by %. Over the life of the loan,your interest rate is guaranteed
to never be lower than %or higher than %.
Even If you make payments on time,can your loan balance rise? ❑X No ❑ Yes,it can rise to a maximum of$
Even if you make payments on time,can your monthly ❑X No ❑ Yes,the first increase can be on and the monthly
amount owed for principal,interest,and mortgage insurance rise? amount owed can rise to$
The maximum it can ever rise to is$
Does your loan have a prepayment penalty? ❑X No ❑ Yes,your maximum prepayment penalty is$
Does your loan have a balloon payment? ❑X No ❑ Yes,you have a balloon payment of$
due in_years on
Total monthly amount owed including escrow account payments ❑X You do not have a monthly escrow payment for items,such as property
taxes and homeowner's insurance. You must pay these items directly
yourself.
❑ You have an additional monthly escrow payment of$NfAthat results
in a total initial monthly amount owed of SN/A. This includes
• principal,interest,any mortgage insurance and any items checked below:
❑ Property taxes El Homeowner's insurance
❑ Flood insurance ❑
❑ ❑
Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender.
Page 3 of 3 HUD-1
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