NCG550073_owner (name change)_20240322

NORTH CAROLINA
NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
PERMIT NAME OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number:
1. Facility Name:
11�i�1*���Ly �]_►_I:�L�;7L►L1►�iL�IVif�1:�► T_��I�1�F
1. This request for a name change is a result of:
_X—a. Change in ownership of property/company
b. Name change only
c. Other (please explain):
NPDES PERMITTING
or NCGS—J—J—/—J_
2. New owner's na a (name to be put on permit):
V-14N RNDV WS
3. New owner's or signing official's name and title:
(Person legally responsible for permit)
(Title)
4. Mailing address:
5gto
3*G&T- t`'1/
4 __City:
CRAM — WUL
State: PJG
Zip Code:
Z7sl (O
Phone: ( j lQ
) SZS ' S 240
E-mail address: 6P NLV6 -WA/p , CoM
FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same asunder the previous owner? Yes 1A No ❑
2. Will the treatment system and discharge location remain the same? Yes o 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.
O."'t-1 of EMi=ffH oW
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
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:
Q w0f kKpig-W S , 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: 12 `C / Date: 3 lZ Z
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
Version 07/2021

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A. Settlement Statement (HUD-1)
$rN oEJEt-
B. Tvoe of Loan
OM� Approval No. 2502-0265
C621 C f 664
1. ❑ FHA 2. Q RHS 3. Z Conv. Unins. 16. File Number:
4. Q VA 5.0 Conv, Ins. 13ANDREWS PURCHASE
7. Loan Number: 8. Mortgage Insurance Case Number:
1001001991
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.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name and Address of Borrower:
Brian Andrews
332 Bainbridge St
Philadelphia, PA 19147
E. Name and Address of Seller:
Jim Alcor Unmarried
Heather Aloor
5012 Timmons Dr.
Durham, NC 27713
F. Name and Address of Lender:
FM Lending Services, LLC'
1000 St. Albans Drive, Suite 400
Raleigh, NC 27609
G. Property Location:
5420 Bobcat Rd
Chapel Hill, NC 27516
Orange County, North Carolina
H. Settlement Agent:
The Maitland Law Firm
Maitland Law Building- 2 Couch Road
Chapel Hill, NC 27514 Ph. [phone]
I. Settlement Date:
August 22, 2013
Place of Settlement:
Maitland Law Building- 2 Couch Road
Chapel Hill, NC 27514
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
197,000.00
401. Contract sales price
197,000.00
102. Personal property
402, Personal properly
103. Settlement Charges to Borrower Line 1400
6,143.06
403.
104.
404.
105.
405.
Ad ustments f r items paid by Seller in advance
Adjustments for items ald by Seller in advance
106.0own Taxes to
406.Citv.?TownTaxes to
107. Crourity Taxes to
407. CoumvTaxes to
_
106. Assessments to
408. Assessments to
109.
409.
410.
110,
111.
411.
112-
412
120. Gross Amount Due from Borrower
203,143.06
420. Gross Amount Due to Seller
197,000.00
200. Amounts Paid by or in Behalf of Borrower
500. Reductions in Amount Due Seller:
201. Deposit or earnest money
1,600,00
501. Excess deposit see instructions i
202. Princi al amount of new loans
157,000.00
502. Settlement charges to Seller (Line 1400)
12,037.89
203, EAsfing loan s1 taken subject to
503. EAstiloan(s) taken su6lectto
204. Overpayment of Credit Report
27.75
504. Payoff First Mortgage to US Bank Home Mortgage/680 I
150,300.02
205.
505. Payoff Second MorTgMe
208.
506. Dep. retained $1,600.00
1,600.00
207.
507.
208. Due Diligence
500.00
508. Due Diligence
500.00
209. Seller Paid Closiag Costs
6.000.00
509. Seller Paid Closing Costs !
6,000.00
Ad ustments for items unpaid by Seller
Adjustments for items unpaid by Seller
210. Ci !Town Taxes 10
510. City/Town Taxes to
211. County Taxes to
511. Coun Taxes to
212. Assessments to
512. Assessments to
213.
513,
214.
514.
216.
515.
216.
516.
217.
517.
218•
518. Home Warranty to Home Security ofAmerica, Inc./31
464.00
219.
519.
220. Total Paid by/for Borrower
165,127.75
520. Total Reduction Amount Due Seller
170.901.91
300. Cash at Settlement from/to Borrower
600. Cash at settlement to/from Seller
301. Gross amount due from Borrower line 120
203.143.06
601. Gross amount due to Seller line 420
197,000.00
302. Less amount c,aid b !for Borrower (line 220)
: ( 165,127.7E
602. Less reductions due Seller (line 570)
(
170,901.91
303. Cash O From To Borrower
38,016.31
603. Cash El To From Seller
,
26.098.09
The undersigned hereby ack noW edge recelpt of a completed copy of this statement & any attact
Borrower ws Sell
Brie ,
TO THE BEST OF MY KNOWLEDGE, THE HUD-1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRM NDA LIRATE AO T L3 � FUNDS .
WHICH WERE RECEIVED AND HAVE BEEN OR WILL BE DISBURSED BY THE UNDERSIGNED AS PART OF THF,6 ETT MEK TIORTIOR /
Th Iland Law Firm, Settlement Agent
WARNING: IT IS 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 & SECTION 1010.
The Public Reporting Burden far this collection of information is estimated a(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 it disPlays s currently valid OMB control number. No confidenflelity i s assured: this disclosure is mandatory. This is designed to provide the parties to a RESnlcovered
transaction with information during the seSementprocess.
Page 1 of 3 HUD-1
(13ANDREWS PURCHASE.PFD/13 ANDREWS PURCHASE/19)