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Home My WebLink AboutWQ0035784_Application_20240610State of North Carolina Department of Environmental Quality Division of Water Resources SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE INSTRUCTIONS FOR FORM: PNOCF 01-16 INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1 This form is for ownership changes or name changes of a sewer system permit. Please note that “Permittee” references the existing permit holder, and that “Applicant” references the entity applying for the ownership/name change. Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ. For more information, visit the Division’s Water Quality Permitting’s website: A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications): Submit an original completed and appropriately executed application (PNOCF 01-16). The Existing Permittee’s Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b). The Applicant’s Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from a person who meets the cri teria in 15A NCAC 02T .0106(b). B. Existing Permit (All Applications): Submit a copy of the most recently issued permit and certification. C. Property Ownership Documentation (All Applications):  The Applicant shall demonstrate they are the owner of all property containing the sewer system facilities: Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or Approved board minutes D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a Privately-Owned Public Utility): Per 15A NCAC 02T .0115(a)(1), provide one copy of the Certificate of Public Convenience and Necessity from the North Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the non-discharge system. E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be sold):  Home/Property Owners’ Associations Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA). Per 15A NCAC 02T .0115(c), submit an original proposed or approved Articles of Incorpor ation, Declarations and By- laws that contain the language required by the Operational Agreement.  Developers of lots to be sold Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement (FORM: DEV). F. Package Submitted in Duplicate Submit a copy of all required documents in Instructions A-E as required THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE TO: NCDEQ - DWR Water Quality Permitting Section PERCS Unit By U.S. Postal Service: By Courier/Special Delivery: 1617 MAIL SERVICE CENTER 512 N. SALISBURY ST. RALEIGH, NORTH CAROLINA 27699-1636 SUITE 925 RALEIGH, NORTH CAROLINA 27604 TELEPHONE NUMBER: (919) 807-6300 DocuSign Envelope ID: 88B44689-9016-43F4-904A-883DF5DB82DE State of North Carolina Department of Environmental Quality Division of Water Resources SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE INSTRUCTIONS FOR FORM: PNOCF 01-16 FORM: PNOCF 01-16 Page 1 of 2 I. EXISTING PERMITTEE INFORMATION: 1. Permittee's name: Wallace Loft LLC 2. Signature authority’s name: Wen De Tam per 15A NCAC 02T .0106(b) 3. Signature authority’s title: Director 4. Permittee’s mailing address: 5 Bryant Park, 28th Floor City: New York State: NY Zip: 10018- 5. Permittee’s contact information: Phone number: (646) 908-6300 Fax Number ( ) - Email Address: tam.wende@mapletree.com.sg II. APPLICANT INFORMATION: 1. Applicant's name: Boone Owner LLC 2. Signature authority’s name: Andrew Stark per 15A NCAC 02T .0106(b) 3. Signature authority’s title: Authorized Signatory 4. Applicant’s mailing address: 2 School St. City: Rye State: NY Zip: 10580- 5. Applicant’s contact information: Phone number: (914) 420-1171 Fax Number ( ) - Email Address: Astark@timberlinerev.com 6. Representative’s name: Andrew Stark 7. Representative’s title: Authorized Signatory 8. Representative’s contact information Phone number: (914) 420-1171 Fax Number ( ) - Email Address: Astark@timberlinerev.com III. PERMIT INFORMATION: 1. Existing permit number: WQ0035784 and most recent issuance date: June 5, 2023 2. Reason for the permit application: Change of Ownership If other, attach detailed explanation 3. Has the facility been constructed? Yes or No 4. Has the facility been certified per 15A NCAC 02T .0116? Yes or No DocuSign Envelope ID: 88B44689-9016-43F4-904A-883DF5DB82DE FORM: PNOCF 01-16 Page 2 of 2 IV. CERTIFICATIONS: Existing Permittee's Certification per 15A NCAC 02T .0106(b): I, Wen De Tam attest that this application (Signature Authority’s name & title from Application Item I.2 & 3) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit into the Applicant’s name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit be violated. I also understand that if all required parts of this application are note completed and that if all required supporting information and attachments are not included, this application will be returned to me as incomplete. NOTE – In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application package s hall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. Signature: Date: Applicant's Certification per 15A NCAC 02T .0106(b): I, Andrew Stark attest that this application (Signature Authority’s name & title from Application Item II.2&3.) has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into the Applicant’s name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non- discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application package are not completed and that if all required supportin g information and attachments are not included, this application package will be returned to me as incomplete. NOTE – In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fin e not to exceed $10,000 as well as civil penalties up to $25,000 per violation. Signature: Date: DocuSign Envelope ID: 88B44689-9016-43F4-904A-883DF5DB82DE 06-Jun-2024 | 11:57 AM PDT 07-Jun-2024 | 8:54 AM SGT 310533851.4 Excise Tax: $182,022.00 PINs: 2900138889000, 2900138977000, 2900139813000, 2900148074000 2900149100000, 2900149137000, 2900149214000, 2900149301000, 2900149347000, 2900228697000, 2900228735000, 2900228793000, 2900228810000, 2900228816000, 2900228922000, 2900228965000, 2900229761000, 2900229835000, 2900229935000, 2900230714000, 2900230770000, 2900230897000, 2900230934000, 2900231637000, 2900231842000, 2900231999000, 2900232605000, 2900232664000, 2900232943000, 2900233644000, 2900233823000, 2900234613000, 2900234660000, 2900235526000, 2900235583000, 2900236550000, 2900237363000, 2900237407000, 2900237430000, 2900238177000, 2900238208000, 2900238242000, 2900239050000, 2900239073000, 2900239098000, 2900239123000, 2900239392000, 2900239478000, 2900240021000, 2900240076000, 2900240169000, 2900240256000, 2900240331000, 2900241044000, 2900249769000, 2900320730000, 2900320792000, 2900320803000, 2900320971000, 2900320987000, 2900321716000, 2900321818000, 2900321822000, 2900329948000, 2900330258000, 2900330514000, 2900331010000, 2900331035000, 2900331096000, 2900331227000, 2900331296000, 2900332088000, 2900332275000, 2900333069000, 2900333255000, 2900334120000, 2900334192000, 2900334266000, 2900334297000, 2900335164000, 2900335269000, 2900336154000, 2900336289000, 2900336322000, 2900336349000, 2900337078000, 2900337112000, 2900337335000, 2900337461000, 2900338034000, 2900338081000, 2900430062000, 2900431009000, 2900326210000 Prepared by and Return to: Seyfarth Shaw LLP 1075 Peachtree Street, Suite 2500 Atlanta, Georgia 30309 Attention: Tim N. Tucker, Esq. Brief Description for the Index Tract 1: Plat Book 23, Pages 136-137; Tract 2: Plat Book 23, Pages 136-137 NORTH CAROLINA SPECIAL WARRANTY DEED THIS DEED made this 7th day of June, 2024, by and between -310533851v.4 310533851.4 GRANTOR WALLACE LOFT LLC, a Delaware limited liability company c/o Mapletree US Management, LLC 5 Bryant Park, 28th Floor New York, New York 10018 GRANTEE BOONE OWNER LLC, a Delaware limited liability company c/o Timberline Real Estate Ventures, LLC 2 School Street Rye, New York 10580 Enter in appropriate block for each party: name, address, and, if appropriate, character of entity, e.g. corporation or partnership. The designation Grantor and Grantee, 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 Grantor, for and in consideration of the sum of TEN DOLLARS ($10) and other good and valuable consideration in hand paid to the undersigned by Grantee, the receipt and sufficiency of such consideration being hereby acknowledged, has GRANTED, SOLD AND CONVEYED, and by these presents does hereby GRANT, SELL, CONVEY and CONFIRM unto Grantee that certain real property being more particularly described on Exhibit A attached hereto and made a part hereof for all purposes, together with all improvements and fixtures situated thereon (collectively, the “Property”); SUBJECT TO all real estate taxes not yet delinquent; covenants, conditions, restrictions, easements, rig hts of way and other matters of record; applicable laws, ordinances, statutes, orders, requirements and regulations to which the Property is subject; and all matters disclosed by an accurate survey of the Property. The Property hereinabove described was acquired by Grantor by instrument recorded in Book 1921, Page 464, Watauga County Registry. All or a portion of the Property herein conveyed do es not include the primary residence of Grantor. TO HAVE AND TO HOLD the Property, together with all and singular the rights, hereditaments, and appurtenances thereto in anywise belonging, unto Grantee, its successors and assigns, and Grantor hereby agrees to WARRANT AND FOREVER DEFEND all and singular the Property unto Grantee, its successors and assig ns, against every person whomsoever lawfully claiming, or claim the same, or any part thereof, by, through, or under Grantor but not otherwise. [Remainder of page intentionally left blank; Signat ures on following pages] IN WITNESS WHEREOF, Grantor has caused this instrument to be signed and delivered as of the date indicated on the first page of this Deed. GRANTOR: WALLACE LOFT LLC, a Delaware limited liability company Name: David Timmerman Title: Director STATE OF NEW YORK ) COUNTY OF &#V Personally appeared before me, the undersigned, a Notary Public in and for said State and County, David Timmerman, with whom I am personally acquainted (or proved to me on the basis of satisfactory evidence), and who upon oath acknowledged himself to be the Director of WALLACE LOFT LLC, a Delaware limited liability company, and that he as such Director, being authorized to do so, executed the forgoing instrument for the purposes therein contained, by signing the name of the limited liability company in his capacity as Director. WITNESS my hand and seal at office this day of June, 2024. � otary Public My Commission Expires: HORIM KATE LEE-McCONNELL NOTARY PUBLIC, STATE OF NEW YORK Registration No. 02LE6300139 Qualified in New York County Commission Expires July 9 20G 310533851.4 EXHIBIT A Legal Description TRACT 1: BEING A CERTAIN TRACT OF LAND, BEING LOCATED IN THE NEW RIVER TOWNSHIP, WATAUGA COUNTY, NORTH CAROLINA BEING THE COMBINED PROPERTY NOW KNOWN AS "TRACT 1", AS RECORDED IN PLAT BOOK 23, PAGE 136 AND PAGE 137, AT THE WATAUGA COUNTY PUBLIC REGISTRY, CONTAINING 60.707 ACRES. TRACT 2: BEING A CERTAIN TRACT OF LAND, BEING LOCATED IN THE NEW RIVER TOWNSHIP, WATAUGA COUNTY, NORTH CAROLINA NOW KNOWN AS "TRACT 2", AS RECORDED IN PLAT BOOK 23, PAGE 136 AND PAGE 137, AT THE WATAUGA COUNTY PUBLIC REGISTRY CONTAINING 10.053 ACRES. TRACT 3: TOGETHER WITH THE APPURTENANT RIGHTS AND EASEMENTS IN THAT ACCESS AND UTILITY EASEMENT AGREEMENT RECORDED IN BOOK 1632, PAGE 826, WATAUGA COUNTY REGISTRY. TRACT 4: TOGETHER WITH THE APPURTENANT RIGHTS AND EASEMENTS IN THAT ACCESS AND UTILITY EASEMENT AGREEMENT RECORDED IN BOOK 1632, PAGE 844, WATAUGA COUNTY REGISTRY, AS AMENDED IN BOOK 1687, PAGE 267, WATAUGA COUNTY REGISTRY. TRACT 5: TOGETHER WITH THE APPURTENANT RIGHTS AND EASEMENTS IN THAT RIGHT OF WAY AGREEMENT RECORDED IN BOOK 911, PAGE 49, WAT AUGA COUNTY REGISTRY.