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Home My WebLink AboutNCG550127_Permit (Issuance)_20090610 ArgC.11A • NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality _ Beverly Eaves Perdue Coleen H. Sullins Dee Freeman Governor Director Secretary June 10, 2009 CHRISTOPHER K KIMSEY . ERICA S KIMSEY 2162 UPPER LAKE ROAD THOMASVTT.L E NC 27360 Subject:NPDES Permit Modification-Name and/or Ownership Change Christopher K.Kimsey&Erica S.Kimsey-Residence Formerly Zachary T.Harris-Residence Certificate of Coverage NCG550127 Davidson County Dear Mr. and Ms.Kimsey: Division personnel have reviewed and approved your request for ownership change of the subject certificate of coverage received on June 10,2009. This permit modification documents the change of ownership of the above reference facility. Please find enclosed the revised certificate of coverage. All other terms and conditions contained in the original certificate remain unchanged and in full effect. This modification is issued under the requirements of North Carolina General Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.Environmental Protection Agency. If you have any questions concerning this permit modification,please contact the Point Source Branch at(919) 807-6304. Sincerely, r/ Coleen H. Sullins rl cc: Central Files Winston-Salem Regional Office, Surface Water Protection - MI �: Vilna 1617 Mail Service Center,Raleigh,North Carolina 27699-1617 . Location:512 N.Salisbury St.Raleigh,North Carolina 27604 One Phone:919-807-63001 FAX:919-807-64921 Customer Service:1-877-623-6748 North Carolina Internet:www.ncwaterquality.org s,r��Je, An Equal Opportunity\Affirmative Action Employer Natl�6 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY GENERAL PERMIT NCG550000 CERTIFICATE OF COVERAGE NCG550127 DISCHARGE OF DOMESTIC WASTEWATER FROM SINGLE FAMILY RESIDENCES AND OTHER 100% DOMESTIC DISCHARGES WITH SIMILAR CHARACTERISTICS UNDER THE • NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and _ the Federal Water Pollution Control Act, as amended, Christopher K. Kimsey and Erica S. Kimsey is hereby authorized to discharge domestic wastewater [450 GPD] from a facility located at . 2162 Upper Lake Road Davidson County to receiving waters designated as an unnamed tributary to Hamby Creek in subbasin 03-07-07 of the Yadkin River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof. This certificate of coverage shall become effective June 11, 2009. This Certificate of Coverage shall expire on July 31, 2012. Signed this day June 11, 2009. for , een H. Sullins, Director Division of Water Quality 3 By Authority of the Environmental Management Commission NA7 Beverly Eaves Perdue,Governor tir :- J Dee Freeman,Secretary 3 :' North Carolina Department of Environment and Natural Resources Ca" — Coleen H.Sullins,Director Division of Water Quality SURFACE WATER PROTECTION SECTION -1 PERMITf NAME/OWNERSHIP CHANGE FORM I. Please enter the permit number for which the change is requested. NPDES Permit (or) Certificate of Coverage N C 0 0 N 'C G 5 5 O I a ?7 II. Permit status prior to status change. a. Permit issued to(company name): _ b. Person legally responsible for permit: OJT' 7 �•a i vi }h k , First 1 MI Last t am, • ,' . (Pr( 0tabuJNi�C� 1 ;' Title aliDa UPPER LRikil, ?d J U N 1 0 2009 Permit Holder Mailing Address —117\0m2- Nl r 11-Q- N Q_ a13 Lc,0 City State Zip LII DENR - WATER QUALITY >Phoneika'17(0 Fax POINT SOU RC_a_I scharge): Nizi Ns'e k d. Facility address: a l b A PiUt LA Address City State LL,, Zip e. Facility contact person: 2:VIP/N \-�.rtn5 (��7 C 111Q First /MIV Last Phone III. Please provide the following for the requested change(revised permit). a. Request for change is a result of: VI 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: hr5 k i r1f1 iL,L( irst MI Lust a I to ,a l� Title , P>d Permit Holder Mailing Address -116 t'Y1Otb V + ( k. N Zl lQ 0 City State Zip : -3Le) 3S® U U 3'1 Phone E-mail Address d. Facility name(discharge): FIR 00 b �,f e. Facility address: `a I lc,a I R y Address . 1 homQejt 11-Q__ lJ& `a'13 L2 0 City i State Zip f. Facility contact person: 6.,Ilr i,b+c L 1- i ONS,ems, Firs MILast tom ') SSG 44 ' {1 1 Phone E-mail Address Revised 112009 EiV 1 LA 1 v-Y-, eAj gSo q 0 a PERMIT NAME/OWNERSHIP CHANGE FORM Page 2 of 2 IV. Permit contact information(if different fr m the perso legally responsible for the permit) Permit contact: V\1rl 5 0p j (Y First MI ) Last Q3 i �� Title —�-� Mailing ddress t ^�� 1'Yl�i��i 1 t� `^'1� City SS CD 4-Stat -1 Zip Phone E-mail Address V. Will the permitted facility continue to conduct the same industrial activities conducted prior to this ownership or name change? 1�4 Yes C+er� ❑ No(please explain) S( 0.5T'i al WO NdL&c \ Q(.r t\) t +i QS 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. �►; L J/ 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 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. 4709 /7/74--Signature Date APP ANT CERTIFICATION 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 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 ' omplete. Signa Date PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: Division of Water Quality Surface Water Protection Section 1617 Mail Service Center Raleigh,North Carolina 27699-1617 Revised 1/2009 • NORTH CAROLINA GENERAL WARRANTY DEED Excise Tax: S220.00 Recording Time, Book and Page: Tax Map No. Parcel Identifier No: 16-340-F-000-0015 Mail after recording to: GRANTEE: 2162 UPPER LAKE ROAD,THOMASVILLE,NC 27360 This instrument was prepared by: MARK L. MCGUIRE,ATTORNEY AT LAW,THOMASVILLE, NC(NO TITLE SEARCH PERFORMED OR REQUESTED) THIS DEED made this 17th day of April , 2009 by and between GRANTOR Zachary Todd Harris and wife,Ashley Hulin Harris GRANTEE Christopher K. Kimsey and wife, Erica S.Kimsey Property Address: 2162 Upper Lake Road,Thomasville,NC 27360 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 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 or parcel of land and more particularly described as follows: BEING: Lot No. 15 of CHARTER OAKS, according to the plat thereof,which is duly recorded in Plat Book 16, Page 51,in the Office of the Register of Deeds for Davidson County,North Carolina. All or a portion of the property hereinabove described was acquired by Grantor by instrument recorded in Book 1717 , Page 1236 , Davidson County Registry. A map showing the above described property is recorded in Plat Book 16 , Page 51 ,and referenced within this instrument. TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee in fee simple. And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee simple, has the right to convey the same in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against the lawful claims of all persons whomsoever except for the exceptions hereinafter stated. Title to the property hereinabove described is subject to the following exceptions: Power,telephone and utility easements of record or those visible upon the ground,if any. Any and all restrictions of record. IN WITNESS WHEREOF,the Grantor has hereunto set his hand and seal,or if corporate,has caused this instrument to be signed in its corporate name by its duly authorized officer(s),the day and year first above written. / ,,,„4 - (SEAL) (Entity Name) ha odd Harris By: ( EAL) Ash ey Hul n Harris Title: By: (SEAL) Title: (SEAL) NORTH CAROLINA a1.ta 111 COUNTY I certify that the following person(s)personally appeared before me this day,each acknowledging to me that h e or she signed the foregoing document: Zachary Todd Harris and wife,Ashley Hulin Harris .Witness my hand and official stamp or seal, this the 11-ii/1 day of ___ 4 �,0____a®aooa__ , f..)(0Gi I 1 P41,,t...-\(--- My Commission Expires: �q ��; ATI �� 4 s '�� , �`',tLA/1 /.1I1:16vfr � � =� t', ' I 1:a Notary Public Li ' II fl ro 1 (l., ' 1' Notary AÜICia IJIu e iJU+ki,i =�° '2;� 0`' ? PrintNota Name: ) Via, .� J e NORTH CAROLINA COUNTY I certify that the following person(s)personally appeared before me this day,each acknowledging to me that h e or she signed the foregoing document: , .Witness my hand and official stamp or seal,this the day of My Commission Expires: Notary Public Print Notary Name: