NCG520091_Owner (Name Change)_20240809

•
C.`y ;L ipr
a,.r,�. c',n o ny ?
iY
'0,t . NC DEPARTMENT OF ENVIRONMENTAL QUALITY
I. , ' -, - DIVISION OF WATER RESOURCES
ti 1n---, WATER QUALITY PERMITTING SECTION
NORTH CAROLINA NPDES PERMITTING
Environmental Quality
PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCOO / / / /_ or NCG5_2J_0J_0J_9J_1_
1. Facility Name: Kennedy Real Estate Holding
II. NEW OWNER/NAME INFORMATION: 1,
1. This request for a name change is a result of: RECEIVED
_ Change in ownership of property/company AUG 0 9 2024
b. Name change only NCDEQ/DWR/NPDES
c. Other(please explain):
2. New owner's name (name to be put on permit):
Kennedy Real Estate Holding, LLC
3. New owner's or signing official's name and title: Derick Cale Kennedy
(Person legally responsible for permit)
Manager/Member
(Title)
4. Mailing address: 1321 West Fairfield Road,Suite 101 City: High Point
State: NC Zip Code: 27263 Phone: [phone]
E-mail address: [e-mail]
III. FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same as under the previous owner? Yes X❑ No 0
2. Will the treatment system and discharge location remain the same? Yes X❑ No 0
"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.
North Carolina Department of Environmental Quality I Division of Water Quality
E }) 512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617
NORTH CAROLINA
°opa '°'E"'°am°°1°uB°"�/ 919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
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.
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:
I, Derick Cale Kennedy , 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: De‘x e• CAL,e, Date: 7-6-di/
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

2023001411
DAVIDSON COUNTY NC FEE$26.00
STATE OF NC REAL ESTATE EXTX
$349.00
PRESENTED&RECORDED
01/27/2023 01:19:33 PM
MICHAEL E. HORNE
REGISTER OF DEEDS
BY:TERRI S.WARD
ASSISTANT
BK: DE 2585
PG: 506-508
Submitted electronically by "Douglas B. Elliott PA"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Davidson County Register of Deeds.
NORTH CAROLINA
GENERAL WARRANTY DEED
Excise Tax: A 349, Recording Time, Book, and Page
Parcel Identifier No. 1630800000022
Mail after recording to: Grantee at property address.
This instrument was prepared by: CLINT CALAWAY, a licensed North Carolina attorney.
Delinquent taxes, if any, to be paid by the closing attorney to the county tax collector upon disbursement of closing
proceeds. NO TITLE SEARCH REQUESTED OR PERFORMED
THIS DEED made this �"1 day of . C1.V1U ,20/1 by and between
GRANTOR
GLENDA JOYCE BODENHEIMER, unmarried
200 GLENN DR., THOMASVILLE, NC 27360
GRANTEE
KENNEDY REAL ESTATE HOLDING, LLC
MAILING ADDRESS: 1321 W. FAIRFIELD ROAD, SUITE MIHIGH POINT, NC 27263
PROPERTY ADDRESS: 0 NC HWY 109, 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:
SEE ATTACHED LEGAL DESCRIPTION
TOGETHER WITH AND SUBJECT TO ALL EASEMENTS AND RESTRICTIONS OF RECORD, IF ANY.
All or a portion of the property hereinabove described was acquired by Grantor by instrument recorded in Book 108,Page 191;
AND DEED BOOK 134, PAGE 29, DAVIDSON County Registry. ALSO SEE ESTATE OF GLENN BODENHEIMER(09E57)
AND IDA BODENHEIMER(20E1607), DAVIDSON COUNTY.
2023001411

A map showing the above-described property is recorded in Plat Book--, Page--and referenced within this instrument.
The above-described property ❑ does❑ does not include the primary residence of the Grantor.
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, save and except easements, restrictions, and rights of way as
appear of record, and 2023 city-county ad valorem taxes, prorated between parties as of the date of delivery of this deed.
Title to the property hereinabove described Is subject to the following exceptions:
IN WITNESS WHEREOF,the Grantor has hereunto set her hand and seal the day and year first above written.
ALlet.� � ' (SEAL)
GLENDA JOYCE BODENHEIMER
(SEAL)
STATE OF 1 COUNTY OF i V I aJ a
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she
signed the foregoing document: GLENDA JOYCE BODENHEIMER
Witness my hand and official stamp or seal, this the 24 day of
's,�-.T.d1a£•.4i�r<S�?.✓r o'4r�LGt�t�::!<,fn,� �i" �'^—'
I;I BVA a Y L E OTx s�i,,. Notary ublic
NOTARY PUBLIC
c L 46-17L
r!;;'l�)SON COUNT`! Print N tary Name: �i
Sri�,rk C?� NORTH CI�RULII\4� �"'
MYY COMMISSION EXPIRES 0 , )
My Commission Expires: ` Z U L.-
2023001411

EXHIBIT A
BEGINNING at an existing iron pipe in the northwest corner of Lot 14 of Windsor
Hylls Subdivision and in the northeast corner of Lot 15 of Windsor Hylls
Subdivision (Plat Book 15, at Page 15, Davidson County Registry, said beginning
point being located also in the southwest corner of Jimmy Dale Brown and Melanie
Dawn Brown(Deed Book 1454, at Page 1562; thence from said beginning point with
the northern lines of Lots 15 and 16 of Windsor Hylls Subdivision North 87 deg. 47
min. 11 sec.West 200.55 feet to an existing iron pipe in the northwest corner of Lot
16 and in the northeast corner of Lot 17 of said subdivision; thence with the north
lines of Lots 17 and 18 of Windsor Hylls Subdivision North 87 deg. 51 min. 15 sec.
West 440.16 feet to a 5/8ths inch existing rod in the northernmost corner of Lot 19
of said subdivision and in the northeast corner of Victor Ray Murphy and Kathleen
J. Murphy (Deed Book 211, at Page 283 and Deed Book 679, at Page 807, Davidson
County Registry);thence with Murphy's northern line South 88 deg. 40 min. 20 sec.
West 140.08 feet to an existing iron pipe;thence continuing with Murphy's northern
line North 87 deg. 13 min. 11 sec. West 339.23 feet to an existing iron pipe; thence
North 39 deg. 38 min. 16 sec. West 21.83 feet to a point; thence North 60 deg. 35
min. 46 sec. East 25.49 feet to a point; thence North 28 deg. 57 min. 17 sec. West
58.67 feet to a concrete monument;thence South 61 deg. 06 min. 40 sec.West 28.21
feet to a concrete monument; thence North 33 deg. 04 min. 16 sec. West 197.14 feet
to an existing r/w spike; thence with the eastern right-of-way of NC Highway 109
North 19 deg. 17 min. 49 sec.West 709.98 feet to an existing right-of-way rebar and
cap; thence continuing with the eastern right-of-way of NC Highway 109 North 15
deg. 39 min. 39 sec.West 340.28 feet to a point;thence with the centerline of a creek
the following seventeen(17)courses and distances:(1) South 66 deg.46 min.25 sec.
East 87.70 feet to a point; thence (2) South 41 deg. 24 min. 35 sec. East 100.71 feet
to a point; thence (3) South 49 deg. 27 min. 07 sec. East 295.18 feet to a point;
thence (4) South 60 deg. 53 min. 26 sec. East 148.64 feet to a point; thence (5)
South 50 deg. 35 min. 18 sec.East 187.46 feet to a point;thence (6) South 69 deg.03
min, 05 sec. East 210.52 feet to a point; thence (7) South 78 deg. 15 min. 49 sec.
East 99.62 feet to a point; thence (8) South 70 deg. 19 min. 00 sec East 176.32 feet
to a point;thence (9) South 88 deg.44 min. 47 sec. East 35.18 feet to a point;thence
(10) South 74 deg. 33 min. 21 sec. East 105.13 feet to a point; thence (11) South 68
deg. 24 min. 18 sec. East 44.33 feet to a point; thence (12) South 84 deg. 09 min. 10
sec.East 85.97 feet to a point; thence (13) South 78 deg. 48 min. 07 sec. East 91.89
feet to a point;thence (14) South 76 deg. 32 min. 30 sec.East 103.13 feet to a point;
thence (15) South 85 deg. 02 min. 25 sec. East 52.94 feet to a point; thence (16)
North 68 deg. 17 min. 08 sec. East 37.78 feet to a point; and thence (17) South 88
deg. 32 min. 46 sec. East 61.18 feet a point; thence South 11 deg. 58 min. 05 sec.
West, passing through an existing iron pipe at 13.24 feet and continuing for an
additional 530.85 feet, for a total distance of 544.09 feet to the point and place of
BEGINNING, and containing 22.958 acres, more or less, according to a survey for
Ida P. Bodenheimer by Tri County Land Surveying (W. Lee Comer, PLS), dated
July 6th,2015, and designated as Job Number 150706IB/153693.
SUBJECT TO the right-of-way for North Carolina Highway 109, as described in the
NC Department of Transportation's right-of-way deed recorded in Deed Book 1526,
at Page 1459,in.the Davidson County Registry.
Deed Reference: Book 108, at Page 191-192, Davidson County Registry(Tract 2),
and
Deed Reference: Book 134, at Page 29,Davidson County Registry
Additional Back Title Reference: Estate of Glenn Bodenheimer, 09 E 57, Davidson
County;and Estate of Ida Bodenheimer, 20 E 1607,Davidson County
2023001411