NC0076708_Owner (Name Change)_20160509

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May 5, 2016
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: NPDES Permit NC0076708 RECEIVEDINCDEWWR
Riverwind Mobile Home Park WWTP MAY 0 9 2016
Henderson County Water Quality
Permit Ownership Change Request Permitting Section
To Whom It May Concern:
Enclosed for your review, please find a Permit Ownership Change Request application and
supporting documentation for the above reference facility in duplicate.
• Sewer System Permit Ownership Change PNOCF 08-13
• Permit Name/Ownership Change Request
• Current NPDES Permit NCO076708
• Wastewater System Asset Purchase Agreement
• Memorandum of Lease
• Bill of Sale
• Certificate of Public Convenience and Necessity
If you have any questions, comments, or need further information, please feel free to call me
[phone] ext. 128 or email me at sheilat(�oldieassociates.com. Thank you for your
assistance on this application.
Sincerely,
JACABB UTILITIES, LLC
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Sheila J. Tinsle
J-�/
Executive Assistant
Enclosures
210 W. North Second St. 9 Seneca, SC 29678 9 Phone [phone] Fax[phone]

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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Donald R.van der Vaart
Governor WATER QUALITY PERMITTING SECTION Secretary
PERMIT NAME/OWNERSW CHANGE REQUEST
This form is for ownership changes or name changes of NPDES wastewater permits.
• "Permittee"references the existing permit holder
• "Applicant"references the entity applying for the ownership/name change.
1. NPDES Permit No.(for which the change is requested: N C 0 0 7 6 7 0 8
or
Certificate of Coverage#: l l` C G 5 T�
11. Existing Permittee Information:
a. Permit issued to(company name): Riverwind Homeowners Association
b. Person legally responsible for permit: David R Losleben
First Ml Last
Director
Title
30 Riverwind Drive
Permit Holder Mailing Address
Hendersonville NC 28739-
City State Zip
[phone] [phone]
Phone Fax
c. Facility name: Riverwind Mobile Home Park
d. Facility's physical address: 472 Riverwind Drive
Address
Hendersonville NC 28739
City State Zip
e. Facility contact person: David R. Losleben [phone]
First / MI / Last Phone
III. Applicant Information:
a. Request for change is a result of ® Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): JACABB Utilities,LLC
c. Person legally responsible for permit: Stephen R Goldie
First MI Last
Managing Owner
Title
210 W.N.2nd Street
Permit Holder Mailing Address
Seneca SC 29678-
City State Zip
[phone] [e-mail]
Phone E-mail Address
Page 1 of 2 Revised 7/01/2014

d. Facility name: Riverwind Mobile Home Park
e. Facility's physical address: 472 Riverwind Drive
Address
Hendersonville NC 28739-
City State Zip
f Facility contact person: Andrew Hooper
First MI Last
Field Manager
Title
[phone] drewh ,goldieassociates.com
Phone E-mail Address
IV. Will the permitted facility continue to conduct the same commercial/industrial activities conducted prior to
this ownership or name change?
® Yes
❑ No(please explain)
If applicable,the applicant shall submit a major permit modification request to DWR.A major modification shall be
defined as one that increases the volume,increases the pollutant load,results in a significant relocation of the
discharge point,or results in a change in the characteristics of the waste generated.
V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
I. This completed application is required for both name change and/or ownership change requests.
2. 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.
Applicable regulations:40 CFR 122.41,40 CFR 122.61 and 15A NCAC 02H .0114
...................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change(Permittee),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, David Losleben,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.
Signature Date
APPLICANT CERTIFICATION
1,Stephen Goldie,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
reqis not included,this application package will be returned as incomplete.
uired s pportin inform tion
"eF
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
Page 2 of 2 Revised 7/01/2014

MEMORAI"UM OF LEASE
THIS MEMORANDUM OF LEASE is entered into this_ 7— day of_ jNY—,
2016, by and between RIVERWIND HOME OWNER'S ASSOCIATIONS, INC., a North
Carolina non-profit corporation ("Landlord") and JACABB UTILITIES, LLC, a North Carolina
limited liability company ("Tenant").
WITNESSETH:
WfIEREAS, Landlord and Tenant entered into a lease dated October 1, 2015 (the
"Lease"), covering certain premises described and referred to as the "Waste Water Treatment
Plant Lot"' and
WHEREAS, it is the desire of the parties hereto to enter into a Memorandum of Lease for
the purpose of recording the same and giving notice of the existence of the Lease; and
NOW, THEREFORE, in consideration of the rents reserved and the covenants and
conditions more particularly set forth in the Lease, Landlord and Tenant do hereby represent the
following:
1. Landlord has leased unto Tenant and Tenant has rented from Landlord, certain real
property, more particularly described on Exhibit"A" attached hereto and
incorporated herein by preference (the "Premises").
2. The term of the Lease commenced on the 2A/ day of Ay ,
2016 and shall terminate on the last day of the ninety-ninth (99") year thereafter,
unless sooner terminated as provided in the Lease.
3. This instriunent is executed for the purpose of giving public record notice of the fact
of execution of the Lease, and all of the terms and conditions of the Lease and
amendments thereto, if any, are incorporated herein by reference. This Memorandum
of Lease shall extend to and be binding upon the parties hereto and their respective
successors and assigns.
IN WITNESS WHEREOF, the parties hereto have executed these presents and set their
hands and seals the day and year first above written.

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LANDLORD:
RIVERWIND FIONIE OWNER'S ASSOCIATION, INC.,
a North Carolina non-profit corporation
Y
David R. Losleben, President
STATE Or NORTH CAROLINA
COUNTY OF HENDERSON
On _ a (10 , before,- (10� Lf4 `notary
public, personally appeared DAVID R. LOSLEHEN or roved to me on the basis of s tisfactor
p , p Y pp � P � Y
evidence) to be the person whose name is subscribed to the within instrument and acknowledged
to me that he executed the same in his authorized capacity and that by his signature on the
instrument the person or the entity upon behalf of which the person acted, executed the
instrument.
WITNESS my hand and ofTiciaLsta or seal.
Signatur • EAL)
[N .-ARY SEAL OR S'T'AMP]
JAMIE N HARRINGTON
Q , Notary Public, North Carolina
<:. Buncombe County
My Cor niissi n Expires
•. _ L$ �-

TENANT:
JACABB UTILITIES, LLC, a North Carolina limited
liability company
c
By:
tephen R. Goldie, Managing Owner
STATE OF SOUTH CAROLINA
COUNTY OF OCONEE
On ,; > , before, etla J7'7_/r7_�/ee,j , a notary
public, personally appeared TEPHEN R. GOLDIE (or proved to me on the basis o satisfactory
evidence) to be the person whose name is subscribed to the within instrument and acknowledged
to me that he executed the same in his authorized capacity and that by his signature on the
instrument the person or the entity upon behalf of which the person acted, executed the
instrument.
WITNESS my hand and official stamp or seal.
Signature / (SEAL)
[NOTARY SEAL OR STAMP]
my Ccmvn+5s� , Qx�i'res ��aa/ael 6

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EXMBIT"A"
WASTEWATER TREATMENT PLANT LOT
That certain lot located between Lots 35 and 476 of Riverwind,more particularly described as follows:
BEGINNING ata new iron pin located in the common boundary line of the properly of James E.Jones
(now or formerly)("Jones") pursuant to deed recorded in Book 731, Page 893 of the Henderson County
Public Registry(the"Registry")and the properly of Oakwood Land Development Corporation (now or
formerly)("Oakwood")pursuant to deed recorded in Book 813, Page 231 of the Registry,said new iron
pin being located the following two(2)courses and distances from an existing iron pin located at the
easternmost corner of the Oakwood property and a common corner with Jones:(l)North 03-18-01 West
416.82 feet to an existing iron pin, another common corner with Jones; and(2)North 59-18-23 West
263.41 feet to the POINT OR PLACE OF BEGINNING, and running thence from said Point or Place of
Beginning and continuing with the common boundary line of property of Oakwood and Jones the
following two(2)courses and distances: (1)North 59-18-23 West 25.00 feet to a point located at the
southwesterly terminus of the centerline of an easement described in Book 731, Page 898 of the Registry;
and (2)North 59-18-23 West 74.60 feet to a new iron pin, said new iron pin being located South 5948-23
East 1=41.15 feet fi•om an existing iron pin located at another common corner of the property of Oakwood
and Jones; thence leaving the common boundary line of the property of Oakwood.and Jones a new line as
follows,South 30-41-37 West 30.83 feet to a new iron pin;thence North 89-21-16 West 30.69 feet to a
new iron pin; thence South 81-28-05 West 42.55 feet to a new iron pin;thence South 72-18-57 West
108.66 feet to a new iron pin; thence South 80-44-07 West 38.14 feet to a new iron pin located in the
easterly margin of the proposed right-of-way of Riverwind Drive; thence with the easterly margin of the
proposed right-of-way the following three(3)courses and distances:(1)with the are of a circular curve to
the right having a radius of 176.00 feet, an are distance of 31.61 feet and a chord bearing and distance of
South 51-10-17 East 31.56 feet to a point;(2) with the arc of a circular curve to the left having a-radius of
235.00 feet,an arc distance of 44.20 feet and a chord bearing and distance of South 51-24-55 East 44.14
feet to a new iron pin; and(3)with the arc ora circular curve to the right having a radius of 140.00 feet,
an arc distance of 51.28 feet and a chord bearing and distance of South 46-18-36 East 51.00 feet to a new
iron pin; thence leaving the margin of the proposed right-of-way of Riverwind Drive,North 76-54-46
East 175.04 feet to a new iron pin; thence North 37-29-21 East 80.27 feet to the POINT OR PLACE OF
BEGINNING and containing approximately 0.58 acres all as shown on a survey entitled "Plat of
Oakwood band Development Corporation Sewer Plant Lot"dated January 26, 1999 and prepared by
Steven Lloyd Waggoner NC PLS 2874.
TOGETHER WITH a right of way being twenty-five(25) feet in width which extends from the property
described hereinabove to the French Broad River as set forth in the deed to the Grantor recorded in Book
813, Page 231 of dic Henderson County Registry.