SW8181118_CURRENT PERMIT_20200609

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8Q�'�1I M
DOC TYPE
� CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
QOaO J(oO7
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRIAN WRENN
Acting Director
June 9, 2020
NORTH CAROLINA
Environmental Quality
G&H Hauling, LLC, Owner of the Coastal Express Car Wash portion
Attn: Phillip D. Gause, Member Manager
4623 Maple Hill Road
Shallotte, NC 28470
Cook Out — Shallotte, Inc., Owner for the Cook Out portion
Attn: Jeremy Reaves, President
15 Laura Lane, Suite 300
Thomasville, NC 27360
Subject: Approved Minor Modification
Stormwater Permit No. SW8 181118
Coastal Express Car Wash and Cook Out
Brunswick County
Dear Mr. Gause and Mr. Reaves:
On April 9, 2020, the Wilmington Regional Office of the Division of Energy, Mineral and Land
Resources received and accepted a complete minor modification application for changes to the approved
plans for Stormwater Management Permit Number SW8 1811 l 8. It has been determined that the nature
of the proposed change meets the definition of a minor modification in that it does not result in an
increase in the size of the permitted stormwater control measure (SCM) and does not increase the amount
of built -upon area. Please refer to Attachment C for a detailed description of the current proposed minor
modification. We are forwarding you an approved copy of the modified plans for your files. Please add
the attached plans to the previously approved plan set. Please replace the previously issued permit with
the revised permit, dated June 9, 2020, attached.
Please be aware that all terms and conditions of the permit issued on June 9, 2020 and modified as
attached, remain in full force and effect. Please also understand that the approval of this minor
modification to the subject State Stormwater Permit is done on a case -by -case basis. Any other changes
to this project must be approved through this Office prior to construction. The approval of this minor
modification does not preclude the permittee from complying with all other applicable statutes, rules,
regulations or ordinances which may have jurisdiction over the proposed activity, and obtaining a permit
or approval prior to construction.
If you have any questions concerning this matter, please contact Christine Mall in the Wilmington
Regional Office at [phone] or [e-mail].
Sincerely,
r, Brian Wrenn, Acting Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment A — Designer's Certification Form
Attachment C — Permitting History
Application Documents
DESlcanh: 111StorinwaterlPermits & Projects120181i81 118 HD12020 06 permit minor 181 118
cc: Chris Russell, PE; East Coast Engineering & Surveying
Brunswick County Engineering
Wilmington Regional Office Stormwater File
QNorth� Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
egWilmington Regional office 1 127 Cardinal Drive Extension I Wilmington. North Carolina 28405
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Qa �\� 910.7%.7215

State Stormwater Management
Permit No. SW8 181118
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
In compliance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations promulgated and adopted by the North
Carolina Environmental Management Commission, including 15A NCAC 02H.1000 amended on
January 1, 2017 (2017 Rules) (the "stormwater rules"),
PERMISSION IS HEREBY GRANTED TO
G&H Hauling, LLC and Cook Out-Shallotte, Inc.
Coastal Express Car Wash and Cook Out
4447 and 4455 Main Street, Shallotte, Brunswick County
construction, management, operation and maintenance of built -upon area (BUA) and one (1) wet
detention pond ("stormwater control measure" or "SCM") as outlined in the application, approved
stormwater management plans, supplement, calculations, operation and maintenance agreement,
recorded documents, specifications, and other supporting data (the "approved plans and
specifications") as attached and/or on file with and approved by the Division of Energy, Mineral and
Land Resources (the "Division" or "DEMLR"). The project shall be constructed, operated and
maintained in accordance with these approved plans and specifications. The approved plans and
specifications are incorporated by reference and are enforceable part of this permit.
This permit shall be effective from the date of issuance until January 4, 2027 and shall be subject to
the following specified conditions and limitations. The permit issued shall continue in force and effect
until the permittee files a request with the Division for a permit modification, transfer, renewal, or
rescission; however, these actions do not stay any condition. The issuance of this permit does not
prohibit the Director from reopening and modifying the permit, revoking and reissuing the permit, or
terminating the permit for cause as allowed by the laws, rules, and regulations contained in Title 15A
NCAC 2H.1000 and NCGS 143-215.1 et.al.
BUA REQUIREMENTS. The following requirements pertain to the BUA on this project:
a. PROJECT BUA LIMITS. The maximum amount of BUA allowed for the entire project is
65,930 square feet.
b. RUNOFF FROM BUA. The runoff from all BUA within the permitted drainage area of this
project must continue to be directed into the permitted SCM.
c. SCM BUA LIMITS. The SCM has been designed using the runoff treatment method to
handle the runoff from 65,930 square feet of BUA within the delineated drainage area. The
BUA for the future development is limited to a total of 16,684 square feet where 7,096 sf has
been allocated to the Coastal Express Car Wash portion and 9,588 square feet has been
allocated to the Cook Out portion.
Page 1 of 5

State Stormwater Management
Permit No. SW8 181118
2. SCM REQUIREMENTS. The following requirements pertain to the SCMs on this project:
a. SCM DESIGN. The SCM is permitted based on the design criteria presented in the sealed,
signed and dated supplement and as shown in the approved plans and specifications. This
SCM must be provided and maintained at the design condition.
b. SCM DISCHARGE. The peak flow from the 10-year storm event shall not cause erosion
downslope of the stormwater outlet discharge point.
c. PLANTING PLAN. The SCM landscape planting plan shown in the approved plans shall be
followed in its entirety during construction. After the plants are established, the operation
and maintenance agreement must be followed.
d. FOUNTAINS. At this time, a decorative spray fountain has not been proposed within the wet
pond. Decorative spray fountains will be allowed in the wet pond if documentation is
provided demonstrating that the proposed fountain will not cause resuspension of sediment
within the pond or cause erosion of the pond side slopes.
e. IRRIGATION. If the wet pond is to be used for irrigation, it is recommended that some water
be maintained in the permanent pool, the vegetated shelf is planted with appropriate species
that can handle fluctuating conditions, and human health issues are addressed.
3. VEGETATED SETBACKS. A 50-foot wide vegetative setback must be provided and maintained
in grass or other vegetation adjacent to all surface waters as shown on the approved plans. The
setback is measured horizontally from the normal pool elevation of impounded structures, from
the top of bank of each side of streams or rivers, and from the mean high waterline of tidal
waters, perpendicular to the shoreline.
a. BUA IN THE VEGETATED SETBACK. BUA may not be added to the vegetated setback
except as shown on the approved plans.
b. RELEASE OF STORMWATER NOT TREATED IN AN SCM. Stormwater that is not treated
in an SCM must be released at the edge of the vegetated setback and allowed to flow
through the setback as dispersed flow.
4. RECORDED DOCUMENT REQUIREMENTS. The stormwater rules require the following
documents to be recorded with the Office of the Register of Deeds:
a. ACCESS AND/OR EASEMENTS. The entire stormwater conveyance system, including any
SCMs, and maintenance accesses must be located in public rights -of -way, dedicated
common areas that extend to the nearest public right-of-way, and/or permanent recorded
easements that extend to the nearest public right-of-way for the purpose of inspection,
operation, maintenance, and repair.
b. OPERATION AND MAINTENANCE AGREEMENT. The operation and maintenance
agreement must be recorded with the Office of the Register of Deeds.
c. FINAL PLATS. The final recorded plats_must reference the operation and maintenance
agreement and must also show all public rights -of -way, dedicated common areas, and/or
permanent drainage easements, in accordance with the approved plans.
d. DEEDS. The permittee shall record deed restrictions and protective covenants prior to the
issuance of a certificate of occupancy to ensure the permit conditions and the approved
plans and specifications are maintained in perpetuity.
5. CONSTRUCTION. During construction, erosion shall be kept to a minimum and any eroded
areas of the on -site stormwater system will be repaired immediately.
a. SCM OPERATIONAL PRIOR TO DEVELOPMENT. During construction, all operation and
maintenance for the project shall follow the Erosion Control Plan requirements until the
Sediment -Erosion Control devices are converted to SCMs. Once the device is converted to
a SCM, the permittee shall provide and perform the operation and maintenance as outlined
in the applicable section below.
Page 2 of 5

State Stormwater Management
Permit No. SW8 181118
b. SCM RESTORATION. If one or more of the SCMs are used as an Erosion Control device
and/or removed or destroyed during construction, it must be restored to the approved state
stormwater design condition prior to close-out of the erosion control plan and/or project
completion and/or transfer of the state stormwater permit. Upon restoration, a new or
updated certification will be required for the SCM(s) and a copy must be submitted to the
appropriate DEQ regional office.
6. MODIFICATIONS. No person or entity, including the permittee, shall alter any component
shown in the approved plans and specifications. Prior to the construction of any modification to
the approved plans, the permittee shall submit to the Director, and shall have received approval
for modified plans, specifications, and calculations including, but not limited to, those listed
below:
a. Any modification to the approved plans and specifications, regardless of size including the
SCM(s), BUA, details, etc.
b. Redesign or addition to the approved amount of BUA or to the drainage area.
c. Further development, subdivision, acquisition, lease or sale of any, all or part of the project
and/or property area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any
component of the approved SCM(s), stormwater collection system and/or vegetative
conveyance shown on the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement for BUA credit that was not included in the
approved plans and specifications.
g. The construction of any #57 stone area, public trails, or landscaping material to be
considered a permeable surface that were not included in the approved plans and
specifications.
h, Other modifications as determined by the Director.
7. DESIGNER'S CERTIFICATION. Upon completion of the project, the permittee shall determine if
the project is in compliance with the approved plans and take the necessary following actions:
a. If the permittee determines that the project is in compliance with the approved plans, then
within 45 days of completion, the permittee shall submit to the Division one hard copy and
one electronic copy of the following:
i. The completed and signed Designer's Certification provided in Attachment A
noting any deviations from the approved plans and specifications. Deviations
may require approval from the Division;
ii. A copy of the recorded operation and maintenance agreement;
iii. Unless already provided, a copy of the recorded deed restrictions and
protective covenants; and
iv. A copy of the recorded plat delineating the public rights -of -way, dedicated
common areas and/or permanent recorded easements, when applicable.
b. If the permittee determines that the project is not in compliance with the approved plans, the
permittee shall submit an application to modify the permit within 30 days of completion of the
project or provide a plan of action, with a timeline, to bring the site into compliance.
8. OPERATION AND MAINTENANCE. The permittee shall provide and perform the operation and
maintenance necessary, as listed in the signed operation and maintenance agreement, to
assure that all components of the permitted on -site stormwater system function at the approved
design condition. The approved operation and maintenance agreement must be followed in its
entirety and maintenance must occur at the scheduled intervals.
a. CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the
permittee shall take immediate corrective actions. This includes actions required by this
Division and the stormwater rules such as the construction of additional or replacement on -
site stormwater systems. These additional or replacement measures shall receive a permit
from the Division prior to construction.
b. MAINTENANCE RECORDS. Records of maintenance activities must be kept and made
available upon request to authorized personnel of the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
Page 3 of 5

State Stormwater Management
Permit No. SW8 181118
9. PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days prior to the
expiration date of this permit. The renewal request must include the appropriate application,
documentation and the processing fee as outlined in Title 15A NCAC 02H.1045(3). .
10. CURRENT PERMITTEE NAME OR ADDRESS CHANGES. The permittee shall submit a
completed Permit Information Update Application Form to the Division within 30 days to making
any one or more of the following changes:
a. A name change of the current permittee;
b. A name change of the project;
c. A mailing address change of the permittee.
11. TRANSFER. This permit is not transferable to any person or entity except after notice to and
approval by the Director. Neither the sale of the project and/or property, in whole or in part, nor
the conveyance of common area to a third party constitutes an approved transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in Title 15A NCAC 02H.1045(2) and must
be submitted upon occurrence of any one or more of the following events:
i. The sale or conveyance of the project and/or property area in whole or in part;
ii. Dissolution of the partnership, corporate, or LLC entity, subject to NCGS 55-14-05
or NCGS 57D-6-07 and (8);
iii. Bankruptcy;
iv. Foreclosure, subject to the requirements of Session Law 2013-121;
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site inspection
will be conducted by Division personnel to ensure the permit conditions have been met and
that the project and the on -site stormwater system complies with the permit conditions.
Records of maintenance activities performed to date may be requested. Projects not in
compliance with the permit will not be transferred until all permit and/or general statute
conditions are met.
12. COMPLIANCE. The permittee is responsible for complying with the terms and conditions of this
permit and the approved plans and specifications until the Division approves the transfer
request.
a. REVIEWING AND MONITORING FOR COMPLIANCE. The permittee is responsible for
verifying that the proposed BUA for the entire project does not exceed the maximum amount
allowed by this permit. The permittee shall review and routinely monitor the project to
ensure continued compliance with the conditions of the permit, the approved plans and
specifications.
b. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved plans,
application, supplements, operation and maintenance agreement, all applicable recorded
documents, and specifications shall be maintained on file by the permittee at all times.
c. DIVISION ACCESS. The permittee grants Division Staff permission to enter the property
during normal business hours to inspect all components of the permitted project.
d. ENFORCEMENT. Any individual or entity found to be in noncompliance with the provisions
of a stormwater management permit or the requirements of the stormwater rules is subject to
enforcement procedures as set forth in NCGS 143 Article 21.
e. OBTAINING COMPLIANCE. The Director may notify the permittee when the permitted site
does not meet one or more of the minimum requirements of the permit. Within the time
frame specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee shall provide
copies of modified plans and certification in writing to the Director that the changes have
been made.
Page 4 of 5

State Stormwater Management
Permit No. SW8 181118
OTHER PERMITS. The issuance of this permit does not preclude the permittee from
obtaining and complying with any and all other permits or approvals that are required in
order for this development to take place, as required by any statutes, rules, regulations, or
ordinances, which are imposed by any other Local, State or Federal government agency
having jurisdiction. Any activities undertaken at this site that cause a water quality violation
or undertaken prior to receipt of the necessary permits or approvals to do so are considered
violations of NCGS 143-215.1, and subject to enforcement procedures pursuant to NCGS
143-215.6.
Permit modified, updated, and reissued this the 91h day of June 2020,
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Brian Wrenn, irector
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 181118
Page 5 of 5

State Stormwater Management
Permit No. SW8 181118
Attachment A
Certification Forms
The following blank Designer Certification forms are included and specific for this project:
• As -Built Permittee Certification
• As -Built Designer's Certification General MDC
• As -Built Designer's Certification for Wet Detention Pond Project
A separate certification is required for each SCM. These blank certification forms may be copied and
used, as needed, for each SCM and/or as a partial certification to address a section or phase of the
project.
Page 1 of 1

State Stormwater Management Systems
Permit No. SW8 181118
AS -BUILT PERMITTEE CERTIFICATION
1 hereby state that I am the current permittee for the project named above, and I certify by my signature below,
that the project meets the below listed Final Submittal Requirements found in NCAC 02H.1042(4) and the
terms, conditions and provisions listed in the permit documents, plans and specifications on file with or provided
to the Division.
HCheck here if this is a partial certification. Section/phase/SCM #?
Check here if this is part of a Fast Track As -built Package Submittal.
Printed Name
County of
Signature
a Notary Public in the State of
do hereby certify that
personally appeared before me this day of , 20
and acknowledge the due execution of this as -built certification. (SEAL)
Witness my hand and official seal
My commission expires
Pennittee's Certification NCAC .1042(4)
Complet d ed I
Prov
N/A
A. DEED RESTRICTIONS / BUA RECORDS
l . The deed restrictions and protective covenants have been recorded and
Y or N
contain the necessary language to ensure that the project is maintained
consistent with the stormwater regulations and with the permit conditions.
2. A copy of the recorded deed restrictions and protective covenants has been
Y or N
provided to the Division.
3. Records which track the BUA on each lot are being kept. (See Note 1)
Y or N
B. MAINTENANCE ACCESS
I. The SCMs are accessible for inspection, maintenance and repair.
Y or N
2. The access is a minimum of 10 feet wide.
Y or N
3. The access extends to the nearest public right-of-way.
Y or N
C. EASEMENTS
1. The SCMs and the components of the runoff collection / conveyance system
Y or N
are located in recorded drainage easements.
2. A copy of the recorded plat(s) is provided.
Y or N
D. SINGLE FAMILY RESIDENTIAL LOTS - Plats for residential lots that
Y or N
have an SCM include the following:
1. The specific location of the SCM on the lot.
Y or N
2. A typical detail for the SCM.
Y or N
3. A note that the SCM is required to meet stormwater regulations and that the
lot owner is subject to enforcement action as set forth in NCGS 143 Article
Y or N
21 if the SCM is removed, relocated or altered without prior approval.
E. OPERATION AND MAINTENANCE AGREEMENT
Y or N
1. The O&M Agreement is referenced on the final recorded plat.
Y or N
2. The O&M Agreement is recorded with the Register of Deeds and appears in
Y or N
the chain of title.
F. OPERATION AND MAINTENANCE PLAN — maintenance records are
Y or N
being kept in a known set location for each SCM and are available for review.
G. DESIGNER'S CERTIFICATION FORM — has been provided to the
Y or N
Division.
Notel - Acceptable records include ARC approvals, as -built surveys, and county tax records.
Page l of 6

State Stormwater Management Systems
Permit No. SW8 181118
Provide an explanation for every requirement that was not met, and for every "NIA" below. Attach
additional sheets as needed.
Page 2 of 6

State Stormwater Management Systems
Permit No, SW8 181118
AS -BUILT DESIGNER'S CERTIFICATION GENERAL MDC
hereby state that I am a licensed professional and I certify by my signature and seal below, that I have observed
the construction of the project named above to the best of my abilities with all due care and diligence, and that
the project meets the below listed General ,MDC found in NCAC 02H.1050 in accordance with the permit
documents, plans and specifications on File with or provided to the Division, except as noted on the
BUILT" drawings, such that the intent of the stormwater rules and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM 4?
Check here if this is a part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed Name
NC Registration Number
SEAL:
Signature
Date
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
ON/E = not evaluated (provide explanation on page 2) ON/A = not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) & General MDC .1050
OAs-built
ON/E
ON/A
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
Y or N
2. The SCM achieves runoff volume match.
Y or N
3. Runoff from offsite areas and/or existing BUA is bypassed.
Y or N
4. Runoff from offsite areas and/or existing BUA is directed into
Y or N
the permitted SCM and is accounted for at the full build -out
potential.
5. The project controls runoff through an offsite permitted SCM
Y or N
that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project has
Y or N
been accounted for at the appropriate design storm level.
7. The SCM(s) meets all the specific minimum design criteria.
Y or N
B. VEGETATED SETBACKS / BUA
[ . The width of the vegetated setback has been measured from
Y or N
the normal pool of impounded waters, the ,MHW line of tidal
waters, or the top of bank of each side of rivers or streams.
2. The vegetated setback is maintained in grass or other
Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7 (b2)(2)
Y or N
is located in the setback.
4. BUA that does not meet the requirements of NCGS 143-214.7
Y or N
(b2)(2) is located within the setback and is limited to:
a. Publicly funded linear projects (road, greenway sidewalk)
b. Water -dependent structures
c. Minimal footprint uses (utility poles, signs, security
lightin and nd ap urtenances
Page 3 of 6

State Stormwater Management Systems
Permit No. SW8 181118
5. Stormwater that is not treated in an SCM is released at the
Y or N
edge of the setback and allowed to flow through the setback as
dispersed flow.
OAs-built
mN/E
OO N/A
C. STORMWATER OUTLETS — the outlet handles the peak flow
Y N
from the 10 year storm with no downs lope erosion_
or
D. VARIATIONS
1. A variation (alternative) from the stormwater rule provisions
Y N
has been implemented.
or
2. The variation provides equal or better stormwater control and
Y N
equal or better protection of surface waters.
or
E. COMPLIANCE WITH OTHER REGULATORY
Y N
PROGRAMS has been met.
or
F. SIZING -the volume of the SCM takes the runoff from all
surfaces into account and is sufficient to handle the required storm
Y or N
depth.
G. CONTAMINATED SOILS -- infiltrating SCM's are not located
Y or N
in or on areas with contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper than 3H:IV.
Y or N
2. Side slopes include retaining walls, gabion walls, or other
Y or N
surfaces that are steeper than 3H:1 V.
3. Vegetated side slopes are steeper than 3H:1 V (provide
Y or N
supporting documents for soils and vegetation),
L EROSION PROTECTION
1. The inlets do not cause erosion in the SCM.
Y or N
2. The outlet does not cause erosion downslope of the discharge
Y or N
point during the peak flow from the 10 ear storm.
J. EXCESS FLOWS — An overflow / bypass has been provided.
Y or N
K. DEWATERING — A method to drawdown standing water has
Y or N
been provided to facilitate maintenance and inspection.
L. CLEANOUT AFTER CONSTRUCTION — the SCM has been
Y or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair.
Y or N
2. The access does not include lateral or incline slopes >3:1.
Y or N
N. DESIGNER QUALIFICATIONS (FAST -TRACK PERMIT) —
The designer is licensed under Chapters 89A, 89C, 89E, or 89F of
Y or N
the General Statutes.
Provide an explanation for every MDC that was not met, and for every item marked "NIA" or "WE",
below. Attach additional pages as needed:
Page 4 of 6

State Stormwater Management Systems
Permit No. SW8 181118
AS -BUILT DESIGNER'S CERTIFICATION FOR WET DETENTION POND PROJECT
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I have observed
the construction of the project named above to the best of my abilities with all due care and diligence, and that
the project meets all of the MDC found in NCAC 02H.1053, in accordance with the permit documents, plans
and specifications on file with or provided to the Division, except as noted on the "AS -BUILT" drawings, such
that the intent of the stormwater rules and the general statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the Designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed Name
NC Registration Number
SEAL:
Signature
Date
Consultant's Mailing Address:
City/State/Z[P
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan/permit. If is circled, provide an explanation on page 2
ON/E = not evaluated (provide explanation on page 2) ON/A = not applicable to this project or SCM.
This Certification must be completed in conjunction with the General MDC certification under NCAC 02H.1050
Consultant's Certification (MDC .1053)
OAs-built
OWE
OO NIA
A. Forebay / Depths / Fountain
l . The available Sediment storage is consistent with the approved
Y N
Ian and is a minimum of 6 in.
or
2. Water flow over the forebay berm into the main pond occurs at a
Y N
non -erosive velocity.
or
3. The provided Forebay Volume is 15%-20% of the main pool
Y N
volume.
or
4. The Forebay entrance elevation is deeper than the exit elevation
Y N
into the pond.
or
5. The Average Design Depth of the main pond below the
Y N
permanent pool elevation is consistent with the permitted value?
or
6. Fountain documentation is provided.
Y or N
B. Side slopes / Banks / Vegetated Shelf
1. The width of the Vegetated Shelf is consistent with the approved
Y N
Tans and is a minimum of 6 feet.
or
2. The slope of the Vegetated Shelf is consistent with the approved
Y N
Tans and is no steeper than 6:1.
or
C. As -built Main Pool / Areas / Volumes / Elevations
1. The permanent pool surface area provided is consistent with the
Y N
permitted value.
or
2. The Temporary Pool Volume provided is consistent with the
y N
permitted value.
or
3. The permanent pool elevation is consistent with the permitted
Y N
value.
or
4. The temporary pool elevation is consistent with the permitted
Y N
value.
or
Page 5 of 6

State Stormwater Management Systems
Permit No. SW8 181118
DO As -built
©N/E
OO NIA
D. Inlets / Outlet / Drawdown
I .
The design volume draws down in 2-5 days.
Y
or
N
2.
The size of the Orifice is consistent with the permitted value.
Y
or
N
3.
A trash rack is provided on the outlet structure.
Y
or
N
4.
Hydrologic impacts to the receiving channel are minimized from
the l yr 24 hr storm discharge?
Y
or
N
5.
The inlets and the outlet location are situated per the approved
Ian and avoid short-circuiting.
y
or
N
E. Vegetation
1.
The vegetated shelf has been planted with a minimum of 3
diverse species.
Y
or
N
2.
The vegetated shelf plant density is consistent with the approved
plans and is no less than 50 plants per 200 sf or no less than 24
inches on center.
Y
or
N
Provide an explanation for every MDC that was not met, and for every item marked "NIA" or "NIE"
below. Attach additional pages as needed:
Page 6 of 6

Attachment C - Permitting History
Coastal Express Car Wash / Cook Out
Permit No. 5W8 181118
Approval
Date
Permit Action
BIMS
Version
Description of the Changes
Modified Plan Sheets
Original
1 wet pond subject to the 2017 Rules. Co-permittees
DA Map, Cover Letter,
1/4/2019
Approval
1 0
where I is purchasing the property
EC, EC, C2.0, C3.0,
C3.1, C3.2, C6. l
- Legal name change of 1 permittee from Cook Out -
Permit Info
Kings Mountain, Inc to Cook Out-Shallotte, Inc
6/9/2020
Update / Minor
I.1
- Documenting that Cook Out has purchased their portion
C2.0 and C4.0
Modification
of the property and project area.
- Coastal Express Car Wash is using future BUA for
additional buildings, parking, and sidewalks
Page 1 of 1

I
.DEMLR.IJSE,dNLY
Date Received
Fee Paid
Permit Number
STORMWATER PERMITTING FORM 7:
MINOR MODIFICATION
Standard Permitting Program — No Fee for Minor Modification
Express Permitting Program — See Express Fee Schedule
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: http://deq.nc.gov/contacbregional-offices.
This form is to only to be used by the current permittee to notify the Division of a minor
modification. Pursuant to Rule 15A NCAC 02H .1002, a minor modification is a change to the project that:
1) does not increase the net built -upon area; and/or
2) does not change the size or design of the SCM(s).
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW8 181118
2. Current Permit Holder's Company Name/Organization: G & H Hauling, LLC
3. Signing Official's Name: Phillip D. Gause
4. Signing Official's Title: Member Manager
5. Mailing Address: 4623 Maple Hill Road
City: Shallotte State: NC ZIP: 28470
6. Street Address (if different): :
City: State: _ ZIP:
7. Phone: [phone] Email: phildause28(d_)gmai1.corn
8. Describe the minor modifications that you are requesting, including any revised BUA allocations (attach
additional pages or supporting tables similar to Section IV.10 of the original application, if needed):
The current permit allocations for the Coastal Express Car Wash proiect: 1.530 SF for buildings,
24,443 SF for drives/parking, 1,208 SF for sidewalks and 10,000 SF for future development for a
total impervious area of 37,181 SF. This minor modification will re -allocate the impervious areas
for the Coastal Express Car Wash project to include; 3,863 SF for buildings, 24,972 SF for
drives/Rarking, 1,250 SF for sidewalks and 7,096 SF for future development for a total of 37,181 SF.
There are no chances to the Cook Out proiect and there are no chanaes to the previously permitted
BMP.
B. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark X' if previously provided. if not
applicable or not available, please mark N/A.:
Y 1. Two hard copies (with original signatures) and one electronic copy of this completed form.
Y 2. Two hard copies and one electronic copy of the revised plan sheets (must be a revision of the
originally approved plan sheets).
NA 3. If there is reallocation of lot BUA, a copy of the revised recorded deed restrictions and protective
covenants OR the proposed recorded deed restrictions and protective covenants documenting
the changes and a signed agreement to provide the final recorded doc ment.
NA 4. If applicable, the appropriate Express review fee. E C E 5V
APR 0 9 2020 ;
8Y: -
Stormwater Permit Form 7: Minor Modification Page 1 of 2 July 14, 2017

d
C. CONTACT INFORMATION
1. ' The Design Professional who is authorized to provide information on the Applicant's behalf:
Design Professional's Name: J_Christian Russell, P.E.
Consulting Firm: East Coast Engineering 81 Surveying, PC
Mailing Address: PO Box 2469
City: Shallotte State: NC Zip: 28459
Phone: [phone] Fax: [phone]
Email: [e-mail]
2. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City:
Phone: {
Email: :
D. CERTIFICATION OF PERMITTEE
State:
Fax:
Zip:
I, Phillip D. Gause, Member Manager, the current permittee, certify that I have authorized the minor
modifications listed in Section A and shown in the attached revised plan sheets. I further attest that this information is
accurate and complgte to the best of my knowledge.
Signature:
Date:
I, Sabrina B. Babson , a Notary Public for the State of North Carolina
County of Brunswick do hereby certify that Phillip D. Gause
personally appeared before me this the day of , 20 , and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
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APR 0 9 1020
Stormwater Permit Form 7: Minor Modification Page 2 of 2 Oct 6, 2017

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.., - DEMLR USEANLY s _ •, t � —
Date Received Fee Paid Permit Number
STORMWATER PERMITTING FORM 7:
MINOR MODIFICATION
Standard Permitting Program — No Fee for Minor Modification
Express Permitting Program — See Express Fee Schedule
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: http://deg.nc._ovlcontactlregional-offices.
This form is to only to be used by the current permittee to notify the Division of a minor
modification. Pursuant to Rule 15A NCAC 02H .1002, a minor modification is a change to the project that:
1) does not increase the net built -upon area; and/or
2) does not change the size or design of the SCM(s).
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW8 181118
2. Current Permit Holder's Company Name/Organization: Cook Out — Shallotte, Inc.
3. Signing Official's Name: Jeremy A. Reaves
4. Signing Official's Title: President
5. Mailing Address: 15 Laura Lane, Suite 300
City: Thomasville State: NC ,ZIP: 27360
6. Street Address (if different): :
City: State: _ ZIP:
7. Phone: [phone] Email: ireaves(aDcookout.com
8. Describe the minor modifications that you are requesting, including any revised BUA allocations (attach
additional pages or supporting tables similar to Section IV.10 of the original application, if needed):
The current permit allocations for the Coastal_ Express Car Wash project; 1,530 SF for buildings
24,443 SF for drives/parking, 1,208 SF for sidewalks and 10,000 SF for future development for
total impervious area of 37,181 SF. This minor modification will re -allocate the impervious areas
for the Coastal Express -Car Wash project to include; 3,863 SF for buildings, 24,972 SF for
drivesiparking, 1,250 SF for sidewalks and 7,096 SF for future development for a total of 37,181 SF.
There are no changes to the Cook Out project and there are no changes to the previously permitted
B1VIP. Cook Out does not object to the changes proposed by G & H Hauling, LLC for the Coastal
Express Car Wash under this minor permit modification.
B. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark W' if previously provided. If not
applicable or not available, please mark N/A.:
Y 1. Two hard copies (with original signatures) and one electronic copy of this completed form.
Y 2. Two hard copies and one electronic copy of the revised plan sheets (must be a revision of the
originally approved plan sheets).
NA 3. If there is reallocation of lot BUA, a copy of the revised recorded deed restrictions and protective
covenants OR the proposed recorded deed restrictions and protective covenants documenting
the changes and a signed agreement to provide the final recorded document.
NA 4. If applicable, the appropriate Express review fee.
APR 0 9 2020
Stormwater Permit Form 7: Minor Modification Page 1 of 2 BY: July 14, 2

C. CONTACT INFORMATION
1. The Design Professional who is authorized to provide information on the Applicant's behalf:
Design Professional's Name: J. Christian Russell P.E.
Consulting Firm: East Coast Engineering & Surveying, PC
Mailing Address: PO Box 2469
City: Shallotte State: NC Zip: 28459
Phone: [phone] Fax: [phone]
Email: crussell &eces.biz
2. [OPTIONAL] If you would like to designate another person to answer questions about the project:
Name & Title:
Organization:
Mailing Address:
City: State: Zip:
Phone: ( 1 Fax: {
Email:
D. CERTIFICATION OF PERMITTEE
I, Jeremy A. Reaves, President, the current permittee, certify that I have authorized the minor modifications listed
in Section A and shown i the attached revised plan sheets. I further attest that this information is accurate and
complete to the best q my knowIedgp.
Signature:
Date: W ` 2vW
1, �T,�f : , a Notary Public for the State of ti�ezw
County of I Q 6 , do hereby certify that
personally appeared before me this the _XA Y.10— day of jVQ02eA 2W-,6 , and
acknowledge the due execution of the forgoing instrument. Witness y hand and official seal,
(Notary Seal)
Notary Sign
My commis!
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Stormwater Permit Farm 7: Minor Modification Page 2 of 2 Oct 6, 2017

ULMLK'USL'UNLY
Date Received
Fee Paid
Permit Number
NC DEQ Division of Energy, Mineral and Land Resources
ESTATE STORMWATER:!
PERMIT TRMSEERAPPLICATION FORM
Pursuant to 15A NCAC 02H.1045 and other applicable statues as reference within
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: htt .//de .nc. ov/contacbre ional-offices.
After this application is accepted, DEMLR will conduct a compliance inspection and report any deficiencies to the
current permittee and/or the proposed permittee. Per the state stormwater rules and the state stormwater permit
conditions, the permit shall not be transferred until.-
1. the current permittee resolves all non-compliance issues identified in the inspection report;
2. the current permittee negotiates a resolution with the proposed permittee (in writing and signed by both
entities. The negotiated resolution must identify the necessary actions, the responsible party(ies), and the
timelines to correct the deficiencies. The site must either be found in compliance or a copy of the
negotiated resolution must be submitted prior to the transfer of the permit.); or
3. in the case where a transfer falls under G. S. 143-214.7(c2) (see also SL 2011-256), the proposed
permittee resolves all non-compliance issues upon acquiring the permit.
Signature requirements for the named signing official (for current and proposed permittee) must meet the following:
• Corporation - a principal executive officer of at least the level of vice-president;
• Limited Liability Company (LLC) - the designated manager; (Documentation from the NC Secretary of
State or other official documentation must be provided that states the titles and positions held by the
person who signed the application (pursuant to 02H.1040) that shows they have legal authority to sign for
the LLC)
• Municipality - a ranking official or duly authorized employee, -
Partnership or limited partnership - the general partner;
• Sole proprietor;
• The signature of the consultant or other agent shall be accepted on this permit transfer application only if
accompanied by a letter of authorization signed by one of the signatories noted in a-e above, as
applicable.
A. GENERAL INFORMATION
1. State Stormwater Permit Number: SW8 181118
Project name: Coastal Express Car Wash and Cook Out
Is this an updated project name from the current permit? ❑ Yes ® No
3. Reason for the permit transfer request:
The original permit was a three party agreement because Cook Out had not purchased the property from
Milliken and Lennon Inc. Cook Out has now purchased their portion of the property from Milliken and
Lennon Inc. Therefore Milliken and Lennon Inc. are now being eliminated from the permit. Also Cook Out
— Kings Mountain Inc. has changed their name to Cook Out — Shallotte Inc.
APR 0 9 2020
I3Y:
Stormwater Permit Transfer Application Form Page 1 of 7 April 27, 2018

B. PERSON(S) WHO HAVE SIGNED THIS FORM (select only one response below)
® 1. Both the current and proposed permittees
❑ 2. Only the current permittee of a condominium or planned community (skip Part F & G).
1n accordance with G.S. 143-214.7(c2) (see also SL 2011-256), this type of transfer is allowed only
when all of the following items can be truthfully checked:
❑ Any common areas related to the operation and maintenance of the stormwater management
system have been conveyed to the unit owners' association or owners' association in
accordance with the declaration;
❑ The declarant has conveyed at least fifty percent (50%) of the units or lots to owners other than
a declarant (provide documentation per submittal requirements below);
❑ The stormwater management system is in compliance with the stormwater permit.
NOTE: If subdivision was built prior to 1999, the Declarant's Attorney can make a determination that
the elements of the Planned Community Act (see §47F) have been met by the Declarant for the
subdivision. If the Declarant chooses to use this type of transfer, the determination must be in
writing, signed by the attorney, and submitted to DEMLR with this form.
❑ 3. Only the proposed permittee (skip Part D below).
In accordance with G. S. 143-214.7[c5) (see also SL 2013-121), this type of transfer is allowed only
when all of the following items can be truthfully checked:
❑ a. The proposed permittee is either (select one of the following):
❑ The successor -owner who holds title to the property on which the permitted activity is
occurring or will occur;
❑ The successor -owner who is the sole claimant of the right to engage in the permitted
activity.
❑ b. The current permittee is (select at least one of the following, but all that apply):
❑ A natural person who is deceased.
❑ A partnership, Limited Liability Corporation, corporation, or any other business
association that has been dissolved
❑ A person who has been lawfully and finally divested of title to the property on which the
permitted activity is occurring or will occur.
❑ A person who has sold the property on which the permitted activity is occurring or will
occur.
❑ Other (please explain):
❑ c. The proposed permittee agrees to the following requirements (all must be selected):
❑ There will be no substantial change in the permitted activity.
❑ The permit holder shall comply with all terms and conditions of the permit until such
time as the permit is transferred.
❑ The successor -owner shall comply with all terms and conditions of the permit once the
permit has been transferred.
Stormwater Permit Transfer Application Form Page 2 of 7 April 27, 2018

C. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark X' if previously provided. If not
applicable or not available, please mark N/A.:
Y 1. A processing fee of five hundred and five dollars ($505.00) per G.S. 143-215.3D(e)(2).
Y 2. Two hard copies (with original signatures) and one electronic copy of this completed form and the
required items.
Y 3. For proposed permittees that are corporations or LLC's, documentation from the NC Secretary of
State demonstrating that the proposed permittee is a legal and viable entity able to conduct
business in North Carolina.
Y 4. If Part B, Items 1 or 3 of this form is selected, the signed and notarized
applicable O&M agreement(s) from the proposed permittee, as required by the permit.
Y 5. Legal documentation that the property has transferred to the proposed permittee (such as a
recorded deed for the property, uncompleted development and/or common areas) or legal
documentation demonstrating that the proposed permittee is the sole claimant of the right to
engage in the permitted activity.
NIA 6. If required by the permit and if the project has been built, a signed, sealed and dated certification
document from a licensed professional stating that the stormwater management system has been
inspected and that it has been built and maintained in accordance with the approved plans.
NIA 7. A copy of the recorded covenants and deed restrictions, if required by the permit. If the project has
been built, documentation that the maximum allowed per lot built -upon area or the maximum
allowed total built -upon area has not been exceeded. If the project has not been built, the new
owner shall provide a signed agreement to submit final recorded deed restrictions and protective
covenants.
NIA 8. If transferring under G.S. 143-214.7(c2) (i.e., Part B, Item 2 of this form is selected),
documentation verifying that 50% or more of the lots have been conveyed to individuals (not
builders). Copies of the deeds of conveyance or a chart listing the lot number, lot address,
owner's name, conveyance date and deed book and page number are acceptable.
Y 9. If transferring under G.S. 143-214.7(c5) (i.e., Part B, Item 3 of this form is selected), provide legal
documentation supporting the dissolution of the corporation or documentation supporting the
current permittee was lawfully and finally divested of title of the property.
NIA 10. A copy of the lease agreement if the proposed permittee is the lessee.
N/A 11. A copy of the pending sales agreement if the proposed permittee is the purchaser.
NIA 12. A copy of the development agreement if the proposed permittee is the developer.
Stormwater Permit Transfer Application Form Page 3 of 7 April 27, 2018

D. CURRENT PERMITTEE INFORMATION AND CERTIFICATION Please be sure to provide Email.
1. Current Permit Holder's Company Name/Organization:
Inc.
G & H Hauling,
LLC & Cook Out — Kings Mountain,
2. Signing Official's Name: Jeremy A. Reaves, President of Cook Out-Shallotte, Inc., successor by name
change to Cook Out -Kings Mountain, Inc.
3. Signing Official's Title: President
4. Mailing Address: 15 Laura Lane, Suite 300
City: Thomasville
State: NC
ZIP : 27360
5. Street Address: 4447 Main Street
City: Shallotte
State: NC
ZIP : 28470
6. Phone: [phone]
Email: [e-mail]
I, Jeremy A. Reaves, Cook Out-Shallotte, Inc. , the current permittee, am submitting this application for a
transfer of ownership for the above listed stormwater permit under the General Statute and Session Law identified
on Page 1 of this application. I hereby notify DEMLR of the sale or other legal transfer of the property/project
and/or the stormwater system associated with this permit. I have provided a copy of the following documents to
the proposed permittee named in this application form: (select all that apply)
® the most recent permit;
❑ the designer's certification for each SCM;
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
® the approved plans and/or approved as -built plans;
® the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
I further attest that this application and request for a permit transfer is accurate and complete to the best of my
knowledge. I attest that I have provided all of the required items per the law to transfer this permit. I understand
that if all required parts of this request are not completed or if all required supporting information and attachments
listed above are not included, this request package will be returned as incomplete I assign all rights and
obligations as permittee to the proposed permittee named below. I understand that this request to transfer the
permit may not be ap roved by the DEMLR unless and until the facility is in compliance with the permit.
Signature: Date: 313 c)
)I 20
Jere A. Reaves, Presi nt
rr
that
County,of
this the \ � � day of Z 20
execution of the forgoing instrument. Witness hand and official seal,
(Notary Seal)
Notary Signature:
My commission e)
a Notary Public for the State of
, do hereby certify
personally appeared before me
., and acknowledge the due
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Stormwater Permit Transfer Application Form Page 4 of 7 April 27, 2018

E. PROPOSED PERMITTEE INFORMATION
1. The proposed permittee is the:
® Property owner (Also complete Part F.)
❑ Home Owners Association (HOA), Property Owners Association (POA), or Unit Owner Association
(UOA) (Also complete Part F.)
❑ Lessee - Attach a copy of the lease agreement. Both the lessee and the property owner will appear on
the permit as co-permittees. If the lease is terminated, responsibility for the permit reverts to the property
owner. (Also complete Parts F & G.)
❑ Purchaser - Attach a copy of the pending sales agreement. The permit will require submission of a copy
of the recorded deed after the purchase has taken place. If the purchase agreement is cancelled the
permit reverts to the property owner. (Also complete Parts F & G.)
❑ Developer - Attach a copy of the development agreement. Both the developer and the property owner
will appear on the permit as co-permittees. If the development agreement is terminated, responsibility for
the permit reverts to the property owner. (Also complete Parts F & G.)
2. Proposed permittee name (check one of the following and provide the name):
® Corporation, LLC, Partnership, Municipality name: G&H Hauling, LLC & Cook Out — Shallotte, Inc.
❑ HOA 1 POA 1 UOA name:
❑ Sole Proprietor
3. Proposed permittee contact information:
Please be sure to provide Email.
a. Signing Official's Name: Jeremy A. Reaves — Cook Out of Shallotte inc.
b. Signing Official's Title: President
c. Mailing Address: 15 Laura Lane, Suite 300
City: Thomasville State: NC ZIP: 27360
d. Street Address: 4445 Main Street
City: Shallotte State: NC —ZIP: 28470
e. Phone: [phone] Email: iarmfield(@cookout.com
4. 1f there is a Management Entity that manages the property for an HOA, POA or UOA, please provide:
Please be sure to provide Email.
a. Management Company or Business name:
b. Contact Name: Title:
c. Mailing Address:
d. City: State: ZIP:
e. Phone: (_} Email:
Stormwater Permit Transfer Application Form Page 5 of 7 April 27, 2018

F. PROPOSED PERMITTEE CERTIFICATION
I, Jeremy A. Reaves— Cook Out-Shallotte, Inc. _, hereby notify the DEMLR that I have acquired through sale,
lease, development agreement, or other legal transfer, the projecUproperty covered by the stormwater
management permit and/or the responsibility for constructing and/or operating and maintaining the permitted
stormwater management system. I acknowledge and attest that I have received a copy of: (select all that apply):
® the most recent permit;
❑ the designer's certification for each SCM;
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
® the approved plans and/or approved as -built plans;
® the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
® Check here if the proposed permittee agrees to be the entity responsible for addressing any compliance
issues outlined in the Compliance Inspection Report. If checked, the proposed permittee must provide a
written document statement, with a "plan of action and schedule" addressed to this office stating that they will
bring the project into compliance upon receipt of the transferred permit. This written 'plan of action and
schedule" must be received by the Division before the Division will transfer the permit.
I have reviewed the permit, approved plans and other documents listed above, and I acknowledge that I will
comply with the terms and conditions of the permit. 1 will construct the project's built -upon area as shown on the
approved plans; and I will (construct), operate and maintain the approved stormwater management system
pursuant to the requyements listed in the permit and in the operation and maintenance agreement.
Signature: Ar Date:
Jerem A. Reaves, President
I, 2K11JJW :!5 �00- , a Notary Public for the State of
County of 60 lL_FtXQ p , do hereby certify that
personally appeared before me this the day of A , 20,Zo and
acknowledge the due execution of the forgoing instrument. Witnesses hand and official seal,
(Notary Seal)
Notary Signature
My commission e
0
v \0TAR)_ ON
U
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Stormwater Permit Transfer Application Form Page 6 of 7 April 27, 20i8

G. PROPERTY OWNER INFORMATION AND CERTIFICATION
Fill out this section only if the property owner is different from the proposed permittee. The permit will revert to
the property owner if the purchase agreement, development agreement or lease expires or is terminated.
Company Name/Organization: G&H Hauling, LLC and Cook Out -Kings Mountain, Inc.
Signing Official's Printed Name: Jeremy A. Reaves —Cook Out -Kings Mountain Inc.
Signing Official's Title: President
Mailing Address: 15 Laura Lane, Suite 300
City: Thomasville State: NC ZIP: 27360
Phone: [phone] Email: heaves a()cookout.com
I, Jeremy A. Reaves — Cook_Out-Shallotte, I_nc.I hereby certify that I currently own the property identified in
this permit transfer document and acknowledge that the Proposed Permittee listed in Part F will be purchasing the
property, developing the property on my behalf, and/or leasing the property from me. A copy of the purchase
agreement, development agreement or the lease agreement, which names the party responsible for the
construction and/or operation and maintenance of the stormwater system, has been provided with the permit
transfer request.
I agree to notify DEMLR within 30 days if there are any changes to the purchase, developer or lease agreements
and will submit the applicable completed and signed Permit Information Update Form, or Permit Transfer
Application Form to address these changes. As the legal property owner, I acknowledge, understand, and agree
by my signature below, that the permit will revert to me and I will be responsible for complying with the DEMLR
Stormwater permit if the property purchase, lease or developer agreement/contract is cancelled or defaults. I
understand that any individual or entity found to be in noncompliance with the provisions of the stormwater
management permit or the stormwater rules, is subject to enforcement action as set forth in NC General Statute
(NCGS) 143, Article 21. --n
Signature of the property owner kX J
A. Reaves, President
Date: 11,30( ` "
a Notary Public for the State of
f DZ, County of do hereby certi th tt
personally appeared before me this the day of
20_0 and acknowledge the due execution of the forgoing instrument. Witness
my h d and official seal,
MO
(Notary Seal)
Notary Signature
My commission f
Stormwater Permit Transfer Application Form Page 7 of 7 April 27, 2018

4.JL VY \'VJL-'"lllVL I
❑atu Received Fee Paid Permit Number
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT TRANSFER APPLICATION FORM
Pursuant to 15A NCAC 02H.1045 and other applicable statues as reference within
Only complete applications packages will be accepted and reviewed. This form and the required items (with
original signatures) must be sent to the appropriate DEMLR Regional Office, which can be determined by locating
the project on the interactive online map at: htt�//deq.nc.gov/confact/regional-offices.
After this application is accepted, DEMLR will conduct a compliance inspection and report any deficiencies to the
current permittee and/or the proposed permittee. Per the state stormwater rules and the state stormwater permit
conditions, the permit shall not be transferred until:
1. the current permittee resolves all non-compliance issues identified in the inspection report;
2. the current permittee negotiates a resolution with the proposed permittee (in writing and signed by both
entities. The negotiated resolution must identify the necessary actions, the responsible party(ies), and the
timelines to correct the deficiencies. The site must either be found in compliance or a copy of the
negotiated resolution must be submitted prior to the transfer of the permit.); or
3. in the case where a transfer falls under G.S. 143-214.7(c2) (see also SL 2011-256), the proposed
permittee resolves all non-compliance issues upon acquiring the permit.
Signature requirements for the named signing official (for current and proposed permittee) must meet the following:
• Corporation - a principal executive officer of at least the level of vice-president;
• Limited Liability Company (LLC) - the designated manager, (Documentation from the NC Secretary of
State or other official documentation must be provided that states the titles and positions held by the
person who signed the application (pursuant to 02H.1040) that shows they have legal authority to sign for
the LLC)
• Municipality - a ranking official or duly authorized employee;
• Partnership or limited partnership - the general partner,
• Sole proprietor;
• The signature of the consultant or other agent shall be accepted on this permit transfer application only if
accompanied by a letter of authorization signed by one of the signatories noted in a-e above, as
applicable.
A. GENERAL INFORMATION
1. State Stormwater Permit Number. SW8 18111
2. Project name: Coastal Express Car Wash and Cook Out
Is this an updated project name from the current permit? ❑ Yes ® No
3. Reason for the permit transfer request:
The current permit was issued to three parties in January 2019 because Cook Out had not Vet purchased
the Property from Milliken and Lennon Inc. Cook Out has now purchased their portion of the property from
Milliken and Lennon, Inc. Therefore. Milliken and Lennon, Inc, are now being eliminated from the permit.
Also Cook Out — rings Mountain. Inc._has_changed their name to Cook Out — Shallotte, Inc
RECEPJED APR 09 �0
Stormwater Permit Transfer Application Form Page 1 of 7 April 27, 2018

'B: PERSON(S) WHO HAVE SIGNED THIS FORM (select only one response below)
® 1. Both the current and proposed permittees
❑ 2. Only the current permittee of a condominium or planned community (skip Part F & G),
In accordance with G. S. 143-214.7(c2) (see also SL 2011-256), this type of transfer is allowed only
when all of the following items can be truthfully checked. -
Any common areas related to the operation and maintenance of the stormwater management
system have been conveyed to the unit owners' association or owners' association in
accordance with the declaration;
❑ The declarant has conveyed at least fifty percent (50%) of the units or lots to owners other than
a declarant (provide documentation per submittal requirements below);
❑ The stormwater management system is in compliance with the stormwater permit.
NOTE: If subdivision was built prior to 1999, the Declarant's Attorney can make a determination that
the elements of the Planned Community Act (see §47F) have been met by the Declarant for the
subdivision. If the (Declarant chooses to use this type of transfer, the determination must be in
writing, signed by the attorney, and submitted to DEMLR with this form.
❑ 3. Only the proposed permittee (skip Part D below).
In accordance with G. S. 143-214.7(c5) (see also SL 2013-121), this type of transfer is allowed only
when all of the following items can be truthfully checked:
❑ a. The proposed permittee is either (select one of the following):
❑ The successor -owner who holds title to the property on which the permitted activity is
occurring or will occur;
❑ The successor -owner who is the sole claimant of the right to engage in the permitted
activity.
❑ b. The current permittee is (select at least one of the following, but all that apply):
❑ A natural person who is deceased.
❑ A partnership, Limited Liability Corporation, corporation, or any other business
assbciation that has been dissolved
❑ A person who has been lawfully and finally divested of title to the property on which the
permitted activity is occurring or will occur.
❑ A person who has sold the property on which the permitted activity is occurring or will
occur.
❑ Other (please explain):
❑ c. The proposed permittee agrees to the following requirements (all must be selected):
❑ There will be no substantial change in the permitted activity.
❑ The permit holder shall comply with all terms and conditions of the permit until such
time as the permit is transferred.
❑ The successor -owner shall comply with all terms and conditions of the permit once the
permit has been transferred.
CI
APR 0 9 2020 l
BY.•
Stormwater Permit Transfer Application Form Page 2 of 7 April 27, 2018

C. SUBMITTAL REQUIREMENTS
Please mark "Y" to confirm the items are included with this form. Please mark Y' if previously provided. If not
applicable or not available, please mark N/A.:
Y 1. A processing fee of five hundred and five dollars ($505.00) per G.S. 143-215.3D(e)(2).
Y 2. Two hard copies (with original signatures) and one electronic copy of this completed form and the
required items.
Y 3. For proposed permittees that are corporations or LLC's, documentation from the NC Secretary of
State demonstrating that the proposed permittee is a legal and viable entity able to conduct
business in North Carolina.
Y 4. If Part B, Items 1 or 3 of this form is selected, the signed and notarized
applicable 0&M agreement(s) from the proposed permittee, as required by the permit.
Y 5. Legal documentation that the property has transferred to the proposed permittee (such as a
recorded deed for the property, uncompleted development and/or common areas) or legal
documentation demonstrating that the proposed permittee is the sole claimant of the right to
engage in the permitted activity.
N/A 6. If required by the permit and if the project has been built, a signed, sealed and dated certification
document from a licensed professional stating that the stormwater management system has been
inspected and that it has been built and maintained in accordance with the approved plans.
N/A 7. A copy of the recorded covenants and deed restrictions, if required by the permit. If the project has
been built, documentation that the maximum allowed per lot built -upon area or the maximum
allowed total built -upon area has not been exceeded. If the project has not been built, the new
owner shall provide a signed agreement to submit final recorded deed restrictions and protective
covenants.
NIA 8. If transferring under G.S. 143-214.7(c2) (i.e., Part B, Item 2 of this form is selected),
documentation verifying that 50% or more of the lots have been conveyed to individuals (not
builders). Copies of the deeds of conveyance or a chart listing the lot number, lot address,
owner's name, conveyance date and deed book and page number are acceptable.
Y 9. If transferring under G.S. 143-214.7(c5) (i.e., Part B, Item 3 of this form is selected), provide legal
documentation supporting the dissolution of the corporation or documentation supporting the
current permittee was lawfully and finally divested of title of the property.
N/A 10. A copy of the lease agreement if the proposed permittee is the lessee.
N/A 11. A copy of the pending sales agreement if the proposed permittee is the purchaser.
N/A 12. A copy of the development agreement if the proposed permittee is the developer.
1E0EIV:`
APR 0 9 2020
BY-.
Stormwater Permit Transfer Application Form Page 3 of 7 April 27, 2018

-D. CURRENT PERMITTEE INFORMATION AND CERTIFICATION Please be sure to provide Email.
644
1. Current Permit Holder's Company Name/Organization: Coastal Express Car Wash
2. Signing Official's Name: Phillip D. Gause
3. Signing Official's Title: Member, Manager
4, Mailing Address: 4623 Maple Hill Road
City: Shallotte
5. Street Address: 4447 Main S
City: Shallotte
6. Phone: [phone]
NC ZIP: 28470
_State: NC ZIP : 28470
Email: [e-mail]
I, Phillip D. Gause , the current permittee, am submitting this application for a
transfer of ownership for the above listed stormwater permit under the General Statute and Session Law identified
on Page 1 of this application. I hereby notify DEMLR of the sale or other legal transfer of the property/project
and/or the stormwater system associated with this permit. I have provided a copy of the following documents to
the proposed permittee named in this application form: (select all that apply)
® the most recent permit;
❑ the designer's certification for each SCM;
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
® the approved plans and/or approved as -built plans;
® the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
I further attest that this application and request for a permit transfer is accurate and complete to the best of my
knowledge. I attest that I have provided all of the required items per the law to transfer this permit. I understand
that if all required parts of this request are not completed or if all required supporting information and attachments
listed above are not included, this request package will be returned as incomplete I assign all rights and
obligations as permittee to the proposed permittee named below. I understand that this request to transfer the
permit may not be approved by the DEMLR unless and until the facility is in compliance with the permit.
Signature: UAA 9 0 A AP Date: za
that 4
this the
day of
a Notary Public for the State of
County of - - �k! �Srs_1 ���J_ _ do hereby certify
execution of the forgoing instrument. Witness my hand and official seal,
personally appeared before me
20;ZU') , and acknowledge the due
V,r�,�
Pli APR 0 9 2020
BY;`
Stormwater Permit Transfer Application Form Page 4 of 7 April 27, 2018

� f �
1
r

E. PROPOSED PERMITTEE INFORMATION
1. The proposed permittee is the:
❑ Property owner (Also complete Part F.)
❑ Home Owners Association (HOA), Property Owners Association (POA), or Unit Owner Association
(UOA) (Also complete Part F.)
❑ Lessee - Attach a copy of the lease agreement. Both the lessee and the property owner will appear on
the permit as co-permittees. If the lease is terminated, responsibility for the permit reverts to the property
owner. (Also complete Parts F & G.)
❑ Purchaser -Attach a copy of the pending sales agreement. The permit will require submission of a copy
of the recorded deed after the purchase has taken place. If the purchase agreement is cancelled the
permit reverts to the property owner. (Also complete Parts F & G.)
❑ Developer - Attach a copy of the development agreement. Both the developer and the property owner
will appear on the permit as co-permittees. If the development agreement is terminated, responsibility for
the permit reverts to the property owner. (Also complete Parts F & G.)
2. Proposed permittee name (check one of the following and provide the name):
❑ Corporation, LLC, Partnership, Municipality name: G&H Hauling, LLC
❑ HOA I POA 1 UOA name:
❑ Sole Proprietor
3. Proposed permittee contact information:
Please be sure to provide Email.
a. Signing Official's Name: Phillip D. Gause
b. Signing Official's Title: Member, Manager
c. Mailing Address: 4623 Maple Hill Road
City: Shallotte State: NC —ZIP : 28470
d. Street Address: 4445 Main Street
City: Shallotte State: NC ZIP'. 28470
e. Phone: [phone] Email: [e-mail]
4. If there is a Management Entity that manages the property for an HOA, POA or UOA, please provide:
Please be sure to provide Email.
a. Management Company or Business name:
b. Contact Name:
c. Mailing Address:
d. City:
e. Phone: (_)
Email:
Title:
State: ZIP:
APR a 9 2020 {
BY.
Stormwater Permit Transfer Application Form Page 5 of 7 April 27, 2018

T. PROPOSED PERMITTEE CERTIFICATION
1, Phillip D. Gause , hereby notify the DEMLR that I have acquired through sale, lease,
development agreement, or other legal transfer, the project/property covered by the stormwater management
permit and/or the responsibility for constructing and/or operating and maintaining the permitted stormwater
management system. I acknowledge and attest that I have received a copy of: (select all that apply):
❑ the most recent permit;
❑ the designer's certification for each SCM;
❑ any recorded deed restrictions, covenants, common areas, drainage easements or plats;
❑ the approved plans and/or approved as -built plans;
❑ the approved operation and maintenance agreement;
❑ past maintenance records from the previous permittee (where required);
❑ a copy of the most recent inspection report;
❑ Check here if the proposed permittee agrees to be the entity responsible for addressing any compliance
issues outlined in the Compliance Inspection Report. If checked, the proposed permittee must provide a
written document statement, with a `plan of action and schedule" addressed to this office stating that they will
bring the project into compliance upon receipt of the transferred permit. This written 'plan of action and
schedule" must be received by the Division before the Division will transfer the permit.
I have reviewed the permit, approved plans and other documents listed above, and I acknowledge that I will
comply with the terms and conditions of the permit. I will construct the project's built -upon area as shown on the
approved plans; and I ill {construct}, operate and maintain the approved stormwater management system
pursuant to the re r me is listed in the permit and in the operation and maintenance agreement.
Signature: r.Z Date:
a Notary Public for State of
County of '� do hereby certify that
personally appeared before me this the �;)L4=� day of F�� 20,, and
acknowledge the due execution of the forgoing instrument. Witness my hand and official seal,
APp zzo
BY, r
Stormwater Permit Transfer Application Form Page 6 of 7 April 27, 2018

J

'G. PROPERTY OWNER INFORMATION AND CERTIFICATION
Fill out this section only if the property owner is different from the proposed permittee. The permit will revert to
the property owner if the purchase agreement, development agreement or lease expires or is terminated.
Company Name/Organization: CG&H Hauling, LLC; Owner of Coastal Express Car Wash
Signing Official's Printed Name: Phillip D. Gause.
Signing Official's Title: Member/ Manager
Mailing Address: 4623 Maple Hill Road
City: Shallotte
Phone: [phone] Email: [e-mail]
State: NC ZIP: 28470
I, Phillip D. Gause hereby certify that I currently own the property identified in
this permit transfer document and acknowledge that the Proposed Permittee listed in Part F will be purchasing the
property, developing the property on my behalf, and/or leasing the property from me. A copy of the purchase
agreement, development agreement or the lease agreement, which names the party responsible for the
construction and/or operation and maintenance of the stormwater system, has been provided with the permit
transfer request.
I agree to notify DEMLR within 30 days if there are any changes to the purchase, developer or lease agreements
and will submit the applicable completed and signed Permit Information Update Form, or Permit Transfer
Application Form to address these changes. As the legal property owner, I acknowledge, understand, and agree
by my signature below, that the permit will revert to me and I will be responsible for complying with the DEMLR
Stormwater permit if the property purchase, lease or developer agreement/contract is cancelled or defaults. I
understand that any individual or entity found to be in noncompliance with the provisions of the stormwater
management permit or the stormwater rules, is subject to enforcement action as set forth in NC General Statute
(NCGS) 143, Article 21.
Signature of the property owner Date:—s�
nna Notary Public for the State of
f�Y�(�� CQ,�—pi•-Q_ County of �' L`ny c do hereby certify that
personally appeared before me this the �44f-) day of
20� —, and acknowledge the due execution of the forgoing instrument. Witness
my hand and official seal,
B.
�0TA/�y
In4�rri%�tan'a
My Gommion kxpir,s9,���
'"•,......... ',,.
lee
APO V 9 2020 i
BY. f
Stormwater Permit Transfer Application Form Page 7 of 7 April 27, 2018

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DEMLR USE ONLY
Date Received
Fee Paid
1'ermit Number
Applicable Rules:
(select all that apply)
❑ Coastal SIV -1995 ❑ Coastal SW - 2008 ❑ Ph 11 - Post Construction
❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt i'lan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forte tttay be photocopied for use as an original
1. GENPRAI,INFORMATION
'I. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Coastal Exuress Car Wash AND &g k W + -41,L <<1 z11110
2. Location of Project (street address): '. cCt
4447 Main Street AA D 4¢ss hkt%✓ -Yt-cff
City:Shallotte County:Brunswick 7ip:28470
3. Directions to project (from nearest major intersection):
From the intersection of US 17 and US -17 Business in Sha[lotte travel south on US 17 Business for 0.25 miles.
is on the 1
4. Latitude:33° 59' 2.4" N Longitude:-78' 22' "1.2" W of the main entrance to the project.
11. PERMIT INFORMATION:
-1. a. Specify whether project is (check one): ®New [—]Modification ❑ Renewal w/ Mod ificationt
tRcntwafe 7uitl1 rtt0difications atsa requires SWU-702 - Renewal Application Forirr
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's cerlification
2. Specify the type of project (check one):
❑l.ow Density ®I-ligh Density ❑grains to an Offsite Stormwater System ❑Other
3. if this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the Stormwater project
number, if assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAyNIA Major ❑Sedimentation/Erosion Control: ac of Disturber[ Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.l„ 2012-200, Part Vl: httpllportal.ncdenr.or,glweb/lr/rules-and-regulations ELEIVE
` Form SWU-101 Version Oct. 31, 2013 I'age I of'6 NAVY 9 2018
J

III. CONTACT INFORMATION
I. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who /owns the project): y`+1
Applicant/Organization: G & 1-1 Hauling, 1_I_C C Gr
Signing Official & TitIcYIiiliip D. Gause, Member Manager
b.Contact information for person listed in item 1a above:
Street Address: 4623 Maple Hill Road
City: Shallotte State: NC Zip: 28470
Mailing Address (if applicable): Same
City: State: Zip:
Phone: (910 } 274-5667 Fax: ( }
Email:phiigause2$Qgmaii,com
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
Sta
Zip:
City: State:NC Zip:
Phone: ( ] Fax: ( ]
Email:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization-.Fast Coast Engineering & Surveying PC
Signing Official &'Title: 1. Christian Russell, PE - Project Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:PO Box 2469
City:Shallotte State:North Carolina Zip:28459
Phone: (910 } 754-8029 Fax: (910 } 754-8049
i1maiI:cru55eII@ecl:5.biz
4. Local jurisdiction for building permits: Brunswick Counter _
Point of Contact:Andrew Thompson Phone #
Form SWU-101 Version Oct. i I. 2013 Page 2 oF6
(9[0-253 ) 2041
CCEIVE
NOV 2 9 2010

Ill. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated governmentofficial, individual, etc. who owns "the_prr/ojecE): 1
Applicant/Organization: Cook Out -Kings Mountain, Inc. L Lo01.
Signing Official & Title:John Armfield, Vice President
b.Contact information for person listed in item 'Ia above:
Street Address: '15 Laura Lane Ste 300
City: 'Thomasville State: NC lip: 27360
,Mailing Address (if applicable): Same
City:
Phone: (336 ) 313-5226
Email: [e-mail]
State: Zip:
I,ax: f 1
c. Please check the appropriate box. The applicant listed above is:
❑ "1-he property, owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: Milliken and Lennon, Inc.
Signing Official & ,ritle: Calvin E. (Milliken Vice President
b.Contact information for person listed in item 2a above:
Street Address: 14 Stone Chimnev Road
City: Supply_ State: INC Zip: 28462
tMailing Address (if applicable): Same
City: Sta te: NC Zip:
Phone: (910 ) 754-2737
Email: biiiillikeri44Qgmail.conl
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about file project:
Other Contact Person/ Organization:East: Coast Engineering & Surveyin g, PC
Signing Official & Title: 1, Christian Russell PE - Project Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:l'O Box 2469
City:Shallotte State:North Carolina Zip:28459
Phone: (910 ) 754-8029 Fax: (910 ) 754-8049
I mail:crussellaeces.biz
4. Local jurisdiction for building permits: Brunswick County
Point of Contact: Andrew Thorn pson Phone #: (910-253 ) 2041
EVEIVE
Dorm SWU-101 Version Oct. 31, 2013 Page 2 of6 DEC 18 20%
BY: .

IV. PROJECT INFORMATION
'1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Sheet flow off of proposed BUA into catchment area and storm drains that will direct the flow to a proposed
wet 12ond designed for compliance with North Carolina state stormwater requirements. The poDd will
discharge to an existing ditch at the back of the project.
2.a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Othcr: [Date:
bAf claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastai SW -1995 ❑ Ph 11 - Post Construction
3. Stormwater runoff from this project drains to the Lumber River basin.
4. Total Property Area: 2.30 acres 5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area':2.30 acres
Total project area shall be calculated to exclude Elie follozoing: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below fire Normal High Water (NHFlq line or Mean High Water
(MI-11N) lime, and coastal wetlands landroard from the NHIN (or MFIW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Noar-coastal taetlands taridtom•d of tlae NHW (or MI-1W) lime array
be included in the total project area,
S. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 65.70
9. How many drainage areas does the project have?7 (Far high density, count 7 for each proposed engineered
stormuniter BM1'. For lozv density rand other pa'ojects, iise 7 for' ilae tialaole properly area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the sarne format as below.
Basin Information
[Drainage Area -1
Drainage Area
0NT
Drainage Area
CO
Drainage Area
Receiving Stream Name
Shallolte River
Shallotte River
Shallotte River
Strearn Class *
SC, 1-IQW
SC, I-IQW
SC,1-[QW
Stream Index Number *
15-25-2-(7.5)
15-25-2-(7.5)
15-25-2-(7.5)
Total IDrainage Area (so
100,360
66,671
33,689
On -site Drainage Area (so
'100,360
66,671
33,689
Off -site Drainage Area (so
0
0
0
Proposed Impervious Area** (so
65,930
37,181
28,749
% Im ervious Area' total
65.7
55.8
85.3
impervious** Surface Area
Drainage Area 1
]Drainage Area
C W
Drainage Area
CO
Drainage Area
On -site Buildings/Lots (so
3,112
1,530
1,582
On -site Streets (so
0
0
0
On -site Parking (so
40,522
24,443
16,079
On -site Sidewalks (so
2,708
1,208
-1,500
Other on -site (so
0
0
0
Future (so
'19,588
'10,000
9,588
Off -site (so
0
0
0
_E,xisting BUA*** (so
0
0
0
Total (so:
65,930
37,181
78,749
5lream Class and Index Number can be determined at: htt ortnl.ncderrr.or vcb t n
** Impermoais area is drfned as the built upon area including, but ool limited to, biiildir roams, parking areas,
sideznalks, gravel areas, etc. i qv 2018
Form SWU-101 Version Oct. 31. 2013 Page 3 of6 DECEl 1 V O

11. How was the off -site impervious area listed above determined? Provide documentation. NA
Projects in Union Countv: Contact DEVLR Central Office staffto check if the project is located within a Threatened R
Endangered .Species svalershed that rnav be subject to nrore stringent stormwater requirements as per 15?1 AICAC 02B .0600.
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wg/ws/su/bmp-tnanual.
V1. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
http://portaLncdenr.org/web/wq/ws/su/statesw/forms does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at http://12ortal,ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space .
provided for each item. All original documents MUSTbe signed and initialed in blue ink, Download the latest
versions for each submitted application package from
http://portal.ncdenr.org/webZwq/wsZsu/statesw/forms does.
_jLLthals
I. Original and a e copy of the Stormivater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. fif required as per Part V11 below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $$505 payable to NCDENR. (For an Express review, refer to�
http://www.envinelp.org/pages/onestopexpress.htnnl for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the �C�
receiving stream drains to class SA waters within'/z mile of the site boundary, include tile'/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
S. Two sets of plans folded to 8.5" x 14" (scaled, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MFIW or NHW line of tidal
waters, and any coastal wetlands landward of the 1141 I1tT or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or N1- W) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
L Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate
p. Vegetated buffers (where required). 1EIVE
Dorm SWU-101 Version Oct. 31, 2013 Page 4 of Nov 19 201� 9
sY:--- 1

9. Copy of any applicable soils report with the associated S1-I W'F elevations (Please identify NIA�
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BM Ps, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verify the SNWr prior
to submittal, [phone])
'10. A copy of the most current property deed. Deed book: 4076 Page No: 1216
11. For corporations and limited liability corporations (I I-C): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item I a, 2a, and/or 3a per '15A NCAC 21-1.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http:/ /wwtiv.secret,iry.st,ite. nc.us/Corporations/CSeardl.asi)x
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANT'S
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form, The appropriate deed
restrictions and protective covenants forms can be downloaded from httl?:////portal.ncdenr.org/web/lr/state-
stormwater-forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
Hy the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:!. Christian Russell, PE
Consulting Firm: Last Coast Engineering & Surveying, PC
Mailing AddressTO Box 2469
City:Shallotte State:NC Zip:28459
Phone: (910 ) 754-8029 Fax:
[e-mail]
eces.biz
IX. PROPERTY O AUTE-iORIZA'I'ION (if Contact lnfortrutlian, itettt 2 lias beers fillerl out, cotuplele this
section) NIA 6� GDr, c_c_k
1, (print or type tratne of persolr listed in Con nforrnation, item 2a) certify that I
own the property identified in this permit applt<< n, anti thus give permission to (print or type natue of person
listed in Contact Information, it,
]a) with (print or type rattle of orgimization listed in
Conlacl Information, item 1a) to del the project as currently proposed. A cop), of
the lease agreement or pending property sales contract has been provtr with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater systen .
'EceIVE
NOV 2 9 2018
Form SWU-10l Version Oct. 31, 2013 Page 5 of6 ' V..

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
ease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to fttetlhe property owner. As the property owner, it is my responsibility to notify DI?A9LR immediately and
submit a mpleted Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment fa lity without a valid permit. 1 understand that the operation of a stormwater treatment facility
without a validP-C�rmit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the ass ssment of civil penalties of up to $25,000 per day, pursuant to NCGS'143-215.6.
Signatu
a Notary Public for the State of
do hereby certify that
before me this _ day of
a stormwater permit. Witness my hand and official seal,
SHAL
Date:
County of
personally appeared
id acknowledge the due execution of the application for
My commission expires
X. APPLICANT'S CERTIFICATION
5 'C�t Cbr7C•.\ �x�rehS Car �.tc.��1
1, (print or tape name of person listed in Confact h1forrrxrtion, ileur M) Phil Cause
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approves[ plans, that the required deer[ restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
l5A l�1CAC 2H ."1000 and any other applicable state stormwater requirements.
applicable stormwater rules under
Signature: Date: 2
XR
I, j�� 7� ��►� a Notary iPublic for the State of iJal-k--' Cm JriC ounty of
,' t. do hereby certify that l rD . personally appeared
before me thga-41siay of 1V ��,���, c`LQ[1, and acknowledge the clue execution of the application for
a stormwater permit. Witness my hand and official
, ..,sA
OTAR y'•.2
SEAL
My commission expires J 0 �c
ECEI Y G
L,
y ; Nov 2 9 2018
Form SWU-101 Version Oct. 31, 2013 Page 6 of6

ir'
p
` ,`
(•1
S `_'

Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
ovations and boring logs. Include an 85'xll" copy of the NRCS County Soils trial) with the
pr 'ect area clearl\perqons
delineated. For projects with infiltration 13MI's, the report should also
ince soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Inon Devices submitted to WiRO: Schedule a site visit for D1 MLR to verify the SHWT prior
to s1, (910) 79b-7378.) J
10. A ce most current property deed. Deed book: 585 Page No: 578
11. Forrate ns and limited liability corporations (I.LC): Provide documentation from the NC
Secof St, c oe• other official documentation, which supports the titles and positions held
by rsons INted in Contact Information, item la, 2a, and/or 3a per15A NCAC 21-I."1003(e).
Thration o 1_,1-C must be listed as an active corporation in good standing with the NC
5ecof State, a lerwise the application will be rehrrned"
ltttww.secretar stite.iic.us/Coi-poratioiis/CSearcii.aspx
a
VII. DEED RES'rRICT10 AN13 PRO"CECTIVE COVENANTS �! r�t�JJ
For all subdivisions, outparcels, , d future development, the appropriate property restrictions and protective
covenants are required to be recorc prior to the sale of any lot. If lot sizes vary significantly or the proposed
13UA allocations vary, a table listing ea t lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the complet and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms c� be downloaded from http://portal.ncdenr.org/webllr/state-
stormwater-forms does. Download the latest ve -'ons for each submittal.
In the instances where the applicant is different than property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenar form while the applicant is responsible for ensuring
Chat the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify Y t the recorded property restrictions and
protective covenants for this project, if required, shall include all th items required in the permit and listed
on the forms available on the website, that the covenants will be bindi on all parties and persons claiming
tinder them, that they will run with the land, that the required covenant. annot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded for to the sale of any lot.
Vill. CONSULTANTINFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another indivi al and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf r this project (such as
addressing requests for additional information).
Consulting Engineer:)
Consulting Firm: East
Mailing Address:PO 1.
City:Shallotte
ristian Russell. Ph
rinv & SurvevinQ . PC
State:NC Zip:28459
Phone: (910 _ ) 754-8029 T Fax:
F1mail-.Cl'[e-mail]
eces"biz
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has beery filled out, complete this
section) l S W cdj�_ ak 1
1, (print or type name of person lister[ in Contact Information, item 2a) Alvin E. Milliken certify that I
own the property identified in this permit application, and thus give permission to (print or type statue of person
listed its Contact Information, stem U) John Arm icld _ � _ with (print or type name of organization listed iit
Contact Information, item In) -Cook Out -Kings Morrutain to develop the project as currently proposed. A copy of
the lease agreement or pending propert}i safes contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the storinwater system.
norm SWU-101 Version Oct. 31, 2013 Page 5 of
NOV 2 9 2010
BY'

. F.
As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, itern 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts hack
to rue, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. f understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue'143-215.1 and may result in appropriate enforcement
action including the assessment of civil penalties oq up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature;,�q\UC�4.Date:
I� 1�C��(_ �• L� a Notary Public for the State of ,\,Cl�u,\ CCA-0 1Q county of
do hereby certify that i,) , C— 1j� KRr�f personally appeared
before me this 4-)day of "Alk.Qll— , __ _., and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires j0-a7 -2(jz)
X. APPLICANT'SCERTIFICATION 1 • o( CpoAt-L'XA)
I, (print or type rrrrnre of person lister] in Coxfact Information, item 7.n) lolrrr Ar•rxfield ,
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NC41C 2IL-I .1000 and any other applicable states to rmwaLer requirements.
Date:_
Ln'r� a otar� I'ubl'c for the State of 1Q741w_ County of
YU)--'SGWiCAL- , do hereby certify that � ^ �� personally appeared
before me this-"?-fhday of -'�619u , and acknowledge the due execution of the application for
a stormwater permit. Witness my [rand and official seal,
+`0'•:�CD s
�0-doe
y
SEAL
My commission expires
ECEIVE -
Bonn SWU-101 Version Oct. 31, 2013 Page 6 of

SUPPLEMENT-EZ FORM COVER PAGE
Please indicate the types, quantities and locations of SCMs that will be used on this project:
Quantity
I Location(s)
Infiltration System
Bioretention Cell
Wet Pond
1
4447 & 4455 MAIN STREET, SHALLOTTE, NC 28470
Stormwater Wetland
Permeable Pavement
Sand Filter
Rainwater Harvesting
Green Roof
Level Spreader -Filter Strip
Disconnected Impervious Surface
Treatment Swale
Dry Pond
Designer information for this project:
Name and Title:
J. CHRISTIAN RUSSELL, PE
Organization:
EAST COAST ENGINEERING & SURVEYING, PC
Street address:
4918 MAIN STREET
City, State, Zip:
SHALLOTTE, NC 28470
Phone number(s):
910-754-8029
Email:
[e-mail]
Desiqner
\,�1Y 141ff1fl�,
SEAL
35054
12-17-2018
C,,y ��'�;�
Sea]
Cover Page
ignature of Designer
12-17-2018
Date
Applicant-
K---:-- rn Wmamm
QuaNly
5 8111111
Project Name:
COASTAL EXPRESS CAR WASHICOOK
OUT
Address
4447 & 4455 MAIN STREET
City ! Town
SHALLOTTE
Company:
G & H HAULING, LLC
Contact:
PHILLIP D. GAUSE
Mailing Address:
4623 MAPLE HILL ROAD
City, State, Zip:
SHALLOTTE, NC 28470
Prone number(s):
910-274-5667
Email:
[e-mail]
Certificat#on Statement:
I certify, under penalty of law: that this Supplement-EZ form and all supporting
information were prepared under my direction or supervision;
- that the information provided in the form is, to the best of my knowledge
and belief, true, accurate, and complete; and
- that the engineering plans, specifications, operation and maintenance
agreements and other supporting information are consistent with
the information provided here.
I am aware that there are significant penalties for submitting false
information including the possibility of fines and imprisonment for knowing
violations as well as a report being made to my professional board.
ECCI V e
DEC
BY•
12:07 PM 12/17/2018

SUPPLEMENT-EZ FORM COVER PAGE
Please indicate the types, quantities and locations of SCMs that will be used on this project:
Quantity
Location(s)
Infiltration System
Bioretention Cell
Wet Pond
1
4447 & 4455 MAIN STREET, SHALLOTTE, NC 28470
Stormwater Wetland I
I
Permeable Pavement
Sand Filter
Rainwater Harvesting
Green Roof
Level Spreader -Filter Strip
Disconnected Impervious Surface
Treatment Swale
I
Dry Pond
j
I
Designer information for this project:
Name and Title: J
J. CHRISTIAN RUSSELL, PE
Organization:
JEAST COAST ENGINEERING & SURVEYING, PC
Street address:
4918 MAIN STREET
City, State, Zip:
SHALLOTTE, NC 28470
Phone number(s):
910-754-8029
Email:
[e-mail]
Designer
-\F1 C
SEAL 9�
35054 -
�-'• 1-17-2018 -�
�y•NciN���•••r��v
Seal
Signature of Designer
12-17-2018
Date
Applicant:
K"D.- Cnvirnnmrn
Quanly
wtMill%
Project Name:
COASTAL EXPRESS CAR WASHIPOOK
OUT
Address
L- 4447 & 4455 MAIN STREET
City I Town
SHALLOTTE
Company:
COOK OUT -KINGS ROAD, INC.
Contact:
JOHN ARMFIELD�
Mailing Address:
15 LAURA LANE, STE 300
City, State, Zip:
THOMASVILLE, NC 27360
Phone number(s):
336-313-5226
Email:
[e-mail]
Certification Statement:
I certify, under penalty of law: that this Supplement-EZ form and all supporting
information were prepared under my direction or supervision;
- that the information provided in the form is, to the best of my knowledge
and belief, true, accurate, and complete; and
- that the engineering plans, specifications, operation and maintenance
agreements and other supporting information are consistent with
the information provided here.
I am aware that there are significant penalties for submitting false
information including the possibility of fines and imprisonment for knowing
violations as well as a report being made to my professional board.
ECEIVE
DEC 18 2018
BY•
Cover Page 1 2:47 PM 12/17/2018

WET POND
COASTAL EXPRESS CAR WASH/COOK OUT
THE DRAINAGE AREA 1
Drainage area number
1
Break down of BUA in the drainage area (both now and existing):
Total coastal wetlands area (sq ;;)
0 sf
- Parking I dnveway (sq ft)
40,522 sf
Total surface water area (sq ft)
0 sf
- Sidewalk (sq ft)
2,708 sf
Total drainage area (sq fl)
100.360 sf
- Roof (sq ft)
3,112 sf
BUA associated with existing development (sq ft}
5f
- Roadway (sq ft)
0 sf
Proposed new BUA (sq ft)
65,930 sf
- Other, please specify in the comment box below (sq ft)
i9.5W sf
Percent BUA of drainage area
65.7%a
ITotal BUA (sq ft)
65.930 sf
cOMPLIANCE:.WITH THE APPLICABLE STORMWATER PROGRAM
Stormwater programs) that apply (please specify):
Design rainfall depth (in)
1.5 in
2017 ruies for the proposed BUA for calculating the total stcmge volume_
Minimum volume required (cu ft)
B4O44 cf
Design volume of SCM (cu ft)
8,297 cf
GENERAL`MDC FROM 02H .1050
#1 Is the SCM sized to treat the SW from all surfaces at build -out?
YES
#7 If applicable. with the SCM be cleated out after construction?
YES
42 Is the SCM located on or near contaminated soils?
NO
98 Does the manetenance access coon ply with General MDC (8)?
YES
#3 What are the side slopes of the SCM (H:V)?
3.1
#9 Does the drainage easement coon I with General MDC 9 ?
YES
#3 Does the SCM have retaining walls, gabion walls or other engineered side slopes?
Yes
#10 If the SCM is one single family lot, does the plat cam ply with General MDC (10)7
NO
t Are the inlets, outlets, and receiving stream protected from erosion (10.year s;orm)?
YES
#11 Is there an O&M Agreement that can lies with General MDC (11)?
YES
95 Is there a a bypass for Flaws in excess of the design flow?
YES
#12 Is there an O&M Plan that complies with General MDC (12)?
YES
#6 What is the method for dawatering the SCM for maintenance?
Pump (preferred)
1#13 Was the SCM designed b an NO licensed professional?
YES
WET POND MDC FROM 021111 .1053
#1 Method used
SA/DA
#6 Width of the vegetated shelf (feet)
6 ft
#1 Surface area of the main permanent pool (square feet)
2.715 sf
96 Location of vegetated shelf
@ Normal Pool
#1 Volume of the main permanent pool (cubic feet)
15 285 cf
#6 Elevation of top of shelf fmsl
22.00 ft
#2 Average depth of the main i feet
6.0 ft
#6 Elevation of bottom of shelf (fmsE)
21.00 It
#2 Was the vegetated shelf included in the calculation of average d2 h?
No
#S Slope of vegetated shelf (H:V}
61 1
#2 Elevation of the bottom of the permanent pool (fmsl)
15.00 ft
#7 Diameter of drawdmn orifice (incites
1.5 in
#2 Elevation of the top of the permanent pool (fmsq
21.00 ft
#7 Drawdown time for the temporary pool (hours)
64.3 1
#2 Elevation of the top of the tempo (fmsl)
22.50 ft
#7 Does the onfce drawdown from below the top surface of the permanent pool?
YES
#3 Depth provided for sediment storage (inches)
12 in
98 Does the pond minimize impacts to the receiving channel from the 1-yr. 24-hr storm?
YES
#4 Are the inlets) and outlet located in a manner that avoids shofcircuiting7
YES
#9 Are fountains proposed?
NO
#4 Describe any measures, such as bums or baffles, that will be taken to improve the flaw path,
#9 If yes, is documentation provided per Wet Pond MDC (9)?
#10 Is a trash rack or other device provided to protect the outlet system?
YES
95 Volume of the for (cubic foot
2,513 cf
#11 Are the dam and embankment planted in non -clumping turf grass?
YES
#5 Is this 15-20 % of the volume in the main pool?
YES
#11 Species of turf that will be used on the dam and embankment
SOD
#5 Depth of forebay at entrance (inches)
66 in
#11 {Describe the planting plan for the vegetated shelf:
95 Depth of foeebay at exit (inches)
60 in
THE VEGETATED SHELF SHALL BE PLANTED WITH A MINIMUM OF THREE DIVERSE SPECIES OF
HERBACEOUS, NATIVE VEGETATION AT A MINIMUM DENSITY OF 50 PLANTS PER 200 SF OF SHELF AREA.
THE "OTHER" IMPERVIOUS ABOVE IS "FUTURE" IMPERVIOUS AREA TO BE ASSIGNED AT A LATER DATE_
#5 Does water flaw out of the forebay in a non -erosive manner?
YES
#5 Clean -out depth for forebay (inches
48 in
#5 Will the forebay be cleaned out when the depth is reduced to less than the above?
YES
ADDITIONAL INFORMATION
ECEI Y E
DEC 18 2018
BY•

i'
r
Operation & Maintenance Agreement
Project Name
Project Location
Coastal Express Car Wash / Cook Out " 1Um
4447 & 4455 Main Street, Shallotte, NC 28470
nce records shall be kept on the following BMP(s). This maintenance
a loa in a known set location.
Any deficient BMP elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the BMP(s).
The BMP(s) on this project include (check all that apply & co
Bioretention Cell
Quantity:
Dry Detention Basin
Quantity:
Grassed Swale
Quantity:
Green Roof
Quantity:
Infiltration Basin
Quantity:
Infiltration Trench
Quantity:
Level SpreaderNFS
Quantity:
Permeable Pavement
Quantity:
Proprietary System
Quantity:
Rainwater Harvesting
Quantity:
Sand Filter
Quantity:
Stormwater Wetland
Quantity:
Wet Detention Basin
Quantity:
Disconnected Impervious Area
Present:
User Defined BMP
Present:
nding O&M tables will I
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
re aaaea automaucan
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each BMP above, and attached O&M tables. I agree to notify NCDENR of any problems with the system or prior to any changes to
the system or responsible party.
" Responsible Party. Phillip D. Gause ����E
Title & Organization: Managing Member - G and H Hauling, LLC
Street address: 4623 Maple Hill Road
City, state, zip: 5hallotte, NC 28470 NOV 2 9 2018
Phone number(s): 910-274-5667
Email:
Signature: PL 1 Date:
I,�Y: Jar-�StN� a Notary Public for the State of
County of_> �Ls..SL� do hearby certify that�1,
personally appeared before me this day of and
acknowledge the due execution of the O
Witness my handt%.d officia
r'. ..i . f 'd
JTAIQy'°.2
y•..AU130
STOk%#Z
Version 1.4
ns and Maintenance Agreement .
My commission expires
sO i
c6 oTARy'•,2
AG: ' AU1300 •2
2.
11/28/2018
O&M Manual Page 1 of 4

74�

r'.
I Wet Detention Pond Maintenance Requirements
The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the vegetated filter if one
is provided.
Important maintenance procedures
Immediately after the wet detention basin is established, the plants on the vegetated shelf and perimeter of the
_ basin should be watered twice weekly if needed, until the plants become established (commonly six weeks).
No portion of the wet detention pond should be fertilized after the first initial fertilization that is required to
establish the plants on the vegetated shelf.
Stable groundcover should be maintained in the drainage area to reduce the sediment load to the wet detention
- basin,
If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through the
emergency drain should be minimized to the maximum extent practical.
Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and within 24 hours after every storm event
greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance should be kept in a known
set location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
BMP element:
Potential problem:
How I will remediate the problem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the BMP
Areas of bare soil and/or
Regrade the soil if necessary to remove the gully, and then plant a
erosive gullies have formed.
ground cover and water until it is established. Provide lime and a one-
time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of approximately six inches.
long.
The inlet device
The pipe is clogged.
Unclog the pipe. Dispose of the sediment off -site.
The pipe is cracked or
Replace the pipe,
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to smooth it over and provide erosion
Swale.
control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Stone verge is clogged or
Remove sediment and replace with clean stone.
covered in sediment (if
applicable).
The forebay
Sediment has accumulated to
Search for the source of the sediment and remedy the problem if
a depth greater than the
possible. Remove the sediment and dispose of it in a location where it
original design depth for
will not cause impacts to streams or the BMP.
sediment storage.
Erosion has occurred.
Provide additional erosion protection such as reinforced turf matting or
riprap if needed to prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the problem: soils, hydrology, disease, etc.
dying.
Remedy the problem and replace plants. Provide a one-time fertilizer
application to establish the ground cover if a soil test indicates it is
necessary.
Weeds are present.
Remove the weeds, preferably by hand. If pesticide is used, wipe it on
the plants rather than spraying.
t_-GGIVI
Nov 2 9 2010
STORM-EZ 11 /28/2018
Version 1.4 O&M Manual Page 2 of 4

I Wet Detention Pond Maintenance Requirements (Continued) I
The main treatment area
Sediment has accumulated to
Search for the source of the sediment and remedy the problem if
a depth greater than the
possible. Remove the sediment and dispose of it in a location where it
original design sediment
will not cause impacts to streams or the BMP.
storage depth.
Algal growth covers over 50%
Consult a professional to remove and control the algal growth.
of the area.
Cattails, phragmites or other
Remove the plants by wiping them with pesticide (do not spray).
invasive plants cover 50% of
the basin surface.
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and consult a professional to remove
beaver activity is present.
beavers.
A tree has started to grow on
Consult a dam safety specialist to remove the tree.
the embankment.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. (if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Department of Environment and Natural
damage have occurred at the
Resources Regional Office.
outlet.
The measuring device used to determine the sediment elevation shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
ECE1V�"-
NOV 19 1018
STORM-EZ By-.----11/28/2018
Version 1.4 O&M Manual Page 3 of 4

i Wet Detention Pond Design Summary
Wet Nona ulagram
WET POND ID FOREBAY MAIN POND
POND 1
Permanent Pool El.
21
Permanent Pool EL
21
Temporary Pool El:
22.5
Temporary Pool El:
22.5
Pretreatment other No
Clean Out Depth:
4
Clean Out Depth:
6
than forebay?
Sediment Removal El:
17
Sediment Removal El:
15
Has Veg. Filter? No
Bottom Elevation:
15.5
Bottom Elevation:
14
ECEIVE
JAN 0 4 2018
BY•
1
STORM-EZ 1/4/2019
-Version 1 4 O&M Manual Page 4 of 4

Operation & Maintenance Agreement
Project Name: Coastal Express Car Wash 1 Cook Out -Kings Mountain
Project Location; 14447 & 4455 Main Street, Shallotte, NC 28470
1 Cover Page I
Maintenance records shall be kept on the following BMP(s). This maintenance record shall be kept in a log in a known set location.
Any deficient BMP elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can
affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the BMP(s).
The BMP(s) on this project include (check all that apply & co
Bioretention Cell Quantity:
Dry Detention Basin
Grassed Swale
Green Roof
Infiltration Basin
Infiltration Trench
Level SpreaderNFS
Permeable Pavement
Proprietary System
Rainwater Harvesting
Sand Filter
Stormwater Wetland
Wet Detention Basin
Disconnected Impervious Area
User Defined BMP
Quantity:
Quantity:
Quantity:
Quantity:
Quantity:
Quantity:
Quantity. -
Quantity:
Quantity:
Quantity:
Quantity:
Quantity:
Present:
Present:
nding O&M tables will I
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
Location(s):
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each BMP above, and attached O&M tables. I agree to notify NCDENR of any problems with the system or prior to any changes to
the system or responsible party.
* Responsible Party. -
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email. -
John Armfield, Vice President
Cook Out -Kings Road, Inc.
15 Laura Lane, Ste 300
Thomasville, NC 27360
336-313-5226
Signature: :
/} DateZ� 1�
I , �' JI a Notary Public for the State of
County of (L Y" r__Is maydo hearby certify that =J,-,
personally appeared before me this 4-k—) day of � �J1nQ, �1-�� 1 () j ^� and
acknowledge the due execution of the Operations and Maintenance Agreement .
Witness my hand and official seal
.0am-o-Z
rcinn 1 d
ECEIVF '
# NOV 2 9 2013
My commission expires / U ` � �� v 11/28/20
O&M Manual pano 1 n

. r

E Wet Detention Pond Maintenance Requirements
The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the vegetated filter if one
is provided.
Important maintenance procedures
Immediately after the wet detention basin is established, the plants on the vegetated shelf and perimeter of the
basin should be watered twice weekly if needed, until the plants become established (commonly six weeks).
No portion of the wet detention pond should be fertilized after the first initial fertilization that is required to
establish the plants on the vegetated shelf.
Stable groundcover should be maintained in the drainage area to reduce the sediment load to the wet detention
basin.
If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through the
emergency drain should be minimized to the maximum extent practical.
Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and within 24 hours after every storm event
greater than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance should be kept in a knowr
set location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
BMP element:
Potential problem:
How I will remediate the problem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the BMP
Areas of bare soil and/or
Regrade the soil if necessary to remove the gully, and then plant a
erosive gullies have formed.
ground cover and water until it is established. Provide lime and a one-
time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of approximately six inches.
long.
The inlet device
The pipe is clogged.
Unclog the pipe. Dispose of the sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to smooth it over and provide erosion
swale.
control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Stone verge is clogged or
Remove sediment and replace with clean stone.
covered in sediment (if
applicable).
The forebay
Sediment has accumulated to
Search for the source of the sediment and remedy the problem if
a depth greater than the
possible. Remove the sediment and dispose of it in a location where it
original design depth for
will not cause impacts to streams or the BMP.
sediment storage.
Erosion has occurred.
Provide additional erosion protection such as reinforced turf matting or
riprap if needed to prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
Prune according to best professional practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the problem: soils, hydrology, disease, etc.
dying.
Remedy the problem and replace plants. Provide a one-time fertilizer
application to establish the ground cover if a soil test indicates it is
necessary.
Weeds are present.
Remove the weeds, preferably by hand. If pesticide is used, wipe it on
the plants rather than sprayin ECEIVE
'ORM-EZ
rcinn 1 4
NOV 2 9 2018
BY: -_.. 11/28/20
O&M Manual Pena ? n

I Wet Detention pond Maintenance Requirements Continued I
The main treatment area
Sediment has accumulated to
Search for the source of the sediment and remedy the problem if
a depth greater than the
possible. Remove the sediment and dispose of it in a location where it
original design sediment
will not cause impacts to streams or the BMp.
storage depth.
Algal growth covers over 50%
Consult a professional to remove and control the algal growth.
of the area.
Cattails, phragmites or other
Remove the plants by wiping them with pesticide (do not spray).
invasive plants cover 50% of
the basin surface.
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and consult a professional to remove
beaver activity is present.
beavers.
A tree has started to grow on
Consult a dam safety specialist to remove the tree.
the embankment.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. (if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Department of Environment and Natural
damage have occurred at the
Resources Regional Office.
outlet.
The measuring device used to determine the sediment elevation shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
JFECEIVE�
NOV as 2018
8y.
'ORM-EZ 11/28/20
rcinn 1 d O&M Manual pana '; n

{
I Wet Detention Pond Design Summary_
Wet Pond Diagram
WET POND ID FOREBAY MAIN POND
POND 1 Permanent Pooi El. 21 Permanent Pool El 21
Temporary Pool El: 22.5 Temporary Pool El: 22.5
Pretreatment other No Clean Out Depth: 4 Clean Out Depth: 6
than forebay? Sediment Removal El: 17 Sediment Removal Ei: 15
Has Veg. Filter? No Bottom Elevation: 15.5 Bottom Elevation: 14
CCE®VE
4
JANQ42015
BY•
STORM-EZ 114/2019
Version 1.4 O&M Manual Page 4 of 4

Permit Number SW8181118
Program Category
State SW
Permit Type
State Stormwater
Primary Reviewer
christine.hall
Coastal SWRuIe
Coastal Stormwater - 2017
Permitted Flow
Facility
Central Files: APS _ SWP
6/9/2020
Permit Tracking Slip
Status Project Type
Active Minor modification
Version Permit Classification
1.10 Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
Coastal Express Car Wash and Cook Out Minor Wilmington
Location Address County
4447 And 4455 Main Streeet Brunswick
Facility Contact Affiliation
Shallotte NC 28470
Owner
Owner Name Owner Type
G & H Hauling LLCICook Out Shallotte Formerly Cook Out Kings Mountain Inc Non -Government
Owner Affiliation
Phillip D. Gause
Manager Member
4623 Maple Hill Rd
Dates/Events Shallotte NC 28470
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
1/4/2019 4/9/2020 6l612020 6/6/2020 V4l2027
Regulated Activities Requested /Received Events
State Stormwater - HD - Detention Pond
Outfall
Waterbody Name Streamindex Number Current Class Subbasin