SW8160812_Historical File_20160818

General Data: Impervious,Drainage Area and Volume
PROJECT NUMBER:SWB 160612
Reviewer: K Johnson -
DRAINAGE BASIN: Cape Fear
Current Date 18-Aug-16 -
Original Run Date: 9-Aug-10
DA Number 1 2 3 4 5 6 7 8 9 10
M
BMP Type Wet PO No BMP In ,No BMP in No BMP in No BMP in -No BMP in No BMP in No BMP In No BMP in No BMP In
DA DA DA DA DA_ DA DA DA DA
Receiving Stream
Stream Index - •
- -
Class - - -
•
Method used to determine required volume? ample Please Select:Fleece Sete& Please Select Please Select Please Select Please Select Please Select Reese Select-Please Select
Simple Method,Design Storm,P1,,20„in:
(Enter if Project is Subject to SA-NEEDED FOR BOTH SIMPLE AND SCS SA CALCs)
Simple Method,Design Storm of Old Rule,in:
(Enter if Part of Project is Permitted Under an Old Rule Such as 1.0",if not leave blank)
SCS Discrete(TR-55)Method,Design Storm,Value of PPaa m 1,24h„in: - _(Enter the Value of Pm if Non-SA or Ph yh,if SA) -
Project is Subject to SA? N Reese Select Please Select Please Select Please Select Please Select Please Select Please Select Please Select Reese Select'
Volume That Is Required,ft': •
(Volume from either the Simple Method or the SCS Method.If SCS Method for SA,compare 2,639
SCS at 1yr24hrto Situp:"et 1.5"and choose the Luger volume.) _ ,
Simple Method Volume Summary: - • - • —- -- -
Simple Method&SA
(2008 Rule,Greater of 1.5"or 1yr24hr pre/post)+(Old Rule at 1.5")
Simple Method&non-SA
(2008 Rule,1.5')+(Old Rule,1.0") Mil
SCS Discrete(TR-55)Volume Summary If TR-55 is used,then this spreadsheet is not
setup to account for adding that volume to an old rule calculated eta lower(1.0')storm.It
does not make sense to combine the volume calculations that way.
SCS Discrete(TR-55)&SA
(2008 Rule,Greater of 1.5"or 1yr24hr pre/post)
SCS Discrete(TR-55)&non-SA
Im _
Proposed Impervious(ALL IMPERVIOUS),Total,ftz: 21,780 0 0 0 �i 0 0 0 0 6' 0
Onsite Buildings 3,633
Onsite Streets 0
Onsite Parking 17,105 _
Onsite Sidewalks 866
Onsite Other 0
Future - 176 - -
Offsite - 0
Existing a
Previou Permitted Impe
rvious ervious.Old Poe.ti 0 0 0 0 0 0 0 0 0 0.
Onsite Buildings
Onsite Streets -
Onsite Parking
Onsite Sidewalks
Onsite Other - -
Future
Offsite
Existing • -
Proposed Y�tperv, s,Subtl etSP�IWdI Pule,le • � 21,780 0 0 0 0 0 0 0 0 0
Drainage Area: Needed For Seth Sim shad SCS Discrete — _
Drainage Area,Total,ft2: _ 30,141 1MIN
'�
Onsite,ft. 30,141 5--MIMI ---�
Offsite,fe: 13 -..- ----
.DragJe9eAJ sOld Rule,1t; • - 0 0 0 0 0 0 0 0 0 0
Onsite,ft
Offsde,fP: ,
Proposed DA Meng Adoed By Mod),ft2: • 30,141
Drainage Area,Subject to Old Rule,ft2: 0 0 0 0 0 0 0 0 0 0
Drainage Area,Sub'ect to New Rule,ft2:_ _ 30,141
Volume Required,Old Rule,ft': 0 0 0 0 U 0 0 0 0 u
RVP..1 o.r.tepnanr,Old Rule:
Volume Required,2008 Rule,ft': 2,639
RvP„D„yeh,pment,2008 Rule: •
(Enter 0.05 if no pre-development BUS,)
RvP,5 D,naP,,,M,2008 Rule: 0.70
Volume Requiredl.r,ft':' 2,639 0 0 0 0 0 0 0 0 0
Volume Requiredljrz4h„113: 0 0 0 0 0 0 0 0 0 0
Volume Calculations-Page 1/3

Wet Ponds
PROJECT NUMBER:SW8 160612
Reviewer: K Johnson
DRAINAGE BASIN: Cape Fear
Current Date 18-Aug-16
Original Run Date: 9-Aug-la
DA Number 1 2 3 4 5 6 7 8 9 10
BMP Type Wet Pond No BMP in No BMP in No BMP in No BMP in No BMP in No BMP in No BMP in No BMP in No BMP in
Minimum Surrace Area DA DA DA DA DA DA DA DA DA
%impervious 72.3%
Lower Impervious 70.0%
Upper Impervious 80.0%
TSS(85 or 90): 90
Lower SA/DA 7.0 #NIA #N/A #N/A #N/A #N/A #NIA #N/A #N/A #N/A
Upper SA/DA 8.0 #N/A #N/A #N/A #NIA #N/A #NIA #N/A #NIA #N/A
SA/DA ratio 7.2 #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
PP Surface Area req,ft2: 2,178 #N/A #N/A #N/A #NIA #N/A #N/A #N/A #N/A #N/A
Storage Calculations
Elevation,Bottom of Sediment(excavated depth),fmsl: 22 00
Elevation,Top of Sediment(bottom pond/designed bottom),fmsl: 23.00
Elevation,Bottom of shelf,fmsl: 28.00
Elevation,Permanent Pool,fmsl: 29.00
Elevation,Top of Shelf,fmsl: 29.00
Elevation,Temp.Pool,fmsl: 30.25
Area,Top of Sediment(bottom pond/designed bottom),ft2:
Area,Bottom of Shelf,ft2:
Area,Perm Pool,ft2:
Area,Top of Shelf,ft2:
Area,Temp.Pool,ft2:
Volume Provided(Temp Pool),DWQ Calculated,ft3: 3,295 0 0 0 0 0 0 0 0 0
Volume Provided(Temp Pool),Provided per consultant,ft3: 3,295
Volume Required(Temp Pool),DWQ Calculated,ft3: 2,639
Consultant Provided Enough Volume? Y
Average Depth Option 1 or Option 2(Enter 1 or 2)? 2
Average Depth Provided,ft: 3,9
Average Depth-OPTION 1-,DWQ Calculated,ft: 1.50
Average Depth-OPTION 2-,DWQ Calculated,ft: 3.0
Forebay Volume
Permanent Pool Volume,ft3: 3,826 0 0 0 0 0 0 0 0 0
Forebay Volume,Required,ft3: 765 0 0 0 0 0 0 0 0 0
Forebay Volume,Provided,ft3: 720
Percent of Permanent Pool(18-22%is Target): 19%
Drawdown
Avgerage Head,ft: 0.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Average Flow Q2,ft3/sec: 0.015
Average Flow Q5,ft3/sec: 0.006
Q2 Area,in2: 0.720
Q5 Area,in2: 0.288
No.of Orifices 1
Orifice Diameter,in: 1 00
Orifice Area,in2: 0.785 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Weir(enter Y or N)?
Weir Height,in:
Weir Length,in:
Weir C:
Weir L,Effective Length,ft: -0.081 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Average Orifice Flowrate,DWQ Calc(Q )ft3/sec: 0.017 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Average Orifice Flowrate,Reported(QReported)ft3/sec: 0.020
Average Orifice Flowrate is Adequate?Set Range in Calc y
Runoff Coefficient Cc: 0.250 0.250 0.250 0.250 0.250 0.250 0.250 0.250 0.250 0.250
1 yr24 hr rainfall depth,in: 3,80
1 yr 24 hr Intensity(I)in/hr. 0.158 0.000 0.000 0.000 0.000 0.000 0.000 0 000 0.000 0.000
1 yr 24 hr Pre-Development(Q),ft3/sec: f 0.027
Avg.Orifice Flow<Pre Q? OK
Drawdown,days: 2
Soils Report Data
Ground Elevation at Boring in Soils Report,fmsl:
Distance Ground to SHWT per Soils Report,in:
Distance Ground to SHWT per Soils Report,ft: 0.00 0.00 0.00 0.00 0.00 0.0.0 0.00 0.00 0.00 0.00
SHWT Elevation,DWQ Calculated,fmsl: 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
ISHWT Elevation,Reported by Consultant,fmsl:
Distance SHWT to PP,ft: -29.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Design OK if: 0<= Value<=0.5
Permanent Pool Elevation,fmsl: 29.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Pum.
Max HP: N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Wet Pond
Basin Forebay. Total
Contour Contour Contour
El SA Inc Vol Cum Vol El SA Inc Vol Cum Vol El SA Inc Vol Cum Vol
(ft) (sf) (cf) (cf) (ft) (sf) (cfl (cf) (ft) (sf) (cf) (cf)
Excavated Depth 22.00: 6 0 0 22.00 0 0 22.00 6 0 0
Bottom Pond/Top Sediment 23.00 52 0 0 23.00 0 0 23.00 52 0 0
24.00 133 93 93 24.00 0 0 24.00 133 93 93
25.00. 247 193 285 25.00 5 0 0 25.00 252 193 285
26.00 395 358 643 26.00 68 D 0 26.00 463 358 643
27.00 576 486 1,128 27.00 164 116 116 27.00 740 602 1,244
Bottom Shelf 28.00 791 684 1,812 28.00 294 229 345 28.00 1,085 913 2,157
PP 2900 :i, : 1,295 3,IJ 29.00 375 72J 29.00 2,254 1,670 3,826
30.00 2,864 2,559 6,385
TP 30.25 3,026 736 7,121
TP Volume: 3,295 = 7,1--1 - 3,826
PP Volume: 3,826 = 5,f 07 + 720
PP Area: 2,254 = 1 79" + 455
Forebay#1 Volume: 720
%Forebay fit: 19%
Average Depth(Option 1): 1.7 -->Round 1.5
Average Depth(Option 2): 3.0 -->Round 3.0 (He got 3.5ft,but the PP Area provided is OK)
AeotsheIf 1,085 ft' Main Pond+Forebay
APermPoal 2,254 ft2 Main Pond+Forebay
ABotPond 52 ft2 Main Pond Only
depth 5.00 ft Bottom Shelf to Bottom Pond
Bottom Shelf 28 00 msl
Bottom Pond/Top Sediment 23.00 msl

�R5es
ASSIGNMENT AND ASSUMPTION OF LEASE("Assignment"I
ASSIGNOR: WORSLE.Y OPERATING CORPORATION,allorth Carolina
corporation
ASSIGNEE: ( i'1Vt.SOUT'_I I AST, MC,a Dolaware limited liability company
ASSIGNEE'S 1410 Commonwealth Drive, Suite 202,
ADDRESS: Wilmington,NC 28403,Attn:Real Estate Manager
ASSIGNEE'S 8565 Magellan Parkway,Suite 400
NOTICE Richmond,VA 23227,Attn: CEO
ADDRESS: Phone:[phone],Fax:[phone]
With a copy to:
1410 Commonwealth Drive, Suite 202,
Wilmington,NC 28403,Attn:Real Estate Manager
Phone: [phone],Fax:[phone]
LESSOR: ROXANN MACHAC
LEASE: Lease dated May 1,2003 by and between Roxann Machac,successor-
in-interest to Arnold P. Cowan Estate,Lori Cowan Hubbard,William
Joe Cowan,and Roxann Cowan,as landlord,and Worsley Operating
Corporation,as tenant,as amended by First Amendment to Lease
Agreement dated November 23,2010
PREMISES: 15515 Highway 53 East,Maple Hills North Carolina
STORE NAME: #3001
For valuable consideration pursuant to that certain Asset Purchase Agreement by and
between Assignor and Assignee and certain other parties thereto (the `Purchase Agreement"),
effective as of the Closing Date(as defined in the Purchase Agreement),Assignor hereby assigns
and transfers to Assignee all of Assignor's right, title and interest as lessee in the Lease.
Assignee hereby accepts such assignment and transfer and agrees to assume and to perform and
discharge all obligations and liabilities of Assignor under the Lease that arise after the Closing
Date hereof and relate to the period after the Closing Date.
Nothing contained in this Agreement Is intended to amend,modify, restrict or terminate
any obligation of Assignor or Assignee under the Purchase Agreement. To the extent any term,
condition or provision of this Assignment is in any way Inconsistent with or in conflict with any
term, condition or provision of the Purchase Agreement, the Purchase Agreement shall govern
and control.
This Assignment and all of the provisions hereof will be binding upon Assignor and
Assignee and their respective successors and assigns.
This Assignment may not be amended or waived except in a wilting executed by the
party against which such amendment or waiver is sought to be enforced.
ECEIVE
Assignment andAasrwrpfon of Lease—Slone 413001 1
2922997•E AUG 1 6 2016
nV•

IN WITNESS WHEREOF,this Assignment has been executed by Assignee and Assignor
as of August 2013.
GPM SOLTT EAST,LLC,a Delaware WORSLEY OPERATING
limited liability company CORPORATION,a South Carolina
corporation
By: By:
Arie Kotler, CEO Jeffery W. Tiupin, CEO
By:
Mark King, C O
Assignment and Assumption of Lea=•-Store#3001
2922997-1

IN WITNESS WHEREOF,this Assignment has been executed by Assignee and Assignor
as of July___,2013.
GPM SOUTHEAST,LLC,a Delaware WORSLEY OPERATING
limited liability company CORPORATION,a South Carolina
corporation
By: By: f
Arie Kotler,CEO Je ;/�
OCEO
By:
Mark King,CFO
Assignment mid t runptfori ofLears—Store 113001
2922997-t

FIRST AMENDMENT TO LEASE AGREEMENT
Scotchman Store#1
THIS FIRST AMENDMENT TO LEASE AGREEMENT (the"Amendment"),made and
entered into this 23th day of November, 2010,by and between ROXANN MACEiAC, (herein called
"Landlord"),and WORSI..EY OPERATING CORPORATIONS,a North Carolina corporation with its
principal office at 1410 Commonwealth Drive,Suite 202,Wilmington, NC 28403 (the "Tenant"),
WITNESSETH:
WHEREAS, ARNOLD P. COWAN,WILLIAM JOE COWAN,and ROXANN COWAN and Tenant
entered into a certain Lease Agreement,dated as of May 1, 2003 (the"Lease"),with respect to
certain premises commonly known as 15515 Hwy 53 East, Maple Hill,NC (Scotchman Store#1)
and more particularly described in the Lease;and
WHEREAS,ROXANN COWAN MACHAC on May 7, 2010 acquired the exclusive fee interest
in the premises; and
WHEREAS,Landlord and Tenant now desire to amend the Lease by extending the lease
term for three(3) additional terms of five (5)years each from May 1,2018 through April 30, 2033.
NOW THEREFORE,in consideration of the premises and other good and valuable
consideration,the receipt and sufficiency of which are hereby acknowledged,Landlord and
Tenant agree that the Lease is hereby amended as follows:
1. Paragraph 19 of the lease is amended to increase the number of additional terms
from two (2)additional terms of five (5)years duration to five (5) additional terms of five (5)
years duration. The third additional five-year term is from the end of the second term through
April 30, 2023. The monthly fixed rent for the third five-year term shall be$1,750. The fourth
five-year term is from May 1, 2023 through April 30,2028. The monthly fixed rent for the fourth
five-year term shall be$1,925.The fifth five-year term is from May 1,2028 through April 30,2033.
The monthly fixed rent for the fifth five-year term shall be$2,118. In addition, the rent for the first
and second additional terms will be changed from$850 to$1,250 and from$975 to$1,375,
respectively.
2, Except as expressly hereinabove amended,Landlord and Tenant agree that the
terms,conditions and covenants of the Lease shall remain in full force and effect and are hereby
confirmed,approved and ratified by Landlord and Tenant.
IN WITNESS WHEREOF, Landlord h s caused thi .Amendment to be executed by its duly
authorized officers on this a (( day of W tvl e , 2010.
RO MACHAC
By: /71
Printed: )j V-a rah f'YIGAc h4 Title: 1✓iiI-

a I
•
•
STATE OF tt wN"I) )
) ss:
COUNTY OF AK )
On this PiAday ofAriwsuott... , 2010,personally appeared before me, Roxann Machac
,and as such had been duly authorized to execute, acknowledge and deliver the foregoing
instrument in the name of and for and on behalf of said Company,and acknowledged that as such
person he did in the name of said Company,execute and acknowledge said instrument for the uses
and purposes set forth therein.
Asj
(SEAL)
'OFFICIAL SEAL" Notary Publ'
Elvis Seslagic
Notary Public,State of Illinois
Cook County P1e41.— c2.013
My Commission Expires April 7,2013 My Commission Expires
IN WITNESS WHEREOF,Tenant has executed this Amendment this day of
, 2010.
WORSLEY OPERATING CORPORATION
By:
pin
air &Chief Executive Officer
STATE OF NORTH CAROLINA)
) ss:
COUNTY OF NEW HANOVER )
On this j
day of l-C r 1 gitc , 2010,personally appeared before me,Jeffery W.
Turpin who,being by me duly sworn,did say he is the Chairman and Chief Executive Officer of
Worsley Operating Corporation,a North Carolina corporation,and as such had been duly
authorized to execute,acknowledge and deliver the foregoing instrument in the name of and for
and on behalf of said company,and acknowledged that as such officer he did in the name of said
company, execute and acknowledge said instrument for the purposes set forth therein.
rrrli � ( ivtvY.t i2 , .
���•�`(well'.... � Notary Public
My Commission Expires
PUMA
tea '

Ground Lessor Estoppel
Consent
Store 1
ESTOPPEL CERTIFICATE
This Estoppel Certificate ("Estoppel') is made of this 28th day of February
2008, by Arnold P. Cowan Estate. Lori Cowan Hubbard, William Joe Cowan and Roxann
Cowan or their heirs. successors or assigns ("Ground Lessor") in favor of Worsley Operating
Corporation,and its subsidiaries, affiliates, successors and assigns("WOC").
RECITALS
A. Ground Lessor is the lessor under that certain lease further described on Exhibit
"A" attached hereto (the "Ground Lease"), pursuant to which WOC owns and holds a ground
leasehold estate in and to a tract of real property located at 15515 Hwy 53 East. Maple Hill NC,
more particularly described in the Ground Lease("Premises").
NOW THEREFORE, in connection with the foregoing, Ground Lessor does hereby
certify as follows:
1. The Ground Lease described on Exhibit "A" attached hereto is presently in full
force and effect. The Ground Lease represents the entire agreement between Ground.Lessor and
Original Lessee with respect to the Premises. There are no amendments or modifications of any
kind to the Ground Lease except as indicated on such Exhibit"A"; there are no other promises,
agreements, understandings or commitments of any kind whatsoever with respect to the Ground
Lease, including, without limitation, subordination, non-disturbance and attomment agreements
or estoppel certificates except as indicated on such Exhibit"A".
2. Ground Lessor is the sole owner and holder of the Premises and of the Ground
Lessor's interest in the Ground Lease.
3. The Commencement Date of the Ground Lease was May 1, 2003, and the current
term shall expire on April 30.2008.
4. The tenant under the Ground Lease has two(2)five year remaining options to
extend the term of the Ground Lease, and a right of first refusal, as more particularly set forth in
the Ground Lease.
5. The current monthly rental under the Ground Lease is Seven Hundred Fifty and
No/100 DOLLARS ($750.00) per month. The next increase in monthly rental due under the
Ground Lease shall be on May 1.2008 if renewed.
6. No rental or other charges due under the Ground Lease have been paid more than
thirty(30)days in advance of the date when due.
7. To the best of Ground Lessor's knowledge, no uncured default or breach by
Ground Lessor or Original Lessee exists under the Ground Lease, and no facts or circumstances
exist that,with the passage of time will or could constitute a default or breach by Ground Lessor
or Original Lessee under the Ground Lease.
- 1 -

Store 1
IN WITNESS WHEREOF, Ground Lessor has executed this Estoppel as of the date first
above written.
AROUND LESSOR:
5 1 a
10 t kel----""
b„,,-(....trit.0.4- t
-Pain .aame: Ro LArt ([: ,1 in inttCLW.-
Print e:
Print N
Print Name:\
s.
-2-

Ground Lessor Estoppel
Consent
Store 1
EDIT A
Description of Ground Lease
Lease dated May 1, 2003 between Arnold P. Cowan Estate, Lori Cowan Hubbard, William Joe
Cowan and Roxann Cowan("Landlord")and Worsley Operating Corporation("Tenant")
-3 -

TISDALE,MCCONNELL&BARDILL,LLP
ATTORNEY!AND COUNSELORS AT LAW
400 NEW BRIDGE STREET
P.O. BOX 1335
JACKSONVILLE, NORTH CAROLINA 2E540
NORWOOD BOYD TISDALE TELEPHONE
KEVIN MCCONNELL [phone]
MARK D.BARDILL.,RETIRED FACSIMILE
ROBERT E. LOCK,RETIRED [phone]
October 25,2007
Ms. Roxann Machac
832 Hickory Court
Marengo, IL 60152
Re: Tract I,Holly Township,Pender County
Dear Ms.Machac:
Enclosed is the original warranty deed for the property you recently obtained from Lori
Cowan Hubbard and husband Edward Hubbard.This deed has been recorded in Book 3227,Page
210,Pender County Registry. Also enclosed is the original warranty deed for the property you
recently obtained from William Joe Cowan and wife,Barbara Cowan.This deed has been
recorded in Book 3227,Page 212,Pender County Registry.
I hope you enjoy your new property and if I can be of further assistance to you in any
way,please let me know.
Sincerely yours,
_li\irvt--t-Le-Aly... t 44
Kimberly M.Green
Paralegal 'Pt r.'CN 2-t_,- rC-J.rt) L
yv' l/L c h -�'-� C�� 4•z 'I
Ltvi r, /k. r2 At-
;)t :J
ff( .! !et it: G::)f ,n ritA
'��. ..
;�r�.GtiU�i

flECEIVE
JUN282016
BY:
STATE OF NORTH CAROLINA
COUNTY OF PENDER LEASE(#Q
Maple Hill,NC
THIS LEASE, hereinafter called"the Lease", effective this 1st day of May, 2003,by
and between ARNOLD P. COWAN ESTATE, LORI COWAN HUBBARD, WILLIAM JOE
COWAN, and ROXANN COWAN (herein called "Owner"), and WORSLEY OPERATING
CORPORATION, a North Carolina corporation(herein called"Tenant").
WITNESSETH:
Owner hereby leases to Tenant and Tenant hereby leases from Owner the property
described below, on the terms herein set forth.
1. Property. The leased property, herein called "Property", is a parcel of land in
Pender County, North Carolina, described hi Exhibit A attached hereto, together with any buildings,
fixtures or improvements now located or hereafter constructed or placed upon the land described in
Exhibit A.
2. Term. The teen of this lease shall be for five (5)years and shall begin on May 1,
2003 and run through April 30,2008(the"Term"),unless sooner terminated as provided herein.
3. Imo. Tenant shall pay to Owner as base rent, without notice or demand therefor,
Seven Hundred Fifty Dollars ($750.00) per month for the lease term. Each rental payment ,shall be

payable on or before the first day of each calendar month for the then current month. In the event the
lease term begins or ends on a day other than the first or last day of a calendar month,the rent for any
period less than a calendar month shall be a pro rata portion of one month's rent. A late charge of five
percent(5%) of the amount of any installment due hereunder shall be assessed on any such installment
received ten(10)days after the same is due as required herein.
4. Improvements. Except for minor alterations, repairs or improvements to the
Property, Tenant shall make no structural or other changes in the Property without Landlord's prior
written consent. Tenant shall comply with all applicable building codes, laws and regulations in the
construction of any permitted improvements and additions. All improvements, alterations and
additions shall become a permanent part of the real estate and as such the property of Landlord, but
trade fixtures, equipment and other personal property used in any building shall remain the property of
Tenant and may be removed by Tenant at any time. Upon request of Landlord, Tenant shall remove
said fixtures, equipment and other personal property at the expiration or earlier termination of the lease
and shall repair all damage caused by such removal.
5. Owner's Inspection. Owner, during the term of this lease at reasonable times and
during usual business hours,may enter the Property to view it.
b. Fire or Casualty. If(a)the Property or any structure thereon shall be destroyed or
damaged by fire, casualty, or other cause or happening, or (b) any lawful authority shall order
demolition or removal of any such structure, so as to render the Property permanently unfit for
Tenant's use as herein described, then this lease may be terminated at the option of either Owner or
Tenant and, upon such termination, Tenant's obligation to pay rent Anil cease, and any unearned rent
paid in advance shall be refunded to Tenant. If any building or structure on the Property shall be
partially destroyed or damaged by fire, casualty, demolition,removal or other cause or happening so as

to render the Property unfit for Tenant's use as herein described, or shall be declared unsafe by any
lawful authority, then, at Owner's option,the same may be repaired, restored and made safe by Owner
and a just proportion of the rent specified shall abate until said building or structure shall have been
restored and put in proper condition for Tenant's use and occupancy. If such building or structure shall
not be repaired, restored and made safe within ninety(90) days after such partial destruction, damage
or declaration of unsafe condition, then Tenant, at its option,may cancel and terminate this lease in its
entirety, and if Tenant exercises the option to cancel, any unearned rent paid in advance shall be
refunded to it.
7. Condemnation. If all or any portion of the Property shall be condemned or taken by
lawful authority so as to render the Property unavailable or unfit for Tenant's use as herein described,
then either Owner or Tenant may cancel or terminate this lease at any time after final order of
condemnation or taking,and any unearned rent paid in advance shall be refimded to Tenant.
8. Use. Tenant shall use the Property for any lawful cause or purpose. Tenant shall
comply with all laws, regulations and ordinances relating to the Property and its use, shall comply with
any restrictive covenants applicable to the Property, shall not permit any noxious or offensive sights,
odors or activities on the Property and shall not conduct or permit any nuisance thereon.
9. Repairs. Tenant shall make all repairs as are required to maintain the Property in
the condition in which the same existed at the date Tenant took possession, normal wear and tear
excepted.
10. Public Liability Insurance and Indemnity. Tenant will provide and keep in force in
its name and Owner's name public liability in amounts of not less than One Killion Dollars
($1,000,000.00). Premiums for said insurance policy shall be paid by Tenant, and.Tenant shall furnish
Owner satisfiactory proof of all said policies, changes therein and payment of all premiums. Such

insurance shall be maintained with companies which are of sound financial standing and qualified to do
business in the state in which the Property is located. Tenant agrees to indemnify and save harmless
Owner from any loss or expense arising out of any claims asserted or actions brought against Owner
based upon acts or omissions of Tenant, its agents, employees, contractors and invitees, in connection
with Tenant's use and occupancy of the Property.
11. Hazard Insurance Tenant shall obtain and pay for fire and extended coverage
insurance for the fill insurable value of the real property improvements. Owner shall be named as
insured in said policy to the extent of Owner's interest in the Property. Such insurance shall be
obtained and paid for by Tenant with companies of Tenant's choosing, provided, however, that such
companies shall be of sound financial standing and be qualified to do business in the state in which the
Property is located, and provided further than insurance proceeds paid to Owner shall be subject to the
rights granted Tenant under paragraph 6 hereof
12. Utilities and Taxes. Tenant shall pay directly and be responsible for all electric,
water, gas, sewage and other utility expenses arising out of Tenant's occupancy and use of the
Property. Tenant shall pay all property taxes and special improvement assessments levied against the
Property during the lease term.
13. Owner's Covenants. Owner covenants that it is seized of the property hi fee
simply and has the right to execute this lease,that the Property is free of encumbrances,restrictions and
zoning laws and ordinances which would prohibit use of the Property for the purposes heretofore set
forth, that the Property is free of any mortgages or deeds of trust, and that Tenant, upon paying the
rent and fulfilling all covenants and agreements herein contained, shall peacefully and quietly have,hold
and enjoy the Property for the teen of this lease, subject to and upon the restrictions, terms, and
conditions of this lease.

14. Default. If Tenant shall fail to pay any monthly rental within ten (10) days after
same is due, or if Tenant shall fail to pay any other sums or perform any other obligations, duties or
responsibilities for which it is liable hereunder, and such failure cont mies for thirty (30) days after
notice in writing to Tenant to pay or perform, or in the event of Tenant's bankruptcy, insolvency,
receivership or assignment for the benefit of creditors,then in any of said events Owner may terminate
this lease and immediately reenter and resume possession of the Property or any part thereof and
remove all persons and property therefrom, or Owner may take any other legal action or pursue any
other remedy against Tenant, or Owner may terminate the lease and proceed with other remedies con-
currently. Notwithstanding any such termination by Owner as a result of a default by Tenant
hereunder, Tenant shall be and remain liable for all obligations of Tenant under this lease, subject only
to the duty imposed on Owner by law,if any,to mitigate Owner's damages as a result of such default.
If Tenant fans to pay any sum of money or do any act required hereunder Owner may but shall not be
required to pay said money and do said act, and Tenant shall within thirty (30) days after notice in
writing repay said money and reimburse Owner for the entire cost of said act,together with interest at
the legal rate and attorneys' fees as may be required, and any failure on Tenant's part to make such
repayment shall constitute a default hereunder.
15. Tenant Holding Over. In the event that Tenant holds over after the end of the
term, or any renewal hereof, Tenant shall be and constitute a Tenant from month to month only and
may be removed at the end of any month upon seven days'written notice.
16. Notices and Payments. All notices and payments to Owner required by the terms
of this lease shall be sent by first class mail, return receipt requested, to the address listed below. The
Owners shall be solely responsible for allocating the rentals paid hereunder between the individuals
and/or entities constituting the Owners.

Lori C.Hubbard
985 Jones Wynd
Wake Forest,NC 27587
All notices and payments to Tenant required by the terms of this lease shall be sent
by first class mail,return receipt requested addressed as follows:
WORSLEY OPERATING CORPORATION
10 S. Cardinal Drive
P.O.Box 3227
Wilmington,NC 28406
Attn: William A Ambrose
Either Owner or Tenant may by ten (10) days' notice to the other party change the
address above stated. Further, Owner may at any time notify Tenant in 'writing to deposit future
payments due Owner hereunder in a designated bank account, and may revoke or change said
instructions for deposit by ten(10)days'written notice.
17. Binding Effect. This lease shall be binding upon and inure to the benefit of all
parties,their heirs, executors,administrators, successors and assigns.
18. Memorandum of Lease. A memorandum of lease, referring to this lease, may be
executed and recorded in the office of Register of Deeds of the county in which the Property is located.
19. Option to Renew. Tenant may renew this lease for two(2)additional terms of five
years duration each, on the same terms and conditions stated herein except rent. Said lease shall be
renewed automatically at the expiration of the preceding term unless Tenant gives to Owner notice of
intention not to renew not less than 30 days prior to the expiration of the specified term. The monthly
rent for the first five year renewal period shall be Eight Hundred Fifty Dollars($850.00). The monthly
rent for the second five year renewal period shall be Nine Hundred Seventy Five Dollars($975.00).
21. First Refusal Option. Owner will not sell or otherwise dispose of the Property
or any part thereof during the term of this lease or of any extension or renewal thereof unless Owner

shall have first received a separate acceptable bona fide offer for the purchase of the Property, which
offer must be folly acceptable in every respect to the Owner, and shall have notified Tenant in writing
of the names of the party or parties making the same and the price, terms and conditions thereof;and
Owner agrees that Tenant shall thereupon have the prior right to purchase the Property at the same
price and upon the same terms and conditions as are contained in such offer. Said right may be
exercised at any time within sixty days after Tenant's receipt of such written notice of said offer.
Tenant's aforementioned light may be exercised by mailing on or before the date upon which this
option shall expire written notice of such exercise to Owner by registered mail addressed to Owner at
the address hereinafter given;and such notice,if so mailed, shall be deemed valid and effective whether
or not the same in fact is actually delivered to Owner. Upon the exercise of the option Tenant shall
have a period of thirty days thaeafter before being obligated to make payment or accept title to the
Property unless by the terms and conditions of said offer a period of more than thirty days is specified
to the dosing in which case Tenant shall have such longer period. If Tenant faits to exercise its right to
purchase, and for any reason Owner shall not thereafter sell or convey the Property to the party or
parties making said offer at the price and upon the terms and conditions thereof; the foregoing
conditioned prohibition against Owner' sale or other disposition of the Property shall continue in full
force and effect and Tenant's said prior right of purchase shall apply with respect to any new oar for
the Property, all as more particularly provided above. Nothing herein shall prevent Owner from
assigning this lease as collateral for indebtedness. The covenant and agreements herein contained shall
inure to the benefit of the parties hereto and their respective heirs,legal representatives, successors and
assigns.

IN WITNESS WHEREOF, the parties have executed this lease under seal as of the
day and year first above written.
OWNER ARNOLD P. COWAN ESTATE
BY: Iy T1 I W.C .__
L)
Mary BVCowan,Ex
LORI COWAN HUBBARD
WILLIAM JOE CO
COWAN
4/L.--
TENANT WORSLEY PERATIN CO ORATION
By:
Its: PP.5 Ivinlr-
(CORPORATE SEAL)
ATTEST:
4111Pit
[SIGNATURES CONTINUE ON FOLLOWING PAGE]

STATE OF NORTH CAROLINA
COUNTY OF c02,x,„(912.A......)
e-RI, Le r r , r^O tJ v) ,a Notary Public for said County and State,do hereby
certify that MARY B.COWAN,EXECUTRIX OF THE ESTATE OF ARNOLD P.COWAN
personally appeared before me this day and acknowledged the due execution of the foregoing
instrument.
WITNESS my hand and official stamp or seal,this tl day of , !! ,',:_. 2003.
t (134.4240 -)
Notary Pub' o BRp
My Coon Expires: S[. k :•• { T a'k&L..•._
[SEAL] "
STATE OF NORTH CAROLINA
COUNTY OF ‘1/4....iii.i.c)
I, Anr,,s ,.--,.._Q—a..ANotaly Public for said County and State, do hereby
certify that LORI COWAN HUBBARD personally appeared before me this day and acknowledged the
due execution of the foregoing instrument.
WITNESS hand and officialor seal, 01'' )•J.: of ,,� ,2003.
mystamp
lit R '•''_ toPIS A, J14LLQ
'= • Notary ' blic
llo.[y eummissi®.Expires:
ti- �- )( J
Vee��-- i
: , cow
[SIGNATURES CONTINUE ON FOLLOWING PAGE]

STATE OF NORTH CAROLINA
COUNTY OF a/YU&
i r ri DY-0(Ai , a Notary Public for said County and State,do hereby
certify that WILLIAM JOE COWAN personally appeared before me this day and acknowledged the
due execution of the foregoing instrument.
WITNESS my hand and official stamp or seal,this Y Ma y of 2003.
4•11
Notary Public t.3.11.9!11
s<oR.-•• • 1.1
My Commission Expires: S---I 9—
[SEAL) PUBOC" •:*11
atiros‘PY,
STATE OF NORTIteAROHNA S
F COUNTY 01
AILI Iff 'At-Notary Public for said County and State,do hereby
certify that !irV COWAN personally appeared before me this day and acknowledged the due
execution o' e foregoing instrument.
WITNESS my hand and official stamp or seal,this kliY day of ,,- ,2003.
/0-1',17"zeie,,
Notary Public
My Commission Expires:
[SEAL] e0:714FEILCLIIreAcL,
VOTARY PUSLIC, LINOIS
IPSAEAVOLNE STATE OF IL
Y
COMMISSION EXPIRES:01/03JOS
4,44.4,4*-kotA4w,e,o4.24WOOLAMASw.
[SIGNATURES CONTINUE ON FOLLOWING PAGE]

STATE OF NORTH CAROLINA
COUNTY OF NEW HANOVER
I, / �� // :I� . ���.� a Notary Public for said County and State,do hereby
certify that 7 . gr ,personally came before me this day and
ca acknowledged .e is Se of Worsley Operating Corporation,a North Carolina corporation
with its principal office in New Hanover County,and that by authority duly given as the act of the
corporation,the foregoing instrument was signed in its name by its Executive Vice President, sealed
with its corporate seal, and attested by himself as its Secretary.
WITNESS my hand and official stamp or seal,this /ir of i ' ':4; 2003.
44.'t°44)li c dt44ltd
My Commission Expires:
[SEAL]
Leasel.doe

EXHIBIT"A"
Description of Property
BEGINNING at a point where the Western right-of-way line ofN. C.Highway#50 intersects the
southern right-of-way line of N. C.Highway#53 and runs thence with the western right-of-way line of
N. C. Highway#50 southwardly 50 feet beyond a point in said right-of-way line that is opposite the
southeastern corner of the store building located on said lot;thence westwardly and parallel with N. C.
Highway#53 50 feet beyond a point of intersection of the western edge of the store building if
extended would intersect the southern line herein described;thence northwardly and parallel to N. C.
IIghway#50 to the southern right-of-way line of N. C.Highway#53 to the point of BEGINNING,
and being a store and lot located in the southwestern quadrant of the intersection of N. C.Highways
#50 and#53 owned by the Lessors.

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F ° JTE
E N G 1 N E E R 1 N G, I N C.
August 16,2016
Ms. Kelly Johnson
NCDEQ—DEMLR—Land QualityP CCC I/G
0
127 Cardinal Dr. Ext
Wilmington,NC 28405 AUG 1 6 2016
RE: Request for Additional Information BY:
State Stormwater Permit SW8 160612
Maple Hill Scotchman, Maple Hill, Pender County,NC
Dear Ms.Johnson,
On behalf of GPM Southeast, LLC we are submitting a response to the above-referenced additional
information request dated August 9,2016. Please find your comments below with our response
provided in bold.
I. Lease [15A NCAC 02H.1003 (e)(])]: The lease submitted is between Roxann Machac,the
property owner,and Worsley Operating Corporation. Please clarity how the applicant. GPM
Southeast, LLC. is involved.
Response: The assignment of lease between Worsley and GPM is attached.
2. Average Depth [15A NCAC 02H.I003 (g)(7)]: Please double check the average depth calculation.
It looks like the depth to the bottom of the sediment (22.0 msl)was used in lieu of the depth to the
top of sediment(23.0 ms1).
Response: Yes,the depth was incorrectly calculated to be from 28'to 22'instead of from
28'to 23',which is a 5-ft depth. The avg.depth was corrected from 3.9-ft to 3.4-ft and
therefore SA/DA was selected to be 7.20 instead of 7.25,which did not significantly alter
the surface area requirement. See attached revised supplement and calculations for
reference.
3. Seasonal High Water Table [15A NCAC 02H.1003(g)(7)]: Please submit documentation showing
how the SH WT elevation was determined.
Response: Per the Narrative, °the seasonal high water table for the project was
determined using good engineering judgement in coordination with the parameters
described on pages 10-9 and 10-10 of the NCDENR BMP Manual. The elevation for the
permanent pool and seasonal high water table was determined in-part by examining the
depth of the existing ditch nearest natural outfall to permanent pool. in addition,since the
depth of the nearest ditch is as low as the proposed permanent pool,positive hydraulic
conductivity is maintained.' Specific to this pond,the permanent pool is set at 29.0 msl
which is the same as the lowest possible grade of the existing ditch. We cannot set the
pond lower than the ditch. Based on the drainage in this area,we expect to have ponding
and slow release of storm events,therefore we do not want to have more water on the
site than is necessary. We believe sufficient technical information has been provided for
this pond design per 15A NCAC 02H.1003(g)(7).
1P H : (9 CINEMA
1 0)) 7 9 1 DRIVE,
0 7 W I LF MA IXN. G9 100 ), 7N9 C1 - 6 7/4 31 6 2016

Ms. Kelly Johnson
Page 2 of 2
Sincerely,
Paramounte Engineering,Inc.
Branch Smith, PE
[e-mail]
ECEIVE
AUG 1 6 2016
BY:
1 2 2 CINEMA D R I V E , W I L M I N B T O N , NC 2 9 4 0 3
P H ) ( 9 1 D ) 7 9 1 - 6 7 D 7 F A X : (9 1 D) 7 9 1 - 6 7 6 D

PAT McCRORY
Governor
DONALD R. VAN DER VAART
Secretary
Energy,Mineral& TRACY DAVIS
Land Resources Director
ENVIRONMENTAL OURLI i Y
August 9, 2016
Mr.Donald P.Bassell, CFO
d/o William Barlow,Project Manager
GPM Southeast,LLC
1410 Commonwealth Dr, Suite 202
Wilmington,NC 28403
Subject: Request for Additional Information
State Stormwater Application No. SW8 160612
Maple Hill Scotchman
Pender County
Dear Mr.Bassell:
The Wilmington Regional Office received and accepted a State Stormwater Management Permit
Application for Maple Hill Scotchman on June 28,2016. A preliminary in-depth review of that
information has determined that the application is not complete. The following information is needed to
continue the stormwater review:
1. Lease [15A NCAC 02H.1003(e)(1)]: The lease submitted is between Roxann Machac,the property owner,
and Worsley Operating Corporation. Please clarify how the applicant,GPM Southeast,LLC,is involved.
2. Average Depth[15A NCAC 02H.1003(g)(7)]: Please double check the average depth calculation. It looks
like the depth to the bottom of the sediment(22.0ms1)was used in lieu of the depth to the top of the
sediment(23.0ms1).
3. Seasonal High Water Table [15A NCAC 02H.1003(g)(7)]: Please submit documentation showing how the
SHWT elevation was determined.
Please remember that a change to one number may have a domino effect on other numbers. Please check
all plans, calculations and forms to ensure that the numbers are consistent throughout.
Please note that this request for additional information is in response to a preliminary review. The
requested information should be received in this Office prior to September 9,2016,or the application
will be returned as incomplete. The return of a project will necessitate resubmission of all required items,
including the application fee.
If you need additional time to submit the information,please mail,email or fax your request for a time
extension to the Division at the address and fax number at the bottom of this letter. The request must
indicate the date by which you expect to submit the required information, which shall be no later than 30
days past the original due date.The Division is allowed 90 days from the receipt of a completed
application to issue the permit.
The construction of any impervious surfaces, other than a construction entrance under an approved
Sedimentation Erosion Control Plan, is a violation of NCGS 143-215.1 and is subject to enforcement
action pursuant to NCGS 143-215.6A.
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington,NC 28405
910 796'7215

State Stormwater Permit No. SW8 160612
Page 2 of 2
Please reference the State assigned application number on all correspondence. If you have any questions
concerning this matter,please feel free to call me at(910) 796-7215 or email me at
kelly.p.j [e-mail].
Sinc: ,
4641/
fly Joh,son
_ iro p ental Engineer
GDS/kpj: \\\Stormwater\Permits &Projects\2016\160612 HD\2016 08 addinfo 160612
cc: Branch Smith,Paramounte Engineering
Wilmington Regional Office Stormwater Permit File
i
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
Wilmington Regional Office 1127 Cardinal Drive Extension I Wilmington,NC 28405
910 796 7215

5-16-rg-ru 4H(szl.-1
A GPM
SOUTHEAST, LLC
1410 Commonwealth Dr.,Suite#202,Wilmington, NC 28403
8565 Magellan Parkway,Suite 400, Richmond,VA 23227
Georgette Scott
State Stormwater Program Supervisor
Department of Environmental Quality
127 Cardinal Drive Ext.
Wilmington,NC 28405 (�(�
RE: Stormwater Management Permit Application Form
To whom it may concern:
This letter confirms that William Barlow was granted permission and has full power and
authority to execute the enclosed Stormwater Management Permit Application Form on behalf of
GPM Southeast, LLC and any associated documents related to such stormwater project.
An original of the Permit Application Form was previously submitted with Mr. Barlow's
notarized signature. Please include this letter with that application.
If you have any questions,please contact me at e-mail: [e-mail] or phone
804-730-1568 x1132 or Maury Bricks at e-mail [e-mail] or phone 804-
730-1568 x1109.
Authorized by:
tttuurrn
GPM SOUTH' - ST, LLC ���'yORDgN
` .oitoN
) `��yZ pTA �s1=
9pro� =oQ Ar m�
Q t , e
Enclosure `eg a` ��� ,i oNraeH;osikOh
i
ay�c
�M3 Y � a®°rli a Breadao Ey

,
SOSID:1312685
Date Filed:7/6/2016 12:30:00 PM
Elaine F,Marshall
AMENDED LIMITED LIABILITY COMPANY Ali North Carolina Secretary of State
�' j C2416188 44372
NAME OF LIMITED LIABILITY COMPANY:
GPM Southeast. !LC
Fictitious Name,If any,used in North Carolina: "g OeeB Only
SECRETARY OF STATE ID NUMBER: 1312685 STATE OF FORMATION: DE
REPORT FOR THE YEAR. 2016 Changes
SECTION A:REGISTERED AGENTS INFORMATION
1.NAME OF REGISTERED AGENT: Capitol Corporate Services,Inc.
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3.REGISTERED OFFICE STREET ADDRESS&COUNTY 4.REGISTERED OFFICE MAILING ADDRESS
120 Penmarc Drive , Suite 118 120 Penmarc Drive, Suite 118
Raleigh, NC 27603-2400 Wake Raleigh, NC 27603-2400 Wake
SECTION B:PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Convenience Stores with Service Stations Weal
Privacy Redaction
2.PRINCIPAL.OFFICE PHONE NUMBER: 804-730-1568 x1171 3.PRINCIPAL OFFICE EMAIL:
4.PRINCIPAL OFFICE STREET ADDRESS&COUNTY 5.PRINCIPAL OFFICE MAILING ADDRESS
8565 Magellan Parkway,Suite 400 8565 Magellan Parkway,Suite 400
Richmond, VA 23227-1172 Chesterfield Richmond,VA 23227-1172 Chesterfield
SECTION C:COMPANY OFFICIALS(Enter additional Company Officials in Section E.)
NAME: Donald Basseli NAME: GPM Investments, LLG NAME
TITLE: Chief Financial OfficerTITLE: Member TITLE:
ADDRESS: ADDRESS: ADDRESS:
8565 Ma.ellan Pk ,Ste 400 8565 Magellan Pkwy, Suite 400
Richmond.,VA 2322 Lenrico Richmond,VA 23227
SECTION D:. • _NN ;L - -•- Section D must be completed in its entirety by a person/business entity.
iii y
6/29/2016
4 SIGNATURE
DATE
Form must be signed by a Company Official sated under Section C of this form.
Don Bassell CFO
Print or Type Name of Company Official Print or Type The Title of the Company°Riga)
fir ❑
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED.FILING FEE OF$10.00
MAIL TO:Seaetery of State.Corporations Division. Post Office non 25525,Raleigh.NC 27028-0525

DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: ❑Coastal SW-1995 0 Coastal SW-2008 0 Ph TI-Post Construction
. (select all that apply) 0 Non-Coastal SW-HQW/ORW Waters 0 Universal Stormwater Management Plan
❑Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land.Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision,facility,or establishment name-should be consistent with project name on plans,
specifications,letters,operation and maintenance agreements,etc.):
Maple Hill Scotchman 3001
•
2. Location of Project(street address):
15515 Highway 53 East
City:Maple Hill County:Pender Zip:28454
3. Directions to project(from nearest major intersection):
Site is in Southern Corner of Intersection of Hwy 50 and 53
4. Latitude:34°40'21,4"N Longitude:77°42'42.15" W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): New Modification ❑Renewal w/ Modificationt
tRenewals with modifications also requires SWL1 102-Renewal Application Form
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 certification •
2. Specify the type of project(check one):
❑Low Density ®High Density [Drains 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):
ECAMA Major ❑Sedimentation/Erosion Control; ac of Disturbed Area
❑NPDES Industrial Stormwater 0404/401 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 NA
5. Is the project located within 5 miles of a public airport? No ❑Yes
ON1
If yes,see S.L.2072-200,Part VI:http://portal.ncdenr.org/web/Irlrules-and-r ulation �,J %
Form SWU-101 Version Oct. 31,2013 Page 1 of 6

III. CONTACT INFORMATION
1.a.Print Applicant/ Signing Official's name and title(specifically the developer,property owner,lessee,
designated government official,individual,etc.who owns the project):
Applicant/Organization:GPM Southeast,LLC
Signing'Official&Title:William Barlow,Project Manager
b.Contact information for person listed in item la above:
Street Address:1410 Commonwealth Dr.,Suite 202
City;Wilmington State:NC Zip:28403
Mailing Address(if applicable):
City: State: Zip:
Phone:'(910 ) 512-9875 Fax: (910 ) 395-6691
[e-mail]
C.Please check the appropriate box.The applicant listed above is:
❑The property owner(Skip to Contact Information,item 3a)
N 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:Roxann Machac
Signing Official&Title:Property Owner
b.Contact information for person listed in item 2a above: .
Street Address:832 Hickory Court
City:Marengo State:IL Zip:60152
Mailing Address(if applicable):
City: State: Zip:
Phone: (630 ) 563-3600 x3628 Fax: (630 ). 563-3850
Email:[e-mail]
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:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address: •
City: State:
Zip:
Phone: ( ) Fax: ( )
.Email:
4. Local jurisdiction for building permits:Fender County ��
Point of Contact:Pat O'Mahony Phone#: (910 ) 0:20
'u4 9
Form SWU-10 i Version Oct.31,2013 Page 2 of 6 8V:

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
Runoff from parking and rooftop will be conveyed through pipe networkfs)to a single wet detention pond.
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:
❑VaIid Building Permit Issued Date:
❑Other: Date:
b.If claiming vested rights,identify the regulation(s)the project has been designed in accordance with:
❑ Coastal SW-1995 ❑Ph II-Post Construction
3. Stormwater runoff from this project drains to the CAPE FEAR River basin.
4. Total Property Area: 0.92 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*:0.92 acres
'' TotaI project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water(NHW)line or Mean High Water
(MHW)line,and coastal wetlands landward�from the NHW(or MHV line. The resultant project area is used to
calculate overall percent built upon area(BUA). Non-coastal wetlands landward of the Nh'W(or MHW)line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area/Total Project Area)X 100 54 %
9. How many drainage areas does the project haven (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property 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 same format as below.
Basin Information : 'Drainage Area 1.-:Drainage Area;,Y;,; Drainage Area Tlrairtage':Area
Receiving Stream Name Holly Shelter
•
Stream Class * C;Sw
Stream Index Number* 18-74-33
Total Drainage Area(sf) 30,141
On-site Drainage Area(sf) 30,141
Off-site Drainage Area(sf) 0
Proposed Impervious Area**(sf) 21,780
. %Impervious Area**(total) 72%
Impervious"*•Surface.Area:: ••Drainage.:Area.1; •I)rairage Area Drtiriage Area ' Drainage.Area
On-site Buildings/Lots(sf) 3,633
On-site Streets (sf) .0
On-site Parking (sf) 17,105
On-site Sidewalks (sf) 866 G e ���I/El
Other on-site (sf) 0
Future(sf) 176
Off-site (sf) 0
Existing BUA***(sf) 0
Total (sf): .21,780 BY:
Stream Class and Index Number can be determined at: http://portal.ncdenr.org/uieb/wq/vs/csu/classtfications
" Imppervious area is defined as the built upon area including, but not limited to,buildings, roads,parking areas,
sidewalks,gravel areas,etc.
**"'Report only that amount of existing BUA that will remain after development.Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
•
Form SWU-101 Version Oct.31,2013 Page 3 of 6

.
11. How was the off-site impervious area listed above determined?Provide documentation,NA
Projects in Union County: Contact DEMLR Central Office staff to check lithe project is located within a Threatened&
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B.0600.
V. SUPPLEMENT AND O&M FORMS •
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/wq/ws/su/bmp-manual.
VI. 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://portal.ncdenr,org/web/wq/ws/su/statesw/forms docs. 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 athttp://portal.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 MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portaincdenr.org/web/wq/ws/su/statesw/forms does.
I 'tlals
1. Original and one copy of the Stormwater Management Permit Application Form. � S
2. OriginaI and one copy of the signed and notarized Deed Restrictions&Protective Covenants 1"
Form. (if required as per Part VII 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.erwhelp.org/pages/miestopexpress.html 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/managementfor Y/'the project. This is required in addition to the brief summary provided in the Project
Information,item 1,
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the OA
receiving stream drains to class SA waters within 1/a mile of the site boundary,include the 2
mile radius on the map.
%, Sealed,signed and dated calculations(one copy). 9
8. Two sets of plans folded to 8.5"x 14" (sealed,signed,&dated),including:
0144
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 MHW or NHW line of tidal
waters,and any coastal wetlands landward of the MHW 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 NHW)of tidal waters,
i. Dimensioned property/project boundary with bearings&distances, rcEiv.
j. Site Layout with all BUA identified and dimensioned.k, Existing contours,proposed contours,spot elevations,finished floor elevat1, Details of roads,drainage features,collection systems,and stormwater con ee 9 2016m.Wetlands delineated,or a note on the plans that none exist. (Must be deliny a
qualified person. Provide documentation of qualifications and identify the who
made the determination on the plans. BY;
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 document).
Form SWiJ-101 Version Oct.31,2013 Page 4 of b •

i
p. Vegetated buffers(where required).
9. 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
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 BMPs,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 SHWT prior
to submittal, [phone].)
10, A copy of the most current property deed.Deed book:3336 Page No:325
11. For corporations and limited liability corporations(LLC):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 la,2a,and/or 3a per 15A NCAC 2H.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://www.secretary.state,nc,us/Corporations/CSearch,asp
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
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 bttp://portal,ncdenr.org/web/lr/state-stormwater-
forms docs.Download the latest versions tot 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.
By 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:Branch Smith
Consulting Firm:Paramounte Engineering,Inc.
Mailing Address:5911 Oleander Drive
City:Wilmington _ State:NC Zip:28837
Phone: (910 ) 791-6707 Fax: ( )
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION(if Contact Information,item 2 has been filled out,complete this
section)
I,(print or type name of person listed in Contact Information,item 2a)Roxann Machac ,certify that I
own the property identified in this permit application,and thus give permission to(print or type name of person
listed in Contact Information, item la)William Barlow with(print or type name of organization listed in
Contact Infformation,item la)GPM Southeast,LLC to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal,which indicates the
party responsible for the operation and maintenance of the stormwater system.
flECEIVE
I)
JUN292016
Form SWU-101 Version Oct.31,2013 Page 5 of 6 BY:

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go.r[tOtitjty,,iip;red.lh.Ctat.:t'irgkm.aj4o.n,.iteggl,).dis0oivet their cOMpany and/Or cancels,or defaults'myth*
lease agreeneen4 or.pearig aileAesponsihinty'for compliancemith the Di311;fLIZ Stornrwater permit revert:slack:
tamej.the pro!,,,ty,owner,.M:Iiire,ptopert.owner,it my responsibik tomotify Dgivita irrenediately ami. i..
submit it am ro e..it-1gameffly.Merehiichang Form withirrN.days;..°that 1$.., iatlI'vvill he.operatin,a.0oxininater. 1
trent:40th L;lily :itit§..Itt P1414 pOitt4li 11.41tieSatend tiiirehe:operatiOn:nra•etonnrsrater.treahnerit f.gility .
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MICHAEL V SCHERENBERG
Notary Public-State of Illinois
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Casmer, Jo
ti-
From: Casmer, Jo
Sent: Tuesday,June 28,2016 3:47 PM
To: 'wbarlow©gpminvestments.com; 'Branch Smith'
Subject: Maple Hill Scotchman 3001; Stormwater Permit SW8 160612
The Wilmington Regional Office of the Division of Energy, Mineral, and Land Resources (Stormwater Section)
received the Stormwater Permit Application and $505.00 fee on June 28, 2016. The project has been assigned to
Kelly Johnson and you will be notified if additional information is needed. Please be advised that the construction
of built—upon area may not commence until the Stormwater Permit is issued
Jo Casmer
Administrative Assistant for DEMLR/Stormwater Section
North Carolina Department of Environmental Quality
Department of Environmental Assistance&Customer Service
910 796-7336 office
910 350-2004 fax
[e-mail]
127 Cardinal Drive Extension
Wilmington, NC 28405
`Nothing Compares,-.,,�..
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and maybe disclosed to third parties.
1

t--
• . • .
As the legal property owner aranowlecige,-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
lease agreement,or pending sale,
responsibility for compliance with the DEIVILR Stormwakr permit reverts.back.
tame,the pro ty owner:As the property owner,it my responsibility to notify DENIER immediately and
subniit a co let ii:1`.,lame/0wriershiP.Change Form within,30 days;otherwise I will b.e.operating.a Stonnwater
treatment *ty.) litliout a valid permit I understand that the operation of a storniwater treatment facility
s,OttiOut a lid permit ia.001404 of Nc Qeheral Stank 143-215J and'may result in appropriate enforoeinent
aCtiOnincl" ' ' L a: es of- pto-$25,000-pet-dayypurstiant-tONCGS-143-215,6:-
Signatare. Date:
tvl•icina.e, Sc)i-\-e-C-e-C\\De-C) ,a Rotary Public for the State of _1- 1-1--.1 ri ,County of
c )C&iTh 111 akrielekC- personally appeared
before me this. 44Yof. 1\1°'-yi , 00/ t••,..and acknowledge.the due.mention of the application for
a ntoritrwater permit Witness my hand and official seal, Cif\a,SC— &rf,esii•r3010,,te_
SEAL
OFFICIAL SEAL
MICHAEL V SCHERENBERG
Notary Public-State of Illinois
My Commission Expires Sep 24,2017 L.
- - 4. • - My CominiSsion expires i4- 17
Ar-mcANrs. EttrPICATIfjN
I,(print at type ziante alpersokliste4 in.ColtneflOnnation,itent VILLIMA cAr21.0 /11,
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 storm.: rules NCAC 211.1000.04 any other applicable state stortriwater requirements,
Signature: 1--,‘ Date: 6 -2.4--/(
I,. E05.2._ ;a Notary Public for the State of Afh )101,-County of
ND LO L414NOU.eir,do hereby certify-that L01 41 c-41 personally appeared
before me this n day nf 'TOP and ac ledge'tihdue 'Hon of: applicati,on'for
a storniwaiet permit Witness my hand and official sJp.a i '
.:5EAif 1-44
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'MY coniNti‘Vinfrgs" are -
FIEC E IVEI)
JUN 2 8 2016
BY:
Farm SIY15-191 Version Qçt, i,..20i3 Page 6 of 6

William Barlow
From: Maury Bricks
Sent: Friday, June 24, 2016 4:02 PM
To: William Barlow
Cc: Charme McGinn
Subject: RE: 3001 Stormwater permit signature
Approved. Please attach this e-mail to the permit in our records so it is clear it was approved.
Maury Bricks
(.general Counsel
GPM investments, 1...1.C.
856 l Magellan Parkway, Suite 400
Richmond,VA 23227
804-730-1568 ext. 1109
mbrickstn.gpminvestments.com
- '..:H'pm
.,. ....
• .. • I'
From:William Barlow
Sent: Friday,June 24, 2016 3:43 PM
To: Maury Bricks <[e-mail]>
Cc: Charme McGinn<[e-mail]>
Subject: 3001 Stc:rmwater permit signature
Maury-On the last page of attachment I need an original notarized signature for the stormwater permit application.
With your approval I can sign and Charme will notarize.
Thank you
WILLIAM BARI.OW
GPM SOUTHEAST PROJECT MANAGER
(91 O) 512-9875
mailto:[e-mail]
ECEIo/E
JUN 2 8 201b
BY:
1

Scott, Georgette
From: Scott, Georgette
Sent: Tuesday, June 28, 2016 10:16 AM
To: 'Maury Bricks'; [e-mail]
Cc: Charme McGinn; Diana Avery; William Barlow; Casmer, Jo
Subject: RE: Maple Hill Scotchman 3001 (New Project)
Yes, this is the approval I need for Mr. Barlow. Please send the original letter to me. Thank you
Georgette Scott
State Stormwater Program Supervisor
Department of Environmental Quality
Office [phone]
Fax[phone]
Georgette.Scott(a�ncdenr.gov
127 Cardinal Drive Ext.
Wilmington, NC 28405
Email col ; the
North Ciit !". a .w`. I.: . ..... .. s. i a ifrd parties.
From: Maury Bricks [mailto:[e-mail]]
Sent:Tuesday,June 28, 2016 10:11 AM
To: [e-mail];Scott, Georgette<[e-mail]>
Cc:Charme McGinn <[e-mail]>; Diana Avery<[e-mail]>;William Barlow
<[e-mail]>; Casmer,Jo<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001 (New Project)
Branch and Georgette:
Please see the attached notarized Letter of Authorization signed by Don Bassell, who is the CFO of GPM Southeast, LLC
and is listed as such on the Secretary of State website. Please confirm the attached will work to grant sufficient authority
to Mr. Barlow for the document he signed. If so, we will send the original letter to Branch at the address below although
please confirm if you need it to go directly to Georgette or someone else.
Paramounte Engineering, INC.
c/o Branch Smith
122 Cinema Drive,Suite 201
Wilmington, NC 28403
Regards,
Maury
Maury Bricks
General Counsel
GPM investments,LLC
GPM Southeast,LLC
1

Scott, Georgette
From: Maury Bricks <[e-mail]>
Sent: Tuesday, June 28, 2016 10:11 AM
To: [e-mail]; Scott, Georgette
Cc: Charme McGinn; Diana Avery; William Barlow; Casmer, Jo
Subject: RE: Maple Hill Scotchman 3001 (New Project)
Attachments: LOA William Barlow.pdf
Branch and Georgette:
Please see the attached notarized Letter of Authorization signed by Don Bassell, who is the CFO of GPM Southeast, LLC
and is listed as such on the Secretary of State website. Please confirm the attached will work to grant sufficient authority
to Mr. Barlow for the document he signed. If so, we will send the original letter to Branch at the address below although
please confirm if you need it to go directly to Georgette or someone else.
Paramounte Engineering, INC.
c/o Branch Smith
122 Cinema Drive, Suite 201
Wilmington, NC 28403
Regards,
Maury
Maury Bricks
General Counsel
GPM Investments,LLC
GPM Southeast,LLC
8565 Magellan Parkway,Suite 400
Richmond,VA 23227
804-730-1568 ext. 1109
[e-mail]
From:Scott, Georgette [mailto:[e-mail]]
Sent: Monday,June 27, 2016 3:48 PM
To: Branch Smith <[e-mail]>
Cc:Casmer,Jo<[e-mail]>
Subject: Maple Hill Scotchman 3001 (New Project)
Branch,
I have reviewed the application materials for this project. Even though you noted on your
submission letter that the applicant will be in the region next week to sign these applications, I can
not accept this application for technical review until all the proper signatures are on the
application materials.
Also it appears that you have the wrong person signing for this LLC. Mr. Barlow is not listed on the
SOS report as a manager, president or vice president of the company. And you have not submitted
any kind of authorization letter from the manager, president or vp saying he has signature
authority for the LLC.
I would like to suggest that you come and pick up the package and resubmit when you have the
proper signatures. One of the individuais that I mentioned above will also have to sign the 0 Et M if
i

Scott, Georgette
From: Scott, Georgette
Sent: Tuesday, June 28, 2016 9:14 AM
To: 'Branch Smith'
Subject: RE: Maple Hill Scotchman 3001 (New Project)
You can bring it today. But I still need all the items I asked for in order to accept it for technical
review.
From: Branch Smith [mailto:[e-mail]]
Sent: Monday,June 27,2016 5:05 PM
To:Scott,Georgette<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001 (New Project)
Let me know if I can bring it by tomorrow morning or not?
Thanks
Branch
From:Scott, Georgette [mailto:[e-mail]]
Sent: Monday,June 27, 2016 4:16 PM
To: Branch Smith<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001 (New Project)
What exactly do you mean he has authorization to sign email? I also need a copy of the lease
agreement.
From: Branch Smith [mailto:[e-mail]]
Sent: Monday,June 27,2016 4:12 PM
To:Scott, Georgette<[e-mail]>
Cc:Casmer,Jo<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001(New Project)
I actually just got it the signatures from the applicant and he has an authorization to sign email. I will deliver over later
today
Kind Regards;
Branch
From:Scott,Georgette [mailto:[e-mail]]
Sent: Monday,June 27,2016 3:48 PM
To: Branch Smith<[e-mail]>
Cc:Casmer,Jo<[e-mail]>
Subject: Maple Hill Scotchman 3001 (New Project)
Branch,
I have reviewed the application materials this project. though forthis�� f+�0�..��. Even �i wu"rr.�i you noted on your
submission letter that the applicant will be in the region next week to sign these applications, I can

Scott, Georgette
From: Scott, Georgette
Sent: Tuesday, June 28, 2016 9:12 AM
To: 'Branch Smith'
Subject: RE: Maple Hill Scotchman 3001 (New Project)
I need all application materials at the time you submit. I do not accept them until I get all those
materials. So I need the lease agreement with the other signature documents.
Georgette
From: Branch Smith [mailto:[e-mail]]
Sent: Monday,June 27, 2016 4:32 PM
To:Scott, Georgette<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001 (New Project)
He has an authorization email from the LLC to sign the forms. We can provide the lease agreement later right? It's not
a requirement for the application right now is it?
Branch
From:Scott, Georgette [mailto:[e-mail]
Sent: Monday,June 27, 2016 4:16 PM
To: Branch Smith<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001(New Project)
What exactly do you mean he has authorization to sign email? I also need a copy of the lease
agreement.
From: Branch Smith [mailto:[e-mail]]
Sent: Monday,June 27, 2016 4:12 PM
To:Scott, Georgette<[e-mail]>
Cc:Casmer,Jo<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001 (New Project)
I actually just got it the signatures from the applicant and he has an authorization to sign email. I will deliver over later
today
Kind Regards;
Branch
From:Scott, Georgette [mailto:[e-mail]]
Sent: Monday,June 27, 2016 3:48 PM
To: Branch Smith <[e-mail]>
Cc: Casmer,Jo<[e-mail]>
Subject: Maple Hill Scotchman 3001(New Project)
Branch,
I have reviewed the application materials for this project. Even though you noted on your
submission letter that the applicant will be in the region next week to sign these applications, I can
i

PARA Mop-NT
E N G 1 N E E R 1 N G .
1 2 2 CINEMA DRIVE , SUITE 2 0 1
WILMINGT ON , NC 2 8 4 0 3
9 1 0 - 7 9 1 - 6 7 0 7 ( 0 ) 9 1 0 - 7 9 1 - 6 7 6 0 ( F )
LETTER OF TRANSMITTAL
To: NCDEQ-DEMLR-Stormwater Date - ( (o
127 N Cardinal Drive
Wilmington,NC 28405 Re: Maple Hill Scotchman
[phone] Regular Stormwater Review 44 . (N{p
Attn: Georgette Scott Project No. 16130.PE
IWe are sending: ®Originals ❑Prints ❑Shop Drawings ®Calculations
IThe following items: 0 Correspondence ® Plans ❑ Specifications ❑ Other as listed below
Quantity Date Dwg.No. Description
6 PM- M,M4044 ante 1.ces6 t rr-
2 SWU-101 Application Original Signature by Applicant+Owner
-4 A ri4204 J 6n&U. tilt 1. ok .
Issue Status:I For Approval ❑As Requested 0 Construction ❑Bid
❑For Your Use 0 For Review and Comment ❑Approved as Noted 0 See Remarks
Action Taken.. 0 No Exceptions Taken 0 Make Corrections Noted 0 Amend&Resubmit
❑ Rejected-See Remarks ❑ Approved as Submitted ❑ Other E C E I V E
ll
'Remarks:
41 JUN 2 8 2016
Contact me with any additional information or questions. Thank you.
Branch Smith [e-mail] 13V'
!-ff. EMki(, f ervl GDM -vow/ uni44 ,400. 4 o9l 0J
, ,y ID yeti.
Cc. William Barlow,GPM Southeast;File Signed: 1,
J.Bran . mi

Scott, Georgette
From: Scott, Georgette
Sent: Monday, June 27, 2016 4:15 PM
To: 'Branch Smith'
Subject: RE: Maple Hill Scotchman 3001 (New Project)
What exactly do you mean he has authorization to sign email? I also need a copy of the lease
agreement.
From: Branch Smith [mailto:[e-mail]]
Sent: Monday,June 27, 2016 4:12 PM
To: Scott, Georgette<[e-mail]>
Cc:Casmer,Jo<[e-mail]>
Subject: RE: Maple Hill Scotchman 3001 (New Project)
I actually just got it the signatures from the applicant and he has an authorization to sign email. I will deliver over later
today
Kind Regards;
Branch
From:Scott, Georgette [mailto:[e-mail]]
Sent: Monday,June 27, 2016 3:48 PM
To: Branch Smith <[e-mail]>
Cc: Casmer,Jo<[e-mail]>
Subject: Maple Hill Scotchman 3001(New Project)
Branch,
I have reviewed the application materials for this project. Even though you noted on your
submission letter that the applicant will be in the region next week to sign these applications, I can
not accept this application for technical review until all the proper signatures are on the
application materials.
Also it appears that you have the wrong person signing for this LLC. Mr. Barlow is not listed on the
SOS report as a manager, president or vice president of the company. And you have not submitted
any kind of authorization letter from the manager, president or vp saying he has signature
authority for the LLC.
I would like to suggest that you come and pick up the package and resubmit when you have the
proper signatures. One of the individuals that I mentioned above will also have to sign the 0 Et M if
they are to be the permittee. You will also have to send us a copy of the lease agreement with this
application package.
The only other alternative is to have the property owner sign as the applicant and have the
property owner sign the 0 Et M. We will than make the permit out to the property owner and then
they can transfer to LLC at a later date.

Scott, Georgette
From: Scott, Georgette
Sent: Monday, June 27, 2016 3:48 PM
To: 'Branch Smith'
Cc: Casmer, Jo ([e-mail])
Subject: Maple Hill Scotchman 3001 (New Project)
Branch,
I have reviewed the application materials for this project. Even though you noted on your
submission letter that the applicant will be in the region next week to sign these applications, I can
not accept this application for technical review until all the proper signatures are on the
application materials.
Also it appears that you have the wrong person signing for this LLC. Mr. Barlow is not listed on the
SOS report as a manager, president or vice president of the company. And you have not submitted
any kind of authorization letter from the manager, president or vp saying he has signature
authority for the LLC.
I would like to suggest that you come and pick up the package and resubmit when you have the
proper signatures. One of the individuals that I mentioned above will also have to sign the 0 Et M if
they are to be the permittee. You will also have to send us a copy of the lease agreement with this
application package.
The only other alternative is to have the property owner sign as the applicant and have the
property owner sign the 0 Ft M. We will than make the permit out to the property owner and then
they can transfer to LLC at a later date.
Please let me or Jo Casmer know when you can pick up the package. If you do not pick up the
package by Wednesday of this week we will send you a return letter only. We do not return
application packages in the mail with the letter.
Georgette Scott
State Stormwater Program Supervisor
Department of Environmental Quality
Office [phone]
Fax[phone]
Georgette.Scott{a�ncdenr.gov
127 Cardinal Drive Ext.
Wilmington, NC 28405
- Nothing Compares
Email corresponder ....... . ... acidiess is subject to the
North Carolina F't ; and may be discil sed to third parties.
1

pppp41 N C.
1 2 2 CINEMA DRIVE , SUITE 2 0 1
W I L M I N G T O N , NC 2 8 4 0 3
9 1 0 - 7 9 1 - 6 7 0 7 ( 0 ) 9 1 0 - 7 9 1 - 6 7 6 0 ( F )
LETTER OF TRANSMITTAL
To: NCDEQ—DEMLR—Stormwater Date 06/24/16
127 N Cardinal Drive
Wilmington,NC 28405 Re: Maple Hill Scotchman
[phone] Regular Stormwater Review
Attn: Project No. 16130.PE
IWe are sending: ® Originals ❑Prints ❑Shop Drawings ® Calculations
The following items: ❑Correspondence /1 Plans ❑ Specifications ❑ Other as listed below
Quantity Date Dwg.No. Description
1 Check#0043600 for$505.00
I SWU-101 Application
1 Narrative and Calcs
1 SW401 Pond Supplement
2 6-24-16 C-3.0,C-3.0A,C-4.1 24"x36"Pond Plans and Details;Drainage Area Map
1 GPM Southeast Sec. of State Corp. flECEIVE
n.
JUNj4201E
Issue Statusl ®For Approval ❑As Requested El Construction tEl Bid W
BY:
❑For Your Use ❑For Review and Comment El Approved as Noted ❑See Rem E CE TVED
'Action Taken: ❑ No Exceptions Taken ❑ Make Corrections Noted ❑ Amend&Resubmit JUN 2 4 2016
El Rejected-See Remarks ❑ Approved as Submitted ID Other
�i U
—wir Remarks: �?.� `/
Contact me with any additional information or questions. Thank you. P I—G siCie-vt._
Branch Smith bsmith(4aramounte-eng.com VA-
I anticipate comments within 30 days and hope to have a permit within 60 barring no major changes or review
Comments. Let me or my client know if reviews will last longer. Thanks.
Cc: William Barlow,GPM Southeast;File Signed:
J.Branch Smit

Completeness Review Checklist
Project Name: Mc. o hE. tit;(( Sc.tr,,.0 c.A..te, Received Date: oZ 2o i lo,
Project Location: 1e)0 i Accepted Date: ju.In_ D� (- ( t ,
Rule(s) 02008 Coastal *1995 Coastal Phase II (WiRO.) Universal ■?1988 Coastal
Type of Permi . Ne or Mod or PR Existing Permit#(Mod or PR): IT-PE Cert on File?
Density: HD or LD Type: Commercial or Residential 1NCG:
%: rim OK?) Stream Class: ■ISA Map fOffsite to SW8
L-Subdivided?: Subdivision or Single Lot ORW Map 3 9• Exempt
Paperwork Emailed Engineer on:
Su plement(s)(1 original per BMP) BMP Type(s):
&M with correct/original signatures (1 original per BMP except LS/VFS and swales) \ 1
re, A pplication with correct/original signatures ; eed -D 6i
"-olio or LLC: Sig.Auth. per SoS or letter ail Address: De ' n Engineer i `,,a.
P011-7 505 (within 6mo) _ rail Address: Owner /
IM •
oils Report with SHWT Note t. Revie\ er:
li, ?Calculations(signed/sealed) 4l 1`frAA ' I._e_.x5ee #-�� ©"j1 "'
` No obvious errors � "9' J p, 4/,_
J C6 �'-�"t "`�,�`�
_Density includes common areas, etc h eib m t s, -- ''.i y—t ye(•
Illi Deed Restrictions, if subdivided: y fir, .�
i n & Notarized ` ,�Y�-- `�y.. cropriii cc•--Vw""Cac.. 5 is.,...„) O-fvv
I!sed _,-)
��- g3.
!l Correct Template (Comm/Res&HD/LD) or Dec. Covenants& Rest. ��J t`� f V1�
Plans Vf art .g u42--
Sets riBeralls (roads, cul-de-sacs,curbs,sidevvalks3 BMPs, Buildings,etc)
fading ■;Wetlands: Delineated No Wetlands tea)
icinity Map.r --_ i out (proposed BUA dimensions)
Dariend ip:A Maps Eject Boundaries
infiltration Wet Pond Offsite
Soils Report ImuSoils Report ■PE Cert for Master Lot#:
SHWT: SHWT: Deed Rest for Master ',Lot#Matches Master
•
Bottom: IPP: BUA Permitted (Master): sf
Visited: BUA Proposed (Offsite): sf
Additional Information:
Permitted Proposed: . Proposed: Proposed:
BUA(sf)
•
DA(sf)
PP(el)
SHWT(el) •
Depth (ft)
SA(sf) •

MAPLE HILL SCOTCHMAN
PENDER COUNTY, NC
STORMWATER DESIGN NARRATIVE
Prepared for:
GPM Southeast, LLC RECEIVE')
1440 Commonwealth Drive JUN 2 213'
Wilmington,NC 28403
Prepared by: BY:
PARA MOUNTE
E N G I N E 6 R I N C3, 1 N C.
122 Cinema Drive
Wilmington, NC 28403 \\\\�N�CARS/���/
NC License#: C-2846 � per ES S '•��?�
SEAL 9 cam
Project#16130.PE
91NGINE��'.\
June 2016
�«r1 ./6

MAPLE HILL SCOTCHMAN
PENDER COUNTY, NORTH CAROLINA
Project#16130.PE
Table of Contents
Design Narrative
Proposed Stormwater Control Measure
USGS Map
Soil Map
Property Deed
Stormwater. Calculations
Pagel

DESIGN NARRATIVE
GPM Southeast, LLC is proposing to construct a gas station at the corner of NC Highway 53
and NC Highway 50 in Maple Hill within Pender County, NC. The latitude and longitude of
the property are 34°40'21" N and 77°42'42" W, respectively. The Parcel ID # is 3383-78-3254
and the deed is located in Deed Book 3336,Page 325. Enclosed is a design narrative, plans, and
supporting calculations for stormwater quality control of the 1.5-inch regulated design storm.
Currently, there is an existing gas station on this site. The existing site has approximately 31%
impervious cover, with the remaining area being grass cover. Some trees exist on site. Soils
consist almost entirely of Foreston loamy find sand (Fo) with an HSG rating of B, according to
the enclosed web soil survey. According to the attached.USGS map, the project drains to Holly
Shelter Creek (18-74-33) which has a classification of C; Sw. The site is not within 2 mile of SA
waters.
PROPOSED STORMWATER CONTROL MEASURE
The applicant is proposing to build a one story retail building along with associated parking
and gas pumps, and a stormwater management system. It is proposed that all runoff resulting
from impervious surfaces will be collected by a storm drainage system and then be conveyed
to a wet detention pond where stormwater quantity requirements will be met. The pond has
been designed to meet NCDENR requirements, which includes a forebay and a drawdown
orifice at permanent pool. Stormwater from greater storm events will be allowed to exit the
wet detention pond by means of a riser barrel outlet structure and a secondary spillway during
emergency situations.
The seasonal high water table for the project was determined using good engineering
judgement in coordination with the parameters described on pages 10-9 and 10-10 of the BMP
manual. The elevation for the permanent pool and seasonal high water table was determined
in-part by examining the depth of the existing ditch nearest natural outfall to permanent pool.
Since no wetlands are in, or around the pond,the concern for draining wetlands is not an
issue. In addition,since the depth of the nearest ditch is as low as the proposed permanent
pool,positive hydraulic conductivity is maintained. In regard to the life of the vegetative shelf
in times of drought,the developer will provide necessary irrigat ion to maintain the plant life if
necessary.
Page 1

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iaNatural Resources Web Soil Survey 6/6/2016
Conservation Service National Cooperative Soil Survey Page 1 of 4

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Hydrologic Soil Group—Pender County,North Carolina
Hydrologic Soil Group
Hydrologic Soil Group—Summary by Map Unit—Pander County,North Carolina(NC141)
Map unit symbol Map unit name Rating Acres in AOI Percent of AOI
Fo Foreston loamy fine sand B 1.1 99.5%
Gt Grifton loamy fine sand B/D 0.0 0.5%
Totals for Area of Interest 1.1 100.0%
Description
Hydrologic soil groups are based on estimates of runoff potential. Soils are
assigned to one of four groups according to the rate of water infiltration when the
soils are not protected by vegetation,are thoroughly wet, and receive precipitation
from long-duration storms.
The soils in the United States are assigned to four groups(A, B, C, and D)and
three dual classes(A/D, B/D,and C/D).The groups are defined as follows:
Group A. Soils having a high infiltration rate(low runoff potential)when thoroughly
wet.These consist mainly of deep,well drained to excessively drained sands or
gravelly sands.These soils have a high rate of water transmission.
Group B. Soils having a moderate infiltration rate when thoroughly wet. These
consist chiefly of moderately deep or deep,moderately well drained or well drained
soils that have moderately fine texture to moderately coarse texture. These soils
have a moderate rate of water transmission.
Group C. Soils having a slow infiltration rate when thoroughly wet. These consist
chiefly of soils having a layer that impedes the downward movement of water or
soils of moderately fine texture or fine texture.These soils have a slow rate of water
transmission.
Group D. Soils having a very slow infiltration rate(high runoff potential)when
thoroughly wet.These consist chiefly of clays that have a high shrink-swell
potential, soils that have a high water table, soils that have a claypan or clay layer
at or near the surface, and soils that are shallow over nearly impervious material.
These soils have a very slow rate of water transmission.
If a soil is assigned to a dual hydrologic group(A/D, B/D, or C/D),the first letter is
for drained areas and the second is for undrained areas. Only the soils that in their
natural condition are in group D are assigned to dual classes.
Rating Options
Aggregation Method: Dominant Condition
Component Percent Cutoff: None Specified
Natural Resources Web Soil Survey 6/6/2016
-- Conservation Service National Cooperative Soil Survey Page 3 of 4

Hydrologic Soil Group—Pender County,North Carolina
Tie-break Rule: Higher
Natural Resources Web Soil Survey 6/6/2016
Conservation Service National Cooperative Soil Survey Page 4 of 4

{
FIL_, D 1(3336PG325
07 OCT 12 AM 9:51 " t+,
FEEDER COUNTY NC 10/12/2007 d4YCE M.SWICEG00.)
$36.00 REGISTER OF DEEDS
stem 4'? PENDER COUNTY,NC
Real Estate
Excise Tex .'
AV- 339 3- 7p. oou) �01,
Prepared By: Tisdale,McConnell&Bardill,LLP PIN# 3,(i-lode; 17- l). VV.
400 New Bridge Street DATAttorneys at Law 3 -. P 5 le T C
Jae 0
Ise TIM $36.00
NORTH CAROLINA GUARDIAN'S DEED
PENDER COUNTY
tkf—THIS DEED,made and entered into this 1 day of October,2007,by and between LAWRENCE S.
BOEHLING,as Guardian ad Litem for the UNBORN CHILDREN of ROXANN COWAN MACHAC,party of the
first part;and ROXANN COWAN MACHAC of Marengo,Illinois,party of the second part;
WITNJrSSETH0
THAT WHEREAS,said party of the first part was by the Clerk of the Superior Court of Pender County duly
appointed and is now acting as Guardian ad Litem for the unborn children of Roxann Cowan Machac;and
WHEREAS,the unborn children of Roxann Cowan Machac are seized of the remainder interests in the lands
hereinafter described;and
WHEREAS,said party of the second part has filed hi said court a verified Petition offering to purchase the said
remainder interests belonging to her unborn children at the gross purchase price of Seventeen Thousand Nine
Hundred Fifteen and 97/100ths Dollars($17,915.97);and
WHEREAS,following a hearing before the Clerk of the Superior Court of Pender County on the 18th day of
September,2007,an Order was entered permitting the sale as requested in the said verified Petition,said Order having
also been signed by the Judge of the Superior Court sitting in and for the County of Pender;and
WHEREAS,following the posting of a Preliminary Report of Sale,said matter remained open for ten(10)days
and no advanced or upset bid for the said remainder interests was filed with the court;and
WHEREAS,by an Order signed on the I ,day of October,2007,the Clerk of said court confirmed said
sale and directed said party of the first part as Guardian ad Litem as aforesaid,to make,execute,and deliver to said
parry of the second part a good and sufficient deed for the lands so sold upon the receipt by him of the purchase price;
and
WHEREAS,said Order of Confirmation was approved by the Superior Court judge sitting in and for the
County of Pender;and
WHEREAS,said purchase price having been fully paid;
NOW, THEREFORE, said party of the first part, acting under authority of said Order of court and in
consideration of the said purchase price of Seventeen Thousand Nine Hundred Fifteen and 97/tOOths Dollars
($17,915.97)to him in hand paid,the receipt of which is hereby acknowledged,has bargained and sold and by these
presents does bargain,sell,and convey unto said party of the second part and her heirs and assigns the remainder
interests of the unborn children of Roxann Cowan Machac in and to the following three(3)certain tracts or parcels of
land lying and being in Holly Township,Pender County,North Carolina,and more particularly described as follows:
Tract No; 1: BEGINNING at a fence post at the west edge of the Chinquapin road,George
W.Cowan,dec.corner,and runs thence with the west edge of said road North 29 degrees 25 minutes
West 414 feet to a fence post by said road,the K.F.Powers corner,thence the said Powers line South
47 degrees 30 minutes West 876 feet to the intersection of a cuss fence at edge of mud land,and old
line;thence with old line and fence South 42 degrees 50 minutes East 421 feet to a stake George W.
Cowan's line fence;thence the line fence North 48 degrees 15 minutes East as the Cowan line 772 feet

BK3336PG326
to the beginning,containing seven and 8/10 acres more or less.See Deed Book 262 at Page 444 of the
Fender County Registry and see Will of Arnold Paul Cowan in 97 E 34 of the Fender County Clerk of
Superior Court's office.
LESS and EXCEPT all conveyances of record from this tract.
TRACT NO. 2: Beginning at a stake on the public road, the dividing line between R.M.
Cowan and the land formerly owned by John Jones and running South 462 East 55 poles to K F.
Powers line;thence with his line 12 1/2 poles to the line between G.T.Cowan and J.R.Marshbum;
thence with said line North 45 East 54 poles to the public road; thence with said road to the
Beginning,containing four and one-half(4.1/2)acres,more or less.This being the same tract of land
conveyed to G.B.D.Parker as tract number two in a deed from John Jones and Ivey Jones his wife,by
deed dated November 15th,1923,and recorded in the records of fender County in Book#132 at Page
#420 in the records of Fender County. See Book 199 at Page 397 and see Will of Arnold Paul Cowan
in 97 E 34 of the Fender County Clerk of Superior Court's Office.
LESS and EXCEPT all conveyances of record from this tract.
TBACT NO.3: Located in Holly Township,Pander County,North Carolina.
BEGINNING at an iron pipe at the intersection of the pavement centerline of NC Highway
No.53 and NC Highway No.50 and runs thence
1. With the pavement centerline of NC Highway No. 53 South 48 degrees 40 minutes West
227.00 feet to an iron pipe;thence
2. South 29 degrees 47 minutes East 257.15 feet to an iron pipe below present ground level;
thence
3. North 48 degrees 40 minutes East 227.0 feet to an iron pipe in the pavement centerline of NC
Highway No.50;thence
4. With the pavement centerline of NC Highway No.50 as it curves to the Point of Beginnina.
chord of said curve being North 29 degrees 47 minutes West 257.15 feet to the Point of Beginning,
containing 1.34 acres,more or less,and being a part of that land as described in a deed to Robert and
Arnold Cowan,from S.A. Lanier and wife,Ruby Lanier,as recorded in Book 252, Page 174,of the
Fender County Registry. Also see Will of Arnold Paul Cowan in 97 E 34 of the Pender County Clerk
of Superior Court's Office.
EXCEPTING from the above described lot is all land which is located within the 100-foot right-of-
way of NC Highway No.53 and the 60-foot right-of-way of NC Highway No.50 and also the view area
across the southwest corner of the intersection of NC Highways No.53 and 50.
TO HAVE AND TO HOLD said lands and premises together with all privileges and appurtenances thereunto
belonging,to her the said party of the second pan and her heirs and assigns,in as full and ample a manner as said
party of the first part as Guardian ad Litem as aforesaid is authorized and empowered to convey the same.
IN TESTIMONY WHEREOF, said party of the fir a ing as Gua ' n ad Litem as aforesaid, has
hereunto set his hand and seal the day and year first above itten.
LAWRENCE S.BOEHLUNG,Guardian ad Lite for the
UNBORN CHILDREN of ROXANN COWAN CHAC
STATE OF NORTH CAROLINA
COUNTY OF_ FENDER
I,r�ikyS'T3D4,Notary of this county and state,do hereby certify that LAWRENCE S.BOEHLING,
Guardian ad Litem for the UNBORN CHILDREN of ROXANN COWAN MACHAC,personally appeared before
me this day and acknowledged the execution of the foregoing deed.
Witness my hand and official seal this I f i hday of October,2007.
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Maple Hill Scotchman
Stage-Area-Storage Calculations
Stage/Storage Above Permanent Pool (Including Forebay)
Contour Incremental Cumulative
Contour Area (SF) Volume (CF) Volume, S (CF)
29.0 2,254 0 0 + Permanent Pool
30.0 2,864 2,559 2,559
31.0 3,531 3,198 5,757 + Top of Pond
Stage/Storage Total Pond (Including Forebay)
Contour Incremental Cumulative
Contour Area (SF) Volume (CF) Volume, S (CF)
n3,3, --ja 22.0 6 - - +-Pond Bottom
(30a i'u" 23.0 52 0 0 +•- Sediment Storage
24.0 133 93 93
25.0 252 193 285
26.0 463 358 643
27.0 740 602 1,244
28.0 1,085 913 2,157
coQ — 29.0 2,254 1,670 3,826 +•••Permanent Pool
30.0 2,864 2,559 6,385
1? 30.25 3,026 736 7,121 + Temporary Pool
31.0 3,531 3,198 9,583 -Total Pond Volume
Forebay
Contour Incremental Cumulative
Contour Area (SF) Volume (CF) Volume, S (CF)
25.0 5 - - -Forebay Bottom
26.0 68 0 0 +-Sediment Storage
27.0 164 116 116
28.0 294 229 345
29.0 455 375 720 •-Forebay Volume

.I �r
DfEP
ni u, 3 727PG2 ! 0
01 ii•ii i0 io: 55
iN # 33 S3 g :P
p MTER OF DEEDS
; • ,, %^UNTY,ht,
DATE . 1 ° °IOffrie
ecorci.d and Verifie
J8ycx M. Swrcegood
Register of Oceds
NORTH CAROLINA NON-WARRANTY DEED Feder Comity,NC
Exc': Tax:$0.00
Parcels o. 3383-58-4571-Q00 Verified by_County on the_day of_20
By:
M, - � ��� s• .L . ii - Brid C28540
This •w was picpmei by: Tisdale.McComtell&Bardr&l.L.L.P.
Brief description for the Index: 1 Tract.Holly Township.Pender County
THIS DEED made this 14t day of March,200,by and between
GRANTOR GRANTEE
LORI COWAN HUBBARD AND HUSBAND, EDWARD ROXANN COWAN MACHAC
HUBBARD
Enter in appropriate block for eachparty: name,address,and,if appropriate,character of entity,e.g.corporation or partnership.
The designation Grantor and Grantee as used herein shall include said parties,their heirs,successors,and assigns,and shall include
singular,plural,masculine,feminine or neuter as required by context.
WITNESSETH,that the Grantor,for a valuable consideration paid by the Grantee,the receipt of which is hereby acknowledged,
has and by these presents does grant,bargain,sell and convey unto the Grantee in fee simple that certain lot or parcel of land
situated in the City of-,Holly Township,Eandar County,North Carolina and more particularly described as follows:
Beginning at a stake on the public road,the dividing line between R.M.Cowan and the land formerly owned by John Jones
and running South 461/2 East 55 poles to K.F.Powers line;thence with his line 121/2 poles to the line between G.T.Cowan
and J.R.Marshbura;thence with said line North 45 East 54 poles to the public road;thence with said road to the Beginning,
containing four and one-half(4-1/2)acres,more or less.This being the same tract of land conveyed to G.B.D.Parker as tract
number two in a deed from John Jones and Ivey Jones his wife,by deed dated November 15,1923,and recorded in the
records of Pender County in Book#132 at Page#420 in the records of Pander County.See Book 199 at Page 397 and see
Will of Arnold Paul Cowan in 97 E 34 of the Pander County Clerk of Superior Court's Office.
Less and Except all conveyances of record from this tract,
The property hereinabove described was acquired by Grantor by instrument recorded in Book 3055,page II Pander County
Registry and from the Estates of Arnold Paul Cowan,File No.97 E 34,Pander County Superior Court,and Delores Home Cowan,
File No. 02 E 992,New Hanover County Superior Court.Also see Paragraph A,Tract No.3 and Paragraph E,Tract No.2,as set
forth in the Affidavit of Allotment of Real Assets recorded in Book 3053,Page 183,Pender County Registry.
NC Bar Association Form No.7©1977,2002
Printed by Agreement with the NC Bar Association—1981-Chicago Title Insurance Company
a

ris 1 I
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the Grantee
in fee simple.
The Grantor makes no warranty,express or implied,as to title to the property hereinabove described.
IN WITNESS WHEREOF,the Grantor has duly executed the foreg ' g as of the day and year first above written.
�~.y (SEAL)
(Entity Name) LORJ.C(W B 1
,
t A i
By: Z1 r( (SEAL)
Title: EDWARD HUBBARD
By: (SEAL)
Title:
SEAL-STAMP State of North Carolina—County of Welt that LORI COWAN HLTB�ARD
I,the undersigned Notary Public of the County and State aforesaid,certify
AND HUSBAND EDWARD HUBBARD personally appeared before me this day and acknowledged the due
execution of its foregoing instrument for the purposes therein expressed.Witness my band andNotarial stamp
or seal this 1i' day of f'fl4't h
Commission Expires: OA& LOoit tY 1 Veto, •�nsyluit
N N. Public
0,S.TA yzO
1I0TAR1-`:
'n . AUB1.\ 2F
9 ... =� *•
fi11Nco'i
NC Bar Association Form No.7©1977,2002
Printed by Agreement with the NC Bar Association—1981-Chicago Title Insurance Company