SW3140802_Major Mod Application_20190114

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources R EC IFIV D
Division of Energy, Mineral and Land Resources
�C 17 2 0 11
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original DENR-LAND QUALITY
STORMWATER PERMITTING
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.):
GOLDMINE CONVENIENCE CENTER
2. Location of Project (street address):
4600 GOLDMINE ROAD
City: MONROE County: NC Zip: 28110
3. Directions to project (from nearest major intersection):
From 485 Outerloop in Matthews, NC, take exit 51 B-A then mere onto US-74 E/E Independence Blvd (-5
mi). Turn right onto WesleyCChapel Stouts Rd and stay for -3.6 mi until the traffic circle. At the traffic circle,
take the 3rd exit onto Goldmine Road. In approximately 1.7 miles, the entrance to the Operations Center is on
the left. The project site is along this driveway pproximately 1,280 feet north of the Goldmine Road entrance.
Latitude and longitude provided below is at the driveway station 0+00 on Goldmine Road.
4. Latitude:35° 00' 52.77" N Longitude:80° 38' 50.91" 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 SWU-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 SW3140802 , 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, N/A and the previous name of the project, if different than currently
proposed, N/A
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):
❑CAMA Major ®Sedimentation/Erosion Control: 6_0 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts _N/A
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:
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6

5. Is the project located within 5 miles of a public airport? [-]No ®Yes
If yes, see S.L. 2012-200, Part VI: http://portal.ncdenr.org/web/lr/rules-and-regulations
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: UNION COUNTY GOVERNMENT
Signing Official & Title: MICHELLE LANCASTER, ASSISTANT COUNTY MANAGER
b. Contact information for person listed in item 1a above:
Street Address: 500 NORTH MAIN STREET, SUITE #900
City: MONROE State: NC Zip: 28112
Mailing Address (if applicable): SAME AS ABOVE
City: State: Zip:
Phone: ( 704 ) 283-3576 Fax:
Email: [e-mail]
nc.gov
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organizf Organization: (An 1, 01 cry n 1-
Signing Official &Title: V ►' l l'il/ I � � i� 1'l� C4til k Wf 4 j l
b. Contact information for person listed in item 2a above:
Street Address: 5 00 AJ 6 Z'j 6, i ty Si P G%r�
City: Al O ti ro 'L State:AJC-, Zip:
Mailing Address (if applicable):
City:
State: Zip:
Phone: ( 10 �f Z3 — l'o S to Fax:
Email: (C�'��PJ-(?Gt�`CIS'tPi ti, (/1✓1 iC�1! [°DUYt`�-�/N�.Ct6 i1
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: JOHN YVARS / UNION COUNTY PUBLIC WORKS
Signing Official & Title: SOLID WASTE DIVISION DIRECTOR
b. Contact information for person listed in item 3a above:
Mailing Address: 500 N MAIN ST, STE 600
City: MONROE State: NC Zip: 28112
Phone: ( 704 ) 283-3576 Fax:
Email: john.yyars@unioncoun!ync.gov
nc.gov
4. Local jurisdiction for building permits: UNION COUNTY
Point of Contact: Phone #:
Form SWU-101 Version Oct. 31, 2013 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Because the site is considered low density, the stormwater runoff will be treated using overland flow and
infiltration. Some piping have been added to pass under roads. An existing dry pond will be used for
additional infiltration.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ 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 CATAWBA River basin.
4. Total Property Area: 100 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+: 100 acres
+ Total 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 (NHA) line or Mean High Water
(MHM line, and coastal wetlands landward from the NHW (or MHVO line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHVO line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 1.2
9. How many drainage areas does the project have? 1 (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.
Form SWU-101 Version Oct. 31, 2013 Page 3 of 7

Basin Information
Drainage Area I
Drainage Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
East Fork
Twelvemile
Creek
Stream Class
C
Stream Index Number *
11-138-2
Total Drainage Area (sf)
4,356,436
On -site Drainage Area (sf)
766,656
Off -site Drainage Area (sf)
0
Proposed Impervious Area** s
49,135
% Impervious Area** total
1.2
Impervious— Surface Area
Draina e Axea 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
467
On -site Streets (sf)
48,147
On -site Parking (sf)
521
On -site Sidewalks (sf)
0
Other on -site (sf)
0
Future (sf)
0
Off -site (sf)
0
Existing BUA*** (sf)
254,481
Total (sf):
303,409
* Stream Class and Index Number can be determined at: htW.aortal.nedenr.org/web/wq[ps/esu/classifications
Impervious 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.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Proi ects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 1 SA 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 htt-o://vortal.ncdenr.ora/web/wq/ws/su/bmv-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 at http://portal.ncdenr.org/web/wq�Jsu/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 h=://portal.ncdenr.org/web/wq/ws/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. PAB
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants N/A
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M N/A
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to PAB
htW://www.envhelp.org/pages/onestopexpress.html for information on the Express program
Form SWU-101 Version Oct. 31, 2013 Page 4 of 7

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 PAB
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
PAB
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7.
Sealed, signed and dated calculations (one copy).
PAB
8.
Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
PAB
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.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9.
Copy of any applicable soils report with the associated SHWT elevations (Please identify
PAB
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: 358 Page No: 428
PAB
11.
For corporations and limited liability corporations (LLC): Provide documentation from the NC
N/A
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 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.
htip://vrvvw.secretaiy.state.nc.us/Corporations/­CSearch.as,px
Form 5WU-101 Version Oct. 31, 2013 Page 5 of 7

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 http://portal.ncdenr.org/web/lr/state-stormwater-
forms docs. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
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: NATHAN T. BIVINS, P.E.
Consulting Firm: CIVIL & ENVIRONMENTAL CONSULTANTS, INC.
Mailing Address: 1900 CENTER PARK DRIVE, SUITE A
City: CHARLOTTE State: NC Zip: 28217
Phone:( 980 ) 237-0373 Fax: ( 980 ) 237-0372
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) , 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 1a) with (print or type name of organization listed in
Contact Information, item 1a) 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.
Form SVJU-101 Version Oct. 31, 2013 Page 6 of 7

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment of civi penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature:
Date: /1 !.-,I N
I, Jo c(-- 9 Pil CCi a Notary Public for the State of IVOrV-4 L�[/`a!%�'4 County of
�(G do hereby certify that M C k CI (-e L-0 K C a S 4f i- personally appeared
before me this day of A4Pv1 h- bC 1 w W and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,�<[ I G -
SEAL
My
X. APPLICANT'S CERTIFICATION
(VOTARY
L:_ PUBLIC
I, (print or type name of person listed in Contact Information, item 1a)
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 21-1.1000 and any other applicable state stormwater requirements.
Signature: Date:
I, , a Notary Public for the State of County of
do hereby certify that
before me this _ day of
personally appeared
, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Form SWU-101 Version Oct. 31, 2013 Page 7 of 7

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XXCUe'at.x $350.00
a05K368PACE 4Z8
MARY V. CARRIKER, Ret;ster of
Union County, Monroe, Borth Ceroi,fll
nreardhea Time, nook and Paso
Tax Lot No ........................................ .. ........... ....... Parcel identifier Na, ...............................
............... .
yerihedby..................................................................... County on the ... day of ....... .......................... 18............
Mall after recording to..............._.........................................,................. .._.......,.............. ............... ...,..................
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............................................................................................... .......................
This Instrument was prepared b QRIFFIN, CALDWELL & HELAER, p. A. Monroe. N. C. „ , .
y.........................................................................._ .....
Brief deseription for the Index
.NORTH CAROLINA GENERAL WARRANTY DEED
Ting DEFT) made thin .., 20th day of...................NY.............................. 1rj....82.. , by and between
GRANTOR j GRANTEE
WADL N. NOWEY, JR. and wife, GAY H. NOWEY;
and HUGH 0. MURRILL, widower
UNION COUNTY
Eater in Rppreprlale blotk for eaeb parlrt rurne, addre,., and, it ipproprlate, ehararler of runty, r.q. rarp.rRilan or parinrr.hlp.
The designation Grantor and Grantee as uned herein shell include enld purtlen, their heirs, successors, and asslgna, and
sball include singular, plural, masculine, feminine or neuter an required by context.
WITNESSFTH, that the Grantor, for a valuable consideration pald by the Grantee, the recaipt of which In hereby
acknowledged, has and by these presenta does grant, bargain, sell and convey unto the Grantee In fee simple, all that
certain lot or parcel of land situated In the City of ._ ... Monroe Township,
yri,tgn..................... County, North Carolina and more particularly deaerllped ns follown t
BEGINNING at a point located within the right of way of State Road 1162, a corner of
the Gordonsville Baptist Church (now or formerly) property and runs thence with a line
of said church property, North 11 degrees 04 minutes 45 seconds East 77.42 feet to an
iron; thence North 43 degrees 56 minutes 55 seconds East 1930.56 feet to an iron atoka,
a corner of the V. T. Balms, Jr. (now or formerly) property, thence with a line of said
Nelms (now or formerly) property, North 61 degrees 45 minutes 00 seconds F.nst 480.31 feet
to an iron; thence North 28 degrees 15 minutes West 1699.89 feet to an iron in a line of
the Glenn Winchester (now or formerly) property; thence with a lino of said Winchester
(now or formerly) property, South 60 degrees 10 minutes 50 seconde West 176.57 feet to
an iron stake, a corner of the 0, M. Rogers (now or formerly) property; thence with n
line of said Rogers (now or formerly) property, South 60 degrees 14 minutes 15 seconds
West 1422.96 feet to an iron stake, a corner of the Marie Griffin (now or formerly)
property; thence with line of the said Griffin (now or formerly) property, South 61
degrees 41 minutes 10 seconds West 727.45 feet to an iron stake by a hickory in a line
of the Pilgrim Forest Subdivision property; thence with two lines of said subdivision
property as -followa: let., South 38 degrees 35 minutes -35 seconds Fear 1646.72 feet to
an iron stake; 2nd.,gauth 51 degrees 32 minutes 40 seconds West 802.02 feet to an iron
located within the righe of way of State Road 1162; thence a line within the right of way
of said read, South 67'degrees 58 minutes 00 seconds East 708.24 feet to the point and
place of BEGINNING, and chntaining 100.00 acres, more or less, per plat and survey by
P. Donald Lawrence Ir Associates, P. A., R.L.S., dated July 14, L982.

... 0358
0429
K358r
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THERE TS EXCEPTED from this conveyanc&�a non-exclusive right of way for the purpose of
ingress, agrees, and regress to other property owned by Wade H. Howey, Jr. and wife,
Gay M. Howey, and Hugh C. Murrill adjoining the above -described property for the purpose
of ingress, egress, and regress to said other property, said non-exclusive right of way
being along the eastern line of the above -described tract. and being sixty (60) feet in
width, and being more particularly described as follows:
BEING a right of way sixty (60) feet in width, thirty (30) feet on either aide of the
center line of which is described as follows: BEGINNING at a point in the right of way
of County Road 11629 evid beginning, point being located North 67 degrees 58 minutes 0
seconds West 280 feet from an iron'marking the southeastern corner of the above described
100 acre tract, and running thence along and with the center line of said 60-foot
easement as followat Nat., North 25 degrees 45 minutes East 141.42 feet to a point;
thence in a curve to the right having a generally northeasterly direction with a radius
of 150 feet, an are distance of 149.44 feet; thence North 82 degrees 50 minutes 0
seconds East 240.19 feet to a point; thence in a curve to the left having a generally
northeasterly direction with a radius of 250 feet, an are distance of 169.67 feed
thence North 43 degrees 56 minutes 55 seconds East 1485.53 feet to a point; thence
North 6l degrees 45 minutes 0 seconds East 485.01 feet to a line of said 100-acre
tract, the terminus of said 60-foot right of way.
Said 100 acres and right of way are all as shown on plat by 9. Donald Lawrence 6 Associates,
P.A., R.L.S., dated July 14, 1982, and retarded in Plat Cabinet B , File No, 75-A , Union
County Register of Deeds office, to which reference is'hereby made.
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The property om°m"bov ow"auawee acquired bvGrantor wInstrument recorded In'-- ..... ......
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xn IIAVE AND TO HOLD the aforesaid lot mparcel aland and all privileges and ap=rto^nncem thereto ^u^iiglnxm
the OrWee In fee simple,
And the Grantor covenants with the Grantee, Gralittle Is Wzed of the Promiffea In fee aimple, has the right to convcy
(be same in fee simple, thal. title la marketable aed free and clear of all encumbrances, and t1lat Grantor will warrant
&Ind defend tho title againilt the lawful claims of all persons whonuinovor except for the exceptionA hereinafter stated,
Title to the property hereinabbve described la subject to the following exceptions:
Rights of way for roads and utilities that border or cross the subject
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SKAL? STAMP �', ., .l NVRTIt CANCIANA, _........ Union ..................Canafjf.
�• J 1•' ,•,^r% �'I A T!a$arr ruknc at the C..Kly and orti state aforesaid, ffy that WADL-H:......Y__r_ ,T_R_t ..and....rife.
'tj'i'o `'•,r GAY Me HOOEY, and HUGH C. MURRILL, widower arA*u,
Petsa.ally appeared krrari me this �day and orknowlydp a ak CaIt" of floe fgatelat kX6411R/R1. WlttlaA my
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SKAL- STAMP I.aRTN CAA.utJNA............................ .------ C.untY•
1, a N: iiry Publtr of the C.bnlY and State iroll/ald, Cernly $list .........-..........
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Per—Aly aPPearei before roe this day ARd aekhowledttel the aoseutiot of eke foratartg Iattrda.a4 Wltaus by -
-' hand and official stamp or sell, this ..-.-. day of ......_........ ..........its...... '
Myrwamlalan eapirrq ............................... ......------------------------- --•----Naf#rr roles
SRAL,-STAMP NORTH CAROLINA- ___.............. .................Caun1Y.
1, R N.taey Pabllt at the CounlY and Prate af.ruale, cattily that ...........................................
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pnaonalty apprated W.F. his this day end ult—vitadtsd the axeeutloR of sloe #.,.going 4LLrul-tout. Witasu ay
~ hand and official ;lamp sr alai, this ...... day of ............................. It .....
11y—ool-dun expl—t ............................... ................. ...................... MOUSY r11114
SRAL - STAMP NORTIt CAka LINA• ...___._... ......................•County
1.. Nota,y 1WAk of the C.unty, and Slate afouaald, nr/IfY that ................................ ............
at
µeraonally Appeared lefore an. this day And .ekmortadted the .YaektiaR or Ills for.taing la.traulak WilAeu ray,
U.1'4 .nd WINAt,tamp of teal. this ._..-_ day of ---------------------- ..... f►......
airvununhatun aasters: ................................ _........... ........................... NOUry rakes
SKAL-STAMP NllltTil t•AIMIAN,t, ... ..............................County,
1, a Nul,tly Ilublie of the County and gist. afafuatd, etrlifr that .........................................r
ji—onally tame belura me this day end ark—wltdted !bat .... It, Is .............. I ............ K.ttetary W
a' a H.III, CRf.14a esrr.7441.1, Aad Bloat by A.Mollty daily
..."........................................ ..........
x liven and at the Arl of the Corporation, lhs fuet.ing lmllumml was altaed la lit xsno by its ..... ..........
ps.sldenl, seated with 11, torPurale seal and miat.d by ........... .a Its ......... I ........ 4,
Wltnett my hand and olllelal stamp or .sal, tit. --- day ol........... :...... ......„to......
MY...... 6,lon -lit re .:..............................__ ................. :.......... ....... _... Notary lulu.
iltAL. STAMP NORTH CAROLINA. ......... .........................County, -
i, A mWary publle or the Couhly and State araeeaaid, CtrilfY east ...........................................
personally cxn;t before his thl9 day and acknowltdted that .... he le ............. .I..__._.. tfela Rly W
............. N-Lb Caiolina corµeutialh most that by AuMarity duty • .
oven .,,it 3. the .ci .1 the t, rponllon, th. lotttoint lnetrumtat was alxail to its Karate ►y its ...............
Pfe-Ident, .rated with Its Corporate ICAI and Aliened by , As lte ...............
Witness my hand And uItI,,W stamp or -tar, this __-___ day of .......................... lP.-._.,
MYcumm$.rton explresl .................................:...... ............ .................. NOUry hki4
Tito toru.int C.rudNt.td( of .._..Dianne.]ihita$err.a-nottcy..puhliq_nf_.Uniaa.Coutsty, .i2C......._...................
....u1.................................... ........................... .............. Y-_...................................................
KY— t#,Mtd lv be C.rttel. This laalrumeaf ..A this eertideatt are duly retlrtered al Iho ditto ado tibia ARd t1 sloe IN.k sad Pigs dawA ea the
first rise Rar.af. .
.........'. _. J•Sri H B 117._,.,.._}7 RR4fATgR OM bLSPg Fox._...UMIt)f{......................COUNTT
toy ... w�y`. !'.'C.r .. r •........-••.••• ... Pr.ds•