NCC205527_NOI Signed Certification_20201202

NCG01 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NO1.
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6`" Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL YOUR APPLICATION HAS BEEN
REVIEWED AND ACCEPTED AS COMPLETE
Per NC General Statute 143-215.68 (i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($10,000).
Undepenalty of law, I certify that (check all boxes to indicate your agreement):
IiK I am the person responsible for the construction activities of this project, for satisfying the
requirements of this permit, and for any civil or criminal penalties incurred due to violations of this
—/ permit.
i� The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and
complete based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information.
L� I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and
Sediment Control Plan.
If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
I hereby request coverage under the NCGO10000 General Permit and understand that coverage under
this permit will constitute the permit requirements for the discharge(s) and is enforceable in the
same manner as an individual permit.
Name of Project: �q . t&K 6w- WAs,/ - CA"B*_
Legally Responsible Organizational Entity: �(C•W "fk0pegz •jeS V� L'W
Legally Responsible Person: SA x JJ4•ibz
Title of Legally Responsible Person:
*Signature:
Date: //•Z3 zo
*Print Name and Title o ned if Authorized
Individual Differs from Permittee: e'if'/S Mg, 6AJ
Phone Number: /D -9'1G 68y9
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that owns or operates the
construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is
authorized in accordance with Part IV, Section 8, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section 8, Item (6) of the NCGO10000 permit.

UNANIMOUS WRITTEN CONSENT AND RESOLUTIONS
OF THE SOLE MEMBER OF
LLCs
WHEREAS, the undersigned, Sami I. Nafisi, certifies that he, individually, is the sole
Manager of, among others, each limited liability company set forth on Schedule 1 attached
hereto (as Schedule 1 may be amended from time to time, collectively, the "LLCs" and each a
"LL(") and each LLC is a North Carolina limited liability company, having its principal place of
business at 7935 Council Place, Suite 200, Matthews, North Carolina; and
WHEREAS, the undersigned hereby consents in writing, pursuant to the Limited
Liability Company Act of the State of North Carolina (the "Act"), and adopts the following
resolution of the LLCs, all pursuant to the laws of the State of North Carolina; and
WHEREAS, the undersigned, in adopting the resolutions set forth below by signing his
consent hereto (this "Consent"), hereby confirms, ratifies and approves the acts stated in this
Consent and directs that this Consent be filed with the minutes and proceedings of the LLCs.
Without otherwise limiting the generality of the foregoing, this Consent shall be effective, as of
the date set forth below, as if adopted by the vote of the undersigned at a meeting called pursuant
to notice, all as required by the Operating Agreement of the LLCs, at which meeting the
undersigned was present in person.
NOW WHEREFORE, by executing this Consent, as indicated below, the undersigned
agrees to, consents to and approves the following:
RESOLVED, that Chris Morgan as Development Manager of Sam's Xpress Car Wash
shall have a limited right, power and authority to execute, sign, verify, acknowledge, deliver, and
accept all construction and development documents and applications submitted to and/or
required by any governmental authority, including but not limited to documents relating to
permitting, building permit applications, site plan approval documents, surveys and plats, storm
water mitigation, zoning applications, variance requests, utility applications, tap fees,
applications for driveways and encroachments, erosion control, grading permit applications and
environmental questionnaires on behalf of the LLCs; and
FURTHER RESOLVED, the undersigned further certifies that the LLCs' Articles of
Organization and Operating Agreement remain in full force and effect and nothing has occurred
to limit the LLCs' ability to enter into or complete the actions contemplated. This Consent is
executed by the sole Manager of the LLCs for the purposes contemplated.
[Signature Page Follows]

IN WITNESS WHEREOF, the undersigned, as the sole Manager of the LLCs hereby
executed this Unanimous Written Consent and Resolutions of the Sole Member of LLCs as of the
date written below.
Sarni I. Nafisi, as Mabager of each LLC
Dated: --�' 12— I Zb 1

SCHEDULE 1 TO UNANIMOUS WRITTEN CONSENT AND RESOLUTIONS
OF THE SOLE MEMBER OF LLCs
LIST OF LLCS SAMI I. NAFISI IS SOLE MANAGER OF
AND FOR WHICH CHRIS MORGAN AS DEVELOPMENT MANAGER OF
SAM'S XPRESS CAR WASH
1. Sam's Xpress Car Wash, LLC
2. Sam's Xpress Car Wash II, LLC
3. SXCW Properties, LLC
4. SXCW Properties II,jLLC
Sami I. Nam', anager off' each LLC
Dated: 1111 2 0 `CA