NCC222925_FRO Submitted_20220816

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION 08012007
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before
this form and an acceptable erosion and sedimentation control plan have been completed and approved
by the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/or
fax information unavailable, place N/A in the blank.)
Part A. ROCKET WASH EXPRESS MEBANE INC
1. Project Name
2. Location of land -disturbing activity: County ALAMANCE City or Township MEBANE
Highway/Street211 FIELDALE RD Latitude36.075796 Longitude-79.275397
3. Approximate date land -disturbing activity will commence: 9/1121
4. Purpose of development (residential, commercial, industrial, institutional, etc.): COMMERCIAL
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 1.06
6. Amount of fee enclosed: $ 250.00 . The Express Permitting application fee is a dual charge.
The normal fee of $65.00 per acre is assessed without a ceiling amount. In addition, the Express
Permitting supplement is $250.00 per acre up to eight acres, after which the Express Permitting
supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585). NOTE: Both fees are
rounded up to the next whole acre and need to be paid by separate checks to NCDENR.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name DOUG ROWLAND E-mail Address [e-mail]
Telephone [phone] Cell # 919-262-6858 Fax # N/A
9. Landowner(s) of Record (attach accompanied page to list additional owners):
ROCKET WASH EXPRESS MEBANE INC. 919-262-6858 N/A
Name Telephone Fax Number
276 W MILLBROOK RD SAME
Current Mailing Address Current Street Address
RALEIGH NC 27609 SAME
City State Zip City State Zip
10. Deed Book No, 3888 Page No. 413 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
ROCKET WASH EXPRESS MEBANE INC. [e-mail]
Name
276 W MILLBROOK RD
Current Mailing Address
RALEIGH NC 27609
City
State Zip
Telephone [phone]
E-mail Address
SAME
Current Street Address
SAME
City State Zip
Fax Number N/A

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
N/A N/A
Name E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A
City State Zip City State Zip
Telephone N/A Fax Number N/A
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone Fax Number
(c) In order to facilitate Express Permitting, it is necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
OnSite Civil Group of the Carolinas [e-mail]
Engineering Firm or other consultant E-mail Address
Jarrett M. Senkbeil 404-822-9147 n/a
Individual contact person (type or print)
Telephone
Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney -in -
fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there be
any change in the information provided herein.
DOUG ROWLAND
Type or print name
manull
Title or Authority
IDUUZI 1b112®Z\
SignatureO Date
Suzanne Jones , a Notary Public of the County of Wake
State of North Carolina, hereby certify that Doug Rowland appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and notarial seal, this 12 day of October 12021
' Notary
My commission expires 6/22/24
�VB LIr'

BK 3888 PG 0400
FILED ELECTRONICALLY
ALAMANCE COUNTY NC
HUGH WEBSTER
This instrument prepared by: Brady Law Firm PLLC,
FILED Jun 21, 2019
AT 02:24:09 PM
a licensed North Carolina attorney,
BOOK 03888
START PAGE 0400
Delinquent taxes, if any, to be paid by the
END PAGE 0403
INSTRUMENT # 09730
EXCISE TAX $3,$00.00
closing attorney to the County Tax Collector
upon disbursement of closing proceeds.
Submitted electronically by "Brady Law Firm PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Alamance county Register of Deeds.
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: 3800.00
Parcel Identifier No.9814866696 Verified by County on the day of 20
By: "
Mail/Box to: GRANTEE
This instrument was prepared by: Schell Bray PLLC (HRA), 100 Europa Dr., Suite 271, Chapel Hill, NC 27517 (without title
examination)
Brief description for the Index: 211 Fieldale Road, Mebane, NC
TtHS DEED made as of this t 94 "` day of June, 2019, by and between
GRANTOR.
NBT PARTNERS-MEBANE, LLC
A North Carolina limited liability company
3201-141 Edwards Mill Road
PMB #128
Raleigh, NC 276I2
GRANTEE
4 POINTS OF NC 2, INC.
a North Carolina corporation
120 Wind Chime Court
Raleigh, NC 27615
Enter in appropriate block for each Grantor and Grantee: name, mailing 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.
ITNESSETH, 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, all that certain lot, parcel of land or
condominium unit situated in the City of Mebane, Melville Township, Alarnance County, North Carolina and more particularly
described as follows:
See Exhibit A attached hereto and incorporated herein by this reference.
NC Bar Association Form No. 3 9 1976, Revised (9) 11112010, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association —NC Bar Form No. 3

BK 3888 PG 0401
The property hereinabove described was acquired by Grantor by instrument recorded in Book 2412 page 389.
All or a portion of the property herein conveyed _ includes or X does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Plat Book 4, Page 142.
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.
And the Grantor covenants with the Grantee, that Granter is seized of the premises in fee simple, has the right to convey the same
in fee simple, that title is marketable and free and clear of all encumbrances, and that Grantor will warrant and defend the title against
the lawful claims of all persons whomsoever, other than the fbilowing exceptions:
Easements, rights of way and restrictions of record, zoning ordinances affecting the property hereinabove described, matters known
by the Grantee, matters that would be disclosed by a current and accurate survey and inspection of the property, the lien of ad valorem
taxes for the current year and taxes imposed by special assessment.
[Signature page to follow]
NC Bar Association Form No. 3 9 1976, Revised p 1/1tZ010, 2013 This standard form has been approved by
Printed by Agreement with the NC Bar Association North Carolina Bar Association —NC Bar Form No. 3

BK 3888 PG 0402
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above
written.
GRANTOR:
NBT PARTNERS — MEBANE, LLC
BY: NBT PARTNERS, LLC
STATE OF NORTH CAROLINA
COUNTY OF JLW�6tnj
I, the undersigned Notary Public, certify that Dale A. Carey and Robert J. Glosson, Member/Managers of
NBT Partners, LLC, sole Member/Manager of NBT Partners — Mebane, LLC, personally came before me this day
and acknowledged that they executed the foregoing North Carolina General Warranty Deed for the purposes stated.
therein.
WITNESS my hand and official seal this the day of June, 2019.
10
Notary Public s '�
My omt fission expires:
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pusham
STATE OF 'lf'`,;�rH CP�"v�`���`•
COUNTY OF
I, the undersigned Notary Public, certify that personally came before me this day and
acknowledged that she executed the foregoing North Carolina General Warranty Deed for the purposes stated
therein.
WITNESS my hand and official seal this the day of
My commission expires:
Notary Public
2019.
NC Bar Association Forra No. 3 01976, Revised @ i/M010, 2013 This standard form has been approved by:
Printed by Agreement with the NC Bar Association North Carolina Bar Association —NC Bar Form No. 3

Exhibit A
Legal Description
All of that tract or parcel of land lying and being in the in the City of
Mebane, Melville Township, Alamance County North Carolina and being more
particularly described as follows:
BEING All of Lots Number 59, 60, 61, 62, 63, 75, 76, 77, 78, 79, 80, 81, 82 and
83 of Oakgrove Subdivision, as shown on plat recorded in the office of the Register of
Deeds for Alamance County, North. Carolina in Plat Book 4, Page 142, reference to
which is hereby made for a more complete description.
The property is also shown on the plat of survey by Alley, Williams, Carmen &
King, Inc. Engineers & Architects, Job No. 96125, entitled: "Final Map Recombination
of Property of WCL One, LLC", dated July 22, 1996, being all of Lot Number Five (5),
consisting of 44,958 sq.. feet, more or less, recorded in Plat Book 56, Page 40, Alamance
County Registry, to which reference is hereby made for a more particular description of
the same.
LESS AND EXCEPT that certain portion of the above described parcel conveyed and
described in that certain Deed for Highway Right of Way recorded in Book 1973 at Page
719, Alamance County Registry.

BK 3888 PG 0413
As of the Date of this Certification, On the Real Property
described in this Deed, there are No Delinquent Taxes
Owed which are (1) ad valorem County taxes, (2) ad
valorem Municipal Taxes collected by Alamance County
or (3) any other taxes collected by Alamance County
Date: 06/21 /2019
Deputy/Tax Collector: Kathy Winn
Excise Tax: N/A
Tax Lot No.:
Verified by_
by
FILED ELECTRONICALLY
ALANANCE COUNTY NC
HUGH WEBSTER
FILED Jun 21, 2019
AT 02:24:19 PM
BOOK 03898
START PAGE 0413
END PAGE 0415
INSTRUMENT # 09732
EXCISE TAX $0.00
Recording Time, Book and Page
Parcel Identifier No. 90(ii9r6 164574
County on the d ay of 12019
Mail after recording to: GRANTEE
This instrument was prepared by: Schell Bray PLL.0 (I114A), 100 Europa Dr., Suite 271, Chapel Hill, NC 27517
Brief description for the Index: 1211 Fieldale Road, Mebane, NC
QUITCLAIM DEED
THIS DEED made as of this
day of June, 2019, by and between
GRANTOR
NBT PARTNERS-MEBANE, LLC
a North Carolina limited Iiability company
Address:
3201-141 Edwards Mill Road
PMB #129
Raleigh, NC 27612
GRANTEE
4 ]POINTS OF NC 2, INC.
a North Carolina corporation
Address:
120 Wind Chime Court
Raleigh, NC 27615
Enter in appropriate block for each party: 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.
NOW THEREFOR, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of
which is hereby acknowledged, has and by these presents does remise, release„ forever quitclaim, and convey unto
Grantee, its heirs, successors and assigns, all of Grantor's interest in all that certain lot or parcel of land (the
633452v1
submitted electronically by "Brady Law Firm PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Alamance County Register of Deeds.

B K 3888 PG 0414
"Property") situated in the City of Mebane, Melville Township, Alamance County, North Carolina, and more
particularly described on Exhibit A attached hereto and incorporated herein by this reference.
TO HAVE AND TO HOLD said real property, with all privileges, and appurtenances thereunto
belonging, to the said Grantee, their heirs, successors, and assigns forever, free and discharged from all light, title,
claim, or interest of the Grantor, without warranty, subject however, to all matters of record in Alamance County
affecting the Property.
IN WITNESS WHEREOF, Grantor has caused this instrument to be duly executed as of the day and year first
above written.
GRANTOR:
NBT PARTNERS-MEBANE, LLC
By: NB7
Its s
By:
By:
STATE OF NORTH CAROLINA
COUNTY OF-e%hf +6ft'btXY6M
I, the undersigned Notary Public, certify that Dale A. Carey and Robert J. Glosson,
Member/Managers of NBT Partners, LLC, sole Member/Manager of NBT Partners — Mebane, LLC,
personally came before me this day and acknowledged that they executed the foregoing North
Carolina Quit -Claim Deed for the purposes stated therein.
WITNESS my hand and official seal this the VJq
9 day ofhme, 2019.
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My Commission Expires: Aaql=3

BK 3888 PG 0415
EX IIBIT A
Property Description
BEING all of that certain tract or parcel of land located adjacent to the northwestern intersection of Fieldale Road
and Mebane Oaks Road identified as being Lot 5, containing 43,910 square feet or 1.008 acres as shown on that
certain plat entitled "Survey For: Baker Bell, 211 Fieldale Road, Melville Township, Mebane, Alamance County,
North Carolina" dated May 29, 2019, last updated June 17, 2019 (1905f600.Fie211) prepared by E.P. Morgan, PLS,
of Morgan Surveying, C972702, to which reference is made for a more complete description thereof.
P1N##9814866696