NCC241405_FRO Submitted_20240508

DEVELOPMENT SUBMITTAL FORM
Carteret County Department of Planning and Development
Eugene Foxworth,Director
Main Office: 402 Broad Street-Beaufort,NC 28516-1896 Tel: [phone] Fax[phone]
Western Office: 701 Cedar Point Blvd.-Cedar Point,NC 28584-8013 Tel: [phone] Fax:[phone]
All fees must accompany this form and checklist
PROPERTY or DEVELOPMENT NAME: Dollar General
ADDRESS and PIN(s): 3810 Hwy 58, Stella, NC 28584; PIN: 536800151504000
APPLICANT: Glandon Forest Equity,LLC CIO George Barnes OWNER(S): Ricky T Morris,Jeffrev E Morris,Sheila Morris
ADDRESS: 3825 Barrett Drive,Suite 100 ADDRESS: 582 Wetherington Lnd Rd
Raleigh, NC 27609 Stella,N_C 28582
PHONE# [phone] PHONE#
E-MAIL ADDRESS: venters van uard .co E-MAIL ADDRESS:
1 ri r
Signature of Applicant/Agent: Date: ) t) ! ?' 7`3
PLEASE C C RK ALL APPLICABLE ITEMS
SUBMITTING FOR: ❑In-house review ❑ TRC* ❑PC ❑ZBoA 0 Other
* TRC meetings are held in the Planning Departments 2nd floor Conference Room.If you need special accommodations,please let us know.
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SUBDIVISIONS: Acres Lots
❑ Exemption to the Subdivision Regulations 0 Preliminary Plat
m Lot Split ❑ Completed and signed copies of Appendices A and B ❑ Completed and signed copies of Appendices A and B
El Alternative Access Subdivision ❑ Mylar+dxf or dwg file El Minor Subdivision
❑ Completed and signed copies of Appendices A and B ❑ Major Subdivision 0 Paper+pdf or jpeg
El Access Easement El Family Subdivision ❑ Planned Conservation Development 0 Paper+pdf or jpeg
El Private Lane 0 Flag Lot 0 Preliminary Nat Approval Extension
❑ Sketch Plan ❑ Completed and signed copy of Appendix A ❑ Final Nat 0 Mylar+dxf or dwg file
0 Minor Subdivision El Performance Guarantee Processing
El Major Subdivision ❑ Paper+pdf or jpeg El Performance Guarantee Extension
❑ Planned Conservation Development 0 Paper+pdf or jpeg El Final Plat Approval Extension
El Recreation Fee(Amount$ and District#n)
ALL OTHER PLANNING AND ZONING MATTERS
❑ ABC Permit Zoning Review ❑ Ordinance Interpretation
❑ Airport Height Limits Permit:Proposed height= ❑ Planned Unit Development: Acres Units
❑ Appeal of an Administrative Decision ❑ Regular 0 Paper+pdf or jpeg
❑ Communication Tower:Height= 0 Flexible ❑ Paper+pdf or jpeg
❑ Exemption 0 Consultant Fees 0 Rezoning from to
❑ Tower ❑ Road Abandonment
❑ Co-Location •
❑ Road Addition •
0 Performance&Removal Surety Processing i
ElTemporary Use ❑ Meteorological Tower
❑ Sign Permit: Square Feet
❑ Conditional Use Rezoning: District Use 0 Special Use Permit for
❑ Group Housing Development: Acres Units El Text Amendment
El Preliminary Plan 0 Paper+pdf or jpeg ❑ Variance
❑ Final Plan and Permit ❑ Wind Energy Facility: kW Height
❑ Final Plan Amendment or Revision 0 Temporary Pole or Tower ❑ Small System
El MH Park or RV Park Preliminary Plan: Spaces 0 Large System 0 Utility-scale
❑ Preliminary Plan ❑ Paper+pdf or jpeg ❑ Performance&Removal Surety Processing
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❑ Preliminary Plan Approval Extension RI Other:
❑ Final Plan and Permit
El Final Plan Amendment or Revision Staff Use Only:
Triennial Park Inspection
kniOunt Paid Data:Ree'd : : -:':=:,::.;
0 p {:"'

Check if this project is ARPA-funded ❑
Attach a copy of the Letter of Intent to Fund
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCGO1 permit, 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 address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project NameDollar General - Stella
`If this project involves American Rescue Plan Act(ARPA) funds, list the Project Name or Project
Number(e.g., SRP-D-ARP-0121) below under which you were approved for funding through the
Division of Water Infrastructure(DWI).
2. Location of land-disturbing activity: CountyCarteret City or Township Stella
Hwy 58 34.7923 -77.1311
Highway/Street LatltUde(declmaldegrees) LongltUde(decimaldegrees)
3. Approximate date land-disturbing activity will commence:4/1/24
4. Purpose of development(residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 2.20
6. Amount of fee enclosed: $300 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes El Enclosed 0 No El
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name George Barnes E-mail [e-mail]
Phone: Office# 919-459-2601 Mobile# [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Ricky T. Morris
Name Phone: Office# Mobile#
582 Wetherington Lnd Rd
Current Mailing Address Current Street Address
Stella NC 28582
City State Zip City State Zip
10. Deed Book No,1644 Page No.360 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)maybe listed as the financially responsible party(ies).
Glandon Forest Equity, LLC [e-mail]
Company Name E-mail Address
3825 Barrett Drive, Suite 100 3825 Barrett Drive, Suite 100
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
Phone: Office#91 0-459-2601 Mobile#
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Sherri Hepps [e-mail]
Name of Registered Agent E-mail Address
3825 Barrett Drive, Suite 100 3825 Barrett Drive, Suite 100
Current Mailing Address Current Street Address
Raleigh NC 27609 Raleigh NC 27609
City State Zip City State Zip
Phone: Office# 919-459-2600 Mobile#
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile#
Name of Individual to Contact(if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
George T. Barnes4 Manager, Glandon Forest Equity, LLC
Type or print nay Title or Ayt�hority
/�' �/ �1�` , vl 3
Signature Date {
I, Ti- ''7 l o U j , a Notary Public of the County of Mite
ite
State of North Carolina, hereby certify that 61-r i eTbOni$ �(. appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this l day of 01 ram' , 20
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"`,Itil l 1111111!/���
��`�F AN I yl0�i,��� Not
:Seal
My commission expires AAP/ L 11 avdo
Notary Public —
Wake County

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Jeffrey E. Morris
Name Phone: Office# Mobile#
582 Wetherington Lnd Rd
Current Mailing Address Current Street Address
Stella NC 28582
City State Zip City State Zip
Deed Book No. 1644 Page No.360 Provide a copy of the most current deed.
Landowner 3 of Record:
Sheila Morris Cole Cain
Name Phone: Office# Mobile#
582 Wetherington Lnd Rd
Current Mailing Address Current Street Address
Stella NC 28582
City State Zip City State Zip
Deed Book No.1644 Page No.360 Provide a copy of the most current deed.
Landowner 4 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. Provide a copy of the most current deed.
Landowner 5 of Record:
Name Phone: Office# Mobile#
Current Mailing Address Current Street Address
City State Zip City State Zip
Deed Book No. Page No. _ Provide a copy of the most current deed.

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Project Name: Dollar General - Stella
Project Location: Stella, Carteret County
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Maintenance records shall be kept on the following SCM(s). This maintenance record shall be kept in a log in a known set location.
Any deficient SCM elements noted in the inspection will be corrected, repaired, or replaced immediately. These deficiencies can affect
the integrity of structures, safety of the public, and the pollutant removal efficiency of the SCM(s).
The SCM(s)on this project include (check all that apply&corresponding O&M sheets will be added automatically):
Infiltration Basin Quantity:, Location(s):
Infiltration Trench Quantity: Location(s):
Bioretention Cell Quantity: Location(s):
Wet Pond Quantity: 1 Location(s):
Stormwater Wetland Quantity: _ Location(s):
Permeable Pavement Quantity: Location(s):
Sand Filter Quantity: Location(s):
Rainwater Harvesting Quantity: Location(s):
Green Roof Quantity: Location(s):
Level Spreader-Filter Strip Quantity: Location(s):
Proprietary System Quantity: Location(s):
Treatment Swale Quantity: Location(s):
Dry Pond Quantity: Location(s):
Disconnected Impervious Surface Present:- No Location(s):
User Defined SCM Present: No Location(s):
Low Density Present: Yes Type: Dispersed flow only
I acknowledge and agree by my signature below that I am responsible for the performance of the maintenance procedures listed for
each SCM above, and attached O&M tables. I agree to notify NCDEQ of any problems with the system or prior to any changes to the
system or responsible party.
Responsible Party: Glendon Forest Equity, LLC
Title&Organization: George Barnes-Manager
Street address: 3825 Barrett Drive, Suite 100
City, state, zip: Raleigh, NC 27609
Phone number(s): 910-459-2601
Email: [e-mail]
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Signature: Date:
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I, l /l k.. , a Notary Public for the State of 1 V it 4 l ( pp i y k,,
County of nQ( P , do hereby certify that � ,111A .
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personally appeared before me this 1)- day of �� 1/C/1� �� and
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acknowledge the due execution of the Operations and Maintenance Agreement.
Witness�yt�ihi8tdie /.à4'1jw
officialseal,
in
Notary Public
Woke County
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Seal My commission expires M rV/ 51,
STORM-EZ 10/10/2023
Version 1.5 O&M Agreement Page 1 of 1

Wet Pore.Maintenance Requbr
Important operation and maintenance procedures:
Immediately after the wet detention basin is established, the plants on the vegetated shelf and
- perimeter of the basin should be watered twice weekly if needed, until the plants become established
(commonly six weeks).
No portion of the wet pond should be fertilized after the initial fertilization that is required to establish
- the plants on the vegetated shelf.
Stable groundcover will be maintained in the drainage area to reduce the sediment load to the wet
- pond.
_ If the pond must be drained for an emergency or to perform maintenance, the flushing of sediment
through the emergency drain will be minimized as much as possible.
_ At least once annually, a dam safety expert will inspect the embankment. Any problems that are
found will be repaired immediately.
The measuring device used to determine the sediment elevation shall be such that it will give an
-
accurate depth reading and not readily penetrate into accumulated sediments.
After the wet pond is established, it will be inspected quarterly and within 24 hours after every storm event greater
than 1.0 inches (or 1.5 inches if in a Coastal County). Records of operation and maintenance shall be kept in a
known set location and shall be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
SCM element: Potential problem: How to remediate the problem:
The entire wet pond Trash/debris is present. Remove the trash/debris.
The perimeter of the wet Areas of bare soil and/or Regrade the soil if necessary to remove the gully, plant ground
pond erosive gullies have cover and water until it is established. Provide lime and a one-
formed. time fertilizer application.
The inlet pipe is clogged (if Unclog the pipe. Dispose of the sediment off-site.
applicable).
The inlet pipe is cracked or
The inlet device otherwise damaged (if Repair or replace the pipe.
applicable).
Erosion is occurring in the Regrade the swale if necessary and provide erosion control
swale (if applicable). devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Sediment has
accumulated to a depth Search for the source of the sediment and remedy the problem
greater than the original if possible. Remove the sediment and dispose of it in a location
design depth for sediment where it will not cause impacts to streams or the SCM.
storage.
The forebay
Erosion has occurred. Provide additional erosion protection such as reinforced turf
matting or riprap if needed to prevent future erosion problems.
Weeds are present. Remove the weeds, preferably by hand. If pesticide is used,
wipe it on the plants rather than spraying.
1

Wet POrki infe i s 00,011160)
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SCM element: Potential problem: How to remediate the problem:
Sediment has
accumulated to a depth Search for the source of the sediment and remedy the problem
greater than the original if possible. Remove the sediment and dispose of it in a location
'design sediment storage where it will not cause impacts to streams or the SCM.
depth.
The main treatment area Algal growth covers over Consult a professional to remove and control the algal growth.
50% of the area. g
Cattails, phragmites or
other invasive plants cover Remove the plants by wiping them with pesticide (do not spray).
50% of the basin surface.
Best professional practices
show that pruning is Prune according to best professional practices.
needed to maintain
optimal plant health.
The vegetated shelf Determine the source of the problem: soils, hydrology, disease,
Plants are dead, diseased etc. Remedy the problem and replace plants. Provide a one-
or dying. time fertilizer application to establish the ground cover if a soil
test indicates it is necessary.
Weeds are present. Remove the weeds, preferably by hand. If pesticide is used,
wipe it on the plants rather than spraying.
Shrubs have started to Remove shrubs immediately.
grow on the embankment.
Evidence of muskrat or Consult a professional to remove muskrats or beavers and
beaver activity is present. repair any holes or erosion.
The embankment A tree has started to grow Consult a dam safety specialist to remove the tree.
on the embankment.
An annual inspection by
an appropriate
professional shows that Make all needed repairs immediately.
the embankment needs
repair.
Clogging has occurred. Clean out the outlet device and dispose of any sediment in a
location where it will not cause impacts to streams or the SCM.
The outlet device
The outlet device is Repair or replace the outlet device.
damaged.
Weeds or volunteer trees Remove the weeds or trees.
are growing on the mat.
Floating wetland island
(if applicable) The anchor cable is
damaged, disconnected or Restore the anchor cable to its design state.
missing.
1

r 00' Mainieiii ce 4 4,6ir rt eb � c l lad i
SCM element: Potential problem: How to remediate the problem:
Erosion or other signs of
damage have occurred at Repair the damage and improve the flow dissipation structure.
the outlet.
The receiving water Discharges from the wet
pond are causing erosion Contact the local NCDEQ Regional Office.
or sedimentation in the
receiving water.
Wet Pond Diagram
WET POND ID FOREBAY MAIN POND
1 Permanent Pool El. 20.75 Permanent Pool El. 20.75
Temporary Pool El: 21.5 Temporary Pool El: 21.5
Pretreatment other No Clean Out Depth: 4.75 Clean Out Depth: 4.75
than forebay? Sediment Removal El 16 Sediment Removal Er 16
Has Veg. Filter? No Bottom Elevation: 15 Bottom Elevation: 15
ATTACH ADDITIONAL SHEETS IF NECESSARY
1

`Co Q'ensify Maintenance Ralvireina fts
Important maintenance procedures:
_ The drainage area to the vegetated conveyance or vegetated receiving area will be carefully managed
to reduce the sediment load to the vegetated conveyance or vegetated receiving area.
_ After the initial fertilization to establish the grass in the vegetated conveyance or the vegetated receiving
area, fertilizer will not be applied to the vegetated receiving areas.
The vegetated conveyance or vegetated receiving area will be inspected quarterly. Records of operation and
maintenance will be kept in a known set location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
SCM element: Potential problem: How to remediate the problem:
Vegetation Vegetation is too short or Maintain grassed vegetation such that the swale or vegetated
too long. area does not erode during the peak flow from the 10-year storm
Trash/debris is present. Remove the trash/debris.
Vegetated receiving Areas of bare soil and/or Regrade the soil if necessary to remove the gully, and then re-sod
areas erosive gullies have (or plant with other appropriate species) and water until
formed. established. Provide lime and a one-time fertilizer application.
Clogging has occurred. Clean out the outlet device. Dispose of the sediment off-site.
The outlet device (if
applicable)
The outlet device is Repair or replace the outlet device.
damaged
Erosion or other signs of
damage have occurred at Repair the damage and improve the flow dissipation structure.
the outlet.
The receiving water Discharges from the site
are causing erosion or Contact the local NCDEQ Regional Office.
sedimentation in the
receiving water.
1

DEMLR USE ONLY
Date Received Fee Paid Permit Number
Applicable Rules: ❑Coastal SW-1995 ❑Coastal SW-2008 0 Ph II-Post Construction
(select all that apply) ❑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.):
Dollar General-Stella
2. Location of Project(street address):
3810 Hwy 58
City:Stella County:Carteret Zip:28584
3. Directions to project(from nearest major intersection):
The project is located approximately 700 ft northwest of the intersection of NC Hwy 58 and SR 1100 towards.
Maysville
4. Latitude:34°47'32.2"N Longitude:77° 07'52.0"W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is(check one): New ❑Modification El 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 _,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 DDrains to an Offsite Stormwater System DOther
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):
O CAMA Major ®Sedimentation/Erosion Control: 2.20 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: _
5. Is the project located within 5 miles of a public airport? No 1-_]Yes
If yes,see S.L.2012-200,Part VI:http://portal.ncdenr.org/web/lr/rules-and-regulations
Fonn 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:Glandon Forest Equity,LLC
Signing Official&Title:George Barnes,Manager
b.Contact information for person listed in item la above:
Street Address:3825 Barrett Drive,Suite 100
City:Raleigh State:NC Zip:27609
Mailing Address (if applicable):
City: State: Zip:__
Phone: (910 ) 459-2601 Fax: ( )
Email:[e-mail]
c.Please check the appropriate box.The applicant listed above is:
❑The property owner(Skip to Contact Information,item 3a)
❑Lessee*(Attach a copy of the lease agreement and complete Contact Information,item 2a and 2b below)
❑Purchaser*(Attach a copy of the pending sales agreement and complete Contact Information,item 2a and
2b below)
®Developer*(Complete Contact Information,item 2a and 2b below.)
2.a.Print Property Owner's name and title below,if you are the lessee,purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Ricky T.Morris,Jeffrey E.Morris,Sheila Morris Cole Cain
Signing Official 8r Title:Ricky T.Morris,Jeffrey E.Morris,Sheila Morris Cole Cain;Property Owners
b.Contact information for person listed in item 2a above:
Street Address:582 Wetherington Lnd Rd
City:Stella State:NC Zip:28582
Mailing Address(if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
3.a. (Optional)Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Timmons Group
Signing Official&Title:John Wall,PE-Project Manager
b.Contact information for person listed in item 3a above:
Mailing Address:430 Eastwood Road,Suite 100
City:Wilmington State:NC Zip:28403
Phone: (910 ) 746-1174 Fax: ( )
Email:[e-mail]
4. Local jurisdiction for building permits:Carteret County
Point of Contact:Gene Foxworth Phone it: (252 ) 728-8545
Form SWU-l01 Version Oct.31,2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below,briefly summarize how the stormwater runoff will be treated.
Stormwater runoff will be treated by one wet pond that will detain the 1-year 24-hour,10-year 24-hour,and
100-year 24-hour storms.
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. Stonnwater runoff from this project drains to the White Oak River basin.
4. Total Property Area:2.00 acres 5. Total Coastal Wetlands Area:N/A acres
6. Total Surface Water Area:N/A acres
7. Total Property Area(4) -Total Coastal Wetlands Area(5)-Total Surface Water Area(6)=Total Project
Area': 2.00 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 Hi h Water(NFRAO line or Mean High Water
(MHW)line,and coastal wetlands landward from the NHW(or MHM line. The resultant project area is used to
calculate overall percent built upon area(BLIA). Non-coastal wetlands landward of the NHW(orMHW)line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area/Total Project Area)X 100 =40.2
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 I 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. LD 1
Basin Information Drainage Area 1 Drainage Area_ Drainage Area_ Drainage Area_
Receiving Stream Name Taylor Creek Taylor Creek
Stream Class * C C
Stream Index Number* 20-20 20-20
Total Drainage Area(sf) 46,949 41,671
On-site Drainage Area(sf) 46,949 41,671
Off-site Drainage Area(sf) 0 0
Proposed Impervious Area**(sf) 35,000 1,502
%Impervious Area**(total) 74.5 3.60
Impervious**Surface Area Drainage Area 1 Drainage Area Drainage Area Drainage Area
On-site Buildings/Lots(sf) 10,607 0
On-site Streets (sf) 0 0
On-site Parking (sf) 20,039 1,502
On-site Sidewalks (sf) 1,534 0
Other on-site (sf) 0 0
Future(sf) 2,820 0
Off-site (sf) 0 0
Existing BUA***(sf) 0 0
Total (sf): 35,000 1,502
* Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq/ps/csu/classifications
** hpervious area is defined as the built upon area including,but not limited to,buildings, roads,parking areas,
sidewalks,gravel areas,etc.
Form SWU-101 Version Oct.31,2013 Page 3 of 6

***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
Projects 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 114 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/formsdocs. 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/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://portal.ncdenr.org/web/wq/ws/su/statesw/forms_docs.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions&Protective Covenants
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.envhelp.org/pages/onestopexpress.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/management for
6. A USGS map identifying the site location If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within'/z mile of the site boundary,include the
mile radius on the map.
7. Sealed,signed and dated calculations(one copy).
8. Two sets of plans folded to 8.5"x 14" (sealed,signed,&dated),including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures,the banks of streams and rivers,the 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).
Form SWU-101 Version Oct.31,2013 Page 4 of 6

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:1644 Page No:360
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.aspx
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:John Wall,PE
Consulting Firm:Timmons Group
Mailing Address:430 Eastwood Road,Suite 100
City:Wilmington State:NC Zip:28403
Phone: (910 ) 746-1174 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)Ricky T.Morris,Jeffrey E.Morris,and Sheila Morris
Cole Cain ,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)George
Barnes with(print or type name of organization listed in
Contact Information,item 1a)Glandon Forest Equity,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.
Form SWU-101 Version Oct.31,2013 Page 5 of 6

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 civil penalties of up to$25,000 per day,pursuant to NCGS 143-215.6.
Signature: Date:
I, ,a Notary Public for the State of ,County of
, do hereby certify that personally appeared
before me this day of ,and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information,item la)George Barnes ,
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 ecorded,and that the proposed project complies with the requirements of the
applicable stormwater 15A NCAC 2H.1000 and any other applicable state stormwater re ' ements.
Signature: �, Date: 1 L,\ 11,-- 7-3
I,Multi
N rifh(.&,a Notary Public for the State of 4 (I V 4.. County of
MV U WlLe ,do hereby certify that eX O AD personally appeared
before me this 1)—day of ON 1lUY ,A ,and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,_ lir-
` _ 1 '"_I
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olitI '8f p 14'//��
`. *-%. SEAL
a
Notary Public E
Wake County '� , l b
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y y My commission expires l
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Form SWU-101 Version Oct.31,2013 Page 6 of 6

High Density Commercial Subdivisions
Deed Restrictions & Protective Convenances
In accordance with Title 15 NCAC 2H.1000 and S.L. 2006-246, the Management Regulations, deed
restrictions and protective covenants are required for High Density Commercial Subdivisions where
lots will be subdivided and sold and runoff will be treated in an engineered stormwater control facility.
Deed restrictions and protective covenants are necessary to ensure that the development maintains a
built-upon area consistent with the design criteria used to size the stormwater control facility.
George Barnes , acknowledge, affirm and agree by my signature below,
that I will cause the following deed restrictions and covenants to be recorded prior to the sale of any lot
within the project known as
9. The following covenants are intended to ensure ongoing compliance with State Stormwater
Management Permit Number , as issued by the Division of Energy, Mineral
and Land Resources under the Storm water Management Regulations.
2. The State of North Carolina is made a beneficiary of these covenants to the extent necessary to
maintain compliance with the stormwater management permit.
3. These covenants are to run with the land and be binding on all persons and parties claiming
under them.
4. The covenants pertaining to stormwater may not be altered or rescinded without the express
written consent of the State of North Carolina, Division of Energy, Mineral and Land Resources.
5. Alteration of the drainage as shown on the approved plan may not take place without the
concurrence of the Division of Energy, Mineral and Land Resources.
6. The maximum allowable built-upon area per lot is_35,000 square feet.
*Note: If the BUA per lot varies, please substitute the following statement for the one above and
provide a complete listing of the proposed BUA for each lot:
The maximum built-upon area per lot, in square feet, is as listed below:
Lot# BUA Lot# BUA Lot# BUA Lot# BUA
This allotted amount includes any built-upon area constructed within the lot property boundaries,
and that portion of the right-of-way between the front lot line and the edge of the pavement. Built
upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone, slate,
coquina and parking areas, but does not include raised, open wood decking, or the water
surface of swimming pools.
7. All runoff from the built-upon areas on the lot must drain into the permitted system. This may be
accomplished through a variety of means including roof drain gutters which drain to the street,
grading the lot to drain toward the street, or grading perimeter swales to collect the lot runoff
and directing them into a component of the stormwater collection system. Lots that will naturally
drain into the system are not required to provide these additional measures.
8. The owner of each lot, whose ownership is not retained by the permittee, is required to submit a
separate stormwater permit application to the Division of Energy, Mineral and Land Resources
and receive a permit prior to construction.
9. The project and each lot will maintain a 30**foot wide vegetated buffer between all impervious
areas and surface waters.
**50 foot for projects located in the 20 coastal counties.
Form DRPC-1 Rev.2 05Nov2009 Page 1 of 2

High Density Commercial Subdivisions
Deed Restrictions & Protective Convenances I tp 1 I I-2- Z3
Signature: Date: #
I, Tif f MM, ��l_O-U-`AI , a Notary Public in the
State of I v l)Yrk 11 i AA- 1 , County of I\1Gilit ,
do hereby certify that GreAnly I A-t-c. personally appeared
before me this the « day of Dc b(!/ , 20 93 , and acknowledge
the due execution of the foregoing instrument. Witness my hand and official seal,
j n �, `\\\\`���+++�1FtfigNiEAL
Sign a `.`` 4y ,
OS
My Commission expires ��y �o y p _
%ti
i
Form DRPC-1 Rev.2 05Nov2009 Page 2 of 2

APPLICATION IDENTIFICATION N.C. DEPARTMENT OF TRANSPORTATION
Driveway Date of STREET AND DRIVEWAY ACCESS
Permit No. Application
County: Carteret PERMIT APPLICATION
Development Name: Dollar General
LOCATION OF PROPERTY:
Route/Road: NC HWY 58
Exact Distance 700 ❑ Miles N S E W
® Feet EDON
From the Intersection of Route No. NC HWY 58 and Route No. SR 1100 Toward Maysville
Property Will Be Used For: 0 Residential/Subdivision El Commercial ❑ Educational Facilities ❑ TND 0 Emergency Services 0 Other
Property: ® is 0 is not within Stella City Zoning Area.
AGREEMENT
• I, the undersigned property owner, request access and permission to construct driveway(s) or street(s)on public right-
of-way at the above location.
• I agree to construct and maintain driveway(s) or street entrance(s) in absolute conformance with the current"Policy on
Street and Driveway Access to North Carolina Highways"as adopted by the North Carolina Department of
Transportation.
• I agree that no signs or objects will be placed on or over the public right-of-way other than those approved by NCDOT.
• I agree that the driveway(s) or street(s)will be constructed as shown on the attached plans.
• I agree that that driveway(s) or street(s) as used in this agreement include any approach tapers, storage lanes or
speed change lanes as deemed necessary.
• I agree that if any future improvements to the roadway become necessary, the portion of driveway(s) or street(s)
located on public right-of-way will be considered the property of the North Carolina Department of Transportation, and I
will not be entitled to reimbursement or have any claim for present expenditures for driveway or street construction.
• I agree that this permit becomes void if construction of driveway(s) or street(s) is not completed within the time
specified by the"Policy on Street and Driveway Access to North Carolina Highways".
• I agree to pay a$50 construction inspection fee. Make checks payable to NCDOT. This fee will be reimbursed if
application is denied.
• I agree to construct and maintain the driveway(s) or street(s) in a safe manner so as not to interfere with or endanger
the public travel.
• I agree to provide during and following construction proper signs, signal lights, flaggers and other warning devices for
the protection of traffic in conformance with the current"Manual on Uniform Traffic Control Devices for Streets and
Highways" and Amendments or Supplements thereto. Information as to the above rules and regulations may be
obtained from the District Engineer.
• I agree to indemnify and save harmless the North Carolina Department of Transportation from all damages and claims
for damage that may arise by reason of this construction.
• I agree that the North Carolina Department of Transportation will assume no responsibility for any damages that may
be caused to such facilities, within the highway right-of-way limits, in carrying out its construction.
• I agree to provide a Performance and Indemnity Bond in the amount specified by the Division of Highways for any
construction proposed on the State Highway system.
• The granting of this permit is subject to the regulatory powers of the NC Department of Transportation as provided by
law and as set forth in the N.C. Policy on Driveways and shall not be construed as a contract access point.
• I agree that the entire cost of constructing and maintaining an approved private street or driveway access connection
and conditions of this permit will be borne by the property owner, the applicant, and their grantees, successors, and
assignees.
• I AGREE TO NOTIFY THE DISTRICT ENGINEER WHEN THE PROPOSED WORK BEGINS AND WHEN IT IS
COMPLETED.
2004-07 NOTE: Submit Four Copies of Application to Local District Engineer, N.C. Department of Transportation TEB 65-04rev.
61-03419

SIGNATURES OF APPLICANT
PROPERTY OWNER(APPLICANT) WIT ESS ,,
COMPANY Gland F r uity,LLC--George Barnes NAME \j 1(t1
A/
SIGNATURE SIGNATURE j
ADDRESS 3825 ar ft Dr, Suite 100, Raleigh, ADDRESS iU 1 . S •j dt7
NC, 2 9 Phone No. 910-459-2601 6toh NC p /1F U
AUTHORIZED AGENT WITNESS
COMPANY Timmons Group—John Wall, PE NAME
SIGNATURE SIGNATURE
ADDRESS 430 Eastwood Road,Suite 100,Wilmington, ADDRESS
NC, 28403 Phone No. 910-746-1174
APPROVALS
APPLICATION RECEIVED BY DISTRICT ENGINEER
SIGNATURE DATE
APPLICATION APPROVED BY LOCAL GOVERNMENTAL AUTHORITY(when required)
SIGNATURE TITLE DATE
APPLICATION APPROVED BY NCDOT
SIGNATURE TITLE DATE
INSPECTION BY NCDOT
SIGNATURE TITLE DATE
COMMENTS:

STATE OF NORTH CAROLINA
ROUTE SR 1100(Hunters Creek Rd) PROJECT Dollar General-Stella COUNTY OF cameral
DEPARTMENT OF TRANSPORTATION THREE PARTY RIGHT OF WAY
A- ND- ENCROACHMENT AGREEMENT ON
Glandon Forest EQulty,LLC PRIMARY AND SECONDARY SYSTEM
3825 Barrett Dr,Suite 100,Raleigh,NC 27609
-AND-
Carleret County
210 Turner Street,Beaufort,NC 28516
THIS AGREEMENT,made and entered into this the day of ,20 ,by and between the Department
of Transportation,party of the first part;and Glandon Forest Equity,LLC-CIO George Barnes-Manger
party of the second part;and Carteret County-C1O Gene Foxworlh-
Director of Planning/Inspections party of the third part,
WITNESSETH
THAT WHEREAS,the party of the second part desires to encroach on the right of way of the public road designated as
Route(s) SR 1100(Hunters Creek Rd) ,located approximately 600 LF northeast of the intersection of NC Hwy 58
with SR 1100(Hunters Creek Rd).
with the construction and/or erection of: Tapping into the existing waterline with 47 LF of 3/4"CTS water service line and corporation stop.
WHEREAS,it is to the material advantage of the party of the second part to effect this encroachment,and the party of
the first part in the exercise of authority conferred upon it by statute,is willing to permit the encroachment within the limits of the
right of way as indicated,subject to the conditions of this agreement;
NOW,THEREFORE,IT IS AGREED that the party of the first part hereby grants to the party of the second part the right
and privilege to make this encroachment as shown on attached plan sheet(s),specifications and special provisions which are
made a part hereof upon the following conditions,to wit:
That the installation,operation,and maintenance of the above described facility will be accomplished in accordance with the party of
the first part's latest UTILITIES ACCOMMODATIONS MANUAL, and such revisions and amendments thereto as may be in effect at the
date of this agreement. Information as to these policies and procedures may be obtained from the Division Engineer or State Utilities
Manager of the party of the first part.
That the said party of the second part binds and obligates himself to install and maintain the encroaching facility In such safe and proper
condition that it will not Interfere with or endanger travel upon said highway,nor obstruct nor interfere with the proper maintenance
thereof,to reimburse the party of the first part for the cost Incurred for any repairs or maintenance to its roadways and structures
necessary due to installation and existence of the facilities of the party of the second part,and if at any time the party of the first part shall
require the removal of or changes In the location of the said facilities,that the said party of the second part binds himself,his successors
and assigns,to promptly remove or alter the said facilities,In order to conform to the said requirement,without any cost to the party of the
first part.
That the party of the second part agrees to provide during construction and any subsequent maintenance proper signs,signal lights,
flagmen and other warning devices for the protection of traffic in conformance with the latest Manual on Uniform Traffic Control Devices
for Streets and Highways and Amendments or Supplements thereto. Information as to the above rules and regulations may be obtained
from the Division Engineer of the party of the first.
That the party of the second part hereby agrees to Indemnify and save harmless the party of the first part from all damages and
claims for damage that may arise by reason of the Installation and maintenance of this encroachment.
Thal the party of the second part agrees to restore all areas disturbed during Installation and maintenance to the satisfaction of the
Division Engineer of the party of the first part. The party of the second part agrees to exercise every reasonable precaution during
construction and maintenance to prevent eroding of soli;silting or pollution of rivers,streams,lakes,reservoirs,other water
impoundments,ground surfaces or other property;or pollution of the air. There shall be compliance with applicable rules and regulations
of the North Carolina Division of Environmental Management,North Carolina Sedimentation Control Commission,and with ordinances
and regulations of various counties,municipalities and other official agencies relating to pollution prevention and control. Men any
installation or maintenance operation disturbs the ground surface and existing ground cover,the party of the second part agrees to
remove and replace the sod or otherwise reestablish the grass cover to meet the satisfaction of the Division Engineer of the party of the
first part.
That the party of the second part agrees to assume the actual cost of any Inspection of the work considered to be necessary by the
Division Engineer of the party of the first part.
Thal the party of the second part agrees to have available at the construction site,at all times during construction,a copy of this
agreement showing evidence of approval by the party of the first part. The party of the first part reserves the right to stop all work unless
evidence of approval can be shown.
Provided the work contained in this agreement Is being performed on a completed highway open to traffic;the party of the second part
agrees to give written notice to the Division Engineer of the party of the first part when all work contained herein has been completed.
Unless specifically requested by the party of the first part,written notice of completion of work on highway projects under construction will
not be required.
That in the case of noncompliance with the terms of this agreement by the party of the second part,the party of the first part reserves
the right to stop all work until the facility has been brought Into compliance or removed from the right of way al no cost to the party of the
first part.
Thal It Is agreed by both parties that this agreement shall become void If actual construction of the work contemplated herein is not
begun within one(1)year from the date of authorization by the party of the first part unless written waiver is secured by the party of the
second part from the party of the first part.
FORM RNV 16.6
Rev.February 2021

During the performance of this contract,the second party,for itself,its assignees and successors in interest(hereinafter referred to as
the"contractor"),agrees as follows:
a. Compliance with Regulations: The contractor shall comply with the Regulations relative to nondiscrimination In Federally-
assisted programs of the U.S.Department of Transportation,Title 49,Code of Federal Regulations,Part 21,as they may be
amended from lime to lime,(hereinafter referred to as the Regulations),which are herein Incorporated by reference and
made a part of this contract.
b. Nondiscrimination: The contractor,with regard to the work performed by it during the contract,shall not discriminate on the
grounds of race,color,or national origin in the selection and retention of subcontractors,Including procurements of materials
and leases of equipment. The contractor shall not participate either directly or indirectly in the discrimination prohibited by
Section 21.5 of the Regulations,including employment practices when the contract covers a program set forth in Appendix B
of the Regulations.
c. Solicitations for Subcontracts,Including Procurements of Materials and Equipment: In all solicitations either by competitive
bidding or negotiation made by the contractor for work to be performed under a subcontract,Including procurements of
materials or leases of equipment,each potential subcontractor or supplier shall be notified by the contractor of the
contractor's obligations under this contract and the Regulations relative to nondiscrimination on the grounds of race,color,or
national origin.
d. Information and Reports: The contractor shall provide all Information and reports required by the Regulations,or directives
Issued pursuant thereto,and shall permit access to its books,records,accounts,other sources of information,and its
facilities as may be determined by the Department of Transportation or the Federal Highway Administration to be pertinent
to ascertain compliance with such Regulations or directives. Where any information required of a contractor is in the
exclusive possession of another who fails or reluses to furnish this Information,the contractor shall so certify to the
Department of Transportation,or the Federal Highway Administration as appropriate,and shall set forth what efforts it has
made to obtain the information.
e. Sanctions for Noncompliance: In the event of the contractor's noncompliance with the nondiscrimination provisions of this
contract,the Department of Transportation shall Impose such contract sanctions as it or the Federal Highway Administration
may determine to be appropriate,Including,but not limited to,
(1) withholding of payments to the contractor under the contract until the contractor complies,and/or
(2) cancellation,termination or suspension of the contract,in whole or in part.
f. Incorporation of Provisions: The contractor shall include the provisions of paragraphs"a"through'P in every subcontract,
Including procurements of materials and leases of equipment,unless exempt by the Regulations,or directives issued
pursuant thereto. The contractor shall take such action with respect to any subcontract or procurement as the Department
of Transportation or the Federal Highway Administration may direct as a means of enforcing such provisions Including
sanctions for noncompliance: Provided,however,that,in the event a contractor becomes Involved In,or is threatened with,
litigation with a subcontractor or supplier as a result of such direction,the contractor may request the Department of
Transportation to enter into such litigation to protect the Interests of the State,and,in addition,the contractor may request
the United States to enter Into such litigation to protect the interests of the United States.
That when title to the subject that constitutes the aforesaid encroachment passes from the party of the second part
and vests in the party of the third part,the party of the third part agrees to assume all responsibilities and rights and to
perform all obligations as agreed to herein by the party of the second part.
RAN(166) : Party of the Second Part certifies that this agreement is true and accurate copy of the form
RAN(166)incorporating all revisions to date.
IN WITNESS WHEREOF,each of the parties to this agreement has caused the same to be executed the day and
year first above written.
DEPARTMENT OF TRANSPORTATION
BY:
DIVISION ENGINEER
WITNESS:
/ , Glendon Forest Equity,LLC CIO George Barnes Manager
3y/p avV 3825 Barrett Dr, Suite 100
Raleigh, N609
(2--
Second Party
WITNESS:
Carteret County-C/O Gene Foxworlh-Director of Planning/inspections
210 Turner Street
Beaufort, NC 28516
Third Party