WQ0040009_Owner Name Change_20181002

State of North Carolina
Department of Environmental Quality
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SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
atew Quality INSTRUCTIONS FOR FORM: PNOCF 01-16
Division. of Water .Resources ,t� a m,tt, m
This form is for ownership changes or name changes of a sewer system permit. Please note that "Permittee" references the
existing permit holder, and that "Applicant" references the entity applying for the ownership/name change.
Sewer permits start with a WQ or WQCS and contain the terms sewer extension or collection system in the subject field. This
form should not be used for permits with NC, NCG, SW or other types of non -sewer permits beginning with WQ.
For more information, visit the Division's Water Quality Permitting s website:
A. Sewer System Permit Ownership/Name Change (FORM: PNOCF 01-16) Application (All Applications):
]' Submit an original completed and appropriately executed application (PNOCF 01-16).
t] The Existing Permittee's Certification shall be signed in accordance with 15A NCAC 02T .0106(b). Per 15A NCAC 02T
.0106 c , an alternate person may be designated as the signing official if a delegation letter is provided from a person who
meets the criteria in 15A NCAC 02T .0106(b).
❑ The Applicant's Certification shall be signed in accordance with 15A NCAC 02T .0106 h). Per 15A NCAC 02T .0.106(c), an
alternate person may be designated as the signing official if a delegation letter is provided from a pffm*,?R .a
in 15A NCAC 02T .0106(b).
B. Existing Permit (All Applications): ® Submit a copy of the most recently issued permit and certification. OCT 2 2018
C. Property Ownership Documentation (All Applications):
➢ The Applicant shall demonstrate they are the owner of all property containing the sewer system facilihl r QuAity Regional
® Legal documentation of ownership (i.e., GIS, deed, article of incorporation, or contract), or
qp-erations Section
Wilmington Regional Office
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ Approved board minutes
D. Certificate of Public Convenience and Necessity (All Applications where the Applicant is a•Privately-Owned Public Utility):
❑ Per 15A NCAC 02T .011, provide one copy of the Certificate of Public Convenience and Necessity from the North
Carolina Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served
by the non -discharge system.
E. Operational Agreements (Applications where the Applicant is a Home/Property Owners' Association or Developer of lots to be
sold) :
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit an original properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c�, submit an original proposed or approved Articles of Incorporation, Declarations and By-
laws that contain the language required by the Operational Agreement.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit an original of the properly executed Operational Agreement FORM: DEV).
F. Package Submitted in Duplicate
® Submit a copy of all required documents in Instructions A-E as required
THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION SHALL BE SUBMITTED IN DUPLICATE
TO:
NCDEQ DWR
Water Quality Permitting Section
PERC S Unit
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1636
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY ST.
SUITE 925
RALEIGH, NORTH CAROLINA 27604
INSTRUCTIONS FOR APPLICATION PNOCF 01-16 Page 1 of 1

State of North Carolina
Department of Environmental Quality
Division of Water Resources
D-INR
SEWER SYSTEM PERMIT OWNERSHIP/NAME CHANGE
IN
Division of Water Resources
FOR FORM: PNOCF 01-16
I. EXISTING PERMITTEE INFORMATION:
1. Permittee's name: Zippy's Hampstead, LLC
2. Signature authority's name: Daniel York per 15A NCAC 02T .0106(b)
3. Signature authority's title: Member
4.. Permittee's mailing address: PO Box 19154
City: Atlanta State: GA Zip: 31126-
5. Permittee's contact information: Phone number: [phone] Fax Number
Email Address: dyork °,caliber-capital.com
II. APPLICANT INFORMATION:
1. Applicant's name: Caliber Car Wash Hampstead, LLC
2. Signature authority's name: Daniel York per 15A NCAC 02T .0106(b)
3. Signature authority's title: Member
4. Applicant's mailing address: PO Box 19154
City: Atlanta State: GA Zip: 31126-
5. Applicant's contact information: Phone number: [phone] Fax Number
Email Address: dyorkkcaliber-capital.com
6. Representative's name: Eric Brown
7. Representative's title: Asset Manager
8. Representative's contact information
III. PERMIT INFORMATION:
Phone number: [phone] Fax Number
Email Address: ebrowngcaliber-capital.com
4j~ W 4 OOL4 0
1. Existing permit number: and most recent issuance date: June 14, 2018
2. Reason for the permit application: Select If other, attach detailed explanation
3. Has the facility been constructed? ❑ Yes or Z No
4. Has the facility been certified per 15A NCAC 02T .0116? Z Yes or No
FORM: PNOCF 01-16 Page 1 of 2

IV. CERTIFICATIONS:
Existing Permittee's Certification per 15A NCAC 02T .0106(b):
attest that this application
(Signature Authority's name & title from Application Item I.2 & 3)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that prior to reissuance of the permit
into the Applicant's name, I will continue to be responsible for compliance with the current permit and any discharge of wastewater
from this system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will also make no claim against the Division of Water Resources should a condition of the existing permit
be violated. I also understand that if all required parts of this application are note completed and that if all required supporting
information and attachments are not included, this application will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: � Uy
Applicant's Certification per 15A NCAC 02T .0106(b):
y®(.V lKirm ad"rz- attest that this application
(Signature Authority's name & title from Application Item II.2&3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that after issuance of the permit into
the Applicant's name, I will be responsible for compliance with the issued permit and any discharge of wastewater from this non -
discharge system to surface waters or the land may result in an enforcement action that may include civil penalties, injunctive relief,
and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition of this permit be violated.
I also understand that if all required parts of this application package are not completed and that if all required supporting information
and attachments are not included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
/t
Signature: D ate :
FORM: PNOCF 01-16 Page 2 of 2

BK 4671 PG 1182 - 1185 (4) DOC# 20040608
This Document eRecorded: 08/29/2018 01:58:52 PM
Fee: $26.00 DocType: DEED Tax: $1,600.00
Pender County, North Carolina
Sharon Lear Willoughby, Register of Deeds
NORTH CAROLINA SPECIAL WARRANTY DEED
Excise Tax: $1,600.00 PIN 3282--86-7651-0000
Parcel Identifier No. Verified by _"......,.......,_."...,....... ,_..'..,.,._.,..,..,......_._ County on the day of.--,-.,--....-- . 20
........:.77..-,.... ...............................
Mail/Box to: C1,�1l�1K1��
. ,0 (Wit1QUt ttlC �xanlratiThis instrument was prepared b • :hAl Bray �I,XJ �:O:f }x 21. � �'�� off _274-1 q
Brief description for the Index: Lot lA Ma Book 30 Page 104 RETURN TO:
P p _ g : lcy & 8j4bV°. p"m.c
THIS DEED made this , Y , �# „ day of August, 2018, by and between
GRANTOR
Zippy's Hampstead LLC
a North Carolina limited liability company
309 E. Paces Ferry Rd. NE
Suite 400
Atlanta, GA 3 03 05
GRANTEE
Caliber Car Wash Hampstead, LLC, a North
Carolina limited liability company
3 09 E. Paces Ferry Rd. NE
Suite 400
Atlanta, GA 30305
Enter in appropriate block for each Grantor and Grantee: name, mailing address, and, if appropriate, character of entity, e.g:
corporatio.... ........ I ... ........ ..n or partnership.
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged, has and
by these presents does grant, bargain, sell and convey unto the Grantee in fee simple, all that certain lot, parcel of land or condominium
unit situated in the Town of Hampstead, Pender County, North Carolina and more particularly described as follows:
See attached Ex0hibi.t A incorporated. herein.
The property hereinabove described was acquired by Grantor by instrument recorded in Book 4656 pages 1303-1307.
All or a portion of the property herein conveyed includes or ET does not include the primary residence of a Grantor.
A map showing the above described property is recorded in Map Book 30 page 104.
#f589551
submitted electronically by "Bailey & Busby, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Pender County Register of Deeds.

B K 4671 PG 1183
D O C# 20040608
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 Grantor has done nothing to impair such title as Grantor received, and Grantor will
warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, other than the following
exceptions:
Easements, restrictions, and rights of way ofrecord, governmental regulations, ad valorem taxes for the current
year.
[signature page to, foil ow]
NC Bar Association Form No. 6 © 1/1/2010, 2013
Printed by Agreement with the NC Bar Association
#589551
4820-6909-5536 v1
This standard form has been approved by:
North Carolina Bar Association — NC Bar Form No. 6

BK 4671 PG 1184
D O C# 20040608
IN 'WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
Zippy's Hampstead LLC
a North Carolina limited liability company
By: Caliber Blue Steele, LLC, a Delaware limited liability
company, its sole Member
By:
Name; Daniel P. York
Title: Manager
..........................................................................................
State of Georgia - County of F+At4aR Dt K4 I b
I, the undersigned Notary Public of the County of Fulton and State aforesaid, certify that Daniel P. York personally
came before me this day and acknowledged that he is the Manager of Caliber Blue Steele, LLC, the sole Member of
•.:~ „t-.lYl.te. LlX, a North Carolina limited liability company, and that by authority duly given and as the act of
such entity, he signed the foregoing instrument in its name on its behalf as its act and deed.
Witness my hand and Notarial stamp or seal, this '2 j day of V. o_wA , 2018.
.- .,..::Z__.�Yh Notary Public
::'� ....,n.°:�.——t.Printed Name
.:. z My C��i i .. s kk �� Expires; l r O. Z .. .......::,-
•C,rt
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NC Bar Association Form No. 6 O 1/1/20107 2013
Printed by Agreement with the NC Bar Association
#589551
This standard form has been approved by:
North Carolina Bar Association — NC Bar Form No. 6
4820-6909-5536 v1

B K 4671 PG 1185 D O C# 20040608
EXHIBIT A
Legal Description
Lying in Pender County, North Carolina, and being more particularly described as follows:
Being all of Lot 1A, containing 1.2771 acres, as depicted on that certain plat entitled "Map of Survey for
Hampstead Center Associates, Limited Partnership Revision 2", recorded in Map Book 30 at Page 104,
Slide 415 in the office of the Register of Deeds of Pender County, North Carolina.
NC Bar Association Form No. 6 © 1/1/20105 2013
Printed by Agreement with the NC Bar Association
4589551
This standard form has been approved by:
North Carolina Bar Association — NC Bar Form No. 6
4820-6909-5536 vl