SW8140102_HISTORICAL FILE_20140110

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 IT Pl o2
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
2014 0l 10
YYYYMMDD

���
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Stormwater Section
Tracy E. Davis, PE, CPM
Director
January 10, 2014
Pat McCrory, Governor
John E. Skvada, III, Secretary
Haddon Clark III, President
Sampson-Bladen Oil Company, Inc.
Post Office Box 469
Clinton, NC 28328
Subject: Stormwater Management Permit No. SW8140102
Han -Dee Hugo
High Density Commercial Constructed Wetlands Project
Pender County
Dear Mr. Clark:
The Wilmington Regional Office received a complete Stormwater Management Permit
Application for Han -Dee Hugo on January 8, 2014. Staff review of the plans and specifications
has determined that the project, as proposed, will comply with the Stormwater Regulations set
forth in Session Law 2008-211 and Title 15A NCAC 2H.1000. We are forwarding Permit No.
SW8 140102, dated January 10, 2014, for the construction, operation and maintenance of the
BMP's and built -upon area associated with the subject project.
This permit shall be effective from the date of issuance until January 10, 2022, and shall be
subject to the conditions and limitations as specified therein. Please pay special attention to the
Operation and Maintenance requirements in this permit. Failure to establish an adequate
system for operation and maintenance of the stormwater management system will result in
future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing by filing a written petition with the Office of
Administrative Hearings (OAH). The written petition must conform to Chapter 150E of the North
Carolina General Statutes, and must be filed with the OAH within thirty (30) days of receipt of
this permit. Unless such demands are made this permit shall be final and binding. You should
contact the OAH with all questions regarding the filing fee and/or the details of the filing process.
The mailing address, telephone and fax numbers for the Office of Administrative Hearings are:
6714 Mail Service Center, Raleigh, NC 27699-6714. Telephone [phone] or visit their
website at www.ncoah.com..
If you have any questions, or need additional information concerning this matter, please contact
Chris Baker, at [phone].
Sincerely, !�
Tracy Da Is, P. E., DirerZV
Division of Energy, Mineral and Land Resources
GDS/csb: WWQ1Shared\Stormwater\Permits & Projects120141104102 HM201410 permit 140102
cc: David Newsome, P. E., Crystal Coast Engineering, P. A.
Pender County Inspections
Wilmington Regional Office Stormwater File
Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 Phone: [phone] Fax: [phone]

State Stormwater Management Systems
Permit No. SW8 140102
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Sampson-Bladen Oil Company, Inc.
Han -Dee Hugo
11.795 US Highway 117 South, Rocky Point, Pender County
FOR THE
construction, operation and maintenance of a constructed wetlands in compliance with
Session Law 2008-211 and the provisions of 15A NCAC 2H .1000 (hereafter collectively
referred to as the "stormwater rules') and the approved stormwater management plans
and specifications and other supporting data as attached and on file with and approved
by the Division of Energy, Mineral and Land Resources and considered a part of this
permit.
This permit shall be effective from the date of issuance until January 10, 2022 and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit.
3. The application form, supplement forms, approved plans and specifications for
this project are incorporated by reference and are enforceable parts of the
permit.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The project shall maintain a 50' wide vegetated buffer adjacent all surface
waters, measured horizontally from and perpendicular to the normal pool of
impounded structures, the top of bank of each side of rivers and streams and the
mean high water line of tidal waters.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW8 140102
7
All runoff being directed into wetlands shall flow into and through those wetlands
at a non -erosive velocity of 2 fps or less.
The following design elements have been approved for this constructed wetlands
stormwater facility, and must be provided in the system at all times:
a. Drainage Area, acres:
Onsite, ft2:
Offsite, ft2:
b. Total Impervious Surfaces, ft2:
Onsite, ft2:
Offsite, ft2:
c. Plant Depth, feet:
d. TSS removal eff., %:
e. Design Storm, inches:
f. Permanent Pool Elevation, FMSL:
g. Permitted Wetland Surface Area, ft2:
h. Shallow Land Area, ft2:
i. Shallow Water Area, ft2:
j. Deep Pool Area, ft2:
k. Permitted Temporary Storage Volume, ft3:
I. Temporary Storage Elevation, FMSL:
m. Controlling Orifice O":
n. Nos..Plants (Shallow Land);
o. Nos. Plants (Shallow Land)
p. Receiving Stream / River Basin:
q. Stream Index Number:
r. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
1.74
75,871
N/A
57,437
57,437
N/A
12
90
1.5
21
7,624
2,842
3,180
1,602
7,100
22
1.5
800
752
Northeast Cape Fear / Cape Fear
18-74-(47.5)
B;Sw
No person or other legal entity shall alter the approved stormater management
system, or fill in, alter, or pipe any drainage feature, including swales, shown on
the approved plans as part of the stormwater management system, unless and
until the permittee submits a modification to the permit and receives approval
from the Division.
2. The permittee is responsible for verifying that the proposed built -upon area for
the entire project does not exceed the allowable built -upon area.
3. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
4. The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
5. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately. Infiltration systems should not be used
as erosion control devices, due to the potential clogging. If the stormwater
system was used as an Erosion Control device, it must be restored to design
condition prior to operation as a stormwater treatment device, and prior to
occupancy of the facility.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW8 140102
6. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to the approved plans, regardless of size.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area.
e. Further subdivision, acquisition, or sale of all or part of the project area.
The project area is defined as all property owned by the permittee, for
which Sedimentation and Erosion Control Plan approval or a CAMA Major
permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
7. The Director may determine that other revisions to the project should require a
modification to the permit.
8. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification.
9. The permittee shall at all times provide the operation and maintenance
necessary to assure that all components of the permitted stormwater system
function at optimum efficiency. The approved Operation and Maintenance Plan
must be followed in its entirety and maintenance must occur at the scheduled
intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and revegetation of side slopes.
d. Maintenance of the wetlands plants and replacement of dead plants.
e. Immediate repair of eroded areas.
f. Maintenance of side slopes in accordance with approved plans and
specifications.
g. Trash and debris removal and unclogging of the wetlands, outlet structure,
orifice, catch basins and piping.
h. Access to all components of the system must be available at all times.
10. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DEMLR. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
11. Permanent seeding requirements for the stormwater control must follow the
guidelines established in the North Carolina Erosion and Sediment Control
Planning and Design Manual.
12. Prior to transfer of the permit, the stormwater facilities will be inspected by
DEMLR personnel. The facility must be in compliance with all permit conditions.
Any items not in compliance must be repaired or replaced to design condition
prior to the transfer. Records of maintenance activities performed to date will be
required.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW8 140102
13. This permit shall become voidable unless the facilities are constructed in
accordance with the conditions of this permit, the application, approved plans
and specifications, and other supporting data.
14. 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.
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and
approval by the Director. At least 30 days prior to a change of ownership, or a
name change of the Permittee or of the project, or a mailing address change, the
permittee shall submit a completed and signed "Name/Ownership Change Form"
to the Division of Energy, Mineral and Land Resources, accompanied by the
appropriate documentation as listed on the form. The project must be in good
standing with DEMLR. The approval of this request will be considered on its
merits and may or may not be approved.
2. The permittee is responsible for compliance with all of the terms and conditions
of this permit until such time as the Director approves the transfer request.
Neither the sale of the project area in whole or in part, nor the conveyance of
common area to a third party, constitutes an approved permit transfer.
3. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Energy, Mineral
and Land Resources, in accordance with North Carolina General Statute 143-
215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances which may be imposed by
other government agencies (local, state, and federal) which have jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. Permittee grants permission to staff of the DEMLR to access the property for the
purposes of inspecting the stormwater facilities during normal business hours.
8. The permittee shall submit a permit renewal application and processing fee at
least 180 days prior to the expiration date of this permit.
9. A copy of the approved plans and specifications shall be maintained on file by
the Permittee at all times.
Permit issued this the 10th day of January, 2014.
NO H CAROLINA ENVI NMENTAL MANAGEMENT COMMISSION
* racy Da ' , P. E., Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 5 of 7

State Stormwater Management Systems
Permit No. SW8 140102
Han -Dee Hugo
Stormwater Permit No. SW8 140102
Pender Countv
Designer's Certification
Page 1 of 2
I, , as a duly registered in
the State of North Carolina, having been authorized to observe (periodically/weekly/full
time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form are a part of this Certification.
Noted deviations from approved plans and specifications:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW8 140102
Certification Requirements: Page 2 of 2
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The wetland zone elevations are per the approved plan.
6. The wetland is located per the approved plans.
7. A trash rack is provided on the outlet structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of wetland zone surface area and volume have
been provided.
12. Required drawdown devices are correctly sized and located per the
approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided.
15. The required number of wetlands plantings have been provided.
cc: NCDENR-DEMLR Regional Office
Pender County Building Inspections
Page 7 of'7

CONSTRUCTED WETLAND ANALYSIS
FILE NAME: S:\WQS\STORMWATERIE%CELSPREADSHEETSIPOND1140102.WK1
PROJECT#: SW8 140102 REVIEWER: c. baker
PROJECT NAME: Original Run Date: Jan. 10, 2014
Note -User input boxes are she ad, in blue _] Last Modified: 10-Jan-14
DA
0.00
Receiving Receiving Stream: Northeast Cape Fear
-DA
Classification: B{Sw
Index Number: 18-74-(1 5)
Onsite DA, at= 75871.00
Offsite DA, at
0.00
0.00
Total Drainage Area: 0.00 75871.00 0.00
Built -Upon Area
Buildings/Lots, sf=
0.00 517
Streets/Parking, sf=
35940.00
SidewalklConuete, st=
1392.00
Other, sf=
14935.00
Offsite, at=
Total Built-uponArea: 0.00
57437.00
0.00
0.00
0.00
0.00
Storage Volume Calculation
Pre-dev. % impervious,
Post-dev'%impervious
_ #D
1 yr 24 hr storm Rd, in
I_ _
Pre-dev. Rv
0
Posldev. Rv
_ #D
Predev. volume
1
Post-dev. Volume
_.#D
Post volume - pre volume
010
1.5" volume, cf
#D
Required Volume
#D
Surface Areas
4
IV/01
75.70%
#DIV/01
#DIVl01
#D0
_0.00_
------
___--_-.__._-
_
0.05
_
0.05
.05
0.05
0.1
IV_/01
0.73
#DIV/01
__#Dll
0.0
I.0
_ _
0.0
_#DIV/01
0.0
0.
IV/DI_
__ 0.0
_ #DIV/01
_#DIV/01_
_#Dll
IV/01
0
#DIV/01
#DIV/01
#DI'
IV/01
6935.85625
#DIV/01
#DIV/01
#DI'
IV/01
6936
#DIV/01
#DIV/01
#DI'
//01 #DIV/01
IS 0.05
//01 _ _ #DIV/01__
0 0.0
/l01 _#DIVl01 _. J
/I01 #DIV/01
/101 #DIV/01
001 #DIV/01
Plant Depth, teal (<=12") r _
--_-_
- _1.0 __ __ _
__
Min. Surface Area,R
#DIVI01
6936 #DIV/01
#DIVI01
#DIV/01
#DIV/01
Req. Deep Pool Area wlo FB
#DIV/01
347
Pmv. Deep Pod Area w/o FB
824
Req. Deep Pool Area w/FB
#0IV/01
694
Pmv. Deep Pod Area wl FB
778
Req, ShalbwwalerAma
#DIV/01
2774
Pmv. Shallow Water Area
3180
Reg Shallow Land
#DIVl01
2081
Pmv. Shallow Land Area
2842
Depths $ Elevations
Deep Pool (18%361
24.00
Top of Deep Pool, fmsl
21.00
Shallow Water (3"-6")
6.00
Top of Shallow Water, PPE
21.00
Shallow Land (12" max) i
12.00
Top of Shallow Land, TPE
22.00
Upland (optional)
-
DA- DA- PA= DA- DA- DA-
Drawdown OrificelWeir
Avg. Head, If
Average Flow 02, cfs #
Average Flow 05, cfs #
02 Area, sq. in. _ #
OS Area, sq. in. _ #
No. of Orifices
L.
Orifice Diameter, in.=
_.
Orifice Area, sq. in. = 0
Weir Height, inches=
Weir Length, inc hes=
_
Weir C= If
Weir L', off, length= 0.
Avg, Flowrete; Q, cfs = 0
I.00
DIV101
DIV/01
DIV/01
DIV/01
DIV/01
0.31
0.00
0.00
0.00
0.00
0.040
#DIV/01
#DIV/01
#DIV/01
#DIV/01
0.016
#DIV/01
#DIV/01
#DIV/01
#DIV/01
2.147
#DIV/01
#DIV/01
#DIV/01
#DIV/01
0.859
#DIV/01
#DIV/01
#DIV/01_ _
-
_ #DIV/01
1 __
_-
1.50_
_.
_
.000
1.767
0.000
0,000
0.000
0.000
#DIV/01
#DIV/01
#DIV/01
#DIV/01
#DIV/01
000
-0.063
0.000
0.000
0.000
0.000
.000
0.033
0,000
0.000
0.000
0.000
Runoff Cc value
0.000
0.000
#DIV/01
#DIV101
#DIV/01
#DIV_/01
1 yr 24 hr intensity, I [-
_
1 yr 24 hr predev Qp
_ _]
0.000
0.000
#DIV/01
#DIV/01
#DIV/01
#DIV/01
DIP <avg 0owiate7
YES
YES
#0IV/01
#DIV/01
#DIV/01
#DIV/01
Drawdown, days= I
#DIV/01
2.43
#DIV/01
I #DIVI01
#DIV/01
I #DIVI01
Required Number of Plants (Per 200 square feel of wetland)

MEMORY TRANSMISSION REPORT
TIME :01-10-2014 16:55
FAX NO.1
NAME
FILE NO.
818
DATE
01.10 16:53
TO
:R 919103250060
DOCUMENT PAGES
8
START TIME
01.10 16:54
END TIME
01.10 16:55
PAGES SENT
8
STATUS
OK
"SUCCESSFUL TX NOTICE"'
6tate of North Carollva
Lepartment of RnVlrovmsnl evd IYelurAl Rwvnrca
WtlmlvAtov itaAbval OTry
hl Mct-Ivry, Governor FAX COVER 81iE F:9' John BSlbnrla J/! Secretary
UAto:
To:
Co:
Pazi
Ro:
n
No: Pages (exQl. Dover): � -
Prom: JQ�AQILAr
Phone: (910)796-�3"+6
V.:
.21 Cu . Delves Wl�n8tvnr WC 18e05 - (91O)')98-'13t� - M "91 Acllon H,Wb

State of North Carolina
Department of Environment and Natural Resources
Wilmington Regional Office
ParMeCrory, Governor FAX COVER SHEET
Date: -1�-4,,/
To: �%�d %O
Co: liiQ��S/�gS i 7��
Fax:
Re:
FMJ
Inter._ C/-.
John E Skvarfa III, Secretary
No. Pages (excl. cover):
From: Jo Casmer
Phone: [phone]
Fax: [phone]
127 Cardinal Drive Extension, Wilmington, NC 28405 • [phone] • An Equal Opportunity Affirmative Action Employer

JOHN L. PIERCE & ASSOCIATES, P.A.
LAND SURVEYING — LAND PLANNING — MAPPING
P.O. 130X 1685
JACKSONVILLE, NC 28541
OFFICE: [phone] PAX: [phone]
EMAIL: bettybnjlonc.com
Or hrianj n ilone.com
TO: Ms. Christine Nelson
N.C. Department of Environment and Natural
Resources — Department of Stormwater
127 Cardinal Drive Extension
Wilmington, NC 28405
Letter of Transmittal
DATE:
January 6,2014
ATTENTION:
Christine Nelson
Re:
Han-Dce Ilu o — Rocky Point
COPIES
DATE
NUMBER
DESCRIPTION
2
Sets of revised plans
2
Sets of revised Stormwater applications with calculations
2
Revised narrative
2
Quad maps
1
Co of Deed of Record
1
Copy of Annual Report
1
Copy of Certificate of Incorporation
1
Copy of Articles of Amendment Business Corporation
1
Cog of Purchase Agreement
I
i
A I" I
SIGNED:

.-.... ...., - °:;DWQUSEONLY
Date Received
Fee Paid
Permi Number
Applicable Rules: U Coastal SW -1 ❑ 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
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
77iis 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.):
Han -Dee Hugo
2. Location of Project (street address):
11795 US Hwy. 117 S.
City:Rocky Point County:Pender Zip:28457
3. Directions to project (from nearest major intersection):
Proiect is located at intersection of US 1131iy.177 & NC Hwy 133 Pender County
4. Latitude:34023' 22.0" N Longitude:770 53' 35.8" W of the main entrance to the project.
IL PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationi
tRenemals with modifications also requires SM-102 - Renermil Application Form .
bAf 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* "proaide a designer's certificatigm
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 DWQ
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
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):
[]LAMA Major ®Sedimentation/Erosion Control: 1.9 ac of Disturbed Area
[]NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.lf 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 ❑Yes
If yes, see S.L. 2012-200, Part V1: littp:/Lportal.ncdenr.org/web/wq/ws/su/s-tatesw/rules laws
JAN 0 6 2014
BY:
Form SWU-10l Version 06Aug2012 Page I of

III. CONTACT INFORMATION
La. 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:Sampson-Bladen Oil Company Inc
Signing Official&Title_ J}0_dd0f1-.M..0AQy-V-,Z11Pre-,4AP-ni-
b.Contact information for person listed in item la above:
Street Address:3309 Drake Circle
City:Raleigh State:NC Zip:27607
Mailing Address (if applicable):P.O. Box 469
Qty:Clinton State:NC Zip28328
Phone: (919 ) 785-1904 Fax:
c. Please check the appropriate box. The applicant listed above is:
❑ The pro erty owner (Skip to Contact Information, item 3a)
❑ lessee" (pAttach 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:Edna Wilson Shepard Henson Trust
Signing Official & Title:Edna Wilson Shepard Henson Property Owner
b.Contact information for person listed in item 2a above:
Street Address:140 Oak Hill Drive
City:RockyPoint State:NC Zip:28457
Mailing Address (ifapplicable):
Phone:
Fax:
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:
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing
Phone:
4. Local jurisdiction for building permits: Burgaw
State:
Fax:
Point of Contactlaki Pace Phone #: (910 ) 259-1518
Form SWU-101 Version 06Aug2012 Page 2 of 6
JAN 0 6 2014
8V:

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be collected and diverted to a constructed wetlands capable of accommodating the
difference between Post -Development and Pre -Development runoff from the 1-year/24 hour storm.
2. a. If daiming 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 daiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW —1995 ❑ Ph If —Post Construction
3. Stormwater runoff from this project drains to the Cape Fear River basin.
4. Total Property Area: 2.37 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*:1.74 acres
' Total project area shall be calculated to exclude the followin : the nonnal pool of imppounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward f�rroom the NHW (or MHW) line. The resultant project area is used to
calculate overall percent belt upon area (BUA). Non -coastal wetlands landruard of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 75.70 %
9. How many drainage areas does the project have?l (For high density, count 1 for each proposed engineered
stornavater 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.
Information ::;
raea:
a
raa Area
_rams Area >
Receiving Stream Name
NortheastLape
Fear River
Cream Class
tream Index Number
Total Drainage Area s
s
n-site Drainage ea(s)
s
site ramage ea s
Proposed Impervious Area (sf)
s
% Impervious Area (total)
Im envious?. ..-
; carnage _ ea :.
_rainage A .ea _
` _ _age ea_
.Drainage , a _,
-stte u urge ots (s
s
Qn-site Streets (s
-
site Parking s
s
site Sidewalks s)
s
Other on -site s
-
Tuture s
s
off -site s
-
wstmg s-0-
total s
s
' Stream Class and Index Number can be determined at: http.4ortaimcdennoro ueb/
" Impervious area is defined as the built upon area including, but not limited to, buildii
Sidewalks, gravel areas, etc.
'•' Report only that amount of existing BLIA that will remain after development. Do not
is to be rei oved and which will be replaced by nezu BLIA.
Forth SVM-101 Version 06Aug2012 Page 3 of 6

11. How was the off -site impervious area listed above determined? Provide documentation. n/a
Projects in Union County: Contact DWQ Central Office staff to check- if the project is located tvidrin a Threatened &
Endangered Species watershed that may be subject to more stringent stornovater requirements as per 15A 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.oEgweb wq/ws/su/bml2-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality (DWQ).
A complete package includes all of the items listed below. A detailed application instruction sheet and BMP
checklists are available from htW://portal.ncdenr.org/web/wq/ws/su/statesw/fonts_ does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at hqp:/ /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/forrns_docs.
_IrL/ 6
1. Original and one copy of the Stormwater Management Permit Applintion Form. i /1/_
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants Vl //1
Font. (if required as per Part V11 belora)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M T AI C
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to INC
h!W://www.envhelp.org/pages/onestopeUress.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/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USCS map identifying the site location. If the receiving stream is reported as class SA or the -7 / V
receiving stream drains to class SA waters within 1h mile of the site boundary, include the ifi
mile radius on the map.
7. Sealed, signed and dated calculations (one copy). �
S. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including. ? N C
a. Development/Project name.
b. Engineer and firth.
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 MI3W 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 wat —�
i. Dimensioned property/project boundary with bearings & distances. � 'Li
j. Site Layout with all BUA identified and dimensioned.
k Existing contours, proposed contours, spot elevations, finished floor elevations. JAN 3 G 20M 1
1. Details of roads, drainage features, collection systems, and stormwater control mea es.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by
qualified person. Provide documentation of qualifications and identify the person W%6 ---—_._._
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).
Form SWU-101 Version 06Aug2012 Page 4 of 6

01
Copy of any applicable sells 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"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPa, 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 DWQ to verifij the SHWT prior
to sttbntittal, [phone].1
A.1�
A'f-
A copy of the most current property deed. Deed book:1145 Page No: 50
For corporations and Iimited 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.
hft://www.secretary.state.nc.us/CoEporations/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
htto://portal.nedeii.org/web/wq/ws/su/statesw/forms does. 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 DWQ and that they will be recorded prior to the sale of any lot.
VIlf. 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:David K Newsom, PE
Consulting Firm: Crystal Coast Engineering PA
Mailing Address205-3 Ward Road
City:Swansboro State:NC Zip28584
Phone: (910 ) 325-0006
Email:[e-mail]
Fax: (910 ) 325-0060
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, itent 21ars been filled out, complete this
section)
I, (print or type""rre ofpersmt listed in Contact Gtformation, itettt 2n) Edrtn Wilson Shepard Henson certify that I
own the property identified in this permit app cation, and thus give permission to (yrint or hjpe name of yerson
listed in Contract Iriformntimt, item la) I2a ers�H. Clark P�res. with (print or type rurme ofarganizntimt listed in
Contact brformntion, stern la) Smn Son-8 ade�ltl Oil Comynnn Inc. to develop the preject 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 far the operation and maintenance of the stormwater system.
JAN 0 G 201-1
Form SWU-101 Version 06Aug2012 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 DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ 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.
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
X. APPLICANTS CERTIFICATION
I, (print or type name of person listed in Contact Infonnatimt, item In) AMAC o r\ M brK =-Tt
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 C 2H .. 0^00 and any other applicable state stormwater requirements.
Signature: 4 ( /�_ M-ft Date: I "�0 -0) 17
I, \ jrCOn'R C� � ufl'e n a Notary Public for the State ofNaAk County of
W gxC do hereby certify that H CAA o h M • C b rk-i-tr personally appeared
before me thi�day of De m )P—r o(c)13 and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, (A-r+'� OC 4ealk--A *
:0616
My commission expires i / ay t `otrj G
r--`q..a tom.: .---�;,;._ 1V E
JAN 0 G 201)
13v:
Form SWU-l01 Version 06Aug2012 Page 6 of 6

Design Calculations `�� F
Constructed Wetland System _ / ;..l11_
for
- �
Han-Dee Hugo — Rocky Point Township = 4111`'3
GtNrE
K. NE14
Design Calculations by: 1 •.I
Crystal Coast Engineering, PA l�l
Firm License No.: C-2553
1. Project Description
The project consists of the proposed construction of convenience mart & associated parking & sidewalks on
tract located at intersection of US Hwy 117 and NC Hwy 133
2. Impervious Surface Areas
Proposed
Buildings 5,170 sf
Streets/Parking 35,940 sf
Sidewalks 1,392 sf
Offsite -0- sf
Subtotal 42,502 sf
Future
Reserve for Future 14.935 sf
TOTAL. 57,437sf
Total Drainage Area = 75,871 sf (1.74 ac)
Percent Impervious = 57,437 sf / 75,871 sf
= 75.70%
3. Design Volume
In accordance with Section .1008(c)(1), the required design volume is computed as follows:
Using Schuler "Simple Method":
Rv = 0.05 + 0.009(I) where I = Percent Impervious (75.70%)
= 0.7313 in/in
Design Volume (Qvolume) = Design Rainfall (1.5") x Rv x Drainage Area
= 1.5" x .7313 x 75,871 sf
= 83,230 in-sf or 6,936 cf
4. Required Surface Area
Surface Area Req'd = Qvolume / DPlants E
Let DPlants= 12" - JAN 116 2099 f
So, Surface Area Req'd = 6,936 cf/1 ft = 6,936 sf 6 __
Surface Area Actual (at Temp Pool) = 7,624 sf (> 6,936 - OK)

5. Configure Zone Areas
Deep Pool (Elev. 19.00 — 21.00) = 1,602 sf (21.0% - OK)
Shallow Land (Elev. 21.00 — 22.00) = 2,842 sf (37.3% - OK)
Shallow Water (Elev. 20.50 — 21.00 = 3,180 sf (41.7% - OK)
6. Confirm Storage Volume
Confirm actual "Storage Volume" (actual basin volume between Elev 21.00 & Elev. 22.00) can accommodate
in excess of 6,936 cf. Using average end method, actual Storage Volume is:
Avg. Incr.
Elev Area Area Depth Volume
21.00 6,198
22.00 8,062 7,100 1.00 7,100 cf
7,100 cf > 6,936 cf (ok)
7. Discharge Rate
Size discharge orifice such that the storage volume is discharged over 2 — 5 day period. Using orifice equation
(D = (Q / 0.026 (h).5).5), where It = D (depth) / 3.
Solving for Diameter (D) = 1.25 Use 1.5" Orifice
Actual drawdown rate (Q) = 0.034 cfs
Draw Down Period = 2.43 days.
8. 010 Routing
Routing (attached) indicates a Q10 stage of 1.35' (Elev 22.35)
9. 0100 Routing
Routing (attached) indicates a Q 100 stage of 1.47 (say 1.50) (Elev 22.50)

C20 t 235600525
State of North Carolina
Department of the Secretary of State
SOSID: 0128585
Date Filed: 12/21/2012 3:44:00 PDI
Elaine F. Marshall
North Carolina Secretary of State
C201235600525
ARTICLES OF AMENDMENT
BUSINESS CORPORATION
ar
Pursuant to §55-10-06 of the General Statutes of North Carolina, the undersigned corporation hereK brtJNV4 I0Ildw2�Ancc {
of Amendment for the purpose of amending its Articles of Incorporation. '
BY:
1. The name of the corporation is: Sampson-Bladen Oil Company, Incorporated
1 The text of each amendment adopted is as follows (Slate below or attach):
Paragraph 4 of the Articles of Incorporation is deleted and replaced with the following:
The total authorized Capital Stock of this Corporation is one hundred (100) shares of Preferred Stock par
value $100,00; four hundred (400) shares of Class A Common Stock par value $100.00; and thirty nine
thousand six hundred (39,600) shares of Class B Common Stock. Class A Common Stock is voting stock. Class
B Common Stock is non -voting stock.
3. If an amendment provides for an exchange, reclassification, or cancellation of issued shares, provisions for implementing the
amendment, if not contained in the amendment itself, are as follows:
The currently issued Common Stock shares of the Corporation will be reissued on a one for one basis as Class A
Common; each holder of Class A Common will be issued 99 shares of Class B Common for each share of
Class A Common owned.
4. The date of adoption of each amendment was as follows -
December 20, 2012
5. (Check either a, b, c, or d, whichever is applicable)
a._The amendment(s) was (were) duly adopted by the incorporators prior to the issuance of shares.
b.—The amendment(s) was (were) duly adopted by the board of directors prior to the issuance of shares.
c._The amendment(s) was (were) duly adopted by the board of directors without shareholder action as shareholder action
was not required because (set forth a brief explanation of why shareholder action was not required.)
d. V The amendment(s) was (were) approved by shareholder action, and such shareholder approval was obtained as required
by Chapter 55 of the North Carolina General Statutes.
CORPORATIONS DIVISION
(Revised January 2002)
P. O. BOX 29622
RALEIGH, NC 27626-0622
(Form B-02)

t
... C201235600525
ARTICLES OF AMENDMENT
Page 2
6. These articles will be effective upon filing, unless a delayed time and date is specified:
This the I4 day of '95ma .202,
Oil Company, Incorporated
of Corporation , /
Rogers H. ClarkvPresident
Type or Print Name and Title
NO1T•.S:
1. Filing fee is $50. This document must be filed with the Secretary of State.
CORPORATIONS DIVISION
(Revised January 2002)
P. 0. BOX 29622
RALEIGH, NC 27626-0622
(Form B-02)

G !I/li1,CG%7� �4%�!L' IJG/7�i111�/�9Z/L�
1073-1 Gregory Fork Road J
Richlands, NC 28574
Phone [phone]
Fax [phone]
pittmansoil@yahoo. com
January 6, 2014
John L. Pierce Surveying
409 Johnson Blvd
Jacksonville, NC 28540
Ref: Hardee Hugos Pender County
Dear Mr. Pierce,
A soil evaluation was conducted on the above referenced tract to determine the sites
suitability for storm water treatment. The current laws and rules of NC was used as guide
for this evaluation.
Hand Auger borings on the site were used to characterize the soil texture, infiltration rate,
and depth to SHWr. The borings were conducted in the proposed storm water device
and showed a seasonally high water table between 12 and 18" from the surface. This was
based on the presence of soil chroma of less than 2, as observed from the Mansell Soil
Color Chart.
At the time of my evaluation no wetlands were found on the property.
If you have any questions please feel free to contact me at 910-330-2784. Thank You.
Sincerely,
R. Haywood Pittman 11
NC Licensed Soil Scientist

r
North Carolina Secretary of Stale
http://www.secretary.state.nc.us/corporations/Corp.aspx?Pitemld=4592599
North Carolina
Elaine F. Marshall DEPARTMENT of--rl-tE
Secretary SECRETARY OF STATE
PO Box 29022 Raleigh, NC 27626-0622 [phone]
Date:
12/20/2013
Click here to:
View Document Filings I File an Annual Report i
®A Print a pre -populated Annual Report Form
i Amend A Previous Annual Report i
Corporation Names
Name
Name Type
INC SAMPSON-BLADEN OIL
LEGAL
COMPANY, INCORPORATED
Business Corporation Information
SOSID:
0128585
Status:
Current -Active
Effective Date:
3/3/1939
Citizenship:
DOMESTIC
State of Inc.:
NC
Duration:
PERPETUAL
Annual Report Status:
CURRENT
Registered Agent
Agent Name:
CLARK, ROGERS H.
Office Address:
932 US 421 NORTH
CLINTON NC 28328-0410
Mailing Address:
PO BOX 469
CLINTON NC 28329-0469
Principal Office
Office Address:
932 US 421 NORTH
CLINTON NC 28328-0410
Mailing Address:
PO BOX 469
CLINTON NC 28329-0469
Officers
Title:
FINANCIAL OFFICER
Name:
JEFFREY POWELL SMITH
Business Address:
932 HWY 421 NORTH
CLINTON NC 28328
:CEl��n�
JAH 0 6 209-'i
Title: VICE PRESIDENT
_ro 12/200011 1029 AM

North Carolina Secretary of State
Name:
Business Address:
Stock
Class
PREFERRED
COMMON CLASS A VOTING
http: //www.secreLary.state. ne. us/corporations/Corp.aspx?Pi temld=4592599
HADDON M. CLARK
PO BOX 469
CLINTON NC 28328
Shares No Par Value Par Value
100 100
400 100
This website is provided to the public as a part of the
2098
system. Version:
I _r, 19/9n/9n Z In•99 AM

"yeresnagr , l Filed Annual Report
4592599
3�'rri BUSINESS CORPORATION
�1��� 1t Do not data enter manually.
��°� ANNUAL REPORT
NAME 017 BUSINESS CORPORATION: Sampson-Bloden Oil Companh. Incorpormed
FISCAL YEAR ENDING: 1013112012 SPATE? OF INCORPORATION: NC
SGCRI: I'AIZY 017 S'fA'1'Ei COItPOItA'Il: ID NUMBER: 01285.55
NATUREOF BUSINESS: Pen•nleum Mm-kcler and healing and air conditioning installation & repair
RFGIS'fP,ItIiD AGL'N'I': CURK. ROGE1611.
REGISTEM' 1) OFFICE MAILING ADDRESS: PO Box 469
Clinton, NC 28329-0469
REGISI'EILED OFFICE SI'REI TA 1) DR ELM: 932 Us 42l North
Clinton, NC 28318-0410 Sampson County
PRINCIPAL OFFICE TELFP110NE NUM131-IR: [phone]
PRINCIPAL OFFICE MAILING; ADDRESS: PO Boa 469
Clinton. NC 28329-0469
PRINCIPAL OFFICE. STRE1 l' ADDIUSS: 932 Us 411 North
Clinton, NC 28328-0410
PRINCIPAL OFFICERS:
Nainc: lluddon At.. Clark
Tide: Vice President
Address:
PO Box 469
Clinton, NC 28328
A'rnue:.1effiey Powell Smith
Title: Finuncinl0fficer
Address:
931 /lwir 421 North
Climon, NC 28328
CERTIFICATION 01: ANNUAL RfiPOlt"f M115T 13E COMPLI:I'ED BY ALL BUSINESS CORPOKA'IIONS
Jeffrey Powell Smith
FORM MUST HE SIGNED BY AN OFFICER 01: THE CORPORATION
Jeffrey Powell Smith
12/6/2013
DATE
Financial Officer
TYPE Olt PRINTNAMF TYPE OR PRINT TI'I LE
ANNUAL REPORT PEG: G-Paid MAIL "TO: Secretary of State • Corporations Division • Post Office Box 29525 • Raleigh, NC 27626-0525
1Ai1 0 G 291:)
BY:

• JVWJJ: Ul LO303
Date Filed: 6/21/2012 10:55:00 ABM
Elaine F. Marshall
CD-419(39) Business Corporation North Carolina Annu North Carolina Secretary of State
11-22-10
This report may be filed online at the Secretary of State wobsite: www.sosnc.corn 2012 194 00065
Name of Business Corporation: SAMPSON—BLADEN OIL COMPANY, INC
Fiscal Year Ending: 10 31 11 State of Incorporation: NORTH CAROLINA
Month 1 0, 1 year
Secretary of Stale 10 Number: 0128585
® I hereby certify that an annual report completed in its entirety has been submitted and the information requested below (required by
NCGS 55.16-22) has not changed and is therefore complete.
Nature of Business:
Registered Agent:
Registered Office Mailing Address:
County. City. State: ZIP Code:
Registered Office Street Address:
County: City: State: ZIP Code:
Signature of New Registered Agent:
(Signature obnsbtutes consent to the appoin"mr)
Principal Office Telephone Number:
Principal Office Mailing Address:
Principal Office Street Address:
City: State: ZIP Code:
City. State: ZIP Code:
Name Title and Business Address of Principal Officers:
Name: Tille:
Address:
City: State: ZIP:
Name: Title:
Address:
city, State: ZIP:
Name: Title:
Address:
Certification of annual
069511 12-04.10
be completed by all Business Corporations).
LAW_ o610V
by an officer of Corp«avon) / ale
t�. rr fr e€ 7 VRfs.
t Nam rite

SOSID:0128585
Date Filed: 5/11/2011 11:18:00 AM
_ . OD-479(3i)
Business Corporation North Carolina Anni
Elaine F. Marshall
10-28-08
North Carolina Secretary of State
This report may be filed online at the Secretary of state webshe: www. osnc.co
2011309 01368
Name of Business Corporal),
rE SAMPSON—BLADEN OIL COMPANY, INC
Fiscal Year Ending:
10 31 10 State of Incorporation: NORTH CAROLINA
Month / Day / Yw
Secretary of State ID Numbe
. 0128585
[] I hereby certify that the i
iformation requested below (required by NCGS 55-1E22) has not changed since the
filed
therefore complete.
most recently
annual report and is
Nature of Business:
RETAIL
SALES
Registered Agent
ROGERS
H. CLARK
Registered Office Maping Address:
P.O. BCX
469
County.
City. state:
ZIP Code:
CLINTON,
NC 28329-0469
Registered Office Street Address:
932 US
421 NORTH
County.
City. State:
ZIP Code:
CLINTON,
NC 28328
Signature of New Registered i
pent
151pnaM1ra mnstlOrtq mneent to th. apptlntnanq
Principal Office Telephone Nui
iber.
910-592-4177
Principal Office Mailing Addre
s:
P.O. BOX 469
City. State:
ZIP Code:
CLINTON, NC 28329-0469
Principal Office Street Address
932 US 421 NORTH
City. State:
ZIP Code:
CLINTON, NC 28328
Name Title and Business Add
ess of Principal Officers:
Name:
Title:
ROGERS
. CLARK PRESIDENT
& CEO
Address: P.O. BO
469
CLINTON,
NC 28329-0469
Name: Title:
HADDON m. CLARK VICE PRESIDENT
Address: P.O. BOX 469
CLINTON, NC 28329-0469
Name: Title:
ROGERS H. CLARK, JR. MANAGER
Address: P.O. BOX 469
CLINTON, NC 28329-0469
CityState: ZIP:
Certification of annual repo be completed all sineee Corporations).
AA
a(F moat be 4�etl en oln�e-of oorporatlon)
Date
s t CFO
90511 DD-10.0D T".a P 61 N.*
rna

ti
1
JA?d 0 0 .?. ;:1
oseTtnc�Ts or Iaooalo mum
We, the undersigaed, 1n.order to fda a corporation fer•the pur-
poses hereinafter stated,• under and pursuant to the provisions of the laws
of the State of North Carolina as ant aided in Chapter 22 of the Consoli-
dated Statutes entitled 'Corporationse:and aota�aasndatory thereof and sup-
lenental thereto, Ao hereby certify is follo4.end agree to tehn the number
. of shares, of stocksin said'corpontton set opposite ow -respective bases:
.1. Toe nans.of'the corporation let Saapoor—Bl.aden Oil' Company,
Incorporated. •,
2. The location of its princlpsl,office in in Clinton, North Carolina;
bat.it say have one or more branch offices and places of business out of
the State of North Carolina,, as well as, '.in said state.
}. The objects for which'the corporation is formed are:
(a) To buy, sell, trwneport, distribute, and otherwise deal in
gasoline, kerosine, lubricating oiL and greases, and all kinds of petrol-
eum prodnatd'and.1tpVod4ots, motor vehialls, tires, tubed, and accessories
of every Had—
(b) To buy, own, erect, lease, sub -let, equip, operate and main -
twin tracks, automobiles, and other vehicles, buildings, warehouses, stores,
storage plants, tanks, pumps, appliances, and service stations; and deal in
and transport for hire or otherwise all kinds of goods, worse, machinery,
supplies, and merchandise of every kind.
And in order pmopee}yrtp prosecute the objects and purposes above
set forth, the corporation shall have full power and enthirity­to-pmr'J'='a,
lease, sub -let, and otherwise acquire, hold, mortgage, convey and otherwise
dispose of, all kinds of property, both real and personal both'in this 6tats
and other states, territories, and dependamoles of the United States, to
purchase the business, good -will; And all other property of may. Individual,
firm, corporation;, or partnership, as a going concern, and to assume all of
Its debts, contracts and obligations; provided, that the said'business is
authorised by the powers contained heroin; to conetradt,' equip and maintain'

buildings, works and plants; to install, maintain, and operate all kinds of
machinery, motor vehicles, and appliances; to operate the sane by head,
steam, water, electric or other motive power, and generally to perform all
acts which may be necessary or expedient for the proper and successful prose-
cution of the objects and purposes for which the Corporation Is created.
4. The total authorised capital stock of this Corporation Is Fifty
Thousand Dollars ($50,000), divided into one hundred (100) shares of pre-
ferred stook, wash of the amount and par value of One Hundred Dollars ($100);
and four hundred (400) shares of common stork, each of the per value of
one Hundred Dollars ($100). The Corporation may commence business when
four (4) shares of the common stock shall have been subscribed and paid for.
5. Jhe holds" of the preferred stock shell be entitled to cumula-
tive dividends at the rate of Six Dollars ($6.00) per share of wiz per
edntum of the amount or par value for each and every fiscal year of the life
of the Corporation and no sore, payable out of any and all surplus or net
profits, annually as and vim declared by the Board of Directors, before
any dividends shall be declared, set apart for, or paid upon the common
stock of the Corporation. The said dividends on the preferred stock shall
be cumulative, so that If the Corporation shall tail in any fiscal year to
pay such dividends on all of the issued "and outstanding preferred stock,
such deficiency in the dividends shall be fully paid, but without interest,
before any dividends shall be paid or not apart an the common stock. Subject
to the foregoing provisions, the said preferred stock shall not be entitled
to participate in any other or additional earnings or profits of the
In the event of the dissolution or liquidation of the Corporation,
or a sale of all of its assets (whether voluntary or involuntary) or in the
event of its insolvency or upon any distribution of its capital, there shall
be paid to the holders of the preferred stock the par value thereof, to wit:
One Hundred Dollars ($100) per dens and the amountof all unpaid accrued
dividends thereon, before any sums shall be paid or any assets distributed
among the bolders of the common stock; and after the payment to the holders
of the preferred stock of its par value and the unpaid accrued dividends
thereon, the remaining assets and funds of the Corporation shall be divided
among and paid to the holders of the common stock according to their respective
shares.

The Board of Directors may in their discretion declare and pay
dividends an the common stork concurrently with dividends on the preferred
stork, for any dividend period of any fisoal year when ouch dividends are
applicable to common stock; provided, that all accumulated dividends oncthe
preferred stock for all preview fiscal years and all dividends on the pre-
ferred stork for previous dividend periods for that fiscal year shall have
been paid in full. ,
The dale of said preferred stock say be redeemed on any dividend
day at the option of the Board of Directors, upon ten (10) days' notice by
mail to the holders of record of such stork se may be prescribed by the by-
laws, or, in the absence of any by -lawn upon the subject, by resolution of
its Board or Directors, by paying for each sham of the preferred stock
One 8:mdmd and Ton Dollars ($110) in cash, and in addition thereto. all
unpaid dividends accrued thereon at the date fixed for such redemption.
Hrom time to time the preferred stock and the common stock say
be increased according to law and nay be issued in such amounts and pro-
portions as shall be determined by the Board of Directors and as may be
prescribed by law. And all shares issued as permitted by this section shall
be deemed fully paid and non -assessable and the holder of snob shares shall
not be liable to the Corporation or to its creditors in respect thereof.
b. The control and management of the Corporation shell be vested in
the holders of the common stock eo long as the Corporation is able to pay
from its earnings, or surplus, the anmal dividend of Six Dollars ($6.OD)
per sham on all preferred stock outstanding, the holders of the said pre-
ferred stock to have no voting power. But in the event that the said divi-
dends shall not be earned or paid for a period of two years then after the
expiration of such time said stock shall have the same voting power as the
common shame, to wit: one vote for each ebere of stock.
7. The Corporation may loom and may sell its authorised shares from
time to time for much consideration as say from time to time be fixed by
Its Board of Directors.
S. The duration of the Corporation is to be perpetual.

9. The name and post office addressee of the subscribers of stock,
the number of shares subscribed for by each, the aggregate of which being
the amount of capital stock with which the Corporation will commence business,
are as follows$NANO
O
H. M. MARK
Elizabethtown.
B. C.
MARRY B. CIANK
Elizabethtown.
B. C.
H. L. Flom
Elieabethtown,
B. C.
HOW C. FISW
Elizabethtown,
H. O.
one (1)
(trio (l)
one (1)
one (1)
.10. The Board of Directors of the Corporation shall have power by a
vote of all the directors, and without the assent or veto of the shareholders,
to asks, alter, &send, and rescind the by-law of the Corporation.
III inn= wgeg OF, we he" hereunto set our hands and seals, this
the 21 day of February, 1939.
STATE OF BOBTR CABDIJU
OoORTf of BIAIW
This to
two certify that on this the X 2-day of Febivery, 1939.
before me, dAp�dA tIRA RA for the above written Canty and State.
personally appeared H. M. Clark, Mary B. Clark, M. L. Fisher, and Mabel C.
Fisher, who, I an satisfied are the persons named in and who executed the
foregoing certificate of incorporation of Sasleon—Bladen Oil Oompegy,
Incorporated, and I, having first me" known to that the contents thereof,
they did each acknowledge that tbgy signed, sealed, and delivered the same as
their voluntary act and deed, for the uses and purposes therein expressed.
In testimony where I�tia_e harem to at ry and no Sal
seal, this theZ2 day of !e vei alv
�':» { t t:

•
m,.m.m _ . ... . p
i Ib i 'Z EL1eaB CA IIIQ :j B11 .I.`�
MN Ai IO fill P401'mn 19 AUK' .
A Wkfts. MM IAIR Is Sam CI .. ,
ail Aim mcetB Ct111BNWL FILED .
'96 JUN 18 HIU . 11 '
,IoYCE IE.
REGISTER HF o:US
FENDER COUNT, H.C.
IhtW ens -
Bmt and Pete
Ter Lot No,,....�jli,iubl........................... ......................... ........... ..... parent Identifier No...... ......... ... _.........._........................ :...........
VeriOedbYnW.._...... .... :....... ....................................... County an the ..............., day of .................... ....... ................ ........ .... IB._........
by... . .............. .:........._.......................................... ......_............... ,......... ...._............. ........_..._............. ._................... ..._............ ................
Dili] after recording to..._..................IBERST..........................................................._.......... ...........................
..........._....._..:..........._..
....._....................................__....._............. ............_....._....._........................... .............._.....................................
Thin instrument wen prepared by ....._............BIN 8 ..... NUNALBE t 0i ,93„NA.WCEPNC_
,_..d9525.._.
.......... ...r _.. _ .....
Brief det,dptlun for the Index
NORTH CAROLINA GENERAL WARRANTY DEED
THIN USED made this ... 11 Lh. day of ......:June .............. _........... _..... ..... lg. 96 ., by and belwuen
ORANTOR I GRANTEE
EDNA NILSON SHEPARD HENSON, TRUSTEE FOR
EDNA NILSON SHEPARD HENSON THE EDNA NILSON SHEPARD HENSON REVOCABLE
TRUST
Purr I pervplaw MUA for _,b pry: pme. addrtq -ad. It apPraPtYle, tluralW el 0.1141..1 rarywettea er aarut.,Al,
"be daelipmllan Cronin' and Grant" tie tined hot shall Include told parties, their heirs, iuee.pan, and utltn., ..it
.hall NNmin singular, plan), ran s..line, famlulne or neuter as roepired by contest.
LVITNESSEril. that the Crnnhlr, far n rAluald. a alliteration paid by the Orontes, the recolpt of which Is hereby
.6nan9edaml, line and by In... pregame dues amak bnrtehl, .,If and tmney unto the Grantee In lee Canada..11 that
.ortnin tut ar Pn rcul of land At ultcd In ilia City of ....... .. ... .. _ ... flOSky.. Point ................ Township,
,, Ponder _ Cmmly, Nudh Carolina and mere pur0cularly d.s.ribed nA follow.:
Gains all or that certain tract and parcel or lend described in a deed recorded in
Book 3I9, Page 252 or the Pander County Register or Deeds, oald description which
is hereby Incorporated by rareronce.
RnsoT6a6 end VeTifie6
Vitalist.? A, o Da�
7eR6er 0003.5
tyl
N.1'. ar, anw. /rrm MM1l4IrlL arrlx. Ilrl. 1������YL�, I
BY:_-----

Stormwater Treatment &
Erosion Control Narrative
Han -Dee Hugo — Pender County
Sampson-Bladen Oil Company, Inc. proposes to develop one tract, 2.37 acre, located at the
intersection of US Hwy. 177 and NC Hwy 133, in Pender County. The property is currently
owned by Edna Wilson Shepard Henson, Trustee. A title of ownership will transfer between
Edna Wilson Shepard Henson, Trustee, and Sampson-Bladen Oil Company, Inc. once the
terms of their offer to purchase are met. The proposed development includes a 2,800 sf C-
Store and associated fuel pumps, a 1,500 sf restaurant and a 6,000 sf building space with
associated parking, loading zones & sidewalks.
The site currently contains two small block buildings, a concrete pad and asphalt parking
that will be removed. Site topography is generally flat to gently sloping (0 - 2%).
The project site is located in the Cape Fear River basin and drains to Northeast Cape Fear
River. The proposed development activities are high density (percent impervious > 24
therefore, stormwater treatment facilities are required. The attached Stormwater Plan
includes a Constructed Wetlands system to meet the State Coastal Rules (Session Law
2008-211). The Constructed Wetlands system is designed according to current BMP
Manual Specifications.

205-3 Ward Road
Swansboro, NC 28584
Tel: [phone]
Fax: [phone]
I
To: Chris Baker
Ra Han -Dee -Hugo Rocky Point
From: David K. Newsom
Date: Jan 7, 2013
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycle
Attached:
1) Soils Report
c2)-Drainage.Area Supplements.(S1_ S4)>
3) Revised Sheet 3 of Wetland Supplement (Length to Width Ratio)
Please review and approve,
RECE VED
JAN U 8 ZU14

EXCLUSIVE 1MYCk ,�C:IiNC"' A(:RIi1::JU?N'I
�C,rluilf "Gui lriin':>- d4hrm _'UIGI li,r vtIidilve ill .olnjgedrw IiliN lirill
�
-Illis FX(i. IS Vfi BUYER AGPNC}• AGRI;1 P1ir.NT i..Agvemenl'.t i, en(acd illio Dut<) � � .7
IxIN4:er1 �Q i21�• 'v I r—.0-..^,--.--__._._—____-----__--
....- -—— -----------.-....._ ,
,._ Piro! -:
;tc tln• ISuy+r'< exclusive agent to :nzi,I the Buyer in the acquisul(u) ,)I yeti pR yxrp' a�hi:'h may itx•itak :Trey' 1:x.lr. hare:. ,)Ix i, vi ,n Y:Jor
exchange on terms aid eunJiiion+:wocltohlc to Buycr.'llte intlk itb.d agent wllo Nigns tlis Agrecnn:lt on Ix!lmll of tiv Firm - le41,
Ix -hall' of the 1.11•01. IV lxim:u'ilyresticxnihic kv ensuring that lix Firni s duties hen`ulNier aV Rll Ii Ile+!: IlrNwwr, it iN to uk:•y.sxi „r:s
agreed !hat ,dhrr auenls nl'tile I=inn nmY F,c assignal to fulfill a.lvll Julies if ckeuled ❑1yxr.>ni:ac Ix the I•irin, Ion ptult,v-> itt IN
At;, l'CCtI1C111, the Icrill "Fil'I I i",;LJ idle �'nita'Nl Ilta)' fV ILJil't•. aIlUlt IV LICctilnl h) 11R'kn le the 6`1cliV d1Lli it 'd'hi, 4t L'[iry Ihi.. A(:I•,•vlm'rt .In.+.
:uly , thcr ogmi"tf illro Finn.
13uy'cr represents that. its of the tcgnfneuca[nunf (life or this Arreamcot, the Royer is not :I parry Ina borer rept'e>cnLrtion
alpreenient i+ith any other mill estate firm. Buyer lms received it copy orthe "WORKING WI•I'll REAL J.Xr,\•1'F.
bntcdmre and has reviemed it with Firm. Buyer further repnuots lhnt Iiucer Ilm dis 1o'cli to 1°€rnl inron'nntion :!heal :mt
properties of the type dusel'Und in paragrrlph 1 below that Ruyer alas Visited ut an)' open houses or that Bracer hn: be0l Nhotco
betray (gher real estate th'nl.
I. •f1'1'IiO1'NItO1'IiRTi': U kcsidcniiatlimrl'osxrJ:drllutinryxoctdl +�,]' t;'ummcrrI:dtioliin,crJ:tt,ltfn:'il
unINn
.� (cll;lc.�Awl- (hher._ _ -
U�S"' Gc.J a Z� --
?. Iihhli(_'f OF ,1C:ki;IB\IISti G liuyar intends to acquire reNl pitfVriv of (fie tNj tk>urilvti in p.lr;l r lIAl I. lip rmpu{±vec firma.
!facer''.+ eve-114 ire agena, purer nArues P2 rmidurr rill IwAmia!im+s fi'l'suc* pmgrertr thmuglr Firer. and !u relr•r' rn Fine ell hirptow
rr!'c•ired in rein' Juan l'rvun utter!' rral e.vurr fines prus,uv'lice tr?1krc,,rage nilrc7• waax•e, dariuA rirr lime chic aArcc?nrm is in (jrirr.
3. DURATION Of LGENC.I f u nl's:wlhnrty its St MN L— ,.lust+e.rgenl !ir ti l'n:It.ill s_Z-4f/1 .�_., ____..� ..ulJ
to pg,rigrij)h 4, shall e.%p le ru midnight •..... A2_�L____—...._._...___..�... 'r +ehcn fSnycr ,Ir.hurr. IVaI 1}nrlurl+ ,11 the 1_clx.
dv,.-viixtil in part milli I. +chiubmei wends sts Liter,
4, COMPENS:VnON Olt FIRM.
lai hirm .n:kn,)a•lalgr,. Rveilx of it 1x'm-rdulcjithle rel:liner Ice in Ille allhull of .
DJ)all ❑Jldl Ind Iv crmlit cda)w:ucl:upcominntNini,)n'Ale Firm tit t,ltrihi,Agicemcni.
(Ili IItI\ agr,:rs Ih:t Pirni. fie I;w stavices heR:uln.iu• ..poll Ix. in tile :on,nntl,d��— EQq_rvJ_j
(hisely dn/lar rrur,u!1l. prrzrntlige oi, punllacr prica. Or other nrelhrwr nJ derel"llblin,q Firm'c rvnnlu•nenrk n (irr vrwh r)'pr r•i
prolx•rn' rirr Ba.wr roar purr-(urar, cur11 as naculr. nru•c'nnsrruniun. hctrdRot andlrn• ura'r•prrsrated srl/cr, De) not ia.crr; N/A'ev:;
;;era ($Q)),
lid Fillo shall soak the Pcc nom a :,xil-writing li,lint_ lime phnitigh the iisling firms ,tin• of L:on1pvll":di„n in INll ti tr
<Ahcrwinei ru• from the xAler if there IN ta) listing line, :ual Buyer lipwN ih!a Pirni 'ball IV cnlilled to Ic,•ci,r N:uuc ill
o xi,,itleritlion lux f irm!: scrsia•> hcra imler.
L
II' iWiiliooa l a)atpensa[itxr, irudxiee. I•snttts, redl:ac and/or olhe• %alual?ie oxi"ider:ti„n I "AddiNaml C'nnrprnstuiun"; i,
olfiaTd thn)ugh the MIS or rtherwise. liner kill dx+rmii ihu Virm to R-evive it in xkdifi:+o to (In• Fee. Firm h:ill Tim i
flux•!, )sG,lhc pt'omisc c,r exptrtatitxt of Rtic Mill, aity such Additi,ciA CoagVI)SWitul and ::,)ofn'nl the Ji,,.'Inctnr is Wcilllt.
Icelire Buyer makes or :r•eed>is an oiler to huy. (Note: NC:AR Firm 4770 play ix• ua:d to cculfirm the iiii:l,,,tu'c of ,un
su•Ii Atkiilitmul C'ongn7lvationi
le)'ihcannitensNli,ut sh:tl ha d,Ynled t:mrui to Ooi m'v of the Iiglowinp:irumslafe:.•>:
lid Ir. (luring the Icrm uithis AgR:cnlanl, liuyn'. MN.:ts+iltnec of Blayt:r !W any i).rs,nA9cgul cnlin :t,•lin> I'll MiAl of Ru+rr
dirccl ly ,r indirwh. cruet inln an agra+ntenl h) lxlmhase. rgxi.et. WILI/or c),:hnnge :rev profvrn' of the Icl+,• tksailsv
ul+,,ve hg:vJless rdlhe in:uttter in whidl Buy" %Lid' imr, kimcd to thm in'olx'ny: ra' .
Page I ol'i
STANDARD FORM 201
L13+•j`
�I htdiaidu:d ogall
o°�xe:iwr'r.
Revised 7l2011
`ii 7/Zt1I3
Qrn*ghu+i'egartles.l,r.6lN f4wlMne.At SM l06 S?ilnv�sn>NC2fFll
Pi.:er llti,+LS-<-4577
Ia,. Y)II:3Yii4?.+ Ik:;.:t-:
Nmm W.M. P.00IDM 00'11A.Wtty 2Glyw l,j-M'FWw Idg4 N000.FIOcm 4it0M 49ltt5 at�,;,cpr,(y•?,;gry
�i
JAY 0 6 2041'
BY:_

6i) II; within /02,0Jays arm c:\piratikul (,I' [his Agrrconae. ku)cr Litters inw a cmu-icl 1„ ac(iuirle Ixtgxrn
II1111a,ImkxI IC, liU)'elJurlll} file lerin vl t111v Agrectimit by firm 1w ;afy Iltir,l pan\, unle:•v RUyvr has eIIIored into a v.,10
huyt r ugmtey agmuc•ut wilh am uhcr real c:0a4 firm: rw
(ill) IL hat•iog meted imam) enizwcoahlc Ctnitrm J,:) delude lwup.rty during the form ill' M , Apvcunnt. IinyCl' del•oills wn.ler
the terms (tf than Ci nllrct.
Ia1171 L ett Ix n,aliuu will Ile due alai It yuhh: at MIT iw ups Buyer's Math of aoy ptliclmst ojwemcmt If kuyer:kfaulls. die
local crunlx:nsa,i,.ul 111:11, woulJ llmt Ives due the firm will IV due and Iwy'id,le imme lialcly in Lash fltlnl Ills liuyer. N•
nssigmmcn ilf rights in ival prtyt.ny )hlisinvd 6w Buyer of any anywc it Buyer tw miy p::niat/ Ind Lnti[y acting "I N hAwl
litn'erpursuant Al Illk Agreemenl shall olVralC ktLIdoat any of Hrm rights timlorihis Agrean e.iii.
Nan:: Iit, yer Urxiarsla,xis ana arkinity le:h!Cx ilm there is Ilc Itaential fiw it etutfiieI of it it: IVsI gcneniled he ❑ Ix:r:cn, age
pl•iec Ixa.k•d fa AT releestnting Iillyer. The aInk Ali It. Iw'unn tw ralC of real cAtac eamm issi,XI is net lived fl+' lilt, hui is set I„
ewlI hrtdicr itidit'idualIy, iald Inil\' IV Ile, ohtt hafw'crn Buyer afId Finn.
5. OTItER POTENTIAL, Bl.11'P.ItS. Buyer tnh.lar alnds Iha ,uhcr pn ry,ra ice purdlascrs roprcxelilcd by limn nluv scci. 15011een.
nthmil c,ITcrs.:ald t:lunraA lit puwhaNc pn,lvity Ilrettlgh Fine, VICILI ling the same ur simi La• pr.g,cny an liuyar >vcks I,+ Ivurha,r.
Buyer il:kri'm IL•llgvp. lnkim4culls Md can:+ants Ili MICII ITIWIsmait ikm) f)I PthCf prUNll:dlll'C fttwchic cr> I,y Fu'nt le -la ieh its agcnl s.
6. FiRNYS DUTI F'S. During the term ill* this Agrocmcot. I"inn shitll pnmxnc file flncl'tsti, ill But or 1'1l': (;l) Ixfl'Awtning the term,
this Agretimcm: fill seeking pl'olxrn al it la•it'e ana (gran occerehP,le fit Buyan let revwcntinli in a linuly manner all %rival ui fc n ,a.
U tUlllt`rUl ha's 10 Llixi Ian III) Buyer; cd) LGO,+sing 11) Hefter all tml,el'ial I'I:lN wrilltxf I" the pllgk.rl\' kii't'tim-emliip file d.aIN:wti,,tl
Firm hits :cmul kuowledgc: all) icl IWCouliing liir in it timely manner all m.mky and pny,eriy rovoivcd in r+hich Buyerhas.w may flits•
cal inlcltsl. Unless rthenviw priwilled by hie ca' Buyer avisents A writing At 111c ra ome of the uuiwneui,t i. flirt, shall nimmain the
umtid rmiality of all Px:nrand and I'imwhd ulliwmwkm mx.i tMm InWlcm i lagificv:l as o.inliJa dhd by Buyer. if 00 wA:wmmi•.nl is
wzeivcd Crum Buyer &Wit% the hlYtkari y It'liai 11411, In binisl'pirip these dtni,wa. Ginn aholI exen•ise ,rdin;lry rlrc..umply milli .111
ipplit;d,lr laws aau.l n•guLnicals, and Iraal all proxpcctive ,open l u lolly and Ina kn„w ingly vile them hdse in(it•u)rnil m, In ;xklif i,•n.
Firm may Sfn'rw the. .+ana rin)i illy Iu urher I'myot's, rcixetiant uhcr huyers, repva :nt sober, rdwki: to lher prtgxrdc!' .w pr, vikh
itssisimx:e h, it ,olive yr prUs)xCtivc scllcr by rierli,rniing ministerial iict, that sue Ina ilx',mnisrele ,vilh liil•nis duli:N under tilt,
Agrccmall.
Urem ckisint! of m)y side vi pruixaly not email in it liming Berri;e If' lvhich 1'i'nl k :I mcmhel. Buyer atnikwiias Firm lit suhmii
Ixnincnt infunv;lion ccwiCerning the prigx:rly. illcluJiug saes Deice. IC, SWI) lisling e,a•virC,
Z DISCLOSURE OF BUYER'S NAMMAII.INIS ADDRESS.
fit) Unless elhcrw•iew slamd ill 11 wagrapl) 13 hch lev. 11rnl has Itu}'cr'> ixrnlissil "I a, dis.avw: Buyer's male,
till in :wctndmx'c with NC Gaurtil Staunas Stetion 11-1A-1^_. if ;I dispute It:gar'ding Ilia wail tw Ill IV afro Of any catriCet nhyx,
dclxisit ru•ises Ix•Itecn Buyer omf the doper of IV ly ival pngxt•1y kul of- 1110) ;IgIVC li, IAlydlaw. II IC el"I"M agclit Ix,ldinl the dcl�+sit
nitly dcla,sit lhc*dkIluad manic, with the al;,rigwi;m: Citrk ill' Cvurl fi,Uutring. Millen ntaicc al the I,iat its. Ill the OWN ai .Im .nail
di>pula. IiuyLr JiroCIS firm eel di,.auv Buycr'N hide knUwil arliling iaidlvNs [v the csk:1"m agent Uha) rc(lueu Iu crlid,lc tits cxI0kN
agent wcvniply will) the rnuice raluirenxnt of such Ina.
it. NON DISCRIMINATION. THE AGENT (FIRM) SHALL CONDUCT ALI. BROKERAGE ACl-iVl' IE-s IN 91-X; lRII
TO THIS AGREEAIENT WITHOUT RG51%0' TO THE RAM COLOR. RELIGION• SEX. NATIONAi. ORIGM
HANDICAP OR FAMILIAL. STATUS OF ANY PARTY OR PROSPECTIVE. PARTY TO THK AGREEMENT. FUR'I'HF.R.
REAL:PORSM HAVE AN ETHIC.AI, DUTY TO CONDUCT SUCH ACTT ,minS N71'HOU'r RESPECT TO THE. Sh:CUAL
ORIENTATION OE ANY PARTY OR PROSPECTIVE PARTY TO Tills AGREEMENT.
9. BUYKRT WI TlliS. Buyer .:hall: ±iii mik cwlasivciy whh pirm Wig llla term of thi+;\elrrtnunl: lhf p,p 1:inu. )finale n'
ill,fireelly. [lit• wInivil>atx)ri set firth akwc; rel evnlply' with lilt reasiwrd,it rtsluesis of Firm u, supple ,rely Ilerlinern linalvi;l ur
llemnur ditto moke.l al fulfill die inn,<.d this Agrccuicnf: Ith be avililuhtr fiw lraxnlahl.: ixritikk ui tune It) rv.lntine pn,Ix!nit:,: ana
let pay fiw all prtxitWIS and/ra• sarciccs required in dx• axamiu;ai;al iuid evAtiini,ai ul' lN111vnic. iesitmpie : survey', a'aterfN it
title reixtns• Iatgxny irliiw ioims, cl:J.
IU.OTHEM PROFESSIONAL ADVICE. lu ilddilivn In the WI'Vliei m1xlCred to Buyer hp the Firm urxirr the m-m, vt' thi,
Agreement. Buyer is Ixlvi . l to souk other Ier,lis5icaml ixivice in maacrs of line. lasmnn• finaming, insterance, xtwr ct'illg,
des anfig Insect iol'esmafrtn). sut>Lturid cxmdntss, eengints:ring• and "Alter nrlur15 pertaining a, any prcgx,N)sl mins.wfi,a,. A10h,utal
Firm nmy lwt i k: Ruycr the manes of Ilnn'idcrs whu C lain, t,, tx•rllwnl such su•vicas. Buyer undcrsiallilN than Firm etnusu gu allICe Ill,
yuallty ui service u,' level of extxxtix t>i iulc Such provider. Kayo agrees N, par file full :unuurn due fiw all senhem WOO its the
scrriee i,i)it'ider whether tn' Ixt file !r.ur:u•tinn e•last,. Blli or ol,u agrccs lit uxlcnmil'y tell Indd Finn harmless faun inxJ i;�ilinsl :m;
Bilge 2of5 STANDARD FORdi 2111
Z Revised 712011
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SN'tild Firm Iiccollic :t dual agcnl. Itnyer uaivos all chdriis. dalnapcs, Musses. eslnuu S i1r li:dtilifies. tither than fir viol:daxts of IN -
Moll Cnttdnut kcal L-.4we Liccnsc Late tmd inicnlional wnrll}ful ti':I,. arising fmru Finns trolee na a dual agent. Auyer shall h:n'C .I
duty to pt tvct Buyer', own inincsts ulal eltuild re:Id Tiny pun•Itase and x,lic.:ttlrclucnt ea'cfuhy n? ensure Ih:u it ,rcuratcly' sets Sixth
thr+crlin tchieh ISuvcl'wants included in Niiid itInvvilivni.
[[,,�.�11 /Ida. ;U nlnrri'ariluu fbri1inlrnlA•19A4:a.
I'J•I ' \�" _ liursr uudr xizcs the Irian to ;w4 as it dual npert, representing NNh Ili: I:tuycr and the sclbr. td+cct to the terms alxl
KUndllitn„tcl brill it) lhn Fm ilp, q'h 14.
I toyer Jc,in•, cxc lu<irr rcprescntal it+n al all l i mes during this :rgwomou ;aid t6 xvs N(il• auilx rizc 11rnl to i" in the capik it t
of ,ILIA ❑pent. /J'Rai,verv/r.e�s nut rntlkr,r'ice Firer Irarlct as It dual agent, dw renuliruler ujthis jxirggrvph,shall not apply.
lei. 11esI gIMI (•tl A;tent Option I bririal rush' ijap;+li(•nBle).
._.._.__ luja hereby t movites the I•irm to thsitinwc au in(lividual ctgenl(s) to rclwesvnl the Buyer, a, [Ile .aeiusitnl of Wly IAlnx
imik iduat 1Igcnts il'-A •iour] with the 119111. llic individuid dcsignaled apcnt(si shall relresent only the inicryl6 of ilte 1�111yar
It, the cxrenl 1xrnliuc(I hyfaty,
NOTE.: When dull agance :mia•s, on itxfividual acent Shall ntt prmlice dcsignultxl ngvncy :uni :hall relmdu a died ;V'Ilt ifill,
itnlicidual aitent tlua iII•walty rwcitcd conFulential inArnmlion concerning. a eelItreIienl al the I•irnl in c,tlneetion with die u;ln,:cti. n
It• if ,lt•signal,.xi :igeri:y iS tlihcrwii(• prkiIihilcd I late.
(fI D11:11 A;elley Compensaflon. lithe Fi1111 :s to a0 a dual agcm lirialtilinp dcaignocel :i�(ne)l, ill,! total be the Firn1 cxlx cls u,
nivive 12x in smvic, in Mpm4oahw Buyer and the sclicrshiill he..----�__�
(Arcr•il J,dlur unH+wlC perrenroge aj p lcha<e prim. orWGer nretknd ujclefennirtinm Firu)k cnur/xnrurtic>a jr r cart ly1w (j/ projwrir
sai i) as )cvdc, new• cna.ctruc'tirin andlew Gnu!?»t flu' &(err nmy ptin-luew.). THN WILL IN NO WAY Ai-VEC'T OR MODIi•Y THI-.
ANWUN•r OF 1110 FIR SLI• Iwmi M 1'ARAGRAl'H 4 AROVI:THAT FIRM IiXI'ISCi'S'ro I?F'Ci;IVL irOR ITS' IERVIC'FS IN
I<lil'Itlitil:N'fIN(i R1 )TR UNI )11. 111I.S A(JRFFip9FKI', In the ecetll Buyer i, iolviv'sicd in 1ltlrchrising it I,t't1voy when the Firlti>
loud lcc i, diMI'vili h\'In Ural drserilvd in this mAja :ignWh to, the ITMI shall timely eli:ckne the be in Huycr :md atMnu h in
teritin lx•iirry Buyer nmkc, +r iWcclln an oflcr ul ivay .t' Sell any siteh prolxrty'
15.1\1BDIATION. If it dislxnc :discs out of IV rvieted to Illk Agreement or the hreae.h lhcru4. ;,nd if the dislui! canton he settled
Ihrough ncpotiatittl. the p.v'tics agicc lust to I, in perii htith to senle die dispute by medialicti lvlora rt.•saning to :,rhinwil.xl,
litigaliwl. or >ume oilier dispute IVdrduliixl txzVJLmr. II the need fit• mediation :micas, the belie. Will clux++e a ni(ntially :cceiu lhtc
metliair idol will Mere the ('I tt of nlediidiot equally.
I( P;wuu', ,0.CItlili A'IIi:N'IYCNANGI?tilfF.RJtIN:\ PION. "11tis Agruenicni ctttstiiulcs the entire agreenioni IxJlwdcll Buyer atal
firm vokilini;• to the Stthject 111crexd', aryl :my pri'v aIx':"nolin pertaining lhercto. whether oral Cr xcriaat, Nivc Ixcn nierged ansf
integrated into this Agivenicnt. This Agroenicni nwy Ix signed in muhipic. CrigAUk Of counterivin, all of which i,getlwr :mstitutc
.n:.• :dld the'wile in.irutnont. No nudificaticnt of idly r;f the tutus tWAN Apmulient shall N; valid. binding uivn the parties. or eat itleJ
L+c1)lIAC meal unle,t such niS kl i14iea1 j,41h;tx Blew heed reductxl itwsh%:am MpW(I by N)Ih Buycrand 1=0'111. Buycr:Iektnneletlges:11m
inukr.l:uils Ihid thi. Agicentenl c.rl.:IilutV'i ;I hintiint! .Itltraa hetween Buyer ;nJ Firm. Atll'n.,ugh Buyer miry at any time willvdrao
from lee fiduci:n'y relationship c.xi.4iog hvItvccn Buyer atxl Irirni. the conn'i" emoted by this Agivenu•ni may rna he lornlinaed by
lhi vcr It' 1•irm prim' to its Iispit-whvi lkw willicnt legally sdlieiwu cans('. Any Well terminuion shatli Iv hti mutu:Jiv-:wecixahlr
%vino sl agrcenaxll Signed by N411 Iduycr and Finn,
NOTE: Buyer slxtdd onvuh with Firnl lvhvc visilinp. any reside cr new IE1111en or "Mulc'Iltip wly other real emwe Ann rcl,xesendng
:010M. n+=11 the p Icaihility td' el tll'tt it tl „ter dm Muket'gc rclm ioliJlip tuul mi,(atdursmtxlings ANIllt liid,ilily )i,r oillilxnsaim,
Pape 4 0l
Irilividual spent iniri;ds� ;_„•_ liuyvr initi:ds,J
tifANDMU) FORM 241
Rev'isO W-11011
0 712013
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Buyer mvl Firni each hereby a t kunwledge receipt of a sit tteti cotiv ttl'tills Agreement.
'IHIi NOtati CAROLINA ASSOCIA-I ION OF REALTORS,*. INC. MAKES NO 0"PRI-NI_NI'ATION AS TO THV LEGAL
VALIDITY OR ADEQUACY OVA NY PROVISION OFTHIS PDRM IN ANy SI'ligC'I�hIC�fR.4NSACl'IQN. �p
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STANDARD FOR:A'I 31H
Revised 7/2011
Cu 7/20 1.;

WORKING WITH REAL ES'1'A'IT AGENT'S
N07F; F_11eahr.ledy 1. 2001, in earn rt rot esrurr .tzdra rtzrr roc'tiun. rr teal evare al enrshall, ar li+ r suhsrruuiul ruuhrr4 rlit crtir will:
a prretlkx'lisr• fluter (excilo-. prurida dic poxvim rii to l+uve•+• ortcHer with he, hrllmrin;; hQitr'urutirm l;V<` Real If- Prat(' Ow ntiesieni
Ruly 21 NCAr tiM,t1ftldW)1.
IlAwn I IEV tr s01% iotd wawn your eery Intl it helpful ter hale a )tad eslaw agem assist your. Kcal csuae agttu< con
provide many useful xrviccs and work 6•Ilh lykr tit (IliICrou ways. III S,:nttc real esutte lr;olsn-.t lens. llte agctas work lie' tits seller. la
others. the jeIler and Ixtycr may owli htaye agents. And stutetimos the smile agent. Work tier Kill) the Ixryor anti the scllcr, it i,
inyxrtutl fir most nt l 01w Whollcr an agent is working Iia• ytxr a, your agent k%-siugtly a"siting %yItII void whih• a,aing u,:a avant j d
the,aller party.
This hot lvin: addrrs,cs doe v;a'iou, ly'Ixs ill lurking rc atitashitIN Thal inay IV m'ailid1c toy, ill. It Nhould hrll-t yttu decid.,
which rclaii,nshir yea u:ut to huva with a rod emmu agent. It will also giro pot useful inlin•Inalion Assn (In+ Various xrrices real
v>latc ugyrns can rruvidc huyel•s and , Ilers. ;on) it still hcip explain It, roll emaic agents tar rani,
SELLERS
SeAcr'., Agent
II' you .rc soiling rend esletc. you may want to ' 61" ys,ur Ixvpuyy I ,;ale uilh a iral ".11C firm. If xt, you raid sign .a
"listing avrccnurm•• :unhsri'ring the lino and ❑s uplts to (t'Ix't'tinl wu in yMu' dcalnlg., with lxlyer'9 aN )sure Pe-Ilcr'x ut;cra. you in:",
alx, he ask "Ito at lute avntls rwin other fuels to Itch And a txtycr the y,al' IV. JX!rty.
lie wee it, Icad wo unthrst:axi Ile• listilty agavane a Ixlire ytut Sign it, your aitcul Intna give you it solos of the limn)
agrcenienl ttlie r you sigrt it.
pertie.e Io Ne lee: •Ill• listing firm mkt its agent: nlusl • Itronkua y.ua• IVS1 ituo'c'sls • Ise his to you • AM" e,ar WWI
inane.')isa)s • pn',vidc you with all malarial lileis Una :mild Ittilook'C Ymlr del'Isile, • use rear,nttt'tle skilL care :all diligowc. al tl
• account ISr all monies dtoy bundle for tout. Once y(e havc sigricd the listing avrcenicnt, the firm and its il);o ab nlarc tka vice :ill;
Confidential inl',ru atiot alxtut you it, rtr'os1wditc huyers,r their agcnls wilhcwl y,uu' IXT1I)is,ilul so Itt)it as Ihcy n•fral011 y,tto. Itta
until you sign thlr listing agreoucnt, sill, should neold telling the listing ngcot auythhtg y'on Nsould nor Want a Intycr to know,
.Srreic"and r: btrgasaaUiue: To hole you Neil yoilr Iystits•rty. the listing Jinn and its agov, still oftia- a, Ix:rfurnl a nand-,c(
of s•ryires fix• ytut.'Ilnxe lint inaltule • helping YOU Ilrke y,ua• Ixoltcny • aivalkitig and nuarlsomit your p ollony • giving. p a all
Ietiuircel plrJN:Iiy diw iostur tornts l t you to complete • neg,ri:ting kA' y,xi the ixN I>>`nihle price and tarots • oe ietying :dl urincu
ot'los with you taa:l • ,uhcnvisc pinmNing turn' haurt•sis.
f'nr rclxv'senling yial and hclriog you moll tsar pllpvyly. cowl will pay tole IiMing fuel a sides ronnnissilat oi. roe. l'hc
listing agivollent nalst Marc the anew (r Mato Ra',Ietcr how the cumlil 06U or we and \t11CIhCl• yuu will ;dh!w file firm Ir
shall its conmli;ri,a ,sigh aganla tvlwcsauing the Ixryer.
Dual Agew
1'te may aver rcrntit lho listing Bone and ils agents 10 rerresu•m putt :Slid a buyer at Ole sennc lime. This "dual •lano
rclatilntshili• is nxtst lik,tly tot InglIx:n it an agent with your listing lien) is u"thig x a bucer•.r us;cru kith wale„etc wx, \%jet, t,,
Ixtrrhase per I'll IVI•ty. 11'this ,xxur, and y,x) hate niv already agreed tot a dual ageuty relationship in cool listing. at:reen)rnt. ;Sul:
list ing you will ask y,a u t ainoid your listing agrec•mcla to Ikrolil the agent to act as event Iia• Ixfth )oLl 1n10 the leyo..
II Ina) IV ditfi.ldt for a dual 4(yelp1 it, advaluc the interests of Nall tha tnn'er and seller. NcterthelcsN. it dwrl a.v ni mu,i
bell Ixtycrm toll seller, fairly and equally. Altlxutgh the dual a,ecof otyca client the s:onc dutico, huyun and seller?, eon I'nohihit rha,)
n,eanis from divulging Certain confidonlial inka•nlinaxt aixal Ihenl to the o Uler pill I} .
Some firms alsoollo it I:trm ol'dutd agau•y caned ••dasigintcd agency" 1VOW one ugcnl in tha title rcprcsant>, dlc Sena.;
mid :ut,tllcr anent ilq,rusems the Ixly'cr. This„ Ai„n oNhen mailahici may idkow each "doaignowd gvnl" to nnu'0 fully rgtrt,col .awl!
Ivn•ty.
It you N'lusnc the "dual ;kg-0I y (glum)• rvmcuihm' that Nhice a And ugeru•s h1airy is diyittal Kauven puma: o.ith
congxling inlo'csis. it is csrcci:Ale inllx'awnt that you hate a View utle aNmidil,g it •what moult, reluliunshi i is kith tin: dun,' u_0<arr
:eta • Whitt th,: atoll will Ix doitre• fir you in the tiallaa'li,et.
BUYERS
11001 Ixn,iry: Ilal estalc. plu may hLn'e .NVVa'al ehoiecs a:: ht Iknt moll urea a real cstatt• heel and am agents to w,ek uhh
you. Fla enantrly, y,ti may eanl then) to rvlx'csnt only yuu (its a buyer's a"Clit 1. )',)it lnoa IV Miling Iiti'tlioll lul'Cix'Csou INall
alai Iwo caller at lhr mu iv timo was it dmit agent i. Or moll nl;n' agree 10 kt them rclxcasn ,ally ate iciler iselie•r's agent or cube) oll t.
Some ugoa, Neill oiler gill a choice• ol'thcse so -vices. (biters may rla.
irrimm Pogo I of I
ST:MUrUtU IT)KhI SZtt
Neirlh Cartdhitt Association at' REAL ORS(r), lilt,, 121 RK I/l/21109
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New Store P.opesues• Inc-6109 ltuathmtse Rd Sir. 1001k1nangt�n,PC 28403
I Jkmc:[phone] Far. NO I3ls,647( Mnnae Walwr,
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HlttlKtq ,41rn EICFOnrrfl py Eililtgh 186i0 Fiflaml R4Vi RUnCI. F'r:ti2r. FeBrit10n11 un25{rVj;Qr,95.r1,•tn

6ttrcr'.+ Agra!
l hoies !n Buyer; I I the ,flail eslalC firm dual its ,pert, tvpresCnl yin, they must • pn)m01C your lv,%t interesis • Ile. Iny'al w
eno • f,lkny y,nn' lowl'td iwlru2 hm • lrovide you wkll ull owwrial Ams tha axdd in%mwe ydxu•chrcisi+xts • tKC reasonable ;krill.
rout and diligence. and • aua,tnt Ind all nitnics they handle fed you. Uncc y'tnt have :IgrcCJ iiilhcr Oily cr in writings (tat' the Grit
and it,, agents u, le• your blevvv'v ogr•ul, they itey m4 Eire :illy oni idcntiul inhirntali+n tlx,ul you o„cilcrs „r their agents wilh+ntt
ytwaperutiSsitn w long cv a., lhrrlvoont roll. Hul until cull make this agreenwrif with }cu
te buyer's a>;ent, you alxruld ncoftl
felling the agent anything you wnukl Rot want a -seller ti Nolte.
Uatrrinen A>;reer+n utY: 11, lli lic Sure that yev and the real estate firm have a clear ulxklvtnnling of w•h:x yt xa- rclaliunshif,
will Ix will what the hrul trill do for ytxl, v(n ntay want It' have a written agre0niety, However, some lirrtu may le tv illing L,
rclxvsvw and assist vt nt 1:4' a lilac as a hirer's ggent wilhow it written atlreeinenl. But if ytw dceidc 10 make un alter to Ixrchaase e
pan'liodal pet gxny. the agent mull '61itio a wrincn agency agmemvil hclixr %Thing 111C nfl'er. 11 YOU ilk, lox Sign it, the ugent aua la,
I. n at�cn elx'ew•nt mxl assist ycnt .lad is nu Iongcr required Ire keep ini:rntatiou tdxno gait cool itlom ial.
lie sure In 1'cad alai undersarxl aiy agvney agivemem IvRwe }tau sign H. (Nice y,xt sign it, the agat must give yin a COP.
14 it . '
S'erruv,t tad Cbugn'llvainn: Whether y,.a.t have it wrincn ar unurinen agreement. a buyer's (.vent will lxxliwill a ound,o. of
'seed;s-, tar you. These play ilOodc helping cokt • fitxl n. suitable prnlxrly • arrange linalx•.ing • leaven nuxe uh„ut the lrolv.•rn' lat4l
- otherckv Iroux,ty y,ntr bvm iuteresls. If y,.x, have a wriliell UVOWy' Iig6:e` no0. tax' agov can w1m, help y,w iwcl%trc wxJ Suhntit it
wi incil t,IlCr It, Ile wIler.
A huyrr•'e' n,gew cam IV eannlenxwcd in thilirrnt way". Vial. "sample, YOU out pay Ilse agent tar Of )tnr iMn fxvko,
ail• the agni wily steak etnnl ns uxaa fwal Iho .self cor listing agent first, Into n7luire YOU Ill lxlt if the listing agent rclilu., R'h:toccl'
the cast•, IV sun: yxIr urnnlsnsntitn arrangcnetH with rtxn' bkw.-Kv ugenr is yellcd,nt in it huger agcrtey :Ilrevnenl IVIi nv }rill mute
au aiir a, lnrelli v pr'lvrry :uaJ than v, x.t, anrlialfy rvad and ul0ersmatsl dIr ttnyxns:a inn pnwisitn.
Dual Agent
Yau aiay p.:rtnit on agent or tir,l to reln•escnt y tit and ale acller at the same lino. '11tis "dual agency rclalitnshili' is nnsl
likely to hnpl,en if yrn Ixeonlo ilticrcnccl inn IvOleny Iimed with your bIger'.e alrnl or the atom's firm. 11'thi. trcurs'mxl <ou hat o
ma Kok, apmml b, A&A agency rdmi,xuhip hipA r twdlm"x "At miyer agency igmentenl. your borer's agent will a.,k ytu a,
aumtxl the Ixtyer agctx•y Wwumwm tar sign a scpawule 19WOrnern or tkr.•wramll IxrmMhW him or her a, act as agent air fv,ih }toll :nnl
the wIler. h may Ix difl"euh )ir a dine/ n,ev,lt to aaly; nev the infurests nr hoot the buyer :all >clIvr. Nv%ev tekcaS, it dlual n•ve•nt mum
neat huyera aril ,Seller, fairly :uxl ryually. Although the duel ugent oweN then) the sine tkoics. huger, ink] Sellers caul prohihil dual
umvws Ih w❑ divulging erttaki con/ idential inr(rmalion alxxll then) to Ilie Odee• party.
C,.nne. firm., also olio, a Gem of dual agency called 'de.,igltacd agency' where On . agcnl in the firm relxvscnlS the seller
and ale rih4'I- age lll mprc+entx the huyrd- 'I Ili, oi'Mhn (whin avutlable l mac alkat' each dust:nanet.i atgtru' t:> more gully relxcscrN r:n•h
party.
It' yrxt ehtx+se Ian• "'Jual ajmVxy Opium. renirithor th.e since a duat agrill" loyalty is JiN ,best Itelw-cen pwln', with
ovilmhw interestm it is esin:cinily iml>,rhem that yt,u have a clear uFOU.1 Aalxling of • wh;4 year rCJill itnship is with Ile dual agera
and • whal the apcul will lie cloiny: Ibr ytn in (lie ❑ansactitn. llis :all host Ill accomplished by 1XIIIine the aprconcnt in writing al tam
carlir.0 I'.,.:ible lime.
Selhr'SAgrill Wnrking will, a Bluer
If the read estate agent tr firm thin can contal:1 4vs nni , dice buret ugrwr v in, van do tail went, then, it) get :Is y,xlr buvrr
uxrnr, you eau slip a'.nit with the firm anal it< agcnl>. However. IIcy will iv :w•ting as the seller's ,gwwa ttw "Subugo If, I.'lle :gent
::nt'sill help yt n fitxl and ptrcho e Ixk4wrly :nil lit wide many Of the same service, us a btnrv''s rr,crnt. The agent must Ill fair with
y',u and Iwwkk pm with any "ntmerKI facts" (Nrlch its a leaky nx,D alxwl ItroiVnics.
Hill rc,a•mhxi', the quilt rep,esoms the Seller - W4 caw - and thetnli,re must hT t0 t+iltain flax' the Nelier tine Its pos,ibir
bier aunt levins for (he seller'., lnulxx'ly. FUI'IlArmu,:. it lCller:t' agent is reltlulreti t0 gtl'C the sCllcr a11)• inl:n•watiun aLxwl poll (et'en
I,or.,wtnl. financial of ct nlfide:rlthd intin'nutl i,ni that wewltl help the scUur in the sale t,I' his ,r her ptolvi-ty. Aguas oing IS You in
w rifine it lhcy are eellert'' ugemis Ivi'lre veal say :nn'ihing Ihat cavil help Ile seller. Bait until you are stm•e that an rigmt is not it
seller', agent• y'uu should avoid sny'htt,, tatcihing YOU do nil tv ant a seller to know.
S'CHt"'T a.eenls arc o nolrn.,atsrl by ncc wtla-s.
WANDARD FORM 521)
RRC 1111200e
PrCfh1^.M,1 lvlaiL Vf om,t.+try upt,nge IacY0Fc1�n,a Mltu Ao:ln. frasur tdkN*an40924 w•nyr"r_;ILit,{,vi,_ctip, MUM

FOR IMAI.W IiLLER
This is aol a cnnUact
lxtta
Disclosure ojSellcr Subagency
(Cbnlp/cle, i(applicable)
❑ When shrnring wu prfmcrlronrl assisting you in the purritose.ifa prolxrrly. lire elxnr agent and li nu will repmsenr are SELLER,
For noun in(onnaliorr, see ",SrRcr's Agcra Working with a Rorer"in the hnx/rum.
Agenr'sbritialsackrunrlcr{grog Di.n;ln�ut'r1A-
The Ntoh C:xolina Real !:stage Ccmimissi,ni
P.O. Wm 17100- Raleiglt Ncath Car, luiu 376111-71(%)
1) OM75-37W • \b'ch Si lc: w%v% jwr x x, r.
RFC ?.d5 l/ UOJ
:nc?Nd
STANDARD 1'0R0I 52ti
RP.C: 1/ 1/20041
PrOdMad vRlU Z4rF�rrcrro Up 2iRLu4ip IEC9n FlAtian IdlN}FIoaU.Flasur. tdh;h;u,na0o2b Lnr_i[LtUO,apr Cv9Jea

WORKING 1VITFI RrAL ESTATE.AGENTS
Agents rntrnl retail) rhks acknowledgment jrrtheir Iihts.
T114ii is not a contract
IIy signing. I .1CI 1hlwllYl)1C II);II II7C uptil 1 imcd I Xthtw ftinikhrd ❑ Copp of Ibis NwInI•c Ald rtcirwea it with tile.
Huccrar,'dertVutuc!!h'iruarTrl �l
nil ,—
Bnreror Selfer 5'iptuaum
Utue
Bueertar•ScBrr.ManncO'rinf%a•7;rlx•1 --- --_--
liutz�r ar St°der Sigrvaw•e
lkrrc•
Disclosure al'.Sc1lcr Subagency
f(Amtplete, i/'applicable)
[J When showing tau proln•rlyand assistln,t; sou in The pur'ehuse o(u propeny. rflr ahmv o,grm mad lirm will repo-sem- the MV.. k.
Fee ounr inlrn'uunion, sve ".Sel er'.s AAeur WorAiria with a Buvcr" i4 rite baWflun'.
Butv�r:e lnitirrb• Aeknon•hrlgine; pierlrarm'r:
I':ig,c .i of +1
STANDARD FORM 5211
RF'C 1/1/2MW
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