NCC240770_NOI Signed Certification_20240318

NCGO1 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete,scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with$120 check if paying by check)
at:
Division of Energy, Mineral& Land Resources Stormwater Program
512 N.Salisbury Street, 6th Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.221
Per NC General Statute 143-215.68(i), any person who knowingly makes any false statement, representation, or
certification in any application, record, report,plan, or other document filed or required to be maintained under this
Article or a rule implementing this Article. . .shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars($10,000).
Under penalty of law, I certify that(check all boxes to indicate your agreement):
�✓ I am the person responsible for the construction activities of this project,for satisfying the requirements of this
permit, and for any civil or criminal penalties incurred due to violations of this permit.
�✓ The information submitted in this NOI is,to the best of my knowledge and belief,true, accurate, and complete
based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information.
0✓ I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan..
❑✓ If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan)of the NCG010000 General Permit, I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
E✓ I hereby request coverage under the NCG010000 General Permit and understand that coverage under this
permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Project Name (must match Ala): Sam's Xpress Car Wash
Specific Lot Numbers(must match Alb):
Permittee (must match B1): SXCW Properties II, LLC
Legally Responsible Person (must match B2& B3): Anthony Warren
Title of Legally Responsible Person (must match B3b): Development Manager
Print Name&Title of Signed if Authorized
Individual Differs from Legally Responsible Person: William Vibbert & Development Manager
Phone Number: 704-648-4703
3/11/24
Signature of Legally Responsible Person or Authorized Individual Date
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that owns or operates the construction activity,
such as a president,secretary, treasurer,or vice president, or a manager that is authorized in accordance with Part IV,Section 8,
Item(6)of the NCG010000 permit.

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

IN WITNESS WHEREOF, the undersigned, as the Manager Pro Tern of the LLCs hereby
executed this Unanimous Written Consent and Resolutions of the Manager Pro Tern of LLCs as of
the date written below.
Rima Anabtawi, as anager Pro Tern of each LLC
Dated: O i /Q 212 2 L"

SCHEDULE 1 TO UNANIMOUS WRITTEN CONSENT AND RESOLUTIONS
OF THE MANAGER PRO TEM OF LLCs
LIST OF LLCS RIMA ANABTAWI IS MANAGER PRO TEM OF
AND FOR WHICH WILLIAM VIBBERT AS DEVELOPMENT MANAGER OF
SAM'S XPRESS CAR WASH
1. Sam's Xpress Car Wash, LLC
2. SXCW Properties, LLC
3. SXCW Properties II, LLC
4. SXCW Properties III, LLC
5. SXCW TEMP,LLC
.14(44614iaL
Rima Anabtawi, as Manager Pro Tern of each LLC
Dated: 01/ O Z/20 Li
County, North Carolina
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she signed the foregoing document:
Rima Anabtawi .
Name(s) of principal(s)
Date: I (Official Seal)
s�cn��-�13• J� J� , Notary Public �o O
My commission expires: -?_a.o a = NOTARy
PUB LAG C.
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