SW7910903_HISTORICAL FILE_20210225

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
�(9�
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRIAN WRENN
Director
NORTH CAROLINA
Environmental Quality
February 25, 2021
Peachtree Shoreside, LLC
c/o Hudgens Management, LLC, Manager
Attention: William A. Brogdon
3425 Duluth Park Lane
Duluth, GA 30096
Subject: Stormwater Permit No. SW7910903 Renewal
Shoreside Center — Walmart — Kitty Hawk, NC
High Density Stormwater Project
Dare County
Dear Mr. Brogdon:
wU VQ
A Division of Energy, Mineral, and Land Resources file review has determined that
Stormwater Permit SW910903 for a stormwater treatment system consisting of a wet
detention pond and an infiltration basin to serve Shoreside Shopping Center - Walmart
located at 5400 North Croatan Hwy, Kitty Hawk, NC expires on August 4, 2021. This is
a reminder that permit renewal applications are due 180 days prior to expiration. We do
not have a record of receiving a renewal application.
To keep this permit active please submit a completed permit renewal application along
with a $505.00 fee for permit renewal. Permit application forms for renewal can be found
on our website at:
https•//deq nc gov/about/divisions/energy_-mineral-land-resources/energy mineral-land-
rules/stormwater-program/post-construction. North Carolina General Statutes and the
Coastal Stormwater rules require that this property be covered under a stormwater
permit.
If you have questions, please feel free to contact me at [phone]. 1 will be glad to
discuss this by phone or meet with, you. If you would like, I can e-mail you a copy of the
application forms. You can request a copy by e-mailing me at roger.thorpeftcderingov.
Sincerely,
Roger K. Thorpe
Environmental Engineer
�tt North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 27889
NPIiH GttYJNA //
252.946.6481

®� Kimley-Horn
and Associates, Inc
Transmittal
RECEIVED
JUL - 5 2012
Date: July 3, 2012 QmWA
Project Name: Kith Hawk Walmart #2000-05
To: At Hodee
943 Washington Square Mall
Washington, NC 27889
We are sending these by
❑ U.S. Mail
❑ Other:
We are sending you
❑ Attached
❑ Shop Drawings
® Other:
2000 South Boulevard
Suite 440
Charlotte, North Carolina
28203
® FedEx ❑ Hand Deliver
❑ Under separate cover via the following items:
❑ Prints/Plans ❑ Samples ❑ Specifications ❑ Change Orders
Copies Date No. Description
These are transmitted as checked below
'❑ For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval
❑ As requested ❑ Approved as noted ® Submit ❑ Copies for distribution
❑ For review and comment ❑ Returned for corrections ❑ Return ❑ Corrected prints
Remarks:
Please call the at 704-333-5131 with any questions. Thanks.
Copy to:
TEL [phone]
FAX [phone]
Signed Matt Cox
Page I

r, A 7.

State Stormwater Management Systems
Permit No. SW7910903 MOD
Shoreside Center
Stormwater Permit No. SW7910903 Modification
Dare County
Designer's Certification
W7y as a duly registered P I l jlylt"' in the
State of North Carolina, having been authorized to observe io ica weekly/ full
time) the construction of the project,
.��,A,.-1 �,,,,�In � r.l, �i�l �q �n u �Ii1, 0 inv�
(Project) Shore alL
(-{a\A)
for �f Mns Val, p�p/��� ' � je I<H ), ereby
� Pro ect 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 is included in the Certification.
Noted deviations from approved plans and specification:
FARO �4
a SEAL
031446
SEAL
i GINti • O ��
Signature. 'i yR1jyE`N,G��`�
Registration Number 03 ('+4-b
Date
Page 7 of 8

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State Stormwater Management Systems
Permit No. SW7910903 MOD
Certification Requirements:
✓ 2.
✓ 5.
✓ 6.
dL,.2_7.
✓ 8.
/. 10
nwL 12.
The drainage area to thesystem contains approximately the permitted
acreage.
The drainage area to the system contains no more than the permitted
amount of built -upon area.
Ali the built -upon area associated with the project is graded such that the
runoff drains to the system.
All roof drains are located such that the runoff is directed into the system
The outlet/bypass structure elevations are per the approved plan.
The outlet structure is located per the approved plans.
Trash rack is provided on the outlet/bypass structure.
All slopes are grassed with permanent vegetation.
Vegetated. slopes are no steeper than 3:1.
The inlets are located per the approved plans and do not cause short-
circuiting of the system.
The permitted amounts of surface area and/or volume have been
provided.
Required drawdown devices are correctly sized per the approved plans.
,✓ 13. All required design depths are provided.
�14. All required Parts of the system are provided,
�Z/ 15. The required system dimensions are provided per the approved plans.
cc: TowDn of KiittttyVHawk ashington Planning /Regional Office Buuildingl Inspections
Page 8 of 8

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Colleen H. Sullins
Governor Director
August 4, 2011
Mr. Thomas W. Wheeler, Jr, President
TW&W at KHNC, LLC
PO Box 957209
Duluth, GA 30095 see o ,, nQY cLa.K� 8//8/ir
Subject: Stormwater Permit No. SW7910903 Modification
Shoreside Center, WalMart, Kitty Hawk
High Density Project
Dare County
Dear Mr. Wheeler:
Dee Freeman
Secretary
The Washington Regional Office received a complete Stormwater Management Permit Application for
the modification of Shoreside Center, WalMart, Kitty Hawk on August 1, 2011. Staff review of the
plans and specifications has determined that the project, as proposed, will comply with the
Stormwater Regulations set forth in Title 15A NCAC 2H.1000 and Session Law 2008-211. We are
forwarding Permit No. SW7910903 Modification dated August 4, 2011, for the construction of a new
infiltration basin and building expansion for the subject project. The permit for this project issued on
November 18, 2008 is hereby rescinded and replaced with this permit.
This permit shall be effective from the date of issuance until August 4, 2021, 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 upon written request within thirty (30) days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150E of the
North Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail
Service Center, Raleigh, NC 27699-6714. Unless such demands are made this permit shall be final
and binding.
If you have any questions, or need additional information concerning this matter, please contact Scott
Vinson, or me at [phone].
Ulod
Regional Supervisor
Surface Water Protection Section
AH/sv: K:\SAV\K — Stormwater\PERMIT\SW7910903 Mod
cc: Matt Cox — Kimley-Horn & Associates
Town of Kitty Hawk Planning / Building Inspections
t/Washington Regional Office
North Carolina Division of Water Quality Internet:w .nmaterquality.org one
943 Washington Square Mall Phone: [phone] FAX [phone] f�]O[-tl t CarO� l lla
Washington, NC 27889 FAX: [phone] Naturally
An Equal Opportunity Affirmative Action Employer bi

State Stormwater Management Systems
Permit No. SW7910903 MOD .
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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
TW&W at KHNC, LLC
Shoreside Center, Wa1Mart — Kitty Hawk
Dare County
FOR THE
construction, operation and maintenance of one wet detention pond and one infiltration
basin in compliance with the provisions of 15A NCAC 2H .1000 and Session Law 2008-
211 (hereafter 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 Water Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until August 4, 2021, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data. This permit modification
covers the addition of a new infiltration basin to collect and treat the runoff from
62,291 square feet of existing parking impervious area in order to allow for the
new building expansion of 33,106 square feet of impervious area to be collected
and treated by the existing wet detention basin.
This stormwater system has been approved for the management of stormwater
runoff as described on page 3 of this permit, the Project Data Sheet. The two
stormwater controls have been designed to handle the runoff from 630,967
square feet of impervious area.
The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
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.
Page 2 of 8

State Stormwater Management Systems
Permit No. SW7910903 MOD
The runoff from all built -upon area within the permitted drainage areas of this
project must be directed into the permitted stormwater control systems.
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a.
Drainage Area, acres:
15.25 (664,290 s.f.)
b.
Total Impervious Surfaces, ft':
568,676
C.
Pond Depth, feet:
4.50
d.
TSS removal efficiency:
85%
e.
Permanent Pool Elevation, FMSL:
4.00
f.
Required Permanent Pool Surface Area, f2:
35,207
g.
Provided Permanent Pool Surface Area, ft :
35,269
h.
Permanent Pool Volume,. ft :
87,511
i.
Temporary Storage Elevation, FMSL:
5.50
j.
Required Storage Volume, ft3:
49,822
k.
Provided Storage Volume, ft :
57,279
I.
Controlling Orifice:
3@2"0 pipe
M.
Receiving Stream/River Basin:
Kitty Hawk Bay / Pasquotank
y0-19
n.
Stream Index Number:
o.
Classification of Water Body:
"SC"
The following following design elements have been permitted for the infiltration
basin stormwater facility, and must be provided in the system at all times.
a. Drainage Area, ft2:
b. Total Impervious Surfaces, ft2:
C. Design Storm, inches:
d. TSS removal efficiency:
e. Basin Design Depth:
f. Bottom Elevation, FMSL :
g. Bottom Surface Area, ft :
h. Bypass Weir Elevation, fmsl:
i. Permitted Storage Volume, ft3:
j. Type of Soil:
k. Expected Infiltration Rate, in/hr
I. Seasonal High Water Table, fmsl:
m. Time to Draw Down, hrs:
n. Receiving Stream / River Basin:
o. Stream Index Number:
p. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
75,359
62,291
1.50
85%
1.90 feet
5.50
7,032
7.40
16,294 at temporary pool
Fripp / fine sand
10.64
3.50
1.30
Kitty Hawk Bay / Pasquotank
30-19
"SC"
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.
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
Page 3 of 8

State Stormwater Management Systems
Permit No. SW7910903 MOD
3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions 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. Mowin.9 and revegetation of slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other
supporting data.
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. A
modification may be required for those deviations.
7. 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.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. 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 any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease 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
Mayor permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
Page 4 of 8

State Stormwater Management Systems
Permit No. SW7910903 MOD
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Permittee at all times.
12. 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.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division of Water Quality,
accompanied by a completed name/ownership change form, documentation
from the parties involved, and other supporting materials as may be appropriate.
The approval of this request will be considered on its merits and may or may not
be approved. The permittee is responsible for compliance with all permit
conditions until such time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
3. 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) having jurisdiction.
4. 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.
5. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
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. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
Page 5 of 8

State Stormwater Management Systems
Permit No. SW7910903 MOD
9. The permittee shall notify the Division any name, ownership or mailing address
changes within 30 days.
10. This permit shall be effective from the date of issuance until August 4, 2021.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee.
Permit issued this the 4th day of August, 2011.
NO I
TH CA OLINA ENVIRONMENTAL MANAGEMENT COMMISSION
A,
L - for
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7910903 Modification
Page 6 of 8

State Stormwater Management Systems
Permit No. SW7910903 MOD
Shoreside Center
Stormwater Permit No. SW7910903 Modification
Dare County
Designer's Certification
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 is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 7 of 8

State Stormwater Management Systems
Permit No. SW7910903 MOD
Certification Requirements:
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 outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass 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 surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Washington Regional Office
Town of Kitty Hawk Planning / Building Inspections
Page 8 of 8

DWQ USE ONLY znj,17w,
Date Received
C u,1 0,V77 Fee Paid
Permit Number
T`l000 I
,SL,U 7 t o O M o
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources v
Division of Water Quality AUG 0 12011
STORMWATER MANAGEMENT PERMIT APPLICATIGA&PRM DWQ
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on
plans, specifications, letters, operation and maintenance agreements, etc.):
Walmart, Kittv Hawk, NC - Store #2000-05
2. Location of Project (street address):
5400 North Croatan Highway
City:Kitty Hawk County:Dare Zip:27949
3. Directions to project (from nearest major intersection):
Heading north on US Highway 158 from downtown Kitty Hawk the main site entrance is located
approximately 1,100 feet west from the intersection of US Highway 158 (North Croatan Highway) and
4. Latitude:36* 05' 46" N Longitude:75° 43' 09" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ❑New ®Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberSW7910903 , its issue date (if known)11/18/2008 and the status of
construction: El Not Started ❑Partially Completed* ® Completed* *provide a designer's
certification
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
proposed, N/A
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: 4 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit
Number, issue date and the type of each permit:N/A
aQp
Form SWU-101 Version 07Jun2010
Page 1 of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:TW & W AT KHNC, LLC
Signing Official & Title:Mr. Thomas W. WFleeler. Jr. - President
b.Contact information for person listed in item 1a above:
Street Address:1960 Satellite Boulevard. Suite 1300
City:Duluth State:GA Zip:30097
Mailing Address (if applicable):P.O. Box 957209
City:Duluth State:GA Zip:30095
Phone: (770 ) 476-4801 Fax: (770 ) 495-1458
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a
and 2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if
City:
Phone: ( 1
State:
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: Matt Cox. Kimlev-Horn and Associates Inc
Signing Official & Title:Engineer of Record
b.Contact information for person listed in item 3a above:
Mailing Address:2000_South Boulevard, Suite 440
City:Charlotte State:NC Zip:20203
Phone: (704 ) 954-7492 Fax: [phone]
Email:[e-mail]
4. Local jurisdiction for building permits: Dare County
Point of Contact: Phone #:
Form SWU-101 Version 07Jun2010 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, brieFlv summarize how the stormwater runoff will be treated.
A infiltration basin has been designed to treat the impervious area increase (0.76 ac) due to a proposed
walmart expansion. The infiltration basin is identified as Drainage Area 2 on this application The
infiltration basin overflow drains to the existing wet pond which was previously permitted (No SW7910903)
and identified as Drainage Area 1 on this application. Drainage Area 1 information was taken from the
previous stormwater permited issued by DWO.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph II - Post Construction i
3. Stormwater runoff from this project drains to the
4. Total Property Area: 18.26 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°:18.26 acres
Total project area shall be calculated to exclude the followin the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the ormal High Water (NHW) Line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward 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 = 66 %
9. How many drainage areas does the project have?Two (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use I for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each
area provided in the same format as below.
Rig
Form SWU-101 Version 07Jun2010 Page 3 of 7

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G, 5101
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Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area
Drainage Area
Receiving Stream Name
^ �'� n s/s
M Kitty A
Hawk Bay
Rat drain
- to Kitty
Hawk Bay
Stream Class *
SC
SC
Stream Index Number
1 30-19
30-19
Total Drainage Area (so /
'y,3 664,290
33,106
On -site Drainage Area (so %
7 664,290
33,106
S
Off -site Drainage Area (so
0
0
Proposed Impervious Area"*
s
597,861
33,106
7. Impervious Area** total
90
100
937,
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
597,861
33,106
On -site Streets (so
0
On -site Parking (so
0
On -site Sidewalks (so
0
Other on -site (so
0
Future (so
0
Off -site (so
0
Existing BUA*** (so
597,861
4' �S
Total (so:
597,861
630,967
6.2,,zS/
Stream Class and Index Number can be determined at: lrttp.aortal.ncdenr.org webhvas/esu/classifications
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BLIA.
11. How was the off -site impervious area listed above determined? Provide documentation. No Off -site water.
Proiects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 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 htt2://12ortal.ncdenr.orgZweb/wq/ws/­su/bml2-nianual.
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 http://yortal.ncdenr.org/web/wq/ws/so/statesw/forms 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
http //12ortal.ncderLr.org/ web /wq /ws/su/mal2s.)
Please indicate that the following required information have been provided by initialin 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://12ortal.ncdertr.org/web/wq/ws/su/statesw/forms dots. (b"�
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. 5
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants y
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and cigedl and O&M
agreement(s) for each BMP.
Form SWU-101 Version 07Jun2010 Page 4 of 7

Basin Information
Draina a Area 1
Draina e Area 2
Draina a Area _
Draina e Area _
Receiving Stream Name
Does not drain
to Kitty
Hawk Bay
Does not drain
to Kitty
Hawk Bay
Stream Class *
y
-H�z
L
Stream Index Number *
30-19
30-19
Total Drainage Area (so
664,290
33,106
On -site Drainage Area (so
664,290
33,106
Off -site Drainage Area (so
0
0
Proposed Impervious Area** (s
597,861
33,106
% Impervious Area" (total)
90
100
Impervious— Surface Area
Draina a Area 1
Draina e Area 2
Draina a Area _
Draina a Area _
On -site Buildings/Lots (so
597,861
33,106
On -site Streets (so
0
On -site Parking (so
0
On -site Sidewalks (so
0
Other on -site (so
0
Future (so
0
Off -site (so
0
Existing BUA*' (so
597,861
Total (so:
597,861
63D,967
Stream Class and Index Number can be determined at: httpl/vortal.ncdenr.or hvebhoq(ps/csu/classificnhbns
Bnppenvious area is defined as the built upon area including, but not lintited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
***Report only that antomtt of existing BUA dint will remain after development. Do not report any existing BUA flat
® is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. No Off -site water.
Projects in Union Countv: Contact DIVO Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stornnvaler requirements as per 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://portai.ncdem.org/web/wq/ws/su/bap-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 h!M://portal.ncdeiir.org/web/wq/ws/su/statesw/forms 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 http //portad.ncdem.orgJweb/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 fromhttp://portal.ncdem•.oro/web/wq/ws/su/statesw/forms does.
Initials
1. Original mid one copy of the Stormwater Management Permit Application Form. AA;_;
2 Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants NIE
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
® agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to Wz
http://www.envhelp.org/pages/onestopexpress.html for information on the Express program
Form SWU-101 Version 077un2010 Page 4 of 7

and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
® additional information and to schedule the required application meeting.) _
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for M�1=
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the _)VAV -
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations. MC:
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: WE
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the NEHW or NI-lW lines.
o Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
® 9. Copy of any applicable soils report with the associated SHWT elevations (Please identify �2
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"xII" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to veiifij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book:1495 Page No: 412 M A C
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 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.
hgp://www.secretary.state.nc.us/Corporations/CSearch.asRx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from -
http://portal.ncdenr.org/web/wo/ws/suIstatesw/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 signatmre(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.
Form SWU-101 Version 07Jun2010 Page 5 of 7

i'
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envhelp.org/12ages/onestopexl2ress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the'/x
mile radius on the map.
7. Sealed, signed and dated calculations.
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verifij the SHWF prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1495 Page No: 412
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 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.
httl2://www.secretary.state.nc.us/Corl2orations/CSearch.asl2x
Form SWU-101 Version 07Jun2010 Page 5 of

VIL DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from
http://12ortal.ncdenr.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.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Matt Cox, PE
Consulting Firm: Kimley-Horn and Associates, Inc.
Mailing Address:2000 South Boulevard, Suite 440
City:Charlotte State:NC Zip:28203
Phone: (704 ) 333-5131 Fax: (704 ) 333-0845
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, itern 2a) certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) with (print or type name of organization listed in
Contact Information, item 1 a) to develop the project as currently proposed. A copy
of the lease agreement or pending property sales contract has been provided with the submittal, which indicates
the party responsible for the operation and maintenance of the stormwater system.
Form SW-101 Version 07Jun2010 Page 6 of 7

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
do hereby certify that
before me this _ day of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item la) Thomas W. Wheeler, fr.
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 NCAC ?H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
Date:_ 7iZ z --2 #9//
d1A a Notary Publi£for 7the State of _f i Q- County of
�t4&n a1, doh ereb certify that ! eA1/jS !?/, "PG/� ✓✓ personally appeared
c
before me this day of aoh , aend ackn a due exg utio of the applicat on for
a Stormwater permit. Witness m hand and official seal !//LJ�
SEAL
My commission expires /�%'�aA4
Form SWU-101 Version 07Jun2010 Page 7 of 7

ll
i
Permit No.
(to be Provided by DWQ)
o?�F WaiF9pG
®� STORMWATER MANAGEMENT PERMIT APPLICATION FORM o�
PICDENR 401 CERTIFICATION APPLICATION FORM
INFILTRATION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part III) must be printed, filled out and submitted along with all of the required information.
_ -
L, PROJECT:INFORMATION'
Project Name r Walmart Supementer'-Kitty Hawk, NC
Contact Person Matthew Edwards
Phone Number 704-954-7493 -
Date 712812011
Drainage Area Number 1
IL DESIGN,INFORMATION. -
e
-
4- _
Site Characteristics
Drainage area
75,358.80
ft2
-
Impervious area
62,290.80
ft2
Percent impervious
Design rainfall depth
0.83
1.50
%
in
�Y gq 7�-y
u��
JmFie • E I `/ p� - D
`�,J
Peak Flow Calculations
V
1-yr, 24-hr rainfall depth
4.00
in
AUG O' 2U11
1-yr, 24-hr intensity
- 0.14 '4
inlhr
Pre -development 1-yr, 24-hr discharge
0.00
ft3/sec
Post -development 1-yr,24-hrdischarge
'- 0.00;_.
ft3lsec
DWQ
Pre/Post 1-yr, 24-hr peak flow control 0.00 ft3/sec PROJ #
Storage Volume: Non -SA Waters
Minimum design volume required
Design volume provided
Storage Volume: SA Waters
1,5* runoff volume
Pre -development 1-yr, 24-hr runoff volume
Post -development 1-yr, 24-hr runoff volume
Minimum required volume
Volume provided
Soils Report Summary
Soil type
Infiltration rate
SHWT elevation
Basin Design Parameters
Drawdown time
Basin side slopes
Basin bottom elevation
Storage elevation
Storage Surface Area
Top elevation
Basin Bottom Dimensions
Basin length
Basin width
Bottom Surface Area
7,479.00 rya
-16,294.00 ft3
ft3
ft3
ft3
ft3
ft3
Fripp l fine sand
10.64 in/hr
3.50 fmsl
0.03 days
3.00
:1
5.50
fmsl
7.40
first
10,120,00:'
ft2
.. 12.00
fmsl
135.00 It
52.00 If
7,032.00 ft2
OK for non -SA waters
OK
OK
OK
Form SW401-Infiltration Basin-Rev.4
Parts I. & II. Design Summary, Page 1 of 3

Permit No.—' '
•
(to be pmvidetl by DWQ)
Additional Information
"
Maximum runoff to each inlet to the basin?
0.04
ac-in
OK
Length of vegetative filter for overflow
NA
- = ft
OK
Distance to structure
NA
ft
OK
Distance from surface waters
NA
ft
OK
Distance from water supply well(s)
NA
ft
OK
Separation from impervious soil layer
NA
ft
OK "
Naturally occuring soil above shwt
2.00
- ff
OK
Bottom covered with 4-in of clean sand?
Yes
(Y or N)
OK
Proposed drainage easement provided?
Yes
(Y or N)
OK
Capures all runoff at ultimate build -out?
Yes
(Y or N)
OK "
Bypass provided for larger storms?
Yes
(Y or N)
OK
Pretreatment device provided
NA
Form SW401-InfAragon Basin-Rev.4 Pans t. & II. Design Summary, Page 2 of 3

T
Permit
(to be provided by DWQ)
IIL;REQUIRED ITEMS CHECKLIST .
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Pagel Plan
Initials
Sheet No.
UYJ
11 PE
C 0
1. Plans (1" - 50' or larger) of the entire site showing:
- Design at ultimate build -out,
- Off -site drainage (if applicable),
- Delineated drainage basins (include Rational C coefficient per basin),
- Basin dimensions,
- Pretreatment system,
- High flow bypass system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
j/1 AE
C-tD
2. Partial plan (1" = 30' or larger) and details for the infiltration basin showing:
- Bypass structure,
- Maintenance access,
- Basin bottom dimensions,
- Basin cross-section with benchmark for sediment cleanout,
- Flow distribution detail for inflow,
- Vegetated filter, and
- Pretreatment device.
t� F
C�(y
3. Section view of the infiltration basin (1" = 20' or larger) showing:
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
M A
C Ir,s
4. A table of elevations, areas, incremental volumes & accumulated volumes to verify the volume provided.
5. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. The
results of the soils report must be verified in the field by DWQ, by completing & submitting the soils
investigation request form. County soil maps are not an acceptable source of soils information.
'pp�A
r�
E'
6. A construction sequence that shows how the infiltration basin will be protected from sediment until the
entire drainage area is stabilized.
MAC
7. The supporting calculations.
MkE
8. A copy of the signed and notarized operation and maintenance (08M) agreement.
M��
✓
9. A copy of the deed restrictions (if required).
Form SW401-Infiltration Basin-Rev.4
Page 3 of 3 Part III. Required Items Checklist, Page 3 of 3

EXPRESS 1 9 Permit Number: sw c) i O q QJ
(to be provided by DWQ)
Drainage Area Number:
NC M_ Rtion Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
Important maintenance procedures:
— The drainage area will be carefully managed to reduce the sediment load to the
infiltration basin.
— Immediately after the infiltration basin is established, the vegetation will be .
watered twice weekly if needed until the plants become established (commonly
six weeks).
— No portion of the infiltration basin will be fertilized after the initial fertilization
that is required to establish the vegetation.
— The vegetation in and around the basin will be maintained at a height of
approximately six inches.
After the infiltration basin is established, it will be inspected once a quarter and within
24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a Coastal
County). Records of operation and maintenance will be kept in a known set location
and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to
infiltration basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
The inlet device: pipe or
The pipe is clogged (if
Unclog the pipe. Dispose of the
swale
applicable).
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged (if
applicable).
Erosion is occurring in the
Regrade the swale if necessary to
swale (if applicable).
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Form SW401-Infiltration Basin O&M-Rev.3 Page 1 of 3

BMP element:
Potentialproblem:
How I will remediate theproblem:
The forebay
Sediment has accumulated
Search for the source of the
and reduced the depth to 75%
sediment and remedy the problem if
of the original design depth.
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred or
Provide additional erosion
riprap is displaced.
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticides are used, wipe
them on the plants rather than
spraying.
The main treatment area
A visible layer of sediment
Search for the source of the
has accumulated.
sediment and remedy the problem if
possible. Remove the sediment and
dispose of it in a location where it
will not cause impacts to streams or
the BMP. Replace any media that
was removed in the process.
Revegetate disturbed areas
immediately.
Water is standing more than
Replace the top few inches of filter
5 days after a storm event.
media and see if this corrects the
standing water problem. If so,
revegetate immediately. If not,
consult an appropriate professional
for a more extensive repair.
Weeds and noxious plants are
Remove the plants by hand or by
growing in the main
wiping them with pesticide (do not
treatment area.
The embankment
Shrubs or trees have started
-spray).
Remove shrubs or trees
to grow on the embankment.
immediately.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the NC Division of Water
damage have occurred at the
Quality 401 Oversight Unit at 919-
outlet.
733-1786.
Form SW401-Infiltration Basin O&M-Rev.3
Page 2 of 3

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name:Walmart, Kitty Hawk, NC - Store #2000-05
BMP drainage area mnnber:One
Print name:T W and W at KHNC, LLC - Thomas W. Wheeler, Jr.
Title:Sole Managing Member
Address:1960 Satellite Blvd, Suite 1300, Duluth, GA 30095
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
I, &� BSIfA /7 Adk'OZ, - , a Notary Public for the State of
G7t 0601'a County of C7u),nne do hereby certify that
_%� personally appeared before me this llf
day of S ao/� , and acknowledge the due execution of the
forgoing infiltration basin maintenance requirements. Witness my hand and official seal,
muinry�,� �%iY�/�,}.O.IGL �l��at2trOl�i
p. ANp,9iey�
G ..,�pug�•���'" 2 tea.
tG��``�.
SEAL
My commission expires 3--1 3 --� a SZ
Form SW40 I -Infiltration Basin O&M-Rev.3
Page 3 of 3

. 1.
6

DWQ USE ONLY
at cziv
C�.0 7-itFee Paid
Permit Number
n
Sb l q10903
Applicab 1e Rhoastal SW -1995 ❑ Coastal SW
(select all on -Coastal SW- HQW/ORW Waters
❑ Other WQ Mgmt
- 2008 ❑ Ph If - Post Construction
❑ Universal Stormwater Management Plan
Plan:
State of North Carolina 1
Department of Environment and Natural Resources �1 ��( rt
Division of Water Quality G /vim
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form rnny be photocopied for use as an original y' ���
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.):
Walmart, Kitty Hawk, NC - Store #2000-05
2. Location of Project (street address):
5400 North Croatan Highway
City:Kitty Flawk County:Dare Zip:27949
3. Directions to project (from nearest major intersection):
Heading north on US Highway 158 from downtown Kitty Hawk the man site entrance is located
approximately 1,100 feet west from the intersection of US Flighway 158 (North Croatan Highway) and Ocean
Boulevard. ,
4. Latimcle:360 05' 46" N Longitude:75° 43' 09" W of the main entrance to the project.
H. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ❑New ®Modification
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberSW7910903 , its issue date (if known)11/18/2008 , and the status of
construction: ❑Not Started ❑Partially Completed* ® Completed* "Provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑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
proposed, N/A
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):
❑CAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 4 ac of Disturbed Area
0404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:N/A
Form SWU-101 Version 07Jun2010 Page 1 of

III. CONTACT INFORMATION
1, a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:TW & W AT KHNC LLC
Signing Official & Title:Mr. Thomas W. WHeeler, Jr. - President
b.Contact information for person listed in item la above:
Street Address:1960 Satellite Boulevard, Suite 1300
City:Duluth State:GA Zip:30097
Mailing Address (if applicable):P.O. Box 957209
City:Duluth State:GA Zip:30095
Phone: [phone] Fax: [phone]
Email: [e-mail]
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/
Signing Official &
b.Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
Phone: ( 1 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:Matt Cox. Kimlev-Horn and Associates Inc
Signing Official & Title:Engineer of Record
b.Contact information for person listed in item 3a above:
Mailing Address:4651 Charlotte Park Drive Suite 300
City:Charlotte
Phone: [phone]
Email:[e-mail]
4. Local jurisdiction for building permits: Dare County
State:NC Zip:28217
Fax: (704 ) 333-0845
Point of Contact: I
_ Phone #:
Form SWU-101 Version 07Jun2010 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
A infiltration basin has been designed to treat the impervious area increase (0.76 ac) due to a proposed
walmart expansion The infiltration basin is identified as Drainage Area 2 on this application The infiltration
basin overflow drains to the existing wet pond which was previously permited (No SW7910903) and
identified as Drainage Area 1 on this application Drainage Area I information was taken from the previous
stormwater permit issued by DWQ
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph 11- Post Construction
3. Stormwater runoff from this project drains to the Does not drain to Kitty Hawk Bay RiN
4. Total Property Area: 18.26 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+:18.26 acres
Total project area shall be calculated to exclude the folloroin the noruml pool of impounded structures, the area
bettoeen 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 front the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line nray
be included in the total project area.
S. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 66
9. How many drainage areas does the project have?Two (For high density, count I for each proposed engineered
stornnoater BMP. For low density and other projects, use 1 for the eohole 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.
Form S WU-101 Version 07Jun2010 Page 3 of 7

Basin Information
Drainage Area 1.
Drainage Area 2
Draina e Area
Draina e Area
Receiving Stream Name
Dew
-4e-Kitty
Hawk Bay
Beat uQt c4riin
4o-Kitty
Hawk BayfytY
_
1
''
Stream Class
Pydregrnphy
H" iy
5C
Stream Index Number *
30-19
30-19
Total Drainage Area (so
664,290
33,106
On -site Drainage Area (so
664,290
33,106
Off -site Drainage Area (so
0
0
Proposed Impervious Area** (so
597,861
33,106
% Impervious Area** (total)
90
100
hn ervious" Surface Area
Drainage Area 1
Drainage Area 2
Prainage Area
Drainage Area
On -site Buildings/Lots (so
597,861
33,106
_
_
On -site Streets (so
0
On -site Parking (so
0
6 2 CI l
On -site Sidewalks (so
0
Other on -site (sf)
0
Future (so
0
Off -site (so
0
Existing BUA*** (so
597,861
q ]) 6 z z5 egdSt-
Total (so:
597,861
630,967
6 ag
5 (v
Stream Class and Index Number can be determined at: http://portal.nedenir o),Q/rneb/zo9/ps/esu/clnssificatioris
imppervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidernalks, gravel areas, etc.
***Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and zohich Will be replaced by nezv BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. No Off -site water.
Projects in Union County: Contact DIVQ Central Office staffo check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stornnrater requirements as per YCAC 028.0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/%veb/wcl/;vs/su/bniu-nianual-
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 http://portal ncdenr org/web/wq/ws/su/statesw/forms dots. 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 http'/ /portal ncdenr orgZ web/wq/ws/su/mUs)
Please indicate that the following required information have been provided by initialin in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal ncdenr org/web/wq/ws/su/statesw/forms does.
Ini 'als
1. Original and one copy of the Stormwater Management Permit Application Form. F
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants' AE
Form. (if required as per part VIi below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP. ,nt
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to Mn�
http'//www envhelp org/paees/onestopexpress html for information on the Express program
Form SWU-101 Version 07Jun2010 Page 4 of 7

and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for M A�
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the MAc
receiving stream drains to class SA waters within rh mule of the site boundary, include the'/Y
mile radius on the map.
7. Sealed, signed and dated calculations. A�
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including: MArC
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
I. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
on. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required). ry�
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify ►I A�
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"xlI" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to venfij the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1495 Page No: 412 MAF
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC M AF—
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 NCAC 21-1.1003(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.
hap://www.secretary.state.nc.us/CorporationsICSearch asnx
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
ht!p://portal.ncdenr.org/web/wg/ws/su/statesw/forms does. Download the latestversions 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.
Form SWU-101 Version 07Jun2010 Page 5 of 7

VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Matt Cox, PE
Consulting Firm: Kimley-Horn and Associates, Inc
Mailing Address:4651 Charlotte Park Drive, Suite 300
City:Charlotte
Phone: (704 ) 333-5131
Email:[e-mail]
State:NC Zip:28217
Fax: [phone]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or type riarne of person listed in Contact hrforrmtion, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact In ormation, item In
f ) with (print or type name of organization listed in
Contact Information, item la) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
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.
do hereby certify
before me this _ day of
a Notary Public for the State of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
Form SW U-101 Version 07Jun2010 Page 6 of 7

,
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item la) 77mnms W. Wheeler T
certify that the information included on this permit application form is, to the best df 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 wirthequ.?meats of the
applicable stormwater rules under I5A NCAC 21-I.10 , SL2006-246 (Ph. 11- Post Coon) rSL2008-211.SigNnnature: / �/ Da
1,///4 SA- <T • /!n dKi ��?-�-� a Notary Public or the State of C County of
Q , do hereby certhat npm'tS lf%• 1!%IJZ/=iL�, J,<. personally appeared
before me this'xr day o aO!! and acknowledge the due execution of the application for
a stormwater permit. itness*)If
d and official seal3?74 �l Z A �/JCL6
SEAL
My commission expires
ForinSWU-101 Version 071un2010 Page 7of7

:4me r z .4
July 28, 2011
Ms. Lyn Hardison
NCDENR
943 Washington Square Mall
Washington, NC 27889
RE: Wal-Mart Expansion 92000-05 — Kitty Hawk, NC
KHA Ref: 015476085
Dear Ms. Hardison:
e
Suite 440
2000 South Boulevard
Charlotte, NC 28203
On behalf of our Client, Wal-Mart Real Estate Business Trust, we hereby re -submit
the following items for DWQ review:
Two revised Landscape Plans;
Two signed Stormater Management Permit Application Forms; and
Two Infiltration Basin Supplement forms.
We trust this meets your needs at this time. Should you have any further questions or
comments, please feel free to contact me at 704-954-7493.
Sincerely,
Matthew A. Edwards, P.E.
Enclosures
RECFIV'ED
AUG 0 1 �jit
DWQ
FROJ #

it
',CXRRESS
IAUG u 1 2Ut1
WC DENR
0

North Carolina Secretary of State
Page 1 of 1
JUL 19 2911 North Carolina
EMIDOE Shall DEPARTMENT OFTHE
Secretary SECRETARY OF STATE
PO Box 29622. Raleigh, INC 27626-0622 (919}807-2000
Date: 7/18/2011
Click here to:
View Document Filings I Sign
Up for E-Notifications
J®.I Pre -populated Annual Report
Fillable PDF Form I File an Annual Report �
Corporation Names
Name
Name Type
NC T W AND W AT KHNC,
LEGAL
LLC
Limited Liability Company
Information
SOSID:
0672564
Status:
Current -Active
Effective Date:
4/23/2003
Dissolution Date:
Annual Report Due Date:
Citizenship:
FOREIGN
State of Inc.:
GA
Duration:
PERPETUAL
Annual Report Status:
CURRENT
Registered Agent
Agent Name:
CT CORPORATION SYSTEM
Office Address:
150 FAYETTEVILLE ST., BOX 1011
RALEIGH NC 27601
Mailing Address:
150 FAYETTEVILLE ST., BOX 1011
RALEIGH NC 27601
Principal Office
Office Address:
3525 MALL BLVD., SUITE 5AA
DULUTH GA 30096
Mailing Address:
P O BOX 957209
DULUTH GA 30195
Officers
Title:
MANAGER
Name:
THOMAS W WHEELER JR
Business Address:
3525 MALL BLVD., SUITE 5AA
DULUTH GA 30096
Title: MEMBER
Name: J A WALTERS
Business Address: 718 GREEN STREET
GAINESVILLE GA 30501
Title: MEMBER
Name: CHARLES TREMEL
Business Address: 425 NORTH LUMPKIN STREET STE 205
ATHENS GA 30601
This website is provided to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version: 451
http://www.secretary.state.nc.us/corporations/Corp.aspx?Pitemld=56400')6 7/18/2011

North Carolina Secretary of�t,�t,n®ESS
Page 1 of 1
JUL 19 Nil
North Carolina
Elaine F Marrsha!!
NC DEsh DEPARTMENT OF THE
.
Secretary SECRETARYOFSTATE
PO Box 29622 Raleigh, NC 2762"622 [phone]
Date: 7/18/2011
Click here to:
View Document Filings I Sign
Up for E-Notifications I
®I Pre -populated Annual Report Fillable PDF Form I File an Annual Report
Corporation Names
Name
Name Type
INC T W AND W AT KHNC,
LEGAL
LLC
Limited Liability Company Information
SOSID:
0672564
Status:
Current -Active
Effective Date:
4/2312003
Dissolution Date:
Annual Report Due Date:
Citizenship:
FOREIGN
State of Inc.:
GA
Duration:
PERPETUAL
Annual Report Status:
CURRENT
Registered Agent
Agent Name:
CT CORPORATION SYSTEM
Office Address:
150 FAYETTEVILLE ST., BOX 1011
RALEIGH NC 27601
Mailing Address:
150 FAYETTEVILLE ST., BOX 1011
RALEIGH NC 27601
Principal Office
Office Address:
3525 MALL BLVD., SUITE 5AA
DULUTH GA 30096
Mailing Address:
P O BOX 957209
DULUTH GA 30195
Officers
Title:
MANAGER
Name:
THOMAS W WHEELER JR
Business Address:
3525 MALL BLVD., SUITE 5AA
DULUTH GA 30096
Title: MEMBER
Name: J A WALTERS
Business Address: 718 GREEN STREET
GAINESVILLE GA 30501
Title: MEMBER
Name: CHARLES TREMEL
Business Address: 425 NORTH LUMPKIN STREET STE 205
ATHENS GA 30601
This website is provided to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version: 451
http://wwryv.secretary.state.nc.us/corporations/Corp.aspX?PitemId=5640036 7/18/2011

y
` E)(PRESS
JUL 19 2011
SIC ®ENR
FIIM •�..�" pool: Ip9a PY,:p,Y3P1 p: NaT'd—
OplplaOH� µ:�1P11_-_.. ;;:.�:..�� Ne asal„ ru Pd: atapDa,a
Dp, tae.: D¢m
'Lt. n pAar, WatRip aF DEiDa DARE ca, nC
INIIIIIIN�IINIIII0DIEMEIIIIII�llff °"'I"12m .,pn
REAL FS'fATE
DARE . TRANSFER TAX =
COUNTY
Excise Tax - $
APPROVED
DARE COUNTY TAX
COLLECTOR aa�
NO. 211P'-'L(L 5 °1 N Y)
NORTH CAROLINA SPECIAL
THIS DEED made this
HOME DEPOT U.S.A., INC., a
KHN'C, LLC, a Georgia limited h
1800 Parkway Place, See. 70C�
The designations //"�Grant&
parties, their heirs, succe5sofs,^�n d
feminine or neuter as reauiredd Vv
Prepared
L800
rd Kelm to:
n Kt p I
ity N u nal Title
Park , Place, Suite 700
30067
DEED
it, 2003, by and between Grantor,
Pon, and Grantee, T W and W at
o Fidelity National Title,
30067.
as used herein shall include said
include singular, plural, masculine,
Wl'INESSETH, �Ui5b
a� for a valuable consideration paid by the
Grantee, the receipt of y acknowledged,has and by these presents does
grant,bazgain, and nGrantee in fee simple, all that cetiain lot orparcel
of land co wnd 2 of Shoreside Shopping Center situated in Kitty
Hawk, Dar o ina, and more particularly described in Exhibit A
attached o by 'a erenee made a part hereof (the 'Property'; provided,
however oing t and conveyance is made subject to the restrictive
covenan Property set forth in Exhibit C attached hereto and by this
reference a art her as if fully set forth (the "Deed Restrictions').

I�IWIIIIII�I111111IIIVIE111l�H1111111111 Pp '13
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges
and appurtenances thereto belonging to the Grantee in fee simple.
THIS CONVEYANCE is made subject to the matters set forth in Exhibits B and
C attached hereto and by this reference made a part hereof (the 'Permitted Exceptions"
and "Deed Restrictions' respectively) to which, by acceptance of this Deed, Grantee for
it and its successors and assigns, agrees to be bound and subject.
AND the Grantor covenants with the Grantee, that except for the tted
Exceptions, Grantor will warrant and defend the title against the lawful cl eiuo(all
persons whomsoever claiming by, through or under Grantor but not othe 'se.
[SIGNATURES COMMENCE ON FOLLO AGE]
O
1 0.1P56Xq

IMIIVIIIII®I�IWI�N�IIIWI1011II 6p 3'ea a:4ivn
IN WITNESS WHEREOF, the Grantor and Grantee have hereunto set their
hand and seal the day and year first above written.
HOME DEPOT U.S.A., INC.,
a Delaware comoration

I�IIIIIIIIIIIIIAI��IN�IIIIOIIIIBill III P."1�3 MAIM
,4013
IN WITNESS WHEREOF, the Grantor and Grantee have hereunto set their
hand and seal the day and year first above written.
STATE OF GEORGIA
COBB COUNTY
I, N A n
certify that'M.mAs
Georgia limited liability company, and that b
limited liability company, the foregoing b
MfYN6*04 and sealed with its
Witness my. hand
2003.
N
My Commission
T W and W at KHNC, LLC, a
Georgia limited liability company
[ ;;Sctal
O
Adul*
Cottng4Statc,
re me this day aud�
d W at KHNC, LLC, a
en and as the act of the
ed in its name by its
tWe dayof APIUC�
ON FOLLOWING PAGE]

I1�IUI MININaIIVIIIII�M IN � ; 5 or NO3a:,,oM
[CONTINUED FROM PRECEDING PAGE]
EJdyn Clkjjon an4 Nam Csraham 2
The foregoing Certificate(s) of Wotartes iC-is/am
certified to he correct. This instrument and this certificate are duly registered ( e date
and time and in the Book and Page shown on the first page hereof. \
BARBARA M. GRAY
REGISTER OF DEEDS FOR DARE CO
Bjodnin6 \ TM4
Deputy/Awiskmt Register of Deeds
O

EXHIBIT A
LECAL DESCRIPTION
FOR
LOT 1, RECOMBINATION OF PORTIONS OF PREVIOUSLY PLATTED LOTS
A PORTION OF KITTY HAWK WOODS,
A NORTH CAROLINA GENERAL PARTNERSHIP - COMMERCIAL
ATLANTIC TOWNSHIP, DARE COUNTY
KITTY HAWK, NORTH CAROLMA
BEGINNING at an existing rebar located in the southern i ht-of-ray
Of U.S. 159, said rebar located N70-09-45E, 55.00 fe t from an
existing Control Corner rebar having North Carol'n Grid
Coordinates (NAD '27) of Y = 270,710.076 and X = 2,
said Control Corner being further located 562-54-25 98 1 0 and
from North Carolina Geodetic Survey monument "Cross Azimu 0 eet
thence with the southern right -of -ray of U.SQ38,0-o9 E,
40.36 feet to an existing PK nail;
thence leaving the right -of -ray of U.5. 138 and.lot line of Lots 1 and 2, Shoreside Center,interior
calls: ��nine (9)
519-50-15E, 291.11 feet to an existin K nai
570-09-45W, 30.82 feet to anoisting
ai ,
519-30-13E, 75.00 feet to an P ai ,
570-09-45W, 32.00 feet to an P nail,
519-30-15E, 599.66 feet to a
N70-09-45E, 8.91 feet to a p
519-50-15E, 124.00 feet to ag r ar,
570-09-45W, 334.50 feet to aar,
519-53-22E, 497.70 feet to abar, a common corner
with John T. Lancaster, Inc..M. Shaver,111, Inc.:
turning, thence with th a of Lancaster and Shaver, the
following three (3) calls:
561-20-16W, 52.92 feet n e is ing rebar,
561-20-16W, 17.83 fee n xi ing rebar,
560-56-27W, 192.17 fe t e 'sting rebar, a common corner
with Lancaster and Sh er, th own of Kitty Hark, and Kitty
Hark Estates; O
thence with the line o i Estates the following three (3)
calls:
N19-53-22W, 84 9 fe to an existing rebar,
N46-48-29W, 64 0 feet o an existing rebar,
N19-07-5}S) 21 2 fe to an existing rebar in the southern
right-o Y+ ro- 1
thence wit �F( so h right-of-way of U.S. 138, N70-09-45E,
81.38 fe to an istt rebar, being the northwest corner of Dare
County A v ge Control Board;
� IIIIIIIBIIII �IIIII�III�III1NII6gIIII �°,0t;;,,,pK

1AlIIIIIIIIIIIIIIII IIIIIIIIII III Vllull °¢a :!17.1 12:4vn
thence turning and with the line of Dare County yygphol Qppllrage
Control Board, S19-52-15E, 202.11 feet to an existing rei,ar, said
rebar having North Carolina Crid Coordinates (NAD '27) of Y =
870,248.560 and X = 2,967,914.410;
thence N70-09-45E, 250.05 feet to an existing 1" open pipe, a
common corner with Eckard Land Holding, Inc., and Dare County
Alcohol Beverage Control Board;
thence N70-09-45E, 99.85 feet to an existing 1" open pip a common
corner with William P. Davis and Eckard Land Holding, 1 c ;
thence with the lines of Billy Roughton and Davi 0- 45E,
449.94 feet to an existing rebar;
thence with the line of Roughton the following call
N70-10-14E, 9.38 feet to an existing rebar
with a curve to the left, having a radius o 4 00 f an arc
length of 71.23 feet and a chord of N25-31-1 feet to
an existing rebar,
N19-50-15W, 157.11 feet to an existinZIn
the point of BEGINNING, containing 18.25 nown as Lot 1
as shown on a plat by StroQ.a
A., entitled
"Recombination of Portions of Pre, A Portion of
Kitty Hawk Woods, A North Cral Partnership -
Commercial," dated September 8,d platrecorded in
Plat Cabinet C, Slide166 A - C,ublic Registry.

I�IIIppIIpII01��llpalll�llll�lll�I�II DAMM 012
4:41M
LEGAL DESCRIPTION FOR
LOT 2, RECOMBINATION OF PORTIONS OF PREVIOUSLYrI:m'TEO'L't1T3,
A PORTION OF KITTY HAWK WOODS,
A NORTH CAROLINA GENERAL PARTNERSHIP - COMMERCIAL
ATLANTIC TOWNSHIP, DARE COUNTY, KITTY HAWK, NORTH CAROLINA
BEGINNING at an existing rebar located in the southern right-of-way
of U.S. 138, said rebar located N70-09-43E, 35.00 feet from an
existing Control Corner rebar having North Carolina Grid
Coordinates (MAD '27) of Y = 870,710.076 and X =
2,968,598.140 and said Control Corner being further loca a 562-54-
25W, 1,265.90 feet from North Carolina Geodetic Survey nument
"Cross Azimuth;"
thence with the southern right-of-way of U.S. 158, E,
40.36' to an existing PK nail, THE TRUE POINT OF NINC;
thence continuing with the southern right-of-way f U. 58,-
09-45E, 40.18 feet to an existing rebar, a co corne ith Lot
2 and Lot 3, Shoreside Center;
thence leaving the right-of-way of U.S. 15 , d it t line of
Lot 3, the following three(3) calls:
S19-50-15E, 189.94 feet to an existin ebar,
S66-06-16E, 23.52 feet to an existing at,
N70-09-45E, 229.00 feet to an e s ng a common corner
with Kitty Hawk Woods, A Nort�lina oral Partnership
property and Lot 2;
thence with the line of Kitty Haw oods Part ership the following
three (3) calls;
S19-50-ISE, 340.16 feet to an a 'n ar,
N70-09-45E, 15.00 feet to an exi 'n ar,
S19-50-15E, 244.00 feet to an existing rebar, a common corner
with John T. Lancaster, ln4`. nd Paul F.M. Shaver,111, Inc.;
thence with the line of Lancas
(14) calls:
S70-09-45W, 246.73 fe
S40-48-34W, 107.22 fe
S19-50-15E, 400.00 f�
S70-09-45W, 104FQ0 fe
S19-50-ISE, 19 0 e
disturbed,
S70-09-45W, 100.0a
N19-50-15W, 195 0 e
S70-09-45W, 11 0 fey
S19-53-22E, 20 25 fe,
N70-06-3 19 fe,
S19-53- 00. 0
S70-06 3 W 0
S19-53 , 2 ee,
561-j13- W, 74.2 f e
with La c s roman Shavo.
Shaver the following fourteen
; to e"ting concrete monument,
Ma
isting rebar,
isting rebar,
xisting concrete monument,
x!sting concrete monument,
'So a point,
o an existing concrete monument,
an existing concrete monument,
to an existing concrete monument,
to an existing concrete monument,
to an existing concrete monument,
to an existing concrete monument,
to an existing rebar,
to an existing rebar, a common corner
and Lot 1, Shoreside Center;

INIIIIIIIIIIIIIIIIIIIn�IIRRIBII1IIII "f nl, "Alm
thence with the interior lot line of Lots 1 andai.''the Col Towing
nine (9) calls:
N19-53-22W, 497.70 feet to an existing rebar,
N70-09-45E, 334.50 feet to an existing rebar,
N19-50-15W, 124.00 feet to a point,
S70-09-45W, 8.81 feet to a point,
N19-50-15W, 599.66 feet to an existing PK nail,
N70-09-45E, 32.00 feet to an existing PK nail,
N19-50-15W, 73.00 feet to an existing PK nail,
N70-09-45E, 50.92 feet to an existing PK nail,
N19-50-15W, 291.11 feet to an existing PK all
in the o thern
right-of-way of U.S. 158,
being the TRUE POINT OF BEGINNING, containing 8.19 es an o n
as Lot 2 as shown on a plat by Stroud Engineeri entit e
'Recombination of Portions of Previously Platted ts, rtio f
Kitty Hawk Woods, A North Carolina Gene, Partn ship -
Commercial,- dated September 8, 1992, and sai t r rded in
Plat Cabinet C. Slide 166 A - C. Dare County Pub 'c stry.
O

70
11 „Y� M WWII R M IR YI �IIE IY ICI 0'I @ .( 1341P11
Exhibit B
Permitted Encumbrances
L Taxes for the year 2003 and thereafter.
2. Building restriction lines, easements and any other facts as shown onNefrom
recorded in Plat Cabinet C,_Sl_idesA62F.md-.162G and Plat Cabin
a66A-C, Dare County Registry.
3. Restrictive covenants, conditions and easements (deleti restrictions indicating any preference, limitation or discrimi color, religion, sex, handicap, familial status or national o " ') recor
827„page_869; Book 974,;page-94; and Book�999;= e' 07, D e County
°Registry (Lots 1 and 2).� - "-1.
4. Easement/Right of Way in favor of Virginia Electri owe pan orded
in Book-17, page 255; Book 44, page 22; and Boo 96, page 1 ; Dare County
Registry (Lot 1 only).
5. Easement/Right of Way in favor of V is Electti Power Company doing
business in North Carolina as North Tina Power ed in Botik'862; Page
580; Dare County Registry (Lots 1 an 2
6. Rights of others in and to the non-exclusi si t easement for ingress
and egress easement as set forth in Deed recur ook 662;.page .225 and as
shown on Plat recorded in C ' et C;: Slides'116A-E, Due County Registry (Lot
I only).
7. Deed of Easement/Right of W e n Kitty Hawk Building and Supply
of North Carolina, Inc., reco -- k 8 page'895 and as shown on plat
recorded in Cabinet C, Slid s 66 County Registry (Lot I only).
S. Transmission Link ach e t e ent with Virginia Electric and Power
Company in Book 828,' a 12, unty Registry (Lot 1 only).
9. Right of Way Agr a rec eam Book 763, page 350, Dare County Registry
(Lot 1 only).
10. Deed ent a oreside Associates Limited Partnership and Billy
G. R ton c ed r ok:974, page 99, Daze County Registry (Lot l only).
11. s in a the waters of any small pond, retaining pond or other
t e 'c ins or traverses the land (Lots I and 2).

II1IIIIIIIII0IA,IIAIf1IIW11111IIIIHI111I11I111P. U�fM13
AIM
12. Reciprocal Easement Agreement dated September 14, 2001, by and between
Home Depot U.S.A., Inc., and Billy G. Rougbton and Mildred H. Roughton,
recorded September 20, 2001, in Book.13921Page 80; Dare County Registry, re-
recorded in Book,1402, Page 336, aforesaid records.
13. Memorandum of Lease by and between Sboreside Associates Limited
Partnership, Nash -Finch Company and Seamark Enterprises, Inc., reorded in
Book 911-, page.73,:Dare County Registry (Lot 2 only).
14. Right of Way Agreement from Home Depot U.S.A., Inc. in
Electric and Power Company doing business in North Carc
North Carolina Power, dated April 2, 2002, recorded. in. Boo;
Dare County Registry.
15. Consent Agreement between McDonald's Corporation
Inc., dated August 31, 2001, recorded in Book_1435,
Registry. /
Rights of tenants, as tenants only.
Any and all matters created by, thm
Grantee.
All survey matters set forth on the AL
Nancy Herman -Thompson, L-3165 of 1
Deed restrictions set forth in Exhibit C.
omissions of
N Land)T�e Survey prepared by
dated p 119, 2003.

IIIIIIIUIVII11111111Elul IUlllIll ulul1101 °"°p°1.fa3.,°a
Exhibit C
Deed Restrictions
1. Grantor, as lessee under that certain Lease by and between Billy G.
Roughton and Mildred H. Roughton (the "Lease'), as evidenced by that certain
Memorandum of Lease dated April 3, 2002, recorded on April 5, 2002 in Deed Book
1422, page 380, Register of Deeds, Daze County, North Carolina, hereby a rves for
itself and its successors and assigns, the rights under the Reciprocal Access ent by
and between Grantor and Billy G. Roughton and Mildred H. Roughton dated Sdptbcr
14, 2001, recorded September 20, 2001 in Deed Book 1392, Page 80,
Dare County, North Carolina ("REA') for the benefit of the adjacent p r
particularly described in the REA (the "Adjacent Parcel''
and G here wvenan
that the casement areas, driveways, accessways and related rov on t e
Property shall not be relocated without Grantor's prior written t. The regoing
real covenant runs with the land, and the parties so intend the fore 1 o enant to
run with the land.
2. Grantor may cause the relocation and ent a Wes roost,
driveway on the Property providing access to No Croa 'ghwa S. Route 158)
as generally shown on the Entrance RelocatioPdreali
rep e & Associates,
P.C. dated February 15, 2002 and last re .ch 27 and Grantee shall
cooperate with Grantor in such relocatio n and in procuring any
approvals therefore and shall execute such ion r ed to accomplish such
relocation and realignment.
3. Grantor, as conveyor of the Properg�antec. as purchaser of the
Property, hereby covenant and aer that no improvement erected or to be erected on the
Property, nor any other portion of a petty, shall be used for a home: improvement
center or for any business which sells, ' , leases, rents or distributes the following
items or materials, singly or in any com ' : lumber, hardware, tools, plumbing
supplies, pool.supphes, electrical u h par allpaper and other wallcoverings,
window treatments, kitchen or ba o r components thereof (including tubs,
sinks, faucets, mirrors, cabinets, s ow , v ' es, countertops and related hardware),
windows, hard and soft ring o r ering, siding, coiling fans, gardening and
garden nurserysupplies, c' an na plants, outdoor cooking equipment and
accessories, patio frmitur an r cessories, Christmas trees, indoor and outdoor
lighting systems and li es, a and unfinished and finished furniture, kitchen
and household appiian s closet zmg systems, pictures or picture framing, interior
design services or orb r roducts a orally sold in a retail home improvement center,
except for th riy'd f items. An "incidental sale of such items" is one in
which there o or er of (i) five percent (5%) of the total floor area of
such busin ') uare feet of sales and/or display area, relating to such items

I��I�IWCII�W�YI III WIUIIIII III�IQ�III� 05JNI 01�t":.I"
The foregoing real covenant shall be enforceable by Grantor as the holder of a leasehold
estate or other interest in the Adjacent Parcel, and shall run with the land and benefit such
interest in the Adjacent Parcel and shall burden the Property. The parties so intend the
foregoing real covenant to run with the land and the covenant touches and concerns both
the dominant and servient estates. In addition, the foregoing restrictive covenant shall
constitute an equitable servitude and shall be for the benefit of Grantor, its successors,
affiliates, and assigns. Grantor may enforce the foregoing restrictive covenant as a real
covenant or an equitable servitude against Grantee, its successors, tenants, o assigns.
The duration of the real covenant created hereby shall be co -extensive with rm of
the Lease, including any extensions and amendments thereto. The duration o the
equitable servitude created hereby shall be the maximum allowed and o ltrla
law but in no event shall the duration be shorter than the term of the Dine u y�
extensions and amendments thereto.
Grantor and Grantee acknowledge and agree that the restri nt& set fo in this
Paragraph 3 shall not apply to a lease agreement executed prior to d (a "Pre -
Existing Lease') to the extent that such Pre -Existing e i e ows such
restricted use; provided that Grantee, its successors and as ' o e t nsent
to any assignment, modification or amendment of an re -Exist g Lease, or any
subletting, license or similar agreement under any Pre-Exi ti Lease t the extent that
Grantee has a consent right to such matters) an matters) as ' t, modification,
amendment, subletting, license or similar a t would a result in any use of
such portion of the Property for any of the for ing restrict es. Any expansion of or
modification to premises under a Pre-Existin a shall be b ect to the restrictions of
this Paragraph 3, unless the expansion or mo ' tion is p t to a present right in a
Pro -Existing Lease.
4. The foregoing restric ' e covenants and equitable servitude set forth in this
Exhibit shall be binding upon ee, ' successors, and assigns as the Owners of the
Property and shall remain in effect anrceable for the maximum period of time
permitted by applicable law. To the tent-l"41GRrace, its successors, or assigns shall
sell, lease, assign, transfer or oth s an ' terest in the Property or a portion of
the Property, they shall impose n s r, tenant, or assign the foregoing
restrictions set forth in this Exhi t did 16 oing restrictions shall be binding upon
Grantee, its tenants, suce sirs
n��0

Reviewer: CC'
North Carolina Department of Environment and
Natural Resources seoma.
NC®EP1R Request for Express Permit Review Time:
Confirm,
FILL-IN all the information below and CHECK the Permit(s) you are requesting for express review. Call and Email the completed form to the
Permit Coordinator along with a completed DETAILED narrative, site plan (Pi file) and vicinity map (same items expected in the application
package of the project location. Please include this form in the application package.
• Asheville Region -Alison Davidson 828.296-4698;alison.davidson(a)ncdenr.gov
• Fayetteville or Raleigh Region -David Lee 919-791-4203; david.lee(&,ncdenr.gov
• Mooresville & Winston Salem Region - Patrick Grogan 704-235.2107 or patrick.arogan(7a ncdenr.aov
• Washington Region -Lyn Hardison 252-948-3842 or Iyn.hardison(7g ncdenr.r1ov
• Wilmington Region -Janet Russell 910-796.7307or janet.russell(dncdenr.gov
• Wilmington Region -Cameron Weaver 910-796.7421 or cameron.weaveroncdenr.gov
NOTE: Project application received after 12 noon will be stamped in the following work day.
Permits of Request
SW 7910903
SW _
SW_
SW _
SW
Project Name: WALMART, KITTY HAWKM NC - STORE #2000-05 County: DARE Applicant: THOMAS W. WHEELER, JR - PRESIDENT Company: TW & W AT KHNC, LLC a.n R ES
Address: 1960 SATELLITE BOULEVARD, SUITE 1300 City: DULUTH, State: GA Zip: 30097-_ JUL 19 2011
Phone: [phone], Fax: [phone], Email: [e-mail]
Physical Localion:5400 NORTH CROATAN HIGHWAY, KITTY HAWK, NC NC DENR
Project Drains into DOES NOT DRAIN TO KITTY HAWK B waters — Water classification HYDROGRAPHY. SC (for classification see-
http://h2o.enr.state.nc.us/bims/reports/reportsWB.html)
Project Located in PASQUOTAN River Basin. Is project draining to class ORW waters? NO, within Y2 mile and draining to class SA waters NO or within 1
mile and draining to class HQW waters? No
Engineer/Consultant: MATT EDWARDS Company: KIMLEY-HORN & ASSOCIATES. INC.
Address: 2000 SOUTH BOULEVARD SUITE 440 City: CHARLOTTE, State: NC Zip: 28203
Phone: [phone], Fax: [phone], Email: [e-mail]
SECTION ONE: REQUESTING A SCOPING MEETING ONLY
❑ Scoping Meeting ONLY ❑ DWQ, ❑ DCM, ❑ DLR, ❑ OTHER:
SECTION TWO: CHECK ONLY THE PROGRAM (S) YOU ARE REQUESTING FOR EXPRESS PERMITTING
❑ 401 Unit ❑ Stream Origin Determination: _ # of stream calls — Please attach TOPO map marking the areas in questions
❑ Intermittent/Perennial Determination: _ # of stream calls — Please attach TOPO map marking the areas in questions
❑ 401 Water Quality Certification ❑ Isolated Wetland ( linear ft o r acres)
❑ Riparian Buffer Authorization ❑ Minor Variance ❑ Major General Variance
® State Stormwater ❑ General ❑ SFR, ❑ SFR < 1 ac. ❑ Bkhd & Bt Rmp, ❑ Clear & Grub, ❑ Utility ❑ Other
❑ Low Density ❑ Low Density -Curb & Gutter _ # Curb Outlet Swales ❑ Off -site [SW _ (Provide permit #)]
❑ High Density -Detention Pond _ # Treatment Systems ® High Density -Infiltration 1 #Treatment Systems
❑ High Density -Bio-Retention _ # Treatment Systems ❑ High Density —SW Wetlands _ # Treatment Systems
❑ High Density -Other _ # Treatment Systems / ❑ MOD:❑ Major ❑ Minor ❑ Plan Revision ❑ Redev. Exclusion SW (Provide permit#)
❑ Coastal Management ❑ Excavation & Fill ❑ Bridges & Culverts ❑ Structures Information
❑ Upland Development ❑ Marina Development ❑ Urban Waterfront
❑ Land Quality
❑ Erosion and Sedimentation Control Plan with _ acres to be disturbed.(CK # (for DENR use))
SECTION THREE — PLEASE CHECK ALL THAT IS APPLICABLE TO YOUR PROJECT (for both scooing and express meeting request)
Wetlands on Site ❑ Yes ® No
Wetlands Delineation has been completed: ❑ Yes ® No
US ACOE Approval of Delineation completed: ❑ Yes ® No
Received from US ACOE ❑ Yes ® No
DI3NR use
Fee Sol it for multiple Dermits: (Check # 9i o 8.2- 1 l
Buffer Impacts: ® No ❑ YES: ac re(s)
Isolated wetland on Property ❑ Yes'® No
404 Application in Process w/ US ACOE: ❑ Yes ® No Permit
Total Firm Amnunl
SUBMITTAL DATES
Fee
SUBMITTAL DATES
Fee
CAMA
$
Variance ([IMal: ElMin)
$
SW (❑ HD, ❑ LD, ❑ Gen)
$ lE.�,E,h
407:
$
LQS
$
Stream Deter,_
$
NCDENR EXPRESS June 2011

STORMWATER SUBMITTAL REQUIREMENTS
WET DETENTION POND
I. Objective
A. Collect all runoff from all BUA (proposed and/or existing and/or offsite) as the case may be,
by any means including piping or swales, and direct it to the pond.
B. Check the proposed pond design to make sure it meets or exceeds the minimum design
criteria for surface area, volume and drawdown.
IL What makes up a complete wet detention pond application package?
A. Two sets of sealed, signed & dated layout & grading plans with appropriate details.
(Additional sets of plans may be requested for projects in certain counties)
B. Completed application with supplement(s), SWU-101, SW401-Wet Pond, and inspection and
maintenance agreements.
C. Deed restriction document, if applicable (for subdivisions & projects with out parcels)
D. Sealed, signed & dated calculations.
E. Estimated seasonal high water table elevation at all pond locations.
F. Chlorides test results must be provided if the project is within '/z mile of SR waters (Phase II).
(This is only required to test out of SR water treatment requirements)
III. BIMS entry (for DWQ use only)
Enter & track application acknowledged date, review date, add info requested/received dates, permit
issue dates, and drainage area info. Best done after the add info letter is written and before sending
permit up for signature.
IV. Shell documents (for DWQ use only)
Permit shells: s:\wqs\stormwater\shells\highcompond
s:\wqs\stormwater\shelis\highsubpond
s:\wqs\stormwater\shells\HDhybrid
Spreadsheet: s:\wqs\stormwater\excel spreadsheets\pond
VI. Review Procedure
A. APPLICATION
1 Y An original signature is required. Photocopied signatures cannot be accepted.
2. A completed wet detention pond supplement and a signed, dated and notarized wet
detention pond Inspection and Maintenance Agreement with an original signature.
3. The numbers on the supplement match up to the numbers used in the calculations and
shown on the plan details.
4. Built -upon areas are reported in square feet in Section 111.6.
5. Receiving stream name and classification. This is important because in the non -Phase
II counties, a wet pond cannot be used on a project that is within''/2 mile of and draining
to SA waters. For Phase 11, a wet pond is allowed within '/z mile of SA waters.
6. Section 111.6 is filled in -cannot be left blank. One column must be filled in for each
proposed wet pond.
7. If the applicant is a corporation, partnership or LLC, look it up on the Secretary of State
Corporations Database. Make sure corporation is spelled correctly (capitalization and
punctuation matter) and that the person signing the application is at least a vice-
president in the corporation, a General Partner in the partnership, a member in a
member -managed LLC, or the manager of a manager -managed LLC. Need
documentation to support if the Articles of Incorporation do not list the members or
managers of the LLC. If an agent signs, then a letter of authorization is needed from the
president, vice president, general partner, member or manager.
8. For subdivided projects, a signed and notarized deed restriction statement must be
provided.
APP�i4�n

Wet Detention Pond, cant.
B. CALCULATIONS
1. The orifice is sized based on drawing down the calculated minimum volume in 2-5
days. The average head to use in the orifice equation is approximately one-third of
the distance between the permanent pool elevation (PPE) and the elevation of the
next available outlet above the permanent pool. The elevation of the next available
outlet must be either the elevation where the minimum volume is provided, or it can
be higher. The temporary pool elevation (TPE) to report on the supplement will be
the elevation of the next available outlet above the PPE. The temporary pool volume
(TPV) to report on the supplement is the volume between the specified PPE and the
TPE.
2. For Phase II projects that are within'/ mile of and draining to SR waters, the
difference in runoff from the predevelopment and post -development conditions for
the 1 year 24 hour storm must be controlled and treated.
3. For Phase II projects, the discharge rate leaving the pond can be no more than the
pre -development discharge rate for the 1 year 24 hour storm.
4. For Phase II projects draining to SA water, no discharge to surface waters may occur
from wet ponds. The discharge leaving the orifice must be effectively infiltrated prior to
reaching surface waters.
5. The average pond depth is the permanent pool volume divided by the permanent pool
surface area. The result must be between 3 ft. and 7.5 ft. Parts of the pond can be
deeper than 7.5 ft., but in no case can any part of the pond be less than 3 ft deep.
6. If the 85% TSS chart is used a 30' vegetated filter must be provided at the outlet of the
pond. If the 90% TSS chart is used, no filter is required.
7. Use the correct SA/DA TSS chart from the BMP Manual noting that there are different
charts for different areas of the State.
8. Required surface area at permanent pool.
9. Provided surface area at permanent pool (Based on pond dimensions)
10. Required volume calculation based on 1.5" storm for Phase II projects* and 1" storm for
all others projects. *unless the project is Phase II and within '/2 mile of and draining to
SR waters then the volume calculation must be based on difference between the pre
and post development conditions for the 1-yr 24-hr storm.
11. Table of elevations, areas, incremental volumes and accumulated volumes for overall
pond and for forebay, to verify volumes provided.
12. Forebay designed to hold 20% of the permanent pool volume. (Range of 18%-22%
OK.)
13. Non -erosive flow for 10 yr. storm in the vegetated filter, if using 85% TSS.
14. The seasonal high water table must be at or below the proposed permanent pool
elevation to assure that the necessary volume will be available above the permanent
pool.
15. Rounding numbers off during the calculation process can result in deficiencies. Do not
round the numbers until you get to the final result.
16. An additional one foot must be excavated below the bottom elevation of the pond. The 1
foot sediment accumulation depth is not included in the average depth calculation.

Wet Detention Pond, cont.
C. PLANS- Due to storage space constraints, plan sheets should be kept to a minimum. For
small commercial single wet pond projects, the plan set could consist of only 2 or 3 sheets,
layout, grading and details. For larger projects, show as much information as possible on as
few sheets as possible, without cluttering them up.
1. Development/Project Name
2. Engineer name and firm.
3. Legend
4. North Arrow
5. Location Map with nearest intersection of two major roads shown. Major road is any 1,
2, or 3 digit NC, US or interstate highway.
6. Scale- standard engineering scale, no off-the-wall stuff.
7. Date
B. Revision number and date, if applicable.
9. Original contours, proposed contours, spot elevations, finished floor elevations, pipe
inverts, swale inverts, etc.
10. Existing drainage (piping, swales, ditches, ponds, etc.), including off -site. Include a map
delineating the offsite drainage areas.
11. Property/Project boundary lines, bearing & distances.
12. Mean High Water Line or Normal High Water Line, if applicable.
13. The permanent pool elevation must be above the SHWT and above the lowest
elevation of adjacent wetlands. Evaluate the need for a liner and/or berm/slurry wall to
prevent dewatering the wetland.
14. Drainage easement widths, pipe sizes and swale inverts are provided.
15. Wetlands delineated, or a note on the plans that none exist. Get a copy of the wetlands
delineation map signed by the Corps of Engineers, or have the applicant include a copy
of the unsigned delineation map submitted to the Corps. Wet ponds may not be located
in wetlands unless a permit to fill those wetlands has been obtained.
16. Details for the roads, parking, cul-de-sacs, including sidewalk width, radii, dimensions &
slopes.
17. Apartment / Condo development- Provide a typical building footprint with dimensions
and note all concrete and wood deck areas.
18. The drainage area for each wet pond is clearly delineated and numbered to match up to
the calculations and supplement. Drainage area delineation is best done as a separate
plan sheet.
19. A pond section detail to include the forebay, a 10 foot wide vegetated shelf, pertinent
elevations for the bottom, permanent pool, temporary pool, and SHWT, 3:1 slopes
above the permanent pool, and the weir elevation between the main pond and the
forebay.
20. The 10 vegetated shelf extends 6" below and 6" above the permanent pool elevation.
21. An outlet structure detail showing a trash rack with <_6" square openings, the necessary
orifice invert elevation (i.e., the permanent pool), orifice size and temporary pool
elevation.
22. Dimensions for each line and arc formed by the permanent pool contour.
23, Where the 85% TSS chart was used, a 30 ft. vegetated filter strip is required to be
shown on the plans & detailed (elevations, inverts, slopes, and flow spreader
mechanism). Please note that the filter strip is not a ditch.
24. A forebay is provided for each inlet and located so as to prevent short-circuiting.
25. The pond must have a minimum 1.5:1 length to width ratio and a minimum 3:1 flow path
length. Artificial "baffles" of timber, vinyl, or earth can be used to create a longer flow
path. The top elevation of the baffle should be set at the temporary pool elevation or
higher.
26. A Vegetation plan is specified for the pond, including slopes. Wetlands species are
listed for planting on the 10:1 shelf. Weeping Love Grass is not suitable as a permanent
vegetated cover for pond slopes.
27. All roof drainage must be directed to the pond. Show the roof drain collection lines on
the plan. This is necessary for projects where the buildings back up the property lines
where roof drainage may leave the site prior to going through the pond.

W� fzo c�Pi
i'
DWQ USE ONLY
Date Received
I Fee Paid
Permit Number
5
6WActL ID/S/oq
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality SEP 2 9 2008
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forni may be photocopied for use as an original
I. GENERAL INFORMATION
1. Applicants name (specify the name of the corporation, individual, etc. who owns the project):
7w;5, Ca ,:�NWff. ,GC
2. Print Owner/Signing Official's name and title (person legally responsible for facility and compliance):
77!© xrld S bt% IfVF(bZ C r= y J/Z.
3. Mailing Address for person listed in item 2 above:
City: / (�C (%I Ei State: 64 Zip: 50(5 9-5
Phone: Fax: i 7-7- O ) SC9/7
4. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
SW9Z76: CF.-Wi E /z SVZz -f XIA� r 7�Bl�D
5. Location of Project (street address):
55E8O tV, C-(?dk i A-W MX// C
City: /lr i%y W4 Kra County: 7>A Z E
6. Directions to project (from nearest major intersection):
7. Latitude: 0 1" N Longitude: " W of project
8. Contact person who can answer questions about the project:
Name: C/t Telephone Number:
Email: QCtf e@et4ti-►eQyrMQ @ cf,Qv&✓.HN-6—
II. PERMIT INFORMATION:
1. Specify whether project is (check one):
❑New 2 ewa] 2<odification
Form SWU-101 Version 03.27.08 Page 1 of

2. If this application is being submitted as the result of a renewal or modification to an existing permit, list th
.existing permit number 5', &74 44� l Cf7E-P and its issue date (if known) // /Z �� /
Lti /i. C C,c
3. Specify the type of project (check one): f=d h/Ct=-
❑Low Density ❑High Density Redevelop ❑General Permit ❑Universal SMP ❑Other
4. 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):
❑CAMA Major ❑Sedimentation/Erasion Control 7404/401 Permit ❑NPDES Stormwater
III. PROJECT INFORMATION
1. In the space provided below, summarize how stormwater will be treated. Also attach a detailed narrative
(one to two pages) describing stormwater management for the project.
1TeC1 (?Fh FZL6t'6T Exis7'/xrG' i�f�C-�dre7/r Sr F42G-S is C»✓y�'YEJ�
-b exl�T/J�' -Vf� i �d7tl� rlrriT�F �`)r/s7''iXIS' D�SC,6���z6t'
2. Stormwater runoff from this pro�jec�dra�ins to the River basin. �UO_IAAf<_/
3. Total Property Area: ZG acres 4. Total Wetlands Area: �� %� acres
5. 100' Wide Strip of Wetland Area: acres (not applicable if no wetlands exist on site)
6. Total Project Area*": = Z acres 7. Project Built Upon Area: 3 %
8. How many drainage areas does the project have? I
9. Complete the following information for each drainage area. If there are more than two drainage areas in the
project, attach an additional sheet with the information for each area provided in the same format as below.
For high density projects, com lete the table with one drainage area for each engineered stormwater device.
Basm Information (t. s"
y �r Drainage µArea-1
„ a" Dramage Area 2,"
Receiving Stream Name h/0X/
y/EQZCS /f/� may.
7A
Stream Class & Index No.
SC
Total Drainage Area (sf)
2
On -site Drainage Area (so
N
Off -site Drainage Area (sf)
Q —
pr/!GLlWf E , 1cE7t
Existing Impervious Area (sf)
'+ ,5 �j'G /
776
Proposed Impervious*Area (sf)
4 e (o.
% Impervious* Area (total)
Im` evrousSu ce Ar a
On -site Buildings (so
.krc�,: °Drama e Areavl 1`
3� g
° * t ?.
On -site Streets (so
On -site Parking (so
¢3:�Z713
On -site Sidewalks (sf)
Other on -site (sf)
Total (so:
96
' Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
"Total project area shall be calculated based on the current policy regarding inclusion of wetlands in the built upon area
percentage calculation. This is the area used to calculate percent project built upon area (BUA).
Form SWU-101 Version 03.27.08 Page 2 of 4

10. How was the off -site impervious area listed above derived?
IV. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
One of the following deed restrictions and protective covenants are required to be recorded for all subdivisions,
outparcels and future development prior to the sale of any lot. If lot sizes vary significantly, a table listing each lot
number, size and the allowable built -upon area for each lot must be provided as an attachment. Forms can be
downloaded from http://h2o.enr.state.nc.us/su/bmp forms.htm - deed restrictions.. . . .
Form DRPC-1
High Density Commercial Subdivisions
Form DRPC-2
High Density Developments with Outparcels
Form DRPC-3
High Density Residential Subdivisions
Form DRPC-4
Low Density Commercial Subdivisions
Form DRPC-5
Low Density Residential Subdivisions
Form DRPC-6
Low Density Residential Subdivisions with Curb Outlets
By your signature below, you certify that the recorded deed restrictions and protective covenants for this
project shall include all the applicable items required in the above form, 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 State, and that they will be recorded prior to the
sale of any lot.
V. SUPPLEMENT FORMS
The applicable state stormwater management permit supplement form(s) listed below must be submitted for each
BMP specified for this project. Contact the Stormwater and General Permits Unit at [phone] for the status
and availability of these forms. Forms can be downloaded from http://h2o.enr.state.nc.us/sufbmp forms.htm.
Form SW401-Low Density
Form SW401-Curb Outlet System
Form SW401-Off-Site System
Form SW401-Wet Detention Basin
Form SW401-Infiltration Basin
Form SW401-Infiltration Trench
Form SW401-Bioretention Cell
Form SW401-Level Spreader
Form SW401-Wetland
Form SW401-Grassed Swale
Form SW401-Sand Filter
Form SW401-Permeable Pavement
Low Density Supplement
Curb Outlet System Supplement
Off -Site System Supplement
Wet Detention Basin Supplement
Infiltration Basin Supplement
Underground Infiltration Trench Supplement
Bioretention Cell Supplement
Level Spreader/Filter Strip/Restored Riparian Buffer Supplement
Constructed Wetland Supplement
Grassed Swale Supplement
Sand Filter Supplement
Permeable Pavement Supplement
Form SWU-101 Version 03.27.08 Page 3 of 4

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. The complete application package should be
submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the
interactive online map at http:/ih2o.enr.state.nc.us/su/msi mans hum)
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original and one copy of the Stormwater Management Permit Application Form
=P_ _
• Original and one copy of the Deed Restrictions & Protective Covenants Form (if
N/0
required as per Part IV above)
• Original of the applicable Supplement Form(s) and O&M agreement(s) for each BMP
;9%G
• Permit application processing fee of $505 (Express: $4,000 for HD, $2,000 for LD)
payable to NCDENR
Z7jC
• Calculations & detailed narrative description of stormwater treatment/management
A11Q.
• Copy of any applicable soils report
Af/4
• Two copies of plans and specifications (sealed, signed & dated), including:
�$2
- Development/Project name
- Engineer and firm
-Legend
- North arrow
- Scale
- Revision number & date
- Mean high water line
- Dimensioned property/project boundary
- Location map with named streets or NCSR numbers
- Original contours, proposed contours, spot elevations, finished floor elevations
- Details of roads, drainage features, collection systems, and stormwater control measures
- Wetlands delineated, or a note on plans that none exist
- Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations
- Drainage areas delineated
- Vegetated buffers (where required)
VII. AGENT AUTHORIZATION
If you wish to designate authority to another individual or firm so that they may provide information on your
behalf, please complete this section. (ex. designing engineer or firm)
Designated agent (individual or firm): E4 L?t 2 CA-C r E'�F-
Mailing Address: .3046? M47Z% MS- /�'B!?r —r /7�1Z>
City:_ 'c"77Y ke4 VclA::- State: %'GC Zip: Z� % ¢ /7
Phone: ( Z�$�, 1 Z e Z /� Fax:
Email: CQ N /C nPuG r Q v-(_e e' Kp�
VIII. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in General Information, item 2) 7~4-C IX/'- 4rroeF G C?
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 15A
NCAC 2H 1000
/ 9 Signature: a GC/ Date:F-Z _LT
Form SWU-101 Version 03.27.08 Page 4 of 4

Permit
(m be pmvid.d by DWO)
Red triangles at the upper right hand corner indicate design comments
Please complete the yellow shaded items.
SEP 2 9 2008
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This lone must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted elong with all of the required information.
Contact person Ralph D. Calf", PE - --
Phone number (252) 2024025
Date September 23, 2008
Drainage area number 1
I11DESIGNIINF-ORMAT 10IN
Site Characteristics
Drainage area 661 ft2 15.25 Ad tributary area from original stormwater management plar
Impervious area 597,861.00 ft2 15.25 Ad at 90% cover from original stonnwater mgt plan
%impervious 90.00 %
Design rainfall depth 1.00 in
Storage Volume: Non-SRWatem
Minimum volume required
Volume provided
Storage Volume: SR Waters
1-yr, 24-hr runoff depth
Pre -development 1-yr, 24-m runoff
Post -development l-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: l-yr, 24-hr stomt
Preulevelopment 1-yr, 24-hr peak flow
Post -development l-yr, 24-hr peak flow
PrelPost 1-yr, 24-hr peak flow control
Basin Elevations
Basin bottom elevation
Sediment deanout elevation
Bottom of shelf elevation
Permanent pool elevation
SHWT elevation
Top of shelf elevation
Temporary pool elevation
49,822.00 ft3
57,279.00 ft3
NIA in
NIA ft3
WA 113
0.00 ft3
WA 113
NIA
in
NIA
(unitless)
NIA
(drudges)
WA
Whir
NIA
ft3/sec
NIA
ft3/sec
0.00
031sec
-0.50 ft
0.63 ft
NIA it
4.00 ft
3.50 It
NIA ft
5.50 it
Assuming runoff coefficient 1.0 for all impervious surfaces
[OR
Farm SW401-Wel Detention Basin-Rei
Pam I. 81t. Design Summary, Page 1 of 2

Permit No
It. be pmvi0ed by Di
Volume and Surface Area Calculations
SAIDA ratio
0.053
(unitless)
From DWC/WaRO, 85%TSS removal, 30'veg filter req'd, 10131I97
Surface area at the bottom of shelf
WA
R2
Volume at the bottom of shelf
N/A
Yt3
Permanent pool, surface area required
35,207.00
f12
Permanent pool, surface area provided
35,269.00
ft2
OK
Permanent pool volume
87,511.00
ft3
Average depth for SAIDA tables
2.48
it
Above cleanout elevation, min of 3 it not required October, 1991
Surface area at the top of shelf
N/A
ft2
Volume at the top of shelf
N/A
U
Forebay volume
NIA
U.
Forebay %of permanent pad volume
0.00
%
Temporary pool, surface area provided
41,103.00
ft2
Drawdown Calculations
Treatment volume drawdown time
4.50
days
From orginal stormwater management plan, OK
Treatment volume discharge rate
8.84 GPM
Ms
Average
Pre -development 1-yr, 24-hrdischarge
WA
113rs
OK _
Post -development l-yr, 24-hr discharge
NIA
R31s
OK
Additional Information
Diameter of onfce
3 @ 2'
in
Design TSS removal
85
%
Basin side slopes
VARIES
:1
OK
Vegetated shelf slope
N/A
:1
OK
Vegetated shelf width
WA
it
OK
Length of ftowpath to width ratio
WA
:1
OK
Length to width ratio
N/A
:1
OK
Trash rack for overflow 8 orifice?
N
(Y or N)
OK, Not required October, 1991
Freeboard provided
1.50
ft
OK
Vegetated filter provided?
Y
(Y or N)
OK
Recorded drainage easement provided?
N/A
(Y or N)
OK, Not required October, 1991
Capures all runoff at ultimate build-0ut?
N
(Y or N)
OK, Not required October, 1991
Drain mechanism for maintenance or emergencies
N
Farm SW401-Wet Detention Basin-Rev.4
Peru I. a It. Design Summary, Page 2 of 2

"if. be pmvided by DWO)
Permit
r'
III. REQUIRED ITEMS CHECKLIST
Please indicate the page or plan sheet numbers where the supporting documentation can be found. An incomplete submittal package will
result in a request for additional information. This will delay final review and approval of the project. Initial in the space provided to
indicate the following design requirements have been met. If the applicant has designated an agent, the agent may initial below. If a
requirement has not been met, attach justification.
Pagel Plan
Initials Sheet No.
Mg*�— ALTA Survey
1. Plans (1' - 50' or larger) of the entire site showing:
Z)_ C-1 & C-2
2. Partial plan (1' = 30' or larger) and details for the wet detention basin showing:
,0,4@2 C-1 & C-2
3. Section view of the dry detention basin (1' = 20' or larger) showing:
NIA
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is
�Z 7_ C-1 & C-2
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and for
NIA
6. A construction sequence that shows how the wet detention basin will be protected from sediment
_ X
7. The supporting calculations.
X
B. A copy of the signed and notarized operation and maintenance (0&M) agreement.
NIA
9. A copy of the deed restrictions (if required).
NIA
10. A soils report that is based upon an actual field investigation, soil borings, and infiltration tests.
Form SW401-Wet Detention Basin-Rev.4 Parts I. & II. Design Summary, Page 1 of 1

W ATF9
WW
Mr. Thomas W. Wheeler, Jr
TW&W at KHNC, LLC
PO Box 957209
Duluth, GA 30095
Dear Mr. Wheeler:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen 11. Sullins, Director
Division of Water Quality
November 18, 2008
Subject: Stormwater Permit No. SW7910903 Modification
Shoreside Center
High Density Project
Dare County ,
The Washington Regional Office received a complete Stormwater Management Permit
Application for Shoreside Center on September 29, 2008. Staff review of the plans and
specifications has determined that the project, as proposed, will comply with the Stormwater
Regulations set forth in Title 15A NCAC 2H.1000. We are forwarding Permit No. SW7910903
Modification dated November 18, 2008, for the construction of the subject project.
This permit shall be effective from the date of issuance until November 18, 2018, shall void
Permit No. SW7910903 issued November 27, 1991, 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 upon written request within thirty (30) days
following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150B of the North Carolina General Statutes, and filed with the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714. Unless such
demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact Samir Dumpor, or me at [phone].
Sincerely,
AL1-- U
Al Hodge
Regional Supervisor
Surface Water Protection Section
AH/sd: J:\WPDATA\WQS\ State SW-SD\Permits —Wet Pond\SW7910903 Mod
cc: Ralph Calfee, PE, Calfee Engineering (3048 Martin's Point Rd., Kitty Hawk, NC
27949)
Dare County Building Inspections
shington Regional Office
Central Files
North Carolina Division of Water Quality Internet. www ncwatergualitv.ore 7�7One 1.
943 Washington Square Mall Phone [phone] V orthCar011na
Washington, NC 27889 Fax [phone] Natl/r lly
An Equal OpportunitylAffrmative Action Employer- 50%Recycled110% Post Consumer Paper !4 K !i �/

State Stormwater Management Systems
Permit No. SW7910903 Mod
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
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
TW&W at KHNC, LLC
Shoreside Center
Dare County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with
the provisions of 15A NCAC 2H .1000 (hereafter 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 Water
Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until November 18, 2018, 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 on page 3 of this permit, the Project Data Sheet. The
stormwater control has been designed to handle the runoff from 597,861 square
feet of impervious area. This pond must be operated with a vegetated filter.
3. The tract will be limited to the amount of built -upon area indicated on page 3 of
this permit, and per approved plans.
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 runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7910903 Mod
6. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, acres:
b. Total Impervious Surfaces, ft2:
C. Pond Depth, feet:
d. TSS removal efficiency:
e. Permanent Pool Elevation, FMSL:
f. Required Permanent Pool Surface Area, ft2:
g. Provided Permanent Pool Surface Area, ft2:
h. Permanent Pool Volume, ft3:
i. Temporary Storage Elevation, FMSL:
j. Required Storage Volume, ft3:
k. Provided Storage Volume, ft3:
I. Controlling Orifice:
M. Receiving Stream/River Basin:
n. Stream Index Number:
o. Classification of Water Body:
11. SCHEDULE OF COMPLIANCE
15.25 (664,290 s.f.)
597,861
4.50
85%
4.00
35,207
35,269
87,511
5.50
49,822
57,279
3@2"0 pipe
Kitty Hawk Bay / Pasquotank
30-19
"SC"
1. 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.
2. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
3. The permittee shall at all times provide the operation and maintenance
necessary to assure the permitted stormwater system functions 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 slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, flow
spreader, catch basins and piping.
g. Access to the outlet structure must be available at all times.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7910903 Mod
4. Records of maintenance activities must be kept and made available upon
request to authorized personnel of DWQ. The records will indicate the date,
activity, name of person performing the work and what actions were taken.
5. the facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with
the conditions of this permit, the approved plans and specifications, and other
supporting data.
6. 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. A
modification may be required for those deviations.
7. 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.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
9. 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 any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease 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.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plans and specifications shall be maintained on file by
the Permittee at all times.
12. 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.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7910903 Mod
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division of Water Quality,
accompanied by a completed name/ownership change form, documentation
from the parties involved, and other supporting materials as may be appropriate.
The approval of this request will be considered on its merits and may or may not
be approved. The permittee is responsible for compliance with all permit
conditions until such time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
3. 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) having jurisdiction.
4. 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.
5. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
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. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division any name, ownership or mailing address
changes within 30 days.
10. This permit shall be effective from the date of issuance until November 18, 2018.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee.
Permit issued this the 18th day of November, 2008.
N RTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
4 1w-e-
for
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7910903 Modification
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7910903 Mod
Shoreside Center
Stormwater Permit No. SW7910903 Modification
Dare County
Designer's Certification
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 is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW7910903 Mod
Certification Requirements:
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 outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass 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 surface area and/or volume have been
provided.
.12. Required drawdown devices are correctly sized per the approved plans.
.13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Washington Regional Office
Dare County Building Inspections
Page 7 of 7

North Carolina Secretary of State
http: //ww w. secretary.state. nc. us/corporations/Corp. aspx?P itemld=5640036
CORPORATIONS
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Corporation Names
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NC T Wand W Legal
at KHNC, LLC
Limited Liability Company Information
SOSID:
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Duration:
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Office Address
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Mailing
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Address:
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Address:
0672564
Current -Active
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Foreign
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Perpetual
CT Corporation System
150 Fayetteville St., Box
1011
Raleigh NC 27101
150 Fayetteville St., Box
1011
Raleigh NC 27101
3525 Mall Blvd., Suite
5AA
Duluth GA 30096
P O Box 957209
Duluth GA 30195
1 of 1 11 / 17/2008 4:10 PM

�r�i .t, 1. �.'.� ,I �. tv✓
4 t^ rrnn<sa. .
.''.fl.�C'h1•. :74 �'.bta
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I Af 11 i L':•' i i I- I .,,

CALFEE ENGINEERING
MECHANICAL • CIVIL • STRUCTURAL • CONSTRUCTION MANAGEMENT
September 25, 2008 1"" h: C
�"'', tc,. ,.r'm IaJ E SidY
Mr. Scott Vinson, P.E.
NC DENR / DWQ
943 Washington Square Mall
Washington, NC 27889
T
Dear Scott:
SEP 2 9 2008
UINO-Ill�AR0
Shoreside Center, Kitty Hawk, Dare County,
Stormwater Pond Under Letter of
Determination of Compliance; Change of
Ownership Application and Permit
Application
Attached please find a check payable to NCDENR in the amount of
$505.00 and 3 sets of the following submittal documents:
1. Coastal Stormwater Permit Name/Ownership Change Form; executed,
2. Stormwater Management Permit Application Form and Agent
Authorization, executed,
3. Coastal Stormwater Permit Renewal Application Form, executed
4. Wet Detention Basin Operation and Maintenance Agreement, executed
and notarized,
5. Wet Detention Basin Supplement and Required Items Checklist,
6. Photocopy of Engineer's Certification of original construction
within substantial compliance and intent of the approved plans
and specifications,
7. Drawing C-1, Rev. 0, "As -built & Proposed Stormwater Pond Plan &
Profile", Calfee Engineering,
9. Drawing C-2, Rev. 0, "As -built & Proposed Stormwater Pond
Details", Calfee Engineering,
10. Drawing "ALTA/ACSM Land Title Survey, Lot 1 & 2, Shoreside
Center", Sheet 1 of 2, Rev. 3-12-06, Nancy Herman -Thompson, and
11. Drawing "ALTA/ACSM Land Title Survey, Lot 1 & 2, Shoreside
Center", Sheet 2 of 2, Rev. 3-12-06, Nancy Herman -Thompson.
These documents are provided to you to support T W & W at KHNC, LLC's
application to change the ownership of record of the Shoreside Center
Stormwater Basin to T W & W at KHNC, LLC, and to regularize the permit
status of the pond.
The pond was originally approved under a Letter of Determination of
Compliance issued November 27,.1991.
3048 MARTIN'S POINT RD., KITTY HAWK, NC 27949-3816
[phone] VOICE, 261-4025 FAX
[e-mail]

F9O61
� r
O r
SEP 2 9 2008
Michael F. Easle7, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W, Klimek, P.E. Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
COASTAL STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION: Sc/&Tz�Sr Gtt/Z
1. Stormwater Management Permit Number: /2��Q/
2. Permit Holder's name: C4PiirQ(- C&-v'rzE�- 1 c/i= LO?ME�vT� ZTD
3. Signing official's name: Title:
(person legally responsible for permit) C7�'
4. Mailing address: �{O2© WC5R''AW& Ailp 480 City: -Pk L6;7rcbr
State: fv ( ZipCode: Z4 6 0 Phone: FAX:
(Area Code and Number) (Area Code and Number)
II. NEW OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
ea. Change in ownership of the property/company (Please complete Items #2,
#3, and #4 below)
b. Name change of project (Please complete Item #5 below)
C. Mailing address change. (Please complete Item #4 below)
d. Other (please explain):
2. New owner's name to be put on permit: TW-4V 9T 1-c�(%C { L G C
3. New owner's signing official's name and title: 77. 1p ,r 5- KK' Gf�ElE6CE�y �e _
Title)
4. New Mailing Address: TO �8,- %5 7-26 City: PC1(-V7'W
State: ZipCode:.3604 5 Phone: ¢V6 - 4>°6/ FAX:( )
(Area Code and Number) (Area Cade and Number)
5. New Project Name to be placed on permit:-rl'&QZ5 6— 00V EZ
��n�w.�-rE-iZ ?oivr7
Page 1 of 2
North Carolina Division of Water Quality Internet: www.nc%vmcrnualirv.ore
943 Washington Square Mall Phone [phone]
Washington, NO 27889 Fax [phone]
NorthiCarolina
Naturally
An Equal Opportunity/Affirmative Action Employer— 50% Recyded/10% Post Consumer Paper

PERMIT NAME/OWNERSHIP CHANGE FORM
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF WATER
QUALITY UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED
WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed form.
2. Legal documentation of the transfer of ownership.
3. A copy of the recorded deed restrictions, if required by the permit.
4. The designer's certification, if required by the permit.
5. A signed Operation and Maintenance plan, if a system that requires maintenance will
change ownership.
6. Maintenance records.
CERTIFICATION MUST BE COMPLETED AND SIGNED BY BOTH THE CURRENT PERMIT
HOLDER AND THE NEW APPLICANT IN THE CASE OF A CHANGE OF OWNERSHIP.
FOR NAME CHANGES, COMPLETE AND SIGN ONLY THE CURRENT PERMITTEE'S
CERTIFICATION.
CurrentPermittee's Certification:
I attest that this application for a name/ownership
change has been reviewed and is accurate and complete to the best of my knowledge. I
understand that if, all required parts of this application are not completed and that if all required
supporting information and attachments are not included, this application package will be
returned as incomplete.
Signature:
Date:
New Applicant's Certification: (Must be completed for all transfers of ownership)
I, ? MdS tR' t�C/�Cl�x'G�� sfZ, attest that this application for an ownership
change has been reviewe—d and is accurate and complete to the best of my knowledge. I
understand that if all required parts of this application are not completed and that if all required
supporting information and attachments are not included, this application package will be
returned as incomplete.
Signature:_Z;27 Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION AND MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
North Carolina Department of Environment and Natural Resources
Division of Water Quality, SWP
943 Washinton Square Mall
Washington, NC 27889
Page 2 of 2

p
®eaua ®m
Post Office Box 549 Phone [phone]
101 Veterans Memorial Drive C ee RULE]I ,6, Fax [phone]
Kitty Hawk, NC 27949 11.1www.townofkitUhawk.org
apt
LETTER OF APPROVAL WITH CONDITIONS
June 17, 2008
TW & W at KHNC, LLC
Post Office Box 957209
Duluth, GA 30195
RE: Project Name: Harris Teeter/Shoreside Center
Submitted By: Eddie Valdivieso, Quible Engineering
Date Received: 5.28.08
Plan Type: Sediment and Erosion Control, Commercial
Permit Number: 5E-061708
To Whom It May Concern:
This office has reviewed the subject erosion and sedimentation control plan for
5400 N. Croatan Highway, PIN # 986720809279. This office finds the plan to be
acceptable and hereby issue this Letter of Approval with Conditions for land disturbing
activities on the portion of land outlined on the plan. The conditions for approval are
listed on the attached page. This plan approval shall expire three (3) years following
the date of approval, if no land -disturbing activity has been undertaken, as is required
by Title 15A NCAC 4B .0129 of the North Carolina Administrative Code.
Please be advised that Section 16-27 (b) of the Kitty Hawk Town Code requires
that a copy of the approved erosion control plan be on file at the job site. Also, you
should consider this letter to give the Notice required by G.S. 113A-61.1(a) of our right
of periodic inspection to insure compliance with the approved plan.
North Carolina's Sedimentation Pollution Control Program is performance -
oriented, requiring protection of existing natural resources and adjoining properties. If,
following the commencement of this project, it is determined that the erosion and
sedimentation control plan is inadequate to meet the requirements of the
Sedimentation Pollution Control Act of 1973 (North Carolina General Statute 113A-51
through 66), this office may require revisions to the plan and implementation of the
revisions to insure compliance with the Act.

Acceptance and approval of this plan is conditioned upon your compliance with
Federal and State water quality laws, regulations, and rules. In addition, local town or
county ordinances or rules may also apply to this land -disturbing activity. This approval
does not supersede any other permit or approval.
Please note that this approval is based in part on the accuracy of the information
provided in the Financial Responsibility Form, which you have provided. You are
requested to file an amended form if there is any change in the information
included on the form. In addition, it would be helpful if you notify this office of
the proposed starting date for this project. Please notify us if you plan to have a
pre -construction conference.
Your cooperation is appreciated.
Sincerely,
Joseph H. Heard, AICP
Director of Planning & Inspections
Enclosure: Conditions of Approval
Certificate of Approval

CONDITIONS OF APPROVAL
RE: Project Name: Harris Teeter/Shoreside Center
Submitted By: Eddie Valdivieso, Quible Engineering
Date Received: 5.28.08
Plan Type: Sediment and Erosion Control, Commercial
Permit Number: SE-061708
1. Within 30 working days of completion of any phase of grading, graded slopes and fill
areas will be planted or otherwise provided with ground covers, devices, or structures
sufficient to restrain erosion.
2. During the development of the site, the person conducting the land -disturbing
activity shall install and maintain all temporary and permanent erosion and
sedimentation control measures as required by the approved plan or any provision of
Chapter 16 of the Town of Kitty Hawk Town Code.
3. Approval is only for land disturbing activities for roads and utilities.
4. The applicant must complete a State Stormwater Change of Ownership form and a
Redevelopment permit applied for and issued by the Division of Water Quality (DWQ)
prior to a Certificate of Occupancy being issued. DWQ will require current
information on the depths within the wet pond system to be included with the
stormwater application package and notes on any plans to restore the design depths
before, during, or after the redevelopment construction phase.

S�910103
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
1. Stormwater Management Permft Number:
2. Project Name: :5'1fyye9Ws ssa
3. Current Permit Holder's ComDanv Name/(
4. Signing Official's Name:
••• :. i?/:R1�19i'r�5lR-'1�i�4'�Tri�3�i'��'
city: AA laf4 state: cg'A z. a,
Ot Fax: 98 It
II. PROPOSED PERMITTEE / OWNER / PROJECT I ADDRESS INFORMATION
This request is for: (please check alf that apply)
❑ Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ dame change of project (Please complete Item 5 below)
Change in ownership of the property/company (Please complete Items 1,.2, 3, and 4 below)
❑ Mailing address / phone number change. (Please complete Item 4 below)
❑ Other (please explain):
1. Proposed permittee's company name/organization:
2. Proposed permittee's signing official's name:
3. Proposed permittee's tide: 4f"e-
4. Mailing Address:Qo "e.e140t.
City: Z/"/ccfft State: —4;A-,_Zip:' ,30 O 9 A"
Phone: (140) _ ` 6 —1FSe ( Fax: (4401 - - gait
5. New Project Name to.be placed on permit:
Please check the appropriate box. The proposed permittee listed above is:
HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA .in#1 above and provide name of HOA/POA's authorized representative in #2 above)
vlThe property owner
Lessee (Attach a copy of the lease, agreement and complete Property Owner Information on
page 4)
❑ Purchaser (Attach a copy of the pending sales agreement Final approval of this transfer wig be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner information on page 4)
SSW N/O Change Rev24Sept2012 Page 1 of 4

111. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quadly (DWQ) unless all
listed Neins�maly result DrocesItems siina ded elays or d included
of hee ttrrsn�s[e Failure to provide the
2. Legal documentation of the property transfer to a new rf�� -' owne"�"'
3. A copy of any. recorded deed restnctions, covenants, or easements N required by the
4. The designer's certification (DWQ Engineer and Designer Certification Forms are.avaii able from
each DWQ Regional office), N required by the permit and N not already submitted to DWQ..
5. If the propos permtttee is a firm, partnership, association, Institution, corporation, limited Iiabidly
company, w other cotporete errtlty provide documenation showing the authorNy of the nomad
representative to acf on, behalf of the proposed permittee.
S. The $40.00 processing fee. If this 16 an initial transfer from the original ppeerrtiNtee the proceaing
fee is not required. Subsequent ownership transfers will require the $40.00 processing tee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please crack one of the following statements and rill out the cerNflcation below drat statement
❑ Check here if the current pemdtiee iss only changing hisiherAts name, the protect name, ormaf6gg
address, but wi/I retain thepermft.1, the current
permittee, hereby notify the DWQ thatI am c ng n my name a or am c gg ng m mallInp
address and/or I am changing the name of the permitted project. I further attest that this applfNiion
for a name/ownerehip Change is accurate and complete to the heat of my knowledge. I understand
that N all required parts of this application are not completed or if all required supporting information
and attachments listed above.are not Included, this application package will be returned as
[$"Check here Ncurrent pefrnfttee Is transfeaft the property to a new ownerand wfil not retain
ownersh of fhe permitt
1. nl gt .V-G ]VC. L LC' the current permittee, am subrri tftls application
for a transT oofowners p for pe—rmTi#— 03 . I hereby nptfiy DWQ of the sale or
other legal transfer of the stormwatersystam as at w this (rave pr ��
the most recent permit, the designer's certi ication for each BMP, a recorded deed restrictions py of
covenarita, or easements, the 1 approved plans and/or aooroved as built eleras. ttu; annrewrerl
further attest that this app
of my knowledge. I unden
required supporting inforn
package will be returned
proposed perniittes name
ownership cannot be appi
permit _—
Signature:
ice rec m% and the most recent DWQ
named in Sections II and V of ihts form. I
change is accurate and complete to the best
of this application are not completed or If ail
above are not included. thlie ennllfu nn
unless and until the faclRy is In
U�.
��. a (Votary Public for the State of
sa �_ County of C vJ4vcty M— do hereby certify that
Tv'" personally appeared before me fide the
_ day of !i1 .20 �15-- and acknowledge the due exec m of the
forgoing Instrument. Witness my hand and official seal, (Notary Seal)
SSW N/O Change Rev24SspM12 Page 2 of 4

V. PROPOSED PERMMME CERTIFICATION: (This section must he.complated by the
Proposed Penri for all transfers of ownership)
1, pa"f ree 1-to- , hereby notify the DWQ that I have aoqulred
through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted
stormwater management system, and, 9 applicable, constructing the permitted system, I
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
6most recent permit
designer's certification for each SMP
0 ,�riv recorded deed restrictions, covenants, or easements
4,th' e_ DWQ approved plans and/or approved as -built plans
7 �e approved operation and maintenance agreement
p'past maintenance reoords from the previous pennittee (where required)
TDWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit,, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed in the penalt and in the
operation and maintenance agreement I further, attest that this application for a namelowriership
change is accurate and complete to the best of my knowledge. I understand that it all required parts
of this appr'icallon are not completed or If all required supporting information and attachments listed
above are not IncludId,this applicptionfi�kage 0 tp returned as incomplete.
Signature: A w c ✓%n Data: '
1, U. LA ✓ a Notary Pride for the State of
County of. do hereby ceMy that
_ personally appeared before me this the
day of 204 and acknowledge the due axecuflon of the
forgoing instrument. Witness m land and official seal,
(Nff2ube, eoryU
Countylon ii pY 9507, 4016
Additional ies, of the original pert and the appi operation and Ma/ntenance agreement can
be obtained the appropriate Reggional Oflyce of the DMision of Water Quality.
ted
Including all
ocessIng
sent to t�@ag%p ateRegionalQshould be
be ho North the alb su porting documents �ed map. t feeIV
and Natural
A@SOUroe3, Dl
Please note that if the Proposers Permittee listed above is not the property owner, the properly owner
must cwFMIe and sign page d of this document Both the lessee /developer and the property
owner will appear on the pemdt as permlttees.
SSW NIO Change Rev24Sept2012 Page 3 of 4

VI. PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections Il and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name:
Organization:
Title within the Organization:
Street Address:
City:
State:
Zip:
Mailing Address:
(ff different from street address)
City: State: Zip:
Phone:
Fax:
Email:
I certify that I own the property Identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections 11 and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWO Stormwater permit. As the property owner, It is my responsibility to notify
DWQ by submitting a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS)143-215.1, and may result in appropriate enforcement action Including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner
County of
Date:
a Notary Public for the State of
do hereby certify that
personally appeared before me this the
day of . 20_, and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
Notary Signature
SSW N/O Change Rev24Sept2012 Page 4 of 4
(Notary Seal)

Moore, Bill
From: Ralph Calfee <[e-mail]>
Sent: Thursday, July 16, 2015 9:15 AM
To: Moore, Bill
Cc: [e-mail]; 'Thomas W. Wheeler, Jr.'; 'Lois Mittiga'; 'Dj Adams'
Subject: SW7910903 Shoreside Center Stormwater Permit Change of Ownership Request
Attachments: 07004_15Shoreside5tormPermitModSW7910909,8-4-1l.pdf; 07004_
16ShoresideStormPermitS W7910903 Desig nCert07-2012.pdf;
PeachtreeShoresideStormPermitS W7910903OwnerTra nsferApp7-14-15.pdf;
Peachtree5horesideDareCOParcelDescr7-9-15.pdf
Bill,
Attached please find PDF file format copies of documents supporting Stormwater Permit SW7910903 application for
Change of Ownership of Shoreside Shopping Center, Kitty Hawk, NC 27949:
1. Copy of SW7910903 Permit Modification issued August 4, 2011.
2. Copy of SW7910903 Permit Designer's Certification issued by B. Mathew Cox, PE 031446, about July, 2012. Please
note that there have been no subsequent changes or modifications of the system, and the system is fully functional and is
operating normally.
3. State Stormwater Permit Name/Ownership Change Form completed by the Seller and the Buyer. Note that the
Owner's representative for the Seller is Thomas W. Wheeler, Jr, Manager of TW&W at KHNC LLC, and the Buyer's
representative is Thomas W. Wheeler, Jr, Executive Vice President of the General Partner which is the Manager of
Peachtree Shoreside LLC.
4. Copy of Dare County website Parcel Descriptions for Peachtree Shoreside LLC Parcels #027566058 and #027566059,
which together make up Shoreside Shopping Center. The Parcel Descriptions document the Shopping Center transfer
06/22/2015 from TW&W to Peachtree Shoreside LLC by Deed Book and Page 2028/0729 in the Dare County Registry of
Deeds.
No fee is attached because this is an initial transfer. A site visit has been requested and is pending.
Thanks
Ralph

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• PARCEL DA"I'A $HEhT
• BUILDING PHOTOS
• TAx. BiL
• TAx CERTIFICA770N
Parcel: 027566059
PIN: 986720900357
Location: 540o A-K N CROATAN HWY
District: [o8] KITTY HAWK
Subdiv: [K5oo] KITTY HAWK BEACH -
COMMERCIAL
Lot -Block -Sect: LOT: 2A BLK: SEC:
Multiple Lots: -
Living Units: o
Plat -Cab -Slide: PL: H SL: 303
Status: ACTIVE
Owner: PEACHTREE SHORESIDE LLC
Owner:
Address: 3425 DULUTH PARK LN
DULUTH GA 3oo96
Ownership: PRIMARY - i00%
Nature of Ownership:
Deed Date: o6/22/2015
Bk/Pg:2028/0729
PUSE: [20oo] RETAIL
Billing Values
Next Year Values'
Land: 1,350,800
Land: 1,350,800
Building: 3,46i,too
Building: 3,461,ioo
Misc: 8.s.400
Mise: 8.C;Aoo
Total: 4,897,300
Total: 4,897,300
rrrrxrrrrr END OF RECORD rrrrrrrrrr
(data file last updated on 6/26/2015)
"Next year values on file as of 6/26/2015
Dare County Government
954 Marshall C Collins Dr
PO Box l000 Manteo NC 27954
Phone: [phone]
http://www.darenc.com/publicfraxingParceIRsits.asp?ParcelNumber-027566059 7/9/2015

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• PARCEI. DATA SHF.FT
• BUILDING PHaros
• TAX BILL
• TAX CERTIFICATION
Parcel: 027566o58
PIN:9867208o6122
Location: 5400 M N CROATAN HWY
District: [o8] KITTY HAWK
Subdiv: [K5oo] KITTY HAWK BEACH -
COMMERCIAL
Lot -Block -Sect: LOT: 1A BLK: SEC:
Multiple Lots: WALMART ETAL
Living Units: o
Plat -Cab -Slide: PL: H SL: 303
Status: ACTIVE
Owner: PEACHTREE SHORESIDE LLC
Owner:
Address: 3425 DULUTH PARK LN
DULUTH GA 30o96
Ownership: PRIMARY- t00%
Nature of Ownership:
Deed Date: o6/22/2015
Bk/Pg: 2028/0729
PUSE: [2000] RETAIL
Billing Values
Next Year Values*
Land: 2,177,200
Land: 2,177,200
Building: 5,747,900
Building: 5,747,900
Misc: 2o6.400
Misc: 2o6.400
Total: 8,131,500
Total: 8,131,500
NMNMNN#NNN END OF RECORD #NN#NNNNNN
(data file last updated on 6/26/2015)
*Next year values on file as of 6/26/2015
Dare County Government
954 Marshall C Collins Dr
PO Box l000 Manteo NC 27954 .
Phone: [phone]
http://www.darenc.com/public/TaxfngParceiRslts.asp?ParcelNwnber=027566059 7/9/2015

Mr. Scott Vinson, PE
September 25, 2008
The property subsequently changed hands twice prior to coming into
possession of the current owner. There is no evidence that the
original owner or any owners prior to the current owner performed any
maintenance on the system. No maintenance records have been found and
none are anticipated to be found. The most recent prior owner, The
Home Depot, is not anticipated to sign the Change of Ownership form.
Copy of the March 3, 2008, Engineer's Certification of construction of
the basin within substantial compliance and intent of the original
approved plans and specifications is attached. A current field survey
shows that the entire pond and overflow structure were constructed,
after adjusting for a change in reference elevation to NAVD `88, at a
higher elevation than shown on the drawings, but the pond
configuration and the depths of the permanent and flood pools, and the
overflow structure, are otherwise generally consistent with the
original approved plans and specifications. Slight adjustment of the
drawdown orifice elevations and the elevation of the crest of the
overflow weir as shown proposed on Drawings C-1 and C-2 provides
general consistency with the approved plans at an elevation
approximately 1 foot higher than shown on the original plans (the
elevation increase generally improves the quiescent condition of the
permanent pool, and prevents the drawdown orifices from performing as
a groundwater lowering system). The field survey data and reports
from the field survey crew suggests that some sedimentation of the
pond has occurred, but that the elevation of the pond bottom remains
below the 25% sedimentation elevation limit.
The discharge swale has become overgrown with natural maritime forest
vegetation, and requires maintenance clearing.
Please review and approve the application for Change of Ownership and
issue a current permit at your earliest opportunity. Please call me
at [phone] if you have any questions or if you require
additional information.
Sincere r
Ralph D. Calfee, P.E.
cc: Mr. Thomas Wheeler, Jr.
2

F. Michael F. Easley, Governer
William G. Ross, Jr., Secretary
SEP 2 9 2008 North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
COASTAL STORMWATER PERMIT RENEWAL APPLICATION FORM
I. CURRENT PERMIT INFORMATION:
�,E/d)rzG',S/�C GC'TrC'.� dr= !'7Er�1LatrtrdTRi�Y
1. Stormwater Management Permit Number: ®t-r ce rr�urnrcv ii/ice/Pi
2. Permit Holders name: 7W 7� I/V AT- cAr irC GG C
3. Signing official's name:77d6f4rh:z W(r<rrcEc��✓eTitle: P�F3 i7lT
(person legally responsible for permit)
4. Mailing address: Po 28 9 City; �Uc yTiV
State: _d ZipCode:3Do9S Phone:4K-48©/ FAX:(-I•4d) 1-?,7- 8S!/
(Area Code and Number) I (Area Code and Number)
5. Project Name:_ S',�lS�c-�7i'i✓ C`C�Vr�E� STo�T.rfryJer e e? �dt�d
6. Location of Project: (street address)_ S-gdo N C-d,d d ac/ h!WY Cry
7. Directions to Project (from nearest major intersection) U rwWro4R— (g
IL PERMIT INFORMATION
i . Specify the type of stormwater treatment (wet pond, infiftration, etc.): W& / 70^61! 2. List any Changes (from project that was originally approved, attach additional pages_ if needed)
7RA60<W(Zs, ecdez <:TcC-: r/A f <d-,A/ C��kliC, S
Do you have a copy of the original Operation and Maintenance Agreement? Yes_ o_
Applicant's Certification:
I, (print)^)r/(� Ix/ IfTl62-EGC--fZ J'/Z , certify that the information included on this
permit renewal application, is to the best of my knowledge, correct and complete.
Signature: Date: L�Z S- U
Submit this completed form along with an application fee of �s48 and a copy of the
designer's certification to the address listed below.
North Carolina Division of water Quality, 943 Washington Square Mall Phone (2521 Q46-Wl Customer Service "77E23E748
Washington Regional Office Washington, NC Z7889 FAX [phone] Internet h2o.encstate.no.us One
N�o�rthCarolina
An Eaual O000rtunitylAffirraEve Acton Emptover - 50% Recrded110% Post Consumer P3oer .1 UR%1 /i0I h!

u.: o t�rc �:7� 7©46286i5d CES SAL _NMEF - ... _... .. F�Gt 02/02
CEfiTIFICATIDN SEP 2 9 2008
I, J t (114, - E ' f 2n n -r 3 r , as a duly registered
Professional Engineer in the State of North Carolina, having been
authorized to observe (periodicall!ly weekly ull time) the construction
of the project, 5htyre-g tde rp, 4. .r—
(Project) 1 1
-1�(TT�'C�ato for the. no.0 TPc�dJ�oDM1tw�"�
(Locatio ) I (Project Owner_)
hereby state that, to the best of my abilities, due care and diligence
was used ir. 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.
Signature- tration No. r e- d.4 S9h,
`��ttto Uolllalll
Date O� O'S - Zod'�S ����� OAROIJ ,°04
;� Q• �5310� ';
4 $G �a = CE
�•
''%qM E. PE,��•

QIUIble
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
May 13, 2008
Mr. Scott Vinson
Surface Water Protection Section
PO. Drawer B70
Kitty Hawk NC 27949
Phone'. 252-261-3300
I'm 252-261-1260
PRINCIPALS
Sean C. Boyle. P.E.
Joseph S, Lassite[ C.E.P.
Ed.odo J. Voldlym, P.E.
�tShJi�J!u
^ "Katherine C. Marchello. P.L.S.
Division of Water Quality OGt9&WAR
North Carolina Department of Environment and Natural Resources
943 Washington Square Mall
Washington, NC 27889
Re: Shoreside Center VIA FEDERAL EXPRESS
5400 N. Croatan Highway
Kitty Hawk, Dare County, NC
Dear Mr. Vinson:
On January 8, 2008, in between "express" scoping meetings at your office for two other
projects, you and I briefly discussed a proposed Harris Teeter food store being
contemplated to replace an existing food store (SeaMark Foods) in the referenced
Shoreside Center, Kitty Hawk, Dare County, NC.
To the best of our knowledge, the shopping center was permitted sometime near the
end of 1991 and constructed in 1992.
The scope of the proposal, in general, was that the existing store and a couple of
adjacent retail shops would be completely demolished and a new store with a larger
footprint constructed thereon and immediate adjacent paved area. There would be no
net increase in built upon area between the existing and proposed layout. In addition,
there would be no new construction outside the current approved/existing built upon
boundary.
The purpose of my inquiry at that time was to seek your concurrence that since the
proposal would be, in essence, in compliance with the active stormwater approval then
no additional formal permitting action should be mandated.
While reserving your final decision pursuant to our submission and your subsequent
review of the proposed plan in comparison with the permitted plan, it was your opinion
that a formal stormwater permitting regime should not be necessary.
You graciously pulled the permit file for Shoreside Center and copied the compliance
letter for me records.

Scott Vinson
May 13, 2008
Page 2 of
Enclosed for your review and concurrence find:
A copy of the original NC Division of Environmental Management
"Determination of Compliance with Stormwater Regulations" letter dated
27 November 1991.
2. A copy of the original site plan and grading plan (sheets 1 & 2 of 5
respectfully) dated 09-16-91 with revisions thru 02-12-92 as prepared by
Stroud Engineering, PA. Note that the building area in question has been
highlighted for ease of understanding,
3. A copy an "Engineer's Certification", re -issued on 03-03-08, by the original
design engineer of record, William E. Fenner, Jr.
4. A copy an as -built survey entitled "ALTA/ACSM Land Title Survey; Lot 1 &
2, Shoreside Center" dated 01-08-04 with revisions thru 03-11-08 as
prepared by Nancy Herman -Thompson, PLS.
5. A copy of proposed civil/site development plans for the new Harris Teeter
food store. Plans sheets included: Cl Overall Plan
C2 Existing Site/Demolition Plan
C3 Site Plan
C4 Grading & Drainage Plan
Again, it is our position that the proposed work scope is in full compliance with the
current stormwater approval and no further action is required from NCDENR.
Please consider and contact with any questions or comments. Otherwise, we
respectfully request a written acknowledgment (letter or e-mail note) of no further
action.
Sincerely,
Quible & Associates, PC
Eduardo J. Valdivieso, PE
Vice President
cc: Bondurant Associates

03/07/2008 15:57 7046286164 CES SALES FENNER
PAGE 02/02
CERTIFICATION
E rQ�hv� er 3 r , as a duly registered
Professional Engineer in the State of North Carolina, having been
authorized to observe (periodically weekly ull time) the construction
of the project,
V%* � 4 C�d�ofor the (n0k( '�t���JeS ritaxC
(Locatio ) (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.
SignatureA ):&tration No-y 1,449V!n.
P`Qe�tauou�,rp��,
Date o'!S - zooms
-0 �SSIp
t� r
i4 $WA i�q

gigs- 3
State of North Carolina
Department of Environment, Health and Natural Resources
Northeastern Region
1424 Carolina Avenue, Washington, North Carolina 27889
James G. Martin, Governor Lorraine G. Shinn
William W. Cobey, Jr., Secretary Regional ;Manager
DIVISION OF ENVIRONMENTAL MANAGEMENT
November 27, 1991
Capital Centre Development, Ltd.
4020 Westchase Blvd., Suite 400
Raleigh, N.C. 27607
M�
SUBJECT: Determination of Compliance with Stormwater Regulations
Shoreside Center
Dare County
Dear Sir:
The Washington Regional Office received your Sedimentation and Erosion
Control Plan (or Stormwater Management Plan) submittal for the subject
project on November 7, 1991. Based upon our review of the project, the
document complies with the Stormwater Regulations set forth in Title 15
NCAC 2H .1000.
In order to assure that the proposed stormwater control facilities are
constructed properly, this Division will require an engineer's
certification upon completion of the project. The attached
certification should be submitted within 60 days after completion of the
facilities.
If you have any questions concerning this matter, please contact Bill
Moore at [phone].
Sincerely,
A,
Roger K. sThorpe, P.E.
Water Quality Regional Supervisor
cc: Bill Mills
Stroud Engineering
P.O. lloa 1507, Washington, I brth Carolina 2713591507 Telephone 919-94Cr6481 F K 919-975-3716
\n Fnual Onnnrmniry Affinnarve Action F.mMover

sty:
4._
Brief E+planationi
NET DETENTION POND
I. Yes No The design storage is for the runoff from all surfaces resulting from 1-inch of rainfall and is located ibr..e
permanent pool.
The permanent pool is designed for 35% TSS removal,
The runoff completely draws down to the permanent pool in 2 to 5 days,
The mean depth is ) 3 feet,
The inlet structure is designed to minimise turbulence and short circuiting.
All overflow and discharge flows through a vegetative filter at least 30 feet in length.
A swale is used to provide even distribution of runoff over the length of the vegetative filter.
The slope and width of the vegetative filter provides r.on-erosive flow for the 10-year 24-hr -tun with a I9-h
intensity.
The first 30 feet of the vegetative filter has a slope of 51 or less.
The vegetative filter is natural, grassed or artificially planted wetland vegetation.
Infiltration swales are used where practicable for pretreatment of runoff.
An appropriate operation and maintenance plan has been provided for the system.
THIS PROJECT MEETS THE STORMNATER CONTROL REAOIREMENTS OF IS NCAC 2H , Igl, li), .), M , and +!: 'For yes, !
through 12 must all be circled yes).
Brief Explanation; See Narrative
m
;Attach additional sheets if necessary,)
DIVISION OF ENPIRONMENTAL MANAGEMENT SIGN -OFF
Regional Office
Datp indi,idual Evaluating Form f;Plans
Gat ueoiorial Water Dual Supervisor ; i