SW5130201_CURRENT PERMIT_20130405

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

I'
A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality_ _
Pat McCrory Charles Wakild, RE _John E. Skvarla, III
Governor Director �� - Secretary
March 12, 2013 1� APR 5 2013
�u
Wal-Mart Real Estate Business Trust _--
c/o Mr. Steve Mitchael ,
2001 SE 10th St., Mail Stop 5570�� - e
Bentonville, AR 72716-5570
Subject: Stormwater Permit No. SW5130201- Administrative Permit Correction
Bailey Walmart #5163-00
High Density Commercial Wet Pond Project
Nash County
Dear Mr. Mitchael:
it was brought to the Division's attention that the subject permit, originally issued March 5, 2013, had an error
in the store number that was shown on the application. Please find enclosed the corrected permit and 0&M
Agreement. The original permit conditions are unchanged.
If you have any questions, or need additional information concerning this matter, please contact Robert
Patterson at [phone]; or [e-mail].
Sincerely,
for Charles Wakild, P.E., Director
cc: SW5130201 File
ec: Chris Bailey- Bailey Associates, Inc.
Matthew A. Edwards, PE - Kimley-Horn & Associates, Inc.
Danny Smith - Raleigh Regional Office
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone]
lnlerrmet: www.ncwaterquality.org
An Equal Oppc0oily 1 Affirmative Action Employer
NorthCarolina
Naturally

State Stormwater Permit
Permit No.SW5130201
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
Wal-Mart Real Estate Business Trust
Bailey Walmart #5163-00
12077 Oak Ave., Bailey, Nash County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with
the provisions of 15A NCAC 02H .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 March 5, 2021, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 74,923 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.7
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.
6. An undisturbed riparian buffer must be provided 50 feet landward of all surface
waters.
Page 1 of 6

State Stormwater Permit
Permit No.SW5130201
7. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a.
Drainage Area, aSres:
2.21
Onsite, ft :
96,268
Offsite ft2:
0
b.
Total Impervioys Surfaces, ft2:
74,923
Buildings ft :
11,855
Roads/Parking, ft2:
63,068
Other, ft2.
0
Offsite, ft�:
0
C.
Pond Avg. Depth, feet:
3.0
d.
TSS removal efficiency:
90%
e.
Design Storm, inches:
1.0
f.
Permanent Pool Elevation, FMS�:
252.0
g.
Permitted Surface Area @PP ft .
5,286
h.
Permitted Storage Volume, ft�:
6,165 at temporary pool
i.
Storage Elevation, FMSL:
252.9
j.
Controlling Orifice:
1.5" 0 pipe
k.
Permanent Pool Volume, ft3:
15,838
I.
Forebay Volume, ft3:
3,019
m.
Receiving Stream/River Basin:
Camp Branch 1 Neuse
n.
Stream Index Number:
27-86-3-7-1
o.
Classification of Water Body:
"C; NSW"
II. SCHEDULE OF COMPLIANCE
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.
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 stormwater treatment system shall be constructed in accordance with the
approved plans and specifications, the conditions of this permit, and with other
supporting data.
Page 2 of 6

State Stormwater Permit
Permit No.SW5130201
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 for a minimum of ten years from the date of the completion of
construction.
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 completed Name/Ownership Change form, to the Division of Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. The approval of this request will be considered on its merits and may or
may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
Page 3 of 6

State Stormwater Permit
Permit No.SW5130201
3. 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.
4. The issuance of this permit does not preclude the,Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The 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.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. 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.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2006-
246, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11.The permittee shall notify the Division of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12. The permittee shall submit a renewal request with all required forms and
documentation at least 180 days prior to the expiration date of this permit.
Permit issued this the 51h day of March, 2013,
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Page 4 of 6

State Stormwater Permit
Permit No.SW5130201
Bailey Walmart #5163-00
Stormwater Permit No. SW5130201
Nash 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 5 of 6

i
State Stormwater Permit
Permit No.SW5130201
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.
Please submit this Designer's Certification to:
Cc:
DWQ - Raleigh Regional Office
Surface Water Protection
3800 Barrett Drive
Raleigh, NC 27609
Nash County Building Inspections
Page 6 of 6
ti

Patterson, Robert
From:
[e-mail]
Sent:
Tuesday, March 12, 2013 12:20 PM
To:
Patterson, Robert
Cc:
[e-mail]
Subject:
Bailey Stormwater Permit No, SW5130201
Robert,
Per our phone conversations, we noticed that there was an error on the original application to NCDWQ. The Walmart
Store Number on the application does not match the Store Number on the Construction Plans. The correct Store
Number is 5163-00.
Please update the original permit and approval letter with the correct store number.
Thanks for your help and let us know if you need anything else.
Matthew A. Edwards, P.E.
Kimley-Horn and Associates, Inc.
Suite 440
2000 South Boulevard
Charlotte, NC 28203
Ph: 704-954-7493

Compliance Inspection Report
Permit: SW5130201 Effective:03/05/13 Expiration: 03/05/21
Project: Bailey Walmart #2573
Owner: Wal-Mart Real Estate Business Trust
County: Nash Adress: 12077 Oak Ave
Region: Raleigh
City/State/Zip: Bailey NC 27807
Contact Person: Michael Thomas Title: Dor of Project Design & Mgmt. Phone: [phone]
Directions to Project:
from us 264 take nc 581 (oak ave) exit She site is approx 450 ft southeast of the offramp of nc 581 (oak ave) and us 264
Type of Project: State Stormwater - HD - Detention Pond
Drain Areas: 001 - (Camp Branch (Bailey Branch)) (03-04-07) ( C;NSW)
On -Site Representative(s):
Related Permits:
Inspection Date: 12/041201H Entry Time: 10:40AM Exit Time: 10:55AM
Primary Inspector: Thaddeus W Valentine
Secondary Inspector(s):
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: State Stormwater
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
State Stormwater
(See attachment summary)
page: 1

Permit: 5W5130201 Owner - Project: Wal-Mart Real Estate Business Trust
Inspection Dale: 12104/2018 Inspection Type Compliance Evaluation
Reason for Visit:
Routine
Inspection Summary:
This project never started
File Review
Yes No NA NE
Is the permit active?
❑
❑ 0 ❑
Signed copy of the Engineer's certification is in the file?
❑
❑ ■ ❑
Signed copy of the Operation & Maintenance Agreement is in the file?
❑
❑ ❑
Copy of the recorded deed restrictions is in the file?
❑
❑ ❑
Comment: Not Started
Built Upon Area Yes No NA NE
Is the site i constructed as per the permit and approval plans? ❑ ❑ 0 ❑
Is the drainage area as per the permit and approved plans? ❑ ❑ ❑
Is the BUA (as permitted) graded such that the runoff drains to the system? ❑ ❑ 0 ❑
Comment: NOt Started
SW Measures Yes No NA NE
Are the SW measures constructed as per the approved plans? ❑ ❑ M ❑
Are the inlets located per the approved plans? ❑ ❑ 0 ❑
Are the outlet structures located per the approved plans? ❑ Elm ❑
Comment: NOt Started
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? ❑ 0 ❑ ❑
Are the SW i inspection and maintenance records complete and available for review or provided to ❑ 0 ❑ ❑
i upon request?
Comment: Not Started
Other Permit Conditions Yes No NA NE
Is the site compliant with other conditions of the permit? ❑ ❑ ❑
Comment: Not Started
Other WO Issues Yes No NA NE
Is the site compliant with other water quality issues as noted during the inspection? ❑ ❑ 0 ❑
Comment: Not Started
page: 2

DWQ USE ONLY
Dat V Received
Fee Paid
Permit Number
1 VI V
f
Applicable Rules: Cl Coastal SW - 1995 ❑ Coastal SW - 2008 h 11 - Post Construction
(seleel 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
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forte pray be photocopied for use as an original
L 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.):
Bailev Walmart #2573
2. Location of Project (street address):
12077 Oak Avenue
City:Bailey County:Nash Zip:27807
3. Directions to project (from nearest major intersection):
From US 264, take the NC 581 (Oak Ave) exit. The site is approxiamately 450 feet southeast of the offramp of
NC 581 (Oak Ave) and US 264.
-a-ol
s
4. Latitude: ° 47' 09" N. Longitude:78° 07' 01" W of the main entrance to the project.
II. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with rrrodifcalions also reflirires SWLI-702 - Rencuial Application Form
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* 'provide a designer's cerlificatiort
2. Specify the type of project (check one):
❑Low Density El-ligh Density ❑Drains to an Offsite Stormwater System ❑
3. If this application is being submitted as the result of a previously returned application or a I' er flo' "ID►NQ 1 ��
requesting a state stormwater management permit application, list the stormwater project r ir, r
assigned, N/A and the previous name of the project, if different than cOrehtly
proposed, NA
4, a, Additional Project Requirements (check applicable blanks; information on required state pe it can be
obtained by contacting the Customer Service Center at 1-877-623-6748): DENR ' '�ti , �T. w • r.• ,
�rtdS
❑LAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 4 ac of Disturbed Area
0404/401 Permit: Proposed Impacts
b.lf any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit: N/A
5. is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 20I2-200, Part Vl: litt�)://k)ortat,ncdciir.org/web/­wq/ws/sii/statesw/ruies laws
Form SWU-101 Version 06Aug2012 Page I of

III. CONTACT INFORMATION
].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:Wal-Mart Real Estate Business Trust c/o Steve Mitchael
Signing Official & Title:Design Director
b.Contact information for person listed in item 1a above:
Street Address:2001 SE 10th Street, Mail Stop 5570
City:Bentonville
Mailing Address (if applicable):See above
City:
S tate: A R
State:
Zip:72716-5570
Zip:
Phone: (479 ) 204-1195 Pax: (479 ) 204-0934
Enia i I:[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 ]])formation, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Bailey Associates, Inc
Signing Official & Title:Chris Bailey, President
b.Contact information for person listed in item 2a above:
Street Address:405 Western Blvd, Suite D
City:lacksonvil le State: NC Zip:28541
Mailing Address (if applicable):Same as above
City:
State:
Zip:
Phone: (910 ) 520-4676 Pax: (910 ^ ) 346-8637
I. mail:cwbaile,y BaileyAndAssociates.biz
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: Kimley- Horn & Associates, Inc
Signing Official & Title:Matthew A. Edwards Pro'ect Engineer
b.Contact information for person listed in item 3a above:
Mailing Address:2000 South Boulevard Suite 440
City:Charlotte
Sta te: N C
Phone: (704 ) 954-7493 Pax:
hmail:[e-mail]
4. Local jurisdiction for building permits: Nash Coun
Point of Contact:
Zip:28203
Phone #: [phone]
Form SWU-101 Version 06Aug2012 Page 2 of

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Al2roposed wet detention pond will treat runoff from the site.
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 I I - Post Construction
3. Stormwater runoff from this project drains to the Neuse River basin.
4. Total Property Area: 2.85 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`:2.85 acres
Total project area shall be calculated to exclude the foliowiu : the normal pool of impounded structures, the area
between the m banks of streams and rivers, [lie area below the Normal High Wither (NHW) lure or Mean High Water
(MHW) lute, and coastal wetlands landinard front the NHW (or MHVV) litre. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal ioethrmts landivard of the NHW (or MHW) line rimy
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 77.83 %
9. How many drainage areas does the project have?l (For high densil y count 1 for each proposed engineered
stormwater BMP. For low density and other projects, rise 1 for the Whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. if there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
Receiving Stream Name
Camp Branch
Stream Class *
QNSW
Stream Index Number *
27-86-3-7-1
Total Drainage Area (so
.1.2�_
7, gG A r- ,
q 2Gq-
On -site Drainage Area (so
_4214 582—
4 ZC 5�
� 1g
t-'WS
Off -site Drainage Area (so
0
Proposed Impervious Area**(so
74923
% Impervious Area** (total)
16(�"
g
Impervious- Surface Area
Draina e Area 1
Draina e Area _
Draina e Area _
Draina e Area _
On -site Buildings/ Lots (so
11,855
On -site Streets (so
63,068
On -site Parkin (so
0 oe
On -site Sidewalks (so
0
Other on -site (so
0
Future (sf)
0
Off -site (so
0
Existing BUA*** (so
0
Total (so:
74,923
* Strermt Class and Index Number can be determined at: http://pnrfrrl,rrcdcnr.or�ra�eb/ii»l[ps/csn/elassi cations
lut 7ervious area is drfned as the built upon area including, brrl nol litnited to, buildings, roads, parkingareas,
sitllewalks, gravel areas, etc.
Form SWU-101 Version 06Aug2012 Page 3 of

'Report only that anrowd of existing BUA that will remain after development. Do not report any existing BUA that
is to be rewoved and which will be replaced by neu, BL1A.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A
Projects in Union County: Contact DfYQ Cetural Office staff to check if the projecl is located irithin a Threatened cf
Endangered Species watershed that nray be subject to more siringent slor•nnrater requirements as per 15,4 r1'C4C 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 httr)://L)ortal.ncdenr.ore/web/wci/ws/su/bmv-manual.
VL 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://12ortal.ncdenr.org/web/wq/ws/su/statesw/forms_docs. 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 httl2://12ortal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item, All original documents M UST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/w2/ws/su/statesw/forms _dots.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form, 0AAE
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants &E
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M to
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to��
httl2:%/www.envheII2.org/L)ages/onestol2exi2ress.htmi 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 M
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the M
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/ Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
Form SWU-101 Version 06Aug2012 Page 4 of

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"x1l" copy of the NRCS County Soils map with the
project area dearly delineated. For projects with infiltration BM Ps, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Seltedule a site visit for DWQ to verify the SHWT' prior
to submittal, [phone])
10. A copy of the most current property deed. Deed book: 541, 2410, 2227, Page No: 44
125,591
11. For corporations and limited liability corporations (Ll_C): 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 1a, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
httR://www,secretary.state,nc.us/Cor2c)ratiotis/CSearch.a.-,Px
VI1. 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
httL)://portal.ncdenr.org/web/wq.Zws/su/statesw/fornis 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 Iisted
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.
Vill. 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:Matthew Edwards, P.E.
Consulting Firm: Kimley-I-lorn and Associates, Inc.
Mailing Address:2000 South 131vd Suite 440
City:Charlotte State:NC Zip:28203
Phone: [phone] Fax:
Ema i I:m a tt.ed wards@ki m 1 ey-horn. corn
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled oat, complete° this
Section)
1, (print or type mine of person listed in Contact Information, item 2a) Orris Baileit , certify that 1
own the property identified in this permit application, and thus give permission to (print or type name of person
listen iri Contact Information, item la) Steve Mildrael with (print or type trame of organization listed in
Contact Information, item lit)Wal-Mart Real hstalc Business Trust 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 S W U-101 Version 06A ug2012 Page 5 of 6

As the legal property owner 1 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 1 will be operating a stormwater treatment
facility without a val' ermit. 1 understand that the operation of a stormwater treatment facility without a valid
permit is a violati of e al Statue 143-215.1 and may result in appropriate enforcement action including
the assessment civi ena s up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date:7i
1, W 0. T �dS a Notary Public for the State of
gorty- County of
Ga NOV4 do hereby certify that UAr( Sk f:�J personally appeared
before me this 8441day of u t 13 ankno d ledge the ue�g ution of the I' tion for
a stormwater permit. Witness my hand and official seal,d ��/�
Z� NARY �Ns
Pula\-- 2
O
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires 3' o 1-1
I, (print or type game of person lister! in Contact Information, item 1a) Steve Mitchael
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 21-1 .1000 and any other applicable state stormwater requirements.
Signature: Date:
a Notary Public for the State of , County of
do hereby certify that
personally appeared
before me this _ day of , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAT.
My commission expires
Form SWU-101 Version 06Aug2012 Page 6 of 6

As the legal property owner l 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. 1 understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date:
[, a Notary Public for the State of , County of
do hereby certify that personally appeared
before me this_ day of , and acknowledge the clue execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Injhrin ation, item ]a) Steve Mitchael
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructs n nformance with the approved plans, that the required deed restrictions
and protective covenants will b9trecorde "'al i that t9 proposed project complies with the requirements of the
applicable stormwaterfrs ur 1eA 21 I 0 and any other applicable state stormwater requirements.
Date: 2 - I4
I, 14, (Y�i)�l"� V ?ry i a , a Notary Public for the State of A t-V-G i1SS , County of
do hereby certify that _111) I C_QQ-personally appeared
before me this 1L `L ay of r , ,9013 and ac Howled e the due execution of the application for
a stormwater permit. Witness my hand and official seal,
"NOTARY SEAL -
Kimberly Pruitt
State of Arkansas, A County Benton
Arty Commission Expires 1111/2015
SEAL
My commission expires I I A h -) 1
Form SWU-101 Version 06Aug2012 Page 6 of 6

Permit Number:-t/S'i30 L0/
(to he prorided by Di1'Q)
Drainage Area Number: t
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMI'. This maintenance record will be kept in a
log in a known set location. Any deficient IMP 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.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ❑ does not incorporate a vegetated filter at the outlet.
This system (check one):
❑ does ®does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
— Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
— No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
— Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
— If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
— Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month 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 should be kept in a known set
location and must 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 wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention 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.
Vegetation is too short or too
Maintain vegetation at a height of
long.
a) roxim tely six inches.
Form SW401-Wet Detention Basin ORM-Rev.4 Page 1 01'4

BM P element:
The inlet device:
Swale
The forebay
Permit Number: f 3 O Zn f
(to be provided by DfV )
Drainage Area Number: !
Potential vroblem:
pipe or I The pipe is clogged
The vegetated shelf
The main treatment area
The pipe is cracked or
otherwise damaged.
Erosion is occurring in the
Swale.
Sediment has accumulated to
a depth greater than the
original design depth for
sediment storage.
Erosion has occurred
Weeds are present.
Best professional practices
show that pruning is needed
to maintain optimal plant
health.
Plants are dead, diseased or
dying.
Weeds are present.
Sediment has accumulated to
a depth greater than the
original design sediment
storage depth.
Algal growth covers over
50% of the area.
Cattails, phragmites or other
invasive plants cover 50% of
the basin surface.
How I will remediate the probl
Unclog the pipe. Dispose of the
sediment off -site.
Replace the pipe.
Regrade the swale if necessary to
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
Search for the source of the
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.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
Prune according to best professional
practices
Determine the source of the
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
Search for the source of the
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.
Consult a professional to remove
and control the algal growth.
Remove the plants by wiping them
with pesticide (do not spray).
Form SW401-Wet Detention Basin O&M-Rev.4 Paget of

Permit Number: 56✓v£'l3V z.nl
(10 be proi,ided by Dtt'O)
Drainage Area Number: I
BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. Lf applicable)
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 local NC Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads 249.50 feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads 249.65 feet in the forebay, the sediment
shall be removed.
BASIN DIAGRAM
(fill in the blanks)
0 Permanent Pool Elevation 252.00
Sediment Removal . 249.65 Pe anen Pool
�7\ 1 Volume Sediment Removal Elevation 249.50 Volurne
Bottom Eievatior 248.65 -ft Min.
-------------------------------------------- 1---.--
Sediment Bottom Elevation 248.50 1-ft 4n.
Storage Sedrmen'
Storage
FOREBAY MAIN POND
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4

Permit Number: ✓S w s) 3 oZ di
(10 he provided by DI FQ)
I acknowledge and agree by my signature below that 1 am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ ofany
problems with the system or prior to any changes to the system or responsible party.
57163—c.D0 —gDP
Pi-gjecl name:13ailey Store 46+53-00
BA4P drainage area number: I
Print name:Steve Mitchael
Title:Design Director
Address:2001 SE 10" StrekCWntonville AR 72716
9
Phone:[phone]
Signature:
74
Date: 1+ `
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.
1, t a Notary Public for the State of
County of!R(2.,-)+o n do hereby certify that
personally appeared before me this
day of t 013 ,and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
"NOTARY SEAL"
Kimberly Pruitt
State of Arkansas, A County Benton
My Commission Expires 1111J2015
SEAL
My commission expires i 1 /I / f 0I
Form 5W401-Wet Detention Basin O&M-Rev.4 Page 4 of 4