SW7111109_CURRENT PERMIT_20111207

F;
STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW l ,Y,�
DOC TYPE
CURRENT PERMIT
APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

Beverly Eaves Perdue
Governor
Q
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
December 7, 2011
Mr. Robert W. Hargett, Managing Member
Rebkee Partners Satterfield, LLC
15871 City View Drive, Suite 300
Midlothian, VA 23113
Dear Mr. Hargett:
Dee Freeman
Secretary
Subject: Stormwater Permit No. SW7111109
Pet Smart (at Satterfield Landing Center)
High Density & Partial Redevelopment Wet Pond Retrofit Project
Dare County
The Washington Regional Office received a complete Stormwater Management Permit Application for
Pet Smart, located at Satterfield Landing Shopping Center on US 158, Nags Head, North Carolina, on
November 28, 2011. Staff review of the plans and specifications has determined that the project, as
proposed, will comply with the Stormwater Regulations set forth in Session Law 2008-211 and Title
15A NCAC 2H.1000. We are forwarding Permit No. SW7111109 dated December 7, 2011, for the
construction of the subject project.
This permit shall be effective from the date of issuance until December 7, 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 adtudicatory 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, P.O. Drawer
27447, Raleigh, NC 27611-7447. 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].
Sincerely,
AI Hodge
Regional Supervisor
Surface Water Protection Section
AH/ sv: K:\WQS\STORMWATER\PERMIT\SW7111109
cc: Michael Strader, PE — Quible & Associates, PC (ergo) )>
City of Nags Head Planning / Building Inspections /
David Moye, DCM - WaRO
,^ashington Regional Office
North Carolina Division of Water Quality Internet www.ncwaterquality.org One 943 Washington Square Mall Phone: [phone] FAX: [phone] i 1�rOit11C1COtl.] nc`l
Washington, NC 27689 FAX: [phone] Yatura!!�
An Equal Opportunity) Affrrmative Action Employer IZ Ll1

State Stormwater Management Systems
Permit No. SW7111109
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
Rebkee Partners Satterfield, LLC
Pet Smart
On US 158, City of Nags Head, Dare County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the
provisions of Session Law 2008-211 and 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 December 7, 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 43,591 square feet of new and redeveloped impervious area,
55,806 square feet of existing impervious area and 84,005 square feet of existing off -site
impervious area. The existing pond will be retrofitted with a small expansion of the pond
and will continue to draw down through infiltration with an overflow beyond the design
storm to a level spreader and trapezoidal flat bottomed grassed swale prior to runoff
leaving the property.
3. The tract will be limited to the amount of built -upon area indicated in Section I. 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. SW7111109
6. The built -upon areas associated with this project shall be located at least 50 feet
landward of all perennial and intermittent surface waters.
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, ftZ:
C. Design Storm, inches:
d. Pond Depth, feet:
e. TSS removal efficiency:
f. Permanent Pool Elevation, FMS�:
g. Permanent Pool Surface Areq, ft
h. Permitted Storage Volume, ft :
i. Temporary Storage Elevation, FMSL:
j. Predevelopment 1 year 24 hour:
k. Post development 1 year 24 hour:
I. Controlling Orifice:
M. Permitted Forebay Volume, ft':
n. Fountain Horsepower, HP
o. Receiving Stream/River Basin:
P. Stream Index Number:
q. Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
9.31
183,402
1.50
3.0 average
90%
7.54
78,793
98,760 at temporary pool el
8.70
0.84
0.10
(infiltration)
n/a
3/4 hp
Atlantic Ocean / Pasquotank
99 — (7)
"SB"
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 time 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 re -vegetation of slopes and the vegetated filter strip.
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, level spreader,
filter strip, catch basins and piping.
g. Access to the outlet structure must be available at all times.
4. Records of maintenance activities must be kept for each permitted BMP. The records
will indicate the date, activity, name of person performing the work and what actions were
taken.
Access to the stormwater facilities shall be maintained via appropriate easements at all
times.
6. Decorative spray fountains will be allowed in the stormwater treatment system, subject to
the following criteria:
a. The fountain must draw its water from less than 2' below the permanent pool
surface.
b. Separated units, where the nozzle, pump and intake are connected by tubing, may
be used only if they draw water from the surface in the deepest part of the pond.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7111109
c. The falling water from the fountain must be centered in the pond, away from the
shoreline.
d. The maximum horsepower for a fountain in this pond is 3/4 horsepower.
7. The facilities shall be constructed as shown on the approved plans. This permit shall
become void unless the facilities are constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
8. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, a certification must be received from an
appropriate designer for the system installed certifying that the permitted facility has
been installed in accordance with this permit, the approved plans and specifications, and
other supporting documentation. Any deviations from the approved plans and
specifications must be noted on the Certification. A modification may be required for
those deviations.
9. 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.
10. 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.
11. 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.
12. The permittee shall submit final site layout and grading plans for any permitted future
areas shown on the approved plans, prior to construction.
13. A copy of the approved plans and specifications shall be maintained on file by the
Permittee at all times.
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.
The permittee is responsible for compliance with all permit conditions until such time as
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7111109
the Division approves the transfer request.
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 2008-211, 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. This permit shall be effective from the date of issuance until December 7, 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 7th day of December, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
Division of Water Quality
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7111109
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7111109
Pet Smart
Stormwater Permit No. SW7111109
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. SW7111109
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
Nags Head Planning & Building Inspections
Page 7 of 7

State Stormwater Management Systems
Permit No. SW7111109
Pet Smart
Stormwater Permit No. SW7111109
Dare County
Designer's Certification
.00T 10 2012
1, K,V A4 1 W. 54roko.r,�r.,P.E. , as a duly registered ar s in the State of
North Carolina, having been authorized to observe periodically weekly/ full time) the
construction of the project,
Pek SmgrT �ok Sa 64er1r',�1a Lan�.n� Cen4er1
(Project)
for Re�okp P ParktNec•s SaNerl<.,I�a L uc (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
Noted deviations from approved.plans and specification:
Signature
Registr ion Numb r o3 ►B13
Date 1a/z2(zot2-
the Certificati
ROl,��i
C SE aL 9
=3:a 037813
.*GINE�e
78/2 2 f 2 012.
Page 6 of 7

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State Stormwater Management Systems
Permit No. SW7111109
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.
0
6.
The outlet structure is located per the approved plans.
7.
Trash rack is provided on the outletibypass structure.
/
t3.
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.*Pl,. 4s ,V,,kk be '�ns�hllo� Aer 4ppropr" .}e.
/ 15. The required system dimensions are provided per the approved plans.
Pen" e]cpa/nw�erA cssoc.c
cc: �NCDERR: D7NQ' shmgton-e`gionalOffice -QX'—"j•1'�^��—
Nags Head Planning & Building inspections
Page 7 of 7

7
TO
QVIBLE•& ASSOCIATES, P.C.
8 Juniper Trail
P.O. Drawer 870
KITTY HAWK. NC 27949
[phone] FAX [phone]
y
ILMUTEn @IF 4 e [ 93WOVIVII
DATE
l0 2012
)OB NO.
10 6S
ATTENTION
RE:
PE RT
pie?' ak Flo. SW -1 o
WE ARE SENDING YOU S Attached ❑ Under separate cover via the following items:
❑ Shop drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ® cEi2T1F cATIoa
COPIES
DATE
NO.
DESCRIPTION
I
ESl S.IER+ OEK F cATa - S OR whZE E � o. SW � �1\0
RECEIVED
n
VT 1 LV IL
DWQe
THESE ARE TRANSMITTED as checked below:
❑ For approval
For your use
❑ As requested
❑ For review and comment
❑ FORBIDS DUE
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
El
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
TH p�.{K Yayl
COPY TO clue �/
SIGNED:
/f enclosures are not as noted, kindly notify us at once.

��wi 4 ,, ... ,�
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' DWQ USE ONLY
ate eceive
Fee Paid C1C+4-- (t $
Permit Number
I
Zee0 m.� �tm
- N1 -1 I11I O
Applicable Rules: ❑ Coastal SW -1995 ❑Coasta SW - 2008 ❑ Ph II - Post Construction
(select all tlt rp � r�ENn-Coasta(SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
her WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
1. 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.):
2. Location of Project (street address):
2210 S. Croatan Hwy (US 158)
City:Nags Head County:Dare Zip:27959
3. Directions to project (from nearest major intersection):
Entrance to the property is located on the west side of US 158 approximately 400 lineal feet north of the
intersection of US 158 and Satterfield landing road
4. Latitude:35° 59' 23.3" N Longitude:75° 38' 56.5" W of the main entrance to the project.
it. PERMIT INFORMATION:
1.a.Specify whether project is (check one): ®New ❑Modification
6.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
certification
2. Specify the type of project (check one):
[]Low Density ®High Density NDrains 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, and the previous name of the project, if different than currently
proposed,
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
NSedimentation/Erosion Control: 2.0 ac of Disturbed Area
❑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:
Form SWU-101 Version 07Jun2010 Page I of

III. CONTACT INFORMATION
I. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the nroiect):
Applicant/Organization:Rebkee Partners Satterfield, LLC
Signing Official & Title:Robert W. Hargett - Managing Member
b.Contact information for person listed in item la above:
Street Address:15871 City View Drive, Suite 300
City:Midlothian State:VA Zip:23113
Mailing Address (if applicable):]5871 City View Drive, Suite 300
City: Midloth ian State:VA Zip:23113
Phone: (804 ) 419-0740
Email:
Fax: (804 ) 419-0759
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): Par+CAI Duner e§ SAzr. wv +re- Ee se mein+
- Property Owner/ Organ ization:Town of Nags Head
Signing Official & Title:Cliff Ogburn, Town Manager
b.Contact information for person listed in item 2a above:
Street Address:5401 S. Croatan Hwy.
City:Nags Head State:NC Zip:27959
Mailing Address (if applicable):same
Phone: (252 ) 441-5508 Ext. 2010 Fax:
Einail:[e-mail]
3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project:
Other Contact Person/ 0rganization:Quible & Associates, PC
Signing Official &'I'itle:Derek A. Dail, Design Engineer
b.Contact information for person listed in item 3a above:
Mailing Address
City:Kitty Hawk
Phone: (252 ) 261-3300
Email:
4. Local jurisdiction for building permits:
State:NC Zip:27949
Fax: (252 ) 261-1260
Point of Contact:Kelly Wyatt, Zoning Administrator Phone#: (252 ) 441-7016
Form SWU-101 Version 07Jun2010 Page 2 of 6

IV., PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be collected by descrete collection and conveyed to an existing wet detension basin located
at the rear of the Property
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
3. Stormwater runoff from this project drains to the Pasquotank River basin.
4. Total Property Area: 9.84 acres
5. Total Coastal Wetlands Area: acres
6. Total Surface Water Area: acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+:9.84 acres
Total project area shall be calculated to exclude the following: file nornwl pool of inipoimded structures, the area
between the banks of streams and rivers, the area below the Nornnal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands lmndivard from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal toetlauuds landward of the NHW (or MHW) line only
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 55 o
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
,stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each
area provided in the same format as below.
Basin Information
Drain e Area _
Drainage Area _
Drainage Area
Drainage Area _
Receiving Stream Name
Atlantic Ocean
Stream Class *
SB
Stream Index Number *
99-(7)
Total Drainage Area (so
405617
On -site Drainage Area (sf)
194003
Off -site Drainage Area (sf)
211614
Proposed Impervious Area**
sf
183402
% Impervious Area** total
45
Impervious- Surface Area
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
12757 \
On -site Streets (sf)
On -site Parking (so
27435
/
On -site Sidewalks (so
Other on -site (sf)
3399
Future (so
Off -site (sf)
84005
Existing BUA*** (sf)
55806
Total (sf):
183402
Stream Class and Index Nuunber can be deterunined at: http://portaLocdeur.oroi?cl7/evq/ps/csu/classifications
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Form SWU-101 Version 07Jun2010 Page 3 of 6

'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 BUA.
11. Flow was the off -site impervious area listed above determined? Provide documentation.
AutoCAD Area Routine
Projects 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 storrnwater 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://portal.ncdenr.org/web/wq/vvs/su/bmp-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 http: / Z portal.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://portal.iicdeiir.org/%veb/­`%%,q/­`ws/­`sLi/mal2s.)
Please indicate that the following required information have been provided by initialing in the space
provided for each item. All original documents MUST be signed and initialed in blue ink. Download the latest
versions for each submitted application package from
http://portal.ncdenr.org/web/wq/"'s/su/statesw/forms does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. „Jf
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants tib%
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M Wulf
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to •tvs
htto://www.envhelp.org/pages/onestopexpress.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 KW5
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the wW i
receiving stream drains to class SA waters within lh mile of the site boundary, include the V2
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 MFIW 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.
I. Details of roads, drainage features, collection systems, and stormwater control measures.
in. 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.
*^�J5
MJ�
Form SWU-101 Version 07Jun2010 Page 4 of 6

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 Wv5
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 SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1721 Page No: 470 0w3
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC *k'o�
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.
h ttn: / / www.secreta ry.state. nc.us/ Corpo rations/ CSearch.as�x
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://portal.ncdenr.org/web/wq/ws/su/statesw/forms dots. 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: Michael W. Strader, Jr. P.E.
Consulting Firm: Quible & Associates, PC
Mailing Address:PO Drawer 870
City:Kitty Hawk State:NC Zip:27949
Phone: (252 ) 261-3300 Fax: (252 ) 261-1260
Email:[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section) t'ar-Kal Ovher oS 54,otmuwier Easement
I, (print or type name of person listed in Contact hnfornnation, item 2a) Cli f Ovburn, Tome Manager 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, items 1a) Robert W. Hargett with (print or type name of organization listed in
Contact Infornumtion, item 1a) Rebkee Partners SntterEteld, LLC 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 SWU-101 Version 07Jun2010 Page 5 of

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.
Signature:
I / Date: 1'f
I, I V t ) GVIel le a NotarylP I' for the/State of N)cCounty of
DDLM do hereby certify that l/1� J` `� ��f fi ✓1 personally appeared
before me thialay of O ✓ eMl1, and acknowledge the due execution of the application for a
stormwater permit. Witness my hand and official seal,
S
A08LIC
r�rUUgH�N
SEAL 7 �
My commission expires_/mil%
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item la) Robert W. Hargett, Managing Member (Rebkee
certify that the information inclu
that the project will be construct(
and protective covenants will be
applicable stormwater rules un�
d on this permit application form is, to the best of my knowledge, correct and
in conformance with the approved plans, that the required deed restrictions
corded, and that the proposed project complies with the requirements of the
1d5pAI PC 2H .1000, SL 2006-246 (Ph. II - Post Construction) or SL 2008-211.
/t 1 Date: 11 (Z2.I ( (
1 V
jam, a Notary Public for the State of � C%A, 14 County of
1 Vw1W: r; hi do hereby certify that /41be. t
before me this Jeday of QtNl Lj nll
stormwater permit. Witness my hand and official seal,
Notary Public
Commonwealth of Virginia
Reg.#359624
.� , ..maim etas. Aat1100. 0010
SEAL
My commission expires . ! g� ' 0
of
appeared
Form SWU-101 Version 07Jun2010 Page 6ol'6

Permit N0. 5W 1 LI I I on
tro be p-ovlded by Dl
EXPRESS
NOV 2 g 2011
OF W A rF9
A� NC DENR
NCDENR T
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION 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.
I. PROJECT INFORMATION
Project name
PetSman
Contact person
Michael Stradar, Jr., P.E.
Phone number
252-261.3300
Date
11JS12O11 -
Drainage area number
1
II. DESIGN INFORMATION
Site Characteristics
Drainage area
405,617 ft2
Impervious area, post -development
183,402 ft2
%impervious
45.22
Design rainfall depth
1.5 in
Storage Volume: Non-SAWaters
Minimum volume required
Volume provided
Storage Volume: SA Waters
1.5" runoff volume
Pre -development l-yr, 24-hr runoff
Post -development l-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
Is the pre/post control of the 1yr 24hr storm peak flow required?
1-yr, 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hr storm
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
PrelPost 1-yr, 24-hr peak flow control
Elevations
Temporary pool elevation
Permanent pool elevation
SHWT elevation (approx. at the perm. pool elevation)
Top of 1Oft vegetated shelf elevation
Bottom of 1Oft vegetated shelf elevation
Sediment cleanout, lop elevation (bottom of pond)
Sediment cleanout, bottom elevation
Sediment storage provided
Is there additional volume stored above the state -required temp. pool?
Elevation of the top of the additional volume
35,006 ft3 OK
98,760 ft3
OK, volume provided is equal to or in excess of volume required. 11
ft3 �JL Q
R3 - '
fl3 It R3
f
Yes (Y or N)
3.3 in
0.64 (unidess)
0,69 (unitless)
0.14 ill OK
0.84 ft3lsec
0.89 ft3/sec
0.05 fl�/car
8.70 fmsl
7.54 must
7.54 fins)
8.00 fmsl
7.00 fmsl
4.50 fmsl
3.50 fmsl
1.00 ft
y (Y or N)
8.7 fmsl OK
Fona SW401-Wet Detention Basin. Rev.8.9117109 Pans I. B II. Design Summary, Page 1 of 2

Permit
no be provided by DWQl
II. DESIGN INFORMATION
Surface Areas
Area, temporary pool
Area REQUIRED, permanent pool
SAIDA ratio
Area PROVIDED, permanent pool, Apo„ p,
Area, bottom of 10ft vegetated shelf, A,,„„
Area, sediment cleanout, top elevation (bottom of pond), A,a ,4
Volumes
Volume, temporary pool
Volume, permanent pool, Vpa,,,y,a
Volume, forebay (sum of forebays if more than one forebay)
Forebay%of permanent pool volume
SAIDA Table Data
Design TSS removal
Coastal SAIDA Table Used?
Mountain/Piedmont SAIDA Table Used?
SAIDA ratio
Average depth (used in SAIDA table):
Calculation option 1 used? (See Figure 10-2b)
Volume, permanent pool, Vp,,,, pia
Area provided, permanent pool, Ap,,,,_p„ i
Average depth calculated
Average depth used in SAIDA, d„, (Round to nearest 0.511)
Calculation option 2 used? (See Figure 10-2b)
Area provided, permanent pool, A.-.,
Area, bottom of 10ft vegetated shelf, Aw xtiu
Area, sediment cleanoul, top elevation (bottom of pond), A,.y
'Depth' (distance bAv bottom of 10ft shelf and top of sediment)
Average depth calculated
Average depth used in SAIDA, d„, (Round to nearest 0.5ft)
Drawdown Calculations
Drawdown through office?
Diameter of onfice (if circular)
Area of on ice (if-noncircular)
Coefficient of discharge (CD)
Driving head (Ho)
Drawdown through weir?
Weir type
Coefficient of discharge (C.)
Length of weir (L)
Driving head (H)
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Storage volume discharge rate (through discharge orifice or weir)
Storage volume drawdown time
Additional Information
Vegetated side slopes
Vegetated shelf slope
Vegetated shelf width
Length of flowpath to width ratio
Length to width ratio
Trash rack for overflow 8 orifice?
Freeboard provided
Vegetated filter provided?
Recorded drainage easement provided?
Capures all mnott at ultimate build -out?
Drain mechanism for maintenance or emergencies is:
Form SW401-Wet Detention Basin-Rev.e-9117109
91,483 ft'
20,484 ft'
5.05 (unitless)
78,793 ft' OK
4,090 it ?d,b Ex PANS10N AAEA
2,850 ft'
98,760 ft' OK
206,682 ft'
Oft' ExrsTrus
90
y (Y or N)
n (Y or N)
5.05 (unitless)
A a 4 0 ,firs P6-r 11Aul6.A FOREr3AY
(Y or N)
206,682 ft' AQy - FoR Ex. pro NO
78,793
2.60 Need 3 it min.
3.0 R Insufficient. Check calculation.
n (Yor N) 3 . 7N Nk"'DED =H
78,793 ft'
tOJArrSea 7-7 AREA
4,090 It'
2,850 ftz
2.50 It
It
ft
n (YorN)
SEE
SToRMWMEA 1441tQATtvLC
in
FOR
,)(ZA%J b0%Jq LALCULA"rrOHj
in
FOR
1-S" S-104M
(unitless)
R
n (Y or N)
(unitless)
(unitless)
It
ft
0.84 ft'Isec
-
0.89 ft'Isec
0.10 ft'Isec
4.78 days
OK, draws down in 2-5 days.
3:1
OK
E%JAKfrON AREA
10 :1
OK
10.0 It
OK
1 :1
Insufficient
Flaw path to width ratio. Must not shodcirouit pond.
1.1 :1
n (Y or N)
Insufficient
OK
length to width ratio. Must not shod circuit pond.
GLO%J AA e7A5 PEEN fx TENdEO !3Y
1.3If
OK
ApOQOx, 200 L -F CLOU PATH ANC
y
OK
LEHbTH 1-0 UIOTH ARE '6tSPR6?ORTlcNa�E
y (YorN)
y (Y or N)
OK
OK
F THE -E xtESS S-TotlA 6E AREA oic
pump
T N £ ex r7O H )
Parts I. 8 II. Design Summary, Page 2 of 2

Permit
(to be provided by D WQ)
III. REQUIRED ITEMS CHECKLIST f
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.
AWS Plc^Slnrei
f,`rr4,l°
MW$ l�(a�smarT
u 1110
Plans (V - 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),
-Basindimensions, rse� �rar^•5o 3a�+ S
- Pretreatment system,
- High flow bypass system,
- Maintenance access,
- Proposed drainage easement and public right of way (ROW),
- Overflow device, and
- Boundaries of drainage easement.
2. Partial plan (V = 30' or larger) and details for the wet detention basin showing:
- Outlet structure with trash rack or similar,
Maintenance access,
Permanent pool dimensions,
Forebay and main pond with hardened emergency spillway,
Basin cross-section,
Vegetation specification for planting shelf, and
Filter strip.
Aw_ N&o L, .•n q 3. Section view of the wet detention basin IV = 20' or larger) showing
- Side slopes, 3:1 or lower,
- Pretreatment and treatment areas, and
- Inlet and outlet structures.
hW S
91A
4. If the basin is used for sediment and erosion control during construction, clean out of the basin is specified
on the plans prior to use as a wet detention basin.
M�+S
N#a IL.
5. A table of elevations, areas, incremental volumes & accumulated volumes for overall pond and forlarebay,
Aped)( e,
to verify volume provided.
Mu s
6. A construction sequence that shows how the wet detention basin will be protected from sediment until the
entire drainage area is stabilized.
nos
NnRR.
7. The supporting calculations.
Ands G
aw s
H«h�
8. A copy of the signed and notarized operation and maintenance (0&M) agreement.
Maas µ A 9. A copy of the deed restrictions (if required).
FIWs AAt,dr• A 10, A soils report that is based upon an actual field investigation, soil borings, and infiltration tests. County
soil maps are not an acceptable source of soils information.
Form SW401-Wet Detention Basin-Rev.8-9I77I09 Part III. Required Items Checklist, Page 1 of 1

Penn it Number:. (� (1(, ��]
EXPRESS (tbe provided by DWQ)
Drainage Area Number:
NOV 2 @ zo et Detention Basin Operation and Maintenance Agreement
NO D�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.
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.
� cv�F1j
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the wet
detention basin
Areas of bare soil and/or
erosive gullies have formed.
Regrade the soil if necessary to
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
lon
approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 1 of

q6 FoRE3A
='.N Ex. Pot-
Permit Number:
(to be provided by DWQ)
Drainage Area Number:
_BMP
element: Potential problem: How I will remediate the problem:
The inlet device: pipe or The pipe is clogged. Unclog the pipe. Dispose of the
swale sediment off -site.
The pipe is cracked or Replace the pipe.
_otherwise damaged._�� ,
Erosion is occurring in the Regrade the Swale if necessary to
swale. smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
h orebay Sediment has accumulated to Search for the source of the
a depth greater than the sediment and remedy the roblem if
original design depth for possible. Remoxe-t�ediment and
ediment storage. dispose of-i it iii a location where it
ill o cause impacts to streams or
the BMP.
Erosion has occu e Provide additional erosion
protection such as reinforced turf
in t-
or riprap if needed to
revent u e erosion roblems.
Weeds are present. Remove the wee , referably by
hand. If pesticide is use `wipe it on
the plants rather than s ra ing�
The vegetated shelf Best professional practices Prune according to best professional
show that pruning is needed practices
to maintain optimal plant
health.
Plants are dead, diseased or Determine the source of the
dying. 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.
Weeds are present. Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area Sediment has accumulated to Search for the source of the
a depth greater than the sediment and remedy the problem if
original design sediment possible. Remove the sediment and
storage depth. dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over Consult a professional to remove
50% of the area. and control the algal growth.
Cattails, phragmites or other Remove the plants by wiping them
invasive plants cover 50% of with pesticide (do not spray).
the basin surface.
Form SW401-Wet Detention Basin O&M-Rev.4
Page 2 of 4
Form SW401-Wet Detention Basin O&M-Rev.4
Page 2 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
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. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Re air or re lace 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 4.0 feet in the main pond, the sediment
shall be removed.
When the permanent pool depth reads feet in the forebay, the sediment
shall be removed.
Sediment Ren
Bottom
BASIN DIAGRAM
('fi11 in the blanks)
Permanent Pool Elevation 7.54
\
I Pe m
nen Pool
YZ---i--
V
-ft
lume
in.
Sediment Removal Elevation4.54
-------------
Volume
Sed
me nt
Bottom Elevation 3.54
1-ft
/
Stor
ige
Sedimei
-FORLBA "
—N!Api-P9NH
Storage
POND ExPxwSicuAREA
No rotcesAV 1N tx, PaHL)
Form SW401-Wet Detention Basin O&M-Rev.4 Page 3 of 4

Permit Number:
(to be provided by DWQ)
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 of any
problems with the system or prior to any changes to the system or responsible party.
Project name:PetSmart
BMP drainage area number. 1
Prim name: Robert W. Hargett - Rebkee Partners Satterfield LLC
Title:Managing Member
Address:15871 City View Drive. Suite 300 Midlothian VA 23113
Note: The legally responsible party should not be a homeowners association unless more than SO% of
the lots have been sold aAd a resident of the subdivision has been named the president.
a -(/LPLS Notary Public for the State of
U/ County of (kJ iLc-k 1 ! , do hereby certify that
nGrr� f� /. ! cl personally appeared before me this 22N `
day of_ NoVe h4 L 001 and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
QXREBECCA ANN ROGEAS•OVERSTAEET
Notary Public
Commonwealth of Virginia
Reg. #359624
My 6®�iml§§I®a Rbbi a ni se, esfs
SEAL
My commission expires 1 lyy`/ 3
Form S W401-Wet Detention Basin O&M-Rev.4 Page 4 of 4

\' Si✓� I � 11�q -�Sr�
RECEIVE®
JAN302012
®WQ-V AR®
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
Part A.
1. Project Name Pet Smart
2. Location of land -disturbing activity: County Dare City or Township Nags Head
Highway/Street S. Croatan Highway Latitude 35° 59' 23.3" N Longitude 75` 38' 56.5" W
3. Approximate date land -disturbing activity will commence: Dec. 1, 2011
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Commercial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): �? i;<�.
6. Amount of fee enclosed: $ 40.00
7. Has an erosion and sediment control plan been filed? Yes Y No Enclosed Yes
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Brian McNeal E-mail Address bmcneal(a)rebkee.com
Telephone [phone] Cell # [phone] Fax # [phone]
M
Landowners) of Record (attach accompanied page to list additional owners):
Rebkee Partners Satterfield, LLC [phone]
Name Telephone
1020 Old Bon Air Road 1020 Old Bon Air Road
Current Mailing Address Current Street Address
Richmond VA 23235 Richmond VA
City State Zip City State
[phone]
Fax Number
23235
Zip
10. Deed Book No. 1721 Page No. 470 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
Rebkee Partners Satterfield, LLC [e-mail]
Name I E-mail Address
15871 City View Drive, Suite 300 15871 City View Drive, Suite 300
Current Mailing Address Current Street Address
Midlothian VA 23113
City State Zip
T
Midlothian VA
City Stale
Fax Number
23113
Zip

IV
2. (a) If the Financially Responsible Party is nut si resident of North Carolina, give name and street'Jdchass
of The designated Nurttl Carolina Agent:
Cl Corporation System
Name ---
150 Fayetteville Street, Box 107:1
Current Mailing Address
Ra
City
NC 27601
State Zip
E-mail Address
150 Fayetteville Street, Box 1011. _
Current Street Address
Raleigh
City
Telephone [phone] _ Fax Num
NC 27601
State Zip
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Name of Registered Agent
Current Mailing Address
City State
E-mail Address
Current Street Address
Telephone Fax Number
State Zip
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change in the information provided herein.
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Type or print name 7
Signature
t"'t' "' t. ON'o
Title or Authority
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Date
a Notary Public of the County of c'r {-r r )C' '
State of Vt: 1 • n 1 r: , hereby certify that {- C IIA C'e r t 1 t' :>' appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him.
Witness my hand and notarial seal, this t tlday of _(� 1:; ,^�.r,,l �: c .% 20
:REGISTRATION
NNA RUTI I SCNorr
NOTARY PUULIC
# 715005000NWEAISII OF VIRGINIAMY tVtlrT ExPIRLS JULY J 1, 2012
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Notary
My commission expires
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