SW7060704_CURRENT PERMIT_20200323

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW %17j7�
DOC TYPE
LP CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
DOC DATE
aaao_zQ 3 A 5
1LYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
.Secretcry
BRIAN WRENN
Acting Director
NORTH CAROLiNA
Environmental Quality
March 23, 2020
CCHC Properties, LLC
Attention: Stephen W. Nuckolls, Manager
1020 Medical Park Avenue
New Bern, NC 28562
Subject: Stormwater Permit No. SW7060704 Renewal
Coastal Carolina Health Care
High Density Stormwater Project
Craven County
Dear Mr. Nuckolls:
The Washington Regional Office received a Stormwater Management Permit
Application for renewal of the subject permit on February 24, 2020. Staff review of the
application has determined that the permit can be reissued. We are forwarding Permit
No. SW7060704 dated March 23, 2020, for the continued operation of the subject
project.
This permit, upon its effective date, will replace all previous State Stormwater permits for
this project. This permit shall be effective from August 11, 2020 until August 10, 2028 and
shall be subject to the conditions and limitations as specified therein, and does not
supercede any other agency permit that may be required. Please pay special attention to
the Operation and Maintenance requirements in this permit. Failure to establish an
adequate system for operation and maintenance of the stormwater management system
will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you
have the right to request an adjudicatory hearing upon written request within thirty (30)
days following receipt of this permit. This request must be in the form of a written petition,
conforming to Chapter 150B of the North Carolina General Statutes, and filed with the
Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-6714.
Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please
contact me at [phone].
Sincerely,
Roger K. Thorpe
Environmental Engineer
North Carolina Ce>i artn:ert of'cnvirorr,e ntai Qu3iity i Division of=nerg», Mineral and Land Resources
S Vdasninston ftegior,a€ O±flce Q43 "Vashingtort Square Mail j Washington. North Carolina 27889
il.y.Nnad ul �.VmintlIW OUM� /"f 7�?.q.ln.o131

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
CCHC Properties, LLC
Coastal Carolina Health care
Located at 1020 Medical Park Avenue, New Bern, NC, Craven County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and
the approved stormwater management plans and specifications and other supporting
data as attached and on file with and approved by the Division of Energy, Mineral, and
Land Resources (Division) and considered a part of this permit.
This permit shall be effective from August 11, 2020 until August 10, 2028, and shall
be subject to the following specified conditions and limitations:
1. 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 1.6 of this permit. The stormwater control has
been designed to handle the runoff from 6.27 acres of impervious area. A pocket
wetland system is provided as a pretreatment device.
3. The tract will be limited to the amount of built -upon area indicated in Section 1.6
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 per
approved plans.
6. Final plans. including site layout and drainage for the "Future" area shall be
submitted and approved by the Division prior to the construction of any of the
1.31 acres of future impervious area.
7. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a. Drainage Area, acres: 9.42
b. Total Impervious Surfaces, ft2: 273,156 (6.27ac.)
Future On -site Impervious, ft2: 57,064 (1.31ac.)
C. Design Storm, inches: 1.0
d. Pond Depth, feet: 6.00
e. TSS removal efficiency: 90%
f. Permanent Pool Elevation, FMSL: 21.00
g. Permanent Pool Surface Area, ft2: 16,988
h. Permanent Storage Volume, ft3: 53,383
i. Permitted Forebay Volume, ft3: 11,996
i. Temporary Storage Elevation, FMSL: 22.20
j. Temporary Storage Volume, ft3: 22,193
k. Controlling Orifice: 2.0" 0 pipe
I. Receiving Stream/River Basin: Wilson Creek 1 Chowan
M. Stream Index Number: 27-101-37
n. Classification of Water Body: "C; Sw, 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 the Division. The records will indicate the
date, activity, name of person performing the work and what actions were taken.
5. The facilities shall be constructed as shown on the approved plans. This permit
shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
6. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations,from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
7. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
8. Access to the stormwater facilities shall be maintained via appropriate
easements at all times.

9. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
10. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
11. A copy of the approved plants 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.
13. This permit shall be effective from August 11, 2020 until August 10, 2028.
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.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a formal permit transfer request to the Division, accompanied by a
completed name/ownership change form, documentation from the parties
involved, and other supporting materials as may be appropriate. The approval of
this request will be considered on its merits and may or may not be approved.
The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
2. Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division, in accordance with
North Carolina General Statute 143-215.6A to 143-215.6C.

3. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
4. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
5. The permittee grants DEQ Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
6. The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and reissuance or
termination does not stay any permit condition.
7. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
8. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
9. The permittee shall notify the Division of any name, ownership or mailing
address changes within 30 days.
Permit issued this the 23 rd day of March 2020.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
Brian Wrenn, Acting Director
Division of Energy, Mineral, and Land Resources
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7060704

ROY COOPER
Govemar
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
January 27, 2020
CCHC Properties, LLC
Attention: Mr. Stephen W. Nuckolls, Member/Manager
1020 Medical Park Avenue
New Bern, NC 28562
Subject: Stormwater Permit No. SW7060704 Renewal
Coastal Carolina Health Care
High Density Stormwater Project
I Craven County
Dear Mr. Nuckolls:
A Division of Energy, Mineral, and Land Resources file review has determined that
Stormwater Permit SW7060704 for a stormwater treatment system consisting of a wet
detention pond to serve Coastal Carolina Health Care located at 1020 Medical Park
Ave. in New Bern, NC expires on August 10, 2020. This is a reminder that permit
renewal applications are due 180 days prior to expiration. We do not have a record of
receiving a renewal application.
To keep this permit active please submit a completed permit renewal application along
with a $505.00 fee for permit renewal. Permit application forms for renewal can be found
on our website at:
1 r - - -
rulgs/stormwater�rogram f nost-construction. North Carolina General Statutes and the
Coastal Stormwater rules require that this property be covered under a stormwater
permit.
If you have questions, please feel free to contact me at [phone]. i will be glad to
discuss this by phone or meet with you. If you would like, I can e-mail you a copy of the
application forms. You can request a copy by e-mailing me at roeer.thorpe@ncderingov.
Sincerely,
/c
Ro r K. Thorpe
Environmental Engineer
aEQ5 North Carolina Department of Environmental Quality I Dtvtsion of Energy, Mineral and Land Resources
zr-,e- — Washington Regional Office 1 943 Washington Square Mall I Washington, North Carolina 278139
NORM OARO r
;,.�.�a.,,.�,.n,.a. 252.946.64$1

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Date Received
Fee Paid
Permit Number
$ w �IGC, o'7G�
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew theirhigh densitypermit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781)
Section 60. (c). This application form is for permit renewals only.
A- PROJECT INFORMATION
RFCEIVED FEB 4 4 2021
1. State Stormwater Permit Number; SW7060704
2. Project name: Coastal Carolina I-lealth Care High Density Stormwater Project Craven County
3. Project street address: 1020 Medical Park Ave
City: New Bern County: Craven ZIP
28562
4. What, if any, changes have been made to the project as permitted? None
If the project has changed from the original approved plans, please complete SWU-101 for a Major
Modification or Minor Modification Application form available at: https://deg.nc.gov/about/divisionslenergy-
mineral-land-resources!energy-mineral-land-ruleslstormwater-programlpost-construction.
B. PERMITTEE INFORMATION
If changes to the permittee or project name have been made, please complete either the Permit Update form
or the Permit Transfer form available at: htt s:llde .nc. ov/about/divisions/ener -mineral-land-
resourceslenergy-mineral-land-ruleslstormwater-programlpost-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company Name/Organization: CCI-IC Properties, LLC
2, Signing Official's Name: Stephen W. Nuckolls
3. Signing Official's Title: Member/Manager
4. Mailing Address: 1020 Medical Park Avenue
City: New Bern State: NC ZIP: 28562
5. Street Address: 1020 Medical Park Avenue
City: New Bern State: NC ZIP: 28562
6. Phone: [phone] Email: nuckolls(Dcchealthcare.corn
Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018

C. SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORM. Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial) each item below to indicate that the required information is provided in the application package:
✓ 1. A permit application processing fee of $505.00 payable to NCDEQ.
2. One original signed hard copy and one electronic copy of this completed form_ The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation — a principle executive officer of at least the level of vice-president;
Limited Liability Company (LLC) — a manager or company official as those terms are defined
in G.S. 57D "North Carolina Limited Liability Company Act;"
c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee;
d. Partnership or limited partnership — the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the
signature of another entity.
N3. One hard copy and one electronic copy of recorded documents required by the original permit that
have not yet been received by DEMLR, including: deed restrictions, protective covenants,
condominium/planned community declaration and easements. If the project has been built, include
documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
/ and protective covenants will be submitted at a later date.
4. O&," greements, Please select one:
Lf l have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
❑ I do not have a copy of the current recorded O&M Agreement for all SCMs and am
/ requesting a copy be sent to me. I agree to keep this on file with the permit.
✓ 5. D ''9ner Certifications, Please select one:
A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
inspected, and that they have been built and maintained in accordance with the permit.
7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC):
Provide one hard copy and one electronic copy of documentation from the NC Secretary of State,
or other official documentation, which supports the titles and positions held by the persons listed in
Section C.2 per 15A NCAC 2N. 1043(3)(b).
https://www.sosnc.gov/online services/search/by title/ Business_ Registration
Stormwater Permit Renewal Application Forin Page 2 of 3 May 11, 2018

D. PERMITTEE'S CERTIFICATION
I. �e.1 �. �c 11 , the person legally responsible for the permit, certify that I have
a copy o the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCMs, or ownership. All information provided on this permit renewal application is, to the best of my
knowledge, correct and complete.
Signature: ���Date: Oz � Z
NOTARIZATION
1,1 V� l��L a Notary Public for the State of
County of ��rp��,rj _ do hereby certify
that _ 51►� , W _�y�,1CO�Ls _ personally appeared before me
this the Lt _ day of Peb rua rL4 20 20 and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,\,,�ti~»ltiiirr�,,��
(Notary Seal)
Notary Public
Craven _
n County
Notary Signature: T
My commission expires Oalb-7 Ma 1 fIC4�ko '\\`
Stormwater Permit Renewal Application Form Page 3 of 3 May 11, 2018

t:aa LIMITED LIABILITY COMPANY ANNUAL REPORT
■
1012017 ~
NAME OF LIMITED LIABILITY COMPANY: CCHC Properties, LLC
SECRETARY OF STATE ID NUMBER: 0691058 STATE OF FORMATION: NC
REPORT FOR THE CALENDAR YEAR: 2020
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Davis, Michael Scott
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
0691058
CA202003001733
1/30/2020 05:00
Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1020 Medical Park Avenue
New Bern, NC 28562-5248 Craven Cou
SECTION B: PRINCIPAL OFFICE INFORMATION
1020 Medical Park Avenue
New Bern, NC 28562-5248
R]SC E"V'E') r�6 r 4 2020
1. DESCRIPTION OF NATURE OF BUSINESS: Investment Property
2. PRINCIPAL OFFICE PHONE NUMBER: 252 514-2061 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
1020 Medical Park Avenue
New Bern. NC 28562-5248
5. PRINCIPAL OFFICE MAILING ADDRESS
1020 Medical Park Avenue
New Bern, NC 28562-5248
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Christine BOunous NAME: Richard F Gorman , Jr. NAME-, Warren E Murray, Jr.
TITLE: Member TITLE: Member TITLE: Member
ADDRESS:
ADDRESS:
ADDRESS:
1020 Medical Park Ave 1020 Medical Park Ave 1020 Medical Park Ave
New Bern, NC 28561 New Bern, NC 28561 New Bern, NC 28561
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Stephen W Nuckolls 1/30/2020
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Stephen W Nuckolls Member
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $200.00
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME: Stephen W Nuckolls
NAME: David Oliver, MD
NAME: John W Burnett, Jr.
TITLE: Member
TITLE: Member
TITLE: Member
ADDRESS:
ADDRESS:
ADDRESS:
1020 Medical Park Ave
1020 Medical Park Avenue
1020 Medical Park Ave
New Bern, NC 28561
New Bern, NC 28561
New Bern, NC 28561
NAME: E Phillip Bounous
NAME: David E Byrd, MD
NAME: John Cho, MD
TITLE: Member
TITLE: Member
TITLE: Member
ADDRESS:
ADDRESS:
ADDRESS:
1020 Medical Park Ave
1020 Medcial Park Avenue
1020 Medical Park Ave
New Bern, NC 28561
New Bern, NC 28561
New Bern, NC 28561
NAME: Martin C DeGraw , MD
NAME: Joseph S Healy, MD
NAME: David B Maybee , MD
TITLE: Member
TITLE: Member
TITLE: Member
ADDRESS:
ADDRESS:
ADDRESS:
1020 Medical Park Avenue
1020 Medical Park Ave
1020 Medical Park Ave
New Bern, NC 28561
New Bern, NC 28561
New Bern, NC 28561
NAME: Leann D Moore, MD
NAME: Staley C Moore, MD
NAME: Overby Joseph R Jr
TITLE: Member
TITLE: Member
TITLE: Member
ADDRESS:
ADDRESS:
ADDRESS:
1020 Medical Park Ave
1020 Medical Park Ave
1020 Medical Park Ave
New Bern, NC 28561
New Bern, NC 28561
New Bern, NC 28561
NAME: Jennifer A Ratle MD
NAME: Wright D Shields, MD
Name: William C Taylor, MD
TITLE: Member
TITLE: Member
TITLE: Member
ADDRESS:
ADDRESS:
ADDRESS:
1020 Medical Park Ave
1020 Medical Park Ave
1020 Medical Park Ave
New Bern, NC 28561
New Bern, NC 28561
New Bern, NC 28561
NAME: Craig M Zavelo MD
NAME: Wood B Gibbs MD
NAME:
TITLE: Member
TITLE: Member
TITLE:
ADDRESS:
1020 Medical Park Ave
ADDRESS:
1020 Medical Park Ave
ADDRESS:
New Bern, NC 28561 New Bern, NC 28561

State Stormwater Management Systems
Permit No. SW7060704
Coastal Carolina Health Care
Stormwater Permit No. SW7060704
Craven Coun
Designer's Certification
I.,
MAR 18 2014
- ♦Y' f. � i� t y
as a duly registered
in the State of North Carolina, having been authorized to observe (periodically/ 4eeklyF
full time) the construction of the project, ,
ect)
for (Project Owner) hereby state that, to the
best of my abilities, &e 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:
SEAL
Signature ``.�►ti'��ir�lir,,�
GAR p4��,��
Registration Nu ber f�3v _ _ 1�oQ oFss�o,'^y •��
Date r f UGS#A232A �C
CO
Page 6 of 7

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State Stormwater Management Systems
Permit No. SW7060704
Certification Requirements:
The drainage area to the system contains approximately the permitted
acreage.
The drainage area to the system contains no more than the permitted
amount of built -upon area.
All the built -upon area associated with the project is graded such that the
runoff drains to the system.
All roof drains are located such that the runoff is directed into the system.
The outlet/bypass structure elevations are per the approved plan.
The outlet structure is located per the approved plans.
Trash rack is provided on the outlettbypass structure.
All slopes are grassed with permanent vegetation.
Vegetated slopes are no steeper than 31.
1. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
The permitted amounts of surface area and/or volume have been
provided.
Required drawdown devices are correctly sized per the approved plans.
All required design depths are provided.
All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
City of New Bern Building Inspections
Page 7 of 7

State Stormwater Management Systems
Permit No. SW7060704
Coastal Carolina Health Care
Stormwater Permit No. SW7060704
Craven County
Designer's Certification
i,la�� -fir , as a duly registered r
in the State -of North Carolina, having been authorized to obs rve (periodically/ - eeklyl
full time) the construction of tha nrniRrt-
for tProject Owner} hereby state that, to the
best of my abilities, a 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;
SEAL
Signature ����10ARO� ffrii
Registration Nu ber ! 3 f , q-
a
DateSOL
l i G232 Y 4
���pHEN,1111 `"P ��
Page 6 of 7

Certification Requirements:
MEN
State Stormwater Management Systems
Permit No. SW7060704
The drainage area to the system contains approximately the permitted
acreage.
The drainage area to the system contains no more than the pemnitted
amount of built -upon area.
All the built -upon area associated with the project is graded such that the
runoff drains to the system.
All roof drains are located such that the runoff is directed into the system.
The outlet/bypass structure elevations are per the approved plan.
. The outlet structure is located per the approved plans.
Trash rack is provided on the outlet/bypass structure.
All slopes are grassed with permanent vegetation.
Vegetated slopes are no steeper than 3:1.
3. The inlets are located per the approved plans and do not cause short-
circuiting of -the system.
t. The permitted amounts of surface area and/or volume have been
provided.
?. Required drawdown devices are correctly sized per the approved plans.
All required design depths are provided.
All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
3. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
City of New Bern Building Inspections
Page 7 of 7

V.
w
yici-Viv 150,
Permit No. S�J`7'J
(to be provider! by DO'&
Yu - State of Norih Carolina
DWQ artment of Envii•omnent anti iNatural Resources
Division of Water Qualily
STORMWATEk 1\dANAGLMEly! `f'FR'MTT APPLICATION FORM
WE'T DETENTION BASIN SUPPLEMENT
This %rnr rrr;f f. phowrotptcd for use es an adgirial
T)WQ Stornlwater i�l �n.7gttrte�tt � tt l eview:
A coinplwc ston7 nwuter management plan submittal includes an application form, a wet detention basin
supplement for each basin, design calculations. and plans and spccifications showing all baisiu and outlet
smicture details.
1, l'l2U.lIC"i' 1\l�C)Itz�•Ir�"f'fOi\
Project Name: Coastal Carolina Health care
Callt.tct 1'ers7n: J. Stephen Janowski, PE Phone.tt1tnlber: ( 252 756-1390
For projects with multiple basins, specify which basin this worksheet supplies to:
>,-
s
elevations f I�
14•5 f ! b
Basm Bottom FlevaEtoil
.Permancm Pool Elevation
Temporary Pool (Elevation
(rrtrrS
Permanent Pool Surface Area
Dliiinage Area
IlZtpervious Area
;'Oir MCIS
Permanent Pool Volume
Temporary foal Volume
forebay Volume
0(her parameier:s
SAMA t
Diametcr of Orifice
Design Rainfld
Design TSS Removal'-
Forst S%Vu• 102, Rev 3.99
t,
l/Itror rip r ,e CIS 1)
21.00
ft,
(elevation of Me Orifice)
21.68 _
—
in
It.
(elevarion of the clischarge struclrrre 0170flOW)
G'� .Z--
16,988
sq. ft.
(i�atrr.crrrfrce urcrr rrr tlrcc+�r ce eleiatir)rr)
9.42 acres
aL,
(on -site, and off site. elrainrrge to the beisin)
6.27 acres
tic,
(on -site and off -site chwinage to the basin)
53,383 ctu. fl. (combineel volume vJ!Piaui basin and foreho
22,193 c u. ft. (ti>rrlurr;E ricpuriraerlaFin�e rlrc�lserrnarrerrt pnn11
11,996 cu. fj. (ahl�,c�,rirnatcalb� M(l��vjrr�trrl rola�,trr�)
3.73 (surf ice ru•err to droina;e area ratio from D I(IQ table)
2 i23. (2 to ` elgv remporeny poni (imly-dcwn r•eqr hwr
1 in.
90 % (rrrirNrrtum SSin regidreci)
Pau f ni 4

Maintenance activities shall be performed as follows:
1. After every significant runoff producing rainfall event and at least monthly:
a. Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation,
vegetated cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days as designed.
2. Repair eroded areas immediately, re -seed as necessary to maintain good vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth (see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality (i.e.
stockpiling near a wet detention basin or stream, etc.).
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 4.5 feet in the main pond, the sediment shall be removed.
When the permanent pool depth reads 4.5 feet in the forebay, the sediment shall be removed.
Sediment
Bottom
1 El. 3.5 j 7
tion 13 0 N°i
FOREBAY
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation 19.5
--------------------------------------------
Sediment Removal Elevation 15.0 75%
Bottom Elevation 13.0 t 25% /
MAIN POND
5. Remove cattails and other indigenous wetland plants when they cover 50% of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. if the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
Form SWU-102 Rev 3.99 Page 3 of

'I VID
C-FIS, Al-
-%s ^ Ova
Permit No.
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
(to be provided byDWQJ
0.11
�WQ
�RMWATER MANAGEMENT PERMIT APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form may be photocopied for use as an original
DWO Stormwater Management Plan Review:
A complete stormwater management plan submittal includes an application form, a wet detention basin
supplement for each basin, design calculations, and plans and specifications showing all basin and outlet
structure details.
I. PROJECT INFORMATION
Project Name: Coastal Carolina Health care
Contact Person: J. Stephen Janowski, PE Phone Number: 252 756-1390
For projects with multiple basins, specify which basin this worksheet applies to:
elevations
Basin Bottom Elevation ft. (floor of the basin)
Permanent Pool Elevation 5 ft. (elevation of the orifice)
Temporary Pool Elevation 22•2 ft. (elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area 16,988 sq. ft. (water surface area at the orifice elevation)
Drainage Area 9.42 acres ac. (on -site and off -site drainage to the basin)
Impervious Area 6.27 acres ac. (on -site and off -site drainage to the basin)
volumes
Permanent Pool Volume
Temporary Pool Volume
Forebay Volume
Other parameters
SA/DA1
Diameter of Orifice
Design Rainfall
Design TSS Removal z
53,383 cu. ft. (combined volume of main basin and forebay)
22,193 cu. ft. (volume detained above the permanent pool)
11,996 cu. ft. (approximately 20% of total volume)
3.73 (surface area to drainage area ratio from DWQ table)
2 in. (2 to 5 day temporary pool draw -down required)
1 in.
90 % (minimum 85% required)
Form SWU-lot Rev 3.99 Page 1 of 4

Maintenance activities shall be performed as follows:
1. After every significant runoff producing rainfall event and at least monthly:
a. Inspect the wet detention basin system for sediment accumulation, erosion, trash accumulation,
vegetated cover, and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of the temporary pool occurs within
2 to 5 days as designed.
2. Repair eroded areas immediately, re -seed as necessary to maintain good vegetative cover, mow vegetative
cover to maintain a maximum height of six inches, and remove trash as needed.
3. Inspect and repair the collection system (i.e. catch basins, piping, swales, riprap, etc.) quarterly to maintain
proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75% of the original design depth (see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality (i.e.
stockpiling near a wet detention basin or stream, etc.).
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 4.5 feet in the main pond, the sediment shall be removed.
When the permanent pool depth reads 4.5 feet in the forebay, the sediment shall be removed.
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation 21.0
Sediment Ren\oval El. 3.5 175
-------- ---
---�- Sediment Removal Elevation 16.5 75%
Bottom Eie ation 14.5 °--------------------------------------------- ------
FOREBAY
Bottom Elevation 14.5 , 25%
MAIN POND
5. Remove cattails and other indigenous wetland plants when they cover 50% of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. If the basin must be drained for an emergency or to perform maintenance, the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
Form SWU-102 Rev 3.99 Page 3 of 4