SW8951014_HISTORICAL FILE_20130913

STORMWATER DIVISION CODING SHEET
POST —CONSTRUCTION PERMITS
PERMIT NO.
SW8 q 510 14
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
zw "D 0 c 1 Q)
YYYYMM DD

w
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Tracy E. Davis, PE, CPM Pat McCrory, Governor
Director John E. Skvarla, III, Secretary
September 13, 2013
Mr. Christopher Bunch, SecretaryfTreasurer
MedSery Management Company, LLC
1202 Medical Center Drive
Wilmington, NC 28401
Subject: Stormwater Permit No. SW8 951014 Renewal
Wilmington Health Associates Clinic
High Density Project
New Hanover County
Dear Mr. Bunch:
Effective August 1, 2013 the State Stormwater program has been transferred from the Division
of Water Quality (DWQ) to the Division of Energy, Mineral and Land Resources (DEMLR). All
previous references to DWQ will remain in older stormwater permits issued prior to August 1,
2013 until they are modified. Please note that any updated pages or addendums to this permit
will now reference DEMLR as the Division responsible for issuance of the permit.
The Wilmington Regional Office received a complete Stormwater Management Permit Renewal
Application for Wilmington Health Associates Clinic on July 29, 2013 with a total fee of
$1010.00. Two fees were submitted to DEMLR because this permit had expired on January 2,
2006. One renewal fee would have placed this permit back into expiration within 4 months of the
renewal. Therefore, the Division has accepted both renewal fees and is hereby notifying you
that permit SW8 951014 has been renewed on September 13, 2013, and shall be effective until
January 2, 2022. The renewal and reissuance of this stormwater permit does not imply that the
site is currently in compliance with the terms and conditions of this state stormwater permit. The
plans previously approved on January 2, 1996, in accordance with the regulations set forth in
Title 15A NCAC 21-1.1000 effective September 1, 1995, remain in full force and effect. Please
attach this cover letter and permit addendum to your High Density Permit originally issued on
January 2, 1996.
This permit is subject to the conditions and limitations as specified therein. Please pay special
attention to the conditions listed in this permit regarding the Operation and Maintenance of the
BMP(s), recordation of deed restrictions, procedures for changes of ownership, transferring the
permit, and renewing the permit. Failure to establish an adequate system for operation and
maintenance of the stormwater management system, to record deed restrictions, to transfer the
permit, or to renew the permit, 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 by filing a written petition with the Office of
Administrative Hearings (OAH). The written petition must conform to Chapter 150B of the North
Carolina General Statutes, and must be filed with the OAH within thirty (30) days of receipt of
this permit. You should contact the OAH with all questions regarding the filing fee (if a filing fee
is required) and/or the details of the filing process at 6714 Mail Service Center, Raleigh, NC
27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com.
Unless such demands are made this permit shall be final and binding.
Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 Phone: [phone] Fax: [phone]

If you have any questions, need additional copies of the permit or approved plans, please
contact David Cox with the Division of Water Quality in the Wilmington Regional Office at (910)
796-7230.
Sinc rely,
4�
frTracy .. Davi
Division of Water Quality
GDS/dwc: G :\WQS\Stormwater\Permits & Projects\1995\951014HD\2013 08 permit 951014
cc: Branch Smith, McKim & Creed
Wilmington Regional Office
Page 2 of 2

State Stormwater Management
Permit # SW8 951014
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL and LAND RESOURCES (DEMLR)
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
MedSery Management Company, LLC
Wilmington Health Associates Clinic
120 Medical Center Drive, New Hanover County
FOR THE
operation and maintenance of stormwater management systems 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 and considered a part of this permit.
The permit is hereby renewed subject to the following addendums, clarifications, conditions and
limitations:
1. The original permit conditions contained in the permit issued on January 2, 1996
remain in full force and effect, except as amended herein. (An additional copy of this
original permit can be obtained from the DEMLR, Wilmington Regional Office.)
2. This permit shall be effective from the date of issuance until January 2, 2022. Please
submit a renewal fee within 30 days upon receipt of this renewal.
3. The permittee shall submit a permit renewal application request at least 180 days
prior to the expiration date of this permit. The renewal request must include the
applicable documentation and the processing fee.
4. If the use of permeable pavement is desired, this permit must be modified to add the
permeable pavement conditions.

D1N'Q USE ONLY
„ Date Received
Pee. Paid
Permit Number
51 `f
�' " ,
Mate of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
(NCDENR DWQ)
STORMWATER MANAGEMENT PERMIT RENEWAL APPLICATION FORM
_ 77ris fmnr umr/ he photocopied for use ns nn original- — __
his form is to be completed by the current permit holder pursuant to Title 15A NCAC 211.1003 (h) (2). This states
that stornm ater management permits, issued for projects that require the construction of engineered stor nnw ater
control measures (High Density Permits), shill be required to submit an appbcation to renew the permit 180 days
pfor to expiration of the permit. Renewed permits are valid for a period of 8 \,ears per Session Law 2011-398 (513
781) Section 60. (c).' -- - - - -
I. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the North Carolina Department of
Environment and Natural Resources (NCDENR) Division of Water Quality (DWQ). A complete package
includes all of the items listed below. The complete application package should be submitted to the
appropriate DWQ Regional Office. (The appropriate office may be found by clicking on the interactive online map
at litti2:/112ortal.ncdeiir.org/%N,eb/v\,q/honie/ro. Copies of the original permit can be obtained from the Regional Office
of the Division of Water Quality.)
This Renewal is for STORMWATER PERMIT It SW 951014
Please check which of the following permit renewal scenarios apply. Initial in the spaces provided that you have
provided the required information.
❑ A. Renewal Only:
-$505 fee
-Renewal Form - Sign and complete all sections (send original & 1 copy)
-Recorded Documents Required By Permit Deed restrictions, covenants, condominium/planned
community declaration & easements (if not already submitted to NCDENR DWQ). Copies are
acceptable.
-Designer's Certification (if required by permit and not already received by NCDENR DWQ) (See the last
page of your permit jirr a copy of the certification firma.)
-1 Have a Copy of the Current Operation and Maintenance Agreement (O&M): Please Keep this on File
with your permit.
-I Do Not Have a Copy of the Current O&M: Initial This Line to Request a copy. (If NCDENR DWQ does
not have a copy on fil(,, then you will be notified to submit a new O & M form.)
® B. Renewal and Modification:
-$505 Fee and Pages 7 & 2 of this Renewal Form
-SWSWU-1O7 Application Form (htfv://tiortahnedenr.org/each/ruq/rns/sn/stntestu/forms dots)
-Recorded Documents Required By Permit: Deed restrictions, covenants, condominium/planned
community declaration & easements (if not already submitted to NCDENR DWQ). Copies are
acceptable.
- Under #11. 1. on SWU-101 Application Form --Check Box for Modification w/Renewal
-Designer's Certification (if required by permit and not already receli-ZIM R C�
page of your permit far a copy of the certification form.) �Y@`
- O&M Agreement(http:llportnhncdmrr.oror;hocblwghuslsrdbnrp-mm�uald JUL 2 9 2013
NIA -
the last
AI
Fonn SWU-102 (Renewal Forni) Rev 15Aug2012 Page I of BY:

C. Renewal and Either: 1.) Permit Transfer to a New Permittee, or 2.) Project Name Change:
Please submit all items in I.A, and:
Request a NCDENR DWQ site inspection if transferring permit to new property owner.
Submit One of the Two Following Forms below (forms available at:
littl2:1/portal.iicdeiir.org/­NN,eb/wql%vs/stilstatesw/fornis docs#tab-3):
1. HOA Name/Ownership Change Form: For planned communities (per Chapter 47C or
Chapter 47F of the General Statutes)
2. Name/Ownership Change Form: For all other transfers
Please make Sure all required information is submitted with the Name/Ownership Change form (as
stated in each of the available forms) and that all required signatures and initials are filled in pi operb,
Otherwise the name change or transfer can not be, processed and the original owner will remain as the
Perinit holder
❑ D. Renewal, Modification, and Transfer (or Name Change): Please submit pages I and 2 of this
Renewal form along with all items listed in 1. B. and C. above (check this box and initial items in B.
& C. that you are submitting to NCDENR DWO).
II. APPLICANT'S CERTIFICATION
Note: The legally responsible part), is the current Permittee and/or the legally responsible representative until such time that the permit is
officially transferred through a request to DtVQ by the permiltee.
I, (Print or type umne of permittee or person 1e"'ally responsible fir the perurit ) Christopher Bunch
certify that I have a copy of the DWQ Approved Permit and O&M Agreement on -site (OR I have obtained a copy
from DWQ and it will be kept on site), that I ana responsible for the performance of the maintenance procedures
and the site has been, and will be, maintained according to the O & M Agreement. I agree to notifv DWQ of any
problems with the system and prior to any changes to the system or changes in ownership I will (or have through
this renewal application) notify NCDENR DWQ and submit the proper forms to modify or transfer the permit. All
information provided on this permit renewal application is, to the best of my knowledge, correct and complete.
Permittee Title: Treasurer/Secretary, MedSery Management Company I.LC
Address: 1202 Medical Center Drive, Wilmington NC 28401
NOTARIZATION:
I, L�6rnf, ( j—) c LL Q IN, S /� a Notary Public for the State of �r�h �� ✓UL (t l�
County of Vn, l) f 0 � , do hereby certify that 0-h &ncl
personally appeared before me this day of-TU—L It = 01. (j 13 and acknowledge the due execution of the
forgoing stormwater BMP maintenance requirements. Witness my hand and official seal,
My commission expi
Notary Signature:
ECEIVE
JUL 2 9 2013 1
r
8Y:
Form S WU-102 (Renewal Form) Rev 15Aug2012 Page 2 of 4

-VI
'-f. J,

III. GENERAL INFORMATION
1. Stormwater Management Permit Number: S1V951014
2. Permit Holder's name (specify the name of the corporation, individual, etc.):
MedSey Management Company, LLC
3. printOwner/Signing Official's name and title (person legally responsible for permit):
Christopher Bunch, 5«a'1tiC6go
4. Mailing Address for person listed in item 2 above:
1202 Medical Center Drive
CStyMilmington State:NC Zip:28401
Phone: (910 ) 341-3300 Fax:
Finail:
5. Project Name: Wilmington Health Associates Clinic
6. Location of Project (street address):
1202 Medical Center Drive
CityMilmington County:NC Zip:28401
7. Directions to project (from nearest major intersection):
Medical Center Drive from 17°i Street
Take a left onto Canterwood Rd
Wilmington Health is big white building on the corner
Stormwater Pond is located at the back corner of the parking lot
JUL 2 9 2013
Fonn SWU-102 (Renewal Font) Rev 15Aug2012 Page 3 of 4 * tl
µV:

IV. PERMIT INFORMATION:
I. Specify the type of stormwater treatment: ❑Constructed Wetland ❑Bioretention ®Wet Detention Pond
❑Dry Detention Basin ❑Infiltration Basin ❑Infiltration Trench ❑Sand Filter ❑Other:
2. If any changes were made to the original DWQ approved project list them in the space below (attach additional
pages if needed and provide "As -Built" drawings with this application). If major changes have been made to You] -
project please request a plan revision or modification of the permit and submit "As Built" drawings along with a
final or updated stormwater system engineer certification (if not already provided to NCDENR). DWQ Engineer
and Designer Certification Forms are available from each NCDENR DWQ Regional Office.
Form SWU-102 (Renewal Fonn) Rev 15Aug2012 Page 4 of 4
F(CEIVE
JUL 2 9 2013
�v

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Tracy E. Davis, PE, CPM
Director
September 4, 2013
To: Chris Bunch, Treasurer/Secretary
MedSery Management Company, LLC
1202 Medical Center Drive
Wilmington, NC 28401
Re: Wilmington Health Associates Clinic
1202 Medical Center Drive, Wilmington, NC
SW8 951014
INVOICE
Permit Renewal Fee due for 1/02/2014 Renewal: $505.00
Pat McCrory, Governor
John E. Skvada, III, Secretary
Please make payable to: NC DENR and mail to address below to attention of David Cox.
lMhnmgton Regional Office
127 Cardinal Drive Extension, W hington, North Carolina 28405 Phone: [phone] / Fax: (910) 3%2004

Casmer, Jo
From:
Casmer, Jo
Sent:
Wednesday, September 04, 2013 11:26 AM
To:
'[e-mail]'
Cc:
David W Cox ([e-mail]); Scott, Georgette
Subject:
Permit Renewal Fee SW8 951014
Attachments:
Wilmington Health Associates Invoice.pdf
Chris:
Per your request to David Cox, attached is an "invoice" in order to cut the second renewal fee check for the captioned
permit. We normally don't send invoices so I hope this fabricated version will meet your need. If not, please email me
directly and I will revise it according to your requirements.
Jo Casmer
Administrative Assistant IV
NC Department of Environment & Natural Resources
Division of Environmental Assistance & Customer Service
127 Cardinal Drive Extension
Wilmington, NC 2W5
Phone: [phone]
Fax: [phone]
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third
parties

r

Casmer, Jo
From: Scott, Georgette
Sent: Wednesday, September 04, 2013 9:10 AM
To: Casmer, Jo
Subject: RE: Renewal of SW permit
That would be great. Yes this is the one I mentioned yesterday. I am sending David your way.
G
From: Casmer, Jo
Sent: Wednesday, September 04, 2013 8:12 AM
To: Scott, Georgette
Cc: Cox, David
Subject: RE: Renewal of SW permit
We don't have an "invoice' but I can fabricate something if need be. I think this is the one David sent to me last
Thursday to send him something but I just haven't had the time to do it yet. I can email him something today. Is this the
one that has the "second" term renewal that you and I talked about yesterday? I just need to know what the renewal
term is and I can fabricate it and send to him ..... but I need the file too.
fo Casmer
Administrative Assistant IV
NC Department of Environment & Natural Resources
Division of Environmental Assistance & Customer Service
127 Cardinal Drive Extension
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Email correspondence to and from this address may be subject to the North Carolina Public Records Caw and may be disclosed to third
parties
From: Scott, Georgette
Sent: Wednesday, September 04, 2013 7:58 AM
To: Casmer, Jo
Cc: Cox, David
Subject: FW: Renewal of SW permit
Jo,
Do we ever send out invoices? Or do we have to send them a letter?
Georgette
From: Chris Bunch[mailto:cbunch(cbwilmingtonhealth.coml
Sent: Tuesday, September 03, 2013 2:49 PM
To: Scott, Georgette
Cc: Cox, David
Subject: RE: Renewal of SW permit
Can you please send us an invoice for our accounting department to cut the check?
Thanks
Chris

From: Scott, Georgette[mailto:georgette.scott(a)ncdenr.gov]
Sent: Tuesday, September 03, 2013 10:26 AM
To: Chris Bunch
Cc: Cox, David
Subject: RE: Renewal of SW permit
Make sure you put it to the attention of David Cox or Georgette Scott.
Thanks
Georgette Scott
Stonnwater Program Supervisor
State Stormwatcr Progrvn
NC Division of Encrgy, Mineral and Lmd Resources
127 Cardinal Drive Ext.
Wilmington, NC 28,105
Phone [phone]
Fax [phone]
P-mail correspondence to and from this address may be subject to the Noah Carolina Public Records rare and may be disclosed to third panics.
From: Cox, David
Sent: Wednesday, August 28, 2013 1:10 PM
To: cbunch(cbwilmingtonhealth.com
Cc: Scott, Georgette
Subject: Renewal of SW permit
Chris,
Just submit a check for $505.00 without a new application.
127 Cardinal Dr.
David Cox
The contents of this electronic mail message and any attachments are confidential, possibly privileged and
intended for the addressee(s) only. Only the addressee(s) may read, disseminate, retain or otherwise use this
message. If received in error, please immediately inform the sender and then delete this message without
disclosing its contents to anyone.

�McKIM&CREED
HAND DELIVER
D' NCDENR - DWQ
127 Cardinal Drive Extension
Wilmington, NC 28405
ATFEN71ON: Georgette Scott
WE ARE SENDING: ®Originals ® Prints
❑ Specifications ❑ Calculations
LETTER OF TRANSMITTAL
DATE: July 29, 2013
PROJECT NO: 00826-0003
TASK NO: 14
RE: Wilmington Health
SW8 951014 Permit Renewal
7RANSMITTALNO: 1 01'
PAGE 1 OF 1
❑ Shop Drawings ❑ Samples
❑ Other -
Quantity
Drawing No.
Rev.
Description
Status
2
Permit Renewal Form (1 original + 1 copy)
G.
1
NCDENR Fee Check 6f $5 0.00-0 per, eAe)
C
2
Copy of Original Designer's Certification
G
Issue Status Code: A. Preliminary B. Fabrication Only C. For Information D. Bid
E. Construction F. For Review & Comments G. For Approval H. See Remarks
Action Status Code: 1. No Exceptions Taken 2. Make Corrections Noted 3. Other
4. Amend & Resubmit 5. Rejected - See Remarks
REMARKS: Ms. Scott: Please accept these forms in regards to your letter dated June 26, 2013 for the
expired stormwater permit SW8 951014 for MedSery Company (now Wilmington Health). The permitted
wet pond is undergoing mowing and maintenance efforts to restore it to the permitted design standards.
243 NORTH FRONT STREET, WILMING'I'ON, NC 28401 [phone] FAX [phone]
c= File
McKIM &CREED, INC.
"�F—iVF JUL292013
Signed
BY. _-____ Branch Smith, PE
Project Engineer
S:\00826\ 0003\ 1 OLomm\ 130229_DN'Q TransI.Doc
REC'D JUL 2 9 2013

North Carolina
Pat McCrory
Governor
June 26, 2013
Ms. Diane Atkinson
MedServe Company
1202 Medical Center Dr.
Wilmington, NC 28401
N�®ENS
Department of Environment and
Division of Water Quality
Thomas A. Reeder
Acting Director
Subject: PERMIT RENEWAL REQUEST
Stormwater Permit No. SW8 951014
Wilmington Health Associates Clinic
New Hanover County
Dear Ms. Atkinson:
Natural Resources
John E. Skvarla, III
Secretary
The Division of Water Quality issued a high density Stormwater Management Permit # SW8 951014 to the
MedServe Company for the Wilmington Health Associates Clinic project on January 2, 1996. This permit
expired on January 2, 2006. A letter was sent to you on July 11, 2007 requesting that an application for
renewing the permit be submitted and, at this time, a response has not yet been received. Per 15A NCAC
2H.1003(h) (the stormwater rules), it is your responsibility to submit an application to renew the permit 180
days prior to the expiration of a permit.
If this is still an active project please complete and submit the enclosed renewal application along with the
processing fee, which is currently set at $505.00 prior to July 29, 2013. If this project has not been
constructed and a permit is no longer needed, please submit a request to have the permit rescinded. If you
have sold the project please provide the name, mailing address and phone number of the person or entity
that is now responsible for this permit. If there has been a change in the property ownership, the project
name, or the contact information for the MedServe Company, please complete and submit the enclosed is
a form emitted "State Stormwater Permit Name/Ownership Change Form".
Your permit requires that upon completion of construction and prior to operation of the permitted
stormwater treatment system, a certification of completion be submitted to the Division from an appropriate
designer for the type of system installed. This is to certify that the permitted facility has been installed in
accordance with the permit, the approved plans, specifications and supporting documentation. If you have
not already provided a Designer's Certification to our office, please include a copy with your permit renewal
request and processing fee. A copy of the certification form is enclosed for your convenience.
You should be aware that failure to provide the Designer's Certification and the operation of a stormwater
treatment facility without a valid permit, are violations of NC General Statute 143-215.1 and may result in
appropriate enforcement action including the assessment of civil penalties of up to $25,000 per day.
If a renewal application is not submitted prior to July 29, 2013, enforcement actions may be initiated, which
may include the assessment of civil penalties. If you have any questions, please feel free to contact
Christine Nelson at [phone].
Sinc ely,
Georgette Scott
Stormwater Supervisor
encl.
GDS/can S:\WQS\Stormwater\Permits & Projects\1995\951014 HD\2013 06 req_ren 951014
cc: Wilmington Regional Office File
Wilmington Regional Office One
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 NorthCarolina
Phone: [phone] \ FAX: [phone] \ DENR Assistance: 1-877-623-6748 Naturally
Internet: m ncwaterquality.org Nar
An Equal Opportunity \ Affirmative Acton Employer

W AtF9
�I� r
T� Y
July 11, 2007
Ms. Diane Atkinson
MedServe Company
1202 Medical Center Drive
Wilmington, NC 28401
Subject:: Stormwater Permit No. SW8951014
Wilmington Health Associates Clinic
New Hanover County
Dear Ms. Atkinson:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
The Division of Water Quality issued a Coastal Stormwater Management Permit, Number SW8951014
to MedServe Company for a High Density pond to serve Wilmington Health Associates Clinic on
1/2/1996. This permit expired on 1/2/2006. Section .1003(h) of 15 A NCAC 2H .1000 (the stormwater
rules) requires that applications for permit renewals shall be submitted 180 days prior to the expiration
of a permit and must be accompanied by a processing fee, which is currently set at $420.00. If this is
still an active project please complete and submit the enclosed renewal application in a timely manner.
If this project has not been constructed and a permit is no longer needed, please submit a request to
have the permit rescinded. If you have sold the project, or are no longer the permittee, please provide
the name, mailing address and phone number of the person or entity that is now responsible for this
permit. Enclosed is a form for change of ownership, which should be completed and submitted if the
property has changed hands.
Your permit requires that upon completion of construction and prior to operation of the permitted
treatment units a certification of completion be submitted to the Division from an appropriate designer
for the system installed. This is to certify that the permitted facility has been installed in accordance with
the permit, the approved plans, specifications and supporting documentation. Please include a'copy of
the certification with your permit renewal request and processing fee. Enclosed is a copy of a sample
certification. Also enclosed is a new Operation and Maintenance agreement that should be completed
and submitted along with your renewal application.
You should be aware that failure to provide the Designer's Certification and the operation of a
stormwater treatment facility without a valid permit, are violations of NC General Statute 143-215.1 and
may result in appropriate enforcement action including the assessment of civil penalties of up to
$10,000 per day.
If you have any questions, please feel free to contact staff in the stormwater group at 910-796-7215.
Sincerely,
Ed Beck, Regional Supervisor
Surface Water Protection Section
Wilmington Regional Office
Enclosures
cc: Wilmington Regional Office
North Carolina Division of Water Quality Internet: www.newaterquality ore one
127 Cardinal drive Extension Phone [phone] NorthCarolina
Wilmington, NC 28403 Fax [phone] i, i' tuna l ff
An Equal Opportunity/Affirmative Action Employer - 50% Recyded/10% Post Consumer Paper �/{�KL LIfL[