SW8180310_Current Permit_20180412

Energy, Mineral &
Land Resources
ENVIRONMENTAL QUALITY
April 12, 2018
MCB Camp Lejeune
Attn: Commanding Officer
c/o Neal Paul, Deputy Public Works Officer
1005 Michael Road
Camp Lejeune, NC 28547
Subject: State Stormwater Management Permit
Hadnot Point Ambulatory Care Center
High Density Project
Onslow County
Dear Mr. Paul:
ROY COOPER
Governor
MICHAEL S. REGAN
secretary
WILLIAM E. (TOBY) VINSON, JR.
Interim Director
No. SW8180310
/ Dental Clinic
The Wilmington Regional Office received a complete State Stormwater Management Permit Application for
the subject project on April 12, 2018. Staff review of the plans and specifications has determined that the
project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A NCAC 2H.1000
effective January 1, 2017. We are forwarding Permit No. SW8 180310 dated April 12, 2018, for the
construction, operation and maintenance of the stormwater control measures (SCMs), built -upon areas, as well
as the stormwater collection system and/or vegetated conveyance system associated with the subject project.
This permit shall be effective from the date of issuance until April 12, 2026 and shall be subject to the
conditions and limitations as specified therein, and does not supersede any other agency permit that may be
required. Please pay special attention to the permit conditions regarding the operation and maintenance of the
SCMs, stormwater collection system, and/or vegetated conveyances; the limitation of built -upon area;
modification of the project; the procedures for changing ownership of and/or transferring the permit; and the
need to renew the permit. Please also pay attention to the permit conditions that requires the recordation of
deed restrictions and protective covenants, easements, and the maintenance agreement, which must all be
provided along with certification upon completion of the project. Failure to comply with these requirements
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 919431-3000, or visit their website at
www.NCOAH.com. 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 Christine Hall
in the Wilmington Regional Office, at [phone].
Sincerely,
r
c` )
a3�; William E. (Toby) Vinson, Jr., PE, CPESC, CPM, interim Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment A — Certification Forms
GDS/canh: %StormwaterTermits & Projects120181180310 HD12018 04 permit 180310
cc: Joseph C. Avolis, PE; Avolis Engineering, PA
Wilmington Regional Office Stormwater File
State of North Carolina I Environmental Quality I Energy, "nelal and Land Resources
Wilmington' Regional Office 1 127 Cardinal Drive Extension I Wilmington, NC 28405
910 796 7215

State Stormwater Management
Permit No. SW8 180310
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
US MCB Camp Lejeune
Hadnot Point Ambulatory Care Center/Dental Clinic
1 Street, Camp Lejeune, Onslow County
FOR THE
construction, operation and maintenance of two (2) areas of infiltrating permeable pavement
("stormwater control measures" or "SCMs") and an area of redevelopment in compliance with the
provisions of Title 15A NCAC 2H .1000 effective January 1, 2017 (the "stormwater rules") and the
approved stormwater management plans, application, supplements, specifications, and other
supporting data (the "approved plans and specifications") as attached and/or on file with and
approved by the Division of Energy, Mineral and Land Resources (the "Division" or "DEMLR") and
considered an enforceable part of this permit.
This permit shall be effective from the date of issuance until April 12, 2026 and shall be subject to the
following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the management and volume of stormwater
described in the approved plans and specifications. The maximum amount of built -upon area
(BUA) allowed for the entire project is 114,482 square feet.
2. The redevelopment portion of this project is exempt from State Stormwater permitting
requirements under the following conditions: 1) The project must be constructed as shown on
the plans submitted to this Office; 2) the proposed redeveloped BUA of 114,482 square feet
does not exceed the existing BUA of 114,794 square feet; and 3) The proposed stormwater
control (vegetated sheet flow to a piped collection system) provides equal protection of surface
waters as the existing stormwater control (vegetated sheet flow to a piped collection system).
3. The drainage areas for the on -site stormwater systems will be limited to the amounts of built -
upon area indicated in this permit and the approved plans and specifications. The runoff from all
built -upon area within the permitted drainage areas of this project must be directed into the
permitted stormwater control measures. in addition to the permeable pavement area, the
stormwater control measures labeled Drainage area 2 (smaller in size) and 3 (larger in size)
have been designed using the runoff treatment method to handle the runoff from 319 and 4,094
square feet of adjacent built -upon area, respectively. This permit does not provide any allocation
of built -upon area for future development.
Page 1 of 5

State Stormwater Management
Permit No. SW8 180310
4. A 50-foot wide vegetative setback must be provided and maintained adjacent to all surface
waters, measured horizontally from the normal pool elevation of impounded structures, from the
top of bank of each side of streams or rivers, and from the mean high waterline of tidal waters,
perpendicular to the shoreline in accordance with the stormwater rules and the approved plans
and specifications.
5. The stormwater control measures are permitted based on the design criteria presented in the
sealed, signed and dated supplements and as shown in the approved plans and specifications.
These stormwater control measures must be provided and maintained at the design condition.
The approved supplements are incorporated by reference into this permit.
6. The peak flow from the 10-year storm event shall not cause erosion downslope of the
stormwater outlet discharge point.
7. Except for the incidental, unavoidable runoff from the stable vegetated areas shown on the
plans, runoff from adjacent pervious areas shall be prevented from reaching the permeable
pavement.
8. It is recommended that during the installation of the permeable pavement, care is taken to avoid
compaction of the underlying subgrade soils. To confirm compaction has not occurred, it is
recommended that a direct measurement of the soil's infiltration rate be conducted after
excavation and before the aggregate is placed. If the infiltration rate has diminished, it is
recommended to scarify, rip, or trench the subgrade to restore the infiltration rate.
9. After installation, the permeable pavement shall be protected from sediment deposition until the
site is completed and stabilized.
10. Concentrations of oils, grease, heavy metals, and toxic chemicals shall not be stored or handled
where they may enter the permeable pavement.
11. At no time shall the approved permeable pavement be paved over or repaired with any type of
conventional paving material.
II. SCHEDULE OF COMPLIANCE
1. The project and SCM(s) shall be constructed, operated and maintained in accordance with the
conditions of this permit and the approved plans and specifications.
2. The on -site stormwater system shall be entirely constructed and operational prior to the
construction of any development within the drainage area, per the approved plans and
specifications.
3. During construction, erosion shall be kept to a minimum and any eroded areas of the on -site
stormwater system will be repaired immediately. If the stormwater system is 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.
4. All stormwater control measures, stormwater collection systems, vegetated conveyance
systems, and/or maintenance accesses must be located in public rights -of -way, dedicated
common areas that extend to the nearest public right-of-way, and/or permanent recorded
easements that extend to the nearest public right-of-way for the purpose of inspection,
operation, maintenance, and repair.
5. The permittee shall provide and perform the operation and maintenance necessary, as listed in
the signed Operation and Maintenance Agreement, to assure that all components of the
permitted on -site stormwater system functions at the approved design condition. The approved
Operation and Maintenance Agreement is incorporated by reference into this permit and must
be followed in its entirety and maintenance must occur at the scheduled intervals.
6. The operation and maintenance agreement must be recorded with the Office of the Register of
Deeds.
Page 2 of 5

State Stormwater Management
Permit No. SW8 180310
7. 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.
8. The final plats for the project must be recorded with the Office of the Register of Deeds. The
recorded plat must reference the Operation and Maintenance Agreement and must also show all
public rights -of -way, dedicated common areas, and/or permanent drainage easements, in
accordance with the approved plans.
9. The permittee is responsible for verifying that the proposed built -upon area for the entire project
does not exceed the maximum allowed by this permit.
10. Upon completion of the project, the permittee shall determine whether or not the project is in
compliance with the permitted plans and take the necessary following actions:
a. If the permittee determines that the project is in compliance with the permitted plans, then
within 45 days of completion, the permittee shall submit to the Division one hard copy and
one electronic copy of the following:
i. The completed and signed Designer's Certification provided in Attachment A
noting any deviations from the approved plans and specifications. Deviations
may require approval from the Division;
ii. A copy of the recorded maintenance agreement;
iii. Unless already provided, a copy of the recorded deed restrictions and protective
covenants; and
iv. A copy of the recorded plat delineating the public rights -of -way, dedicated
common areas and/or permanent recorded easements, when applicable.
b. If the permittee determines that the project is not in compliance with the permitted plans,
the permittee shall submit an application to modify the permit within 30 days of completion
of the project or provide a plan of action, with a timeline, to bring the site into compliance.
11. No person or entity, including the permittee, shall alter any component shown in the approved
plans and specifications. Prior to the construction of any modification to the approved plans, the
permittee shall submit to the Director, and shall have received approval for modified plans,
specifications, and calculations including, but not limited to, those listed below:
a. Any modification to the approved plans and specifications, regardless of size including the
stormwater control measures, built -upon area, details, etc.
b. Redesign or addition to the approved amount of built -upon area or to the drainage area.
c. Further development, subdivision, acquisition, lease or sale of any, all or part of the project
area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading or resizing of any
component of the approved stormwater control measure, stormwater collection system
and/or vegetative conveyance system shown on the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement for BUA credit that was not included in the
approved plans and specifications.
g. The construction of any #57 stone area, public trails, or landscaping material to be
considered a permeable surface that were not included in the approved plans and
specifications.
h. Other modifications as determined by the Director.
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 modified plans and certification in writing to
the Director that the changes have been made.
13. Prior to transfer of the permit, a file review and site inspection will be conducted by Division
personnel to ensure the permit conditions have been met and that the project and the on -site
stormwater system complies with the permit conditions. Any items not in compliance must be
repaired, replaced restored, or resolved prior to the transfer. Records of maintenance activities
performed to date may be requested.
Page 3 of 5

State Stormwater Management
Permit No. SW8 180310
III. GENERAL CONDITIONS
1. Any individual or entity found to be in noncompliance with the provisions of a stormwater
management permit or the requirements of the stormwater rules is subject to enforcement
procedures as set forth in NCGS 143 Article 21.
2. The issuance of this permit does not preclude the permittee from complying with and obtaining
any other permits or approvals that are required for this development to take place, as required
by any statutes, rules, regulations, or ordinances, which may be imposed by any other Local,
State or Federal government agency having jurisdiction. Any activities undertaken at this site
that cause a water quality violation or undertaken prior to receipt of the necessary permits or
approvals to do so are considered violations of NCGS 143-215.1, and subject to enforcement
procedures pursuant to NCGS 143-215.6.
3. If the facilities fail to perform satisfactorily, the permittee shall take immediate corrective actions.
This includes actions required by this Division and the stormwater rules such as the construction
of additional or replacement on -site stormwater systems. These additional or replacement
measures shall receive a permit from the Division prior to construction.
4. This permit is not transferable to any person or entity except after notice to and approval by the
Director. The permittee shall submit a completed and signed State Stormwater Request Form
for Permit Transfer or Permit Information Update, accompanied by the supporting
documentation as listed on the form, to the Division at least 60 days prior to any one or more of
the following events:
a. Any ownership change including:
i. The sale or conveyance of the project area in whole or in part, except in the case of
an individual lot sale that is made subject to the recorded deed restrictions and
protective covenants;
ii. Dissolution of the partnership or corporate entity, subject to NCGS 57D-2-01(e) and
NCGS 57D-6-07;
b. Bankruptcy;
c. Foreclosure, subject to the requirements of Session Law 2013-121
d. A name change of the current permittee;
e. A name change of the project;
f. A mailing address change of the permittee;
5. The permittee is responsible for compliance with all terms and conditions of this permit until the
Division approves the transfer request. Neither the sale of the project, in whole or in part, nor
the conveyance of common area to a third party constitutes an approved transfer of the permit.
6. The permittee grants Division Staff permission to enter the property during normal business
hours to inspect all components of the permitted project.
7. The permit issued shall continue in force and effect until the permittee files a request with the
Division for a permit modification, transfer, renewal, or rescission; however, these actions do not
stay any permit conditions.
8. Approved plans, application documents, supplements, calculations, operation and maintenance
agreement, and specifications for this project are incorporated by reference and are enforceable
parts of the permit. A copy of this permit, application, supplements, operation and maintenance
agreement, and approved plans and specifications shall be maintained on file by the permittee.
9. Unless specified elsewhere, permanent seeding requirements for the on -site stormwater system
must follow the guidelines established in the North Carolina Erosion and Sediment Control
Planning and Design Manual.
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 for cause as allowed by the
laws, rules, and regulations contained in Title 15A NCAC 2H.1000 and NCGS 143-215.1 et.al.
11. A permit renewal request must be submitted at least 180 days prior to the expiration date of this
permit. The renewal request must include the appropriate application, documentation and the
processing fee as outlined in Title 15A NCAC 02H.1045(3).
Page 4 of 5

State Stormwater Management
Permit No. SW8 180310
Permit issued this the 12th day of April 2018.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Willia E. (Toby) Vinson, Jr., PE, CPESC, CPM, interim Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 180310
Page 5 of 5

State Stormwater Management
Permit No. SW8 180310
Attachment A
Certification Forms
The following blank Designer Certification forms are included and specific for this project:
• As -Built Permittee Certification
• As -Built Designer's Certification General MDC
• As -Built Designer's Certification for Permeable Pavement Project
A separate certification is required for each SCM. These blank certification forms may be copied and
used, as needed, for each SCM and/or as a partial certification to address a section or phase of the
project.
Page 1 of 1

State Stormwater Management
Permit No. SW8 180310
AS -BUILT PERMITTEE CERTIFICATION
I hereby state that I am the current permittee for the project named above, and I certify by my signature below,
that the project meets the below listed Final Submittal Requirements found in NCAC 02H.1042(4) and the
terms, conditions and provisions listed in the permit documents, plans and specifications on file with or provided
to the Division.
'—' Check here if this is a partial certification. Section/phase/SCM #
Check here if this is part of a Fast Track As -built Package Submittal.
Printed Name
I,
County of
Signature
a Notary Public in the State of
do hereby certify that
personally appeared before me this day of , 20
and acknowledge the due execution of this as -built certification. (SEAL)
Witness my hand and official seal
My commission expires
i - Permittee's Certification IvC AC .1042(4} -- - ----
CGmpleted i
Provided
N/A
i
A. DEED RESTRICTIONS / BUA RECORDS
1. The deed restrictions and protective covenants have been recorded and
Y or N
contain the necessary language to ensure that the project is maintained
consistent with the stormwater regulations and with the permit conditions.
2. A copy of the recorded deed restrictions and protective covenants has been
Y or N
provided to the Division.
_
3. Records which track the BUA on each lot are being kept. (See Note 1)
Y or N
B. MAINTENANCE ACCESS
1. The SCMs are accessible for inspection, maintenance and repair.
Y or N
2. The access is a minimum of 10 feet wide.
Y or N
3. The access extends to the nearest public right-of-way.
Y or N
C. EASEMENTS —
1. The SCMs and the components of the runoff collection / conveyance system
are located in recorded drainage easements.
Y or N
2. A copy of the recorded plat(s) is provided.
Y or N
D. SINGLE FAMILY RESIDENTIAL
DENTL LOTS - Plats for residenfiW.lots that
have an SCM include the following:
—i---
( Y or N {
1. The specific location of the SCM on the lot.
Y or N
2. A typical detail for the SCM.
Y or N
3. A note that the SCM is required to meet stormwater regulations and that the
lot owner is subject to enforcement action as set forth in NCCS 143 Article
Y or N
_ 21 if the SCM is removed, relocated or altered withgApKr or approval. —
—_
E. OPERATION AND MAINTENANCE AGREEMENT
Y of N
I
1. The O&M Agreement is referenced on tie final recorded plat.
Y or N
2. The O&M Agreement is recorded with the Register of Deeds and appears in
Y or N
_
the chain of title.
F. OPERATION AND MAINTENANCE PLAN — maintenance records are
I y or N
being kept in a known set location for each SCM and are available for review.
1—
G. DESIGNER'S CERTIFICATION FORM — has been provided to the
I j
Y or1�F
Division. 1_
_
Note 1- Acceptable records include ARC approvals as -built surveys and rnunty tax rennrds
Page 1 of 6

State Stormwater Management
Permit No. SW8 180310
Provide an explanation for every requirement that was not met, and for every "N/A" below. Attach
additional sheets as needed.
Page 2 of 6

State Stormwater Management
Permit No. SW8 180310
AS -BUILT DESIGNER'S CERTIFICATION GENERAL MDC
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I have observed
the construction of the project named above to the best of my abilities with all due care and diligence, and that
the project meets the below listed General MDC found in NCAC 02H.1050 in accordance with the permit
documents, plans and specifications on file with or provided to the Division, except as noted on the "AS -
BUILT" drawings, such that the intent of the sormwater rules and statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM #?
Check here if this is a part of a Fast -Track As -Built Package Submittal per .1044(3).
Check here if the designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed Name
NC Registration Number
fawAx
Signature
Irate;
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
OO N/E = not evaluated (provide explanation on page 2) OO N/A = not applicable to this SCM or project.
Consultant's Certification NCAC .1003((3) & General MDC .1050
OAs-built
j ON/Es
ZN/A
A. TREATMENT REQUIREMENTS
1. The SCM achieves runoff treatment.
Y or N
2. The SCM achieves runoff volume match.
Y or N
_
3. Runoff from offsite areas and/or existing BUA is bypassed.
Y or N
4. Runoff from offsite areas and/or existing BUA is directed into
Y or N
the permitted SCM and is accounted for at the full build -out
potential.
5. The project controls runoff through an offsite permitted SCM
Y or N
that meets the requirements of the MDC.
6. The net area of new BUA increase for an existing project has
Y or N
been accounted for at the appropriate design storm level.
7. The SCM(s) meets all the specific minimum design criteria.
Y or N
B. VEGETATED SETBACKS / BUA -- -------------
-------.._.-
---
-- —
1. The width of the vegetated setback has been measured from
Y or N
the normal pool of impounded waters, the MHW line of tidal
waters, or the top of bank of each side of rivers or streams.
2. The vegetated setback is maintained in grass or other
Y or N
vegetation.
3. BUA that meets the requirements of NCGS 143-214.7 (b2)(2)
Y or N
is located in the setback.
4. BUA that does not meet the requirements of NCGS 143-214.7
Y or N
(b2)(2) is located within the setback and is limited to:
a. Publicly funded linear projects (road, greenway sidewalk)
b. Water -dependent structures
c. Minimal footprint uses (utility poles, signs, security
lighting and appurtenances)
5. Stormwater that is not treated in an SCM is released at the
Y or N
edge of the setback and allowed to flow through the setback as
dispersed flow.
Page 3 of 6

State Stormwater Management
Permit No. SW8 180310
®As -built__ 4�IC
GN/A
1 C. STOPAMATM 01MUTS — the outlet handles the peak- flow
Y N
from the. 10 year storm with no downslope, erosion.
or
D. VARIATIONS
1. A variation (alternative) from the stormwater rule provisions
Y N ----
has been implemented.
or
2. The variation provides equal or better stormwater control and
Y N
equal or better protection of surface waters.
or
E. COWLIANCE WITH OTHER REGULATORY
Y N
PROGRAMS has been Met.
or
F. SIZING -the volume of the SCM takes the runoff l—rom aff-
surfaces into account and is sufficient to handle the required storm
Y or N
depth.
G. CONTAMINATED SOILS — infiltrating SCM's are not located
Y or N
in or on arm with contaminated soils.
H. SIDE SLOPES
1. Vegetated side slopes are no steeper thanJ_H:M
Y or N
2. Side slopes include retaining walls, gabion walls, or other
Y or N
surfaces that are steeper than 3 H: IV.
3. Vegetated side slopes are steeper than 3H:1V (provide
Y or N
supporting- documents for soils and vegetation
L EROSION PROTECTION
I inlets do not cause erosion in the SCM.
Y or N
.... ...
2. The outlet does not cause erosion downslope of the discharge
Y or N
point during the peak flow from the 10 year storm.
.
J. EXCESS FLOWS —.An overflow 2'bypass has been provided.
Y or N
X UWATERING — A method to drawdown standing water has
Y or N
been -provided to facilitate maintenance and inspection.
L. CLEANOUT AFTER CONSTRUCTION — the SCM has been
Y or N
cleaned out and converted to its approved design state.
M. MAINTENANCE ACCESS
1. The SCM is accessible for maintenance and repair.
Y or N
2. The access does not include lateral or incline slopes >3: 1.
Y or N
N. DESIGNER QUALIFICATIONS (FAST -TRACK PERMIT) —
The designer is licensed under Chapters 89A, 89C, 89E, or 89F of
Y or N
the General Statutes.
jjj
Provide an explanation for every MDC that was not met, and for every item marked "N/A" or "WE",
below. Attach additional pages as needed:
Page 4 of 6

State Stormwater Management
Permit No. SW8 180310
AS -BUILT DESIGNER'S CERTIFICATION FOR PERMEABLE PAVEMENT PROJECT
I hereby state that I am a licensed professional and I certify by my signature and seal below, that I have observed
the construction of the project named above to the best of my abilities with all due care and diligence, and that
the project meets all of the MDC found in NCAC 02H.1055 in accordance with the permit documents, plans and
specifications on file with or provided to the Division, except as noted on the "AS -BUILT" drawings, such that
the intent of the stormwater rules and the general statutes has been preserved.
Check here if this is a partial certification. Section/phase/SCM 4?
Check here if this is a part of a Fast -Track As -Built Package Submittal per .1044(4).
Check here if the Designer did not observe the construction, but is certifying the project.
Check here if pictures of the SCM are provided.
Printed Name
NC Registration Number
SEAL:
Signature
Date
Consultant's Mailing Address:
City/State/ZIP
Phone Number
Consultant's Email address:
O Circle N if the as -built value differs from the Plan. If N is circled, provide an explanation on Page 2.
OO N/E = not evaluated (provide explanation on page 2) OO N/A = not applicable to this project or SCM
This Certification must be completed in conjunction with the General MDC certification under NCAC 0211.1050
Consultant's Certification (MDC .1055) -- -
COAs-built 0.
ON/A
A. DESIGN / DRAWDtIWN
1. Washed aggregate base material has been used.
Y or N
2. The provided amount of permeable pavement surface area is
Y or N
consistent with the approved plans.
3. The amount of non -roof adjacent built -upon area is consistent with
the approved plans and is directed onto the permeable pavement
Y or N
surface and does not exceed the required 1:1 ratio Aa/A .
4. The runoff from adjacent pervious areas is prevented from
reaching the permeable pavement except for incidental,
Y or N
unavoidable runoff from stable vegetated areas.
5. The permeable pavement infiltrates the design volume to the
Y N
bottom of the subgrade within 72 hours.
or
6. If the permeable pavement was installed as a detention system, the
drawdown assembly releases the stormwater stored in the
Y or N
aggregate in 2_ _-5 days.
B. SOILS // SHWT / SUBGRADE-
1. The hydraulic properties and characteristics of the in -situ soils
Y N
conforrn to the soils report.
or
2. For infiltrating permeable pavement, the lowest point of the
Y N
system is a minimum of 2 feet above the SHWT.
or
3. For infiltrating permeable pavement, if the lowest point of the
system is less than 2 feet above the SHWT, the soils have been
Y or N
modified to assure drawdown within 72 hours.
4. The in -situ soils have been removed and replaced with infiltration
Y or N
media in accordance with the approved plan.
5. Infiltration media has been placed on top of in -situ soils.
Y or N
Page 5 of 6

State Stormwater Management
Permit No. SW8 180310
C.As-built
I ®N/F
QN/A�
C. CONSTRUCTION
1. At least one capped observation well has been provided at the low
point of each permeable pavement area?
Y or N
2. The subgrade is terraced in accordance with the approved plans
and has at least one capped observation well within each terrace
Y or N
section.
3. For PICP and concrete grid pavers, an edge restraint has been
used around the perimeter of the permeable pavement.
Y or N
4. The subgrade for infiltrating permeable pavement was graded
Y or N
when _it was dry and there was n_oreciQrtation
D. CERMICATION--
1. The infiltration rate of the pavement surface is at least 50 inches
per hour using a head less than orequal to four inches.
Y or N
2. After installation, the permeable pavement was protected from
Y N
sediment deposition.
or
3. The site is complete and stabilized.
Y or N
Provide an explanation for every MDC that was not met, or for every item marked "N/E" or "N/A".
below. Attach additional pages as needed:
Page 6 of 6

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph Il - Post Construction
(select all that apply) ❑ Non Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifiac�tioINOs, 1pet Ts, operation and maintenance agreements, etc.):
2. Location of Project (street address):
"I" STREET
City:MARINE CORPS BASE, CAMP LETEUNE County:ONSLOW Zip:28547
3. Directions to project (from nearest major intersection):
PROTECT IS LOCATED 100 FEET SOUTHWEST OF THE INTERSECTION OF "H" AND "I" STREETS AT
MCB CAMP LETEUNM
4. Latitude:340 39' 42" N Longitude:770 20' 54" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenewals with modifications also requires SWU--102 - Renewal Application Form
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberREDEVELOPMENT , 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 []Drains to an Offsite Stormwater System []Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR 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):
❑LAMA Major ®Sedimentation/Erosion Control: 3.5 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:EROSION CONTROL SUBMITTED CONCURRENTLY
5. Is the project located within 5 miles of a public airport? ®No [-]Yes E C
If yes, see S.L. 2012-200, Part V1. http://portal.ncdenr.org/web/lr/rules-and-regulations MAR 2 7 201
Form SWU-101 Version Oct. 31, 2013 Page 1 of 6 gy:

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organ
Signing Official &
b. Contact information for person listed in item la above:
Street Address:1005 MICHAEL ROAD
City:MCB CAMP LEiEUNE State:NC Zip:28547
Mailing Address (if applicable):
City: State: Zip:
Phone: (910 ) 451-3238 X3285 Fax: [phone]
Emai1:THOMAS.BRADSHAW®USMC.MIL
Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City:,
Mailing Address (if applicable):
City:
Phone: ( )
Email:
State: Zip:
State: Zip:
Fax: f 1
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official & Title:
b. Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
4. Local jurisdiction for building permits: NLA
Point of Contact: Phone #: X L; E I y
MAR 2 7 2018
BY:
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater runoff will be treated by redevelopment with equal or better stormawter management controls
Permeable pavers (8,161 SF) will be used to reduce the total impervious area below the quantiy of BUA
rev sently existing at the site.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b. If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the WHITE OAK' River basin.
4. Total Property Area: 4.68 acres
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area+:4.68 acres
+ Total project area shall be calculated to exclude the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHM line or Mean High Water
(MHM line, and coastal wetlands landward from the NHW (or MHM line. The resultant project area :s used to
calculate overall percent built upon area (B UA). Non -coastal wetlands landward of the NHW (or MHKq line may
be included in the total project area.
8. Project percent of impervious area: (i otai Impervious Area / Total Project Area) X 100 = 56.2 %
9. How many drainage areas does the project have?3 (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. ,T" VP OANI, ?'P ,
Basin Information
Drama a Area 1
Drainage Area 2
Drainage ArYa 3
Drainage Area _
Receiving Stream Name
UT TO NEW
RIVER
UT TO NEW
RIVER
UT TO NEW
RIVER
Stream Class *
SC,NSW
SQNSW
SQNSW
Stream Index Number *
19-(15.5)
19-(15.5)
19-(15.5)
Total Drainage Area (so
203,861
1,820
10,754
On -site Drainage Area (sf)
203,861
1,820
10,754
Off -site Drainage Area (sf)
0
0
0
Proposed Impervious Area** s
104,820
319
4,094
% Impervious Area** total
56.2
17.53
38.07
Impervious** Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area _
On -site Buildings/Lots (sf)
25,959
0
0
On -site Streets (sf)
0
0
0
On -site Parking (sf)
74,551
319
4,094
On -site Sidewalks (sf)
10,797
0
0
Othey on -site (s€)
3,175
0
0
Future (sf)
0
0
0
Off -site (sf)
0
0
0
11,
Existing BUA*** (sf)
0
0
0
Total (sf):
114,482
319
4,094
* Stream Class and Index Number can be determined at: tp ortal.ncdenr.org/`webAvq s/cs sjcations
Form SWU-101 Version Oct. 31, 2013 Page 3 of 6

Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
'Report only that amount of existing B UA that will remain after development. Do not report any existing B UA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. Field visit and
topographic survey.
Projects in Union County: Contact DEMLR Central Offace staff to check if the project is located within a Threatened &
Endangered Species watershed that maybe subject to more stringent stormwater requirements as per 1 SA 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.ortz/web/wo/ws/su/bmlD-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists. are available from
http://portal.ncdenr.org/web/wg/ws/su/statesw/forms docs. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map atft://RL3rtal.ncdenr.org/web/yA/ws/su/maRs.)
://portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from ft://portal.ncdenr.org/web/wA/ws/su/­statesw/forms docs.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants �'M%
Form. (if required as per Part VII below) I/ --
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
hM://www.envhelp.org/paages/onestOR2xRress.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/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1h mile of the site boundary, include the 1h If
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface wafters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or 1`41'1F.`l line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impo ' e..•
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal water
i. Dimensioned property/project boundary with bearings & distances. MAR 2 7 20%
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations. BY:
1. Details of roads, drainage features, collection systems, and stormwater control measures.
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

10. A copy of the most current property deed. Deed book: N/A Page No: FEDERAL
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
hn://www.secr2tM.state.nc.us/CorRorations/CSearch.aWx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify '
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" 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 DEMLR to verify the SHWT prior
to submittal, [phone].) �/
, , VA P-
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/lr/state-stormwater-
forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, 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 joseyh C. Avolis, PE
Consulting Firm: Avolis En in tnn PA
Mailing Address:PO Box 15564
City:New Bern State:NC Zip:28561
Phone: (252 ) 633-0068 Fax: ( 1
Email:avohseng,[e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type name of person listed in Contact Information, item 2a) . certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) with (print or type name of organization listed in
Contact Information, item 1a) to develop the project as currently prop-osed. A copy
the lease agreement or pending property sales contract has been provided with the submittal, t!"' hates 611
party responsible for the operation and maintenance of the stormwater system. MAR
Form SWU-101 Version Oct. 31, 2013 Page 5 of 6
BY:

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 DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR 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 $25,000 per day, pursuant to NCGS 143-215.6.
Signature: Date:
a Notary Public for the Striate of County of
do hereby certify that personally appeared
before me this — day of , _ , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a) THOMAS BRADSHAW, PE
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the appWved plans, that the required deed restrictions
and protective covenants will b recorded, and that the pro d project complies with the requirements of the
applicable stormwater rules der15ANCA .1000 ny other applicable state stormwater requirements.
Signature: Date
a Notary Public for the State of Nicounty of
do hereby certify than � personally appeared
before me this day of `�y\a� r, C�"1,D61 and a owledge the due execution of the application for
a stormwater permit. Witness my hand and officials _ !_ __
SA
Notary Public
Onslow County
HMV commission t;xpiri
2 06/26/2019
i
��'��i;rl►•CAlto$-,
Form SWU-101 Version Oct. 31, 2013
SEAL
NIN commission c?xpires �/1�
AA
..ZIP
Mg27201
Page 6 of 6

Operation & Maintenance Agreement
Project Name:
Project Location:
P4041 AMBULATORY CARE CENTER/DENTAL CLINIC REPLACE
"I" STREET MCB CAMP LEJEUNE
'
maintenance recoras snap oe kept on the following BMP(s). This maintenance record shall be kept in a log in a known set
location. Any deficient BMP elements noted in the inspection will be corrected, repaired, or replaced These
deficiencies can affect the integrity of structures, safety of the public, and the pollutant removal efficiency of the BMP(s).
The BMP(s) on this project include (check all that apply & carres onding O&M tables will
Bioretention Cell Quantity: Location(s):
Dry Detention Basin Quantity. Location(s):
Grassed Swale Quantity: Location(s):
Green Roof
Quantity:
Location(s):
Infiltration Basin
Quantity:
Location(s):
Infiltration Trench
Quantity:
Location(s):
Level Spreader/VFS
Quantity:
Location(s):
Permeable Pavement
Quantity:
Location(s):
PARKING LOT NW SIDE OF "I" STRE
Proprietary System
Quantity,.
Location(s):
Rainwater Harvesting
Quantity:
Location(s):
Sand Filter
Quantity:
Location(s):
Stormwater Wetland
Quantity:
Location(s):
Wet Detention Basin
Quantity.,
0
Location(s):
Disconnected Impervious Area
Present:
No
Location(s):
User Defined BMP
Present:
No
Location(s):
GLICK TO UPDATE O&M MANUAL
I acknowledge and agree by my signature below
that I am responsible for the performance of the maintenance procedures listed
for each BMP above, and attached O&M tables.
I agree to notify NCDENR of any problems with the system or prior to any
changes to the system or responsible party.
" Responsible Party:
Title & Organization:
Street address:
City, state, zip:
Phone number(s):
Email:
COMMANDING OFFICER MCB CAMP LEJEUNE
THOMAS BRADSHAW, PE, PUBLIC WORKS
1005 MICHAEL ROAD
MARINE CORPS BASE CAM LEJEUNE, NC 28547
910) 451-3238 X3285
[e-mail]
Signaturg* Date:
L i� 1 �y , a Notary Public for the State of
County of pkk') do hearby certify that t I
personally appeared before me this day of MaA ck-) _ o1 J1 and
acknowledge the due execution of the Operations and Maintenance Agreement
Witness my hand and official seal,
T
AIN
No?cirylrub110 '
E OnNow County
!lay Commt:alon fxRlree
�$l�6/ZO1 R
QV:
V
ly commission expires NCr
4
STORM-EZ
Version 1.4
O&M Manual
2128/2018
Page 1 of 1

Permeable Pavement Maintenance Requirements
At all times, the pavement shall be kept free of:
Debris and particulate matter through frequent blowing that removes such debris, particularly during the fall and
spring.
Piles of soil, sand, mulch, building materials or other materials that could deposit particulates on the pavement.
- Piles of snow and ice.
- Chemicals of all kinds, including deicers.
The permeable pavement will be inspected once a quarter. Records of operation and maintenance will be kept in a known set
location and will be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall be repaired immediately.
BMP element:
Potential problem:
How to remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the
Areas of bare soil and/or
Regrade the soil if necessary to remove the gully, then plant ground
permeable pavement
erosive gullies
cover and water until established.
A vegetated area drains
Regrade the area so that it drains away from the pavement, then plant
toward the pavement.
ground cover and water until established.
The inlet device
The pipe is clogged.
Unclog the pipe. Dispose of the sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to smooth it over and provide erosion
swale.
control devices such as reinforced turf matting or riprap to avoid future
problems with erosion.
Stone verge is clogged or
Remove sediment and replace with clean stone.
covered in sediment (if
applicable).
The surface of the
Trash/debris present
Remove the trash/debris.
permeable pavement
Weeds
Do not pull the weeds (may pull out media as well). Spray them with a
systemic herbicide such as glyphosate and then return within the week
to remove them by hand. (Another option is to pour boiling water on
them or steam them.)
Sediment
Vacuum sweep the pavement.
Rutting, cracking or slumping
Consult an appropriate professional.
or damaged structure
Observation. well
Water present more than five
Clean out clogged underdrain pipes. Consult an appropriate
days after a storm event
professional for clogged soil subgrade.
Educational sign
Missing or is damaged.
Replace the sign.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose of the sediment off -site.
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Department of Environment and Natural
damage have occurred at the
Resources Regional Office.
outlet.
n, u-IEW
NlAR 2 7 2018
STORM-EZ 3/27/2018
Version 1.4 O&M Manual Page 3 of 3

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