SW8950317_CURRENT PERMIT_20170720

m
STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 C+503�"1
DOC TYPE
CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
201'1012 0
YYYYMMDD

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Energy. Mineral &
Land Resources
ENVIRONMENTAL QUALITY
July 20, 2017
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Mr Daniel T Waller, Sr. Vice President
Onslow Memorial Hospital
241 New River Drive
Jacksonville_ INC 28540
Subject: State Stormwater Management Permit No. SW8 950317 Mod 3
Parking - RR & Surgical Services Pavilion - Onslow Memorial Hospital
Wet Pond No. I Retrofit -High Density Project
Onslow County
Dear Mr. Waller:
The Wilmington Regional Office received a complete, modified Stormwater Management Permit
Application for BR & Surgical Services Pavilion, Wet Pond No. I Retrofit, on May 22,. 2017. This permit
modification was required to expand wet detention Pond No. 1, located in the northwestern section of the
site_ to handle the pre-1988 BUA plus new BUA plus any future BUA requirements. This permit
modifies permit SW8 950317. issued on April 5, 2012. by increasing the built -upon area (BUA) in the
high -density pocket of an overall 30% low density development; and b-V modiNing the design of the wet
detention pond in drainage area 1 (DA 1) to handle the increased BUA. 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 214 1000 Therefore, we are forwarding Permit No. SW8 950317 Mod 3,
dated July 20, 2017, for the construction, operation, and maintenance of the subject parking project.
This permit shall be effective from the date of issuance until August 3,. 2020, and shall be 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,
certification of the BMP's, procedures for changing 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 certify the BMP's, 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 919-43 1 -3000, or visit their
website at w1vw.NCOAH.com. Unless such demands are made this permit shall be. final and binding.
If you have any questions, or need additional information, please contact Steve Pusey in the Wilmington
Regional Office, at [phone].
Sincerely,
",Tracy Dakis, P.E , Director
Division of Energy, Mineral and Land Resources
GDS/ sgp \\\Stormwater\Permits & Projects\1995\950317 HD\2017 07 permit 950317
cc: David Newsom, PE — Crystal Coast Engineering, PA
John Pierce, PLS — John L. Pierce & Associates, PA
Danny Bryan, City of Jacksonville
Wilmington Regional Office Stormwater File
State of North Calohna I Environmernal Quality I Energy. Nlinclal and Land Rcsom2vs
Wilmington Regional Office 1127Cardlna1DrneEateuslon I Wihnington,NC 28405
910 796 7215

State Stormwater Management Systems
Permit No. SW8 950317 MOD 3
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
OVERALL LOW DENSITY SUBDIVISION DEVELOPMENT
WITH POCKETS OF HIGH DENSITY
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
Onslow Memorial Hospital
Parking - ER & Surgical Services Pavilion - Onslow Memorial Hospital
317 Western Blvd., Jacksonville, Onslow County
FOR THE
construction, operation and maintenance of an overall 30% low density development
with one (1) State Stormwater wet detention pond and one (1) City of Jacksonville wet
detention pond to treat the higher density areas, in compliance with the provisions of
Title 15A NCAC 2H .1000 (hereafter referred to as the "storm water 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 and considered a part of this permit.
This permit modification was required to expand wet detention Pond No. 1, located in
the northwestern section of the site, to handle the pre-1988 BUA plus new BUA plus
any future BUA requirements. This permit modifies permit SW8 950317, issued on April
5, 2012, by increasing the built -upon area (BUA) in the high -density pocket of an overall
30% low density development; and by modifying the design of the wet detention pond in
drainage Area 1 (DA1) to handle the increased BUA. 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. Therefore, we are
forwarding Permit No. SW8 950317 Mod 3, dated July 20, 2017, for the construction,
operation, and maintenance of the subject project.
Please reference the "BUA Summary" table on the next page for a summary of BUA
and project area
Page 2 of 9

State Stormwater Management Systems
Permit No SW8 950317 MOD 3
BUA Summary
SWS 950317
19-Jul-17
Onslow Memorial Hospital MOD 3
Total
DA1
HD Pocket 1
(2006 DWQ)
DA2
HD Pocket 2
(HD Jax)
DA3
LD
Proposed 2017 with improvements: Impervious (Pre1988+ "new" +future)
buildings
211,135
84,329
9,824
116,982
parking / streets, ind. add'I, pre-88
437,512
182,504
90,195
164,813
sidewalk
42,557
23,383
2,508
16,666
pre-88 BUA onsite *
Incl. above
Incl. above
Incl. above
incl. above
pre-88 BUA offsite
5,378
5,378
0
0
future
55,742
14,742
41,000
0
BUA Total (Pre1988+"new") + Future
752,324
310,336
143,527
298,461
"New" BUA
484,677
I 292,091
92,303
100,283
Pre1988 BUA
267,647
18,245
51,224
198,178
Project Area (sf)
I 1,956,725
( 594,158
172,945
1,189,622
Project Area (acres)
44.92
13.64
3.97
27.31
Pre-88 BUA onsite is included in buildings, parking, streets, & sidewalk
This permit shall be effective from the date of issuance until August 3, 2020 and shall be
subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. The overall tract built -upon area percentage for the project must be maintained at
30% per the requirements of Section .1005 of the stormwater rules. This
stormwater system for the high density pocket (drainage area DA1) has been
approved for the management of stormwater runoff as described in Section 1.8 of
this permit. The stormwater control measure labeled DA1 has been designed to
handle the runoff from 310,336 square feet of impervious area.
3 The maximum built -upon area allowed for the entire project is 752,324 square
feet.
4. The drainage area(s) will be limited to the amount(s) of built -upon area Indicated
in Sections 1.2 and 1.8 of this permit, and per approved plans. The built -upon area
for the future development is limited to 14,742 square feet in drainage area DA1.
5. The runoff from the design built -upon areas within drainage areas of the pockets
of high density must be directed into the permitted stormwater control systems.
6. The stormwater systems proposed to treat the runoff generated by the
designated high density areas have been approved for the management of
stormwater runoff as described in Section 1.6 of this permit and in the City of
Jacksonville permit.
7. The low density portions of this project will maintain a minimum 30 foot wide
vegetated buffer between all impervious areas and surface waters.
sf
sf
sf
sf
sf
sf
sf
sf
sf
Page 3 of 9

State Stormwater Management Systems
Permit No SW8 950317 MOD 3
8. The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
DA 1
a-
Drainage Area, acres.
Onsite, ft'
Offsite. ft'.
1364
594,158
NA
b
Total Impervious Surfaces, ft'.
Onsite. ft'
Offsite, ft'
310,336
304.958
5.378
c.
Average Pond Design Depth. feet:
5.0
Id
TSS Removal Efficiency:
90%
le
Design Storm, inches.
1 5
If
Permanent Pool (PP) Elevation, FMSL
320
Ig
Permitted PP Surface Area, ft'
21,859
Ih
Temporary Storage Elevation, FMSL
I 33.64
li
Permitted Storage Volume, ft'
39,522
if
Predevelopment 1 yr-24 hr. discharge rate, cfs
0.31
Ik ,
Controlling Orifice, inch 0 pipe
2.5
I
Orifice Flow Rate. cfs
0 12
�m.
PP Volume ft':
109,223
In
Forebay Volume, ft'
22,108
to
Maximum Fountain Horsepower
1/6
l p
Receiving Stream / River Basin
I Scales Creek / White Oak
I
Stream Index Number
19-16-4
1r
Classification of Water Body:
SC, HQW. NSW
II. SCHEDULE OF COMPLIANCE
No homeowner/lot owner/developer shall fill in, alter, or pipe any drainage feature
(such as swales) shown on the approved plans as part of the stormwater
management system without submitting a revision to the permit and receiving
approval from the Division.
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.
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.
4. Within the low density portions of the permitted project, all roof drains shall
terminate at least 30 feet from the mean high water mark of surface waters
5. The Director may determine that other revisions to the project should require a
modification to the permit
6. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
must be recorded showing all such required easements, in accordance with the
approved plans.
Page 4 of 9

State Stormwater Management Systems
Permit No SW8 950317 MOD 3
7. 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 the approved plans, regardless of size
b Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area.
e. Further development, subdivision, acquisition, or sale of any, 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.
g. The construction of permeable pavement for BUA credit.
8. During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
9 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.
10. 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.
11. Unless otherwise shown, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
12. The facilities shall be constructed, operated and maintained in accordance with
the provisions of this permit, the approved plans and specifications, and the
supporting documents attached to this permit and on file with the Division.
13 The permittee shall at all times provide the operation and maintenance
necessary to assure that all components of the permitted stormwater system
function at optimum efficiency. The approved Operation and Maintenance Plan
must be followed in its entirety and maintenance must occur at the scheduled
intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b Sediment removal
C. Mowing and re -vegetation of side slopes.
d. Immediate repair of eroded areas
e. Maintenance of side slopes in accordance with approved plans and
specifications.
f Debris removal and unclogging of structures, orifice, catch basins and
piping.
g. Access to all components of the system must be available at all times.
14. Records of maintenance activities must be kept by the permittee. The records will
indicate the date, activity, name of person performing the work and what actions
were taken.
Page 5 of 9

State Stormwater Management Systems
Permit No. SW8 950317 MOD 3
15. Prior to transfer of the permit, the stormwater facilities will be inspected by
DEMLR personnel. The facility must be in compliance with all permit conditions.
Any items not in compliance must be repaired or replaced to design condition
prior to the transfer. Records of maintenance activities performed to date will be
required.
16. Decorative spray fountains will be allowed in the stormwater treatment system,
subject to the following criteria:
a. The fountain must draw its water from less than 2' below the permanent
pool surface.
b. Separated units, where the nozzle, pump and intake are connected by
tubing, may be used only if they draw water from the surface in the deepest
part of the pond
C. The falling water from the fountain must be centered in the pond, away from
the shoreline.
d. The maximum horsepower for the fountain's pump in this pond is 1/6 hp.
17. If the use of permeable pavement for BUA credit within any area is desired, the
permittee shall submit an application with all supporting documentation and the
application fee to the Division and receive a permit modification prior to
construction of the permeable pavement
III. GENERAL CONDITIONS
1 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
Name/Ownership Change Form, accompanied by the supporting documentation
as listed on the form, to the Division of Energy, Mineral and Land Resources at
least 60 days prior to any one or more of the following events
a. An ownership change including 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,
b. The sale or conveyance of the common areas to a Homeowner's or Property
Owner's Association, subject to the requirements of Session Law 2011-256,
c. Bankruptcy;
d. Foreclosure, subject to the requirements of Session Law 2013-121,
e. Dissolution of the partnership or corporate entity, subject to NCGS 57D-2-
01(e) and NCGS 57D-6-07;
f. A name change of the current permittee;
g A name change of the project:
h. A mailing address change of the permittee
2. The permittee is responsible for compliance with all permit conditions until such
time as 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 shall
constitute an approved transfer of the stormwater permit.
3. Any individual or entity found to be in noncompliance with the provisions of this
stormwater management permit or the requirements of the Stormwater rules is
subject to enforcement procedures as set forth in NCGS 143 Article 21.
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal), which have jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
Page 6 of 9

State Stormwater Management Systems
Permit No. SW8 950317 MOD 3
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition
Permittee grants permission to staff of the DEMLR to access the property for the
purposes of inspecting the stormwater facilities during normal business hours.
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 in writing of any name, ownership or
mailing address changes at least 30 days prior to making such changes.
10. A copy of the approved plans and specifications shall be maintained on file by
the Permittee at all times. At the time the permit is transferred to a new owner,
the permittee shall forward the approved plans to the new owner.
11. 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
appropriate documentation and the processing fee.
Permit updated, modified, and re -issued this the 20'h day of July, 2017.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 950317 MOD 3
Page 7 of 9

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
Wet Detention Basin Operation and Maintenance Agreement
I will keep a maintenance record on this BMP. This maintenance record will be kept in a
log in a known set location. Any deficient BMP elements noted in the inspection will be
corrected, repaired or replaced immediately. These deficiencies can affect the integrity
of structures, safety of the public, and the removal efficiency of the BMP.
The wet detention basin system is defined as the wet detention basin,
pretreatment including forebays and the vegetated filter if one is provided.
This system (check one):
❑ does ® does not incorporate a vegetated filter at the outlet.
This system (check one):
❑ does ® does not incorporate pretreatment other than a forebay.
Important maintenance procedures:
- Immediately after the wet detention basin is established, the plants on the
vegetated shelf and perimeter of the basin should be watered twice weekly if
needed, until the plants become established (commonly six weeks).
- No portion of the wet detention pond should be fertilized after the first initial
fertilization that is required to establish the plants on the vegetated shelf.
- Stable groundcover should be maintained in the drainage area to reduce the
sediment load to the wet detention basin.
- If the basin must be drained for an emergency or to perform maintenance, the
flushing of sediment through the emergency drain should be minimized to the
maximum extent practical.
- Once a year, a dam safety expert should inspect the embank !? I�E
After the wet detention pond is established, it should be inspected e a m nth any
r�rri (, I, su
within 24 hours after every storm event greater than 1.0 inches (or inches if in a
Coastal County). Records of operation and maintenance should be t in a known set
location and must be available upon request.
Inspection activities shall be performed as follows. Any problems that are found shall
be repaired immediately.
BMP element:
Potentialproblem:
How I will remediate theproblem:
The entire BMP
Trash/debris is present.
Remove the trash/debris.
The perimeter of the wet
Areas of bare soil and/or
Regrade the soil if necessary to
detention basin
erosive gullies have formed.
remove the gully, and then plant a
ground cover and water until it is
established. Provide lime and a
one-time fertilizer application.
Vegetation is too short or too
Maintain vegetation at a height of
Ion
approximately six inches.
Form SW401-Wet Detention Basin O&M-Rev.4 Page 1 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The inlet device: pipe or
The pipe is clogged.
Unclog the pipe. Dispose of the
swale
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the swale if necessary to
swale.
smooth it over and provide erosion
control devices such as reinforced
turf matting or riprap to avoid
future problems with erosion.
The forebay
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design depth for
possible. Remove the sediment and
sediment storage.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Erosion has occurred.
Provide additional erosion
protection such as reinforced turf
matting or riprap if needed to
prevent future erosion problems.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than s ra in .
The vegetated shelf
Best professional practices
Prune according to best professional
show that pruning is needed
practices
to maintain optimal plant
health.
Plants are dead, diseased or
Determine the source of the
dying.
problem: soils, hydrology, disease,
etc. Remedy the problem and
replace plants. Provide a one-time
fertilizer application to establish the
ground cover if a soil test indicates
it is necessary.
Weeds are present.
Remove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The main treatment area
Sediment has accumulated to
Search for the source of the
a depth greater than the
sediment and remedy the problem if
original design sediment
possible. Remove the sediment and
storage depth.
dispose of it in a location where it
will not cause impacts to streams or
the BMP.
Algal growth covers over
Consult a professional to remove
50% of the area.
and control the algal growth.
Cattails, phragmites or other
Remove the plants by wiping them
invasive plants cover 50% of
with pesticide (do not spray).
the basin surface.
EC'EQVt
APR 2 5 2017
Form SW401-Wet Detention Basin O&M-Rev.4 By. -e2 of 4

Permit Number:
(to be provided by DWQ)
Drainage Area Number:
BMP element:
Potentialproblem:
How I will remediate theproblem:
The embankment
Shrubs have started to grow
Remove shrubs immediately.
on the embankment.
Evidence of muskrat or
Use traps to remove muskrats and
beaver activity is present.
consult a professional to remove
beavers.
A tree has started to grow on
Consult a dam safety specialist to
the embankment.
remove the tree.
An annual inspection by an
Make all needed repairs.
appropriate professional
shows that the embankment
needs repair. if applicable)
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site -
The outlet device is damaged
Repair or replace the outlet device.
The receiving water
Erosion or other signs of
Contact the local NC Division of
damage have occurred at the
Water Quality Regional Office, or
outlet.
the 401 Oversight Unit at 919-733-
1786.
The measuring device used to determine the sediment elevation shall be such
that it will give an accurate depth reading and not readily penetrate into
accumulated sediments.
When the permanent pool depth reads 10.0 feet in the main pond, the
sediment shall be removed.
When the permanent pool depth reads 99:0 feet in the forebay, the sediment
shall be removed.
Sediment Removal
Bottom
2400 I 1
------------------
FOREBAY
BASIN DIAGRAM
(fill in the blanks)
I ft Min.
Sediment
Storage
Form SW401-Wet Detention Basin O&M-Rev.4
Permanent Pool Elevation 32.00
Pool
Sediment Removal Elevation 2200 Volun
---------------------- -------------- I -----
Bottom Elevation 21.00 j 1-ft N}ir
Sedimei
Storage
MAIN POND
ECEIVE
APR 2 5 2017
BY:
Page 3 of 4

Permit Number:
(to be provided by DWQ)
I acknowledge and agree by my signature below that I am responsible for the
performance of the maintenance procedures listed above. I agree to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Project name: Parking -ER & Surgical Pavilion - Onslow Memorial Hospital (Wet Pond
BMP drainage area number:
Print name:Daniel T. Waller
Title: Senior Vice President
Address:214 New River Drive
Note: The legally responsible party should not be a homeowners association unless more than 50% of
the lots have been sold and a resident of the subdivision has been named the president.
I,t` ""�` �1 Y a Notary Public for the State of
N County of r-)SA p u3 , do hereby certify that
personally appeared before me this Zo
day of ,\ ZO t , and acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
"\0
0" S UN pq y �iiIEs y
QSARv APR 2 5 2ai1
Ze Y 9
U 2
PUSV�G 2 BY
OW COJ�'`��\��
SEAL
My commission expires V . I) i 7 b �__,
Form SW40I-Wet Detention Basin O&M-Rev.4 Page 4 of 4

P A

POND MAINTENANCE REQUIItEMENTS
project Name:Onslow PJewrial Hospital -Navcare Urgent Care Center Project No. � $ 950 ail
Responsible Patty:
Onslow Memorial Hospital phone No [phone]
Address: Post Office Box 1358, Jacksonville, N.C. 28541
I. Monthly, or after every runoff producing rainfall event, whichever comes first
A. Inspect the trash rack; remove accumulated debris, repair/replace if it is not functioning.
B. Inspect and clear the orifice of any obstructions. If a pump is used as the drawdown
mechanism, pump operation will be checked. A log of test runs of the pump will be kept
on site and made available to DEM personnel upon request.
C. Inspect the pond side slopes and grassed inlet swales; remove'trash, and repair eroded
areas before the next rainfall event.
D. If the pond is operated with a vegetated filter, the filter will be checked for sediment
accumulation, trash accumulation, erosion and proper operation of the flow spreader
mechanism. Repairs/cleaning will be done as necessary.
II. Quarterly:
A. Inspect the collection system (ie. catch basins, piping, grassed swales) for proper
functioning. Accumulated trash will be cleared from basin grates, basin bottoms, and
piping will be checked for obstructions and cleared as required.
B. Pond inlet pipes will be checked for undercutting, riprap or other energy dissipation
structures will be replaced, and broken pipes will be repaired.
III. Semi-annually:
A. Accumulated sediment from the bottom of the outlet structure will be removed.
B. The pond depth will be checked at various points. If depth is reduced to 75 % of original
design depth or 3 feet whichever is greater, sediment will be removed to at least the
original design depth.
C. Grassed swales, including the vegetated filter if applicable, will be reseeeededt�
as necessary. 1.0
�
" TER
MAR 2 0 1995 U
DEM
rROJ 5wF4503/7

POND MAINTENANCE REQUIREMENTS
PAGE 2
IV. General:
A. Mowing of the side slopes will be accomplished according to the season. Maximum grass
height will be 6".
B. Cattails are encouraged along the pond perimeter, however they will be removed when they
cover more than 1/2 the surface area of the pond.
C. The-orifice/pump is designed to draw down the pond in 2-5 days. If drawdown is not
accomplished in that time, the system will be checked for clogging. The source of the
clogging will be found and eliminated.
D. All components of the detention pond system will be kept in good working order. Repair
or replacement components will meet the original design specifications as per the approved
stormwater plan.
V. Special Requirements:
I hereby acknowledge that I am the financially
responsible party or%niai�ntcnanc of this detention pond. I will perform the maintenance as outlined
above, as part of the ificate t of Compliance with Stonnwater Regulations received for this project.
Signature: Date.
I ZZ0jZC1U/K& a Notary Public for the State Y
Count of do hereby certify that LA
personally appeared before me this day of IY9_, and acknowledge the
due execution of the foregoing instrument. Witness my hand and official seal,
SEAL
FOR

DEMLR USE ONLY
Date Received
Fee Paid
er it Number
5
S.
Applicable Rules: ❑ Coastal SW -1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of 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,
specifications, letters, operation and maintenance agreements, etc.):
Parking - ER & Surgical Services Pavilion - Onslow Memorial Hospital (Wet Pond No. 1 Retrofit)
2. Location of Project (street address):
City: lacksonviIle County:Onslow Zip:28546
3. Directions to project (from nearest major intersection):
From intersection of NC 24 and NC 53 (Western Boulevard) in Jacksonville, north on NC 53 approx. 1.5 miles.
4. Latitude:34° 45' 50" N Longitude:77° 23' 2.7" W of the
it. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ❑New ®Modification ❑ Renewal w/ Modificationt
tRenemals 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 numberSW8 950317 , its issue date (if known)4/5/12 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: 0.80 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:
Form SWU-101 Version Oct. 31, 2013 Page t of

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5. Is the project located within 5 miles of a public airport? ®No Dyes
If yes, see S.L. 2012-200, Part VL http://12ortal.ncdenr.org/web/lr/rules-and-regulations
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/Organization:Onslow Memorial Hospital, Inc.
Signing Official & Title:Daniel T. Waller Senior Vice President
b.Contact information for person listed in item 1a above:
Street Address New River Drive
City: lacksonviIle State:NC Zip:28540
Mailing Address (if
City:
Phone: (910 ) 577-2345
Zip:
Fax: (910 ) 577-2465
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:Onslow County
Signing Official & Title:David B. Cotton, Interim County Manager
b.Contact information for person listed in item 2a above:
Street Address:234 NW Corridor Drive
City:lacksonville State:NC Zip:28540
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
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: ea IVIE
Other Contact Person/Organization:
Signing Official & Title: A! 6o�I
b.Contact information for person listed in item 3a above: BY. -
Mailing Address:
City: State: Zip:
Phone: ) Fax: (
4. Local jurisdiction for building permits: City of Jacksonville
Form SWU-101 Version Oct. 31, 2013 Page 2 of 7

Point of Contact:Danny Bryan
Phone #: (910 ) 938-5232
IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Existing Wet Pond to be enlarged to accommodate additional BUA.
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 11— Post Construction
3. Stormwater runoff from this project drains to the White Oak River basin.
4. Total Property Area: 13.64 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':
13.64 acres
Total project area shall be calculated to exclude thefollowing: the normal pool of imppounded structures, the area
between the banks of streams and rivers, the area below the 1Vormal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHW) line. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 =
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole property area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
ECEI'!I E
APR 2 5 2017
BY:
Form SWU-101 Version Oct. 31, 2013 Page 3 of 7

Basin Information
Draina e Area _
Drainage Area _
Drainage Area _
Drainage Area
ReceivingStream Name
Scales Creek
Stream Class *
SC;HQW,NSW
Stream Index Number *
19-16-4
Total Drainage Area (sf)
594,158 sf
On -site Drainage Area (sf)
594,158 sf
Off -site Drainage Area (sf)
-0-
Pro osed Impervious Area** (sf)
310,336 sf
% Impervious Area** (total)
522
Im ervious** Surface Area
Drainage Area _
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
-0-
On-site Streets (sf)
-0-
On-site Parkin (sf)
-0-
On-site Sidewalks (sf)
-0-
Other on -site (so
-0-
Future (sf)
14,742 sf
Off -site (so
-0-
Existin BUA*** (sf)
295,594 sf
Total (sf):
310,336 sf
Stream Class and Index Number call be determined at: http:/lportalportalttcdenr.ororghoebl7WIVs/csu/classificatimts
** 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 BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. n/a
Projects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per I5A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation a�� rms
must be submitted for each BMP specified for this project. The latest versions of t forms can be down] ed
from http://portal.ncdenr.org/web/wq/ws/su/bmi2-manuil. APR 2 5 2017
VI. SUBMITTAL REQUIREMENTS By;
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/wq/ws/su/statesw/forms does. 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 at httl2://portal.ncdenr.org/web/wq/­ws/­suZmal2s.)
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 htto //nortal� ncdenr.org/web/wq/ws/su/statesw/forms does.
Initials
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
Form. (if required as per Part VII below)
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
httl2://www.envhelp.org/12ages/onestopexpress.html for information on the Express program
Form SWU-101 Version Oct. 31, 2013 Page 4 of 7

and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management for _
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'/2 mile of the site boundary, include the'h
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
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 vertfj the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 390 Page No: 625 _
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 la, 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.
http://www.secretary.state.nc.us/Corl2orations/CSearch.aspx
0 rRIVE
APR 7 g 2017
BY:
Form SWU-101 Version Oct. 31, 2013 Page 5 of

VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from httl2://portal.ncdenr.org/web/ir/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:David K. Newsom, PE
Consulting Firm: Crystal Coast Engineering, PA
Mailing Address:205-3 Ward Road
City:Swansboro
Phone: (910 ) 325-0006
Email:[e-mail]
State:NC Zip:28584
Fax: (910 ) 325-0060
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) David B. Cotton 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) Daniel T. Waller with (print or type name of organization listed in
Contact Information, item la) Onslozo Memorial Hospital, Inc. to develop the project as currently proposed. A
copy of the lease agreement or pending property sales contract has been provided with the submittal, which
indicates the party responsible for the operation and maintenance of the stormwater system.
ECEIVE
APR Z 5 2017
BY:
Form SWU-101 Version Oct. 31, 2013 Page 6 of 7

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.
I, _ , a Notary Public for the State of --------------------, County of
--------------------, do hereby certify that
before me this day of ------------------
personally appeared
-------, and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item la) Daniel T. Waller
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable sto wAteles under 1 NCAC 21-1.1000 and any other applicable state stormwater requirements.
Sig((naat�ture\\ Date:
�._�c__ ____, a Notary Public for the State of _
'5cAq �pr _ Ol_n{�, County of
_C�nS�'Qtz�L______- do h reby certify that n-�_ ��ig�___---___ Personal appeared
i 17_, and ackno ledrge t eAeco,oft pplication for
before me this day of --`--____-, �4.%hY/�ua stormwater permit. Witness my hand and official seal-
\\\\\\\\\�\' `i S UAl� /
U. �OTAPJk 9
02 pUB0 _
SEAL
My commission expires JO.i(1 `r) ,2L`f)
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6

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. /� V -�
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VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from http://portal.ncdenr.org/web/Ir/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:David K. Newsom, PE
Consulting Firm: Crystal Coast Engineering PA
Mailing Address:205-3 Ward Road
City:Swansboro State:NC Zip:28584
Phone: (910 ) 325-0006
Email:[e-mail]
Fax: [phone]
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) David B. Cotton , 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 1a) Daniel T. Waller with (print or type name of organization listed in
Contact Information, item 1a) Ouslow Memorial Hospital, Inc. to develop the project as currently proposed. A
copy of the lease agreement or pending property sales contract has been provided with the submittal, which
indicates the party responsible for the operation and maintenance of the stormwater system.
ECEIVE
MAY 19 2017
BY:
Form SWU-101 Version Oct. 31, 2013 Page 6 of 7

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 pen to $25,000 per day, pursuant to NCGS 143-215.6.
�f
Date: C55,)9,"
1,,�-ADQ ? A U ' v V j l RI M . a Notary Public for the State ofKQ1ft «County of
t-J RSLC -N do hereby certify that personally appeared
before me this D day of I �LQ� . L�, and acknowledge the due Iexecrutiioon1 of the application for
a stormwater permit. Witness my hand and official seal, l -)o
u
G!tw/`/r
�OTAp yN
x Y ,
oGs AU S 1.0 �V\\\
i%�Ow COVNfi���\
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires( hn" at1 Out
1, (print or type name of person listed in Contact Information, item la) Daniel T. Waller
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
a Notary Public for the State of
do hereby certify that
before me this _ day of
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
Form SWU-101 Version Oct. 31, 2013 Page 7 of
ECEI V
MAY 19 2017
BY:

a
I I
i

VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
for all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from http://12ortal.ncdem.ore/web/ir/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
at 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:David K. Newsom, PE
Consulting Firm: Crystal Coast Engineering PA
Mailing Address:205-3 Ward Road
City:Swansboro State:NC Zip:28584
Phone: (910 ) 325-0006
Efnail:[e-mail]
Fax: (910 ) 325-0060
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) David B. Cotton 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 1a) Daniel T. Waller with (print or type name of organization listed in
Contact Information, item la) Onslow Memorial Hosyital, Inc. to develop the project as currently proposed. A
copy of the lease agreement or pending property sales contract has been provided with the submittal, which
indicates the party responsible for the operation and maintenance of the stormwater system.
ECEI\/E
MAY 19 ton
BY;
Form SWU-101 Version Oct. 31, 2013 Page 6 of 7

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 o $25,000 per day, pursuant to NCGS 143-215.6.
Date: 55•)g, )`7
I, AY K la 6 - W r I K i n s a Notary Public for the State of NOf lY 1 CQ O11 nQ. County of
0 ris 1DW do hereby certify that bay(LL 6. GQt+C r) personally appeared
before me this I 8day of MQ� �� , and acknowledge the
�due
'execution of the application for
astormwater permit. Witness my hand and official seal,
',OTAq` ZN
Oys pVet10 �G
C
�;i'.
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires An UUN a01 2YO18
I, (print or type name of person listed in Contact Information, item la) Daniel T. Waller
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 21-1.1000 and any other applicable state stormwater requirements.
1, a Notary Public for the State of County of
do hereby certify that
before me this _ day of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
ECE' V E
My commission expires MAV 1 0 n
BY;
Form SWU-101 Version Oct. 31, 2013 Page 7 of 7

Otf 7

.,
Permit No.SWI�P31%M00
l (m be provided by DWQ)
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER 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.
1. PROJECT INFORMATION
Project Name: 1-- 9 d' 5 o
vice-S rcrv.Ito.. —
Contact Person: ,Sian Fo r'At-,er C M v Ikey Cep Phone Number: 51 S58- 1 8 6,6
For projects with multiple basins, specify which basin this worksheet applies to: g�Z
elevations
Basin Bottom Elevation 2-7. 50 ft.
Permanent Pool Elevation 3 (. S 0 ft.
Temporary Pool Elevation 3 2 • !o o ft.
(floor of the basin)
(elevation of the orifice)
(elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area 30 sq. ft. (water surface area at the orifice elevation)
Drainage Area 1 3. y ac. (on -site and off -site drainage to the basin)
Impervious Area prop - G • 5 y ac. (on -site and off -site drainage to the basin)
Ctc - 2.to4
volumes
Permanent Pool Volume 4 St 13 2 cu. ft.
Temporary Pool Volume 2 4t 9 b b cu. ft.
Forebay Volume 10 t 1 7 5 cu. ft.
Other parameters ( �
110o
SA/DA I C"L3. 3 4 6
Diameter of Orifice 2 .a' in.
Design Rainfall 1,00 in.
Design TSS Removal 2 70 %
(combined volume of main basin and forebay)
(volume detained above the permanent pool)
(approximately 20% of total volume)
Fpj1
(surface area to drainage area ratio from DWQ table)
(2 to 5 day temporary pool draw -down required)
(minimum 85% required)
Form SWU-102 Rev 3.99 Page I of 4

B1L1,-r, -4'�ieP,;# /—z, S-w8 1So3/7MbP
Footnotes:
1 When using the Division SA/DA tables, the correct SAMA ratio for permanent pool sizing should be computed based upon the
actual impervious % and permanent pool depth. Linear interpolation should be employed to determine the correct value for non-
standard table entries.
2 In the 20 coastal counties, the requirement for a vegetative filter may be waived if the wet detention basin is designed to provide
90% TSS removal. The NCDENR BMP manual provides design tables for both 85% TSS removal and 90% TSS removal.
II. REQUIRED ITEMS CHECKLIST
The following checklist outlines design requirements per the Stormwater Best Management Practices Manual
(N.C. Department of Environment, Health and Natural Resources, February 1999) and Administrative Code
Section: 15 A NCAC 2H .1008.
Initial in the space provided to indicate the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. If a requirement has not been met, attach justification.
Applicants Initials
S F a. The permanent pool depth is between 3 and 6 feet (required minimum of 3 feet).
$ F b. The forebay volume is approximately equal to 20% of the basin volume.
.S F c. The temporary pool controls runoff from the design storm event.
SF d. The temporary pool draws down in 2 to 5 days.
N M e. If required, a 30-foot vegetative filter is provided at the outlet (include non -erosive flow
calculations)
S F f. The basin length to width ratio is greater than 3:1.(Flo ,r c h S ` + 3 ; I)
SF g. The basin side slopes above the permanent pool are no steeper than 3:1.
$ F h. A submerged and vegetated perimeter shelf with a slope of 6:1 or less (show detail).
S F i. Vegetative cover above the permanent pool elevation is specified.
F j. A trash rack or similar device is provided for both the overflow and orifice.
t f� k. A recorded drainage easement is provided for each basin including access to nearest right-
of-way. C Ik� ha5^tr-�wl • ,II ?-ay.da Rl1 ref aired rn4In�enroc c,
SF
1. If the basin is used for sediment and erosion control during construction, clean out of the
basin is specified prior to use as a wet detention basin.
5F in. A mechanism is specified which will drain the basin for maintenance or an emergency.
��Ie�ei-tons w,11 1ref vira t6te pond is b � P"^P�d i� er dpr
-1, Qr4 t*n CGMp�t7e�Y
III. WET DETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
The wet detention basin system is defined as the wet detention basin, pretreatment including forebays and the
vegetated filter if one is provided.
This system (check one) 0 does (does not incorporate a vegetated filter at the outlet.
This system (check one) does 0 does not incorporate pretreatment other than a forebay.
Form SWU-102 Rev 3.99 Page 2 of 4

Maintenance activities shall be performed as follows:
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.
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 3. 6
When the permanent pool depth reads /1 55
Sediment ReINC
val El. 30.0
Bottom Ele •ation 29,5
FOREBAY
feet in the main pond, the sediment shall be removed.
feet in the forebay, the sediment shall be removed.
BASIN DIAGRAM
(fill in the blanks)
Permanent Pool Elevation 3 1, 5
Sediment Removal Elevation 2 8, 5
-----------------------------------
Bottom Elevation L 7,S
MAIN POND
75%
25%
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.
Forth SWU-102 Rev 3.99 Page 3 of 4

7. All components of the wet detention basin system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the seven
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print name: FIN/EL % co6e,/&c
Title: Seni nr Vi c-P President Snnnnrt- Sc rvi rec
• • New River
910-57-"Z-28
Date: S=2uO�
Note: The legally responsible party should not be a homeowners association unless more than 50% of the lots have been sold and a
resident of the subdivision has been named the president.
1, a Notary Public for the State of N OY-�h Yb [ y`4-
County of f)1k do hereby certify that 170.n(>✓� T �l l l e ir'
personally appeared before me this '5 day of LLt 7 "Of)y , and acknowledge the due
execution of the forgoing wet detention basin maintenance r4irements. Witness my hand and official seal,
�'• j0UBL1G i
O �•. , .� 4
SEAL
My commission expires a D 4- l O-'OOq
Form SWU-102 Rev 3.99 Page 4 of 4

Permit No _510Z / ✓ 3 /
(fo be Pmvxled by DWQ)
®�nA0�
WArF�O�
HCDENR
>_ -
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
401 CERTIFICATION APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form must be filled out, printed and submitted.
The Required Items Checklist (Part 111) must be printed, filled out and submitted along with all of the required information.
I.IP-ROJECTtINEORMATION-„
Project name
Parking -ER 8 Surgical Pavilion - Onslow Memorial Hospital (Wet Pond No 1 Retrofit)
Contact person
David K Newsom, PE
Phone number
910-325*M
Date
4115/2017
Drainage area number
INDESIGMINEORMATION -
. -x.>7
Site Characteristics
Drainage area
594,158 ft'
Impervious area, post -development
310,336 112
%impervious
52.23 %
Design rainfall depth
1.5 in
Storage Volume: Non -SA Waters
Minimum volume required
38,626 ffs
Volume provided
39,522 ft3
OK, volume provided Is equal to or in excess of volume required.
Storage Volume: SA Waters
1 5' runoff volume
Pre -development 1-yr, 24-hr runoff
Post -development 1-yr, 24-hr runoff
Minimum volume required
Volume provided
Peak Flow Calculations
Is the prelpost control of the 1 yr 24hr stone peak flow required?
1-yr. 24-hr rainfall depth
Rational C, pre -development
Rational C, post -development
Rainfall intensity: 1-yr, 24-hr storm
Pre -development 1-yr, 24-hr peak flow
Post -development 1-yr, 24-hr peak flow
Pre/Post 1-yr, 24-hr peak flow control
Elevations
Temporary pool elevation
Permanent pool elevation
SH WT elevation (approx. at the perm. pool elevation)
Top of 10ft vegetated shelf elevation
Bottom of 1011 vegetated shelf elevation
Sediment cleanout, top elevation (bottom of pond)
Sediment cleanout, bottom elevation
Sediment storage provided
Is there additional volume stored above the state -required temp. pool?
Elevation of the top of the additional volume
ft3
It
ft3
It,
ft3
N (Y or N)
3 7 in
0.15 (unitless)
0.57 (unitless)
0,15 inlhr OK
0.31 f0/sec
117 ft3/sec
0.86 ft'/sec
33.64 first
3200 fmsl
N/A fmsl
32.50 hmsl
31.50 fmsl
22.00 fmsl
2100 first
1.00ft
N (Y or N)
fmsl
ECEIVE
APR 2 5 2017
BY:
Data not needed for calculation option #1, but OK if provided.
Data not needed for calculation option #1, but OK if provided.
Form SW401-Wet Detention aasnFRev 4411e/12 Pans I & ll Design Summary, Page i of 2

Permit No
(to be pmwded by DKD)
II. DESIGN INFORMATION
Surface Areas
Area, temporary pool 26,338 ft'
Area REQUIRED, permanent pool
21,856 ft'
WDA ratio
3.68 (unldess)
Area PROVIDED, permanent pool, A..
21,859 ftz OK
Area, bottom of 1 Oft vegetated shelf, A.,,
21,722 ft'
Area, sediment deanout, lop elevation (bottom of pond), A,,
4,460 ft'
Volumes
Volume, temporary pool
39,522 ftr OK
Volume, permanent pool, V...
109,223 Its
Volume, forebay (sum of forebays if more than one forebay)
22,108 ft'
Forebay %of permanent pool volume
20.2% % OK
SA/DA Table Data
Design TSS removal
90 %
Coastal SA/DA Table Used?
N (Y or N)
Mountain/Piedmont SA/DA Table Used2
N (Y or N)
SA/DA ratio
3.68 (unidess)
Average depth (used in SA/DA table):
Calculation option 1 used? (See Figure 10-21b)
Y (Y or N)
Volume, permanent pool, Vp, -r,
109,223 ft'
Area provided, permanent pool, A..
21,859 It'
Average depth calculated
5.00 It OK
Average depth used In SAIDA, dam., (Round to nearest 0.5ft)
5.0 ft OK
Calculation option 2 used? (See Figure 10-21b)
N (Y or N)
Area provided, permanent pool, A.ym
21,859 ft'
Area, bottom of 1 Oft vegetated shelf, A..
21,722 ft'
Area, sediment cleanout, top elevation (bottom of pond), A,.
4,460 ft'
'Depth' (distance b/w bottom of 10ft shelf and top of sediment)
9.50 If
Average depth calculated
500 It
OK
Average depth used in SA/DA, d., (Round to down to nearest 0 5ft)
5.0 It
OK
Drawdown Calculations
Drawdown through onfice?
Y
(Y or N)
Diameter of onfce(if circular)
2.50 in
Area of orifice (if-noncircular)
in'
Coefficient of discharge (Co)
003 (unitless)
Driving head (Ho)
0.55 ft
Drawdown through weir?
N
(Y or N)
Weir type
(unitless)
Coefficient of discharge IQ
(unitless)
Length of weir (L)
ft
Driving head (H)
ft
Pre -development 1-yr, 24-hr peak flow
031 ft'/sec
Post -development 1-yr, 24-hr peak flow
1 17 ft'/sec
Storage volume discharge rate (through discharge onfice or weir)
012 tt'/sec
E q ' V E
Storage volume drwdown time
3.72 days
OK, dews down in 2-5 days. IC+�.,pr
Additional Information
APR 2 5 2017
Vegetated side slopes
3 .1
OK
Vegetated shelf slope
10 1
OK
Vegetated shelf width
10.Oft
OK BY,
Length of ftowpalh to width ratio
3 :1
OK
Length to width ratio
3.0 :1
OK
Trash rack for overflow & onfice?
Y
(Y or N)
OK
Freeboard provided
10 It
OK
Vegetated filter provided?
N
(Y or N)
OK
Recorded drainage easement provided?
Y
(Y or N)
OK
Capures all runoff at ultimate build -out?
Y
(Y or N)
OK
Drain mechanism for maintenance or emergencies is:
Pump
Form SW401-Wet Detenboo Basra -Rev 9-411a/12 Parts 1811 Design Summary. Pape 2 of 2

State Stormwater Management Systems
Permit No. SW8 950317 Modification
r UI�I�Q
ER & Surgical Services Pavilion - Onslow.Memorial Hospital
Stormwater Permit No. SW8 950317 Modification Page 1 of 2
Onslow Countv
Designer's Certification 1' 0
I, STcn l ey T. Fo At Pr , as a duly registered
in the State of North Carolina, having been authorized to observe riodically weekly/
full time) the construction of the project,
L R d-
(Project)
for bcth,e 1 T. via I I e (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
�1�L1 lti�
Registration Number 2, Z 79 6
Date 7-3o-
SEAL
SEAL
2M6
J.
Page 6 of 7

G
State Stormwater Management Systems
Permit No. SW8 950317 Modification
Page 2 of 2
Certification Requirements:
S F 1. The drainage area to the system contains approximately the permitted
acreage.
SF 2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
S F 3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
S F 4. All roof drains are located such that the runoff is directed into the system.
S F 5. The outlet/bypass structure elevations are per the approved plan.
S F 6. The outlet structure is located per the approved plans.
S F 7. Trash rack is provided on the outlet/bypass structure.
S F 8. All slopes are grassed with permanent vegetation.
_ F 9. Vegetated slopes are no steeper than 3:1.
S F 10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
SF 11. The permitted amounts of surface area and/or volume have been
provided.
S F 12. Required drawdown devices are correctly sized per the approved_ plans.
5F 13. All required design depths are provided.
S F 14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
5F 15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Regional Office
Mike Morris, Onslow County Building Inspections
Page 7 of 7