SW6140602_CURRENT PERMIT_20140626

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
DOC TYPE
[CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD

la;_ r
INC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
June 26, 2014
East Carolina University
Attn: William E. Bagnell, Associate Vice Chancellor for Campus Operations
1001 East Fourth Street
Greenville, NC 27858-4043
Subject: Stormwater Management Permit SW6140602
ECU School of Dental Medicine — Community Service Learning Center No. 7
High Density Constructed Wetlands Project
Robeson County
Dear Mr. Bagnell
The Fayetteville Regional Office of the Division of Energy, Mineral and Land Resources, Land Quality Section
received a complete Stormwater Management Permit Application for the East Carolina University School of
Dental Medicine — Community Service Learning Center No. 7 project on June 18, 2014. 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 herewith Stormwater Management Permit
SW6140602 dated June 26, 2014,for the construction, operation and maintenance of the subject project and
associated stormwater BMPs.
This permit shall be effective from the date of issuance until June 25, 2022 and shall be subject to the conditions
and limitations as specified therein. Please pay special attention to the Operation and Maintenance requirements
in this permit. Failure to establish an adequate system for operation and maintenance of the stormwater
management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request
an 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. Per NCGS 143-215(e), the petition
must be filed with the OAH within thirty (30) days of receipt of this permit. You should contact the OAH with all
questions regarding the filing fee (if a filing fee is required) and/or the details of the filing process at 6714 Mail
Service Center, Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at
www.ncoah.com. Unless such demands are made this permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact Mike Lawyer at
[phone] or by e-mail at [e-mail].
Sincerely,
GBr••aacl Cole, PE
Regional Engineer
_ . Land Quality Section
BC/m I
cc: John C. Martin, El — ColeJenest & Stone, PA (via e-mail)
R. Todd Fisher, PE — ColeJenest & Stone, PA (via e-mail)
Bill Chatfield, Project Manager — East Carolina University (via e-mail)
FRO — Land Quality Section, State Stormwater Files, SW6140602
Division of Energy, Mineral and Land Resources
Land Quality Section
Fayetteville Regional Office, 225 Green Street- Suite 714, Fayetteville, North Carolina 28301-5095
Phone: [phone]/ FAX: [phone] Internet: httpJ/portal.ncdenr.org/web4r
An Equal Opportunity/ Affirmative Action Employer -50% Recycled/ 10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
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
East Carolina University
ECU School of Dental Medicine — Community Service Learning Center No. 7
600 Country Club Drive, Lumberton, Robeson County
FOR THE
construction, operation and maintenance of one constructed wetlands in compliance with the provisions
of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the approved stormwater
management plans and specifications and other supporting data as attached and on file with and
approved by the Division of Energy, Mineral and Land Resources and considered a part of this permit.
This permit shall be effective from the date of issuance until June 25, 2022 and shall be subject to the
following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater described in
the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater runoff as
described in Section 1.6 of this permit.
3. The application form, supplement forms, approJed.plans and specifications for this project are
incorporated by reference and are enforceable parts of the permit.
4. All stormwater collection and treatment systems must be located in either dedicated common
areas or recorded easements. The final plats for the project will be recorded showing all such
required easements in accordance with the approved plans.
5. All runoff being directed into wetlands shall flow into and through those wetlands at a non -
erosive velocity of 2 fps or less. -
6. The following design elements have been approved for this constructed wetlands stormwater
facility and must be provided in the system at all times:
DA2DA3
�'''
u� DA 4
M
DAR5
IDr g 67AW6Rd re9
Onsteft r
Offsde ftz.,
1.53 .
66,777
0
_. ... __.
sb:{aTotal;Im erviousSu'rface's""; ,;<`�
43,167

Tot ,1L1Ot',BUFA dit� s' s
� �
8,162
r. Roads/Parkmg"�ft�>�
21,414
a Other ft€a
13,591
0
cf Plan[ De th f e
0.5
'dTSSremovaleff%oT
85
e�Design Storm gmo�h�es�k
1.0
^fPemanent
Pool€Elevatrori,
133.5
gPeitted Wetland Surface
Area
4,750
(hStiallowLandA[e'a; sS r
1,900
iSfiallowtWater'e#Areal n:
1,900
g' Dee tP6_6IYAr'ea f e-
475
kF�rmittsdT�emporary Storage
,Volume'ft T
4,750
°I ITiemporraryl toraaq[ Elevation
M
134.0
.o- `
Controlling OhjiceaOJ�
1.0
Im
.9-plSh�ubs J'
84
EoHerb'aceousfP�lants�
575
p+ Re eAKmiv,8St eae / a
RerµBasm:
Lumber River /Lumber
,
q.' Streamxlndex Number
14-(7)
r Classification,J,ofjWater,Body
WS-IV,B;Sw,HQW
It. SCHEDULE OF COMPLIANCE
No person or other legal entity shall alter the approved stormwater management system, or fill .
in, alter, or pipe any drainage feature, including swales, shown on the approved plans as part of,
the stormwater management system, unless and until the permittee submits a modification to
the permit and receives approval from the Division.
2. The permittee is responsible for verifying that the proposed built -upon area for the entire project
does not exceed the allowable built -upon area.
3. 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.
4. 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.
5. During construction, erosion shall be kept to a minimum and any eroded areas of the system will
be repaired immediately.. Infiltration systems should not be.used as erosion control devices, due
to the potential clogging. 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.
6. 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 subdivision, acquisition, or sale of all or part of the project area. The project area
is defined as all property owned by the permittee for which Sedimentation and Erosion
Control Plan approval or a CAMA Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the approved plan.
7. The Director may determine that other revisions to the project should require a modification to
the permit.
8. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and prior to
operation of this permitted facility, a certification must be received from an appropriate designer
for the system installed certifying that the permitted facility has been installed in accordance with
this permit, the approved plans and specifications, and other supporting documentation. Any
deviations from the approved plans and specifications must be noted on the Certification.
9. 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 revegetation of side slopes.
d. Maintenance of the wetlands plants and replacement of dead plants.
e. Immediate repair of eroded areas.
f. Maintenance of side slopes in accordance with approved plans and specifications.
g. Trash and debris removal and unclogging of the wetlands, outlet structure, orifice, catch
basins and piping.
h. Access to all components of the system must be available at all times.
10. Records of maintenance activities must be kept and made available upon request to authorized
personnel of DENR. The records will indicate the date, activity, name of person performing the
work and what actions were taken.
a
11. 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. Prior to transfer of the permit, the stormwater facilities will be inspected by DENR 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.
13. This permit shall become voidable unless the facilities are constructed in accordance with the
conditions of this permit, the application, approved plans and specifications, and other
supporting data.
14. Built upon area includes, but is not limited to, structures, asphalt, concrete, gravel, brick, stone,
slate, coquina and parking areas, but does not include raised, open wood decking, or the water
surface of swimming pools.
III. GENERAL CONDITIONS
This permit is not transferable to any person or entity except after notice to and approval by the
Director. At least 30 days prior to a change of ownership, or a name change of the Permittee or
of the project, or a mailing address change, the permittee shall submit a completed and signed
"Name/Ownership Change Form" to the Division of Energy, Mineral and Land Resources,
accompanied by the appropriate documentation as listed on the form. The project must be in
good standing with the Division. The approval of this request will be considered on its merits
and may or may not be approved.
2. The permittee is responsible for compliance with all of the terms and conditions of this permit
until such time as the Director approves the transfer request. Neither the sale of the project area

in whole or in part, nor the conveyance of common area to a third party, constitutes an approved
permit transfer.
3. Failure to abide by the conditions and limitations contained in this permit may subject the
Permittee to enforcement action by the Division of Energy, Mineral and Land Resources in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
4. The issuance of this permit does not preclude the Permittee from complying with any and all
statutes, rules, regulations, or ordinances which may be imposed by other government agencies
(local, state, and federal) 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.
6. The permit may be modified, revoked and reissued or terminated for cause. The filing of a
request for a permit modification, revocation and reissuance or termination does not stay any
permit condition.
7. Permittee grants permission to DENR staff to access the property for the purposes of inspecting
the stormwater facilities during normal business hours.
8. The permittee shall submit a permit renewal application and processing fee at least 180 days
prior to the expiration date of this permit.
9. A copy of the approved plans and specifications shall be maintained on file by the Permittee at
all times.
Permit issued this the twenty-sixth day of June 2014.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
4crrTracy E. Davis, PE, CPM, Director
Division of Energy, Mineral and Land Resources
by, Authority of the Environmental Management Commission
Stormwater Management Permit SW6140602

ECU School of, Dental Medicine — Community Service Learning Center No. 7 Page 1 of 2
Stormwater Management Permit SW6140602
Robeson County
Designer's Certification
I, , as a duly registered in the State of North
Carolina, having been authorized to observe (periodically/weekly/full time) the construction of the
project,
(Project)
for (Project Owner) hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the project construction such that the
construction was observed to be built within substantial compliance and intent of the approved plans
and specifications.
The checklist of items on page 2 of this form is a part of this Certification.
Noted deviations from approved plans and specifications:
SEAL
Signature
Registration Number
Date

Certification Requirements:
Page 2 of 2
1. The drainage area to the system contains approximately the permitted acreage.
2. The drainage area to the system contains no more than the permitted amount of built -
upon area.
3. All the built -upon area associated with the project is,graded such that the runoff drains to
the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The wetland zone elevations are per the approved plan.
6. The wetland is located per the approved plans.
7. A trash rack is provided on the outlet structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-circuiting of the
system.
11. The permitted amounts of wetland zone surface area and volume have been provided.
12. Required drawdown devices are correctly sized and located per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided.
15. The required number of wetlands plantings has been provided.
Please submit this Designer's Certification to: DENR Fayetteville Regional Office
Division of Energy, Mineral and Land Resources
Land Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301

ColeJenest
& Stone
Shaping the Environment
Realizing the Possibilities
Land Planning
Landscape Architecture
+
Civil Engineering
Urban Design
200 South Tryon Street, Suite 1400 Charlotte, NC 28202
p+ 704 376 1555 f+ 704 376 7851 urt+www.colejeneststone.com
October 1. 2014
Mr. Michael Lawyer
North Carolina Department of Environment and Natural Resources
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, North Carolina 28301-5095
Re: 50287.00 — ECU Dental Learning Center— Lumberton, NC
Dear Michael:
Charlotte
Raleigh
Construction of the storm water management facility for the referenced project, as
permitted under the North Carolina Department of Environment and Natural Resources
Division of Water Quality Storm Water Permit Number SW6140602, has been
completed. A copy of the Designer's Certification covering the storm water wetland is
enclosed.
Please let us know if you require anything further.
Best regards,
COLEJENEST & STONE, P.A.
OCT 1 7 2014
t
R. Todd Fisher, PE
Senior Project Manager
sac
Enclosure
cc: Mr. William (Bill) Chatfield — ECU
Ms. Jennifer Amster, ALA, LEED AP BD+C — BJAC
Mr. Todd Fisher PE, LEED Green Associate - CJS
P \SDSKPROJ%50287\Correspondence\Permits\Final Certitiwtiono4CDENR Stonnwatetl110114 - M. Lawyer - Stormwater Certification.doc

200 South Tryon Street, Suite 1400 Charlotte, NC 28202 Charlotte
P. 704 376 1555 f+704 376 7851 nrt,www.colgeneststone.com Raleigh
ECU Dental Learning Center— Lumberton
Storm Water Permit No. 6140602
ColeJenest Robeson County
& Stone Designer's Certification
I, R. Todd Fisher , as a duly registered Professional Engineer in the State of
Shaping the Environment North Carolina, having been authorized to observe periodically the construction of the
Realizing the Possibilities project,
ECU Dental Community Service Learning Center No. 7 Lumberton NC
(Project)
for East Carolina University (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 on Page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
1. None.
Land Planning
Landscape Architecture
Civil Engineering
Urban Design
Signature�
Registration Number:
Date: 10 • \ • N
SEAL IN�CAPO'�4,
OQ` �/
SEAL
' 025163
'•4,IIDDp, F,s; ,gyp
P.\SDSKPROJ\50287\Correspondence\Permits\Final Cerif oetion\NCDENR Stonrn len110114 Engineer Certifi=ion(Slormwner)docx

ECU Dental Learning Center —Lumberton
Storm Water Permit No. SW614O6O2
Pasquotank County
Certification Requirements:
4r1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
Jot 4. All roof drains are located such that the runoff is directed into the system.
0— 5. The outlet/bypass structure elevations are per the approved plan.
Le 6. The outlet structure is located per the approved plans.
NIA 7. Trash rack is provided on the outlet/bypass structure.
OS. All slopes are grassed with permanent vegetation, per the vegetation plan.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been provided.
12, Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided.
15. The required system dimensions are provided per the approved plans.
P:\SDSKPROJ\502B7\Correspondence\Permits\Final Cernfim ion\NMENR Stormwater\110114 Engineer Certification (Stormwater) docx

'
DEMLR USE ONLY
Date Recuived -
Fee Paid
Permit Number
• t a-- !y
I SW&NJ602-
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 he photocopied for use as an original JUN 18 2014
1. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
East Carolina University School of Dental Medicine - Community Service Learning Center No 7
2. Location of Project (street address):
600 Country Chub Drive
City:Lumberton County:Robeson %ip:28360
3. Directions to project (from nearest major intersection):
Site is located +- 500 feet east of the intersection of NC711 and SR 1548 (Nigel Road).
4. Latitude:34° 37' 36" N Longitude:79° 04' 07" W of the main entrance to the project.
it. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modification+
tRentmrals with modifications also requires SWLI-102 - Renewal Application Forro
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit numberN/A , its issue date (if known)N/A , 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 NHigh 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):
❑CAMA Major
❑NPDES Industrial Stormwater
®Sedimentation/Erosion Control: 2.33 ac of Disturbed Area
❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue dale and the type of each permit:Seidment/Erosion Control - East Carolina University School of
5. Is the project located within 5 miles of a public airport? ®No ❑Ye
If yes, see S.L. 2012-200, Part VI: hap2lportilmcdenr.org/web/Ir/rules-and-regulatiors
Form SWU-101 VersionOct.31,2013 Page I ofr0I

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 pro_ject):
Applicant/Organization:William E. Bagnell / East Carolina University
Signing Official & Title:Associate Vice Chancellor for Campus Operations
b.Contact information for person listed in item la above:
Street Address:East Carolina University Facilities Engineering & Architectural Services' 1001 East Fourth
State:NC Zip:27858-4043
Mailing Address (if applicable):East Carolina University, Facilities Engineering & Architectural Services 1001
City:Greenville State:NC Zip:27858-4043
Phone: [phone] Fax: (252 ) 328-4259
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is: -
® The property owner (Skip to Contact Information, item 3a)
❑ 1-essee' (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 21b 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/Orgy
Signing Official & Title
b.Contact information for person listed in item 2a above:
Street Address:
Mailing Address (if
City:
Phone: (
State: Zip
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:
Other Contact Person/Organization:Bill Chatfield / East Carolina University
Signing Official & Title:Project Manager
b.Contact information for person listed in item 3a above:
Mailing Address Facilities. Engineering & Architectural Services 1001 East Fourth Street
City:Greenville
Phone: [phone]
Emaitchatfieldw«ecu.edu
State:NC Zip:27858-4043
Fax: [phone]
4. Local jurisdiction for building permits: North Carolina State Construction Office
Point of Contact Doug Edwards Phone#: (919 ) 807-4114
Fonu SW U-101 Version Oct. 31, 2013 Page 2 of 7

IV. PROJECT INFORMATION
1. In the space provided below, b11114 summarize how the stormwater runoff will be treated.
Last Carolina University is lap nning to build a Service Learning Center in Brunswick County. NC as an
extension of the School of Denistry. This imposed site is east of the intersection of NC711 and Nigel Road.
Stormwnter runoff will be routed through an on -site constructed stormwater wetland basin.
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 PUDApproval 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
4. Total Property Area: 2.33 acres
River basin.
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':
ToMI 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 (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward frmn 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 NNW (or MHW) line nay
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 64.64 %
9. Flow many drainage areas does the project have?1 (For {nigh density, count I for each proposed engineered
stormwater BMP. For low density and other projects, use I 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.
Form S\VU-101 Version Oct. 31, 2013 Page 3 of7

Basin Information
Drainage Area 1
Drainae Area_.
Drainage Area _
Drainage Area _
Receiving Stream Name
RaftSwamp
Stream Class "
C:Sw
Stream Index Number"
'I4-10-(1)
Total Drainage Area (sf)
66777
On -site Drainage Area (sf)
66777
Off -site Drainage Area (sf)
0
Proposed Impervious Area" (sf)
43167
'% Impervious Area"" (total)
64.64
Impervious- Surface Area
Draina >e Area 1
.Draina e Area
Draina e Area _
Draina e Area _
On -site Buildings/Lots (sf)
8162
On -site Streets (sf)
10988
On -site Parking (sf)
10426
On -site Sidewalks (sf)
2243
Other on -site (sf)
0
Future (sf)
11348
Off -site (sf)
0
Existing BUA*'* (sf)
0
Total (SO
43167
" Stream Class and Index Number can be determined at: Irttp://portaLncdenr.orghoeb/eaq/ps/csu/classifications
I ervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, grovel areas, etc.
*** Report only that arrrount 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 BLIA.
11. How was the off -site impervious area listed above determined? Provide documentation..OffsitQ impervious
drainage is collected in roadside ditch and routed to bypass propsoed constructed wetland
Projects in Union County.: Contact DEM1,R Central Office slat'to check ifthe project is located iriihin a Threatened &
Endangered Species ❑wtershed that ntav be subject to more stringent smronvoter requircniems as per 15d NCAC 02U.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 htto://portal.ncciem-.org/tveb/wq/ws/su/bap-manual.
VL 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
ttp.2jportal.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 athttlil/oortal.ncdenr.org/web/wq/ws/su/ma'�.)
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 fromhttp://portal.ncdenr.org/web/wq/ws/su/statesw/forms dues.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. JM /��
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants �^-4)
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M J M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to J M
http //www envhelp org/pages/onestopexl2ress htnilhtnil 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/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'h mile of the site boundary, include the'k
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
S. 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.
I. 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.
I. 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).
JM
m
J M
JM
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify AM
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: M 48 Page No: 110-110 _\ wl
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 ] a, 2a, and/or 31 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.
httn�//www secretary state nc us/Corpa�ntions/CSearch ash
FormSWU-101 Version Oct. 31. 2013 Rage5of7

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://12orta[.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:R. Todd Fisher PE
Consulting Firm: Colclenest & Stone PA
Mailing Address:116 East Hargett Street Suite 300
City:Raleigh State:NC Zip:27601
Phone [phone] Fax: (919 ) 719-1819
Email: [e-mail]
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
1, (print or type name of persmt listed in Contact Information, item 2a) , certify that 1
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item In) with (print or type name of organization listed in
Contact Information, item In) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
Form SWU-101 Version 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 1 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.
, do hereby certify that
before me this _ day of
Public for the State 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 expires
X. APPLICANT'S CERTIFICATION
1, (print or hype name of person listed in Contact Information, item la) (t), 11i a m E 6qne-./I
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 mwater rules under 'I5A CAC 21-1 .1000 and any other applicable state stormwater requirements.
Signature: S"`� //Drrate:
1, �Q(C Ll./ �1 �r? e 1I , a taryPublic for the State of N l/ , County of
I? if , do hereby certify that W I If i o rn F . Bo U m2 d personally appeared
before me this 28 day of MOt , 26 Iq , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, M �
SEAL
My commission expires 9 6 2 166
Form S W U-101 Version Oct. 31, 2013 Poge 7 of 7

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
June 24, 2013
CERTIFIED MAIL: 7010 1870 0003 4774 5040
RETURN RECEIPT REQUESTED
East Carolina University
Attn: William E. Bagnell, Associate Vice Chancellor for Campus Operations
1001 East Fourth Street
Greenville, NC 27858-4043
John E. Skvarla, II
Secretary
SUBJECT: Post -Construction Stormwater Permit Notification (HQW/ORW)
East Carolina University School of Dentistry Service Learning Center - Lumberton, NC
Robeson County
Dear Mr. Bagnell:
Our office has received a copy of the Financial Responsibility/Ownership Form (FR/O) from the Division of
Energy, Mineral & Land Resources, Land Quality Section for the East Carolina University School of Dentistry
Service Learning Center - Lumberton, NC project to be located in Robeson County. Based on project location
information provided on the FR/O Form, we have determined that the project is subject to a State Stormwater
Management Permit for development activities within one mile of and draining to High Quality Waters (HOW).
Please be advised that construction of any built -upon areas prior to issuance of a State Stormwater
Management Permit will be considered a violation of the NC Administrative Codes and could result in the
assessment of civil penalties of up to $25,000 per day, per violation. The State Stormwater Management
Permit is in addition to the NPDES Stormwater General Permit (NCG010000) received for construction activities.
For more information and to obtain the application and applicable supplement forms, please visit:
http://portal.ncdenr.org/web/wq/ws/su/statesw.
If you have any questions concerning this matter, please contact me at [phone] or by e-mail at
[e-mail].
Sincere
Y,
Michael Lawyer, CPSWQ
Environmental Specialist
cc: FRO - Surface Water Protection Section
FRO - Land Quality Section
Location: 225 Green Street, Suite 714, Fayetteville, North Carolina 28301
Phone: [phone] \ FAX: [phone] \ Customer Service: 1-877.623-6748
InterneC hnp://ponal.ncdenr.org/web/wq
NorthCarolina
Naturally
An Equal Opportunity \ Affirmative Action Employer

(Domestic Mail Onl)
For delivery inforimmur
m
Certified Fee
C3
C3
Retum Receipt Fee
O
(Endorsement Required)
.�
Restricted Delivery Fee
O
(Endorsement Required)
M1
E$6
00
ra
Total Postage & Fees
x
Postmark
Here
bVzqO
r �
r
��I ✓L � aL� ♦ I
PS Form 3800. August 2006 scc Revcrsc for l nslructions
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
AST CAROLINA UNIVERSI'l
Al"! N: \\'ILLIAM E. BAGNi3LL..
ASSGCIA'I'E VICE CHANC'ELOR
FOR CAMPIIS OPERA"1 IONS
1001 LAST FOURTH STREET I'
GRETNVILLE, NC 27858-4043
2. Article Number 'TT
TT
(rmnsfer from service label)
PS Form 3811, February 2004
A. X Sign a r//W1L
Agent
D. Is delivery address dlffere4 from item 17 rEl Ye5
❑ No
If YES, enter delivery address below:
3. Service Type
`� Certifled Mail ❑ Express Mail
b Registered Return Receipt for Merchandise .
❑ Insured Mail L] C.O.D.
4. Restricted Delivery? (Extra Fee) jYes
870 01003 4774 5040 T'
Domestic Return Receipt
102595-02-M-1540,

i A
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this
form and an acceptable erosion and sedimentation control plan have been completed and approved by the
Land Quality Section, N.C. Department of Environment and Natural Resources. (Please)type or pro j� f�(�(�
the question is not applicable or the e-mail and/or fax information unavailable, place N/A the blank If 11m11'R(C)
Part A. �? JUN 10 2013
1. Project Name East Carolina University School of Dentistry Service Learning Center —_Lumberton, N '41p�B/iS
2. Location of land -disturbing activity: County Robeson City or Township: Lumberton ������//!
Highway/Street: NC 711 Latitude: _ N 34'37'36" Longitude: W 79'04'07"
3. Approximate date land -disturbing activity will commence: May 1 2013
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Institutional
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 2.33
6. Amount of fee enclosed: $ 195 . The application fee of $65,00 per acre (rounded up
to the next acre) is assessed without a ceiling amount (Example: a 9-acre application fee is $585).
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Bill Bagnell
Telephone [phone] Cell #
E-mail Address bagnellw(v)ecu.edu
Fax # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
State of North Carolina [phone] [phone]
Name Telephone Fax Number
1301 Mail Service Center 116 W. Jones Street
Current Mailing Address Current Street Address
Raleigh NC 27699 Raleigh NC 27603
City State Zip City State Zip
10. Deed Book No. 1699 Page No. 447 Provide a copy of the most current deed.
Part B.
1. Person(s) or firm(s) who are financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible parties on an attached sheet):
East Carolina Universitv c/o William E. Bagnell bagnellwCo ecu.edu
Name E-mail Address
1001 E. Fourth Street 1001 E. Fourth Street
Current Mailing Address Current Street Address
Greenville NC 27858-4043 Greenville NC 27858-4043
City State Zip City State Zip
Telephone [phone] Fax Number [phone]

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Name
N/A
E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A N/A N/A N/A N/A
City State Zip City State Zip
Telephone N/A Fax Num
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
N/A N/A
Name of Registered Agent E-mail Address
N/A N/A
Current Mailing Address Current Street Address
N/A N/A N/A N/A N/A N/A
City State Zip City State Zip
Telephone N/A Fax Number NIA
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath (This form must be signed by the Financially Responsible Person if an individual
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Person). I agree to provide
corrected information should there be any change intheinformation provided herein..
0,11mm �, 12�rfnne 11 ff95ocid to Kee-e&alellol—'�,- &ogea 5
Type or print name n- Title or Authority Zee i?c'i'o// S
u x' �-- I�i l'Jt-hrf-u �F�Z3� l 3
Signature Date
--------------------------------------------I------------
- I - �e 6 , a Notary Public of the County of
State of North Carolina, hereby certify that ij y //, ahi [- . & appeared
personally before me this day and being duly sworn acknowledged that the above form was
executed by him. 7
Witness my hand and notarial seal, this ") day of - - rI I -1� , 20 I
Lj�U + I�
Notary
Seal O 10? q
My commission expires

0
Arch
811 ,
Ralei
VICINITY MAP
TOPOGRAPHICAL AND BASE SURVEY INFORMATION OBTAINEDtlFR S M
SURVEYING, INC. THIS INFORMATION
LY
BY MICHAEL J. ADAMS NORTH CAROLWND PRIGINALONASSUED
SEAL: L-44g7, ON JUNE AND SEALED 8. NORTH
C LAND SURVEYOR
LEGEND
EE
PROJECT PROPERTY LINE
-264p" -- EXISTING CONTOUR
EXISTING SANITARY SEWER AND MANHOLE
EXISTING LIGHT POLE
EXISTING WATERLINE
EXISTING GAS