SW8080426_HISTORICAL FILE_20220727

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 C�HOyZ�
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
® HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
202-20"121
YYYYMMDD

Burd, Tina J
From: Burd, Tina J
Sent: Monday, July 25, 2022 10:08 AM
To: [e-mail]
Subject: SW8 080426 - Masonboro Family Medicine
The Wilmington Regional Office of the Division of Energy, Mineral and Land Resources (Stormwater Section) accepted
the Stormwater Permit Renewal Application and $505.00 fee for the subject project on July 22, 2022. The project has
been assigned to Ashley Smith and you will be notified if additional information is needed.
Best Regards,
Tina Burd
Administrative Associate II
Wilmington Regional Office
Division of Environmental Assistance & Customer Service
Phone [phone]
NCDEQ
Wilmington Regional Office
127 Cardinal Drive Ext.
Wilmington, NC 28405
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Website: http://deancgov/about/divisions/energy-mineral-land-resources/stormwater
Based on the current guidance to minimize the spread of COVID-t9, the Department of Environmental Quality has adjusted
operations to protect the health and safety of the staff and public. Many employees are working remotely or are on staggered
shifts. To accommodate these staffing changes, all DEQ_office. locations are limiting public access to appointments only. Please
check with the appropriate staff before visiting our offices, as we may be able to handle your requests by phone or email. We
appreciate your patience as we continue to serve the public during this challenging time.

Non -Transfer Application Completeness Review Checklist
Project Name: NMASO,ti)80eb F;�MLY MZpI f/,Jfr
Project County/Location: /.�NCArC aCAC4 j?Y�iD
Permit Action: New New Permit Ifr:
Not located in the ET1 of the following delegated
and functioning programs:
Date Delivered to WIRO:
7 2$ Zp ,
BIMS Received/Accepted Date:
7 Z Z 7J
Date Given to Admin:..--rp"l��a
BIMS Acknowledged Date3:
c
NHC: Carolina Beach / Kure Beach / Wilmington / Wrightsville Beach
Bruns: Leland / Navassa (?) / Oak Island
Cart: Emerald Isle Onsk Jacksonville Pend: Surf City
Major Mod / Minor Mod / enewal Existing Permit N:
❑Applicant & Permittee are the same?3 Expiration Date°:
'5'06 43 C>JPZ -
/2 3o zo24
Permit Type: HD LD / LD Overall / HD &LD Combo
General Permit / Offshe / Exempt + Redevelopment E-1011site to SW8:
Development Type: Commercial esidential / Other �Is Offsite Lot approved in Master Permit?s
Subdivided?: Subdivision o Single Lot
Rule(s): F-12017 Coastal �2008 Coastal F-11995 Coastal
nPhase II nUniversal =1988 Coastal
Permit Pe Type & Documents Needed:
Property Owner(s) = Purchaser Lessee =HOA ODeveloper
=Viable? I [I]Viable? I =Viable? =Viable? =Viable?
=Deed =Purchase Agmt nLease nElection Minutes
Paperwork
IR[Application
Fee: ®.5505 (within 6mo) Check#(s): ZD FINo Fee
Supplement' (1 new form or for older forms: 1 original per SCM)
FIO&M2
Soils Report (Infil or PP)
Calculations (signed/sealed)
Deed Restrictions, if subdivided
Project Narrative
USES Map (or onfile?) Subject to SA?: Y / N Subject to ORW?: Y / N
Plans (2 Sets)
NOTES:
'Enter RIMS Acknowledged Date on this Sheet
2For New Projects -(Enter New Permit # on Supplements & Deed Restriction Templates.
3If permittee is different, STOP. Needs to be transferred first.
"If w/in 6 months and they are requesting a mod, STOP. Needs a renewal first.
slf Lot not approved in master permit, STOP. Master permit needs mod.
EMAILED ENGINEER DATE:
REVIEWER NAME: Aa-q4-E !
Comments:
G:WQ\\\Reference Library\Procedures\Checklists\Completeness Review Checklist 20210908

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
BRIAN WRENN
Director
June 20, 2022
A & K of Wilmington, LLC
Attn: Kimberly J. Martin, Member
6419-A Carolina Beach Road
Wilmington, NC 28412
NORTH CAROLINA
Environmental Quality
Subject: Stormwater Permit Renewal Request
State Stormwater Management Permit No. SW8 080426
Masonboro Family Medicine
New I lanover County
Dear Ms. Martin:
State Stormwater Management Permit #SW8 080426 for the subject project expired on December 30, 2021. This
is a reminder that permit renewal applications are due 180 days prior to their expiration per 15A NCAC
21-1.1045(3). North Carolina General Statutes and the Coastal Stormwater rules require that this property be
covered under a stormwater permit. Failure to maintain a permit subjects the owner to assessment of civil
penalties. More information about the Post -Construction state stormwater program can be found on the following
website: deq.nc.gov/SW
Please submit a complete permit renewal form along with a $505.00 fee and other submittal requirements within
30 days. The permit renewal form can be found under the Post -Construction section of this website or at:
A review of the North Carolina Secretary of State corporation's database revealed that this corporation has a new
Address. Please submit a completed Permit Information Update Form to correct your contact information which is
available on the website provided above under the "New Permits & Permit Modifications" section.
If you have any questions regarding this matter, please contact Dylan McPeake (dylan.mepeake lan.mepeake(@,ncdenr.gov or
Ashley Smith (ashleym.smith a ncdenr.gov) either via email or phone at [phone].
Sincerely,
cLt }1;
A&, Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
DES/arras: \\\Stonnwater\Permits & Projects\2008\080426 HD\2022 06 req_ren 080426
cc: Wilmington Regional Office File
Qz>
North Carolina Department of Environmental Quality I Division of Energy, Mineral and land Resources
Wilmington Regional office 1127 Cardinal Drive Extension I Wilmington, North Carolina 28465
910.796.7215

• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
A & K of Wilmington, LLC
Information
Sosld: 0669996
Status: Current -Active O
Date Formed: 4/1/2003
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Illobre, Andrew
Addresses
Mailing
Principal Office
6419-A Carolina Beach Road 6419-A Carolina Beach Road
Wilmington, NC 28412
Reg Mailing
6419-A Carolina Beach Road
Wilmington, NC 28412
Company Officials
Wilmington, NC 28412
Reg Office
6419-A Carolina Beach Road
Wilmington, NC 28412
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Member Member
Andrew Illobre
6419-A Carolina Beach Road
Kimberly J Martin
6419-A Carolina Beach Road
Wilmington NC 28412 Wilmington NC 28412

P. 01
TRANSACTION REPORT
SEP-17-2009 THU 12:15 PM
FOR: NCDENR 910 350 2004
RECEIVE
DATE START SENDER RX TIME PAGES TYPE NOTE M# DP
SEP-17 12:14 PM 9107635631 39" 3 FAX RX OK

SEP 17,2009 11:39A Tripp Engineering 9107635631 page 1
Job No....07083
Date:-9L1.7 09
TRIPP ENGINEERING, P.C.
419 Chestnut. Street, Wilmington, NC 28401
Phone: [phone] . FAX: [phone] AS
Email:[e-mail]
LETTER OF TRANSMITTAL + ��
To: NCDENR
Attention: David Cox
' I
Subject: Masonboro,Family Medicine (SW8 080426)
X FAX TRANSMITTAL: NUMBER OF PAGES INCLUDES COVER 3
I am sending you: ( X ) ATTACHED ( ) UNDER SEPARATE COVER
( ) Prints ( ) Tracings ( ) Copy of letter ( ) Specifications ( X) Other
Copies Item No. Description
1 Engineers Certification
These are transmitted as checked below:
( ) For Approval ( X ) For Your Use ( ) Sign & Return ( ) Review
Remarks: In response to the Notice of Inspection dated September il, Z009 we are
Providingthe engineers certification for the above referenced orgiect. Please contact me if
YQI need anv addltiona formation Thank you
cc: Kimberly Martin
A&K,of Wilmington
Signed:_ Phil Tripp

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
January 27, 2016
Kimberly J. Martin, Manager
A & K of Wilmington, LLC
6132-8 Carolina Beach Road
Wilmington, NC 28412
Subject: Permit Correction and Permit Extension
Masonboro Family Medicine
Stormwater Permit No. SW8 080426
New Hanover County
Dear Ms. Martin:
PAT MCCRORY
Gavemor
DONALD R. VAN DER VAART
secretary
TRACY DAVIS
Director
Effective August 1, 2013, the State Stormwater program was transferred from the Division of Water
Quality (DWQ) to the Division of Energy, Mineral and Land Resources (DEMLR). All previous
references to DWQ will remain in older stormwater permits issued prior to August 1, 2013 until they are
modified. Please note that this letter (permit) references DEMLR as the Division responsible for issuance
of the permit.
The Wilmington Regional Office issued the subject project a permit on May 23, 2008 and recently
discovered it contained an error. This permit correction is to clarify the set of rules under which this
permit was approved and restates some of the previous terms to provide a better understanding of your
obligations under the permit. Please replace the previously issued permit with the enclosed corrected
permit.
Additionally, on,August 5, 2009, the Governor signed Session Law 2009-406. This law impacted any
development approval issued by the former Division of Water Quality under Article 21 of Chapter 143 of
the General Statutes, which was current and valid at any point between January 1, 2008, and December
31, 2010. The law extended the effective period of any stormwater permit that was set to expire during
this time frame to three (3) years from its current expiration date. On August 2, 2010, the Governor
signed Session Law 2010-177, which granted an extra year for a total of four (4) years
extension. Accordingly, this permit shall now be effective from the date of issuance until December 30,
2021, which includes all available extensions.
This project is subject to the conditions and limitations as specified in the corrected permit. 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 project, procedures for changes of
ownership, transferring the permit, and renewing the permit. Failure to establish an adequate system for
operation and maintenance of the stormwater management system, to record deed restrictions, to transfer
the permit, or to renew the permit, will result in future compliance problems.
If you have any questions, need additional copies of the permit or approved plans, please contact
Christine Hall with DEMLR in the Wilmington Regional Office at [phone].
Sine rely,
x, (racy Davis, P.E., Director
Division of Energy, Mineral and Land Resources
GDS/canh: %StormwaterTermits & Projects\2008\080426 HD\2016 01 permit_ correction 080426
cc: Tripp Engineering
Wilmington Regional Office Stormwater File
State of North Carolina I Environmental Quality I Energy, Minensl end Land Resources
127 cardinal Drive Extension I wihnington, NC 28405
910 796 7215 T 1910 350 2004 F I han'//oonal nedeto oretwebAr/

State Stormwater Management Systems
Permit No. SW8 080426
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY DEVELOPMENT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
A & K of Wilmington, LLC
Masonboro Family Medicine
6419 Carolina Beach Rd., Wilmington, New Hanover County
FOR THE
construction, operation and maintenance of one 1) infiltration trench (hereafter referred to as
infiltration system or stormwater control measure discharging to Class SA waters in
compliance with the provisions of 15A NCAC 2H .1000 and Session Law 2006-246 (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 (hereafter referred to as the Division or
DEMLR) and considered a part of this permit.
This permit shall be effective from the date of issuance until December 20, 2021, 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 1.7 of this permit. The runoff from all built -upon area within the
permitted drainage area of this project must be directed into the permitted stormwater
control measure. The stormwater control has been designed to handle the runoff from
52,971 square feet of impervious area.
3. The maximum built -upon area allowed for the entire project is 52,971 square feet.
4. The drainage area will be limited to the amount of built -upon area indicated in Sections
1.2 and 1.7 of this permit, and per approved plans. This permit does not provide any
allocation of built -upon area for future development.
5. The excess design storm overflow from the infiltration basin must be directed into a 50'
vegetated filter strip and level spreader, designed per Section .1008 (f) of the
stormwater rules.
Page 1 of 7

State Stormwater Management Systems
Permit No. SW8 080426
The built -upon areas associated with this project shall be located at least 30 feet
landward of all perennial and intermittent streams.
7. The following design criteria have been permitted for the infiltration trench and it must
be provided and maintained at the design condition:
a. Drainage Area, acres: 1.63
Onsite, ft2: 71,003
Offsite, ft2: None
b. Total Impervious Surfaces, ft2: 52,971
Onsite, ft2: 52,971
Offsite, ft2: None
C. Design Storm, inches: 3.7
d. Trench Length, feet: 285.7
e: Trench Width, feet: 50
f. Trench Depth, feet: 2
g. Perforated Pipe Diameter x Length: 8" x 522' / 12" x 1,000'
h. Bottom Elevation, FMSL: 32.5
i. Bypass Weir Elevation, FMSL: 34.5
l Permitted Storage Volume, ft3. 15,538
k. Predevelopment 1 yr-24 hr. discharge rate, cfs: 2.31
I. Type of Soil: Fine to Medium Sand
M. Expected Infiltration Rate, in/hr: 6.0
n. Seasonal High Water Table, FMSL: 30.5
o. Time to Draw Down, hours: 4.1
p. Receiving Stream/River Basin: ICWW / Cape Fear
Stream Index Number: 18-87-25.5
rr.. Classification of Water Body: "SA, ORW"
II. SCHEDULE OF COMPLIANCE
1. No person or entity, including the permittee, shall alter any component of the approved
stormwater system shown on the approved plans unless and until the Division has
approved of the revised plan.
2. 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.
3. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately. If the stormwater system is used as an Erosion
Control device, it must be restored to design condition prior to operation as a
stormwater treatment device, and prior to occupancy of the facility.
4. The permittee shall at all times provide the operation and maintenance necessary to
assure that all components of the permitted stormwater system function at design .
condition. The approved Operation and Maintenance Agreement is incorporated by
reference into this permit and must be followed in its entirety and maintenance must
occur at the scheduled intervals.
Records of maintenance activities must be kept and made available upon request to
authorized personnel of the Division. The records will indicate the date, activity, name
of person performing the work and what actions were taken.
The facilities shall be constructed in accordance with the conditions of this permit, the
approved plans and specifications, and other supporting data.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW8 080426
7. Upon completion of construction, prior to issuance of a Certificate of Occupancy, and
prior to operation of this permitted facility, a certification must be received from an
appropriate designer for the system installed certifying that the permitted facility has
been installed in accordance with this permit, the approved plans and specifications,
and other supporting documentation. Any deviations from the approved plans and
specifications must be noted on the Certification. A modification may be required for
those deviations.
All stormwater collection and treatment systems must be located in either public rights -
of -way, dedicated common areas or recorded easements. The final plats for the
project will be recorded showing all such rights -of -way, common areas and
easements, in accordance with the approved plans. Access to the stormwater facilities
for inspection and maintenance shall be maintained via appropriate recorded
easements at all times.
9. The permittee shall submit to the Director and shall have received approval for revised
plans, specifications, and calculations prior to construction, for any modification to the
approved plans, including, but not limited to, those listed below:
a. Any revision to any item shown on the approved plans, including the stormwater
management measures, built -upon area, details, etc.
b. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
C. Further development, subdivision, acquisition, lease or sale of any, all or part of
the project area. 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.
d. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
e. The construction of any future BUA listed on the application.
10. Prior to transfer of the permit, the stormwater facilities will be inspected by Division
personnel. The project and the stormwater facility must be in substantial compliance
with all permit conditions. Any items not in substantial compliance must be repaired,
replaced or restored to design condition prior to the transfer. Records of maintenance
activities performed to date will be required.
11. 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.
III. GENERAL CONDITIONS
Any individual or entity found to be in noncompliance with the provisions of a
stormwater management permit or the stormwater rules, is subject to enforcement
action as set forth in NCGS 143, Article 21.
2. The issuance of this permit does not preclude the Permittee from complying with any
and all statutes, rules, regulations, or ordinances, which may be imposed by other
government agencies (local, state, and federal) having jurisdiction.
3. In the event that the facilities fail to perform satisfactorily 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 3 of 7

State Stormwater Management Systems
Permit No. SW8 080426
4. This permit is not transferable to any person or entity except after notice to and
approval by the Director. The permittee shall submit a completed and signed
Name/Ownership Change Form, accompanied by the supporting documentation as
listed on the form, to the Division at least 60 days prior to any one or more of the
following events:
a. An ownership change including the sale or conveyance of the project area in
whole or in part;
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;
e. Dissolution of the partnership or corporate entity;
f. A name change of the current permittee;
g. A name change of the project;
h. A mailing address change of the permittee;
5. 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 constitutes an approved
transfer of the stormwater permit.
6. The permittee grants DEMLR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility. .
7. The permit issued shall continue in force and effect until modified, revoked, terminated
or renewed. 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.
8. Approved plans, calculations, supplement forms, operation and maintenance
agreements and specifications for this project are incorporated by reference and are
enforceable parts of the permit. A copy of the approved plans and specifications shall
be maintained on file by the Permittee for a minimum of ten years from the date of the
completion of construction.
9. Unless specified elsewhere, permanent seeding requirements for the stormwater
controls must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit as
allowed by the laws, rules and regulations contained in Session Law 2006-246, Title
15A NCAC 2H.1000, and NCGS 143-215.1 et. al.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW8 080426
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
application, documentation and the processing fee.
Permit corrected and re -issued this the 27'h day of January 2016.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 080426
Page 5 of 7

State Stormwater Management Systems
Permit No. SW8 080426
Masonboro Family Medicine
Stormwater Permit No. SW8 080426
New Hanover 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 included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW8 080426
Certification Requirements:
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 bypass structure weir elevation is per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the bypass 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 surface area and/or volume have been provided.
12. All required design depths are provided.
13. All required parts of the system are provided.
14. The required system dimensions are provided per the approved plans.
cc: NCDEQ-DEMLR Wilmington Regional Office
New Hanover County Building Inspections
Page 7 of 7