SW8960507_CURRENT PERMIT_20220218 (2)

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8 q�p050`1
DOC TYPE
I CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
20220213
YYYYMMDD

ROY COOPER
Governor
ELIZABETH S. BISER
secretary
BRIAN WRENN
Director
February 18, 2022
New Hanover Community Health Center, Inc.
Attn: Althea Johnson, Chief Executive Officer
925 North 4'h Street
Wilmington, NC 28401
NORTH CAROLINA
Env6vnmentat Quartty
Subject: Permit Renewal
Post -Construction Stormwater Management Permit No. SW8 960507
New Hanover Community Health Center
New Hanover County
Dear Ms. Johnson:
Effective August 1, 2013 the Post -Construction Stormwater Management Program has been transferred from the
Division of Water Quality ("DWQ") to the Division of Energy, Mineral and Land Resources ("DEMLR" ). All
previous references to DWQ will remain in older permits issued prior to August 1, 2013 until they are modified.
Please note that this permit will now reference DEMLR as the Division responsible for enforcement of the permit.
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 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.
The Division of Energy, Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on February 14, 2022. The Division is hereby notifying you that permit SW8960507 has been
renewed, updated, and re -issued on February 18, 2022, as attached. As requested, a copy of the current operation
and maintenance agreement is also enclosed. Please be aware that the renewal and re -issuance of this stormwater
permit does not imply that the site is currently in compliance.
This permit shall be effective until July 9, 2028, which includes all available extensions, and does not supersede
any other agency permit that may be required. The project shall be subject to the conditions and limitations as
specified therein. This permit does not impose new or increased stormwater control requirements; it clarifies the
rules and requirements of this program to provide you with a better understanding of your obligations under this
permit. Failure to comply with these requirements will result in future compliance problems. Please note that this
permit is not transferable except after notice to and approval by the Division.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to request
an adjudicatory hearing by filing a written petition with the Office of Administrative Hearings (OAH). The
written petition must conform to Chapter 150B of the North Carolina General Statutes and must be filed with the
OAH within thirty (30) days of receipt of this permit. You should contact the OAH with all questions regarding
the filing fee (if a filing fee is required) and/or the details of the filing process at 6714 Mail Service Center,
Raleigh, NC 27699-6714, or via telephone at 919-431-3000, or visit their website at www.NCOAH.com. Unless
such demands are made this permit shall be final and binding.
If you have any questions concerning this permit, please contact Ashley Smith in the Wilmington Regional
Office, at [phone] or [e-mail].
Sincerely,
YLO
59 Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
D E QJ� North Carolina Department of Environmental Quality I Division of Energy. Mineral and Land Resources
./ Wilmington Regional Office 1 127 Cardinal Drive Extension I Wilmington. North Carolina 28405
�� / 910.796.7215

State Stormwater Permit No. SW8 960507
Page 2 of 2
Enclosures: Attachment C — Permitting History
Renewal Application Documents
Copy of the current operation and maintenance agreement
DES/ams: \\\Stortnwater\Petmits & Projects\ 1 996\960507 HD\2022 02 permit 960507
cc:
Wilmington Regional Office Stormwater File .
� D 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 28405
.W.A 910.796.7215

Post -Construction Stormwater Management
Permit No. SW8 960507
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
POST -CONSTRUCTION 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
New Hanover Community Health Center, Inc.
New Hanover Community Health Center
925 North 4th Street, Wilmington, New Hanover County
FOR THE
construction, operation and maintenance of a detention pond in compliance with the provisions of 15A
NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and as outlined in the application,
approved stormwater management plans, supplement, calculations, operation and maintenance
agreement, recorded documents, specifications, and other supporting data (the "approved plans and
specifications") as attached and/or on file with and approved by the Division of Energy, Mineral and
Land Resources (the "Division" or "DEMLR"). The project shall be constructed, operated and
maintained in accordance with these approved plans and specifications. The approved plans and
specifications are incorporated by reference and are enforceable part of this permit.
This permit shall be effective from the date of issuance until July 8, 2028 and shall be subject to the
following specified conditions and limitations. The permit issued shall continue in force and effect until
the permittee files a request with the Division for a permit modification, transfer, renewal, or
rescission; however, these actions do not stay any condition. The issuance of this permit does not
prohibit the Director from reopening and modifying the permit, revoking and reissuing the permit, or
terminating the permit for cause as allowed by the laws, rules, and regulations contained in Title 15A
NCAC 2H.1000 and NCGS 143-215.1 et.al.
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.
This stormwater system has been approved for the management of stormwater runoff as
described on page 2 of this permit. The stormwater control has been designed to handle the
runoff from 58,806 square feet of impervious area.
Page 1 of 5

Post -Construction Stormwater Management
Permit No. SW8 960507
DIVISION OF ENERGY, MINERAL, AND LAND
PROJECT DATA
Project Name:
Permit Number:
Location:
Applicant:
Mailing Address:
Application Date:
Water Body Receiving Stormwater Runoff:
Classification of Water Body:
If Class SA, chloride sampling results:
Pond Depth:
Permanent Pool Elevation:
Total Impervious Surfaces Allowed:
Future
Offsite Area entering Pond:
Green Area entering Pond:
Required Surface Area:
Provided Surface Area:
Required Storage Volume:
Provided Storage Volume:
Temporary Storage Elevation:
Controlling Orifice:
New Hanover Community Health Center
SW8 960507
New Hanover County
Althea Johnson, CEO
NHC Community Health Center
925 North Fourth Street
Wilmington, North Carolina 28401
February 14, 2022
Smith Creek
"C Sw"
N/A
5 feet
46.7 MSL
58,806 square feet
11, 809 square feet
N/A square feet
39,204 square feet
4,214 square feet
5,098 square feet
4,819 cubic feet
5,741 cubic feet
47.7 MSL
1-1/4" pipe
3. The tract will be limited to the amount of built -upon area indicated on page 2 of this permit, and
per approved plans.
4. The permittee is responsible for verifying that the proposed built -upon area does not exceed the
allowable built -upon area.
5. 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.
It. SCHEDULE OF COMPLIANCE
The permittee will comply with the following schedule for construction and maintenance of the
stormwater management system:
a. The stormwater management system shall be constructed in it's entirety, vegetated and
operational for it's intended use prior to the construction of any built -upon surface except
roads.
b. During construction, erosion shall be kept to a minimum and any eroded areas of the
system will be repaired immediately.
c. All connections into the stormwater system from future areas/outparcels shall be made
such that short-circuiting of the system does not occur.
Page 2 of 5

Post -Construction Stormwater Management
Permit No. SW8 960507
2. The permittee shall at all times provide the operation and maintenance necessary to assure the
permitted stormwater system functions at the design condition. The approved Operation and
Maintenance Plan must be followed in it's 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. Immediate repair of eroded areas.
e. Maintenance of side slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of outlet structure, orifice device and catch basins and
piping.
g. Access to the outlet structure must be available at all times.
3. Records of maintenance activities must be kept and made available upon request to authorized
personnel of DEMLR. The records will indicate the date, activity, name of person performing the
work and what actions were taken.
4. 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.
5. Decorative spray fountains will be allowed in the stormwater treatment system if calculations
are provided documenting the permeant pool volume is greater than 30,000 cubic feet.
6. 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.
7. No person or entity, including the permittee, shall alter any component shown in the approved
plans and specifications. Prior to the construction of any modification to the approved plans,
the permittee shall submit to the Director, and shall have received approval for modified plans,
specifications, and calculations including, but not limited to, those listed below. For changes to
the project or SCM that impact the certifications, a new or updated certification(s), as
applicable, will be required and a copy must be submitted to the appropriate DEQ regional
office upon completion of the modification.
a. Any modification to the approved plans and specifications, regardless of size including
the SCM(s), BUA, details, etc.
b. Redesign or addition to the approved amount of BUA or to the drainage area.
C. Further development, subdivision, acquisition, lease or sale of any, all or part of the
project and/or property area as reported in the approved plans and specifications.
d. Altering, modifying, removing, relocating, redirecting, regrading, or resizing of any
component of the approved SCM(s), the stormwater collection system and/or
vegetative conveyance shown on the approved plan.
e. The construction of any allocated future BUA.
f. The construction of any permeable pavement, #57 stone area, public trails, or
landscaping material to be considered a permeable surface that were not included in
the approved plans and specifications.
g. Other modifications as determined by the Director.
Page 3 of 5

Post -Construction Stormwater Management
Permit No. SW8 960507
III. GENERAL CONDITIONS
CORRECTIVE ACTIONS REQUIRED. If the facilities fail to perform satisfactorily, the
permittee shall take immediate corrective actions. This includes actions required by this
Division and the stormwater rules such as the construction of additional or replacement on -site
stormwater systems. These additional or replacement measures shall receive a permit from
the Division prior to construction.
PERMIT RENEWAL. A permit renewal request must be submitted at least 180 days prior to
the expiration date of this permit. The renewal request must include the appropriate
application, documentation and the processing fee as outlined in Title 15A NCAC
02H.1045(3).
CHANGES TO THE PROJECT NAME, PERMITTEE NAME OR CONTACT INFORMATION.
The permittee shall submit a completed Permit Information Update Application Form to the
Division within 30 days to making any one of these changes.
TRANSFER. This permit is not transferable to any person or entity except after notice to and
approval by the Director. Neither the sale of the project and/or property, in whole or in part, nor
the conveyance of common area to a third party constitutes an approved transfer of the permit.
a. TRANSFER REQUEST. The transfer request must include the appropriate application,
documentation and the processing fee as outlined in 15A NCAC 02H.1045(2). This
request must be submitted within 90 days of the permit holder meeting one or more of
the following:
i. A natural person who is deceased,
ii. A partnership, limited liability corporation, corporation, or any other business
association that has been dissolved;
iii. A person or entity who has been lawfully and finally divested of title to the
property on which the permitted activity is occurring or will occur through
foreclosure, bankruptcy, or other legal proceeding.
iv. A person or entity who has sold the property, in whole or in part, on which the
permitted activity is occurring or will occur.
b. TRANSFER INSPECTION. Prior to transfer of the permit, a file review and site
inspection will be conducted by Division personnel to ensure the permit conditions
have been met and that the project and the on -site stormwater system complies with
the permit conditions. Records of maintenance activities performed to date may be
requested. Projects not in compliance with the permit will not be transferred until all
permit and/or general statute conditions are met.
5. COMPLIANCE. The permittee is responsible for compliance with the terms and conditions of
this permit until the Division approves the transfer request.
a. APPROVED PLANS AND SPECIFICATIONS. A copy of this permit, approved plans,
application, supplement, operation and maintenance agreement, all applicable
recorded documents, and specifications shall be maintained on file by the permittee at
all times.
b. DIVISION ACCESS. The permittee grants Division Staff permission to enter the
property during normal business hours to inspect all components of the permitted
project.
C. ENFORCEMENT. Any individual or entity found to be in noncompliance with the
provisions of a stormwater management permit or the requirements of the stormwater
rules is subject to enforcement procedures as set forth in NCGS 143 Article 21.
d. ANNUAL CERTIFICATION. The permittee shall electronically submit to the Division an
annual certification completed by either the permittee or their designee confirming the
projects conformance with permit conditions
Page 4 of 5

Post -Construction Stormwater Management
Permit No. SW8 960507
OBTAINING COMPLIANCE. The Director may notify the permittee when the permitted
site does not meet one or more of the minimum requirements of the permit. Within the
time frame specified in the notice, the permittee shall submit a written time schedule to
the Director for modifying the site to meet minimum requirements. The permittee shall
provide copies of modified plans and certification in writing to the Director that the
changes have been made.
OTHER PERMITS. The issuance of this permit does not preclude the permittee from
complying with and obtaining any other permits or approvals that are required for this
development to take place, as required by any statutes, rules, regulations, or
ordinances, which may be imposed by any other Local, State or Federal government
agency having jurisdiction. Any activities undertaken at this site that cause a water
quality violation or undertaken prior to receipt of the necessary permits or approvals to
do so are considered violations of NCGS 143-215.1, and subject to enforcement
procedures pursuant to NCGS 143-215.6.
Permit renewed, updated and reissued this the 18th day of February 2022.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
�Q / rector
1 Brian renn,-6irector
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Permit Number SW8 960507
Page 5 of 5

Attachment C - Permitting History
New Hanover Community Health Center
Permit No. SW8 960507
Approval
Permit
BIMS
Description of the Changes
Date
Action
Version
Original
7/9/1996
10
Approval
9/30/2009
Renewal
2.0
the addition of a 582 square foot storage
building and 296 square feet of sidewalk. In
Plan
the process, 352 square feet of existing
11/19/2010
Revision
2.1
sidewalk shall be removed resulting in a net
addition of 526 square feet of impervious
area.
2/18/2022
Renewal
3.0
Expires July 9, 2028

NOV716-2007 FRI 05:51 PM NCDENR FAX NO, 9103502004 P. 06
Wet Detention Basin Inspection 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, safely 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):
0 does ❑ does not
This system (check one):
❑ does 1y°�c'I does not
incorporate a vegetated filter at the outlet.
incorporate pretreatment other than a forebay.
Important maintenance procedures:
— Inunediately 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 muninuzed to the
maximum extent practical.
— Once a year, a dam safety expert should inspect the embankment.
After the wet detention pond is established, it should be inspected once a month and
within 24 hours after every storm event greater than 1.0 inches (or 1.5 inches if in a
Coastal County). Records of inspection and maintenance should be kept 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:
Flow 1 will remediate the roblem:
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
long.
approximately six inches.

NOV-1.6-2007 FRI 05:52 PM NCDENR FAX N0, 9103502004 1 P, 07
BMP element:
Potentialproblem:
'How I will remediate theproblem:
The inlet device: pipe or
Swale
The pipe is clogged.
Unclog the pipe. Dispose of the
sediment off -site.
The pipe is cracked or
Replace the pipe.
otherwise damaged.
Erosion is occurring in the
Regrade the Swale if necessary to
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
a depth greater than the
original design depth for
sediment storage.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
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.
Reprove the weeds, preferably by
hand. If pesticide is used, wipe it on
the plants rather than spraying.
The vegetated shelf
Best professional practices
show that pruning is needed
Prune according to best professional
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 necessa .
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
a depth greater than the
original design sediment
storage depth.
Search for the source of the
sediment and remedy the problem if
possible. Remove the sediment and
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.

NOV-16-2007 FRI 05:52 PM NCDENR FAX NO. 9103502004 P. 08
BMP element:
Potential problem:
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
Consu It 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.
The outlet device
Clogging has occurred.
Clean out the outlet device. Dispose
of the sediment off -site.
The outlet device is damaged
Re air 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
sediment shall be removed.
When the permanent pool depth reads
shall be removed.
feet in the main pond, the
feet in the forebay, the sediment
BASIN DIAGRAM
0511 in the blanks)
Permanent Pool Elevation
Sediment Removal L- . _ ♦ Pe ncn Pool
----------------- Volume Sediment Removal Elevation _ volume
Bottom F.levatio -ft Min, -- ------ ---- - -- ---- ------ ---- --- +-- --
Sediment Bottom Elevation _ _ 21-R n
Storage Sedimer
Storage
FOREHAY MAIN POND

NOV-16-2007 FRI 05:52 PM NCDENR
FAX N0, 9103502004
I acknowledge and agree by my signature below that 1 am responsible for the
performance of the maintenance procedures listed above. I a&Tee to notify DWQ of any
problems with the system or prior to any changes to the system or responsible party.
Print name: A LPMD 7htm l
&ea-n U6E
Address- 9 z5 /,IL)N/H WiL/hlA)6fdA N. G.-29!Ab/
Note: The legally responsible parry 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,
a Notary Public for the State of
Y Ilan (f bounty of l IQA eJ , do hereby certify that/�
personally appeared before me this I"/ .. ,
day o , _2CUand acknowledge the due execution of the
forgoing wet detention basin maintenance requirements. Witness my hand and official
seal,
eU6(/'w.S
•�0TARy
•.,PUBLIC:.
SEAL
My commission expires0/Yl 5-C-202)

ULMLK USLUNLY-
n Date
ecei ed
Fee Paid
Permit Number
a
�a
s
o5 =
Sul
26 Dso
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 2H.1045(3), the current permit holder shall renew their high density permit 180 days
prior to its expiration. Renewed permits are valid for a period of 8 years per Session Law 2011-398 (SB 781)
Section 60.(c). This application form is for permit renewals only.
A. PROJECT INFORMATION
1. State Stormwater Permit Number: SW8 960507
2. Project name: New Hanover Community Health Center
3. Project street address: 925 North Fourth Street
City: Wilmington County: New Hanover
ZIP: 28401
4. What, if any, changes have been made to the project as permitted? None
If the project has changed from the original approved plans, please complete SWU-101 fora Major
Modification or Minor Modification Application form available at: htti)s:Hdeg.nc.gov/about/divisions/energv-
mineral-land-resources/energy-mineral-land-rules/stormwater-program/post-construction.
B. PERMITTEE INFORMATION
If changes to the permittee or project name have been made, please complete either the Permit Update form
or the Permit Transfer form available at: https://deg.nc.gov/about/divisions/energy-mineral-land-
resources/energy-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holder's Company Name/Organization: New Hanover Community Health Center, Inc.
dba MedNorth Health Center
2. Signing Official's Name: Althea Johnson
3. Signing Official's Title: Chief Executive Officer
4. Mailing Address: 925 N 41h St
City: Wilmington
28401
5. Street Address: 925 N 4rh St
NC ZIP :
City: Wilmington State: NC ZIP
28401
6. Phone: [phone] Email: aiohnsonla'�mednorth.org
FEB 14 2022
13Y:
Stormwater Permit Renewal Form Page 1 of 3 May 11, 2018

C. SUBMITTAL REQUIREMENTS
Submit the application package to the appropriate DEMLR Regional Office (Coastal, SA Waters) or DEMLR
Central Office (Urbanizing Areas Ph 2, USMP, Non -Coastal HQW/ORW). Only applications packages that
include all required items listed below will be accepted and reviewed.
Initial each item below to indicate that the required information is provided in the application package:
ai 1. A permit application processing fee of $505.00 payable to NCDEQ.
aj 2. One original signed hard copy and one electronic copy of this completed form. The signing official
named on this application to represent the current permittee must meet one of the following:
a. Corporation — a principle executive officer of at least the level of vice-president;
b. Limited Liability Company (LLC) — a manager or company official as those terms are defined
in G.S. 57D "North Carolina Limited Liability Company Act;"
c. Public Entity — a principal executive officer, ranking official, or other duly authorized employee;
d. Partnership or limited partnership — the general partner;
e. Sole proprietor; or
f. Letter of authorization signed by one of the signatories noted in a — e above authorizing the
signature of another entity.
3. One hard copy and one electronic copy of recorded documents required by the original permit that
have not yet been received by DEMLR, including: deed restrictions, protective covenants,
condominium/planned community declaration and easements. If the project has been built, include
documentation that the maximum BUA per lot or maximum total BUA has not been exceeded. If
the project has not been built, include a signed agreement that the final recorded deed restrictions
and protective covenants will be submitted at a later date.
4. O&M Agreements, Please select one:
❑ I have a copy of the current recorded O&M Agreement for all SCMs, and I will continue to
keep this on file with the permit; or
® I do not have a copy of the current recorded O&M Agreement for all SCMs and am
requesting a copy be sent to me. I agree to keep this on file with the permit.
5. Designer Certifications, Please select one:
❑ A copy of the certification(s) confirming that the project was built in accordance with the
approved plans have been previously provided to the Division; or
❑ A copy of the certifications) confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
6. [IF APPLICABLE] If the project has been built, one original hard copy and one electronic copy of a
signed, sealed, and dated letter from a licensed professional stating that the SCMs have been
inspected, and that they have been built and maintained in accordance with the permit.
ai 7. [IF APPLICABLE] When the permittee is a corporation or a limited liability corporation (LLC): Provide
one hard copy and one electronic copy of documentation from the NC Secretary of State, or other
official documentation, which supports the titles and positions held by the persons listed in Section
C.2 per 15A NCAC 2H. 1043(3)(b).
httos://www.sosnc.gov/online services/search/by title/ Business Registration
FEB 14 2022 J
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

D. PERMITTEE'S CERTIFICATION
I, Althea Johnson , the person legally responsible for the permit, certify that I have
a copy of the Permit and O&M Agreement on site (or I will obtain a copy and it will be kept on site), that I am
responsible for the performance of the maintenance procedures, and the site has been and will be maintained
according to the O&M Agreement and approved plans. I agree to notify DEMLR of any problems with the SCMs
or built -upon area and to submit the proper forms to modify or transfer the permit prior to any changes to the
project, SCMs, or ownership. All information provided on this permit renewal application is, to the best of my
knowledge, correct and complete.
Signature: Date: February 10, 2022
NOTARIZATION:
I, Francine V. Grovner a Notary Public for the State of
North Carolina County of New Hanover , do hereby certify
that Althea Jol
this the 1nth
execution of the f(
(Notary Seal)
Notary Signature:
My commission e.
personally appeared before me
day of February 2022 , and acknowledge the due
` Notary Public
Q: Brunswick _'O
County
My Comm. F%P.
e. Ot-09.2023 �F
fa
my hand and official seal,
Stormwater Permit Renewal Application Form Page 3 of 3
qEL mat_ iy e° C
FED 14 2022 �I
May 11. 2018

AUG 05,2009 02:21P Tripp Engineering
New Hanover County Community Health Center
Stonnwater Permit No. SW8 960507
New Hanover County
Engineer's Certification
9107635631 page 2
9bC)) 5
State Stermwater Management Systems
Permit No. SW& 960507
1,1l(CIP• (ott(bstlP '(MOP as a duly registered Professional Engineer in the State of
North Carolina, having been authorized to observe (periodically/weekly/full time) the construction of the
project,
W
for _JA.JJ CMW ►'1EAts[R C& _(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 approval plans and specifications.
Noted deviations from approved plans and specification:
Signature .
Registration Number
Date .- 4.
III
8M
27,174
7