SW8960507_HISTORICAL FILE_20220218 (2)

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW8ngc)50-1
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
202202ty
YYYYMMDD
i

Burd, Tina J
From: Burd, Tina J
Sent: Tuesday, February 15, 2022 2:17 PM
To: [e-mail]
Subject: SW8 960507 - New Hanover Community Health Center
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 February 14, 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
p Q0
F-mail correspondence to and horn this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
Website: htto://dea.nc.Rov/about/divisions/enerpv-mineral-land-resources/stormwater
Based on the current guidance to minimize the spread of COVID-tq, 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 DEQoffice 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: 1J6a
QlvoVFk
Contwt JAitTI
�EALT4 GQTek
Project County/Location:
C
Tri S 1 R2�T
Permit Action: New New Permit N2:
❑Nat located in the ETJ of the following delegated
Date Delivered to WIRO:
r/i ( 20
BIMS Received/Accepted Date:
2 2G22,
Date Given to Admin:
o� ci-
BIMS Acknowledged Datet:
5 a �—
and functioning programs:
NHC: Carolina Beach / Kure Beach / Wilmington / Wrightsville Beach
Bruns: Leland / Navassa (?) / Oak Island
Cart: Emerald Isle Onsl: Jacksonville Pend: Surf City
Major Mod / Minor Mod / newal �- ®Existing Permit N:
Applicant & Permittee are the same?3 Expiration Date°:
Permit Type: Hb ID / LD Overall / HD &LD Combo
General Permit / Offsite / Exempt + Redevelopment
Development Type: Commercial esidential/Other
Subdivided?: Subdivision Single Lot"
Rule(s): ) 12017 Coastal ) 12008 Coastal ) 11995 Coastal
Coastal
Su)8 9 (oa567
Z09Z
MOffsite to SW8:
11Is Offsite Lot approved In Master Permit?
Permittee Type & Documents Needed:
Property Owner(s) = Purchaser Lessee =]HOA OlDeveloper
Viable? =Viable? Viable? Viable? Viable?
Deed =Purchase Agmt = Lease MElection Minutes
Paperwork
Application
®Fee: ®$605 (within 6mo) Check#(s/: < Z5 17 Fee
Supplement' (1 new form or for older forms: 1 original per SCM)
FIO&M 2
Soils Report (Infil or PP)
Calculations (signed/sealed)
Deed Restrictions, if subdivided
Project Narrative
FIUSGS Map (or onfile?) Subject to SA?: Y / N Subject to ORW?: Y / N
Plans (2 Sets)
NOTES:
2Enter BIMS Acknowledged Date on this Sheet
2For New Projects -Enter New Permit # on Supplements & Deed Restriction Templates.
3 If 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: Comments:
REVIEWER NAME: S1, E
G:WQ\\\Reference Libra ry\Procedures\Checklists\Completeness Review Checklist 20210909

STATE OF NORTH CAROLINA
DEPARTMENT OF THE SECRETARY OF STATE
STATEMENT OF CHANGE OF REGISTERED
OFFICE AND/OR REGISTERED AGENT
SOS I D: 0306475
Date Filed: 2/23/2016 2:31:00 PM
Elaine F. Marshall
North Carolina Secretary of State
C2016 048 00918
Pursuant to §55D-31 of the General Statutes of North Carolina, the undersigned entity submits the following for the purpose of
changing its registered office and/or registered agent in the State of North Carolina.
INFORMATION CURRENTLY ON FILE
The name of Elie entity is: New Hanover Community Health Center, Incorporated
Entity Type: ❑Corporation, []Foreign Corporation, EINonprofit Corporation, []Foreign Nonprofit Corporation,
[]Limited Liability Company, ❑Foreign Limited Liability Company ❑Limited Partnership, []Foreign Limited Partnership,
❑Limited Liability Partnership. ❑Foreign Limited Liability Partnership
The street address and county of the entity's registered office currently on lile is:
Number and Street: 925 North 4th street
City, Stale, Zip Code: Wilmington, NC 26401 County: New Hanover ..
The mailing address iftlifferent from the street address of the registered office currently on file is:
The name of the current registered agent is: Anganette Young
i
NEW INFORMATION .
I.The street address and county of the new registered -office of the entity is:
(complete this item only if7he adrhress of the registered office is being changed) ++,^
Number and Street: t- ' y tryy�
City, State, Zip Code: County: FEB 14 �2
2. The mailing address if different front the street address of the new registered office is:
(complete this item only if tire address gfthe registered qflice is being changed)
3. The name of the new registered agent and the new agent's consent to appointment appears below:
(complete this item only if tire name of the registered agent is being charged)
Althen Johnson, Chief Executive Officer
Type of Print Name of Net, Agent eYgnalure & Title
4. The address of the entity's registered office and the address of the business office of ils registered agent, as changed,
will be identical.
5. This statement will be effective upon filing, unless a date and/or time is specified:
This is the I I day of January 2016
New Hanover Community Health Center, Incorporated
(�F.ntity Nante
c \,�
01Sfgnannre -
Althea Johnson, Chief Executive Officer
;�. Type or Point Name and Title
Notes: Piling fee Is $5.00. This docmneut must be filed with the Secretary of SMte.
• Instead of signing here, the new registered agent may sign aseparate written consent to the appointment, which most be attached to Ihis statement.
CORPORATIONS DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622
Revised January 2002 Form BE-06

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
BRIAN WRENN
Director
January 26, 2022
New Hanover Community Health Center, Inc.
Attn: Althea Johnson, Registered Agent
925 North Fourth Street
Wilmington, NC 28401
NORTH CAROLINA
Environmental Quality
Subject: Stormwater Permit Renewal Request
State Stormwater Management Permit No. SW8 960507
New Hanover Community Health Center
New Hanover County
Dear Ms. Johnson:
State Stormwater Management Permit #SW8 960507 for the subject project expired on July 9, 2020. This is a
reminder that permit renewal applications are due 180 days prior to their expiration per 15A NCAC 2H.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:
deg.nc.nov/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 may have
a new address new point of contact. 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 Ashley Smith at [phone] or
[e-mail].
Sincerely,
Brian Wrenn, Director
Division of Energy, Mineral and Land Resources
DES/ams: \\\Stormwater\Permits & Projects\1996\960507 HD\2022 01 req_ren 960507
cc: Wilmington Regional Office File
D E QJ� North Carolina Department of Environmental Quality I Division of Energy. Mineral and Land Resources
Wilmington Regional Office 1 127 Cardinal Drlve Extension I Wilmington, North Carolina 28405
lz_tam�rps a" ./
'a.� / 910.796.7215

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Non -Profit Corporation
Legal Name
New Hanover Community Health Center, Incorporated
Information
Sosld: 0306475
Status: Current -Active O
Date Formed: 5/22/1992
Citizenship: Domestic
Annual Report Due Date:
Registered Agent: Johnson, Althea
Addresses
Reg Office Reg Mailing
925 North Fourth Street 925 North Fourth Street
Wilmington, NC 28401 Wilmington, NC 28401
Officers