SW8061216_CURRENT PERMIT_20230421

STORMWATER DIVISION CODING SHEET
POST-CONSTRUCTION PERMITS
PERMIT NO. SW8 ylg\21�n
DOC TYPE © CURRENT PERMIT
❑ APPROVED PLANS
❑ HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE Zo23 04 Z►
YYYYMMDD
I
i

�..
srnrr-o
w n
ROY COOPER =
Governor
-
ELIZABETH,S.BISER
Secretary
DOUGLAS R.ANSEL NORTH CAROLINA
Interim Director Environmental Quality
April 21, 2023
CF Sports Medicine, LLC
Attn:Dale Boyd Jr.,Manager
6019 Oleander Drive, Suite 200
Wilmington,NC 28403
Subject: Permit Correction and Renewal
Post-Construction Stormwater Management Permit No. SW8061216
Cape Fear Sports Medicine
New Hanover County
Dear Mr. Boyd:
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.
Correction:
The Wilmington Regional Office issued the subject permit on June 8, 2007 and recently discovered it contained
an error. This permit correction is necessary to correct the permit ownership from Cape Fear Sports Medicine,
P.A.to CF Sports Medicine, LLC. Please replace the previously issued permit with the enclosed correct permit.
Renewal:
The Division of Energy,Mineral and Land Resources received a complete 8-year Permit Renewal Application for
the subject permit on April 17, 2023. The Division is hereby notifying you that permit SW8061216 has been
renewed, updated, and re-issued on April 21,20023,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 stortriwater
permit does not imply that the site is currently in compliance.
This permit shall be effective until June 8,2029,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.
�Dg 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. SW8061216
Page 2 of 2
If you have any questions concerning this permit, please contact Aisia Freeman in the Wilmington Regional
Office, at phone #[phone] or [e-mail].
Sincerely,
Cnay �Xat
Douglas R. Ansel, Interim Director
Division of Energy, Mineral and Land Resources
Enclosures: Attachment A—Designer's Certification Form
Attachment C—Permitting History
Copy of the Renewal Application Documents
Copy of the current operation and maintenance agreement
DES/af: %Stormwater\Permits&Projects\2006\061216 HD\2023 04 permit 061216
cc: Wilmington Regional Office Stormwater File
®��, North Carolina Department of Environmental Quality I Division of Energy.bfineral and Land Resources
Wilmington Regional Office 1 127 Cardinal Drive Extension I Wilmington.North Carolina 28405
910.796.7215

Post construction Stormwater Management
Permit No. SW8061216
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
CF Sports Medicine, LLC
Cape Fear Sports Medicine
6019 Oleander Drive, Wilmington, New Hanover County
FOR THE
construction, operation and maintenance of an underground infiltration trench in compliance with the provisions
of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') 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 June 8, 2029 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
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 on page 2 of this permit. The stormwater control has been designed to handle the runoff
from 38,175 square feet of impervious area. The infiltration trench must be operated with a 30 foot
vegetated filter.
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. 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.
Page 1 of 5

Post construction Stormwater Management
Permit No. SW8061216
5. The runoff from all built-upon area within the permitted drainage area of this project must be directed
into the permitted stormwater control system.
6. The following design criteria have been provided in the infiltration trench and must be maintained at
design condition:
a. Drainage Area, acres: 1.10
Onsite, ft2: 47,877
Offsite, ft2: 0
b. Total Impervious Surfaces, ft2: 38,175
C. Design Storm, inches: 1
d. Trench Bottom Surface Area, ft2: 4,100
e. Perforated Pipe Diameter/Length: 15"/ 1,638 (ADS N-12 H-25)
f. Bottom Elevation, FMSL: 19.5
g. Bypass Weir Elevation, FMSL: 21.49
h. Permitted Storage Volume, ft3: 4,171
i. Type of Soil: Leon
j. Expected Infiltration Rate, in/hr: 6
k. Seasonal High Water Table, FMSL: 17.5
I. Time to Draw Down, hours: <3
M. Receiving Stream/River Basin: Bradley Creek/CPF24
n. Stream Index Number: 18-87-24-4-(1)
o. Classification of Water Body: "SC HQW#"
It. SCHEDULE OF COMPLIANCE
1. 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.
2. During construction, erosion shall be kept to a minimum and any eroded areas of the system will be
repaired immediately.
3. The permittee shall at all times provide the operation and maintenance necessary to assure the
permitted stormwater system functions at design condition. 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 slopes and the vegetated filter.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and specifications.
f. Debris removal and unclogging of bypass structure, filter media, flow spreader, catch basins,
piping and vegetated filter.
g. A clear access path to the bypass structure must be available at all times.
4. 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.
5. 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.
6. 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.
Page 2 of 5

Post construction Stormwater Management
Permit No. SW8061216
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.
8. Access to the stormwater facilities shall be maintained via appropriate easements at all times.
9. 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.
10, 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.
III. GENERAL CONDITIONS
1. 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.
2. 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).
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.
4. 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.
Page 3 of 5

Post construction Stormwater Management
Permit No. SW8061216
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, except in the case of an individual residential lot sale that is
made subject to the recorded deed restrictions and protective covenants;
V. The assignment of declarant rights to another individual or entity;
vi. The sale or conveyance of the common areas to a Homeowner's or Property Owner's
Association, subject to the requirements of NCGS 143-214.7(c2);
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
e. 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.
f. 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.
Page 4 of 5

Post construction Stormwater Management
Permit No. SW8061216
Permit renewed, updated and reissued this the 215'day of April 2023.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
CAS
Douglas R. Ansel, Interim Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission
Page 5 of 5

Post construction Stormwater Management
Permit No. SW8061216
Attachment A
Cape Fear Sports Medicine
Stormwater Permit No. SW8 061216
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:
SEAL
Signature
Registration Number
Date
Page 1 of 2

Post construction Stormwater Management
Permit No. SW8061216
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 elevations are per the approved plan.
6. The bypass structure is located per the approved plans.
7. A Trash Rack is provided on the outlet/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: NCDENR-DEMLR Regional Office
Page 2 of 2

Attachment C-Permitting History
Cape Fear Sports Medicine
Permit No.SW8 061216
Approval permit Action BIMS Description of the Changes Modified Plan Sheets
Date Version
High Density Project-construction,operation and maintenance of an underground
infiltration trench in compliance with the provisions of 15A NCAC 214.1000,The
6/82007 Original Approval 1.0 stormwater control has been designed to handle the runoff from 3$175 square Feet of C-I-S,C-9-I0
impervious area.The infiltration trench must be operated with a 30 foot vegetated
filter.
'this permit correction is necessary to correct the permit ownership from Cape Fear
Renewal/ Sports Medicine,P.A.to CF Sports Medicine,LLC. Please replace the previously
4/21/2023 Correction 2.0 issued permit with the enclosed correct permit. This permit shall be effective until
June 8,2029
Page 1 of 1

Perm it No. 56'JS OCv/Zl(P
(to be provided by DWQ)
State ol'North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORM WATER MANAGEMENT PERMIT APPLICATION FORM
UNDERGROUND INI-ILTRATION 'fRENCH SUPPLEMENT
This frnrrn may be photo copied fin- use as an original
DWQ Stormwater Mana,ement Plan Review:
A complete storinwater management plan submittal includes a Stormwater management permit application, an
underground infiltration trench supplement for each system, design calculations, and plans and specifications
showing all stormwater conveyances and system details.
I. PROJECT INFORMATION
Project Name: Cane Fear SpQas Medicine
Contact Pcrsow Garry S. Papc. P.E. Phone Number: (910) 256-9277
For projects with multiple infiltration systems, a supplement form must be completed for each system. This
worksheet applies to: Trench I in Drainage Area I
(from plans) (from Form SWU-101)
11. DESIGN INFORMATION (attach supporting calculations/documentation):
Soils Report Summary (based upon an actual field investigation and.coil borings)
Soil Type Leon
Infiltration Rate 5.9 in/h or et%hr/sf(circle appropriate units)
SH WT Elevation 17.5 finsl (Seasonal 1-ligh Water'fable elevation)
Trench Design Parameters
Design Volume 3,060 c.f.
Design Storm 1.0 inch event (1.5-inch vent for SA waters, I inch for others)
Drawdown Time 0.11 days
Perforated Pipe Size 15" inch diameter
Perforated Pipe Length 1638 ft.
No. Observation Wells N/A (may be required on a case-by-case basis)
Stone Type(if used) #57 Washed Stone
Stone Void Ratio 40 %
Trench Elevations (in feet mean sea level)
Bottom Elevation 19.5 fins[
Storage/Overflow Elevation 21.49 fmsl
PorinSWU-107 R60.99 Page I of

Ttreuch Dimensions
Height �5• ft. Length *4-2— ft
surfa�e*ea
Width �i4-2 4��x� ft. Volume Provided 4rF97 171 cu. ft.
III. REQUIRED ITEMS CHECKLIST -
The following checklist outlines design requirements per the Stormwater Best Management Practices manual
(N.C. Department of Environment, Health and Natural Resources, November 1995) and Administrative Code
Section: 15 A NCAC 21-1.1008.
Initial in the space provided to indicate that the following design requirements have been met and supporting
documentation is attached. If the applicant has designated an agent in the Stormwater Management Permit
Application Form, the agent may initial below. Attachjustification if a requirement has not been met.
Applicants Initials
�a. System is located 50 feet firom class SA waters and 30 feet from other surface waters.
�n4b. System is located at least 100 feet from water supply wells.
c. Bottom of system is at least 2 feet above the seasonal high water table.
vs-Qd. Bottom of the system is 3 feet above any bedrock or impervious soil horizon.
e. Off-line system, runoff in excess of the design volume bypasses the system (bypass detail provided)
IZA f. System is designed to draw down the design storage volume to the proposed bottom elevation under
seasonal high water conditions within five days based upon infiltration through the bottom only(a
phydrogeologic evaluation may be required).
)`g. Soils have a minimum hydraulic conductivity of 0.52 inches per hour.
� It. System is not sited on or in fill material or DWQ approval has been obtained.
�i. Plans ensure that the installed system will meet design specifications(constructed or restored) upon
initial operation once the project is complete and the entire drainage area is stabilized.
System is sized to take into account the runoff at the ultimate built-out potential from all surfaces
draining to the system, including any off-site drainage.
System is located in a recorded drainage easement for the purposes of operation and maintenance
and has recorded access easements to the nearest public right-of-way.
1. System captures and infiltrates the runoff from the first 1.0 inch of rainfall (1.5 inch event for areas
draining to SA waters).
in. Drainage area for the device is less than 5 acres.
n. A pretreatment device (filter strip, grassed swale, sediment trap, etc.) is provided.
We. Trench bottom is covered with a layer of clean sand to an average depth of 4 inches.
ForinSWU-107 R60.99 Page 2 of

p. Sides ofthe infiltration trench are lined with geotextile fabric.
q. Rock used is free of fines (washed stone) and has a large void ratio.
b}�r. Side to bottom area ratio is less than 4: I.
As. Observation well(s) are provided (case-by-case basis).
t. Vegetated filter is provided for overflow (50 feet for SA waters, 30 feet for other waters) and detail
is shown on plans.
u. A benchmark for checking sediment accumulation is provided.
IV. UNDERGROUND INFILTRATION TRENCH OPERATION AND MAINTENANCE AGREEMENT
I . After every runoff producing rainfall event and at least monthly inspect the bypass/overflow structure for
blockage and deterioration and the infiltration system for erosion, trash accumulation, grass cover, and
general condition.
2. Repair eroded areas immediately, re-seed as necessary to maintain adequate vegetative cover, mow
vegetative cover to maintain a maximum height of six inches, and remove trash and blockages as needed
to maintain system performance.
3. Remove accumulated sediment annually or when depth is reduced to 75%of the original design depth.
Restore depth to original design depth without over-excavating. Over-excavating may cause the required
water table separation to be reduced and may compromise the ability of the system to perform as
designed.
4. The water level in any monitoring wells will be recorded after a I-inch rainfall event and at least once a
month. Chronic high water table elevations (within I foot of the bottom of the system for a period of three
months) shall be reported to DWQ immediately.
5. II'DWQ determines that the system is failing, the system will immediately be repaired or replaced to
original design specifications. I f the system cannot be repaired to perform its design function, other
stormwater control devices as allowed by NCAC 21-1.1000 must be designed, approved and constructed.
6. Remove accumulated sediment from the infiltration system annually or when depth in the unit is reduced
to 75%ofthe original design depth. The system shall be restored to the original design depth without
over-excavating. Over-excavating may cause the required water table separation to be reduced and may
compromise the ability of the system to perform as designed. Removed sediment shall be disposed of in
an appropriate manner and shall not be handled in a manner that will adversely impact water quality (i.e.
stockpiling near a stormwater treatment device or stream, etc.).
A benchmark shall be established in the infiltration system. The benchmark will document the original
design depth so that accurate sediment accumulation readings can be taken. The measuring device used to
determine the depth at the benchmark shall be such that it will give an accurate depth reading and not
readily penetrate into accumulated sediments.
Each drop inlet structure has a sump that sits one foot below the infiltration system. When the
depth of the structures reaches 0.90 feet the accumulated sediment shall be removed from the
system.
ForinSWU-107 R6v3.99 Page 3 of

I acknowledge and agree by my signature below that I am responsible for maintaining the stormwater collection
system in accordance with the six maintenance procedures listed above. I agree to notify D WQ of any problems
with the system or prior to any changes to the system or responsible party.
Print Name and Title: Dr. Dale Boyd, Owner
Address: 5710 Oleander Drive, Suite 108, Wilmington,NC 28403
Phone: [phone] 4 Date:
Signature:
Note: The legally responsible party should not be ar homeou,neia associalion unless more than 50'%of the dots
have been sold and a resident of the subdivision has been named the president.
I, P1 Ce G ran , a Notary Public for the State of 'h�i COunty of
K)elI-)J4Wode ' do hereby certify that l dJe- ,J personally appeared
before me this ILI day of and acknowledge the due execution of the forgoing infiltration
basin maintenance requirements. Witness my hand and official seal,
;Al My commission expires I Ilrch J r�y 9
REBECCA A. GREEN
NOTARY PUBLIC
NEW HANOVER COUNTY,N.C.
My Commission Expires 3-3-2009
FOrinSWU-107 R6v3.99 Page 4 of

CAPE FEAR SPORTS MEDICINE
OPERATION AND MAINTENANCE AGREEMENT FOR PERMEABLE PAVEMENT
Per Table 3.10-1 of the NCDWQ Policy on Use of Permeable Pavement Systems
I. Initial inspection to be performed monthly for 3 months after installation
2. Ensure that permeable pavement surface is free of sediment to be performed monthly.
3. Ensure that the contributing and adjacent area is stabilized and mowed, with clippings
removed to be performed as needed, based on inspection.
4. Vacuum sweep permeable pavement surface to be performed annually.
5. Inspect the surface for deterioration to be performed annually.
6. Verify that the permeable pavement system dewaters between storms to be performed
annually.
7. Not Applicable.
8. Substantial repairs of permeable pavements must be performed with permeable material
to be performed as needed, based on inspection.
9. Material in green spaces to be inspected periodically to insure that the material is not
being compacted and the water is continually infiltrating. This material will need to be
loosened and replaced as needed.
RECEIVED
MAR 19 2007
DWQ
PROJ#

I acknowledge and agree by my signature below that 1 am responsible for the performance of the
eight maintenance procedures listed above.
print name: Dr. Dale Boyd
Title: Owner
Address: 5710 Oleander Drive, Suite 108, Wilmington, NC 28403
phone: [phone]
Date:
Signature:
11 gehPptf� �eIn a Notary public for the State of �bdhdaroIinA
County of NP il 4A-mV2✓ do hereby certify that -Ew�e- 1b14Gl
personally appeared before me this 3p day of NDyernb-,l and
acknowledge the due execution of the forgoing permeable pavement maintenance requirements.
Witness my hand and official seal,
I±LNEWHANOVER
REEN
LIC
NTY,N.C.
3-3-2009
SEAL
My commission expires Ay� 3� e9
20 � �

DEMLR USE ONLY
Date R ceiv d Fee Paid Permit Number
7 a� Soy — lil 2/
NC DEQ Division of Energy, Mineral and Land Resources
STATE STORMWATER:
PERMIT RENEWAL APPLICATION FORM
In accordance with 15A NCAC 21-1.1045(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: �
2. Project name:
3. Project street address: (0 0 1 C?I P 0.r)lcy
City: t ry County: Gt -e ZIP : J�Lctp3
4. What, if any, changes haveiieen made to the project as permitted? In D n e
If the project has changed from the original approved plans, please complete SWU-101 for a Major
Modification or Minor Modification Application form available at:https://deg.nc.gov/about/divisions/energy-
m i neral-land-resources/energv-min era l-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/energv-mineral-land-
resources/energv-mineral-land-rules/stormwater-program/post-construction. State Stormwater Permits do not
automatically transfer with the sale of the property.
1. Current Permit Holders Company Name/Organization: ( { J�poYtS I"sPrP i UY�k, LLC
2. Signing Official's Name: -0 a(e G�,60( ,I r'
3. Signing Official's Title: Ow h Py-
4. Mailing Address: f I (�bl ll r'I PGn�Y PY A
City: W" I mo4 State: ,nl_zip : 2-JL /Df
5. Street Address,
I SI 'Z 2 iG,4 n
City: ! 1 rn� JUn /1 /�, � KL/C) State: ZIP :
6. Phone (,3 iI 'Email: 1721d I S)Z 60 Ma I •CT;
r2023
Y'---_—
I\ 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/ORIM. Only applications packages that
include all required items listed below will be accepted and reviewed.
ti
Initial each item below to indicate that the required information is provided in the application package:
1. A permit application processing fee of$505.00 payable to NCDEQ. •
_ 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 -- `-
❑d 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 certification(s)confirming that the project was built in accordance with the
approved plans are enclosed; or
❑ The project has not yet been built.
/'�, r _V. l rf- Ieflt, ',{, . v(:L;L �
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. ' '. 1
7. [IF APPLICABLE]When the permittee is a corporation of 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).
httl)s://www.sosnc.gov/online services/search/by title/ Business Registration
. r
Stormwater Permit Renewal Application Form Page 2 of 3 May 11, 2018

D. PERMITTEE'S CERTIFICATION
I, _T� (e (uoetW?hI Jh• , the person legally responsible for the permit, certify that I have
a copy of the Permit an 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 complet
Signature: ""v Date: I �14� 2,01
NOTARIZATION:
I, h yl CFu Itt�/��7 a Notary Public for the State of
L County of /i/Ck- 'do hereby certify
that personally appeared before me
this the /4/•/-A day of 4/L 20-2 3 , and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
G. VICTOR ALLEN
(Notary Seal) Notary Public
North Carolina
New Hanover County
Notary Signature: ( ' _
My commission expires d o�
APR 11 2023
Storrnwater Permit Renewal Application Form Page 3 of 3 May 11. 2018