SW8980729_Historical File_20111110

ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
November 10, 2011
Edgar Haywood, CEO
Dosher Memorial Hospital
924 Howe Street
Southport, NC 28461
Subject: Stormwater Permit No. SW8 980729 Renewal
Dosher Memorial Hospital
High Density Subdivision Project
Brunswick County
Dear Mr. Haywood:
The Wilmington Regional Office received a complete Stormwater Management Permit Renewal
Application for Dosher Memorial Hospital on October 10, 2011. The Division is hereby notifying
you that permit SW8 980729 has been renewed on November 10, 2011, and shall be effective
until January 31, 2022. The plans previously approved on January 31, 2001, in accordance with
the regulations set forth in Title 15A NCAC 2H.1000 effective September 1, 1995, remains in full
force and effect. Please attach this two page renewed permit to the original permit issued on
January 31, 2002.
The renewal and reissuance of this stormwater permit does not imply that the site is currently in
compliance with the terms and conditions of this renewed and reissued state stormwater permit.
A plan of action to correct the deficiencies noted in the November 1, 2011 Notice of Inspection
must be submitted to the Division of Water Quality by December 15, 2011. Failure to provide
the requested plan of action may initiate issuance of a permit condition violation.
Please pay special attention to the Operation and Maintenance requirements in this permit.
Failure to establish an adequate system for operation and maintenance of the stormwater
management system will result in future compliance problems.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty
receipt of this permit. This request must be in the form of a written petition, conformingto
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447. Unless such demands are made this
permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact
David Cox, at [phone].
Si;cerely, �r
eorgette Scott
Stormwater Supervisor
Division of Water Quality
GDS/dwc:
S:IWQSISTORMWATERIPERMIT&PROJECTS119981980729HD12011 11 permit 980729
cc: Vkidniinatci Res-,vo gar Office
Wilmington Regional Office
127 Cardinal Drive Extension,Wilmington,North Carolina 28405 One
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 NorthCarolina
Internet www.ncwaterquality.org ssyt/� A�
An EOual OnnnrluniN 1 Affirmativ Art inn Fmnin„o, Nata / tfriI

November 9, 2011
Dosher Memorial Hospital
Permit# SW8 980729
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY COMMERCIAL 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
Dosher Memorial Hospital
924 Howe Street, Brunswick County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with the
provisions of 15A NCAC 2H .1000 (hereafter referred to as the "stormwater rules') and the
approved stormwater management plans and specifications and other supporting data as
attached and on file with and approved by the Division of Water Quality and considered a part of
this permit.
The permit is hereby renewed subject to the following addendums, clarifications, conditions and
limitations:
1. The original permit conditions contained in the permit issued on January 31, 2002
remain in full force and effect, except as amended herein. (An additional copy of this
original permit can be obtained from the Division of Water Quality, Wilmington
Regional Office.)
2. This permit shall be effective from the date of issuance until January 31, 2022.
3. 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
applicable documentation and the processing fee.
4. Decorative spray fountains are allowed in a wet detention pond, subject to the
following criteria:
a. The fountain must draw its water from less than 2' below the permanent pool
surface.
b. Separated units, where the nozzle, pump and intake are connected by tubing,
may be used only if they draw water from the surface in the deepest part of the
pond.
c. The falling water from the fountain must be centered in the pond, away from the
shoreline.
d, The maximum horsepower for a fountain in this pond is 1/16th horsepower.
e. A fountain is not allowed if the permanent pool volume of the pond is less than
30,000 cubic feet.
5. If the use of permeable pavement is desired, this permit must be modified to add the
permeable pavement conditions.
2

Operations and Maintenance Verification
I acknowledge and agree by my signature below that I am responsible for the performance of the
maintenance procedures listed in the original Operations and Maintenance Agreement. I agree to notify
DWQ of any problems with the system or prior to any changes to the system or responsible party.
Print name:NetPORPRGABM Ed(J I a.r Hal wood
Title: ai 4- C -€D
Address: 924 A • )- we St:
Phone: CI 1 ° — 4\S-7 " 39 11
k sS4
Signature: CL
Date: 9— IS- 11
Note: The legally responsible party 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, K,4'TH I l=£r i —Pi 6 EON , a Notary Public for the State of Ak(iii ea rdir74,
County of Bti u nsLii le k , do hereby certify that Ect,r HGL ywoodi -az-
personally appeared before me this day of Seep ,bey 16 , 40/I , and acknowledge the due
execution of the forgoing stormwater BMP maintenance requirements. Witness my hand and official
seal,
Notary Signature: /( 7 q z c .
SEAL
ass-e-srn--fl-6-4,a r-II--it a-4P 4,--11-II,r-ram
KATHLEEN PIGEON
NOTARY PUBLIC
TY,NC
MY COMMISSIBRUNSWICKON EXPIRES
(o ' I`- e
My commission expires: `j u.st '7, o--9I 1-
CEIVED
OCT052011
BY:
Form SWU-102(Renewal Form) Rev 06May2010 Page 3 of 3
`

DWQ USE ONLY
r g 9&jV c3-7
Date Received Fee Paid Permit Number
State of North Carolina N r Ho*
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT RENEWAL APPLICATION FORM
This form may be photocopied for use as an original
I. GENERAL INFORMATION
1. Stormwater Management Permit Number: SW8 980729
2. Permit Holder's name(specify the name of the corporation,individual,etc.):
Dosher Memorial Hospital
3. Print Owner/Signing Official's name and title(person legally responsible for permit):
Edgar Haywood,CEO
4. Mailing Address for person listed in item 2 above:
924 Howe Street
City:Southnort State:NC Zip:28461
Phone: (910 ) 457-3910 Fax: ( ) N/A
Email:N/A
5. Project Name:Dosher Memorial Hospital
6. Location of Project(street address):
924 Howe Street
City:Southport County:Brunswick Zip:28461
7. Directions to project(from nearest major intersection):
Located at the southeasr corner of Howe Street(NC 211)and Fodale Avenue
IL PERMIT INFORMATION:
1. Specify the type of stormwater treatment: ['Constructed Wetland ❑Bioretention ®Wet Detention Basin
❑Dry Detention Basin ❑Infiltration Basin ❑Infiltration Trench ['Sand Filter ❑Other:
2_ List any changes from project that was originally approved(attach additional pages if needed):
REc i'IVED
OCT 062011
Form SWU-102(Renewal Form) Rev 06May2010 Page 1 of 3
BY:

3. Do you have a copy of the original Operation and Maintenance Agreement? (check one)
ZYes (If yes,submit the attached(page 3) Operations and Maintenance verification sheet.)
❑No (If no,then submit a new Operations and Maintenance Agreement that can be located on the
Division of Water Quality Home Page under the BMP Manual link:
http://h2o.enr.state.nc.us/su/bmp_forms.htm)
III. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Water Quality(DWQ).
A complete package includes all of the items listed below. The complete application package should be
submitted to the appropriate DWQ Office. (Appropriate office may be found by locating project on the
interactive online map at http://portal.ncdenr.org/web/wq/ws/su/maps)
1. Please indicate that you have provided the following required information by initialing in the space provided
next to each item.
Initials
• Original&1 copy of the Stormwater Management Permit Renewal Application Form %)-PA1
• Application fee of$505.00(made payable to NCDENR) P /
• Operation&Maintenance Verification or a new O&M Agreement .1 PAPf tz"'
• SWU-101 Application Form(if requesting a modification to the permit) N/i4
2. If you are also requesting a ownership change or a name change then also submit the"State Stormwater
Name Ownership change Form"available at:http://portal.ncdenr.org/web/wq/ws/su/statesw/forms docs.
When requesting a permit ownership change please make sure that all signatures and initials for both parties
are filled in on this form or the transfer cannot be completed and the original owner will remain as the permit
holder.
VI. APPLICANT'S CERTIFICATION
I,(print or type name of person listed in General Information,item 3)Edgar Haywood, CEO
certify that I have a copy of the Permit and O&M Agreement on-site and that the information included on this
permit renew applicati .• ,• the best of m knowledge,correct and complete.
F r
Signature: —A
Date: 7
Note:Additional copies of the original permit can be obtained from the appropriate Regional Office of the
Division of Water Quality. (http://portal.ncdenr.org/web/wq/home/ro)
[RECEIVED—
OCT 0 5 2011
BY:
Form SWU-102(Renewal Form) Rev 06May2010 Page 2 of 3

Air ll07q.
A&K#01012
Permit No. 9PD 7a y oft 6J
State of North Carolina (to be provided by DWQ)
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
WET DETENTION BASIN SUPPLEMENT
This form may be photocopied for use as an original
DWQ Stormwater Management Plan Review:
A complete stormwater management plan submittal includes an application form, a wet detention basin
supplement for each basin,design calculations,and plans and specifications showing all basin and outlet
structure details.
I. PROJECT INFORMATION
J'.A.Dosher Memorial Hospital'Additions and Renovations-Phase II and Physicians
Project Name: Office Complex
Contact Person: Edgar Haywood Phone Number: • [phone]
For projects with multiple basins,specify which basin this worksheet applies to: ' 1
elevations
.Basin Bottom Elevation 6.60 .ft. (floor of the basin)
Permanent Pool Elevation 14.10 . ft. (elevation of the.orifices)
Temporary Pool Elevation 16.10 ft. (elevation of the discharge structure overflow)
areas
Permanent Pool Surface Area 14,503 sq.ft. (water surface area at the orifice elevation)
Drainage Area 9.948 ac. (on site and off-site drainage to the basin)
Impervious Area 6.963 ac. (on-site and off-site drainage to the basin)
volumes
Permanent Pool Volume 49,628 cu.ft. (combined volume of main basin and forebay)
Temporary Pool Volume 32,187 cu.ft. (volume detained above the permanent pool)
Forebay Volume 10,178 cu.ft. (approximately 20%of total volume)
Other parameters
SA/DA1 0.0230 (surface area to drainage area ratio from DWQ table)
Diameter of Orifice 2.0 in. (2 to 5 day temporary pool draw-down required)
Design Rainfall 1.0 in.
Design TSS Removal 2 90 % (minimum 85%required) ; -RECEIVED
0-- 5 2011
Fore SWU-102 Version 3.90 Page i of.4
l_ v —may

Footnotes:
1. When using the Division SA/DA tables,the correct SA/DA ratio for permanent pool sizing should be computed based upon the
actual impervious%and permanent pool depth. Linear hittapolatian should be employed to determine the correct value for non-
standard table entries.
2. In the 20 coastal counties,the requirement for a vegetative filter may be waived ifthe wet detention basin is designed to provide
90%`l SS ranoval. The NCDENIP?B P mpm,p1 provides design tables fca Igth85 TSS r ancval and 90%TSS r oval.
IL 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,February 1999)and Administrative Code
Section: 15 A NCAC 2H.1008.
Initial in the space provided to indicate 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. If a requirement has not been met,attach justification.
Applicants 1,i itials
, a. The permanent pool depth is between 3 and 6 feet(required minimum of 3 feet).
b. The forebay volume is approximately equal to 20%of the basin volume.
j'� a. The temporary pool controls runoff from the design storm event.
- d. The temporary pool draws down in 2 to 5 days.
N/A e. If required,a 30-foot vegetative filter is provided at theoutlet(include non-erosive flow
calculations.
f. The basin length to width ratio is greater than 3:1.
g. The basin side slopes above the permanent pool are no steeper than 3:1.
h. A submerged and vegetated perimeter shelf with a slope of 6:1 or less(show detail).
i. Vegetative cover above the permanent pool elevation is specified.
j. A trash rack or similar device is provided for both the overflow and orifice.
k4e . A recorded drainage easement is provided for each basin including access to nearest right
of-way.
I. If the basin is used for sediment and erosion control during construction,clean out of the
basin is specified prior to use as a wet detention basin.
m. A mechanism is specified which will drain the basin for maintenance or an emergency.
• I
IIL WET DETENTION BASIN OPERATION AND MAINTENANCE AGREEMENT
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) ❑does ►ii does not incorporate a vegetated filter at the outlet
This system(check one) D does 0 does not incorporate pretreatment other than a forebay.
Form SW►LL102 Version 3.99 Pogo 2 of 4 R•ECEIVED
OCT 0 5 2011
BY:

r
Maintenance activities shall be performed as follows:
1. After every significant runoff producing rainfall event and at least monthly:
i
a. Inspect the wet detention basin system for sediment accumulation, erosion,trash accumulation,
vegetated cover,and general condition.
b. Check and clear the orifice of any obstructions such that drawdown of temporary pool occurs
within 2 to 5 days as designed.
2. Repair eroded areas immediately,re-seed as necessary to maintain good vegetative cover,mow vegetative
cover to maintain a maximum height of six inches,and remove trash as needed.
3. Inspect and repair the collection system(i.e.catch basins,piping, swedes, riprap,etc.)quarterly to
maintain proper functioning.
4. Remove accumulated sediment from the wet detention basin system semi-annually or when depth is
reduced to 75%of the original design depth(see diagram below). Removed sediment shall be disposed of
in an appropriate manner and shall be handled in a manner that will not adversely impact water quality(i.e.
stockpiling near a wet detention basin or stream,etc.)
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 5.625 feet in the main pond,the sediment shall be removed.
When the permanent pool depth reads 3.750 feet in the forebay,the sediment shall be removed.
BASIN DIAGRAM
(fill in the blanks)
Q Permanent Pool Elevation 14.10
•
Sediment R El. 10.35 75°
Sediment Removal Elevation 8.475 75%
Bottom Elation 8.10 5%
Bottom Elevation 6.60 5%
FOREBAY MAIN POND
5. Remove cattails and other indigenous wetland plants when they cover 50%of the basin surface. These
plants shall be encouraged to grow along the vegetated shelf and forebay berm.
6. If the basin must be drained for an emergency or to perform maintenance,the flushing of sediment through
the emergency drain shall be minimized to the maximum extent practical.
I RECEIVED
corm SINii-102 Version 3.99 Page 3 of 4 OCT 05 2011
BY:

7. All components of the wet detention basin system shall be maintained in good working order.
I acknowledge and agree by my signature below that I am responsible for the performance of the seven
maintenance procedures listed above. I agree to notify DWQ of any problems with the system or prior to any
changes to the system or responsible party.
Print name: Edgar Haywood, III
Title: Administrator
Address: 924 Howe Street, Southport, NC 28461
Phone: [phone]
.5.. „, zz..
Signature: 96.4.
Date: i t /g/o /
•
Note: The legally responsible party should not be a homeowners association unless more than 50%of the lots have been sold
and aressiidentt of s 'vision has been ed the president.
I, SqZ t S S . 1.41'0 I ,a Notary Public for the State of Noe 0 e 1"
County of e.-6Q0a°,ek- do hereby certify that Eck 42 4414i° +r-.
Personally appeared before me this /b day of ND V ., 'Z 60% ,and acknowledge the dye
Execution of the foregoing wet detention basin maintenance requirements. Witness my hand and official seal;
SUZANNE S HAYWOOD
Notary Public
Brunswick County
State or North Carolina
SEAL
My commission expires . fie/4 u Ott,/ P 6 r o?60 ,
RECE : D
Form SWU-102 Version 3.99 Pane 4 of 4
i
2011
1

Compliance Inspection Report
Permit: SW8980729 Effective: 01/31/02 Expiration: 01/31/12 Owner: Dosher Memorial Hospital
Project: Dosher Memorial Hospital
County: Brunswick 924 Howe St
Region: Wilmington
Southport NC 28461
Contact Person: Edgar Haywood Title: CEO Phone: [phone]
Directions to Project:
SE corner of Howe Street and Fodale Avenue
Type of Project: State Stormwater-HD-Detention Pond
Drain Areas: 1 -(Price Creek) (03-06-17)(SC;Sw)
On-Site Representative(s):
Related Permits:
Inspection Date: 11/01/2011 Entry Time: 01:30 PM Exit Time: 02:05 PM
Primary Inspector: David W Cox Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Transfer Renewal
Permit Inspection Type: State Stormwater
Facility Status: 0 Compliant ■Not Compliant
Question Areas:
•State Stormwater
(See attachment summary)
Page: 1

Permit: SW8980729 Owner-Project: Dosher Memorial Hospital
Inspection Date: 11/01/2011 Inspection Type: Transfer Renewal Reason for Visit: Routine
Inspection Summary:
In order to bring this stormwater system into compliance you must provide the following:
1. Provide the required P.E.certification.
File Review Yes No NA NE
Is the permit active? ■ ❑ ❑ ❑
Signed copy of the Engineer's certification is in the file? 0 • 0 0
Signed copy of the Operation&Maintenance Agreement is in the file? ■ ❑ ❑ ❑
Copy of the recorded deed restrictions is in the file? 0 0 0 •
Comment: There is no Engineer's Certification in File.
Operation and Maintenance Yes No NA NE
Are the SW measures being maintained and operated as per the permit requirements? ■ ❑ ❑ ❑
Are the SW BMP inspection and maintenance records complete and available for review or provided to DWQ ❑ ❑ ❑ ❑
upon request?
Comment: The pond was being maintained at the time of inspection.
Page: 2

Norris & Tunstall
902 Market Street Consulting Engineers, P.C.
1429 Ash-Little River Road
Wilmington,NC 28401 Ash,NC 28420
[phone] [phone]
[phone] Fax [phone] Fax
John S.Tunstall,RE. J.Philip Norris,P.E.
October 3, 2011
Ms. Jo Casmer
NC DENR/ Division of Water Quality
Water Quality Section
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
Re: State Stormwater Permit Renewal Submittal
Dosher Memorial Hospital
Southport, NC
N&T Project No. 11074
Dear Ms. Casmer:
Enclosed are the original Division of Water Quality Stormwater Management Renewal
Permit application and one (1) copy, a copy of the original Operation and Maintenance
Agreement and a $505.00 check for the permit review fee.
Please review this information for approval and contact us with any questions or
comments you may have. Thank you for your assistance on this project.
Sincerely,
NORRIS & TUNSTALL
CONSULTING ENGINEERS, P.0
f7e'N
J. Phi lli rris, P.
J PN/neh
RECEIVED
1107410-03-11-s-sw-renewal-Itr
Enclosures OCT 05 2011
cc: Mr. Coy Overton / Dosher Memorial Hospital'
NC License No. C-3641

All:51FA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H.Sullins Dee Freeman
Governor Director Secretary
August 18,2011
Mr. Edgar Haywood, CEO
Dosher Memorial Hospital
924 Howe Street
Southport, NC 28461
Subject: PERMIT RENEWAL REQUEST
Stormwater Permit No.SW8 980729
Dosher Memorial Hospital
Brunswick County
Dear Mr. Haywood:
The Division of Water Quality issued a Coastal Stormwater Management Permit, Number SW8 980729 to Dosher Memorial
Hospital for a High Density project on December 22, 1998, with a modification issued on January 31, 2002 .This permit expires
on January 31, 2012 . Per 15A NCAC 2H.1003(h)(the stormwater rules),applications for permit renewals shall be submitted
180 days prior to the expiration of a permit and must be accompanied by a processing fee,which is currently set at$505.00. If
this is still an active project please complete and submit the enclosed renewal application as soon as possible. If this project has
not been constructed and a permit is no longer needed, please submit a request to have the permit rescinded. If you have sold
the project please provide the name, mailing address and phone number of the person or entity that is now responsible for this
permit. Enclosed is a form for change of ownership,which should be completed and submitted if the property has changed
hands.
Your permit requires that upon completion of construction and prior to operation of the permitted stormwater treatment system,
a certification of completion be submitted to the Division from an appropriate designer for the type of system installed.This is to
certify that the permitted facility has been installed in accordance with the permit,the approved plans, specifications and
supporting documentation. If you have not already provided a Designer's Certification to our office, please include a copy with
your permit renewal request and processing fee.A copy of the certification form is enclosed for your convenience.
You should be aware that failure to provide the Designer's Certification and the operation of a stormwater treatment facility
without a valid permit, are violations of NC General Statute 143-215.1 and may result in appropriate enforcement action
including the assessment of civil penalties of up to$10,000 per day.
If you have any questions, please feel free to contact David Cox at(910)796-7318.
SincerelySc--(1
Georgette Scott 4
Stormwater Supervisor
GDS/dwc S:1WQS1Stormwater\Permits&Projects119981980729 HD12011 08 req_ren 980729
cc: Wilmington Regional Office File
encl.
Wilmington Regional Office
127 Cardinal Drive Extension,Wilmington,North Carolina 28405
Phone: [phone] FAX:[phone] Customer Service:1-877-623-6748 One
Internet www.ncwaterquality.org 1VorthCarolina
7aturallrf
Equal Opportunity 1 Affirmative Action Employer

O�QF VVA7-FR QG QGMichael F. Easley, Governor
William G. Ross,Jr., Secretary
r2 r North Carolina Department of Environment and Natural Resources
—I
Alan W. Klimek, P.E. Director
Division of Water Quality
April 29, 2005
Thomas O. Savidge, MD
905 N. Howe Street
Southport, NC 28461
Subject: Modification of Stormwater Permit
J. A. Dosher Memorial Hospital
Stormwater Project No. SW8 980729
Brunswick County
Dear Dr. Savidge:
Per our telephone conversation I have enclosed the following materials:
1. Stormwater Management Permit Application Form
2. Bioretention System Operation and Maintenance Plan
3. Existing Stormwater Permit Number SW8 980729
4. Application that was submitted with the existing permit
5. Wet Detention Basin Supplement that was submitted with the existing permit
The above items 1 and 2 along with the items detailed on page 4 of 4 of the Stormwater Management
Permit Application Form (Section VI)will need to be completed and submitted to this office in order to
do a modification of this permit.
I hope that this information is helpful. If you have any questions, please do not hesitate to call me at
[phone].
Sincerely,
Rhonda Hall
Environmental Engineer
ENB\rbh: S:\WQS\STORMWAT\LETTERS12005\980729.apr05
cc: Rhonda Hall
Wilmington Regional Office
North Carolina Division of Water Quality 127 Cardinal Drive Extension Phone[phone] Customer Servicel-877-623-6748
Wilmington Regional Office Wilmington,NC 28405-3845 FAX [phone] Internet h2o.enr.state.nc.us
N Carolina
An Equal Opportunity/Affirmative Action Employer—50%Recycled/10%Post Consumer Paper Naturally