NCC231015_FRO Submitted_20230414

City of Greensboro, NC
Grading Permit Application
GREENSBORO
HORIN CFROIiHA
Owner Information: Permit#:
Company The Moses H.Cone Memorial Hospital Contact Heather Brazell
Address 1200 N.Elm Street Phone No. 336-890-2424
Greensboro,NC 27401 Email [e-mail]
Project Information:
Project Name The Moses H.Cone Memorial Hospital-Express Duke Energy Feed
Address 1200 N.Elm St,Greensboro NC 27410 Latitude 36.091410 Longitude -79.788545
Current Projects on the Campus Tax Map PIN 7865738631
0.17ac Fire Pump Project+0.71ac Cath Lab Project+0.80ac Express Feed
Area Graded 0.80 Acres and/or sq.ft. Site Area 62.30 Acres and/or sq.ft.
Proposed Use of Property Hospital Zoning PI
Brief Description of Project Location Parcels bound by N.Elm St.,E.Northwood St,N.Church St.,and Tankersley Dr.
Brief Description of Development Plan Construction of a Duke Energy Electrical Duct Bank with manholes. This project disturbed area is
less than lac however when combined with the two ther ongoing projects,the total exceeds lac.
If this application is approved by the properly designated authorities and a grading permit issued,the undersigned does hereby agree to
comply with all applicable City regulations under the Greensboro Soil Erosion and Sedimentation Control Ordinance as described in
Chapter 30-12-6 of the Greensboro Land Development Ordinance.
Before beginning any grading operation, call for an on-site pre-construction meeting,and when area has been protected, call for final
inspection. r,
Signature of owner,developer,or agent: 044-4“ 44 ifC.!/✓ Date: ,1 4 /�3
The Moses H.Cone Memorial Hospital
Anne Macner,Chief Administrative Officer
FOR OFFICE USE
Approved by Date
Permit No. Date
Tracking No. Date Approved Tracking Type: TRC Grading
Surety Amount Surety Type: LOC SCB HOD Check
Surety Number Surety Expiration Date
Temporary Measures Approved Date
Final Inspection Approved Date

CITY OF GREENSBORO
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity covered by the Sedimentation Pollution Control Act before this form
has been completed and filed with the Sediment and Erosion Control Section of the City of Greensboro. (Please type
or print and, if questions are not applicable, place N/A in the blank).
Part A:
1. Project Name: The Moses H.Cone Memorial Hospital-Express Duke Energy Feed
2. Location of land-disturbing activity: 1200 N.Elm St,Greensboro NC 27410
3. Approximate date land disturbing activity will be commenced: 3-15-2023
4. Development type: Commercial Industrial v Institutional_MF residential SF residential
5. Approximate acreage of land to be disturbed: 0.80 acres
6. Has an erosion and sediment control plan been filed? Yes v No
7. Landowner(s)of Record (attach pages to list additional owners):
The Moses H.Cone Memorial Hospital
Name Telephone Email
1200 N.Elm Street
Current Mailing Address Current Physical Street Address
Greensboro NC 27410
City State Zip City State Zip
8. Deed County: Guilford-DB 002804 PG 00539
9. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name: Heather Braze!! Telephone: [phone]
E-mail: [e-mail] Other:
Part B:
1. Company(ies)or firm(s)who are financially responsible for the land-disturbing activity(Provide a comprehensive
list of all responsible parties on an attached sheet.) If the company or firm is a sole proprietorship the name of the owner
or manager may be listed as the financially responsible party.
The Moses H.Cone Memorial Hospital 336-832-7851
Name Telephone Email
1200 N.Elm Street 1200 N.Elm Street
Current Mailing Address Current Physical Street Address
Greensboro NC 27410 Greensboro NC 27410
City State Zip City State Zip

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address of the
designated North Carolina Agent:
Name Telephone Email
Current Mailing Address Current Physical Street Address
City State Zip City State Zip
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an assumed
name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible Party is a Corporation,
give name and street address of the Registered Agent:
Name Telephone Email
Current Mailing Address Current Physical Street Address
City State Zip City State Zip
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney-
in-fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there
be any change in the information provided herein.
Anne Macner Chief Administrative Officer
Type or print name Title or Authority
aKA.,e o2/r l02.-23
Signature Date
�75 I, � a Notary Public of the County of )J1/
�F��
State of 407* 0,,t)-0 //it , hereby certify that // 12A°
Personally accepted before me this day and under oath acknowledged that the above form was
executed by owner(s).
Witness my hand and notarial seal, y this /Stda of Si'U'tv a
My Commission expires i �/� do a�0
NOTgR •:N
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CITY OF GREENSBORO
WATER RESOURCES DEPARTMENT
SEDIMENT AND EROSION CONTROL SECTION
6REENSBORO
RESPONSIBILITY: The owner of any property within the City limits of the City of
Greensboro where a land-disturbing activity is taking place, shall be solely responsible for any
off-site damage to adjacent property or to City streets (mud and erosion in street), that may
have been caused by the lack of erosion control measures and poor maintenance. The soil
erosion measures detailed on your plans are the minimum required by the City of Greensboro.
When conditions become apparent the owner/developer may be required by the City of
Greensboro to have his/her engineers to design or redesign additional measures/devices to
assure land protection.
1. Erosion Control measures shall be installed prior to grading and according to plans or as
directed by the City of Greensboro's Erosion Control Inspector.
2. The approval of the Erosion Control plan does not mean that additional measures may
not be required to stop off-site sediment.
3. The Owner/Developer shall require the Contractor to take every reasonable precaution
throughout construction to prevent erosion of soil and sedimentation of streams, lakes,
reservoirs, other impoundments, ground surfaces or other property, as required by
Chapter 30, Soil Erosion and Sedimentation Control, of the Code of Ordinances, City of
Greensboro, North Carolina.
4. The Owner/Developer is responsible for maintaining the erosion and sediment control
devices for the duration of the construction.
a. Inspect the site after each rain and periodically to ensure workmanship is according
to plan and site is in compliance with the Erosion Control Ordinance.
b. Repair or replace damaged or inoperative devices as directed by the Soil Erosion
Inspector within a reasonable time or time set forth by the inspector.
c. Keep mud off city streets
5. If eroded soil from the site is deposited on adjacent property, public street or into a
waterway, the Owner/Developer shall be responsible for returning the adjacent property,
city street or waterway to its original condition satisfactorily to the City or the owner of
the property.
6. After placement of asphalt binder on newly constructed street the shoulder shall be
seeded within fourteen (14) days according to the Seeding Specifications.

7. Temporary or permanent groundcover shall be provided on all perimeter areas and
slopes 3:1 or greater within 7 calendar days following completion of any phase of
grading. Provide groundcover for all disturbed areas within 14 calendar days following
completion of construction or development.
8. The Owner/Developer must plan site work so stone placement on drive entrance,
driveway and parking lot can start immediately after fine grading.
9. The Owner or Responsible Party is responsible for the long-term maintenance of the
groundcover on the property. Groundcover must be maintained to a degree that
prevents soil erosion and sedimentation at all times. The City of Greensboro has the
authority to require changes in the owner's groundcover maintenance plan in order to
stop soil erosion and sedimentation at any time.
Section 30-5-5.4 (B)—Specific Civil Penalties
Any person who violates any of the provisions of this chapter, or rules or orders adopted or
issued pursuant to this chapter, or who initiates of continues a land-disturbing activity for which
an erosion control plan is required except in accordance with the terms, conditions, and
provisions of an approved plan, shall be subject to a civil penalty of up to five thousand dollars
($5000.00) per day. No penalty shall be assessed until the person alleged to be in violation has
been notified of the violation by registered or certified mail return receipt requested, or other
means. The notice shall describe the violation with reasonable particularity, give the person a
reasonable time period to correct the violation and state that failure to correct the violation will
result in assessment of a civil penalty of up to five thousand ($5000.00) per day or other
enforcement action including criminal penalties. Each day of continuing violation shall constitute
a separate violation. The city council shall determine the amount of the civil penalty to be
assessed under this subsection and shall make written demand for payment upon the person in
violation, and shall set forth in detail a description of the violation for which the penalty has been
imposed. In determining the amount of the penalty the governing body shall consider the
degree and extent of harm caused by the violation and the cost of rectifying the damage. If
payment is not received or equitable settlement reached within thirty (30)days after demand for
payment is made the matter shall be referred to the city attorney for institution of a civil action in
the name of the city in the appropriate division of the general courts of justice for recovery of the
penalty. Any sums recovered shall be used to carry out the purposes and requirements of this
chapter. /�
Signature: gilt�tc.t, 44-A'd'Af l/i/ Date: oZil 47-02-j
Owner(Print): Anne Macner,Chief Administrative Officer Date:
Project Address: 1200 N.Elm St,Greensboro NC 27410