SW7100804_HISTORICAL FILE_20101129

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW (�
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
COMPLIANCE EVALUATION INSPECTION
DOC DATE
-z
YYYYM M D D

HensonFoley
Landscape Architecture I Civil Eugmeuring
10224 Hickorywood Hill Avenue, Suite 101 A
Huntersville, North Carolina 28078
704-875-1615 ph. 704-875-0959 fx.
Letter of Tra�yl nsmittal
NOV 2 9 2010
To: NCDENR
Date: 11-23-10
Job #: 2848
Attn: Samir Dumpor, PE
Phone: [phone]
Dept: Division of Water Quality
Re: Washington County Hospital
Address: 943 Washington Square Mall
Washington, NC 27889
We are sending you:
_ Shop drawings
_ Copy of letter
X Attached _ Under separate cover via
_ Prints _ Plans _ Samples
_ Change Order _
_ Specifications
Copies
Pages
Description
2
revised Washington County Hospital plans
2
NC DWQ comment letter
2
NC DWQ comment response
These are transmitted as checked below:
_ For approval
_ For your use
_ As requested
For review and comment
Remarks:
_ Approved as submitted _ Resubmit copies for approval
_ Approved as noted _ Submit copies for distribution
_ Returned for corrections _ Return corrected prints
Signed: 4X 9 —
Tim Foley

HensonFoley
Landscape Architecture I Civil Engineering
11/19/2010
Mr. Samir Dumpor, PE
NCDENR
Division of Water Quality
943 Washington Square Mall
Washington, NC 27889
a:
NOV 2 92010
Re: Washington County Hospital, Washington County - SW7100804
Dear Mr. Dumpor:
r
•rr, 1 ,
This letter is in response to the NCDENR DWQ stormwater review letter dated
November 1, 2010. We want to explain the need for the temporary gravel
parking.
The existing hospital facility will stay in operation during the construction of the
new hospital. There is a new parking lot being constructed with the new hospital.
There is also some "re -work" of the bigger existing parking lot behind the existing
smaller Medical Office Buildings. This situation created a need for temporary
parking to be available for the patients, family and employees to use during the
construction of the new hospital. This gravel parking lot shares the same physical
location on the site as the new stormwater wetland BMP's. After the new
parking lot is operational, the gravel parking lot will be removed and the
stormwater wetlands can be installed. This would be the final phase of
construction.
We appreciate your consideration of the site constraints during your review.
Sincerely,
J"P� Qo-x
Timothy D. Foley, P.E. 6
Vice President
HensonFoley
10224 Hickorywood Hill Avenue, Suite IOTA - Huntersville, NC 28078 - 704.875.1615 ph - 704.875.0959 fax
www.hensonfoley.com [e-mail]

LTXWA
sir
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor
Director
November 1. 2010
Mr. Danny Cooper — Chief Construction Officer
HMC/CAH Acquisition Company, LLC
143 K. Shaffer
OK 74030
Dear Mr. Cooper:
Secretary
Subject: Stormwater Review SW7100804
Washington County Hospital
Washington County
This office received a Coastal Stormwater Permit Application for the subject project on
September 21, 2010. A preliminary review.of your project indicates that before a State
Stormwater permit can be issued the followino additional information is needed:
1. As stated on Site plan sheet (C2), the temporary gravel parking lot (64 spaces),
located at the southwestern corner of the hospital's property, is to be abandoned and
removed in the final phase of construction. Please be reminded that the stormwater
rules and the stormwater permit require the stormwater management system to be
constructed in its entirety, vegetated and operational for its intended use prior to the
construction of any built -upon surface. Considering the cost of planting material and
labor, it would be acceptable to have the Stormwater Wetland constructed prior to
installation of any built -upon area, but vegetated at the time when the construction is
finalized and the site is stabile. Please revise the construction sequence concerning
the temporary parking area or relocate the said temporary parking.
2. Provide two copies of signed and sealed revised sheets and requested document.
The above requested information must be received in this office prior December 1, 2010
or your application will be returned as incomplete. The return of this project will necessitate
resubmittal of all required items including the application fee. If you need additional time to
submit the required information, please mail or fax your request for time extension to me at the
Letterhead address and include the application number on the request. The request must
include justification for the amount of additional time needed. The request will only be granted
for justifiable delays that are unforeseen and beyond the owner or consultant's control.
You should also be aware that the Stormwater Rules require that the permit be issued
prior to any development activity. Construction without a permit is a violation of 15A NCAC
2H.1000 and North Carolina General Statute 143-215.1 and may result in civil penalties of up to
$25,000 per day.
North Carolina Division of Water Quality Internet: www.ncwaterquality.ore
943 Washington Square Mall Phone: [phone]
Washington, NC 27889 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper
NorthCarolina
Naturally

Page 2 of 2
Please reference the Stormwater Project Number above on all correspondence. If you
have questions, please feel free to contact me at [phone].
Sincerely,
Samir Dumpor, PE
Environmental Engineer
/ Washington Regional Office
cc: v Washington Regional Office
Tim Foley, PE, Henson Foley, Inc. (10224 Hickorywood Hill Av., Suite 101A,
Huntersville, NC 28078)

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September 17, 2010
NCDENR SEP 2 12010
Attn: Stormwater Department
943 Washington Square Mall ,;.. •.A As,
Washington, NC 27889
Re: Stormwater Management Permit Application
Dear NCDENR,
AC I �°'+�
AND
A PC N I T E C T S PEA ENINTBR 0Rl0 E S I G N E RS
1
T
10547
The following attachments are included in this Stormwater Management Permit Application:
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Not Applicable.
3. Original:
• Original Stormwater Wetland Operation and Maintenance Agreement — 1.
• Original Stormwater Wetland Operation and Maintenance Agreement — 2.
4. Permit application processing fee of $505.
5. Detailed Narrative — See Calculations Book.
6. USGS map identifying the site location — See Calculations Book.
7. Sealed, signed and dated calculations — See Calculations Book.
8. Two -sets of plans folded to 8.5"x 14" (sealed, signed and dated).
9. Copy of applicable soils report.
10. A copy of most current property deed.
11. Documentation which supports titles for Item No. 111-1a, III-3a.
• North Carolina — General Contracting Registration for J.E. Dunn.
• Affidavit of Corporate Identity for CAH Acquisition Company # LLC and Danny
Cooper.
a. Exhibit B —North Carolina Bill of Conveyance and General Warranty Deed.
Sincerely,
ACl/Boland, Inc.
R ger E. Claar, Architect
\Copy: Betty Bowen — WCH, Jeffrey M. Judd — WCH, Danny Cooper — HMC, Tim Foley — HF
David Glueck — JED, Larry Diehl - ACI
File #4-07029
'7 Olde Cabin Road, Suite 100
ouis, Missouri 63141
4991.9993
4.991.8878
11229 Nall, Suite 140
Leawoodl Kansas 66211
T 913.338.2300
F. 913.338.2003
1421 E. 104th Street
Kansas City, Missouri 64131
T 816.763.9600
F. 816.763.9757

�-CEIVED
AFFIDAVIT OF CORPORATE IDENTITY AN,AUTHORITY�A
STATE OF MISSOURI
COUNTY OF JACKSON
SEP 2 1 2010
COMES NOW, Dennis Davis, being first duly sworn, who deposes and says:
SEP 17 2010
AC,I,< OLANID
1) That he is the Secretary of CAH Acquisition Company #1 LLC, a limited liability
company existing under the laws of the State of Delaware, d/b/a Washington County Hospital
(the "Hospital Company'). The Hospital Company is authorized to transact business in the
State of North Carolina, as evidenced by the Certificate of Authority issued April 26, 2007, a true
copy of which is attached hereto as Exhibit A.
2) That he is the Executive Vice President/Chief Legal Officer of HMC/CAH
Consolidated, Inc., a corporation existing under the laws of the State of Delaware (the "Parent
Company'). The Parent Company is the 100% member of the Hospital Company.
3) That the Hospital Company is the fee owner in possession of the land and
improvement ("Project Acreage") described in the North Carolina Bill of Conveyance and
General Warrant y Deed dated May 31, 2007, a true copy of which is attached hereto as Exhibit
B.
4) That Danny Cooper is the Chief Construction Officer of the Hospital Company
and the Parent Company, and is authorized to execute any and all agreements or instruments
relating to the County Hospital Expansion Project including, without limitation, documents for the
Erosion and Sedimentation Control Plan No. WASHI-2011-003 ("Plan"), with the North Carolina
Department of Environment and natural Resources ("NCDENR").
s
5) That this Affidavit is made to induce the NCDENR to approve the Plan.
6) FURTHER AFFIANT SAYETH NAUGHT.
UNDER PENALTIES OF PERJURY, I declare that I have read the foregoing Affidavit
and that the facts stated in it are true to the best of my knowledge and belief.
DATED this 16 day of September, 2010.
SUBSCRIBED AND SWORN to before me this L day of September, 2010.
v. Bqq
aryPublic `.�`yy\ON/�fit99�c
PUBLIC
s�%O
NOTARY =
.� SEAL
. COMMISSION

NORTH CAROLINA
Department of The Secretary of State
CERTIFICATE OF AUTHORITY
I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do
hereby certify that
CAH ACQUISITION COMANY #1, LLC
having filed on this date an application conforming to the requirements of the General Statutes
of North Carolina, a copy of which is hereto attached, is hereby granted authority to transact...
business in the State of North Carolina.
IN WITNESS WHEREOF, I have hereunto
set my hand and affixed my official seal at the
City of Raleigh, this 26th day of April, 2007
Secretary of State
Document 1d: C20070920051
0

FILED in Washington County. W
on ,An 01 2007 at 10:4335 AM
by. Elans G. Vann
Rogieior of Node
BOOK 445 PAGE 832
FILED In Washngton County, NC
on ,An 01 2007 at 04.38:19 PM
by: Elakta 0. Vann
Rogiatsr of Deeds
BOOK 445 PAGE 697
fRANSFER HAS BEEAA
MADE IN TAX DEPT,
Revenue stamps: Exempt
Tax Parcel ID Numbers: 7871, 7872, 7873, 7874, 7875, 9591, 1577
Prepared by and return to: WASHINGTON COUNTY, N. G. 6177, it, _ 36 - $ 6
PARCEL IDENTIFIER N0.
13
Mary Beth Johnston ASSIGNED OR VERIFIED BY: DATE: s 7 zoo?
Kennedy Covington
430 Davis Drive, Suite 400
Morrisville, NC 27560
NORTH CAROLINA BILL OF CONVEYANCE
AND GENERAL WARRANTY DEED
THIS BILL OF CONVEYANCE AND GENERAL WARRANTY DEED (this "Deed")
is made this 31s1 day of May, 2007, by and between the COUNTY OF WASHINGTON, NORTH
CAROLINA, a political subdivision of the State of North Carolina (collectively the "Grantor"),
acting by and through its Board of Commissioners, WASHINGTON COUNTY HOSPITAL,
INC., a North Carolina nonprofit corporation, and CAH ACQUISITION COMPANY H1, LLC.,
a Delaware limited liability company, acting by and through its Board of Directors (the
"Grantee"), whose mailing address is 4254 N. Oak Traffieway, Kansas City, Missouri 64116.
RECITALS:
A. Grantor is a municipality as defined in N. C. Gen Stat. Section 131 E-6(5) and is
;'the owner of certain hospital facilities and related property located in Washington County, North
Carolina that are operated as a hospital system (collectively, the "System").
Bi In accordance with that certain Asset Purchase Agreement by and between
Grantor and Grantee dated as of April 2, 2007 (the "Transfer Agreement') attached as Exhibit
A, Grantor has agreed to transfer the System to Grantee in accordance with the provisions of N.
C. Gen. Stat. Section 131E-13, subject to the terms and conditions of this Deed and the "Transfer
Agreement.
031141.00001 43300762-06W02

BOOK 445 PAGE 833
BOOK 445 PAGE 698
NOW, THEREFORE, for and in consideration of $10.00 cash in hand paid by Grantee to
Grantor, and other good and valuable consideration, the receipt and sufficiency of which are
hereby acknowledged, Grantor has and by these presents does grant, bargain, sell and convey
unto Grantee, its successors and assigns, that certain tract or parcel of land located in
Washington County, North Carolina, more particularly described on Exhibit B, attached hereto
and incorporated by reference (the "Land");
TOGETHER WITH all buildings, structures, other improvements, all equipment and all
personalty located thereon and all other property interests, and other improvements located
thereon, and all appurtenances thereunto used in connection with the System (together with the
Land, the "Property").
THIS CONVEYANCE is made pursuant to the provisions of N.C. Gen. Stat. Section
131E-13, and upon the express condition that Grantee shall comply with the terms and
conditions set forth in the Transfer Agreement, subject to the right of reversion and transfer to
Grantor as follows:
1. Fee Simple Determinable Interest. This conveyance of the Property to Grantee,
its successors and assigns, conveys a fee simple determinable interest. Should Grantee fail to
comply with the terms and conditions of the Asset Purchase Agreement as described in Sections
10.6 and 10.10 of the Asset Purchase Agreement, as the same may be amended from time to
time, all the Property, together with all improvements, additions and replacements thereto as
described in Section 10.7 of the Asset Purchase Agreement, shall automatically revert and
transfer to Grantor, or its successors and assigns, and the estate held by Grantee shall
automatically terminate.
TO HAVE AND TO HOLD the Property belonging to Grantee and its successors and
assigns, in fee simple determinable, subject to the right of reversion and transfer to Grantor upon
failure of the conditions set forth above.
Grantor covenants with Grantee that Grantor is seized of said Land in fee simple, that
Grantor has the right to convey the same, that title thereto is marketable and free and clear of all
encumbrances, and that Grantor will warrant and defend said title against the lawful claims of all
persons whomsoever, except for the right of reversion set forth above and those matters listed on
Exhibit C attached hereto and incorporated by reference.
Grantee by its acceptance of this Deed and by execution below hereby agrees and is
legally bound by the terms and conditions hereof. The Asset Purchase Agreement is hereby
incorporated by reference as if hilly set forth herein.
IN WITNESS WHF.RF.OF, Grantor has caused this Deed to be executed in its name by
its Chairman of the Board of Commissioners and its official seal to be hereto affixed and attested
by its Clerk of the Board of Commissioners, all by authority of the Board of Commissioners of
Grantor duly given.
(Signatures Follow on Next Page)
003 114 1 00001 4830-0762-0609.02

BOOK
445
PAGE
834
BOOK
445
PAGE
699
COUNTY OFyVyy/ASJHINME
i CAROLINA
By: ,,(.C,i
Name: William R. Sexton, Jr.
Attest: Vice Chairman, Board of Commissioners
Nam : 'Lois Askew
Clerk to Board of Commissioners
Washington County, North Carolina
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she signed the foregoing document.
William R. Sexton, Jr. Vice Ch ' �rd Co issioners
Date: 5 - 3 I - 0'7 `i/
7"� Ck�T,, ecia 'ignatureofNotary
tip% G a I� T,- r• i; t h e r-
NOTARY �a
6. Notary s printed or typed name, Notary Public
(O cip� ,PUBLIC i Ci My commission expires: 5 - 30. 09
q'.FXPIAESS•10.09,� ��'
°.y�Lrr� ••• '�����:` CAH ACQUISITION.COMPANY HI, LLC
..
13y:
Name: LavYrence J. X rthur
Title: Manager
Tncrs,a County, Missouri
I certify that the following person(s) personally appeared before me this day, each
acknowledging to me that he or she signed the foregoing document.
Lawrence J. 4rthur, Manager, 011 Acquisition Company O1, LLC
Date: -/77 2O ;7, o 7 1:n �JZ e
— 1 —i Ooeial Signature of Notary
0->- -, K. 11w-ckeno9e.
Notary's printed or typed name, Notary Public
(Official Seal) My commission expires: rG i aoo P
DDRIS K LUECKENOTrE
Notary Seal
$ATE OF MISSOURI
Jackson County
My CpnlmissIon Expires: June 1, 2008
0031141.00001 4830 0768-0609.02

EXHIBIT B
Legal description of entire 22.73 acre campus as reflected on the deed recorded in Deed Book
230, Page 174, Washington County Registry (the "Deed"):
Begin at point on the southern edge of the right of way of U.S. Highway 64, said point
being also the westernmost corner of the Dr. E.W. Furgurson land, and run thence from said
beginning point South 84 degrees 05 minutes East 13 feet to a point in the line of the land of the
William Johnson Estate; thence running South 10 degrees 25 minutes West 430.7 feet to a point
in the western edge of the William Johnson Estate cemetery; thence running South 19 degrees
East 508 feet to Persimmon Branch; thence with said branch the following courses and distances:
South 67 degrees 50 minutes West 208 feet, South 78 degrees 30 minutes West 141 feet South
69 Degrees West 147 Feet, South 43 degrees 15 minutes West 108 feet, South 46 degrees 30
minutes West 109 feet, South 57 degrees 50 minutes West 165 feet, South 63 degrees 40 minutes
West 153 feet, South 54 degrees West 97.5 feet, South 52 degrees 15 minutes West 88.5 feet,
and South 46 degrees 40 minutes West 94 feet to a point in the Owens Estate line; thence with
said Owens Estate line, North 4 degrees East 1198 feet, more or less, to the southern edge of the
right of way of U.S. Highway 64; thence along and with the edge of said right of way North 69
degrees East 994 feet to the point of the beginning, and containing 22.73 acres, more or less all
as shown on the map entitled "Map of the Allen & Johnson Tracts Plymouth, Ts. — Washington,
Ts., N.C. Total Area: 22.73 acres Scale: 1 in = 200 ft Surveyed: 12-9-65 Blake C. Lewis Reg.
Surv" attached to the Deed to which reference is made for a more particular description
4830 0762-060902
0031141.00031

Lirrutir rur +cirmr No.
2010 /,/♦' 47174
Ito
+.Girrnsing Nuttrb for (6rurrat Tontrartur,o
04is is to Lertifg 00 4at:
J. E. Dunn Construction Company
Kansas City, MO
is Aulg registered aub rutitirb to itrartirr
wrurrai C�n�t ttr#tn
Limitation: Unlimited
Classification: Building
until
December 31, 2010
utilru tllis Trrtiftratr expires.
Witurss our llanNi anb oral of tllr Boars.
Data, 4Ratrig4. NA.
January 1, 2010
04ta rertiflrate may not he Mureb.
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CLIENT:
• 1 0al11I4H
WEATHER:
TERRACON JOB NO
DATE: December 15, 2008
TERRACON
314 BEACON DRIVE
WINTERVILLE, N.C. 28590
TELEPHONE [phone]
Henson Design, Inc.
Limited Soil Exploration
Washington County Hospital
Plymouth, North Carolina
Sunny
72085078
PERSONNEL: Lei Gu
As requested by Mr. Jeffrey D. Lundy, representing Henson Design, Inc., a representative
of Terracon Consultants, Inc. was on site on December 15, 2008 to provide visual soil
classification and to determine the depth to the seasonal high water the areas selected by
the client. The hand auger borings included HA-1 and HA-2 as shown on the attached
drawing.
Each of the borings encountered approximately 6 inches of grass and topsoil at the ground
surface. The soils encountered in HA -I consist of yellowish brown (IOYR-5-6), light
yellowish brown (IOYR-6-4) and pale brown (IOYR-6-3) clayey sand to approximately 4
feet below the existing grade. An indication of a seasonal high water table was observed
at a depth of 4 feet below the existing grade. Light brownish gray (I OYR-6-2) sandy clay
sand silty sand was encountered to about 7-5-feet below the existing grade. Groundwater at
the time of our hand auger boring was observed at a depth of 7.5 feet below the existing
grade.
The soils encountered in HA-2 consist of yellowish brown (10YR-5-6) and orange brown
silty sand to approximately 4 feet below the existing grade. An indication of a seasonal
high water table was observed at a depth of 4 feet below the existin rade. Light gray
(10YR-7-2) and orange brown sity sand was encountered to about 7 feet below the
existing grade. Groundwater at the time of our hand auger boring was observed at a depth
of 7 feet at HA-2.
Samples for flexible wall permeability testing were obtained from both borings at a depth
of 4.5 to 5 feet below the existing grades. Upon return to the laboratory, the permeability
samples were remolded to the conditions indicated on the attached permeability test data
sheets. The permeability test results obtained are attached.
Mr. Jeffrey D. Lundy was advised of our results by written transmittal.
RESPECTFULLY SUBMITTED
TERRACON
Ca. F ju-"-�

wYF
II
�i P'•i' CONDITIONAL USE PLAN
Washington County Hospital
°i
Plymouth, North Carolina
m�
ACI 441 BOLAND

PERMEABILITY TEST REPORT
TEST DATA: SAMPLE DATA:
Specimen Height (cm): 10.15 Sample Identification: HA-1 at 4.5-5.0 ft
Specimen Diameter (cm): 7.26
Dry Unit Weight (pcf): 98.3
Moisture Before Test (%): 22.4
Moisture After Test (%): 22.5
Run Number: 1 • 2
Cell Pressure (psi): 45.0
Test Pressure(psi): 42.0
Bock Pressure(psi): 39.9
Diff. Head (psi): 2.1
Flow Rote (cc/sec): 5.09 . 10--5
Perm. (cm/sec) : 7.59 . 10--8
J
a
I
U
U
>
2
W
7
J
0
3
3
O
J
u- 4
10000
Visual Description: Gray & Tan Brown Silty
F-Sandy Clay w/ Occasional Medium Sand
Remarks: ASTM D 5084
Maximum Dry Density (pcf):
Optimum Moisture Content (%):
Percent Compaction:
Permeameter type: Flexible Wall
Sample type: Remolded
TIME - t (sec)
20000 30000 4000D
5
I x 10--7
U
a
� 8 x 10--8 •
E
u 6 x 10--8
Y
1 4 x 10^-8
}
i-I
J
H 2 x 10--8
M
Q
W
f
W
o_ 1. 10--e
0 5 10 15 20
AVERAGE HYDRAULIC GRADIENT - dH/L (cm/cm)
Project: Washington County Hospital
Location: Plymouth, NO
Dote: 12-17-2008
PERMEABILITY TEST REPORT
TERRACON CONSULTANTS, INC
Project No.: 72085078
File No.:
Lob No.:
Tested by: LW
Checked by: CFB
Test: CH - Constant head

PERMEABILITY TEST REPORT
TEST DATA: SAMPLE DATA:
Specimen Height (cm): 10.15 Sample Identification: HA-2 at 4.5-5.0 ft
Specimen Diameter (cm): 7.27
Dry. Unit Weight (pcf): 102.2
Moisture Before Test (7): 19.4
Moisture After Test (%): 19.4
Run Number: 1 • 2
Cell Pressure (psi): 44.0
Test Pressure(psi): 42.0
Bock Pressure(psi): 39.9
Diff. Head (psi): 2.1
Flow Rate (cc/sec): 2.89 x 10--2
Perm. (cm/sec): 4.43x 10--5
I
U
UI
N
E
Y
}
H
H
J
H
0]
W
W
0'
W
a
Visual Description: Gray &. Ton -Brown Silty
Clayey Fine to Medium Sand
Remarks: ASTM D 5084
Maximum Dry Density (pcf):
Optimum Moisture Content (%):
Percent Compaction:
Permeameter type: Flexible Wall
Sample type: Remolded
TIME - t (sec)
O 50 100 150
0
2
4
6
10
1 x 10--4
8 x 10--5
6 x 10--5
4 x 10--5
2 . 10^-5 .
I x 10--5
0 5 10 15 20
AVERAGE HYDRAULIC GRADIENT - dH/L (cm/cm)
200
Project: Washington County Hospital
Location: Plymouth. NC
Dote: 12-17-2008
PERMEABILITY TEST REPORT
TERRACON CONSULTANTS, INC
•
Project No.: 72085078
File No.:
Lab No..
Tested by: LW
Checked by: CFB
Test: CH - Constant head

September 17, 2010
NCDENR
Attn: Stormwater Department
943 Washington Square Mall
Washington, NC 27889
Re: Stormwater Management Permit Application:
Dear NCDENR,
(T�goijpil�
ACI -AIVD
ARCHITECTS PLAN TiE R� ON. O E S I G N E RS
10547
C� 0OO \ccj
1-11-1a
The following attachments are included in this Stormwater Management Permit Application:
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Not Applicable.
3. Original:
• Original Stormwater Wetland Operation and Maintenance Agreement — 1.
• Original Stormwater Wetland Operation and Maintenance Agreement-2.�
4. Permit application processing fee of $505.
5. Detailed Narrative — See Calculations Book. SEP 2 1 2010
6. USGS map identifying the site location — See Calculations Book.
7. Sealed, signed and dated calculations — See Calculations Book.
8. Two -sets of plans folded to 8.5"xl4" (sealed, signed and dated).
9. Copy of applicable soils report.
10. A copy of most current property deed.
11. Documentation which supports titles for Item No. Ill - la, 111-3a.
• North Carolina — General Contracting Registration for J.E. Dunn.
• Affidavit of Corporate Identity for CAH Acquisition Company # LLC and Danny
Cooper.
a. Exhibit B —North Carolina Bill of Conveyance and General Warranty Deed.
Sincerely,
ACl/Boland, Inc.
R ger E. Claar, Architect
Copy: Betty Bowen — WCH, Jeffrey M. Judd — WCH, Danny Cooper — HMC, Tim Foley — HF
David Glueck—JED, Larry Diehl - ACI
File #4-07029
11477 Olde Cabin Road, Suite 100 11229 Nall, Suite 140 1421 E. 104th Street
St. Louis, Missouri 63141 Leawoodl Kansas 66211 Kansas City, Missouri 64131
T. 314991.9993 T. 913.338.2300 T. 816.763.9600
F 314.991.8878 F. 913.338.2003 F 816.763.9757