SW6130401_HISTORICAL FILE_20130408

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑ COMPLIANCE EVALUATION INSPECTION
DOC DATE
�Q/(
YYYYMMDD

®� Kimley-Horn
® and Associates, Inc
Tratumittal
Dale: 4/05/13
Project Name: CVS Pharmacy- Erwin
To: NCDENR-Division of Water Qua
ATTN: Robert Patterson
Stormwater Permitting Unit
512 N Salisbury St., Suite 942
Raleigh, North Carolina 27604
333 Fayetteville Street,
Suite 600
Raleigh. North Carolina
27601
TEL [phone]
FAX [phone]
Job Number: 012426063
We are sending these by
❑ U.S. Mail ® Fed Ex
❑ Other
We are sending you
® Attached ❑ Under separate cover via _
❑ Shop drawings ® Prints/Plans ❑ Samples
® Other NCDENR Stormwater Permit Application Pack
Conies Date No. Descriotion
❑ Hand Delivery
rlre following itern.s:
❑ Specifications ❑ Change Orders
I original
I co
CVS Erwin Stormwater Management Permit Application Form
I original
NCDWQ Infiltration Supplement Form
I original
NCDWQ Infiltration O&M Agreement
I original
NCDWQ Biorelention Supplement Form
1 original
NCDWQ Biorctention O&M Agreement
I
Check for $505 made payable to NCDENR
I
Geotechnical Soils Report
I
Lease Agreement (Deed)
2 sets
CVS Erwin Permit Set folded to 8.5" x 14"
2 sets
CVS Erwin Stormwatcr Analysis
These are transmitted as checked below:
El
For your use ❑ Approved as submitted
❑
Resubmit, ❑
Copies for approval
❑
As requested ❑ Approved as noted
®
Submit ®
Copies for distribution
®
For review and comment ❑ Returned for corrections
❑
Return ❑
Corrected prints
Remarks: If you have any questions or comments, please feel free to contact me directly at
[phone].
Copy to: File
Signed:
APR -32013

North Carolina Secretary of State
Page 1 of)
Account Login Register
North Carolina
Elaine F. Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, INC 276264622 [phone]
Date: 4/5/2013
Click here to:
View Document Filings I File an Annual Report I
JPrint a Pre -populated Annual Report Fillable PDF Form I Amended A Previous Annual Report I
Corporation Names
Name
Name Type
NC HART-REDD, L.L.C.
LEGAL
Limited Liability Company Information
SOSID:
1042833
Status:
Current -Active
Effective Date:
5/12/2008
Citizenship:
FOREIGN
State of Inc.:
TN
Duration:
PERPETUAL
Annual Report Status:
CURRENT
Registered Agent
Agent Name:
REGISTER, TIM
Office Address:
455 N. INGOLD AVENUE
GARLAND NC 28441
Mailing Address:
455 N. INGOLD AVENUE
GARLAND NC 28441
Principal Office
Office Address:
116 WILSON PIKE CIRCLE, SUITE 103
BRENTWOOD TN 37027-2707
Mailing Address:
116 WILSON PIKE CIRCLE, SUITE 103
BRENTWOOD TN 37027-2707
Officers
Title:
MEMBER
Name:
G. MARSHALL HART JR
Business Address:
116 WILSON PIKE CIRCLE, SUITE 103
BRENTWOOD TN 37027-2707
Title: MEMBER
Name: MARGARET P. STAATS
Business Address: 4200 NORTHSIDE PARKWAY,NW
BUILDING 10, SUITE 101
ATLANTA GA 30327
https://www.secretary.state.ne.us/corporations/Corp.aspx?Pitemld=8806166 4/5/2013

North Carolina Secretary of State
Page 2 of 2
This website is provided to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version:
4398
https://www.secretary.state.nc.us/corporations/Corp.aspx?Pitemld=8806166 4/5/2013

I�II�I��iIII�I�IIIII�R�III���II
2eeeeiaee7
COUNTY TAX ID#
FOR pEOI6TppTION REOrETrR OF DEEDS
xrrr cwwr pN°c�
2000 M 15 04:103 M
-I -0I OU43 Cff
BK:2543 P6:619-624 RE:S2 A
2-Ire LY113U1
KREV STPAP42,000.00
AiRIk'fM 12MIXI
AROLINA SPECIAL WARRANTY DEED
Excise $ Tr. 1 Parcel Identifier No. 0597-02-68-7.18 and
Tr. 2 Parcel Identifier No. 0597-02-68-4.65
Mail art"rcco ma tat =d O. ambler P. O. &nc 1777• Raleigh, NC 27602
This instrument wa�,pfc ed b
Wyrick Robbins YeleS Pu on P •AV7(�j1hout benefit of title examination) 4101 tyke Boone Trnil, Ste. 300,
Raleigh, NC 27607 \w\)
Brief Description for a Tr s 1 & 2, BM 2003, Page 811, Hametl County Registry
THIS DEED ma th' lc4y of August, 2008, by and between:
Hamett Health System, Inc., to er k wn Buffaloe Bowling Partnership,
as Betsy Johnson Health Care $y e a North Carolina general partnership
Incorporated, a North Carolina non m 670 etteville Road
corporation eigh, C 27603
800 Tilghman Drive
Dunn, NC 28334
The designation Grantor and Grantee as
successors, and assigns, and shall include
required by context.
WITNESSETH, that Grantor, for a valuable consi rah
is hereby acknowledged, has and by these presents
Grantee in fee simple, all that certain lot or parcel of h
County, North Carolina and more particularly described
Those certain lands as are more particularly
hereto and made a part hereof by reference.
2 S I0-546516A
include said parties, their heirs,
oasculine, feminine or neuter as
:, the receipt of which
sell and convey unto
in Township, Hamen
which is attached

y hereinabove described was acquired by Grantor by instrument recorded in Book
962, Hamett County Registry (Tr. 1), and Book 1807, Page 630, Harnett County
.2).
the above -described property is recorded in Map Book 2003, Page 709 and Page
unty Registry.
D TO HOLD the aforesaid lot or parcel of land and all privileges and
Veto bb�longing to Grantee in fee simple.
Grantee that Grantor has done nothing to impair such title as
will warrant and defend the title against the lawful claims of all
hrough Grantor, other than the following exceptions:
/ (Signature page follows)
V
C>
zosoz.tuswste.i

IN WITNESS WHEREOF, Grantor has executed the foregoing as of the day and year
its ve written.
Harnett Health System, Inc., formerly known as
Betsy Johnson Health Care Systems Incorporated,
a North Car ina non-profit corporation
l.: By: —.177 l6enneth E. Bryan
Title: President
STATE 0
COUNTY
1 cerlilk�ft the fo owing person personally appeared before me this day,
acknowledging to e t at h v lunt signed the foregoing document for the purpose stated
therein and in the p city ca nncth E. Bryan, President of Harnett Health System,
Inc. fomterly know, as B tsy J n ealth Care Systems Incorporated, a North Carolina non-
profit corporation.
r
�
tier WaV-tri.ts
-+ ,'.
a"'E'•
otary Printed Name
My Co is 'on Expires: d 0 1
/�1o• •`���'Z.�!''..�.
a91 Scal)
51
� J
L/
zosoz.iasrasra.r
0

EXHIBIT A
LL of Tract 1, containing 6.80 acres more or less, and all of Tract 2, containing 1.00
or less, as shown on plat entitled "Boundary Survey for Betsy Johnson Health Care
Inc." dated September 27, 1999, revised July 22, 2003, and recorded in Map Book
09, Harnett County Registry, said plat being further revised August 18, 2003 and
p Book 2003, Page 811, Harnett County Registry.

EXHIBIT B
Exceptions to Title
I. Taxes for 2008 which are not yet due and payable.
n2 Matters shown on plats recorded in Map Book 2003, Page 709, and Map Book
;2�003, Page 81I, Harnett County Registry, which include the following:
. �3 ' setback for right-of-way along US Hwy. 421 (Tract 1);
along the western property line of Tract 1; and
casement along the southeastern property line of Tract 1.
3. VAI her asements, rights -of -way, restrictions, and encumbrances of record.
0�/ '0
3UMZ. 104N016 vI
Q

Y S. HARGROVE
STER OF DEEDS, HARNETT
CORNELIUS HARNETT BLVD
\ SUITE 200
*2008013887*
2008013887