SW6131002_HISTORICAL FILE_20131127

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

., DWQ USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW - 1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ M mt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
L GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name -should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
FirstI-Iealth of the Carolinas, Hoke Community Hospital -
2. Location of Project (street address):
NOV'OV2-? 20Z13
6408 Fayetteville Road
City:Raeford County:NC Zip:28376
3. Directions to project (from nearest major intersection):
3430 LF Northeast on US 401 (Fayetteville Road) from the intersection of Johnson Mill Roads 2 7 2013
4. Latitude:35° 01' 15.279" N Longitude:79° 08' 59.449" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modification[
t Renewals with modifications also requires SWU-102 - Renewal Application Form
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number its issue date (if known) and the status of
construction: []Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from DWQ
requesting a state stormwater management permit application, list the stormwater project number, if
assigned, hoke08142013 and the previous name of the project, if different than currently
proposed, Intial site package -Hoke County Hospital Site
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 24.8 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts None
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permitSite Improvements, Hoke County Hospital Site Poject ID Hoke 2012-
056, Additional Acerage Approved 5-1-13
5. Is the project located within 5 miles of a public airport? ®No ❑Yes
If yes, see S.L. 2012-200, Part VI: ham://portal.ncdenr.org/web/wq/ws/su/statesw/rutes laws
Form SWU-101 Version 06Aug2012 Page I of

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/ Organization: FirstHealth of the Carolinas
Signing Official & Title:Brian Canfield, COO
b.Contact information for person listed in item 1a above:
Street Address:155 Memorial Drive
City:Pinehurst State:NC
Zip:28374
Mailing Address (if applicable):Post Office Box 3000
City:Pinehurst State:NC
Zip:28374
Phone: (910 ) 715-1543 Fax: (910
) 715-1537
Email:[e-mail]
c. Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State: Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the projects construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Cindy Hetzler, Project Manager, FirstHealth of the Carolinas
Signing Official &
b.Contact information for person listed in item 3a above:
Mailing Address:Post Office Box 3000
City:Pinehurst State:NC Zip:28374
Phone: (910 ) 715-1525 or [phone] Fax: (910 ) 715-1537
Email:[e-mail]
Form SWU-101 Version 06Aug2012 Page 2 of 7

4. Local jurisdiction for building permits: Hoke County
Point of Contact:Danny Paschal
IV. PROJECT INFORMATION
Phone lt: (910 ) 875-8407
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
A series of Storm drainage inlet structures and piping to cam storm water from streets, parking buildings,
concrete pads and site to a permanent storm water pond and inflitration bed on the southwest side of site.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the
4. Total Property Area: 30 acres
River basin.
5. Total Coastal Wetlands Area: 0 acres
6. Total Surface Water Area: 0 acres
7. Total Property Area (4) - Total Coastal Wetlands Area (5) - Total Surface Water Area (6) = Total Project
Area`:30 acres
Total project area shall be calculated to exclude the followin the normal pool of impounded structures, the area
between the banks of streams and rivers, the area below the Normal High Water (NHW) line or Mean High Water
(MHW) line, and coastal wetlands landward from the NHW (or MHIline. The resultant project area is used to
calculate overall percent built upon area (BUA). Non -coastal wetlands landward of the NHW (or MHW) line may
be included in the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 45.8 %
9. How many drainage areas does the project have?2 (For high densihj, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use 1 for the whole properhJ area)
10. Complete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Form SWU-101 Version 06Aug2012 Page 3 of 7

Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
Receiving Stream Name
Beaver Creek
Beaver Creek
Stream Class *
C
C
Stream Index Number *
18-31-1951
18-31-1951
Total Drainage Area (so
1,128,923
187,230
On -site Drainage Area (so
1,128,923
133,333
Off -site Drainage Area (so
0
53897
Proposed Impervious Area** (so
521,160
39,120
Impervious Area** total
46.16
20.89
Impervious— Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area _
Drainage Area _
On -site Buildings/Lots (so
86,847
0
On -site Streets (so
179,555
39,120
On -site Parking (so
117,470
0
On -site Sidewalks (so
25,051
0
Other on -site (so
18,822
0
Future (so
93,415
0
Off -site (so
0
0
Existing BUA*** (so
0
0
Total (so:
521,160
39,120
Stream Class and Index Number can be determined at: http://portal.ncdenr.org/web/wq(ps/esu/classifications
Impervious area is defined as the built upon area including, but not limited to, buildings, roads, parking areas,
sidewalks, gravel areas, etc.
Report only that amount of existing BUA that will remain after development. Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. Off -site area is
adjacent NCDOT roadway with area determined based on ground survey.
Projects in Union County: Contact DWQ Central Ojjrce.siaffo check ifthe project is located within a Threatened &
Endangered Species watershed that may be .subject to more stringent stormwater requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from http://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VL 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. A detailed application instruction sheet and BMP
checklists are available from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does. The complete
application package should be submitted to the appropriate DWQ Office. (The appropriate office may be
found by locating project on the interactive online map at http://portal.ncdenr.org/web/wq/ws/su/maps.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from http://portal.ncdenr.org/web/wq/ws/su/statesw/forms does.
1. Original and one copy of the Stormwater Management Permit Application Form.
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VIl below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
http://www.envhelp.org/pa&es/onestopexpress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
Form S WU-101 Version 06Aug2012 Page 4 of 7

5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
the project. This is required in addition to the brief summary provided in the Project
Information, item 1.
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
6
receiving stream drains to class SA waters within'/2 mile of the site boundary, include the 1/2
mile radius on the map.
++
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
d4►
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
I. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
p. Vegetated buffers (where required).
[[��
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
erDtl�
10.
IL
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DWQ to verifij the SHWT prior
to submittal, [phone].) JJ''
Ak
IU L
A copy of the most current property deed. Deed book: 1012 Page No: 693
For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http://www.secretary.state.nc.us/Corporations/"`CScarch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be provided
as an attachment to the completed and notarized deed restriction form. The appropriate deed restrictions and
protective covenants forms can be downloaded from
http://portal.ncdenr.org/web/wq/ws/su/statesw/forms dots. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DWQ and that they will be recorded prior to the sale of any lot.
Form SWU-101 Version 06Aug2012 Page 5 of 7

VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer:Billy 1. Roark, P.E.
Consulting Firm: McGill Associates
Mailing Address:5 Regional Circle, Suite A
City:Pinehurst State:NC Zip:28374
Phone: (910 ) 295-3159
Email:[e-mail]
Fax: (910 ) 295-3647
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or hype name of person listed in Contact Information, item 2a) , certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item la) with (print or type name of organization listed in
Contact Information, item 1a) to develop the project as currently proposed. A copy of
the lease agreement or pending property sales contract has been provided with the submittal, which indicates the
party responsible for the operation and maintenance of the stormwater system.
As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DWQ Stormwater permit reverts back to
me, the property owner. As the property owner, it is my responsibility to notify DWQ immediately and submit a
completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater treatment
facility without a valid permit. I understand that the operation of a stormwater treatment facility without a valid
permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement action including
the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
a Notary Public for the State of
do hereby certify that
before me this _ day of
Date:
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
Form SWU-101 Version 06Aug2012 Page 6 of 7

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item 1a) B ( 10A l..L(o- B0'
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and tha proposed project complies with the requirements of the
applicable stormw er rulJazz
u 15 NCAC 2I- .10 0 and any other applicable state stormwater re uirements.
Signature: Date: Jo S 13
ry�' I, A ( H. ScicttcIetrS a Notary Public for the State of N C- County of
MD01/^r, , do hereby certify that �t t4V1 CQ��2(� personally appeared
.�{pp,
before me this�3ay of C LW and ac nowled the due a ution of the application for
a stormwater permit. Witness my hand and official seal, Gq
X%QTAp
e•. z. 9
10
SEAL
My commission expires-4 - jD - 7)0 1S
Form SWU-101 Version 06Aug2012 Page 7 of 7

Bill Roark
From: Bill Roark
Sent: Thursday, August 29, 2013 3:01 PM
To: '[e-mail]'
Cc: 'Hetzler, Cynthia'; Mike Apke
Subject: Stormwater Permit for Hoke County Hospital Site ID: hoke08142013
Mike,
Thank you for taking time yesterday to discuss Moore Regional Hospital's Hoke Campus project (Hoke County
Hospital). As we discussed on the telephone, the hospital project is under construction and we are assembling the
information needed for the Hospital's stormwater permit application. The project includes a stormwater dry pond to
control the stormwater runoff from the project site. As the site is comprised of sandy soils, we believe that infiltration
within the pond bottom should be able to satisfy the standard for 85%TSS removal rate. We will include the necessary
calculations and design drawings with the application submittal.
Thank you again for your time.
Sincerely,
Bill Roark, PE, CPSWQ
Senior Project Manager
McGill Associates, P.A.
S Regional Circle, Suite A I Pinehurst, NC 28374
Phone: [phone] Mobile: [phone] Fax: [phone]
Email: [e-mail] I Website: www.mcgillengineers.com
Nov 2 7 2013

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
August 14, 2013
Cynthia Hetzler
FirstHealth of the Carolinas
PO Box 3000
Pinehurst, NC 28374
Pat McCrory, Govenor
John E. Skvada, Secretary
Subject: Post -Construction Notification
Project ID: hoke08142013
Project: Site Improvement Hoke County Hospital Site
Hoke County, North Carolina
Dear Sir or Madam,
A review of the Financial Responsibility/Ownership (FRO) form required under the
Sedimentation Pollution Control Act received on May 1, 2013 has determined that the Site Improvement
Hoke County Hospital Site project is subject to a State Stormwater Permit for Post -construction.
Unless excluded under the provisions of Session Law 2006-246, Section 8, you must submit
within 30 days an application for a Post -Construction Stormwater Permit to:
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
Post -Construction Application NOV 2 7 2013
1612 Mail Service Center
Raleigh, NC 27699-1612
The Post -construction permit is in addition to a North Carolina General Permit (NCG010000)
permit received for construction activity from the Division of Energy, Mineral and Land Resources. For
more information regarding MSl Post -Construction and Phase 11 Session Law 2006-246 please visit:
littp:Hportal.iiedeiir.ot-glweb/wq/ws/su/statesw
If you have any questions concerning this matter please feel free to call me at 919-807-6374 or e-
mail me at [e-mail].
Sincerely,
<y Mike Randall, Environmental Engineer
cc: Fayetteville Regional Office, Surface Water Protection Section
Stormwater Permitting Program Files
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919.707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: httn://oortal.ncdenr.ora/webllr/
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

JMcGiff
A S S O C I A T E S
ENGINEERING • PLANNING • FINANCE
October 30, 2013
Mike Randall, Environmental Engineer
North Carolina Department of Environment And Natural Resources
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
Post -Construction Application
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Dear Mr. Randall:
RE: Project: Site Improvements Hoke Community
Hospital Site
Project ID: hoke08142013
FirstHealth of the Carolinas
Hoke County, North Carolina
NOV272013
Please find enclosed for your review and approval one (1) original and one (1) copy of
the Stormwater Management Application Form and required documentation for the above
referenced project. Please also find enclosed a check in the amount of $505.00 to cover the
application fee.
If you have any questions or require additional information regarding this application,
please feel free to contact me at 910-295-3159.
Sincerely,
McGILL ASSOCIATES, P.A.
Bill J. Roark, PE
Senior Project Manager, CPSWQ
Enclosures
12.04012 Mike Randall Transmittal.doc
E n g i n e e r i n g P l a n n i n g F i n a n c e
McGill Associates. P.A. • 5 Regional Circle, Suire A, Pinehursr, North Carolina 28374
Phone. [phone] • Fax [phone]

Diuguid, Bill
From: Diuguid, Bill
Sent: Tuesday, November 12, 2013 10:13 AM
To:'bill,[e-mail]'
Subject: First Health of the Carolinas, Hoke Community Hospital
Bill Roark:
I have been reviewing your site plan package for completeness, and it appears that the package is complete, except for
the required State Stormwater Application Supplement forms for the Infiltration Basin and the Dry Extended Detention
Basin.
They are found here on our website: Dry Detention Basin Supplement Form--
http://Portal.ncdenr.org/web/wq/ws/su/bmp-chl7
And Infiltration Basin--http://portal.ncdenr.org/web/wq/ws/su/bmp-ch16
If you could fill these out and email them to me then we would have a complete application package.
Thanks.
Bill Diuguid, AICP, Planner
Stormwater Permitting
Land Quality Section NOV 2 7 2013
Division of Energy, Mineral and Land Resources I NCDENR
1617 Mail Service Center (Mail)
512 N. Salisbury St, Raleigh, NC 27604 1 911, Floor (Location & Parcels)
Raleigh North Carolina 27699-1617
Phone: [phone] Fax: [phone]
Website: fittp://I)ortal.ncdenr.org/web/wcl/ws/su
E-mail correspondence to and from this address maybe subject to the North Carolina Public Records Law and maybe disclosed to third parties.

-hlg-,) -1-b /Y1i lk£ RA-XJdA- l/
/ Application Completeness Review
t1 First Submittal ❑ Re -submittal Date Received: a 30 13 Date Reviewed
Development/Project Name: -e.CA -1144
Receiving stream name BEAV�A�REek- Classil
River Basin: L.Tr,¢ F;
/3 By Bill
For post -construction requirements, a program will be deemed compliant for the areas where it is
implementing any of the following programs: WS-1, WS-Il, WS-III, WS-IV, HOW, ORW, Neuse River Basin
NSW, Tar -Pamlico River Basin NSW, and the Randleman Lake Water Supply Watershed Nutrient
Manaaement Strategy.
High Density Projects that require a 401/404 within an NSW require 85% TSS, 30% TN and 30% TP removal.
T&E Species (Goose Creek, Waxhaw Creek or Six Mile Creek Water Sheds): Af A
Latitude and Longitude: 3S s Z % 91 f - U t?i �`%40PIkj Jurisdi tion
Project Address: A C' a - I
Engineer name and firm: ,Y �. •wrt f ;r7 1soGq
Phone: Wo—ZYS-31Email: to o v
Is the project confirmed to be in the State MSI Stormwater Permit junsdictioen4 Ye or ❑ No
❑ Low Density (no curb and gutter) ❑ Low Density with curb and gutter outlets [High Density ❑ Other
h f� Tla401'404 impacts to surface waters, wetlands, and buffers (add language to cover letter and/or add info letter)
ii�i UA 6LE S
V Check for $505.00 included
ik�Original signature (not opy) on application
[y Legal signature ( orpotration P/higher, Partnership -General Partner/higher, LLC-member/manager, Agent).
3 G kt—(CLD coo
Check spellino, capitalization, punctuation: http://www.secretarv.state.nc.us/comorations/theDaee.asDx
If an agent signs the application, a signed letter of authorization from the applicant must be provided which
includes the name, title, mailing address and phone number of the person signing the letter.
Copy of property deed showing ownership or control
t 4 --a- For subdivided projects, a signed and notarized deed restriction statement
ram Seated, signed & dated calculations
�(❑ Correct supplement and O&M provided for each BMP on site (check all that were provided & number of each)
❑ /Bioretention
Ge Dry Detention Basin
❑ Filter Strip
❑ Grass Swale
�'Infiitration Basin
❑ Infiltration Trench
❑ Level Spreader
❑ Permeable Pavement
❑ Restored Riparian Buffer
❑ Rooftop Runoff Management
❑ Sand Filter
❑ Stormwater Wetland
❑ Wet Detention Basin
❑ Low Density
❑ Curb Outlet
❑ Off -Site
❑ NCDOT Linear Road
0 it � 1
NOV 2 7 2013
[9' ,two sets of sealed, signed & dated layout & finish grading plans with appropriate details
/ eEd
of Stormwater management provided
r>Yi oils rVsde
information provided
;sss or a note on the plans or in the accompanying documents that none exist on site and/or
'Itacent property
Details for the roads, parking area, cul-de-sac radii, sidewalk widths, curb and gutter;
mensions & slopes provided
rainage areas delineated ❑ Pervious and impervious reported for each ❑ Areas of high density
BMP operation and maintenance reements provided
�❑ Application complete Application Incomplete Returned: (Date)
Comments-
9
April 26, 2013 Revision, Bill Diuguid

r
9
I
1(° 2 1c
y.0693
7
Cantoane N Apmvaf fer n000rt!!ng
t Nr�!y certify ftt this transaction
h :.r has been found to comply vAllf as
t dreion Regulat"Is of am Ccunhy of
Hsi x' North Carolina, cM t'-41 t!ti� has
bca' approved for rcorE:ng I.. f,;a C�':se
tl a� Reg!sttr of Oce^^ Ho!cs C. pry
Prepared by: F. Stuart Clarke, THORP AND CLARKE, PA
Post Office Box 670, Fayetteville, NC 28302
"WITHOUT TITLE EXAMINATION"
Return to: John M. May, ROBBINS MAY & RICH LLP
120 Applecross Road, Pinehurst, NC 28374
BK:01012 PG:0693
FILED
HOKE COUNTY NC
ONNIE B. DUDLEY
RF(;ISTFR OF OFrDS
FILED Nov 20,2012
TIME 04:08:51 pm
BOOK 01012
START PAGE 0693
END PAGE 0702
INSTRUMENT # 07723
RECORDING $26.00
EXCISE TAX ELS$5,158.00
Excise Tax: $ 5, Y59 _e
NORTH CAROLINA GENERAL WARRANTY DEED
THIS DEED made this � day of November, 2012, by and between:
EDMUND M. WILLIAMS, unmarried; VICTORIA C. WILLIAMS,
unmarried; CHARLES C. WILLIAMS and wife, JILLINDA WILLIAMS;
JOHN A. WILLIAMS, JR., unmarried; and DEBORAH WILLIAMS
CUTTS and husband DARRELL CUTTS, hereinafter "Grantor"
and
FIRSTHEALTH OF THE CAROLINAS INC., hereinafter "Grantee" whose
mailing address is: PO Bpx 3C't7D Ptn d;Ltrs+ N C d 8371V
Nov 2 7 2013
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors, and assigns, and shall include singular, plural, masculine, feminine or neuter as
required by context.
APPROVIIIIIQ POR RRCORDINRI
' TA19 IYM"Mill
I

1012 '
0694
BK:01012 PG:0694
WITNESSETH:
THAT the Grantor, for a valuable consideration paid by the Grantee, the receipt of which
is hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the
Grantee in fee simple, all that certain lot or parcel of land situated in HOKE County, North
Carolina and more particularly described as follows:
SEE ATTACHED EXMBIT "A".
The property hereinabove described was acquired by Grantor by instrument recorded in
Book 71] , Page 2L9, Hoke County Registry.
All of the property conveyed herein does not include the primary residence of Grantor.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and li
appurtenances thereto belonging to the Grantee in fee simple.
And the Grantor covenants with the Grantee, that Grantor is seized of the premises in fee
simple, has the right to convey the same in fee simple, that title is marketable and free and clear
of all encumbrances, and that Grantor will warrant and defend the title against the lawful claims
of all persons whomsoever, other than the following exceptions:
Matters shown on Exhibit'B" attached hereto and incorporated herein by reference (the
Permitted Exceptions");
IN WITNESS WHEREOF, the Grantor has duty executed the foregoing as of the day and
year first above written.
(THE BALANCE OF THE PAGE IS INTENTIONALLY LEFT BLANK
SIGNATURE PAGES ATTACHED HERETO)

1012 — .._..
0695 BK:01012 PG:0695
SIGNATURE PAGE FOR WILLIAMS DEED TO FIRSTHEALTH
(Seal)
Edmund M. Williams
STATE OF /Vo.
CO TY OF VV
I, so f t 8(/ a notary public of the aforesaid County and State,
certify that EDMUNU M. WILLIAMS personally appeared before me this day and
acknowledged that they signed the foregoing instrument for the intents and purposes therein
expressed. Q�--
Witness my hand and officigaw, this th 0 day of 2 )�
'$• r••V• Public
My co 'ss' n e i;�i ; g
= S U' O 1
I

1012
0696 BK:01012 PG:0696
SIGNATURE PAGE FOR WILLIAMS DEED TO FIRSTHEALTH
V e, O (Sea)
VictoriaC. Williams
STATE OF GP6v
COUNTY OFf /n� t-tllior`
I, Je vlV U nn Krv�- , a notary public of the aforesaid County and State,
certify that VICTORIA C. WILLIAMS personally appeared before me this day and
acknowledged that they signed the foregoing instrument for the intents and purposes therein
expressed ff//�� /I
Witness my hand and official seal, this the P day ofNjyew,l ✓ , 20 (1—.
aU .f, (A�
NOTTAFrf A1BtJC Offici Signatu�reofNot"
� Notary's riotyy,,d/typed name:
OEIImBON
(j'liror
My Commission Expires: 201 {.

1012 '
0697
BK:01012 PG:0697
STATE OF ( 4 ;Zwn
COUNTY OF _ o..o
I, 7' L TAn Snn a notary public of the aforesaid County
and State, certify that JU124DA WII.UAMS personally appeared before me this day and
acknowledged that they signed the foregoing instrument for the intents and purposes therein
expresse&
Witness my hand and official seal, this the day of m&L
20L.
n�iwv �.,aHNsoni
OF7E (OLOFinDo Of5 Si �fr i n t
Not y's printed/typed name:
Mycanatrmt�Yotwa-me T'�-�anv/ L..Tr� <on
My Conimiskon Expires: n - 7(1--yMb

_------------
1012
0698 BK:01012 PG:0698
SIGNATURE PAGE FOR WILLIAMS DEED TO FIRSTHEALTH
VV tt (Seal)
Joili A. Williams, Jr. 10,
STATE OF Yt
COUNTY O�/F�• 1'
I, 1&42n LLQU3Q2%-W , a notary public of the aforesaid County
and State, certify that JOHN A. WILLLIAMS, JR. personally appeared before me this day and
acknowledged that they signed the foregoing instrument for the intents and purposes therein
expressed.
This the � lQNday of November, 012.
Y
I�
NOTARY PUBLIC
STATEOFARIZONA O � Signe otary
COL EENOI BAR_ Notary' printed typed e:
Colnmissori Nwenbar23 2012
My Commission Expires: ),->p Y]-

1012
0699
BK:01012 PG:0699
SIGNATURE PAGE FOR WEUJAMS DEED TO FIRSTHEALTH
U•X;l (Seal)
Deborah Willams Cutts
STATE OF GR
COUNTY OF - An.. _ ._�. _
I �" a notary public of the aforesaid County and
State, certify that DEBORAH S CU.ITS and DARREI.L CUTTS personally appeamd''
before me this day and aclmowledged that they signed the foregoing instrument for thq,int6w;',,,,
and purposes therein expressed.
This the 1 {_ day of2011
Offi Sigoahm fNotary ,; ,:•: �,';.,,�'•.,, 4;P`=� ;,';,;
Notary's printed yp e'd`':`; n'U'ime^."
My Commission Expires:
m

1012
0700 BK 01012 PG:0700
SIGNATURE PAGE FOR WILLLIMS DEED TO FIRSTHEALTH
G�4 �W (Seal)
Charles C. Williams
STATE OF 0 / 7'1 Q.✓V ! n4
COUNTY OF Ire -
I, { <XI.GGAA4 I✓/L . P"Gg2S , a notary public of the aforesaid County and State,
certify that CHARLES C. WILMAMS personally appeared before me this day and
acknowledged that they signed the foregoing instrument for the intents and purposes therein
expressed. I'
Witness my hand and official seal, this the cxrday of /"die vt't b� , 20 d .
'9.4 To O ral Signature o tary
A - Not r'y's print dl�ryyped name:
'O GBLIC .Tu&nl- a � U�oyer
%9d`C 6'.� My ommission Expires: �� 0
o. OUu7Y .0.�'�

1012
0701
BK:01012 PG:0701
EXHIBIT `B"
Permitted Exceptions
Master Declarations recorded in Book _, Page . Hoke County, NC Registry
2. Taxes for the year 2013, and subsequent years, not yet due and payable.
in

P
1612 EXHIBIT A BKO1012 PG:0702
0702
A certain tract or parcel of land situated in the McLauchlin Township, Hoke County, North
Carolina. Said tract or parcel fronting on the southeast right-of-way of US Highway 401, situated across
from Bugle Call Drive, bounded by the Williams property as recorded in deed book 722, page 292 in the
Hoke County Registry. More particularly described as follows:
Beginning at a set number 5 rebar in the southeast right-of-way of US Highway 401, said
beginning point being located North 48-28-27 East 10.70 feet from an existing number 4 rebar having
North Carolina Grid coordinates, (NAD 83 Cors 96) of North 462778.60 feet, East 1954715.77 feet at the
beginning of a curve at station 126+50.44; thence from the beginning with the southeast right-of-way
of US Highway 401 as a curve to the left having a radius of 11559.16 feet, a chord bearing and distance
of North 48-17-56 East 60,00 feet to a set number 5 rebar, thence a new line leaving said right-of-way
South 41-42-04 East 70.00 to a set number 5 rebar, thence as a curve to the left having a radius of
11629.16 feet, a chord bearing and distance of North 47-10-29 East 396.33 feet to a set number 5 rebar,
thence South 42-25-04 East 93.50 feet to a set number 5 rebar, thence North 47-26-47 East 31.08 feet
to a set number 5 rebar, thence as a curve to the right having a radius of 381.10 feet, a chord bearing a
distance of North 79-33-25 East 405.15 feet to a set number 5 rebar, thence as a curve to the left having
a radius of 360.91 feet, a chord bearing and distance of South 94-52-10 East 205.46 feet to a set number
5 rebar, thence South 45-11-32 East 23.50 feet to a set number 5 rebar, thence South 13416-51 East
75.49 feet to a set number 5 rebar, thence South 38-11-55 East 53.29 feet to a set number 5 rebar,
thence South 05-24-50 East 6.68 feet to a set number 5 rebar, thence South 51-22-07 West 48.65 feet to
a set number 5 rebar, thence South 64-53-08 East 52.49 feet to a set number 5 rebar, thence South 26-
57-47 East 33.87 feet to a set number 5 rebar, thence South 61-58-02 East 79.0S feet to a set number 5
rebar, thence South 14-54-42 West 20.22 feet to a set number 5 rebar, thence South 14-58-57 East
34.92 feet to a set number 5 rebar, thence South 30-34-02 East 70.36 feet to a set number 5 rebar,
thence South 01-10-03 West 47.60 feet to a set number 5 rebar, thence South 09-55-50 West 67.47 feet
to a set number 5 rebar, thence South 18-54-04 West 123,77 feet to a set number 5 rebar, thence South
66-19-27 West 58.76 feet to a set number 5 rebar, thence South 17AS-28 West 51.22 feet to a set
number 5 rebar, thence South 03-29-24 East 105.71 feet to a set number 5 rebar, thence South 15-14-03
East 47.95 feet to a set number 5 rebar, thence South 77-01-06 West 44.30 feet to a set number 5 rebar,
thence North 40-06-04 West 17.57 feet to a set number 5 rebar, thence North 28-45-00 West 72.08 feet
to a set number 5 rebar, thence South 42-00-12 West 222.38.feet to a set number 5 rebar, thence North
78-24-48 West 389.65 feet to a set number 5 rebar, thence North 42-32-21 West 23.26 feet to a set
number 5 rebar, thence South 47-34-56 West 708.91 feet to a set number 5 rebar, thence North 42-47-
05 West 790.45 feet to a set number 5 rebar in the southeast right-of-way of US Highway 401, thence
with the right-of-way of US Highway 401 North 48.30-02 East 60.02 feet to a set number 5 rebar, thence
leaving said right-of-way South 42-47-05 East 70.02 feet to a set number 5 rebar, thence North 48-30-02
East 629.13 feet to a set number 5 rebar, thence as a curve to the left having a radius of 11629.16 feet, a
chord bearing and distance of North 48.28-25 East 10.96 feet to a set number 5 rebar, thence North 41-
42-04 West 70.00 feet to the beginning containing 30 acres more of less and being a portion of the
Williams property as recorded in deed book 722, page 292-Hoke County Registry. �d

Hoke County
j Fish and Wildlife SerVice.
Hospital Site
National Wetlands Inventory
Aug 6, 2012
Wetlands
Q Freshwater Emergent
- Freshwater ForestedlShlub
_ Estuarine and Marine Deepwnter
Q Estuarine and Marine
Q Freshwater Pond
® Lake
Riwxine
Q Other
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"In acc d an base data shown men this nun. An
w.mm. �,.,m data .male a used In accordance with ma layer ,nmem ream on.
rra wMl.m. Mapper va0 eXe.
User Remarks:
FirstHealth of the Carolinas

NOV 2 7 2013

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pp. f�ll3r

North Carolina Secretary of State
Page 1 of 1
Account Login Register
Noah Carolina
Elaine l= ;Marshall DEPA Z"i"11�Ei`T OFTHE
Secretary SECRETARY oir STATE
Date: 10/30/2013
'O Box 2= RaleiO, NO 27526- tg4WW7-2000
Click here to:
View Document Filings I
PC, PLLC, LP and Non -Profit entities are not required to file annual reports.
Corporation Names
Name Name Type
NC FIRSTHEALTH OF THE LEGAL
CAROLINAS, INC.
NC FIRSTHEALTH OF THE CSL LEGAL
CAROLINAS, INC.
NC MOORE REGIONAL HOSPITAL PREV LEGAL NOV 2 7 2013
ACQUISITION CORP.
Non -Profit Corporation Information
SOSID: 0375751
Status: Current -Active
Effective Date: 8/17/1995
Citizenship:
DOMESTIC
State of Inc.:
NC
Duration:
PERPETUAL
Registered Agent
Agent Name:
KILARSKI, DAVID J.
Office Address:
155 MEMORIAL DRIVE
PINEHURST NC 28374
Mailing Address:
Principal Office
PO BOX 3000
PINEHURST NC 28374
Office Address: NO ADDRESS
Mailing Address: NO ADDRESS
Officers
This website is provided to the public as a part of the Secretary of State Knowledge Base (SOSKB) system. Version:
1881
http://www.secretary.state.nc.us/corporations/Corp.aspx?PitemId=4887844 10/30/2013

Soil Map —Hoke County, North Carolina
FIR Z Z AON (Inital Site Grading Hoke County Hospital)
35- 1'34'
667911U 668000 66616() 669ZW Bti83w tiUu4W obaaw ccaaw eoarw 0000w ooanw
ens 4, !+ L ` w, .. � .. Pr' ✓ ; 5 a wTs lrvT tx _ � K A . .w- A, e
4
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3 �; •I'���''\\1 � �f� r�`'xPRO)ECT ,r r a" Y: � ..✓ � ?
�' � ."�' k } �� � •\ � � '.�
r _.� ^ � ail � a.� {� ^'fJ`f o � � �°' y, • � a + '� 1't' �
. �^ we. ' - .fi six s ) Q+R«tn _ a r.
� s:�,; K �R ' t � d t'j� �'a' � =1�� � `i • t ¢
r A .�aG a e � �' 1r�� � f A �, '.. �' �1�•y.
'�` `741. Y' \ r• .. ; t t' -r �.
x
35` 1' 33'
35°0'S7" + r s. ., - 35. 0'56
66]900 6680M 60100 66820(1 6683m 668400 668500 668(im 668700 ME1800 668900 669000 66910D 669200 669300 66mm 6695M 5(3ww
Map Scale: 1:8,300 if pmted an A size (8.5' z 11') sheet
N Meters
r 0 100 200 400 600
Feet
P 0 450 900 1,800 2,700
USDA Natural Resources Web Soil Survey
�\ iiM1111011 Conservation Service National Cooperative Soil Survey
4/10/2012
Page 1 of 3

r
0
Soil Map —Hoke County, North Carolina
(Inital Site Grading Hoke County Hospital)
MAP LEGEND
MAP INFORMATION
Area of Interest (AOI)
M
Very Stony Spot
Map Scale: 1:8,300 if printed on A size (8.5' • 11 ") sheet.
O
Area of Interest (AOI)
Wet Spot
The soil surveys that comprise your AOI were mapped at 1:24,000.
Soils
(]
Soil Map Units
A
Other
Warning: Soil Map may not be valid at this scale.
Special
Line Features
Enlargement of maps beyond the scale of mapping can cause
Special
Point Features
,y
Gully
misunderstanding of the detail of mapping and accuracy of soil line
V
�?
"J
Short Steep Slope
placement. The maps do not show the small areas of contrasting
®
Borrow Pit
soils that could have been shown at a more detailed scale.
Other
X.
Clay Spot
Political Features
Please rely on the bar scale on each map sheet for accurate map
Closed Depression
O
Cities
measurements.
X
Gravel Pit
Water Features
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL: http://websoilsuNey.nres.usda.gov
..
Gravelly Spot
r
Streams and Canals
Coordinate System: UTM Zone 17N NAD83
®
Landfill
Transportation
This product is generated from the USDA-NRCS certified data as of
Lava Flow
Rails
the version date(s) listed below.
Marsh or swamp
N
Interstate Highways
Soil Survey Area: Hoke County, North Carolina
US Routes
Survey Area Data: Version 8, Nov 2, 2007
St
Mine or Quarry
Major Roads
Date(s) aerial images were photographed: 6/22/2006
p
Miscellaneous Water
an
Local Roads
The orthophoto or other base map on which the soil lines were
p
Perennial Water
compiled and digitized probably differs from the background
.�
Rock Outcrop
imagery displayed on these maps. As a result, some minor shifting
of map unit boundaries may be evident.
}
Saline Spot
Sandy Spot
Severely Eroded Spot
C
Sinkhole
Slide or Slip
0
Sot is Spot
a
Spoil Area
Q
Stony Spot
USDA Natural Resources
2111 Conservation Service
Web Soil Survey
National Cooperative Soil Survey
4/10/2012
Pace 2 of 3

Soil &p-Hoke County, North Carolina
Inital Site Grading Hoke County Hospital
Map Unit Legend
Hoke County, North Carolina (NC093)
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
BaB
Blaney loamy sand, 2 to 8 percent slopes
39.7
16.2%
BaD
Blaney loamy sand, 8 to 15 percent slopes
6.4
2.6%
CaB
Candor sand, 1 to 8 percent slopes
4.5
1.8%
FaB
Faceville loamy sand, 2 to 6 percent slopes
32.9
13.4%
JT
Johnston loam
26.3
10.7%
Mc
McColl loam
5.4
2.2%
NoB
Norfolk loamy sand, 2 to 6 percent slopes
6.6
2.7%
WaB
Wagram loamy sand, 0 to 6 percent slopes
123.6
50.4%
Totals for Area of Interest
245.5
100.0%
Natural Resources Web Soil Survey 4/1012012
Conservation Service National Cooperative Soil Survey Page 3 of 3

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WATERSHED 1
WATERSHED
II
II
II
II
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2
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NOT TO SCALE
NOV 2 1 2013