SW7110114_HISTORICAL FILE_20200826

STORMWATER DIVISION CODING SHEET
POST -CONSTRUCTION PERMITS
PERMIT NO.
SW C ez�`�
DOC TYPE
❑ CURRENT PERMIT
❑ APPROVED PLANS
HISTORICAL FILE
❑. COMPLIANCE EVALUATION INSPECTION
DOC DATE
YYYYMMDD
d

ROY COOPER
Govarnor
WCHAEL S. REGAN
Secretary
BRIAN WRENN
Mwtor
NORTH,CAROLINA
Environmental Quality.
August 26, 2020
Dr. Michael Sue
1537 Clubhouse Drive
Elizabeth City, NC 27809
Subject: Stormwater Permit Renewal,'
Stormwater, Management Permit SW7110114
Dr. Michael Sue Office
'Elizabeth City,,NC; Pasquotank'County '
Dear Dr. Sue:
A Division of Energy, Mineral; and Land Resources file' review has'determined that
Stormwater Permit SW71.10114 for a stormwater treatment system consisting of a wet
detention pond serving an office located at 102 Northside Park Drive, Elizabeth City,. NC
expires on February 8, ?021. This is a reminder that permit renewal applications are
due 180 days prior to expiration. We•do:not have a record,of receiving a renewal
application.
Please submit a completed permit renewal application along -with a $505:00 fee for
permit renewal. Permit application forms for renewal can be found on our website at: .
h=s /,//degnrgQy/ bout/divisions/en rgy-mineral-land-resources/energy-mineral-land-
rules/stormwater_nrogram/pyr•ronstructlon. North Carolina General Statutes and the
Coastal Stormwater rules require that this property be covered under,a Stormwater .
permit. Failure to maintain a permit subjects the owner to assessment of civil penalties.
If you have questions, please feel free to contact me at [phone]. 1 will be glad to
discuss this by phone or meet with you. If you would like, I can a -mail you a copy of the
application form. You can request a copy by e-mailing me at'rooer thorpe(a)ncdenr.4ov.
Sincerely,
Roger K. Thorpe
Environmental Engineer.
P9.
--L�Nw2h Carolina Departmentof EnvhonmentalQyalhy I DMslondfEnergy:Mineraland Land Rnourms
J� wesHngton Regional Office 1943 Washing ton Square Mell Wehington�North CaroNne 27889
..n.d252.946.6481

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Dr. Michael Sue
102 Northside Park Dr.
Elizabeth City, NC 27909
Dear Dr. Sue:
John E. Skvarla, III
Secretary
May 21, 2014
Subject: NOTICE OF INSPECTION
Permit No. SW7110114
Dr. Michael Sue, MD at 102 Northside Park Drive
Pasquotank County
This office received a designer's certification from your consultant for the subject project. On March 12, 2014,
Roger Thorpe of the Washington Regional Office of the Division of Energy, Mineral, and Land Resources
inspected the wet detention pond serving your office located at 102 Northside Park Drive in Elizabeth City, NC to
determine compliance with Stormwater Management Permit Number SW7110114, which was issued on February
8, 2011. The site inspection revealed that the wet detention pond is well operated and maintained and is in
compliance with stormwater permit SW7110114.
If you have any questions please contact me at the Washington Regional Office, telephone number (252) 948-
3923.
Sincerely,
Roger K. Thorpe
Environmental Engineer
Division of Energy, Mineral, and Land Resources . Land Quality Section
Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889 • Phone: [phone] FAX: [phone]
Internet: http://I)ortal.ncdenr.org/web/ir/land-guality
An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper

NFA
WC®EW
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
Dr. Michael Sue 1�2-%6
Elizabeth City, NC 27909
Dear Dr. Sue:
Pat McCrory, Governor
John E. Skvada, III, Secretary
October 28, 2013
Nor7Lk Jaca-r k D r.
Subject: Failure to Provide Certification
Stormwater Management Permit SW7110114
Dr. Michael Sue, MD at 270 Northside Park Drive
Pasquotank County
This letter is to inform you of certain conditions of your stormwater permit that have not been met.
[&Kn
A Division of Energy, Mineral, and Land Resources file review confirms that a certification of completion has not been
submitted. Permit condition number II. 8 states "Upon Completion of construction, prior to issuance of a Certificate of
Occupancy, and prior to operation of this permitted facility, a certification must be received from an appropriate designer
for the system installed certifying that the permitted facility has been installed In accordance with this permit, the approved
plans and specifications and other supporting documentation. Any deviations from the approved plans and specifications
must be noted on the Certification. A modification may be required for those deviations."
Please provide a copy of the certification to this Office at the letterhead address within 30 days of receipt of this letter. If
you have questions, please feel free to contact me at [phone].
Sincerely,
Roger K. Thorpe —
Environmental Engineer
Washington Regional Office
Cc Albemarle & Associates
Washington Regional Office
943 Washington Square Mall, Washington, North Carolina 27889 • Phone: [phone] / FAX: [phone]
Internet: http:]Avww.portal.nodenr.org/webArAand-quality
An Equal Opportunity / Affirmative Action Employer - 50%Recycled/1056 Post Consumer Paper

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1

: NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 8, 2011
Dr. Michael Sue, Owner
1134 North Road St., Suite 8
Elizabeth City, NC 27909
Subject: Stormwater Permit No. SW7110114
Dr. Michael Sue, MD
High Density Commercial Wet Pond Project
Pasquotank County
Dear Dr. Sue:
The Washington Regional Office received a complete Stormwater Management Permit Application for
Dr. Michael Sue, MD office building on January 31, 2011. Staff review of the plans and specifications
has determined that the project, as proposed, will comply with the Stormwater Regulations set forth in
Session Law 2008-211 and Title 15A NCAC 21-1.1000. We are forwarding Permit No. SW7110114
dated February 8, 2011, for the construction of the subject project.
This permit shall be effective from the date of issuance until February 8, 2021, and shall be subject to
the conditions and limitations as specified therein. 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 (30) days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150E 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 Scott
Vinson, or me at [phone].
S�cerely, .
� 1
Al H'1odge
Regional Supervisor
Surface Water Protection Section
AH/ sv: K:\WQS\STORMWATER\PERMIT\SW7110114
cc: Mike Morway, PE — Albemarle & Associates
Pasquotank County Planning/Building Inspections
',Aashington Regional Office
North Carolina Division of Water Quality Internet: www,ncwaterquallty.org One
943 Washington Square Mall Phone: [phone] FAX: [phone] }�] O rt}� CaPO} I n R
Washington, NC 27889 FAX: [phone]
An Equal Opportunity 1 AManative Action Employer Xaturally

State Stormwater Management Systems
Permit No. SW7110114
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
STATE STORMWATER MANAGEMENT PERMIT
HIGH DENSITY 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
Dr. Michael Sue
Dr. Michael Sue, MD
Lot 10, Northside Park Drive in Elizabeth City, Pasquotank County
FOR THE
construction, operation and maintenance of a wet detention pond in compliance with
the provisions of Session Law 2008-211 and 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.
This permit shall be effective from the date of issuance until February 8, 2011, and shall
be subject to the following specified conditions and limitations:
I. DESIGN STANDARDS
1. This permit is effective only with respect to the nature and volume of stormwater
described in the application and other supporting data.
2. This stormwater system has been approved for the management of stormwater
runoff as described in Section 1.7 of this permit. The stormwater control has been
designed to handle the runoff from 34,784 square feet of impervious area.
3. The tract will be limited to the amount of built -upon area indicated in Section I. of
this permit, and per approved plans.
4. All stormwater collection and treatment systems must be located in either
dedicated common areas or recorded easements. The final plats for the project
will be recorded showing all such required easements, in accordance with the
approved plans.
5. The runoff from all built -upon area within the permitted drainage area of this
project must be directed into the permitted stormwater control system.
6. The built -upon areas associated with this project shall be located at least 50 feet
landward of all perennial and intermittent surface waters.
Page 2 of 7

State Stormwater Management Systems
Permit No. SW7110114
7
The following design criteria have been provided in the wet detention pond and
must be maintained at design condition:
a.
b.
C.
d.
e.
f.
9.
k.
I.
m
Drainage Area, acres:
Total Impervious Surfaces, ftZ:
Design Storm, inches:
Pond Depth, feet:
TSS removal efficiency:
Permanent Pool Elevation, FMS�:
Permanent Pool Surface Areq, ft
Permitted Storage Volume, ft :
Temporary Storage Elevation, FMSL:
Predevelopment 1 year 24 hour:
Post development 1 year 24 hour:
Controlling Orifice:
Permitted Forebay Volume, ft3:
Fountain Horsepower, HP
Receiving Stream/River Basin:
Stream Index Number:
Classification of Water Body:
II. SCHEDULE OF COMPLIANCE
2
C!
5.
91
1.65
34,784
1.50
5.10 (3.10 average)
90%
8.10
6,706
13,189 at temporary pool el
9.60
0.07cfs
0.02cfs
1.00"0 pipe
3,376
0 (fountain not allowed, pond too small)
Knobbs Creek/ Pasquotank
30-3-8
C; Sw"
The stormwater management system shall be constructed in its entirety,
vegetated and operational for its intended use prior to the construction of any
built -upon surface.
During construction, erosion shall be kept to a minimum and any eroded areas of
the system will be repaired immediately.
The permittee shall at all time provide the operation and maintenance necessary.
to assure the permitted stormwater system functions at optimum efficiency. The
approved Operation and Maintenance Plan must be followed in its entirety and
maintenance must occur at the scheduled intervals including, but not limited to:
a. Semiannual scheduled inspections (every 6 months).
b. Sediment removal.
C. Mowing and re -vegetation of slopes and the vegetated filter strip.
d. Immediate repair of eroded areas.
e. Maintenance of all slopes in accordance with approved plans and
specifications.
f. Debris removal and unclogging of outlet structure, orifice device, level
spreader, filter strip, catch basins and piping.
a. Access to the outlet structure must be available at all times.
Records of maintenance activities must be kept for each permitted BMP. The
records will indicate the date, activity, name of person performing the work and
what actions were taken.
Access to the stormwater facilities shall be maintained via appropriate
easements at all times.
Decorative spray fountains shall not be allowed in the wet detention basin
stormwater treatment system due to the ponds small size.
7. The facilities shall be constructed as shown on the approved plans. This permit
shall become void unless the facilities are constructed in accordance with the
conditions of this permit, the approved plans and specifications, and other
supporting data.
Page 3 of 7

State Stormwater Management Systems
Permit No. SW7110114
8. Upon completion of construction, prior to issuance of a Certificate of Occupancy,
and prior to operation of this permitted facility, a certification must be received
from an appropriate designer for the system installed certifying that the permitted
facility has been installed in accordance with this permit, the approved plans and
specifications, and other supporting documentation. Any deviations from the
approved plans and specifications must be noted on the Certification. A
modification may be required for those deviations.
9. If the stormwater system was used as an Erosion Control device, it must be
restored to design condition prior to operation as a stormwater treatment device,
and prior to occupancy of the facility.
10. The permittee shall submit to the Director and shall have received approval for
revised plans, specifications, and calculations prior to construction, for any
modification to the approved plans, including, but not limited to, those listed
below:
a. Any revision to any item shown on the approved plans, including the
stormwater management measures, built -upon area, details, etc.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built -upon area or to the
drainage area.
e. Further subdivision, acquisition, lease or sale of all or part of the project
area. The project area is defined as all property owned by the permittee,
for which Sedimentation and Erosion Control Plan approval or a CAMA
Major permit was sought.
f. Filling in, altering, or piping of any vegetative conveyance shown on the
approved plan.
11. The Director may notify the permittee when the permitted site does not meet one
or more of the minimum requirements of the permit. Within the time frame
specified in the notice, the permittee shall submit a written time schedule to the
Director for modifying the site to meet minimum requirements. The permittee
shall provide copies of revised plans and certification in writing to the Director
that the changes have been made.
12. The permittee shall submit final site layout and grading plans for any permitted
future areas shown on the approved plans, prior to construction.
13. A copy of the approved plans and specifications shall be maintained on file by
the Permittee at all times.
III. GENERAL CONDITIONS
This permit is not transferable except after notice to and approval by the Director.
In the event of a change of ownership, or a name change, the permittee must
submit a completed Name/Ownership Change form, to the Division of Water
Quality, signed by both parties, and accompanied by supporting documentation
as listed on page 2 of the form. The project must be in good standing with the
Division. The approval of this request will be considered on its merits and may or
may not be approved.
2. The permittee is responsible for compliance with all permit conditions until such
time as the Division approves the transfer request.
Failure to abide by the conditions and limitations contained in this permit may
subject the Permittee to enforcement action by the Division of Water Quality, in
accordance with North Carolina General Statute 143-215.6A to 143-215.6C.
Page 4 of 7

State Stormwater Management Systems
Permit No. SW7110114
4. The issuance of this permit does not preclude the Permittee from complying with
any and all statutes, rules, regulations, or ordinances, which may be imposed by
other government agencies (local, state, and federal) having jurisdiction.
5. In the event that the facilities fail to perform satisfactorily, including the creation
of nuisance conditions, the Permittee shall take immediate corrective action,
including those as may be required by this Division, such as the construction of
additional or replacement stormwater management systems.
6. The permittee grants DENR Staff permission to enter the property during normal
business hours for the purpose of inspecting all components of the permitted
stormwater management facility.
7. The permit issued shall continue in force and effect until revoked or terminated.
The permit may be modified, revoked and reissued or terminated for cause. The
filing of a request for a permit modification, revocation and re -issuance or
termination does not stay any permit condition.
8. Unless specified elsewhere, permanent seeding requirements for the stormwater
control must follow the guidelines established in the North Carolina Erosion and
Sediment Control Planning and Design Manual.
9. Approved plans and specifications for this project are incorporated by reference
and are enforceable parts of the permit.
10. The issuance of this permit does not prohibit the Director from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit
as allowed by the laws, rules and regulations contained in Session Law 2008
211, Title 15A NCAC 2H.1000, and NCGS 143-215.1 et.al.
11. The permittee shall notify the Division of any name, ownership or mailing
address changes at least 30 days prior to making such changes.
12. This permit shall be effective from the date of issuance until February 8, 2021.
Application for permit renewal shall be submitted 180 days prior to the expiration
date of this permit and must be accompanied by the processing fee.
Permit issued this the 8th day of February, 2011.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for
goleeh H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission
Stormwater Permit No. SW7110114
Page 5 of 7

State Stormwater Management Systems
Permit No. SW7110114
Dr. Michael Sue, MD
Stormwater Permit No. SW7110114
Pasquotank County
Designer's Certification
I, , as a duly registered in the
State of North Carolina, having been authorized to observe (periodically/ weekly/ full
time) the construction of the project,
(Project)
for (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
The checklist of items on page 2 of this form is included in the Certification.
Noted deviations from approved plans and specification:
Signature
Registration Number
Date
SEAL
Page 6 of 7

State Stormwater Management Systems
Permit No. SW7110114
Certification Requirements:
1. The drainage area to the system contains approximately the permitted
acreage.
2. The drainage area to the system contains no more than the permitted
amount of built -upon area.
3. All the built -upon area associated with the project is graded such that the
runoff drains to the system.
4. All roof drains are located such that the runoff is directed into the system.
5. The outlet/bypass structure elevations are per the approved plan.
6. The outlet structure is located per the approved plans.
7. Trash rack is provided on the outlet/bypass structure.
8. All slopes are grassed with permanent vegetation.
9. Vegetated slopes are no steeper than 3:1.
10. The inlets are located per the approved plans and do not cause short-
circuiting of the system.
11. The permitted amounts of surface area and/or volume have been
provided.
12. Required drawdown devices are correctly sized per the approved plans.
13. All required design depths are provided.
14. All required parts of the system are provided, such as a vegetated shelf,
and a forebay.
15. The required system dimensions are provided per the approved plans.
cc: NCDENR-DWQ Washington Regional Office
Pasquotank County Planning / Building Inspections
Page 7 of 7

t
DWQ USE ONLY
_
-E a e ft cei SS
Fee Paid C.te.l� 1"1
Permit Number
3500
S�nl "1 O lk4
Applicable est 1 :N coastal SW -1995 Coa 1 SW - 2008 ❑ Ph II - Post Construction
(select all thatell l��Von-Coastal SW- HQW/ORW Waters El Universal Stormwater Management Plan
igtherWQM
��jj tPlan:
State of North Carolina O
Department of Environment and Natural Resources
Division of Water Quality WW
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form may be photocopied for use as an original
I. 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.):
Dr. Michael Sue MD
2. Location of Project (street address):
270 Northside Park Drive
City:Elizabeth City County:Pasquotank Zip:27909
3. Directions to project (from nearest major intersection):
4.5 miles south on N. Road Street (US 17 Bus) from its intersection with US 17 Bypass Turn left onto
Northside Park Drive (adjacent to State Employees Credit Union) and follow loop road 0.25 miles. Site is on
4. Latitude:360 20 41" N Longitude:76° 15' 15" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification
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, and the previous name of the project, if different than currently
proposed,
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):
❑LAMA Major ®SedimentaLion/ Erosion Control:1.77 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
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 permit:

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:M ichael Sue
Signing Official & Title:Owner
b.Contact information for person listed in item 1a above:
Street Address:] 134 North Road St., Suite 8
City:Elizabeth City State:NC Zip:27909
Mailing Address (if applicable):
Phone: (252 ) 3354619 Fax:
Emad:[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 Owners 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 project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Albemarle & Associates. Ltd.
Signing Official & Title:Michael 1. Morway, PE
b.Contact information for person listed in item 3a above:
Mailing Address:P.O. Box 3989
City:Kill Devil Hills State:NC Zip:27948

Phone: (252 ) 441-2113 Fax: (252 ) 441-0965
Email:[e-mail]
4. Local jurisdiction for building permits: City of Elizabeth City
Point of Contact:Stanley Ward
IV. PROJECT INFORMATION
Phone #: (252 ) 337-6868
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Runoff from impervious surfaces for this facility will be directed into swales around the perimeter of the
building & parking areas, which will convey the runoff to a stormwater wet detention pond Both the orifice
& riser discharge trough a 12" pipe that in turn will discharge into the front swale along Nprthside Park Dr.
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 Pasguotank River basin.
4. Total Property Area: 1.65 acres 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+:1.65 acres
Total project area shall be calculated to exclude the following: the normal y001 of imyyounded strictures, the area
between the banks of streams and rivers, the area below the Normal High Water (NM line or Mean High Water
(MHP1) line, and coastal wetlands landward from the NHW (or MHM line. 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 = 48.3 %
9. How many drainage areas does the project have?1 (For high density, count 1 for each proposed engineered
stormwater BMP. For low density and other projects, use I for the whole property 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.

Basin Information
Drainage Area 1
Drainage Area
Drainage Area _
Drainage Area _
Receiving Stream Name
Knobbs Creek
Stream Class *
C, SW
Stream Index Number *
30-3-8
Total Drainage Area (so
72,045
On -site Drainage Area (sf)
72,045
Off -site Drainage Area (so
0
Proposed Impervious Area** (so
34,794
Impervious Area** total
48.3
Impervious" Surface Area
Drainage Area 1
Drainage Area _
Drainage Area _
Drainage Area _
On -site Buildings/Lots (sf)
9,000
On -site Streets (so
0
On -site Parking (so
21,789
On -site Sidewalks (so
3,995
Other on -site (so
0
Future (so
0
Off -site (so
0
Existing BUA*** (so
0
Total (so:
34,784 V
* Stream Class and Index Number can be determined at: http://nortal.ncdenr.org/web/wq/ns/csu/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 arnount 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. Autocad
Projects in Union County: Contact DWQ Central Office staff to check if the project is located within a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 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 htW://portal.ncdenr.org/web/wq/ws/su/bmp-manual.
VI. 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://12ortal.ncdenr.org/web/wg/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://12ortal.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 dots.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. AMJM
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants 'J/A
Form. (if required as per Part V11 below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M AAJ,v\
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to /vl W'1
http:/ /www.envhelp.org/pages/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.)

5. A detailed narrative (one to two pages) describing the stormwater treatment/managementfor
M-IM
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
11A.1M
receiving stream drains to class SA waters within 1h mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations.
MJM
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
M 3 M
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. 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
IK-1 rA
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"xll" 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 verify the SHWT prior
to submittal, [phone].)
10. A copy of the most current property deed. Deed book: 1091 Page No: 469 M eA
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC �J %A
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 NCAC 21-1.1003(e). The
corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application wit] be returned.
h!W://www.secretaiy.state.nc.us/Corporations/CSearch.asp
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
hqp://portal.ncdenr.org/web/wq/ws/su/statesw/forms does. 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.

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.Michael I. Morway, PE
Consulting Firm: Albemarle & Associates, Ltd.
Mailing Address:P.O. Box 3989
City:Kill Devil Hills State:NC Zip:27948
Phone: (252 ) 441-2113 Fax: (252 ) 441-0965
Email:[e-mail]
IX, PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type 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 1a) with (print or type name of organization listed in
Contact Information, item la) 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
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

X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Co;
certify that the information included on
that the project will be constructed in cc
and protective covenants will be record4
applicable stormwater rules under 15AJ
ation, item la) Michael Sue
r it application form is, to the best of my knowledge, correct and
Lnce with the approved plans, that the required deed restrictions
that the propo project complies with the requirements of the
2H .1000,, SL 2 6 246 (Ph.11- Post Construction) or SL 2008-211.
- l ._._9 Date: 141 i 1'y
I, I --Z�E . a Notary Public for the State of tJ 6(t-rH-(AI-" L 1. fA. County of
PAr� Q u trTfW L- do hereby certify that N1 ` U I A — 5 U C personally appeared
before me this ) rl day of 36- V 2 O I I , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal, (�—
UASO►d A. PAIZELLE
NOTARY PUBLIC
pASQUOTANK COUNTY, N.C.
SEAL
My commission expires G { 5 Zp 13

Volumetric Runoff Calculations
Simple Method
Project Name: Dr. Michael Sue MD - 270 Northside Park Drive
Project Area Description - DRAINAGE AREA #
Bashi Information
existing
0
0
0
0
0
0
0
0
existing (to
remain)
0
0
0
0
0
0
0
0
proposed
(additional)
9,000
0
21,.769
3,995
0
0
0
34,784
Receiving Stream Name
Knobbs Creek
Receiving Stream Class 8 Index Number
C. SW (30-3-8)
Drainage Area
72.045 SF
Existing Impervious Area
0 SF
Proposed Impervious Area
34.784 SF
% Impervious Area (total)
48.3%
Impervious Surface Area
On -sire Buildings or Lot BUA
9.000 SF
On site streets
0 SF
On -site Parking
21.789 SF
On-sfte Sidewalks
3.995 SF
Other on -she
0 SF
Future
0 SF
Off -site
0 SF
Total:
3a,784 SF
Runoff Calculations (Simple Method)
NCDENR
1yr/24hr(pre)
1yr/24hr(post)
Design Runoff (in)
1.5
0
0
Total Area (so
72,045
72,045
72,045
Coverage
48.3%
0.00/0
48.3%
R(v)
0.485
0.050
0.485
Rainfall Volume
4,363
0
0
u.uu (cts) u.uu icrs/
NCDENR 1.5: 4,363
NCDENR Pre/Post 0
:J

STORMWATER MANAGEMENT CALCULATIONS -WET DETENTION POND DESIGN
Project
Drainage Area
Receiving Wet Pond
Dr. Michael Sue MD - 270 Northside Park Driv,
1
Wet Detention Pond Volume Calculations
By: mjm
Date : 01/17/11
EXPR S
JAN 31 2011
Description
Forebay
B,gsin
Description
elev
(ft)
area volume
(sf) (cf)
elev
(ft)
area
(sf)
volume
(cf)
Excavated Bottom
2.0
9
2.0
310
Bottom (sediment clean -out elev.)
3.0
83
3.0
797
4.0
228 156
4.0
1,330
1,064
6.5
846 1,343
6.5
2,957
5,359
Bottom of Bench
7.6
1,223 1,138
7.6
3,778
3,704
Permanent Pool Elevation :
8.1
1,738 740
8.1
4,968
2,187
Permanent Pool Volume:
3,376
12,313
Top of Bench
8.6
2,333 1,018
8.6
6,236
2,801
Storage Elevation
9.6
2,865 2,599
9.6
7,306
6,771
Storage (Temp. Pool) Volume :
3,617
9,572
Total Permanent Pool Volume:Volume :
15,689
Forebay Percentage of Total Volume :
21.5%
Total Storage Volume:
13,189
Total Excavated Volume Below Storage Elevation :
29,477
Pond Design Parameters Pond Drawdown Calculations
Storage Elevation :
9.6
(ft.)
Area at Storage Elev.:
10,171
(s.f.)
Permanent Pool Elev.:
8.1
(ft.)
Area at Perm. Elev.:
6,706
(s.f.)
Storage Volume:
13,189
(c.f.)
Design Volume:
4,363
(c.f.)
Orifice:
1.00
(in)
Discharge coefficient:
0.6
Design Volume =
4,363
cf
Design Storage Height =
1.50
ft
Average Head =
0.49
ft.
Discharge Coefficient =
0.60
Area of Orifice =
0.005
sf.
Discharge Rate =
0.018
cfs.
Drawdown Calculations
NCDENR Design Volume =
66
hrs
Average Depth,(opt#2): 3.1
Percent Coverage: 48%
Required SA/DA ratio: 5.4 (coastal county, 90% tss removal, depth = 3.0 ft.)
Req'd Surface Area : 0.09 (ac) ( 0.15 provided)
Prepared by Albemarle and Associates, Ltd.

lbemarle
& ASSOCIATES, LTD.
EXPRESS 270 Northside Park Drive
JAN 31 2011 Stormwater Management Narrative
prepared for
NC ®ENR Dr. Michael Sue MD
January 17, 2011
Existing Conditions: The 1.65 acre parcel is located at 270 Northside Park Drive
(off US-17) in Elizabeth City (Pasquotank County), NC. The lot was previously
cultivated but has since been converted into a commercial subdivision. Elevations on
the site range from 8 (within drainage inverts) to 11 feet above msl. The property is
currently drained by a system of perimeter swales installed during the construction of
the development. The majority of the lot drains to the front swale (along Parkside
Drive), with the remainder draining offsite via the rear swale. Ultimately, both drain to
the US-17 collection system and eventually into Knobbs Creek. The Soil Survey for
Pasquotank County has mapped the soils to consist of Tomotley fine sandy loam
(ToA) and Gertie silt loam (GrA). The project is not within 575' feet of ORW
classified waters, or within 'Y2 mile of those classified as SA. A Stormwater
Management Permit (SW7050215) was issued for the commercial subdivision
(Northside Park) as a low density project on February 17, 2005.
Proposed Development: Dr. Michael Sue, MD intends to construct a 9,000 sf
medical facility with parking. The project will include two new driveway entrances,
sanitary sewer connection (to a proposed sanitary sewer collection system along
Northside Park Drive) and waterline system connection. Existing permit SW7050215
allows 20,893 sf of built upon area to be constructed on this parcel (lot 10) in order
for the parcel to remain in compliance with the permit. Since a greater amount of
coverage is necessary for this project (34,784 sf), a new stormwater management
wet pond will be constructed in order to comply with NCDENR as well as Elizabeth
City regulations.
NCDENR Permitting Compliance: The combined impervious coverage for this
project is approximately 48%, thereby classifying the project as a "high density"
development within the 20 coastal counties. Runoff from impervious surfaces for this
facility with be directed into swales around the perimeter of the building and parking
areas, which will convey the runoff to a stormwater wet detention pond. The wet
pond has been selected for this site due to the nature of the soils (fairly heavy with
clay) and relatively high water table (24" — 48" below existing grade). The swales will
be grassed, providing pretreatment by allowing the opportunity for filtration and
infiltration of stormwater, and will direct stormwater into the forebay of the pond. The
pond has been sized to conform to the North Carolina Division of Environment and
Natural Resources Division of Water Quality "Best Management Practices Manual".
In order to meet Pasquotank County standards (25 year, 24 hour pre vs. post
development runoff rates), storage for runoff resulting from more than 1'/z" of rainfall
is provided below the riser. The ponding level for the 1 'W event is approximately
Land Planning - Engineering - Surveying - Ernim mental - Constnxtion Management
117C North Water Street, Elizabeth Gry. North Cerana 27909
Phone: [phone] ~v.AlbemarleAssoolates.00m Fax: [phone]

270 Northside Park Drive
Stormwater Management Narrative
January 17, 2011
Page 2 of 2
8.7. This runoff drains through a 1" orifice (invert elevation = 8.1), which will release
the runoff from I in 66 hours based upon the average head provided from the top
of riser elevation of 9.6. Both the orifice and the riser discharge trough a 12" pipe
that in turn will discharge into the front swale along Northside Park Drive. The
Estimated Season High Water Table (ESHWT) for the site is at or around 8.1 feet
above mean sea level, which is nearly the same elevation as the majority of the
adjacent ditches. The soil composition, which includes significant amounts of clay,
should allow for the permanent pool elevation to be fairly consistent even during
times when the water table is low.

I em rle ba
& ASSOCIATES, LTD.
EXPRESS 270 Northside Park Drive Soils Narrative
prepared for
JAN 31 2011 Dr. Michael Sue, MD
NC DENR December 17, 2010
Dr. Michael Sue, MD intends to construct a 9,000 square foot medical office with
parking at 270 Northside Park Drive, located off US 17 in Elizabeth City, North
Carolina. A wet pond is proposed on the north edge of the property to facilitate
stormwater management requirements. The Soil Survey for Pasquotank County
has mapped the soils to consist of Tomately fine sand (ToA), with Gertie silt loam
(GrA) along the north and south edge of the property. The project is located
within a commercial subdivision with mostly vacant lots. The existing
improvements within the subdivision itself consist of a roadway with swales on
either side. Lots are well graded with swales along the side and rear. Elevations
on 270 Northside Park Drive range from 8 feet above msl at adjacent ditch
inverts to 11 feet above msl at the crown of the property. The region was
previously .cultivated prior to being subdivided. Albemarle & Associates
performed soils investigations on November 191h, 2010. The results of this
investigation are summarized as follows:
Stormwater Management Pond:
At the time, it was uncertain whether the proposed pond would be located on the
north or south side of the property. Soils borings were performed in both
locations, each yielding very similar findings. Each location appeared to be fairly
consistent with Gertie, as clay was consistently found within the boring through
it's termination five feet below the surface. Mottling was observed between the 24
to 30 inches below the surface, indicating season high water table between 8.0
and 8.5 feet above msl. However, the current ground water table appeared to be
approximately 48" below the surface. Existing ditches with inverts near 8.0 were
dry. Based upon the condition of the vegetation within the swales, they appear•to
remain mostly dry throughout the year. For these reasons, the permanent pool
was set at 8.1, allowing the pond to drain above the permanent pool, while
maintaining maximum temporary storage capabilities. A nearby constructed
stormwater pond in Gertie mapped soils maintain a permanent pool at it's orifice,
although the surface water in the adjacent ditch was at least 18" below the pool.
This confirms that the soils have the ability to retain water without excess
infiltration, thus allowing the desired permanent pool to be maintained more
consistently. A copy of the USDA Web Soil Survey for the site and soils boring
report are attached.
Land Planning — Engineering — Surveying — Emdronmental — Construction Management
117C North Water Street, Elizabeth City, North Carolina 27909
Phone: 252,338-5771 mmvAlbemaA6Assoctates.com Fax: [phone]

07808C - Coastal Studies Institute
Soil Boring Log
Soil Boring
Depth
B-1
B-2
0" to 6"
brown topsoil
brown topsoil
6" to 12"
brown topsoil
brown topsoil
12" to 18"
grey sandy clay
grey sandy clay
18" to 24"
grey sandy clay
grey sandy clay
24" to 30"
grey sandy clay w/ some
grey sandy clay wl some
mottling
mottling
30" to 36"
grey sandy clay w/ some
grey sandy clay wl some
mottling (wet)
mottling
36" to 42"
grey sandy clay w/ some
grey sandy clay wl some
mottling (wet)
mottling
42" to 48"
grey sandy clay w/ some
tan sandy clay w/ some
mottling (wet)
mottling (wet)
48" to 54"
light grey sandy clay
tan sandy clay w/ some
(saturated)
mottling (saturated)
54" to 60"
light grey sandy clay
tan sandy clay wl heavy
(saturated)
mottling (saturated)
Soil Type
Gertie Silt Loam
Gertie Silt Loam
Date of Boring
11/19/10
11/19/10
Ex. Ground
Elevation (ft
10.5
10.5
above MSL)
Depth to
ESHWT (in)
30
30
ESHWT
Elevation
8 0
8.0
Depth to Water
table (in)
48
48
Estimated Water
table Elevation
6.5
6.5
(ft
Prepared by Albemarle and Associates, Ltd.

- AenmS IIoS angeLadooO leuogeN aolmas uopemasuoO _
FanmS iloS q9M sawnosa eLn e
211 1 N y(]$(1
.EY AZ .K
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of oz o s o
veyyy MEMORN
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.BE AZ.%
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(anuO )Pad OPISWON OLZ - OW anS l9e40% LO)
euilaeo WON '/qunoO AueMbsed—deW IpS

Soil Map—Pasquotank County, North Carolina
(Dr Michael Sue MD - 270 Northside Park Drive)
MAPLEGEND
Arse of Interest (AOI)
Q Area of Interest(AOI)
Soft
Soil Map Units
Special
Point Features
V)
Blowout
®
Borrow Pit
X
Clay Spot
e
Closed Depression
X
Gravel Pit
..
Gravelly Spot
®
Landfill
A
Lava Flow
,,l,,
Marsh or swamp
R
Mine or Quarry
po
Miscellaneous Water
p
Perennial Water
�.
Rock Outcrop
}
Saline Spot
Sandy Spot
Severely Eroded Spot
0
Sinkhole
Slide or Slip
0
Sothic Spot
dd
Spoil Area
Q
Stony Spot
Natural Resources
Conservation Service
�r1 Very Stony Spot
1 Wet Spot
Other
Special Line Features
Gully
Short Steep Slope
Other
Political Features
0 Cities
Water Features
Oceans
Streams and Canals
Transportation
+++ Rails
N Interstate Highways
US Routes
Major Roads
Local Roads
MAP INFORI
Map Scale: 1:776 if printed on A size
The soil surveys that comprise your/
Please rely on the bar scale on each
measurements.
Source of Map: Natural Resources
Web Soil Survey URL: http:l/webs
Coordinate System: UTM Zone 18
This product is generated from the U1
the version date(s) listed below.
Soil Survey Area: Pasquotank Coi
Survey Area Data: Version 11, Oc
Date(s) aerial images were phologra
The orthophoto or other base map of
compiled and digitized probably diffe
imagery displayed on these maps. A
of map unit boundaries may be evid(
Web Soil Survey
National Cooperative Soil Survey

Soil Map-Pasquotank County, North Carolina
Dr Michael Sue MD - 270 Northside Park Drive
Map Unit Legend
Pasquotank County, North Carolina (NC139)
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AD]
GrA
Gertie sill loam, 0 to 2 percent slopes
0.6
38.8%
ToA
Tomotley fine sandy loam, 0 to 2
percent slopes
1.0
61.2%
Totals for Area of Interest
1.6
100.0%
Natural Resources Web Soil Survey 12/112010
Conservation Service National Cooperative Soil Survey Page 3 of 3

I
• �, - >r , eta '. �• ; �_ R3d10'

J
BOOK 1091 PAGE 469(2)
4obt3 IIIIIII�IBII�B�I�II�
This document presented and filed:
08252010 12:20:36 PM
JOYCE W. PRITCHARD, Pasquotank County, NC
Excise Talc: $264.00
NORTH CAROLINA GENERAL WARRANTY DEED
Gxrcisc Iav s
�
JAuN 1
]
e c DC
Parts ldemilier No. 8905856640 Verified he Cnunq on the_ dac of ,20_
B,:
WWII.,w G. Wendell Sni,ec P.O. In,, 581 fliiabeth C. NC 27907-0581
This instrument ,. prepared 61
Brief des:ripcion ter the Indes:_
THIS DEED made this 19" day of August .20 10 , by and between
GRAN FOR I GRANTEE
J.O. G. Development, L.L.C. Michael Sue & or Assigns
a North Carolina Limited Liability Company 1537 Clubhouse Road
Post Office Box 448 Elizabeth City, NC 27909
Elizabeth City, NC 27907
The designation Grantor and Grantee as used herein shall include said parties, their heirs, successors, and assigns, and shall
include singular. plural, masculine. feminine or neuter as required by context.
WITNESSETH, that the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents does grant, bargain. sell and convey unto the Grantee in fee simple, all that certain lot
or parcel of land situate in Providence Township. Pasquotank County, Noah Carolina and more particularly described as
follows:
Being all of Lot 10 (containing 1.65 acres), as described and delineated on that plat entitled in part "Final Plat of
Northside Park, dated February 14, 2006, prepared by Scan L. Temple, Professional Land Surveyor, which plat is
recorded in Map Book 41, Pug" 12 and 13. in The Pasq uotank County Public Registry and which plat is incorporated
herein by reference.
The property herein above described was acquired by Grantor by instrument recorded in Deed Book 794 ,Page 866
A map showing the above described property is recorded in Map Book 41, Pages 12 and 13.
PA8000TANK P,piOM
Dead number /
Trwrorhx$ 1a . y N
squognk taady rseseae OOke
14)

BK 1091 PG 470 DOC#402313
r
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and appurtenances thereto belonging to the
Grantee in fee simple.
And the Grantor covenant 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 Gmntor will warrant and defend the title
against the lawful claims of all persons whomsoever except for the exception hereinafter stated.
IN TESTIMONY WHEREOF. said Grantors have hereunto set their hands and seals the day and year first above written.
J.O.C. Develoilment, L.L.C., a North Carolina
Stephen L.
James T C.Mory, Manager
IL
William C. (livens, Jr, Manager
STATE OF NORTH CAROLINA COUNTY OF PASOUOTANK
I, the undersigned Notary Public of the County and State aforesaid, certify that Stephen L. Jones personally came before me
this day and acknowledged that he is Managing Member of J.O.G. Development. L.L.C.. a North Carolina limited liability
company and that he as Managing Member being authorized to doh , executed the foregoing on behalf of the company.
Witness m% hand and
My Commission Expires:
Wm Wrolm•P
TERESA1.h
NOTARY
kN Cammmnfin
Notary Public
STATE OF NORTH CAROLINA COUNTY OF PASOUOTANK
1, the undersigned Notary Public of the County and State aforesaid. certify that James T. Gregory personally came before me
This day and acknowledged that he is Managing Member of J elopment, L.L.C., a North Carolina limited liabilih
company and that he as Managing Member being authorized o do so, a ecuted the foregoing on behalf of the company.
Witness my hand and Notarial stamp or seal this � d>lyvT s1..2010, I ' r /� A /1
My Commission Expires
D-Ib`o901
r Canir.. Pmpntadi cM?M
TERESA 1. HECKSTALL
40 NOTARYPOBLIC
STATE OF —NOR IH CAROLINA
Notary Public
COUNTY OF PASOUO"TANK
I, the undersigned Notary Public of the County and State aforesaid, unify that William C. Owens, Jr. personally came before
me this day and acknowledged that he is Managing Member of1.O.G. Development, L.L.C., a North Carolina limited liability
company and that he as Managing Member being authorized to &�:so�xfcuted the foregoing on behalf of the company.
Witness my hand and Notarial stamp or seal
My Commission Expires:
ERESA I. HEC�KSTAAL
.. _ NOTARYMBLIC

For DENR Use ONLY
Reviewer:
©, 0 North Carolina Department of Environment and
ANatural Resources Submit:
A _
NCDENR Request for Express Permit Review Time. —
Confirm:
FILL-IN all the information below and CHECK the Permit(s) you are requesting for express review. FAX or Email the completed form to Express
Coordinator along with a completed DETAILED narrative, site plan (PDF file) and vicinity map (same items expected in the application package
of the project location. Please include this form in the application package.
• Asheville Region -Alison Davidson 828-296.4698;alison.davidson(a,ncdenr.gov
• Fayetteville or Raleigh Region -David Lee 919-791.4203; david.lee(g ncdenr.gov
• Mooresville & -Patrick Grogan 704-663-3772 or patrick.gropan(a)ncdenr.pov
• Washington Region -Lyn Hardison 252-946.9215 or lyn.hardison(a)ncdenr.gov
• Wilmington Region -Janet Russell 910-350.2004 or janet.rusself(a.ncdenr.gov
NOTE: Project application received after 12 noon will be stamped in the following work day
Project Name: DR MICHAEL SUE, MD OFFICE County: PASOUOTANK
Applicant: DR. MICHAEL SUE Company:
Permits of request
SW
SW
SW
SW
SW
Address: 1134 NORTH ROAD ST., SUITE 8 City: ELIZABETH CITY, State: NC Zip: 27909-_ C '1 " (� LI
Phone: [phone]. Fax: _ _ y Email: [e-mail] v T
Physical Location:270 NORTHSIDE PARK DRIVE, ELIZABETH CITY - ADJACENT TO NCSECU
Project Drains into KNOBBS CREEK waters — Water classification C SW (for classification see-http://h2o.enr.state,nc.us/bims/reports/reportsWB.html)
Project Located in PASOUOTANK River Basin. Is project draining to class ORW waters? YIN , within '/: mile and draining to class SA waters YIN or within 1
mile and draining to class HOW waters? Y/N EXPRESS
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Engineer/Consultant: MICHAEL MORWAY Company: ALBEMARLE & ASSOCIATES !EXPRESS
Address: PO BOX 3989 City: KIL DEVIL HILLS, State: NC Zip: 27948-_
Phone: [phone], Fax: [phone], Email: [e-mail] JAN 21 2011
SECTION ONE: REQUESTING A SCOPING MEETING ONLY EEC DENR
❑ Scoping Meeting ONLY ❑ DWO, ❑ DCM, ❑ DLR, ❑ OTHER:
SECTION TWO: CHECK ONLY THE PROGRAM (S) YOU ARE REQUESTING FOR EXPRESS PERMITTING
❑ 401 Unit ❑ Stream Origin Determination: _ # of stream calls — Please attach TOPO map marking the areas in questions
❑ Intermittent/Perennial Determination: _ # of stream calls — Please attach TOPO map marking the areas in questions
❑ 401 Water Quality Certification ❑ Isolated Weiland ( linear ft o r acres)
❑ Riparian Buffer Authorization ❑ Minor Variance ❑ Major General Variance
® State Stormwater ❑ General ❑ SFR, ❑ SFR < 1 ac. ❑Bkhd & Bt Rmp, ❑ Clear & Grub, ❑ Utility ❑ Other
❑ Low Density ❑ Low Density -Curb & Gutter _ It Curb Outlet Swales ❑ Off -site [SW _ (Provide permit #)j
® High Density -Detention Pond 1 # Treatment Systems ❑ High Density -Infiltration _ #Treatment Systems
❑ High Density -Bio-Retention _ # Treatment Systems ❑ High Density —SW Wetlands — # Treatment Systems
❑ High Density -Other _ # Treatment Systems / ❑ MOD:❑ Major ❑ Minor ❑ Plan Revision ❑ Redev. Exclusion SW (Provide permit#)
❑ Coastal Management ❑ Excavation & Fill ❑ Bridges & Culverts ❑ Structures Information
❑ Upland Development ❑ Marina Development ❑ Urban Waterfront
® Land Quality ® Erosion and Sedimentation Control Plan with 1_8 acres to be disturbed.(CK # n—� (for DENR use))
SECTION THREE — PLEASE CHECK ALL THAT IS APPLICABLE TO YOUR PROJECT (for both scoping and express meeting request)
Wetlands on Site ❑ Yes ❑ No Buffer Impacts: ❑ No ❑ YES: ac re(s)
Wetlands Delineation has been completed: ❑ Yes ❑ No Isolated wetland on Property ❑ Yes ❑ No
US ACOE Approval of Delineation completed: ❑ Yes ❑ No 404 Application in Process w/ US ACOE: ❑ Yes ❑ No Permit
Received from US ACOE ❑ Yes ❑ No
For DENR use mdv
Fee Split for multiple permits: (Check# %G,SG ) Total Fee Amount S 4000
SUBMITTAL DATES
Fee
I
I SUBMITTAL DATES
Fee
CAMA
$
Variance (❑ Maj; ❑ Min)
$
Sw (® HD, ❑ LID, ❑ Gen)
$ 0Z)
401,
$
LQS
$ CZ)
Stream Deter—
$
NCDENR EXPRESS March 2009