WQG100001_Accessory Dwelling Units GP Application_20200611

Accessory Dwelling GP Form
State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
ACCESSORY DNA-ELLLNG UNITS GENEP—A-L PERILII APPLICATIOti
Division of Water Resources IVQG 12-19 & SUPPORTING DOCUIIE.NIATIOti
I. APPLICATION INFORMATION
1. Applicant's name:* Gail Crabtree
2. Applicant type:* r Homeowner r: Authorized r Other
Representative
a. If Authorized Representative or Other is selected above, please complete the below information AND attach the "Agent
Authorization" form (required):
Authorized Representative's Gail Crabtree
name:
Title/Company:* Owner/G Crabtree Spaces, LLC
Relationship to Homeowner:* General Contractor
Representative's mailing
address:*
Street Address
1509 Tyler Court
Address Line 2
City
State / Frovince / tbgion
Durham
NC
Fbstal / Zip Code
Country
27701
us
Applicant's contact information:
Phone Number* Email Address*
[phone] [e-mail]
(xxx) xxx-xxxx
authorization upload:*
1001 Agent Form img431.pdf 1.1 MB
FDF only
3. Homeowner's name(s):* Michael A. Gillespie Trustee
Homeowner's mailing address:*

Street Address
81 Beverly Drive
Address Line 2
City
State / Frovince / Rion
Durham
NC
Fbstal / Zip Code
Country
27707-2223
US
Homeowner's contact information:
Phone Number:* Email Address*
[phone] [e-mail]
(xxx)xxx-xxxx
II. PROJECT INFORMATION
1. Application/Project Status:*
* Proposed (new Certificate of Coverage)
* Existing Permit/Project (Certificate of Coverage previously issued for this address)
2. Countywhere project is Durham
located:*
*** If the primary residence is existing please provide the address. If the primary residence is new construction, please
either provide the address OR provide the latitude and longitude of the parcel.
3. Address of project primary residence:
Street Address
1001 Urban Street
Address Line 2
city
Durham
Fbstal / Zip Code
27701-1530
Latitude: 36.0084569
State / Ftovince / Rion
NC
Country
US
Longitude:-78.9084357
4. Parcel ID (if applicable):* 102181
(or parcel ID to closest downstreamsew er)
III. GENERAL REQUIREMENTS
1. Is the primary residence, as defined in the General Permit definitions, existing or proposed?*
r Existing (please complete Item 2 below)
* Proposed (please complete Item 3 below)
2. If the primary residence is existing, please provide a description of the current sewer service below (select
one):
* Gravity sewer service of 4-inches in diameter or greater
r Gravity sewer service of 3-inches in diameter
* Pump station with force main between 1.25 — 3-inches, tying into a non -pressurized sewer main
* Other (please describe below, and attach additional information as necessary)
2. Comments:
2. File Upload: pdf only

2a. Please provide a description of the new sewer service for the ADU/ARB below — note that the ADU/ARB may
be an existing building to which a sewer service is being added (select one):*
(-- Gravity sewer service of 4-inches in diameter or greater
C Pump station with force main between 1.25 — 3-inches, tying into an existing, non -pressurized primary residential sewer
Other (please describe below, and attach additional information as necessary)
2a. Comments:
2a. File Upload FDFonly
4. Describe the size of the primary residence and ADU/ARB:
Number of bedrooms* Total Daily Flow a*
Size of the Primary Residence 3 360
(120 gallons/day per bedroom no. of bedrooms)
Size of ADU/ARB 2 240
(120 gallons/day per bedroom no. of bedrooms)
a. See 15A NCAC 02T.0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per dwelling; proposed
unknown non-residential development uses; public access facilities located near high public use areas; and residential property located
south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4).
b. If the primary residence is a duplex structure, please include the total number of bedrooms for the entire building.
V. CERTIFICATION STATEMENTS:
1. Is the primary residence a single family or duplex structure?*
r Yes
(- No
2. The parcel on which both the primary residence and the ADU/ARB are located is deed restricted in perpetuity
from subdivision of the parcel in any form that would result in the separation of the primary residence and the
ADU/ARB to discrete parcels. A copy of the completed and filed deed with included restriction or a copy of the
complete and separately filed deed restriction must be uploaded for this application to be complete. Deeds
which are unsigned/not filed or do not include the restriction will not be accepted.*
�' Yes
No
Deed\Deed Restriction Gillespie_ 202006111018_Deed_20200611.pdf 103.82KB
Upload:* FDFOnly
3. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump
Stations and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as
applicable?*
c' Yes c' No
(-- N/A (primary residence is existing)
Links to 15A NCAC 02T, the Mnimum Design Criteria for the Permitting of Pump Stations and Force Mains (latest version), and
the Gravity Sewer Mnimum Design 0iteria (latest version).
4. Is either the primary residence or the ADU/ARB served by a pump station/force main, with the other structure
served by a gravity sewer? *
C Yes C No
r NW (both are gravity)
5. Is the tie-in from the ADU/ARB's new sewer line to the primary residence's existing sewer located outside of
the existing primary residence's basement or crawl space, and is not located under the foundation?*
( Yes C No
C NW (all new construction)

6. Is the tie-in from the ADU/ARB's new sewer line to the primary residence's existing sewer located as far as
practicable from the existing building and from any natural features such as streams, ponds, or wetlands; and as
far as possible from any other utilities, including wells used for irrigation or drinking water? *
6' Yes r' No
r' NW (all new construction)
If the answers to any of the above statements is "No," this project is ineligible for coverage under this General Permit, and must
proceed through either the Fast Track or standard sewer permitting processes.
Applicant's Certification per 15A NCAC 02T .0106(b): I, *
Gail Crabtree
(Signature Authority's narre from Application Item1.3.)
attest that this application for the primary residence and ADU/ARB located at
1001 Urban Street Durham, NC 27701
(parcel address or latitude/longitude)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting documentation and attachments are not included, this application package
is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -discharge system to surface waters
or the land will result in an immediate enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I
will make no claim against the Division of Water Resources should a condition of this permit be violated I also understand that if all
required parts of this application package are not completed and that if all required supporting information and attachments are not
included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.61% any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, wbich may include a fine not to exceed
$10,000 as well as civil penalties up to $25,000 per violation.
Signature:
17zlr
Submission Date: 6/11/2020
filled out automatically

Initial Review Form
Does this application meet the requirement to issue a COC?*
r Yes
r No
ID#:* WQG100001
rJ All information in BIMS has been filled out.
Reject Email Comments
Please put in comments that need to be added to the email sent out.
Reviewer: Fertenbaugh, Christyn L
Reviewer Email: [e-mail]
Review Date: 6/11/2020

Please note that multiple forms may be necessary if there are more than two owners of the property.
PROPERTY LEGAL DESCRIPTION:
STREET ADDRESS OF EXISTING HOME or LATITUDE/LONGITUDE OF NEW CONSTRUCTION:
1001 Urban Street
Durham. NC 27701
Parcel ID:
102181
Property Owner Name(s) — please print:
Property owner: Michael A Gillespie Trustee
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Gail Crabtree of G Crabtree Spaces, LLC
(Contractor/Agent) (Name of company)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached,
Property Owners Mailing Address (if different than property address above):
81 Beverly Drive, Durham, NC 27707
81 Beverly Drive, Durham, NC 27707
Property Owner(s) Telephone
919-604-6693
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Dat
A /
Authorized Signature
Date

Book8971 - Page 149 Page 1 of 2
For Registration Sharon A. Davis
Register of Deeds
Durham County, NC
Electronically Recorded
2020 Jun 11 10:42 AM
Book: 8971 Page:149
NC Rev Stamp: $ 0.00 Fee: $ 26.00
Instrument Number: 2020022063
DEED
NORTH CAROLINA GENERAL WARRANTY DEED
Excise Tax: 0.00 Parcel Identifier No: 102181
Prepared By: Lance A. Wootton
Return to : Grantee
The property transferred herein ❑ includes IN does not include the primary residence of the grantor.
THIS DEED made this 10 day of June, 2020, by and between:
GRANTOR GRANTEE
Michael A. Gillespie, as Trustee of the Michael A. Michael A. Gillespie, as Trustee of the Michael A.
Gillespie Revocable Trust u/a 5/22/2001, as amended Gillespie Revocable Trust u/a 5/22/2001, as
amended
1001 Urban Ave., Durham, NC 27701
1001 Urban Ave., Durham, NC 27701
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 situated in the State of North Carolina, more particularly described as
follows:
BEING all of Lot 16 in Block B of the B.L. Duke North Durham Property, as per plat and survey thereof now
on file in the Office of the Durham County Register of Deeds, Plat Book 5, Page 102, to which reference is
hereby made for a more particular description of same.
1
submitted electronically by "Lance A. Wootton Attorney"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Durham county Register of Deeds.

The Property hereinabove described was acquired by Grantor by instrument recorded in Book 9693 at Page 157.
A map showing the above described property is recorded in Plat Book 5, Page 102.
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 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 except for the exceptions
hereinafter stated. Title to the property hereinabove described is subject to the following exceptions:
This lot shall not be subdivided and shall adhere to any applicable zoning and subdivision regulations. Said
subdivision restriction shall run with the land and be binding upon all heirs, successors and assigns.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has caused
this instrument to be signed in its corporate name by its duly authorized officers and its seal to be
hereunto affixed by authority of its Board of Directors, the day and year first above written.
IN TESTIMONY WHEREOF, the said Grantor has hereunto set his hand and seal, the day and year
shown in notary acknowledgment. .N
t (SEAL)
Michael A. Gillespie, as Trustee of the Michael A.
Gillespie Revocable Trust u/a 5.22.2001, as amended
(SEAL)
(SEAL)
(SEAL)
State of Vde ll, Cer— t; a. l County of 10 L4 ✓ k q ,,,
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he
or she signed the foregoing document: Michael A. Gillespie, as Trustee of the Michael A. Gillespie Revocable
Trust u/a 5.22.2001, as amended. Witness my hand and official stamp or seal this 11 day of June, 2020.
My Commission Expires: Cs — Z I
(SEAL - STAMP)
JOANNE ABEL
NOTARY PU LIC
DURHAM COUNTY, NC
2
J
Notary Public