WQG100002_Accessory Dwelling Units GP Application_20200613

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:* Brian Oschwald
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 Brian Oschwald
name:
Title/Com an *
p Y�
Relationship to Homeowner:*
Representative's mailing
address:*
Street Address
1 Glenwood Avenue
Address Line 2
Suite 600
City
Raleigh
Fbstal / Zip Code
27603
Applicant's contact information:
Phone Number*
[phone]
(xxx)xxx-xxxx
Agent authorization upload:*
AGENT-AUTFfFORM.PDF
FDF only
3. Homeowner's name(s):*
Homeowner's mailing address:*
Project Manager, formerly at SEPI
Client
State / Rovince / F-egion
NC
Country
USA
Email Address*
[e-mail]
Dr. Gail Belvett
111.3KB

Street Address
2014 Ashe Street
Address Line 2
City
State / Frovince / Pegion
Durham
NC
Fbstal / Zip Code
Country
27703
USA
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
2014 Ashe Street
Address Line 2
City State / Frovince / Region
Durham NC
Fbstal / Zip Code Country
27703-4122 USA
Latitude: 35.9829458 Longitude:-78.8786243
4. Parcel ID (if applicable):* 112486
(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):
r Gravity sewer service of 4-inches in diameter or greater
r Gravity sewer service of 3-inches in diameter
r Pump station with force main between 1.25 — 3-inches, tying into a non -pressurized sewer main
r Other (please describe below, and attach additional information as necessary)
2. Comments:

2. File Upload: SumpPump_FM_Layout.pdf 14.94KB
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):*
r Gravity sewer service of 4-inches in diameter or greater
r 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*
Size of the Primary Residence 3
Size of ADU/ARB
Total Daily Flow a*
360
(120 gallons/day per bedroom no. of bedrooms)
120
(120 gallons/day per bedroom no. of bedroorrs)
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
r 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 anyform 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.*
r Yes
r No
Deed\Deed Restriction 419688 - 1 - Belvett - Recorded Deed - General Business
Upload: * 129.87KB
Matters.PDF
FDF Only
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?*
r Yes r No
r N/A (primary residence is existing)
Tanks to 15A NCAC 02T, the NTudmurn Design Criteria for the Permitting of Pump Stations and Force Mains (latest version), and
the Gravity Sewer Mnimum Design Criteria (latest version).
4. Is either the primary residence or the ADU/ARB served by a pump station/force main, with the other structure
served bya gravitysewer?*
r Yes 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 No
r 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? *
r Yes c' No
c' 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, *
Brian Oschwald
(Signature Authority's narre from Application Item 1.3.)
attest that this application for the primary residence and ADU/ARB located at
2014 Ashe Street, Durham, NC 27703
(parcel address or latitudeilongitude)
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 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed
$10,000 as well as civil penalties up to $25,000 per violation.
Signature:
&1r 0410Al
Submission Date: 6/13/2020
filled out autocratically

Initial Review Form
Does this application meet the requirement to issue a COC?*
r Yes
r No
D#: * WQG 100002
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: Litzenberger, Kristin S
Reviewer Email: Kristin. [e-mail]
Review Date: 6/16/2020

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AGENT AUTHORIZATION FORM
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:
2014 Ashe Street
Durham, NC 27703
Parcel ID: 112486
Property Owner Name(s) — please print:
Property Owner:
Property Owner:
Gail Belvett
n/a
The undersigned, registered property owners of the above noted property, do herebyauthorize
Brian J.P. Oschwald, PE of SEPI Inc.
(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):
same as above
same as above
Property Owner(s) Telephone: [phone]
We hereby certify that the above information submitted in this application is true and accurate to the
best of our knowledge.
A15thorized Signature Authorized Signature
2/10/2020
Date
Date

Book8971 - Page 19 Page 1 of 3
For Registration Sharon A
Register of Deeds
Durham County, NC
Electronically Recorded
2020 Jun 11 09:54 AM
Book: 8971 Page
NC Rev Stamp: $ 0.00
Davis
19
Fee: $ 26.00
Instrument Number: 2020022040
DEED
NORTH CAROLINA NON WARRANTY DEED
Excise Tax: $ N/A
Parcel Identifier No 112486 Verified by County on the day of '2020
By:
Mail/Box to: Grantee
This instrument was prepared by: Kennon Craver, PLLC (without benefit of title examination)
Brief description for the Index: : Plat Book 2 Page 44 / Plat Book 29 Page 171
THIS DEED made this iI day of J G11 r') � , 2020, by and between
GRANTOR
Gail Belvett
Address:
2014 Ashe Street
Durham, NC 27703
Gail Belvett
Address:
2014 Ashe Street
Durham, NC 27703
GRANTEE
Enter in appropriate block for each Grantor and Grantee: name, mailing address, and, if appropriate, character of
entity, e.g. corporation or partnership.
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 parcel of land located in the Durham County, North Carolina and more particularly described as follows:
See Exhibit A attached hereto and incorporated herein
submitted electronically by "Kennon Craver, PLLC"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Durham County Register of Deeds.

The purpose of this North Carolina Non -Warranty Deed is to add the following Restriction:
The Primary Residence and the ADU/ARB (as defined in The Durham Unified Development Ordinance) cannot be
subdivided such that the Primary Residence and the ADU/ARB are on discrete panels in perpetuity.
All or a portion of the property herein conveyed does include the primary residence of a Grantor.
TO HAVE AND TO HOLD the said lands, together with all improvements, privileges and appurtenances thereunto
belonging to the Grantee, in fee simple
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above
written.
Gal Belvett (SEAL)
STATE OF NORTH t_._HR064A
COUNTY OF IJ uRHAM
I certify that the following persons personally appeared before me this day, each acknowledging to me that he or she
voluntarily signed the foregoing document: Gail Belvett
Date: I o 2.0
[Official Seal]
,-g AWA }.\
Pl) av
® I cc�V
Notary Public
Print Name: SAM SAWAM
My commission expires:07 2.q- 2.DZ4

EXHIBIT A
IM ONE
BEGINNING at a stake on the south side of Old Angier Avenue at the northwest coiner of D. B.
Boone's Horne Place (formerly owned by Holland Holton); thence along the west line of D. B.
Boone Home Place lot South 23° 35' West 156.5 feet to a stake; thence North 63' 46' West 4,211
feet to a stake; thence North 19°' 16 East 150.6 feet to a stake in the south side of Old Angier
Avenue; thence along and with the south side of Old Angier Avenue South 71 ° 24' East 54.25 feet
to a stake, the point of beginning. Reference is hereby suade to flat of the D. B. BOONE ROME
PLACE property recorded in Plat Book 2 at page 44, Durhann County Registry. For iiuther referectce
see Deed Book 52 at page 89, Durhai n Comity Registry. See also flat Book 2 at page 44, Durham
County Registry.
3A T TWO
DE GINNING at a stake in the property line on the south side of Ashe Strcet (forruerly known as Old
Angier Avenue) and being South 72' 39 East 315.90 feet from the property line on the east side of
Clay Street and being the northwest corner of Mr. Blanche Boonne's lot; running thence South 18 °
10' West 166.3 feet to a stake; running thence North 78" .04' West 13.1 feet to u stake; running
thence South 22° 48' West 168.5 feet to a stake the point of place of begi itWg and being a triangular
strip of property cut from the west side of Mrs. Blanche Boozne's lot and bcung Lint No. 2, as per plat
recorded in PIat Book 29 at page 171, Durham County Registry.
Saving and excepting (as to both tracts) the property conveyed to the City of Dw'hami by deed
recorded in Deed Book 264 at page 1, Durham County Registry.
This property has street address 2014 Ashe Street.