WQG100004_Accessory Dwelling Units GP Application_20200622

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.NIATIO
I. APPLICATION INFORMATION
1. Applicant's name:* Jonathan Fish
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 Jonathan Fish
name:
Title/Com an *
p Y�
Relationship to Homeowner:*
Representative's mailing
address:*
Street Address
1109 Huntington Ave.
Address Line 2
City
Durham
Fbstal / Zip Code
27707
Applicant's contact information:
Phone Number*
[phone]
(xxx) xxx-xxxx
authorization upload:*
511KnoxAGENT-AUTH-FORM (1).PDF
FDF only
3. Homeowner's name(s):*
Homeowner's mailing address:*
Acanthus Construction, LLC
Contractor
State / Frovince / Pbegion
NC
Country
Durham
Email Address*
[e-mail]
Chelsea Groves
435.33KB

Street Address
511 W. Knox Street
Address Line 2
City
State / Frovince / Rion
Durham
NC
Fbstal / Zip Code
Country
27701
Durham
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
511 W. Knox St.
Address Line 2
city
Durham
Fbstal / Zip Code
27701
Latitude:
State / Ftovince / Rion
NC
Country
Durham
Longitude:
4. Parcel ID (if applicable):* 105499
(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:
New sewer from ADU to tie into existing sewer line down slope in front yard of existing house per the attached drawing
2a. File Upload Uncommon Upholstery Studio-AS01 NCDENRComments-
1.21 MB
200621.pdf
FDF only
4. Describe the size of the primary residence and ADU/ARB:
Number of bedrooms* Total Daily Flow a*
Size of the Primary Residence ; 360
(120 gallons/day per bedroom no. of bedroorrs)
Size of ADU/ARB 2 240
(120 gallons/day per bedroomx 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
c' 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
C No
Deed\Deed Restriction Groves Declartion - recorded.pdf
Upload:* FOF only
71.2 KB
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 Minimum 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 by a gravity sewer? *
r: Yes c' No
c' 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?*

r Yes r 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 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 15ANCAC 02T.0106(b): I,*
Jonathan Fish
(Signature Authority's narre from Application Item1.3.)
attest that this application for the primary residence and ADU/ARB located at
511 W. Knox St. 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 143-215.6B, 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:
C1AMz*1q.,V ;?a,
Submission Date: 6/22/2020
filled out autorretically

Initial Review Form
Does this application meet the requirement to issue a COC?*
r Yes
r No
D#: * WQG 100004
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: 6/22/2020

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Architectural Site Plan
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2 location map
site plan keynotes
1 - new concrete ramp up
2 - new chapel hill gravel path w/ steel landscape edging
3 - new split rail fence with pet screen and gates to match existing
4 - new condensing unit cassettes on 4" concrete pad
5 - new trench for domestic water service, electrical service, and 3/4" conduit for ethernet; coordinate service branch points from
inside existing home
6 - existing sewer clean out
7 - existing water meter
8 - new sanitary sewer line, connects to existing line north of main house
9 - existing sanitary sewer line
zoning notes
The design complies with the following pursuant to the Durham Unified Development Ordinance, Section 5.4.1 Accessory
Structures
A. An accessory structure shall be clearly subordinate to the primary structure in aspects of size and purpose.
B. Accessory structures shall be located as follows:
1. Accessory structures associated with a single-family or duplex structure shall be
located to the rear of the rear building line of the primary structure, with the
following limitations and exceptions:
b. Accessory structures in the RU and RC Districts shall be no closer than three
feet to the side and rear property lines.
D. The height of an accessory structure in residential areas shall comply with the following standards:
2. In the RU and RC districts, the height of an accessory structure shall not exceed
25 feet when the structure is within five feet of the property line.
Morgan Strider Haynes
701 W Trinity Ave #117
Durham, NC 27701
for permit 3/11/20
per it comments 4/13/20
NCDE R comments 6/21/20
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Site Plan
AS-01
SCALE: 1" = 20'

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:
511 W. Knox Street Durham, NC 27701
Parcel ID:
Property Owner Name(s) — please print:
Charles Groves
Property Owner:
Amanda Chelsea Groves
Property Owner:
The undersigned, registered property owners of the above noted property, do herebyauthorize
Jonathan Fish
(Contractor/Agent)
,of Acanthus Construction, LLC
(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):
Property Owner(s) Telephone: [phone]
We hereby certify that the above information submitted in this application is true and accurate to the
Authorized Signature
03/07/2020
Date
best of our knowledge.
Authorized Signature
03/07/2020
Date

REGISTER OF DEEDS
Sharon A. Davis
Durham County, NC
2020 Apr 24 03:21:34 P M
BK:8919 PG:362-363
DECLARATION
FEE: $26,00
INSTRUMENT # 2020013048
IIIIIIIIISTHO
11111,11111111111
Prepared by and return to Joseph W. Marion, 2741 University Dr.,'Durhara, NC 27707
NORTH CAROLINA DECLARATION OF
RESTRICTION OF PROPERTY
COUNTY OF DURHAM
The undersigned Owners ("Declarant") hereby certify and declare as follows:
1. We are the owners of property located in the City of Durham, North Carolina,
known as 511 W. Knox Street, Durham, NC 27701 (the "Property") and also
known as Durham County Tax Parcel # 105499, more particularly described on
the attached Exhibit A, which is incorporated herein by reference.
2. In connection with the proposed construction of an Accessory Structure ("AS")
on the Property, and complying with the permitting of said construction of the
AS with the City of Durham, the Property (on which our primary residence is
located, and on which the AS will be located) is hereby restricted in perpetuity
from subdivision in any form that would result in the separation of the primary
residence and the AS to discrete parcels.
3. Upon recording of this Declaration, the terms and conditions herein shall
completely and conclusively govern the ownership, use and occupancy of the
Property relative to the subject matter herein.
4. The restriction set forth herein is a restriction appurtenant, running with the:
land, perpetually in full force and effect, and at all times shall inure to the
benefit of and be binding on the Declarant, their successors and assigns, and
any Owner, purchaser, mortgagee, and other person or entity now or hereafter
having an interest in the Property.

IN WITNESS WHEREOF, the undersigned have set their hands and seals, this the
day of April, 2020.
(SEAL)
Charles William Groves
dW401A A6�icM
SEAL)
Amanda Chelsea Groves
NORTH CAROLINA
COUNTY OF ALAMANCE
Charles William Groves
Sworn and subscribed by and Amanda Chelsea Groves , before me, a Notary
Public, this the 22nd day of April ,aVJP . Further, I,
Maria Ann sconzo . a notary public of the above county and state, hereby
certify that Charles William Groves and Amanda Chelsea Grovespersonally came
before me this day and acknowledged the due execution of this Declaration.
Maria Ann Sconzo Notary Pu 11C
My Commission Expires: 6/2/2023