WQG100006_Accessory Dwelling Units GP Application_20200626

Accessory Dwelling GP Form
State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
ACCESSORY DWELLING UNITS GENEP—A-L PERIIII APPLICATIO
Dlvlslon of Water Resources IVQG 12-19 & SUPPORTING DOCUME.NI ATIO
I. APPLICATION INFORMATION
1. Applicant's name:* Deonto McCormick
2. Applicant type:* r Homeowner r Authorized
Representative
3. Homeowner's name(s):*
Deonto McCormick
Homeowner's mailing address:*
Street Address
1106 Scout Drive
Address Line 2
City
State / Rovince / Fbgion
Durham
NC
Fbstal / Zip Code
Country
27707-1840
us
Homeowner's contact information:
Phone Number:* Email Address*
[phone] [e-mail]
(xxx)xxx-xxxx
II. PROJECT INFORMATION
r Other
1. Application/Project Status:*
r Proposed (new Certificate of Coverage)
r Existing Permit/Project (Certificate of Coverage previously issued for this address)
2. County where 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
1106 Scout Drive
Address Line 2
City State / Rovince / Fbgion
Durham NC
Fbstal / Zip Code Country
27707-1840 us

Latitude: 35.9832844 Longitude:-78.90519739999999
4. Parcel ID (if applicable):* 118443
(or parcel ID to closest dow nstream sew 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: 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
r Other (please describe below, and attach additional information as necessary)
2a. Comments:
2a. File Upload IDFonly
4. Describe the size of the primary residence and ADU/ARB:
Number of bedrooms*
Size of the Primary Residence
Size of ADU/ARB
Total Daily Flow a*
120
(120 gallons/day per bedroom no. of bedroorrs)
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 C.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 Recorded deed for McCormick - with restriction.pdf 697.49KB
Upload:* PDFpnly
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 021, the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains (latest version), and
the Gravity Sewer Minimum 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 gravity sewer?*
r Yes r 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 r No
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,*
Deonto McCormick
(Signature Authority's name from Application Item1.3.)
attest that this application for the primary residence and ADU/ARB located at
1106 Scout Dr, Durham, NC 27707
(parcel address or latkude/longkude)
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 wl►o 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:
Submission Date: 6/26/2020
filled out autocratically

Initial Review Form
Does this application meet the requirement to issue a COC?*
r Yes
r No
ID#:* WQG100006
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: 6/29/2020

Book8986 - Page 595 Page 1 of 3
For Registration Sharon A, Davis
Register of Deeds
Durham County, NC
Electronically Recorded
2020 Jun 26 09:31 AM
Book: 8986 Page:595
NC Rev Stamp: $ 0.00 Fee: $ 26.00
Instrument Number: 2020024683
DEED
NORTH CAROLINA GENERAL ,WARRANTY DEED
Excise Tax: $0
REID:118443
Mail/Box to: Grantee at address shown below
i
This instrument was prepared by: Hatch, Little & Bunn LLP (without benefit of title examination or tax advice)
Brief description for the Index: Lot 5 Block 1, New Hope Realty Company Property
THIS DEED made this 251' day of June, 2020 by and between
GRANTOR I GRANTEE
Deonto Ant -wain McCormick, unmarried I Deonto Antwain McCormick, unmarried
1106 Scout Drive
Durham, NC 27707
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 DURHAM County, North Carolina and more particularly described as follows:
See Legal Description marked as EXHIBIT A attached hereto and made a part hereof.
*The purpose of this deed is subject this property to the following restriction to run with the land in
perpetuity:
This Property is hereby restricted in perpetuity from subdivision in any form that would result in the
separation of Primary Residence and the ADU/ARB to discrete parcels.
submitted electronically by "Hatch Little and Bunn LLP"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Durham county Register of Deeds.

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:
Restrictions, easements, rights of way of record, and assessments, pending or otherwise
Ad valorem taxes for the current and future years.
IN WITNESS WHEREOF, the Grantor has duly executed the foregoing as of the day and year first above written.
Deon o ntwain McCormick
STATE OF NORTH CAROLINA
COUNTY OF WAKE
I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or
she voluntarily signed the foregoing document for the purpose stated therein and in the capacity indicated:
Deonto Antwain McCormick, unmarried
Date:J�
My Commission expires:
OfficiAf Signature of Notary
e4'44C 14• Cpt-"u
Printed Name of Notary Public
JANIES A. OLIVER
NOTARY PUELI� ]2022
�,VAKE COIiNTY,
{Vly Commission Expires 11-1

m
EXMBYT A
Being all of Lot 5, Block 1 of the New Hope Realty Property Company, as shown in Plat Book
5, Page 88, in the Office of the Register of Deeds of Durham County, to which reference is
made for a full and completed description. Said lot being on the west side of Park Drive
between Umstead Street adn Enterprise Street, said lot having a frontage of 50 feet and
running backa distance of 183 feet., See deed from New Hope Realty Company to Connie
Hester, dated May 21, 1919, and recorded in Deed Book 51, Page 555. See deed from Citizens
Investment Company to D. C. Upchurch, dated April 17, 1937, and recorded in the Office of the
Register of Deeds of Durham County in Deed Book 76, Page 505,