WQG100007_Accessory Dwelling Units GP Application_20200708

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:* Josh Scala
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 Josh Scala
name:
Title/Company:* Owner/ GreenSource Construction
Relationship to Homeowner:* contractor
Representative's mailing
address:*
Street Address
204 Craggy Street
Address Line 2
City
State / Frovince / Plegion
Black Mountain
NC
Fbstal / Zip Code
Country
28711
BUNCOMBE
Applicant's contact information:
Phone Number* Email Address*
[phone] [e-mail]
(xxx) xxx-xxxx
authorization upload:*
pdf .pdf 3.71 MB
FDF only
3. Homeowner's name(s):* Preston Maultsby
Homeowner's mailing address:*

Street Address
3 Upland Road
Address Line 2
City
Asheville
Fbstal / Zip Code
28804-2724
Homeowner's contact information:
Phone Number:*
[phone]
(xxx)xxx-xxxx
II. PROJECT INFORMATION
State / Frovince / Rion
NC
Country
Us
Email Address*
[e-mail]
1. Application/Project Status:*
* Proposed (new Certificate of Coverage)
* Existing Permit/Project (Certificate of Coverage previously issued for this address)
2. Countywhere project is Buncombe
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
3 Upland Road
Address Line 2
city
Asheville
Fbstal / Zip Code
28804-2724
Latitude: 35.6350941
4. Parcel ID (if applicable):*
State / Ftovince / Rion
NC
Country
Us
Longitude:-82.53403519999999
9750-041706
(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
r No
Deed\Deed Restriction Maultsby recorded Restrictive Agreement Book 5918, Page
104.56KB
Upload:*
919.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?*
'Yes rNo
r N/A (primary residence is existing)
I inks 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 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? *
C Yes C No
�' 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,*
Josh Scala
(Signature Authority's narre from Application Item1.3.)
attest that this application for the primary residence and ADU/ARB located at
3 Upland Rd Asheville NC 28804
(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:
,7 5WVA- 5CAL A -
Submission Date: 7/8/2020
filled out automatically

Initial Review Form
Does this application meet the requirement to issue a COC?*
r Yes
r No
ID#:* WQG100007
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: 7/8/2020

0ANN.-F,RCS AFFIDAVIT
before a they are the
The persons listed below do herebY 3PPM Public and swear Or 3ffirl" that
legal owners of the p"4x:rty 1(=tcd at: N e- -'9 v
e k Q 0 'L '; 'I -e
PIN q /7 6 (o
I'hc persons jisteij below do hereby give authorization acts] permission to
CC -
(_Name of RepresentativdAgmt) (Namc of Ofganizafi'un)
to -mbinit to the City of Asheville the following roqumt for the above referenced PfOPert)r-
Rezonino. 13 planning Rntilkownt
C, Subdivision RcN'icW
conditio" Zoningn Oradiog And aosioac()tArol Permit%
Conditional Use Permit&PMpriateness x"Ruilding K"rI3)dfor iI$
-major WCWk Ccrtificate Of requited the compIction of Work
ri All applications, drawings, andSUPP'ernenLal 'nf($.Tnat"Dn r
ef oper(Y: including but rwc tin)ked to entitlement
with the development of the above r - erenceA pt
rL,view, 1aAd disurisan;e wdvitics and building perwiU,
The Persons listed b0ow also consem to all owditions andtor stiPubtions dwE may be imposed or
adopted by the City of Asbefille, as Part of d= PCtiti0n/2PPl!wIio0 3PPmvaL
43M.. I Si turc Bate
13
AROLINA
��TATE: OF NORTH r
AaLwYJ� COUNUY
i
On tilt -L day of k(p, -tod above personally appeared befoft ram. who
2() ft, the pmon(s) lis
ed that Wshe executed the see and beingsw(,rn
"vecuted the foreong documcm.and each acknow1o4
in
oNf>ub �v e oath c stateme the foregoin document are truAc4
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f>ubljc
blic
Printod Narm:
Fxpirc$:
HERIBERTO GUERRA GOMEZ
Notary Public
Buncombe Co., North Carolina
My Commission Expires June 17, 2024

Type: CONSOLIDATED REAL PROPERTY
Recorded: 7/6/2020 11:04:56 AM
Fee Amt: $26.00 Page 1 of 1
Buncombe County, NC
Drew Reisinger Register of Deeds
BK 5918 PG 919
RESTRICTIVE AGREEMENT
111,111 Ili iiiiFiiii MUMEMM=
THIS RESTRICTIVE AGREEMENT is made and entered into this the 6th day of July, 2020 (the
"Date"), by and between Ronald P. Maultsby, unmarried, and Marlee L. Maultsby, unmarried, hereinafter
collectively referred to as "Maultsby", and all future purchasers and owners of the Property defined
ei-t.
man iin. p.11 .. . . � - . .. . . - - IiiIi MM29MEMM
GM14 6
i,;urjLl %-drululd Aegibuy k1lertunduer L
aid
TI'AEREAS, a smigle-family residence (hereinafter "Sli is located on the Property and Maultsby
is constructing an accessory dwelling unit (hereinafter the "ADU") on the Property in addition to the SFR
that is already located on the Property; and
WHEREAS, Maultsby desires, for the benefit of the Property and for the benefit of the present
and future owners of the Property that the Property be developed and used exclusively as hereinaftcr set
forli
NOW, THEREFORE, in consideration of the premises and for the benefits which Maultsby a
and their successors, and hereby restricts the Property as follows:
1. No Division of the Property. The Property shall not be subdivided in any form that
would result in the separation of the SF R and the AU in to separate and different parcels.
In Witness Whereof, the parties hereto have caused the due execution of the foregoing.
�—A
AL) S,
L) EAL)
Ronald P. Maultsby" Marlee L. Maultsby
STATE OF NORTH CAROLINA - COUNTY OF BUNCOMBE
1, a Notary Public of said County and State, certify that Ronald P. Maultsby and Marlee L.
Maultsby, personally appeared before me this 6th day of July, 2020 and acknowledged the execution of
the foregoing instrument for the purposes expressed therein.
C, MAFI
%L
9;mi; Sio es.- 03-13-2024
XP
OTARY Notary P�blic
Print Name: Mark C. Martin
.6
V zl
9E 091 % 4"4f ami
Submitted electronically by "Patla, Straus, Robinson & Moore, PA"
in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Buncombe county Register of Deeds.
Book:5918 Page:919 Page 1 of 1