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Home My WebLink AboutEHPR-05-2022-40970.TIF $4 � THIS IS NOTA PERMIT Case# EHPR-05-2022-40970 11-.Z t 111 CATAWBA COUNTY HEALTH DEPARTMENT , ,, �� PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 4 Environmental Health Plan Review-OSWP NEW WELL Owner JESSICA KISER,4611 KISER ISLAND RD,TERRELL NC 28682 C:7049898389 Paid By TRAVIS KISER,4611 KISER ISLAND RD,TERRELL NC 28682 NAME TO APPEAR ON PERMIT Jessica Kiser SITE ADDRESS: 4611 KISER ISLAND RD,TERRELL NC 28682 PIN# 461602563893 NAME of SUBDIVISION: B L KISER Lot# PT 21 Section/Block PROPERTY SIZE: Square Feet 25,700.40 Acres 0.59 DIRECTIONS: NC-150,right onto Kser Island Rd,go about 2 miles,home is on the right PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: New well,currently sharing well with 4603 Kiser Island Rd they are no longer willing to share the well SITE INFORMATION Do any of the following apply to the property for which this application is applied? If the answer to any of the questions below is"YES",then supporting documentation is required: Does this site contain any jurisdictional wetlands? No Does this site contain any existing wastewater systems? Yes Is any of the wastewater going to be generated on the site other than domestic sewage? No Is the site subject to approval by any other public agency? No Are there any easements or right-of-ways on this property? No APPLICATION FOR: Existing Structure STRUCTURE TYPE: PRIMARY RESIDENCE '"--_____..-_..e__..,_..._..__...___..._._....._..._.,...,.m FACILITY TYPE: House OTHER DESCRIPTION: DESCRIPTION OF EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION EMPLOYEES PER SHIFT: NUMBER OF SHIFTS: TOTAL EMPLOYEES: SEATING CAPACITY: TOTAL FLOOR SPACE(SQ FT): Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO elapplication 05/09/2022 13:05 Page I of 3 1 CATAWBA COUNTY Case# f• Public Health Department Subdivision B L KISER Environmental Health Division PIN# 461602563893 ErHPR-OS-2022-40970 PO Box 389,100-A Southwest Blvd,Newton,NC 28658 NAME ON PERMIT: (JESSICA KISER),4611 KISER ISLAND RD,TERRELL NC 28682 (Jessica Kiser) Site Address: 4611 KISER ISLAND RD,TERRELL NC 28682 Property Size: Square Feet 25,700.40 Acres 0.59 Directions: NC-150,right onto Kser Island Rd,go about 2 miles,home is on the right Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=60 months(5 years);with complete plat =without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes. Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the property or legal agent of the owner. Date„. /(2 � Signature of Applicant or Agent /� !' If you need further information or assistance please call 828-465-8270 AREAS FEENAME DATE FED AMOUNT Well Permit& Inspection Fee 05/09/2022 $300.00 TOTAL FEES,`i . . 3...; ,.. $300.00 l , , FEES ARE NON-REFUNDABLE ONCE A SITE VISIT IS MADE OR WORK ON A PLAN REVIEW HAS COMMENCED SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE (SEE FEE SCHEDULE) ehapplicatiuI 05/09/2022 13:05 Page 2 of 3 (a catawba county public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction 0 Existing Facility ❑ Improvement Permit 0 Authorization to Construct ❑ New Septic 0 Septic Septic Repair/Malfunction 0 Relocation P PP � ❑Septic Expansion 0 Existing System Inspection or Reconnection Da New Well El Replacement Well ❑ Weil Abandonment ❑Well Repair Property Address (u(1 14tie.c islanc-12(l -re vrelFi Nc $(p Z Acres w(cC Subdivision Lot# IL Driving Directions to Property On .f1e right g ide, o-F V,kfex k\nd abo.-4- 2 miles o n Describe work Old Wel' 1S oft a CAtiitr i1-k- 14-) \" e CA (a nc vj wtIl or our 1 G4- Applicant Name e c c 1 c Cl -1 ce1Q. Applicant Address (p l\ tcP v- (cloth a e �d `C 'ce 11, I\c, 2 21�V L Phone Q(4-q 8 _ p49q Cell Phone Li _ j —e3 Owner Name C c Ca \ Owner Address bit (q ty. 1c A Rot i yyt i t C, Phone 7()t,i -q q _'3t Gt Cell Phone Contractor Name License# Contractor Address Phone Cell Phone Name to Appear on Permit? Owner ❑Applicant ❑ Contractor Who will be the Primary Contact? fa Owner ❑Applicant ❑Contractor Proposed New Construction-Residential Primary Residence 02 New Residence ❑ Addition to Residence #of New Bedrooms*t 3 #of Occupants 3+ Project Description 1'.eeal N ew uue 1 I Structure Dimensions,also specify dimensions of decks&porches 1(e34 in h o od., 1100 W%l-h ()arch(dam V, Basement ❑Yes IN No Basement Plumbing 0 Yes IJ No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions Basement 0 Yes 0 No Basement Plumbing 0 Yes ❑ No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing 0 Yes ❑No Describe Plumbing Needed Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Structure Dimensions Basement 0 Yes 0 No Basement Plumbing ❑Yes 0 No Well£ozlStnietion/Abandonment/Repair Proposed Well Type 51 Individual Well 0 Semi-Public Well ❑Community Well Abandonment Type 0 Drilled ❑ Bored 0 Dug ❑ Unknown Well Repair Requested 0 Yes 0 No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? Yes 0 No cataw acountync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 1 Newton NC 28658 ( 828.465.8270 MAKING. LIVING. BETTER. • Existing Structures on Site Describe --4/,Il 566 f::;;,� 1Gz � Structure Dimensions #of Bedrooms* 3 #of Occupants 0 Basement 0 Yes f'No Basement Plumbing ❑Yes ❑'No Existing Water Supply 0 Individual Well (l Shared Well—Number of Connections 7, 0 Community Well ❑County/City/Township Water Line Is a public water supply available?** ❑ Yes El No 4e ..? l'i�'s .i /o?d J1 Commercial ❑Proposed New Construction ❑Existing/Change of Use El Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare 0 Yes El No #of Children #of Employees per Shift #of Shifts Commercial Kitchen 0 Yes ❑No Residential Kitchen ❑ Yes ❑ No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions --- Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in question. a answer to any question is"yes",applicant must attach supporting documentation. CI Yes Ifo Does the site contain any jurisdictional wetlands? i?''Yes 0 No Does the site contain any existing wastewater systems? ❑Yes Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes I l o Is the site subject to approval by any other public agency? ❑Yes lanNo Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑Accepted 0 Alternative 0 Conventional ❑Innovative 0 Other 0 Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit issuance- This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. **If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE) Completed applications are valid for a period of 2 years. Improvement Pei inits are valid:with complete site plan=60 months(5 years); with complete plat=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct,issued for septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/site plan changes or if the intended use for the proposed facility changes.Permits may be revoked if site conditions are altered such that they effect permit conditions or installation requirements. I have read this application and certify that the information provided herein is true,complete and correct. Authorized county and state officials are granted right of entry to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that I am solely responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation can be performed. The undersigned is the owner of the pro rty or legal agentCa/ -e of the owner. Signature of Owner or Legal Agent Pi{,� Date 11l2/ 7 7 Printed Name of Owner or Legal Agent (a • 7 Survey LEGEND ~.4 B • EXlSTINC CORNER AS DESCRIBED OR. DEED B OOOOK . 4 • 0 SET#5 REBAR MB. MAP am( LI.. ' ' \� t t Mrla•n O POINT OLE T CGF COMBINED GRID FACTOR d @2. $h 1 r • BOUNDARY AS SURVEYED 65 N Yaw So TIE UNE 6Z It - - BOUNDARY BY DEED OR PLAT Op�I,pO,p --------- EASEMENT <t3 \J -' -•-' -•-•--.-- SCALED FLOOD ZONE(SEE NOTE DVS) m U U OVERHEAD UTIUTY UNE W i TO MAP NOT SCALE --4'r-X-X-X-X-X-1t- FEN #1100.00,. TAX PARCEL NUMBER _,_ _.-. -- - ._._ - -- ' ; f-X t SHED I � t)x \+ r PIPE s,] L .+.D 1'PIPE N 87.21`48'E I,P� P l `. 95.32' X 1ST.BRICK 3 CANE • DWELLING . m af a, MICHAEL L. KISER God wife, r_ ROBIN S. KISER �' }' 0LOTS 19 & 20, MB. 13 PG. 19 �'l to DB. 2319 PG. 894 & 0 461602582879 - S 86'53'49' W n I g 40.54' �'' I.PIPE r PIPE - y' 1 \ SCALED LOCAT101V JACK L. RISER k wife, W \ OF FL000 ZONE X NAOMI B. KISER r •, SEE NOTE#5 LOT 21, MB. 13 PG. 19 1 EARL L. KISER !'1 \ OB, 1685 PG. 253 9¢ TRACT FIVE,46T6025B3693 `- DEL 3426 PG. 90 6 o \4' AC. • , 461602564860 'D SCALED LOCATION OF FLOOD ZONE AE \ �pp,O�l',3 BENT/4 REBAR SEE NOTE ►5 \ PORTION OF "1;L -- • 481604739313 TT'�F d4 REBAR '0 BE COMBINED WITH ,k' 461602563893 AC. EARL L. KISER cool wife, 11 CHERYL C. KISER 2, LOT 22 REVISED, qn' MB. 38 PG. 221 V �` 08. 1954 PG. 1212 POCK \ 461602584742 \ F4 REBAR i "i'NC GRID NAD 83(2011) I ,U,t Z \ EPOCH 2010.00 LAKE NORMAN ) N-668,716.74' !-'w ` ; E-1,415.361.36' 'm B. L. KISER ond wife, c� j ZULA CORNELIUS KISER TRACT NO. ONE, OB. 621 PG. 115 0 1 j NORTH CAROLINA GEODETIC TRACT NO. 1, DO 021 PG. 1.10 • SURVEY MONUMENT-OSPREY' 461604739313 _ (' NC GRID NAD 83(2011) PERMANENT EASEMENT TO00 .., lB5$8' DUKE POWER COMPANY I' / E-1,415,480.14' OB. 655 PG. 223 / CIF-0.99963562 REFERENCES: 1. ALL DEEDS AND MAPS SNOYM HEREON. NOTES: 2. MAP TITLED'PROPERTY OF B.L.(USER SUBDIVISION NO.3'BY J.C. 1. TRAVERSE ADJUSTED BY THE LEAST SQUARES ADJUSTMENT METHOD. GAMBLE; DATED FEB. 26.1966; MB. 13 PG. 19. 2. AREAS DETERMINED BY COORDINATE COMPUTATIONS. 3. MAP ITTPED'MAP 5 B.L.KISER LAKE PRO.'; MB. 13 PC.21. 3. ALL DISTAJICES ARE HORIZONTAL GROUND DISTANCES UNLESS OIHERWSE 4. MAP STIED'REVI51ON Or LOTS 21 sr 22 OF B. L.KISER SUBDIVISION NOTED. NO. 3'BY HILDERBRAN SURVEYING COMPANY: DATED JANUARY 19. 4. NO UNDERGROUND UTI UTIES WERE LOCATED INN THIS SURVEY. BEFORE 1995: MB. 36 PG. 221. OOND ANY DIGGING,CALL NC ONE-CALL(1-800-632-49A9). �.David L Haywood,Jr,certify that toll plot was drawn antler mywperllsbn 5. FLOOD ZONE DATA SCALED FROM FLOOD INSURANCE RATE MAP NUMBER 37104816001.; MAP REVISED MARCH 18,2008, from an actual survey made under ray supervision(Deed recorded fa DB. 1685 ZONE AZ-11I ANNUAL CHANCE F1000 VAIN BASE FLOOD ELEVATIONS p9.25,1 Map recorded In MB.13 pg. 19); that the boundaries not surveyed DETERMINED. are clearly Indicated as drown from Information found M deeds as shown: ZONE n- AREAS DETERMINED TO BE OUTSIDE THE 0.2%ANNUAL that the rotlo of preclelon as calculated is I;28,300; that thte mop meets CHANCE FI.O DPtAIN. the requirements of Tins Standards of Practice far Lord Surveying In North B. THIS SURVEY WAS PERFORMED 1WTNOUT THE BENEFIT OF A TILE REPORT, Carolina(21 NCAC 58.1600): and that the fallowing information was used to COMMITMENT OR OPINION. THERE MAY BE EASEMENTS OR OTHER MATTERS perform the CPS survey eetoblirhln9 the horizontal datum. NOT SHOWN THAT WERE NOT FOUND OR PROVIDED TO THE SURVEYOR. 1 Gass of mover. Horfzontd Class A RECOMBINATION 2 Horizontal -" 23MW7 poeltlonof accuracy. 0.07' 3 Type of CPS field procedure: Red Klnm-Urns eaUc(RIK)network Jack L. Kiser & Wit@, Naomi D. Kiser and 4)Dates of survey January 26. 2022 to January 27.2022 PROPERTY OF: B. L. Kiser and w)fe, Zula Cornelius Kiser 5)Datum/Epoch: NAD 83(2011)EPOCH 2O10.00 MOUNTAIN CREEK TOWNSHIP. CATAWBA COUNTY. NC B)Published/Fixed-control used, Redone'SpaUd Reference System - (NSRS)NC Network AIERICAN FINANCIAL NETWORK 7)Geoid Medal: GEg018 SURVEY FOR: B)Combined grid factor 0.991285582 SCAM ,w.- 50 exit: FEBRUARY 1 m 22 9)Unhtw US Survey 1t Jj.�p �ps�QP }Ny}-`/�1 $ !1'ct�A+ J��p W- r mess myy orglnd 6;1'1\'U� Y 6P IRGI. s , 1U1,l),day of , 0 1 1 February, 202Z ry CM - C.otecankol - Surveying CONVEYANCES OR SALES t",��{1 1°k' I 43 SARNO snrET sei CaNC0110( 71e-2404 :I.^. CO4C0110.NC 2102E FAX )7ee-74e4 KC.MY 11EDIS2 N0.C-0203 Dead L.Haywood,Jr.,PLS L-41522 8)cr'+zor: JOB NO.: 220066.000 'CAD nLE: ..� 2E0066-000,dw4� • Catawba County Environmental Health 1 O 2'1 19 N It) 285.00 aft 95.32 *4603 Erl A� 40,54 20 � g co •G}j 21 85.0 h r oo 22 G tr7 cs� � Parcel: 461602563893, 4611 KISER ISLAND RD 1in=50ft TERRELL, 28682 This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and ' personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 05/09/2022 Page 1 of 2 Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461602563893 Owner: KISER JESSICA CATE Parcel Address: 4611 KISER ISLAND RD Owner2: KISER TRAVIS RAY City: TERRELL, 28682 Address: 4611 KISER ISLAND RD LRK(REID): 19754 Address2: Deed Book/Page: 3723/1411 City: TERRELL Subdivision: B L KISER State/Zip: NC 28682-9770 Lots/Block: PT 21/ Last Sale: School Information: Plat Book/Page: 36/221 School District: COUNTY Legal: LOT PT 21 PT 21 PL36-221 KISER PL Elementary School: SHERRILLS FORD 36-221 Middle School: MILL CREEK Calculated Acreage: .590 High School: BANDYS Tax Map: 018FX 01106 School Map Township: MOUNTAIN CREEK State Road #: 1841 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $209,500 Zoning2: Land Value: $210,900 Zoning3: Assessed Total Value: $420,400 Zoning Overlay: CRC-O,WP-O,FPM-O Year Built/Remodeled: 1967/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2008-03-18 Building Permit Address Search for this parcel. Firm Panel #: 3710461600L If available, Building Permits for this parcel. 2010 Census Block: 5019 Septic links are not permits. 2010 Census Tract: 011504 Septic Final Permits prior to 08/2018, contact Agricultural District: Environmental Health. Building Details WaterShed: WS-IV Critical Area Voter Precinct: P41/Voting Map Parcel Report Data Descriptions List all Owners Deed History Report Assessment Report This map/report product was prepared from the Catawba County,NC Geospatial Information Services.Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. 5/9/2022 V'A �� CATAWBA COUNTY Tli 100A SOUTHWEST BLVD $ NEWTON,NORTH CAROLINA 28658 RECEIPT ( �4r PHONE:828.465.8399 L) Monday,May 9,2022 1842 sM www.catawbacountync.gov PAYOR: Kiser,Jessica PAYMENTS TRANSACTION NUMBER: TRC-39561659-09-05-2022 PAYMENT DATE: 05/09/2022 PAYMENT TYPE: Credit Card INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT • 05-22-406174 110-580200.663000 Well Permit&Inspection Fee $300.00 TOTAL PAYMENTS: $300.00 EHPR-05-2022-40970 CASE TYPE: Environmental Health Plan Review WORK CLASS: OSWP SITE ADDRESS: 4611 KISER ISLAND RD,TERRELL NC 28682 Owner JESSICA KISER,4611 KISER ISLAND RD,TERRELL NC 28682 C:7049898389 **NO PEOPLESOFT ACCOUNT ASSIGNED** Paid By TRAVIS KISER,4611 KISER ISLAND RD,TERRELL NC 28682 receipt 05/09/2022 13:04 Page 1 of I