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REF-000036986.TIF
Ref 431,091 ,fr 'lb ,.:.., 3co ztp IMP 'ID caaw�aa can �� � public healti 3Co q q 4 W Pc/ Application for Environmental Health Services THIS IS NOT A PERMIT Application is.for: New Construction ❑Existing Facility in Improvement Permit Authorization to Construct KINew Septic ❑Septic Repair/Malfunction ❑Septic Relocation ❑Septic Expansion ❑Existing System Inspection or Reconnection [ New Well ❑ Replacement Well 12i Well Abandonment ❑Well Repair Property Address 4909 Kiser Island Road, Terrell, NC. 28682 Acres 0.52 subdivision Kiser Keys Extension Lot# 46 Driving Directions to Property Traveling Won E NC 150 Hwy, Turn L on Kiser Island Road, Property is —3 Miles • down on the R. Describe work New 4 BR single Family Residence Applicant Name Agri-Waste Technology (Trevor Hackney) Applicant Address 501 N Salem Street; Apex, NC, 27502 Phone 704-268-9160 Email thackney@agriwaste.com Owner Name Kunal and Pina Dave Owner Address 4820 Nations Crossing Road, Suite D101, Charlotte, NC`. 28217 Phone 980=722-4326 Email laxmi43(caol.com Contractor Name Agri-Waste Technology(Trevor Hackney) Contractor Address 501 N Salem Street, Apex, NC. 27502 Phone 704-268-9160 Email thackney@agriwaste.corn Nameto Appear on Permit? gi Owner .❑Applicant ❑Contractor Who will be the Primary.Contact? ❑Owner 1 Applicant ❑Contractor Proposed New Construction-Residential Primary Residence ® New Residence 0 Addition to Residence #of New Bedrooms* 4 #of Occupants 8 Project.Description New Single Family Residence Structure Dimensions,also specify dimensions:of decks&porches See Site Plan 79' Deep x 56' Wide (choose One) 0 Basement in Crawl Space ❑ Slab If Basement.Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Accessory Dwelling #of New Bedrooms*j' #of Occupants Structure Dimensions (Choose One) 0 Basement ❑Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement 0 Yes 0 No Retaining Wall>2' 0 Yes ❑ No Accessory Structure(s)Describe Pool 40' x 20' and putting green 18' X 8' Structure(s)Dimensions Plumbing. ❑.Yes. 0 No Describe Plumbing Needed (Choose One) ❑Basement 0 Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' 0 Yes 0 No Multi-Family Residence. #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Stricture Dimensions (Choose One) ❑Basement 0 Crawl Space 0 Slab If Basement.Will There Be Water Using Fixtures In Basement 0 Yes ❑ No Retaining Wall>2' ❑ Yes ❑ No Well Construction/A bandonmentlRepair • • Proposed Well Type In Individual Well .❑ Semi-Public Well ❑Community Well Abandonment Type 0 Drilled ❑ Bored ❑ Dug Unknown Well Repair Requested ❑Yes ❑No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank? Yes ❑No RECEIVE DEC 132023 Environmental Health Catawba County Government Center,25 Government.Drive I PO.Box 389, Newton, NC 28658 Phone:(828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.A0V1rOnmOntal Health Existing Structures on Site Describe None Structure Dimensions #of Bedrooms* #of Occupants Basement ❑Yes ❑ No Basement Plumbing ❑Yes 0 No Existing Water Supply n Individual Well ❑Shared Well-Number of Connections D Community Well ❑County/City/Township Water Line Is a public water supply available?** ❑ Yes 6 No Commercial ❑Proposed New Construction ❑Existing/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare❑Yes ❑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. If the answer to any question is"yes",applicant must attach supporting documentation. ❑Yes it No Does the site contain any jurisdictional wetlands? ❑Yes g No Does the site contain any existing wastewater systems? ❑Yes No Is any wastewater going to be generated on the site other than domestic sewage? ❑Yes ti No Is the site subject to approval by any other public agency? ❑Yes No 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>stir preference) ❑Accepted 0 Alternative 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) Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground.Property owner/applicant is responsible for marking all underground utilities,including but not limited to: underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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. Signature of Owner or Legal Agent rr �7 Date )Z--'�a 3 Printed Name of Owner or Legal Agent fl(rot JP v STATE0?, ROY COOPER•Governor NC DEPARTMENT OF KODY H.KINSLEY•Secretary ' HEALTH AND . !r °I HUMAN SERVICES MARK BENTON•Deputy Secretary for Health SUSAN KANSAGRA•Assistant Secretary for Public Health Division of Public Health Application for Services This application,in conjunction with the common form established in G.S.130A-335(a3)and(a5),is optional for local health departments to be used for applications submitted in accordance with G.S. 130A-335(a2),(a3),and(a5). (hereinafter,G.S.130A-335(a3)and(as)permits referred to as(a2)Improvement Permit and(a2)Construction Authorization] Applying for: 0 (a2)Improvement Permit 0 (a2)Construction Authorization ❑ (a2)Repair/Construction Authorization Please check one of the following: 0 New Construction ❑ Expansion 0 System Relocation 0 Change of Use 0 Repair 0 5 Year Expiration Requested(site plan provided) ❑ Non-Expiring Permit Requested(plat provided,as defined in G.S.130A-334(7a) Property Owner Name: Kunal and Pina Dave Property Owner Mailing Address:4820 Nations Crossing Rd Suite D101, Charlotte NC 28217 Property Owner Phone Number: 980-722-4326 Property Owner Email Address: laxmi43@aol.com Applicant Name: Jeff Vaughan Applicant Mailing Address: 501 N Salem St, Suite 203, Apex, NC, 27502 Applicant Phone Number: 919-859-0669 Applicant Email Address:jvaughan@agriwaste.com Does the property include,or is subject to,any of the following: ['Yes 2 No Previously identified jurisdictional wetlands ❑Yes Q No Existing or proposed easements,rights-of-way,encroachments,or other areas subject to legal restrictions ❑Yes❑✓ No Approval by other public agencies A site plan or plat is required,OR the site sketch submitted from the LSS/AOWE,must include the following: (A)existing and proposed facilities,structures,appurtenances,and wastewater systems (B)proposed wastewater system showing setbacks to property line(s)or other fixed reference point(s) (C)existing and proposed vehicular traffic areas (D)existing and proposed water supplies,wells,springs,and water lines;and (E)surface water,drainage features,and all existing and proposed artificial drainage,as applicable. Requesting DHHS review: QYes ❑No I understand that the documentation and fees,as required in G.S. 130A-335(a2),(a3),(a5),and(a6),attached to this application are to be used to issue an Improvement Permit and/or Construction Authorization pursuant to G.S. 130A-335(a2),(a3),and(a5). I understand that authorized county and state officials are granted right of entry to the property indicated on this application to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that if the information in the application for an Improvements Permit and/or Construction Authorization is falsified,changed,or the site is altered,then the Improvement Permit and Construction Auth i `iobecome invalid. Applicant Signature: Date: 12/7/2023 Owner's Signature: + Date: !'Z- - -a NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Building 3.Raleigh,NC 27609 MAILING ADDRESS:1632 Mail Service Center,Raleigh,NC 27699-1632 www.ncdhhs.gov • TEL:919-707-5854 • FAX:919-845-3972 AN EQUAL OPPORTUNITY I AFFIRMATIVE ACTION EMPLOYER ��' TATf 3t. t,�"w„,•„� tio� ROY COOPER•Governor ��r P� :#'. NC DEPARTMENT OF KODY H. KINSLEY•Secretary '�� r; o 1154kasilEARIVICES MARK BENTON • Deputy Secretary for Health ++.a. * SUSAN KANSAGRA•Assistant Secretary for Public Health �gWJ1 3' Division of Public Health Application for Services This application,in conjunction with the common form established in G.S. 130A-335(a3)and(a5),is optional for local health departments to be used for applications submitted in accordance with G.S. 130A-335(a2), (a3),and(a5). [hereinafter, G.S. 130A-335(a3)and(a5)permits referred to as(a2)improvement Permit and(a2)Construction Authorization] Applying for: 0 (a2)Improvement Permit El (a2)Construction Authorization ❑ (a2) Repair/Construction Authorization Please check one of the following: CI New Construction 0 Expansion 0 System Relocation 0 Change of Use ❑ Repair El 5 Year Expiration Requested (site plan provided) 0 Non-Expiring Permit Requested(plat provided,as defined in G.S. 130A-334(7a) Property Owner Name: Kunal and Pina Dave Property Owner Mailing Address: 4820 Nations Crossing Rd Suite D101, Charlotte NC 28217 Property Owner Phone Number: 980-722-4326 Property Owner Email Address: laxmi43@aol.com Applicant Name: Jeff Vaughan Applicant Mailing Address: 501 N Salem St, Suite 203, Apex, NC, 27502 Applicant Phone Number: 919-859-0669 Applicant Email Address: jvaughan@agriwaste.com Does the property include,or is subject to,any of the following: likes ❑✓ No Previously identified jurisdictional wetlands ❑Yes �✓ No Existing or proposed easements,rights-of-way,encroachments,or other areas subject to legal restrictions ❑Yes No Approval by other public agencies A site plan or plat is required,OR the site sketch submitted from the LSS/AOWE, must include the following: (A)existing and proposed facilities,structures,appurtenances,and wastewater systems (B)proposed wastewater system showing setbacks to property line(s)or other fixed reference point(s) (C)existing and proposed vehicular traffic areas (D)existing and proposed water supplies,wells,springs,and water lines;and (E)surface water,drainage features,and all existing and proposed artificial drainage, as applicable. Requesting DI-IHS review: ❑✓ Yes ❑No I understand that the documentation and fees,as required in G.S. 130A-335(a2), (a3),(a5),and(a6),attached to this application are to be used to issue an Improvement Permit and/or Construction Authorization pursuant to G.S.130A-335(a2),(a3),and(a5). I understand that authorized county and state officials are granted right of entry to the property indicated on this application to conduct necessary inspections to determine compliance with applicable laws and rules. I understand that if the information in the application for an Improvements Permit and/or Construction Authorization is falsified,changed,or the site is altered,then the Improvement Permit and Construction Auth i ioj become invalid. Applicant Signature: r'� Date: 12/7/2023 Owner's Signature: Date: NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH LOCATION:5605 Six Forks Road,Building 3,Raleigh,NC 27609 MAILING ADDRESS:1632 Mail Service Center,Raleigh,NC 27699-1632 www.ncdhhs.gov • TEL:919-707-5854 • FAX:919-845-3972 AN EQUAL OPPORTUNITY!AFFIRMATIVE ACTION EMPLOYER Pemlit#: This Section for Local Health Department Use Only Initial submittal received: by Date Initials G.S. 130A-335(a3)states the following: When an applicant for an Improvement Permit submits to a local health department an Improvement Permit application,the permit fee charged by the local health department,the common form developed by the Department,and a soil evaluation pursuant to subsection(a2)of this section,the local health department shall, within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the Improvement Permit includes all of the required components.If the local health deportment determines that the Improvement Permit is incomplete,the local health department shall notify the applicant of the components needed to complete the improvement Permit.The applicant may submit additional information to the local health department to cure the deficiencies in the improvement Permit.The local health department shall make a final determination as to whether the Improvement Permit is complete within five business days after the local health department receives the additional information from the applicant.If the local health department fails to act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The Department shall develop a common form for use as the improvement Permit. The review for completeness of this Improvement Permit was conducted in accordance with G.S. 130A-335(a3). This Improvement Permit is determined to be: ❑ Incomplete(If box is checked, information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Applicant on Date State Authorized Agent: Date: ❑Complete State Authorized Agent: Date: This Improvement Permit is issued pursuant to G.S. 130A-335(a2)and (a3)using the signed and sealed LSS/LG evaluation(s) attached here. The issuance of this permit by the Health Department in no way guarantees the issuance of other permits.The permit holder is responsible for checking with appropriate governing bodies in meeting their requirements.This permit is subject to revocation if the site plan,plat,or the intended use changes. The Improvement Permit shall not be affected by a change in ownership of the site. This permit is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to evaluations,submittals,or actions from a licensed soil scientist or licensed geologist pursuant to GS 130A-335(a2). Improvement Permit Expiration Date: *See attached site sketch* G.S. 130A-335(a2)Common Form 2 V.2023.07 Permit#: Re-submittal of Improvement Permit LHD USE ONLY: This IP resubmittal received: by Date Initials The following items are being resubmitted pursuant to G.S. 130A-335(a3) for issuance of the Improvement Permit: I, hereby attest that the information required to be included with this re-submittal Licensed Soil Scientist(Print Name) is accurate and complete to the best of my knowledge and that the proposed Improvement Permit meets all applicable federal, State,and local laws, regulations, rules, and ordinances. Signature of Licensed Soil Scientist Date The section below is for Local Health Department use after submittal of items noted as missing above. LHD Follow-up Completeness Review of Improvement Permit The review for completeness of this Improvement Permit re-submittal was conducted in accordance with G.S. 130A-335(a3). This Improvement Permit is determined to be: ❑ Incomplete (If box is checked, information in this section is required.) The following items are missing: Copies of this were sent to the LSS and the Applicant on Date State Authorized Agent: Date: ❑Complete State Authorized Agent: Date: G.S. 130A-335(a2)Common Form 3 V.2023.07 Permit#: CONSTRUCTION AUTHORIZATION FOR G.S. 130A-335(a2) County: Catawba PIN/Lot Identifier: 461604634334 Issued To: Kunal and Pina Dave Property Location: Lot 46 Kiser Island Rd, Terrell NC 28682 AOWE/PE Plans/Evaluations Provided: Yes El No❑ If yes,name and license number of AOWE/PE: Jeff Vaughan, 1227 Facility Type: Single Family Residence ElNew ❑Expansion ❑Repair 0 System Relocation ❑Change of Use Basement? ❑Yes ❑✓ No Basement Fixtures? ❑Yes 0 No Type of Wastewater System* Pressure Manifold(50%Reduction)Vertical PPBPS (Initial) Repair Area Exempt (N/A) (Repair) *Please include system classification for proposed wastewater system types in accordance with 15A NCAC 18A.1961 Table V(a) Design Daily Flow: 480 GPD Wastewater Strength:E domestic 0 high strength D industrial process Session Law 2014-120 Section 53,Engineering Design Utilizing Low-flow Fixtures and Low-flow Technologies? 0 Yes 0 No (if yes,please provide engineering documentation) Installation Requirements/Conditions Septic Tank Size: 1,000 gallons Total Trench/Bed Length: 268 feet Trench/Bed Spacing: 8 feet on center Trench/Bed Width: 24 inches LTAR: 0•3 gpd/ft2 Soil Cover: 6+ inches Slope Corrected Maximum Trench/Bed Depth*: 36 inches *Measured on the downhill side of the trench Aggregate Depth: - inches above pipe - inches below pipe 18 inches total Pump Tank Size(if applicable): 1,000 gallons Requires more than 1 pump? D Yes ❑✓ No Pump Requirements: 14.9 ft.TDH vs. 29 GPM Grease Trap Size(if applicable): N/A gallons Distribution Method: 0 Serial ❑D-Box or Parallel El Pressure Manifold(s) 0 LPP 0 Other: Artificial Drainage Required: Yes 0 No❑✓ If yes,please specify details: Legal Agreements(If the answer is"Yes"to any type of legal agreements,please attach a copy of the agreement.) Multi-party Agreement Required[.1937(h)]: ❑Yes ElNo Easement,Right-of-Way,or Encroachment Agreement Required[.1938(j)]: 0 Yes ❑✓ No Declaration of Restrictive Covenants: 0 Yes 0 No Pre-Construction Conference Required: Yes 0 No 0 Conditions: This property is repair area exempt. A well must be properly abandoned prior to installation The construction and installation requirements of Rules.1950,.1952,.1954,.1955,.1956,.1957,.1958,and.1959 are incorporated by reference into this permit and shall be met. Systems shall be installed in accordance with the attached system layout. AOWE/PE Print Name: Jeff Vaughan Expiration Date: 12/7/2028 �j�/ AOWE/PE Signature: 1'/� Date: 12/7/2023 This AOWE/PE submittal is pursuant to and meets the requirements of G.S.130A-335(a2)and(a5). *See attached site sketch* G.S. 130A-335(a2)Common Form 4 V.2023.07 Sti;14 Permit#: This Section for Local Health Department Use Only Initial submittal received:___ by Date Initials G.S. 130A-335(a5)states the following: When an applicant for a Construction Authorization,or an improvement Permit and Construction Authorization together,submits a Construction Authorization,or an improvement Permit and Construction Authorization application together,the permit fee charged by the local health deportment,the common form developed by the Department,and any necessary signed and sealed plans or evaluations conducted by a person licensed pursuant to Chapter 89C of the General Statutes as a licensed engineer or a person certified pursuant to Article 5 of Chapter 90A of the General Statutes as an Authorized On-Site Wastewater Evaluator,the local health department shall,within five business days of receiving the application,conduct a completeness review of the submittal.A determination of completeness means that the Construction Authorization or Improvement Permit and Construction Authorization includes all of the required components.If the local health department determines that the Construction Authorization or Improvement Permit and Construction Authorization is incomplete,the local health department shall notify the applicant of the components needed to complete the Construction Authorization or Improvement Permit and Construction Authorization.The applicant may submit additional information to the local health department to cure the deficiencies in the Construction Authorization or Improvement Permit and Construction Authorization.The local health department shall make a final determination as to whether the Construction Authorization or Improvement Permit and Construction Authorization is complete within five business days after the local health department receives the additional information from the applicant.If the local health department fails to act within any period set out in this subsection,the applicant may treat the failure to act as a determination of completeness.The applicant may apply for the building permit for the project upon the decision of completeness of the Construction Authorization or Improvement Permit and Construction Authorization by the local health department or if the local health department fails to act within five business days.The Authorized On-Site Wastewater Evaluator or licensed engineer submitting the evaluation pursuant to this subsection may request that the local health department revoke or suspend the Construction Authorization or improvement Permit and Construction Authorization for cause. Upon written request of the Authorized On-Site Wastewater Evaluator or licensed engineer,the local health department shall suspend or revoke the Construction Authorization or improvement Permit and Construction Authorization pursuant to G.S. 130A-23.The Department shall develop a common form for use as the Construction Authorization. The review for completeness of this Construction Authorization was conducted in accordance with G.S. 130A-335(a5). This Construction Authorization is determined to be: ❑ Incomplete (If box is checked, information in this section is required.) The following items are missing: Copies of this were sent to the AOWE/PE and the Applicant on Date State Authorized Agent: Date: ❑Complete State Authorized Agent: Date of Issuance: This Construction Authorization is issued pursuant to G.S.130A-335(a2)and (a5)using the signed and sealed plans or evaluations attached here.This Construction Authorization is subject to revocation if the site plan,plat,or the intended use changes. The Construction Authorization shall not be affected by a change in ownership of the site. This Construction Authorization is subject to compliance with the provisions of the Laws and Rules for Sewage Treatment and Disposal and to the conditions of this permit. The Department,the Department's authorized agents,and the local health departments shall be discharged and released from any liabilities,duties,and responsibilities imposed by statute or in common law from any claim arising out of or attributed to plans,evaluations,preconstruction conference findings,submittals,or actions from a person licensed pursuant to Chapter 89C of the General Statutes as a licensed engineer or a person certified pursuant to Article 5 of Chapter 90A of the General Statutes as an Authorized On-Site Wastewater Evaluator in GS 130A-335(a2), (a5),and (a7).The Department,the Department's authorized agents,and the local health departments shall be responsible and bear liability for their actions and evaluations and other obligations under State law or rule,including the issuance of the operations permit pursuant to GS 130A-337. Construction Authorization Expiration Date: *See attached site sketch* G.S. 130A-335(a2)Common Form 5 V.2023.07 Sac Permit#: Re-submittal of Construction Authorization LHD USE ONLY: This CA resubmittal received: by vo t, Initials The following items are being resubmitted pursuant to G.S. 130A-335(a5)for issuance of the Construction Authorization: hereby attest that the information required to be included with this re-submittal Authorized Onsite Wastewater Evaluator(Print Name) is accurate and complete to the best of my knowledge and that the proposed Construction Authorization meets all applicable federal,State,and local laws,regulations,rules,and ordinances. Signature of Authorized On-Site Wastewater Evaluator Date The section below is for Local Health Department use after submittal of items noted as missing above. LHD Follow-up Completeness Review of Construction Authorization The review for completeness of this Construction Authorization re-submittal was conducted in accordance with G.S. 130A-335(a5). This Construction Authorization is determined to be: ❑Incomplete(If box is checked,information in this section is required.) The following items are missing: Copies of this were sent to the AOWE/PE and the Applicant on Date State Authorized Agent: Date: ❑Complete State Authorized Agent: Date: G.S. 130A-335(a2)Common Form 6 V.2023.07 �moll AGRITEC-01 GKROHL A�RC CERTIFICATE OF LIABILITY INSURANCE DA3/1412023 YI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Connie Garkalns Hartsfield&Nash Agency, Inc. PHONE 919 556-3698 l FAX ) 10405 Ligon Mill Rd.,Ste H (E-MAIL o,Ext):( ) (A c,No):(919 556-8758 Wake Forest, NC 27587 DDRESS;Connie@hartsfield-nash.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of the Southeast 39926 INSURED INSURER B:ACCIDENT FUND INSURANCE COMPANY OF AMERICA 10166 Agri-Waste Technology Inc INSURER C:Evanston Insurance Company 501 N.Salem St Ste 203 INSURER D: Apex,NC 27502 INSURER E: __ _, INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY_ HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYY) (MMIDDIYYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR S 2253659 1/18/2023 1/18/2024 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) S MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY X gle LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ COMBINED A AUTOMOBILE LIABILITY Ea accident SINGLE LIMIT $ 1,000,000 X ANY AUTO IS 2253659 1/18/2023 1/18/2024 BODILY INJURY(Per person) $ OWNED — SCHEDULED AUTOSE� ONLY AUTOS yy BODILY INJURY(Per accident) $ AURTOS ONLY AlJ OS ON DY (Peda�identDAMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE S 2253659 1/18/2023 1/18/2024 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION X I'MUTE ERH AND EMPLOYERS'LIABILITY 100003072 1/18/2023 1/18/2024 1,000,000 ANY PROPRIIETgORIPARTNEREXECUTIVE YINN N i A E.L.EACH ACCIDENT $ (Mandatory In NH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Prof&Pollution MKLV3ENV103400 8/22/2022 8/22/2023 Each Claim 5,000,000 A Leased/Rented S 2253659 1/18/2023 1/18/2024 Equipment 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ***This is ONLY For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. Contact Agency for Specific Holder info to be added AUTHORIZED REPRESENTATIVE I K� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AWT ::r :::::::o::: cIent1sts g S Cr- '' -�'; y,� c. Now OS 501 N Salem Street,Suite 203,Apex,NC 27502 ,' agriwaste.com I 919.859.0669 Soil Suitability for Domestic Sewage Treatment and Disposal Systems Lot 46 Kiser Island Rd, Terrell NC 28682 (Catawba County PIN: 461604634334) PREPARED FOR: Kunal and Pina Dave PREPARED BY: Jeff Vaughan, Senior Agronomist & Soil Scientist Trevor Hackney, Environmental Scientist DATE: December 7, 2023 Soil suitability for domestic sewage treatment and disposal systems was evaluated on December 29, 2022, for the proposed property located at Lot 46 Kiser Island Rd, Terrell NC 28682. Jeff Vaughan and Trevor Hackney of Agri-Waste Technology, Inc. (AWT) conducted the soil evaluation. This evaluation was done to facilitate permitting for a septic system. This report and attached documents were prepared to meet the requirements for G.S. 130A-335(a2). A drawing of the site plan, septic layout, and boring locations is included in Attachment 1. Profile descriptions for each boring are included in Attachment 2. Additional documentation about the property is included in Attachment 3. This property is approximately 0.52 acres and is a wooded lot. The home is proposed near the center of the property and the septic system is proposed towards the front of the property. The proposed septic system is a pressure manifold septic system with a 50% reduction vertical PPBPS trench product for the primary. This property is repair area exempt; therefore, a repair septic system area is not required. Soil Suitability for Domestic Sewage Treatment and Disposal Systems The drawing in Attachment 1 details the property boundaries(as surveyed by Dedmon Surveys), soil boring locations, and layout of drain field trenches (Completed by AWT). Soil borings were examined to determine soil suitability for on-site sewage disposal systems in accordance with 15A 18A .1900 Rules for Sewage Treatment and Disposal Systems. These borings were advanced with a hand auger. 1 A septic layout was performed to demonstrate available space (.1945). The layout in Attachment 1 indicates there is available space for a four-bedroom pressure manifold septic system with a 50%reduction vertical PPBPS trench product. The proposed LTAR(Long Term Acceptance Rate) by AWT is 0.3 GPD/ft2. The soils on this property are group IV soils within the distribution and treatment zone as used to define the LTAR. Since usable slope corrected soil depths meet or exceed 48"AWT is recommending the use of the 50%reduction vertical PPBPS dispersal drain-field product. The maximum trench bottom should not exceed 36". With an LTAR of 0.3 GPD/ft2, 267 linear feet of trench are necessary to support a four-bedroom home septic system. The attached drawing proves that 268 linear feet of trench can be installed for the primary septic system with the proposed home location on the property. This property is repair area exempt; therefore, no repair system area is required. Any disturbances or grading done in the usable area or within the proposed setbacks will change the potential of using the area designated for a drain field. We appreciate the opportunity to assist you in this matter. Please contact us with any questions, concerns, or comments. Sincerely, Jeff Vaughan, LSS/AOWE 0110 Attachment 1: Site Plan/Drawing and Calculations 1 i * 1 ! , - % ^ �� ! | } 7\ ; §!f|i �! i)` ! g # ! t : a!� jbh / f k3 33 !! /eb , § § $ .�! am r COf s } IE - , /6 / % \ y a \ » m * / o / e ƒ \ 0 u) - ( $ $ \ @ 5 § 0- E / / \ \ ( 0 / 0 ƒ / / w 1 x a.) / -o E . _ 0 - & CO # 6 CO w Q 5 3 £ $ $ $ $ \ \ / / / / / / § C.) 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' g tgE a11 $ 2 �g 5 u y S§^ 1 v 8j E 11 � p 1a it O I a !�• t 3 P ` `g- `� �5 ii a 11 lef ..Cg i4 a' i il aasii J +° ; Ea b yyEii ill iii de �14 Oil y a _£# �17 1� �., I a Ys E. 1 7g „ sill'$ aspj S Ag a�'� � ii g P— z�so III II 1� e= E10 ak (F� �t 9 A.P eaE i'S� \ 1'a 4C121i i y t. a 1 a i ii Via# @ f ; ��= 3sa F 1py i 01 s 1-4t. sai 111 f 1 la 2 F r a g ap 1' 77 { yj * y a ill ifil <"a A :ii 8 STEM;114 II5gPf P is R a 2� m an 3� Septic System Design - Summary Page Project: Kunal Dave-LSS Permit Date: 1/0/1900 Property: Kiser Island Road Terrell, NC County: Catawba Engineers and Soil Scientists Subdiv.: Agri-Waste Technology,Inc. Lot#: 46 Permit#: Project Manager: Owner: 0 Jeff Vaughan, PhD, LSS Address: 4820 Nations Crossing Rd Type of System: II a jvaughan@agriwaste.com Charlotte, NC 28217 919-859-0669 Phone: 980-722-4326 Engineer: Email: laxmi43@aol.com PIN: 0 0 #JN/A EHS: Soil Parameters Soil Evaluation By: Special Conditions/Notes: LTAR: 0.30 gpd/ft2 Design Parameters Type of Establishment: Residence,5 or fewer bedrooms Unit: Bedroom #of Units: 4 Septic Tank Specifications Min.Tank Capacity: 1,000 gal Exterior Interior Actual Tank Volume: 1,000 gal Length: 108.0 102.0 in. Tank Manufacturer: Shoaf Width: 58.0 52.0 in. Tank Model: TS 1000 STB Depth: 67.5 60.5 in. Primary Draintield Specifications Type of Distribution: Parallel Distribution Box Trench Bottom Area: 1600 ft2 Trench Media: PPBPS,Vertical Minimum Drain Line: 267 ft Trench Width: 3 ft Actual Drain Line: 269 ft Trench Depth: in. Number of Lines: 5 (or as specified on permit) Minimum Line Spacing: 8 ft O.C. Wastewater Treatment System Design Calculations Project: Kunal Dave- LSS Permit Location: Kiser Island Road Terrell, NC County: Catawba Septic Tank Sizing Daily Flow Estimate: Unit #of Units Flow/Unit Flow/Day Bedroom 4 120 480 Q= 480 gpd Septic Tank Minimum Capacity: Per NCAC T15A:18A .1952(b)(1): For individual residences with 4 bedrooms, Minimum Liquid Capacity(V)= 1,000 gal Septic Tank Specs: Manufacturer: Shoaf Model:r TS 1000 STB Volume: 1,000 gal Weight: 10,500 lbs Exterior Interior Length: 108.0 102.0 in. Width: 58.0 52.0 in. Depth: 67.5 60.5 in. Shape of Risers: Circular Diameter: 2.00 ft Pump Tank Storage & Float Settings Project: Kunal Dave- LSS Permit Location: Kiser Island Road Terrell, NC County: Catawba Tank Manufacturer Shoaf Tank Model TS 1000 PT Interior Height(in.) 50.0 in. Avg. Storage 20.16 gal/in. Primary System Elevations, measured from bottom towards top (0 = Interior Bottom of Tank): Top of pump (including 4" block) 16.1 in. (Pump height= 12 1/16") Pump Off 18.0 in. Pump On 25.5 in. (set for dose volume) Alarm On 31.5 in. (6 in. above On Float) Emergency Storage Available Pump Tank 373 gal Days of Storage 0.78 days (determined from"interior top of tank"-"High Water Alarm") Repair System Elevations, measured from bottom towards top (0 = Interior Bottom of Tank): Top of pump (including 4" block) 14.1 in. (Pump height= 10 1/16") Pump Off 16.0 in. Pump On 16.0 in. (set for dose volume) Alarm On 22.0 in. (6 in. above On Float) Emergency Storage Available Pump Tank 564 gal Days of Storage 1.18 days (determined from"interior top of tank"-"High Water Alarm") ELEVATIONS Project: Kunal Dave-LS5 Permit Location: Kiser Island Road Terrell,NC County: Catawba Benchmark IP NW Corner of Property BM Elev 765 ft Septic Tank 1,000 gal Ground Surface ft Depth of Soil Cover 12 in. 1.00 ft Overall Ht of Tank 67.5 in. 5.63 ft Elev,Base of Tank 758.75 ft Ht to 4"Inlet Invert 57 in. 4.75 ft Elev,4"Inlet Invert 763,50 ft Ht to 4"Outlet Invert 55 in. 4.58 ft Elev,4"Outlet Invert 763.33 ft Gravel Base in. 0.50 ft Elev,Bot of Excavation 758.25 ft Pump Tank 1008 gal Ground Surface 764.02 ft Depth of Soil Cover 12 in. 1.00 ft Overall Ht of Tank 57 in. 4.75 ft Elev,Base of Tank 758.27 ft Ht to 4"Inlet Invert 46 in. 3.83 ft Elev,4"Inlet Invert 762.10 ft Ht to 2"Outlet Invert 58 in. 4.83 ft Elev,2"Outlet Invert 763.10 ft Gravel Base Amin. 0.50 ft Elev,Bot of Excavation 757.77 ft ST Inlet Pipe Grade @ Stub-out 1111EM ft Depth of Stub-out,top ft Elev,Stub-out Invert 763.89 ft Elev @ ST Inlet Invert 763.50 ft Length � ft Slope 3.9 % Pipe,ST to PT ID 4!in. 0.33 ft OD L _4.5 in. 0.38 ft Elev,ST Outlet Invert 763.33 ft Elev,PT Inlet Invert 762.10 ft Length 4jft Slope 30.6% Cover over inlet pipe 1.52 ft Pump Reqmt. Floor Thickness 4 in. 0.33 ft Elev,Pump Tank Floor 758.60 ft Pump Block Ht. in. 0.33 ft Elev,Pump Intake 758.94 ft Grade @ Primary D-box ft Not used ft Min.Cover in. 1.50 ft Max Elev,Primary 764.50 ft Max Elev,Repair 98.50 ft Elev Diff,Primary 5.56 ft Elev Diff,Repair -660.44 ft Drainfield Design Project Kunal Dave-LSS Permit Location Kiser Island Road Terrell,NC County Catawba Drainfield Sizing Primary LTAR 0.3 gpd/ft2 Daily Design Flow 480 gpd Type of Drainfield Media PPBPS,Vertical Req.Drainfield Area 1,600 ft2 Required Drainline Trench Width,Eff. 3 ft After 50%Reduction 267 ft Required Drainline 533 ft Minimum Line Spacing 8 ft(O.C.) Repair LTAR 0.3 gpd/ft2 Daily Design Flow 480 gpd Type of Drainfield Media Chambers Req.Drainfield Area 1,600 ft2 Required Drainline Trench Width,Eff. 3 ft After 25%Reduction 400 ft Required Drainline 533 ft Minimum Line Spacing 9 ft(O.C.) Drainfield Layout Elevation line Length Used as :,,,_sine Use uFlag Color (ft) (ft) Primary(ft) Columns_ 1 _ Layout Line Blue 766.9 48.28 _ _ 2 Layout Line White 766.7 57.38 56.3 3 Layout Line Yellow 768.1 34.67 _ 4 Layout Line Purple 767.0 59.72 56.3 5 Layout Line Blue 766.5 59.42 52.0 6 Layout Line __White 766.1 58.65 _ 52.0 7 Layout Line Yellow 765.8 57.23 52.0 Total 375 269 Count 7 5 Note:Line length totals are shown to the nearest foot. For Chambers or Low-profile Chambers: Effective trench lengths are shown.Add 1'for total installation length. PRESSURE MANIFOLD DESIGN (Primary) Site Information Project: Kunal Dave-LSS Permit Location: Kiser Island Road Terrell,NC County: Catawba Design Information Estimated Daily Flow 480 gal/day L.T.A.R.(from Catawba Co.) 0.3 gal/day/ft2 L.T.A.R.+5% 0.315 gal/day/ft2 Trench Width 3 ft. Line Length Required 533 ft. Length after 50%Reduction 267 ft L.T.A.R.Reduced 0.600 gal/day/ft2 L.T.A.R. Reduced+5% 0.630 gal/day/ft2 DRAINFIELD INFO,- Primary Proposed Type of System/Distribution: Pump to Pressure Manifold using PPBPS, Vertical Flag I Line Flow I Flow/Foot 1 Line Line No. Color Length(ft) Tap (Rom (gpm/ft) L.T.A.R. 2 White 56.311 ll2in SCH 80 5:s=';; 0.097 0.568 4 Purple 56.3 1/2in SCH 80 5.48» 0.097 0.568 5 Blue 52 1/2in SCH 80 5.48,: 0.105 0.615 6 White 52 1/2in SCH 80 5.48r: 0.105 0.615 111 7 I Yellow 52;1 1/2in SCH 80 5.48 0.1051 0.615 Total 269 Total 27.40 Ave.l 0.60 Note:Line lengths are calculated in 4'increments to reflect use of Chambers product.2'added for endcaps. Total Run Time 17.52 min. Drainfieid Capacity 223.2 gal %of Drainfield Cap '_' ' ,69.0%+ (Max.97.6%) Dose Volume 154.0 gal/dose Run Time/Dose 5.6 minutes Time to deliver max.3.6 gal/panel Volume/depth 20.16 gal/in. (Per tank manufacturer's specifications) Estimated Drawdown 7.64 in. Manifold Box Number of Taps 5 with 0 Split(s) Manifold Length 4.0 ft. (approximate) PUMP DESIGN System(initial/repair): Primary Project: Kunal Dave-LSS Permit Location: Kiser Island Road Terrell,NC County: Catawba Friction Losses Suction Head ft (submersible 0) Elev.Difference(highest point from pump) 5.56 ft Design Pressure At Outlet ft Supply Line-1.5"Schedule 40 PVC Pipe Diameter,Nominal! 1.5jin. Pipe Diameter(ID) 1.59 in. Flow 27.4 gpm Pipe Length 65Ift Velocity 4.43 ft/sec Pipe Length for Fittings 6.5 ft Meets requirement that 2 ft/s<v<5 ft/s. Equivalent Length 71.5 ft Estimated Friction Loss in Supply Line 3.38 ft Pressure Filter Friction Loss ft (from manufacturer) Friction Loss-Taps/Special Fittings ft TOTAL 14.90 ft. Flow for Anti-Siphon Hole Hole Diameter in. Hole Flowrate 1.60 gpm Pump Efficiency 0.7 (assumed,typical) Motor Efficiency 0.9 (assumed for electric pumps) Flow 29.00 gpm Required Horsepower 0.17 hp TDH 14.90 ft Pump Selection Manufacturer: Zoeller Model: N98 Horsepower: 0.5 PUMP PERFORMANCE CURVE MODEL 98 26 Operating 4 Point �I _J 10- 2 I�. 0 I 10 20 90 40 60 60 70 BO GALLONS UTERS I I I 0 SO 180 240 FLOW PER MINUTE Attachment 2: Soil Boring Description Sheets . \. 1 501 N Salem St,Suite 201 Engineers ad Soii Scientists 919 859 0669 n Apex,NC 27502 www.agriwaste.com Agri-Waste Technology, Inc. SOIL/SITE EVALUATION for ON-SITE WASTEWATER SYSTEM CLIENT: Kunal Dave APPLICATION DATE ADDRESS: 4820 Nations Crossing Rd Suite D101,Charlotte NC 28217 DATE EVALUATED: 12/29/22 PROPOSED FACILITY: Single Family Residence PROPOSED DESIGN FLOW(.1949): 480 GPO PROPERTY SIZE: 0.52 ac. LOCATION OF SITE: Lot 46 Kiser Island Rd Terrell NC 28682 COUNTY: Catawba PROPERTY RECORDED: WATER SUPPLY: Private Public AWell LI Spring LI Other EVALUATION METHOD: lkugerBoring Pit ❑Cut TYPE OF WASTEWATER: ys Sewage C.Industrial Process ❑Mixed • • • • P R SOIL MORPHOLOGY OTHER 0 F (.1941) PROFILE FACTORS I .1940 L LANDSCAPE HORIZON E PROFILE POSITION/ DEPTH .1942 # SLOPE% ('N•) .1941 .1941 SOIL .1943 .1956 .1944 CLASS STRUCTURE/ CONSISTENCE/ WETNESS! SOIL SAPR RESTR <AR TEXTURE MINERALOGY COLOR DEPTH 0 HORIZ CLASS 0-10 GR;SCL SS;SP;FR - 50" - - 0.3 5% 10-50" SBK;C SS;SP;FI 1 0-16 WSBK;SCL SS;SP;FR - 511" - (13 16-50 SBK;C SS;SP;Fl 2 5% 0-10 GR;SCL SS;SP;FR . -5(0" - - 0 10-50 SBK;C SS;SP;FE 3 8% ,,.- 0-8 GR;SCL SS;SF;FR 50" - (I 8-50 SBK;C SS;SP;Fl 4 i. I DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Provisionally SITE CLASSIFICATION(.1948): Available Space(.1945) Suitable Exempt Pressure Manifold EVALUATED BY:_Jeff Vaughan System Type(s) 50%Reduction Exempt OTHER(S)PRESENT: Trevor Hackney Vertical PPBPS Site LTAR 0.3 GPD/Ft2 Exempt Updated February 2014 LEGEND use the following standard abbreviations SOIL CONVENTIONAL LPP MINERALOGY/ LANDSCAPE POSITION GROUP TEXTURE .1955 LTAR* .1957 LTAR* CONSISTENCE STRUCTURE CC(Concave Slope) I S(Sand) 1.2-0.8 0.6-0.4 SEXP(Slightly Expansive) G(Single Grain) CV(Convex Slope) LS(Loamy Sand) EXP(Expansive) M(Massive) D(Drainage Way) CR(Crumb) DS(Debris Slump) II SL(Sandy Loam) 0.8-0.6 0.4-0.3 GR(Granular) FP(Flood Plain) L(Loam) SBK(Subangular Blocky) FS(Foot Slope) ABK(Angular Blocky) H(Head Slope) III Si(Silt) 0.6-0.3 0.3-0.15 PL(Platy) L(Linear Slope) SiCL(Silty Clay Loam) PR(Prismatic) N(Nose Slope) CL(Clay Loam) R(Ridge) SCL(Sandy Clay Loam) MOIST WET S(Shoulder Slope) SiL(Silt Loam) T(Terrace) VFR(Very Friable) NS(Non-sticky) IV SC(Sandy Clay) 0.4-0.1 0.2-0.05 FR(Friable) SS(Slightly Sticky) SiC(Silty Clay) Fl(Firm) S(Sticky) C(Clay) VFI(Very Finn v.Very Sticky) VS(Very Sticky) 0(Organic) None None EFT(Extremely Firm) NP(Non-plastic) SF(Slightly Plastic) *Adjust LTAR due to depth,consistence,structure,soil wetness,landscape,position,wastewater flow and quality. P(Plastic) NOTES VP(Very Plastic) HORIZON DEPTH In inches below natural soil surface DEPTH OF FILL In inches from land surface RESTRICTIVE HORIZON Thickness and depth from land surface SAPROLITE S(suitable)or U(unsuitable) SOIL WETNESS Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less-record Munsell color chip designation CLASSIFICATION S(Suitable),PS(Provisionally Suitable),or U(Unsuitable) Evaluation of saprolite shall be by pits. Long-term Acceptance Rate(LTAR):gal/day/8= Showprofile locations and other site features(dimensions,reference or benchmark,and North). t 1 1 . .4_— ..-1____ ______ 1 , , -1 h 1 , , . ___ - _ l_. _ __ _ _-_ t _i , I I ' - ,._ , . 1 , _,__________..___. . ____._ . ._ _ __..._.____ ___1 , _-_ _..._. _ _ ._ _....._......________. ---------7.-- - _ .___ __ , _:, COMMENTS: This property is exempt from the requirements of a repair area for the drain field. 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M V I Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 461604634334 Owner: DAVE KUNAL Parcel Address: 4909 KISER ISLAND RD Owner2: DAVE PINA City: TERRELL, 28682 Address: 4820 NATIONS CROSSING RD STE LRK(REID): 805260 D101 Deed Book/Page: 3805/1170 Address2: Subdivision: City: CHARLOTTE Lots/Block: 46/ State/Zip: NC 28217-1878 Last Valid Sale: $623,000 on 2023-04-21 School Information: Plat Book/Page: 13/20 School District: COUNTY Legal: LOT 46 PLAT 13-20 Elementary School: SHERRILLS FORD Calculated Acreage: .520 Middle School: MILL CREEK Tax Map: High School: BANDYS Township: MOUNTAIN CREEK School Map State Road #: TaxNalue Information: Tax Rates Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoningl: R-30 Building(s) Value: $0 Zoning2: Land Value: $698,400 Zoning3: Assessed Total Value: $698,400 Zoning Overlay: WP-O, CRC-O, FPM-O Year Built/Remodeled: / Small Area: SHERRILLS FORD Tax Revaluation 2023: Info, COMPER Split Zoning Districts: / Online Appeals Zoning Agency Phone Numbers Valid Sales (COMPER) for this parcel Contact Tax Dept. at 828-465-8436 Current Tax Bill Miscellaneous: Firm Panel Date: Building Permit Address Search for this parcel. Firm Panel #: If available, Building Permits for this parcel. Septic 2010 Census Block: 3024 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 Catawba County Environmental Health /��' 25 Government Drive Receipt Number: RCPT-121323- (T Newton, NC 28658 021 U7111 (828)465-8270 envhealth©catawbacountync.gov 1842 zn+ https://www.catawbacountync.gov Payer: AGRI-WASTE TECHNOLOGY Cashier: Julia English Date: 12/13/2023 501 N SALEM ST APEX NC 27502 REF#-000036994 WELL PERMIT 4909 KISER ISLAND RD Fee Description Fee Amount Amount Paid Fee Balance Well Construction Permit and Inspection Fee (New or Repair) $300.00 $300.00 $0.00 $300.00 $300.00 $0.00 REF#-000036986 RESIDENTIAL SEPTIC IMPROVEMENT 4909 KISER ISLAND RD PERMIT Fee Description Fee Amount Amount Paid Fee Balance Authorization to Construct with Improvement Permit(Private Option) $90.00 $90.00 $0.00 [applied for together] $90.00 $90.00 $0.00 REF#-000036984 RESIDENTIAL SEPTIC AUTHORIZATION 4909 KISER ISLAND RD TO CONSTRUCT Fee Description Fee Amount Amount Paid Fee Balance Authorization to Construct with Improvement Permit (Private Option) $90.00 $90.00 $0.00 [applied for together] $90.00 $90.00 $0.00 Total Paid: $480.00 Payment Method Reference Payment Amount CREDIT CARD APPROVED $480.00 Total Paid: 480.00 Printed 12/13/2023 13:26:00 by Julia English Page 1 of 1