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• NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
•
VARIANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS:
PRIVATE DRINKING WATER WELLS UNDER ISA NCAC 02C.0300
WATER SUPPLY WELLS UNDER 15A NCAC 02C.U107
All water supply wells not considered"Privaie Drinking Water Wells"and including Irrigation,industrial,and commercial wells.
WELLS OTHER THAN WATER SUPPLY UNDER ISA NCAC 02C.0108
Including monitoring and recovery wells.
Print clearly or type information. Illegible submittals will be returned as incomplete.
DATE: � 2- , 20 1--2" PERMIT NO.: (to be completed by DWQIDPH)
A. WELL OWNER-For single family residences list the property owner(s). For all others, list name of the business,
organization,or government agency and person delegated signature authority:
(-) l IA, C-::k-Vi'Q Y
Mailing Address: l b 01,41
City;c ..C.c- State:>-)C_ Zip Codil 3 ounty:l l ti � d C'cA
Day Tele No.: -S t fic07 r Cell No. & - 3 3 - 8 3
EMAIL Address: Sty42:
00 c4.1 [Qr14%A Fax No.:
B. PHYSICAL LOCATION OF WELL SITE t ' p
(I) Parcel Identification Number(PIN) of well site: b� b O 5. S 1
County:
(2) Physical Address(if different than mailing address): V
City: State:,Nc Zip Code: ' ‘.7
C. WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name: _
NC Well Drilling Contractor Certification No.:
Company Name; Contact Person:
City: State; Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
Fenn C1 W-22V Page 1 Revised Febreary 201]
D. REASON FOR VARIANCE REQUEST - Include type of well(s) to be constructed; rule for which the variance is
being requested; description of how the alternate construction will not endanger human health and welfare and the
environment;and reason why construction and/or operation in accordance with the standards is not technically feasible
and/or provides equal or better protection of the groundwater.
5Q le-� "— S"cSA- �V vS 3 -L,(-
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E. ATTACIIME•NTS-Provide the following information as attachments to this application:
(1) A map showing general location of the property (including road names, NC Slate Route Number, distances,
any key landmarks,etc.)sufficient for finding the well location,
(2) Detailed site map with scale showing location of proposed well relevant to septic system(s), building
foundations,property lines,water bodies,potential sources of contamination,other wells,etc.
(3) Submit a copy of the local well permit application and site evaluation map(if applicable).
(4) Any other information relevant to the variance request such as a well construction diagram showing proposed
well liner or atypical construction materials/methods.
F. OTHER MINIMUM CONSTRUCTION REQUIREMENTS
For water supply wells, approval of a variance will require that additional construction requirements beyond those
specified in 15A NCAC 02C .0107 be met, Minimum additional construction requirements for Coastal Plain and
Piedmont and Mountain region wells are referenced on Anachments A and B on pages 4 and 5 of this application.
Approval of a variance will not be considered in cases where the specified minimum additional construction
requirements cannot be met.
G. SIGNATURES C4/1
•
Signuture of Pere Responsible for Well Construction(typically the well driller)
Kevin James Carter
Print or Type Full Name of Person Responsible for 11`cll Construction
(typically the well driller)
, Ur
Signature of County Environmental Health Specialist
Print or Type Full some or County Environmentul Health Specialist
Per 15,4 NCAC 02C.0118 the Secretary of the Division of Water Quality or the Division of Public Health may require
submittal of Information deemed necessary to make a decision on the variance, may impose conditions as part of the
decision, and shall respond in writing to the request within 30 days of receipt of the variance request. A variance
applicant who is dissatisfied with the decision of the Director may commence a contested case by filing a petition as
described in G.S. 150E-23 within 60 days after receipt of the decision.
Form Gw•22V t'.ge 2 Revised Febru&..y 2013
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NOTES SURVEYORS CEITTEXA110N
I) THIS PRCPEPJTY MAY BE SUBJECT I.PRAM M. ALLDH C1 RWT TWAT Pelf MAP WAS DRAWN
TO ANY EAASSEEkMKENTS AND/OR MOOT MY SUPERVISION neoM AN ACTUAL SURVEY WADE
RIGHTS OF WAY OF RECORD. UNDER MY SUPEMSION O®DE90iPTI.l RECORDED
2) ACREAGE COMPUTED BY THE IN ROOK 3161,PACE 1711; nut TIE RATIO OF
COORDINATE METHOD. PPE090N AS CALCULATED BY LAITILDES AND
3 OVERHEAD POWER DEPARTURES IS 1:100 (TIME. (TT THE 80UNDA TES NOT
SURNETED ARE SHOWN AS :ROMIMES PLOTTED FROM
♦ NO GRID MONUMENT FOUND WITHIN PFORMA110N MARCIN SOCK 12,PAGE 32):
i 8) TAX PARCEL/DEED/ADDRESS:
1 2000 FEET. THAT THIS MAP WAS PREPARED IN ACCORDANCE NTHas 47-33,AS AMENDED.
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1. PARCELIE 460004638367 .17NE1&MY HAIR AND SEAL TFIIS 41N DAY OF
DEED: 774/301 Auc+IST.Aa'2021
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LEVEL AT COWAN'S FORD DAM (READING
L I;37.J I� ON 5/17/2021) ELEVATION: 757.4'
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PLOT PLAN SURVEY
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SCALE IN FEET VISTA VIEW DRIVE
3=) .d?ba..S PARCEL 460604838567
DON ALLEN & ASSOCIATES P. A. MTN CREEKTMISP., CATAMBA CO, N.C.
"Sines 1971' SCALE: 1' - 60' DATE: 6/4/2021
Commercial •RrWKKttol •Mortiqaag.Survey. • MIItI-Famly RENSED DATE: 12\16\2021
Con•iructlon StakIng•SubdlMdorl Design •Topographic* PURCHASER: KEVIN J. CARTER
131 Crud,.Pak Onv.—SNIt.102• Meor..•SI•,MC. 26117
C704)664-70211 (704)664-6041 Fee .
nix NAME; NST VIEW DR - PARCELS.DWG
7,895.Vista View Dr-Google Maps 5/24/22,2;59 PM
Google Maps 7895 Vista View Dr
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7895 Vista View Dr,
Sherrills Ford,NC 28673
13 min drive•home
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https://www.google-corn/maps/place/7895+Vista+View+Dr,+Bherrills+.,.x8858b2a00e7c2727:Oxa29eaade28dcc22flBm2!3d35.55703!4d-80.98764 Page 1 of 2
STATE Q
% .m..„ tio . ROY COOPER • Governor
,yam ,�\%.• NC DEPARTMENT OF
l���; KODY H. KINSLEY • Secretary
� HEALTH AND
Q; HELEN WOLSTENHOLME • Interim Deputy Secretaryfor Health
„ MI ;:� . .= HUMAN SERVICES p y
74 n. MARK T. BENTON •Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
June 3, 2022
Kevin Carter
7029 Denison Rd
Summerfield,NC 27358
Re: Approval No. JMB2658
Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C
.0107(a)(2)(P)]
Property location:
7895 Vista View Dr
Sherrill's Ford,NC 28673
Dear Mr. Carter:
On June 2, 2022, the On-site Water Protection Branch received your request for a
variance from the Well Construction standards, Title 15A North Carolina Administrative
Code Subchapter 2C .0100. The request for a variance concerns a proposed water supply
well on the referenced property that will serve a single-family dwelling and part of a
structure on the property will be within twenty-five feet of the well. The home is on a lot
with very difficult topography.
Specifically, the variance request grants you permission to construct a water supply well
at a distance closer than the twenty-five-foot setback to a building perimeter. Achieving
the twenty-five-foot setback would be difficult given the challenges of the property.
Based upon information provided by the Catawba County Health Department, and the
property owner, it is my finding that based upon current conditions as the site exist
today(as well as the current proposal for use of the structure) you meet the conditions
necessary for approval of a variance as specified by 15A NCAC .0118 (a) (1)and(2).
On that basis and if the following conditions are met, the requested variance is
approved:
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF PUBLIC HEALTH
LOCATION 5605 Six Forks Road, Raleigh, NC 27609
MAILING ADDRESS 1642 Mail Service Center, Raleigh, NC 27699-1642
www.ncdhhs.gov • TEL: 919-707-5874 • FAx•919-845-3972
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
1) The new water supply well shall be constructed of either PVC, steel, or galvanized
metal casing.
2) The well shall be located as far as possible from the structure where, depending upon
where well rig can actually set up, will possibly encroach upon the 25foot setback,
but not be closer than 10feet.
3) A preconstruction meeting shall be required with the Catawba County Health
Department staff to ensure that the maximum possible distances are achieved.
4) The well will be required to have casing installed to a minimum of 43 feet below land
surface or to bedrock, whichever is greater.
5) The well shall be at least fifty feet from any part of the septic system including repair
area.
6) Grout will be required the entire length of the casing from land surface into bedrock.
7) A drill bit with a diameter of a least one third greater than the diameter of the casing
must be used to drill the cased portion of the well.
8) Grout must be either pumped into place with the use of a tremmie pipe or pressure
method.
9) If a full-length grout is not possible due to site conditions, then a packer-liner
must be installed in the well. The liner must extend at least five feet beyond the
end of the casing and grouted entirely with a neat cement grout.
10)The well must be constructed outside of any road right of way.
•
The granting of this variance is for the well location only. It in no way relieves the owner
or agent from other requirements of the North Carolina Well Construction Standards
including, but not limited to the requirements in 15A NCAC 2C .0113(b)to repair or to
abandon any well which acts as a source or channel for the migration of contamination.
This approval does not imply sufficient water quality. Further, the approval does not
relieve your responsibility to comply with any other applicable Federal, State, or local
laws or regulations.
If you have any questions regarding this variance, please contact me at(828) 713-3335.
Sincerely,
John M. Brooks R.E.H.S, MS
2