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Home My WebLink AboutRBPR-10-2021-38941.TIF • • NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES VARIANCE APPLICATION FOR 2C .0100 WELL CONSTRUCTION STANDARDS: PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C.0300 WATER SUPPLY WELLS UNDER 15A NCAC 02C.0107 All water supply wells not considered"Private Drinking Water Wells"and including irrigation,industrial,and commercial wells. WELLS OTHER THAN WATER SUPPLY UNDER 1SA NCAC 02C.0108 Including nzoaitornrg and recovery wells. Print clearly or type information. Illegible submittals will be returned as incomplete. DATE: f d /-`f , 20 �-Z PERMIT NO.: (to be completed by DWQ/DPH) 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: Dav�! elercl,cY Mailing Address: (7G z LOAD T.f/^' , City: Corfkihdn �p State: pc Zip Code:„2. °'County: COD 1vtc Day Tele No.: 70 T/ 0 l - OoZ 1 Cell No.: EMAIL Address: p'1v7J, IS'/Cicl.Cr yi'40't',L000 Fax No.: B. PHYSICAL LOCATION OF WELL SITE (} n / ? �j (1) Parcel Identification Number(PIN)of well site: 37 r C�l,'4'b g(oC ` I County: (Pic 01 (2) Physical Address(if different than mailing address): City: State: NC Zip Code: C. WELL DRILLER INFORMATION (if known) r� Well Drilling Contractor's Name: -1.1 Vn wt W�(1 Or; LL C NC Well Drilling Contractor Certification No.: (� Company Name: 4 tfi )r)tf1 /'(��I v LLG Contact Person: /CCU! h, City: C n i n i ct State: L./QC Zip Code:...! County: C ryt`�(l 0l'Q Day ide No.: �� g - V0�1 S77/ CellNo.: 92,� 70- 577? EMAIL Address: Fax No.: Form GW-22V Page 1 Revised February 2013 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. S1 f�' 1 f / �> ) I Gi Igcit. rf f of JEw C/1I Ito f�'�t`nya ISU.i7 (r}1 ^ �L'wrC fie e iJ dw; �diry {/�' 1.CGd h7 ktC, G01dr^T� ►/,enOv/PS �l .Zak 1rJr - T�C 60/>1Cr f o tke Well r 9r•1 e o (SS tut AM VG I((Nm' ) 1^, Q r eeC f/ ca f • E. ATTACHMENTS—Provide the following information as attachments to this application: (I) A map showing general location of the property (including road names, NC State 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 arc referenced on Attachments A and 13 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 Signature of Person Responsible for Weil Construction(typically the well driller) V1 C? 1 � 1 el� r~ 64t eawner Print or Type Full Name of Person Responsible for We Construction (typically the well driller) Signature of County Environmental Health Specialist Print or Type Full Name of County Eos iroornctital Health Specialist Per I SA!CAC 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. 15013-23 within 60 days after receipt of the decision. Form G1V-22V Page 2 Revised February 2013 • • Catawba County Environmental Health Pr"- oei .r c> d , 1- I.4 ik- -.-\—_ -'- 4 _ _. - \ --‘ 5 > :' ; VS Vo Q� ''. to XN� por�l e 'LSD' V‘\ Ar• c VI ,r. t 5-t \c; 4A * ° '1, ?- \,,,\ o ec L * P. ,.i -r .;r--- • c.1 6 c i i.r+��- 1 J .aperac:n..f.1,/ 2rooP} O • fo". 1,3„5 t'o,.) r,- 0 itiop fr. (238) 339. .6762 (240) * fa0.67� �aa9 ` (95) V 0101 lap (170).6mi (200) Parcel: 379004633241, 6762 LONG ISLAND RD ii I i Z 13 P ►i (,,`a t,,„,) lln=100ft CATAWBA, 28609 R4Pa _ lb - 2- 1 - 18014 t . 13 f Aic. / l.v,Il S }c P1..,\ This mapfreport product was prepared from the Catawba County,NC Geos_pedal Inforrnadon Services. Catawba County has made substantial efforts' to ensure the accuracy of location and labeling InformeUon contained on this map or data on this report.Catawba County promotes and recommends the Independent veriflca ion of any data contained on this map/report product by the user.The County of Catawba.Its employees,agents,and' • personnel.disclaim,and ahadl not be held[table for any and all damages,toss or liability,whether direct,Indirect or consequential wtildr arises or may wise from this map/report product or the use thereof by Crm person or ent1 ity. County NC Scanned with CamScanner � S;r!ka 4H•' ROY COOPER • Governor %� •`� � opy\.. NC DEPARTMENT OF 0 . ^- �; KODY H. KINSLEY• Secretary ,��,.� r� �` HEALTH AND Q� HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health � "•••^ MARK T. BENTON•Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch October 27, 2022 David Bleicher 6762 Long Island Rd Catawba, NC 28607 Re: Approval No. JMB2806 Private Well Located Less than 25' from Building Perimeter [Rule 1 SA NCAC 2C .0107(a)(2)(P)] Property location: 6762 Long Island Rd Catawba, NC 28607 Dear Mr. Bleicher: On October 26, 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 the variance concerns a water supply well on the referenced property. A structure is proposed to be within twenty-five feet of the well. Specifically, the variance request grants you permission to use 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 you, and the Catawba County Health Department, 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 well/wellhead shall meet all current 2C. 0100 standards, including but not limited to being properly grouted, terminated at least 12"above land surface, properly sealed, and having a thread-less sample tap etc. 2) The well shall be sampled for the same parameters required of a newly constructed well. If samples indicate contamination, further repairs or treatment will be necessary. 3) No potential sources of groundwater contamination shall be stored near the well-head. 4) No termite treatment shall be applied to the structure within twenty-five feet of the well unless alternative methods are approved by Catawba County Health Department. 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