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Home My WebLink AboutRBPR-01-2022-39795.TIF • NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES - 'I rr VARIANCE,APPLICATION FOR 2C .0100 WELL CONSTRUCTION STANDARDS: , _ 2 .. PRIVATE DRINKING WATER WELLS UNDER ISA NCAC 02C.0300 WATER SUPPLY WELLS UNDER 15A NCAC 02C.0107 A!!water supply wells not considered"Private Drinking!Pater Wells"and including irrigation,industrial,and commercial wells. WELLS OTHER THAN WATER SUPPLY UNDER 15A NCAC 02C.0108 Including monitoring and recovery wells. Print clearly or t pe information. Illegible sitbiirittals kill be returned as incomplete. DATE: 3 U%12 2 l 2022 PERMIT NO.: (to be completed by DWQ/DPH) A. WELL OWNER - For single family residences list the property oHmer(s). For all ethers, list name of the business; organization,or government agency and person delegated signature authority: UDf;-4- 6 Mailing Address: Ci N1-7 32 /✓Ls/ S i IL( �IGiG-r NC 2xgni City: State: _ Zip Code:_ County: Day Tele No.: ' '2. 355 ' 512_ Cell No.: EMAILAdditss: IY19 saNI CLS2DDIsOlgiMDp.eas Fax No.: B. PHYSICAL LOCATION OF WELL'SITE (I) Parcel Identification Number(PIN)of well site: County: _ (2) Physical Addreü(if different than mailing addre55): lilO 'Are-its (.407 City: /1/P_t✓#,r. Statc:NC Zip Code: . 2865-P C. WELL DRILLER INFORMATION (if known) Well Drilling Contractor's Name: 4 /4 NC.Well Drilling Contractor Certification No.: Company Name: Contact Person: City: State: _ Zip Codc:_ County: Day Tele No:: Cell No.: EMAIL Address: Fax No.: .Fenn G W-22 V Page;I Revised February 2013 U. 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. We. are. CAdr..it � c , /n�, 4;,', ( Qt j(;4, Ut l'-J- gore U I S (7wn. si' . t i 5 Pfil: �7 �C I s 11.rxe +-1\91te. c* L crtly„ , le_ ii , A(o veii e r f E'>`'i 4t i ( e ( in , cc; e: SPI it 4' 'nn 40,4. i4 5 '7 -FGc- ►4ell 5(7 *Itrn, {e i4r (in r•ic-Inrr Stv,:c 462- Tn.o u-e.ifitKS CRoft E. ATTACHMENTS-Provide the following information as attachments to this application: (1) 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 .010Tbe met. Minimum additional construction requirements for Coastal Plain and Piedmont and Mounthin region wells arc referenced on Attachments 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 [vetI// 1 rFcn n � y / (^Irr77 fXi.c c- Signature of Penn Responsible fur We struc to •pically the well driller) I206,-/- - l-tnvl.t' De.. neg.. Print or Type Full Name of Person Responsible for Well Construction (typically the well.driller) Signature of County Environmental Health Specialist Print or Type Full Name of County Environmental Health Specialist Per 15A 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 pan 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. Rim G W-22V Page 2 Revised February 2013 North Carolina Please submit this form along with a Well Department of Health and Human Services Variance Application for an existing Division of Public Health private water supply welt Existing Well Variance Inspection Report Well Site Location: NMWk) Town,community,subdivision and Lot N) Address. 19010 Ap -i c (p/ay County: Co 61„ii el ____ _ City/ST/Zip: /Uew-on /VC Zelo51' Date of SiteVisit:__ thIo/ZZ �1 ell ( iin�trurliun Well Head Completion Date of Well Construction: Is the well head 12"above land surface?YES or 0 If unknown, was it drilled before 1972? YES or NO If no,what is the height of the casing: inches If unknown,was it drilled before 7/1/2008'&) or NO Is there a sanitary well seal? �► it NO What type of well is it: Is the sanitary well seal in good repair?�or NO `Drille Bored Hand Dug Jetted Other Are the following items present at the well head? Does the well have a cement slab? 012,or NO Vent Sample Tap Well Tag Pump Tag Does the well appear to be grouted? OP or NO Potential Sources of Contamination? Does the well currently meet separation requirements with known sources of contamination, S or NO If no,please provide distances to those it does meet: Other comments: VrCanCL • ) elC(oatt Oil 100 4eb4-- S-64-1,aC/C Wifl p'uM6 Au,eico - dWelt;4,, . Complete below. Name of person completing this form(please print): C C�✓1t1, /vto�}a✓1 Catawba County Environmental Health ad J3 \ a -\\ f \ � K188B..f q 1 j ' { a 1906; I •y r t v \ 1- L i"-- `Oz /617% 4.41 er t-: 4. ' ugh roti •" 7 ' ��`� P w I,,. Ash _It Parcel: 363917009078, 1906 APRILS WAY 1in=60ft NEWTON, 28658 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 07/26/2022 1 ROY COOPER • Governor i, NC DEPARTMENT OF _ HEALTH AND KODY H. KINSLEY•Secretary 1,4 Q HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health •.1 ! MARK T. BENTON•Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch July 26, 2022 Robert Griffin 905 Hwy 321NW Suite 321 Hickory NC 28601 Re: Approval No. JMB2709 Private Well Located Less Than 100' To A Septic System [Rule 15A NCAC 2C .0107(a)(2)(C)] Property location: 1906 Aprils Way Newton, NC 28658 Dear Mr. Griffin: On July 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 a variance concerns a water supply well on the referenced property currently serving one dwelling. Another connection is proposed to share the well. The closest part of the septic system will be more than fifty feet away from the well, but closer than the required one hundred feet. Specifically, the variance request grants you permission to use an existing water supply well at a distance closer than the one-hundred-foot setback to a septic system and twenty- five-foot setback to a building perimeter. Achieving the setbacks 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 I 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, having a thread-less sample tap etc. 2) The well shall be sampled for the same parameters as required for newly constructed wells. If samples indicate contaminants, further repairs/treatment may be required. 3) No potential sources of groundwater contamination shall be stored near the well-head. 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