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HomeMy WebLinkAboutRBPR-02-2022-39991.TIF -$ •6 THIS IS NOT A PERMIT Case It RBPR-02-2022-39991 CATAWBA COUNTY HEALTH DEPARTMENT PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES 18 2 sM Residential Building Plan Review-Building New IMPROVEMENT-AUTH CONST- NEW WELL 6/1,h) Qvl sed to 36R Applicant RICHARD &KRISTIN SALKOWSKI, 1896 LOTUS LN,DENVER NC 28037-7896 Contractor *ELITE BUILDERS OF SURRY INC (KRISTEANA INMAN).PO BOX 1044,DOBSON NC 27017-1044 C:336-325-8760 DAVIDRDCONST@ SURRY.NET Owner RICHARD &KRISTIN SALKOWSKI, 1896 LOTUS LN,DENVER NC 28037-7896 NAME TO APPEAR ON PERMIT *ELITE BUILDERS OF SURRY INC (Kristeana Inman) SITE ADDRESS: 3974 CEDAR WOOD TR,TERRELL NC 28682 PIN# 461704734177 NAME of SUBDIVISION: Lot# 4 Section/Block PROPERTY SIZE: Square Feet Acres 0.49 DIRECTIONS: 16 South left on 150 east Right on Kiser island left on cedar wood trail last wooded lot on left PRIM : • . . . Contractor SEWER TYPE: Septic Tank LLONS PER DAY: 360 WATER SUPPLY: Private Well DESCRIBE WORK: ./6/22 REVISED TO 3 BEDROOMS SAME LOCATION PER KRISTIN SALKOWSKI New 48x78 SFR with 4 bedrooms with basement walk out plus deck will be 2nd floor becasuse of basement 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? No 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? Yes Are there any easements or right-of-ways on this property? No APPLICATION FOR: New Structure STRUCTURE TYPE: PRIMARY RESIDENCE FACILITY TYPE: Single Family Residence OTHER DESCRIPTION: DESCRIPTION OF vacant lot EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: 0 #OF OCCUPANTS: 4 PROPOSED CONSTRUCTION NEW IM:: 49x78 OF NE BEDROOMS:: 3 Yes BASEMENT FIXTURES? Yes PLUMBING REQUIRED? Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: YES Other described: APPLICATION FOR WELL CONSTRUCTION PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO ehapplicati,n 06/06/2022 16:47 Page 1 of 3 CATAWBA COUNTY Case RBPR-02-2022-39991 qt.ar Public Health Department IngEnvironmental Health Division Subdivision .;�� PO Box 389,100-A Southwest Blvd,Newton,NC 28658 PINk 461704734177 NAME ON PERMIT: *ELITE BUILDERS OF SURRY INC (KRISTEANA INMAN),PO BOX 1044.DOBSON NC 27017-1044 'ELITE BUILDERS OF SURRY I Site Address: 3974 CEDAR WOOD TR,TERRELL NC 28682 Property Size; Square Feet Acres 0.49 Directions: 16 South left on 150 east Right on Kiser island left on cedar wood trail last wooded lot on left 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 Authonzatton to Construct will remain valid as long as the Improvement Permits valid.An Authorization to Construct issued for septic repair Is valid for eo 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 reed 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: (.r fP 2-2__ Signature of Applicant or Agent 4L: if need further you tnfonnation or nssi nee please call 82 65-8270 AREAS SETBACKS: 30'from 760'coutour line YEENAME DATE FEE AMOUNT Authorization to Construct Fee(New/Expansion) 02/03/2022 S300.00 Fee Improvement Permit Fee 02/03/2022 S150.00 Weil Permit& Inspection Fee 02/03/2022 S300.00 TOTAL FEES S750,00 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) chapptik wpm 06/06/2022 16:47 Page 2 of 3 a :ace c s s 1 P (- Fs 31-214 iiilligill!Iii! U 1 4--:11. —arine......._,(2j0110,0111aE)...._ z 1 1 *rs MIA ;iii f 1 '1 .,:02 ".--} . / -6)) .1* ill _ o° ; i y -a . ,/ g d5Siq C1J 44 .: --„,..i.:4:4- il!ll 111 :7. --t n :ji:: CP) I i eak , i(•• �\ \'c+ µ' I \\14. .is° ' .... A L ,.....,„\ ...:. ,,.„%. . t , r. \\\\\ ' N r H • C[ 1 r --'\w a _, 7 ,,...... __-,—In- 1 ,_____ _ !boa 6., 17,,,:l. / g/ A r $ . ij +r I lilttlr 0 ' U Z it ll m x' o ZI lI' 111 Z.C. l 1ltl -1 6) lull ifiL\1111111. Catawba county public health June 2, 2022 Rick and Kristin Salkowski 1896 Lotus Ln Denver, NC 28037 Re: Application for Improvement/Authorization to Construct Permit for property site 3974 Cedar Wood Trail, Terrell,NC 28682 Health Department file number RBPR-02-2022-39991. Dear Mr. and Mrs.Salkowski: The Catawba County Health Department, Environmental Health Division on 03/25/2022,evaluated the above referenced property at the site designated on the plat/site plan that accompanied your Improvement Permit application. According to your application the site is to serve a 4-bedroom home with a design wastewater flow of 480 gallons per day. The evaluation was done in accordance with the laws and rules governing wastewater systems in North Carolina General Statute 130A-333 including related statutes and Title 15A,Subchapter 18A, of the North Carolina Administrative Code,Rule.1900 and related rules. Based on the criteria set out in Title 15A,Subchapter 18A,of the North Carolina Administrative Code, Rule.1940 through .1948,the evaluation indicated that the site is UNSUITABLE for a sanitary system of sewage treatment and disposal. Therefore,we must deny your request for an improvement permit. A copy of the site evaluation is enclosed. The site is unsuitable based on the following: Unsuitable soil topography and/or landscape position(Rule.1940) Unsuitable soil characteristics(structure or clay mineralogy)(Rule.1941) Unsuitable soil wetness condition(Rule.1942) Unsuitable soil depth (Rule.1943) Presence of restrictive horizon (Rule.1944) X Insufficient space for septic system and repair area (Rule.1945) X Unsuitable for meeting required(Rule.1950) Other(Rule.1946) These severe soil or site limitations could cause premature system failure,leading to the discharge of untreated sewage on the ground surface, into surface waters, directly to ground water or inside your structure. The site evaluation included consideration of possible site modifications,as well as use of modified, innovative,or alternative systems. However,the Health Department has determined that none of the above options will overcome the severe conditions on this site. A possible option might be a system designed to dispose of sewage to another area of suitable soil or off-site to additional property. catawbacountync.gov Environmental Health Cotcwbc County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. Page 2 For the reasons set out above,the property is currently classified UNSUITABLE,and no Authorization to Construct- Relocation shall be issued for this site in accordance with Rule .1948(c). Note that a site classified as UNSUITABLE may be classified as PROVISIONALLY SUITABLE if written documentation is provided that meets the requirements of Rule.1948(d). A copy of this rule is enclosed. You may hire a consultant to assist you if you wish to try to develop a plan under which your site could be reclassified as PROVISIONALLY SUITABLE. You have a right to an informal review of this decision. You may request an informal review by the soil scientist or environmental health supervisor at the local health department. You may also request an informal review by the North Carolina Department of Health and Human Services regional soil scientist. A request for informal review must be made in writing to the local health department. You also have a right to a formal appeal of this decision. To pursue a formal appeal,you must file a petition for a contested case hearing with the Office of Administrative Hearings,6714 Mail Service Center, Raleigh, NC 27699- 6714. To get a copy of a petition form,you may write the Office of Administrative Hearings or call the office at (919)431-3000 or download it from the OAH web site at http://www.ncoah.com/forms.html . The petition for a contested case hearing must be filed in accordance with the provision of North Carolina General Statutes 130A-24 and 150B-23 and all other applicable provisions of Chapter 150B. N.C. General Statute 130A-335 (g)provides that your hearing would be held in the county where your property is located. Please note: If you wish to pursue a formal appeal,you must file the petition form with the Office of Administrative Hearings WITHIN 30 DAYS OF THE DATE OF THIS LETTER. The date of this letter is 6/2/2022. Meeting the 30 day deadline is critical to your formal appeal. If you file a petition for a contested case hearing with the Office of Administrative Hearings,you are required by law(N.C.General Statute 150E-23)to serve a copy of your petition on the Office of General Counsel, N.C. Department of Health and Human Services, 2001 Mail Service Center, Raleigh, N.C. 27699-2001. Do not serve the petition on your local health department. Sending a copy of your petition to the local health department will not satisfy the legal requirement in N.C.General Statute 150E-23 that you send a copy to the Office of General Counsel, N. C. Department of Health and Human Services. You may call or write the local health department if you need any additional information or assistance. Sincerely, ames R Ross, REHS Environmental Health Specialist Enclosures: Site evaluation Rule .1945, .1948 and .1950 15A NCAC 18A.1945 AVAILABLE SPACE (a) Sites shall have sufficient available space to permit the installation and proper functioning of ground absorption sewage treatment and disposal systems,based upon the square footage of nitrification field required for the long-term acceptance rate determined in accordance with these Rules. (b) Sites shall have sufficient available space for a repair area separate from the area determined in Paragraph(a)of this Rule.The repair area shall be based upon the area of the nitrification field required to accommodate the installation of a replacement system as specified in Rule .1955, .1956, or .1957 of this Section. Prior to issuance of the initial Improvement Permit for a site, the local health department shall designate on the permit the original system layout, the repair area,and the type of replacement system. (c)The repair area requirement of Paragraph(b)of this Rule shall not apply to a lot or tract of land: (I) which is specifically described in a document on file with the local health department on July 1, 1982,or which is specifically described in a recorded deed or a recorded plat on January 1, 1983;and (2) which is of insufficient size to satisfy the repair area requirement of Paragraph(b)of this Rule,as determined by the local health department;and (3) on which a ground absorption sewage treatment and disposal system with a design daily flow of: (A) no more than 480 gallons is to be installed;or (B) more than 480 gallons is to be installed if application for an improvement permit which meets the requirements of Rule .1937(c)of this Subchapter is received by the local health department on or before April 1, 1983. (d)Although a lot or tract of land is exempted under Paragraph(c)from the repair area requirement of Paragraph(b), the maximum feasible area, as determined by the local health department,shall be allocated for a repair area. History Note: Authority G.S. 130A-335(e)and(0; EfJ:July 1, 1982; Amended Eff. February 1, 1992;July 1, 1983;January 1, 1983. 15A NCAC 18A.1948 SITE CLASSIFICATION (a) Sites classified as SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules. A suitable classification generally indicates soil and site conditions favorable for the operation of a ground absorption sewage treatment and disposal system or have slight limitations that are readily overcome by proper design and installation. (b)Sites classified as PROVISIONALLY SUITABLE may be utilized for a ground absorption sewage treatment and disposal system consistent with these Rules but have moderate limitations. Sites classified Provisionally Suitable require some modifications and careful planning, design, and installation in order for a ground absorption sewage treatment and disposal system to function satisfactorily. (c)Sites classified UNSUITABLE have severe limitations for the installation and use of a properly functioning ground absorption sewage treatment and disposal system. An improvement permit shall not be issued for a site which is classified as UNSUITABLE. However, where a site is UNSUITABLE, it may be reclassified PROVISIONALLY SUITABLE if a special investigation indicates that a modified or alternative system can be installed in accordance with Rules .1956 or.1957 of this Section. (d) A site classified as UNSUITABLE may be used for a ground absorption sewage treatment and disposal system specifically identified in Rules.1955,.1956,or.1957 of this Section or a system approved under Rule.1969 if written documentation,including engineering,hydrogeologic,geologic or soil studies,indicates to the local health department that the proposed system can be expected to function satisfactorily. Such sites shall be reclassified as PROVISIONALLY SUITABLE if the local health department determines that the substantiating data indicate that: (1) a ground absorption system can be installed so that the effluent will be non-pathogenic, noninfectious,non-toxic,and non-hazardous; (2) the effluent will not contaminate groundwater or surface water;and (3) the effluent will not be exposed on the ground surface or be discharged to surface waters where it could come in contact with people,animals,or vectors. The State shall review the substantiating data if requested by the local health department. Ilistory Note: Authority G.S. I30A-335(e); Eff.Jul v 1, 1982; Amended Eff. April 1, 1993;January 1, 1990. 15A NCAC INA.1950 LOCATION OF SANITARY SEWAGE SYSTEMS (a) livery sanitary sewage treatment and disposal system shall be located at least the minimum horizontal distance from the following: (I) Any private water supply source, including any well or spring 100 feet; (2) Any public water supply source 100 feet; (3) Streams classified as WS-I 100 feet; (4) Waters classified as S.A. 100 feet, from mean high water mark; (5) Other coastal waters 50 feet.from mean high water mark; (6) Any other stream,canal,marsh,or other surface waters 50 feet: (7) Any Class I or Class II reservoir 100 feet, from normal pool elevation: (8) Any permanent storm water retention pond 50 feet,from flood pool elevation; (9) Any other lake or pond 50 feet,from normal pool elevation; (10) Any building foundation 5 feet; (II) Any basement 15 feet; (12) Any property line 10 feet; (13) Top of slope of embankments or cuts of'2 feet or inure vertical height 15 feet; (14) Any water line 10 feet; (15) Drainage Systems: (A) Interceptor drains,foundation drains,and storm water diversions (i) upslope 10 feet, (ii) sideslope 15 feet,and (iii) downslopc 25 feet; (13) Groundwater lowering ditches and devices 25 feet; (16) Any swimming pool 15 feet; (17) Any other nitrification field(except repair area) 20 feet; (h) Ground absorption sewage treatment and disposal systems may he located closer than 100 feet from a private water supply, except springs and uncased wells located downslope and used as a source of drinking water, for repairs, space limitations,and other site-planning considerations but shall be located the maximum feasible distance and in no case less than 50 feet. (e) Nitrification fields and repair areas shall not he located under paved areas or areas subject to vehicular traffic. If effluent is to be conveyed under areas subject to vehicular traffic,ductile iron or its equivalent pipe shall he used. I lowever.pipe specified in Rule.1955(e)may he used if a minimum of 30 inches of compacted cover is provided over the pipe. (d) In addition to the requirements of Paragraph(a)of this Rule,sites to he used for subsurface disposal for design units with flows over 3.000 gallons per day, as determined in Rule .1949 (a) or (b) of this Section, which include one or more nitrification fields with individual capacities of greater than 1,500 gallons per day, shall be located at least the minimum horizontal distance from the following: (I) Any Class I or II reservoir or any public water supply source utilizing a shallow(under 50 feet)groundwater aquifer 500 feet; (2) Any other public water supply source,unless determined to utilize a confined aquifer 200 feet: (3) Any private water supply source,unless determined to utilize a confined aquifer I00 feet; (4) Waters classified as SA 200 feet.from mean high water mark; (5) Any waters classified as WS-I 200 feet; (6) Any surface waters classified as WS-11,WS-III,B.or SB 100 feet;and (7) Any property line 25 feet. (e) Collection sewers, force mains, and supply lines shall be located at least the minimum horizontal distance from the following: (I) Any public water supply source,including wells,springs, and Class I or Class II reservoirs 100 feet,unless constructed of leakproof pipe,such as ductile iron pipe with mechanical joints equivalent to water main standards,in which case the minimum setback may be reduced to 50 feet; (2) Any private water supply source, including wells and springs 50 feet,unless constructed of similar leakproof pipe,such as ductile iron pipe with mechanical joints equivalent to water main standards,in which case the minimum setback may be reduced to 25 feet; (3) Any waters classified as WS-I,WS-II, WS-Ill, 13,SA,or S13 50 feet,unless constructed of similar leakproof pipe,such as ductile iron pipe with mechanical joints equivalent to water main standards,in which case the minimum setback may be reduced to 10 feet; (4) Any other stream,canal,marsh,coastal waters, lakes and other impoundments,or other surface waters 10 feet; (5) Any basement 10 feet; (6) Any property line 5 feet; (7) Top of slope of embankments or cuts of two feet or more vertical height 10 feet; (8) Drainage Systems: (A) Interceptor drains,storm drains,and storm water diversions 5 feet; (13) Ground-water lowering ditches and devices 10 feet; (9) Any swimming pool 10 feet; (10) Any other nitrification field S feet. (f) Sewer lines may cross a water line if 18 inches clear separation distance is maintained,with the sewer line passing under the water line. When conditions prevent an 18-inch clear separation from being maintained or whenever it is necessary for the water line to cross under the sewer,the sewer line shall be constructed of ductile iron pipe or its equivalent and the water line shall be constructed of ferrous materials equivalent to water main standards for a distance of at least ten feet on each side of the point of crossing,with full sections of pipe centered at the point of crossing. (g) Sewer lines may cross a storm drain in (I) 12 inches clear separation distance is maintained;or (2) the sewer is of ductile iron pipe or encased in concrete or ductile iron pipe for at least five feet on either side of the crossing. (h) Sewer lines may cross a stream if at least three feet of stable cover can be maintained or the sewer line is of ductile iron pipe or encased in concrete or ductile iron pipe for at least ten feet on either side of the crossing and protected against the normal range of high and low water conditions,including the 100-year flood/wave action. Aerial crossings shall he by ductile iron pipe with mechanical joints or steel pipe. l'ipe shall he anchored for at least ten feet on either side of the crossing. (i) Septic tanks,lift stations,wastewater treatment plants,sand filters,and other pretreatment systems shall not be located in areas subject to frequent flooding (areas inundated at a ten-year or less frequency) unless designed and installed to be watertight and to remain operable during a ten-year storm. Mechanical or electrical components of treatment systems shall be above the 100-year flood level or otherwise protected against a 100-year flood. History:Note_ Authority(;.S. l3(1.•I-3350 and(fl. 1 fJ'July 1, 1982; .I nestled!f/.',lunuury I, 19911; October 1. 1982. DEPARTMENT OF HEALTH AND HUMAN SERVICES Sheet of DIVISION OF PUBLIC HEALTH,ENVIRONMENTAL.HEALTH SECTION PROPERTY ID#: ON-SITE WATER PROTECTION BRANCH COUNTY: Catawba SOIIJSITE EVALUATION for ON-SITE WASTEWATER SYSTEM (Complete all fields in full) 1G , �' "]� C .5 r - �► —f-hw Yt,1 OWNER: 4 _ APPLICATION DATE ADDRESS: 1 � 2. ©f 1 DATE EVALUATED:y�ZT ' PROPOSED FACILITY: PROPOSED D• IG ''LO 1949): PROPERTY SIZE: }� LOCATION OF SITE: /f rC4JI 4' PROPERTY RECORDED: WATER SUPPLY: 0 Private 0 Public ell 0 Spring Other EVALUATION METHOD: 0 Au er Boring D Cut TYPE OF WASTEWATER: Z-Sewage U Industrial Process 0 Mixed �).+� s 1 r j r �. S '-'1, s S rk ■ _ _ � 'YT esE ;' a �bS r. ,, 05 ',4 3„ 4• ,y r „ z,etgt; Y fW�• tl 'W�vl, f•`,' N'� ,. IkR „d 1 d r i. M � r ;g r7 a u "�q� t`� L��'•. � :,iC s'ta ,,'yk `sYre A, 'kYinr?.`9' k + �' ,, e u�• 5a� .-s e"L, `g a J siY� j; S. +n Jai u rc a/ i b',-)' ,�2},ti-,4` , i .0 • ;+ ' ' + ''' l5 . Gu T a r. b? 9€ : `„.. ., w 7'' 5 r ('t +F I i 1 i'V b t �IFi I ,? 4.c; 'tir _ •,i• P ,� i 1�a.i a q �A.' �,�r; .y .' �� It. 8 ti ,.i rl 71 mow" l x t• A •w i 7F r7 7, Q } a� '. �4F' � 4 c� a s .a, eg � � '411 ti J �� r _ J, t k s +, �` _ r :II):(1et sr. 4..` +' = „.. - 'ct i. , y a. t� x '1( ,d "► { $ti , 9t' t t t v , tt ;;, c. '�+T+: ta+ ? wl T h,� 41E is ' fts •� iw td ii: a Q•;' �_I' ° W,`:' i1 J� + R YO 1 .P . s "tHf, isq. ",Y� `? 1 .R....• is,i�lG'E.rp £,-,,•M � y�lf hel 2 �e'�t• �� i �'`''i •kC/`�F 11 y$ '�•alx"' Us�.' A t Y �. ��1+`+ 11� ry' •C 5AK /, ), 1 l� )-)-3 c4 /( r( 2- , 3 5 -Lig L nil 17 // y j /c L 1' • f r c lI 2 11-627 C. sB i rr, • 6/ 3 1� o E1- f , (_ 56K fc `,� all - 5 C rCI_ eK.-F7 SE 0 / , Cct0./K if 3f � S4r'( m` 1i r Len Ir /( DESCRIPTION INITIAL SYSTEM REPAIR SYSTEM OTHER FACTORS(.1946): Available Space(.1945) (� I>' b/ SITE.CLASSIFICATION(.1948): , /i.,/ System Type(s) EVALUATED BY: OTHER(S)PRESENT: Site LTAR ! COMMENTS: Updated February 2014 > 2l . Pg 31-214 C !t! 2 PI; 1, F tli o cgs .-C / :ill hi 21 9 / -84 oo� o /' / 11 d 5-5 ,(- 4 • // g . ...._, Opp `:y`� rUI Li ''' ' Lh� ? So ill W ..1..\-6 4 ;:?:f4liii4M- h ovy._ (Do el f-ov- 511q 1 ' '� p� ;g1 1411 X --0 Pi ,&-r- ,04 v y. o v a m\CD \'\ N v. J. 0:H IQ cn o . _p $8'4 48 C so:: p�. �.. PI m 1 r '(..\--; ___-- ---Serica.7---,z.-- --..."" • -- 1 �• r e r j _`RO�IIn. �� / $g 2 ���s ,nos�n a9L ro // . J s? g / Itl;ll C I › j v Z jixill (A r0 N ` / T C 9. 1 11 9 L82 Ill O a (11flplla tlltl -1 P--C it llll' yC nut 3 • f F p 0 1yC Q ,nw, �, 7�p c p � � C� / / lb .92 5:,:-.* 7 ',-...-.-.1 t t,:i . cluo -1 gS1;eN� Al v� .11I/J�r y �pA f�-i KPq E' - hi-1 i a ax�n4�lC,jS1 i '2gS-a < np i R —< + C, s V/ AS �41 6j • _56 Ypi( LIDO 3(A 3 )- p ',I --S- ,/) -5/-2-2-- • , Catawba County Environmental Health &CI.- . D Lli ► Dk 15 (61 - '` J( N 1 Oj'cij .39'S8 � � � �� 0,L(f/-14.,,, 11. 2 t-(4 No. 1--il " , ) .151 5 .v‘ . pili( 3966 ,j 10 ,5 G� 2,�"$5 5. C\IV l'_/l 5 1.!F .I "t— i 8.10 .3974 4 • C_ OA r�- ♦39 ICN) 6° "4.7 �br 6P .3986 eNi nr $ �./� Parcel:461704734177, 3974 CEDAR WOOD TR 6 C L tc,,gA = TERRELL, 28682 tin50ft - se) C_ w3 / L6�CL ws6/ to This map/report product was prepared from the Catawba County,NC Geospatial information Services. Catawba County has made substantial efforts ensurethe the accuracy of location and labeling information contained on this map or data on this report.Catawba County pendent verification of any data contained on this map/report product by the user.The County of Catawba,its employees, promotes ged s,and rinds Personnel,disclaim,and shag not be held liable for any and all damages,loss or liability,whether direct. PloYeial which a and arise from this mapfteport product or the use thereof by any person or entity. consequential which arises or may Copyright 2021 Catawba County NC 02/03/2022 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY • Complete items 1,2,and 3. A. Si re Print your name and address on the reverse / ( 0 Agent so that we can return the card to you. X �; '!YJ t.Lt,�C�? Addressee • Attach this card to the back of the mailpiece, B. Deceived b Printed Name) C. DaeFif Delivery or on the front if space permits. �� ,-, '-;t,i•"4A 1 C 1. Article Addressed to: D. Is delivery address different from item 1? 10 Yes If YES,enter delivery address below: 0 No Rick and Kristin Salkowski 1896 Lotus Ln Denver, NC 28037 3. Service Type ❑Priority Mail Express® II III (II 'I(I I II I! ( I I II1II I I I❑dolt Sied Mail®Restricted Delivery D Regis tiered Mail istered Restricted 9590 9402 6545 1028 0685 68 ❑Certified Mall Restricted Delivery 0 Signature ConfirmationTM ❑Collect on Delivery 0 Signature Confirmation 2. Article Number(Transfer from service label) 0 Collect on Delivery Restricted Delivery Restricted Delivery A Insured Mail r u i,5 152 0 0000 3290 6780 ❑Insured Mail Restricted Delivery —____, (over$500) PS Form 3811,July 2020 PSN 7530-02-000-9053 Domestic Return Receipt LISPS TRACKING# First-Class Mail ? 3s Postage&Fees Paid 111111 LISPS Permit No.G-10 9590 9402 6545 1028 0685 68 United States •Sender:Please print your name,address,and ZIP+4®in this box Postai Service RECEIVED RBPR-02-2022-39991 James R Ross, REHS Jii"' i n 2022 Catawba County Environmental Health PO Box 389 Environmental Healttl ewton, NC 28658 "721--03Eii iwi 111i1Illl11'111111111111111111111111f1} 111'1"1'1n1111111' • 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 OZC.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 monitoring and recovery wells. Print clearly or type information. Illegible submittals will be returned as incomplete. DATE: MAJ fr% I , 20 9..2 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: R.t C l A(2`D G . & 14(2-t 5;r N A . mac.tK-o't,3 S KA Mailing Address: 1 S' to L-p'N`v I N€- City: Pt NV (Z State: KC Zip Code:2-5'37 County: L_► N Go t_tu Day Tele No.: ct 0113- ZS�" 3�8 8 7 Cell No.: ci 0e Z 61.0 - 60 EMAIL Address: 2t Sri t\S ZZ-�-440i • (-44-1 Fax No.: B. PHYSICAL LOCATION OF WELL SITE (1) Parcel Identification Number(PIN)of well site: L 45 t 1 D ? 3 y l 7 7 County: GAt ( .A (2) Physical Address(if different than mailing address): 3°1 7 `I T t I-- City: State:NC Zip Code: 2E(O aZ 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.: FonnGW-22V Page 1 Revised February2013 D. REASON FOR VARIANCE REQUEST—Include type of well(*)to be constructed; rule for which the variance is being requested; description of bow 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. I)u €.- TC L 0 T' R.i;.ST 12-t c.T—i C7 N S 4- t--o r<-(e.,_. 5 t 2 i J 1.� mot.L r.) �c OS Ta Qom. I #J T- € 5D ' Z5CT BAc.< 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,othor 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 mct. Minimum additional construction requirements for Coastal Plain and Piedmont and Mountain region wells are 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 (...4‘.e."6.7 Signature of Person Responsible fur Well ell Construction(typically the well+/**flat) 1Wcky. A r- c.ikeesik; _...., Print or Type Full Name of Person Responsible far Well Construction (typically the well driller) -/--- / .--4Q__ Signature of County Environmental Health Specialist 3a e 5 k '4515- PH ri t or'type Full Name or County EnvIrontruntal Health Specialist Per 1 SA NCAC 01C.0118 the Secretary of the Division of Water Quality or the Division of Public health may require submittal of information deemed necessary to matte 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 whh the decision of the Director may commence a contested case by filing a petition as described in G.S. 1508-23 within 60 days after receipt of the decision. Form Cw-22V Page 2 Revised February 2013 ;Pillagi211510 Pg 31-214 !III illiNii!: i >t- 111441 % iti o . 1 c4:$11_ 7:9- ../".' Iiii hIIiI ! 511 V Si rn - 11.1 _ / s I / / y / 0� �� $ il!!111 1 --7. •---t. • / ter .. �R �• 13k114 ill :; !fir•;:.:. 0R % Ci::i:i:i,.- s, \J` � 1 . L T.,-.. \ $ \ 'ate ...i.. , ,.‘,..\;:, V to -a \ .�" Us in' tri r i ° <:) u S 'ft .Y�+ m nx °� ./'C\j' - fir:- .�\�-;ter? _ _ / o !I S2 P I coN �ao ltiltl K7 ZJ ti tiit CI vA,r,tcc) > (' z l t ',3iiitill "' li ltl ltglltll -1 A.c ll mil littl n Q ii K 4 IR b:,,.. 11 I 1 a g4 it bw 6 '+ c� P xi., z .,.,,,,::N• 44,0.; -•-• g 1 — / / "3 I/111h P: 1N .::-4: 4 g.iill Z LI. IE .51: `` `rrrmt � ta ga Ise,...0"' 1 ii J fl El tD T TA.c.t-A V1/4-4 (I ) MAP M A < . t-4 f; 1 f 01'3 _ •ly Jt a r4\ CD ZND LEFT 1 X 3971-i v-tepc, T12-A L__ SA L_K-DCJSV-- t STATE o- l Jiro Ty ROY COOPER• Governor M,.=a,,,s o 10 NC DEPARTMENT OF KODY H. KINSLEY• Secretary ,. HEALTH AND HUMAN SERVICES HELEN WOLSTENHOLME• Interim Deputy Secretary for Health ..a,=.^,. MARK T. BENTON•Assistant Secretary for Public Health F QU�M VI O# Division of Public Health Onsite Water Protection Branch May 20, 2022 Richard and Kristin Salkowsky 1896 Lotus Lane Denver, NC 28037 Re: Approval No. JMB2641 Private Well Located Less than 50' from Surface Water [Rule 15A NCAC 2C .0107(a)(2)(Q)] Property location: 3974 Cedar Wood Trail Terrell, NC 28682 Dear Mr. and Mrs. Salkowsky: On May 17, 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 lake on the property will be within fifty 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 fifty-foot setback to a surface water body. Achieving the fifty-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 50foot setback, but not be closer than 25feet. 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 50 feet below land surface or to bedrock, whichever is greater. 5) The well shall be at least one hundred 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 U.S. Postal Service"' CERTIFIED MAIL® RECEIPT 1=3 1=13 Domestic Mail Only r— `6•...—l.,ii.W. -13 For delivery information,visit our website at www.usps.com®. i • ' a cows 1 m I Ii .0',-;,.• ..,'hr,-, 'IMP .",,,ta .o,ut cr 1Certified Mail Fee M $ Extra Services&Fees(check box,add lee as appropriate) 0 Return Receipt(hardcopy) $ _ (? Q?"N ED U Return Receipt(electronic) $ tf:P StIlliNa 1/41.• c3 El Certified Mail Restricted Delivery $ Here v CO E3 D Adult Signature Required $ El Adult Signature Restricted Delivery$ — VT C3 Postage ....) 11J 4/ • Y) up $ rl Total Postage and Fees $ RBPR-02-2022-39991 u-, Sent To Rick and Kristin Salkowski r--1 CI -Street and Aple9 fitottekn P- City,State,oDenver,-NC-28037 Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail •A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPScti-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' -Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or t:•..e addressee's authorized agent. Important Reminders: • mice,which requires the r •You may purchase Certified 'id, E f o r :St 21 years of age(not First-Class Mail®,First-Clas a 1 •.t ' .i). or Priority Mails service. -Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail. a ►yQQes delivery to the addressee specified •Insurance coverage is not available f+�r rNiase•— A by tie r to the addressee's authorized agent with Certified Mail service.However,�roe purchase (no avalllabble at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. LISPS postmark.if you would like a postmark on •For an additional fee,and wi en{f 'citr?J]I eeipt,please present your endorsement on the m , (�ailpie nd c t1' find 0e I t a Post Office'"for the following services: postmarking.It you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Forrn 3800,April 2015(Reverse)PSN 7530-02-000-9047 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES • VARIANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS: PRIVATE DRINKING WATER WELLS UNDER I5A 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 15A NCAC 02C.0108 Including monitoring and recovery wells. Print clearly or t}pe information. Illegible submittals will be returned as incomplete. DATE: S 1(- , 20 PERMIT NO.: (to be completed by DWQ/DPH) A. 1VELL 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: Mailing Address: / %�o i e? "uS ��'!L- City: „' ., StaterC Zip CodoU057County: Z./Hrt.)Ih Day Tele No.: 908 2S1 5—?1 3 Cell No.: EMAIL Address: e25C in AILS e,Pi(ryLett FaxNo.: B. PHYSICAL LOCATION OF WELL SITE / zt� ) ''J (1) Parcel Identification ` (! /J 1 / /Number(PIN)of well site: / 170 7 County, c-LtAa GL (2) Physical Address(if different than mailing address): 3 ` 7/ Ce Id- &az' (I Q et • City: )U'rc`, State:NC Zip Code: 2E6Z2 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.: Form GW-22V Page 1 Revised February 2013 D. REASON FOR VARIANCE REQUEST—Include type of welI(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. t.r-e i Mc A-L o 2 L .n r 07 i) (i)(P) 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 she 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 Attachments A and B on pages 4 and S 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 A Signature of Peru Responsible for Well Construction(typically the well driller) lc 4-- 1 � l'rint or Type Full Name of Person Responsible for Well Construction (typically the well driller) , L _ Signature of County Environmental Health Specialist AOL � Pft.t�r 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 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. 150B-23 within 60 days after receipt of the decision. Form GW-22V Page 2 Revised February 2013 •••••.... -4* • I:47. 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'.4.# ., * 47 ' .1/4'...••" \IF... 1•:!..-. • V91#41' 7.,i7:17.. V% :•- 1 ./.1'..:•: •:. i .....;•:".:::.'.. .. ..e • •••'6".,:.;:t:',-, 4 • it.......„:::-. • • — —. • .4 -74 s r • .-e:t •• am ....., .:.:10/..k..., .. IP p Itslorir ; 6, . •A . • ......... , ...-- ND • 5011 • ,35... 0 fitpv-0-1 - 3--6 P-3- ........ 6°I RivNi ., - .. .7,. )9 /--.) Lizi Rt v400° ..._,_ ,. . • L - Li cEoPkR , • - L _ 03- 19 4SS- , • - - .......- . -- - -Aii1/ 14-0 I Y . , .....,,,;.,,......._ _ . , - STAiF q s.a „•Y10.i>„ W04, ROY COOPER • Governor la,, ti NC DEPARTMENT OF KODY H. KINSLEY • Secretary ri HEALTH AND HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health P .,Mr.•^ tl. MARK T. BENTON •Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch May 19, 2023 Rick Salkowski 1896 Lotus Lane Denver, NC 28037 Re: Approval No. JM 133019 Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 3974 Cedar Wood 'Trail Terrell,NC 28682 Dear Mr. Salkowski: On May 16, 2023, 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 I 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 at 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. 11)A grout inspection must be performed by the 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