HomeMy WebLinkAboutRBPR-01-2022-39908.TIF 1
A:IAN. CATAWBA COUNTY Case il RBPR-01-2022-39908
(, tar Public Health Department Subdivision CYPRESS FARMS
(i . /# Environmental Health Division PINN 461703013140
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'� /� PO Box 389,100-A Southwest Blvd,Newton,NC 28658
fall 6,
NAME ON PERMIT: PRINCETON LAND DEVELOPMENT LLC ( ),1'0 BOX 3608,MOORESVILLE NC 28117-3608
PRINCETON LAND DEVELOPA
Site Address: 8072 CYPRESS ST,SHERRILLS FORD NC 28673
Property 51z11: Square Feet Acres 0.77
Directions: Hwy 150 E Right Slanting Bridge RD.Left on Cypress,property os on the left.First lot beside the sub div sign
Other described:
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
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 fadUty thong...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 heroin is true,complete end correct Authorized county and state officials era
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 end 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.
/ 2 /
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Date: V` ( d '�) Signature of Applicant or Agent
If you need further information or assistanc pica •' 1828-465.8270
AREAS
._FEENAME: - PATE FEE AMOUNT
Authorization to Construct Fee(New/Expansion) 01/27/2022 S300,00
Fee
Well Permit&Inspection Fee 01/27/2022 S300.00
Re-Trip or Redesign Fee 04/05/2023 S70.00
TOTAL FEESa F 3670.00
ua=
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)
shsppGution
04/01R023 14,19 Pats 2 of 3
• NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION FOR 2C .0100 WELL CONSTRUCTION STAND/tau'
PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C.0300
WATER SUPPLY WELLS UNDER 15A NCAC 02C.0107 l wells.
All water supply wells not considered"Private Drinking Water Wells"and Including irrigation.industrial,and�nmercia
WELLS OTHER THAN WATER SUPPLY UNDER 15A NCAC 02C.0108
Including monitoring and recovery wells.
Print dearly or type information. Illegible submittals will be returned as incomplete.
DATE: (5� 20?, ) PERMIT NO.: (to be completed by DWQMPH)
tADVOI\ �
•
A. WELL OWNER—For single family residences list the property owner(s). For all others, list name of the busines
organization,or government agency and person delegated signature authority:
Mailing Address: €O1 1-9-- Cep its S S Gam-±
City:\J"40 t* . fD(4 State: t\\G Zip Code 1 County: '(
Day Tele No.: ' Tu t9•1 go C7 Cell No.: S' —
EMAIL Address: S\p &\e.' O4 C,FTN► I - Fax No.:
B. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number(PIN)of well site:3S23.11) 01 3�
County:
(2) Physical Address(if different than mailing address):
City:
State:NC Zip Code:
C. WELL DRILLER INFORMATION (if known)
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.:
Contact Person:
Company Name:
State: Zip Code: County:
City Cell No.:
Day Tele No.: Fax No.:
EMAIL Address:
Pit y"o'a3
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[f. it1 ASbfil FOR Vlit tL4N4>U fttZ'i 1.fEy`f Inclut'. t3'pc, of v` i14 ubticndK�trtte bureau health
ltls;nnd ael[a►e�aatl tliv�
being requested, lesctnpt'a►i.of bow iw atternite cdtistructioo:
': Criviconpl.or.
t.orici reasc n why cornStlntctlop and/or oper•Atioil in eecrttanCe.n ith rile srendurds is not teehuict#11y fcaii5 "
$ndlorprovidi cqutrl or bu ter liratc'ettou a£thc gmundw4er {
. ok, I irvo), tp.._ c. fiv\c -
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• 1?, AT1 CiHMENTS Provide tht('ullowia information as tttachaients.tothis appltcatwn
(1) A mite s}tpititnn 8e0erat lot ahon of the property(iacjudinU to of naracs, 'tiC.�i�c P.outc Number/distant:ts;
any licy landmarks,eta:)suElicicitt foi. (intling the well location. .
• (2) Dctuiied stie reap with Scale.'showing;'location.of:proposed ,Heil relevant to septic system(s)s butiding
foundations;prope�ty lines,wattr bodies, powntial sout'Ces,of coirit„rn;nappr,other ::ells,eto
(3) •Submit a,copy of the local well r cnni*application rind site t:Naluatiart tnap(tf cipplicnb.le. g p P.
(�t) • : : "Artyoilicr iaforfnuttaii'i•clarvarat to the vari,tnee rein nest Such as s�vcil.cgttctniCtton rota rtirlt shatvtn ro os�d
well liner or at 'picul.construction teatetjal..liryuthods. .
R. • ()TitEllt 1ilt 11t m&CONSTRUcTR)M REQ.IIIRER'IWNTS
For;Water:Supply:\tells, opp.roy it of a Variance will r64tr4 thet addit ona1 eons Ciet ci rl're quo a Mt beyond{'lulu}ose
ne
' specified in 15A NCA(. 02C .0107 be•inct. , Minimum edditt(m .
• Pir;dtnont and i+.^louuutin tcgioti wells are referenced on Attachments A 1 and oil ;k7ger 4 and 5 or this nppltcatibu, .
Appravul'.of a Vtiria,,C: w 1l riot: e considered in ,else •v ben the Specified.ittinirnurn additional aonatructio.
tequireit1Cats,onanot he,ruet. .
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Catawba County Environmental Health
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Parcel: 461703013140, 8072 CYPRESS ST 1 in=50ft
SHERRILLS FORD, 28673
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure tha 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 empbyees,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
anse from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
05/15/2023
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STATtc ROY COOPER • Governor
1,,' ;'y'; NC DEPARTMENT OF KODY H. KINSLEY• Secretary
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HEALTH A N D, 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
May 15, 2023
Sherry Pollex
8072 Cypress Street
Sherrill's Ford,NC 28673
Re: Approval No. JMB3017
Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C
.0107(a)(2)(P)]
Property location:
8072 Cypress Street
Sherrill's Ford,NC 28673
Dear Ms. Pollex:
On May 15, 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 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 wellhead.
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,
dart, ti.'W7E4
John M. Brooks R.E.H.S, MS
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