Loading...
HomeMy WebLinkAboutWELL-04-2022-168758.TIF . . , o sks -ri.ko Re_ta M r_u OR CA- a al -34rios. • ' .1 ' , i E.-• - • ' 4°' \ • f ... r, , -072 cyervAs sr Auct-K Pict! a4-2cat- xi' 7s9 \ . • apo coas'icid giadinis KM 1041 ilin TO . 1 . li *PI • • o• p.0 \ I 6- 9.1c4 . . • • \ 1 R sig • 14 I \ I 0' fpfien 6 -5,71 . . i •‘30 .- IN.,. I. • - (1111- OM OIL 011110:W. a 00 • • 1 i : irifr I . , 401r0 servioixkiatO oat 40 Newd Oa -'-Wi°'.' • I • lik ......;04°-*ap. I • ....034c..- . ii _ %.,, . . • ..0. . , . topoollemp • 9. lb.._ . . &r .. 4 go.. ._...., ,. ..1 i'. .0,,' : ,Iiiv . . . . •• '. . .6 + ),- ,•0,1 la- .• • • . :• . \ --... ),.."-- 4 .• • • 10°4... A li • • • 1 . s... AIIIIPr-' ••,/ -' 1 , ., dim, __.iii, 11.- :f.-•'' ..)'''' /O..— 1 . ., . . .. . ,•.,,,I -4.115w .. , 001001114 . : ., .40144111. % % 4 • I • '• i -- • • • • dig.'41.41 • I \4:34• • . • • • 1\0•4...4. • I • •.‘ I • /1 ." OOP • . I • •• NO • I . •e. '. . WIWCO . 4 • API L I 010 Vie • • I I . I \ . H s. '1.111;.'4 I. & • . • II .1 i • 4rotH . i it toi 1 isc:\e I. . ... I .iumt wr - •• 1 aii .., \ ,...a. i . . • CLOB t .. .1 , VIM •0440-- 1 -1 ,11 11' i f . . ... . • MB • • I 11 IF • ' OW, •• 1 . •• • • . WS I , , • • • keiftiii, • '•• x . I. i . . • I. • • ' I • . • goift..... • 1 I 414 ' • • i I • I il. . 1 .0 i . Nis:i ..... —4—IWO OOP .. ENalt'llkilirs j 1mi 411101Aeoima arm IIIMIN ANNEN glj • V IV • * • • S V ' • • • ;-•-4±.•,•, •• a . V- / _. al • .. . • • ot door . Fr if 1 '-.r - . . • . - _ .. • • • •* ) • — • • • , r 1 . / • • , . . • gm....alle awls IMO 4 • a . / , • . t - 1~07- W E LL Co sTRUC-TION RECORD ((:w•-1/ l FM II:tel al I 1141:t. I Neu t notrartfr thew Nohow: I` __ Spence(Adams i1 V 1 f k tO"Lti N'Ml l n,n .t:Itr nt It. sOC IY. . .aw r 4449-A "- M. • �� � N..Well(emu. / i r(♦dd-w odd-woos rsW l.ry. Ifs Qt,,([,1< �}4M;1, l'ittri itaft_OR Lt./F•11(K�y Mei fRrnt In ' bl.►MU.N __., INNei,"1-S% 7j MAtr trial--Rowan Well Drilling n. E 1:41 in. sass' °'n i (-..apsll.ti.s11 {L INSI N(A%IS(,IUl 11.Crti din r 0M ctn.al 4i71 --.—J 1NELL Oa 2022 168758 fllhst -Jet i 1-4.041:IEN 111MK�t.4% l N11in4U. 2.Well f.•aastrYttlrta rerun rl: :71' 1.sort ,t•• IL ft- t ..f rJf.(tr'(a oni.u.n, ,.n..h,H l+r,'•tat•^r ft. t 3.u al I fr lrheck"tell use l: 11.7t(RE(-ti i:11:1/)attr\»pptf♦titll: nem 111] •.t�,t irk- yQtlliL 1MKb iL±<- �4t1W�1.' D1lfulrw:gtwl+Pllh(h R R Aptwuhlp.Il � 1'rollartud 0licalnsg.•l oolote loptiltI ®Rotekrelii Wrier Suppt>,.utrkl h, i h. In.?.strud't'omnrrrrtil ::::enriisi:tkisuppr"hared) It.tilttl7 awm� ItN�, � N.sl .rq t_ p�1t4.3tLVL.t 4lliltt4iIff 1,11s.np h. p h• r,otr:ru,c, aw.vlrr..la tuas Sim IA Orr Serpi,Well' �'Itti�kp1I1.rwiP _.. .. lnlrtiwm 1�rll: h. N. '- 1yu.IcrRCtedi2: otri.,undw«Ire RrlrcJlana+ his%U,GN Itt.l'P,1(.A}1l apld!Iat'IrL.--- - �SoItnm Ituncr / rt/ 16 N.�/1-WU �.. � Itltl µtat�I trl rIMN_...— •1.lµdrf 111Yaltc talc Rra•tcrs p, n. lquifn lest �Suirmrlsort ikrutylc t- - I nptrotlelttal ttxdr(1hy) ❑Suhf•drnse(ontrit O. „ 1— p,I»lYf le RILLI (;LOG wade r1 i.aal tl•rts if fat_ r.naraJ (rtlld♦KtltNl((.ItaC.d 14,tlp I f/M Ita pi u all('1 nt.(.rtr+�t*+efs...int/hM.V!ir'�•/611 —. (nsMhemtal II(eatindr'.t+tlt!R Rcltrll l ni)Ilttr I:•+Iain*wider 121 Itemari.,l fl h. , .0 A- rU.r _ _ __ ---\ 3J{Ot23 042022168758 h- v; n' •{,a.aDY i7.t«EVRt,-Pa ____. J.tale W elN+l completed': 11 el l I I1M ------- .. { Il. I tl rl" tYfATtrt aED•7Vt:K Via.Well Location: S? n• a2 h• 7t(10 Root t•M IMI£1(;H'.►NC C!E.TI(*MEW et. h '�^ la,ihl, :1)-'..1+:4h4a1'1r I _ 1 444d1.I*run Nfn.. .. h. IL 8072 CYPRESS ST SHERRILLS FORD 28673 - -- n. n. :,1.t.t,,,t at.Aso/y. •--"-- CATA WBA 4417030131 40 Pst.i lehre& ur•\..- '•,I •---'-- ( «rr. r Sb I.dtrdr and In itrde In defTrr.'rtwrlr►'ttt•aJa.tt drt mad Je{IR^' i— .,ti«.csi, l2(-trlieratioa: ita<Ii C�a Ll,.nl tY�lry I. . �� ^� i I I. 12 3 35 34 40 841 ` Bo 58 59 722 w -' it sr e ifertMaatal •rr I tlrittlrpn I.,rn, , r,t•. PAO Mc vnYhi.-It.(»;,.•...au.In.kit Al.a.•,.t.t. b.Willi IYt wtlll 1� Mt •qP••"N µ'»rn p'c�4 Conk,.v.ax.r Mwt11/J,.».! Me:I r.rt1 IJ,(M'.lt nY tlir.v.�. .•1.41 ii'uh' U)'9.' to ea ealtltNtR'toll: ON w ©Sn .. r uu,r.,,v11 A...s..r pr._,.•A.1 4..'At»:tf r...«., ',It lab a repk r n du. t.I',pH.NJ oW a+w+»w..a.'a•MMgJn.•. ow..6..••••'•"•t r.M..w ItM»M1t✓Y+r/IM 23.Me diagram or additional n r1I Jrtallf: n ptrr tamer it rlM,Vil..n lreWnn.Mr Anl•d this}...+ You ma) use Oar but of this paw:11,pruvttk 1x14aiiafNll stcll car tt.ga,ll ui we N.}or t:eopeobelIMT or(User►-Loop Geothermal'A rut having the some (v,nsxnnt«Y Jct►.k 1'tnl Iltas.d•.•sttls h ai Ulwmvl Istur+4 a r.+un .reAnsetten olds 1(AN•I is tiredest tothsith: 11 I Ai. (?rotltl-R,J wr11 �L'@% 1 t L L�1�IRl' '71115� drilled '_._ .,_ — If1.1 ;aa. fur All 41e�: suhmu tits, dram wnhm 41 dad'. ofamgllctwm of tscll q,i Wat mil irM11 load srrftlte: 305 v'AM' 'a.•/AO PArI�ra�.M.«fstr.•� rtKnlfuilKlll to UKfull(,w•nF I-w t•pmoot*»..rM h."on t1 d'lyrAt y.><•IA•r, N,Stalk*seer level a(tas(as: (rti dash...of Water Ilr+t.artr*.lake ration Pewee...0nm 1 ail. Ire�r1.'•1,'r1l It tatu.l kip16t?%tail Service(ratty.Rekteh.SI'2'6'al-1617 . �•.t,iv l' ..•• 11.Borehole tdiaalMrr; 6 .__„ ___-fin l 241Rt a...1.4°rill: III nd.oleo t,.semiotic the I.trm it,IIIc at.11:-.,in- rAtvc. also.ullmll.mt•Ann ,rf 11s11 1.1111 wvllun to alas,atunlpkttrt' r.1 w••I. i;, RfOTARY 1.«nitU.11,141 to Inc lullt.wtn,. *al alwd rrrliva tnrlb..xl: ectIrf coated Prieraa. „r ..1`r „atr),;tlrk,•drill p..h,: lMris{trw to WaterIllrsflurtw ('niNrljrnuatl 1 1( 2?fAtl-ILJ� Mitt%tail Server('eater.Rakiet.. FOR N.%TER til'Pf't.Y t#F l.t. (►S1 1: .• in wld/tatn 1tt scrl.ImK Ile limn,to 4 {elh,.d..f trvt; Y1I:I '•k Msitsi Iths,tc rise +uMn,t one cigly of 1i11s I.»ln %%ohm tt1 J:rti, of 13a \Irld(LBW._�•-- }— Irtmrnt .ti the .nlu,il Cn1,ORINE ••' ,,.,1' Alai t,l wcl4 a+!«,uuctlts. I. 11,r t111111 twtllih ttci `Mltrtrr- -- -". t 111..Ihvni'rrM1r P.M" ..—..... _—. .—. - �— li e.,+a:<7-Uli, Napli%C1/IdtriIk•iw4lIM«I,.II ,. I n.u .n,taulQualiI •tts,.1r11.41 N'.ttt,}tr.'I.o • 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 • Or [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 - - T— • 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. . G. s ci A `VR'6s :1 . $l t ui tltctut e. rl1 YjUlc.ior\Ve: uhxtrVc tort gt'pt aEE} t1aK sv�l1+!(ill y) ""ilftiC tl Print tj> � run amp ar Pcr1u� c oislbtorVUorstrtcon . . (t-plcuil)�the ry U Oriller') 'itatii.rdt•C4iinia i riv utl itui-.iiscii i 2nt h:<[tcri 5. iZr. Fi t1 ume a k t'Countty 'n iruam,:i�isl IU;cattlt.SV=t-in11't • ,19A'NCi1�'COI.. C O118 tlrr,Seer•i•t� e ry of di Ult+tsinri of TYWter gira.II6,,or the IJr vistan of P.utatic:fl rlthr r►igy require ' ''' i .. 1bnt1►u1 rf�tijfpritrarto ?'deatr}ga::rice-sur� lo rrsulr� u,decrsrctn pn:tlra tuirlOnc�, r',�`�tj�r arit�a irequ�rl��+�rl�uT1re Cf@b�S'i0f1,;.luJrlj ,�dallr P'£SpQt#[J�{a:1VYlllff�; I{7 !lid. t Ct'�`iltsf it tlhlti',3(k[1'LtyY t�f}CC���t of , t t tX (il�O1T IIS. t CG C(J0(4.re1F1: it. tKJ f .: apple arnt who fs disSatlsfred w i?t me decr,'iioir of ttte fJfisrt[ ma .cotntrteii �" 4.t ribed in G.£ 15O1 23 uarilirr 60 aaiyc ajler�i't,.ctclpI ofrhs-Lft.lLslrrt i ari'a SIW 221r �° " • W�JI vatb.t& Q j Catawba County Environmental Health 86.0O 41.33 12\2‘ 29.89 2 32 Sr Pr L--- _ 1. •8094 /77\ / • 72 if / 091 k 441 CIOIE c2321 0921 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 im.sot : • ' ( .-1) ' /ft .—. .t.:. - . ./ - L22 - .23 - 16321. 0 e- 1--- --------1 r.....1,......., .......... . , ,.......... jh I 1 '" -"'~ . • 1 - ! i 4.- Ilk 4_ ; . !. ,o, . . . I LOT #3 • l • , �,�. t,� ,� � LOT - • I -• ‘ � , (3 t;5 WO-. 1 - i . 1 1 LOT it k 1 • AIM ao . i - \ I ' % i .4 -{*se1.5 PeICCI4 EVIL-" •rr• V0 , 1 ,,S + rOW dka...00.0114- • , .. . , , . L.,.....-- _ ,,iiiiivi.-lior ik . : _ , 1 *3 , ',..,, ,.., .. , .,. ....-041. : . . . . la Niirleter°:. , ..- -1100riv, t �� TO eC t1U IAA1m � ) ' ' I bell ,a 1 \ Pei 4617-0300-4777 ''�'e - g 1 1 ..D. ORIONacid ° e 0 0.6. 2676 PC. 1635 P ° • ....,.0.A �� / 1 ‘, ,d• /. . ,ziffIQ CY►Oress St. STATtc ROY COOPER • Governor 1,,' ;'y'; NC DEPARTMENT OF KODY H. KINSLEY• Secretary � iIr3 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 2