HomeMy WebLinkAboutRBPR-05-2022-41012.tif D s DON ALLEN &Since1971 A 'SSOCIATES , P. A.
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Commercial • Residential • Mort•age Surveys • Multi-Family
Construction Stoking • Subdivi-on Design Topographical
131 Crosslake Park Drive - Suite 02 * Mooresville • NC:• 28117
(704) 554-7029 (704) 664-8041 Fax
I, certify that this map was drawn under ,y supervision from an actual
survey made under my supervision recorded in de=. book 36'7 , page 0432 and/or
plat book 45__ , page 53 that the rati• of precision is 1'110,000, that this map
was prepared in accordance with the General Stat tes of North Caroina Chapter 89C.
my hand and seal on the 2B , day of AP•iL ,
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1) THIS PROPERTY MAY BE SUB.ECT TO
ANY EASEMENT AND/OR MGRTS-OF-WAY `. .44.... POWER TRANS.RA
OF RECORD. ELP.- FJa.S ING IRON FOUND
2) AREA COMPUTED BY THE COORDINATE i LPS- /{REBAR SET
3) m,NC 760'&761'CONTOUR ELM- PHYSICAL U R VE Y R/IY AA RIGHT-OF-WAY
AT'ON BASED ON LAKE NORMAN LAKE # At LP- txa1T P0.6
LEVEL AT COWAN'S FORD DAM(READING
ON 11/23/202D)ELEVATION: 756.5 OF POE PUBLIC DRAINAGE EASEMENT
♦) UNO NE ERGROUNO POOR_ 2534 PENNGATE DRIVE
5) N2aaa D GRIDFEET MONIiMENT F W T1SCT LOT 9 L A K E P O I TE NORTH CP a COLll'UIED POINT
SCALE 1" = 50' MTN. CREEK TWSP., CA AWBA CO., N.C. i FIELD eo , So3Y
FlLE LAKEPOINTE NORTH B
ACQUIRED BY: RENEE A. BAKER TRUST Dc ETMA
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TAX MAP ND: 462801374525
1
•
• 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(rater 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 type information. Illegible submittals will be returned as incomplete.
i
DATE: t(I L,O I , 20' 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:
Renee- BaVer TrVsf
Mailing Address: c263 T Finn9Q'k by .,,�/ A
Cityilyy(IB5 F(d State: KC ZipCody 'lounty: 1 tU)2
Day Tele No.: ' Cell No.: -11 4t-a 15- a 0Q 3
EMAIL Address(CV i fe ee`'g mad I!t Cann Fax No.:
B. PHYSICAL LOCATION OF WELL SITE(1) Parcel Identificationl Number(PIN)of well site: 4 . 0 I' A4 sc, �5
County:0(�..1/.l A IY,l
(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.:
Company Name: Contact Person:
City: State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
Fonn 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.
u e[( t)1 (l L- . c (c;y propct4
616x 3'D n rir af.anoi l -40 t1`14 il'
1-0,l( f It ! 0 fir i f Vti w ih p Poo 1
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 wel 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 additioral construction requirements beyond those
specified in I5A NCAC 02C .0107 be met. Minimum additional construction requirements for Coastal Plain and
Piedmont and Mountain region wells are referenced on Ana:.bments 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 constructioJn
requirements cannot be pat. Y�-
frk .tu.i/-e_loid-Xa( Poi - •
G. SIGNATURES
Signature of Person Responsible for Well Coast.uction(typically the well driller)
Print or Type Full Name of Person Responsible for Well Construction
(typically the well driller)
W/V
•
Signature of County Environmental Health Spcctialist
g0 U- fog1
Print or Type Full Name of County Environmental Hen th Specialist
Per 15A NCAC 02C.0118 the Secretary of the Division of Water Quality dr the Division of Public Health may require
submittal of information deemed necessary to make a decision on the varance, 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 Directo-may commence a contested case by filing a petition as
described in G.S. 150E-23 within 60 days after receipt of the decision.
Form GW-22V Page 2 Revised February 2013
Please submit this form along with a Well
North Carolina Variance Application for an existing
Department of Health and Human Services private water supply well.
Division of Public Health
Well Site Location: Lc-AE r P I ,v�}c il/�rib t,T (f _
(Town,community,subdivision and Lot N)
Address: 2-S 3 K Y r n 054'k Dr. _ County: C IAbet
City/ST/lip: S' , , , ,ItS r-cr(-/vC ssb-73 Date of SiteVisit: S'/;?24 1 2
Well Construction
\\ Illead Completion
Date of Well Construction: 17-J 141 ?-pt7 p Is the well head 12"above land surface? YES o NO;
If unknown, was it drilled before 1972? YES or NO If no,what is the height of the casing: e inches I�
If unknown, was it drilled before 7/1/2008?YES or NO Is there a sanitary well seal? ESj or NO
What type of well is it: Is the sanitary well seal in good repair' YE or NO
Drilled Bored Hand Dug Jetted Other Are the following items present at the well head?
Does the well have a cement slab? YES o N Vent Nu Sample Tap Nv
Well Tag No Pump Tag No
Does the well appear to be grouted? YES or NO
Potential Sources of Contamination?
Does the well currently meet separation requirements with known sources of contamination?I'YES or NO
If no,please provide distances to those it does meet:
Other comments:
Complete below.
Name of person completing this form(please print):
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Catawba County Environmental Health , ,. 07_2,az_ 17/ t -
20.45 7.7 4
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9.91 17.93
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i Parcel:462801374825, 2534 PENNGATE DR 11r1=60ft.``
SHERRILLS FORD, 28673
I
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
07/29/2022
•
STA7E ct
ti° ROY COOPER •Governor
-ter �'y NC DEPARTMENT OF
A HEALTH AND KODY H. KINSLEY• Secretary
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
August 25, 2022
Renee A. Baker Trust
2534 Penngate Dr
Sherrill's Ford,NC 28673
Re: Approval No. JMB2735
Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C
.0107(a)(2)(P)]
Property location:
2534 Penngate Dr
Sherrill's Ford, NC 28673
To Whom It May Concern:
On August 24, 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