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HomeMy WebLinkAboutRBPR-07-2022-41629.TIF A• THIS IS NOT A PERMIT Case# RBPR-07-2022-41629 CATAWBA COUNTY HEALTH DEPARTMENT d "Not PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES Residential Building Plan Review-Accessory Structure EXS SYSTEM Owner OSCAR MARTINEZ,6184 LITTLE MOUNTAIN RD,SHERRILLS FORD NC 28673 C:704-641-3432 NAME TO APPEAR ON PERMIT Oscar Martinez SITE ADDRESS: 6184 LITTLE MOUNTAIN RD,SHERRILLS FORD NC 28673 PIN# 369803106058 NAME of SUBDIVISION: GOLDEN MEADOWS Lot# 6 Section/Block PROPERTY SIZE: Square Feet Acres 1.24 DIRECTIONS: E NC 150 Hwy,Left Little Mt Rd,3 miles on left just past Mountain Creek Dr PRIMARY CONTACT: Owner SEWER TYPE: Septic Tank GALLONS PER DAY: WATER SUPPLY: Private Well DESCRIBE WORK: New 20x20 Stick Built Carport& 10x18 Front Deck"'May Require well variance 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? Yes 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 APPUCATION FOR: New Structure STRUCTURE TYPE: ACCESSORY STRUCTURE FACIUTY TYPE: Accessory Structure OTHER DESCRIPTION: DESCRIPTION OF 47x27 SFD 3 Bedrooms, No Basement EXISTING STRUCTURES ON SITE(IF ANY) DIM EXISTING STRUCTURE: NUMBER OF EXISTING BEDROOMS: #OF OCCUPANTS: PROPOSED CONSTRUCTION NEW STRUCTURE DIM:: 20x20 Carport&10x18 front porch Desired system types(Improvement Permit or Authorization to Construct): ACCEPTED: ALTERNATIVE: CONVENTIONAL: OTHER: INNOVATIVE: ANY: Other described: ehapplication 07/122022 I3:31 Page 1 of 3 40:11r• CATAWBA COUNTY Case W RB PR-07-2022-41629 �y !! Public Health Department Subdivision GOLDEN MEADOW% Environmental Health Division PINtO 369803106058 PC)Box 389, 100-A Southwest Blvd,Newton,NC 28658 a. NAME ON PERMIT: (OSCAR MARTINEZ),6184 LITTLE MOUNTAIN RD,SHERRILLS FORD NC 28673 (Oscar Martinez) Site Address: 6184 LITTLE MOUNTAIN RD,SHERRILLS FORD NC 28673 Property Size: Square Feet Acres 1.24 Directions: E NC 150 Hwy,Left Little Mt Rd,3 miles on left just past Mountain Creek Dr Completed applications are valid for a period of 2 years.Improvement Permits are valid:with complete site plan=80 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 fia 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 read 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: 7^/11- - Z Signature of Applicant or Agent If you need further information or assistan ease call 828-465-8270 AREA3 FEENAME DATE FEE AMOUNT Existing Tank Check Fee 07/12/2022 S80.00 TOTAL FEES $80.00 __ 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) chapph.;eriom 07/12/2022 13:31 Page 2 of3 • catawba county M public health Application for Environmental Health Services THIS IS NOT A PERMIT Application is for: ❑New Construction Existing Facility ❑ Improvement Permit 0 Authorization to Construct ❑New Septic ❑Septic Repair/Malfunction 0 Septic Relocation ❑ Septic Expansion 54 Existing System Inspection or Reconnection ❑ New Well j ❑Replacement Well / ❑ Well Abandonment1 Well Re air Property Address G[ ill Li f i-i e p h/yf (cihj Act �thcry it5- Repair NC• Acres ubdivision Lot# Driving Directions to Property e ue I SD k / WI' L, 11Iz Mfr. ill 33l' c pi lef I.�► (f c* om"•1�c4t L-&ilk Pr Describe work ft""' pi t th tL vaW I al r 1 L Applicant Name OS C (,t► r 1 Il c.r /it Q 7 Applicant Address (9(c 4 1,,!..L. c. ,p{'y�.1.e( ;yj , 4 �`J Phone feu Co �l 7117� Email Sc 4 y J�c1/i .e 0 ,/i(co A. f O1 Owner Name C„ e. ct be,ve Owner Address Phone Email Contractor Name C co( il/l r f.,r I/fl r Z_ _ Contractor Address Phone Email Name to Appear on Permit? Owner ❑ Applicant ❑Contractor Who will be the Primary Contact? Owner ❑Applicant 0 Contractor Proposed New Construction-Residential Primary ResidenceNew Resi nce a Addition`to Residence #of NewBedrooms *t #of ccupants Project Description rG pay-Cr N- 1 , 17 c c �, c Cc. r` p -' nffStructure Dimensions,also specify dimensions of decks&po10 X' l .,-- $.o x 0,.0 Cell" PaYT (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement, Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes El No Accessory Dwelling #of New Bedrooms*t #of Occupants Structure Dimensions (Choose One) 0 Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' ❑ Yes 0 No Accessory Structure(s)Describe Structure(s)Dimensions Plumbing El Yes ❑No Describe Plumbing Needed (Choose One) ❑Basement 0 Crawl Space ❑ Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes ❑ No Retaining Wall>2' 0 Yes ❑ No Multi-Family Residence #of Apartments #Bedrooms per Apartment*t Total#Bedrooms in Structure*t #of Occupants Stricture Dimensions (Choose One) ❑Basement ❑Crawl Space 0 Slab If Basement,Will There Be Water Using Fixtures In Basement ❑Yes 0 No Retaining Wall>2' 0 Yes ❑ No Well Construction/Abandonment/Repair Proposed Well Type ❑ Individual Well 0 Semi-Public Well 0 Community Well Abandonment Type 0 Drilled ❑ Bored ❑ Dug 0 Unknown Well Repair Requested ❑Yes 0 No Describe Will Certified Well Contractor Install Water Line or Electrical Line from Well Head to Pressure Tank?❑ Yes 0 No Environmental Health Catawba County Government Center, 25 Government Drive I PO. Box 389, Newton, NC 28658 Phone: (828)465-8270 I Fax: (828)465-8276 I EHAdmin@CatawbaCountyNC.gov Existing Structures on Site r �/ Describe _ _ Structure Dimensions ( 7 24 #of Bedrooms * 3 #of Occupants 4 Basement ❑ Yes No Basement Plumbing 0 Yes 1K No Existing Water Supply ,Individual Well ❑ Shared Well—Number of Connections ❑ Community Well ❑ County/City/Township Water Line Is a public water supply available? ** ❑ Yes ❑No Commercial ❑Proposed New Construction ❑Exlsting/Change of Use ❑Repair Food Service Specify Type #Seats Dining Area(Sq.Ft.) #Employees per Shift #of Shifts Church #of Seats Daycare ❑ Yes 0 No #of Children #of Employees per Shift #of Shifts Commercial Kitchen ❑Yes ❑No Residential Kitchen ❑Yes ❑No Daycare#of Children #of Employees per Shift #of Shifts Business/Other Specify Type Structure Dimensions Retail Floor Space #of Employees per Shift #of Shifts Other Information Calculated Design Flow,Commercial t (This value will be determined by EH staff) The Applicant shall notify the local health department upon submittal of this application if any of the following apply to the property in qu on. If the answer to any question is"yes",applicant must attach supporting documentation. sIo Does the site contain any jurisdictional wetlands? es ❑No Does the site contain any existing wastewater systems? ❑ Y,es Jjlo Is any wastewater going to be generated on the site other than domestic sewage? D'Ves 0 No Is the site subject to approval by any other public agency? ❑Yes Jlk No Are there any easements or right of ways on this property? Describe If applying for an Improvement Permit or Authorization to Construct,Please Indicate Desired System Type(s): (systems can be ranked in order of your preference) ❑ Accepted ❑ Alternative ❑ Conventional 0 Innovative 0 Other 0 Any *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications.The number of bedrooms will be confirmed by rooms identified on floor plans as a bedroom at the time of building permit issuance. This may prevent the need for septic system expansion in the future. t If structure is plumbed but has no bedrooms,calculated design flow will be determined by EH Staff. ** If No,a well permit must be issued with the Authorization to Construct. RETRIP TO THE PROPERTY AND/OR SYSTEM REDESIGN WILL INCUR AN ADDITIONAL CHARGE(SEE FEE SCHEDULE1 Environmental Health soil/site evaluations require digging,augering,and/or probing into the ground. Property owner/applicant is responsible for marking all underground utilities, including but not limited to:underground power,cable,telephone,gas,water lines,and irrigation systems/sprinkler systems.Catawba County Environmental Health is not responsible for damage to unmarked utilities. 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 facility changes. 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 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 p •serty or legal agent o e owner. 0, `] 1 q Signature of Owner or Legal Agent Date G �f Printed Name of Owner or Legal Agent O5P 124'l' Mc,rillet,7,1 40 ------._----- -_____-_--___---- - -- - • I .42A 136)I ( 8253 , , ,. 6 5 .0""' I 30A51:28 4N... \ 1 .24A , lb 6 COS h / .. \ ...... 6058 ` 4 l c. i R-40 7071 . . .. ► l + ;- 1 44/ lo. n. ,. _ t00' \ 1\-) + % E 't% di& iI 6784 i ' � i• °C IL. Lwo6w 6172 • Li 10 0o (1"-". • %5 l i p M 60te�. `; K oI co CO R-40 a 1 • CV , a IcO 12O .00x , ( 76. ., qo .„. P • 139.1 0_ — (8O) ) LITTLE MOUNTAIN RD 1hb map product was prowled from the Celawba County, NC.Geographic Information System.Catawba County has Selected Parcels ,• made tube tanteI efforts to ensure the accuracy of 4 location and Miming information contained on this map. / Catawba CwMy prvnotes and recommends the independent a� iedaem b of any data contested..this map product N PIN:369803106058 ., - ga.euaar.the County Gteheldns employees tiro 7/12/2022 LRK:100631 aana 1d asonlossor.bny,wheeelyddsea y MARTINEZ OSCAR 1 this maacerectp product or She use gdia rises bya..m may eorr eddy. 1 inch=60 feet 6184 LITTLE MOUNTAIN RD, SHERRILLS FORD 28673 For Informational Purposes Only ' - A.,, 0catawba county ~ Catawba County Environmental Health ess. IP ess,885_,..................N\ •, (158) ., Igo ' ' v N. 8' ■ 135.29 • 910 w 06 K "fir. ar 4? z 0 Om 50 't 120.00 16i, (80) 139.11 Parcel: 369803106058, 6184 LITTLE MOUNTAIN 1in=60ft RD 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 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 07/12/2022 7/12/22, 12'.54 PM Parcel Report Parcel Report - Catawba County NC Parcel Information: Owner Information: Parcel ID: 369803106058 Owner: MARTINEZ OSCAR Parcel Address: 6184 LITTLE MOUNTAIN RD Owner2: City: SHERRILLS FORD, 28673 Address: 6184 LITTLE MOUNTAIN RD LRK(REID): 100631 Address2: Deed Book/Page: 3717/1556 City: SHERRILLS FORD Subdivision: GOLDEN MEADOWS State/Zip: NC 28673-7833 Lots/Block: 6/ School Information: Last Sale: $190,000 on 2022-01-18 School District: COUNTY Plat Book/Page: 45/148 Elementary School: BALLS CREEK Legal: LOT 6 GOLDEN MEADOWS PL 45-148 Middle School: MILL CREEK Calculated Acreage: 1.240 High School: BANDYS Tax Map: Township: MOUNTAIN CREEK School Map State Road #: 1815 TaxNalue Information: Tax Rates(pdf) Zoning Information: City Tax District: All in County Zoning District: COUNTY County Fire District: SHERRILLS FORD Zoning1: R-40 Building(s) Value: $70,600 Zoning2: Land Value: $14,200 Zoning3: Assessed Total Value: $84,800 Zoning Overlay: WP-O Year Built/Remodeled: 2000/ Small Area: SHERRILLS FORD Current Tax Bill Split Zoning Districts: / Zoning Agency Phone Numbers Miscellaneous: Firm Panel Date: 2007-09-05 Building Permit Address Search for this parcel. Firm Panel #: If available, Building Permits for this parcel. Septic 2010 Census Block: 3017 links are not permits. 2010 Census Tract: 011501 Septic Final Permits prior to 08/2018, contact Agricultural District: PROXIMITY Environmental Health. Building Details L [At S- SqS 11i5P 4 L) WaterShed: WS-IV Critical Area `� ( Q �+� 3 lL.R 36b p1 Voter Precinct: P31/Voting Map r J ( 1(` Q�ip( " Parcel Report Data Descriptions 4 �C'cC( b� �th- List all Owners Deed History Report Assessment Report 01116 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. ©2022, Catawba County Government, North Carolina.All rights reserved. gis.catawbacountync.govinomap/parcel_report.php?key=369803106058&type=u 1 1 . .CATAWBA COUNTY HEALTH DEPARTMENT a �c Telephone: (704) 46-8270; TDD: (704) 465-8200 N .f 3 0 0 3 �� Improve. Permit thorization to Construct epair Permit_Oper. Permit System TypeQA Owner/Agent `�T,EL, � , .5L.AD C Phone 7' - 4 7 46 '"�� Address p!89 t rjrlr A iti Subdivision • J?7�g 014Z _Ciiej2.004 tis' tr-01L,N! C. Section/Block/Phase Lot# 6 Lot Size ),_3t c Directions: • iSif:s s e 4220-e- Oil Ur /t p�.S t /-•t 01.4 /�D 4p Ai P .o' XC !6 i, 6- Facility: House ile Home Business . Other: Tax Map # X" Multi-family Other Zoning Approval # 8671'/;,3 # Bedrooms . # Seats # Employees . Application Rate GPD Flow 36:0 Hot Tub or Spa yet Special Fixtures . 100% Repair Arealent, no Basement yes— Basement Plumbing ye:f6015 Water Supply: Private Well // Public Type of System: Trench I./Ted Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size /0 Pump Tank Size Nitrification Field: Total Square Feet /G� o'a' Depth of Stone Bed Size Trench Width 3 ' Total Length ofAll Trenches 3�r Number of Trenches 5'6` g 73 / .S/7J /7.3/ , P �t Individual Trench Length Feet on Center 7 Maximum Trench De t Distance of Nearest Well 3-7)'t *DO NOT I STALL WHEN WET* *4t-i r Topo ..6-* % Slope Texture C fi'ytzf 1 ` Structure k Clay"Min. -177- . . � -31.,?F, - --- . �� --- - ---- °r-i Soil Wetness 11 Soil Depth lit. . k. Restric. Hoz. at a--� , - 4 `O Available spat= e= no , -- - . � Overall Class 01 -- ._ - Comments: p� I ' ,� -�4,r ' rne:vt tr ` • **NQ GUARANTEE OR WARRANTY IS, IMPLIED OR GWAU AS TO THE PERFORMANCE OR LENGTH OF TIME THIS SYSTEM WILL FUNCTION** Gerri,Fa-0077:/.., *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) fiv yea from date issued and is not transferable. Permit Date e • J/4Q8 Owner/Agent / Sanitarian LG.. Installed By 7 e 13/-98 Sanitari n White-Office Blue-Building Inspection Operation Permit Yellow-Owner/Agent Green-Building Inspection Authorization to Construct 1 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 02C.0107 All water supply wells not considered"Private Drinking Ff'ater 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 he returned as incomplete. DATE: / / J LI , 20 /,-./L-. PERMIT NO.:70 h-('t (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, o 'zation,or government ag ncy and person delegated signature authority: Mailin Address: G`�4 rL /i'Vc fil,°Vei �Cj l , City: (tQrVU( . �Yc State: 2 Zip Codet$G? Osounty: Ca,tt.W4 Ci _ Day Tele No.: Cell No.: lG tt^ 6 Li/ 3 7 32.... /I � EMAIL Address:.NC�LC{ C.y 5-,S F -ail- JQ .w l . B. PHYSICAL LOCATION OF WELL SITE 7 C1/4-i ("� /(1) Parcel Identification Numbe (PlI`D of well site: J V v 3 (0 ( 0 c County:CO`E-Ct. h/ CA. (2) Physical Address(if different than mailing address): 3 c 144Q. 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.: Form GW-22V Page I 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. ( cal 1 ' Cvc2 0 oirc6 1 5) ( (1 r ve,vir-k C.e)a 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 h•ILNB[Ul1•I 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 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 44"---t-- Signature of Pers n Res onsible for Well- Construction(typically the well driller) nre-41� 14i r `� i n e`7r Print or Type ulme of Person Responsible for Well Construction .P p (typically the well driller) 6C X$ /6I0 ature of County •ironmental 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 part of the decision, and shall respond in writing to the request within 30 days of receipt of the variance request. A variance applicant vi'ho is dissatisfied with the decision of the Director may commence a contested case by filing a petition as - described in G.S. 1S0B-23 within 60 days after receipt of the decision. Form GW-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 private water supply Division of Public Health well. Existing Well Variance Inspection Report Well Site Location: (;, i a Lr L,. 1.41 A'1 R ) k,,_, H (S F ,, ) L (1 rnrn,r 1,mnruuilr,..uhdiri..iu t and Luf N) Address £ ( Y`{ L '-rl l<_ f" t o I Z c) County: C c (-7�, ('ity/S"l'lZip: _:_,r r-II Is 1%,, ,-:) N c- 2,?(, ;J Date of SiteVisit IZ /S z 10 I. 3S 4✓vl Well Head Completion Well Construction Date of Well Construction: _ U/ k Is the well head 12"above land surf is . YE. or NO If unknown, was it drilled belure 1972? YES or NO If no, what is the height of the casing: lc) _.inches If unknown, was it drilled before 7/I/2008'. F:S r N( ) I. there a sanitary well seal? 6/‘13 or NO What type of well is it: Is the sanitary well seal in good repair YEJ or NO `Drilled Bored I land [)ug Jetted Other Are the folio 'ng items present at the well head? \,. /. ► Vent Sample Tap s/ Does the well have a cement slab. YES orNO Well'Tag ‘// Pump Tag Does the well appear to be grouter : YES or NO Potential Sources of Contain mat ion? Does the well currently meet separation requirements with known sources of cunt•ntination:' YES orCNO If no, please provide distances to those it does meet: 1 kg t to if\+.,2. r'^t__... .to o r,..1., Other comments: ('ili?t/llc'h' hc'/u►t•. Name of person completing this torn (please print): $o_✓. IS V) 12-5 II ? 0 Catawba County Environmental Health iT,. a . f :I / ... C) • • 7J ,cek • a 6 • � • J� '1 3. A N t-1�/iv ' v —/ '1-� xL a __AI �6184 x 'st Id r xrlr'.6172 W a,'1 m m X 0 S xi r.1 t , ..\13 /TRH 50 Q (00) 120.00 139.10 LITTLE MOUNTAIN RD 3 .)03 P. r 51.,ev t r‘4 v Parcel: 369803106058, 6184 LITTLE MOUNTAIN 1In=60ft RD SHERRILLS FORD, 28673 RRP2 - ( - ZZ — ylbCi 5AM - 11 _ 1 Z - CBS311 'This map/report product was prepared from the Catawba County.NC Geospatlal 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,ents.end personnel,disclaim,and shall not be held Aable for any end all damages,loss or liability,whether direct,indirect or consequential whkh arises or may arise from this map/report product or the use thereof by any person or entity. Copyright 2021 Catawba County NC 12/08/2022 Scanned with CamScanner � STATE q v �a • ao\ ROY COOPER•Governor ,o y'` NC DEPARTMENT OF KODY H. KINSLEY• Secretary HEALTH AND ; HELEN WOLSTENHOLME • Interim Deputy Secretaryfor Health 4, HUMAN SERVICES p y . ,. MARK T. BENTON•Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch December 7, 2022 Oscar Martinez 6184 Little Mtn. Rd Sherrill's Ford,NC 28673 Re: Approval No. JMB2845 Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 6184 Little Mtn. Rd Sherrill's Ford, NC 28673 Dear Mr. Martinez: On December 6, 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