HomeMy WebLinkAboutWELL-07-2022-175937.TIF 1f CATAWBACOUNTY Case l WELL-07-2022.175937,
ggo.:~r`��L,PuBc Healtht rstmmt Subdivision MONBO POINTE
%+./ "1: Eivirotunewl Health Division PINM 471003437801
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!�/�. PO Box 389,25 Government Drive,Newton,NC 28658 LOU 2
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. Site Address: 8474 MONBO RD,CATAWBA NC 28809
Name on Pemmt 'FOURTEESINC
Property She: Acres 0.58
Directions: Hwy/8 S Left Buffalo Shoals RD, Right Bandy's cross RD, Right Shenille Ford Rd Left Hopewell ChurchRD,
Right Monbo RD,house on left of culdesac
Owner/Authorized Representative Acknowledgement of Permit Receipt
')//
w1 certify that I um the owner or authorized agent(owner's authorization required)representing the owner of
the property escribed above.
41' As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-01-2022-39921,by the following method(s):
_ Received in Person
Facsimile Transmittal(Return th signature requited)
7 lectronic Image Transmittal/E-mailE-snail (Return receipt required)
_ As the property owner or authorized representative 1 have reviewed and understand the specific conditions
o the permit issued, and further understsridthat all applicable,regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Systems.(15A NCAC ISA:1900), j
and/or WeIl Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date:07/18/2022
Owner/Aut
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/or
�ized Representative Signal CiI
lt(
Date 1(i(.r —
/ II Documentation of Permits)Transmittal
• (permit transmitted by electronic or other means)
Permit transmitted by _ (name of person sending permit)
Signatureif-,C---/
Date/Time 701 era_
Method: Fax V Email US Mail Other
Owner's request to send by the above Indicated method of transmittal in lieu of signature
We wantttto hear from yostlease ttake a few moments tto complete our customer service survey at
htp://www.surveymonkey.tom/s/EHCusttomerServlce
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Ali. • CATAWBA COUNTY Case# WELL07-2022-175937
/E •t•n 2 Public Health Department Subdivision MONBO POINTE
�Q `j Environmental Health Division P[N# 471003437601
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
•
Site Address: 8474 MONBO RD, CATAWBA NC 28609
Name on Permit: 'FOURTEES INC
Property Size: Acres 0.58
Directions: Hwy 16 S Left Buffalo Shoals RD, Right Bandy's cross RD, Right Sherrills Ford Rd Left Hopewell ChurchRD ,
• Right Monbo RD, house on left of culdesac
NEW WELL PERMIT
VARIANCE WELL
See attached state well variance approval for well construction standards and setbacks.
PERMIT CONDITIONS
'The septic system on this property is a saprolite system.This well must be at least 100 feet from all septic
system components,which includes septic tank/treatment unit, pump supply line, and drainfield.
*This well must be at least 50 feet from the septic system located at 8480 Monbo Rd.
*This well must be at least 30 feet from the Lake.
'A pre-drill meeting is required. Call 828-320-3077 to schedule.
'The well should be drilled before house construction begins.
Wells shall be constructed in accordance with state regulations:
Article 15A North Carolina Administrative Code Subchapter 2C
The well'driller must verify all setbacks before drilling the well. If the well driller is unable to maintain the
required setbacks,contact Catawba County Environmental Health at 828-465-8270, before drilling the well
•
Casing Height: 12 inches minimum above finished grade
All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private
Drinking Water Well Testing(15A NCAC IRA.3800).The fee for this sampling is included in the cost ofthe well permit.It is the applicant or
propeny owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an
outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health,
41A fhb/4Y .
07/18/2022
Authorized State Agent Permit Issuance Date
7/18/2027
Permit Expiration Date
ehpcimit 07/19/2022 I4:37
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Parcel: 471003437601, 8474 MONBO RD lin=40ft
CATAWBA, 28609
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
07/18/2022,
.>ea,,sUT[uA,O ROY COOPER•Governor
`nTt HEALTH AND •
KODYH. KINSLEY•Secretary
f HELEN WOLSTENHOLME• Interim Deputy Secretary for Health
�,r,r "�, HUMAN SERVICES
o��. MARK T. BENTON•Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
May 20, 2022
Dave Novotny
1232 Waterwyck Tr
Dayton, OH 45458
Re: Approval No.JMB2642
Private Well Located Less than 50' from Surface Water [Rule 15A NCAC 2C
.0107(a)(2)(Q)]
Property location:
8474 Monbo Rd
Catawba, NC 28609
Dear Mr. Novotny:
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:1842 Mail Service Center,Raleigh, NC 27699-1842
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 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,
;,, l.,
John M. Brooks R.E.H.S, MS
2
7/19/22,3:43 PM about:blank
ntz WPDT Report
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Area of Interest (AOI) Information
Area : 3,134,508.74 ft2
Jul 19 2022 15:42:55 Eastern Daylight Time
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Kno Releases or Contamination Omer System Roads 0 003 006 0.12 MI
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C5 Ur tegrourxd Tarir Irotrdents — Ramps.Rest Areas,Non-Mainline 0 0.05 0.1 0.2 km
Parcels(Polygons)•Parcels .. Protected Route
Non-System Roads — Other State Agency Route
_ Federal Route — Seconttary Route EaA Cu..am<r tt.P.Gxrb.taa effete Canty State ce!Meath Glo.t.
C101 U OaNtS....P,rae. letreaaaa Era NEAS, L.,n. 84.0..0
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USDA NC001 G S uM.Sm+nr* Ean Aroma DS USGS NGA.NASA
Interstate
about:blank 1/2
7/19/22,3:43 PM about:blank
8474 Monbo Rd,Catawba NC
Known Releases of Contamination
# Site ID Site Name Site Type Data Current As Of Count
BELL TOWER GREEN Underground Tank
1 4t)9:i.i 12/18;2019 1
RELEASE Inicidents
All North Carolina Department of Environmental Quality(NCDEQ)GIS data Is expressly provided"AS IS"and "WITH ALL FAULTS", The
NCDEQ makes no warranty of any kind,express or implied, concerning this information, including but not limited to any warranties of
merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy,
reliability,completeness,timeliness,or usefulness.The data is not intended to constitute advice nor is it to be used as a substitute for specific
advice from a professional.Users should not act(or refrain from acting)based upon information in the Data without independently verifying
the information and obtaining any necessary professional advice. Users are solely responsible for ensuring the accuracy,currency and other
qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be
modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and
attribution of GIS features and makes no warranty concerning same.
about:blank 2/2
UST Section
Description of Dataset
The Underground Storage Tank(LIST)Section's data presented here is representative of two different
programs within the Section;the UST program and the Aboveground Storage Tank/Non-UST(AST)
program. While the UST data specifically relates to UST systems,the AST data may be related to a
variety of release sources, i.e. AST systems, fuel tanker spills, illegal dumping, etc. Whereas, the UST
data Is specific to releases of regulated substances from USTs, All UST Section features presented in this
tool represent locations where the latest reports document confirmed or assumed exceedance(s)of the
NC Groundwater Quality Standard and/or the Soil-to-Groundwater Maximum Soil Contaminant
Concentrations (MSCCs).
Contaminants Potentially Present
UST and AST Program Sampling Recommendations;
• Volatile Organic Compounds
• Semivolatile Organic Compounds
• Metals (Cr and Pb)
Contact Information
To request additional information from the LIST Section please contact the NCDEQ Regional Office
assigned to the area of Interest and ask to speak with a member of the UST Section. A map of the UST
Section's Regional Office coverage areas and phone numbers can be viewed by following this link.The
UST Section's Regional Office contact Information is also presented below.
UST Section-Regional Office Contact Information
Asheville(ARO)—2090 US Highway 70,5wannanoa,NC 28778(828)296-4500
Fayetteville(FAY)—225 Green Street,Suite 714,Systel Building,Fayetteville,NC 28301(910)433-3300
Mooresville(MOR)—610 East Center Avenue,Suite 301,Mooresville,NC 28115(704)663-1699
Raleigh(RRO)—1628 Mall Service Center,Raleigh,NC 27699(919)791-4200
Washington(WAS)-943 Washington Square Mall,Washington,NC 27889(252)946-6481
Wilmington(WIL)-127 Cardinal Drive Extension,Wilmington,NC 28405(910)796-7215
Winston-Salem(WS)—450 West Hanes Mill Road,Suite 300,Winston-Salem,NC 27105,(336)776-9800
Guilford County Environmental Health,400 West Market Street,Suite 300,Greensboro,NC 27401,(336)641-3771
WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or multiple welts
I,Well ContractorInformation: RECEIVED
Shane Gossett 1:4.WATERZONES.
FROM TO DESCRIPTION
Well Contractor Name 140 ft• 160 rt. 40gpm
MAY 3 0 2023 ft. ft.
3528-A
NC Well Contactor Certification Number &:OUTER.CASING(lbr.mutli.easedwells):ORr.L1NER:(if au triable)
FROM TO DIAMETER THICKNESS MATERIAL.
McCall Brothers, Inc. Environmental Health 1 ft. 116 ft. 6.25 in. 0.25 Steel
Contpauy Name 16...iNNiIRCASfNG=URTIIBINGAgeothermaLebeed400(t)
175937 FROM TO DIAMETER THICKNESS MATERIAL
2.Well Conshuction Permit#: 0 ft. 122 ft, 4 in. 0.25 Pvc
l.i.el all applhvehlr well ionstrae tine permits lke.County,Slate,Variance.etc.)
ft. ft. in.
3.Well Use(check well use): 17:SCREEN
Water Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
❑Agricultural ❑ unicipal/Public
0 ft. It. in.
CI Geothermal(Heating/Cooling Supply) residential Water Supply(single) ft. R. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) 18..GRO.UT
FROM TO MATERIAL. EMPLACEMENT'METHOD&AMOUNT
❑WO(RID 0 rt. 20 ft. Bentonite Poured from surface
Non-Water Supply Well: chips
0 ft. 122 ft. Portland Trlmmie rout
❑Monitoring ❑Recovery Cpmant 9
Injection Well: fr. ft.
❑Aquifer Recharge ❑Groundwater Retnediation t9.SAND/GRAVEL.PACK.0tapplicable)
FROM TO MATERIAL — EMPLACEMENT METHOD
0 Aquifer Storage and Recovery DSalinity Barrier 0 R. ft.
DAquifer Test ❑Stontmvatcr Drainage
ft. ft.
❑EepetiMental Technology ❑Subsidence Control
20.D.RLLLINGi G(attt�ehaddirioni4vheitsifattxxpttiy)
❑Geothentutl(Closed Loop) ❑'tracer FROM TO DESCRIPTION(eor,turdnemt,,unit/tuck type,pram una.etc.)
❑Cteolltenmai(Heating/Cooling Return) ❑other(explain under#21 Remarks) 0 ft, 30 ft. Red clay
19 2 31 ft. 90 rt, Sandy clay
J,Date Well(s)Completed: 5� � 023
91 ft• 100 ft. Rocky clay
5.Well Location:
101 ft. 200 ft• Granite
David novotny rt. ft.
Facility/Om t eel Name Facility IN(ifapplicable) It. rt.
8474 mono road catawba nc 28609 ft. rt.
Plnsteal Address.City.and Zip 21.REMARKS
Catawba Put a packer liner In to depth of 122'and trimmie grouted.
County Parcel Identification No.(PiN)
51).Latitude and Longitude in degrees/minutes/seconds or decimal degrees: 22.Certification:
ill well field.one lat/long is sufficient)
35°40'02.568" IV 80°58'14.358" W /; 5/24/2023
. Signature of Certified Well Contractor Date
(i.Is(are)tlic wet ar Ianeni or ❑lcrnpuran' By.signing thus fans.1 hereby certify rhea the well(s)ryas(were)constructed in accordance
with 15A NCAC'02C.0100 or 1SA NCAC 02C.0200 Well Construction Standards and Oar a
7.Is this a repair to an existing well: OYes D•No copy of this rerr,rrl has been provided to the well owner.
If this is a repair,fit oat krona well construction information and explain the nature of the
repair under#2/remarks.sesrinn ur nn the back of this farm. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.Number of wells constructed: 1 contraction details. You may also attach additional pages if necessary.
FM multiple injer•eiun,'r Inn•Brat.r moots wells ONLY with the sane construction,you con
submit use(,rue. 24.Submittal instructions:
9.Total well depth below land surface: 200 (ft,) 24a. For All Wells: Submit this font within 30 days of completion of well
For multiple wells list all depths Ifdi((eeent(example..i@200'and 2(a'IOW) cortstniction to the following:
10.Static water level below top()leasing: 20 (ft.) Division of Water Quality,Information Processing Unit,
If wetter level is ahaee cosine.use",'' 1617 Mail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 (in.) 241)..For Iniection Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this font within 30 days of completion of well
12.Well construction method: Air rotary construction to the following:
li.e auger rniary.cable,direct push.ctc.l
Division of Water Quality,Underground Injection Control Program,
13.FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 40 Method of test: Air lift 2-1c.For Water Slimily,&Geothermal Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13h,Disinfection type:_ Hth Amount: 20ounces completion of well construction to the county health department of the count'
where constructed.
Form GW•I Non Carolina Department of Environment and Natural Resources—Division of Water Quality Revised Ian.2013
(3)
catawba county
public health
Memorandum
July 31, 2025
To: David Novotny
From: Megen McBride, Environmental Health Administrator
Re: Well Samples Required. Permit: WELL-07-2022-175937
Site Address: 8474 Monbo Rd, Catawba NC 28609
The North Carolina Department of Health and Human Services requires all private drinking water wells
be sampled for bacteria, nitrate, nitrite, pH, and a number of naturally occurring inorganic minerals.
Our office has made several attempts to contact you to schedule the water sample collection and
have been unable to reach you. Please contact our office so that we can schedule a time,at your
convenience,to collect the required samples.
The fees normally charged for these samples were included in the cost of your well permit, so there is
no additional charge for this service. The samples will be taken from an outside source.The sample test
results will be sent to you when they are received by our office. Typical process time is 6-8 weeks.
You may reach our office at (828)465-8270, or by e-mail at EHAdmin@CatawbaCountyNC.gov
catawbacountync.gov
Environmental Health
Catawba County Government Center
25 Government Drive PO Box 389 Newton NC 28658 828.465.8270
MAKING. LIVING. BETTER.