HomeMy WebLinkAboutSAM-07-2022-176268.TIF vo kr arce,
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.U107
All water supply wells not considered"Private Drinking f'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 be returned as incomplete.
DATE: 7 ' / , 20 ,2 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,orr government agency and person delegated signature authority:
Mailing Address: I.) 7 /'i S t y(i'G_ jj` v i Ve_ r i
City: ',act t c C rl) State: NJ Zip Code:, {05(Vounty: C
Day Tele No.:Q S'2) -S7/.-S 6 72 Cell No.:
EMAIL Address: Fax No.:
R. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number(PIN) of well site: L di- 7
County: (1 c AckAk:'�
(2) Physical Address(if different than mailing address): `I ? "4' S'/C'1 IA (J ('•
City:Y" 1c e N 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.
C - o rt 1-6 C.C a. 4-t-1 ()C.R.
E. ATTACHMENTS—Provide the following information as attachments to this application:
(1) A map showing genera) 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 MINIMUM 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
Signature of Person Responsible fur Well Construction(typically the well driller)
Print or Type Full Name of Person Responsible for Well Construction
(typically the well driller)
_ 74/(,/k‘ i4k4r.
Signature of County Environmental Health Specialist
Print or Type Full Name of County Environmental Health Specialist
Per 15,4 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 who is dissatisfied with the decision of the Director may commence a contested case by filing a petition as
described in G.S. 150B-23 within 60 days after receipt of the decision.
Form CW-22V Pane 2 Revised February 2013
• . q- 2 z Vob5'
North Carolina Please submit this form along with a Well
Variance Application for an existing
Department of Health and Human Services private water supply well.
Division of Public Health
Well Site Location: a 7 40 Sierrol 'Pr, f14Al i i' ,go. - brO - LC: 1 3 j
Town,community,subdivision and Lot II)
Address 1.-fl 144 Si error Dr\ County:-----__- 0 pl t" t
City/ST/Zip: /V1 o,A evi, NC a-S b So Date of SiteVisit: 7/%81%2
Well Construction NN ell He act ( iintl�lcti��n
Date of Well Construction: 41 (/I0 -•,,Ao),v- 1 Is the well head 12"above land surface?YES 0 NO
If unknown, was it drilled hefurc 1972? YES or er, If no, what is the height of the casing:_ 1 V _inches
If unknown,was it drilled before 7/1/2008 YES r NO Is there a sanitary well seal? E or NO
What type of well is it: Is the sanitary well seal in good repair' or NO
D rtlle Bored Hand DugJettedOther
Arc the following items present at the well head?
Does the well have a cement slab? YE or NO Vent PI0 Sample Tap fiQ
Well Tag_. /Ya_ Pump Tag 4 _
Does the well appear to be grouted. YES ot,,,:ey\f--
,
Potential Sources of Contain ination:'
Does the well currently meet separation requirements with known sources of contamination? YES o N• 1
If no,please provide distances to those it does meet: /1 'eft- ce4tar t 1' -k, j,r,,4se. arc/ si-iaiIc
Ova �c7{ {A rt4-bac V 4-0 oe-I �.__ j
()thee comments: Concrete Pad sound vklell. (,Anna4 verif7•
rout dell has -f 4,regied -}op,
No venk . No oteh Inds th VS` kW, Gige.n -t"he- cif-tile Welt, rt t5 IceaSOnab ly
Co n.{rvcird ro er l
Name of person completing this form (please print): ____jg( a'tit Perk;tli __.______ _
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• Catawba County Environmental Health
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Parcel: 367704803133, 4744 SIERRA DR 1in=50ft
MAIDEN, 28650
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 vertticatlon 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.mey
arise from this map/report product or the use thereof by any person or entity.
Copyright 2021 Catawba County NC
03/07/2022
sT : °ti,
N,6 �,•.,,, NQ�ti ROY COOPER • Governor
•
. NC DEPARTMENT OF KODY H. KINSLEY• Secretary
• i1 ,kW 'EES
HELEN WOLSTENHOLME • Interim Deputy Secretary for Health
. "••^' MARK T. BENTON •Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
July 29, 2022
Charles and Elizabeth Helin
4744 Sierra Drive
Maiden,NC 28650
Re: Approval No. JMB2612
Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C
.0107(a)(2)(P)]
Property location:
4744 Sierra Drive
Maiden,NC 28650
Dear Mr. and Mrs. Helin:
On July 28, 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, 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) A repair permit must be obtained from the Catawba County Health Department to
bring the well into compliance with respect to grout.
3) 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.
4) No potential sources of groundwater contamination shall be stored near the well-head.
5) 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
;I��A OG Case# SAM-07-2022-176268
1111\z. CATAWBA COUNTY HEALTH DEPARTMENT C<L,i-er:a l
v\., H Environmental Health Section I floc 1;c
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WATER SAMPLE FIELD REPORT
Owner CHARLES HELIN,4744 SIERRA DR,MAIDEN NC 28650
C:252-571-5672
Paid By ELIZABETH HELIN,4744 SIERRA DR,MAIDEN NC 28650
Site Address: 4744 SIERRA DR,MAIDEN NC 28650
Parcel Number: 367704803133
Driving Directions NC 16 S,right onto Tower Rd,right onto Sierra Dr
Sample Collected by: ) 4A T /( L►hl DatetTime Sampled: -1 f ZS;rA-2-- JI:IS /141
Sampling Point: 1 IA recteled oet t,,,,•/1 heed
Is well head accessible? Yes LNo Reason for inaccessibility
Well New or Existing? New Existing
Type of Well: Drilled ✓Bored Hand Dug Punch
Does well meet adequate construction standards from what can be observed: Yes ✓ No
Items of non-compliance: vidence of improper grouting or no grouting
rWell does not meet a required setback(comment)
Improperly constructed sanitary well seal
V Well head not term at>= 12"above finished grade
/ Well head missing vent
ell head does not have a threadless tap
l/ Well missing identification plate or pump tag
Wire conduit opening not sealed
Other(comment)
Comment:
Ws'11 1‘S r 0' .A,N 0,6 To Y--t-
rsamfieldreport 07/22/2022 13:26 Page 1 of2
Case# SAM-07-2022-176268
E.� t" % CATAWBA COUNTY HEALTH DEPARTMENT
Ys4-4 (€) Environmental Health Section
Ig 42 5M 07/22/2022
WATER SAMPLE TEST RESULTS
Owner CHARLES HELIN,4744 SIERRA DR,MAIDEN NC 28650
C:252-571-5672
Paid By ELIZABETH HELIN,4744 SIERRA DR,MAIDEN NC 28650
Site Address: 4744 SIERRA DR,MAIDEN NC 28650
Parcel Number: 367704803133
Lab Coliform Analysis Results: Total Coliforms: Fecal/E.Coli: Cl 71'/I f1
No Collection Date Over 30 hours old
Invalid Results: Excessive turbidity Excessive Chlorine
Lab Accident
Lab Tech Initials E emu Date/Time Received o I i f 20 1-4 14" Date/Time Completed - " '91\ I 1)).
no aoswx/ r)ot/fika RECEIVED
A! u 1 2022
rok44801,44e111 Hata
rsamfieldreport 07/222022 13:26 Page 2 of 2
#STA1E o',•
< a 4312 District Drive
' > North Carolina State Laborato of Public Health M5c,9,a
treyryRaleigh,NC 27699-1918
ill► � `` i Environmental Sciences http:/fslph.ncpublichealth.com
" Phone: 919-733-7308
, ; Inorganic Chemistry ry Fax: 919-715-8611
Certificate of Analysis FINAL REPORT
Report to: ENVIRONMENTAL HEALTH Name of System:
CATAWBA COUNTY ENVIRONMENTAL HEALTH Charles Helin
P 0 BOX 389 4744 Sierra Dr
NEWTON,NC 28658 Maiden,NC 28650
EIN: 566001814EH Delivery: NC Courier
StarLiMS ID: ES220802-0041 Date Collected: 07/28/2022 Time Collected: 11:15 By: Blake Perkins
Date Received: 08/02/2022 Time Received: 07:58
Sample Type: Raw Sampling Point: Threaded tap Well Permit No. SAM-07-2022-176268
Sample Source: Well water Receipt Temp. : GPS Number:
Profile: New Well-No Nitrate I
Analyte Test Result Allowable Limit Unit Qualifier(s)
Arsenic <0.001 0.010 mg/L
Barium _ <0.1 2.0 mg/L
Cadmium _ _ <0.0001 _ 0.005 mg/L
Calcium 2 mg/L
Chloride _ <5 250 mg/L
Chromium <0.02 0.10 mg/L
Copper 0.069 1.3 mg/L
Fluoride <0.1 4.00 mg/L
Iron <0.06 0.30 mg/L
Lead 0.004 0.015 mg/L
Magnesium 1 mg/L _
Manganese 0.008 0.05 _ mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH 6.8 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 1.3 mg/L
Sulfate <5 250 mg/L
Total Alkalinity 10 _ mg/L
Total Hardness 9 mg/L
Zinc <0.05 5.0 mg/L
RECEIVED
Report Date: 08/22/2022 Reported By: /10771111.42
Marc Komlos
EnV r(.•nMCatrii Health
Page 1 of 1
North Carolina Division of Public Health
Occupational and Environmental Epidemiology Branch, Epidemiology Section
BIOLOGICAL ANALYSIS REPORT
Private well water information and recommendations
County: Catawba Name: Charles Helin Sample ID Number: 176268
Location: 4744 Sierra Dr, Maiden NC 28650 Reviewer: Megen McBride
Initial Sample X Confirmation Sample:
BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR
PRIVATE WELL WATER(These recommendations are based on biological analysis only.)
No coliform bacteria were found in your well water. Your water can be used for all purposes
including drinking, cooking, washing dishes, bathing and showering.
X Total coliform bacteria were detected in your water sample. Total Coliform are a group of related
bacteria that are(with few exceptions) not harmful to humans. A variety of bacteria, parasites, and
viruses, known as pathogens, can potentially cause health problems if humans ingest them. EPA considers
total coliforms a useful indicator of other pathogens for drinking water. Total coliforms are used to
determine the adequacy of water treatment and the integrity of the distribution system
It is recommended that your well water be re-tested to verify that the result is accurate.
Fecal coliform bacteria were detected in the sample. Do not use the water for drinking,
cooking,washing dishes,bathing or showering.
If the re-test shows contamination by bacteria contact your local health department for assistance. There
may be a problem with the construction of the well,the groundwater source, or operation of the well. The
well needs to be inspected by the local health department or a local well contractor to determine the
problem with the well and to give guidance on how to correct the problem.
Your well water was tested for biological contaminants(total coliform and fecal coliform bacteria). The
results were evaluated using the federal drinking water standards.
Drinking water may contain substances that can occur naturally in water or can be introduced into water
from man-made sources.Total coliform bacteria are found in soil and fecal coliform bacteria are found in
animal and human waste.Total coliform or fecal coliform bacteria in well water indicate that the well
may have structural problems or that the well was not properly disinfected.
If you have been drinking the well water and are pregnant, nursing, have a child in the household under 5
years of age, or immunocompromised (such as an individual with AIDS, cancer, hepatitis, dialysis or
surgical procedures) inform your physician of these results at your next visit.
If the contamination continues,you should investigate the possibility of drilling a new well or installing a
point-of-entry disinfection unit which can use chlorine, ultraviolet light, or ozone.
For further information please contact your county health department or the Occupational and
Environmental Epidemiology Branch at 919-707-5900.
N 0 R T H C A R 0 L I N A
'A4�y Private Well Information
: and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Charles Helin—4744 Sierra Dr, Maiden NC 28650
Sample ID#: 176268 Reviewer: Megen McBride 1
TEST RESULTS AND USE RECOMMENDATIONS
1. ® Your well water meets federal drinking water standards for inorganic chemicals. Your water can be used for
drinking, cooking,washing,cleaning, bathing,and showering based on the inorganic chemical results only. You may
have other water sampling results that are not taken into account in this report.
2. ❑ The following substance(s)exceeded federal drinking water standards or the North Carolina 2L calculated health
levels. The North Carolina Division of Public Health recommends that your well water not be used for drinking and
cooking, unless you install a water treatment system to remove the circled substance(s). However, it may be used for
washing,cleaning,bathing and showering based on the inorganic chemical results on(v.
❑ Arsenic ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper El Fluoride ❑ Iron
n Lead n Manganese ❑ Mercury ❑Nickel El Nitrate/Nitrite ❑ Selenium ❑ Silver _
❑Zinc
3. ® While your lead levels do not exceed federal or state standards,the North Carolina Division of Public Health has
concerns with any detection of lead. Should you have any questions please contact the NC Private Well and Health
Program at(919) 707-5900.
4. ® Re-sample for lead and/or copper. Take a first draw and 30-second flush sample inside the house (preferably the
kitchen sink)and a first draw and 4 minutes flush sample at the wellhead to determine the source of lead and/or copper.
5. ❑The following substance(s)exceeded aesthetic drinking water standards. Your water can be used for drinking,
cooking, washing,cleaning, bathing, and showering based on the inorganic chemical results on(v, but aesthetic problems
such as bad taste, odor, staining of porcelain, etc. may occur. You may want to install a household water treatment system
to address aesthetic problems.
❑ Chloride [' Copper n Fluoride ❑ Iron [' Manganese
❑ pH ❑ Silver ❑ Sulfate ❑ Zinc
6. ❑ a. Sodium levels exceed the U.S. Environmental Protection Agency's(USEPA) Health Advisory level for sodium of
20 mg/I. The North Carolina Division of Public Health recommends that only individuals on no or low sodium-restricted
diets not use this water for drinking or cooking. It may be used for washing, cleaning, bathing,and showering based on
the inorganic chemical results only.
El b.Your sodium level exceeds 30 mg/I and may pose aesthetic issues such as bad taste, odor, staining of porcelain, etc.
7. ❑ Re-sampling is recommended in months,to reinvestigate
For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.
. --.. , ,,..... _
Total Coliform
1
Bacteria, E. coli & ... . . .
.- -
_.__. ,
PRIVATE WELLS :,,,,. 4#
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What are total coliform bacteria
and E. coli? •
Total coliform bacteria are a group of microorganisms found 4
, !
in soil and surface water.Total coliform bacteria water tests h ► •
look at all coliform bacteria in water.This includes fecal
v l F a y , ::.
coliform bacteria,which are a group of bacteria found in the '''!"
intestines and feces of animals and humans.
E.coli or Escherichia coli is a type of fecal coliform bacteria.
There are many strains of E.coli. When should I be concerned
about coliform bacteria or E. coli?
How does coliform bacteria and You should be concerned if coliform bacteria or E.coli are
E. coli get in my private well water? present in your well water.
Rain may wash coliform bacteria or E.coli from soil on The NC Department of Environmental Quality
the surface to groundwater.Coliform bacteria or E.coli developed a groundwater standard of 1 colony of
can also enter your water if your private well is poorly coliform bacteria in 100 milliliters of water(colonies/
constructed,cracked or unsealed, mL).Ground water standards are developed to protect
public health.This standard was developed in 2013.
How can coliform bacteria The US Environmental Protection Agency requires
follow up testing and treatment when coliform bacteria
or E. coli affect my health? or E.coli is found in any public water supply system across
Most coliform bacteria and E.coli strains will not make you the country.Public drinking water guidance are based on
sick.The presence of some types of coliform bacteria in the public health protection and cost of treatment/testing at
water signal the presence of feces or sewage waste. Feces large utilities.These rules were established in 1989 and
and sewage wastes are usually the source of the disease- updated in 2014.
causing organisms.
Total coliform bacteria and E.coli water tests are used as How do I test for total coliform
indicators for the presence of disease-causing organisms. bacteria or E. coli in my
The following are some disease-causing organisms or
pathogens that could be present in your water: private well?
• Bacteria that cause diarrhea and vomiting, Use a certified lab to test your well water for coliform
• Protozoa that cause dysentery, bacteria and E.coli every year.Contact the private well
• Viruses that cause polio and hepatitis,and program at your county health department to assist you
• Helminths,such as roundworms and tapeworms, with getting your water tested.Pricing of testing varies
that cause chronic diarrhea. from county to county.
Percent of Private Wells Tested ��# i= it?
Detection of E. coli, 2011-2013 I�, "" >�~ I'� '� �� It
areirkflialilter'im0111
�4 ` r
50.40
Percent of Private Wells Tested With
Detection of Total Coliform, 2011-2013 ' ' 'y ai 1r JIM h.j!" no
..efirlebh*Arts'avair elk 16"givd•Eli
fit !Irmo%
_ >50%with detection •L� k, v
'Iti■."41vairi,
25.1-50%with detection veiwi_ micro
=t377 n.
<25%with detection •
0%with detection
Insufficient data(<10 wells tested)
What if total coliform bacteria Where can I find more
or E. coli levels are present? information about total coliform
Shock chlorination is a method to remove bacteria bacteria, E. coil and my well?
contamination in private wells.If contamination persist Visit the NC Division of Public Health's Private Well and
you can install a treatment system to reduce the levels Health Program website:http://epi.publichealth.nc.gov/
of bacteria in your private well.Treatment systems that oee/programs/wellwater.htm(.
reduce the level of bacteria in your well water include:
• Ultraviolet(UV)filtration treatment system There you can find:
• Contacts for your county private well program
You can also reduce your exposure by using bottled water • Total coliform bacteria or E.coli in well water maps
or connecting to public water supply,if possible. • A guide for selecting a treatment system
• Other private well resources
Where are total coliform bacteria You can also call the Private Well and Health Program
and E. coli found in NC? at 919-707-5900.
Coliform bacteria are detected throughout NC.About 26%
of wells sampled for microbial contamination in NC from Where did this information come
2011 to 2013 tested positive for coliform bacteria.Yet, from?
there are several areas in NC with at least 50%of wells with
coliform bacteria present.See map for areas with high Centers for Disease Control and Prevention:www.cdc.gov/
coliform bacteria detections. healthywater/drinking/private/wells/disease/e coli.html
E.coli is detected throughout NC.About 2%of wells Environmental Protection Agency:httnsJ/safewater,
sampled for microbial contamination in NC from 2011 to zendesk.com/hc/en-us/sections/203309158-E-coli-0157-H7-
2013 tested positive for E.coli.Yet,there are several areas National Sanitation Foundation:www.nsf.org/consumer-
in NC with at least 25%of wells with E.coli present.See resourceslwater-auality/water-filters-testing-treatment/
map for areas with high E.coli detections. contaminant-reduction-claims-guide
NC Department of Health and Human Services•Division or Public Health•Epidemiology Section•Occupational and Environmental
'"1117
� Epidemiology Branch•Private Welland Health Program•httnsJleol.oublichealth.nc.gov/oeelnrograms/wellwater.html• NCDHHS is an
— - w•<auec•.d�°�m�. equal opportunity employer and provider.•09/2019
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