The URL can be used to link to this page

Home My WebLink AboutSAM-10-2022-183145.TIF 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 it'ater lf'ells"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: 1 D , 20 0� . PERMIT NO.: (lo 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: m \. cam 1 Mailing Address: c Lk-- AD PE? ��C� . City: State: 00, Zip Code:LRWT•ounty: COLSi Day Tele No.: 5t�_�� ~ &I.`b� Cell No.: EMAIL Address:t;' f l C>tXAC(\S Fax No.: C*-( -' 4C-, t B. PHYSICAL LOCATION OF WELL SITE (1) Parcel Identification Number(PIN)of well site: 3(1.3 G.›.1 (9 Lk-1 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.: Company Name: Contact Person: City: State: Zip Codc: County: Day Tele No.: Cell No.: EMAIL Address: Fax No.: Form 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. PckC c,C \cL tT7 -Th6) Cr t `� ��. � �' c--cicY\ LOLAI he E. ATTACHMENTS—Provide the following information as attachments to this application: (I) 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 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 Bon 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 (yi, j ignature of Person Responsiblcor well Constr Lion(typically the well driller) ,7 c. ita - ( `J 0 Print or Type Full Name of Person Responsible for Well Construction (typically the well driller) Signature of County Environmental Health Specialist r Print or Type Full Name of County Environmental Health Specialist Per 1 SA 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 GW-22V Page 2 Revised February 2013 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: Nk c i a e r, C e o.p i e ikj f?i of c' t t t3 4# (Town,eonnrunity,subdivision and Lot H) Address. k i1 7 e er-fi-T le) .?' -- County: __ (-\ R+A v,b,{ City/ST/Zip: Al a i c'd t A, /V e., ;7-8 i; S U Date of SiteVisit: 11 J'j 2..z ______ Well Construction Ilead Completion Date of Well Construction: Li1 y\hi 0 wvl Is the well head 12"above land surface?YES o(NO) If unknown, was it drilled before 1972? YES or €1O ) If no, what is the height of the casing: inches If unknown, was it drilled before 7/1/2008?'U�or NO Is there a sanitary well seal? ` or NO What type of well is it: Is the sanitary well seal in good repair? ES r NO Drilled ore Hand Dug Jetted Other Are the following items present at the well head? Does the well have a cement slab? 4110 or NO Vent No Sample Tap f Well Tag iV Pump Tag /�� 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 ►r NO If no,please provide distances to those it does meet: Other comments: Weil 'Jr I9 ' -CxtM Proforyd 01ecr Complete below. Name of person completing this form(please print): J =='MtSTATfa •,• �� ao ROY COOPER • Governor Nor • sw.. NC DEPARTMENT OF -�� -,Q^�,� � �, KODY H. KINSLEY• Secretary r: HEALTH AND i HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health .,�.a^• MARK T. BENTON•Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch November 4, 2022 Michael and Janet Hoff 2284 Deerfield Dr Maiden, NC 28650 Re: Approval No. JMB2818 Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 2284 Deerfield Dr Maiden, NC 28650 Dear Mr. and Mrs. Hoff: On November 3, 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 I Iealth 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 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: Janet& Michael Hoff Sample ID Number: 183145 Location: 2284 Deerfield 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. mom. _ Total Coliform 1 Bacteria, E. coli & PRIVATE WELLS _. .. , , ,, _:, i , r‘ • , What are total coliform bacteria , and E. coli? . ,i, Total coliform bacteria are a group of microorganisms found .,1 1►k in soil and surface water.Total coliform bacteria water tests \ , look at all coliform bacteria in water.This includes fecal 1 41 coliform bacteria,which are a group of bacteria found in the s4,u1wr1" 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 concerneda 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 T _ J j �, t, With Detection of E. coli, 2011-2013 1 : mop �C 7, __,,,,,.' - 44 i „ , -it' --)-\ , , ,, _, 41 Percent of Private Wells Tested With dr�`v�, . .y LEL 1ly� rizii t, Detection of Total Coliform, 2011-2013 yr.'-��' r`W1r_I P.i. �,I#t Pm 0 o ',nag .4 ..i. . .li ar- , - >50%with detection _ "rll�--►> ICAP 1♦ l 1� - 25.1-50%with detection • lirir L � Itir <25%with detection d-. Alit IP 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. coli 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:htto://epi.publichealth.nc.gov/ of bacteria in your private well.Treatment systems that oee/programs/wellwater.html. 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.toll is detected throughout NC.About 2%of wells Environmental Protection Agency:httos://safewater, sampled for microbial contamination in NC from 2011 to zendesk.com/hden us/sections/203309158 E toll 0157 H7 2013 tested positive for E.coll.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 resources/water-quality/water-filters-testing-treatment/ map for areas with high E.coli detections. contaminant-reduction-claims-guide Ili, NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental _`.' N I lipEpidemiology Branch• Private Well and Health Program•httos://eoi.oublichealth.ncgov/oee/programs/wellwater.html•NCDHHS is an . / N.In ca..l..a equal opportunity employer and provider..09/2019 PPMie Health N 0 R T H C A R 0 L I N A .,---' 4', yN� � S 9y Private Well Information 0 1„g, zgry ,,,, ,- t „. „ and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba I Name: Janet& Michael Hoff—2284 Deerfield Dr, Maiden NC 28650 Sample ID#: 183145 Reviewer: Megen McBride 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 on(v.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 only. ❑ Arsenic ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper ❑ Fluoride ❑ Iron ❑ Lead ❑ Manganese ❑ Mercury ❑Nickel ❑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 only, 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 ❑ 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/l.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. ❑ 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.