HomeMy WebLinkAboutSAM-11-2022-184602.TIF •
(is)
co a;ta7ba county
public health
Water Sample Application
Sample Requested By /41),) Casito COn5ita.1-,C*4 fipme Phone .2
Property Address &(IaOO Prtfy) a.er\e-"?...,t_ ,nd.' Business Phone_
Mailing Address,,4›?1-/41.0_01:4011164.A.. /4c.- v002. —
Driving Direttians H14,1 I Jrdi ,Vbk R crP_rov RA r1
&bop SD f-
Sample Requested: Bacteriological 't, Inorganic Chemical j/__.Other •
Sample reason: Aal-e% 6c4ry,e LR.[\ Val Of‘c_.
Type of Well: Drilled v" Bored Dug Other
Is the well on this same property? Yes /No
PLEASE NOTE:Sample will be taken at the well head. If well head is not accessible, sample will be
taken from a spigot on outside of home, unless otherwise specified:
Is outside spigot available to collect sample? Yes No _
Is power on? Yes V No
Has well been tested before? Yes No Unknown ‘,/ Results
Does the plumbing come out the top of the well through a sanitary well seal? Yes No Unknown
Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes No
Does the well top extend 12 inches above the ground or well slab? Yes No Unknown l..-.••••"""
The well is located in front rear Vieft side _ right side , of the house,
Does well supply water to more than one home? Yes No V"
Date _ 11/ II/22- Signature of Owner or Agent -1,-
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• NORTH CAROL I?'A OF PART MENT OF ENVIRONMENT AND NATURAL RESOURCES
VARIANCE APPLICATION FOR 2C.0100 WELL.CONSTRUCTION STANDARDS:
PRIVATE DRINKING WATER WELLS UNDER ISA NCAC 02C.O300
WATER SUPPLY WELLS UNDER liA NCAC 02C.D107
All wooer apply oretts*or ciouside tf"Petiole Drinking Water Was"gni rMhu6rrg Rrtjttnwt, oidwrnd/.and matabererol wet
WELLS S OTHER THAN WATER SUPPLY UNDER ISA NCAC(12C.0100
botanic irowt rirrp oral rsrnvert Went:
Print clearly or Nit information. !flexibly snIn ithtls will be re-tamed its incoarplate.
DATE: /1I7I , 2v ;2 PERMIr(�(3.: ............_..__ (wbecout lctts:byDWQ't.wit)
A. WELL OWNER-for single family residences fist the property ownerta). For all others, list trams of the business,
otgmizatioo,or government agency mj person delegat1 si8naturc.utbonty-
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Matting Address.: VL'
City: State lip Code: _ , County
Day Telc No, Cell No,' L 1
EMAIL Address.; ... fax No.:
B. PHYSICAL LOCATION OF WELL SITE
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County: t .?4.T 44,r?b _
(2) Pkyolul Autrt ss(if different then mailing address): >r '
City. Stow..NE Zip Code:
C, WELL DRILLER INFORMATION(if known).
Well t)nlIins Cont*nctor'a Nome, 1 `s O -
NC Welt Chilling Cosa ac or Caliuc:snot No.:
Company Name. Contact Person:
City: State. Zip Code: County: _. _..,..
Day Teic No Cell No.:
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North Carolina Please submit this form along with a Well
Department of Health and Human Services Variance Application for an existing
Division of Public Health private water supply well.
Well Site Location: Vale
(Town,comnumiry,subdivision and Lot#)
Address: do OU Pcov)lfe/)C-2 f hNrC 1, County: �,a�� I+l�a__
City/ST/Zip: \fa It MC i 2Q1 c Date of SiteVisit: .._!Z LS I ZZ
Wen ('oast ruct ion
Well head Completion
Date of Well Construction: "{ f 19 I my( Is the well head 12"above land surrface? 0 or NO
1f unknown, was it drilled before 1972? YES or NO If no, what is the height of the casing: inches
If unknown,was it drilled before 7/1/2008?YES or NO Is there a sanitary well seal? E or NO
What type of well is it: Is the sanitary well seal in good repair?(a4 or NO
Drilled Bored Hand Dug Jetted Other Are the following items present at the well head?
Vent v" Sample Tap
Does the well have a cement slab? YES or O
�--- Well Tag ✓ Pump Tag
Does the well appear to be grouted? .YES or NO
Potential SOH rees of('ontatnination''
Does the well currently meet separation requirements with known sources of contamination?&S)or NO
If no,please provide distances to those it does meet:
Other comments:
( -olti/'h'ie hc'1��►►'.
Name of person completing this form(please print): Neyams( , , ".6.A._____
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�� u.•.,», ro ROY COOPER• Governor
NC DEPARTMENT OF KODY H. KINSLEY• Secretary
HEALTH AND
HELEN WOLSTENHOLME• Interim Deputy Secretary HUMAN SERVICES p y
for Health
MARK T. BENTON•Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
December 7, 2022
Ron Sessions
6600 Providence Church Rd
Vale, NC 28168
Re: Approval No. JMB2844
Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C
.0107(a)(2)(P)]
Property location:
6600 Providence Church Rd
Vale, NC 28168
Dear Mr. Sessions:
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,
,` t.
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: Ron Sessions Sample ID Number: 184602
Location: 6600 Providence Church Rd,Vale NC 28168 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.
Total Coliform
Bacteria, E. coli & t v
PRIVATE WELLS
What are total coliform bacteria
and E. coli?
Total coliform bacteria are a group of microorganisms found
in soil and surface water.Total coliform bacteria water tests
look at all coliform bacteria in water.This includes fecal
coliform bacteria,which are a group of bacteria found in the ''441....."rr.i
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. coii?
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 private well?
pathogens that could be present in your water:
• 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 M#= ig11111 N,W ..
With Detection of E. coli, 2011-2013 '11G�� L 4
agvilAwantitilvf
iNairaini714-FiniValle 4746
41114
11011.
it
Percent of Private Wells Tested With ` ' ■� ` ,
Detection of Total Coliform, 2011-2013t; /04i
4446.1111 :kik*
- >50%with detection ` .
25.1-50%with detection L 11 '
<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. 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:http://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. healthvwater/drinking/private/wells/disease/e coli.html
E.coli is detected throughout NC.About 2%of wells Environmental Protection Agency:httpsJ/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 resources/water-quality/water-filters-testing-treatment/
map for areas with high E.coli detections. contaminant-reduction-claims-guide
lbw, NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental
"141 Epidemiology Branch•Private Well and Health Program•httos://eoi.oublichealth.nc ov/oee/oro rams/wellwater.html•NCDHHs is an
P 9Y g .9 9
• Nr,,.M,kw waNnttI, equal opportunity employer and provider.•09/2019
N 0 R T H C A R 0 L I N A
as STATFy"; Private Well Information
9N1/�r 4�'•,
•
40. and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Ron Sessions—6600 Providence Church Rd, Vale NC 28168
Sample ID#: 184602 J 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 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 El Barium El Cadmium n Chromium El Copper ❑ Fluoride El Iron
❑ Lead ❑ Manganese ❑ Mercury ❑Nickel El Nitrate/Nitrite El Selenium ❑ Silver
El Zinc
3. El 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. 0 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 ❑ Fluoride ❑ Iron El Manganese
❑ pH El Silver n Sulfate n 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 on(v.
El b. Your sodium level exceeds 30 mg/land 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.\'orth Carolina Division of Public Health at 919-707-5900.