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HomeMy WebLinkAboutSAM-11-2022-185311.tif K$A U Case# SAM-11-2022 185311 �.,� H CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 1$ Z Ski 11/30/2022 WATER SAMPLE APPLICATION Applicant OSCAR MARTINEZ,6184 LITTLE MOUNTAIN RD,SFIERRILLS FORD NC 28673 C:704-641-3432 Site Address: 6184 LITTLE MOUNTAIN RD, SHERRILLS FORD NC 28673 SELECTED SAMPLES " Bacterial ,:,,,- ; Name of Subdivision: Inorganic Parcel Number: 369803106058 Lot: Block: Nitrate/Nitrite Specific Directions Description: Well Variance Reason for Sample: well variance Type of Well >Oriitdlt-qq3SSZI Is the well on this same property? Is outside spigot available to collect sample? es * ' Is power on? YeiF= Has well been tested before? tAi$. ' Results Does the plumbing come out the top of the well through a sanitary well seal? :Yea e Does the well ever become cloudy or has there ever been a problem with taste and/or odor? 1 7,rNn750 , Explain Does the well top extend twelve(12)inches above the ground or well slab? `°y The well is in: : ate Does this well supply water to more than one home? Ai01 , Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results; therefore,you may receive several different reports concerning your water sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270. Date ` Signature or Owner or Agent Jason Boyd z14+t �RJP 3 °`, 3 •7 r oJ,933}'si1i -.Nip l. �'LrF.,.E O„ T z«.w�' ..a Bacteriological Sample Fee 11/30/2022 $58.00 Inorganic Chemical Sample Fee 11/30/2022 $128.00 Nitrate Sample Fee 11/30/2022 $99.00 r a1"t a.N TOT RE SY ` � �� ��� 5 a fa ��f � �� � � Po Q .0 ,a st d,xti. - .. �.r.....�.;�� w.W.�...,,a� � -.� ua� .� ���� ,�,rd ate., � ..= 3 .,..,��: < rsamapplication 11/30/2022 Page 1 of 1 Catawba county public health cIC0(1" W ter S mple Application (?Sample Requested By A4�"r ( �l� �"' Home Phone Property Address Wq !. 4 1 h'i /1/1c9vet 4I,t VNL1. ' Business Phone �dtc^l�l /—3`� ,2_ �( Mailing Address �'� Cis ' Oird C \ ,c Driving Directions v ,, C✓ Q-C-g r Sample Requested: Bacteriological Inorganic Chemical Ni n Other I V 1kee.) Sample reason: / Type of Well: Drilled ✓ Bored Dug Other Is the well on this same property? Yes V No PLEASE NOTE: Sample will be taken at the well head. If well head is not acce able, sample will be taken from a spigot on outside of home, unless otherwise specified: 1S 5 pr o I C(, (Ai Is outside spigot available to collect sample? Yes V.No Is power on? Yes V No Has well been tested before? Yes No Unknown V Results Does the plumbing come out the top of the well through a sanitary well seal? Yes V No Unknown Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes No Explain Does the well top extend 12 inches above the ground or well slab? Yes No Unknown The well is located in front rear left side right side of the house. Does well supply water to more than one home? Yes No )/ Date I ( 30 t t, Signature of Owner or Agent ( v C i catawbacountync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 AR$II GO dOYlEG0 'A ta. CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE:828.465.8399 Wednesday,November 30,2022 1$42, sM www.catawbacountync.gov -PAYOR: Martinez,Oscar PAYMENTS TRANSACTION NUMBER: TRC-52275671-30-11-2022 PAYMENT DATE: 11/30/2022 PAYMENT TYPE: Credit Card 298069886 ..,, INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT ' '('. s:(1' r' 11-22-415352 110-580200-663000 Bacteriological Sample Fee $58.00 - MN RI,ONO „ttrl ttiO " R6 7eie p l +: d$99M 11-22-415352 110-580200-663000 Inorganic Chemical Sample Fee $128.00 - TOTAL PAYMENTS: $285.00 SAM-11-2022-185311 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 6184 LITTLE MOUNTAIN RD,SHERRILLS FORD NC 28673 Applicant OSCAR MARTINEZ,6184 LITTLE MOUNTAIN RD,SHERRILLS FORD NC 28673 C:704-641-3432 **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 11/30/2022 12:38 Page 1 of 1 1 NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES • VARIANCE APPLICATION FOR 2C .0100 WELL CONSTRUCTION STANDARDS: PRIVATE DRINKING WATER WELLS UNDER 15A NCAC 02C.0300 WATER SUPPLY WELLS UNDER 15A NCAC 02C.0107 All water supply wells not considered"Private Drinking Ff'ater Wells"and including irrigation,industrial,and commercial wells. WELLS OTHER THAN 'WATER SUPPLY UNDER 15A NCAC 02C.0108 Including monitoring and recovery wells. Print clearly or type information. Illegible submittals will he returned as incomplete. DATE: / / J LI , 20 /,-./L-. PERMIT NO.:70 h-('t (to be completed by DWQ/DPH) A. WELL OWNER- For single family residences list the property owner(s). For all others, list name of the business, o 'zation,or government ag ncy and person delegated signature authority: Mailin Address: G`�4 rL /i'Vc fil,°Vei �Cj l , City: (tQrVU( . �Yc State: 2 Zip Codet$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 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: Oscar Martinez Sample ID Number: 185311 Location: 6184 Little Mountain Rd, Sherrills Ford NC 28673 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.) X 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. 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 i � Private Well Information ,,a M ,.do iii i' fi .,,,, Q ,, and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Oscar Martinez—6184 Little Mountain Rd, Sherrills Ford NC 28673 Sample ID#: 185311 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 n Barium ❑ Cadmium El Chromium El Copper ❑ Fluoride ❑ Iron [' Lead ❑ Manganese El Mercury ❑Nickel El Nitrate/Nitrite El Selenium ❑ Silver n 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. El 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 jiorganic 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 El Iron . El Manganese El pH El Silver El Sulfate El Zinc 6. El 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. ❑ b. Your sodium level exceeds 30 mg/I and may pose aesthetic issues such as bad taste, odor, staining of porcelain,etc. 7. El Re-sampling is recommended in _months,to reinvestigate . Far more information regarding your well water results,please call the North Carolina Division of Public Health at 9/9-707-5900.