HomeMy WebLinkAboutEXSY-01-2023-187096.TIF Ott
CATAWBA COUNTY Case# EXSY-01-2023-187096
,z Public Health Department Subdivision MOUNT ANDERSON PHASE:
.ive 7
Environmental Health Division PIN# 367704803133
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 33
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Site Address: 4744 SIERRA DR, MAIDEN NC 28650
Name on Permit: CHARLES HELIN
Property Size: Acres 0.6
Directions: NC 16, Right onto Tower Rd, Right onto Sierra Dr
Owner/Authorized Representative Acknowledgement of Permit Receipt
XI4ertify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
6' 7�'s the property owner or authorized representative,I have received the above referenced
as re requested in the application for service RBPR-04-2022-40696,bythe followingmethods :
permit(s) q PP ( )
Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
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y l the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900),
and/or Well 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: 01/04/2023
Owner/Authorized Representative Signature 4
Date J' / 'a3
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature Date/Time
Method: Fax Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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ehpennii 01/06/2023 05:09
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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
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