HomeMy WebLinkAboutSAM-05-2023-194822.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 U2C.0107
All water supply wells not considered "Private Drinking Water 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:5 - c __ , 20aJ 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,or government agency and person delegated signature authority:
ROID Q\C
MailingAddress.0 1 1 R e
City: Li t 1S ,S b° State: IN L Zip Comae` ' S 9County:
Day Tele No.:3 3 CD -Lp(o a Cell No.:5 3 6 C l 0 a
- 4.3,-)cR
EMAIL Address: Fax No.:
B. PHYSICAL LOCATION OF WELL SITE
(1) Parcel Identification Number(PIN)of well site:
County:
(2) Physical Address(if different than mailing address):
City: State: NC Zip Code:
C. WELL DRILLER IN FORMATION (if known) 1 1 '
Well Drilling Contractor's Name: ,l 0 S l 1 c,
NC Well Drilling Contractor Certification No.:
Company Name: Contact Person:
City: State: Zip Code: County:
Day Telc 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.
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t `-)0' ,E. ATTACHMENTS—Provide the following information as attachments to this application:
(l) 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 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
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2
Signature of Person Responsib a for Well Construction(typically the well driller)
.R0 b ‘Q-r A- 1--F-a\ e.c
Print or Type Full Name of Person Responsible for Well Construction
(typically the well driller)
1 Tj l'l
Signat 0
f County Environmental Health Specialist
5,, o� l�i .ya JZ5 1r0
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
111,
Please submit this form along with a Well
North Carolina
Variance Application for an existing
Department of Health and Human Services private ;voter supply well.
DiViSi011 of Public Health
Existing Well Variance inspection Report
Well Site Location:
(Town,community,subdivision and Lot
Address: 4 9g-ts Ci . Pt- si.4.- 51- County: Cc-4 c •
City/S17Zip: cl Date of SiteVisit: g /2-•11 2.3 .9 1
1111111111111122E1111111111111111ENNEE11111
Date of Well Construction: N I A Is the well head 12"above land surface' YES w No
If unknown, was it(frilled before 1972? YES or NO Km,wh:#is the height of the casing: inches
If unknown, was it drilled before 7/1/2008 YES NO Is there a sanitary well seal? aper NO
What type of well is it: Is the sanitary well seal in good repair?YES 0 NO
I Drilled Bored Hand Dug Jetted Other Are the f011owing items present at the well head?
Vent I\1 w ._
Does the well have a cement slab? YES or TGO Sample Tap AIR.,.Well Tag,. NI I Pump Tay.kLIA..
Does the well appear to he grouted? Y -S or NO
Does the well currently meet separation requirements with known sources of contarnination or NO
if no,please provide distances to those it does meet:
Other comments:
complete below.
Name of person completing this form(please print): s Ig .y )
Catawba County Environmental Health
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to f •4919J Parcel: 377302898241, 4949 CLIFFSIDE ST 1in=50ft
CATAWBA, 28609
This map/report product was prepared from the Catawba County,NC Geospatial 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,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 may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
05/02/2023
� STATfi
„„°..,,, Ho�. ROY COOPER • Governor
�1-", NC DEPARTMENT OF KODY H. KINSLEY• Secretary
- �oA HEALTH AND
22.4
HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health
MARK T. BENTON •Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
May 26, 2023
Robert Hayes
205 Tiger Dr
North Wilkesboro, NC 28659
Re: Approval No. JMB3035
Private Well Located Less Than 100' to a Septic System [Rule 15A NCAC 2C
.0107(a)(2(C)]
Property location:
4949 Cliffside St.
Catawba, NC 28609
Dear Mr. Hayes:
On May 25, 2023, 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 a variance concerns a water supply well on
the referenced property proposed to serve more than one connection.
Specifically, the variance request grants you permission to use an existing water supply
well at a distance closer than the one-hundred-foot setback to a septic system. Achieving
the one-hundred setback would be difficult given the challenges of the property.
Based upon information provided by the Catawba County Health Department, and the
property owner, 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:
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, having a thread-less sample tap etc.
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
2) The well shall be sampled for the same parameters as required for a newly
constructed well. If samples indicate contaminants, further repairs/treatment may be
required.
3) No potential sources of groundwater contamination shall be stored near the wellhead.
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.l l.S, MS
2
il
catawba county
public health
5/26/23
Robert Hayes
205 Tiger Dr
North Wilkesboro, NC 28659
Dear Mr. Hayes:
We have received the well variance approval from the state, copy attached. Please note that well
must be brought up to current standards as part of the well variance approval.
Please contact Jason Boyd at 828-244-0943 with any questions and for him to inspect once required
improvements have been completed. Building final cannot be scheduled until improvements are
completed.
Sincerel ,
Julia English
Administrative Assistant II
catawbacountync.gov
Environmental Health
CAA() County Govenurent Center
25 6overnn-cnt Drin I PO Box 389 I Newton NC 28658 I 828.465.8210
MAKING. LIVING. BETTER.
,,- .;,.srArE, 4312 District Drive
'';,, North Carolina State Laboratory of Public Health Raleigh,1NC276991918
jEnvironmental Sciences http://slph.ncpublichealth.corn
.40. � Phone: 919-733-7308
Inorganic Chemistry Fax: 919-715-8611
Certificate of Analysis FINAL REPORT
Report to: ENVIRONMENTAL HEALTH Name of System:
CATAWBA COUNTY ENVIRONMENTAL HEALTH Robert Hayes
P 0 BOX 389 4949 Cliffside
NEWTON, NC 28658 Catawba, NC 28609
EIN: 566001814EH Delivery: NC Courier
StarLiMS ID: ES230525-0054 Date Collected: 05/24/2023 Time Collected: 09:15 By: Jason Boyd
Date Received: 05/25/2023 Time Received: 08:07
Sample Type: Raw Sampling Point: Outside spigot at well Well Permit No. SAM05-2023-194822
Sample Source: Well water Receipt Temp. : GPS Number:
Profile: Inorganic Chemical+ Metals I
Analyte Test Result Allowable Limit Unit Qualifier(s)
Arsenic <0.001 0.010 mg/L
Barium <0.1 2.0 mg/L
Cadmium <0.0005 0.005 mg/L
Calcium 22 mg/L
Chloride <5 250 mg/L _
Chromium <0.02 0.10 mg/L
Copper <0.01 1.3 mg/L
Fluoride 0.349 4.00 mg/L
Iron 0.49 0.30 mg/L
Lead <0.003 0.015 mg/L
Magnesium 4 mg/L
Manganese 0.033 0.05 mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH 7.7 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 13.2 mg/L
Sulfate 11.2 250 mg/L
Total Alkalinity 73 mg/L
Total Hardness 70 mg/L
Zinc 1.52 5.0 mg/L
Report Date: 06/06/2023 RECEIVED Reported By:
Marc Komlos
J L.; 1 .:93
Environmental Health
°age 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: Robert M. Hayes _ Sample ID Number: 194822
Location: 4949 Cliffside St, Catawba NC 28609 _ Reviewer: Megen McBride
Initial Sample X Confirmation Sample: _
BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR
PRIVATE WELL WATER(These recommendations arc 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 arc(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
f4%,.,.1 4,,,..i0.i.*lii.t.T.._r4.•.,v1.i,;.t1:.,
„ "°% Private Well Information
g
„ 0♦ and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba J Name: Robert M. Hayes—4949 Cliffside St, Catawba NC 28609
Sample ID#: 194822 I 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 jtturr'anic chemical results ono,. 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 n Nitrate/Nitrite n 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. Aesthetic problems such as had 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 ❑ Sullhte ❑ 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.
n 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)veil water results,please call the North Carolina Division of Public Health at 919-707-5900.
Zinc &
41) Y
PRIVATE WELLS
What is zinc?
Zinc is a natural element found in rocks deep
underground,air,soil,and water.Zinc is found in What level of zinc should I be
the environment as zinc compounds joined to other
elements like chloride,oxygen and sulfur. concerned about?
Zinc is used to produce metals,batteries,and pennies. The NC Department of Environmental Quality
Zinc is also used as a metal coating to prevent rust. developed a groundwater standard of 1 milligrams
Zinc compounds are used to make paint,rubber,dyes,
of zinc per liter of water(mg/L).Ground water
ointments,and wood preservatives. standards are developed to protect public health.
This standard was developed in 2013.
How does zinc get in my The US Environmental Protection Agency
developed an aesthetic standard of 5 mg/L.This
private well water? standard was developed to prevent metallic taste.
Zinc compounds can enter your private well water
from erosion of rocks underground.Zinc can also enter How do I test for zinc in
groundwater from industrial practices like mining,steel
production,coal burning,and burning of waste. my private well?
Use a certified lab to test your well water for zinc
How can zinc affect my health? every two years,as part of the inorganic panel screen.
Contact the private well program at your county
Zinc is an essential element,meaning your body health department to assist you with getting your
needs it small amounts.It helps with enzyme water tested.Pricing of testing varies from county
function,structure,and regulation throughout the to county.
body. However,drinking high levels of zinc may
cause adverse health effects.You can't smell or see
zinc.Zinc may have a detectable taste. What if my zinc levels are high?
Drinking high levels of zinc over short periods can You can install a treatment system to reduce the
lead to: levels of zinc in your private well.Installing a filtration
• Stomach cramps treatment system can reduce the level of zinc in your
• Nausea well water.
• Vomiting You can also reduce your exposure by using bottled
Drinking high levels of zinc over long periods can water or connecting to public water supply,if possible.
cause anemia,decreased good cholesterol levels and
reduced copper absorption.
Percent of Private Wells Tested
Exceeding State Standards for
Zinc, 2011-2013
f ldll
I
iipiti"41 _,,-...--,
*Plottiviiiaink
4 ,
i . .,,,,_ T.,4_,„,,, __
4t1h.
_>25•/exceeded health standards
-10-25%exceeded health standards
--",„,_ fit
<10%exceeded health standards
0%exceeded health standards
Insufficient data(<10 wells tested)
Where is zinc found in NC? Where did this information
Zinc is found at low levels(0.05-43 mg/L)throughout come from?
NC.About 8%of wells sampled for zinc in NC from Agency for Toxic Substances and Disease Registry:
2011 to 2013 exceeded the N.C.Department of www.atsdr.cdc.gov/toxfaqs/tfacts60.pdf
Environmental Quality groundwater standard
(1 mg/L). Yet,there are several areas in NC with at World Health Organization:www.who.int/water
sanitation health/dwq/chemicals/zinc.pdf
least 10%of wells exceeding state standards.See
map for areas with elevated zinc. National Sanitation Foundation:www.nsf.org/
consumer-resources/water-quality/water-filters-
Where can I find more testing-treatment/contaminant-reduction-
information about zinc and claims guide
my well? King,J.C.The American journal of clinical
nutrition Zinc an essential but elusive nutrient
Visit the NC Division of Public Health's Private Well 2011:www.ncbi.nlm.nih.gov/pmc/articles/
and Health Program website:http://epi.publichealth. PMC3142737/pdf/ajcn9420679S.pdf
nc.gov/oee/programs/wellwater.html.
There you can find:
• Contacts for your county private well program
• Zinc in well water maps
• A guide for selecting a treatment system
• Other private well resources
You can also call the Private Well and Health Program
at 919-707-5900.
e
NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental
g
j Nj C. 1 Epidemiology Branch•Private Well and Health Program•httos://epi.Dubiichealth.nc.gov/oee/programs/wellwater.html•NCDHHS is an
ac.ac..ah..• equal opportunity employer and provider.•09/2019
Whh,Ilealth