HomeMy WebLinkAboutRBPR-05-2023-44260.tif .44,:iiii 1. 1116., IN THIS IS NOTA PERMIT Case# RBPR-05-2023-44260
CATAWBA COUNTY HEALTH DEPARTMENT
R '� , � PLAN REVIEW APPLICATION FOR ENVIRONMENTAL SERVICES
ems• s' Reside ial Building Plan Review-Building New
(IMPROVEMENT AUTH CONST NEW WELL
SI ))iofRe14sF4
Applcant AFSHIN&NADIA GHAZI,,
C:7049687888
Contractor SAME AS APPLICANT,,
Owner CARMEN DEANDREA 1R,354 SHORELINE LOOP,MOORESVILLE NC 28117
C:704-791-8028
NAME TO APPEAR ON PERMIT
Afshin & Nadia Ghazi
SITE ADDRESS: 2520 CROSSGATE TR,SHERRILLS FORD NC 28673 PIN# 4621302571968
NAME of SUBDIVISION: CRESCENT LAND AND TIMBER CORP LAKE LOT 260
Lot II Section/Block
PROPERTY SIZE: Square Feet Acres 0.52
DIRECTIONS: Hwy 150 E Left Shemlls Ford RD,Right Island Point RD,Left Bay Leaf LN,Property at end of Crossgate Trail
PRIMARY CONTACT: Applicant SEWER TYPE: Septic Tank
GALLO P Y: 400 WATER SUPPLY: Private WellSCRIBE WORK: 8110123 revise to add new Improvement Permit
e
New 1 story 4 bedroom Single Family Dwelling WI attached garage
3RE INFORMATION
Do any of the following apply to the property for which this application is applied?
If the answer to any of the questions below is"YES",then supporting documentation is required:
Does this site contain any jurisdictional wetlands? No
Does this site contain any existing wastewater systems? No
Is any of the wastewater going to be generated on the site other than domestic sewage? No
Is the site subject to approval by any other public agency? Yes
Are there any easements or right-of-ways on this property? No
APPLICATION FOR: New Structure
STRUCTURE TYPE: PRIMARY RESIDENCE
FACILITY TYPE: Single Family Residence OTHER DESCRIPTION:
DESCRIPTION OF vacant lot
EXISTING STRUCTURES
ON SITE(IF ANY)
DIM EXISTING STRUCTURE:
NUMBER OF EXISTING BEDROOMS: S OF OCCUPANTS: 8
PROPOSED CONSTRUCTION
NEW STRUCTURE DIM:: 131x89
0 OF NEW BEDROOMS:: 4
BASEMENT? No BASEMENT FIXTURES? No PLUMBING REQUIRED?
Desired system types(Improvement Permit or Authorization to Construct):
ACCEPTED: ALTERNATIVE: CONVENTIONAL:
OTHER: INNOVATIVE: ANY: YES
Other described:
APPLICATION FOR WELL CONSTRUCTION
PROPOSED WELL TYPE: Individual Well REPLACE WELL?: NO
eltarpin all,n 06/10d023 16:29 Page I of 3
iti CATAWBA COUNTY case N RBPR-05-2023-44260
( ��i� Public Health Department Subdivision CRESCENT LAND AND TIMBER
' 1; Environmental Health Division
1 J - PIN* 462802671988
'�\ A PO Box 389,100-A Southwest Blvd,Newton,NC 28658
&IVNAME ON PERMIT: (AFSH!N&NADIA GHAZI),,
(Afshin&Nadia Ghazi)
Site Address: 2520 CROSSGATE TR,SHERRILLS FORD NC 28673
Property Size: Square Feet Acres 0.52
Directions: Hwy 150 E Left Sherrills Ford RD,Right Island Point RD,Left Bay Leaf LN,Property at end of Crossgate Trail
Completed applications are valid fora period of 2 years Improvement Permits are valid:with complete site plan•60 months(5 years):with complete plat
=without expiration. An Authorization to Construct will remain valid as long as the Improvement Permit is valid.An Authorization to Construct Issued for
septic repair is valid for 60 months(5 years).Permits may be revoked if the information on this application/sits plan changes or Mite intended use for the
proposed faddy changes. Permits may be revoked if site condtions are altered such that they effect permit conditions or installation requirements
I have read this application and certify that the Information provided herein is true,complete and correct Authorized county and state officials are
granted right of entry to conduct necessary Inspections to determine compliance with applicable laws and rules. I understand that I am solely
responsible for the proper identification and labeling of all property lines and corners and making the site accessible so that a complete site evaluation
can be performed.
The undersigned is the owner of the property or legal agent of the owner.
Date: 8.16.23 16'23 Signature of Applicant or Agent -
If you need further information or assistance please call 828-465-8270
AREA5
:ETUCUU: 30'buffer from shore=no structures
FEENANE DATE FEE AMOUNT
Authorization to Construct Fee(New/Expansion) 05/05/2023 5300.00
Fee
Well Permit&Inspection Fee 05/05/2023 5300.00
Improvement Permit Fee 08/10/2023 570.00
TOTAL FEES 5670.00
FEES ARE NON-REFUNDABLE
ONCE A SITE VISIT IS MADE OR
WORK ON A PLAN REVIEW HAS COMMENCED
SYSTEM REDESIGN AND/OR RETRIP WILL INCUR AN ADDITIONAL CHARGE
(SEE FEE SCHEDULE)
r iapplicmn.0 0H/10/2023 16:29 Page 2 of3
e),V)A- CATAWBA COUNTY
100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Thursday,August 17,2023
www.catawbacountync.gov
PAYOR:
Ghazi,Afshin&Nadia
PAYMENTS
TRANSACTION NUMBER: TRC-71035834-17-08-2023
PAYMENT DATE: 08/17/2023
PAYMENT TYPE: Credit Card
309554252
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
08-23-427011 110-580200-663000 Improvement Permit Fee $70.00
TOTAL PAYMENTS: $70.00
RBPR-05-2023-44260
CASE TYPE: Residential Building Plan Review WORK CLASS: Building New
SITE ADDRESS: 2520 CROSSGATE TR,SHERRILLS FORD NC 28673
Applicant AFSHIN&NADIA GHAZI,,
C:7049687888
**NO PEOPLESOFT ACCOUNT ASSIGNED**
Owner CARMEN DEANDREA JR,354 SHORELINE LOOP,MOORESVILLE NC 28117
C:704-791-8028
Contractor SAME AS APPLICANT,,
receipt 08/17/2023 10:27 Page 1 of I
i 1
• NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
tr.
VARIANCE APPLICATION FOR 2C.0100 WELL CONSTRUCTION STANDARDS:
PRIVATE DRINKING WATER WELLS UNDER ISA NCAC 02C.0300
WATER SUPPLY WELLS UNDER 1SA NCAC 02C.0107
AU water sp{ r wells not oonsteks d"Private Drinking f t otar Wells" Including irrigation.industrial,and c+omtaercial well:.
WELLS OTHER THAN WATER SUPPLY UNDER 15A NCAC 02C.0108
Including monitoring and recovery walk,
Print clearly or t}pe information. Illegible submittals will be returned as incomplete j1
DATE: y ) t , 1013PERMIT NO.: _(to be completed by DWQ6DPH)
J
A. WELL OWNER — For single family residences list the property owner(s). For all others, list name of the business,
organization,or government agency pmt person delegated signature audio '
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Mailing Address: 51 3 t C.)z,r‘%.Q...R
City: Q. .et \j t- c. State: p$C Zip Code:71214 County: !'r1Lt,k tt4-. !' ,
Day Tale No.: 5 6\n. Ccii No.: 70-1 94. 6 1 i a Q
EMAIL Address: 0.-cc\...... 1... t 42,7+ +1.ttia•-Fax No.:
S. PHYSICAL LOCATION OF WELL SITE
(1) Parcel identification Number(PIN)of well site:
County:
2510 Cress. fe. rw t
(2) Physical Address(if different than mailing address): ) ..
City: c1N air r t.A l;�Dr State: Zip Codc: 2(1. L 13
C. WELL DRILLER INFORMATION(if known) ''� K ,r
Well Drilling Contractor's Name:
NC Well Drilling Contractor Certification No.: IN
Company Name: Contact Person:
City: State: Zip Code: County:
Day Tele No,: Cell No.:
EMAIL Address: Fax No.:
Pars GW-22V Pip 1 Revised rebrwzy 2Otn
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D. REASON FOR VARIANCE REQUEST—Include type of wcll(g)to be conasrucled;s ik far which the variance is
,.'bring requested;dcssription of how the alternate consrructioo 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
tuad/or provides equal or better protection of the groundwater.
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E. A1TACUUMENTS—Provide the fallowing 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 materialsimethods.
F, OTHER NIIltfa'tMClhi CONSTRUCTION REQUIREMENTS
For water supply wells, approval of a variance will require that additional construction requirements beyond those
specified in 15A NCAC 02C .O107 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 S of this application.
Approval of a variance will not be considered in cases where the specified minimum additional construction
requirements cannot be met.
C. SIGNATURES
Signature of Person Responsible for Well Construction(typically the well driller)
--- Print or Type Full Name of Person Responsible for Well Construction
(typically the well driller)
1
IrK`—'
Signature of County Eavtro I Moltlet !"'
mom$ _) 5 5-
Print or Type Roil Name of County Environmental!!califs Spsciatbe
Per 154 NC 1 C 02C.011,E the Secretary oldie 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 at port of the
decision, and shall respond to writing to the request within 30 days of receipt of the lwrkute.request. 4 variance
applicant who is dissatisfied with the decision of the Director may commence a contested case by fling a petition as
,described in G.S. 150D-23 within 60 days alter receipt of the decision.
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ROY COOPER •Governor
4 4 s,. NC DEPARTMENT OF
Irr e ! KODY H. KINSLEY• Secretary�y,� ► . ' HEALTH AND
% le „ ,re HUMAN SERVICES HELEN WOLSTENHOLME• Interim Deputy Secretary for Health
.,8,9 MARK T. BENTON•Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
August 3, 2023
Afshia Ghazi
5131 Gorham Dr
Charlotte,NC 28026
Re: Approval No. JMB3122
Private Well Located Less than 25' from Building Perimeter and Located Less than 50'
from Surface Water [Rule 15A NCAC 2C .0107(a)(2)(P)(Q)]
Property location:
2520 Crossgate Trail
Sherrill's Ford, NC 28673
Dear Mr. Ghazi:
On August 1, 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 proposed water supply
well on the referenced property that will serve a single-family dwelling and part of a
structure on the property will be within twenty-five feet of the well and surface water on
the property will be within fifty feet of the well. The home is on a lot with very difficult
topography.
Specifically, the variance request grants you permission to construct a water supply well
at a distance closer than the twenty-five-foot setback to a building perimeter and at a
distance closer than the fifty-foot setback to a surface water body. Achieving the twenty-
five-foot and fifty-foot setbacks 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:
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 new water supply well shall be constructed of either PVC, steel, or galvanized
metal casing.
2) The well shall be located as far as possible from the structure where,depending upon
where well rig can actually set up,will possibly encroach upon the 25foot setback,
but not be closer than 10feet.
3) The well shall be located as far as possible from the surface water where, depending
upon where well rig can actually set up, will possibly encroach upon the 50foot
setback, but not be closer than 30feet.
4) A preconstruction meeting shall be required with the Catawba County Health
Department staff to ensure that the maximum possible distances are achieved.
5) The well will be required to have casing installed to a minimum of 50 feet below land
surface or to bedrock, whichever is greater.
6) The well shall be at least fifty feet from any part of the septic system including repair
area.
7) Grout will be required the entire length of the casing from land surface into bedrock.
8) A drill bit with a diameter of at least one third greater than the diameter of the casing
must be used to drill the cased portion of the well.
9) Grout must be either pumped into place with the use of a tremmie pipe or pressure
method.
10)If a full-length grout is not possible due to site conditions, then a packer-liner
must be installed in the well. The liner must extend at least five feet beyond the
end of the casing and grouted entirely with a neat cement grout.
11)The well must be constructed outside of any road right of way.
12)A grout inspection must be performed by the 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