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HomeMy WebLinkAboutWELL-05-2023-196221.tif \+,\ ( I.Al Us1i%1 O1 \11 i ` et. t j Public health Ikpartmeni SohJrvi.um Emu.ximcnul Ilcalth I)isnnn , _�C;,� t'tNr a6i70473a,77 I`OIlos ix.) 2s(iuscrnnw•nr Iknc,Ne.skm,tie :It6SS I I)tii 4 ;x.l2 Site Address 3974 CEDAR WOOD TR.TERRELL NC 28682 Name on Permit: 'ELITE BUILDERS OF SURRY INC Property Sue: Acres 0 49 Directions: 16 South left on 150 east Right on Kiser island left on cedar wood trail last wooded lot on lee Owner/Authorized Representative Acknowledgement of I'crmit Receipt g1 certify that I am the.»sncr or authoriicd agent((Miler's authuri/atlurt required representInl.. III,:us%nor nl 1\9— the pmpert) dcxrihcd abuse. X .ktl)' As the property owner or aulhoriied representative. I have received the above referenced permits)as requested in the application fur service RBPR-02-2022-3999I.by the following method(s): Received in Person Facsimile Transmittal(Return form with signature required) 41 Electronic Image Transmittal'E-mail (Return receipt required) :11 '� " As the property owner or authorised 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(ISA NCAC I8A.1900), and/or Well Construction Standards(ISA NCA('2C.0100), shall apply to the issuance of this permit and the construction(tithe wastewater system and or water supply well permitted. Permit Issue Date:04/27/2023 OssneriAuthuri/cd Representative Signature //ei/Dateatc Z) Documentation of I'erniil(s) transmittal (hermit transmitted by electronic or other means) Pet tilt tranvnittril hs fnume of 7rrrsrin semhng 7terMlii 4 .,signature Date Iime 5�1 ll� 'Method: Fax .1 Email t S Mail Oilier Owner's request In send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yoiPlease ttake a few momentts no complette our custtomer service survey all http://www.surveymonkey.com/s/ENCusttomerScrvice (aUld(c�itYkSrCa5Liiry, )lei .SZI • CATAWBA COUNTY Case# WELL-05-2023-196221 g(....,t Public Health Department Subdivision d � ', Environmental Health Division PIN# 461704734177 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 4 g. su Site Address: 3974 CEDAR WOOD TR,TERRELL NC 28682 Name on Permit: *ELITE BUILDERS OF SURRY INC Property Size: Acres 0.49 Directions: 16 South left on 150 east Right on Kiser island left on cedar wood trail last wooded lot on left NEW WELL PERMIT VARIANCE WELL See attached state well variance approval for well construction standards and setbacks. Wells shall be constructed in accordance with state regulations: Article 15A North Carolina Administrative Code Subchapter 2C The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain the required setbacks,contact Catawba County Environmental Health at 828-465-8270, before drilling the well Casing Height: 12 inches minimum above finished grade All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private Drinking Water Well Testing(I5A NCAC I8A.3800).The fee for this sampling is included in the cost of the well permit.It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health. ./- f14,. 05/19/2023 Authorized State Agent Permit Issuance Date 5/19/2028 Permit Expiration Date ::Iq k1 tint 05/19/2023 13:58 ..S-,t4.1..1: 454ftvi 130:0/044::::::::‘,...?":"'.'' 7-•-r-4:4::: liY.: 1 4+14 „, _„,..,4. e Aw t,1i:r f ,i r Ail; _,.. _.•• -- 1 - ."-Y741`. 11` kr°' .• ,.. _ 4,iist,t,..4:.;4 . a... 40 ,s .„,.. afivir, I �;� �� � I 0 Ceti. , V ♦ r co-.1.........\ye / sl !'kl,?._L. „-- E . . ,T,,,,......v. cifitlp ,tix,\ ›Lk.,).4:11 --6iA. k......... y Un/.n.,�y,r . V ` (1) '.466% ' fi; C?? yu;w9se11 3 lit \\I- LIPm ' T g Z. L... 4 iv 4t, (A0--"") ... Nac ti is& k - , rii, 440 /-7 a NV Y ,...,../ 7: �, 1 io z ' ) 1 &A moo, J le1 N .6eie l 'tNir 41''' 4.„, „ eati 4,40 1.4e '.-47Al.:."--.... ,Nk i• ., ... 4 ..1:-.::, ‘ 14 41 ! '6::f sr' 4 1411it....--.''' ' • .. ....„ ...„:......? r— PT ~ i , . . am-' QQ-a)-- 6j„...,--,A-61-566--* � k5 51'1l KAI _._.''- ri, .R/ pv-oL-1 - .) -3.... lel MI5 Li1 CEDAROd1-155- 19 , • _ r STAiF q s.a „•Y10.i>„ W04, ROY COOPER • Governor la,, ti NC DEPARTMENT OF KODY H. KINSLEY • Secretary ri HEALTH AND HUMAN SERVICES HELEN WOLSTENHOLME • Interim Deputy Secretary for Health P .,Mr.•^ tl. MARK T. BENTON •Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch May 19, 2023 Rick Salkowski 1896 Lotus Lane Denver, NC 28037 Re: Approval No. JM 133019 Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 3974 Cedar Wood 'Trail Terrell,NC 28682 Dear Mr. Salkowski: On May 16, 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. 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. Achieving the twenty-five-foot 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: 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 I 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) A preconstruction meeting shall be required with the Catawba County Health Department staff to ensure that the maximum possible distances are achieved. 4) The well will be required to have casing installed to a minimum of 43 feet below land surface or to bedrock, whichever is greater. 5) The well shall be at least fifty feet from any part of the septic system including repair area. 6) Grout will be required the entire length of the casing from land surface into bedrock. 7) 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. 8) Grout must be either pumped into place with the use of a tremmie pipe or pressure method. 9) 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. 10)The well must be constructed outside of any road right of way. 11)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 7/19/22, 11;57 AM about:blank WPDT Report Area of Interest (A0I) Information Area : 3,134,508.74 ft2 Jul 19 2022 11:57:31 Eastern Daylight Time hf n, � QN ►� r rha N rc►4i \\\\ d • • /\\I \ ls�H 1:4.51_ Pot s Pn^;gansi Pa. C.KAeC ROUSE I 1 1 1 i ti l llor+5';U 'r Rows — O8w Stale Agency Route •;1 _ • - Fesra Rate — Seeomer y Parte Nor.;;sttm Pr,-n ,PCaas O!PMr Sister Raa:s — Heistale — Ramps Rest A•eas I o,'MSc — US Rate " /K .Poule .',. . about:blank 1/2 7/19/22,11:57 AM about:blank 3974 Cedar Wood Tr All North Carolina Department of Environmental Quality(NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The NCDEQ makes no warranty of any kind,express or implied,concerning this information,including but not limited to any warranties of merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy, reliability,completeness,timeliness,or usefulness.The data is not intended to constitute advice nor is it to be used as a substitute for specific advice from a professional.Users should not act(or refrain from acting)based upon information in the Data without independently verifying the information and obtaining any necessary professional advice.Users are solely responsible for ensuring the accuracy,currency and other qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and attribution of GIS features and makes no warranty concerning same. about:blank 2/2 CONSTRUCTION flECORD(GW-1) For lntcmal Use only !� .,P!')i t Holm WELL 1.Welt CunlrvclorMinn:na,(ion: CHAD HARTNESS R,`uJ4Caulra_iorilamc TO 1 DESCRIvr1O1',• ., _ ,...-, 'FROM 2901A 409 IL j 410 rt \ WcflCdnawtorCenifkatior:'Number ft, It. AIR ORELUNG INC '13 01EfF.R•CsA.SINi,`` ieranlilev+Fed,:elISIOR=LR1'E&(iSia treu6le, _. 1 FROM. I TO DIAMETER' I Trf1C14ESS I IIATF-RIAL Cbmfiary,Maine 0 ft i 1Q7 fr- 1 6 1/4 1°- I IGALV 2. O5-2023-196221 ,t4,7NNEIt:CASINGXWIUr3ING.fecoiherSrinl&lied:Taop1. lVCll.CA11SfrUrllatiPct'nill � Fltaal TO. DWMi,1tit ' TIIICIOVLS,S 111TERI.At, I Liar 61l o0p?nwhfea ell cotuir trha+r lemthvb..e,IIR,(opnry;Spa;1 irranre;ere.; rG ff. in 3.1Yell Use(cheek well Irsc): 1r: if. ' r°• IDWater Supply Well: _SCREEN`. _.':° Agricultural FROM I TO DIAMETER SLOTSt2E Tuto:NE,':S' amrsxtAc OIvlunicipaiJPublic 0 ft. fr. iu. ©Cicothermai(Htetiut'/Caoling Supply) xDResiderunl Water Supply jsingle) �lndustnalICommet in) fr. h. I i°, I ['Residential Water Supply shnr-e41 78.CROr1t[ ' I. fl tri irrigation FTIONI I-TO MATERht 1. I PAIPIAC MEATM HOn&A+toi'tir Non-Wtt(cr Supply Welt: 0 rL 107 xft' TREbvdlc'GROUT. POURED • E)Ivfoniloring ri Recovery ft: I h- injection`Well: JAquifer Rethnrge ©Groundwater Remedintion to it. 5}Aquifer and Ret ovtTy ©Stilinity]lamer 'c19:SVNt17GR;►VEL,PACKlifapiHiea'ble).. ,, FROn i TO MATERIAL EMP1ACEMD7T METHOD ,• rlquiferTest DSto moater Drainage ft: I fr. 1 Experimental'I'echntilogy 'DStlhsidenenConml OL, i8 fr GeatherrataiClt>ra:dLoop) OTracer ,2o.DIDLIANGIAG,fatrneltadieuonbtalieersifner_euatv); nGeothermal(T)eatin(t/CoolmgReturn) r)ptlier(explaintmdciit2tRemarks) FROM TO DF3CRI77Y0N(rolar,'da°InaGiulVrorl ir1r•4n4ave,etr.r 0 It' 97 ft. DIRT 4.Date-Well(s)Completed;8-24-23 Well 1D& 97 e: i 425 ri ROCK 5a,Well Location: I ft ft . ELITE.BUILDERS ft. fr. Faciliiy.'Ownerti'arne. Facility fl>Niif`ftplible) ft. ft. 3974 CEDAR WOOD TRAIL,TERRELL,N.C. 28682 fr. ft:. PtiysicatAddrets.City;and-Zip fr fr. I CATAVVBA 461704734177 ' 21.<RLIttA;RKS - , County Parcel.ltle°[ification No.lPLN)a, Sb.Latitude and longitude-in deg es/min-1nes/seconds or decimal degrees: tifacU Tielti,.air°latflong'is suiiicient) 35° 35.021. 89° 57,.325 stun ' on: �v LI, .,2‘, .,..t ,, .�r , .8-24-G3 6-rs(nre)the welt(s)OI..erinanent or QCCemporury Stanton-. Date T..1s'thit a repair to an exl3tin }velf' ki'n J;tunfi this prig.1 lierrl a rWrtft•.IJ+ur MEtroll fej"at f ran j rOns7lictulln rraardance g' • D v- tit' ONo. myth I5.-1.AVA P2C.)/Urf tar 154iiC ilr 0?('.0280• teliCumirwarularmulai7kUnclMU!u If am rs a triton,fill uutirp,lir arc!/ctatrrocumt II jarnmileir and ter nirt Il,r:r ur,e•-,ji'rc soar i r:Zna rrmn:hag bAer P.Z'''4.1la;h "nor. repair ander 41 re.rtarkt srdn,n nr.tt arc hang h{ 14,1I m. 23.Site diagram or additional well details: li.For Ceoprobcf1)1''f or Chased,Loop Geothermal Wells lrrving the same You may'use the hock of this page to pro Ede additional.tell site tictaits or well cemslructiort,only i GW-1 is nee-dec2. ttu)icatc TOTAL NUMBER of i+•etis Conatruotiontletaits. You may also attach additional pages if necessary, St t ti MTiTtt I._INS 3 RUCTIONS 9.Total.well depth Won,land surface:425 lbrmuimlr<e rdl lldepdtr jJt{er>nrlcmniplr d ?Ott'vml.[rrt1003. (ft) 24a•For AU Wells: Submit this-form within 30 daya of Cotnplctlon of well constnictianIn the following: [I),Static tcatrrlcvel beio+r top-of-casing:30 (fnwtatIcI izcrtr•el (ft.) Division of Water Rcsauic lnftiematiou Processing unit. �.Q�� 11;1 t Bail Service Venter,Raleigh,rNC:2.769941617 I1.Borehole diameter:. (in.) 24h.For.irileltion Wells: In addition:to sending the form toAic L'ddresS,ire2ila 17_Well construttit,°method: above.ialso:submit one Copy.Ia(-Ibis form Within 3i)days of completion of welt (n.r .mew..cable.dircct push.eia) cortdrt,dioirtDt?te1011owing: FOR WATER Sl1PPL1'1VEL7S,ONLY: Division of Water Resources,Uridelground fujeclinta Control Program, I.63ti Mail Service Center,Raleigh,NC 27L99-163G' 'i3a.Yield(gpm)6 Method ofiest:AIR. 2,1c-For Water Supply&luiectitiu Wells: In addition to sending the farm to 13b.Disinfection type:HTH the addresses) a1Xiv>,also Submit rang e¢pv a this farm within 30 days of Amount: egmp)etioti:of:well construction to the county health department of the'county whom eongtructed. Farm Cty-f North Carpiiaa Dcparmient ofEnvaroni°caul Quality-'Oh isitm of WarerResoarrnt. Revised 2-Z2-29 I6 I 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: Richard Salkowski Sample ID Number: 196221 Location: 3974 Cedar Wood Tr,Terrell NC 28682 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 Private Well Information � n and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Richard Salkowski—3974 Cedar Wood Tr,Terrell NC 28682 Sample ID#: 196221 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 onto. n Arsenic ❑Barium n Cadmium n Chromium ❑ Copper n Fluoride ❑Iron n Lead n Manganese ❑Mercury ❑Nickel ❑Nitrate/Nitrite ❑ Selenium n 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. Z 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 onto,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 n Copper n Fluoride n Iron ®Manganese ❑ pH n Silver ❑ Sulfate ❑Zinc 6. n a. Sodium levels exceed the U.S.Environmental Protection Agency's(USEPA)Health Advisory level for sodium of 20 mg/1.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 onk n b.Your sodium level exceeds 30 mg/1 and 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 North Carolina Division of Public Health at 919-707-5900.