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Home My WebLink AboutSAM-07-2023-200321.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 O2C.0107 All water supply hells 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 ON information. Illegible submittals will be returned as incomplete. DATE: Ig r 9- 20,713 PERMIT NO.: (to be completed by DWQlDPN) 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: 1,4) f 14)DeihrAoh Mailing Address: IO O (T`)PW D freithif/4) flICL City: A.){ State: I t '. r , �1�-` Zip Code'��I'1 County: �..-=��`.1�' �,..) Day Tele No.: 7 Oti Cell No.:.` 21 • ) I V' 17011 �r # ' " _ ' l° c�� / EMAIL Address: (-'1 • "{ 1 (Y)C =(Y1 )ck. Fax No.: � B. PHYSICAL LOCATION OF WELL SITE �f / (1) Parcel Identification Number(PIN)of well site: f 'L f 5 7 ilk, County: ( It 1-491v l " (2) Physical Address(if different than mailing address): City: State:NC Zip Code: C. WELL DRILLER INFORMATION(if known) pp { ^� Well Drilling Contractor's Name: # 8.Il 1t,'j Oe # \`— NC Well Drilling Contractor Certification No.: ttren / Company Name: Contact Person: City: State: Zip Code: County: Day Tele No.: Cell No.: EMAIL Address: Fax No.: Form OW-fly Page 1 Revised Febryary 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. t5l .ill 11 :.:4.i try ' , = 1,00 ; ail i--\a/ �`l �1 i / -*), To --iL,Dep-1"),-I'i-4., 1)i• Al).--i-i,i no; citcounci, i oe,) 1 c.A. imi t 0 t. I1 j ( t (.. )Y') .),(4- ..-to P� { .1,, F K- 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 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 ' Signature of Person Responsible for Well Construction(typically the well driller) oicy , ' i Print or Type Full Name of Person Responsible for Well Construction (typically the well driller) qc,,v7 ature of County Enfi onnlental Health Specialist 3 3 % '\ 0 oy) 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. 1 S0B-23 within 60 days after receipt of the decision. Form CW-22V Page 2 Revised Februa ry 2013 Please sit snit this,form along with a Well 1 North Carolina Variance Application jar an existing Department of Health and Human Set-vices private water supply well Division of f'ubile flea itit Existing Wen Variance Inspection Report Weil Site Location: to 6 o V►n 1- w io Jul C� (1 rs�ln,Coanrrraaaraty,.cubdivislan anti Las RI _ i Address: I D 4 o m v n b o /i t_, k-�,S County: Gqk s„ ?14 v.. C ity S l"l :.tl : Gckc e, Fs o Date;.of Site Visit:t:stt .........._....,. ........,_ ......_..._ ./..r._�.�..�..M Weil Construction Well He.-id Completion Date of Well Construction: ... .. Nil _______ Is the well head 1 ."above land surface? YES ct:GO r a ? YE. It-unknown., was it drilled before f:97 Ka or NO It" ; , hat is tie height af'the easing:„_ ,,...3_ inches If unknown. was it drilled before 71112OO8` YES r NO Is there a sanitary well seal? ' t r NO t i What type of well is it: Is the sanitary well seal in good repair? .. ' or NO Drilled Bored Hand Dug Jetted Other Are the Ibilowing items present at the well head? Vent,..,�\( ,,.._.,... Sample TTap.:_.,.. .�-L Does the well have a.cement t slab? Y.IS or 1 O �1 Well Tag /\ u :.w.Y.. Pump Tag,..,_ .0..__ Does the well appear to be grouted?Eg.) or No I t Potenfjai Sources of .:ontamination:' Does the well currently meet separation requirements with known sources of contamination?YES or N if no,please provide distances to those it does meet f6,..Q...11 _...�s...._+:' .. E_d�. r �-o rg fix. l e r�4� \ .�...:.� .:...�...,.,0„17 t .�.MI .,w....I.,V,< 4,C.e n. �1� �.�-}2 n5...1/_t.a.s.4.5 -..,. .wk....� +�..,wi.�,......,,141, . :iv. ,G., m._. .r�?.Qti.4,:). .,...,...,....—.. f Other COMM I i i x 3 i complete be/tom • 1 Name:of person completing this tonic(please prim): __. Ts S 4..,1_.,.... e ,S 1 c6 , a t 1 Catawba County Environmental Health • 156,30 f/ ,• d t v. r Y 0 Q. r R u M106 1 ., i . , Oyla r,� -' 1,k. I I �r �' k S r";t^ 0 q C. w ft aJ 4 Q f 9 Q oC o--v Lt b r (63) Qc �7 ( 7) o rp r C. (6) C / . '8412 ( 99 Parcel: 471003338469, 1060 MONBO HEIGHTS 1 in=60ft DR CATAWBA, 28609 SRC 0 - - Z.-) 23 - Z0 3z-. t 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 07/25/2023 • Surf \5' % ROY COOPER • Governor rItip t~ QQs NC DEPARTMENT OFKODY H. KINSLEY• Secretary HEALTH ANDHELEN WOLSTENHOLME • Interim Deputy Secretary for Health HUMAN SERVICES MARK T. BENTON •Assistant Secretary for Public Health Division of Public Health Onsite Water Protection Branch July 31, 2023 Thomas and Deborah White 1060 Monbo Heights Rd Catawba, NC 28609 Re: Approval No.JMB3114 Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 1060 Monbo Heights Rd Catawba, NC 28609 Dear Mr. and Mrs. White: On July 26, 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 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 welllwellhead 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 casing height. 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 wellhead. 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 2