HomeMy WebLinkAboutSAM-10-2023-205824.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 02C.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: CI— , 20 '21 PERMIT NO.: (to be completed by DWQIDPIi)
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:
Li"vr Lees Assc t L.LL MbaAQvc e'kz.,,e,svruk.
Mailing Address: 1'12-1 r L .T •
City: lUOkitnr State: NC_ Zip Code: Z S$County: CAMw3A
Day Tele No.: Cell No.: d%,1 6t% -3232
EMAIL Address: LtetSrL S bA1 Q IL .CoM 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):
_ Z-1Lf .fJt bc) ( rJ
City: NA^'Tb" State:NC Zip Code: 2E
C. WELL DRILLER [Ni IFORAIATION (if known)
Well Drilling Contractor's Name: Not" 41,10t.o N?
NC Well Drilling Contractor Certification No.:
Company Name: Contact Person:
City: State: Zip Code: County:
Day Tele No.: Cell No.:
EMAIL Address: Fax No.:
RECEIVED
Fornw GW-22V 0 C T 2 2023 Page I Revised February 2013
Environmental Health
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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E. ATTACHMENTS—Provide the following 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 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 D 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
CgSi tore of Person Responsible for 'ell C truction(typically the well driller)
KcAST likes
Print or Type Full Name of Person Responsible for Well Construction
(typically the well driller)
e
Signa f County Envir nmental Health Specialist
P\ N/c) s 1E5 I
Print or Type Full Name of County En.ironmental Health Specialist
Per 15A 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 snake 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 50B-23 within 60 days after receipt of the decision.
Form GW-22V Page 2 Revised February 2013
North Carolina Please submit this,form along with a Well
Department of health and Human Services Variance Application for an existing
private
Division of Public Health
water supply well.
Well Site Location: NO-vAa.n IN C. _
(Town,caunn►nity,subdivision and l.ot 4)
Address: 1-7 8'1 g, S`.,,, a) 1. v• County: G4-I w`o es,
t;it /ST'Zi Lw a .. cr 28 <— Date of SiteVisit: 1J I 16 123
Well Head Completion
ell (.onstnueti(oi
Date of Well Construction: N I A Is the well head 12"above land surfitc ? YES w NO
II unknown,was it drilled hefbre 1972'1 YES or NO If no,what is the height of the easing: inches
If unknown, was it drilled before 7/1/2008'. !a or NO Is there a sanitary well seal? *Pr NO)
What type of well is it: Is the sanitary well seal in good repair'. ES r NO
'grille Bored Hand Dug Jetted Other Are the following items present at the well head?
Does the well have a cement slab'? YES r NO VentN. Sample'lap Y
Well Tag kl Pump Tag N ._
Does the well appear to he grouted'.41113110or NO
Potential Sources ot'Contamination?
Does the well currently meet separation requirements with known sources of contamination'. YIS )r NO
If no, please provide distances to those it does meet: 1
Other comments: \cri(1. s 4.1%) 4-.34 I-- C.-C. r '2-t
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Complete lielo►c.
Name of person completing this form (please print): _._----_._3=s a r\ 13 �y y�) S
Catawba County Environmental Health
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.STATfq'�;,
ROY COOPER • Governor
„. , ova.
NC DEPARTMENT OF KODY H. KINSLEY• Secretary
HEALTH AND
HUMAN SERVICES HELEN WOLSTENHOLME• Interim Deputy Secretary for Health
14sto a^ MARK T. BENTON •Assistant Secretary for Public Health
Division of Public Health
Onsite Water Protection Branch
October 30, 2023
Limitless Assets LLC
Monique Gruenthal
427 E L St
Newton, NC 28658
Re: Approval No. JMB3220
Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C
.0107(a)(2)(P)]
Property location:
2784 Rosewood Ln
Newton,NC 28658
Dear Ms. Gruenthal:
On October 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 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) 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.
3) No potential sources of groundwater contamination shall be stored near the wellhead.
4) 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