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Home My WebLink AboutSAM-11-2023-207847.TIF CA Case# SAM-11-2023-207847 �' li�� CATAWBA COUNTY HEALTH DEPARTMENT 0 Environmental Health Section $Lk�. SM 11/03/2023 WATER SAMPLE APPLICATION Applicant LESLIE GERRITY, 1256 ASTORIA PKWY,CATAWBA NC 28609 H:614-361-3560 LGERRITY@GERRITYBURRIER.COM Site Address: 1256 ASTORIA PKWY, CATAWBA NC 28609 SELECTED SAMPLES Bacterial Name of Subdivision: Inorganic Parcel Number: 471001258740 Lot: Block: Nitrate/Nitrite Specific Directions Description: Reason for Sample: well variance Type of Well Drilled Is the well on this same property? Yes Is outside spigot available to collect sample? Yes Is power on? Yes Has well been tested before? Yes Results Does the plumbing come out the top of the well through a sanitary well seal? Unknown Does the well ever become cloudy or has there ever been a problem with taste and/or odor? No Explain Does the well top extend twelve(12)inches above the ground or well slab? No The well is in: Rear Does this well supply water to more than one home? No Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results; therefore,you may receive several different reports concerning your water skn ple. For questions or more information, please contact Catawba County Environmental Health at(828)465-827 . Date ' — / Signature or Owner or Agent ,�� Jason Boyd FEE DESCRIPTION DATE FEE AMOUNT Bacteriological Sample Fee 11/03/2023 $58.00 Inorganic Chemical Sample Fee 11/03/2023 $128.00 Nitrate Sample Fee 11/03/2023 $99.00 TOTAL FEES S285.00 rsamapplication 11/3/2023 Page 1 of 1 catawba county public health /..6// �C.r atteer Sample Application / �Sample Requested By L I d/ ) Home Phone / 3% Property Address /Z>(d2 tO Yla /),LL i Business Phone Mailing Address Driving Directions as Sample Requested: Bacteriological V7 Inorganic Chemical V Other iittfiel AAI Sample reason: Gila Va t y7- Type of Well: Drilled V Bored Dug Other Is the well on this same property? Yes V No PLEASE NOTE: Sample will be taken at the well head. If well head is not accessible, sample will be taken from a spigot on outside of home, unless otherwise specified: Is outside spigot available to collect sample? Yes N/ss No Is power on? Yes V No Has well been tested before? Yes ' No Unknown Results Does the plumbing come out the top of the well through a sanitary well seal? Yes No Unknown Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes Nod/ Explain Does the well top extend 12 inches above the ground or well slab? Yes No V Unknown V The well is located in front rear left side V right side of the house. Does well supply water to more /than one home? Yes No k Date /161 3, 2023 Signature of Owner or Agent " 1 catawbacountync.gov Environmental Health Catawba County Government Center 25 Government Drive I PO Box 389 I Newton NC 28658 1828.465.8270 MAKING. LIVING. BETTER. • Catawba County Environmental Health 4� �if�' , ,*?1.�'� w 41 c, •i .1 I . 1 , A. 3. qlp y ,M+j*{?I.,,. `lad r • 9 14 wit.Ik 15.68 Ywr'a� 1' • �' L. 1 .r t Co r%r >,.� S, \ 147 � 6S , _oa/ Ily. ow . s. �7\ v /0. IP tr ir 91.71 a tt C?r 4, / Parcel: 471001258740, 1258 ASTORIA PKWY 1 in=50ft CATAWBA, 28609 RaP1 - /o - !&- 3o3ai ti ._, s..... I-- "1 • - This mapfrepoil product was prepared from the Catawba Caudy, Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and tabu :tnfOnnatlon oonEal on this map or data on this report Catawba County promotes end reoanmends Me independent verification*irony data eon shed on this maprreport product by the user.Thd County of Catawba.Its empioyeea[agents,and pars nnel. is end shall mate held liable for any end alldamepes,lose or nobility,whether'direct,lndiriiet or oonsequentl l which arises or may ads. product or ttie.use.thereof by.eny pawn m.enet', • Copyright ZOu Cetawbw COuntY N.(', $A • CATAWBA COUNTY �" 100A SOUTHWEST BLVD Cj NEWTON,NORTH CAROLINA 28658 RECEIPT v O PHONE:828.465.8399 Tt Friday,November 3,2023 1842 sM www.catawbacountync.gov PAYOR: Gerrity,Leslie PAYMENTS TRANSACTION NUMBER: TRC-76940789-03-11-2023 PAYMENT DATE: 11/03/2023 PAYMENT TYPE: Check 472 NCDL 40167921 Dob2/13/1944 exp 2/13/2028 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 11-23-430036 110-580200-663000 Bacteriological Sample Fee $58.00 11-23-430036 110-580200-663000 Nitrate Sample Fee $99.00 11-23-430036 110-580200-663000 Inorganic Chemical Sample Fee $128.00 TOTAL PAYMENTS: $285.00 SAM-11-2023-207847 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 1256 ASTORIA PKWY,CATAWBA NC 28609 Applicant LESLIE GERRITY, 1256 ASTORIA PKWY,CATAWBA NC 28609 H:614-361-3560 LGERRITY@GERRITYBURRIER.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 11/03/2023 14:10 Page 1 of 1 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[voter 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: f 1 re f �Da �7, 20 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: 4-Le5/ie ti Mailing Address: f_1�� ""5 OS-Livia— C k �61 City: �Lg`�`�LL¢�'lX;� State:,(,)(_ Zip Code: &ounty:E�(2(k7 Day Tele No.: l�(l�- 361_ �s e") Cell No.. EMAIL Address:r(t f'i i f ti I"r/P1iSsictFax No.: Nl/i— B. PHYSICAL LOCATION OF WELL SITE (1) Parcel Identification Number(PIN) of well site: County:(2) Physical Address(if different than mailing address): ! 5 7 c 6' 4-toi''/L r Luy¢a` C City: ((irto 2J 17e, State: NC Zip Code:oz p '/ C. WELL DRILLER INFORMATION (if known) Well Drilling Contractor's Name: NC Well Drilling Contractor Certification No.: Company Name: Contact Person: City: State: Zip Code: County: Day Tele No.: Cell No.: _ EMAIL Address: Fax No.: Form GW-22V Page 1 Revised February 2013 1 4 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. 7 e_ t r Zpp r=�x/ iet� e'f Is"--i'r��m Sri M S, CI pa__ 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 e o erso ponsible for Well ction(typically the well driller) Print or Tv a Full Name of Person esponsible for%%'ell Construction (typically the veil driller) g 4—* Si, re of County Environmental Health Specialist J ) \ 50y) )Zs pia Print or Type Full Name of County Environmental 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 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. 1508-23 within 60 days after receipt of the decision. Form GW-22V Page 2 Revised February 2013 0 Please submit this form Wong with a Well i I North Carolina Variance Application for an existing 1 Department of'Health and Human Services private water supply well. Division of Public Health I Existing Well Variance inspection Report Well Site Location: Cr. {-c- to A 4, p�P k.,�,a./ (lawn,a anununir y,subdivision and Lot u) Address: 'Z s 0 pi s o r,~._P..n 1✓.N- County CA.+c...)to City/ST/Zip: .GG!r�s.,)log.. N (—+ 2. DI _ Date of SiteVisit. ('I 1 2 i /-3 i 6 `s- A in Well Construction Well head Completion i . Date of Well Construction: 1 2- -- - 19 Is the well head i 2"above land surfaceriTS r NO or NO If no, what is the height of the casing: _inches [Li'unknown, was it drilled bc(bre t972:' YES If unknown, was it drilled beti)re 7/1./2008?YES or NO Is there a sanitary well seal? YES ar NO What type of well is it: Is the sanitary well seal in good repair.; YES or NO ' I.)rilled Bored Hand Dug Jetted Other Are the following items present at the well head? Sample`I"el'.. ' Does the well have a cement slab? YES or 0Vent V_._.--_�__. Well Tag_....._,...,_/.. Pump Ta'_.....-.. _ Does the well appear to he grouted'. YE or NC) Potential Sources of Contamination? Does the well currently meet separation requirements with known sources ofcontaminalion? tS)o r NO If no,please provide distances to those it doss niee:t:_ _Al2.i. (Tr,'0 _ P.r},l c Sw ',,,.,fps is, -t.,.. Other comments: 6-.1 t,_,, ' ' - s a�, complete below. Name of person completing this form(please print.):. �e S a-. 00-s o) a S ! 6 i 6 1 I�! Catawba County Environmental Health :. T:. E -t r:• :• ::: :� it". 70y�; 18,1 4i faa' - S4j a r ?Ks:Yi�'1 a 411 i » �° N. ,CA" ., r i iv 0 f` L2// X 1 4 / / ;is's.',s.,,N, .,a 15.68 / Slu . 6, ,a } 4� ,� e g.1 iv— I �k ' r i , % Sx'• r 4 7s of t q.92561Z _ . il w f /KNI- NN 47 \ 4 �N s �3 qt q?,., / 91.71 v44 •14 I. if S \ / Qr Parcel: 471001258740, 1256 ASTORIA PKWY 1 in=50ft CATAWBA, 28609 • . \ 0 ye4-% c.... 9Jc4 ,-, ``.,.lcJ n1J r"',p S `� SA it- i1 - ZD't f-a? VG.is- ‘..nc.e.. < i' 4e_ P( , 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 11/20/2023 1 Catawba County Environmental Health a- r0 74•a5 , ° 99.99 6z2.65 _r ' "' ja A r� d 3-5 c'� IZ1, • 1013 9935 100-00 100A0 Parcel: 471003146817, CATAWBA, 28609 1 in=50ft Ucc• .5 .4- (_ af ,23PR -- r D — 1E - 3°3E' I 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 end recommends the Independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,end 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 tills map/report product or the use thereof by any person or entity, Copyright 2014 Catawba County NC , STATE 1,4 11 . ROY COOPER•Governor 4,474 �'y,, NC DEPARTMENT OF t .__,, \ KODY H. KINSLEY•Secretary o HEALTH AND +�d 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 November 27, 2023 Timothy and Leslie Gerrity 1256 Astoria Parkway Catawba, NC 28609 Re: Approval No. JMB3240 Private Well Located Less than 25' from Building Perimeter [Rule 15A NCAC 2C .0107(a)(2)(P)] Property location: 1256 Astoria Parkway Catawba, NC 28609 Dear Mr. and Mrs. Gerrity: On November 20, 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