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Home My WebLink AboutWELL-05-2015-061120.TIF a t a CATAWBA COUNTY Case# A Public Health Department Subdivision ®.` Environmental Health Division PIN# 266601286507 _I PO Box 389, 100-A Southwest Rlvd;Newton,NC 28658 LOT/Di NAME ON PERMIT: CLYDE & KAREN BROWN, 1308 SW 39TH ST, HICKORY NC 28602 Site Address: 8940 JACOB FORK RIVER RD,VALE NC 28168 Property Size: Square Feet:865,101.60 Acres:19.86 Directions: Old Shelby Rd/approx 5 miles/right Jacob Fork River Rd Owner/Authorized Representative Acknowledgement of Permit Receipt 6,0 certify that l am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. 7C CO As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service RBPR-05-2015.21536 by the following method(s): Received in Person /Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) x` `f(iM As the property owner or authorized representative I have reviewed and understand the specific conditions ( o 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 (15ANCAC 18A.1900),and/or Well Construction Standards (15A NCAC 2C.0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date: 02/16/2016 > Owner/Authorized Re presentative Signature at /1 4 r Date ?/ 'yrl/ o Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by t. ,P , ' ■ , 11% name of person ending permit Signature �'R A/1 1 t� ` Date/Time _� : / t it., O Method: Fax mail US Mail Other Own is request to send by he a ove indicated method of transmittal in lieu of signature k We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/ENCustomerService ehpermit 02/16/2016 10:06 Page 4 of 4 ■ cam..a WELL-05-2015-061120 • Q • ` � CATAWBA COUNTY HEALTH DEPARTMENT tea, trt. Environmental Health Section 184 04.112/2016 2 sa WATER SAMPLE FIELD REPORT Owner CLYDE&G.KAREN BROWN, 1308 SW 39111 ST,HICKORY NC 28602 C:8282926474 Contractor SAME AS OWNER.. Site Address: 8940 JACOB FORK RIVER RD, VALE NC 28168 Name of Project: Panel Number: 266801286507 Lot: Block: Speoitic Directions Old Shelby Rd/approx 5 miles/right Jacob Fork River Rd o1,� Rue) �, Initial Collected hy: ' '\P�t?A&I1 --\C^^e)n�� Date/Time Sampled: 4113116 IO S7gr Type of Sampling Point: Net Y`i'rt-il Well New or Existing? New >r Existing Type of Well: Drilled X Bored Dug Spring City Does well meet adequate construction standards from what can be observed: k Yes No Reason for non-compliance: Defective well cap and/or seal Piping does not exit through top of well by approved cap and sanitary well seal Evidence of improper grouting or no grouting Opening in the well casing or cap Supply too close to source of potential contamination Notification: Existing well owner notified that well does not meet adequate construction? Yes No Date of Notice: E9-rsamfieldreport 4/12/2016 Page 1 of 2 S13A Case WELL-05-2015-061120 CATAWBA COUNTY HEALTH DEPARTMENT c\Ftl-07fr Environmental Health Section 1842 94 04/12/2016 WATER SAMPLE TEST RESULTS Owner CLYDE& KAREN BROWN, 1308 SW 39TH ST,HICKORY NC 28602 0:8282926474 Contractor SAME AS OWNER,. Site Address: 8940 JACOB FORK RIVER RD, VALE NC 28168 Name of Project: Parcel Nwnber: 266801286507 Lot: Block: Lab Coliform Analysis Results: Total Colifonns: I)"" 'I Fecal/E.Coll: o IyJKit IT No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorite (LLab Accident al 1'n 1n, I,, ""4 al I I IJ 11 ID `11'10 Date/Time Completed" I I�I W t D pH Lab Tech Initials Date/ Received RECEIVED APR 18 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH E9-rsamfieldreport 4/12/2016 Page 2 of 2 o > ! n f ® Zr _ ! 2 )rt,fp 0- / { % °Q \ -- t 7 § ƒ • C"0 a 4 -_ , o C..- ( \ � � ` / { 3 `rD/ _ • § E. � - !0 - : - _ \ : � o r 4. , - - ( 2 ; % { • , -- ) Sit ; c ; \ ( \ \ 7 % % Ji / ( } { } f ( _ $ . m | § ` > t § Diet } ) ® r ° ° ° ' C 2 t � & , r \_ r- \ { E ^ }\ ( c a _ ) 3 ) R § a@ ƒ , ( � ` k r \ / Q * § 6 & \ \ . { { ' / 92 : ; * Cr- 3 ( z « m � \ / ~ 7 ® r 22 2 MI _ .� a / » ( - 11 - I/ .t7. £ _ 2 > } \ / ` ` E. ro 4. \ \ \ $ ) ] 2 \ 9 / Jo- \ \: - _ / � : 0 g/ \ . _ }/ / rii / $-7-..4 � \ �\ 0 0 10 10 x , ° ° 6 � [ w 6 � o 133 2 Cr. f a . „..,s,,,„,„:... North Carolina State Laboratory of Public Health P.°.Box 26o47 :::„0 -,- -A, 4,..„: 4312 District Drive Environmental Sciences Raleigh,NC 27611-8047 t% $�� http//slph.ncpublichealth.com Inorganic Chemistry Phone: 919-733-7308 Certificate of Analysis Fax: 919-715-8611 Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH CLYDE 8, KAREN BROWN P 0 BOX 389 8940 JACOB FORK RIVER RD NEWTON, NC 28658 Courier#09.70-01 VALE, NC 28168 EIN: 566001814EH StarLiMS ID: ES041516-0015001 Date Collected: 04/13/16 Time Collected: 10:57 AM Date Received: 04/15/16 Collected By: Megen McBride Sample Type: Raw Sampling Point: Well head Well Permit#: WELL-05-2015-061120 Sample Source: New Well Temp. at Receipt: GPS#: Sample Description: Comment: New Well-No Nitrate I(Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic 0.006 0.010 mq/L Barium <0.1 2.00 mq/L Cadmium <0.001 0.005 mg/L Calcium 18 mg/L Chloride < 5.00 250 mq/L Chromium < 0.01 0.10 mq/L Copper <0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron <0.10 0.30 mg/L Lead <0.005 0.015 mg/L Magnesium 4 mq/L Manganese <0.03 0.05 mq/L Mercury <0.0005 0.002 mg/L pH 7.8 N/A Selenium <0.005 0.05 mg/L Silver <0.05 0.10 mg/L Sodium 5.90 mq/L Sulfate 12.00 250 mg/L Total Alkalinity 62 mg/L Total Hardness 61 mg/L Zinc <0.05 5.00 mq/L Report Date: 04/29/2016 Reported By: Defie.Sono! Page 1 of 1 > „f` U ✓ -nevim x'Y N�-5 ..£'»3 �;ry (a ..c t t;N A O �. R hva ,T � <H�. `� *s. , A =. 4R�, O `rI , .; .� N S � k ,Q Jt * r -.t a, a�>x p, Wd :•xtYS s ii s._d;-.� pris Private Well Information ne department and Use Recommendations of hearth and human services For Inorganic Chemical Contaminants -SuS.._ r t _'"i'." za•�,.:i`^`+'.§.. ..t...s S tiY: a,:.;'Hn'a" t;"',i+..'S'. i a e..- s"ew.s�+Y"` 'i_ r �_. ...., y �:h : . County: Catawba Name: Clyde and Karen Brown Sample ID#: 61120 Reviewer: M. Cash n:4:e.4,, n .arAt °x;73 t t..x.' 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' only. ['Arsenic ['Barium ['Cadmium ['Chromium ❑Copper ['Fluoride ❑Lead ❑Iroil ❑Manganese ❑Mercury ❑Nitrate/Nitrite ['Selenium ❑Silver ['Magnesium ❑Zinc ❑pH 3. ❑ a. Sodium levels exceed the U.S. Environmental Protection Agency's (USEPA) Health Advisory level for sodium of 20 mg/I. 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 only. ❑ b. Levels over 30 mg/1 may pose aesthetic problems such as bad taste,odor, staining of porcelain, etc. 4. ❑ Re-sampling is recommended in months. 5. ❑ Re-sample for lead and/or copper. Take a first draw, 5 minute, and 15 minute sample inside the house (preferably the kitchen) and if possible a first draw, 5 minute and a 15 minute sample at the well head to determine the source of the lead and/or copper. 6. ❑ The following substance(s) exceeded federal drinking water standards. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inorganic chemical results only. 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. ❑Barium [Cadmium ❑Chromium E1Fluoride ❑Iron ❑Magnesium ❑Manganese ❑Selenium ['Silver p1-1 ['Zinc For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900. North Carolina Division of Public I-Iealth Occupational and Environmental Epidemiology Branch, Epidemiology Section BIOLOGICAL ANALYSIS REPORT Private well water information and recommendations County: Catawba Name: Clyde and Karen Brown Sample ID Number: 61120_ Location: 8940 Jacob Fork River Rd. Vale. NC 28168 Reviewer: M. Cash 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 the sample which indicates that harmful bacteria from human or animal waste could enter the well. Do not use the water for drinking or cooking unless it has been boiled for 3 minutes. You may use your water for all other purposes including washing dishes, bathing or showering. Your well water needs to 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. �>aA F .1' [ °� CATAWBA COUNTY y:.c: J » •v! C P 0 Box 389 -Newton,North Carolina 28658 -(828)465-8270 - Fax(828)465-8276- TDD(828)465-8200 1842 H Public Health - Environmental Health Division CLYDE K. KAREN BROWN 5/4/2016 1308 SW 39TH ST HICKORY NC 28602 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 8940 JACOB FORK RIVER RD, VALE NC 28168 WATER ANALYSIS This certifies that a sample of drinking water was taken from the above address on 04/13/16 and examined under laboratory number WELL-05-2015-061120. Laboratory findings reveal that this sample was FREE from coliform bacteria at the time of collection of the sample. CONDITION OF SUPPLY Your water supply was observed to MEET adequate construction standards (in regards to well head protection). NOTES *The results of any water analysis only reflects the quality of the water at the time of the samp If you have any questions concerning your water sample analysis, please call me at the number below. Megen McBride (828)320-3079 Environmental Health Specialist N:: 1 »mu11 "Keeping Spirit Alive S/nce. 1842!" GREATEN 'dfiv. naafi HICKORY METRO E9-rsamwatersampleletter 5/4/2016 Page 1 of 1