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HomeMy WebLinkAboutWELL-08-2015-063538.TIF ;cl RESIDE ��IAL WELL CONSTRLcTION RECORD K'es r' �,nu Ca-oi ;Ja�am .. r., i::. T r ,ca \, t�.,, 2�c.;c� u,„ia rrc- ,=Pr. �,„,°^°` WELL CONTRACTOR CERTIFICATION 7 3.Z 1 1.WELL CCNTRACTOR: g. WATER ZONES to^v :, f'% �1�..,1 b' Tel So':o- 1./8' senor. We t CcneactAr(Ind:vbcPl)Name - - ,-,. -Ta Nlldrf ,eAaz.[.tr01 _ `co _ec^Or. -OD x ;.-„cm `het Co.�tra..cr Ccni any Narw - ThiCMnm44f # gt /�w„�i�x” 7. CASING: Depth Diameter Weight 11Htera S:reet A.ddresP �/ -ca /a Saror_ =: t i _,_!?2 eZ/ %ca A/�- fl'at/ Top scot Sr PI/Cr, pc.:rys Town Sate Z Cobs _ - _ --- Area cote Rene`.::r.`_.e• 5. G4:r--. Death Mane-a:: � -memos 2.WELL INFORMATION: -CD 73 Soften cn AS Ft / ] L CONSTRUCTION PER: .Tt Of an-104 Tx Bolton' Tre-A SE.DC.AT ELI FERM:T r;?1 anrc cpar�re.1 -oo Setter Ft, / A ,o_4 SITE WELL'0=::`e.o-::a:e: rL.dS2-. 9. SCREEN: Depth Clammier Slat Size Material 3,WELL USE(C`ecc Aoo-icable Eox:: Res den:'el''.v=Der Su-a y0 Tx 0 Eclat = orE DR'.LLED 3 a, 7' /6 Too ?atom F:� .n _ In Tac 5g7crr . In in 7:ME CC?F°_E ED /TO .AM_ oM© A WELL LOCATION: 10.SANDIGRAVEL PACK: ��� e Depth Size Material C-”• Gf'L eri CO-rtrY a.att4e Ton D Edon'^ , R6/D ti,w'a ne. Oner;e6,4 .28'655-61 Tou Ec"`m. -t /S•-et,Nn^fn,Nuctae ..D,trAy S.:ee-rT,iQ',La:No.'are'.2:e._oae: Too 30ttvw 1 FL CPCGRAPH'C i LAND SETTING' (:new eom_I'Y'e ae*` iaR .1, p4:LLIN"LCG one :Matey ° t ^ io9e _ a"?f To` Ecttem Format:on D . _ton LATITUDE � DMS OR 3x.xxxxxxxxx DD E / _O'.GMLIDE • . -D\S OR 7x.xxxxxxxxx DD T I • 1" ,7" �i S a i Latttdalongit..ie SO:a'ce. 72.0 PS :!Opeore3ric nap r �,� , . .7 a6s /'r !;otrop prwe!'most 3?Strewn C 9 USGS two map acm e:ac e0 to ,/J ._.s fool;if npt using Gel - /TrM� 5.WELL OWNER ratite. 6i-e G011, /ZiaAT _Chimer Name Street'.odrgs _ .UL 6S77 City or Town State Lc oche - i area code Phone number 12. REMARKS: 5,WELL DETAILS: ./ a. TOTAL DEPTH: A G3 • U. DOES WELL REPLACE EXISTING WELL? YES D NO:: I DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN e. WATER LEVEL Selow Top of Caning: SD FT, . ACCORDANCE WIT!15A NCAC 2C,WELL CONSTRUCTION (L'Se'+''F Above Top of Casing) STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. d. TOP OF CASING LS / i Aoova Land Swine' 'Too of desing terminated el/or celow land surface may require • -17/7-41.14.ACae iel S ,i« a vatlnnce n acr...^'dance with 15A NCAC 20.G118. i SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE e. YIELD 19pe1 PC METHOD OF TEST A( C W D T O „NT e./1 r. DISINFECTION:Typo ti 774 Arnoum J �1 PT I N NAME CONSTRUCTING G T TE WEL1 h_. _ ._-_,L1...•.z aa._ sn-s—r ...-s4at-mo•eurdn+.rb:efraw h i.iaw. AFAR•rnMNmmfinn that c..,..,atm. $A C� Case fl WELL-08-2015-063538 C� 4 G CATAWBA COUNTY HEALTH DEPARTMENT "...",,e` �' Environmental Health Section I842 sm 2 05/19/2016 WATER SAMPLE FIELD REPORT Applicant NCDOT, 840 WALLACE GROVE DR, SHELBY NC 28105 B:7044805472F:7044805476 JDANGEL @NCDOT.GOV Owner GREGORY HILTON, 2293 E MAIDEN RD, MAIDEN NC 28650 H:828-428-9015 Site Address: 3610 EMMA DR, MAIDEN NC 28650 Name of Project: Parcel Number: 367702766824 Lot: Block: Specific Directions HWY-16, 5TH HOUSE ON LEFT PAST RANT DRUM RD Initial Collected by: R P Date/Time Sampled: S—19—/6/ /:3 a pYM Type of Sampling Point: 14.211 /201 Well New or Existing? New V Existing Type of Well: Drilled ✓ Bored Dug Spring City Does well meet adequate construction standards from what can be observed: / 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 5/19/2016 Page 1 of 2 ,<A (' Case# WELL-08-2015-063538 N ., , tik CATAWBA COUNTY HEALTH DEPARTMENT d '' 1'9F■a Environmental Health Section \ c) It anuRi.II1I ism)' 18 1: 42 sm 05/19/2016 WATER SAMPLE TEST RESULTS Applicant NCDOT, 840 WALLACE GROVE DR, SHELBY NC 28105 B:7044805472F:7044805476 JDANGEL@NCDOT.GOV NCDOT.GOV Owner GREGORY HILTON, 2293 E MAIDEN RD, MAIDEN NC 28650 H:828-428-9015 Site Address: 3610 EMMA DR, MAIDEN NC 28650 Name of Project: Parcel Number: 367702766824 Lot: Block: Lab Coliform Analysis Results: Total Coliforms: arAkllii" Fecal /E. Coli: OITAME No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials &C/&L Date/Time Received 05/'91do di vs Date/Time Completed D 5I MOI1LP ltY(99 Q RECEIVED MAY 2 3 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH E9 - rsamfieldreport 5/19/2016 Page 2 of 2 n > N n it It z - 0. r 0 0 - s = n n et 3 ep .. n c O F 2 • m f1 ut w n N • 7 CU O' r' - f w a - c-. r S 7 c - o F o O m ❑ Z tong i m n • 7 • 2 m - 7 to A 3 G [T� m 2 •2 a Y w o , ac rt S• S ✓ C -a E 21 - m 0. i > ..c Z n "0 u rt z T ri N S Se = n -F. > ?, '74' -0 z ° A � ``' a C -, > A 's7 lV .L C A n ft O ri, A rt a co m .< A U d .T C I 7 r. n ,,,� Z :t • w o. • T 11,, 9 v\ n N v :7 • 0 t.... P"0 N 00 O7 S U 000 W b n .. .� a' 3 b i w o R • ra.,7l m = n `.O .. NO n z o r G1 ' O 'S P: T VI c-> W n 3 S .. a C' • D m ° .. ` r O iv m w O F z D G nm c F ti C F r _a; s--2 ❑ ' S ' 4 I a n r a a z z > a O m m m - - ` - 8 A \ _ m_ T 7 n -. " a 0 > > r n ` A U ' n• T > > n o m n „ m m m x — — 6 - v:' 'n V 0 4 o O (f 9 p 2 i 0 A a 4... 0 ^1 °0 $ n 'r i O ^ N W n O rn i Q) m cn n i Pa O O 1 I I --I z m cry y `� I ^ I n ' • n -v j0 1 — 3 3 I 2 r x %"STATi�s4•f� At4 T=:y P.O. Box 28047 North Carolina State Laboratory of Public Health `- �� Laboratory 4312 District Drive �'� �+ a Raleigh, NC 27611-8047 ',J C�M Environmental Sciences httD://slph.ncpublichealth.com Inorganic Chemistry Phone: 919-733-7308 �S`� =� Fax: 919-715-8611 . - Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH GREGORY HILTON P O BOX 389 3610 EMMA DR NEWTON, NC 28658 Courier# 09-70-01 MAIDEN, NC 28650 EIN: 566001814EH StarLiMS ID: ES052316-0002001 Date Collected: 05/19/16 Time Collected: 1:30 PM Date Received: 05/23/16 Collected By: RP Sample Type: Raw Sampling Point: Well head Well Permit#: WELL-08-2015-06353E 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 < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 23 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride 0.39 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 4 mg/L Manganese 0.033 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 8.1 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 4.00 mg/L Sulfate 10.00 250 mg/L Total Alkalinity 76 mg/L Total Hardness 75 mg/L Zinc < 0.05 5.00 mg/L Report Date:06/06/2016 Reported By: Dett e-91loncol SECEIVED JUN .1 0 2016 CATAUjrA COUNTY ENVIRONMENTAL HEALTH Page 1 of 1 p N 0 R T IH -> iC :A R= O L I l'''!'1.1■174 Ati `; Private Well Information ne department and Use Recommendations of health and human services For Inorganic Chemical Contaminants County: Catawba Name: Gregory Hilton Sample ID#: 63538 Reviewer: M. Cash• ._i. .'7 z #.Y71;, of ri,r. .. . .7 'f'2_ a ::%C*,3 Vi=i , TEST RESULTS AND USE RECOMMENDATIONS ® 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 FIChromium Copper ['Fluoride ['Lead ['Iron ❑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/I 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. 'fake 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 ['Fluoride Droll ❑Magnesium ❑Manganese ['Selenium ['Silver ❑pl-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 Health Occupational and Environmental Epidemiology Branch, Epidemiology Section BIOLOGICAL ANALYSIS REPORT Private well water information and recommendations County: Catawba Name: Gregory Hilton Sample ID Number: 63538 Location: 3610 Emma Dr. Maiden,NC 28650 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. �gA R ; CATCATAWBA COUNTY r �s�►s. ` P 0 Box 389 -Newton,North Carolina 28658- (828)465-8270- Fax(828)465-8276 -TDD(828)465-8200 \842 M Public Health - Environmental Health Division NCDOT 6/13/2016 840 WALLACE GROVE DR SHELBY NC 28105 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 3610 EMMA DR, MAIDEN NC 28650 WATER ANALYSIS This certifies that a sample of drinking water was taken from the above address on 05/19/16 and examined under laboratory number WELL-08-2015-063538. 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 sampling. If you have any questions concerning your water sample analysis, please call me at the number bel Robbie Phelps (828)320-3077 Environmental Health Specialist �',n�'�n all'�y . H I�h it,.aJ4 ' >? D P a� ielI $(Wye',Ol,t "Keeping the Spirit Alive Since 1842!" GREATER HICKORY 'mem °�` METRO E9-rsamwatersampleletter 6/13/2016 Page 1 of 1