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HomeMy WebLinkAboutWELL-01-2016-068241.TIF WELL CONSTRJJcTION RECORD For Menial Use ONLY: This term cm be used for angle or multiple wells • 1.Well Contactor Information: Ashley T_ Moretz u=wwrsA ,, FROM TO of C ON 2586a N» Wf • sly'L 576 /2 6P/71 NC well Contractor Certification Number IS.OUTER.CASLN(i((ot tomDaated wdJs)O&LBVPJ[.(d.. Moretz Well Drilling FROM TO DIAMETER THICKNESS MA a• s p R. C R BIND dui a t'vc Company Name 'lR INNERCASING:OR.T MING(SalEvw l ctasedaaaS) ' �/ FROM -rp • ImaMLTeR Tar :LS MATTnux, Z.Well Construction Permit#:0/—ao76 —O68ay1 D re. nn List all aty!eable well wcstrnenaq permits(e:C y State, Variance.ere) ft. I. 3.Well Use(cheek well use): 'iT S(`BFFN Water Supply Well: FROM TO IIAM:ITER sun SIZE TrocKRESS ataTERim OAgdculoral 0Mmtiap4/public R. a OGealtermal(Heating/Cooling Supply) i Igkesidaitial Water Supply(single) c. °Indushial/Commmcial • ORcsidattial Water Supply(shared) FaOM room To MATsoUAL a AMOUNT Non-Water Supply Wdl: R' 0 n a r c.cr&€y °Monitoring , °Recovery 2 R Injection Weil: re n. °Aquifer Recharge : OCroundwater RcmaJation 19.SAND/GRAVgL'Pnt1e(ifapp}teaytd) .. FROM TO_ MATERIAL °Aquifer Storage and Recovery 1 °Salinity Bonier rJ�� R FA/PLnCaArr]Yt'arF:rROO °Aquifer Test OStormwater Drainage ( \ 'rt— , °Experimental Technology °Subsidence Control ~1� .2a<pnaaNGLoc(atnot+ddtnoaal sitects Ifuumsr.l °Geothermal(Closed Loop) ' °Tracer s 4 TO nfe4RIPrION(me,t !urarm%,anhadmt e.er.epse etc.) °Geothermal(Heating/Cooling Ream)// °Other(cipiain undo#21 Remarks) 2 6s- R- C Al V G Aro/i+,Q� . d.bale Wcll(s)CamplHed3`%�6t Well 1DA S�J A.D c.k le m 53.Well Location: • 2 ti A 6o//et/1 RoyAor • tt.- n. Facihity/Owncr Name Facility IDA(if applicable) yell &f /SOA Rd, (4.-ter Physical Address.qty,and Zip • . • .... . .. . . c76.9033as691 2LRI7dART6 County Panel IdentificationNo.MN) • 511.Latitude and Longitude in degrees/Minutesernadsor decimal degrees: (if well field,nee Wong is sufteleat) Z2.certification: 3SS7y/S6/ N 2/ . 908 60o,e1 W r ficriveC 3- 7-/6 '' // Signature of Cat ,ed Well Conhamor — Date 6.1s(are)the well(s): �Permanent or °Temporary By sin title Jbnra I heady aerate that the well(s) war(were)conr>,med le accordance ./ uimm)SA NC4C 02C.0100 or ISA NCAC 02C.0200 Well Coarnuctiw,Stater*and that a 7,1s this a repair ro an existing wen: °Yes or ONo copy of Ode rernNhas ban provided u Ow weft owner. pfd.;.,it o repair,ft/our.Gown well eomauclmu information and explain the nape of the renarande.,e11 nark section or en the Sectofmitform. 23.Silt diagram or additional well details: / You may use the hack of this page to provide additional well site details or well &Number of wells constructed: ! construction details. You may also attach additional pages if necessary. For multiple infecti771 w,mn•uy¢rsupp0.weaS ONLY with the UMW eomnaCVa you can ad,em one font SUWtll7TAL INSIUCIIONS 9.Total well depth helots land surface; 6-415 (ft.) 24a.For An WsJs: Submit this lima within 30 days of completion of well For muitt&was list all depths rat/resew(trample-3@2200'ond2f /OO) construction to the fallowing ID.Static water level below top of casing: SQ (ft.) Division of Water Quality,Information Processing Unit, If ale.level u above canny tar°+- 1617 Mail Service Center,Raleigh,NC 276994617 11.Borehole diameter: 6 r-(1n.) to Mb.For Infection Wells: In addition to sanding the form to the address in 24e above,also submit a l2.Well construction method: R'..r I'o I A ry construction no doe following; of This form within 30 days of completion of well (SC.AVM',rotas%rabic.dirty push ire) Division of Water Quality,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636 n r J 13a.Yield(gpm) / a Method of test:Al r /1 f ?Ac Par Water Suoniv R Infection Wellax In atlditimt It sa,ding the form to t the adds sgeS) above, also submit one copy of this form within 30 clays of 13b.Disinfection type: MTH Amount: /2 0 completion of well construction to the coimty health deoastman of the county _ w'nem constructed. lam 0W-I North Carolina De-yam-rent of Environment and Natural Resources—Division of Water Quality Revised Jan.2013 Ld MITT :°J 910E 7GJ .add EEETE9b1%OL : 'ON XUA dwnd 2 11211 Z13JOw : Wniyd n > 2 n ct Z a r 0 0 i c ° C n 3 v G n o _ A ^ 0 c n o. 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Box 28047 4312 District Drive Environmental Sciences Raleigh, NC 27611-8047 http://shoh.ncoublichealth.com 7,d.R: �, Inorganic Chemistry Phone: 919-733-7308 .;`�v:::.,m, Far 919-715-8611 Certificate of Analysis Report To: Name of System: RECEIVED CATAWBA CO ENVIRONMENTAL HEALTH A COLLEEN RAYNOR P O BOX 389 JUN 0 7 2016 NEWTON, NC 28658 Courier#09-70-01 4021 W VALE, NC 28168 ILSON RD CATAWBA COUNTY ENVIRONMENTAL HEALTH EIN: 566001814EH StarLiMS ID: ES051816-0012001 Date Collected: 05/16/16 Time Collected: 09:40 AM Date Received: 05/18/16 Collected By: Megen McBride Sample Type: Raw Sampling Point: Well head Well Permit*: WELL-01-2016-068241 Sample Source: New Well Temp. at Receipt: GPS#: Sample Description: Comment: Inorganic Chemical + Metals 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 9 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron 0.12 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 2 mg/L Manganese 0.078 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 6.8 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 3.60 mg/L Sulfate 11.00 250 mg/L Total Alkalinity 28 mg/L Total Hardness 30 mg/L Zinc 0.06 5.00 mg/L Report Date:06/03/2016 Reported By: Veggie Mona{ Page 1 of 1 .a- '4me y 1,41T HA` ' v"t=F.•' �k y +k� as' ?p .0 ..,- .e _ n,N 0 R iT, �H� , Cp ( A'4 R � �O ``L l `r NitlecPA , 1t- 'zt i Yi. ittt 't tr Z3 f } tr�„ `3 �, ¢.1. i ' Xf ix''£.J 'rs` r •+. .? rJ .[, 'k Private Well Information human cerviees and Use Recommendations ne department of health and For Inorganic Chemical Contaminants N',r * 'S°4'.•1 y. -. �+, z tf-.7inifcn,. '` ,i }� . :d= r.. R.rv:dt rya '4�'.'�5 � . �»s aX�. ��t County: Catawba Name: A. Colleen Raynor Sample ID#: 68241 Reviewer: M. Cash e "'w a a''�sr^5 ':Ltic?.°A>"+,:✓1✓•:v�.r' _n..R,r�.:S9IS`!, a..,,c`:...v,C.e .'s,Y_.ie st `e ii.&:earm ."<m,a i b.. L,c6 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 ❑Iron ❑Manganese Mercury ❑Nitrate/Nitrite (Selenium ❑Silver ['Magnesium ['Zinc ❑pH 3. fl 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. ❑ h. 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. 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 ❑Fluoride ['Iron (Magnesium ®Manganese ❑Selennun ❑Silver ❑p1-I ❑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: A. Colleen Raynor Sample ID Number: 68241 Location: 4021 Wilson 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 coli form 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. � A E � CATAWBA COUNTY U ��►�f, 4 P 0 Box 389 -Newton,North Carolina 28658 -(828)465-8270 -Fax(828)465-8276 -TDD(828)465-8200 44-, Public Health - Environmental Health Division 1842 $M PAUL RAYNOR 6/9/2016 4021 WILSON RD VALE NC 28168 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 4021 WILSON RD, VALE NC 28168 P Y WATER ANALYSIS This certifies that a sample of drinking water was taken from the above address on 05/16/16 and examined under laboratory number WELL-01-2016-068241. 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 ra0.SH p Nilf-H hh 04' Y D C Vn r "Keeping the Spirit Alive Since 1842/rr GREATER ( i `°� METRO ' is E9-rsamwatersampleletter 6/9/2016 Page 1 of 1