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HomeMy WebLinkAboutWELL-03-2016-070192.TIF 40?'. • CATAWBA COUNTY Case# WELL-03-2016-070192 r r n L Public Health Department Subdivision 4 d.3i ey ti 'Environmental Health Division PIN# 365910469263 PO Box 389, 100-A Southwest Blvd,Newton,NC 28658 LOT# 184 o NAME ON PERMIT: SEAN PAGE, 4865 LEE CLINE RD, CONOVER NC 28613 Site Address: 1682 DALE ST, NEWTON NC 28658 Property Size: Square Feet:25,700.40 Acres:0.50 Directions: Hwy 16 S, Left onto Coley Fish Pond Rd, Left onto Dale St, 5th house on Right. Owner/Authorized Representative Acknowledgement of Permit Receipt . .\I_` S.t' certify that I am the owner or authorized agent(owner's authorization required) representing the owner of the N' property described above. Sp_As the property owner or authorized representative, I have received the above referenced permit(s) as requested in the application for service EHPR-01-2016-22969 by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) Electronic Image Transmittal/E-mail (Return receipt required) S(2 As the property owner or authorized representative I have reviewed and understand the specific conditions of 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 (15A NCAC 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: 03/18/2016 � Owner/Authorized Representative Signature 4,e- Date 3-/d= /( Documentation of Permit(s) Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Date/Time Method: Fax Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We want to hear from you. Please take a few moments to complete our customer service survey at: http://www.surveymonkey.com/s/ENCustomerService ehpennit 03/18/2016 10:26 Page 3 of 3 , • • CATAWBA COUNTY 0 ft n 0 Case# WELL-03-2016-070192 (Zli.i�y Public Health Department yy Subdivision Q ti Environmental Health Division r.--._.-....-7-.: -: PINK 365910469263 K r 'A' PO Box 389, 100-A Southnest Blvd,Newton,NC 28658 ' �El,. LOT# Igo s° 5'a`f' — +y-N. 0 0 ; . NAME ON PERMIT: SEAN PAGE, 4865 LEE CLINE RD, CONOVER NC 28613 Site Address: 1682 DALE ST, NEWTON NC 28658 Property Size: Square Feet: 25,700.40 Acres:0.59 Directions: Hwy 16 S, Left onto Coley Fish Pond Rd, Left onto Dale St, 5th house on Right. WELL PERMIT WATER SUPPLY: Individual Well SETBACKS: 1. BUILDNG FOUNDATIONS 25 FT. 2 . EXISTING & PROPOSED SEPTIC SYSTEMS MIN. 50 FT. 3 . EXISTING & PROPOSED SEPTIC REPAIR AREA MIN. 50 FT. 4 . SEWAGE PUMP SUPPLY LINE 50 FT. 5. UNDERGROUND STORAGE TANKS 100 FT. 6. STREAMS/BROOKS/CREEKS 50 FT. 7. LAKES/PONDS RESERVOIRS 50 FT. ALL OTHER POSSIBLE SOURCES OF GROUND WATER CONTAMINATION 100 FT. The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of the above setbacks, contact Catawba County Environmental Health at (828) 465-8270 before drilling the well. Grouting Depth: Minimum 20 Feet Casing Height: 12" Above Land Surface All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private drinking Water Well Testing (15A NCAC 18A .3800). The fee for this sampling is included in the cost of the well permit. It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling. 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 sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270. Robbie Phelps 03/18/2016 AUTHORIZED STATE AGENT APPROVAL DATE ehpermit 03/18/2016 10:26 Page 1 of 3 Catawba County Environmental Health w�i( 3 2016 0 7o 19 Z Ail CD a 5 ° F QS 1 / IN S- F f • yam4 I i= I/ +11 tip i ?0— 199 30 2 ti O/ o0 ti w Q c u; o i O `4.�k ti .74 3 Ear �� Qom' n 19 22 'r i i if 0. r I/ / i Ir /5S e c j 0 . r Parcel: 365910469263, 1682 DALE ST 1in=40ft NEWTON, 28658 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 2014 Catawba County NC 03/1512016 I ., 1.70.°$ _ ,s � ti ilT;�J1.- 4,1fin14-T'» ii/r<�1W'� a�05{�i-af^'N*wr .k �s' x y, . a .s;. _— 1'1'.' . br , \ LIESJDERT•IAL WELL CONSTRCGTION RECORD jW; rl :Cnrth Carolina Deoamrr,::n. En.I.,nrn...r.‘;r.d i:awni Aea‘curces• Divirn n or V-etcr Q•.reliti 4. WELL CONTRACTOR CERTIFICATION t+ /2 32 1.WELL CONTRACTOR:g g. WATER ZONES(deot-d: c.f• • Toe Bottom 4200 To. Baton Wed Contra/tar(IM:viduei)Name • Too Bottom. TY Bottom - Tap Bottom Top Bottom Well C ntraCOr Company Name ����,�!, . Thicket-3W 9 i., �/ ,( 7. CASING: Depth Diameter Weight Matanai Street Add MI, „/ / : T°° _eotom/c( 5. ' / k( J.26 Top acttom Ft. of /idr':, Cc;Cr lawn State Zip Code Tco Bottom FL 7jfi G.91. Y377 Area code Phone r.umcar • 5. GRO”. Death Slate-al taetnoc_ 2.WELL INFORMATION: ^ w Top T Bottom 3 _a Ft ` WELL CONSTRUCTION PERM:T*og Lot& 076 tat Top Bottom OTHER ASSOC:ATEDFERM1TTraf`aeoaco:o) 0 The Bottom Ft. SITE WELL!D*la aDCrca:el iZLZ g, SCREEN: Depth Diameter Slot Size Material 3.WELL USE(Check Applicable Bcxj1//oes•dentlel Water SuoD:y0 T c 0 Bottom F n. in. i DATE DRILLED ] .2 , /b Tce swim Ft�in. _ in. q Too So`:om Ft, in. in, THE COM°i_EiED 2'; AM`= ° a.WELL LOCATION: 10.SAND/GRAVEL PACK: ....{{�� � Depth Size Material CITY, that Ql COUN—Y_etateadatineE Top d Borer IS tn s-t ,t4ourvt • S81 Toe Bdttn, Ft {Street Name,Nurnberg.Cxnmunity.Sulsduisic-.LC,No,plena',Zlo Gael Top dottcm Ft. TCPOGRAPH:C/LAND SETTING: (:heat ascrop 1 box) lope =Valley ❑°lal E.Rine -Otner '.i.DRILLING Top E Ito ttom Formation DMagrtion LATITUDE � "DMS OR 3X.xxxxXXxxX DD / LONGITUDE -oM5 OR 7x.xxxxxxxxx CD i r0 11JD Ff S .. Latitude-longitude Source. tPS ET:Topenra0ntc map (lers+on of wen must be shown on s USGS two map andattscneo to ,r:s form if not using GPS) I ;01 Pt. T i.2.,_< 5.WELL OWNER �1n;.2 4 e <' snwrc i° . l Owner Name . j Street Address e,ayrat.(a A'( 1K /J _ City or Town State Do Code i 18.,18; 510/ D%71 / Area code Phone number 12. REMARKS: 6.WELL DETAILS: ,, a. TOTAL DEPTH: ddk_s5 • b. DOES WELL REPLACE EX15T{NG WELL? YES❑ NCO I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN c. WATER LEVEL Below-op of Casing: 60 FT. ACCORDANCE WITH 15A NCAC 20,WELL CONSTRUCTION (L Ve•'•it Above Tao of Casing; STANDARDS.AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER. 0. TOP OF CASING IS / FT.Atxwe Land Surface' 'Top of casing terminated et/or below land surface may reouore 7 �snstdel " 07 '& . r /� a variance in acoordence with 15A NCAC 2C.0118. SIG t7ATURE OF CERTTIpI�l'ED WLE/LL CONTRACTOR DATE a. YIELD(goal): /C _METHOD OF TEST AA.L, �]41/a/�. /'(C l/( t7 /1 vtsej/ f. DISINFECTION:Type Mir/+ Amount L NTED NAME OF PERSON CONN.5577FR2UCTING THE WELL Subtnftlhe original to#foe DIVISI n Of-Water QerHOty Within 30 days.,.A rl:tnkii,. Oon Met, Form GW1a .1617 Mali Service Center-.Raleigh,NC:2769B-f61A7 : Phone 4cR( P� 01 :. - Rev,11/08 $A Case# WELL-03-2016-070192 r°f° �~IA CATAWBA COUNTY HEALTH DEPARTMENT U 414va k-c Environmental Health Section 1842 sM 05/19/2016 WATER SAMPLE FIELD REPORT Owner _ :. - • ' !, &NO tf?R Nt2g'1i C.828-46I-09-7-1- Site Address: 1682 DALE ST, NEWTON NC 28658 Name of Project: Parcel Number: 365910469263 Lot: Block: Specific Directions Hwy 16 S, Left onto Coley Fish Pond Rd, Left onto Dale St, 5th house on Right. Initial Collected by: fi f Date/Time Sampled: c— 16- / 6 / 1 3 Upnr, Type of Sampling Point: del(heu LI Well New or Existing? New ✓ Existing Type of Well: Drilled 1/"-- Bored Dug Spring City Does well meet adequate construction standards from what can be observed: 1/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 2 111-VJA Case# WELL-03-2016-070192 G CATAWBA COUNTY HEALTH DEPARTMENT v '�i 1;if, Environmental Health Section t,',1 s /842 sM 05/19,/2016 WATER SAMPLE TEST RESULTS Owner SEAN PAGE, 4865 LEE CLINE RD,CONOVER NC 28613 C:828-461-0971 Site Address: 1682 DALE ST, NEWTON NC 28658 Name of Project: Parcel Number: 365910469263 Lot: Block: VI Lab Coliform Analysis Results: Total Coliforms: p-r/'U 'i Fecal /E. Coli: rirt&tilt No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident r� I ff nn Lab Tech Initials e Date/Time Received OSh /i6 to"- Date/Time Completed V6aeli� `W( III RECEIVED MAY 2 3 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH E9 - rsamfieldreport 5/19/2016 Page 2 of 2 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: Sean Page Sample ID Number: 70192 Location: 1682 Dale St. Newton, NC 28658 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.) 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. X 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 E1G� CATAWBA COUNTY U -06:1) P O Box 389 -Newton, North Carolina 28658 -(828)465-8270- Fax (828)465-8276-TDD(828)465-8200 'A =' /Public Health - Environmental Health Division 1842 sM WILLIAM CARPENTER 5/25/2016 1682 DALE ST NEWTON NC 28658 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 1682 DALE ST, NEWTON NC 28658 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-03-2016-070192. Laboratory findings reveal that this sample was potentially unsafe and should not be used unless boiled or otherwise disinfected. Steps need to be taken to correct the condition of your water supply. 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. Robbie Phelps (828)320-3077 Environmental Health Specialist OptHCNF0� ;.`ys �,•, A ��dt E�l9if, AirWIHnii 'lli;4Yi ,A;IT : �, �ero„li�� "Keeping the Spirit Alive Since 1812!° HICKORY -8'lmen 5'4 METRO E9-rsamwatersampleletter 5/25/2016 Page 1 of 1 > \ } \ T. \ \ tt s - aE - / } ( � | g . - e • • { t3 \ 2 NJ CU- m CO DO - El ° \ / , • -' - \ » .• a - c SO eD ) } - , \ > / — > a - - \ ] •• ` r 4a — • ; » .. , I §tsa \ / rri e.• � \ \ \ { P • ; « § z / ( 5 < - . )/ /! . ® 1 o ) / � 5 2J } � [ ƒ \ ^ \ --I ' ; )\ / p J ® R G . ) / k rn -a @ § -c c »— - 2 \ _ ] § /t3 « \ esz \ -C"It - \ \ > \ } \ 7 / \ \ r ) § 9 , J1 / « .. { th 110 n / / \ n : _tie \ ) © : \ � } _ U 1:1. / / / CP z \ - / z » I & I g � \ 0 I 10 y < < 1 i � 1 3 3 110 - 1 e e b. - Z,, North Carolina State Laboratory of Public Health P.O. District 280Drive g, Environmental Sciences Raleigh,NC 27611-8047 ", �f http://slph.ncpublichealth.com ''�� 'R Inorganic Chemistry Phone: 919-733-7308 '' . Q.,„,ym`:, Fax: 919-715-8611 Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH WILLIAM CARPENTER PO BOX 389 1682 DALE ST NEWTON, NC 28658 Courier#09-70-01 NEWTON, NC 28658 EIN: 566001814EH StarLiMS ID: ES052316-0005001 Date Collected: 05/19/16 Time Collected: 2:30 PM Date Received: 05/23/16 Collected By: RP Sample Type: Raw Sampling Point: Well head Well Permit#: WELL-03-2016-07019; 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 25 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 < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 7 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 7.7 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 6.30 mg/L Sulfate 5.10 250 mg/L Total Alkalinity 93 mg/L Total Hardness 90 mg/L Zinc < 0.05 5.00 mg/L Report Date:06/06/2016 Reported By: Debbie .YWOnCO( RECEIVED JUN 1 0 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH Page 1 of 1 y 1/4C North Carolina State Laboratory of Public Health P.O. District 28 Drive £ Raleigh, NC 27611-8047 it Environmental Sciences Raleigh, NC 27611-8017 � ,, Inorganic Chemistry Phone: 919-733-7308 1 , ' Fax: 919-715-8611 -- Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH WILLIAM CARPENTER P O BOX 389 1682 DALE ST NEWTON, NC 28658 Courier#09-70-01 NEWTON, NC 28658 EIN: 566001814EH StarLiMS ID: ES052316-0005001 Date Collected: 05/19/16 Time Collected: 2:30 PM Date Received: 05/23/16 Collected By: RP Sample Type: Raw Sampling Point: Well head Well Permit#: WELL-03-2016-07019; 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 25 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 < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 7 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 7.7 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 6.30 mg/L Sulfate 5.10 250 mg/L Total Alkalinity 93 mg/L Total Hardness 90 mg/L Zinc < 0.05 5.00 mg/L Report Date:06/06/2016 Reported By: nellie.Al0ncol RECEIVED JUN 1 0 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH Page 1 of 1 _ ''� t SNI 7. Private Well Information nc department of health and and Use Recommendations human services For Inorganic Chemical Contaminants • .. .-.• County: Catawba Name: Sean Page Miaalt'Ltal Sample ID 4: 70192 Reviewer: M. Cash :'uad;t(5{h'h.c,".::.., 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 [Ikon ❑Manganese ❑Mercury ❑Nitrate/Nitrite ❑Selenium ['Silver ❑Magnesium ❑Zino ❑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 ❑Fluoride ❑Iron ❑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.