HomeMy WebLinkAboutWELL-12-2018-109464.tif WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
I.Well Co tractor Information:
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Well Contractor Name FROM TO DESCRIPTION
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ft. ft.
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NC `I Contractor Corti fIcatINI NuuntbberrI. D ) a;,t3,'•oritt?ll�t`., r$II;IG reY i71tirweribF6liJ�ll#jtQl)tipf1+Ilr t?(fl,ag ilc bt6);'.'s
/�(,1 t S 4/e L/D /GAY! ,' Ti,.. FROM tt. TO q rt. DIAMETER
A METER THICKNESS
MATERIAL
Company Nam . , ..
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' 2.Well Construction Permit If: /.t 21)!d •` /o !� ! FROM TO DIAMETER THICKNESS MATERIAL
List all applicable well construction permits(Le.U1C,County,State,Variance.etc.) it. ft. In.
3.Well Use(check well use): ft. ft. In.
17iiSQREEC1 t-rt' -:is4.ia Pryi.:=,-F'i,r 4,.' fish`'•:•'<r;'. _:'.', ._•.; _... .
Water Supply Well: FROM _ TO DIAMETER SLOT SIZE THICKNESS MATERIAL
Agricultural 0MunicipaVPublic ft. ft. In.
Geothermal(Heating/Cooling Supply) )Residential Water Supply(single) ft, - ft. In.
Industrial/Commercial 0 Residential Water Supply(shared) ;y18tTiificar ivio- :::;: p,?ra.-r ;sr s,1°s x,s.... ,: :• ;A, :max+ ` -`,:;• .
Irrigation FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ) ft. !j/ ft. 4e{yze/C Q 1..1)11)0 -aZ. )3,
Monitoring ()Recovery it. ft. r
Injection Wells ft, ft.
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Aquifer Recharge DOroundwater Remediation x •.
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Aquifer Storage and Recovery ' Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test oStormwater Drainage ft. ft.
Experimental Technology Subsidence Control ft, ft,
Geothermal(Closed Loop) ()Tracer ''.2b:'b)IG11.1N.C'•1;ID? ?( tticji; tlptttorl'suehiiit'igRe''eiii'ij 'f.•'v:f;)•ti.L.....;,.,;:ra . -
O FRM TO DESCRIPTION(color,hardnmr,rotllroek trpR aratn aim etc.)
Geothermal(Healing/Cooling Return) Other(explain under ti21 Remarks)
D n. 171-n. �..f cti
4.Date Well(s)Completed:/. -/ -,-2.q ' Well ID# •
CY p ft. „.6-5-ft' 4r��-ni
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5a.Well Locatio
. R. ft.
5 ro,e r P j' ft. ft.
fissility/Owner Name Facility IDi/(if applicable)
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Y. jit #-A-it Rd. VA el" A q 15—g ft. ft.
Physical tl/dd es,Cityl,aftd Zip j r/
C SP ft. ft.
County Parcel Identification No.(PIN)
Val iance No,.� a.r__'7
5b.Latitude and longitude In degrees/minutes/seconds or decimal degrees:
(if well field,one lat/lon4Is sufficknt) f ,!�j/I 22.Certification: ,� �f
.6, Zi AZ.gON g I r 4 /4,9% ,U W �s;%%i!ZG /^-'•.(�', / -rQ M
6.Is(are)the weli(s)OPermanent ' Or Temporary Signature of Certified Wall Contractor �f bate
By signing this form,I hereby cerl1fy that the well(s)was(were)constructed in accordance
7.1s this a repair to an existing well: LJYes or ENo with 15A NCAC 02C.0100 or ISA NCRC 02C.0200 Well Conshuclion Standards and that a
If this is a repair,fill out known wall,cofstructlon in formations and explain the nature of the copy of this record has been provided to the well owner,
repair under t121 remarks section or on the back of this form. 23.Site diagram or additional well details: •
You may use the back of this page to provide additional well site details or well
B.For Geoprobe/DPT or Closed-,LOOP.Geothermal Wells having the same
construction,only I GW-1 is needed' Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (0 .5 (ft,) 24a.For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all depths Ifdiferent(example-3(a®200'and 2@l00) construction to the following:
10.Static water level below top of casing: (2 0 (ft.) Division of Water Resources,Information Processing Unit,
((water level Is above casing,use"4- r 1617 Mail Service Center,Raleigh,NC 27699-1617
6 /11,Borehole diameter: 4 (In.) 24b.For Infection Welly: In addition to sending the form to the address in 24a
above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: Y D A.r(� construction to the following:
(I.e.auger,rotary,cable,direct push,etc.) f
Division of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: i 1636 Mall Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) 1 5 Method of test: 4/✓1 24c.For Water Supply&Infection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b.Disinfection type: -A lb Y/it e, Amount: a 6/1- completion of well construction to the county health department of the county
where constructed.
Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22.2016
'44Y'A Co Case# WELL-12-2018-109464
CATAWBA COUNTY HEALTH DEPARTMENT
., Environmental Health Section
09/09/2025
WATER SAMPLE TEST RESULTS
Owner RSH PROPERTIES FAMILY LTD PARTNERSHIP,1381 GRANDS OAKS LN,HICKORY NC 28602-880
H:8283244455B:8288553040
Site Address: 8573 BRITTAIN RD,VALE NC 28168
Name of Subdivision: WESTON
Parcel Number: 266901457507
. J\y
Lab Coliform Analysis - , ° Results: Total Coliforms: l�"�"�"�n I Fecal/E.Coli: V41;N Jl/t I -
No Collection Date Over 30 hours old
Invalid Results: "Excessive.turbidity Excessive Chlorine
Lab Accident
0)0'94
Lab Tech Initials Date/Time Received 0°1Date/Time Completed
RECEIVED
S E P 1 2 2025
Environmental Health
rsamfieldreport 09/09/2025 15:46 Page 2 of 2
$A # WELL-12-2018-109464
q���
CATAWBA COUNTY HEALTH DEPARTMENT
� y
VCase
'= .1 Environmental Health Section
j$L�Z sM V k‘I f 6,,�- L�` -e r 09/09/2025
WATER SAMPLE FIELD REPORT
(Owner? RSH PROPERTIES FAMILY L PARTNERSHIP,z f1381 GR'°'Np S OAKS LNG,HICKORY NC 28602-880
H:8283244455B:8288553040 (Jo f ckl ow, iv°cote- 'J lti 3 _u.5
Site Address: 8573 BRITTAIN RD,VALE NC 28168
Name of Subdivision: WESTON
Parcel Number: 266901457507
Driving Directions South on Old � left
Shelby Rd,right on Brittain Rd, 1/2 mile on le �7
Sample Collected by: 2 i$Lk //�''t � ) r Date/Time Sampled: 0 4/lI /2- ' . c 7 r
Sampling Point: S. ► 64 . 0 n e('6irk- 0'C IN.
Is well head accessible? Yes No V Reason for inaccessibility eeiSR.s g f fake r o tk CAV eG )u&i'
e4.1 demo
it" 44)1�. -1' Alf ok.+.
Well New or Existing? New ' Existing
Type of Well: Drilled Bored Hand Dug Punch U k h dwh
Does well meet adequate construction standards from what can be observed: Yes No (A. vvo WIN
Items of non-compliance: Evidence of improper grouting or no grouting
Well does not meet a required setback(comment)
Improperly constructed sanitary well seal
Well head not term at>=12"above finished grade
Well head missing vent
Well head does not have a threadless tap
Well missing identification plate or pump tag
Wire conduit opening not sealed
Other(comment)
Comment:
rsamfieldreport 09/09/2025 15:46 Page 1 of 2
Analytical Results STATESVILLE
ANALYTICAL
Catawba County Public Health
PO Box 389
Newton, NC 28658
Receive Date: 09/11/2025
Reported: 09/12/2025
For: Jordan Justus: 8573 Brittain Rd,Vale NC 28168
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
250911-42-01 Nitrate 109464 <1 mg/L 353.2 09/11/2025 CL
250911-42-01 Nitrite 109464 <0.1 mg/L 353.2 09/11/2025 CL
Respectfully submitted,
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 •Statesville,NC 28687 • 704/872/4697
Page 1 of 2
1i1=.s:3 ; s
•
122 Court Street Statesville,NC 28677
704-872-4697 wvrw.sa-nc.com
•
_ .TEA E/NtIlllITE ANALYSIS .
• Nett Aaiate=oiea=Ebel:p:-d Iercoa9rix=ea6e
•
L(„- f 2 =,20I1?-JDq I CY County: Catawba •
Name of Water System: J O r ot.a.r J IAS}es
Sample Type: Ll Entry Point f, SpeNon-comtpliance
Lo cation Where Collected: F5 7 SrJ�3 ;Oa:it Re , kd(e Al • ? (F-/C&
Facility ID No. I o 4q 6 4
" D4 yan" I i# Collection Date I Collection Time
SamplePoini: .sit oh �r.h I
Collected By: Pw;5 hi- Al;/"y. .I • O 91 I,9/AS' ' _/: 'S.7, P M
(Plea.> (2Cd1DDfYY) (Sp:ay A24=IN)
Mill Results to(water system representative):
CA T AWBA COUNTY PUBLIC HEALTH Phone 4:t (828)465-8270
•ENVIRONMENTAL HEALTH Faxi: I,(828 465-8276
, PO BOX389 Responsible Person's email:
EHAdmin@catawbacountync.gov
NEWTON,NC 28658
LABORATORY$10 fi: 3 7-755 . ❑SAMPLE UNSATISFACTORY 0 RESANPLE REQUIRED
1 METHOD - REQUIRED NOT DETECTED QUANTIFED • ALLOWABLE
CONTAM CONTAMINANT REPORTNG LIMIT (Le.<R R L) LIMIT
CODE CODE (R.R.L) (X) • RESULTS'
1040 Nitrate 3532 1.00 mg/L [ mg/L 10.00 mg/L
1041 Nitrite • 3532 0.10 mg/L __ mg/L 1.00 mg/L
*Note:If result exceeds allowable limit,the laboratory must fax analytical results to the State on.day test completed.
DATE: TIME:
i ANALYSES BEGUN: O C! / I I /25 : `3:7--' PM
tsraz,ra7..
ANALYSES COMPLETED:1 O el / !i /26 _u 2-�5 1m
i1 =ate armrus.rn)
A
•
LaboratoryLogil: D.SOCI 11'till-6 1 Certified By:
COMMENTS: .
212118 Laboratory sbauld Mail Re-snits to: •
Public Water Supply Section,Attn:Data Entry,1634 Mai)Service Center,Raleigh,Ilt 27699-1634
PO Box 228 • Statesville, NC 28687 • 704/872/4697
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: cs' -n -)4 -f S Sample ID Number: I
Location: b 7 3 (3',H . fit,) \i..�'_ Reviewer: Jason Boyd
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.
Total coliform bacteria were detected in your water sample. Total Coliform are a group of related
bacteria that are(with few exceptions)not harmful to humans.A variety of bacteria,parasites, and
viruses,known as pathogens, can potentially cause health problems if humans ingest them. EPA considers
total coliforms a useful indicator of other pathogens for drinking water.Total coliforms are used to
determine the adequacy of water treatment and the integrity of the distribution system
It is recommended that your well water 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 depai talent 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 colifonn 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.
N 0 R T H C A R 0 L I N A
ff
ty Private Well Information
a.-• and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Jordan Justus—8573 Brittain Rd,Vale NC 28168
Sample ID#: 109464 Reviewer: Megen M. Thomas
TEST RESULTS AND USE RECOMMENDATIONS
1. El 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 onty.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 on(v.
El Arsenic El Barium El Cadmium ❑ Chromium El Copper El Fluoride ®Iron
El Lead El Manganese El Mercury El Nickel El Nitrate/Nitrite El Selenium ❑ Silver
El Zinc
3. El While your lead levels do not exceed federal or state standards,the North Carolina Division of Public Health has
concerns with any detection of lead. Should you have any questions please contact the NC Private Well and Health
Program at(919)707-5900.
4. ❑ Re-sample for lead and/or copper. Take a first draw and 30-second flush sample inside the house(preferably the
kitchen sink)and a first draw and 4 minutes flush sample at the wellhead to determine the source of lead and/or copper.
5. El The following substance(s)exceeded aesthetic 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.
El Chloride El Copper El Fluoride El Iron El Manganese
El pH ❑ Silver El Sulfate El Zinc
6. ❑ a. Sodium levels exceed the U.S.Environmental Protection Agency's(USEPA)Health Advisory level for sodium of
20 mg/l. 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 on(v.
❑ b.Your sodium level exceeds 30 mg/1 and may pose aesthetic issues such as bad taste, odor, staining of porcelain, etc.
7. El Re-sampling is recommended in months,to reinvestigate
For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.
Iron &
.
PRIVATE WELLS e
What is iron?
Iron is a natural element found in rocks deep
underground.Iron is found in the environment as What level of iron should
iron compounds joined to other elements like sulfur, I be concerned about?
carbon,and oxygen.
Iron is used for constructional material and pipes. The NC Department of Environmental Quality
Iron compounds are used as pigments in paint and calculated a health based value of 2.5 milligrams of
plastics.Iron compounds are also used in water- iron per liter of water(mg/L).This calculation was
treatment plants as a coagulant. developed with consideration of health effects in 2017.
The US Environmental Protection Agency and
How does iron get in NC Department of Environmental Quality
developed an aesthetic standard of 0.3 mg/L.This
my private well water? standard was developed to prevent staining,rusty
Iron compounds can enter your private well water color and metallic taste.
from erosion of rocks underground.Iron can also
enter groundwater from industrial practices.Acidic How do I test for iron
water(water with low pH)can make iron compounds
more soluble. in my private well?
Use a certified lab to test your well water for iron
How can iron affect my health? every two years,as part of the inorganic panel
screen.Contact the private well program at your
Iron is an essential element,meaning your body county health department to assist you with getting
needs it in small amounts.It helps with oxygen your water tested.Pricing of testing varies from
transport,electron transport,and deoxyribonucleic county to county.
acid (DNA)synthesis.However,drinking high levels
of iron may cause adverse health effects.You can't
smell iron.Iron may have a detectable taste or have What if my iron levels are high?
a rusty color. You can install a treatment system to reduce the levels
High levels of iron can cause gastrointestinal of iron in your private well.Treatment systems that
problems.For people with preexisting conditions,
reduce the levels of iron in your well water include:
like hemochromatosis,drinking high levels of iron • Oxidizing filters
may cause heart,liver and pancreas toxicity. • Cation exchange,also known as a Water Softener
You can also reduce your exposure by using bottled
water or connecting to public water supply,if possible.
Percent of Private Wells Tested
Exceeding Federal Standards for
Iron, 2011-2013
— Alli
---Akierpo FR, n
rift iiki . 0.41gpr
406 . ii,
•0- ' iliki 0 i mit
or Ilkii. liar vial, *
IN
->25%exceeded health standards
- 10-25%exceeded health standards 411111a1 liri
NE <10%exceeded health standards
0%exceeded health standards
Insufficient data(<10 wells tested) —v
Where is iron found in NC? Where did this information
Iron is found at low levels(0.1-62 mg/L)throughout come from?
NC.About 6%of wells sampled for iron in NC from World Health Organization:www.who.int/water
2011 to 2013 exceeded the state health-based value sanitation health/dwq/chemicals/iron.pdf
(2.5 mg/L).Yet,there are several areas in NC with at
least 10%of wells exceeding the state health based Nazanin Abbaspour et al.Journal of Research in
Medical Sciences Review on iron and its importance
value.See map for areas with elevated iron. for human health 2014:www.ncbi.nlm.nih.gov/
pmc/articles/PMC3999603/
Where can I find more
information about iron
and my well?
T s
Visit the NC Division of Public Health's Private Well ti,
•
and Health Program website:http://epi.publichealth.
nc.gov/oee/programs/wellwater.html.
There you can find: _: '
• Contacts for your county private well program
• Iron in well water maps "' { 0' g.
• A guide for selecting a treatment system a`\ 44 ;,
• Other private well resources `04 � ` '
You can also call the Private Well and Health Program
at 919-707-5900.
- NC Department of Health and Human Services-Division of Public Health•Epidemiology Section•Occupational and Environmental
j
NCljlIE idemiolo Branch•Private Well and Health Pro ram•htt s://e i. ublichealth.nc. ogee/ ro rams/wellwater_html•NCDHHS is an
: P 9Y 9 Ppp 9 P 9• North C II•, equal opportunity employer and provider.•09/2019
Public Health