HomeMy WebLinkAboutWELL-04-2020-131322.tif WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Stec. S f it) tit 14.WATER ZONIS
Vyell(uritactur Name FROM {(1 DESCRIPTION _ -
10 oft. i loft.
L itki Aoir�.A �c 1r ft. ft.
N(`Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER if a Icable)
S94 FROM TO - DIAMETER _ TI(I(K\ISS Al ATER/Al.
m ft. V!_5. n. 4 In. 5 VC.
Company Name
I 16.INNER CASING OR T'URING(geothermal clewed-loop)
2.Well Construction Permit R: FROM TO DIAM LIER ' 7711CKNESs -. MATERIAL
list Ulf apli,old,. run+rrnrrranlvrneits(i.e.WC.County.State.Variance,end rt. R. in•p
3.Well Use(check well use): ft. rt. --�ta.
Water Supply Well: tT.SCREEN
FROM '10 DIAMETER SLOT SIZE TIIICK\ESS ARTERIAL
(Agricultural D 1unicipaliPuhiic it. ft. In.
Dicuthcmial(Heating Cooling Supply) acsidential Water Supply(single) n. n•-` in.
Qlndtistrial'Comnicrcial (Residential Water Supply(shared) IB.GROUT y
hltrigation FROM TO MATERI�U. FkLACEM ENT M€TNOI&AMOUNT
Non-Water Supply Well: i...A ft' a 5- R. pif.44l�a7 "VI f (6& .D. •
°Montioring (Recovery / n. ft.
Injection Well: -- - -
n. n,
(Aquifer Recharge (Groundwater Remediation ---- -
19.SAND/GRAVEL.PACK(Ifapplkable)
(Aquifer Storage and Recovery 0Salinity Harrier FROM To MATERIAI. t:Ml'LACEMI:\T SILUHUn
(Aquifer Test 0Stonitwater Drainage II. ft. ^I
OixperimentalTechnology (Subsidence Control ft. ft. 1
0(ic\nher n ul(Closed Loop) (Tracer 20.DRILLING LOG(attach additional sheets if necessary)
0(ia,ihennal(I teating/C ooling Return) ❑Other(explain under a 21 Remarks) FRIISI TO nE\('RIPrI(W I(bMer.hardaeu.wil'n,cs i)pc.grail.site,eta)
r I n. n.
4.Date Well(s)Completed:(,I Ai 1 a Well Ma j ft. .f D. a fa4r
5a.Well Location: ft. Col. ft. d1{-V 1113 dt40}k
II. 1 !0II. wave
Vac tiny Owner Name Facility Ma(if applicable Ft. t.
ik�S 3 C uSa t i QLo <At` fry rut. (�� n. ' �II. -- -
Physical Aildre.a,(11:.,and uip 1 O. fl.
/
TNtre1II5 t) n c. Lk,i 301178 ca l 21.REMARKS -- -
County Parcel Identification No.(PINT __ ---.-_--'-.
5h.Latitude and longitude in degrees/minutes/seconds or decimal degrees: - 1
Of well field one lot long is sufficient) 22.Certification:
3 S-{4S ?Go N ` 09 4,a5 ao W g_telli6.Is(are)the wells) 'ermanent or (TemporarySignature r, c ,,d N'cll I antracun
If,•signing this pron.I hereby.rr(ifi'chat the we/A)was(tire)cpnatnrctrd an accprdaut e
7.Is this a repair to an existing well: (Yes or (No with 15A.CAC 1/2C.0100 or 15A MAC 0.2C.0J00 1Fr/!Canstnntimr Standard,and that a
If chi,L'a relalr.fill(net known well(vm.at la.0pn in/innnttien and explain the nature al-the "RV of this,s.wc 1 hn-i seen peaeykled to Ih,'awl!owner.
repair ender All reMarki section or on the lal*of this firm.
• 23.Site diagram or additional well details:
R.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the hack of this page to provide additional well site details or well
constnietion.only I OW-I 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: i/O (n.) 24a. For All Wells: Submit this form within 30 days of completion of well
For mdt$dr oils for all dcptha it(lrflerreni facample-.@r.20O'and?fd,'100') eonstnictiun to the following:
10.Static water level below top of casing: 2.5 (ft.) Division of Water Resources,Information Processing Unit,
lf„nter fed is above casing.rise ++- 1617 Mail Service Center,Raleigh.NC27699-1617
//
11.Borehole diameter: - GO ' (in.► 24b.j'or lnlection Well!: In addition to sending the farm to the address in 24a
Pa
lm
� above.also submit one copy of this form within 30 days of completion of well
12.K'cll construction method: r �Y construction to the following:
i i.c auger,sitar).cable.direct push.etc I
Division of Water Resources.Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
n
13a.Yield(gpm) �C Method of test: Pr030t a 24c.For Water Supply& Infection Wells: In addition to sending the form to
/' the addresses) above, also submit one copy of this form within 30 days of
13b.Disinfection type: C.'1OCFoo t Amount: �Q'tR completion of well construction to the county health department of the county
where constructed.
Form OW-I North Carolina Department of Ern irormeentat Quality-Division of Water Resources Revised 2-22?111r,
•
.
Analytical Results STATESVILLE
ANALYTICAL
Catawba County Public Health
PO Box 389
Newton, NC 28658
Receive Date: 08/31/2022
Reported: 09/01/2022
For: CCIG, LLC: 8683 Casa Del Rio Dr, Sherrills Ford,
NC
Comments: Acceptable limits for drinking water are:
Total Coliform =Absent, E.Coli = Absent, Lead <0.015 mg/L,
Nitrate <10.0 mg/L, Nitrite<1.0 mg/L
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
220831-29-01 Nitrate 131322 <1 mg/L 353.2 08/31/2022 CL
220831-29-01 Nitrite 131322 <0.1 mg/L 353.2 08/31/2022 CL
Respectfully submitted,
p
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
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le ST.ATESVILLE
aitANALYTICAL
122 Court Street Statesville,NC 28677
70-872-4697 W :w.sa-rc.corn
NITRATE/NITRITE ANALYSIS
You:All ottoman n mho be suppled r v oting:an.vole
WATER SYSTEM ID ft: 0 _ 9it0.JJU2?. County: Catawba
Name of Water System: CC-1 6, IL-(.
Sample Type: 0 Entry Point Cr7?4'peeel II/Non-compliance I-yy��
Location Wbere Collected: a`E i(3 CaJA L)e) 70 Pei S lkk"r/1/,� d+'ft 'VC--
Facility ID No. / 7 f,3%z 2-
Sample Paint: _ Collection Date ,l Collection Timf
Collected By: a> f dl k t ° Li' _ ,c"17/4 92- _is ,`�/, /1- M
(Paste thee: IMCITho FI 3nee,fe A.4a:PC
Mail Results to(water system representative):
CATAWBA COUNTY PUBLIC HEALTH Phone N:,(828)465-8270
ENVIRONMENTAL HEALTH Fat p; )828)465-8276
PO BOX 389 Respoadble Perso n's email:
NEWTON,NC 28658 EHAdmin@catawbacountync.gov
LABORATORY II)4: 37755 0 SAMPLE UNSATISFACTORY 0 RF:SANIPLE REQUIRED
REQUIRED NOT DETECTED ALLOWABLE:CONTAM Nib-THOU ALLOWABLE:
• CODE CONTAMINAN1 Cf1DE REPORTING L sin (i.e.<R.R.L.) RESULfS* LIMIT
•
(itR.I..) (X) i
1040 Nitrate 333 2-�-A I.00 mg/L. __ _. _ Ittg L 10.00 mg:L
1041 Nitrite 133 2 0.l0 m8'L 4.__ mg'L 1.00 mg L.
--
*time:If result exceeds allowable limit,the laboratory must fax analytical results to the State cm day test completed mT
l DATE: TIME:
ANALYSES BEGUN: 0 /N. 1 122 _3:246 , P.M
.AN.tl.I'SES COMPLETED: ' 0 *./_a I / 2 2 q :5Z . �1
--- -- /.AMrr4)
Laboratory Log't:Z-2 a t) /• .229 Certified Bv: (`~7 _
COMMENTS: 1
200,5
Lattorators should Mail Resulu la.
Public*wet Surly Swuun,Ann Data tnlry,1634 Maul service Center,Raleigh.NC 27699.1634
PO Box 228 • Statesville, NC 28687 • 704/872/4697
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