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Home My WebLink AboutWELL-06-2021-152268.TIF Form WELLCONSTRUCTION RECORD(CW-1) For Internal USc Only: n) 1.Weil Contractor Information: Joseph Bailey 14.WATF.Rzoxrs - WtllCoctnerttNatm FNO,I 'to U}-SCRII'flllN �- 3271-A `� rt. 4 n. -_ NC Well Contractor Cent6eatton Number FL I ft. B&K Well Drilling Inc 15.OUTER CASING(for multi-cased wells)OR LINERQf applicable) . „ , FROM TO DIAMETER rTHICKNLSS I MA fMAI. Company Name f6 rI. In. U (��' � G-z� J sOk)l � l�G I.Well Construction Permit#:1��/�y/// ( -aQa/ _I Jf a a(a,� ,_l6.INNER CASING Oa TUBING(gentkerm.d closed-loopy : 'r-r, ' List all ap ea2rtructit xnntrf FROM Tr) DIAMETER TtiICKNF-44 MA IllUAL - B e• WC.County.Stoll.I onancr,ter.) ft. it, In. 3.Well Use(check well use): ft. ft. in. - Water Supply Well: - 17_SCREEN Agricultural FROM TO aA DIA.Mi 1iR SI.O'f.stet Tf11CK?I.s MATERIAL ft. ft. in. -�a Geothermal(Heating/Cooling Supply) EDResidential Water Supply(single) •Industrial/Commercialft, it. In QResidential Water Supply(shared) t Irrieat 18.GRour Non-Water SupplyFRO}i TO StATf:x1AI. E51rr.ACF,51EvT.?IETIUO)/. \MOUNT Well: ill Monitoring D ft. 20 ft. Benoty Pour /, - /��,~ Injection Well: Recovery ft. ft. •Aquifer Recharge ft. ft. OGroundwater Remediation II-Aquifer Storage and Recovery Salinity Barrier 19.SAND/GRAVEL PACK Ofappfkabe)• . , •- AQUIfCI TCSI FROM TO MATERIAL EMPLACEMENT SIF.THOD OStormwater Drainage ft. ft. II Experimental Technology DSubsidcnceControl ft. ft. ■Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach acts ftleoal sheets H eeeessary) ■Geothermal(Heatin Coolin Return FROM TO Dt;SCR vt ION(r Ins,ha daeax wit/rock Rpe min are, Other(ex.lain under 421 Remarks) Q �1 7 ft. / ft. 4.Date Well(s)Completed:J 77 ,) / � 0 �J ��1�. Weil ID# .4 ( i Sft. 3s--rL 5a.Well Location: (��Urz/� j4r/ f 75"ft. y '7j Ft. VC////.//?rr. 'P,5.1,,dt/,,:Oi� n 1-- 7-1 ai - c4.9L ✓ !)h;Qcr s0 it. ��ft. /r}',� ;ri•7 e 5 G/7 Facility/OwnerName Facility 1Da(ifapplicable) cit• 7(fr. ,Sd r -„( nv,1. 8: • lids • . - II rr/� 1h, f ,l Y� ly.and /lei-ii 0,11 N( l •CD- 3 Q, /-4 17 i __ _ Physical Address,City,and Zip CJ'� C'�� c �/J �J/ p �j (� ft. ft. ''(f�/(l ..1. /0/! OdSR ,5:j 21.RE.4IARKS County ! y� t4r Parcel Identification No.(PIN) di I�u� Con jC/;/�e;�� ' �,p;Ju.FE{ 0,, ii 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: / k; �+r41 L✓d1 J�1 F 4''oU//- f j/(if well field,one lat/tong is sufficient) /7 2j0ti tion: -) T `J�( 6.Is(are)the»ell(s) Permnncat or Temporary Sfind cn Conte ctor /I Date 7.IS this a repair to an existing well: By signing this form.1 hereba,dertify that the well(st Mar(were)consrruncd in accordance Oyes or ®No with 11A NCAC 02C 0100 or 15A NCAC 02C.0:00 lIe/f Construction Standards and that a If this is a repair,fill out known well construction Information and explain die nature of the copy of this record has been provided to the well swots. repair under#21 remarks section or on the back of this form. 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary, drilled:' � I SIIBh11TTAL INSTRUCTIONS9.Total well depth below land surface: ��jj (rt.) 244. For All IVclls: Submit this form within 30 days JCJ For multiple wells list all depths if-different(example-3 200'and 2@100') of completion of wCll CORSlmction to the following: 40 10.Static water level below top of casing: (ft. If cater level is abuse casing.use"+ ) Division of Water Resources,Information Processing Unit, 6 JS 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: (lit,) //�� - r 24b,E'or Injection Wells: In addition to sending the form to the address in 24a 12.Well construction method: (/C Or�'yt1r,r/1 above,also submit one copy of this form within 30 days of completion of well (i.e auger,rotary,cable,direct push,etc.) // construction to the following: FOR WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground Injection Control Program, '� 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) ,I PM `fethod of teat:Airlift 24e.j_or Water Supply t.i: Injection Wells: In addition to sending the form to Chios'Tabs t trz Tags the addresses) above, also submit one copy of this form within 30 days of 13b.Disinfection type; Amount: completion of well construction to the county health department of the county where constructed. Form GW.t North Carolina Department of Environmental Quality-Division of Water Resources Res lscd?:2-2016 tv Analytical Results ;, STATESVILLE ANALYTICAL Catawba County Public Health PO Box 389 Newton, NC 28658 Receive Date: 07/11/2023 Reported: 07/13/2023 For: John Posek 8518 Ridgewood Rd Sherrills Ford NC 28673 Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 230711-47-01 Nitrate 06-2021-152268 <1 mg/L 353.2 07/12/2023 CL 230711-47-01 Nitrite 06-2021-152268 <0.1 mg/L 353.2 07/12/2023 CL Respectfully submitted, Tyibithe Melissa Myers NC Cert#440, NCDW Cert#37755, EPA#NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 2 .r STATESYit.LE ANALYT%CAL c..a :27 Cou::Street Statesville,NC 2E677 704-S72-4697 vwru:. a_ttc.coJ NITR��ATE/NITRITE ANALYSIS :•,...NI ist,rm•oz,mug b,surAEJ tot tote Lt xa aniyt ?-° t 1 S 7l�.68 County: Catawba WATER SYSTEM II);�: .--.-- Name of Water System:_-. 0 h h poSek_ _-_-- -- —-- SampleType: r'Entry Point XSpecial/Non-compliance 851 9 R; � � Rd S�,Eiri)i5 C4 NC a8673^ • Facility ID No. Location Where Collected:_-- _4 /—-- 5)- 26? __ a rr''-- ,'1 Collection i itnc }i Cgllection Date J Sample Point: . `gIt rn:ke4,1 =�o7ito 13_ 1°- ° , A Collected By: .._W — — µwrowrri rt`-hA'K"rM: rrww r�mf Mail Results to(water system representative): CATAWBA COUNTY PUBLIC HEALTH Phone it::.(828)465-8270 - �'- - , ENVIRONMENTAL HEALTH Paz.Il: (828)_465-8276___r...__—— --__ PO BOX 389 —— Responsible Periods email: _ -- EHAdmin@catawbacountync.gov NEWTON,NC 28658 _ --- LABORATORY II)`#: 37755 :i SAMPLE UNSATISFACTORY RESAMPLE REQUIRED Lt TECTED QUANTIFIED AL:OWAHLG REQUIRED I4I CONTAN M.L:FiOU REPORTING LIMIT !i.e.<R R.L.i RESULTS UMT ;;ONTAb11tiAA'CODE CODE rp.R l..) tx 1040 Nitrate 351% ._— 1.U0 mg/i., ' trp1- O mWL f. 1041 Nitrite 3512 0.':U :ng/L X ---- �./,�. ,� LOU Note:if result exceetLs allowable:Milt,the laboratory mast fax ara vrcat tosults to the State on day test completed. !!11 —/ DATE: TIME: ANALYSES BEGUN: 0 i ! 1 f^ f 23 1:.41_, AM ppvm ni t+rm.AK..nc t2 ; 23 a: 00 pm ANALYSES COMPLETED: Q 1! , +l ':s,•.v ten' Certified 2301 I 1. 1�_•_Lll- By: en* —-------`—_— —-- Laboratory Log,a: — .tuJs I•attoratorY l id a t Rg a to_ ,...,,,,a.,.„c..-...i.,c...;... att..tit.FA try.1634 Mail Service Center,Raleigr NC 27699-;634 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: John Posek Sample ID Number: 152268 Location: 8518 Ridgewood Rd, Sherrills Ford NC 28673 Reviewer: Megen McBride 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 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 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. N 0 R T H C A R 0 L I N A yry rT 5 . Private Well Information 1 " j1�. ,..._....,_ and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: John Posek—8518 Ridgewood Rd, Sherrills Ford NC 28673 Sample ID#: 152268 I Reviewer: Megen McBride 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 El Barium ❑ Cadmium ❑ Chromium ❑ Copper ❑ Fluoride 0 Iron ❑ Lead ❑ Manganese ❑ Mercury ❑Nickel ❑Nitrate/Nitrite ❑ Selenium ❑ Silver ❑ Zinc 3.❑ 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. ❑ 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. ❑ Chloride ❑ Copper 0 Fluoride ❑ Iron ❑ Manganese ❑ pH ❑ Silver El Sulfate ❑Zinc 6. ❑ 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.Your sodium level exceeds 30 mg/I and may pose aesthetic issues such as bad taste, odor. staining of porcelain,etc. 7. ❑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.