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Home My WebLink AboutWELL-06-2021-152321.TIF WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: I.Well Contractor Information: Chris C Russell 14.WATER ZONES Well Connector NameFROM TO DESCRIPTION 8254 A 50 IL 165 ft• ft. rt. NC Well Contractor Certification Number 15.OUTER CASING(fee mill-eased welt OR LINER(If a Noble) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATTRIAL 0 n. 48 IL 6.325 1s• SDR21 1PVC Company Nemo 16.INNER CASING OR TUBING(geothermal eIos d4uop) 2.Well Construction Permit il: Well-06-2021 152321 FROM TO DIAMETER THICKNESS MATERIAL Litt ell applicable well conrrtctionpermits(i.e.(i.r.U1C County,State,Variance,etc.) ft. ft. la, 3.Well Use(check well use): ft. It. In. Water Supply Well: 11,SCREEN PROM TO DIAMETER SLOT SITE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public ft. rt., in. - ❑Geothermal(Heating/Cooling Supply) IBResidential Water Supply(single) A. . ft• in. ' Olndustrial/Comtnereial ❑Residential Water Supply(shared) 114.GROUT Dlr-igation ❑Wells> 100,000 OPD FROM TO MATERIAL EMPLACEMENT METI,OD A AMOUNT Non-Water Supply Well: 0 fl' 20 Grout Poured DMonitoring 0 Recovery ft. ft. Injection Well: a. ft. ❑Aquifer Recharge ❑Groundwater Remtxliation 19.BAND/GRAVEL PACK(If applicable) ❑Aquifer Storage and Recovery DSalinily Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test DStormwater Drainage ft• ft. DExperimental Technology ❑Subsidence Control ft. ft. ❑Geothermal(Closed Loop) DTracer 20.DRILLING LOG(attach additional sheets If necessary) ❑Ocuthe anal(Heating/Cooling Return) DOlher(explain under#21 Remarks) FROM TO DESCRIPTION*ter,Martinis,hlUrock type,vain she,etc.) 0 ft, 43 ft. Dirt 4.Date Well(s)Completed: 10-7-2022 Well ID# 43 ft. 165 n, Rock _ ft. ft. Sa.Well Location: Brian Collins Sedgewick Homes ft. It. _ Facility/Owner Name Facility ION(if applicable) ft• rt. 3915 25th Ave NE, Hickory, NC 28601 ft. ft. Physical Address.City,and zip ft ft Catawba I1.RM.MARKS County Parcel Idemification No.(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,ore larking is sufficient) 22.C radon: 35' 78.298' N 081' 28.072' W 1 in 1/2022 6.la(are)the we'll* Q Permanent or °Temporary Signature of Certified Well tractor Date By signing this Ion,,,I hereby orrr(fy that the wefts)was(were)constructed ucted in accordance with 7.Is this a repair to an existing well: ❑Yes or LINO 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Coourvction Standards and that a copy 1f th/s to a repair.Jill out brown well construction information and explain the nature oldie 0-this record has been provided to the well ownee repair under 1121 remarks steam or an the back of this fern'. 23.She diagram or additional well details: 8.For Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info construction,only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells (add'See Over'in Remarks Box).You may also attach additional pages if necessary. drilled: 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 165 (h') Submit this GW-I within 30 days of well completion per the following: For multiple wells list all depths(f dint(example-3(BI200•and 2®100') y mPon 24a. Fur All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below top of caving: 50 (R) If water level is above casing,We„+„ Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617 24b.For Injection Wells:Copy to DWR,Underground Injection Control(IUC) II.Borehole diameter: 6.25 (la) Program, 1636 MSC,Raleigh,NC 27699-1636 12.Well construction method:Air Drilled 24c,For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e.auger,rotary,cable,direct push,etc.) county environmental 1m.fit;department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 13a.Yield(gpm)40 Method of test:Air Permit Program,1611 MSC,Raleigh,NC 2 7699-1 6 1 1 13b.Dislnfecdon type: HTH Amount: 1/3 cup Form GW.I North Carolina Depenment of PlIviromnenial Quality.Division of Water Resources Revised 6-6-2016 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: Brian Collins Sample ID Number: 152321 Location: 3915 25th St NE, Hickory NC 28601 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 he 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 r "°As Private Well Information h and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Brian Collins—3915 251I' St NE, Hickory NC 28601 Sample ID#: 152321 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 arc 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 n Barium ❑ Cadmium ❑ Chromium IT Copper ❑ Fluoride ❑ Iron ❑ Lead ❑ Manganese ❑ Mercury ❑Nickel ❑ Nitrate/Nitrite ❑ Selenium ❑ Silver ❑ 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. ❑ 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. E Chloride ❑ Copper [' Fluoride ❑ Iron ❑ Manganese ❑ pH ❑ Silver E 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.