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Home My WebLink AboutWELL-09-2021-157037.TIF ``l1)�)l 1 ,?J-,J 'Il lr. Print Form WELL.CONSTRUCTION RECORD(GW-11 Fur internal the Only: 1.Well Contractor Information: Robert Teague 14.WAl FR ZONES I•Hunl io a.c(KlVi tIO Well Contractor Namc if 0 fr. C Q ft, Z_ 2857-A 57 n. g O n. !^ NC Well Contraclol Certification Number 1�OUTER CA91N(i far IN ated!ells)OR LINER/If ap tremble)1 B&K Well Drilling Inc FRUSI _In___ MAUL IER IIIICKNESS MATERIAL o ►1• n n ae In. SDH-11 roc 1 l an,pan)Name e //��(� r�1 '] 7 /�,/^, �16.INNERCA NGOR7UBIN(i_(geothermdelaeddoopj_ 2.Well Construction Permit SIC) l v'0 d I — LD 1 [ L- FROM _ Ill MAME.IER TIIICK:ESS MA'ff.R1AL • vr .. '- --_. List all applicable wwO con struction pin mils ae.(.7C.Coturn•.State.Variance.et.) It. rt. In. 3.Well Use(check well use): rt. rt. In. water Supply Well: k FL SCREEN FntMt 'It) -IIIAME tiltl sin!SIZE THICKNESS MATERIAL �gnculturnl 0hlunicipalirublic ft. ft. in. I Geothermal(Heating Coaling Supply) OResidentrul Water Supply(single) R. ft, in. I f r]Industrial'Commercial QRcsidenliol Water Supply(shared) ie lCho01. -- 111 f ImpaIion FROM TD MA FERIA'. L1IPI,4E01 1'METHOD&AMOUNT Non-Water Supply Well: ft. Ft. °Monitoring El Recovery fr. ft. injection Nell: �. —. ft. ft. D Aquifer Recharge QGroundwatcrRcmediation 19.SAND/GRAVRIPACK 1(f�a ellcble) Aquifer Storage and Recovery DSalinity Barrier FROM 10 --I-11.11TRIAL EMPLACEMENT METHOD Aquifer Test OStomlwater Drainage ft.. It. ❑Experimental Technology Subsidence Control II. _ ft, ----i JGeothennal(Closed Loop) OTracer 20.DRILLING LOG attach additional sheets if arortsa ) F'HDt1 1(7 twccHlrl iris(Cahn.hardn snlltroch npr.grin Ms.ee-, Geothermal(Heating/Cooling Return) ❑Other(explain under;Pi Remarks) R 7-— it 4.Date Well(s)Completed:3 )9-s- Well ID# 1-c;"--?-46)TErt' ' ft. - . —I , SC Well Loca s L ] nc rrt:t•C- .5f<• tCa $1 a H. , I_J- E, Facility/Chanel-Name Facility IOa of applicable( .5 01 • ft. cLaLsL5._a_V_WAtz..__ .)AG i t-h 0r)7 LlNI . ;In ft.� ft. Physical Address.City,and Zip t_� .3V . h. r r.. rA W(.� 21.REMARKS County Parcel Identification No.(PM) Sb.Latitude and longitude In degrees/minutes/seconds or decimal degrees: (if well field,one IaL'long is sufficient) 22.Cerlifr atio . 6.Is(are)the well(s) Permanent or (JTemparan iyrwtarc ofCcnificd Conuuctot Dat. y d,mgmng thin lane.1 hrreh'rentk Ay the n.11tq nun Noel.onsourred in ucco.dance 7.Is this a repair to an existing well: Dies or No mots 15-1 NGIC 02C 0100 or 15.1.'CC+C S C 0200 Well Cauurmcnan Standards and that a phis isa repair.fill out known well construction informally a etplain the manor of the '"PS`d tbrt rhnrd tsar been provided to the ur11 under. repair under all remarks section or Off the back of this form 23.Site diagram or additional well details: You may use the back of this page to pros tde additional sell site details or well 8.For Geoprobe/DPT or Closed-Loop Geothermal Wells haling the same conswetion only 1 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: CI b (fl•) Na, For All Wells: Submit this form within 30 days of completion of well Far multiple netts lit all depths if d:Jjrrent(example-3i 200'and 2(l(X') construction to the following: 10.Static water level below top of casing:40 (ft.) Division of Water Resources,Information Processing Unit, ) iif water level is showcasing.use 1617..tuil Sersicc Critter,Raleigh,NC 27699-1617 I I.Borehole diameter: 6 1/8 (in.) 24h. For Inlectiun Wells: In addition to sending the form to the address in 24a above• also submit one copy of this tort within 30 days of completion of well ), 12.Well construction method: Air construction to the following: (i.e.auger,rotary,cable,direct push.etc.) Division of Vaster Resources.Underground Injection Control Program. FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) Method of test: Air Flow 24c.For Water Sunnis & Injection Wells: In addition to sending the form to the addressies) above. also submit one copy of this form within 30 days of Chlor Tabs +u2 cos completion of well construction to the departmentcounty health of the county 13b.Disinfection type: Amount: where constructed • Form GW-I North Carolina Department of Ens nronwenwl Quality•Dmicion of Wai r Rccourccs Rsucd 2-22.2016 .-'"-J 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: Donald Yates Jr. Sample ID Number: 157037 Location: 1294 Thurber Ln,Newton NC 28658 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 depat tuient 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 Y 0g, Private Well Information and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Donald Yates Jr.—1294 Thurber Ln,Newton NC 28658 Sample ID#: 157037 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 onbv.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 n Barium n Cadmium n Chromium n Copper n Fluoride ❑Iron ❑Lead ❑ Manganese ❑ Mercury ❑Nickel ❑Nitrate/Nitrite ❑ Selenium n 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 n Fluoride ®Iron n Manganese ❑ pH ❑ Silver n Sulfate n Zinc 6. ❑ a. Sodium level's 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 onlv. ❑ b.Your sodium level exceeds 30 mg/I and may pose aesthetic issues such as bad taste, odor, staining of porcelain,etc. 7. n 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.