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Home My WebLink AboutWELL-09-2021-157951.TIF l'E,1 L CONSTRUCTION RECOPI)(GW-lj For internal Ul:rt)nly: 1,Well Contractor Information: Robert Teague -14,WATER 2(Tn t0 — ---- Mom tri__ DFACRRTIO,N Well Contrxtor Name r, ` fl. / - - — B&K Well Drilling Inc v� ( '' 355 n. G 6 ft. y 4„ _ NC Well Contractor r.'enrficatan Number IS.OUTER CASING for multi-eased wen!)DR LINER(If• ) 2857-A FROM to DIAMETER THICXNFA1 AIIERIAI. -, a ft. 7 fl. ff 6tl8 le• 150R-21 PVC Company Name �- t---`-` S �_, 16.INNER CASING OR T USING(rteotaermal elosed-loop) 2,Well Construction Permit N: Faust 10 DIAMETER THICKNESS Al sT FATAL Lot all applicuble well camtimitton pertain(1.e.IX.County,State,runauce.ew.) ft. ft. In. 3.Well Use(check well use): ft. it. In. J Water Su 1 Well: 17,SCREEN _ PP Y FROAinI Ttl DiAritETCR SLOT Ain TIIIC'NNPSti..htA_rERIAI gAgncultural DMunicipalJPuhlic h. ft. In. Geothermal(Heating/Cooling Supply) Residential Water Supply(single) n. ft. In. RIndustnallCommereial esidcntial Water Supply(shared) is.GROUT Irripohon FROM _To Sts1Ek1U, F.st PI.Ar.EAt1:NT METHOD i,:yvI/n NT Non-Water Supply Well: ft. It. tiMonttonng Recovery ft. ft. ' ` Injection Well: n. . n. BAquifer RechargeGroundwater Reinediation 1'l.SANU)GRAvEt.PACK(if■pplk■hie) _ Aquifer Storage and Recovery �Snliniryl)arrier ^rROAI en ?IATERLAI. I%1PLICCMYVTMI;(IiO�, Aquifer Test DStonnwatcr Drainage ft. ft. 0 Experimental Technology OSubsidenceControl ft. ft. 1 0Gtothermal(Closed Loop) OTrscer 20.DRILUNC LOG(attach additional drat If oeerisary) • FRODI TO DESCRIPTION(color.ha ii.wnlroct opc.trOn strr,nc) 0Geolhermal(Healing/Cooling �'Return) [,Other(explain under N21 Remarks) R 7 {rcs -J ,y 4.Date Well(s)Cont toted:{P )Well i M r7 C ft. f \ \ 2? > Si,Well Locatlo rt. i�t) fl��Y � _ -- _ - �G/e�66/0. 1 ft. ft. GII�� Facility/Owner Name Facility 1Da(If appii;able) ft. ft, J) S S Gil 6.h r,c,1\j � Pr. ClarC;\ fi. II. Physical —+ Physol Ad s.City.and Zip �V .-� rt. 1 ft. — CeaA 21,REMARKS ARKS G.".,.jAc.. County Parcel Ideaificetion No.IPIN) Sb,Latitude and longitude In degrees/minutes/seconds or decimal degrees: — (if well field.one IaOiong is sufficient) 22,Certl Y N W / eb - a 7--.z) -tsfguature of t-ertified We ontnetur Dan 6.is(are)the well(s)0Permanent orTemporary By signing this form.I lovely corm).that the wr111U was Nerd cnnerucred in acnirdonce 7.Is this a repair to an existing well: D Yes or RNo a oh i54 N(-,IC o1C.o/UU or i1.1 NCAC 02C.0200 Well Corotracrtau Standard)and that, fffhra it a repair,fill bl l!aown well conttnrcaon min.-manor, d tplam the nature of the copy n(this,ermd harken provided In the yell owner. I rjwrr until-tl21 remark).moon or on the hark ofthh form. 23,She diagram or additional well details: You may use the back of tins page to provide additional wellshe details or well S.For Geaprobe/DPT or Closed-Loop Geothermal Wells having the same W-I is needed. Indicate TOTAL NUMBER of wells constriction details. You may also attach additional pages if necessary. coastnictioo,only 1 drilled: / SIIIs611'ITAI INSTRUCTION 9.Total well depth below land surface: �O-5 ill•) 24a. For All Wells: Submit this form within 30 days of completion of well Fa'multiple nr/lt lot all depth;ifdyferent('nranple-3f0i'/Nl'and 2 a@10U') constriction to the following: 10.Static water level below lop of easing:40 (ft.) Division of Water Resources,Information Processing Unit, if icier lClf/Li above crating,me'"• 1617 Mall Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 1/8 (in.) 24b.For Injection Wells: In addition to sending the torn to the address in 24a Air Rotary above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: construction to the following: (1.e.auger.miry.cable.direct push.etc) Division of Water Resources,Underground injection Control Program. FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) ` method of teat: Air Flow 24c.For Water Supply& Injection Wells: In addition to sending the Conn to the eddresslcsl above, also submit one copy of this Conn within 30 days of Chlor Tabs Amount: 1 1/2 Lbs completion of well comuuctmu to the countyhealth department of the county on.Disinfection type: where constructed. form GR•1 North Carolina Department of Environmental Quality-DI%61011 of Rater Rexnuces Revised 2.22.2016 ( ) catawba county public health Memorandum March 15, 2023 To: Jeff Lail, Glenda Lail From: Megen McBride, Environmental Health Administrator Re: Well Samples Required. Permit:WELL-09-2021-157951. Site Address: 1395 Chancellor Dr,Claremont NC 28610 Our records indicate that the above referenced well permit was issued 9/21/2021.We have received a well record from your well contractor indicating the well has been completed. In recent weeks, our staff inspected the completed work and noted that a well pump tag was missing and the spigot does not have a backflow preventer. For these reasons, we cannot final your well case and issue a Well Certificate of Completion. Despite this, the fee you paid for the well permit included water samples. If you would like our office to sample and test your well water, please contact us at the number below. The samples would be taken from an outside source, so it is not necessary that you are present.There is no additional charge for these samples.The sample test results would be sent to you when they are received by our office.Typical process time is 6-8 weeks. If you have additional questions, please call us at (828) 465-8270, or by e-mail at: EHAdminnu CatawbaCountvNC.gov catawbacountync.gov Environmental Health Catawba County Government Center 25 Government Drive ( PO Box 389 I Newton NC 28658 ( 828.465.8270 MAKING. LIVING. BETTER. KA Case# WELL-09-2021-157951 ' ' CATAWBA COUNTY HEALTH DEPARTMENT 41-4 Environmental Health Section 18 4 Z sM 05/26/2023 WATER SAMPLE TEST RESULTS Applicant JEFF/GLENDA LAIL, 1395 CHANCELLOR DR,CLAREMONT NC 28610 C:8283137968 Site Address: 1395 CHANCELLOR DR,CLAREMONT NC 28610 Name of Subdivision: SHERWOOD LANES Parcel Number: 376010278028 Lab Coliform Anal‘sis Results: Total Coli forms: O Oc 1W Fecal/E.Coli: ay; No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials Date/Time Received Tot. ° ') I ``'� Date/Time Completed CO' ' ° ' NOUN�" RECEIVED s,, , 2 023 Environmental Health rsamlicldreport 05/26/2023 13:56 Page 2 of 2 $A C� Case# WELL-09-2021-157951 t t CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section Vs I8 Z sM 05/26/2023 WATER SAMPLE FIELD REPORT Applicant JEFF/GLENDA LAIL, 1395 CHANCELLOR DR,CLAREMONT NC 28610 C:8283137968 Site Address: 1395 CHANCELLOR DR,CLAREMONT NC 28610 Name of Subdivision: SHERWOOD LANES Parcel Number: 376010278028 Driving Directions E NC 10 Hwy,right Chancellor Dr on right Sample Collected by: S M a 1 Date/Time Sampled: os/30/2.? io 00 A r, Sampling Point: S90''1'� Q/F Is well head accessible? Yes v No Reason for inaccessibility Well New or Existing? New 1/ Existing Type of Well: Drilled / Bored Hand Dug Punch • Does well meet adequate construction standards from what can be observed: Yes No 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 VJcll 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: SACk ciow pe€veP+mer we// a� / ,Th r, f450.rsamfiF1da:port 05/26/2023 13:56 Page of 2 4 a1 451Ar4 4312 District Drive � MSC / . North Carolina State Laboratory of Public Health li Raleilh1NC276991918 %Ii 4;!;"\f Environmental Sciences http://slph.ncpublichealth.com •°QUAm oc.,• Phone: 919-733-7308 Inorganic Chemistry Fax: 919-715-8611 Certificate of Analysis FINAL REPORT Report to: ENVIRONMENTAL HEALTH Name of System: CATAWBA COUNTY ENVIRONMENTAL HEALTH Jeff& Glenda Lail P 0 BOX 389 1395 Chancellor Dr NEWTON, NC 28658 Claremont, NC 28610 EIN: 566001814EH Delivery: NC Courier StarLiMS ID: ES230531-0037 Date Collected: 05/30/2023 Time Collected: 10:00 By: Dwight Mikeal Date Received: 05/31/2023 Time Received: 07:50 Sample Type: Raw Sampling Point: Sample tap Well Permit No. WELL-09-2021-157951 Sample Source: New Well Receipt Temp. : GPS Number: Profile: New Well -No Nitrate I Analyte Test Result Allowable Limit Unit Qualifier(s) Arsenic <0.001 0.010 mg/L Barium <0.1 2.0 mg/L Cadmium <0.0005 0.005 mg/L Calcium 12 mg/L Chloride 10.3 250 mg/L Chromium <0.02 0.10 mg/L Copper 0.013 1.3 mg/L Fluoride <0.1 4.00 mg/L _ Iron <0.06 0.300 mg/L Lead <0.003 0.015 mg/L Magnesium 3 mg/L Manganese <0.005 0.05 mg/L Mercury <0.0004 0.002 mg/L Nickel <0.01 0.1 mg/L pH 7.1 N/A Selenium <0.005 0.05 mg/L Silver <0.01 0.10 mg/L Sodium 7.6 mg/L Sulfate <5 250 mg/L Total Alkalinity 38 mg/L Total Hardness 44 mg/L Zinc <0.05 5.0 mg/L Report Date: 06/09/2023 Reported By: r1— ;,- 71 t,.... Marc Komlos .1 fL:- :<...;i v L L J1, . ' 23 Environmental Health Page 1 of 1