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Home My WebLink AboutWELL-11-2021-161226.TIF WELL CONSTRUCTION RECORD(GW-I) For Internal Use Only: 1.Well Contractor Information: Chris C Russell 14,WATER ZONES Well Contractor Name FROM TO DESCRIPTION 3254 A 60 ft• 245 ft ft. ft. NC Well Contractor Certification Number IS.OUTER CASING(for multi-cued wells)OR LINER(If ay. iable) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL Company Name0 ft' 87 ft• 6.25 i°• SDR21 PVC WELL-11-2021-161226 INNER CASING OR TURING(geothermal dosed-loop) 2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.UJC,County.State.Variance.etc.) ft. ft. In. 3.Well Use(check well use): ft. ft. in. Water Supply Well: Et SCREEN FROM TO DIAMETER SLOT SIZE. THICKNESS MATERIAL DAgricultural ❑Municipal/Public ft. ft. In. ❑Geothermal(Heating/Cooling Supply) EIResidential Waler Supply(single) ft. ft. in. ❑Industrial/Comrnercial DResidential Water Supply(shared) 16.GROUT ❑Irrigation ❑Wells> 100,000 GPD FROM ro MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0 ft' 20 ft. Grout Poured ❑Monitoring ❑Recovery ft. ft. Infection Well: ft re DAquifer Recharge OGroundwatcr Remediation 19.SAND/GRAVEL PACK(if applicable) DAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATF.RIAI, EMPLACEMENT METHOD DAquifer Test OStotmwater Drainage ft. rt. ❑Experimental Technology OSubsidence Control ft. ft. ❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DF-SCRIPTION(color,hardness solYroe4 type,grain slur,era) 0 fi• 82 ft• Dirt 4.Date Well(s)Completed: 7-13-22 Well ID# 82 ft- 245 Ft. Rock Sa.Well Location: ft. ft. Steven Marlowe Sedgewick Homes ft. ft. Facility/Owner Name Facility IN(if applicable) ft. ft. 4200 Caldwell Rd, Newton, NC 28658 n. ft. Physical Address,City,and Zip ft. ft. Catawba 21.REMARKS County Parcel Identification No.(PIN) 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22.C tification: 35' 37.613' N 081' 06.709' w ' ice4,4 8/4/2022 6.Is(are)the well(s): OPermanent or OTemporary Signatu of Certified Well Contractor Date By signing this form.I hereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or 2INo 1 SA NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Standards and that a copy. If this is a repair,fill out known well construction inhumation and explain the nature of the of this record bus been provided to the well owner. repair under N21 remarks.section or on the back of this hum. 23.Site diagram or additional well details: S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the sauna You may use the back of this page to provide additional well construction info construction.only 1 GW-I 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: 245 (ft. For multiple wells list all depths if different(exampllee-3(200'and 2000J1007 (ft.) Submit this GW-1 within 30 days of well completion per the following: 10.Static water level below top of casing: U 0 (ft) 24a. For All Wells: Original fonn to Division of Water Resources (DWR), If water level is above casing,use"4- Infonnation Processing Unit,1617 MSC.Raleigh,NC 27699-1617 24b. For Infection Wells:Copy to DWR,Underground Injection Control(IUC) II.Borehole diameter: 6.25 (In) 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 health department of the county whore installed FOR WATER Sl!PPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 25 Air Permit Program, 1611 MSC,Raleigh,NC 27699-1611 I3a.Yield(gpm) Method of test: 13b.Disinfection type: HTH Amount: 2/3 Cup Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources Revised 6.6-201 s Case# WELL-11-2021-161226 t CATAWBA COUNTY HEALTH DEPARTMENT -4 `� Environmental Health Section 18 42 snl 02/13/2023 WATER SAMPLE TEST RESULTS Owner STEVEN MARLOWE, 1815 N COLLEGE AV,NEWTON NC 28658 I i:828-461-4813C:8285147347 Site Address: 4200 CALDWELL RD,NEWTON NC 28658 Parcel Number: 367903206481 Lab Coliform Analysis Results: Total Coliforms: a /�lull tT Fecal/E.Coli: Ctiayin{- No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident •II o Date/Time Completed 010.1 t ")11)0 �-i Lab Tech InitialsC-N Date/Time Received��r�•� F� RECEIVED M AP 2 2 2023 environmental Health rsamfieldreport 02/13/2023 12:57 Page 2 of 2 A C'O Cases WELL-112021-161226 7E1 CATAWBA COUNTY HEALTH DEPARTMENT V ,� Environmental Health Section 18 4 2 sM 02/13/2023 WATER SAMPLE FIELD REPORT O,,ncr STEVEN MARLOWE, 1815 N COLLEGE AV,NEWTON NC 28658 1-1:828-461-4813 C:8285147347 Site Address: 4200 CALDWELL RD,NEWTON NC 28658 Parcel Number: 367903206481 Driving Directions From the intersection of caldwell rd and little mnt rd head east on caldwell rd for 3/4 of a mile turn left on gravel drive Sample Collected by: +i1"`" M +11 e�I NJ; Date/Time Sampled: o3/1)-o/23 1(]o 15P r~ Sampling Point: r, "`'Y' t` I e Is well head accessible? Yes No Reason for inaccessibility Well New or Existing? New ✓ Existing Type of Well: Drilled ✓ Bored Band 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>= I2"above finished grade Well 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: O21/3/29 I -Ff /Ness rsamfieldreport 02/13/2023 12:57 Page I of 2 ' ,r&STATE a. 4312 District Drive %'P , `s, North Carolina State Laboratoryof Public Health MSC 1918 Raleigh,NC 27699-1918 '.,,', .iIr Environmental Sciences http:l/slph.ncpublichealth.com Phone: 919-733-7308 �"--"-'°" F Inorganic Chemistry ry Fax: 919-715-8611 Certificate of Analysis FINAL REPORT Report to: ENVIRONMENTAL HEALTH Name of System: CATAWBA COUNTY ENVIRONMENTAL HEALTH Steven Marlowe P 0 BOX 389 4200 Caldwell Rd NEWTON, NC 28658 Newton, NC 28658 EIN: 566001814EH Delivery: NC Courier StarLiMS ID: ES230321-0037 Date Collected: 03/20/2023 Time Collected: 10:15 By: Dwight Mikeal Date Received: 03/21/2023 Time Received: 08:03 Sample Type: Raw Sampling Point: Sample tap Well Permit No. WELL-11-2021-161226 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 6 _ _ mg/L Chloride <5 250 mg/L Chromium <0.02 0.10 mg/L Copper <0.01 1.3 mg/L Fluoride 0.164 4.00 mg/L Iron 4.71 0.30 mg/L Lead <0.003 0.015 mg/L Magnesium 3 mg/L Manganese 0.056 0.05 mg/L Mercury <0.0004 0.002 mg/L Nickel <0.01 0.1 mg/I, pH 7.1 N/A Selenium <0.005 0.05 mg/L Silver <0.01 _ 0.10 mg/L Sodium 6.2 mg/L Sulfate 10.5 250 mg/L Total Alkalinity 34 mg/L Total Hardness 30 mg/L Zinc <0.05 5.0 mg/L Report Date: 03/29/2023 Reported By: #4/M.ICIgg ----------."..% n r--r•!7.1/ I t--D \F I' :,;..�4,-`s."1----- L Marc Komlos H r)3 Environmental Health Page 1 of 1