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Home My WebLink AboutWELL-11-2021-161577.TIF FROM : MORETZ WELL & PUMP FAX NO. : 7044621322 Jan. 19 2023 04:45PM P1 WELL CONSTRUCTION RECORD (GW-1) For internal Use Only: I.Well Contractor Information: Ashley I Moretz °,14iVFATER ZONES;".:::.:�:•c;;-•::..;;,.. �> , Well Contractor Name FROM TO ~ DE,SC'RR PflON 2586-A ,'20 /7E/a`' 04. P / gart. /2 n. 420 NC well Contractor Certification Number 15..OUTER CAS N (for muJ*-eue'd.weit) R),;ZNI Of alp Ucmble)• ' • Moretz Well and Pump Service LLC FROM TO IMAAMET/ER I THICKNESS MATERIAL Company Name _/ ft. ar2 7 ft- V/, In, 519k!2/� //c We// 1 / / .�rI iG DINER CASING.OR TUnfNG(gcothermsl.clo -lo.pp).: = i •. 2-Well Construction Permit#: / /",02 o2 "/�/.r /7 FROM TO UTAMETER THICKNESS �MATItR[At, tit/all ap➢liCable well COwtroetion permits(i.e, WC,Cotmry,State, Variance,etc..) !. ft. In. 3.Well Use(check well use): ri. in. Water 5u t Well. - '1/..SCREEN .r:r';,:x '` ., r PP 5' FROM TO DIAMETER SLOT SIZE TIICKNFfiS MATRRIAI. I Agricultural UMunicipaUPuhlic n, m• l Geothermal(Heating/Cooling Supply) Ore sidentiul Water Supply(single) /", ft• n • l lndustriaUCoi tncrcial f Rcsidcntial Water Supply(shared) 18:'GROUT• P Irrigation FROM TO MATERIAL EMPLACRM'tiN1'M R'rHOn(4 AMOUNT Non-Water Supply Well: ( ft, a2/ It, eAlor.I L//cps T ` /1, a.Monitoring QRccovety it, ft- +i•��C 1 f injection Well: ft. ft. &Aquifer Recharge DGroundwater Remediation i 19.9ANDl0I2A 11#ACK.Of APpllcablej•' ill Aquifer Storage and Recovery EjSalinity Barrier FROM TO MATERIAL MYI AcEmFN r mirmoD "'Aquifer Test 0Stormwater Drainage ft ft. — E, II'Experimental Technology DSubsidence.Control ft, ft, (3eotherrttal(Closed Loop) 0Traccr 20,DR1LLINGLsOG'(attecti addlttonal'aheets if.fecesaui y) . FROM To DESCRIPTION(color,ha,,1 wss,soiVrocktyii. la size cep) ' a Geothermal(Fleatin• Cooling Return) _q`QO1hcr(explain under#21 Remarks) ,y ft / . f7, //� ... 417.9e0 y7i „�'L 4.Date Well(a)Completed: /--JD r.23 Well IDN • (� ft. I- C• y/ / �r rc ... Sa-Weil Location: ft. / 0 C. 13/`j t-A Wf I�f0/ It. ft. t;uili:yrOwncr Name Facility!Die(if appli(.bk) n• it. 5131 ivX -k. A� Ve /� I. ft. Physical Address,City,and Zip ft. ft. _ Cc 3W6 620'7°3o/Ia6. :. . County Parcel ldentifii Lion No,(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: _ (if well 6cld,one S hallonp is sufficient) 22.Certification /� 3 S7/ l4 Q l� N O( . 7' /927 W , $09 y(�-- ti /-/V signature of ificd Well Contractor 6,la(are)the well(s)rx Permanent or EiTcmporary Date By signing this form,I hereby c:crtf)y that the well(s)wus(were)cc1t.ctructed Is accordance 7.Is this a repair to art existing well: DYes or 1i o with/14 Nr.:4:02C.0100 or 134 NC4C QC.0200 Well Cunstntction Standards and that a 117hWS Is a repair,fill out known well construction infnrmtAtan and explain the nature of Copy of this record has been provided to the,well owner. repair under 421 remarks sermon or on the back of this farm. 23.Site diagram or additional well details: You may use the back of this page to provide additional well site details or well R.For Geoprobc/DPT or Closed-Loop Ccotherntal Welts hAving the same construction,only 1 OW-1 •s needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. drilled. �.,.,. SUBMITTAT,l,NSTRUC'FIoNS 9.Total well depth below land surface: O Far multiple wells list all depths ifd(fferenl(example-3 00'and 2(i iI00') ( ') 24a. For Ail Weld: Submit this form within 30 days of completion of well construction to to the following: 10-Static water level below top of casing: e,2 0 (ft.) Itivision of Water Renou reel,information Processing Unit, (/a.n 1er Jrvcl is ahoy aastne,,ve"+" 1617 Mail Service Center,Raleigh,NC 27699-1 6 1 7 11.Borehole diameter; 6 (in.) 24h.For Iri es.tlun-Wells: in addition to sending the form to the address in 24a 12.Well construction method: Air Rotary above,alto submit one copy of this form within 30 days of completion of well (i.e,euger,rotary,cable,direct push,etc.) construction to the following: Division of Water Resources,Underground Injection Control Program. FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636 13A.Yield(gpm) a NYethud of test: Air Lift 24c.For Water Swint,/.4e Infection wets: In addition to seeding the form to the address(es) above, also submit one copy of this form within 30 days of 13h.Disinfection type: _ Amount: 0 Z completion of well construction to the county health dcparttnent of the county where constructed, Fonts GW-1 North Carolina Dcnartmcnt of Ensimnmentnl(hmiiiv-rli..; r,., an,•nr...n_.,......_, .. . , ._..,., 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 Williams Sample ID Number:161577 Location: 4131 White Rd, Vale NC 28168 Reviewer: Bryan Forsee 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 S7ATfnti0,„ Private Well Information and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division Of Public Health For Inorganic Chemical Contaminants County: Catawba Name: [Brian Williams-4131 White Rd, Vale NC 28168 Sample ID#: 161577 Reviewer: Bryan Forsee 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 on(v. 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 on jr. ❑ Arsenic ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper rI Fluoride ® 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 ❑ Fluoride ❑ Iron ❑ Manganese ❑ pH _ ❑ Silver ❑ 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 router results,please call the North Carolina Division of Public Health at 919-707-5900. Iron &PRIVATE WELLS , � �. � r. ,. , 4 �, Salk What is iron? Iron is a natural element found in rocks deep underground.Iron is found in the environment as What level of iron should iron compounds joined to other elements like sulfur, I be concerned about? carbon,and oxygen. Iron is used for constructional material and pipes. The NC Department of Environmental Quality Iron compounds are used as pigments in paint and calculated a health based value of 2.5 milligrams of plastics. Iron compounds are also used in water- iron per liter of water(mg/L).This calculation was treatment plants as a coagulant. developed with consideration of health effects in 2017. The US Environmental Protection Agency and How does iron get in NC Department of Environmental Quality my private well water? developed an aesthetic standard of 0.3 mg/L.This standard was developed to prevent staining,rusty Iron compounds can enter your private well water color and metallic taste. from erosion of rocks underground. Iron can also enter groundwater from industrial practices.Acidic How do I test for iron water(water with low pH)can make iron compounds more soluble. in my private well? Use a certified lab to test your well water for iron How can iron affect my health? every two years,as part of the inorganic panel screen.Contact the private well program at your Iron is an essential element,meaning your body county health department to assist you with getting needs it in small amounts.It helps with oxygen your water tested.Pricing of testing varies from transport,electron transport,and deoxyribonucleic county to county. acid(DNA)synthesis.However,drinking high levels of iron may cause adverse health effects.You can't What if my iron levels are high? smell iron.Iron may have a detectable taste or have a rusty color. You can install a treatment system to reduce the levels High levels of iron can cause gastrointestinal of iron in your private well.Treatment systems that problems.For people with preexisting conditions, reduce the levels of iron in your well water include: like hemochromatosis,drinking high levels of iron • Oxidizing filters may cause heart, liver and pancreas toxicity. • Cation exchange,also known as a Water Softener You can also reduce your exposure by using bottled water or connecting to public water supply,if possible. Percent of Private Wells Tested Exceeding Federal Standards for Iron, 2011-2013 egitecilip __ �, 1-4 TA/.4 9 ele II ijal DI PA I ik I # i+ Oil Ahillibilr 1 rea 1.41 Fa I 4 I 1 L,i,,,;; 1 ..-1 4.1 0 I I II ti Ili llilv l >M111 exceeded health standards _ 10-25%exceeded health standards <10%exceeded health standards IL 0%exceeded health standards Insufficient data(<10 wells tested) Where is iron found in NC? Where did this information Iron is found at low levels(0.1-62 mg/L)throughout come from? NC.About 6%of wells sampled for iron in NC from World Health Organization:www.who.int/water 2011 to 2013 exceeded the state health-based value sanitation health/dwq/chemicals/iron.pdf (2.5 mg/L).Yet,there are several areas in NC with at Nazanin Abbaspour et al.Journal of Research in least 10%of wells exceeding the state health-based Medical Sciences Review on iron and its importance value.See map for areas with elevated iron. for human health 2014:www.ncbi.nlm.nih.gov/ pmc/articles/PMC3999603/ Where can I find more information about iron and my well? Visit the NC Division of Public Health's Private Well and Health Program website:http://epi.publichealth. nc.gov/oee/programs/wellwater.html. . There you can find: y- • Contacts for your county private well program • Iron in well water maps s • A guide for selecting a treatment system 1 0. , t hilt. • Other private well resources f • +►' You can also call the Private Well and Health Program 1 at 919-707-5900. ' , iiik NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental d, 1,' \ I4I Epidemiology Branch•Private Well and Health Program•httos://coi.oubiichealth,nc,aov/oceloroarams/wellwater.html •NCDHHS is an _� No,lh cn.oh•., equal opportunity employer and provider.•09/2019 •' Public lleal,h