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HomeMy WebLinkAboutWELL-01-2022-163612.TIF 1l I':l.I. ('l)\ti'I'Itl c1:iO\ l't[VIM') (GW-I) For Internal Lis:Only: , . ,I, u uu, .,'. , 111I„',II:,IIo1,. c-Ncv.c aer.\ I 14.WATER ZONES • ' • sal O\ t .--------- , ft. / ,,�, - ---- ----.- rl. .l. I I .()LITER CASING(far Multi-eased Is�)11 LINER(if ap 'legible) 1 Y\ f/•,- )1/4-) ,\ .C._ F'H(UI 1'o I) "1 H1'111CKNESS AIA' 'H11,J�-+cL�">y� 11Y\� ( n. �� li. rQ� I,ill. �I/ , n.I l.•; .., i',I I:,i; �^S )�aW 1�a I It11N a (.OR DIAMETERells HII LINF h 1 r' )4 INNER CA51N' •I UOING(geothermal cloud-loop) r! ( I T 1 .55 tt 'h'.I<Inl. --_-1 It. It. 1 its. 1 • 1 - II. I D. ( ill, �— 1 - r. .r. �lir,I. ,,,II r.r• . . . _ .. .___---------- 17.SCREEN , no l\I '1'0 DIAMETER SLOT:411.F: TI,ICRNF:SS NIA l'I:It1A I. (•,it:I,111,11inUi'chlic It. It. in. ' ,,' i I I•' :Y...ticnlia!Verner Supply ls1n'=1cj ----- II. it. I iu. I G.,.aolllai'), nierSupplyi{II'11'etll ix.CItoU'P t , ,. •:•I!.... IU,).000 GM FROM 10 11A)'F.RIAI. E.)I I'I.ACL.%IEN'I'\IET'llon x:AMOUNT s ... V...... ',IN.! V%,•1 1.1. ,p0:7-1:incl.:"f i 5 hp5_5 IS bads IL n. • • C,I nladwaier RCmediation 10.SAND/GRAVEL PACK(If Applicable), .• . • .. . ::,.I::n,Iv!lamer i--ran)t 'lil sIATEHIAI. EMPLACEMENT,11I:nlo, _--. ,..!. [:.:.4.1,IC.IiCr Dlaitlae. rl. O. -!••:: .:d,1,,,.Control - ii. fl. "i" 1...:co 20.DRILLING LOG{anhich additional shccus il net'Cssare) FHu,\I To ( DEsclll''riuN{c,1hir hankie.,nnlllro.k rvpr,gran nixe.CIO: ,._.... .. . I: .I, . , .: .,' 11,.: I„Il.r,li ,,(. '.irt•, \41iaundcr4_1 Rem arks ! © n. I0IL �_l(1L u:,,.t�:•r; ;,it IC11 J ti�,n!f);r _ _ i Leo n. I 5 (,c)„JC1. l c.�CG __ _ - -' -- - IL _� ►"K.(� �C�rr4 cra4 (3 r(-�k \� it:l�Mir ra apl,IicabI.I ``- YI. IL V �t� ` _ A .` . _ —_ 21.REMARKS • . W r'::,ctl Identification No.i l'INI • . ,..•u„ ..I„ , ,,,I III it. ,'is'l:;in,Ie'' ..:,1h11,ur decimal degrees: -- -"-- lr Certification: yl ,cols,,,.:,l ,�, ;I r�„pul':n t Signature of C'rrulied Weil C unh:lelnr D;rtc O rfr I4 lliu5 du.,1,,,ac 1 het rhv certify that She waits)war(were/cuatn'ucYlhf in accurduoce with III• :, , ,. I i u^II i I: \I ulYl'i,\o IS 4 ArAC NC'.III t10 or l5A NCAC WC.0200 Well Coasu'ursiarr Standard..and thus a copy r ,. „,, , I., .,,,,„:„„,r(„,,Ass,,she n,vurr o/'the of thir record has been yrvvided to the'veil°toter. 23,Site diagram or additional well details: !'1 r t ! I n ;I,Itherulal Wells having the saute You may use the back of this page to provide additional well construction info Ti ITt.VI lMfthi(of uclls (mid'See Over'in Remarks Box).You!nay also attach additional pages if necessary. 24.SUILMII•l'•fA1.INSTRUCTIONS If ,fi rt,l.) -( ') Submit this(uW-I F1 ilhi t 311 days of well pict{un per the following: 249. Por All Wells: Original foniu to Division of Water Resources (DWR), „lull ra.n•_: (11•) Infilrtuatinu I'mccssing Unit,1617 MSC,Raleigh,NC 2 7699-16 1 7 I;,r1:I,.,1,•,!ini, 'I.,: 24h. For Injection Wells:Copy to DWR,Underground Injection Control(IUC) Q 1 IM ._rill ! Program. 1636 MSC,Raleigh,NC 2 76 99-1 636 :. vt,li Cs si risen.,., I: 'Si 1 24e.For Water Supply and Open-Loup Geothermal Return Wells:Copy to the - dountc,nI•ironn1Cnlal health dcpaluncnt of the county where installed . u( \\ \'t I Ii :.,I i'!'1.I )t'I1,1.,., OBI v: 24.11.Fur Water Wells producing over 100,000 CPD: Copy to DWR,CCPCUA ic\ r� Permit Program, 1611 MSC,Raleigh,NC 27699-1611 I::1.1',,:,I '..,,,, Iilellioiloftest: \` N,,:!l::•:,r.d,n,.I),'l,;.rlalC..•,rlhnl. mnlca!al1IIr;11ih'-DivisionofV1ateHeratva'es Revised(I-6-201x I 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: Shawn Deluca Sample ID Number: 163612 Location: 3303 Mountain Creek Dr, Sherrills Ford NC 28673 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 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. �A C Case# WELL-01-2022-163612 E4 "4" - ) CATAWBA COUNTY HEALTH DEPARTMENT K4) ',S, Environmental Health Section 8 4 2 sm 08/24/2022 WATER SAMPLE FIELD REPORT \pplicant *SHAWN&PATRICIA DELUCA,4526 BURRENFORT DR,DENVER NC 28037 C:8283129658 SDELUCA c ATT.NET Land Owner BRADLEY MILLER,PO BOX 535,SHERRILLS FORD NC 28673-0535 Site Address: 3303 MOUNTAIN CREEK DR,SHERRILLS FORD NC 28673 Name of Subdivision: MOUNTAIN CREEK RIDGE Parcel Number: 369803108253 Driving Directions Mt Buleah R on Little Mtn subdivision on Left 1st lot on left Sample Collected by: g a Date/Time Sampled: 8/2 t4/�7-- 1 T 210 41/1 Sampling Point: SG 14/i t —he Is well head accessible? Yes ✓ No Reason for inaccessibility Well New or Existing? New ✓ 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 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: rsamfieldreport 08/24/2022 14:04 Page I oft C Case# WELL-01-2022-163612 CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 1 g 4 2 SM 08/24/2022 WATER SAMPLE TEST RESULTS �pplic.rni *SHAWN&PATRICIA DELUCA,4526 BURRENFORT DR,DENVER NC 28037 C:8283I29658 SDELUCA@ATT.NET land O ncr BRADLEY MILLER,PO BOX 535,SHERRILLS FORD NC 28673-0535 Site Address: 3303 MOUNTAIN CRF,F,K DR,SHERRILLS FORD NC 28673 Name of Subdivision: MOUNTAIN CREEK RIDGE Parcel Number: 369803108253 Lab Coliform Analysis Results: Total Coliforms: Fecal/E.Coli: J l- No Collection Date Over 30 hours old Ins a lid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials Date/Time Received ' `�t,S Date/Time Completed Og` Y 6.9'r ' I W RECEIVED AUG 2 '022 Environmental Health rsamfieldreport 08/24/2022 14:04 Page 2 of 2 Analytical Results T ,TIL l '71- * ANALYTICAL Or: Catawba County Public Health PO Box 389 Newton, NC 28658 Receive Date: 08/25/2022 Reported: 08/29/2022 For: Shawn & Patricia Deluca 3303 Mountain Creek Dr Sherrills Ford NC Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 220825-38-01 Nitrate 01-2022-163612 <1 mg/L 353.2 08/26/2022 CL 220825-38-01 Nitrite 01-2022-163612 <0.1 mg/L 353.2 08/26/2022 CL Respectfully submitted, Melissa Myers NC Cert#440, NCDW Cert#37755, EPA#NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 2 N 0 R T H C A R 0 L I N A 4S4:13 "zq Private Well Information • and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Shawn Deluca—3303 Mountain Creek Dr, Sherrills Ford NC 28673 Sample ID#: 163612 Reviewer: Megen McBride TEST RESULTS AND USE RECOMMENDATIONS I. ® 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 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 ❑ Barium n Cadmium n Chromium ❑ Copper ❑ 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 on(v, 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. El b. Your sodium level exceeds 30 mg/1 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. STAFFSYIALE aitANALYTitAt sr 122 Court Street Statesville,NC 28677 704-872-4697 www.sa-nc.con NITRATE/NITRITE ANALYSIS Na,;y):efornnien must be supplied rorconplunce credit. WATER SYSTEM II)#: 0 l -_ ),/9--- f4, +,'t. County:- Catawba Name of Water System: -C Y1 R tAy\ Pet 1c4Gt pe)t.t G1 _ Sample Type: 0 Entry Point f2'Cecial/Non-compliance Location Where Collected: 3 303 /VI ut,,4-6;el CreeV- 1>n1 fy(ti4-1(ij r--cell, NC_ Facility ID No. _J 36/2- Sample Point: 1Collection Date l Collection Time Collected By: £j1# (tKtiw _CS/w1�/?2-- i7`: +fie) /J-f M (M WOW r,) �op..,AM or fM) Mail Results to(water system representative): CATAWBA COUNTY PUBLIC HEALTH Phonell: (828)465-8270 ENVIRONMENTAL HEALTH Fa:#: ; (828)465-8276 PO BOX 389 Reapoatible Person's email; ` EHAdmin@catawbacountync.gov NEWTON,NC 28658 LABORATORY ID#: 37755 0 SAMPLE UNSATISFACTORY Q RESAMPLE REQUIRED ;i CONTAV METHOD REQUIRED lica DETECTED QUANTIFIED ALLOwABLE I' CODE CONTAMINANT CODE REPORTING LIMIT (i.e.<R.R.C.) (R.R.L.) (x) RF..SULT3 LIMIT I� ( t 040 • Nitrate 353,2 1.00 mg/I. ... 'w.. _— _ . mg/I. 10.00 mg/L „ 1041 Nitrite 333.2 0.10 m&iL — mg/L 1.00 mg/L *Note:If result exceeds allowable limit,the laboratory must fax analytical results to the State on day test completed. m DATE:�} -.— TIME: ANALYSES BEGUN: 011 4(0 /7.2 9 ,0$�t M ! tn`iAuowrr) _ :te�ur . .tin l ANALYSES COMPLETED: OS/ 74 1 Z-2 01: 5 , M 1 I .Laboratory Log,Y: 2.203 25.3 Q-Q I Certified By: ___ ��COMMENTS: 1::".1‘ 2cc8 __•.�.— Laboratory should Mail Regatta to; Public water Supply Section,Ann:Data Entry,1634 Mail Service Center,Raleigh,NC 27699-1634 Far!919.71iAi617 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2 of 2