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HomeMy WebLinkAboutWELL-02-2022-165642.TIF • WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well ntractor In er�mfatlon: l ., S (' ..&I$ F . -IL WATER7.O\•ES .r FROM TO DESCRIPTION W ll Coatroom Nan. y It/G IV-)n' 11�-p1\ T R. n. J NC Well OsramrdntifratimN®brr r�,. IS.OIIIERCA IN'G(rarsada-med wells OR LINER(Ifaotllailde) , Lq i' ri o`n•. v. -r,� I) FROM , TO DIAMETER T:Uc LSS MATLOAL Company Naar ,IL INNER CASING OR TUBING(reotheeessldoed.Eoop)' I 2.Well Construction Permit fit -FROM TO DIAMETER T1na7INLSa MAT>ZIAL List all egpnc rerellco,avc:ionperadf3%r.(llcCmWy.State.Variance.etc) R. it. la 3.Well Use(check well use): ft. R. In. • Water Supply Well: 17.SCUEEN - ". . FROM TO DIAMLILR SLOT SEM THICKNESS MATMAI. OAgricultural OMunicipal/Public e. f(, la. O Geothemtal(Heating/Cooling Supply) OResidential Water Supply(single) a it. to. O bniustriaLfCanmendal Me:ida:dai Water Supply(sbamd) ILGROIIT OIrrigation `,.. FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Nan Water Supply Well: ,:', / n• ;,1 R• Ab/t;Qnd L\r/t(frl�- OMonitormg ORecovay /�.., m tt 1 Injection Well: < OAquiferRecharge OGmua:luaterRemodutioa T. •f' ' R OAquiferStorageandRecovay+ O leit; a;;'. s•`y•`t.•~ .1 `FROSANOJGBAVEI.PACK1ss ToMMARTERIAk)L ttnrruCLMFRTMETHODj OAuiferTest -"- �' OStornawatirDrsirc"ige =`r; q . R• R. OExpeiimentalTechnology OSubsida:eoCoatrol ",Z q, ft. R DGeothmmal(Closed Loop) OTracer • • -.,,,• ,, ..2a DRILLING TOG With addid a1 iambtfveeenay) . OGwthamal.(Eiartinp/CoolingRyeturn) OOther(cxplain under F21Rerirado) FROM -.Tn DLscwrrroaa.�,r �w...k:,v�e.a+..m4.vet 4-Date Wells)Completed:7..III J I / a Wel1IDN 'f 1 a it. t' 5 .WellL.ocatioa:. ` 1 R. tl:S R' Vti✓�+1 - , . .::�* - • 1 a a ,) Name _ . Fmlihy ID/fd. k) --. n. D• C�f4,5-0CgNi ( .�`�+� '�© � S I` J $• to sic,/ art.a_ Physical Address. ./ and rp 1 nJ fy' n• S'it P cal 1-A .„ CA' Vt / ✓i)Vt P(05 l x, a :21.REMAR S. - • Caamy PaoelIdaafmtim Na.(DM Sb.Latitude and longitude in degrcea//mlaatdseconds or decimal degrees: (ifwell Said.ow Wiwi is satfieiem) 22.Certification:• Wac - ,..__. W i4 , 2 7 6.Is(are)the well(s): a-neat or OTemporary'., - sip �W D e . By s)gning this forma hereby cart*that the well(s)war h )con eructed in accordance 7.Is this a repair to an existing well: OYes or -�No n' • with LIA NCAC 02C.0100 or 15ANCAC 02C.0200 Well Construction Standards ant thet a .(Mils liar**fill out bwwn well conrtnutlon irforratlon and a plainihe tntrae of the ropy 0/this Tee ha bun provided to the well owrnr repair ender au reworks section or on the bark of this fonn. •_ 23.Site diagram or additional well details: &For Geoprohe/DPT or Closed-Loop Geothermal Weller having the same You may use the back of this page to provide additional well site details or well coastructiem,only I OW-I is needed Indicate TOTAL NUMBER of wells construction details.You may also attach additional page if necessary. drilled: $uni n r i,INSTRUCTIONS 9.Total well deptk below land surface: I'K�•� (ft.) 24a.For All Wells. g. Submit this form within 30 days of completion of well Foraadlip(sweflrBstalldepehrffdifjerent(areapie-3�I0�0 andl�tov) co�y�onto the following 1. 10.Stolle water level below top of easing: o (ft.)- Division of Water Resources,Information Processing Unit, 'fwaroinel it above caring.we Id r„ 1617 Mall Service Center,Raleigh,NC 27699-1617 1L Borehole diameter. (tar.) , ' 24h For Injection Well* In addition to sending the form to the address in 24a �flp �(r above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: ' , 1 ��I- construction to the following (i.e.sego.rotary,cable,direct pack,etc.) :Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1 • 1636 Mall Service Center,Raleigh,NC 27699-1b"i•6 I ,'7 SG rL' 24e.For Water Sanoly&Injection Welk: In addition to sendingthe form to 13a.Yield(gpm) Method of tab t �� 0 7 the addresses)above,also submit one copy of this form within 30 days of 13h Dlsinfeetioa typo �l % 1c-�Amount: 1r completion of well constuction to the county health department of the county where constructed... 4-5r .,- " ' , Form OW-I -•` Nash Carolina Department ofEavimamental Quality-Division of Water Resources Revised 2-22-2016 i rrip"t: .i` r r41 CamScanner er ,='a y,, ,f 4312 District Drive r 4 -. ik''\ North Carolina State Laboratory of Public Health MSC 191s �•'{�' ��: Raleigh,NC 27699-1918 Il�ll, F Environmental Sciences http://slph.ncpublichealth.com . '°"^n . 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 Ozzie Properties Inc. P 0 BOX 389 8027 Rowe St. NEWTON,NC 28658 Catawba,NC 28609 EIN:566001814EH Delivery: NC Courier StarLiMS ID: ES251013-0002 Date Collected: 10/09/2025 Time Collected: 09:53 By: Dwight Mikeal Date Received: 10/13/2025 Time Received: 08:54 Sample Type: Raw Sampling Point: Well head Well Permit No. WELL-02-2022-165642 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 5 mg/L Chloride <5 250 mg/L Chromium <0.02 0.10 mg/L Copper <0.01 1.3 mg/L Fluoride 0.178 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 6.7 N/A Selenium <0.005 0.05 mg/L Silver <0.01 0.10 mg/L Sodium 6.1 mg/L Sulfate <5 250 mg/L Total Alkalinity 35 mg/L Total Hardness 24 mg/L Zinc <0.05 5.0 mg/L Report Date: 10/23/2025 RECEIVED Reported By: il4"15" 411 Kathy Schnizler NOV 3 2025 Environmental Health Page 1 of 1