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Home My WebLink AboutWELL-02-2022-166111.TIF WELL CONSTRUCTION RECORD (GW 1) 'For Internal Use Only. - r 1.Well Contractor Information: �� orav� g •14:AAT'ERLOIQFS;' t' .�•.,..r.•:,:. .. •..-. .. .. i Well Contractor Nance FROM TO DESCRIPTION v, - ft ft NC Well Contractor Certification NumMt , '15:CD R,Q4SING,(for mtatl ea wills) 'I r 'lrle)'a i Morgan Well &Pump, Inc, • . FROM TO' DIAMETER THICEPuas MATERIAL +1 ft 6 1/3! In, srr2t Pa ! Company Name 9� r , 2.Well Construction Permit#l: Z'°`�'—(1)6 I 14 PROM R.Ci1.SII�FG OR:TDBING:rked(fle-rma2'cl&seO-loop).'.(:.;,.•y• is k'.. FROM TO DIAMETER THICENFSS MATERIAL i List al!applicable well construction permits'Ile UIC Counts.State,Variance,eta) ft ft . in 3.Well Use(check well use): ft• n• i"' Water Supply Well: 17 NSCREE ;:. '^' . ',;•`: %: - •- . •:. •"_ , ..•:' .;:-.it,. :.:.•.:='.' ,, j FROM TO DIAMETER SLOT SIZE TfICKN SS MATERIALS Agricultural 0M cipal/Public ft. ft In. Geothermal(FleatiugtCooling Supply) Wesidential Water Supply(single) ft. . . ft in. - _ 1—ndratrial/Cotmna-cial UResidential Water Supply(sharer)) -,4e ,RoDT•'; t-•: m-:i,,l. ,r,•;{ -:- ':^;‘:,..7.;,: v..' i• `:;•' _ llrigation ---- PROM TO MATERIAL EMPLACEh'iXNI tdETBOD&AMOUNT • Non-Water Supply Well: a ft. 20 ft• bentonte• poured Monitoring nRecoveiy • ft. ft. Injection Well: ft. It Aquifer Recharge OGroundwater Remediation , • Aquifer Storage and Recovery salmi --1:SAND/GRAVI.L-PACIC(if applieablb) „ 4'. .'" 1 ` tY Barrier FROM TO 1 I,fATF.RDIL PL EMACFI,( T METHOD , Aquifer Test !Stormwater Drainage ft. f• Experimental Technology DSubsidence Control ft. ft I Geothermal(Closed Loop) oTracer :20,DRILLING.I:OG-{4tticii'iddlttotillshieti..faeiietsary")•'A• ,1-.:I •'f• ,•,,.:;...':' Geothermal(Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO D cRtPTlON(color,turdnes;totitracktype,Kink ;tea 0 .ft. 416 ft. 0-4 Cl.a . 4.Date Well(s)Completed: S-te-2Z Well ID# C,/- It ft. 04r' $ tc. 5a.Well Location: ft le) ft 1r0 a3Aait•� �OrdA11 �'J� ft ft f • Facility/Owner Name Facility lD#(tfappLicable) ft. ft. J [t ft 6WC,5 1/4) J 10,r.-_AI NG f.t. ft _ Physical Address,City,and Zip ([ / Lio.coi� %1b 40� 175{St; '"21:31RMARICS' :'' •_, ...-. '," , .., - CO.�,�..,. I. County Partelldenti5catlonNo.(PIN) • Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one 1atilong is sufficient) 22.C catlo . 6.Ts(are)the well(s) anent or Temporary Sign a write net-actor Date Perm By signing this form,I hereby certify that the well(s)was(were)constructed in accordance 7.Is this a repair to an existing well: ®Yes or No with 1.5.4 NC[C 02C.0100 or 1SA NCAC 02C,0200 Well Consducrion Standards and that a 1f this It a repair,fill out known well caarouction information and explain the nature of the copy ofthtt record has been provided to the well owner. repair under#21 remarks section or on the back of this form. • 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Dosed-Loop Geothermal Wells having the same You may use the beak of this page to provide additional well site details or well construction,only 1 OW-I is needed. Indicate TOTAL NUMBER'of wells construction details. You may also attach additional pages if necessary. drilled: 4 SIIBIVLCI'I'.tLL INS'I'ILUC);'ZQNS • 9.Total well depth below land surface: KM (ft) 24a. ,For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths tfd ent(example-3Q200'and 2@100' conshuction to the following: 10.Static water level below top of casing: 30 (ft.) Division of Water Resources,Information Processing Malt, - .Ifwnter level Is above casing,ure"+" I617 Mall Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: 6 (in.) 24b.)?or Infection Wills: In addition to starling the form to the address in 24a �-{�}}r j above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: el `mot consruction to the following: (ie.auger,rotary,cable,direetpusb,etc.) . ' . K Division of Water Resources,Underground Injection Control Program, FOR WATER SUPPLY'WET c,C)NLX: 1636 Mail Service Center,Raleigh,NC 27699-1636 13a.Yield(gpm) 30 Method of test air pressure 24c.)?'or Water Supply&Injection Wells: In addition to sending the form to MM__((�� Q the address(es) 'above, also submit one copy of this form within 30 days of 13b.Disinfection type:t,.Ml,►pl tilde. Amount: IQ QZr completion of well construction to the county health department of the county where constructed. Form OW-1 North Carolina Department of Environmental Quality-Division of Water Resources . Revised 2-22 2016 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: Jordan&Lauren Rose Sample ID Number: 166111 Location: 6465 Woodland Dr,Denver NC 28037 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. N 0 R T H C A R 0 L I N A 4�`f � ,°�� Private Well Information .� a. and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Jordan&Lauren Rose—6465 Woodland Dr,Denver NC 28037 Sample ID#: 166111 Reviewer: Megen McBride 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 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 n Barium ❑ Cadmium n Chromium n Copper ❑Fluoride ❑Iron ❑ Lead n Manganese ❑Mercury n Nickel n Nitrate/Nitrite n 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 onto,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 n Copper ® Fluoride ❑ Iron n 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/l. 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 ontv. ❑b.Your sodium level exceeds 30 mg/l 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.