The URL can be used to link to this page

Home My WebLink AboutWELL-02-2022-165919.TIF WELL CONSTRUCTION RECORD(CW-I) For Internal Use Only: I.Well Contractor Information: Chris C Russell 14.WATER ZONES Well Contractor Name FROM TO DESCRIPTION 3254 A 60 "• 178 ft. ft. NC Well Contractor Certification Number IS.OUTER CASING(for multi-cased wells)OR LINER(If a Iicable) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL Company Name 0 ft. 38 It. 6.25 lit SDR21 PVC WELL-02-2 022-165919 16.INNER CASING OR TUBING(geothermal dosed-loop) 2.Well Construction Permit k: FROM TO DIAMETER TIrICKNEaa MATERIAL List all applicable well construction permit,(i.e.U/C,County,State, Variance•etc.) ft. ft. In. 3.Well Use(check well use): ft. ft. to. Water Supply Well: 17.SCREEN FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public tt ft. in. ❑Geothermal(Heating/Cooling Supply) El Residential Water Supply(single) ft. ft In ❑Industrial/Commercial ❑Residential Water Supply(shared) 18,GROUT ❑irrigation ❑Wells>100,000 GPI) FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: O ft, 20 n• Grout Poured DMoniloring ORecovery Cl. rt. Injection Well: ft. ft. ❑Aquifer Recharge OGroundwater Remediation DA uifer Storage and Recovery ❑Solicit gamier 19.SAND/GRAVEL PACK(if applicable) q Y FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage rt. R. ❑Experimental Technology ❑Subsidence Control ft. ft. ❑Geothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets If necessary) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under ik2I Remarks) FROM TO DESCRIPTION(color,hardness,soll/rack type,grain size,etc.) 0 ft 33 It. Dirt 4.Date Well(s)Completed: 6-28-22 Weil ID# 33 ft 178 ft Rock 5a.Well Location: ft. (t, Bondilyn Coley D. It, Facility/Owner Name Facility!Off(if applicable) ft rt. 6296 Ruffin Lane, Conover, NC 28613 ft. ft. Physical Adams.City,and Zip ft. ft. Catawba 21.REMARKS County Parcel Identification No.(PiN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Of well field,one 1st;long is sufficient) 22.C tification: 35' 80.671' N 081' 22.446' wXii.,21) geLeuzie8/24/2022 6.Is(are)the well(s): 4Permanent or O'remporary Signature ofCertified Well Contractor Date 8y signing thisform.1 hereby certify that the*wilts)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or I!INo 13A NCAC 02C.0100 or 154 NCAC 02C.0200 Well Construction Standards and that a rope (j thin is a repair.fill out known well construction information and explain the nature of the of this record has been provided to the well owner. repair under).121 remark*section or on the back t fthis form. 23.Site diagram or additional well details: You may use the back of this page to provide additional well construction info It.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same construction,only I GW-1 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: 178 (ft.) For multiple wells list all depths ifdifercnt(example-3(iy,N)0'and 2tu1100') Submit this GW-I within 30 days of well completion per the following: 10.Static water level below top of easing: 60 (ft. 24a. For All Wells: Original form to Division of Water Resources (DWR), If canter level is above casing,use 'f" ) Information Processing Unit, 1617 MSC,Raleigh,NC 27699-1617 11.Borehole diameter: 6.25 (in.) 24b, For injection Wells:Copy to DWR,Underground Injection Control(R)C) Air Drilled Program,1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.t.eager,rotary,cahle,direct push,etc.) county environmental health depanment of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 1 00 Air Permit Program,1611 MSC,Raleigh,NC 2 7699-16 1 1 13a.Yield(gpm) Method of test: r1 13b.Disinfection type: HTH Amount: 1/2 Cup Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018 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: Bondilyn Coley Sample ID Number: 165919 Location: 6296 Ruffin Ln, Conover NC 28613 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. I)o 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 ',�T;TE . ,a ,4 0 Private Well Information erg �a. and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Bondilyn Coley—6296 Ruffin Ln, Conover NC 28613 Sample ID#: 165919 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). I lowever, it may be used for washing, cleaning, bathing and showering based on the inorganic chemical results only. El Arsenic ❑ Barium ❑ Cadmium El Chromium [' Copper ❑ Fluoride El Iron ❑ Lead ❑ Manganese ❑ Mercury El Nickel ❑Nitrate/Nitrite ❑ Selenium El Silver El Zinc 3. ❑ While your lead levels do not exceed federal or state standards,the North Carolina Division of Public 1 Iealth 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 El Copper ❑ Fluoride _ ® Iron ® Manganese ❑ pH ❑ Silver El 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. D 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 . Tor more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.