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Home My WebLink AboutWELL-03-2022-167241.TIF .P'iinEForm WELL CONSTRUCTION RECORD(GW-) For Internal Use Only: 1.Well Contractor� Information: ff ec Str 5 c e,la 14.WATER ZONES FROM TO DESCRIPTION Well Contractor Name a 5-,i c` %o rL 100 ft. 7 5fst i 12.0 ft. 13o ft• S NC Well Contractor Certification Number 15.OUTER CAS G(far multi-cased )OR LINER(if a able) L41 dri«th FROM ft. TO f4 DIAMETER an THICKNESS MATERIAL Company Name �� Jl....�p5d v 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL List all applicable well construction permits(i.e.UIC,County.State,Variance.etc.) it. ft. In. 3.Well Use(check well use): H. ft. In. Water SupplyWell: 17.SCREEN FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL DAgticuitural OMjnitinaVPublic it. R. In. DGeothermal(Heating/Cooling Supply) esidential Water Supply(single) f, ft. in, . ❑Industrial/Commercial E3Residential Water Supply(shared) Ia.GROUT IrrigationFROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: NQ ft- p'�3/ fL lO sM►r qs;- D45 5 h'1 e i,i fr e Monitoring 0 Recovery ft. ft. (."hr Injection Well: i El `� ��fr/ - ft. ft. BAquifer Recharge Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) Aquifer Storage and Recovery DSa)inity Barrier FROM TO MATERIAL EMPLACEMENT METHOD Aquifer Test DStormwater Drainage R• 0. Experimental Technology 0 Subsidence Control It. H. 1`, BGeothermal Gcothermal(Closed Loop) 0Traccr 20.DRILLING LOG(attach additloaal sheep if necessary) (Heating/Cooling Return) Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,sal/rock type,grain size,etc.) ft O. 4.Date Well(s)Completed: 1I i3`)4- Well ID# ft• �fiii n. 3 rG `4-- 5a.Well Location: ,(_ ft. 0O0 ft. t^.45 MS ft John..., Ir/.16ir►! . '$0 ft. '7cJyyr4 • Facility/Owner Name Facility ID#(if applicable) n' s.5 ft. e•% J 36 c`�t- 1 A ta O to'E+5♦rolN d-tr 1/4I alp ft. ft. Piet ,i. Physical Address.City,and Zip ft. R. C f4W boy 21.REMARKS County Parcel Identification No.(PIN) 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one tat/long is sufficient) 22.Certification: 35. 4,33Ys N 8( . (47 (13119 W 1 / 4 3 ? 6.Is(are)the wells) rmanent or OTemporary Signature, Well ,ontract e By sign R thi. form.I hereby cert(�y that the well(s)was(were)co trotted in accordance 7.Is this a repair to an existing well: ElYes or [ io with ISA NCAC 02('.0100 or 15A NC'AC 02C.0200 Well Construction Standards and that a If this is a repair,fill out known well construction information and explain the nature of the copy of this 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 Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary. drilled: Jh SUBMITTAL INSTRUCTIONS c 9.Total well depth below land surface: I 1O (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well For multiple wells list all depths it-different(example-3(d 2000'and 2(0,100') construction to the following: 0' 10.Static water level below top of casing: `L 0 (ft.) Division of Water Resources,Information Processing Unit, If water level is above casing.use"i" 1617 Mail Service Center,Raleigh,NC 27699-1617 11.Borehole diameter: \O (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a ' - �Ir above, also submit one copy of this form within 30 days of completion of well It Well construction method: ((¢ construction to the following: (i.e.auger,rotary,cable,direct push,etc.) Division of Water Resources,Underground Injection Control Program, FORWATER SUPPLY WELLS ONLY: 1636 Mall Service Center,Raleigh,NC 27699-1636 p 13a.Yield(gpm) (0V Method of test: I- to 5 6.P 4 24c.For Water Supply&Injection Wells: In addition to sending the form toy LI the address(es) above, also submit one copy of this form within 30 dad bf 13b.Disinfection type: C II�0I r�it" Amount:Amount: a Z completion of well construction to the county health department of the sodnty where constructed. k. Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Rejis 224 r tiff •"tic. �a ,, ---, , 4312 District Drive '' .-A! 41 -�,' North Carolina State Laboratoryof Public Health MSC 1918 ,r' I� Or. Raleigh,NC 27699-1918 ,' y I �� Environmental Sciences http://slph.ncpublichealth.com *o�a . ,,>- 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 RSH Proterties Family Ltd. Partnersl P 0 BOX 389 1880 Weston Dr. NEWTON, NC 28658 Vale, NC 28168 EIN: 566001814EH Delivery: NC Courier StarLiMS ID: ES221205-0015 Date Collected: 12/01/2022 Time Collected: 08:45 By: Blake Perkins Date Received: 12/05/2022 Time Received: 11:46 Sample Type: Raw Sampling Point: Sample tap Well Permit No. WELL-03-2022-167241 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 <0.0001 0.005 mg/L Calcium 7 mg/L Chloride 7.8 250 mg/L Chromium <0.02 0.10 mg/L Copper 0.013 1.3 mg/L Fluoride <0.1 4.00 mg/L Iron <0.06 0.30 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 6.2 N/A Selenium <0.005 0.05 mg/L Silver <0.01 0.10 mg/L Sodium 4.1 mg/L Sulfate <5 250 mg/L Total Alkalinity 6 mg/L Total Hardness 28 mg/L Zinc <0.05 5.0 mg/L Report Date: 01/03/2023 R I~-C 7 I E D Reported By: Marc Komlos JAN 1 [nvironmental Health Page 1 of 1 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: RSH Properties Family LTD Partnership Sample ID Number: 167241 Location: 1 880 Weston Dr, Vale NC 28168 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 11 Private Well Information •0 and Use Recommendations NC DEPARTMFN1 OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: RSH Properties Family LTD Partnership— 1880 Weston Dr, Vale NC 28168 Sample ID#: 167241 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 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 inorwanic chemical results on(v. ❑ Arsenic ❑ Barium 0 Cadmium ❑ Chromium ❑ Copper ❑ Fluoride ❑ Iron ❑ Lead ❑ Manganese 0 Mercury ❑Nickel ❑Nitrate/Nitrite ❑ Selenium ❑ Silver ❑Zinc 3. 0 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 n Silver n Sulfate ❑Zinc 6. ❑ a. Sodium levels exceed the U.S. Environmental Protection Agency's (USEPA) Health Advisory level for sodium of 20 mg/1. 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 on(v. ❑ 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.