HomeMy WebLinkAboutWELL-04-2022-169062.TIF Print Form _ �,
WE1.) (-O STR1'CTION RECOR1) (GW-11 For internal Use Only
1..Well Contractor information:
Robert Teague It WATER 7OPfl+S f
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tVeil Contractor Name _... I. _ _., //—�� _._.r......_—.-
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16.INNER C SIPR:ORTU'MING@mNrcimdtiurIWOSP) 1
2.Well Construction Permit 0: 1 LC\ C most To I olaMEr1i� roirxsLri i M+TEa1 I 1
i urr:10tc,..( AJc.ea.o+ 'r" ft. ft. • 'n. i
IS:^a�IIJn Pcr•n ifl it.; [,t, (-Gunn. Nat ✓YnanCa,di( � 1
3.«'ell Use(check well use): ft. ft. n
Water Supply Well: 17.SCRE£N
FRUti L TO I DIAMETERW WE. T E l THtCkh F.% M/TERIAL
Agricultural DMunicipaliPublic ft It. 1 nl.
QGeothcnnal(Heating Cooling Supply) Residential Water Supply(surge) fL ft j n. } y--
�lodus�taL'Comctercial ResideD:iat Water Suppiy lsh.redl I L.—_
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tin ation FROM TO I MATERIAL EMPLACEMENT METHOD.a.LVO1 7
Nun-Water Suppl Well: ft. ft. i I
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Injection Well: _. _---.—.
Q Aquifer Recharge nCiroundwatet Remedialtor. rt. 1 ft. 1
19.SAVINGILL VEL PACK ft/Inpbabk) il
17/Aqu•fer Storage and Recovery DSalmiry Barrier ►Rost l Tn T ?UT ERLLL EMPL.aC FME'cT%IS Hoc,
rpAquifttTest DStormwataDrainage h. h. 1 _� ___i
173 Experimental Technology Subsidence Control ft. ft.
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IDGeotherma'(Closed Loop) QTncer 28.DRILLINt LOG(attack ailditiendsled►31"e w4'
FROM TO +D►SCR)PTION color. :utyrik000L t fw r.i.laar'rttI
Geothermal Mention Conlin Return) Other(es lam under 42l Remarks) tt. (O6 tt. r\f 1 c`i \
4.Dale% ell(s}Completed:.-5-1 d- Well 1Drt F()6 h. ? . _,.„.1
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So.Well Locati : )L.s hvtls� It. rr8�f--'� �` 0Q4 iUsr..C , ! �j46 �,� ft.
Factltty'Owrur Same Facd icy LDa of applicablel
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Physkal AdGcis,City,act zip —T --:-1
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County V,.rcd 1Jeni,ficntlon No iPIN) ------- "—'" —_—_
5b.Latitude and longitude in degreesimioulwsecunda or decimal degrees: __--
(if well sold.oro lu;:on4 a auf`c.ertj .:-Ce[ tt/qn '
71..L.,
N W S, /CI -
iisL.lun:tf C,.-nifia G+na..tot Dst.
6.ls(are)the weUU)alPermaneot or °Temporary
9i vgning:ha form.1 hurt;•:en()that the oCl/lO i.Qt r.rrc'cewuncied In accordance
No ..:h 1 sd•'(.lC 02C(t1Al)ur I i.t 5L.aC NC (J200 AtliCunanvurun Stutih,,la nnJ that a
7.Is this a repair to an existing well: 01'es tar{f��j u� ,;tb.arrc�dharhernprntdcdlnthr'rlia.ncr.
11 Gu.1 a trptat,fill our bio.n.ril cant:race:on tnjirnnaflnn LndT.ytian;tic nat.,':7:hr
irf.oir linden as rrr ut'i archon or on;he bat k of rlii.form. 23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or welt
S.For Geoprobe/DFT or Closed-Loop Geothermal Wells lRg the same construction deco Is. 1bu may also notch additional pages if necessary.
construction,only I CrW I is needed. Indicate TOTAL NUMBER of wells
Milled: .?J J SUBIIT1 AL INSTRUCTIONS
9.Total sell depth below land surface: o < (It•l 24a. For All Wells: Subnut this form within 30 days of compiet.un of wet.
Fa,multiple,,rl(°Ica all drprht 1(dtffe.enr P:ra+npdr•?p.'ile"jnd_.' Mr) W65tme Jon l0 the followir.::
10.Stake water level below top of tying;
40 (ft.) Division of 18ater Resources,laformatioa Processing Unit.
If oat..1.4 a al ore cntiny.toe•"` 1617 Mall Service Crater,Raleigh.NC 27699-1617
11.Borehole diameter: 6 1/8 (in.) 24b.For Tnieelion Wells: In addition to sending the form to the address in 24a
Air Rotary aboie.also submit one copy of this fours within 30 days of completion of well
12.Well construction method: a construct:on to toe following.
l I c a...0.tow:).able.diixo p sdi.en..l
_^ Division of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mad Service Center,Raleigh,NC 27699-1636
13a.Yield(gpm) Method of test. An'glow 24c.Put 1Astet Stools 4 Injection Wells: In addition to cendutg the fan to
the addressees) a cove, also submit one copy of this torn within 30 days of
Chloe Taos 1 11=1.ZIa completion of well const uenon to the county health department of the county
13b.Disinfection type:_ Amount: "
vino.:con soucto.l.
form OK-I Nort'*Cuor,w Depalnrrm 3!Ernrronnxn:al Qurhn-Paunm of w'met Reaaren
Revised 2-22•:Ot8
Memorandum
May 26, 2023
To: Woodrow Adkins
From: Megen McBride, Environmental Health Administrator
Re: Well Head Inspection Not Complete: WELL-04-2022-169062,
Site Address: 9633 Mull Rd
Catawba County Environmental Health permitted a private drinking water well at the above
address. Our records indicate that we have not be notified that the well has been put into use
and is ready for water samples to be collected.
If your well is ready for final inspection and collection of water samples, please notify our office at
the contact information below.
There is no need for you to be present for our inspection. The water samples are collected from
an outside spigot. Please note, however, that the well head needs to be accessible. Please
remove any locked well covering or insulation barrier so that we can visually inspect the well for
compliance.
The fees for the well inspection and water samples were included in the cost of your well permit,
so there is no additional charge for this service. The water sample test results will be mailed to
you once they are received by our office. Typical process time is 4-6 weeks.
Please contact our office if we can answer any questions or provide additional assistance. You
may reach our office at (828) 465-8270, or by e-mail at: EHAdmin@CatawbaCountyNC.gov
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: Woodrow Adkins Sample ID Number: 169062
Location: 9633 Mull Rd,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
TpT,.. Private Well Information
and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name:I Woodrow Adkins—9633 Mull Rd, Vale NC 28168
Sample ID#: 169062 Reviewer: Megen McBride 1
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 Moronic chemical results only.
❑ Arsenic ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper ❑ Fluoride ❑ Iron
❑ Lead n Manganese n Mercury ❑Nickel n 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. LI 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 he 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 ❑ Silver LI 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.
❑ 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 .
For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.