HomeMy WebLinkAboutWELL-04-2022-169155.TIF -j✓l. 'i/ed 81/-zz-
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
I.Well Contractor information:
Chris C Russell 14.WATER ZONES
FROM TO DESCRIPTION
Well Contractor Name ----------
3254 A 60 ft, 345 ft.
ft. ft.
NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(If ap liable)
Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL
Company Name 0 ft. 86 rt. 6.25 In. SDR21 PVC
WELL-04-2022-169155 16.LYNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
Mt all applicable well construction permits(i.e.WC,County,State,Variance,etc.) ft. rt. in.
3.Well Use(check well use): ft ft. in.
17.SCREEN
Watcr Supply Well: FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
OAgricultural ❑Municipal/Public ft. ft. In.
❑Geothermal(Heating/Cooling Supply) %Residential Water Supply(single) - .ft. ft. in.
❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT
❑Irrigation ❑Wells> 100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' 20 ft• Grout Poured
❑Monitoring ❑Recovery ft. ft
Injection Well: ft. ft.
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(If applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft,
❑Experimental Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets If accessary)
Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(valor,hardness,soil/rods type,train slu,etc)
❑Geothermal(Heating/Cooling
E 0 R. 81 it Dirt
4.Date Well(s)Completed: 7-12-22 Well ID# 81 11- 345 it Rock
5a.Well Location: ft. ft.
Clayton Homes ft. ft.
Facility/Owner Name Facility lD8(if applicable) ft. ft.
2885 Wilderness Trace, Claremont, NC 28610 ft. ft.
ft. ft.
Physical Address,City,and Zip
Catawba 21.REMARKS
County Parcel Identification No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/lung is sulTicient) 22.C fication:
35' 80.026' N 81' 16.463' W 44:1 )L f 8/11/2022
6.Is(are)the well(s): %Permanent or ❑Temporary Sr tore of Certified Well Contractor Date
By signing this form,I hereby cent&that the well(s)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or ONo ISA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy
If this is a repair,fill oa known well construction information and explain the nature of the 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/OPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
construction,only 1 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.'I'otal well depth below land surface: 345 (ft.) Submit this GW-1 within 30 days of well completion per the following:
For multiple wells list all depths if different(example-3(W200'and.'a,100')
60 24a. For All Wells: Original form to Division of Water Resources (DWR),
10.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
If water level is above casing,use"4-"
11.Borehole diameter: 6,25 (In.) 24b, For Infection Wells:Copy to DWR,Underground Injection Control(TUC)
Program, 1636 MSC,Raleigh,NC 27699-1636
12.Well construction method:Air Drilled
24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed
FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA
Permit Program,1611 MSC,Raleigh,NC 27695-1611
13m.Yield(gpm) 1 0 Method of test: Air
13h.Disinfection type: HTH Amount: 1 CUB
Form G W-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: Ebony Young Sample ID Number: 169155
Location: 2885 Wilderness Trace, Claremont NC 28610 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.)
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.
X 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
/STD: °4. Private Well Information
' '.el e
. and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba 1 Name: Ebony Young- 2885 Wilderness Trace,Claremont NC 28610
Sample ID#: 169155 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 ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper [' Fluoride ❑ Iron
❑ Lead [' Manganese ❑ Mercury ❑Nickel ❑ 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. ❑ 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 on(v, 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 ❑ 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/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 he 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 ul Public Health at 919-707-5900.
. +'•ems
Total Coliform
Bacteria, E. coli •
& l V
PRIVATE WELLS h 3
What are total coliform bacteria
and E. coli? t.`
Total coliform bacteria are a group of microorganisms found
in soil and surface water.Total coliform bacteria water tests 4,
look at all coliform bacteria in water.This includes fecal
coliform bacteria,which are a group of bacteria found in the
intestines and feces of animals and humans.
E.coil or Escherichia coil is a type of fecal coliform bacteria.
There are many strains of E.coil. When should I be concerned
about coliform bacteria or E. coli?
How does coliform bacteria and You should be concerned if coliform bacteria or E.coil are
E. coli get in my private well water? present in your well water.
Rain may wash coliform bacteria or E.coli from soil on The NC Department of Environmental Quality
the surface to groundwater.Coliform bacteria or E.coil developed a groundwater standard of 1 colony of
can also enter your water if your private well is poorly coliform bacteria in 100 milliliters of water(colonies/
constructed,cracked or unsealed. mL).Ground water standards are developed to protect
public health.This standard was developed in 2013.
How can coliform bacteria The US Environmental Protection Agency requires
follow up testing and treatment when coliform bacteria
or E. coil affect my health? or E.coli is found in any public water supply system across
Most coliform bacteria and E.coil strains will not make you the country.Public drinking water guidance are based on
sick.The presence of some types of coliform bacteria in the public health protection and cost of treatment/testing at
water signal the presence of feces or sewage waste. Feces large utilities.These rules were established in 1989 and
and sewage wastes are usually the source of the disease- updated in 2014.
causing organisms.
Total coliform bacteria and E.coli water tests are used as How do I test for total coliform
indicators for the presence of disease-causing organisms. bacteria or E. coil in my
The following are some disease-causing organisms or
pathogens that could be present in your water: private well?
• Bacteria that cause diarrhea and vomiting, Use a certified lab to test your well water for coliform
• Protozoa that cause dysentery, bacteria and E.coil every year.Contact the private well
• Viruses that cause polio and hepatitis,and program at your county health department to assist you
• Helminths,such as roundworms and tapeworms, with getting your water tested.Pricing of testing varies
that cause chronic diarrhea. from county to county.
- --
Percent of Private Wells Tested '�� �� � ��, t
With Detection of E. coli, 2011-2013 ,''� '11q ` W tr
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—
Percent of Private Wells Tested With , �__ / to:„
Detection of Total Coliform, 2011-2013 �_ }� it
to:„
} -
imr
111, el
- >50%with detection EN ►' —
- 25.1-50%with detection L_
-AO It idt.
Vr
<25%with detection
0%with detection my
Insufficient data(<10 wells tested)
What if total coliform bacteria Where can I find more
or E. coli levels are present? information about total coliform
Shock chlorination is a method to remove bacteria bacteria, E. coli and my well?
contamination in private wells.If contamination persist Visit the NC Division of Public Health's Private Well and
you can install a treatment system to reduce the levels Health Program website:htto://epi.publichealth.nc.gov/
of bacteria in your private well.Treatment systems that oee/orograms/wellwater.html.
reduce the level of bacteria in your well water include:
• Ultraviolet(UV)filtration treatment system There you can find:
• Contacts for your county private well program
You can also reduce your exposure by using bottled water • Total coliform bacteria or E.coli in well water maps
or connecting to public water supply,if possible. • A guide for selecting a treatment system
• Other private well resources
Where are total coliform bacteria You can also call the Private Well and Health Program
and E. coli found in NC? at 919-707-5900.
Coliform bacteria are detected throughout NC.About 26%
of wells sampled for microbial contamination in NC from Where did this information come
2011 to 2013 tested positive for coliform bacteria.Yet, from?
there are several areas in NC with at least 50%of wells with
coliform bacteria present.See map for areas with high Centers for Disease Control and Prevention:www.cdc.gov/
coliform bacteria detections. healthywater/drinking/private/wells/disease/e coli.html
E.coli is detected throughout NC.About 2%of wells Environmental Protection Agency:httpsJ/safewater.
sampled for microbial contamination in NC from 2011 to zendesk.com/hden-us/sections/203309158-E-coli-0157-H7-
2013 tested positive for E.coli.Yet,there are several areas National Sanitation Foundation:www.nsf.org/consumer-
in NC with at least 25%of wells with E.coli present.See resources/water-quality/water-filters-testing-treatment/
map for areas with high E.coli detections. contaminant-reduction-claims-guide
7%4 y' "'" NC Department of Health and Human Services•Division of Public Health• Epidemiology Section•Occupational and Environmental
N. 1.1 i
Epidemiology Branch•Private Weli and Health Program•htt°s://eoi,oublichealth,nc.°ov/oee/oroorams/wellwater,html•NCDHHS is an
North Gmbh. equal opportunity employer and provider.•09/2019
Puhbr Health