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Home My WebLink AboutWELL-04-2022-170115.TIF �Y1r CATAW BA COUNTY • ___ S41• t: Public Health Department Subdivision GABRIELACRES ,R l s' Environmental Health Division PINK 461602573467 .� PO Box 389,25 Government Drive,Newton,NC 28658 LOIN 3&4 VEX/ so Site Address: 4551 KISER ISLAND RD,TERRELL NC 28682 Name on Permit: *ROBY, INC.,ANDREW Property Size: Acres 0.78 Directions: Highway 150E right on Kiser Island Rd lot on right Owner/Authorized Representative Acknowledgement of Permit Receipt KImo'- I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. KCI--- As the property owner or authorized representative,I have received the above referenced permit(s)as requested in the application for service RBPR-03-2022-40528,by the following method(s): _ Received in Person Facsimile Transmittal(Return form with signature required) 1 Electronic Image Transmittal/E-mail (Return receipt required) kY_I-- As the property owner or authorized representative I have reviewed and understand the specific conditions of the permit issued, and further understand that all applicable regulatory requirements specified under the North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(ISA NCAC 18A.1900), and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and the construction of the wastewater system and/or water supply well permitted. Permit Issue Date:04/25/2022 1 Owner/Authorized Representative SignatureJ LA-)'11Miv f 1 Date S / 1-3 / ., - -- \i,1�i l<I-v,Iel I a6a•wnir��6/y' Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) Signature Ej Date/Time 5(1/1> Method: Fax `r Email US Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from yotPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomer5ervice o+e.vejkdancireivrbbyi lest► J chpenn:I 05/032022 14:14 Fra,_, WPDT Screening Report Area of Interest (AOI) Information Area : 3,134,508.67 ft2 Oct 4 2023 14:43:56 Eastern Daylight Time .\\ .,----k----' .,,,_X 2IT �,vsa r /1(\\//./ 41,1r1c .....\, /...„.„- \ .. • _ YbATak r j `V y __, 1 r_______\\ ____ rYov --7ti O i -.1 4p ---<1 �C 4 cc .- ... . c u s `r7N. .. /i 1:4,514 UST Incidents Non-System Roads o 003 a'1 0.12m1 I ti ti ti ti .� ti ti I 0 0.05 0.1 0.2 km i Low Risk — Non-System Parcels(Polygons)-Parcels Secondary Route �r�--��-11 ,ICDOT GIS Uni.Earl Cammuooty Naee GaMnW»rt Ctv0.y W UnMNn l�_-1 County BoundaryProd,I Conley Stmt.of kurn Cs na Doi U Drs,n$vaaaisp.Alrroson `7 Ezn 41E11e.GorBsn.3a6a ram,GeoTedrroMgies Inc..AIETNPJASA.LAGS EPA NPS US Con avmu USDA.Swrcxs Esc. hrbus DS.USCS, 4551 Kiser Island Rd,Terrell UST Incidents # IncidentNumber IncidentName Address 1 36992 CHEN RESIDENCE 4626 KISER TERRELL 11/1/2011, 8:00 PM 1 ISLAND ROAD All North Carolina Department of Environmental Quality (NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The NCDEQ makes no warranty of any kind,express or implied,concerning this information, including but not limited to any warranties of merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy,reliability,completeness,timeliness,or usefulness.The data is not Intended to constitute advice nor is it to be used as a substitute for specific advice from a professional.Users should not act (or refrain from acting)based upon information in the Data without independently verifying the information and obtaining any necessary professional advice.Users are solely responsible for ensuring the accuracy, currency and other qualities of any products derived from or in connection with the NCDEQ's Data.The Data Is collected from various sources and may be modified over time without notice to Improve spatial and attribute accuracy. The NCDEQ disclaims responsibility for the spatial accuracy and attribution of GIS features and makes no warranty concerning same. UST Section Description of Dataset The Underground Storage Tank(UST) Section's data presented here is representative of two different programs within the Section;the UST program and the Aboveground Storage Tank/Non-UST(AST) program.While the UST data relates only to releases of regulated substances from UST systems, the AST data may be related to a variety of release sources, such as AST systems, fuel tanker spills, illegal dumping, etc.All UST Section features presented in this tool represent locations where the latest reports document confirmed or assumed exceedance(s) of the NC Groundwater Quality Standard and/or the Soil-to-Groundwater Maximum Soil Contaminant Concentrations (MSCCs). Contaminants Potentially Present UST and AST Program Sampling Recommendations: • Volatile Organic Compounds • Semivolatile Organic Compounds • Metals (Cr and Pb) Contact Information To request additional information from the UST Section please contact the NCDEQ Regional Office assigned to the area of interest and ask to speak with a member of the UST Section. A map of the UST Section's Regional Office coverage areas and phone numbers can be viewed by following this link.The UST Section's Regional Office contact information is also presented below. UST Section- Regional Office Contact Information Asheville(ARO)—2090 US Highway 70,Swannanoa,NC 28778(828)296-4500 Fayetteville(FAY)—225 Green Street,Suite 714,Systel Building,Fayetteville,NC 28301(910)433-3300 Mooresville(MOR)—610 East Center Avenue,Suite 301, Mooresville,NC 28115(704)663-1699 Raleigh(RRO)—1628 Mail Service Center,Raleigh, NC 27699(919)791-4200 Washington(WAS)—943 Washington Square Mall,Washington,NC 27889(252)946-6481 Wilmington(WIL)—127 Cardinal Drive Extension,Wilmington,NC 28405(910)796-7215 Winston-Salem(WS)—450 West Hanes Mill Road,Suite 300,Winston-Salem,NC 27105,(336)776-9800 Guilford County Environmental Health,400 West Market Street,Suite 300,Greensboro, NC 27401,(336)641-3771 , WELL CONSTRUCTION RECORD)((;18'-1.1 Fct Literal Use Only. 1.Well Contractor information: 1 Alfred Kiesling Sr 14,WATER 7.0'f . . ' welt Counaetor Name TO ec��, I DE«-RI'Tlfn\ _-� ft. I ciat-rL i11 A!2 fir. ti/, NC well Contractor Cenif canon Number l B & K Well Dulling Inc LI..t,1111Ti tCASING(far my1-mKedwlls)1UV1:W/ER¢r ap> ) FROM I TO Der/Mg T11I00115 i MAO'ittiL 1 CotnpanytiapK 0 rt. s�utk, ft' 61/4 1a• SDR-21 )PVC ei �) 1, �1 t4,•11vMER ea, O fltaoehleatmaf dmebfosp) 2.Well Construction Permit n: O'�l'-y2bta2,2 - ) 7 d l f S I I.1t0al I 10 F uIAM4 rER T11uCKNF..S r NATCRI.L Lai'rill app/(able well, W'Uorr Derma IA UK Cowtn Sene 1•a^.arr.v rat I ft. 1 ft. in. 3.Well Use(check well use): 1 ft. ft. to Water Supply Well: 17.SCRIEEN ' • roost I TO I DIAMETER I SLOT SIZE I fock�tSS 1 st:roost O.&grauhtrai CMunicipel/Public ft. I IL I la GGeahemul(HeatittmCooling Supply) 21 estdcntial Water Supply(single, O. l it. I ia• I Clnducmt 'Contnercial ❑Residential Water Supply(Shared) LRouT ❑Irrigeron CWe11s> 100.000 GPO FROM i TO SiAIER.L EN.<TL.10Er'EnT.METHODit.cartivi I I 'uT-•WeterSupply Well: 0 IL 120 fr- Bentonite Pour ❑Mon ironng ❑ReAovery R. fr. I I ( injection Well: CAquifer Recharge °Groundwaterr Remedtation rt. It. I I BGRIVF1.PA(X6f' k). CAquifer Storage and Recovery ❑Salin 19. ity Earner RUN i.4P` I To ntaTF.RIAi. FNtt t-lCEat LYTFT MHt10 CAquifer Tea ❑Stmmwatrr Drainage ft. ft. OExpenmemal Technology ❑Subsidence Control It. I ft. ❑Geothemul(Closed Loop) OTraca •X IS LUNG:LOGfatacbiae6t:su�L�ce+s:g.euF•r•9• . FROM TO DESCRIPTION-(color.turdn�tot/recit 'rant arse.tree ❑Geothermal(Heating/Cooling Return) ❑Other(explain under a2 I Remarks)_ C rt. r 0 ft• /' r (5•CI/ 4.Date Well(s)Completed^ 7r[Z`� W 1J Dsf Q ft. I rs ft. 1, 2 .5�0i / _ • eix. Well Location:- l/ r(. -c fL v)i/yi�f!rr:L/ , lt/11/4- J ' c� Q lo a 0 it- 17 L.) fr. 111/-4k-t .f f`fr 1d/~7iJ FwiIityrClynirMinx • Facility trrctifapplicable; • l� fL I t1 (t ft I //`!, �1///'/7/L!' - I C+ / r fr. l ft. , I Phyaiui Address.City.and Zip 1 ft. (t w>L a w ( Co 0�,5 !/w 152}.RETdARk3: t. Count PLmeI ldenotc.:aao No(PLN1 - Sb.Latitude and longitude in degrees/minatesrseconds or decimal degrees: v (If rcIl tick.one Iet/long is sufficient) 2.2.Cerrificadon: r 6.13(are)the Trell(s): ❑Permt anent or CTemporarr S. u fCmiaed well cot .7 Dar r• r n4e or. rvned in e<rrvdmx r Lain 3rsi¢n+rig![:l101m..rttrl(.1'frmh'rhwtin��r!l�sltws( /� x 7.Is this 2 repair to an existing well: [Yes or 'Jtio 1 c.a NCAC 0!C.01011 or Ilk AC.AC.22C.0200 JEt/i Coarru rat Standcedt and fr..,a.•on+ j r1w:i a rt'pair•fill tart know veil,»rterrvr•nrvt:,tfannarinn cad evicts,tin note,.-i1"rn• If aria rrc^rd bin been in for.r11 owarr. repair mada-Ol i rn,,aris senora or on the back o(rhs form 23.Site diagram or additional well details: S.For Geoprobe/DPT or dosed-Loop Geothermal Wells having the same You may use the back of this page to provide addinonal well construction info eonseocoor..only I GW-1 is nccdod. Indicate TOTAL NUMBER of wells (add' Over'is Remarks Boa).You may aba attach additional page if neceasc dulled: _ 24.SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: 3 Q3 (f.) For multiple wells liv all depth-if different(cramplcc-3(c'=00 wed 2(d!/00) Submit this GW-1 within 30 days of well completion per the following: 10.Static water le.el below top creasing:40 (fr 24a. For All Wells: Orissa1 form to Division of Water Resources (DWR). (1•In,M In-el is ut4nr casing.gear-}'• ) Infortrarimn Processing Unit,1617 MSC.Raleigh.NC 27699-1617 IL Borehole diameter:6 1/8 24b.For Injection Wells:Copy to DWR_Unaery-ound Injection Cannot(TUC) (in.) Program,!OM 36 MSC.Raleigh.NC 27699-1636 12.Well construction method:Air Rotary 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i calm rotary.cable.direct puiR etc.) county enm ronmental health department of the county where inralled FOR WATER SUPPLY WELLS ONLY: :1d For Water Wets producingover 100.000 GPO:Copy fo WAR,CCPCUA 132.Yield(gpm) Method of test: Air Lift Permit Proyvmm,1ri11 MSC.Raleigh.NC 27699.161 13b.Disinfection type: Chior. Tabs &mount_ 1 1/2 Lbs Form GW l Noah Corolla Departmcot of En,iroemooral Qm.aLtr.Division of Water Roaches Rs.is.b n.tt-Olio 1.1.11,A COCase# WELL-04-2022-170115 i- t 2 CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section Ys`790i) 42 sm 07/18/2022 WATER SAMPLE FIELD REPORT Owner JEFFREY CHANDLER,4551 KISER ISLAND RD,TERRELL NC 28682 C:336-669-1271 Contractor *ROBY,INC.,ANDREW,PO BOX 221416,CHARLOTTE NC 28222-1416 B:(704)334-5477C:7045790843F:(704)332-635I JOSIE.VEGTER@ANDREWROBY.COM Site Address: 4551 KISER ISLAND RD,TERRELL NC 28682 Name of Subdivision: GABRIEL ACRES Parcel Number: 461602573467 Driving Directions Highway 150E right on Kiser Island Rd lot on right Sample Collected by: ilGLe Date/Time Sampled: r('h1l7?- /7.a3e41 Sampling Point: r`i/1(Q -47( Is well head accessible? Yes V// No Reason for inaccessibility Well New or Existing? New V Existing/ Type of Well: Drilled �/ Bored Hand Dug I'u eh Does well meet adequate construction standards from what can be observed: • Yes No Items of non-compliance: Evidence of improper grouting or no grouting Well does not meet a required setback(comment) Improperly constructed sanitary well seal Well head not term at>= 12"above finished grade Well head missing vent Well head does not have a threadless tap Well missing identification plate or pump tag Wire conduit opening not sealed Other(comment) Comment: rsamficldreport 07/I8/2022 14:29 Pale 1 of 2 Case# WELL-04-2022-1 70 1 1 5 CATAWBA COUNTY HEALTH DEPARTMENT 5 Environmental Health Section 75 1842 sM 07/18/2022 WATER SAMPLE TEST RESULTS Owner JEFFREY CHANDLER,4551 KISER ISLAND RD,TERRELL NC 28682 C:336-669-1271 •Contractor *ROBY,INC.,ANDREW,PO BOX 221416,CHARLOTTE NC 28222-1416 B:(704)334-5477C:7045790843F:(704)332-6351 JOSIE.VEGTERctANDREWROBY.COM Site Address: 4551 KISER ISLAND RD,TERRELL NC 28682 Name of Subdivision: GABRIEL ACRES Parcel Number: 461602573467 Lab Coliform Analysis Results: Total Coliforms: d tot_ Fecal /E.Coll: A.44a tt>L No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials Date/Time Received GI 9/1' I -9 Date/Time Completed 04123/2o22 15/.w4- RECEIVED JUL 2 9 2022 Environmental Health r.sam l icl drepon 07/18/2022 14:29 Page 2 of 2 a „ems,,, 4 '' 4312 District Drive ntMSC 19) : . ' North Carolina State Laboratory of Public Health Raleigh,1NC27699-1918 try "°� Environmental Sciences httplislph_ncpublichealth.com • �" ' Phone: 919-733-7308 -. ... Inorganic Chemistry ry Fax: 919-715-8611 Certificate of Analysis FINAL REPORT Report to: ENVIRONMENTAL HEALTH Name of System: CATAWBA COUNTY ENVIRONMENTAL HEALTH Jeffrey Chandler P 0 BOX 389 4551 Kiser Island Rd NEWTON, NC 28658 Terrell, NC 28682 EIN: 566001814EH Delivery: NC Courier StarLiMS ID: ES220729-0010 Date Collected: 07/27/2022 Time Collected: 12:43 By: Blake Perkins Date Received: 07/29/2022 Time Received: 07:39 Sample Type: Raw Sampling Point: Sample tap Well Permit No. WELL-04-2022-170115 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 10 mg/L Chloride <5 250 mg/L Chromium <0.02 0.10 mg/L Copper 0.043 1.3 mg/L Fluoride <0.1 4.00 mg/L Iron 0.16 0.30 mg/L Lead <0.003 0.015 mg/L Magnesium 4 mg/L Manganese 0.008 0.05 mg/L Mercury <0.0004 0.002 mg1L Nickel <0.01 0.1 mg/L pH 7.1 N/A Selenium <0.005 0.05 mg1L _ Silver <0.01 0.10 mg/L Sodium 7.6 mg/L Sulfate <5 250 mg/L Total Alkalinity 57 _ mg/L Total Hardness _ _ 44 mg1L Zinc 1.31 5.0 mg/L RECEIVED Report Date: 08/22/2022 Reported By: /".M.14.271---------'.--"' fi' Marc Komlos Env•1n T f:tn! 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: Jeffrey Chandler Sample ID Number: 170115 Location: 4551 Kiser Island Rd, Terrell NC 28682 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 ^`ErSHo;ten Private Well Information 14 4,1• � and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Jeffrey Chandler—4551 Kiser Island Rd,Terrell NC 28682 1 Sample ID#: 170115 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. n Arsenic ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper ❑ Fluoride n 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 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. n Chloride ❑ 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/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 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 are//water results,please call the North Carolina Division of Public Health at 919-707-5900.