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HomeMy WebLinkAboutWELL-05-2022-170691.TIF I Print Form WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: 1.Well Contractor Information: 1 J l J C k Ii WATER ZONES - _ - - _ - C:II Co,Uaelonnk.: � F�WUM f6I( Ilt l. j DESCRIPTION ____.___ as - ,a ,k . It. f \Ctle1(.ranaiG'iCt•rnfi[i;itll!matter i IA.OL7ER CASING troymulticasedwelt)OR LINER litsppakable) Lace (f1U1'rrly �,+ ,(. {1 sRu\t ru nrtifrrrt 1111SALsrss ! NITFRNi rap_ �`.. GAF f. _._ Ci•+np..:1d\"1 ...le.INNER CAS11G OR TCREAG(teateermd timeddaop) i _FROM T TO Dftl ETER THICKEN 1 MVIERtar. I.Well Construction Permit n: hi, ` toy {° '• I.,.t an,Lf :L ir:, ...!leon,7rw.fi,.n p.rour+.1 L. Lit Cuunrt'•Stull.i'N1l/r�.: f i I i �, t d�'! • It. ft. I la I 3.Well Use(check well use): 1 l 1 - 1 ri7.SCREEN - .__T_...___:..._-._._— __..._r.._.._ Water Supply Well: I Fitfmt TQ !DIwtETr.R MLOT MUE TIIICKNEs , MATE.RI.AC Agricuiturat ° iicipal-'l'tthiic ft. rt. 1 in j Geothermal i 1 teating Cooling Supply) Kc.ittentiai Water Supply(single) .±--;- in, t. lndustria6'Commcrcia) °Rcsldentiai Water Milt sty ish[;TC,il toy.CROI'T t RUN U w Al i,1I.I I t CME'ii\MLTiIOD&ANO(\I i Initiation 1 -- it. ft. (fJr`t` ,,,a, Nan-Water Supply'Well: ' -�tor a �� iy � i f 1 Monitoring DRc twCry it--. A. j __i injection Well: l !l. I u. i Ayuticr Recharge °(iluundwalcr krmcduf,o t 1' 19.SA\D.GR*AEI.PA(K fit ieaMe) --- :Wines Storage arid ltccetcry DSahntry ll.::.et t jitn\t ; TO M141111 tr EMPt.\t EMI'il\H.lnon—__., :\yusterTe•:t °StormwatetIhaina e I ft• i b. i.xperimenta:Te hnology °5ub.idcncc('crew,: r — k. j - ft. t I Geothermal I('host-)Loop) °tracer 20.DRILLING 1.IK:(attach additional sheets if penman) FROM 1 10`__ t mYrk1rr10 ftdur_hudnrw.nit ruck npe.jnls she.tic.) ( otl:cmtal rlieatinµ C.t.tlin•Reiu:t:) °Uurcr ic-cpl:n::und.r 2:' Ke'?uf-t.$) I;--fr. Jf� fe. l it. _... n 4-Date Well(s)Compietcd: JiiI3 _ „CII II)._ _ , -!--.y' i 4 11. I C s Sa.%Srll i.oc tiun: __- .---_ S.__.. •aiw.d .it(t5Lq— ._.... ...9s h. ; (a 5 1,,, . - — F'..al,ty l't .:,.. A. tt. i C�f b :�n�b1 ft) C c (r� re.. V.,h__ J'ksa.;,i %JJr.'...Cad..old•/p it. tt. i 1 __ i 51s.I.usitodu and hanKltude in degrees.tninutes'seconds or tit:cintal tieVecs: -------`- -- " ' ... cis.afiic:oa r 22,Certifi.rtinn: 351i�C �31 �+' >v ? G11 OV6.fs(are)the neU(s) l Permanent or °Temporary 'voided 'ell(' -- 7.Is this a repair to to existing%en: °Yes or 1.\o I:rin,n.:',pap.Iiil nu!Ineroao.11.,mct•u,tin"infrm:,tiwa and tepr,:n,%:..-..ur.., •. r,...,•a.1I.•1'. ., . rat,,.r..r.4'r 21 rcw,arl.s whoa of ra:the lw,l.,r ass r„r.r. 23.Site diagram or additional wen details: You may rue tits back of this page topluyide additional well site details or well8.Far Geuprabe-DPT or Closed-Loop Geothermal Wells having the same c.:astr::ctior.,only I GW-1 is needed. Indicate TOTAL NUMBER awes construction.details. You may also attach additional page.~if necessary. dented__- __ 1 cS SUBMITTAL INSTRt'CTiO'% 9.Total sell depth hems land surface: (If.) 24a. Far All Wells: Subm!t this form within 3(1 hays of eotnpi:tion of we if l , . . ;,1rn!h.itdf!'..r,•,,..,.sp'r•iii_b) and:ulfrft s.,•tr1J.til,:to the following. M.Static water level below top of casink: 50 (ft.) Division of Water Resources.Information Processing Unit. ;, :erel I.a.- .now.I... 1St/Man Service Center.Raleleh,NC 27699-16l I I.Horrhole diameter: (4' (in.) 241).For iniretion Arens: in addition to.ending the form to the addres.in 24a tr 12.Well rutr+trucHan method: , ij-/ above. also submit one copy of this loon within 30 days of conviction of wdl ct,nstntctiort to the lollrnsing: e.1.:. ,nr.y.c.tn:c.d,n.•et pu•1...1., Division of Water Resources.Underground injection Control Program. +FOR WATER SUPPLY WELLS ONLY: 1636]tan Service Center.Raleigh.NC 27699-1636 13a.Yield(spin) aPt-J:4('a-- 24e. rrr Water Sunnis &IRiectiull Wells: In addition to sending the form to Method o1 test; j ,f the address(es) above. also submit tine copy of tuis limn within 3t1 days of 13h.Disinfection type: Glrryv JI_- Amount: sK> 2.. completion of well cunsltuetion to the county health department of the aunty I where constructed. 1.nil(RV-I Knt:h I.avhae 1ka.:7::,!enr of Ftnaamr.•ae,:(,I.:-.hty-nn,:wr,a:'11 afar R:,.a:r.e. Rd tu.\'2.27.2016 WELL.- Os- 1W - «O6a[ CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section (t'"( i)„ WATER SAMPLE FIELD REPORT & TEST RESULTS Owner: NORWOOD DELANEY, NORWOOD JAKE WILLIAM Owner's Address: 1046 ARABIAN CT,CATAWBA,NC 28609-8830 Phone#&Email: 33 /' ?O n— ©ROO Site Address: 1046 ARABIAN CT, CATAWBA, NC 28609 Parcel#: 471003328620 Subdivison: LAKE NORMAN WOODS Sample Collected By:r-PW i S Pk.;; e„` Date/Time Sampled: / /O 3/25 /0 5-7 I!'I'1 Sampling Point: "e11 j Is well head accessible? Yes ✓ No Reason for inaccessibility Well New or Existing? New 7 Existing Type of Well: Drilled f Bored Punch Hand Dug 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 in.above finished grade Well head missing vent Well head does not have a threadless tap Well head missing identification plate or pump tag Wire conduit opening not sealed Other(Comment) Comments: • Lab Coliform Analysis Results: Total Coliforms: wow*r Fecal/E.Coll: O,I ral- No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials: ' ' Date/Time Received:' V '0 !.J' Date/Time Completed:\ •04• ' 1 U WOO Y RECEIVEU DEC 5 2025 Environmental Health Analytical Results STATESVILLE ANALYTICAL Catawba County Public Health PO Box 389 Newton, NC 28658 Receive Date: 12/04/2025 Reported: 12/08/2025 For: Delaney Norwood: 1046 Arabian Ct, Catawba NC 28609 Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 251204-17-01 Nitrate 170691 <1 mg/L 353.2 12/04/2025 MD 251204-17-01 Nitrite 170691 <0.1 mg/L 353.2 12/04/2025 MD Respectfully submitted, ��i7e4 0i Melissa Myers NC Cert#440, NCDW Cert#37755, EPA#NC00909 PO Box 228 • Statesville,NC 28687 • 704/872/4697 Page 1 of 2 va...1; _ .. .. _ 122 Court Street Statesville,NC 28677 704-872-4697 www.sa-nc.com . ' _ NT RATE) 1 rRwt;ANALYSIS . . N=Lnbaratuica r..atbeatppne3 lrsco yfa¢e e¢:t WATBB.SYSTT...dt ID#F: WELL? O S� 0').'1—17 0 C c1 f County: Catawba • Name of Water System: '4- ea-.e_1 f r co( - Sample Type: ❑EntryFeint i.54Specia1/Non-complinwPP ` Location Where Collected: I0 . Pt c Q.10 i t'`s CI"1 C -0,1A,loges N C a g60LI Facility ID No. 1'7 0 C Ol 1 Sample Point: W C LI II Collection Date II Collection Time Collected By: DP 31A - 1 n',ik2A1 f 2j63I ` /0: 7 m {ewer,-;) (aw.mer m) (sa_Itr''-�ter.idd) • Mail Results to(water system representative): • CATAWBA COUNTY PUBLIC HEALTH phone#:is(828)465-8270 ENVIRONMENTAL HEALTH Fae#): I(828)465-8276 - , PO BOX 389 Res?onsible Person's email: •EHAdmin@catawbacotlntync.gov NEWTON,NC 28658 LABORATORY ID#I: 37755 - 0 SAMPLE UNSATISFACTORY D RESAT PLE REQUIRED CO:YTA.M laTEOD REQUIRED LE DETECTED QUAt1T1rLFD • ALLOWABLE CODE CONTAMINANT • CODE R�xO� LIMIF (Le. RL) RESULTS* LIMrr• 1040 . Nitrate 3532 LOU mg/L 3/ . . . _____ mom. 10.00 mg LL.. 1041 Nitrite • 3532 0.10 mg/L 0 ^_______ mg/L 1.00 mg/L *Note:L result exceeds allowable limit,the laboratory must fax analytical results to the State on day test completed. . t DATE: Tom : - i ANALYSES BEGUN: L/ ! n(I 1_I • Ll :?l,? M �yYyp eesc.r� ADM f• ANALYSES COMPLETED: �� r 5 1�: ./ =a ;,,�.,0 y 9 - r L-1(Laboratory Logy* 2519 DU- t1-U 1 Cm-tined By: \✓ - fx. / O COMMENTS: . 2008 - Laboratory should Mail Results to: - Public Water Supply Section,Attn:Data Entry,1634 Mal Service Center,Raleigh,NC 27699-1634 PO Box 228 • Statesville,NC 28687 • 704/872/4697 Page 2 of 2