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Home My WebLink AboutWELL-05-2022-170676.TIF t _a CATAWBA(:Ot1NTY kill) Public Ilealth Department Subdivision SPRING ECHO Environmental Health Division PIN# 362916933579 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1-10 Site Address: 1965 TODD ST, NEWTON NC 28658 Name on Permit STEVEN VANG Property Size: Acres 0.95 Directions: TR onto Hwy 10 TL onto Sigrnon Dairy Rd TR onto Shady Ln TR onto Barringer Circle TL onto Todd St Owner/Authorized Representative Acknowledgement of Permit Receipt S•v 1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. XSVAs the property owner or authorized representative, I have received the above referenced permit(s)as requested in the application for service RBPR-03-2022-40379,by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) JElectronic Image Transmittal/E-mail (Return receipt required) i' S.V As the property owner or authorized representative I have reviewed and understand the specific conditions T 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(15A 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:05/04/2022 Owner/Authorized Representative Signature ` Va..1 Date 05/09/2022 Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sending perms!) Signature 0 9 Date/Time5l1/d Method: Fax I 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 yosPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService 5fn. VQ#S p1t a 3'fit4-4. am i.i,.„„, 03n0412022 1415 WELL CONSTRUCTION RECORD(CW-I) For Internal Use Only: I.Well Contractor Information: Chris C Russell 14.WATER ZONES Well Contractor Name FROM TO OI CR1PTI0N 3254 A 60 ff. 245 0• rt. ft. NC Well Contractor Certification Number 15.OUTER CASING(for multi-cased wells)OR LINER(if ap Ilcable) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL 0 ft. 36 ft. 6.25 1i• SDR21 PVC Company Name WELL-05-2022-170676 16,INNER CASING OR TUBING(geothermal closed-trap) 2.Well Construction Permit#: FROM TO DIAMETER THICKNESS NI Arh.RIA]. List all applicable well construction permits(i.e.UIC County.State,Variance.etc.) ft. ft. In. 3.Well Use(check well use): ft. rt. hi. Water Supply Well: 17.SCREEN FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL DAgricultural ❑Municipal/Public rt. rt. in. DGeuthermal(Heating/Cooling Supply) El Residential Water Supply(single) H, • ft. In. ❑lndustrial/Commercial ❑Residential Water Supply(shared) 18.GROUT ❑irrigation ❑Wells> 100,000 GPt) FROM 7O MATERIAL EMPLACEMENT MET110n&AMOUNT Non-Water Supply Well: 0 ft' 20 rt. Grout Poured ❑Monitoring ❑Recovery ft. H. Injection Well: ❑Aquifer Recharge ❑Groundwater Remediation ft. rt. 19.SAND/GRAVEL PACK(Bapplicable) ❑Aquifer Storage and Recovery ❑Salinity Bonier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑Stormwater Drainage ft. ft. ❑E•xperimental'I•echnology ❑SubsidenceCtnttrol ft. R. ❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets If necessary) FROM TO DESCRIPTION(miler.hardness,sot/rock hpc,grain size,etc.) ❑Geothermal(I leating/Cooling Return) ❑Other(explain under#21 Remarks) 0 n. 31 it Dirt 4.Date Well(s)Completed: 5-16-2023 Well ID# 31 rt. 245 fr• Rock R. ft. 5a.Well Location: Steven Vang Sedgewick Homes R. rt. Facility/Owner Name Facility Da(if applicable) ft. R. 1965 Todd St., Newton, NC 28658 n. IL ft. H. Physical Address,City,and Zip Catawba 21,Rh:MARKS County Parcel Identification No.(PIN) sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field one latilong is sufficient) 22.Certification: 35' 63.567' N 081'256.56' W 6/1/2023 6,is(arc)the well(s): ( Permanent or ❑Temporary Signature of Certified Well .ontractor Date By signing this form,I hereby cerrify 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.02(X)Well Construction Standards and that a copy If this is a repair,fill out known well consu'actiott infbrmation and explain the nature ofdre of this record has been provided to the well owner. repair under tl21 remarks section or on the buck of this form. 23.Site diagram or additional well details: S.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info construction,only I 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.Total well depth below land surface:245 r (ft.) Submit this GW-1 within 30 days of well completion per the following: For multiple wells list all depths if different(example-3,tv2oti'and 21(4100') 60 24a. For Al Wells: Original form to Division of Water Resources (DWR), 111.Static water level below top of casing: (ft.) Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 If voter level is above rasing,use"+" 24b.For Injection Wells:Copy to DWR,Underground Injection Control(RUC) 1 I.Borehole diameter: 6.25 (in.) 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 ot'the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPO:Copy to DWR,CCPCUA I 3a.Yield(gpm) 15 Method of test: Air Permit Program.1611 MSC,Raleigh,NC 27699-1611 13b.Disinfection type: HTC Amount: 2/3 cup Form OWI North Carolina I)epnrtment or Environmental Quality-I)ivisiun 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: Steven Vang Sample ID Number: 170676 Location: 1965 Todd St,Newton NC 28658 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 Ai ;"..'sA Private Well Information ,ii\\„... and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Steven Vang— 1965 Todd St,Newton NC 28658 Sample ID#: 170676 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 n Copper ❑Fluoride n Iron ❑Lead ❑Manganese ❑Mercury ❑Nickel ❑Nitrate/Nitrite n Selenium n 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. ❑ Chloride ❑ Copper ❑Fluoride ®Iron n 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/l.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/1 and may pose aesthetic issues such as bad taste, odor, staining of porcelain,etc. 7. ❑ Re-sampling is recommended in months,to reinvestigate . I For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.