Loading...
HomeMy WebLinkAboutWELL-05-2022-172473.TIF 4.�I'.MN. C ATAWBA('OI I 1 I/ -t. Si Prbltc Health(kpanment CuhJwn,nt Vim • FrvrnaenerualIltshhIhvounn K �1 I•Ihr 3790017}12I] lip, Po Not Ile.ZS frmerntnrnt Drive,Ncwnn,NC' antetill . 1010 PT ti See Mem : 6648 LONG ISLAND RD,CATAWBA NC 26609 Plante en Penult AUSTIN HIRSCH Property ilea: Acres 14 a 1 Directions; Shen,Is Ford Rd.Long Island Rd,Properly on Leh lust past Bolton Rd OwncrlAuthorized Representative Acknowledgement or Permit Receipt ikI certify that I am the irony,or autlsr ireJ aµertt(oorwt's euth.,rirru,m rcgwrcdi represcnung the inner nl the pmperty described alritc yAs the property owner or authorized representative,I have received the above referenced permits)as requested in the application for service RUPR•04-2022-4119314,by die following method(s): Received in Person Facsimile I ransmittal(Return form with signature required) ✓ Electronic Image'1'ransmittal/E-mail (Return receipt required) DCAs 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 ISA.I900y, and/or Well Construction Standards(ISA 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:05/27/2022 Owner/Authorized Representative Signature ,___ ___ Date 7— — Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by . (name of person se Jr l permit) Signature Date/Time 6/ 1) Method; _Fax -4 1 J/ Email _IIS Mall Other Owner's request to send by the above indicated method of transmittal in lieu of signature i We wants tto hear from yosPlease stake a few momentts tt0 tomplette our custtomer service survey ett http://www.surveymonkey.com/s/t H Cu sttOmerSery Ice / ,( 1E1Utt-M1^t- • 6IY) . • .............ou ye 44, . CATAWBA COUNTY Case# WELL-05-2022-172473 .t.Ilk "4(t Public Health Department Subdivision Environmental Health Division PIN 379004734223 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# PT 6 Site Address: 6846 LONG ISLAND RD,CATAWBA NC 28609 Name on Permit: AUSTIN HIRSCH Property Size: Acres 14.81 Directions: Sherrills Ford Rd, Long Island Rd, Property on Left just past Bolton Rd NEW WELL PERMIT REQUIRED WELL SETBACKS: Septic Systems and Repair Areas for Single Family Dwellings 50 ft. Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft. Underground Storage Tanks 100 ft. Animal Barns 100 ft. Lakes/Ponds 50 ft. Streams/Brooks/Creeks/Rivers 25 ft. Building Foundations 25 ft. All Other Sources of Groundwater Contamination 100 ft. Saprolite Septic Systems and Repair Areas 100 ft Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft. Wells shall be constructed in accordance with state regulations: Article I5A North Carolina Administrative Code Subchapter 2C The well driller must verify all setbacks before drilling the well.If the well driller is unable to maintain any of the above setbacks,contact Catawba County Environmental Health at 828-465-8270,before drilling the well. Grouting Depth:20 feet minimum Casing Height: 12 inches minimum above finished grade All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private Drinking Water Well Testing(15A NCAC 18A.3800).The fee for this sampling is included in the cost of the well permit.It is the applicant or property owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health. 1/ L)73 05/27/2022 Authorized State Agent Permit Issuance Date 5/27/2027 Permit Expiration Date chpennit 06/08/2022 I1:31 Catawba County Environmental Health 5.00 4A a A D 1 s :-J A 0 N I\ n •i oh : .d,�,ta5 LA >, � � - - -� ti u - ,.1 �'� o� l51 3 a ` ` .c y tow' r - `~rA =! z . 4, 4 _.9 Ws',553 t5 r• • c ti •1050 l 1. 241. t' C Parcel: 379004734223, 6848 LONG ISLAND RD t 11n=60ft CATAWBA, 28609 %, L,, a.t,t_ 5 . -y z _ l 1 1- tt 1 3 A url. 5 - 27, - I ? 1— 9iLi This map/report product was prepared from the Catawba County,NC Geos aUal Information Services. Catawba County has made substantial eons to ensure the accuracy of location and labeling Information oonti lned on this map or data on this report.Catawba County promotes and recommends the Independent verification of any data contained on this ma report product by the user,The County of Catawba,Its employees,agents.end personnel,dsdaimtt and shall not be held!labia for any and an damages,loss or liability,whether direct.Indirect or consequentld which wises or may arise fru'n this rnaDirannrt ram/Carl ry th.I ma thar.ni by any manna%nr..Yku 5/26/22,2:30 PM about:blank WPDT Report Area of Interest (AOI) Information Area : 3,134,508.63 ft2 May 26 2022 14:27:05 Eastern Daylight Time I 4 � D. D. 41'e o�` ♦Tp1 C • 7 sa 1 9.028 C DOS 01 0.c, Non-System Roads — Other State Agency Route I ' . . 1 t • Federal Route — C C.I 0 2 0 1,I* Secondary Route lion System Primary Roads Other System Roads — Interstate gCSOr;.-.I,net Anu1 0:J.Gi 410.4.M1A C.",4R No9npn.ste.s Iva OS NU.A Glwaav"..r T;Y14,iM4II]I 0S4 — Ramps Rest Areas,Non-MalnlIne — US Route ua..a •LMA_Iroyrap PO ma 04 uw cvnn,r,; 9v91 e1. NEM Gal r. IAO A04A US3-C 00115LMCU0=temAve i'IC In* Projected Route OS'Joe,Con'rn. , NC Route ebout:bFank 1/2 5/26/22,2:30 PM about:blank 6846 Long Island Rd 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 andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and attribution of GIS features and makes no warranty concerning same. about:blank 2/2 ( (?)-) - (,-(' ( lc)- y�.`�;�? •• • Print=form WELL CONSTRUCTION RECORD 1GW-1 t For internal Use Only: I.Well Contractor Information: jj ci actz 4 f tf onJ s/,vc'i, 14.LLWATER ZGNES •.c . , well Contractor Name FROM TO DI;eCR1 P'rinK rr. I n. , ilk N ' ell CoullactorCcMiti110nmNumber I n •:�11:f�1UT RAGA f ( -IIZIiti Pwulls�.()R,:IINEIt(trap Nca6te) :_.. � ',\,„Jj„a� r _ ��^J („{,I FROM TO nl f 0 TDICKNESS MATERIAL ERIAL t I,rLl(.,1�(,•Y �jJ[! (,r I (((,,,,,,4 7A n. (�. ft, In. Company Name hhll"''�� j 4��j V 17L III ,j � � j� S/�etCd"( (lt� '.t6:INNER( ING OR TURIN (Eepl�eeraial fffosed.4 p) 2.Well Construction Permit"f LI` FROM To DIAMETER THICKNESS MAI ERIAI. ..... List all rrfy,ArulAr nx•!1 nueva+avian i,e•rnrrr,(le U! .Cuomo.SYntc tar inter.or.) n, ft. in. J.Well Use(check well use): ft. n. M. Water Supply Well: 17+SCREEN .... .-' .. mom 10 IHRMIIIN tr MOI sin. TIIICKKKSS sum CIii ti. Agricultural 0 M a n icipaliPublic tr. n. In. I. Geothertnrl(1 Watng/Conlin Supply) EKtilential Water Supply(single) ft. n. :t — _______I ; OInlustrial/Commcrcial Dtidenlial Water Supply bared) AsGRovT,'.. ",;`r' <1 ',irrigation FROM TO IERIAI. Flie,.tlP1.ACFNILNT sleilOD&.5MG(,5I : Non-Water Supply Well: fr. n. lels OMoniloring 0ftttitwery ? n. n. injection Well: ! _. .__......_.....m._._..................__._ n. rt. Aquifer Recharge 0Oroundwalcr1'lemcxliation 19.SANWCRAYBGPACIyhfpppdill r11tt EDAquifer Storage and Recovery Osaliuity Barrier FROM 110 MATERIAL !`,IPLACEM NI MEIIIOn ()AquiferTest QStomtw•aterDrainage ft. n. --- QBl:xperimenlulTechnology OSubsidenceControl n. n. G wdlcrmal(Closed Loop) Tracer 20,DRILLING LOG•(atlrclr sdditfmlrlabeetslrnleeuary) c' •, Geothermal Flealin Conlin lwoat To PESCRIPTtON puler.aarane,r,w(Bmtklniuraln Orr.err.) l ly g Return) ❑Other(explain under#21 Remarks) `Ihi S dodri �, li n. n. rQ afPears,b be. 4.Date Well(s)Completes: Weil IDk n' n' I? -4- r an errac. sa.Well Locanon: tl '. > U 'n stir �i ft. p n. EN records _ i _____. Faetlirv.'t)wnei Nanlc Facility ID"(it'gpple nblcl ft. ft. indi e L&Li LQ �� G�1?f d C A li' n. n. dorle dri Iles Ph►�__A A�tirees.('ilv,ern zl rt. - ......_ ___._ wAs)oIh1I? . pit 37140DY731/.)23 =2i,:Rl&MAiiKs' MrCounty Parcel Identification No.(PIN) _.__...._..__............_._....._._.. Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: Gfwcll field.one 1st/fang is sufficient) 22.Certification: 3529 LiS I N tl-S I .`DI 4.t U W le)g/ a 6 Is(are)the wells) ermaneaf or ()Temporary Signature of coined Well Well C� Dale Ry signing ehAA limn.I herehr crayift•that the nr11(.c)tune,(were)r'.rnna'aeted hi a[ronleace 7.Is this a repair to an existing well: ©Yes or late with JSd NCO*02C.0too or ISA NC.tCOSC.0 00 Well forums:rlon Standards and that a 1/hhi,!a a month'.fill out Inunn wv11 am..:nre/inn huj/n'neulBm and ory>lain the eatery r f the ropy nr/his,vein'.!has brew yrnviddd in th:'turfi nw,ter. re/arir IMAM'Or:I remark,Iet'rian Or al the bad(V Mit'form. 23.Site diagram or additional well details: S.For Geoprobo/DPT or Closed-Loop Geothermal Wells having Ow same. You may use the back of this page to provide additional well site details or well construction,only I OW1 is needed. indicate TOTAL.NUMBER al wells construction details, You may also attach additional pages if necessary. drilled: ,SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: ! E D (ft.) 24a. For All Wells: Submit this form within 30 days of completion of well l.'.nntop/,•Men.lia all depths i(dllkeens/elample-df.'Ihl'no,!?Al IN1't construction to the following: 10.Static water level below top of casing: (ft.) Division of Water Resources.Information Processing Unit, 1(oarrr,io,rl rs,rhne•onsing,we . MIT Mall Service Center,Raleigh,NC 27600-1617 I I.Borehole diameter: i Yn (In.) 24b.Fur Infection Wells; In addition to sending the form to the address in 24a l�ss�" y above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: f <JIW 1� construction to the following: tie,auger,rotary,cat*,direct push,etc.) Division of Water Resources,Underground Injection Control Program, FOR WATER St;PPI.Y WELLS ONLY: 1616 Mail Service Center,Raleigh,NC 27699-1636 • 13a.Yield tgpm) ! t Method of test: 0 I I"- 24c.For Water Sunnily S.Infection Wells: In addition to sending the form to the address(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: ? Amount: I � _ completion of well construction to the county health department of the comity where constructed. Form fiW•I North Carolina Department of Environmental Quality-Division of Water Resources Revised 2.22.2016 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: Austin Hirsch Sample ID Number: 172473 Location: 6846 Long Island Rd, Catawba NC 28609 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 i, Private Well Information . ,‘I,, , 4.4416.140. and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Austin Hirsch — 6846 Long Island Rd, Catawba NC 28609 1 Sample ID#: 172473 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 Inoreanic 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 jnortmnic chemical results only. ❑ Arsenic ❑ Barium ❑ Cadmium ❑ Chromium 0 Copper El 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. ❑ Chloride ❑ Copper El 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 be used for washing, cleaning, bathing,and showering based on the InorL'anic chemical results anlr. El 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 . For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.