HomeMy WebLinkAboutWELL-06-2022-172826.TIF Y� CATAWBA COUNTY Case
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ik Public Health Department Subdivision
loi EnvirorunentalHealthDivision PIN# 364906276610
ff {,� PO Box 3t9,25 Government Drive,Newton,NC 2R1,58 LOIN
Site Address: 707 SHEA RD, NEWTON NC 28658
Hama on Permit: THOMAS HULLETTE
Property Size: Acres 10.09
Directions: Newton on 10/16, right on St. James,0.6miles,right on Shea Rd, right on driveway at top of the hill,white
house
Owner/Authorized Representative Acknowledgement of Permit Receipt
'ertify that I am the owner or authorized agent(owner's authorization required)representing the owner of
roperty descri. - above.
f' • the property owner or authorized representative, I have received the above referenced
perm' s)as requested in the application for service EHPR-04-2022-40760, by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
VElectronic Image Transmittal/E-mail (Return receipt required)
84 de s the property owner or authorized representative I have reviewed and understand the specific conditions
e 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 I8A.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 permitter
Permit Issue Date:06/03/2022 /�
Owner/Authorized Representative SignaturZ'— •
1 11��
Date L/LPraa
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature _ 4c,_ Date/Time V ((ii?)
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 yo4Please hake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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Catawba County Environmental Health
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Parcel: 364906276610, 707 SHEA RD NEWTON, lin=50ft
28658
This nsap,re.ort prodixt mos prepared from Are Catawba Coolly NC G os atul Inkxmanon Services Catawba County has made sutastanbat efforts
10 eristxe ere eoctaacy of tocatax+and t teIrsj urtoYTr..itian Come od on airs P1.311 or data on this report CaL7Nt+a County promotes and tecmmends
the rideperroerti Mahon or any data ofiriLuned on e s rhonietxrt prpduct C'y tM user. The County of C t tia.its erripicyees,agents.and
personnel.o:s.,nar,+_anC sha4 not be h td ratite t x any arsi aft...><+a ryei.kiss or sab*ty,*+wirier direct,indirect to consequential wAch anses cc may
arise trap:airs mapTeport product or the use thereof by asw person or enety
Copytepf►t:'021 Card*ba County NC
06/03/2022
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 specifically relates to UST systems,the AST data may be related to a
variety of release sources, I.e.AST systems,fuel tanker spills, illegal dumping, etc. Whereas,the UST
data Is specific to releases of regulated substances from USTs, 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
• Semivoiatile 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(MY)—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 Mall 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 MITI 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
Jul 05 22,02:23p p,2
WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only:
1.Well Contractor Information:
Kyle C. Shaw
14_WATER ZONES
Weil contractor Yarnc FROM To I DESCRIPTION
4521-A - G5ft. ,-a R- 51
n ft.
NC Well Contractor CcrtiCrwtion Nrunber
Advanced Well Drilling, LLC IS.OUTER.CASING(for mol i-cased wells)OR LINER(If applicable)
FROM TO DIAMETER I TR1CISTAS I MATERIAL
0 it 41-1 Company Name
" 6 in. heavy 1 PVC
0
16.INNER CASLNG OR TUBING(geothermal closed-leap) -
2.Well Construction Permit#:(,�,11- 6 -,Q r','Zi)1 1-26•--Te FROM TO DL METER TRICIZVESS : MATERIAL •�
Liar ellapplicatble nail catrsrrtction permits tie WC Count,Stare.I urionce oral f1- n in
3.Well Use(check well use): rL n, in {
Water Supply Well: 17.SCREENr —
❑ rlCUlttiral —FROST TO DIAMETER SLOT SIZE THICkl9ESS 1LlTERLAL
❑Municipal/Public n. rt. in.
❑Geothetnal(HeatinerCeolineSupply) OResidertial Water Supply(single)
n n in
°industrial/Comntercial °Residential Water Supply(shared)
Q Irrigation la.GROUT
QWells>100.000 GPD FROM TO MATERIAL EMPL&CEIIFit'T METHOD'S.AMOUNT
Non-Water Supply Well: 0 fL aC it Bentonite Poured
❑Monitoring ❑Recovery
Infection'We11: rt. R
O. fifer Redwroa R. ft.
QGround«ater Rernediation
QAquifer Storage and RacovaS GSalinih'Banier tvs.��D/G><z,►�ELP CK(IrappllobIc)
�FTt0se TO MATERIAL. • E:VPI.ACEIIb1'TMETHOD
DAquifer Test QStornmater Drainage n rt.
°E. crimental Tcchnolorzy °Subsidence Control ft- ft
DGeothertnal(posed Loop) ()Tracer 30.DRILLING LOG(attach additional sleets ifnecessarv)
DGeothertnal(Heatine%Cooling Return) DOUter(explain under 4221 Remarks) -FROM TO DESCRIPT1Q•rotor.hardne�solVroelth•pr,grain slx,ex.)
// ��, it _% -7 t` Dk--/.1n�J '
4.Date Well(s)Completed: b-T t?s-� Well ID# T ) rt. 4 ? is _ 1 ar- �
I �C
3'a..Well Location: 7 n. �`S n' -13e-- (\c- L t f. o`.L.
J) 01- R V ft Rca .f
Facility/Owner Name Fac:lin•p7j(if app:icsble) qD IL
or „`617 `
..0 3 het.. f jUr ar(i cS Z _ . ft. n
Air or.
Physictl Address,City.and Zip ft. ft.
nq't•n a J�n` 21.RE iL(RI{S
C
Cowan Parcel ldeai6carion No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal dog ees:
(ifaell field one lavloag is start ant)
22.Certification:
3S. c is 3? N ( . 13 [[ . .cl".
6.la(are)the well(s): nPermanent or �Tempera ry Ssnat of Certified Well Contractor Dale
Bt•signing'lesfcvas 1 hereby cerrifi•then the ara.r!(s)was?Isere/constructed in accordance rrnh
7.is this a repair to an misting well: CY es or CNo 13.1"C.rC 02C.0100 or 11-1\rC4C 02C.M00(Fell Conslrucrion Sr:nu:lards and tear a cow
Ifdhs is a repair,jilt era known well construction irlomrntion and=plain the narUre ofrhe QI this record has bean provided to the arch!oxtaer.
repair under n21 remark r rectum or on the hack of this farm
23.Sire diagram or additional well details:
3.For GeoprobeMPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info
constructirn.only 1 Glk-1 is meted. Indicate TOTAL,\r_1IBER of wells (add'See Ova'in Remarks Box).1'ou may also attach additional pages ifnr necessary.
drilled:
24.SU MITT_aL INSTRUCTIONS
9.Total well depthbelow land surface:
d (ft.)
For multiple wells list on depths!I-different(example-3:g?00•arid 2 100) Submit this G`[t-1 within 30 days of well completion per the following:
10.Static water keel below ropof casing: CO 24a, For All trolls: Original form to Division of Watts Resources (DWR).
If wester level is above caring.use-=•• (H') Information Processing Unit.1617 MSC,Raleigh.NC 27699-161 7
II.Borehole diameter: 6 (In) 24b, For Injection Wells: Copy to DWR Underitround Injection Control(ILiC)
77 Program,1636 MSC,Raleielr,NC 27699-1636
12.Well construction method: ;C-- Rol-p, 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the
(Le auger,repay,cable,dim at 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 MR,CCPCLr.A
/I Air Permit Program,1611 MSC,Raleigh,NC 27699-1611
13a.field(gpm) Method of test:
13b.Disinfection type: TH Amount: I f b,Lf
- Noah Carolina Department of Ee•.ironmental Quality-Divsion of Wattr Resources -
-..:sec. _-_..-
Cj\.
Case# WELL-06-2022-172826
��I t CATAWBA COUNTY HEALTH DEPARTMENT
Environmental Health Section
/8 4 2 SM 06/13/2022
WATER SAMPLE FIELD REPORT
Owner THOMAS HULLETTE,707 SHEA RD,NEWTON NC 28658
C:8289555485
Site Address: 707 SHEA RD,NEWTON NC 28658
Parcel Number: 364906276610
Driving Directions Newton on 10/16,right on St.James,0.6miles.right on Shea Rd,right on driveway at top of the hill,white
house
Sample Collected by: L fr+v &. M9 f,4-11 Date/Time Sampled: 6 //j e L II 0 A
Sampling Point: .oflf 17?
Is well head accessible? Yes /V No Reason for inaccessibility
Well New or Existing? New YExisting
Type of Well: Drilled / Bored 1 land Dug Punch
Does well meet adequate construction standards from what can be observed: V 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:
rsamficldrepoti 06/13/2022 10:20 Page I oft
.4.Z1/411. Case# WELL-06-2022-I 72826
111 CATAWBA COUNTY HEALTH DEPARTMENT
Environmental Health Section
J 8 4 2 sM 06/13/2022
•
WATER SAMPLE TEST RESULTS
Owner THOMAS HULLETTE,707 SHEA RD,NEWTON NC 28658
C:8289555485
•
Site Address: 707 SHEA RD,NEWTON NC 28658
Parcel Number: 364906276610
Lab C'oliform Analysis Results: Total Coliforms: ri) 1 T Fecal/E.Coli:
No Collection Date Over 30 hours old
Invalid Results: Excessive turbidity Excessive Chlorine
Lab Accident
1�-a O .I►'1") /1� I400 0�� .l�I '��I �O
Lab Tech Initials Date/Time Received Date/Time Completed
RECEIVED
Environmental Health
rsamfieldreport 06/13/2022 10:20 Page 2 of 2
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: Thomas Hullette Sample ID Number: 172826
Location: 707 Shea Rd,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
_1 Private Well Information
v .? and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Thomas I lullette—707 Shea Rd, Newton NC 28658
Sample ID#: 172826 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 n 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 ❑ 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 inorganic chemical results only.
❑ b. Your sodium level exceeds 30 mg/l and may pose aesthetic issues such as had 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.