HomeMy WebLinkAboutWELL-06-2022-173393.TIF .,ruin rorrn
WELL CONSTRUCTION RECORi) ((;11-I) For Internal Use Only:
L Well Contractor Information:
-
Joseph Bailey 14.WATER ZONES
wtdConca:rrNste FROM 1 To D)ScHIrtt1)A
3271-A I fd /2sr1 tr. j Soled �e,PEc e
I h•�
ft_ ! L2r „. 1 1
NC w el Co un.-scr Cenfcrion, ,,t.c;
15.OLTFR CASING(fat mold-eased wens)OR LINER Of tpplksbf) . . '
B&K Well Dulling Inc ill Ir1 DIAstFtER I THICh',LS.S 4 MATERIAL
Corir ar.,.a^it p f. 130 ft 625 to i son 1t ,PVC
'' f/' are.SER CASLNG OR TUBLYG geothermal eNaad-faep) - -'
2.Well Construction Permit 0;,.& vG-2o2- I )33g3 FRUst 10 DIAsIFTF.R I} THICK%rso 1 MATERIAL
jut aIla:;:a.a.'t w':ro..l+v:twin lv,--ra i'
,ft r i. .t'.." n.S:j:r I a,.a(r r,:I ft. ft. ia. i
3.Nell l'se(check well use): ft. ft. in. i !
JN1'tee Supply Nell: 17,SCRF.DI ---
�Ag77cU:Canl 1Rt)st 1 TO DIAMETER SLOT SITE ' THICK.ISS j M TERI_AL
0Municipall'ublic ft ft. in. If 11
JGeothe:mal(Heating Cooling Suppis) ID Residential Water Supply!single)
I. fl, is
0Industnal Commercial 0Rnldential Water Supply(shared)
0Imcannn -it GROUT
Most TO stalLRLs1 E%IPLACEME%TMETHODA astotsr
Non-Water Supply Well: 0 rt. 20 ft' 14 ,
1 aa� ! paw 1-- I
a�lsxiitnnrg QRetosen -H. R. i I
injection Well:
Q QG
Aquifer Rccharcc I ft. 1 ft.
roundwater Rcmcdrati0n
Aquifer Storage and Raov . m 19.SANDrGRA%TL PACK(if applicable))
�Jaliniry'Baer most TO MATERIAL ' EM►LACEMENTMLTHOD
d Aquifer Text �Stormuater Drainage ft. ft. {
hh❑Expenmectal Technology DSubsidence Control ft. tti
�Georhermal(ClosedLoop) °Tracer
Gtro 2a.DRIUING LOG(an,chad�tian,i,eeetsif.eme,t�). _.. .
thelmal(Htatinc'CoolingRrnun) ['Other in ■'_l Remarks) FROM TO DESCRIPTIO%Intor.hard...,wYnel rape grins w.,.W" ,
4.Date W'ell(s)Completed: 7/ i/ 3 Well LDe LDf3 0 It !/h. /?C
Lc 35 �. irs4f1 see
Si.
/41',e�U,,Location: ! rt. 4s ft. 4044 fro.,ei s9i
L�iI pfry LQG4cc9/ ii/1 h- 1!1v r` eYelr/L✓! ✓pf Av. Se/
Facility/Owner Nance Facility II>(ifapplicabte) 1 /I9 rt. 1 '< fL Al 1
%'t o S. olc-S eras5(a*J, ern Acc �s, P 2s I' fL S!/> f ,
Physical Address,City.and Zip /V G fL t°$ !_. _ r - Rse1C
6/(4,, ra. JIMo]233fho 21.RE.MARKS - . ... . . .
County Parcel Idcntiiiution No.(PIN)
I
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
of well Seid.one latlorg is sufficient) 22.Certification
N
Wi/j1i
6.Is(are)the well(s) m Peranent or QTemporary SI o 'en,fie well on for Date
t'signing Mu form.1 here certif.)that the*rills) as Neret taurruned u accordance
7.1s this a repair to an existing well: QYes or O\o nab/54 NCAC 02C.0100 or IJA,V'CAC 02C.0200 Well Consnvctior Standards and than a
(fth s u a repair f7L'out known well construction information and explain)he nan.rr of the copy of this'ecard has been proitdrd to Me..rll name,.
repair under 111 remarlrt section or on the back of rho fora:
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or cell
S.For Geoprobet'DPT or Closed-Loop Geothermal Wells having the same
construction,only I GW-1 is needed, Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled:
gac r SUBMITTAL,INSTRUCTIONS
Total9.To well depth below land surface: (ft) 24a. For All Wells: Submit this form within 30 days of completion of cell
For multiple wells list all depths 1different(example-J a 100'and 1'a l00')
construction to the following:
10.Static water level below top of casing:40 ft
( ) Division of Water Resources,Information Processing Unit,
j WOW,Intl u above caring.use 1617 Mail Service Center.Raleigh,NC 27699-1617
I I.Borehole diameter: 6 1/8 (in.) 24b.For Injection Wells: In addition to sending the form to the address in 24a
Rotary above,also submit one copy of this form within 30 days of completion of well
12.Well construction method: construction to the following.
(t t.auger,rotary,cable,direct push.etc)
Dislsion of Water Resources,Underground Injection Control Program,
FOR WATER SUPPLY WILLS ONLY: 1636 Snail Service Center,Raleigh,NC 27699-1636
GAT
13a.Yield(gpm) g Method of test: Air lift 24c. For Water Suppis it Injection Wells: In addition to sending the form to
Chlor Tabs 1+-0 Tiros the address(es) abme, also submit one copy of this form within 30 days of
13b.Disinfection rape: Amount: completion of well construction to the county health department of the county
where constructed
Form OW-1 No-h Caioiina Department of Ensironmenul Quality-Unislon of N aicr Rcsoarca 2
Rtvuad . .016
Analytical Results ;y� STATESVILLE
ANALYTICAL
Catawba County Public Health
PO Box 389
Newton, NC 28658
Receive Date: 04/11/2025
Reported: 04/14/2025
For: WELL-06-2022-173393
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
250411-25-01 Nitrate 173393 <1 mg/L 353.2 04/11/2025 MD
250411-25-01 Nitrite 173393 <0.1 mg/L 353.2 04/11/2025 MD
Respectfully submitted,
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/87,2/4697
Page 1 of 2
bAraAt.v Iliekkl. •
4.
122 Court Street Statesville,NC 28677
704-872-4497 vnvw.sa nc.com
NITRATE/NITRITE ANALYSIS .
• Nctm,alarceaticn=atte ripPIIei to:rn*rp,•.•-- =St. .
WATER SYSTEMM#f(A111l 0(s-Za7Z - .V593. County: Catawba '
Name of Water System: Ll n,SC, cw e f tI .
Sample Type: ❑Entry Point Ed Special/Non-coomplirnrp
Location Where Collected: I rl 0: S Oil ve rs Cogs focaS, N/eiAnn
Facility ID No.)7•3313
Sample Point: GtOIQ(t 15k I i Collection Date Collection Time
Collected By: NtN+lnt WU kL , U tl/ I 1 2 5 I Z:3 Q WI
(M!f(DnftYl (Spcly A. ciPhi)
Mail Results to(water system representative):
CATAWBA COUNTY PUBLIC HEALTH Phone#:I (828)465-8270
ENVIRONMENTAL HEALTH rat*: l(828)465-8276
,PRO BOX 389 ResrusTle Person's email:
• •EHAdmin@catawbacauntync.gov
NEWTON,NC 28658 • _
_LABORATORY M i1: 37755 El SAMPLE UNSATISFACTORY El REHAMPLE REQUI D
REQURaD L DETECTED QUANTIFIED ALLOWABLE
C.OD CONTAMINANT CODED REPORTING LIMIT (t.a<R.AL) RESULTS"
LL/TIT
(RAS-) (
1040 Nitrate w 35321.00 mg/L . mgf L 10.00 mg/C.
!11 1041 Nitrite 3532 0.10 mg/L ----- mg/1, 1.00 mg/L
Mote:If result exceeds allowable limit the laboratory must fax analytical results to the State on day test completed.
DATE: TIME:
ANALYSES BEGUN: jO Le l / r /Mi.. : Leo : 0(, 1 e Ivy
-caa / Yaarr�v
ANALYSES COMPLETED: ay l /1 / a 6. L6. :"v4 M
t
crren>Ym tsp T.useral 4
Laboratory Lo ' : Stilt I t oZi V"O I CertiiedBy: v` . �'v`' -
gt
COMMENTS: .
2008 •
Laboratory should Mail Results to; •
Public Water Supply Section,Attn:Data End;1634 Mail Se vico Ceate,Raleigh.NC 27699-1634
•
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 2
';'70 4312 District Drive
North Carolina State Laboratoryof Public Health MSC 1918
dr*: Raleigh,NC 27699-1918
c�i�l� �1.a, Environmental Sciences http://slph.ncpublichealth.com
•e.WM V„n" 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 Lindsay Dockery
P 0 BOX 389 4120 S Olivers Crossroads
NEWTON,NC 28658 Newton,NC 28658
EIN:566001814EH Delivery: NC Courier
StarLiMS ID: ES250414-0003 Date Collected: 04/10/2025 Time Collected: 12:30 By: Dwight Mikeal
Date Received: 04/14/2025 Time Received: 07:54
Sample Type: Sampling Point: Sample tap Well Permit No. WELL-06-2022-173393
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 <0.0005 0.005 mg/L
Calcium 14 mg/L
Chloride <5 250 mg/L
Chromium <0.02 0.10 mg/L
Copper <0.01 1.3 mg/L
Fluoride <0.1 4.00 mg/L
Iron 0.188 0.300 mg/L
Lead <0.003 0.015 mg/L
Magnesium 2 mg/L
Manganese 0.023 0.05 mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH 7.0 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 2.5 mg/L
Sulfate <5 250 mg/L
Total Alkalinity 48 mg/L
Total Hardness 43 mg/L
Zinc <0.05 5.0 •mg/L
Report Date: 05/02/2025 RECPIVED Reported By: do0411,42 --------"----*
Marc Komlos
MAY 9 2025
Environmental 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: .��`i��r Sample ID Number: 6- 2Z- 1?33g3
Location: ti(-/-a 5. 0I•s,ePs Gros s 1 ,41 Reviewer:
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.)
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 conforms a useful indicator of other pathogens for drinking water. Total conforms 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 conform 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 occurnaturally in water or can be introduced into water
from man-made sources.Total coliforuibacteria 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, orimmunocompromised (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.
J
A,
Private Well Information
-. 1,*_ m., and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Lj,A 54l, I0b41<o „� Li1Zo.S, 1,,,LrS Crast Rd, N�-�--)�r
Sample ID#: 17,/ 3 e,3 Reviewer: Jason Boyd
TEST RESULTS AND USE RECOMMENDATIONS
1. ®Your well water meets federal drinking water standards for inorganic chemicals.Your water can be used for
driinking,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. n 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 n Barium ❑ Cadmium ❑ Chromium ❑ Copper n Fluoride ❑Iron
❑ Lead Manganese n Mercury n Nickel P Nitrate/Nitrite n Selenium n Silver
n 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 fdr 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 n Copper ❑Fluoride n Iron ❑Manganese
I— pII F 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.
I •
❑ 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.