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Home My WebLink AboutWELL-06-2022-174864.TIF . dotloop signature verification:dtip.us/ILAV-kOlhoymne t q E =s. CATAWBA COUNTY t --- . -, -- --- ..-- ,:2l`� �i Public Health Department Subdivision --- -- . .. ' ,). st Environmental Health Division PINS 267901492879 .Ab'= t®•. PO Box 389,25 Government Drive,Newton;NC 28658 LOTH tZt ,a: Site Address: 7674 COLINY RD, HICKORY NC 28602 Name on Permit ALEXANDER LONG Property Stra: Acres 13.57 Directions: Old Shelby Rd,lot on right just before Coliny Rd strip Owner/Authorized Representative Acknowledgement of Permit Receipt .id,U" ,bnify that I am the owner or authorized agent(owner's authorization required)representing the owner of dot verified nY described above. 41412 a, the property owner or authorized representative,I have received the above referenced a°a ermi(s as requested in the application for service RBPR-04-2022-40657,bythe followingmethod(s):P � ) q PP ( ): _ Received in Person Facsimile Transmittal(Return form with signature required) ALElectronic Image Transmittal/E-mail (Return receipt required) aeYg �� s the property owner or authorized representative I have reviewed and understand the specific conditions .rI 2` To 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 IBA.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:08/30/2022 dotheop// ��jj Qe^ Y�PJre'Oer / mA- OM'/2veanea ,�,� oOn ia2 D4:02 PM EDT l``(�Owner/Authorized Representative Signature Ksswcee .aollsmOv Date 07/11/2022 • Documentation of Permit(s)Transmittal . (permit transmitted by electronic or other means) Permit transmitted by (name of person sending permit) .. 7 Signature GE, Date/Time / 11%172 6 Method: _Fax 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 yo2Please ttake a few momentts tto complette our custtomer service survey att • http://www.surveymonkey.com/s/EHCusttomerService • ION aki,)bide gmato. twin ehpennit 06/30/2022 11:05 Y e FROM : MORETZ WELL & PUMP FAX NO. : 7044E21322 Apr. 27 2023 10:27AM P1 WELL CONSTRUCTION RECORD (GW-lj For Internal Use Only: 1a � 1.Well Contractor Information: Ashley T Moretz 'I4;WATER ZONES,:-.' . Weil contractor Name ` _FROM TO DE.SCRIP7'ION —�� 2586-A �jGln. /90 h /D 4 PIu5 �1 /n, h. NC Well Contractor Cenificarion Number .25.'OUTER CASING(for.maki-,iased''irc&)'OR•L1NRR(if ' cable)-.;.:... Moretz Well and Pump Service LLC _FRRO TO+� DIAMETER THICKNESS MATERIAL / V ft S 4y$ in, SPfir, i I .12v<- Company Name Q r �- o6 i .a-17y.86V •FR INNER'CASINOOR;TIAINMETcotbMeAafe)tged.loep)' •' , 2.Well Construction Permit#; FROM , TO DIAMETER THICKNESS MATERIAL List all applicable well construction pererile•(i.e.VIC,County,Slate.Variance.erg,) ft, ft. in. 3.Well Use(check well use): n. ln, !t7:SCREEN %';,'•i... Y.c Water Supply Well: MIP11111114 UTAMICTIGR Rt.()t I'Lte 't7Rt'iCnT�Ss MATERIAL eultura] oNfunicipalTublic +n Geothermal(Heating/Cooling Supply) esidential Water Supply(single) it. n- industrisl;'Commeteisl D+-Rcsidential Water Supply(shared) 18:GROUT ;:3,:A r ) : - 1...... Irrigation FROM TO MATERIAL • EMPLACEMENT'MErRODkAMOUNT Non-Water Supply Well; O rt. rt_ .�' r _J Monitoring C)Recovery ft. ft. Injection Well: ft. ft. Aquifer Recharge 0Groundw;rtcr 1(rme(litrti(xt 19:'iANDScRAV,ELEACK.(if*ppli6 ylej "'I Aquifer Storage and Recovery 05alinity Barrier FROM TO MATItItIAt. EMPI.ACQMENT Mkl'HAI> Aquifer Test 0Storinwater Drainage , h Experimental Technology f Subsidence Control ft. ft. ' „ . Cjeothenna3(Closed Loop) OTt-acer }2ttDRILLING::;f'tM'r.'(attiih iulditianal'sittetY;lfviietissary),;. ,. ,',L rXUM TO CESCRIRTIUN(color,heednera,sO]Yrnitk bpi;triia sine,etc.) Geothermal(HcstlnCooling Return) 0Other(explain under#21 Remarks) �]' Q ft' t/S ft. C/eb, S %1� Sa-Aii-itP t_ 4.Date Well(s)Completed q2l r 3 Well amf. ft. , �(� v� S ft. ft. /; a.Well Locution: t F:tcolity;(lwnerNarne Facility DDa(if applicable) ft ft, 74 7Y Cc/.►i y ,AI A- , t _ ft, ft. • - ft, N. Physical Addrecz,City,nod Zip "2;1^RF,MA.RF"S " County Parcel Identification No.(PIN) - Sb.Latitude and longitude to degrees/minutes/seconds or decimal degrees: (if wellfield,one laillongit sufficient) [�9- 22.Certification: 3S6!tso f € N —e1, % �-?- /3 W ` 3- 27'07_3 �< L 6.Is(arc)the wcll(s)OlPermanent or Temporary sigma..oCC.Tt d Well taboo,-tor B1'signing this form,I hereby ceriily Aar Illy wrll(c)was(were)earmr.coed in accordance 7.1s this a repair to an existing well: EJYes or L3No with rs,4•NCAC(1717 WOO or 15,1 NCAC OZC.0200 Well Consrrscrion Srcndards and that a 41-:h:,is a repair,fell out Inaua wail enncirurilnn information and erploin the mitre'ajthe coley ofthis record has bean providal to the well owner. repair under 42!remorin erection or on the back of thi.r farm. 23.Site diagram or additional well details: 8.for Ceoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well construction,only 1 GW-1}s needed- Indicate TOTAL NUMBER of wells construction details. You may also attach additional pager;if necessary. drilled: e( 0 SUBMITTAL INSTRUCTIONS 9.Total well depth below land surface: (B-) 24a. for All Wells: Submit this ffrhs withio 30 days of completion of well For multiple wells/ici all depths ifd(fe:rent(example-3(a7200'and 2@lO0') construction 1V the following: 10.Stalk water level below top of cusingc 0 (fr.) Division of water Reaout'eci,Information eroccaying Unit, If Water'level is above casing,use"+'' 1617 Mail Service Center,Raleigh,NC 2769'3-1617 11.Borehole diameter: 6 (in,) 24b.For[niectinn S'itJlt: In addition to sending the form to the address in 24tt Air Rotary above,also submit one copy of this form within 30 days of completion of well 12.Well construction method: construction to the following: (.e.auger,rotary,cable,direct push,etc.) Division of Water Resources,Underground injection Control Program, FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636/13a.Yield(gpm) 0 0 Method of test: Ak Lift 24c.For Water Supply&toirs'tlon Sienls: In addition to sending the form to the addresa(es) above, also submit one copy of this form within 30 days of 13b.Disinfection type: C L. Amount: .5-11 Z. completion of well construction to the county health department of the county where constructed, Form GW-1 North Carolina Department of Environmental Quality-Division of Water Rcaouiccs Revised 2-22-2016 BA C Case# WELL-06-2022-174864 �� CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 1$ `L SM 05/31/2023 WATER SAMPLE FIELD REPORT O►sner ALEXANDER LONG,5494 CI IESTNUT DR,HICKORY NC 28602 C:828-308-7979 LONGALEX266./rGMAIL.COM Site Address: 4279 OLD SHELBY RD,HICKORY NC 28602 Parcel Number: 267901492679 Driving Directions Old Shelby Rd.lot on`right just before Coliny Rd strip Sample Collected by: `S�c i 1�ea1 Date,lime sampled: 005/'2? /0:d-c'Ai Sampling Point: il& TA-P Is well head accessible? Yes ✓ No Reason for inaccessibility _ Well New or Existing? New Existing Type of Well: Drilled / Bored Hand Dug Punch vor 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"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: g�A�2l die;ve b.e#weuN Bucf Look for ke 'Bw Idlers Styr,. Whl.k-f tact, S-4yte 60u.se_ ®s/3 I/23 DIC 4o Soon,to rsamfieldrepon 05/31/2023 12:14 Page 1 of2 .„4.4 . g'A Case# WELL-06-2022-174864 E, t lik�� CATAWBA COUNTY HEALTH DEPARTMENT ,,, � y Environmental Health Section I8 L4 7. sM 05/31/2023 WATER SAMPLE TEST RESULTS Oo ner ALEXANDER LONG,5494 CHES1N11T DR,I IICKORY NC 28602 C:828-308-7979 LONGALEX266@GMAIL.COM Site Address: 4279 OLD SHELBY RD,HICKORY NC 28602 Parcel Number: 267901492679 Lab Coliform Analysis Results: Total Coliforms: ill 10001 l Fecal/E.Coli: 0190i t f No Collection Date Over 30 hours old invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials iN Date/Time Received VW.00• V"J i4O Date/Time Completed IN) 1 "v OH RECEIVED Environmental Health rsamfieldrepon 05/31/2023 12:14 I';ige 2 of2 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: Alexander Long Sample ID Number: 174864 Location: 4279 Old Shelby Rd, Hickory NC 28602 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 4` °z Private Well Information NC DEPARTMENT OF and Use Recommendations HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Alexander Long—4279 Old Shelby Rd, Hickory NC 28602 Sample ID#: 174864 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 onty. ❑ Arsenic ❑ Barium ❑ Cadmium ❑ Chromium ❑ Copper ❑ Fluoride ❑ Iron ❑ Lead ❑ Manganese ❑ Mercury ❑Nickel ❑Nitrate/Nitrite ❑ 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 ® 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/I 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.