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Home My WebLink AboutWELL-07-2022-175269.TIF .-.e. x. --- r-. -w+."IM'Vv, V -rts ht e CATAWIA COUNTY' t‘P Public Health Department Subdivision '1l J Environmental Health Division PIN" 376304626837 t tit�za PO Box 389,25 Government Drive,Newton,NC 28658 LOT" Site Address: 3999 DEAL RD,CLAREMONT NC 28610 Name on Permit: GUILLERMOURIOSTEGUI MELCHOR Property.Size: Acres 28.61 Directions: Bunkerhill School RD the property will be located on the left after passing noy field. Coming from Oxford School RD located on Right. Land is cleared. // Owner/Authorized Representative Acknowledgement of Permit Receipt �T t�/nil'y that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. Ur19olhe property owner or authorized representative, I have received the above referenced permits)as requested in the application for service RDPR-05-2022-41201,by the following method(s): _ Received in Person Facsimile Transmittal (Return form with signature required), �/ '7 Electronic Image Transmittal/E-mail (Return receipt required) U1 /As the property owner oc 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(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:07/08/2022 Owner/Authorized Representative Signature G enmo Un+'Mao, Date 7/14/2022 'Documentation of PermIt(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by lei (name ofperson sen'di/ng permit) Signature Date/Time 7/j7)r)) Method: Fax Email US'Mail . Other Owner's request to send by the above Indicated method of transmittal in lieu of signature J We wantt tto hear from yo2Please ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/DiCusttomerService HCusttomerservice i . • i tiri o egLA 23obo10gn►a . caM chpcmm 07/08/2022 1107 (4: WELL CONSTRUCTION RECORD(GW-1) For internal Use Only: I.Well Contractor Information: Chris C Russell 14,WATE11ZONES Well Contractor Name mom TO DESCRIPTION 3254 A 80 ft. 465 ft• a. ft. NC Well Contractor Certification Number Inc. 15,OUTER CASING(for multi-cased wells)OR LINER(if ap liable)Russell Well Drilling, n FROM TO DIAMETER 'THICKNESS MATERIAL Company Runic 0 ft' 81 rt. 6.25 in• SDR21 PVC WELL-07-2022-175269 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERAAI. List all applicable well consrruetlon permits(i.e.UtC,County.State.Variance,etc.) ft. ft. In. 3.Well Use(check well use): rt. ft. Ls. Water Supply Well: 17.SCREEN FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public ft. ft. in. ❑Geothermal(HeatinglCooling Supply) nResidontial Water Supply(single) rt. rt. in. ❑industrial/Commercial 0 Residential Water Supply(shared) 18.GROUT ❑Irrigation ❑Wells>100,000 GPD FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0 d. 20 a• Grout Poured ❑Monitoring ❑Recovery R. ft. Injection Well: ft. H. ❑Aquifer Recharge ❑Groundwater Rcmediation 19.SAND/GRAVEL PACK(if applicable) ❑Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test ❑StormwaterDrainage R• ft. ❑Experimental Technology °Subsidence Control ft. ft. ❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) ❑Gtxtthermal(Heating/Cooling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(r,,lar,hardness,sullireek type,grain sine•etc.) 0 n• 76 n Dirt 4.Date Wells)Completed: 5-19-2023 Well ID# 76 ft• 465 a• Rock 5a.Well Location: It f. Gullermo Uriostegui Melchor rt. rt. Facility/Owner Name Facility 10k(if applicable) ft. ft. 3999 Deal Rd, Claremont NC 28610 rt. rt. Physical Address,City,and Zip rt. H. Catawba 21.REMARKS County Parcel Identification No.(PIN) 5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one lat/long is sufficient) 22. •IifcatioD: 35' 745.28' N 081' 132.68' w - lee.e.4.4...,40, 6/1/2023 6.Is(are)the well(s): OPermanent or ❑Temporary Signature of Certified Well Contractor Date By signing thisform,I hereby certify that the well(s)was(were)constructed In accordance with 7.Is this a repair to an existing well: DYes or Lal No 15A NCAC 02C.0100 or iSA NCAC 02C..0200 Well Construction Standards and that a copy If this is a repair.fill out known well construction information and explain the nature of the of this record has been provided to the well awes,. repair under$121 remarks section or on the hack 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 l OW-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:465 (B) Submit this GW-1 within 30 days of well completion per the following:For multiple wells list all depths if different(example-3(ii200'and 2@10119 Y P 10.Static water level below top nl'casino: 80 (IL) 24a. For All Wells: Original form to Division of Water Resources ('DWR), if wore,level is above casing,use"*' information Processing Unit,1617 MSC,Raleigh.NC 27699-1617 24b.For Injection Wells:Copy to DWR,Underground Injection Control(TUC)11.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 ealth department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 13a.Yield(gpm) 6 Method of test: Air Permit Program, 1611 MSC,Raleigh,NC 27699-1611 13b.Disinfection type: HTC Amount: 1 1/3 cup Form OW-I North Carolina Department of Environmental Quality.Division or 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: Guillermo Uriostegui Melchor Sample ID Number: 175269 Location: 3999 Deal Rd, Claremont NC 28610 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 Adite, Private Well Information AJg irk 8 and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Guillermo Uriostegui Melchor—3999 Deal Rd, Claremont NC 28610 Sample ID#: 175269 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 oqv.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. n Arsenic n Barium n Cadmium ❑ Chromium ❑ Copper ❑Fluoride ❑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 on*,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 n Silver n Sulfate n 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 on*. n 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.