HomeMy WebLinkAboutWELL-07-2022-176617.TIF t % it CATAWBA COUNTY
-�.Ili Public Health Department Subdivision NORA LYNN ISAAC SIGMON
Environmental Health Division PIN 376403116165
;y A PO Box 384,25 Government Drive,Newton,NC 28656 1011 17
Site Address: 5462 RIVER BEND RD, CLAREMONT NC 28609
Name on Permit: COBBLE CREEK CUSTOM HOMES LLC
Property Size: Acres 1.57
Directions: Hwy 16 N Right onto River RD, lot on the right
Owner/Authorized Representative Acknowledgement of Permit Receipt
Icertify that 1 am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
�R As the property owner or authorized representative, 1 have received the above referenced
permit(s)as requested in the application for service RBPR-05-2022-41039,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
J Electronic Image Transmittal/E-mail (Return receipt required)
9 As the property owner or authorized representative l 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 (I5A 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: 07/29/2022
�f Owner/Authorized Representative Signature _
/ Date
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
(��)
Signature Qie.tc,
Date/Time
Method: Fax 1/ 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 yoPPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/ENCusttomerService
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b ensure the eoaraq of location and lebektp Information contained on this map or data on this report Catawba County promotes and recommends
the Independent verflnfion of any data contained on this product by the user.The County of Catawba,Its employees,agents,and
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Parcel:376403116165, 5462 RIVER BEND RD 1in=60ft
CLAREMONT, 28610
This map/report product was prepared from the Catawba County,NC GeospaUal Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling Information contained on this map or data on this report.Catawba County promotes and recommends
the independent verIficatlori of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
03/27/2023
Print Form
WELL CO\S"TR(C'TIO\ RI';CORI)((;w-1� lot Internal list Only
1,Well Contractor Information:
..]
Joseph Bailey
11.WATER 1AA)YER _�_.__ --_{
Well Contractor Nome ---- 1
`FROM__ fir DLst Rrr nab."
3271-A -.3 5'Urt, 35'0 a ry'515!FiJLi/4 ar(//( Q4l . __i
NC Wcll Cont:acla('cilitiesiiss Number `l r ff.____4r"',f h 5,14i/ fjrG7//rf_.
B&K Well DrillingIncI.OUTER CASING(lot meld-rowed we11s)Uk LINER(if a Div_
nC I iROM I tit _ DIAMETFC I THICKNESS_ NAT!RiAt
Company Nance '-- I/� ft. IVg'IL j h t/2 In. ; SDA•71 PVC
/f)y, / �/'7 vId INNER C'AS1NC OR TUBING(geothermal closed-bap} 1
2.Well Construction Permit M: jj/1/��V J V ',he'll FTtU�1 T(1 1 DIAMETER THICK4LS4 MATERIAL l
Wr all applrrabie wed ron1(•((lon',trail fie.U1C.Comte Stair Farm0cr.rt,1 ! ft. rt. I b•
3,1Yell Use(check well use): I n, I rt Ia.
Water Supply Well: F 17.SCREEN 1
PP!
-
/RnN i TO oiA+rrrEa sr.orah I THICKNESS i AtATcant
['Agricultural �Municipa:Pub:ic ry, I ft. la.
�� — I
Geothermal(Heating Cooling Supply) mdR�tdential\l,try Suppk Ising,cl I p.. ry, in.
Olndustnal,Commetctal °Residential'later Supply(shared)
rl N; ation ia.caotrr
! R FROM 10 I MATERIAL ITA1.Qr "
►LAC1NEvT MEFNODA ANOINT
Non-Water Supply Well: 0 ft. Ce10 tL f2eifigiii.
1 ljA f
DMonitonng °Recovery h. ft.
Injection'}ell: _ —
ft. It. '
pAqu lcr RechargeOGroundicatci Rcmcdiatwn t
13A Aquifer Storage and Recover i 19.SAN.D,GRAV EL PACK(if a�rpibble)
q b �Sahnlry Flamer FROM • 7U AATERIAL Eyt►C AC[AFEn METHOD
0Aquifer Test 0Slomtwaler Drainage 1 ft. Ii. ; 1
inExperimental TechnologySubsidence Control fL 1— n
L.
QGeothermal(Closed Loop) 01racer 1 20.DRILL-LVC LOG,launchadditional sheets Hmein
FRosl 10 Ut.AC IPl r •.leabr.hard n. see h e. nu ase,et.))
t
OGaxhctmal(Hratiae'Cooling Return') nOlhtt(explain under a21 Remarks! - ; � I.i
ra rt. `s N.
4.Date Well(s)Completed: //k/ Well I DM/Or 17 J ' J. ft. • / fil Gil _
Sa Well Location: L / �I 3Sh. FL 4i! f0 ,Q,� ¢/'
[oho le CreekL b� A e ,/� > y"
�5 �S { �-}/�l�' �/�AG I � /'D�fL C/�4/ Tor✓✓( Sa'� o,t
Faellity/O,vrterName ' Fxilrty1De ifapphnhk)J('1 /h i ft. .ft. �i7"_66
5�iAgfl Cr)30 //d 6-4,-,,',C,z-,/ d9 .1;+(9 rr, .b_1'. . /tin C o'G1<
Physical Address.City,and Zip ft. ft.J
6.4"wb1 co 3 7&)gD.311414 12L REMARKS J,
County Parcel Identification Nu'PIN( 1,-- '�e aJ4r IS �f1C� �j PJr /
5b.Latitude and longitude In degrees/minules/seconds or decimal degrees:
(if well field,near I4U1ang is s.,fficicnt) 22.C crtifi ation:
CgA/
6.Is(are)the well(s)0Permaneot or QTemporary ilia of C:wilt tic coax Dal.
,rKnrng din Fpa.1 herrn;n, - th"n:he 4t'JI(.1!vat(veer)contnvrrd a accordance
7,Is this a repair to an existing well: Yes or f)rc nr,15,1.YC'AC AiC 0J00 ne 15A Vc'aC OK 0200 Wel Cnnsrrrcrior,Standards and r/wr n
If(ilia a a reparr••fill our known wrrl contlft n6rn to/,rrnmtr,m and..rpLo r Ii n motor u,the anp)'r/ran rre„r:kr harm prawJei:o the"CJl ovine
apart under'2I remarks radian or on the bat of Ora form
23.Site diagram or additional well details:
8.For GeoprobefDPT or Closed-Loop Geothermal Wells haying the same You may use the back of;his page toprovide additional well site details or well
construction.only 1 GW-I is needed Indicate TOTAL NUMBER of wells construction details. You may alto attach additional pages if necessary.
drilled: �.._ _.__.— S(:B�1I I"1Ah!oll ; ,cflONS
Q N f1tl
9.Tool well depth below land surface: UOJ (n.) 242. Fur All Wells: Submit this form wuh:n 30 days of completion of well
For multiple w,rflr lilt aid deprnu rfdiffrrent(e.amp'e 3 3:00 Jmf.'4i.;1;6) [Uth rdc[wn a the fulls wino
10.Static water level below top of casing:40 (ft.) Division of Water Resources,Information Processing Lnit,
If.oter Ir.eJ is(bow C.S.S.use 1617 Mail Service Center.Raleigh.NC 27699-1617
11.Borehole diameter: 6 1/8 (In.) 24h.For Iniertiun Melia: In addition to sending the form to the address in 24i
Air Rotary abate,also submit one copy of this form within 30 dais of completion of well
12.'Sell construction method: construction to the following:
(IC.ujer,rotary,cahle.duel push.et.1
Division of!later Resources.Underground Injection Control Program,
FOR WATER SUPPLY WELLS
�Oi'aL1: 1616"tail Service Center,Raleigh,NC 27699-1636
/
13a,Yield(gpm) 1'LHI Method of test:Air LI-!r T 21c. Fur_‘‘Ater SuoDls Si!election Neils: In addi non to sending the form to
the addresses) above, also submit one copy of:his form within 30 days cl
13b.DisinfectionChbr Tabs Amount: '''2
type: completion ofwell construction to the county health depar.mcnl of the county
where constructed
Form OW-I North CarotinsDeps.'rmentof Erik rronmcnul°laiiry-Elisironof Water Resources R.is,sod 2:2016
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: Shawn Patterson Sample ID Number: 176617
Location: 5462 River Bend Rd,Claremont 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.)
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.
X 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
ZijPrivate Well Information
and Use Recommendations
NC DEPARTMENT Of
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Shawn Patterson—5462 River Bend Rd, Claremont NC 28609
Sample ID#: 176617 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 ❑ 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 n 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/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.
p......
Total Coliform T 1
Bacteria, E. coli &
:,-,a.
PRIVATE WELLS .
, ,_,,
a P(_
What are total coliform bacteria
and E. toll? 4 3
Total coliform bacteria are a group of microorganisms found . ,: �
in soil and surface water.Total coliform bacteria water tests �-
look at all coliform bacteria in water.This includes fecal e
coliform bacteria,which are a group of bacteria found in the .. . - _ `
intestines and feces of animals and humans.
E.coli or Escherichia coil is a type of fecal coliform bacteria.
There are many strains of E.coil. When should I be concerned
about coliform bacteria or E. coli?
How does coliform bacteria and You should be concerned if coliform bacteria or E.coil are
E. coli get in my private well water? present in your well water.
Rain may wash coliform bacteria or E.coli from soil on The NC Department of Environmental Quality
the surface to groundwater.Coliform bacteria or E.toll developed a groundwater standard of 1 colony of
can also enter your water if your private well is poorly coliform bacteria in 100 milliliters of water(colonies/
constructed,cracked or unsealed. mL).Ground water standards are developed to protect
public health.This standard was developed in 2013.
How can coliform bacteria The US Environmental Protection Agency requires
follow up testing and treatment when coliform bacteria
or E. coli affect my health? or E.coli is found in any public water supply system across
Most coliform bacteria and E.coli strains will not make you the country.Public drinking water guidance are based on
sick.The presence of some types of coliform bacteria in the public health protection and cost of treatment/testing at
water signal the presence of feces or sewage waste. Feces large utilities.These rules were established in 1989 and
and sewage wastes are usually the source of the disease- updated in 2014.
causing organisms.
Total coliform bacteria and E.coli water tests are used as How do I test for total coliform
indicators for the presence of disease-causing organisms. bacteria or E. coli in my
The following are some disease-causing organisms or private well?
pathogens that could be present in your water:
• Bacteria that cause diarrhea and vomiting, Use a certified lab to test your well water for coliform
• Protozoa that cause dysentery, bacteria and E.coli every year.Contact the private well
• Viruses that cause polio and hepatitis,and program at your county health department to assist you
• Helminths,such as roundworms and tapeworms, with getting your water tested.Pricing of testing varies
that cause chronic diarrhea. from county to county.
With Detection of E. coli, 2011-2013
Percent of Private Wells Tested ■ I
1_
■
i■
Percent of Private Wells Tested With 17-
Detection of Total Coliform, 2011-2013 I 5�.,
Joir
>50%with detection LAi
16.
I
- 25.1-50°%with detection
■ 1.
<25°%with detection
0%with detection
Insufficient data(<10 wells tested)
What if total coliform bacteria Where can I find more
or E. coli levels are present? information about total coliform
Shock chlorination is a method to remove bacteria bacteria, E. coli and my well?
contamination in private wells.If contamination persist Visit the NC Division of Public Health's Private Well and
you can install a treatment system to reduce the levels Health Program website:htto://eoi.publichealth.nc.gov/
of bacteria in your private well.Treatment systems that oee/programs/wellwater.html.
reduce the level of bacteria in your well water include:
• Ultraviolet(UV)filtration treatment system There you can find:
• Contacts for your county private well program
You can also reduce your exposure by using bottled water • Total coliform bacteria or E.coli in well water maps
or connecting to public water supply,if possible. • A guide for selecting a treatment system
• Other private well resources
Where are total coliform bacteria You can also call the Private Well and Health Program
and E. coli found in NC? at 919-707-5900.
Coliform bacteria are detected throughout NC.About 26%
of wells sampled for microbial contamination in NC from Where did this information come
2011 to 2013 tested positive for coliform bacteria.Yet, from?
there are several areas in NC with at least 50%of wells with
coliform bacteria present.See map for areas with high Centers for Disease Control and Prevention:www.cdc.gov/
coliform bacteria detections. healthywater/drinking/private/wells/disease/e coli.html
E.coli is detected throughout NC.About 2%of wells Environmental Protection Agency:https://safewater.
sampled for microbial contamination in NC from 2011 to zendesk.com/hden-us/sections/203309158-E-coli-0157-H7-
2013 tested positive for E.coli.Yet,there are several areas National Sanitation Foundation:www.nsf.org/consumer-
in NC with at least 25%of wells with E.coli present.See resources/water-quality/water-filters-testing-treatment/
map for areas with high E.coli detections. contaminant-reduction-claims-guide
NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental
1 C IM Epidemiology Branch•Private Well and Health Program•httos;//epi.oublichealth.nc.gov/oee/programs/wellwater.html.NCDHHS is an
N•nh Grdt.a equal opportunity employer and provider.•09/2019
P.hltr Health