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HomeMy WebLinkAboutWELL-08-2022-178146.TIF �,4`►:0�Y��, CATAWBA COUNTY •;.I`6j Public Health Department Subdivision TERRANCE C+LINDA S HYL . rt Environmental Health Division PINK 374519618991 40, PO Box 389,25 Government Drive,Newton,NC 28658 I QTq 1 t iy tr Site Address: 5511 SPRINGS RD, CONOVER NC 28613 Name on Permit *HOLLOWAY FAMILY HOMES NORTH CAROLINA,LLC Property Size: Acres 2.65 Directions: Left off of N NC 16 Hwy onto Springs Rd. Right onto Three D Ranch Ln. First lot on right. Owner/Authorized Representative Acknowledgement of Permit Receipt 1'"—'certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. fAs the property owner or authorized representative,1 have received the above referenced permit(s)as requested in the application for service RBPR-06-2022-41310,by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) 7 Electronic Image Transmittal/E-mail (Return receipt required) . . ' �YAs the property owner or 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:0B/19/2022 Owner/Authorized Representative Signature_ ' '- 1 Date f-4v- z r- Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sendingpermiO Signature Date/Time 121/1,? Methnd: 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.coom/s/EHCusttomnerServvice j� LiK' I Ioia Irvt / 1 vic.CAI y � chin-tut 08/19/2022 15:28 tei_ [ t;1Font WE:11. CONSTRICTION Rl:("ORI)(.(:14'-1). orlr;tenra! I':c(irly 1.Neil(anlrartor Information: - Robert Teague -i%wit ru ioEw-"_____... .__._. . --__ _ _ ...___..__....._,__.._..____.._......._.�.....___.__.____.__-.. g1r)M1I Ta Uk5CH1Yl19i 2857-A 4.i ' lam'..- _ .5.5 n. 16SrI• l Xi'Well i'cnnra,:tor Coil flail an\;reel%i .•-L•-...,_......-..... .Q ... ...+i.__.._. r�fOL(TF:RCA!iLtiG{brrMsl �casr wrudRi.INtARfappYctbleI , B 8 K Well Drilling Inc. „!Rust _ Tip t,IM1MF:Tr.N THICK%Pii M.�Tf.RUL --._ _ .-.__.-....,.--...-__._--._._......_.....__. _ -_ 0 ra.-I.173 ft- 6 I.� in' S('R.Ii :pvCL - Co'r4iny`same M _ 16.INNER t'a51N t dR T INi eettreea d tlsaed�epl 1.'Well Construction Permit n. 74119 I NUN TO ••�bcvMF.rER 7HICKV4St T H.M1rER)it Luraelcrrtie,efr.rr': ^rvrtnarr•rm.(nr 61i'(..nervy .t'n;,,• t'n(wr,4'.:a i iL i 0, ... 3.\tell Usr tchrch well use): 1), (r. la. ltr Su I) \dell. 17.SCREEN _ _ _ _ _:..,J pp M- rnom r to --W»- inn.terttRR,•,�star slat Ilitrk+lESS ....N1ir;Hl.it__- 1 riculiucal Munic; tVPublic --�•- 1,. . ©• fx fl. f1. 1n. II Geothermal(Hraung.too,lingSupply) BRestdcittial Water Supply(singlet ' rt. n to a induilnal(C'ornmereisl DResidemnal Water Supply(shared) IR RUU'T I -- 6� a iti..etmn i -�TO-_--- 'to.. -__ t_EPLACP.R0 11./1Q) NQ1T 4en•Water Supply dell: fr. R ill icmiurrina �kccnt cry n ft.-•_____-__-__- -. Injection\\'ell: t -...-r.___.._...__.._._ ..., fi. ff ft. a Aquifer Rci harks ©liruundontcr Rcnicdiation , If ---- ...Aquifer Storage. - ---..- __._._-_-------------- and Recoviny Chni -•_,__• ---._- .it, 19.� t0 Ul't RI M, t:H ,t(_C11F.�T 1GT#r __,-.1 I Aquifer Test ❑�a �'Barrier sHu>a _.,._.__..._._...-_.__M1 PL On -1 DS Drainage ❑. n. •Experimental Technology °Subsidence Control ft ft. Geothermal(Closed Loop) ['Tracer ID.DRILLING 1.O6(■rt■cb■ddtdoa+lMeets iTmemory) _, ■Geothermal rHeatinn'C wLn Return'! momTo l mscirieriois decor.honor..,warren Syr,rrn.+ese.rte.) •Other(ex lain under r21 Remarks) t ) •� J�-/'j C,c,"-7t ft. l_.. .ar.. _ LPL..K__•--- } 4.Date Well(s)Completcdf'f Lt- Well MP + ft. b Sr)_ t_j J`,t.. -__ 5a.Well Location: : P� n. ft. , C/--'i�_. ,c) y� d..r_ Frcihty.Oi itr arc ( Facility lne(ifrt ,t.Inr) R. ! R. (�U ,?' l - -n. ----i n. ; i ( Physical Marco:City,and Zip _._._ __._-_---_-_-__-_---i 11.REMARKS Cauaq Parcel Idcncificauun;iv(PI\l -_-1 5b,Latitude and longitude in degrees/minutes/seconds or decimal degrees: - ------ -- ttf wc•Il field ow:siting it sufficient) 22.(:ertilication: .____-_.r.... _�___` ......... w . _._._.. W .,/ •., _� _ `5C -31' '9-5 6.Is(are)the well(s)aPerrrunent or Temporary Signature ofC'cmfied ii'rl onruwr J Date Bs s,gnicg An tweet /he,ahn trhh Mu(the ar(f(iI oat toner u.utn Ind to un'oniwter 7.Is this a repair to an existing well: 0 Yes or igiNo with/LI NC.IC-01C.0iOr pr 1 s.1 4CAC 02C 0200(Fell Co,urnrcfi at Stmrderdr ant ouzo if?ha ir a repay..fill OW known%ell cnn.,tr ar tion to iirnturinn and riplttin ihr nature ul ihr cnpv nl dal retard hat hY'n pu.nvdte!to'he reel Ma we. rrpmr tinder ell remarks JecHon 0.4.oe lilt Lek aphis faun. 23.Site diagram or additional well details: 8.For Geoprobe/DPT or Closed-Loop Gcothernui Wells having the same You may use the back of this page to provide additional well site details or Steil construction.only 1 GW- is needed. Indicate TOTAL NUMBER of wells construction details You may also attach additional pages if necessary. drilled:..____..._..__-..__ __ eiLIBMEITAL INSTRUCTIONS 9.Total well depth below land surface: ()3 „___(ft.) 24.a. For All Well,: Subnut this Iitnn within 30 days of completion of well Far muorpfr trill b-,all dtptkc if thffrrcar trramp,r.r L.!..:01 and:'ititlr: construction to the following. 10.Stack water level below top of caving: 40 ifs.) Division of Water Resources,Information Processing Unit, I *vier)surf is aha.e cawng,use"- 1617 Mall Service Center,Raleigh,.NC 27699-I617 II.Borehole diameter:6 1/8 (In.) 24b.Ear Infection N c113: In addition to lei din;1 the toter to the address in 24a Air Rotary above atso subrni:one,copy or this form within 34 days of completion of well 12.Well construction method: (Le.auger.rater),cable,derccr push,el,. - construction to the loll ow m.$ Division of Water Resources,Underground Injection Control Program, FOR WATER SUPP1LY WELLS ONLY: 1636 Mall Service Center,Raleigh.NC 27699•.1636 13a.Yield(gpm)_ 1 Method of test: Air Flow 24c.for Water Suiuih it injection Web: In tidditian to sending the form to the address(es1 above. also submit one coon of this form within 30 days of 13b.Disinfection type: Chlor Tabs + rut LDs Amount: completion of well construction to the count y health dep artment of the county- consmiccesl y Form GW-I North Casotina Depsrnrknt of li n.trunmcnral Q646ly.Division of Weer Resources Rr).q¢d 2.22,2D16 a" 4312 District Drive "/ ,411 ',, North Carolina State Laboratory of Public Health MSC 1918 J�+',� L' Raleigh,NC 27699-1918 .;, iiii ' irk`41 Environmental Sciences http://slph.ncpublichealth.corn `'.,:! awri„o,'*" Phone: 919-733-7308 Inorganic Chemistry Fax: 919-715-8611 Certificate of Analysis FINAL REPORT Report to: ENVIRONMENTAL HEALTH Name of System: CATAWBA COUNTY ENVIRONMENTAL HEALTH Chang Tong P 0 BOX 389 5511 Springs Rd NEWTON,NC 28658 Conover,NC 28613 EIN:566001814EH Delivery: NC Courier StarLiMS ID: ES240620-0051 Date Collected: 06/18/2024 Time Collected: 08:33 By: Dwight Mikeal Date Received: 06/20/2024 Time Received: 08:07 Sample Type: Raw Sampling Point: Sample tap on well head Well Permit No. WELL-08-2022-178146 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 11 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 <0.06 0.300 mg/L Lead <0.003 0.015 mg/L Magnesium 3 mg/L Manganese <0.005 0.05 mg/L Mercury <0.0004 0.002 mg/L Nickel <0.01 0.1 mg/L pH 7.6 N/A Selenium <0.005 0.05 mg/L Silver <0.01 0.10 mg/L Sodium 5.3 mg/L Sulfate <5 250 mg/L Total Alkalinity 46 mg/L Total Hardness 40 mg/L Zinc <0.05 5.0 mg/L Report Date: 07/09/2024 s I VED? Reported By: Marc Komlos J U L 1 5 2024 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: Tong Chang Sample ID Number: 178146 Location: 5511 Springs Rd, Conover NC 28613 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 :�<,f �E�"°��y Private Well Information < �i A ° °+ and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Tong Chang—5511 Springs Rd, Conover NC 28613 Sample ID#: 178146 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. 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 ❑Barium ❑ Cadmium ❑ Chromium ❑ Copper n Fluoride n Iron n Lead n Manganese ❑Mercury n Nickel ❑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. n 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. n 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 n Fluoride ❑ Iron ❑ Manganese ❑pH ❑ Silver n 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. n 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.