HomeMy WebLinkAboutWELL-08-2022-178884.TIF r
CATAWBA COUNTY
•
f.lik Public Health Department Subdivision
' - Si Environmental Health Division
� PIN# 365803427373
' PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1 o,
SlteAddress: 2367 HENDRIX RD, MAIDEN NC 28650
Name on Permit JESSE FREEMAN
Property Size: Acres 29.73
Directions: NC 16,Right onto Providence Mill RD,Left onto Hendrix RD
/ Owner/Authorized Representative Acknowledgement of Permit Receipt
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that I am the owner or authorized agent(owner's authorization required)representing the owner of
the sr. -rt described above.
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As the property owner or authorized representative,I have received the above referenced
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rmit(s)as requested in the application for service RBPR-06-2022-41297,by the following method(s):
Received in Person
�7 Facsimile Transmittal (Return form with signature required)
�/ Electronic Image Transmittal/E-mail (Return receipt required)
As the property owner or authorized representative l have reviewed and understand the specific conditions
he 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:08/29/2022
Owner/Authorizedj Representative Signature . �,
(Date +2'P
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature 31.
0 Date/Time J hi))
Method: Fax ' Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
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CATAWBA COUNTY Case# WELL-08-2022-178884
Public Health Department Subdivision
' Environmental Health Division PIN# 365803427373
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1
2 sr
Site Address: 2367 HENDRIX RD, MAIDEN NC 28650
Name on Permit: JESSE FREEMAN
Property Size: Acres 29.73
Directions: NC 16, Right onto Providence Mill RD, Left onto Hendrix RD
NEW WELL PERMIT
REQUIRED WELL SETBACKS:
Septic Systems and Repair Areas for Single Family Dwellings 50 ft.
Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft.
Underground Storage Tanks 100 ft.
Animal Barns 100 ft.
Lakes/Ponds 50 ft.
Streams/Brooks/Creeks/Rivers 25 ft.
Building Foundations 25 ft.
All Other Sources of Groundwater Contamination 100 ft.
Saprolite Septic Systems and Repair Areas 100 ft.
Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft.
Wells shall be constructed in accordance with state regulations:
Article 15A North Carolina Administrative Code Subchapter 2C
The well driller must verify all setbacks before drilling the well.If the well driller is unable to maintain any of
the above setbacks,contact Catawba County Environmental Health at 828-465-8270,before drilling the well.
Grouting Depth:20 feet minimum
Casing Height: 12 inches minimum above finished grade
All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private
Drinking Water Well Testing(15A NCAC 18A.3800).The fee for this sampling is included in the cost of the well permit.It is the applicant or
property owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an
outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health.
3/11/44 . 11#14,4 ‘
08/29/2022
Authorized State Agent Pennit Issuance Date
8/29/2027
Permit Expiration Date
chpertnit 08/30/2022 12:11
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0 WPDT Report
Area of Interest (AOI) Information
Area : 3,134,508.72 ft2
Aug 29 2022 15:53:16 Eastern Daylight Time
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Li Parcels lPolygoesl•Pinata "' Protected Route 0 0 03 006 0.12 In
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Non-System Roads — Other State Agency Route 0 0A5 0.1 0.2 km
— Federal Route — Secondary Route
Noe-System Primary Roads
Other System Roads — Interstate NWot c5 unit CC[GA.wa
— Ramps,Rest Areas,Non-Mainline — US Route
— NC Raule
2367 Hendrix Rd,Maiden
All North Carolina Department of Environmental Quality(NCDEQ)GIS data is expressly provided"AS IS"and"WITH ALL FAULTS".The
NCDEQ makes no warranty of any kind,express or implied,concerning this information,including but not limited to any warranties of
merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy.
reliability,completeness,timeliness, or usefulness.The data is not intended to constitute advice nor is it to be used as a substitute for specific
advice from a professional.Users should not act(or refrain from acting)based upon information in the Data without independently verifying
the information and obtaining any necessary professional advice.Users are solely responsible for ensuring the accuracy,currency and other
qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be
modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and
attribution of GIS features and makes no warranty concerning same.
WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only:
1.Well Contractor Information:
Chris C Russell 14,WATER ZONES
Well Contractor Name FROM TO DESCRIPTION
3254 A 50 tt• 245 ft,
ft. ft.
NC Well Contractor Certification Number IS.OUTER CASING(for multi-cased wells)OR LINER(if ap licabk)
Russell Well Drilling, Inc. FROM TO DIAMKTF.R 1 THICKNESS MATERLAI.
0 rt. 52 ft. 6.25 in' SDR21 PVC
Company Name
WELL-08-2 022-178884 16.INNER CASING OR TUBING(geothermal closed-loop)
2.Well Construction Permit#: FROM - TO DIAMF.TFR THICKNESS MATERIAL
List all applicable well construction permits(i.e.UIC.County.State,Variance,etc.) ft. ft. in.
3.Well Use(check well use): ft. ft. in. 1
Water Supply Well: 17•SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL.
❑Agricultural ❑MunicipaVPublic rt. ft. in.
❑Geothennal(Ileating/Cooling Supply) OResidential Water Supply(single) rt. in.
❑Industrial/Commercial ❑Residential Water Supply(shared) IS GROUT
❑lrngation ❑Wells> 100,000 GPD FROM TO MATERIAL . EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: 0 ft' 20 ft. Grout Poured
OMonitoring ❑Recovery ft. ft.
Injection Well: ft. ft. -
❑Aquifer Recharge ❑Groundwater Remediation
19.SAND/GRAVEL PACK(if applicable)
❑Aquifer Storage and Recovery ❑Salinity Barrier FROM To MATERIAL EMPLACEMENT METHOD
❑Aquifer Test ❑Stormwater Drainage ft. ft.
❑Experimental Technology ❑Subsidence Control ft. ft. {
❑Cieothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets If necessary)
❑GeOHILrtnal(licating/Cooling Return) ❑Other(explain under#21 Remarks)
FROM TO DESCRIPTION(color,hardness.soil/rock type,grain size,etc.)
0 ft. 47 R. Dirt
4.Date Well(s)Completed: 11 23 2022 Well ID# 47 ft. 245 ft• Rock
rt. It.
5a.Well Location:
Jesse Freeman ft. ft.
Facility/Owner Name Facility ID#(if applicable) ft. ft.
'1, 2357 Hendrix Rd, Maiden, NC 28650 ft.
H. ft.
✓4 rt.
Physical Address,City,and Zip
Catawba 21.REMARKS
County Parcel Identification No.(PIN)
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(If well field,one Iat/long is sufficient) 22.C lficatlon:
36' 60.531' N 081' 173.240' w 11/23/2022
6.Is(are)the well(s): ❑Permanent or ❑Temporary Signature of Certified Wcl onrac[or Date
fist'signing this,jnrin.1 hereby certify that the wells)was(were)constructed in accordance with
7.Is this a repair to an existing well: ❑Yes or 19No 1 SA NCAC 02C.0100 or ISA NCAC 02C.0200 Well Construction Standards and than a copy
If this is a repair,Jill out known well construction information and explain the nature of the of this record has been provided to the well owner.
repair under 021 remarks section or un the hard of this farm.
23.Site diagram or additional well details:
K.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the hack of this page to provide additional well construction info
construction,only I 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.'l'otal well depth below land surface: 245 (ft.)
Formultiple wells list all depths ifdiferent(example-3(r�200'and 241100') Submit this G�1'-1 within 30 days of well completion per the following:
10.Static water level below top of casing: 50 (ft.) 24a. For All Wells: Original form to Division of Water Resources (DWR),
*water level is above caring.um."+ Information Processing Unit,1617 MSC,Raleigh,NC 27699-1617
11.Borehole diameter: 6.25 (In) 24b.For Injection Wells:Copy to DWR, Underground Injection Control(WC)
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 health 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) Method of test: Air
1 0 Permit Program, 1611 MSC,Raleigh,NC 27699-1611
13b.Disinfection type: HTH Amount: 2/3 cup
Fnnn OW-I North Carolina Department of Environmental Quality-Division of 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: Jesse Freeman Sample ID Number: 178884
Location: 2367 Hendrix Rd, Maiden NC 28650 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
o `a" Private Well Information
� � �• , and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: Jesse Freeman—2367 Hendrix Rd, Maiden NC 28650
Sample ID#: 178884 Reviewer: Megen McBride 1
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 on(v. 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 on(v, 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 /1 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/1. 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.
-
lit
Total Coliform
Bacteria, E. coli & t.„
PRIVATE WELLS440
What are total coliform bacteriaa
and E. coli? '
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
coliform bacteria,which are a group of bacteria found in the
intestines and feces of animals and humans.
E.coil 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.coil from soil on The NC Department of Environmental Quality
the surface to groundwater.Coliform bacteria or E.coli 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.coil 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.coil 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.
Percent of Private Wells Tested ��� � i= '� lpy.
With Detection of E. coli, 2011-2013 � �"r�' a� �` '" L►
iii
111
ar�'"'�ii��rli ' �1611141
4. ,
volit
VI
Percent of Private Wells Tested With 4I$" 11 14 1CV-� �,,
Detection of Total Coliform, 2011-2013 i 'I�'- 'r it i Rpm- � arg
�� CrA ,, u
ria
111111 >50%with detection _ I �� • r1 wI
11116
- 25.1-50%with detection - 111111 o B�/
wit. <25%with detection
vi
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:http://epi.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.coil 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:httosl/safewater.
sampled for microbial contamination in NC from 2011 to zendesk.com/hclen-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
T-aka ;i.i NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental
c -`: . Epidemiology Branch•Private well and Health Program•httos://eoi.oublichealth.nc.gov/oee/programs/wellwater,html•NCDHHS is an
-4'r� s••d,c•••u•• equal opportunity employer and provider.•09/2019
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