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HomeMy WebLinkAboutWELL-09-2022-180797.TIF Jc=�, CATAWBA COUNTY ' 6 a Public Health Department Subdivision RODNEY WHITE LAKE PROP 1 e> Environmental Health Division PINK 460803014087 i ' . il, PO Box 389,25 Government Drive,Newton,NC 28658 LOT!! PTS 5&6 Site Address: 7039 WILSON RD,SHERRILLS FORD NC 28673 Name on Permit DAVID BARRINGER Property Size: Acres 0.54 Directions: Right off of Mt Pleasant Rd onto Locke Dr Take nght onto Wilson Rd. 2nd lot on left. Owner/Authorized Representative Acknowledgement of Permit Receipt 4 I certify that 1 am the owner or authorized agent(owner's authorization required)representing the owner of property described above. '' As the property owner or authorized representative,I have received the above referenced IF rmit(s)as requested in the application for service RBPR-I2-2021-39686,by the following method(s): _ Received in Person Facsimile Transmittal (Return form with signature required) 7 Electronic Image Transmittal/E-mail (Return receipt required) MOP As the property owner or authorized representative I have reviewed and understand the specific conditions 7. e 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(1SA 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:09/21/2022 Owner/Authorized Representative Signa-- E_ &to t,Css__.. .Date ! -ale� � T Documentation of Permit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by (name of person sendingpermit)qypi,) Signature e Date/Time 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 ycuPlease hake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EfiCusttomerService de1s,c Eeppia.6ya _ D.tion chp,ii,i, 09/2 t/2022 12 02 , h, as ri4 6,4ir. f sr r a 1* ` • Print Form WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only. I.Well Contractor Information: Se-3 .3 L4— 14.tHo tATERLO)'E.S DESCRIPTION \\'ell Cuntr,i)ers Name '�y rt, I 0 O rt. 9 �„k i 7- .q q - rt. ft. 1 15.()Unlit CASING for mold-cased wells OR LINER Or a Ikable) NC Well Cuntractut Ccridcauun Numha pr tTr RLtI. J� y� �,{, FROM TO niAnIFTr it TTIIC,/KN SS Lag_ I`Orpk.,v I n. Li �1 rt C. f n. 45 tD 1 i� v� Cumpanv Namc 16.INNER CASIN(.OR(UIIING(gru(hermal dosed-tnopl SL\TCRLeI. MOM TO nLMIrrrrt TITICKNESS 2.Well Construction Permit it: (t• u. In. ' Cur all appbcobh.well(onto non Prrnule ti r U/C,County.Sale,l'urfantc.etc.) ft. ft. In- 3.Well Use(cheek well use): . t T,scREEN I \Yell FROst Tn DIAMETER SLOT stlE rI11CKNESS MATERIAL Water Supply Agricultural ❑M tc ipal/Puhllc 4 ft. 2 in, IIIMI Geothermal 1lIwung/Cooking Supply) esidentlal Water Supply(single) ft. (t• In. industnaVCommercwl Residential Water Supply(shared) IN•GItOL? i ROM TO MATERIAL- l DIPC%C EM LNT XIETIIOU&AstousT !rogation ry.d r ft Ot_ (L iOltI4Ai) GQ 1-1 `�l �r _� Non-Water Supply Well: t D r I\��—�-- OlIccovery ff. ft. Monitoring Injection Weil: ft. f. . OGruundssater Remedtatson III Aquifer Recharge 19.SAND/GRAVEL PACK lit applicable) DSahnityl3arn M XITHU cr ' roost To StATE)UA1 1 F_ PLSCEy11NTO III Aquifer Storage and Recovery n. DStormwat Ill Aquifer Test a Drainage m' NI r,pen menLai.Technology �Subsidet ce Control It. It. IllGcolhrnnal(Closed Loop( D tracer 2o.OR11.1.INC I arA OG(attach additional sheets if nrcca FROM TO nENCIt1PrTON Icalur•hardness,toll/ruck n)rc,gntn.be,etc.) El Geothermal(Medlin t Coalin trrR�eturn) II Other(es lain under 521 Remarks) It, ft. pL a Wa 1DN n, fr. 4.Dale\Yell(s)Completed: ' .._— ft. A.� f(• f, J Su.Well Location: -- fft. (/ r n, n. Facility Llano Name Fdcdlly ma Of applic;iblc) 7b 3 4 ll.�t ,Son R rt. qo ft. e-Ka vl t.- c{5E_w�- I'hysaal� (dress,City,and Zip it. Q' �yt• 1 pq -% 21.REMARKS TT�� County Parcel Idenuiieanun No.(PIN) _-.._ ---___- _ , ,•_ __ Ski,Latitude and longitude lu degreesfrninuteslseconds or decimal degrees: - --------- Id sseil field.rino tarlong is sulticicni) 22.Certification: '5(ci , tpo a33 8i 01 , (:)?4 , 4 a`4cf N 51 ac/ g_Lf s ST. , 1 rrl lit.: r .,nnlr;tckrt Dale6.Island the well(s) I ermanenl nr Temperer) Rt rt vv th .,.m I t,,rhr mettle that Me well/t/ as. (mitt r oaf Inccrec/(n al(Of Janri' 7.is this■repair to an existing well: ElYes or Nu srth I s.l ':[ u oat' WW1 rd IIA N('_le o]C fs?rNl Well Contra arm Standards and Mat If tat it a repair,fill out knaun nee( l inlnrmmson an./taplais the saran•al the trap,'of tit ,,0,3 h.,s M'en pn,rdd,41 to thr nrll nsinrr, rT(ua under 2!,emurL1 iceman or on the lurk of'ha form. ' 23.Site diagram or additional well details: 4* 8.Fur Geaprobe/DPT or Closed-Loop Geothermal Wells basing ale Sallie You may use the hack of this page to provide additional well site details or well eonstmetion,only l GW-I is needed. indicate TOTAL NUMBER of wells construction derails. You may also attach additional pages if necessary. drilled: SU13MITTAL INSTRUCTIONS 9.Total well depth below land surface: a,90 (ft.) 24a. For All Well\: Submit this form within 30 days of completion of well For rnufnple urar firs all depJrr if different feltiatpte,J.u_att'and 79I/ix() construction to the following: 10.Static water level below top of casing: (ft.) Division of Water Resources,Information Processing Unit. ij..utrr Ieerl is nMsv racing usa 1611 Mall Service Center,Raleigh,NC 27699-1617 II.Borehole diameter: G. (in.) 246.For Infection Wells: in addition to sending the form to the address in 24a 12.Well construction method: 7`.O+sir y above, also submit one copy of this form within 30 days of completion of well i (tr auger,away,cable.dinwf push, set construction to the following: FOR WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground injection Cantrell Program, l.� 1636 Mail Ser'vlee Center,Raleigh.NC 27699-1636 Lia.Yield(gpm) / .Method of test: P%b0 cf tG 24e.For\Vater Supply& inicctlon Wells: In addition to sending the form to of within , C.it the address(c.) ahsavc• also 'submit one copy of Otis form w daysdays13b.Disinfection lips: 4t/f�' Amount: �l�� curnpiction of well construction to the county health depanrncnt of the county whcrt constructed. If s tintm s i ',' Q -�a? ;�«-�;p Nonh(-mutual(7cpartment ut aUnirnnrtm,(al()oak) Dr,.us si of St'atcr fr., Rn+,cc!_'22;Ma .swa .�� �'saw _;�, q " _ .y�., 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: P-/+se- Sample ID Number: 1$11711 Location: 7 03 L.) ' V_rr•I I,(_ r") Reviewer: Jason Boyd Initial Sample K. 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 colifonn 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 depar tiuent 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 colifonn 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. Private Well information and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES p Division of Public Health For Inorganic Chemical Contaminants n� • J44:,' ;r y 5._ ._.. 4ftlLfgat i1=Y County: Catawba Name/Address: p` ��� 7 r ro 4 1st, Le- v Jcl h� , vA r•P`.J�S Sample ID#: 14v 711 y q,� Reviewer: •s Jason Boyd yp �y jE[wry �:'•�i�...Yf.fC AREIr. '" 1�AT7Mt�' M11,F3L.M6FT ..4: `7. t- W'KE:2'lfa �•, STRO ]FII, .'..� `�' .'.'. 'S'. ' �C ,S•4 -K 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 n Chromium n Copper ❑Fluoride n Iron ❑Lead ❑Manganese ❑Mercury n Nickel n Nitrate/Nitrite n Selenium n Silver nZinc 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 fu-st 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. C�loi�dc--T�-C peer -❑-�'Iuoi�dc --,=❑�--oi� -Manganese- ---- - - - - - - - - ❑ pH Silver ❑ 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 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.