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Home My WebLink AboutWELL-10-2022-182127.TIF .4,18' e CATAWBA COUNTY Case# WELL-10-2022-I82127 E.3: .g.II 2 Public Health Department Subdivision C L REITZELL PROPERTY UN d - 41 Environmental Health Division PIN# 373516941712 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# Site Address: 6276 LYNCHBURG RD, HICKORY NC 28601 Name on Permit: MW2 LLC Property Size: Acres 0.43 Directions: Sulphur Springs Rd, right Lynchburg Rd,take right to stay on Lynchburg on right Owner/Authorized Representative Acknowledgement of Permit Receipt _I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of the property described above. As the property owner or authorized representative, I have received the above referenced /x permit(s)as requested in the application for service RBPR-08-2022-42032,by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) IElectronic Image Transmittal/E-mail (Return receipt required) As 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: 10/12/2022 ... P. 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 0,?e" Date/Time ID)iT I" Method: Fax Ni 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 ycaPlease ttake a few momentts tto complette our custtomer service survey aft http://www.surveymonkey.com/s/EHCusttomerService lo b boo ke% aol. e vhpr,„it 10/12/2022 12:29 CATAWBA COUNTY Case# WELL-10-2022 182127 /. Public Health Department Subdivision C L REITZELL PROPERTY UN < , 1 � Environmental Health Division PIN# 373516941712 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 1, . w Site Address: 6276 LYNCHBURG RD, HICKORY NC 28601 Name on Permit: MW2 LLC Property Size: Acres 0.43 Directions: Sulphur Springs Rd, right Lynchburg Rd,take right to stay on Lynchburg on right 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. 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S�t z . t. n; ;t1 �!E i fig., 1 X 4 ` P��pO : ' ;,f,E,j 16 `i 3 i \ . 1 \ \� , r`T c• ayi4 k I \ t,pp ` .., `§04c .X£ F t ' F I I -- ' i *Qy E -i g ,i. I I -1 in -,--� -. U ,i i- . d.. a ' nl ti.Xr .4owA� xt " ns 3=`� , 'I71 1 ..- FG. rp�cI �;Cs 9S I 11 11 II �1 4 ypy i Fa I 1} 3 S I•; f. .7 t4 X1.I vr Xati `�.. \C f yi .F,3 .. .74 1 , tfl �A II I. n^ .aFFw in.y, q C� tit Aii . ^Y,t I • }, j"• F2,i3 , ka �`.. M t to i 11- l I �' r F. ,3 4 y ,r r ', n.m? •' •i7-1 : : .— :.'.i ''' 4 -------------A j • � •0 L p , - fTl I I I ; ' ..., 1 l ' SHABELDEEN 'Is . 'n 1 .: 41' .II� ;4- ifda•IIG ,i .l(biFi�F ciillre711, RING < „ ENGINEERING s <1 �; I-I I I „ r,., a ,i. n Mil I, _r.a-I .. — -„�-- :'',: Sri, I� ; 10/12/22,9:52 AM about:blank Me..,, WPDT Report Area of Interest (AOI) Information Area : 3,134,508.67 ft2 Oct 12 2022 9:51:20 Eastern Daylight Time a —��'- b JLrdbr I _an,4 l `t��aeet °/ t, -'`y.Mam zr_17\ - 41. s. ., Allik.. . .......--..\----- P '.....-...--',......._,_. -- \ ' I T -1C\, \V:\,.. ak .'d t_ H \ • -- 1 a . --lt r } 1 l . ...,„( . ........ ,i,t,i._., e . —____--] _ ,..___ -1------------- - \ ___ __. __ _ ....... _______________ .,, it ________, 1:4,514 c 0 03 0(ld 0.12 m L_._!Pmce s IPorwons) Parcels Pt 01ected Route l 1 4 4 4 1 ti r 't Non-Syatem Roads — Otter State Agency Route 0 0.05 0.1 0.2 km — Federal Route — Secondary Route t1an-System Pnmary Roads Other System Raaes — Interstate 'K0Q1 C.5 L I sa,•,..Es"Moo OS.USGS MW.t`ASA.CCAAR N RWnmel.e£.6AS Ms OS MM.GmdataMyrvWn Rp{war•eat G0A Ramps,Rest Areas,Nor Main+ute — US Route 0. MIA ^"•mID aaat w•Gts user.,aa,.avr 5>n Camm.vy Mr,• CeMnbuurt Smw d ?bin Cm:07ns 001 C Coa•Sh•MMap -. NC Route about blank 1/2 10/12/22,9:52 AM about:blank 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. about:blank 2/2 WELL CONSTRUCTION RECORD(GW-1) For Internal Use Only: I.Well Contractor Information: Chris C Russell I4.WATERZONES Well Contractor Name FROM TO DESCRIPTION 3254 A 50 ft. 145 ft. ft. ft.] NC Well Contractor Certification Number IS.OUTER CASING(for multi-cased wellsIOR LINER(if applicable Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS ,MATERIAL 0 ft. 45 ft• 6.25 'a- SDR21 PVC Company Name WELL-10-2 022-18 212 7 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit li: _FaOM TO DIAMETER THICKNESS MATERIAL, Us!all applicable well construction permits 6.e. U!C,County,State.Variance,etc.) ft. ft. in. 3.Well Use(check well use): R. ft. in. Water Supply Well: t7.SCREEN --- FROM TO DIAMETER SLOT SIZE_ THICKNESS MATERIAL. CAgricultuntl ❑Municipal/Public ft. ft. in. 1 GGeotherrnal(Heating/Cooling Supply) iiiResidential Water Supply(single) R. ft. in. ----- -- ❑IndustriaUCommercial 0 Residential Water Supply(shared) ---1 tit.GROU'i' 0 Irrigation ❑Wells> 100,000 UPD FROM 'TO —__ MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: --- 0 ft' 20 ft• Grout Poured ❑Monitoring ❑Recovery ft. et. Injection Well: ft. ft. ❑Aquifer Recharge CiCrroundwater Remediation 19,SAND/GRAVEL PACK(if applicable) CAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD • ❑Aquifer Test ❑Stonnwater Drainage ft ft. C)Experimental Technology LJSubsidence Control ft. ft. ❑Geothermal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets if necessary) CGeothermal(Heating/Cooling Return) ❑Other(explain under S21 Remarks) FROM ro DESCRIPTION color hudam soil/rock s a train size,etc.) 0 ft' 41 ft. Dirt 4.Date Well(s)Completed: 4-26-2023 Well IDi# 41 ft• 145 It. Rock ----- Sc.Well Location: IL rt. MW2 LLC ft. ft. -- ._ --- Facility/Owner Name Facility ID*(if applicable) ft. ft. -----��--N 6276 Lynchburg Rd, Hickory NC 28601 ft. ft. ---Physical Address,City,and Zip ft. ft. Catawba 1--D.REMARKS — County Parcel Identification No.(FIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: 1------- ---._—_ (if well field,one latilong is sufficient) 22.C'e fication- 35' 803.28' 81' 228.94' W � .�fit'' 4/27/2023 b.Is(are)the weil(sl: Perntanenl or :Temporary Signature ofCertified Wcll Cont ctnr Date .St'signing this form,l hereby eartlfi,that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or MN() 15A NCAC 02C.0100 or IBA NCAC 02C.0200 Well Construction Standards and that a cops' j 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 owner. repair under ti21 remarks section or on the back uf this form. 23.Site diagram or additional well details: You may use the hack of this page to provide additional well construction info 8.For Geoprobe/f)P'C or Closed-Loop Geothermal Wells having the same construction,only 1 GW-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: 145 (ft.) For multiple welts list all depths if different(example-3(ty200'and 2(0100'j Submit this GW-1 within.3()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), If water level is above casing,use"+" Information Processing Unit,.1617 MSC,Raleigh,NC 2 7699-1 6 1 7 11.Borehole diameter: 6.25 (in,) 24b. For Injection Wells:Copy to DWR,Underground Injection Control(lUC) Program, 1636 MSC,Raleigh,NC 27699-1636 12.Well construction method: Air Drilled {i.e.auger,rotary,cable,direct push,etc.) 24c.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the county environmental -icalth department of the county where installed FOR WATAR SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPO:Copy to DWR,CCPCUA 1 00 Air Permit Program. 1611 MSC.Raleigh,NC 27699-1611 13a.Yield(gpm) Method of test: t� 13b.Disinfection type: HTC Amount: 1/3 cup Form C1W-I North Cantlina Department of Environmental Quality-Division of Water Resources Revised 6-6-2011t 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: Christopher Chilton Sample ID Number: 182127 Location: 6276 Lynchburg Rd,Hickory NC 28601 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 <� iks. Private Well Information i and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Christopher Chilton—6276 Lynchburg Rd,Hickory NC 28601 Sample ID#: 182127 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 n Chromium n Copper ❑ Fluoride n Iron n Lead n Manganese n Mercury ❑Nickel ❑Nitrate/Nitrite n 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 of*,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. n Chloride n Copper n Fluoride ❑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/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.