HomeMy WebLinkAboutWELL-10-2022-182821.TIF T:!a CATAWBA COUNTY
j,� {�ji Public Health Department Subdivision
:: Environmental Health Division PINk 369609061189
AptaillA
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# TR 5
Site Address: 4713 ZEB LITTLE RD,DENVER NC 28037
Name on Permit: JOHN FULLER
Property Size: Acres 7.41
Directions: 16S to 150E, Right on Zeb Little, Lot is at the end of the road on the right
r . 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
/, 8 4 ) P 8
/P' pr..•rty described above.
Alli/ As the property owner or authorized representative, I have received the above referenced
(rmit(s)as requested in the application for service RBPR-09-2022-42316,by the following method(s):
/
Received in Person
Facsimile Transmittal (Return form with signature required)
00 7 Electronic Image Transmittal/E-mail (Return receipt required)
o,f
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
w�'
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 ply ell permitted.
Permit Issue Date: 10/24/2022
Owner/Authorized Representative Signat e
"Date /O/ o?
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of personsending
��permit)
#,E1
Signature Date/Time joj;.t_ l2z.
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 yoiPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
•
iglier i 6 SrA .
riiprmmit 10/24/2022 09:08
N F.I 1 t'UtiS'I Itl'C`I'lO\ ItH:C'OIZU ((;N'-1) J
For Internal Use 1)nly.
1.Well Contractor Information.
Joseph Barley 14.WATER ZONES _------
� —
w"ail(OMh[Nt Name /NI►N IU 111a1 MIII MS _�....-...._._.
3271-A Ly 90 t. ' 47 c ":_.. - SM,1 f'+lie Ile.--
...,, -�
ikA ft, trt i `/;+6/G he.,:__
Nl Wtll(untrutnr(cniticanon Nwnhcr .--i �----r-.+ ii!._...-._......—
Itt.(slue CAsmq Ifor multilited*tusk Oil ii pr•it n lit_.� _---- --
B U K Well Drilling Inc ►u)M iD iiiVSil u_ _ _itft�stre__ *+�l!Nui. _..--_--,
(ornom`same N. '{7/) rl In, r . . PvC
le I1sKitCAVE GONTI111W rtythermalclosed-loop) N(tf,N1a1
2.Well Construction Permit It: +, e - l ij '"!i,`ig I _MINI I ill L Ilq%li 11 1 _ I1111 h�Rba_�__.___.._- ---
ir.iallaPPlk able aril.ansi,in ruin praua n t 1.II r nw,ri .Bla tar run,r rn, ft. I II. 1 in. jl
in"-
-
3.Well Use(cheek well owl; u. I ft. ,
Water Supply Well: 17.SCREEN
114N1 1 10 1, ',',wit IIH 41UI SW 1 In0.N0f\a 111S1rEA
I Agricultural D1�1unKipal Publicn. n- 1- in
•GeothermalIHcating•Caoling Supply I Qticsidtrntlal Water Supple(single) n. — ' n.'r--"-"---In. i i
■Industna(Comnierctal ❑Residential Water Supply Isharedl `—
la.GROUT
■Im_Mum ►Row T1U ' IUIIAL_ �E%In.((,ENILN_I MtREUDa►MU_t.r
n. j" fl.
Non-Water Supply N' /� �;' � J(�� J— S
Well: 5.! ._._ 7!�h i%G jIIZ(/ / /
■ g QRccoser) rt. I ft. i I
Injection Well: t--- * — -__
__
n, f ram—_—____—.
Aquifer Recharge QGroundwater Rcnrcdiation --"'"'
19.6ANDIGRAVFL PACK If a lubI
■Aquifer Storage and Recover) QSalmty Darner IHOM j 10 _ gull oink. i EM►LSC'EMEN(METHOD
•Aquifer Test QStnnnwala Drainage tt. ft. 1
■Experimental Technology OSubsidence Control ft. i ft. I
Geothermal(Closed Loop) QTracer 20.DRILLING LOG(Mach additional sheets If necessary)
►NUsI 1 O I KC(Met 1OS h u n,.aardnns.soil rock opt.grain Maa.Itch 1
Geothermal(Heating Cooling Return) 1Other(explain under a21 Remarks) I O n n. /rye $d ii 1
-// a ( J
1.DaleNell(slCompleted: 3 Well �� �_�� �Qr l!y�pr1_... 1,c
n. /��n/'�rh. _ �
Si.Nell Location: F IQ h!(/.._ /''�rii ie ode.
n, n.
oho f/it' r //oi , -__ _____
__---
Facility ON ncr Sal: Fu0Liy lDo(If WrililhlcI F__.._ft. ft.
......_._.....--.___..,..-.
0/3 28i) Liii7e 1'?J 08K r AILAl.{89 n. n.
Physica';Addles..Ccy•and%,p j r ft. it. I ----- I
rrqr4hgori C�, vi64)�l H.RENIARKS
Count!,
Parcel - .RLL .eu 14/f s _Je - er7M rD --i
GSb.Latitude and longitude In degrresiminutesheconds or decimal degrees: 1 rJtL.ThA.jiii- -->ti1- r �' fide;5"
of rid I",d.arc lot lorg a sdtii tic nn 22.Certification:
Si.,aline of Toll, .Ii G
6.Is(are)the wall(s)0Permanent or ❑L,•nipurm /
oon-A e is
N, „i;entg; I,i,la, I in.,l d, ,:, ii,,i a m d aa r illi,r, ,; e..,,n u t., ,t,Jn a.., , ••dan.r
�
7.Is thla a repair to an ttisdng well: ON es or l.Y"�,"!r 11
• „rd,1.14.v('I( l)('(Heal„t 11 NC(('o.'(it.(t((OM(mew-m tat Standard,and filar a
IfAuoareMirfillaailnuwnwr/Iroams,w.cmfarnwu.'n,Indr,p.'alrrh.na:uir.,;tar 'Fr.0 in"re,nil'ia,bany„n,drdr,+Ihro.1:.n,rlt•'
repair under r)1 rrnw,kr en Lon or oa;he hu,4 of Ma!win
23.Site diagram or additional wdl details:
ii.For Geoprobe/DPT or Closed-Loop Geothermal V.ells has lag die same You may u`c the hick ut this page to provide additional well site dl't tls or well
construction,only I GN•-1 is needed Indicate TOTAL NUMBER(Audis
construction dclad, 1 ou trial also Mach additional pages if nMClun.
dolled_ ___ /I,^, r St R1111 I.N.1Ns I R('('TIONs
9.Total well depth below land surface: to
9. (rt./ 24a. For All Wells: Submit this Corm within 10 days of completion of wcl)
For iwlnplr well.Lit all depth,.fd(Kr,nr•e.ample 1p:Oa mi.1:-a 1rv15 [unsn 1C(,'n to the t.l!ow Ines
10.Static water level 40 below top of casing: al Dlsision of N Ater Resources.Information Processing Unit,
it wore,loth'alKnr.aa,ng.or 1o17 Mull Service Center,Raleigh,NC 2 7699-1 61 7
I I.Borehole diameter: 6 1/8 (In.) 24h.For Intermit'H ell.: In addition to'ciidmg the toms to the address in 24a
Air Rotary ahotc al„l ,uhnl.t on,.,p of lhis firm within 30 dass of completion of sstli
12.11ell construction method: construction to the tollim ing
u c aultet.n.tr J rc.l pwh tie 1
Division ut Water Resources.Underground Injection Control Program,
FOR N ATER SC PPLS W ELLS
,ONLY: 'intuits 1636 Mail Service Center.Raleigh.NC 27699-1636
13a.l ieid(Rpm) .f. Method of test: /9)r/'fir-
21c.let Water';uls A Injection Weill: In addition to sending the farmlu
1111 the address(csi .ihusc. .11Q submit one copy of this form within 30 days of
13b.Disinfection type: Chior Tabs Amount: 11,2 Loa completion of well cunsinre:lon to the county health department of the county
where constructed
I ,r- ,,1/41 ' North CarolinaDepanmcntofEnsrronnnnialQuahts.D,sun'nofN.acrN,•,,,urc.s Rcswed2.21.2016
i
Analytical Results STATESVILLE
�:�: ANALYTICAL
Catawba County Public Health
PO Box 389
Newton, NC 28658
Receive Date: 05/21/2025
Reported: 05/22/2025
For: John Fuller:4713 Zeb Little Rd, Denver NC 28037
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
250521-43-01 Nitrate 182821 <1 mg/L 353.2 05/22/2025 MD
250521-43-01 Nitrite 182821 <0.1 mg/L 353'2 05/22/2025 MD
Respectfully submitted,
i7 y a LC- i,e/. "
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville,NC 28687 • 704/872/4697
Page 1 of 2
zAIIAt'f iEi
,Z�
122 Court Street Statesville,NC 28677
704-872-4697 www.sa-nc.com
•
_ PIrTRATE/NrIMITE ANALYSIS
NctK1•taknortic'=tbtisdpEcd lcr wrat=abut•
Z_ a Catawba
J
WAI• (SYSTI�Y Dirt �ICIC _ l d _ go)--a. 9&2t County
Name of Water System: a kr. F u-Il c_r
Sample Type: El Emory Point OK Special/Non-compliance
Location Where Collected: 11't)13 2•.b L i+lE gel ► P r✓e.r /tie a gO3 7
Facility ID No. 1 3 a 71-I
Sample Point: {' _ q jl Collection Date 7 Collection'Time
Collected By: 1)w:,L} PO,:k ea..I Of �°'s-° A MQia9
gleam Fria)
Mail Results to(water system representative):
CATAWBA COUNTY PUBLIC HEALTH phone#:1,(828}465-8270
ENVIRONMENTAL HEALTH Fax#: 1(828)465-8276
•
,PO BOX 389 Rap nsible?enoa's email:
EHAdmin@catawbacountync.gov
NEWTON,NC 28658 .
LABORATORY ID#: 37755 Cl SAMPLE UNSATISFACTORY El RESAMPLE REQUIRED
• • !I
CGNTAM MilTROD ' REQUIRED ,NOT DETECTED QUANTIFIED ALT..
CONTAMINANT • CODE REPORTING LIMIT (i.e.<R ILL) RESULTS* F RJIT
i CODE (RILL) Og
1040 Nitrate 3532 1.00 mg/L ----- mg/L. 10.00 m +
1041 Nitrite ri — mg/L 1.00 mg/L 3532 0.10 mg/L 1'�
'Note:If result exceeds allowable limit,the laboratory must fax analytical results to the State on day test completed.
r— DATE: TIME: II
r
( ANALYSES BEGUN: ,�7/ l . • �-:z._ A_L na.,
1 x
Z ANALYSES COMPLETED: Q7 /Z 2 / 2 S 0 -. M_r
:.,.�
ij
Laboratory Log;:a51:15 l•q3'0 1 Certified By: LiCi&--,
COMMENTS: .
2008 Laboratory should Man Results to;, -
Public Water Supply S=tice,Attn:Date Entry,1634 Mail Service Center,Raleigh,NC27699-1634
PO Box 228 • Statesville,NC 28687 • 704/872/4697
Page 2 of 2
r
ma 4312 District Drive
''1` 4--'. North Carolina State Laboratoryof Public Health MSC 191s
,' , + @r: Raleigh,NC 27699-1918
„d If�lt1l,.„,,,,try„
c Environmental Sciences http://slph.ncpublichealth.com
,.ate�' . 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 John Fuller
P 0 BOX 389 4713 Zeb Little Rd
NEWTON,NC 28658 Denver,NC 28037
EIN:566001814EH Delivery: NC Courier
StarLiMS ID: ES250522-0088 Date Collected: 05/20/2025 Time Collected: 10:50 By:
Date Received: 05/22/2025 Time Received: 08:17
Sample Type: Raw Sampling Point: Well Permit No. WELL-10-2022-182821
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
i Barium <0.1 2.0 mg/L
Cadmium <0.0005 0.005 mg/L
Calcium 83 mg/L
Chloride <5 250 mg/L
Chromium <0.02 0.10 mg/L
Copper <0.01 1.3 mg/L
Fluoride 3.55 4.00 mg/L
Iron <0.06 0.300 mg/L
Lead <0.003 0.015 mg/L
Magnesium <1 mg/L
Manganese 0.005 0.05 mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH 8.0 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 38.4 mg/L
Sulfate 241 250 mg/L
Total Alkalinity 43 mg/L
Total Hardness 210 mg/L
Zinc <0.05 5.0 mg/L
Report Date: 06/05/2025 ,--...� Reported By: •
RECEIV
Kathy Schnizler
J U N 1 7 2025
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: S"', r,(I...r Sample ID Number: I ell Z
Location: 4113 2e-1) lit/Q- ,.) Q--,.+.,z-r• Reviewer: Jason Boyd
Initial Sample k Confirmation Sample:
BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR
PRIVAth 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
drin ing, 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 depai fluent 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
` 10°0 Private Well Information
/2 —7F,
>;4, . . and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name/Address:
�.vt,N F. 11�-r Illl; � L;44�.gd 0� ,,.,Lr
Sample ID#: Is.2._ $Z( Reviewer: Jason Boyd
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 onv.
❑Arsenic n Barium n Cadmium n Chromium n Copper ❑Fluoride ❑ Iron
n Lead n Manganese ❑ Mercury n Nickel n Nitrate/Nitrite Selenium ❑ 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. ZI.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.
n Chloride n Copper X Fluoride n Iron n Manganese
❑ pH ❑ Silver nSulfate n Zinc
6. tzta. 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.
1gb.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.