HomeMy WebLinkAboutWELL-12-2022-186344.TIF Print Form
\1'E1,1, CONSTRUCTION RF;CORI) ((;N'-1) I nr Internal Use Only:
1.Well Contractor Information:
Robert Teague _
14.WATER 7.ONE,C
Vl ell Commach7rName teii i ( Itl I nitiC Irr5ri ,.
2857-A /C1 II' ii 7 —". �pA
NC Well Contractor('e fi;a::nn VurIrr �/ oft. r�7� H. 1
8&K Well Drilling Inc 15.OUTER CASING(for muln.ca. L N ed J OR ER(If applicable)
FROrii I—TO I Diana,IFR THICKNESS MATERIAL
Compary Namc o ft. S I. I r it0 In. SDR•71 PVC 1
2.Well Construction Permit 0: 1^ r 16.INNER CASE(,(iR TUBING(geothermal closed-lbop)
11-)"f )��` 1 ���LI�1 FR011 l TO _j D1AMF.TER THICKNESS MATERIAL
list all apPhcat lr wet!ronstru;oon prrmit.I ft r (,'/C.County,State Varian,e,rtr) f6 ft. 1 in.
3.Well Use(check well use): ft, ft. in.
Water Supply Well: 17,SCREEN
rl,\�-j�p(��i FHOM11 I TO nIAsl k.T EH SLOT SIZE THICKNESS 1 M1IATERIAI,
L.J ❑AfunicipaUPubiic ft, ft_ in.
Geothermal(Heating'Cooling Supply) IDRcsidcntial Water Supply(single) in.
ft. It, 1 111
I
❑lndust rtl ial'Comcrcial DResidential Water Supply(shared)
1 imcation 18.GROVT
FROM ; To MATERIAL 1 E?I PLACE N4E1 T NI F.THOD h A.MOL'.\T
Non-Water Supply Well: ft. ft.
0 Mon itonng ❑Rccovcr)' fl. R.
Injection IN ell:
0A offer Rcchar c ft. i et.
❑
y S Groundwater Rcmcdiation
0Ayuifcr Storage and Recove 19.SAND/GRAVEL PACK Of applicable)
ty. ❑SalinityBamer FROM I TO MATERIAL EMPLACEMENT METHOD
(Aquifer Test OStormwater Drainage ft. ft.
0 Expenmcntal Technology ❑Subsidence Control ft. ft.
❑Geothermal(Closed Loop) D Tracer 20.DRILLLNG LOG(*Mich additional sheen'lfoeueaury
aGeothermal(Heating/Cooling Return) Other(explain under.2I Remarks) FROM I TO mP,CRIPi foh(color.hs mess,sciVrx►hp,rain stab rte.)
('r1 rt.Is...� ft.
4.Date Well(s)Completed: S- I S '.13 Well 1Bk 6..�✓ ft. fa I
Si.Well Location: D-!SR. I?�l�e�ft 1 (L�i J 1 , �1
•
C 51 6 010,h l? i fl. N V—� t
Facility/Owner Name Facility IOU(if applicable) ft. ft.
I 1.)-vCA Vk de.,Lic.,11 CI-xurc., -1 .)4..
Physical Address,City,and Zip Lb T ft. ft.
C -, \CA.L41 21.REMARKS j
County Parcel Identification No.(PIN)
5b.Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field,one lat/long is sufficient) 22.Certification:R_NpA*_____14. 1.4ie..„
N W s- )S- O3
6.Is(are)the ssell(s)0Permancnt or 0Temporar Signature ufCrndied\' nacrur Date
to stgniag rhts trim, t hetebi(et*that the ice(/to was(hero consorted in accordance
7.Is this a repair to an existing well: ❑Yes or es uitli 13 ,VCAC 02C 0/00 or/r4 NCAC 02C 0200 Well Construction Standards and thata
If this is u repair.fill out knoun well construction information and er into the nature of the copy tJ this record has been pruruled to the urll owner
repair under ell remarks section or on the back of this form
23.Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
8.For GeoprobetDPT or Closed-Loop Geothermal Wells having the same
construction,only I GW-I is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: 3 O_S^ (ff•) 24a. For All Wells: Submit this form within 30 days of completion of well
For multiple wells list all deptkt if different(example-3'@200'and-U(/001 construction to die following:
10.Static water level below top of casing:40
ft
( ) Division of Water Resources,Information Processing Unit,
/f war fevers ahoie raring,use 1617 flail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 1/8 (in.)
24it. For Iniection Wells: In addition to sending the form to the address in 24a
12.Well construction method:
Air Rotary above,also submit one copy of this form within 30 days of completion of Well
(i e.auger,rotary,cable,direct push.etc.) construction to the following:
Division of Water Resources.Underground injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 2 76 99-1 636
13a.Yield(gpm) '").---(2) Method of test: Air Flow 24c.For Water Supply& Injection Wells: !n addition to sending the form to
Chlor Tabs v2lbs the address(rsl abuse. also submit one copy of this form within 30 days of lib.Disinfection hpc: Amount: completion of well construction to the county health department of the county
where constructed.
Form GW-I 'onh Carolina Depanmen'of Ens ironmenul Quality.Dssision of Water Resources e,
Revis -�2�
2016
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: C.1..t+ 5 c ,i3 Sample ID Number: W^--L-t- I1-1 - — 184 3144
Location: 2-1-1 I4ep&..r�I l C t.. R 5 FF Reviewer: 'Salon Boyd
Initial Sample )( 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 depar indent 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 coliforrn 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 colifornr 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,orimmunocompromised (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.
S ' O
r 1 f
vate Well n o.rmation
NC DEPARTMENT OF andU se Recommendations
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: c 1,�� stq,,,,os, �l'i-4 idop•-mil -I r . 44) F•r7
Sample 1D#: I fsb q'.{ Reviewer: Jason Boyd
TEST RESULTS AND USE RECOMMENDATIONS
1.1K1 Your well water meets federal drinking water standards for inorganic chemicals.Your water can be used for
drmking, 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 n Barium ii Cadmium ❑ Chromium E Copper Fluoride ❑Iron
❑ Lead ❑Manganese _ Mercury ❑Nickel n 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,
co eking,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 C Fluoride _ Iron El Manganese
X pII 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.
pH, Total ., ..ia-, ._
Alkalinity &
PRIVATE WELLS - ,., ,. . ...4,,
11,
I , ,...„
What are pH and total alkalinity?
,,,
, ,
, .
pH is a measurement of the acidity or basicness of
00
r
water.Water with a pH less than 7 is acidic.Water
that has a pH greater than 7 is basic.Water the has a
pH of 7 is neutral, neither acidic nor basic. `-
Total alkalinity is a measurement of the capacity for
water to resist changes in pH.
What affects the pH level acceptable range for pH.This standard was developed
and total alkalinity in to prevent metallic or sour taste,slippery feel,and pipe
my private well water? corrosion.There are no health-based standards for pH.
pH levels and total alkalinity depend on the amount The US Environmental Protection Agency or
of minerals like carbonate, bicarbonate,and NC Department of Environmental Quality have not
hydroxide in groundwater. developed standards for total alkalinity.
How can pH and total How do I test for pH and total
alkalinity affect my health? alkalinity in my private well?
High and low levels of pH can cause gastrointestinal Use a certified lab or buy test kits at your local home
problems. Low pH (less than 4) can cause skin and improvement store to test for pH and total alkalinity
eye irritation. High pH (greater than 10) can cause in your well water.Contact the private well program
hair damage. High and low pH can cause corrosion at your county health department to assist you with
which may cause more harmful contaminants to getting your water tested. Pricing of testing varies
enter groundwater. from county to county.
Alkalinity cannot impact your health.
What if my water is acidic
What level of pH and total or alkaline?
alkalinity should I be If you are concerned about the taste of your
concerned about? well water,you can install a treatment system to
The US Environmental Protection Agency or neutralize the acidity or alkalinity of your private well.
NC Department of Environmental Quality developed A neutralizer is a treatment system that can reduce
an aesthetic standard for pH of 6.5 to 8.5 being an the acidity or alkalinity of your well water.
Percent of Private Wells Tested
Outside of State and Federal Guidelines for
pH, 2011-2013
allM111111111111MIWNP.top
.jign.aolior
0
1 trill lin 11111/14111111111121141111*Vil k
.114_ - I"IIIIMAIIM 11111 ' YAM I 1,LNIP ilk 1 PO- I I UPI I i
tioCIII7L.--: lbw&
E25.1-50%outside guidance range OVA.
<25%outside guidance range
0%outside guidance range
M -4411
Insufficient data(<10 wells tested)
What are the pH and total Where did this information
alkalinity levels in NC? come from?
The pH of private well water varies across NC US Environmental Protection Agency:www.epa.
(3.2-11.6),see map for areas with pH outside gov/sites/production/files/2015-09/documents/
of guidance range (6.5-8.5). 2009 03 13 estuaries monitor chapl 1.pdf
Total alkalinity of private well water varies across and https://safewater.zendesk.com/hc/en-us/
NC ranging from 0 1,020 mg/L. articles/2 1 1 406048-What-is-the-difference-between-
pH-and-alkalinity-
Where can I find more World Health Organization:www.who.int/water
information about pH, total sanitation health/dwq/chemicals/ph revised 2007
clean version.pdf
alkalinity and my well?
Water Quality Association:www.wga.org/learn-
Visitthe NC Division of Public Health's Private Well about-water/perceptible-issues/corrosion/acidity-
and Health Program website: http://epi.publichealth. low-ph-
nc.gov/oee/programs/wellwater.html.
There you can find:
• Contacts for your county private well program
• pH and Total alkalinity in well water maps
• A guide for selecting a treatment system
• Other private well resources
You can also call the Private Well and Health Program
at 919-707-5900.
"7"a.? NC Department of Health and Human Services• Division of Public Health• Epidemiology Section •Occupational and Environmental
NCPH
y, ;,� Epidemiology Branch •Private Well and Health Program• https://epi.publichealth.nc.gov/oee/programs/wellwater.html • NCDHHS is an
.,_.,.r' NPublic Healtunbcar•fb a equal opportunity employer and provider.•09/2019