HomeMy WebLinkAboutWELL-03-2023-192045.TIF 1.Well Canttletor Information: I
Robert Teague
well Caorneror Name14,WATER ZONES -,.
hR 1 DISCRI►IION
2857-A rt. \ID rt. Za P
NC Well Contractor Certification Number ft.
B&K Weil DrillingInc IS.OUTER CASING fror mild-eased"ells OR LINER(ugp0�bk) —
FROM _ TO DtAM£rtR ritta\t3S j MATERIAL.
Company Na 0 ft' j / caft- 61r6 Im. SOR•21 . PVC __
Norm
2.WellREtrneppp permit�: 1 Co 2 D 13 I 1 1�17 f} ii 5 16.INNER CASING OR TUBING(leader a aimed-imp)
���.Jf FROM TO DIAMETER THIC)',U5 MATERIAL •
Lin all appltc tole wit eo+attrucnon perMIO(IT (EC,Coltmty.Stare.Variance.etc 1 11. R la
3.Well Use(cheek well nse): i R. , n. in.
Water Supply Well: 17.St71EE,n
AlricultW'al 0 M `RO\t - TO DIAMETER SLOT SIZE THICKNESS AI ATERL\I.
unicipabF'ubhc ft. ft. Ia.
Geothermal(Heating/Cooling Supply) la}Residential Water Supply(single)
Indust ialCommercial tt. ft. In
['Residentia114'ataSupply(shared)
Irrigation la.GROUT
FROM TO MATERIAL_y EMPLACEMENT METHOD&AMOUNT
Non-Water Supply Well: ft. ft.
Monitoring ['Recovery (L n.
Injection Well:
Aquifer Recharge ['Groundwater Rem:dation n ft.
o Aquifer Storage add Recovery ( Salini Barrier 19.SAhWGRAYEL PACK ftfapp8ob4)
a—r h' FROM TO MATERIAL EMPLACEMENT METHOD
Aquifer Test ['Stormwater Drainage ft. fL
°ExpmII1dptalTcehnology ()Subsidence Control IL - EL
['Geothermal(Closed Loop) ['Tracer 2e.DRu1.1NGLOGstt chaddiimtsbeemIfnocen+ur)Geothermal HeatinFROM To Disclrmo\(r.sre. +e _re aria t
l F1Cooling Return) (explain under a21 Remarks) � rL i `' C
4.Date Well(s)Completed: a' \ weuwj 1. ft. -,U ft Aq{oi 51.kE V 1.,Y
5a.Weil�L.ocaatloon: ] ft- R —'—;
" !pcd/Pl1 (/b5-r14G'l;.k ftn I
FaeilitylpwncTName I� f Facility IDa(if applicable) Si3 rt. rt. —
I95 1 I""/�vtk 144)0 f Qr PLC,, fL fL --�
Physical Address.City,and Zip J � 4„,dLl1 R. it
A) le �I7pDas_q(D.2 7 21.REMARKS -
County Parcel Identification No.(PIN)
I
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: _..l
(if well&ld.one Iattlong is sufficient) 22 C 'Oration:
6. are the wdU s Permanent or Tem n S�gnaturc of Crntficd Wcll L_____veQyest ________.
ctor Dan / / J
ls( ) ()� Q ry
8� signing Diu fern+,!pmb\nrltfy that the wr11R1 Hnr(Pere)eunstraecini is aecaden.e
7,is this a repair to an eslsting well: Dyes or NO Hith 134 NCAC OK 0100 or 154 NCAC 02C.0200 Weil Consovicelon Standards and that c
{/this le a repair,fill our none Kell construction information and explain the nature oldie cnpY Di Mir retard ha,bete Pe”War,l Is the sell"Her.
repair under ill remarks section or on the back of this form.
23.Site diagram or additional well details:
8.For GeoprobeJDPT or Closed-Loop Geothermal Wells having the same
You may use the back of this page to provide additional well site details or Neli
construction,only 1�GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary.
drilled: j C 5t)BMlTTAL INSTRUCTIONS
9.Total well depth below land surface: Z OS (ft.) 24a. For AR Wells: Submit this form within 30 days of completion of well
For.,duple+Nells art all depths fdifferent(example-i 200'and 2 lOCE) construction to the following:
10.Static water level below top of casing:40 • (ft.) Division of Water Resources,Information Processing Unit,
(rKour!fly!Is above Casing.use " 1617)tail Service Center,Raleigh,NC 27699-1617
11.Borehole diameter: 6 118 (in.) 14b.For Iniection Wells: In addition to sending the form to the address in 2-Ia
Air Rotary above,also submit one copy of this form within 30 days of completion of well
12.Well rnnstrtactioa method: construction to the following:
(i.e.sups.rotary,cable,direct push,etc.)
. Division of Water Resources,Underground Injection Control Program.
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center,Raleigh,NC 27699-1636
13a Yield(gpm) Nietbod of tat:Air Flow 2.k,for Water Supply do Infection Wells: In addition to sending the form to
the addresses) above. also submit one copy of this form within 30 days at
1311 Disinfection type: ChlOr Tabs Amount: 1 1r2 Lim completion of well construction to the count health department of the court)
where constructed.
Reviled 2•22•'_Olt
Form GW.1 North Carolina Dcpuvrsnt of Emironmenral Quality-Division of Water Rcsourra
Analytical Results STATESVILLE
ANALYTICAL
Catawba County Public Health ={
PO Box 389
Newton, NC 28658
Receive Date: 05/22/2025
Reported: 05/24/2025
For: Brian Stevenson:4534 North Wynswept Dr, Maiden
NC 28650
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
250522-33-01 Nitrate 192045 <1 mg/L 353.2 05/23/2025 CL
250522-33-01 Nitrite 192045 <0.1 mg/L 353.2 05/23/2025 CL
Respectfully submitted,
71 d- ;9
Melissa Myers
NC Cert tt/40,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2
122 Court Street Statesville,NC 28677
704-872-4697 www.sa-nc.com . '
•
NITRATE/NITRITE ANALYSIS .
. No�A11a. nna aantbec.i'^i,lied 6=r-o';r=Et
WATER SYSTEM ID i WCL.I.-D 3 - 20�-3-!i 2.0 tiS County: Catawba •
Name of Water System: g f:a>- .51-t V el.-So%+ -
Sample Type: ❑Entry Point .(Special/Non-compliance
/, t �+{Ci"1"Z, 1 1 t,ywe. Pei �aa, M . 2 e sb
Location Where Collected: "!'
Facility ID No. /`1 x 6 LE 5
Sample Point:.± i •) I Collection Date 1 Collection Time
I
Collected By: Quin, jnil1ke1ti _O51.2.lI;- • f/ :S'O Mt
(a..P:iA) (d!YJDDDYY) (S fr&Vag'Y60
Mail Results to(water system representative):
CATAWBA COUNTY PUBLIC HEALTH Phone#:1 (828)465-8270
ENVIRONMENTAL HEALTH Fex#: 1(828)465-8276
PO BOX 389 ResponsiblePerson's email:
. •EHAdmin@catawbacountync.gov
NEWTON,NC 28658
LABORATORY ID#: 37755 . ❑SAMPLE UNSATISFACTORY ❑RESAMPLE REQUIRED
. t
CON TAM METHOD REQUIRED NOTDEfECTr.D QUANTSFIr^D • ALLOWABLE
CODE CONTAMJNANT • CODE REPORTNGLIMI' (Lc<RILL.) �r LIMIT
(R.tu) (X)
1040 : Nitrate 3532 1.00 mg/L Wj - . mg/L 10.00 nlg/LI
1041 Nitrite • 3532 0.10 rng2 Y _____. mg/L 1.00 rag/Li
*Note:If result exceeds allowable limit,the laboratory must fax analytical results to the State on day test completed.
DATE: TIME:
1 ANALYSES BEGUN: 5/ 2?J'/ 25 —1 :30 A Al.
. (sF.I.Y .arm.
ANALYSES COMPLETED: 6 2/ 3/ZS ____•_____,
�.3 'M
1 , r,m ne.eD iw:aral
Laboratory Logy": 05 )-' 3 3•o i Certified By: - _�J\
COMMENTS:
2c08 -
Laboratory should Mall Results to: .
Public Water Supply sectira,Anu Data Eat y.1634 Mat Service Ceata Re1d h,NC 27699-1634
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 2
1
")' "�-R 4312 District Drive
/ r ;, North Carolina State Laboratory of Public Health MSC 1918
`; �I ��;1p1 Raleigh,NC 27699-1918
\ :. Environmental Sciences
* +�n.,•. http://slph.ncpublichealth.com
` �^^ _ x' 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 Brian Stevenson
P 0 BOX 389 4534 North Wynswept Dr
NEWTON,NC 28658 Maiden,NC 28650
EIN:566001814EH Delivery: NC Courier
StarLiMS ID: ES250523-0015 Date Collected: 05/21/2025 Time Collected: 11:50 By: Dwight Mikeal
Date Received: 05/23/2025 Time Received: 08:04
Sample Type: Raw Sampling Point: Well head Well Permit No. WELL-03-2023-192045
Sample Source: New Well Receipt Temp. : GPS Number:
Profile: New Well-No Nitrate I
Analyte Test Result Allowable Limit Unit Qualifier(s)
Arsenic 0.002 0.010 mg/L
Barium <0.1 2.0 mg/L
Cadmium <0.0005 0.005 mg/L
Calcium 9
mg/L
Chloride <5 250 mg/L
Chromium <0.02 0.10 mg/L
Copper <0.01 1.3 mg/L
Fluoride <0.1 4.00 mg/L
Iron <0.06 0.300 mg/L
Lead <0.003 0.015 mg/L
Magnesium 6 mg/L
Manganese <0.005 0.05 mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH 7.4 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 5.3 mg/L
Sulfate <5 250 mg/L
Total Alkalinity 54 - mg/L
Total Hardness 46 mg/L
Zinc <0.05 5.0 mg/L
Report Date: 06/05/2025 Reported
RECEIVED p By:
Marc Komlos
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: i3 r 'c^ sk"'s oIr% Sample ID Number: A
Location: 9 S 3'1 rl• Ivy„sw°- U r. /N! 131,-, Reviewer: Jason Boyd
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.
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
Private Well Information
i 4 - - )Q
�� and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name/Address: vp r n S-K_,, ,-aa, L.5"3I-1 N. !✓vyra tfr. p{- � f
Sample ID#: (q y u`I r 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
dr' king, 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.
n Arsenic ❑ Barium n Cadmium ❑ Chromium ❑ Copper ❑ Fluoride ❑ Iron
❑ Lead ❑ Manganese ❑ Mercury n 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 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 n Copper LI 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/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/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.