The URL can be used to link to this page

Home My WebLink AboutWELL-05-2023-195035.TIF r � CATAWBACOUNTY Case# WELL-05-2023-195035 Public Health Department Subdivision Environmental Health Division PIN# 373516941624 PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 4 v, Site Address: 6270 LYNCHBURG RD, HICKORY NC 28601 Name on Permit: JOHN KAISER Property Size: Acres 0.44 Directions: Springs Rd, left onto Wandering Ln, right onto Sulpher Springs Rd NE, right onto Lynchburg Rd,property on the 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 permit(s)as requested in the application for service EHPR-04-2023-44169,by the following method(s): Received in Person Facsimile Transmittal (Return form with signature required) s[ Electronic 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: 05/05/2023 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) lei Signature G Date/Time S/1/1)3 Method: Fax ,J Email US Mail Other Owner's request to send by the abuse indicated method of transmittal in lieu of signature We wantt tto hear from yoLPlease ttake a few momentts tto complette our custtomer service survey att http://www.surveymonkey.com/s/EHCusttomerService " w ? p(LIJ e C I3 0°'j j t.�- '. (1t 4 11013 ehpenn:: 05/05/2023 11:28 10/23/24,6:08 AM about:blank WPDT Screening Report Area of Interest (AOI) Information Area : 3,134,508.8 ft2 Oct 23 2024 6:08:15 Eastern Daylight Time rJ ___- m _ v _ t1 Una c �� \ C rated Sir et \ —.• UnnaMed Street__L if f/ g i c0 ratfity t 4 Ln 1 r• f __, , • M -----.) ig ., . , y" r, „ 0. \,,,.,.. ,---.:- 7----1--------/ \\i, y_____/______________li I______. , / 1.§. ., i , \ \ 1 4,514 UST Incidents 0 0.03 0.06 0.12 mr 1 1 ,. ', LI ti . ti ' ill Low Risk 0 0.05 0.1 0 2 km 0 North Carolina Parcels IPorygorsi-Parcel ni.County Boundary. Non-System Roads SCOOT OS.OL SO.res fs^.Attu:OS.uSGS VGA NASA.CGiAR.N Fbanson NCEA3 M.5 03 NWA.GIWYOsCfeser.R'Ms.aiatnbat.GSA. _.— Non-S"9tefn Geoa'1a FEL% Mellon a10 lt*GO us2,oarnrurr.Esc Canrm,mIN soar Ccntrr:an. Stay or horn Carslna oo' : Oae'Lteentap. ,,woIur;«},',ToroTon.Garin Sirearayr 3IORO,1sG'5'T.MMET. — Secondary Route about:blank 1/2 10/23/24,6:08 AM about:blank 6270 Lynchburg Rd,Hickory NC 28601 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 and attribute 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-I) For Internal Use Only: 1.Well Contractor Information: Chris C Russell 14.WATER ZONES Well Contractor Name FROM TO DESCRIPTION 3254 A 60 rt. 185 t. ft. ft. NC Well Contractor Certification Number 1S.OUTER CASING(for multi-cased wells)OR LINER(if op Ile/Me) Russell Well Drilling, Inc. FROM TO DIAMETER THICKNESS MATERIAL Company Name 0 ft' 44 It. 6.25 In SDR21 PVC 2.Well Construction Permit#: WELL-05-2023-195035 16,FK01dNER C TO NG OR TUBING(geuthermal closed-loop)DIAMETER THICIth ESS MATERIAL List all applicable well construction permits(l.e.WC, County,State, Variance,etc.) ft. rt. In, 3.Well Use(check well use): ft. ft. In. Water Supply Well: 17.SCREEN FROM TO DIAMETER SLOT SIZE TIIICKNESS MATERIAL ❑Agricultural ❑MunicipaUPublic ft It. In. DGeothcrmal(Heating/Cooling Supply) ('Residential Water Supply(single) ft, ft. in. ❑lndustriaUCommeroial ❑Residential Water Supply(shared) 18.GROUT ❑irrigation ❑Wells> 100,000 GPD FROM TO _MATERIAL EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0 ft' 20 ft, Grout Poured ❑Monitoring URecovery ft. ft. - Injection Well: ft. ft. ❑Aquifer Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) OAquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD O Aquifer est ❑StonnwaterDrainage ft• ft.'l DExperimental Technology ❑Subsidence Control ft. ft. DGeothermal(Closed Loop) OTracer 20.DRILLING LOG(attach additional sheets If necessary) DGeothermal(f Ieating/Cdx,ling Return) ❑Other(explain under#21 Remarks) FROM TO DESCRIPTION(color,hardness,soli/rock type,&rain sire.etc.) 0 ft. 39 rt. Dirt 4.Date Well(s)Completed: 8-24-2023 Well ID# 39 ft. 185 ft Rock 5a.Well Location: ft. rt. John Kasier ft. ft. Facility/Owner Name Facility ID#(if applicable) it. ft- 6270 Lynchburg Rd, Hickory NC 28601 ft. ft. - Physical Address.City,and Zip ft. ft. Catawba 2L REMARKS County Parcel Identification No.(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (if well field,one latilong is sufficient) 22.Certification: 35. 803.50' N 81 . 229.09' w ("-- iee.4.../.- 8/31/2023 6.Is(are)the well(s): In Permanent or ❑Temporary signature oFCertille We I Contractor Date Ily signing this farm,I hereby rerti(v that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: DYes or It No I5.4 NCAC 02C,0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy 1(this is a repair,fill out known well construction infin•nation and explain the nature of the of this record hat been prodded to the well owner. repair under h21 remarks section or on the bark of this form. 23.Site diagram or additional well details: K.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info 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: 1 85 ft, For multiple wells list all depths if different(example-3 200'and 2(ai 001 ( ) Submit this GW-1 within 30 days of well completion per the following: 10.Static water level below top of casing 60 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 27699-1617 11.Borehole diameter 6.25 (in) 24b. For Injection Wells: Copy to DWR, Underground Injection Control (IUC) 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 I eaith department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPD:Copy to DWR,CCPCUA 13a.Yield(gem) Method of test: 50 Air Permit Program,1611 MSC,Raleigh,NC 27699-1 61 1 13b.Disinfection type: HTC Amount: 1/3 Cup Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6 201 t: gA CD Case# WELL-05-2023-195035 ET ‘.4 CATAWBA COUNTY HEALTH DEPARTMENT w= ,,5, Environmental Health Section .I8 42 sM 07/23/2024 WATER SAMPLE TEST RESULTS Owner JOHN KAISER,5731 CROWN TER,HICKORY NC 28601 C:9419934748 MW2PROJECTS@GMAIL.COM Contractor CHRIS RUSSELL,RT 12 BOX 363,HICKORY NC 28602 C:8286129860 Site Address: 6270 LYNCHBURG RD,HICKORY NC 28601 Parcel Number: 373516941624 Lab Coliform Analysis Results: Total Coliforms: Ci 1Can+ Fecal/E.Coll: rr No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident 5 e, • el.7 00 Lab Tech Initials 2�u Date/Time Received 08/28'j 20 2�-t Date/Time Completed u 1��/v�{ V Fit' RECEIVED AUG 3 0 2024 Environmental Health rsamfieldreport 07/23/2024 11:10 Page 2 of 2 •$A O Case# WELL-05-2023-195035 7, l-1�fit, CATAWBA COUNTY HEALTH DEPARTMENT ,7 := Environmental Health Section \ 11 Ig 42 sM 07/23/2024 WATER SAMPLE FIELD REPORT Owner JOHN KAISER,5731 CROWN TER,HICKORY NC 28601 C:9419934748 MW2PROJECTS@GMAIL.COM Q 4 70 C 4 4'1 Contractor CHRIS RUSSELL,RT 12 BOX 363,HICKORY NC 28602 C:8286129860 Site Address: 6270 LYNCHBURG RD,HICKORY NC 28601 Parcel Number: 373516941624 Driving Directions Springs Rd,left onto Wandering Ln,right onto Sulpher Springs Rd NE,right onto Lynchburg Rd,property on the right then 7 Sample Collected by: •-ew O!vl vu�„S Date/Time Sampled: 1 I G y 1:0 o )111 Sampling Point: SG,I�nUL, Is well head accessible? Yes V No Reason for inaccessibility Well New or Existing? New ✓ Existing Type of Well: Drilled N/ Bored Hand Dug Punch Does well meet adequate construction standards from what can be observed: •'V Yes No Items of non-compliance:, Evidence of improper grouting or no grouting Well does not meet a required setback(comment) Improperly constructed sanitary well seal Well head not term at>= 12"above finished grade Well head missing vent Well head does not have a threadless tap Well missing identification plate or pump tag Wire conduit opening not sealed Other(comment) z n 3 Comment: „ � "i!, x ro rsamfieldreport 07/23/2024 11:10 Page 1 of 2 Analytical Results STATESVILLE 41( m°, ANALYTICAL Catawba County Public Health �. PO Box 389 Newton, NC 28658 Receive Date: 08/29/2024 Reported: 08/30/2024 For: John Kaiser 6270 Lynchburg Rd. Hickory NC 28601 Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 240829-19-01 Nitrate 195035 <1 mg/L 353.2 08/30/2024 CL 240829-19-01 Nitrite 195035 <0.1 mg/L 353.2 08/30/2024 CL Respectfully submitted, is Melissa Myers NC Cert#440, NCDW Cert#37755, EPA#NC00909 PO Box 228 •Statesville, NC 28687 • 704/872/4697 Page 1 of 2 fit, STATE SYILLE .i ANALYT!CAL r s, h'l•+3;.. 1 122 Court Street Statesville,NC 28677 704-872-4697 www.sa-nc.com ' NITRATE/NITRITE ANALYSIS Note:M iefamation oust be'stlFplied faec:cpGut.:e mesa WATER SYSTEM ID If: WeIIL_-_o_i2 3- Iq.5035. County: Catawba Name of Water System: -i)YttR [Gijpr Sample Type: 0 Entry Point [ peciaUNon-compliance Location Where Collected: (n2. O LVir Iln'J 1td/ I-1CciLoc) NC 2t1(oo[ Facility ID No. 1150.5 5 J J Sample Point: , f 10- N_ Ii1Collection Date 11 Collection Time Collected By: )4tte\ Evctv'S 0El7, 7-(4 01 :OLL, P M Vieux Prat) ( 17 DIYY) (Spiry Mt or PM) Mail Results to(water system representative): CATAWBA COUNTY PUBLIC HEALTH Phone II;) (828)465-8270 ENVIRONMENTAL HEALTH Fax#: i(828)465-8276 •PO BOX 389 Responsible Person's email: • EHAdmin@catawbacountync.gov NEWTON,NC 28658 LABORATORY ID//: 37755 0 SAMPLE UNSATISFACTORY 0 RESA1►4PLE REQUIRED • REQUIRED NOT DETECTED QUANTIFIER ALLOWABLE CONTAM CONTAMINANT METF.OD REPORTING LIMIT (i.e,<RR-G) # LIMIT CODE CODE (R,R,4) (X} �.r-. -v TtESULTS _ 1040 Nitrate 353.2 1.00 mg/L �� 1 --_-- mg/L 10.00 mg/L [�[ 1041 Nitrite 353.2 0.10 mg/L t,( — `— mg/L 1.00 mg/L 'Note:If result exceeds allowable limit,the laboratory must fax analytical results to the State on day test completed, DATE: TIME: i ANALYSES BEGUN: I QT/ Sal 24 • _ :4,1 , 4 M S .- isfli.:,... - -tsFn+r,,F,..m�•i ANALYSES COMPLETED: I ®$/ 3O /2 - _CI: _+ A M yy I -.. ___._.— rawliDIIRf) _ RcRorti,..,rx)I Laboratory Log l:, i- 322 C)-19 C l Certified By: COMMENTS: - 2005 Laboratory should Mail Results to; Public Water Supply Section,Attn:Data Entry,t634 Mail Service Center,Raleigh,NC 27649-1634 PO Box 228 • Statesville,NC 28687 • 704/872/4697 Page 2 of 2 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: MW2 LLC Sample ID Number: 195035 Location: 6270 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. 1 N 0 R T H C A R 0 L I N A `�f 11 -' Private Well Information 4 4 A.41 -.4 ==' and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: MW2TLLC—6270 Lynchburg Rd,Hickory NC 28601 Sample ID#: 195035 ' 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 oniv.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 onbv. ❑Arsenic ❑Barium n Cadmium ❑ Chromium ❑ Copper ❑Fluoride ❑ Iron n Lead n Manganese El Mercury ❑Nickel n Nitrate/Nitrite n Selenium n Silver ❑ Zinc 3.n 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. n Chloride ❑ Copper n Fluoride ®Iron El manganese ❑pH I IIISilver n 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. LI 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.