HomeMy WebLinkAboutWELL-05-2023-195206.TIF t . r
' CATAWBA COUNTY
.F' .t.11 ?. Public Health Department Subdivision
Q.�O Environmental Health Division PIN# 361702672075
PO Box 389,25 Government Drive,Newton,NC 28658 LOTH 2
Site Address: 3647 WILFONG RD, NEWTON NC 28658
Name on Permit: UNDERWOOD, RICHARD WAYNE
Property Size: Acres 5.12
Directions: Startown RD cross 321 Right Blackburn Bridge RD, Right Wilfong Rd on left
Owner/Authorized Representative Acknowledgement of Permit Receipt
Sire7/
1 certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.X
.A/As the property owner or authorized representative, I have received the above referenced
permit(s)as requested in the application for service RBPR-04-2023-44110,by the following method(s):
Received in Person
_ Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
god
As the property owner or authorized representative I have reviewed and understand the specific conditions
f 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: 05/08/2023
Owner/Authorized Representative Signature /i rrJ
,-c-ee'eey-7---9
Date
_4 z-‘f2_�
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by_ (name of person sending permit)
Signature Date/Time
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 yooPlease ttake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
----, 6 c (i 1 (1.3
05/10/2023 05:30
1. 6PR-
_ I I.I.(.O\ti I RI ('"I IO\ RF( ORI) (; -1 I l•'e I I i• •-••••.�•
I.Well Contractor Information.
-- ._ _—. -. _ __--..— —
Robert Teague _.Wtll 1 onas.tnt brie ---_.--- - .._...__._._.,
.wn,1 - rn ....TIP ct Rie-ioN
is�, ��co . ��_________
2857-Ac914("A.,.,
.0 Well Contractor Cer,r Irvin%u.her
i.,or,TER({SiQIror6r61ryca h(wels)ORLINER(i/tpFRcabk)
B&K Well Drilling Inc , Fi,1t; '�Tir _.-- ---
/� _ �nl gull Mt `1NN IsH,Y _—.1Mort RI SI
_— 0 ._ 11.�1 75 fl. J r Ia
Coronary name — 1 3 SCa.1 Per
1 , r1b.1'\FRCAMS(.ORTIIIIM,Ipotber>aalelaaad-Nwp1 1 -- -
2.Nell Construction Permit Cr). -3 - (-(4,\t .FlIONi _ �7 to --_^ut•Y1r L1a Isuc Is SF : Yrafottt—
Cutat.Opp!traPe.t';row urhrn n..w.:1 ha l.', 101✓r,. Su1, /—c•1:cVnrr e,,, ft. • — —1- _
h. I r n.
3.Welll'se((heck well noel: l- — L_ —T —
rt. rt. ' to I
� 0�turicipa.1iti.c
ater SuppSupplyNrll: _I?S(REFV •— —
AgtCUIILIaI - ION tIO ID . 01 YY �11 rt asl(1T SI/(—! Situ IOW. +s111/ut11
— —
rt. ft, 1 la. 1 I
°Geothermal(Heating Cooling Supply( @Residential Water Si.ppls,single, '
ft. I N. I inn.— —
—r-- (
0Indusirial'Cornrnerttal DResidtnua.V1 i er S;.pp is isharedl 1 — _1_
hlmpation I 111(.R(11,T
1 RUN i Nsrl RI u. ' I SI►l.st_l snsr Nf Nob a 044.1 sfr
Non-U Act Supply Well: — — —.._. __—.—._
p\loniturmg Okccus I.._— .—..—....._..— —.. _--
rn n ri. i n ri. _
Injection Neli:
Aqu,fcr Recharge a;roundwaKr kcrncd'atiun h. I ff.
—L
()Aquifer Storage and Rtzo,c. _N.S NDGRAVE PACK tit applreablej
') �Sallnity Darner —T __
❑Agalfer test fRostii. TO 4%11100— I ISIPI aC1Nr,T Sit MOD
°SIorer:water Drainage 14 I ft.
B0F.:tpenmental [ethnology ❑Subsidence Control F I
Geothermal(Closed Loop) [taco
1 29.DR1L1 l\G LOG(attach soldfdoad Are,if merman)
Geothermal tHealinc'Coshrg } twist ro TntcRtrilu�ir.w:.l•ti,r,.,.l..ear.r..aa.,d.. —
Relurnl Other rear"lam cancer=_1 Rem:ukst r —
q.
1.Uau Nell(s)Com leted:1 `9j-1 L0 rt. -'2 ` __ ; ` --i.
P ` `.. Well Ills .2_Sf1. :L?.. �_'. c.a. J�� /C1. - L_._ _
Sa.Nel!Location: 1L v.�- 11lL(.1.1- Sc
/ j�t
Fatthry;pwnct Nem! Fmoldy IDet.rappi,cab4;t ! it It.
3CL)1 VI 1 l fbns j?( tNetf)G11 1 ft. ft. i
}
(+Physu a.Address,Coy,and Zip 1 ft. L ft.
�� �b�` I2r1RR•�fARkS
C'O,.nty Panel identification\oiPlsi 1___.__—
Sb.Latitude and longitude in degrees ttuoules'seconds or decimal degrees: I ,
td*cli acid.one lotions is s-ITulontl �' ---•
22.('erifi
6.h(art)the wellb)OPermanent or ()Temporary
S,arut ac of Ccn,hsJ W;h Corms , •_�
Dai:
rr..(f 81 .lgnrng,t,t lid NI 1 Merrhs Cr,W.that Ott..rlfir wag r•e.er,uau,y,4,1 m a,u,,:,,.,.,
7.Is this a repair to an etisting well: D Yes or [ So NA1i 4 5C4C 0`C 0100 or ISA%C.+C'02C 6.00 Well Cnetrrytnon Standa,dr wet!the,c
if thu Ls repo.,fill OW known well C0aluyu a,.,e inru. upn,fin.a Iatn the neitur car the .ups nJ ton,e,t✓d ha.horn p,usuJrd to lilt"II none,
rep0.r under a21 rr.na,b car non a,on else aaak of rho font
23.Site diagram or additional well details:
8.For GeoprobeiDPr or Closed-Loop Geothermal Wells has mg the same You may t e the back of this page to proside additional well site deeds or well
construction.only I GW I is needed Indicate IOIAL rst,A1DCR of wells construction deeds You may also attach additional pages if necessary.
drilled
St 11%11TIAL)NSTRI CIIO\
9.Total well depth below land surface: 111.1 24a. For All Wells: Submit this form within 30 days of completion of well
Fa,nInrplrnen,AIM all depho eldf/ernunra,npie 1u:,k) a, ._alinli
construction to the following
10.Static water level helotstop of casing:40 _(ft.) Disision of Nater Resources,Information Processing Unit,
If tiara(err!a 0/ase coals cur 1617 Mail Service Center,Raleigh,NC 27699-1617
I I.Borehole diameter: 6 1/8 (in.)
246.For Injection Neils: In addition to sending the form to the address in.Sa
12.Well construction method: Air Rotary above.also submit one copy of this form within 30 clays of completion of wci'
f,e a er ro construction to the following
( tary,cable.direct push,etc)
u Oisision of Water Resources,Lnderground Injection Control Program,
FOR WATER SL PP r.iSDSLY: 1636 Mall Service Center,Rakigh,NC 27699.1636
13a.Yield(gPmt' 77 Method of test: Air Flow 24c.For N aier Sunnis 8. Injection Wells: In addition to sending the iorrn
the addressies) above. also submit one copy of this form within 30 days .if
tab.Disinfection is CriCr Tabs Amount: 1 112124
completion of well construction to the county health department of the counry
where constructed
Form OW-I \orth Carobna D;partmcnt of Ens.ronmenui Quality-Dr„swn of V.ate,Resou•ecs Reseed 2.22•2 u I.
Analytical Results '\ STATESVILLE
ANALYTICAL
Catawba County Public Health
PO Box 389
Newton, NC 28658
Receive Date: 04/11/2025
Reported: 04/14/2025
For: WELL-05-2023-195206
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
250411-27-01 Nitrate 195206 5.05 mg/L 353.2 04/11/2025 MD
250411-27-01 Nitrite 195206 <0.1 mg/L 353.2 04/11/2025 MD
Respectfully submitted,
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2
A
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HHLI MAI. • f
•
122 Court Street Statesville,NC 28677
704-872-4697 www.sa-nc.car •
_ NITRATELNITRINE ANALYSIS .
Nom:blt1E0=1==asrlplied For=pr crut
WATER SYST MID#:k)dl-05 -ZvL i`i 3 - 52a,. County: Catawba •
Name of Water System: !Ana4 i-Y L .
Sample Type: El Entry Point eSpecial/Non-compliance
Location'Where Collected: 1.at13- L.)i k An9 Rid I NPW,Llhrr
Facility ID No. 1q57,0 to
Sample Point: SaIll- kAf 1(I Collection Date Collection Time
•
Collected By: WIAf ) 0 y I t(MISIG�5 r: -'ts`. 4Aat6n V)
Mail Results to(water system representative):
CATAWBA COUNTY PUBLIC HEALTH Phone g:t (828)465-8270
ENVIRONMENTAL HEALTH Fax _ I.(828)465-8276
„PO BOX 389 Responsible Person's email:
•EHAdmin@catawbacountymc.gov
NEWTON,NC 28658 _
LABORATORY U)#: 37755 . 0 SAPOLE UNSATISFACTORY ❑RESAMPLE REQUIRED
' CODITAM •METHOD :its
D gIEDEIELu QUANTIFIED ALLOWABLE
i CODE CONTAMINANT • CODE REPORTINGILar (cc<R11.14 RESULTS'''. LIMIT
(RILL) (X) .
1040 ' Nitrate 353.2 1.00 mglL ❑ • 5. 06 mg(L 10.00 uig/L
1041 Nitrite • 3532 0.10 mg/L ----- mg/L LOU rng/I
• `'Note:If result exceeds allowable lirut,the laboratory must fax arPiytical result to the State on day test completed.
DATE: T]ME: �}
d ANALYSES BEGUN: OM./ /i 12 • /cU n 1 , P M
ANALYSES COMPLETED: Qte l /t I x`J l60%3 , IM
C o / --i, Altd• AMKRO
T,aboratoryl.ogi$: aJO�i(.I �- -1"j-O) Certified
COMMENTS: .
2CO3 .
Laboratory should ItWai Results to: .
Public Water Supply Seeder.,Ara:Data Eatry,1634 Mail Service Center,Raleigh,NC 27699-1634
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 2
4312 District Drive
Y4 °s, MSC 1918
�-:�,...� North Carolina State Laboratoryof Public Health
1i8': tea, Raleigh,NC 27699-1918
11\
IciIN _ Environmental Sciences http://slph.ncpublichealth.corn
,' QuAm veal! 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 Randy Frye
P 0 BOX 389 3647 Wilfong Rd
NEWTON,NC 28658 Newton,NC 28658
EIN:566001814EH Delivery: NC Courier
1
StarLiMS ID: ES250414-0010 Date Collected: 04/10/2025 Time Collected: 13:40 By: Dwight Mikeal
Date Received: 04/14/2025 Time Received: 07:54
Sample Type: Raw Sampling Point: Sample tap Well Permit No. WELL-05-2023-195206
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
•
Barium <0.1 2.0 mg/L
Cadmium <0.0005 0.005 mg/L
Calcium 15 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 0.263 0.300 mg/L
Lead <0.003 0.015 mg/L
Magnesium 6 mg/L
Manganese 0.007 0.05 mg/L
Mercury <0.0004 0.002 mg/L
Nickel <0.01 0.1 mg/L
pH 7.5 N/A
Selenium <0.005 0.05 mg/L
Silver <0.01 0.10 mg/L
Sodium 3.4 mg/L
Sulfate <5 250 mg/L
Total Alkalinity 49 mg/L
Total Hardness 61 mg/L
Zinc <0.05 5.0 mg/L
Report Date: 05/02/2025 IR ECERVED Reported By: "MCItig ....-.'"*44
Marc Komlos
MAY 9 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: Jk y F('Y'L. Sample ID Number: 13 - 19 S Z b
Location: 34.K 7 ,Cb-) HQ-v ia,r1 Reviewer:
Initial Sample Confirmation Sample:
BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR
PRIVATE WELL WATER(These recommendations are based on biological analysis only.)
xNo coliformbacteria were found in your well water. Your water can be used for all purposes
including drinking, cooking, washing dishes,bathing and showering.
Total coliformbacteria 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 colifoiur 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
maybe 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 tment or a local well contractor to deteiurine the
problem with the well and to give guidance on how to correct the problem.
•
Your well water was tested for biological contaminants(total colifoun and fecal coliform bacteria). The
results were evaluated using the federal drinking water standards.
Drinking water may contain substances that can occurnaturally in water or can be introduced into water
from man-made sources.Total coliformbacteria are found in soil and fecal colifoun 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,Az.,,,
,,,,,,pRo., Private Well Information
tj/e "...--, C2
u 4. 1:
Y'4' ;.,,N. and Use RRecommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: { c,^ay rrye' r36L17 L,0; I ¢`0n5 Na2-4.")+6 •\ NC
•
Sample ID#: 19s1...v. 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' ng, 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.
E Arsenic n Barium n Cadmium ❑ Chromium ❑ Copper n Fluoride n Iron
n Lead n Manganese ❑Mercury n Nickel n Nitrate/Nitrite n Selenium n Silver
❑ Zinc
3. 0 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 fdr 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 deteiniine the source of lead and/or copper.
I
5. n 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 instaII a household water treatment system
to address aesthetic problems.
n Chloride n Copper n FIuoride n Iron n Manganese
n pII ❑ Silver [ Sulfate n Zinc
6. n 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.