HomeMy WebLinkAboutWELL-05-2023-196816.TIF .44►1.a • CAIANBACOUNT)
Public Ilealth Department Subdivision
2 ,--. '' Environmental Health Division PIN# 367703417267
(...._
Pt)Box 389,25 Government Drive,Newton,NC 28658 LOP, 3
Site Address: 4145 FISHERMANS LN,MAIDEN NC 28650
Name on Permit: JAMIE&AMY LAITY
Property Size: Acres 3.36
Directions: 16 S, R on Buffalo Shoals, L Olivers Cross Rd, L on Burton, R on Fishermans property on Right
Owner/Authorized Representative Acknowledgement of Permit Receipt
ys,I
/fri_` I certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
f, A
e. ' As the property owner or authorized representative, I have received the above referenced
tp4irtnit(s)as requested in the application for service RBPR-08 2022 41839,by the following method(s):
Y Received in Person
Facsimile Transmittal (Return form with signature required)
Electronic Image Transmittal/E-mail (Return receipt required)
" As the property owner or authorized representative I have reviewed and understand the specific conditions
I pfthe permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(I5A 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::::tivc
Signature // _
Date- '/J /2i-)
/
1
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 yoaPlease ttake a few momentts tto complette our custtomer service survey an
http://www.surveymonkey.com/s/EHCusttomerService
05:30i2o23 09 12
CATAWBA COUNTY Case# WELL-05-2023-196816
(....._
Public Health Department Subdivision
c,, Environmental Health Division PIN# 367703417267
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 3
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Site Address: 4145 FISHERMANS LN,MAIDEN NC 28650
Name on Permit: JAMIE&AMY LAITY
Property Size: Acres 3.36
Directions: 16 S, R on Buffalo Shoals, L Olivers Cross Rd, L on Burton, R on Fishermans property on Right
NEW WELL PERMIT
REQUIRED WELL SETBACKS:
Septic Systems and Repair Areas for Single Family Dwellings 50 ft.
Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft.
Underground Storage Tanks 100 ft.
Animal Barns 100 ft.
Lakes/Ponds 50 ft.
Streams/Brooks/Creeks/Rivers 25 ft.
Building Foundations 25 ft.
All Other Sources of Groundwater Contamination 100 ft.
Saprolite Septic Systems and Repair Areas 100 ft.
Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft.
Wells shall be constructed in accordance with state regulations:
Article 15A North Carolina Administrative Code Subchapter 2C
The well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of
the above setbacks,contact Catawba County Environmental Health at 828-465-8270,before drilling the well.
Grouting Depth:20 feet minimum
Casing Height: 12 inches minimum above finished grade
All newly constructed private drinking water wells are required to be sampled in accordance with the North Carolina Rules Regarding Private
Drinking Water Well Testing(15A NCAC 18A.3800).The fee for this sampling is included in the cost of the well permit.It is the applicant or
property owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an
outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health.
374Vt 1()171
05/26/2023
Authorized State Agent Permit Issuance Date
5/26/2028
Permit Expiration Date
chpcnnit 05/30/2023 09:24
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Catawba County Environmental Health
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This map`rwrt;.eahect was vowed from the Catawba County,NC Geospatlat Information Services. Catawba County has made substantial efforts
to e- c 74 ay.:a:y;'Yiatrrin and Iabel ng rnforrnatx,n contained on this map or data on this report.Catawba County promotes and recommends
the rhe-y. 'lest owifsation of any data 000tairwd on trus maphnpr,rt product by the user.The County of Catawba.its employees.agents,and
vrv,-o- dri:.ar^ are,ttal riot be hog/1 i at.a for any and all damages,boss or Aab4ty,whether dvact,indirect or oonsequenbal which anses or may
arise!'am Pas rratireport product or the use t/wreot by any perw,n or entity.
Copyright 2023 Catawba Coum y NC
05128J2023
WPDT Screening Report
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Area of Interest (AOI) Information
Area : 3,134,508.74 ft2
May 26 2023 14:08:59 GMT 05:00
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County Boundary
Non-System Roads
NCOOT 015 UMI.NC CCL4.Memo
— Non-System
— Secondary Route
4145 Fishermans Ln, Maiden
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.
Analytical Results /' STATESVILLE
ANALYTICAL
Catawba County Public Health -
PO Box 389
Newton, NC 28658
Receive Date: 05/14/2025
Reported: 05/16/2025
For: Jaime Laity:4145 Fishermans Ln, Maiden NC 28650
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
250514-31-01 Nitrate 196816 <1 mg/L 353.2 05/15/2025 MD
250514-31-01 Nitrite 196816 <0.1 mg/L 353.2 05/15/2025 MD
Respectfully submitted,
�y it.20 iii-a2
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 2
r
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_ 122 Court Street Statesville,NC 28677
704-872-4697 www.sa-nc.com .
•
NITRATE/NITRITE ANALYSIS .
L/a cAninfa[catia4 mot Sc 91r/IIr1 Cs-outlaC C Cat.
WATER SYs.c.aM I D t i W�«_ 0 5 _ 03.3^1q c?le County: Catawba '
Name of Water System: J a i ry.e. 1-Q.;k6
Sample Type: 0 Entry Point 181 Specinl/Non-compliance At
a-Where Collected: "t 145 r;(INr M eechC kht Q e\ctzh Ale. ,2 S'6 St?
Facility ID No. f q e fl e
• I
Sample Point: / of J p , Collection Date {
i Collection Time
Collected By: Dv...is-1%.\- fk► 4.,1 US'1/21 /2W: 3g_
..(4 .Pric e) 747mctrq (fir M)
Mall Results to(water system representative): •
CATAWBA COUNTY PUBLIC HEALTH Phone rs`r:t,(828)465-8270
ENVIRONMENTAL HEALTH Fax : l(828)465-8276
,PO BOX 389 RugonstbtePerson'semail:
•EHAdmin@catawbacountync.gov
NEWTON,NC 28658
LABORATORY ID#: 37755 0 SAMPLE UNSATISFACTORY 0 RESAMPLE REQUIRED
REQUIRED NOT DETECTED
CONTAM OD QUANTIFIED • ALLOWABLE
CODE CONTAMINANT i• D REPORTNGLLMIT (i.e.<R I.) RESL'ETe LET
(R.RL) (X)
1040 : Nitrate 3532 too mg/L yr • . ----- mg.. 10.00 mg/L
1041 Nitrite 3532 0.10 mg/L j} • mg/C 1.00 mg/L
'
°Note:If result exceeds allowable limit,the laboratory must fax analytical resits to the State on day test completed.
DATE: TIME:
I ANALYSES BEGUN:I 0 /1..11- • C&NJ 6-,cs Q
m.rt+i.
ANALYSES COMPLETED:I 01/i9l,4 s QQ 4 3• . n_ -
I team wvtix js ..,xl
•
Laboratory Lag i: M61 LI'31'0 I Certified By: - "} 0
COMMENTS: .
zoos
Laboratory should Mail Results to: .
Public Water Supply Section,At Data Entry,1634 Mail Service Center,Raleigh,NC 27697-1634
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 2
j 4312 District Drive
MSC 1918
fit-.
4i _ - , North Carolina State Laboratory of Public Health Raleigh,NC 27699-1918
✓A_10 I 11 n Environmental Sciences http://slph.ncpublichealth.corn
`•,,,,ecv�;‘,00.77- 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 Jamie Laity
P 0 BOX 389 4145 Fishermans Ln
NEWTON, NC 28658 Maiden, NC 28650
EIN: 566001814EH Delivery: NC Courier
StarLiMS ID: ES250515-0047 Date Collected: 05/13/2025 Time Collected: 12:30 By: Dwight Mikeal
Date Received: 05/15/2025 Time Received: 07:49
Sample Type: Raw Sampling Point: Well head Well Permit No. WELL-05-2023-196816
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 24 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 2.48 0.300 mg/L
Lead <0.003 0.015 mg/L
Magnesium 7 mg/L
Manganese 0.030 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 3.6 mg/L
Sulfate <5 250 mg/L
Total Alkalinity 85 mg/L
Total Hardness 90 mg/L
Zinc <0.05 5.0 mg/L
Report Date: 06/04/2025 RECEIVED Reported By: /47/ `
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: LA;i-v Sample ID Number: I \
Location: 9 l 9 5� �. 13 W.r M C i 1e-br, Reviewer: Jason 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.)
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 O L I N A
4,,t~1 Private Well Information
0:57
.� �p. and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name/Address:
f<ra1Q- Let l-->, c.f l `{r F o s n V1A Jan
Sample ID#: Ic j, g 1 ro 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 only.
n Arsenic n Barium n Cadmium n Chromium n Copper I I Fluoride n Iron
n Lead n Manganese n Mercury n Nickel ❑Nitrate/Nitrite n Selenium ❑ Silver
n 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. fX 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 n Fluoride Iron n Manganese
❑ pH n Silver 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. ❑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.