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Home My WebLink AboutWELL-06-2023-197607.TIF WELL CONSTRUCTION RECORD(GW-1) K � For Internal Use Only: 1.Well Contractor Information: Robert Teague 14.WATER 20NZ$ Well COnnnRO[Norm FROM TO DI5CRIPTlON • 2857-A f 14 tit1 , ip en NC Well Contractor Certification Number �� 6' IS.OUTER CANING(lu emdiase wdb OR LEVER(!r . B&K Well Drilling Inc FROM TO DIAMETER THICKNESS MATERIAL Company Name 0 R 7 sfta Id i° SDR-21 PVC 16.INNER CASING OR TUBING(;es al daed4.u) . 2.Well Construction Permit#:1t)-_ \C. (n 0 FROM TO DIAMETER _THICKNESS MATERIAL List all applicable well construction permits(i.e.VIC.County.Statr. Variance.etc 1 R. ft. la 3.Well Use(check well use): It ft. la Watr Supply Well: 17.SCREEN 0 cultural FROM TO DIAMETER SLOT SIZE TNICKNESS MATERIAL �Municipal/Public ft. ft. la. ❑Geothermal(Heating'Cooling Supply) BResidential Water Supply(single) rt. R in. , ciIndustrial/Commercial ❑Residential Water Supply(shared) I1Irritation IS.CROUP FROM TO MATERIAL EMPLACEMENT METHOD•AMOUNT Non-Water Supply Well: ft. ft. QMmitoring D Recovery Injection Well:El R Aquifer Recharge °Groundwater Rcmcdnation ft DAgnifer Storage and Recovery Salini 19.SAND/GRAVEL PACK(Ifapplkablel ry Barrier FROM TO MATERIAL EMPLACEMENT METHOD °Aquifer Test OStotmwater Drainage R. rt. l DExperimental T°clunology °Subsidence Control ft. ft °Geo he mal(Closed Loop) ❑Tracer 2A DRILLLNG LOG(attack additional sleets K ❑Geothamal(Heating/1Coo(in Return FROM TO DESCRIPTION(c`r. k71,grab r�,re) 1 g ) ❑Other(explain under e21 Remarks) , t / 4.Date Weft(s)Completed:11-L-7 Well IDa b fr. t ti ( f Ilec 1 L t Sa:Well Location:� A SfL 4 j�srL >i� c U`6' i1i '- 4,—‘Sa p LA�;� R. �f<. �� Facility/OwnerName Facility!Do Olaf cable) R. fL 317W� cl.v--U c t1 t- 51-) pcVs It ft. rt. Physical Address.Coy.and Zip ft. ft 1 C C.k,G\ptjC� 21.REMARKS i County I Parcel identification No.(PIN) 5b.Latitude and longitude in l Dgidegras/minutes/sernnds or decimal degrees: - (if well field.one 1st/long is sufficient) 22.Certification:--'^-1 N W 6.Is(are)the wells po ry " >'< ) () Perms°tint or Tem a Signature CcruSted Well Con for Bs riving this John.1 kerrbt ceett6-that the wells/rut(n trrl c0nrtritctnd a omardaecr 7.b this a repair to an existing well: Yes or No kith ESA NCAC 02C.0100 or 13A NCAC 02C.0200 Well Cmutrucrion Stondardr and that a !f Mb is a repair,fill out biota well construction itnfarnratiat and din the nature of the tYtpy of this record hat hero pr.aided to Ike"el0rstet. repair under e21 remarks serliar 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 µell 8.For Geoprobe/DPT or Closed-Loop oop Geothermal Wells having the same construction,only I GW-1 is needed. Indicate TOTAL NUMBER of wells construction details. You may also attach additional pages if necessary_ drilled: 5U BM I TTAt.INSTRUCTIONS 9.Total well dep land surface: ti 6.5 (SI) 24a. For All Wells: Submit this form within 30 days of completion of well Few multiple wells list all depths Ifd/jjemu(example-3@200'and 2Q1WI construction to the following: 10.Static water level below top of using:40 (ft.) Static level is above casihr.use`+ Division of Water Resources,Information Processing Unit, 6 ' 1617 Mall Service Center,Raleigh,NC I7699-1617 11.Borehole diameter: /8 (In.) 24b.For Infection 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 wall (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 Mall Service Center,Raleigh,NC 27699-1636 13a Yieldm . Air Flow (YP ) Method of test. 24c.For Water Suoah'A.Infection Wells: In addition to sending the form to Chloe Tabs ;;z tea the address(es) above, also submit one copy of this form within 30 days of •13b completion of well construction to the county health department of the County where constructed Finn GW-1 North Carolina Dcpsnmcnt of EmvonnnCnul Quality•Division of Water Resources Revised 2-22.2016 Analytical Results / STATESVILLE ANALYTICAL Catawba County Public Health PO Box 389 Newton, NC 28658 Receive Date: 05/22/2025 Reported: 05/24/2025 For: Lisa Oefelein 3651Buffalo Shoals Rd, Maiden NC 28650 Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 250522-34-01 Nitrate 197607 <1 mg/L 353.2 05/23/2025 CL 250522-34-01 Nitrite 197607 <0.1 mg/L 353.2 05/23/2025 CL Respectfully submitted, Melissa Myers NC Cert#440, NCDW Cert#37755, EPA#NC00909 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 1 of 2 122 Court Street Statesville,NC 28677 704-872-4697 www.sa-nc.com NITRA.TE/N!'rRUE ANALYSXS . Na:-Blinf rrc:iom=Iti:r.�pr�cl tccx-r—•a d/ WATER SYSTEM ID : W _ QL _ )6,23-1.)7607 County: Catawba Name of Water System: •L i S•� Q e Fe.k i Sample Type: ❑Entry Point I81,Sppecia(Wi on-compiiancn n Location Where Collected: 36 5'� f/u-c-R 10 S : s ic.e1 n�!' e..;de, pl C dZ 86SC Facility ID No. j_tc-1 CO Sample Point cc g 11 Collection Date Collection Time Collected By: 'PW /.i 5 h� / '%,, a: • S),21 / /2:aS f M P,�) (WMDIYY) (sprig nticPht) • Mill Results to(water system representative): CATAWBA COUNTY PUBLIC HEALTH Phone#:i (828)465-8270 ENVIRONMENTAL HEALTH (828)465-8276 PO BOX 389 Responsible Person's rmnil- •EHAdmin@catawbacountync.gov NEWTON,NC 28658 • LABORATORY ID 4: 37755 I]SA82PLE UNSATISFACTORY CI RESAMPLE REQUIRED • REQUIRED NOT DETECTED QUANT 1ED ALLOWABLE CONfA vl CONTAtIMIANT METHOD REPORTING MGT (�a<RILL) CODE • CODE (R- ) RESULTS* LIMIT 00 1040 : Nittatei04035322 1.00 mg/L mg/L 10.00 mg/L I041 Nitrite • 353.2 0.10 mg/L ^_ mg/L 1.00 mg/L *Note:If result exceeds allowable unit;the laboratory must fax analytical results to the State on day test completed. DATE: TIME: ANALYSES BEGUN: . 5 2 3/Zb . -r:30_, 4M ! om at �P?a ANALYSES COMPLETED: 5/ 23, 26" —8:S 3 AM* Laboratory Log : -• 34.01 CertiSed By: - COMMENTS: 2008 Laboratorrsbould MU Results to: . Public Water Supply Saticn,Attu:Data Patsy,1634 Man Service Coats,RaIeisb,NC 27699-1634 PO Box 228 • Statesville, NC 28687 • 704/872/4697 Page 2 of 2 r y:6 `,,� 0 1 4312 District Drive MSC 1918 ,i �'. North Carolina State Laboratory of Public Health l � „F ,. r Raleigh,NC 27699-1918 ,-- ) Environmental Sciences http://siph.ncpublichealth.com + "*��• _ / Phone: 919-733-7308 ` �"""" Inorganic Chemistry_ g ry Fax: 919-715-8611 Certificate of Analysis FINAL REPORT Report to: ENVIRONMENTAL HEALTH Name of System: I CATAWBA COUNTY ENVIRONMENTAL HEALTH Lisa Oefelein P 0 BOX 389 3657 Buffalo Shoals Rd NEWTON,NC 28658 Maiden,NC 28650 EIN:566001814EH Delivery: NC Courier StarLiMS ID: ES250523-0014 Date Collected: 05/21/2025 Time Collected: 12:28 By: Dwight Mikeal Date Received: 05/23/2025 Time Received: 08:04 Sample Type: Raw Sampling Point: Well head Well Permit No. WELL-06-2023-197607 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 22 mg/L Chloride <5 250 mg/L Chromium <0.02 0.10 mg/L Copper <0.01 1.3 mg/L Fluoride 0.120 4.00 mg/L Iron 0.277 0.300 mg/L Lead <0.003 0.015 mg/L Magnesium 4 mg/L Manganese 0.081 0.05 mg/L Mercury <0.0004 0.002 mg/L Nickel <0.01 0.1 mg/L pH 7.9 N/A Selenium <0.005 0.05 mg/L Silver <0.01 0.10 mg/L Sodium 8.9 mg/L Sulfate 7.4 250 mg/L Total Alkalinity 81 mg/L Total Hardness 70 mg/L Zinc <0.05 5.0 mg/L I Report Date: 06/05/2025 RECEIVEDReported By: 4 4114**32- Marc Komlos JUN 1 7 2025 Environmental Health Page 1 of 1 F 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: OQ-$Q 1 z 1,, Sample ID Number: l ( D7 Location: 3657 (3u-P(=41 0. Nam- LT56p4 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. 1 N 0 R T H C A R, 0 L 1 N A. ,, f sT o4�yq Private Well Information r,,, ,-4,...,a, and Use Recommendations NC DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name/Address: - LsS4 (t-Pe IQ-1n 3657 Av:I✓iloslnve0-15Ad Yr\-,tac--,A Sample ID#: ) 97 6v7 Reviewer: Jason Boyd TEST RESULTS AND USE RECOMMENDATIONS 1. m( Your well water meets federal drinking water standards for inorganic chemicals.Your water can be used for dr' cmg, 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. n 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 ❑ Cadmium n Chromium ❑ Copper n Fluoride n Iron n Lead n Manganese n Mercury ❑Nickel n Nitrate/Nitrite n Selenium n 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. 5.7(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 n Iron [,Manganese ❑ pH ❑ 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/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.