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HomeMy WebLinkAboutWELL-06-2023-198536.TIF 4 L Pubic Ilcallh t)rpanmcnt �daJl�...ion I:nVO{N1111C111aI IICJIIh I)I\KIUn PItir 367802671181 l't)Hut 3S'►,25lin�clnrncnl Ikl%c.Pc«uwl.NC :Rhtr I I rl r 1 r SIB Address: 4637 BANDYS SPRINGS RD. CATAWBA NC 28609 Name on Permit DALLAS HENNEBORN Property Size: Acres 1 01 Directions: Left on Government DR.250 ft Right SW Blvd 0 1 mi Left W C ST.2 7 mi continue on NC 16. 2 7 mi Left Balls Creek, Right Little MT RD• Left Caldwell RD Continue to Bandys Spring RD Owner/Authorized Representative Acknowledgement of Permit Receipt X' ertifs that 1 am the ossner or authorised agent((miler's authorisation required)representing the owner of e property described abuse. /4- s the property usyncr or authorized representatise. I have received the above referenced .rtnit(s)as requested in the application for sers ice KBPK-03-2023-43874. by the tiillossing inethod(s): 2 Received in Person s Facsimile Transmittal (Return form ssith signature required) Electronic Image Transmittal: E-mail (Return receipt required) s the property owner or authorized representative I hase 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(I5A NC'AC IRA.191H)), and/or Well Construction Standards(15A NC'A(' 2(' .0100), shall apply to the issuance of this permit and the construction of the ssastessater ssstein and"or ssater supply ssell permitted. Permit Issue Date: 06/21/2023 Owner'Authorized Representative Signature Date_ 00)3A(Z4 Documentation of l'ermit(s)Transmittal (permit transmitted by electronic or other means) Permit transmitted by _ (namee r+/p'ro,:.ccvrrlt,g/'ern► l) Signature tj DJ1C.'Tlllle C\itf913o j -3 Method: Fax Ni Email (IS Mail Other Owner's request to send by the above indicated method of transmittal in lieu of signature We wantt tto hear from youPlease flake a few momentts no complette our custtomer service survey an http://www.surveymonkey.com/s/EHCusttomerService d a llashenn 6 h:t A 4.1 Mid. 10'1 jLi, i . , WELL CONSTRUCTION RECORD (GW-1) For Internal Use Only: 1.•Well Contractor Information: Chris C Russell 14,WATER ZONES FROM TO DESCRIPTION Well CantTOCIOrName 40 R 225 fl' 3254 A ft. R. NC Well Contractor Certification Number 15.OUTER CASING(for multi-clued wells)OR LINER(if ap licabte) Russell Well Drilling, Inc. FROM T» DIAMETER THICKNESS MATERIAL Q ft. 85 ft• 6.25 In• SDR21 PVC Company Name WELL-06-2023-198536 16.INNER CASING OR TUBING(geothermal closed-loop) 2.Well Construction Permit#: FROM TO DIAMETER i THICKNESS MATERIAL. list all applicable well construction permit:(i.e.1.11C,Cranny.State. Variance,etc.) ft. ft. In. 3.Well Use(cheek well use): II. It, In, Water Supply Well: 17.SCREEN FROM i TO DIAMETER SLOT SIZE THICKNESS MATERIAL ❑Agricultural ❑Municipal/Public ft. ' ft. in. ❑Geothermal(Ileating/Cooling Supply) OResidenlial Water Supply(single) R. ft. is. ❑lndustrial/Commercial ❑Residential Water Supply(shared) IB.GROUT CI Irrigation ❑Wells>100,000 GPD FROM TO MATERIAI. EMPLACEMENT METHOD&AMOUNT Non-Water Supply Well: 0 ft. 20 ft. Grout Poured ❑Monitoring ❑Recovery ft. ft. Injection Well: ft. It. UAquifcr Recharge ❑Groundwater Remediation 19.SAND/GRAVEL PACK(if applicable) CI Aquifer Storage and Recovery ❑Salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD ❑Aquifer Test • ❑Stormwater Drainage rt. ft. ❑Experimental Technology OSubsidence Control fr. ft. OGeothertnal(Closed Loop) ❑Tracer 20.DRILLING LOG(attach additional sheets If necessary) ❑Geothermal(Heating/Cooling Return) ❑Other(explain under#2l Remarks) FROM TO DESCRIPTION(color,hardness,romruck type,grain du,NO 0 ft• 80 't' Dirt 4.Date Well(s)Completed: 11-6-2023 Well ID# 80 C. 225 R• Rock 5a.Well Location: ft. R. Dallas Henneborne Clayton Homes ft. ft. Facility/Owner Name Facility lD6(if applicable) II. ft. 4637 Bandy's Springs Rd, Catawba 28609 ft. R. ft. Physical Address,City,and Zip Catawba 21.REMARKS County Parcel Identification No.(PIN) Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: (Swell field,one lat/long is sufficient) 22.C ilieation: 35.620.20' N 81 .099.10' '' y �e�,_a 11/23/2023 6.is(are)the well(s): ©Permanent or ❑Temporary Signature of Certified Well .onaactar Dale 8y signing this form,l hereby certify that the well(s)was(were)constructed in accordance with 7.Is this a repair to an existing well: ❑Yes or CNo )SA NCAC OTC.0100 or ISA NCAC 02C.0200 Well Construction Standards and that a copy If this is a repair.fill out known well construction information and explain the nature of the of this record has been provided to the well owner. repair under#21 remarks section or on the bath of this farm. 23.Site diagram or additional well details: 8.For GeoprobelDP'll'or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well construction info construction,only l 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: 225 (ft.) Submit this GW-1 within 30 days of well completionper the following: For multiple wells list all depths lfOil/Crew(example-3Lll1200'and 2(ip),100') y P 40 24a. For All Wells: Original form to Division of Water Resources (DWR), 10.Static water level below top of casing: (fL) information Processing Unit,1617 MSC,Raleigh,NC 27699-1617 II water level is above casing,use"i" 24b. For injection Wells:Copy to DWR,Underground Injection Control(IUC) 11.Borehole diameter: 6'25 On,) Air 1636 MSC,Raleigh,NC 27699-1636 12.Well construction method:Air Drilled 24e.For Water Supply and Open-Loop Geothermal Return Wells:Copy to the (i.e.auger,rotary,cable,direct push,etc.) county environmental health department of the county where installed FOR WATER SUPPLY WELLS ONLY: 24d.For Water Wells producing over 100,000 GPO:Copy to DWR,CCPCUA 13a.Yield(gpm) Method of test: Air Permit Program,1611 MSC,Raleigh,NC 27699-1 61 1 13b.Disinfection type: HTC Amount: 2/3 Cup Form GW-I North Carolina Department of Environmental Quality-Division of Water Resources Revised 6-6-2018 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: Q°l j"S ��^^�ba r^ Sample ID Number: •1�gs3 4 Location: I (x'1 ��•��,5 S r.� ► . d LL;-4�'b� N 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.) XNo 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 iyoil 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 ATE "°��� Private Well Information PA9tI)) NC DEPARTMENT OF and Use Recommendations HEALTH AND HUMAN SERVICES Division of Public Health For Inorganic Chemical Contaminants County: Catawba Name: Oo I s r 14 nna-loo rn 11(. 31 tgc Cy S p‘`..na,T boy Sample ID#: 18 5 3 6 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. [KThe 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 onty. ❑Arsenic n Barium ❑ Cadmium ❑ Chromium ❑ Copper n Fluoride Iron ❑Lead [E Manganese ❑ Mercury n Nickel ❑Nitrate/Nitrite ❑ Selenium n 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 001,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 ❑ Copper ❑Fluoride ❑Iron n Manganese ❑ pH ❑ Silver ❑ Sulfate ❑ 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 onty. ❑ 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. r Iron & s - , r • ., ... �jr �'A LiPRIVATE WELLS , --,, -, . ,„,,, _ k ,. ..,, . . L „ , , ....„.,, .: ;__, . ..... _ � „4a What is iron? 1 -- Iron is a natural element found in rocks deep underground.Iron is found in the environment as What level of iron should iron compounds joined to other elements like sulfur, I be concerned about? carbon,and oxygen. Iron is used for constructional material and pipes. The NC Department of Environmental Quality Iron compounds are used as pigments in paint and calculated a health based value of 2.5 milligrams of plastics.Iron compounds are also used in water- iron per liter of water(mg/L).This calculation was treatment plants as a coagulant. developed with consideration of health effects in 2017. The US Environmental Protection Agency and How dOeS iron get in NC Department of Environmental Quality my private well water? developed an aesthetic standard of 0.3 mg/L.This standard was developed to prevent staining,rusty Iron compounds can enter your private well water color and metallic taste. from erosion of rocks underground.Iron can also enter groundwater from industrial practices.Acidic How do I test for iron water(water with low pH)can make iron compounds more soluble. in my private well? Use a certified lab to test your well water for iron How can iron affect my health? every two years,as part of the inorganic panel screen.Contact the private well program at your Iron is an essential element,meaning your body county health department to assist you with getting needs it in small amounts.It helps with oxygen your water tested.Pricing of testing varies from transport,electron transport,and deoxyribonucleic county to county. acid(DNA)synthesis.However,drinking high levels of iron may cause adverse health effects.You can't What if my iron levels are high? smell iron.Iron may have a detectable taste or have a rusty color. You can install a treatment system to reduce the levels High levels of iron can cause gastrointestinal of iron in your private well.Treatment systems that problems.For people with preexisting conditions, reduce the levels of iron in your well water include: like hemochromatosis,drinking high levels of iron • Oxidizing filters may cause heart,liver and pancreas toxicity. • Cation exchange,also known as a Water Softener 1 You can also reduce your exposure by using bottled water or connecting to public water supply,if possible. Percent of Private Wells Tested Exceeding Federal Standards for Iron, 2011-2013 $10 EFISIWOM Pk 2114j, *111711111111°A4115101'11101-141411114 >25%exceeded health standards NE 10-25%exceeded health standards I I<10%exceeded health standards Jim,.L__J 0%exceeded health standards Insufficient data(<10 wells tested) Where is iron found in NC? Where did this information Iron is found at low levels(0.1-62 mg/L)throughout come from? NC.About 6%of wells sampled for iron in NC from World Health Organization:www.who.int/water 2011 to 2013 exceeded the state health-based value sanitation health/dwq/chemicals/iron.pdf (2.5 mg/L).Yet,there are several areas in NC with at Nazanin Abbaspour et al.Journal of Research in least 10%of wells exceeding the state health-based Medical Sciences Review on iron and its importance value.See map for areas with elevated iron. for human health 2014:www.ncbi.nlm.nih.gov/ pmc/articles/PMC3999603/ Where can I find more information about iron and my well? Visit the NC Division of Public Health's Private Well and Health Program website:http://epi.publichealth- nc.gov/oee/programs/wellwater.html. - There you can find: • Contacts for your county private well program , f .x • Iron in well water maps x • A guide for selecting a treatment system I ti, � r .l • Other private well resources \ r You can also call the Private Well and Health Program 1 `- ' at 919-707-5900.Allio ,nw.. � NCNH NC Department of Health and Human Services•Division of Public Health•Epidemiology Section•Occupational and Environmental g 3 Epidemiology Branch•Private Well and Health Program•httos://eai.aubiichealth.nc.gov/oee/programs/wellwater.html•NCDHHS Is an PubGHa gar equal opportunity employer and provider.•09/2019 ceeahh Manganese Exposure to Manganese has the potential to harm your health. Contact with any hazardous substances can cause health effects and the occurrence and nature of the effects depend on how much,how long and how one comes into contact with the substance. What is Manganese is an essential nutrient that occurs naturally in the environment. It occurs in low levels in the air,water,soil,and food,Manganese can be found in Manganese? grains and cereals,and is found in high amounts in other foods,such as tea. People can be exposed to manganese by ingestion or inhalation. How could I be What are the sources?Some people are exposed to eating food or exposed to supplements containing manganese. The way manganese gets into your Manganese? body is by eating food,drinking,swimming or bathing in water or breathing in workplace air contaminated with manganese.Workers in the welding or factory industry may be exposed through air in the workplace. Manganese is used in a variety of products such as fireworks,dry-cell batteries, fertilizer,paints and cosmetics. Manganese is also found in the environment in soil and water after release from the manufacture,use and disposal of manganese based products. What are the health effects of Depending on the concentration,manganese exposure may cause neurological Manganese effects on the most vulnerable populations,which includes infants,children,and Exposure? pregnant women. • Avoid manganese exposure sources. How can I limit • Test your well water on a regular basis. or prevent my • Workers with potential for manganese exposure should remove contaminated clothing before getting in car or entering your house. exposure to • Weld objects in a well-ventilated area and use an appropriate respirator to Manganese? reduce inhalation of fumes. Is there a Manganese is an essential element in the body so there will always be medical test to some present. Levels can be measured in the blood,hair,feces,and show if I have urine. Increased levels in your in your body may not indicate the health effects experienced from the exposure. been exposed to manganese? Manganese Fact Sheet 1 February 2015 Additional Call the N.C.Department of Health and Human Services,Division of Public Health at(919)707-5900 for additional information. Information Agency for Toxic Substances&Disease Registry(ATSDR).Manganese.March 2011.Available at:www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=23 References Agency for Toxic Substances&Disease Registry(ATSDR).Public Health Statement for Manganese. January 2015.Available at: www.atsdr.cdc.gov/phs/phs.asp?id=100&tid=23 Agency for Toxic Substances&Disease Registry(ATSDR).ToxFAQs for Manganese.March 2014.Available at: wwvv.atsdr.cdc.gov/toxfaqs/tfasp?id=101&tid=23 State of North Carolina•Department of Health and Human Services Division of Public Health www.nedhhs.gov www.publichealth.nc.gov N.C.DHHS is an equal opportunity employer and provider 2/15. atizi„ nl llh ai md North Carolina human mrvicas Public Health Manganese Fact Sheet 2 February 2015