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Please submit this form along with a Well 1
North Carolina Variance Application far an existing
Department of Health and Human Services private water supply well
Division of Public Health
ri.sting Well Variance Inspection Report
Well Site Location: S h i r r" l b r r `) �l L ZSs b 7 3
(Town,community,subdivision and Lot N.) G
Address: 7 7 3 `.... .._1 e.rr County: ` k G,
City/S.l"/lip: 5 L,a, I s ) a 1\I c t,73 Date of SiteVistt: f f I..23.._..._. ..�.5�..lekr''\
Date of Well Construction: Ud4'!6Wl Is the well head 12"above land surface? rr NO
If unknown, was a drilled before 1972? YES or NO If no,what is the height of the easing: inches
If unknown, was it drilled before 7/1/2008 YES r NO Is there a sanitary well seal? Y E or NO
What type of well is it: Is the sanitary well seal in good repair. YE or NO
Drilled Bored Hand Dug Jetted Other Are the followit items present at the wellhead?
a cement Vent t Sample Tap
cem
Does the well haveent slab? Yf:S or N�
Welt Tag__.M,M , Pump Tag
Does the well appear to be grouted. YES or N() �
Potential Sources of Contamination? �
Does the well currently meet separation requirements with known sources of contamination?YES ott;R
If no,please provide distances to those it does meet:_ 9 ' 4' 0 nu- OMe._gd ±idy.__.._
Other comments:
Complete belr n
Name of person completing this form(please print): S 5o '1 I o^ 12 J if 1 0
Catawba County Environmental Health
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Parcel: 460602698288, 7734 BARRY CT 1 in=60ft
SHERRILLS FORD, 28673
This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report.Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
09/06/2023
%
-1'1"'-� Case a SAM-07-2023-201121
�� �� CATAWBA COUNTY HEALTH DEPARTMENT /a C+e-r;c,
V , �,�,' Environmental Health Section \0Or a,c
I8 2 SM 07/27/2023
WATER SAMPLE FIELD REPORT
Applicant F EUGENE REES, 198 NORTH MAIN ST,MT.AIRY NC 27030
C:3363740992 GENE@F-REES.COM
F-REES.COM
Site Address: 7734 BARRY CT,SHERRILLS FORD NC 28673
Parcel Number: 460602698288
Driving Directions NC 150,right onto Slanting Bridge Rd,right onto Enoch Dr,right onto Barry St,keep straight to get onto
Barry Ct,property on the right
Sample Collected by: 3--,s .^ I?o Y J 1Z'S I a' 1 O Date/Time Sampled: /
S 12 3 9 1. S'a
Sampling Point: 0 0 F S•1 a�,`- 5- 1 1.)o I- o f V...d- 11
Is well head accessible? Yes ✓ No Reason for inaccessibility
Well New or Existing? New Existing `'
Type of Well: Drilled Bored V Hand DugPun
YP
Does well meet adequate construction standards from what can be observed: 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) l
Comment: e, f` rLelc-d- R ,0) utif, E � Pr' ^� new P � 3
� Po4cJ
rsamfieldreport 07/27/2023 15:58 Page 1 oft
Aw.Illy
Case a SAM-07-2023-20 1 12 1
CATAWBA COUNTY HEALTH DEPARTMENT
v
Environmental Health Section
1 8 2 SM 07/27/2023
WATER SAMPLE TEST RESULTS
Applicant F EUGENE REES, 198 NORTH MAIN ST,MT.AIRY NC 27030
C:3363740992 GENE@F-REES.COM
Site Address: 7734 BARRY CT,SHERRILLS FORD NC 28673
Parcel Number: 460602698288
Lab Coliform Analysis Results: Total Coliforms: PM Fecal/E.Coli: 10 M ll.
No Collection Date Over 30 hours old
Invalid Results: Excessive turbidity Excessive Chlorine
Lab Accident
Lab Tech Initials Olt
04 Date/Time Received v"l.1%.'9 IO? I MO Date/Time Completed O .00.In) 1
RECEIVED
SEP 7 2023
Envi'onmental Health
rsamfieldreport 07/27/2023 15:58 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: F Eugene Rees Sample ID Number: 201121
Location: 7734 Barry Ct, Sherrills Ford NC 28673 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.
N 0 R T H C A R 0 L I N A
.00
: Private Well Information
and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba ) Name: F Eugene Rees—7734 Barry Ct, Sherrills Ford NC 28673
Sample ID#: 201121 _J 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 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.
El Arsenic [' Barium ❑ Cadmium El Chromium El Copper ❑ Fluoride El Iron
D Lead n Manganese El Mercury El Nickel n Nitrate/Nitrite El Selenium ❑ Silver
El 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 ontv, 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 El Copper El Fluoride ® Iron ❑ Manganese
El pH ❑ Silver ❑ Sulfate ❑ Zinc
6. ❑ 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 on(v.
❑ b. Your sodium level exceeds 30 mg/land may pose aesthetic issues such as had 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.