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HomeMy WebLinkAboutWELL-240607-02.TIF k :RTZLL CONSTRUCTION RECORD(GW1) For Internal Use Qnly: — — — T 1.Zell ContActor Information: Kyle C. Shaw _ 14.WATERZONES 'Well'Camntcter'Name FROM TO DESCRIPTIO\ - 4521—A a05ft' 105 IL Iry -- .. rt ft. NC Well Contractor-Certification NUmber 1L4 R OUTECASNG(far malt!-eased wells)°RIMER(If applicable) Advanced Well Drilling, LLC FRodr To _ DItli,: rAC I TBTCICiESS I M ItLL Cnmpam Name rz S/d R. In' I Heavy PVC �c'1 r`�v 16.1NNERCASL\GORTUBING(aeothermalclosed-Ioop) 2-Well Constructioni'ermit lit ,JI - [�-I 0 V 6 -7 ` 2. FROM_ ,i'TO- _ - DTAMEL t -1 ratcra ESS f arxrE tl.L.List all applicable:1e71 constnicxiop permits(i.e.UIC Counn;State i3riance,etc) rt. R. in" 3.Well Ilse(thee!:(!ell use): it n Iry_ - _ - _ Water Supply Well: __ --, 17.S BEEN FROM I TO - DIAMETER SLOT SIZE-I THICKNESS I SL•t,TERLAL D_.Rricultural DM.Iunicipa1 Public It. It- In. -- _- - - 'QGeothermal.(Heating/Cooling Supply) I9Residential Water Supply(single) -'I `{t {L ' . in.-- - DlndusttiaifCommercial ••OResideitial Water Supply(shared) 18.GROLZ- - - -- - --- .- -- - - - - -. -- - 'L7Irngatioil .0Wells>.I00.000 GPD FROM TO - I MATERIAL --- .Eli IPLACEMESTIEnHOD 3'AilIOL?rT i\owWuterSupplyWell: - a fL ft: Bentonite Poured DMonitoring. ORecoveiy fL • ft. - - Injectlori Well:- -- - -, - - DAquifOrRecliaree OGroundwaterRemediation •19.SAND/GRAVELPACI (ifanplicable)- - -- - ❑-9quifer Slane'and Recovery ❑SaliniVBatrier ' FROM I TO MATERIAL - ---- - I E L-CEMENT\IEmmOD g Aquifer Test ❑StotmuaterDrainage ft. It PEtpi:rimental Teclinoloz D3ubsidence Control IL ft. D lcothemtal.(Closed Loop) DTmcer • 30.DRIL LINGInOG(attach nddlttonalsheets if necessary) . - FROM '-I TO -DESCRIPTION(mtoz hardness.'mNcvc1 t pe:ttnIn size.etc! OGeothemtal(Heatiff COolina Retum) -_ ;OOthe te4;lain under. 21 Remarks) D la,' i/(t 4.Date Wells)Completed: mil' 1I `2-y Well II) - a It. -75 ft. 3ti• JQ e r - -- aa.WeeILoeafion: �� tz • V tt • •11 wr-ci z,.' _ Ti5c ,e. dkj,A% - U 10 fz' Ea5 - .+I'-Yl gc-'e r- eY, Fact'I_ity/Onir'zi ne. FacllitllD=(ifapplicable) ft. :, - J 6 ?on IsAf l 't r- (aL1 t1,_Ul/(- 5-`r ft. _ it Physical Adiires,Citj;,an3 Z,ip 3Lj`L4}2 - KS County P.arelldenun'cationZo"'(PEN) -- _ .Latitude.andlongitudein•Bet,reeslminutesfsecondsordechnaIde-pies: • . ' _ - . _ _ - (ifwell field oneaadlongissuficiei t) 22.Certification' 3S-6•`71L1/ 9` •- i '.V©._ f7'o1'3 a_ w 4Is(areythei ell( .n',eimarient or GTerriporatti Stanat EotCeizifiedlteliContractor Hatt M Ili,sigmngtlrlsfornt1°7rerebreeniikthart ewe!("s)etas(were)cattstntetedinaccordance with 7.IsthIs a repair to an existing well: GYes or Llo hi\tC.-t'02C.P100 or 15.AC4C 02C"0200 Well CansiructionStandardt attdihata coin If this is-a repair.ftllo ttt:t?toan•tiiell constntctioa'ittfortattan wtd.ecpIain the nature of the of,this recard7ra been provided to the u-ell owner. reye lntderr'l renwies seetion'or on the bird oftlrisfort 23.Site drag ain or additional well details: S.For Geoprobe/DPT.or Ciosetl=Loop Geotht5tiii i11Ye1Is having,the soma You may u5e the back of this page to provide additional Awl'construction info construction,,only'I:,G[�r-1 is.nzedzd: Indicatz�fOT�L ial:TBER of calls (add See Over"iriRetnal3sBox).You may also attach additional pagesifnerrse ty, drilled( - . ." - __ '24.St :ITT L L\STRUCTIO\S 9.Totalil elI.depth beIozr Ian('surfacer S_._ -_-. _--- --- (R•) .Submit this GW 1 within30 days of well completion perthefollouing: Forpr hiple Welk listalI deptltsrf,diferent(example-3;mp00'and20001 Information Processing Unit,16.17MSC-,Raleigh,NC27699-1.617 10_StsstIe Wafer Ielel below top:ofcasiirg: __ /'�.. __. __ _ (fL) 24a.,Fo>;All_'1lelis: Original.form to Division of Water Resources (DWR1 . r If aver kiwi isabare.%aring use•• 11..I3oicl►oie dlartrefer.. _ _ _6_ __ ( ) 2-lb.For Infection Wells:Copyto'DWR,,Undergroltnd Injection Control.UUC�j., • .,;'; �7 Fromm, MSC;,Raleigh,NC 27699-1636 :-- 12.N'O•construction method: ,{✓—rep I°`�I _ - 24c Tar_- ater Supply and Open Loop Geothermal Return Wells:'Copy to ll1e lie ribge,rotary,cable,(Erect push,etc) county environmental health department of the county where installed " -OR) 4TER SUPPLY WELLS ONE* ?Id.For Water Wells.praducina over 100,000 GPD:Copy to DRR,CCPQUk Air Permit Program,I611 yISC;Raleigh,NC27699-I611 '13a.?I'ietd'(gpm) 1 -_ _ - _ _ Nether"oftest: HTH - �. 13b,Dlslnfeetion Type: __ .riro"unt: )1 t'S °_f:- , : a v. :- 'l \ thC.ro1maD�astmantofEnvwonmenta1 Quality-Dnisionof War'ni maces ; j�.� ,4;R: 1 Permit#:WELL-240607-02 011111S CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section wtiI r- i5hk-- eowtf o8/ !7/ r 1l:ocApr, WATER SAMPLE FIELD REPORT & TEST RESULTS c—a-u4 ("L(1 Owner: CCeVe,ViI%-:t ti 4/4" 'I)6:1" � .Swe. �) `�tb 6- 481 Owner's Address: � a�l 9 Phone#&Email: - - 0 V0 ,Sci p'r UW r Site Address: 1266 RON WHICKER DR, CATAWBA, NC 28609 Parcel#: 470002958340 Subdivison: M p�� Sample Collected By:DWI 51_ryC 111 I'�[eet) Date/Time Sampled: /03/25' /o . 1/Ath Sampling Point: W GI k Is well head accessible? Yes 17 No Reason for inaccessibility Well New or Existing? New ✓ Existing Type of Well: Drilled ✓ Bored Punch Hand Dug Does well meet adequate construction standards from what can be observed?: Yes: 17 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 in.above finished grade Well head missing vent Well head does not have a threadless tap Well head missing identification plate or pump tag Wire conduit opening not sealed Other(Comment) Comments: Lab Coliform Analysis Results: Total Coliforms: p 1 '" ^" '� Fecal/E.Coll: vl'0 t 4 No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials: £C'" Date/Time Received: t I/oa/26 16 3 a Date/Time Completed:)` Qk' " -' 1 " " NOV 5 2025 Environmental-Health Analytical Results , STATESVILLE ANALYTICAL Catawba County Public Health .. :r PO Box 389 Newton, NC 28658 Receive Date: 11/04/2025 Reported: 11/05/2025 For: Carolina Hard Money(Wendy): 1266 Ron whicker Dr, Catawba NC 28609 Comments: Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst 251104-46-01 Nitrate 240607-02 1.36 mg/L 353.2 11/05/2025 CL 251104-46-01 Nitrite 240607-02 <0.1 mg/L 353.2 11/05/2025 CL Respectfully submitted, -7A(1-1.-0Q- • .?2 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.cam _ DaTRATENITRITE isNALYSIS . Nca; Rfar.,u:lea owlbe'a{plitd ter ceagliaea ce&r. WATER SYSTEM ID#': I,/e LL 240 CD 17•01_ County: Catawba Name ofWatcr System: cart.1 ii.a 1.14f d l-Nne.y Cy,1Br.oty) Sample Type: ❑Entry Point krSpecial/Noe-compliance Location Where Collected: /26.6 Rvr Whlvkex Dr , kA en fiC 1.? O£7 Facility ID No. 'MO G o'7_(1Z Sample Point: Wel keg) 3— s1'�' Collected By: Collection Date 1 Collection Time /► TWi 111;k ) 2.�i/ /0?/ ' /0: 11 , A M — (eL•rQPr'aa) (tu+�o� (SPa% '�+•deC'b() M3i1 Results to(water system representative): . CATAWBA COUNTY PUBLIC HEALTH Phone 11:1 (828)465-8270 ENVIRONMENTAL HEALTH Fax#: i (82B)465-8276 • PO BOX389 Re?onsibleParson'semail EHAdrnin@catawbacountync.gav NEWTON,NC 28658 LABORATORY Et it: 37155 • 0 SAMPLE UNSATISFACTORY 0•RESAMPLE REQUIRED D CONTAM MSTHOD REQUIRED '�DETECTED ^• QtIANTLz1ED ALLOWABLE 1 C00 CONTAMINANT CODE REPORTINGLIMIT (.e<RRL)• R&SLZTST LIMIT OttRLJ (X) 1040 Nitrate 3532 1.00 mg1L ❑ I . 5b reg/L 10.00 mg/L a L1041 Nitrite • 3532 0.10 rng/L X • mg/L 1.00 mg/L *Note:If result exceeds allowable limit,the laboratory must fax analytical results to the State on day test completed. DATE: TIMId: . . ANALYSES BEGUN: i t /05 /2 5 . .�1:4 5���A M N M ANALYSES COMPLETED: I r 1 / Q /26 __0?: o „ Laboratory g I Log : 251l bq.4 to-0 1 Certified By: C '`+ COMMENTS: • 2008 Laborater?•shad d 14s0 Restate to: • Public WaterSuply Section,Attn:Data Entry,1634 Mail Service Center,Ra1-1701h,NC 27699-1634 • PO Box 228 • Statesville,NC 28687 • 704/872/4697 Page 2 of 2 „a'.., 4 4312 District Drive ', MSC 1918 ��_ North Carolina State Laboratory of Public Health 'i Raleigh,NC 27699-1918 . ids 1t�� 8, ,.11 c Environmental Sciences http://slph.ncpublichealth.com R° �1 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 Carolina Hard Money(Wendy) P 0 BOX 389 1266 Ron Whicker Dr NEWTON,NC 28658 Catawba,NC 28609 EIN:566001814EH Delivery: NC Courier StarLiMS ID: ES251105-0126 Date Collected: 11/03/2025 Time Collected: 10:11 By: Dwight Mikeal Date Received: 11/05/2025 Time Received: 08:37 Sample Type: Raw Sampling Point: Well head Well Permit No. WELL-240607-02 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 10 mg/L Chloride <5 250 mg/L Chromium. <0.02 0.10 mg/L Copper <0.01 1.3 mg/L Fluoride 0.160 4.00 mg/L Iron 0.105 0.300 mg/L Lead <0.003 0.015 mg/L Magnesium 1 mg/L Manganese 0.009 0.05 mg/L Mercury <0.0004 0.002 mg/L Nickel <0.01 0.1 mg/L pH 7.3 N/A Selenium <0.005 0.05 mg/L Silver <0.01 0.10 mg/L Sodium 6.8 mg/L Sulfate <5 250 mg/L Total Alkalinity 35 mg/L Total Hardness 30 mg/L Zinc <0.05 5.0 mg/L Report Date: 11/18/2025 Reported By: RECEIVED Marc Komlos DEC 2 2025 Environmental Health Page 1 of 1