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A35 182.� � The D�strict Health Department _. , CASWELL - CHATHAM - LEE - PERSON COUNTIES Water Supply and Sewage Disposal IMPROVEMENTS PERMIT No. -^�� Date '�_ t • _ I Owner: @ � �� ? ,��r, ��T d+ Jr-�. Location: �T�4 �� -��— Contractor: ' . ��,� Water Suppiy: Private �� Public .— ' �; � r �� f.1 Sewage Disposal Faciliiies: No. bedroorri\� � washing machin other automatic appliapces _ 1 t % i` Size of tank: ; ; '� ! '� � `^i� Nitrification 1 Other disposal facility: Dishwasher, Disposal, • �K �.- ,. — Water supply and sewage disposal facilities location, installation and protection must meet state and local regulations. Septic tank should be pumped out every 3 to 5 years an� shall be main- tained by owner in such a manner as not to create a public health hazard. Septic tank and nitrification line MUST BE INSPECTED AND AP- PROVEB BY A MEMBER OF THE DISTRICT HEAI�THD EPAR.TMENT STAFF BEFORE ANY PORTION OF THE INS.T i. �('T N IS COV- • ERED AND PUT INTO USE. �/ / ri ,! � ;�'` + :�/� , , j ,.� Date approved: — Signed ' % � I�� '' ��/ � � �� Well: t�'�- Sanitarian ..:.. Sewage Disposal: ' ' By: Counter- �d (Owner or his representative) Certifica2e of Compleiion � Date Approved: � � B : -----�� nitaria (OVER) Location of well and sewage disposal facilities sketched on back. y � r �i:r�`��w- .1�:-'s''-��1�!� �� r � ►�t / V�7 � � �1./ �� I�a�a�nsonnn�n�oan��,Il IHI��,ll�ll�na Date: y / /!� /� . - �.. ., �'t ,r � ' ' �'��'�� i Ii7l�� -_;� , Re: Bacteriological Test Results Dear Well Owner: Tax Map:�� Pazcel:�, Z Your well water was sampled on �// 3/<�, and tested for both total and fecal coliform bacteria. Your water sample test results are noted below: X No coliform bacteria were detected in the sample. Your well water is safe to use for drinking, cooking, washing dishes, bathing and showering, based on the bacteriological results only. Total coliform bacteria were detected in the sample. Fecal coliform bacteria were detected in the sample. Total coliform bacteria are naturally found in ttie soil. Fecal coliform bacteria are associated with animnal and/or human waste. The, presence of either total or fecal coliform bacteria in well water may indicate that a new or repaired well was not properly disinfected prior to use, or that contaminated groundwater may be entering the well. If coliform bacteria are present in your water sample, the water may not be safe for use. Young children, the elderly, and the individuals with compromised immune systems are especially vulnerable and their physicians should be not�ed of the test results. A well that tests nositive for total or fecad coliform bacteria shoasld be pro�l disinfected and retested prior to resuming normal use The well may be disinfected using the enclosed disinfection procedure. A well contractor or plumber can assist you if needed. Once the chlorinated water has been thoroughly flushed out of the system, please contact the Iiealth Department to reauest a re-samnle_ For additional information, please feel free to contact Environmental health at 336-597-1790. Our office hours are 8:30 to 5:00, Monday through Friday. Sincerely, — V. � �� Environmental Health Specialist Person County Health Department (rev. 4/20i I 6) Person County Environmental Health, 325 S. Morgan St., Suite C; Roxhoro, NC 27573, Phone: 336-579-1790; FTY 3?5-597-78QR North Carolina State Laboratory Public Health Environrnentai Sciences Report To: PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET tViicrobiology Certificate of Analysis ROXBORO, NC 27573 EIN:566000331 EH COURIER #: 02-33-15 StarLiMS Sample ID: ES021418-0026001 I II�I�� I�I�I) III ��I�' II�'� I��I II��I II��I I�II II��I �'�II �'I�� II�II'll ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: DONNA KIMBROUGH 1471 OAK GROVE RD ROXBORO, NC 27574 Collected: 02/ 13/2018 13:30 Received: 02/14/2018 07:55 Sampie Source: Well Sampling Point: Sink P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htto://sloh.ncpubl ichealth.com Phone: 919-733-7308 Fax: 919-7158611 H Kelly Denise Richardson Well Permit Number: A35-182 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Date Total Coliform, Colilert Absent 02/15/2018 E. coli, Colilert Absent 02It512o1a Report Date: 02/16/2018 Explanations of Coliform Analysis: Reported By: Susan Beaslev G L Cd�z�-�t�!«��.�:/ If coliform bacteria are Absent, the water is considered safe for drinking purpose. If coliform bacteria are Present, the water is considered unsafe for drinking purpose. Presence of E. coli (bacteria) generally indicates that the water has been contaminated with fecal material. It must be remembered that a water analysis refers only to the sample received and should not be regarded as a complete report on the water supply. � I � � � � .., f 1 �'= � c� � �� aa.�nsonan�a��a��.Il ��m.Il��ia Date: ! /�/ 1 � Name: _��, t,� p, l„ �, �_ �.�. Tax Map:��s'Pazcel:_�v- Address: '�'G' �i �? �'� ?� Re: Bacteriological Test Results Dear Well Owner: � Your well water was sampled on r/�/� and tested for both total and fecal colifarm bacteria. Your water sample test results a��e noted below: No coliform bacteria were detected in the sample. Your well water is safe to use for drinking, cooking, washing dishes, bathing and showering, based on the bacteriological results only. '� Total coliform bacteria were detected in the sample. Fecal coliform bacteria were detected in the sample. Total coliform bacteria are naturally found in the soil. Fecal coliform baeteria are associated with animnal and/or human waste. The, presence of either total or fecal coliform bacteria in well water may indicate that a new or repaired well was not properly disinfected prior to use, or that contaminated groundwater may be entering the well. If coliform bacteria are present in your water sample, the water may not be safe for use. Young childrer., the elderly, and the ind:viduals with compromised immune systems are especially vulnerable and their physicians should be not�ed of the test results. A well that tests nositive or total or fecal coliform bacteria shot�ld be nro�erlv disinfected and retested prror to resumtng normal use The well may be disinfected using the enclosed disinfection procedure. A well contractor or plumber can assist you if needed. Once the chlorinated water has been thoroughly flushed out of the system, please contact the Health Departrnent to reauest a re-sam nie_ For additional information, please feel free to contact Environmental health at 336-597-1790. Our office hours are 8:30 to 5:00, Monday through Friday. Sincerely, �� Environmental Health Specialist Person County Health Department (rev. 4/20116) Person County Environmental Health, 325 S. Morgan St.; Suite C; Raxhom, NC 27573, Phone: 336-579-1790, FzY 335-54?-7?OE n 0 PERSON COUNTY HEALTH DEPARTMENT 355A SOUTH MADISON BLVD ROXBORO, NORTH CAROLINA 27573 BACTERIOLIOGICAL WATER SAMPLE ANALYSIS Name of Owner or Tenant �1h� �hr'��2� '�' . � Address 6 n �, County � � � Collected By Date Collected l�� ' Time Collected �v: ��- C� Source: C9.��VYell ❑ Spring o Other Location: House Tap Well Tap ❑ Other ❑ No Charge Charge � .............................................................................., ***************�************************************************************ Total Coliform Fecal/E. Coli Results Present � � Reported Date Reported % " � �' I � Report Called �YES ❑ NO Called To ��"'�1s��-f'�� Absent ■ � :I � �