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A35 195,� . .Q. j- ,ry � u ''� �,1 ,�. r � �i� v� �',,�-. ' The District Health. Department CASWELL - CHATHAM - LEE - PERSON COUNTIES Vliater 5upply and Sewage Disposai IMPROVEMENTg pERMIT- , No. Dat � �c5� Owner; �' Location: ' - .. '�+..� � . � � g-� � � !.. 1�� . _ _ , ., .. Contractor: '" �i �d7�/," Water Supplp: private��! p�lic r �ge Lis sai Faciiilies:�ido. bedrooms�_�_ Dishwasher, Disposal, 1� m ot er auto atic appliances of tank: '" NitriRcation line• �p ;� :� �-� •. Other disposal facility: : Water supply and sewage disposa • protection must meet state and lo , tained:by owner in.suc a m. � `:c $eptic tank and nitrification �:line ;', BROVED BY'"A`'`MEMBER`QF'TiiE �' STAFF BEFORE ANYlPORTION ERED AND PUT INTO.: U5E. Date approved� Well: � Sewage Disposal• By: facilities location, installation and . � ____._.. THE`: 0 Counter- aigne (Owner or his representative) • � �l � j Q ' � 'f`' Ce=ti5�ate of Completion '• �� 2 '' �S Date Approved: , . � � By' ' anitarian (OVER) Location of well and�sewage disposal facilities sketched on back. -- /'� �� --- � -3o-�c� ApplicatioaDate: J'�9-I p(� `�� (��\� Amount Paid: 6 .0 �•�d. � � � 'L%� - �� ,--�_.,.,,� ; � \ P Receipt#: 8�46 Z 8�lN16� ��`� �Ye d�— �:� Il I.[-�[�;.�,.lty::l,�. �� C►-t� rn-a un'Knnnaxa�c�:xn4:.�.. cO`�'`� AppLcation for Service� II improvement Permit (Site Evaluation) $200.00/$300.00 (if> 600 gpd) ��obile Home Replacement or Building Addition � $150.00 (if site visit required) t+ 1Ne11 Permit (New/Replacement/Repair) $3 00.00/$200.00/$75.00 Service§ Ren��ested : . �onstruction Authorization (Fee is dependent on the type of 0 Permit Revision $75.00 'g'�x IYIaP• �� I'arcel#i �� 195 ❑ Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information: Name: Address: �p � �O 2) Name and address of current owner (if different than applicant): Name: t� Ce�C t' P n✓l Address: rj,q� CZ ��v{ I� n � l�C �-1 �7 �l 3) Property Description: Lot Size: Address and/or directions to ion: Phone (home): (work/cell): ;� (7 � � Sj ' Phone: 33� ' �a 1 �0 33 Lot #: �❑ �y I�iio Does the si� contain any jurisdictional wetlands? L'!'yes ❑� �n Does the site contain any existing wastewater systems? ❑ yes Q'no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes �o Is the site subject to approval by any other public agency? ❑ yes �o Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed U�e and T'ype of Structure: �Residential ,2 1�' New Single Family Residence Maximum number of bedrooms: J � �Expansion of Existing System If expansion: Currevt number of bedrooms: ❑ Repair to Malfunctioning System Will there be a basement? ❑ yes L�no With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential Type of business: Maximum number of employees: Total Square footage of Building: Maximum number of seats: 5) Wat�r Suppl�: L�1 New well ❑ Existing Well ❑ Community Well � Public VVater ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes ❑ no 6) If applying for `Authorization to Construct', pleasQ indicate preferred �ystem type(�): ❑ Conventional 0 Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any I cert� that the infarmation provided above is complete and correct. I also understafzd that if the inforn�ation provided is inaccz�rate, or if the site is szrbsequently altered, or the intended arse changes, all permits and approvals shall be invalid. � Supporting documentation required. _13- �y Date Permits are valid for either 60 months or are non-expiring when accompanied by an approved plat. A completed `Lot Preparation' form must accompany any application requiring a site evaluation. (10/11) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) ��--�- __�----- CONTROL - � - - �_ _ _ � CORNER � �" - -- _ _ _.__ _ _ NF -�__�.�_�_ � } i � J � � lQ IPS WALLACE SAM IYRENN D. B. 779. P. 767 5 `� ��"��'_�� WALLACE SAM WRENN D. B. 779. P. 167 ��.s� ��.�� 7.E�s��n:ir-�:r.i„-„-„m�n��.� ��.Il��a. Applicant: (;M }-1 11,C_ ( WA�.vAC� �'��a, Address/Location: A�'Ac�� ► 9`1� � 67�� Tag Map: � Parcel: � 9� Subdivision Phase/Section/Lot # � Improvement Permit Permit Valid for: Five Years � Non-expiring Type of Facility: 5��1►c�L� FAt�+�`c Kksi��£_ New �C Addition _ Number of: Bedrooms �_ / Occupants�/ Employees / Seats: Proposed Wastewater System: �a��a � A. Proposed Repair: v�a-c�o�� ur��P C�r�v� Water Supp�y: �ivAi�. W�,�. Projected Daily Flow: 3b� gallons/day Type: ��A Type:1S � Permit Conditions: F�s�w 5�� 4�.Fe�i ' CA� PCND W� A,�►� O��,sT►�w\s `�PFi�C't L�aES l'�ilS1" �_ C..��4dL�.`( MAttac�p . Authorized State Ageni: �t�� (X) Owner or Legal Representafive: Date: Date: The issuance of this permit b r the Heaith Department does not guarantee the issuance of other required permits. It is th;, resFonsibility of the applicanttproperty owner ±o insure that all Person County Planning and Zoning and BuildinD Insgections requirements are met. This Improvement Permit is subject tu revocation if the site pian, Qlat or the intended use changes. The Improvement is not affected by a change in ownership of the property. This permit was issued ia compliance with the provisions of the North Carolina �Laws and Rules !or Sewa�e Treatrnent and Disnosal Svstems'(lSA NCAC 18A .1900). Neither Person County nor the Environmental Health S�Cecialist warrants t�at t�e septic system will continu� to function satisfacto::ly in tlnc future, or that the water su�ply will remain �otable. -- - -- - Authori�ation to Construct Wastewater Sys#em a�'ee site plan and additional attachments (�. x Proposed Wastewater System: �v��pµ�A�.. (*)Tyge 7��► _ Design Flow 3100 _ gal./day New Repair _ EYpansion Soil LTAR: 0.30 gal./day/ftz Type of Facility: Sti�t�� hA�►�.�t �S�O�Cf- 2►3i2-�313i2 $asement: _ Yes _ 1`.0 ('`) System Types lilh, Ilibg, Ii ; c�nd V, require periodic system inspectiuns by the Penon Cor�nty Health Deparlment. Wastewater Sysiem Requirements Tank Size: Septic Tank ,Fcsr 1►to gal. Pump Tank �' gal. Grease i rap '� gal. Drainfield: 'Total Area 3bU sq. ft. Total Length �Z'� _ ft. Max. "french I3epth �8 in. Trench `,�Vidth 3�. Min.Soil Cover �p( _ in. Min.T'rench Separation � ft. DistribuNon: Distrihution Box / Serial Distribution�, / Pressure Manifoid �__ Specifications: -[�s.�►� A t,tiw "�,E d' ��.�- ��►S�S�6 �x►s-�►r�b SEP�L "�� A00 ►�{�' � �nn.,..\i..�c a,- c►.1t� �c CY�rn�14, l.� Tr. • D�VE,CCX 6�U� 6�i,TiER WA��. AwAY �iw� Sis�,1�1, Authorized State Agent: j�tPS�-�c�. IL. �� tssue Date: - Permit Exp The system permitted is: �'onventional �/Accepted I Alternati�a / Innovative . I accept the conditions and specifications of this permit. ;,%„ /,y (k) Owner or Legal Representative: Date: � I"� Person County Environmental Health, 325 S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12) It --�_ - --- --�--�-- CONTROL �-"�--�`__� CORNER -'�----__�_ �, -��--�---- N82zBz,-W SR 1335 60� R�W �------_---------- � fnoe�. �"-�--_�, _"_------ h� � �--'�--�_----_ � �'- j Sis►Er� �' b � 3 a �OPD i • 120� At��ma�� r1£. P-�4�i�D � � t�1%w �EE � F��E�L ; �►J sFer� -,�a� ; fZE4�1«rD, ' � C�.1►�LT �Ci�i w� 01LES.14�►.5. �, � C33b�59`1-I`19p R o _$ WALLACE SAM WRENN o. e. ns, P. 167 IPS [.t�Et�D ��_��'- � Ns - _ _ iPUBLIC) � NS' 821B27'E-�'-�_�__��_.�_-�._.� . ?90.40' - � _ _� IPS �- � `jo� ------------ � '------- O a � � - _ _ - - (,t�' �►�. -so 4E A�o�D� Caao' �,c,.��b �„�E� N g21B11' W WA�LACE SAM WF2ENN D. B. 779, P. 167 � K�k.P ��w IPS IPS _"�--- �� Easr c�' ec� 5Et'�ir. � ra►.1k . � � `-� ! �f � � � � � � � � H � � � . ,� vN � 'A £ a� � ,o� � .�� .O z� Q 0 t] � � � .� .o 0 0 .� � '� � 4 a 0 � u � �� O a g 0 � ti �V y '�c � y a� o� gq o � v � h�` S ��, sf ��.� �� IE��a-��.� ��.��.Il IF--IL��.11�7� Applicant: W�w�c� WQ Location: �' loslo 4Aw. (, GC'�l�, '=t�.C. '' 'MT Z1o�. Q O�eration Permii Taz Map �3� Parcel # 193 Subdivision Phase/Section/Lot # # of Bedrooms 3 System Type (From Table Va): I6 G Product (IIIg): EZ rww Type V& VI Expiration Date: -- Type V& VI Renewal Date: — This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization. D�R� c� �A . St�� (Authorized Agent) M�c�r�E`. t.�c.'w� (Licensed Contractor) v��''`�..._ +- ►,t�r' �- ��c�o�M p�� ►O� �13 1 ate) 5 13 .1� ( ate) - - - - ��ab �,a�. �W �,a�. �1AK G�•r� � t�'. Z�o� �oa'Q Scale t�S PCHD, rev. 12/14/12 sK�c aF a�w �,*�E ►s to" �o� �w� o� ��.��.. Line Length � tZ.o' Tax Map: � Parcel #: `9� Septic Tank System Checklist (Type II-I� Syst�m Type: �� Notes: Pump System Checklist Cantracted Certified Operator (Type IV S3�stems): Notes• 1� _�__1 � � � , CONTROL �~_� �'"'��- lrJ CORI�R "1�.�_ .._ �_,�'__�-_-�._ „� m N�r'.W --�._ _��.._ SR 1335 gp• R-W-- __--__.�__ - ____.. Q ^�' NS """�--.��-�_� / iPUBLIC) '- ' � o "� S '_ ---�___-r.,_ �.1 �___ � �� ' b r '3 � �OPD r • l2.0� AUDn�t� j �1�� Q�1��fl O � �t t�iEw �EE �i �►�c0.. j� tri SEPn�. "r��►� � �E4>> tR�fl, � � �►-��' PCt�D �►� �ti1�SY1c�1�,S. � � C33V�5q 1- I'194 0 0 a � WALLACE SAM WRENN D.B. 774, P. 167 �.�c�ao 'PS 62'?By��E`-�'-�-�_ 290.*p' �'� �"'�'- _� "' ~�1� ��`�'��rr�r� � �t� �� "` ^�.� �� ' ' - - - ( �d�' �.►+�. �ro 'QE A4DCD� --- t�$o' �n►s�r\b �.►aE� � � ------� _�_ � /� / + IPS i � � , � . Q ' 3 � � � �, . � / . ; � �� ' Q�pp.�� o � /Op� y �Shhi.z�- ��'�tam . y � ,�0, � w�� A� N B77B2/' yy zso..r�• IPS WALLACE SAA1 WF2ENN D. t3. 779. P. ]67 �C kE�P �.1�ti,, ►.k►us,� a�c L�c� �o' o�� SEPnc. `t'A�.i� . � � � r �� 0.� 5s �b s� o � � � 4 U .� � � h�•� _ �� s� ��.� �� .= �--�.- ��- I��-��.�.�:��.Il ]�3C��..Il�]h�. WELL PERMIT (New,�Repair� Tag ylap: �35 Parcel: �� Subdivision: Lot: Applicant's Name: CM i� _C�k„ (.W Av.at�, wR.�,-t�l Maiting Address: 39�0 �i�� RD !- R�.�, r1t �'�'i3 Phone Numbers: 33� 59'L SS3$ Location of Property: qm,��' ib � qq0 OAK C-�R.pv� -- rt-� 'Z�e� jZp Permit Conditions: 1) See attached site plan for propose�l well location 2) All applicable State and County regulations governing consfruction and setbacks apply. 3� Permits ezpire � years from the date of issue. Other Conditions/Comtnents: K�EP wE�.. 50 ��n }}o�i►sk, a' !Dp' i�r�. �A. _ QA�c S v� S�QnC. SYSF,M Permit issued by: DF9.�ic�l �l. Sr+� Date: '� a9 t CERTIFICATE OF CUMPLETZON New Wel1 Inspection: EHS/Date Lacation: S Grouting: -(2'I `� �'4'elI Log: V4'ell Tag: �5 " Pump Ta�;: flir Vent: 5 i3� �`� Hose Bib: Casing Heighi: Concrete Slab: V4'ell DriUer: Q�,��Q,� Pump Installer: " WeII Approved by• �� - Sr�► Date Sample Co!lected: �1� �`�' P�rsun Counry Environmental Health 3?S S. �lorgan St., Suite C Roxhoro, NC 27573 Liner Inspeclaon: EHS/Date Instailer: Depth: Graut: Well Abandonment: EHS/Date Completed: Method/Material(s): License #: License#: Date• � 13 � �i Date Results Mailed: Phone: 336-597-1790 Fax: 336-597-7808 8/1/08 WELL CONSTRUCTION RECORD Y1�is fam can be nud sinstc a multiptc wo11s ,, 1. Welt Contractor,�nformation: � r9 N i f � � �l � l � ► '�"" Well ContracWr Name ��76-�- NC Wcll Contrauoc Cuti6cation Numbc Barnette Well Drilling, Inc. ca�y N�� 2. Wd1 Construction Permitft: Lts� aq applicoblt Mr!! con,rtruction permru (t.e Cmouy, Slme, 4ario� etcf 3. Wdl Use (check well use): �Ag71CU�[ll(2� ❑Geothamal (Heacing/Cooling SuPP�Y) �IndustriaUCommacial OIrri�ation Noa Water Snpply Wdl; OAquifer Recharge ❑Aquifa SWrage and Recovay ❑AquifaTest �Expaimental Technology �Geothermal (Closed C,00p) ❑MunicipaUPubtic- L9R�dtntial WaterSuppfy {single) ❑Resideoaa! Water Sapply (shared) OCrroundwater J2croedia[i0n �Salinity Barricr OStonnwater Drairege �Subsidence Control �Tf3CCC �Other (explain under #2i F 4. Date �{'ell(s) Completed: ��yep �# � ,j L� sa we(1 r.ocahop: C l� /% Iv�. ��/�bc� Faci6ty/Qwncr Name �� N� Fac�lity ID# (if applicable) r�f-} K��Ci dl` e� n-� 1�z. !G�%U (� L� Physioal Addrus, City. and Zip 1'F_ ►`2 S �,�5 f �%S ��r r�i ra�s�u� xa. �rTx> 56. Latitude and Longitude in degrees/adnuteslucoudsor decimat decgrees: (Ewell ficl� one latllvng is safficient) - 3G - Z- `� -�C 7 N 7' `� -- � � -- S'! w 6. Ls (are) thewoll(s): ['�Pirmanent or OTemporary 7. Is this a repair to aa e:isting we(1: ❑Xu or CFPi�' Ijihlt !s a repafr, frlt out brown x�e!/ cautrvction informatFavi aad esplain dx raiwe oJ�he re/�air wider �'Il remarks secrion or pvr �he bac�r ojthiaJorm. 8. Number oPwells eonstructed: —f� For mudrple injection or no�r-water su�ly welLs ONLYwirh dre samt eonsbac(ioq, ynn c� subm�t one form. 9_ Total wdl dept6 below land sorface: !��% (��) For muttiple wells!!st aU deP� I�� (��e-3�100' and 1�l007 10. Static water levd 6elow top of casing. c� � (ft) IJxnfer /evel !s above auing, tcse "+' . 11. Borehole diameter. � �n,) 12. Wtll eonstrue6ou metLod: �/� ��T.�%<�� - wb'�T+�gY, wbte, dicect pustS eu,) For ldunat Use ONLY: 14. A'ATER ZOIVES FROM TO DFSCIt[I'TION ��f� .s�d�- ��Nr 5s f° /�s'f� ja 15. OUIER GASIPIG for mniti-�.ud wdlt OR LINER if a inbic FROM 1'O DIAME[Qt THICKNESS MATRRIAL C� ft 9' � G%, � s�� z� Uc 16.INNER GASINGOR TOBWG cothe�mal dosed�oo FROM 'f0 DWNCI'ER THICIQVES.S MATERtAL ft. R in. ft f6 id ' 17:SCREEN FROM .TO DUMETER SI,OTS[ZE 7RICKNFSS �lA7'BRIAL ft tL in. tL R in. 3S.;GROUT . FROM TO � MATFRIAI. FMPLACONYMM6ITIOD&AMOUIYI' ft � ft ��/n OU� ft ft ft ft 19. SAND/GRAYEL'PACIC if GcaWe >: I FROM TO MATERIAL �� k1HPUCEMENTMETHOD tt R. ft ft 20. DRII.A.iNG LOG: attaeh:pdditional aheeis itnecessa -= FROM TO DFSCRIPITON color, 6a/rd. seiVnek '� dar de. �� ✓ � S !` i�j C% e YL .b L2. �[./V � � -5- r` Gr rr' � Sd a� l 6 S� 5'v � 5� r�� - �vf� /�v" G �c ' � r� 2 it ft R 21::REMARKS :.:;> .. _ . 22. Certircafion: `'� . � � = � -�..� j��.�,_n� -� ��- � Sig�atureofCenified We11 Contrattnr Daze By algrr(ng rhtr form, ! hercby cerr� rhat tha x�e/!(s) w�s (wereJ cvratrycad In accorrfance widr ISA NG4C 02C A700 or ISA NCAC OTC AZ00 fPe!l Conswcdon S�andntds anil thal a oopy ofthJs reoo�d has been provfded ra the we[l owxer. Z3. Site diagram or additional well deta�s: You may use che back of this paee W provide additional wdl site details or wdl construciion deffiils. You may also attach additional pages if ncccssary. SUBM[TTAL IIVS1'UCI'IONS 24a For All Wcllx Submit this form within 30 days of compldion of wdl consUuction tothe foliowin� Divisiou o[ Wxter Qoality, Iaformation Processiog Uaiy 1617 Ma�7 Service Cenhr, Raleig6, NC 27699-1617 24h. For Inieedoo Wells: In addition to sending the fortn to the address in 24a above, also submit a copy of this form within 30 days of completion of well c�u�uction to the followin� Divisiou of Watet Qualily, Undetgroaud [njatioa Control Program, FOR WATER SUPPLY WELIS ONLY• 1636 A�7 Scrvice Center, Raleig�, NC 27699-1636 13a Yidd (gµm) i� Method of tat B�own20 minut 24c. �or Water Suoolv & Iniectioe �i'eUr. in addition to sending the form to the addtess(es) above, also suhmit one copy of this form within 30 days of 136. Disiufection type: HTH �p�r �/2 CV p compldion of wdl construction to the county health dcpartmcnt of the county where conshucted. Form GW-1 Natl� Carolina Deputmeat ot'Environmmt and Na4u1 Reso�e�s – Division of Wa�er Quatiry Revised Jan. 2013 Report To: North Carolina State Laboratory of Public Health Environmental Sciences Inorganic Chemistry Certificate of Analysis PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET ROXBORO, NC 27573 Courier # 02-33-15 EIN: 566000331 EH StarLiMS ID: ES061914-0072001 Date Collected: 06/18/14 Date Received: 06/19/14 Sample Type: Sampling Point: Well head Sample Source: New Well Temp. at Receipt: 7.2 Sample Description: Comment: Name of System: WALLACE WRENN P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 http://slah.ncoublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 1056 OAK GROVE MT ZION RD Time Collected: 2:10 PM Collected By: Derrick A Smith Well Permit #: A35-195 GPS #: New Well I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 13 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 5 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L Nitrate < 1.00 10.00 mg/L Nitrite < 0.10 1.00 mg/L pH 7.6 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 7.20 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 63 mg/L Total Hardness 50 mg/L Zinc < 0.05 5.00 mg/L �� Report Date: 06/30/2014 ,J�� 0 3 2014 Reported By: Arnold Hnll BY:-- - - -�_ .- Page 1 of 1 �`.�.s.f �� .: � ��-�� aa�vnir-aa�m.a�ca¢:3rn�:.rn.� ��sxn,��n 6/26/ 14 Mr. Wallace Wrenn 1056 Oak Grove Mt Zion Road Roxboro, NC 27574 Re: Bacteriological Test Results (Tax Map: A35 Parcel: 195) Dear Mr. Wrenn: Your well water was sampled on 6/18/14, and tested by the Person County Health Department for biological contaminants (total coliform and fecal coliform bacteria). The results of your water sample are 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. X 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 bacteria are associated with animal andlor human waste. The presence of either total or fecal colifortn 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, t/ie water may not be safe for use. Young children, the elderly, and individuals with compromised immune systems are especially vulnerable and their physicians should be notified of the test results. A well that tests positive or total or fecal coliform bacteria should be properlv disin%cted and retested prior to resuminQ 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 Department (597-1790) to request a re-sample. 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, d��..�. Q• �,,�., Derrick A. Smith, LSS, REHSI Environmental Health Specialist Person County Health Department Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573, Phone: 336-597-1790, Fax: 336-597-7808 (revised 07/29/13) North Carolina State Laboratory Public Health Environmental Sciences i'�icrobiology Certificate of Analysis Report To: PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET ROXBORO, NC 27573 EIN:566000331 EH COURIER #: 02-33-15 StarLiMS Sample ID: ES061914-0103001 � �� ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: WALLACE WRENN P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htto://sloh.ncoublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 1056 OAK GROVE MTN ZION RD Col lected: 06/18/2014 14:10 Received: 06/19/2014 09:10 Sample Source: New Well Sampling Point: Well head Derrick A Smith Kathy Schnizler Well Permit Number: A35-195 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert Present Susan Beasley O6/20/2014 E. coli, Colilert Absent Susan Beasley 06/20/2014 Report Date: 06/24/2014 Explanations of Coliform Analysis: Reported By: Susan Beasley / � ' 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 indic�tes that the water has been contaminated with fecal material. It must be remembered that a water analysis r�f�,�� received and should not be regarded as a complete report on the water supply. JUN 2 6 2014