A28 170.j t
�� �
�� � � . �
�,� � ����� ��
���s�n�it���rr�rh�rn:�u�������.� �.���c=�t�.��iL�i�.
Date: � / � /�
Name: � r�P.�
Address: �$ Y � (�.Q9� S �-s- � �—
� ]C�v�,.-o �/C �? 5 ?
Re: Bacteriological Test Results
Dear Well Owner:
Tax Map: Z$ Parcel: ���
Your well water was sampled on �/ 2/�, and tested for both total and fecal coliform bacteria.
Your water sample test results 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, 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 bacteria are associated with
ar,imnal andior human waste. The presence of either total or fe�al colifenn 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, tlie 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 notified of the test results.
A well that tests positive for total or fecal coliform bacteria should be properlv 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 Health Department 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,
, `.�kvv�''�
Environmental Health Specialist
Person County Health Department
(rev. 4l20/16)
Person County Environmerrtal Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573, Phone: 336-579-1790, Fax 336-597-7808
r� - T
PERSON COUNTY HEALTH DEPARTMENT
355A SOUTH MADISON BLVD
ROXBORO, NORTH CAROLINA 27573
BACTERIOLIOGICAl. WQTER SAMPLE ANQLYSIS
Narne of Owner or Tenant ��� �Y1�.2,�
Address r County -�rSd
,.a C 2�1 S'1
Collected By
Date Collected S—�"�� Time Collected ��3
Saurce: �Well ❑ Spring ❑ Other
Location: ❑ House Tap ❑ Well Tap �Other � S�� �.�
❑ Na Charge �Charge
1_g� � � �
%
s���a��i�rr�����s�i�r���������rr������a�����������������������������������+����
Mr�k�k�FabikaF�F+�hiF+k�kir�tiF*�Ir**�Iratir***�Y#�k**Ye*it�ir7lr�t*�1r*****�Y#Yr****Ye�Irit�F4*'k#*�k�tYe�r�t***�rirYs*�k*ilrir*
Toial Coliform
Fecal/E. Coli
Results
Present
❑
❑
Reported By ` G� �
Date Reported �"3��� `�
Report Catled
Called To
❑ YES o NO
Absent
�
�