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A28 46Application Date: `� " � �'�� L�� 0 � � % Tax Map: /1 Z$ AmountPaid: 0(3.00 -T�Q, �'•��J �� Parcel#: Receipt #: � 3 71 1 � o� � 71� � � � �� C, � ✓ �� i�6�'1 IIIl��cna�,•••,,�a�na:an.)l 1HI��,Ild,�n J Apulication for Services Services �Im m t Permit (Site Evaluation) $200.00 $300.00 if> 600 d) ❑ M bile H e Replacement or Buiiding Addition i5G.00 (if site visit requiredj O 'Well Permit (New/Replacement/Repair) $300.00/$200.00/$75.00 I� Construction Authorization (Fee is dependent on the type of ❑ Permit Revision $75.00 0 Repair of Existing Septic System Application: No Chazge/ CA $150.00 or $300.00 1) Applicant Inf rmation: n Name: D� f� l 1 i S Address: Z R O�- �11 � oro .G 3 2) Name and address of current owner (if different than applicant): Name: _—___ ��'?� Address: Phone (home): ��l �� (flc1 � % (mre�c/cell): �3(� - ,SI� 3 - � Sa 3 Pl:nr.e: 3) Property Description: Lot Size:��. g SubdivisiA}�: Lot #: � Ad ess and/or directions to Property: I5� �S O c I r � � ox boti .L. , �w ❑ yes ll no Does the site contain any jurisdictional wetlands? ❑ yes jid no Does the site contain any existing wastewater systems? O yes J� no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes �I no Is the site subject to approval by any other public agency? ❑ yes I� no Are there any easements or right of ways on this property? (if `yes' is checked, please provide supporting documentation) 4) Proposed Use and Type of Structure: jldResidentia) p�l New Single Family Residence Maximum number of bedrooms: 3 � Expznsion of Existing System If expansion: Cu�rar,� r;�mber of bedro�ms: ❑ Re�air to Malfun�tioning System Will there be a basement? � yes � no With plumbing fixtures? ❑ yes ❑ no ❑Non-Residential Type of business: Max:mu:r. �umber of employees: Total Square footage of Building: i�aximum numb�; o: scats: �) Water Sup�ly: j8l, New well ❑ Existing Well ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes ❑ no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): J�I Conventional ❑ Accepted ❑ Innovative � Alternative ❑ Other ❑ Any I cert� that the information provided above is comptete and correct. I also understand that if the information provided is inaccurate, or if the site is subsequently altered, or the intended use changes, all permits and approvals shall be invalid.. ��Q ( �.- ! � -� / � Signature (Owner/ Legal Representative*) Date * Supporting documentation required. 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) ��,sf �� `�.� � � �� l[�a��a��•-�.-n ��.IL IL�'C��.I1.�I�. Tax Map: �� Parcel:�_ Subdivision Phase/Section/Lot # Permit Valid for: Five Years Type of Facility: �.� Number of: Bedrooms � / � Proposed Wastewater System: Proposed Repair: �cr �� Permit Conditions: � �rP - i Authorized State Age (X) Owner or Legal Improvement Permit Non-expiring � New � Addition _ � / Em�loyees � Seats: _T � � Water Supply: �P,�/ Projected Daily Flow: 3G�o gallons/day Type: � Type:� Date: `J -18-/Z Date: �J_ �JG %� Y� The issuance of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibility of the applicandproperty owner to insure that all Person County Planning and Zoning and Building Inspections requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws aitd Ru[es for SewaQe Treatment and Disnosal Svstems'(15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic system wil! continue to function satisfactorily in the future, or that the water supply will remain potable. Authorization to Construct Wastewater System See site plan and additional attachments (�. Propose Wastewater System: �� S� ��uG��n) (�`)Type � Design Flow � gal./day New � Repair Expansion � Soil LTAR: 7� gal./day/ft2 Type of Facility: �iv �ZS� ►�[' Basement: _ Yes _ o (*) System Types IIIb, Illbg, IV, and i�, require periodic system inspections by the Person County Health Department. Wastewater System Requirements Tank Size: Septic Tank � �al. Purnp Tdnk gal. Drainfield: Total Area �o sq. ft. Total Length 33v ft. Trench Width � ft. Min.Soil Cover � in. Distribution: Distribution Box� Serial Distribution �/ Pressure Manifolc S � vrease Trap gal. Max. Trench Depth � in. D,C, Min.Trench Separation � ft. . � Authorized State Agen Issue Date: - - Permit Expiration Date: 9 - ($ -1� The system permitted is: Conventional /Accepted �/ Alternative / Innovative . I accept the conditions and specifications of this permit. (X) Owner or Legal Representative: � Date: ' Z�' � 2 Person Counry Environmental Health, 325 S. Morgan St, Suite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12) ., . __--- ,�- _ __ __ . _ _—' !_.—'` _ J� . �� . • �� . �-.`-��, � �� . . �C � �.� '�f y . srsy-'°c�''��'¢� � . � �'m^�" � , • ' ' � ' ' � � S�T�� : � ' Za . p�cel #��"' S1 . ��M�p�� . - Se�° r — — Z i 1 . � .�ate � N�e � ste�r►sp�or � Sub� � . �pr must.�"� h� �' utho�ed' S�� :contours on y� �� d. � Cj0 00 t� ' � ,ie�,ts �reseni �' u� � pe''� � Sy�e,n cu+r+p� ��,��iun to :n.s oG�...:=___-000t�. M �� P�� ;�5��(��YI V�� XiS-hn u�der r6u�c� � Gw�er ��- 15 561 �S �P �in� �� ._.. a N O • W _ 0 � r so� Is �` t line � SGI�I,� � I � � - I 00 ��o�oE � ► t � 00 � O � � w : rn �� QI S S�►�t �� i� . 3 ��' _ �� 33�' �� _ � � -�,.�,, c� � � l� 0 � �/ � �� o� s� r, �� 6 �`_' i �i�al 1�� , ��nes / �--� \�. Sd , li,�s ,�s� �\� �/�Sd W i � �. \ -13tlW—T \ �� i� 9 � - � " � c�` L`�`''�� /o'SS � di ��r 6� P .�> � rm �� 1 , 7i' l� � oqd � A y�, M . hi�rz�n�,� �al[i,l Q�.�'J�'liii «... .._.. 1 �.�� .__.-.. • �� • ...� •.•+ ...f .._� . � ��.sf ��.� �� IE �.�� .,�,-„ ��.�.Il IF—IC � �.71�I� �,� Applicant: Location: Operation Permit Tax Map.� Parcel # �'� Subdivision Phase/Section/Lot # # of Bedrooms 3 System Type (From Table Va): � Product (IIIg): C Z 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. (Authorized Agent) (Licen Contrac or) ` �,` � 7 �oo � I ��Q'l� _ I�.� . i (Date) /Z—/3—/2 (Date) Scale: �� Cn�� Line Length 1 �� 3 0' 4' Total ,�30 � Q � � � � Tax Map: � Parcel #: _ �(Q Septic Tank System Checklist (Type II-I� Notes • � System Type: � Pump System Checklist Contracted Certified Operator (Type IV +Systems): Notes: NOTIFIED BUILDING INSPECTIONS: (Revised 12/09 BH) Copy of OP e-mail Date: ��.s� ��.�� ` � � �� I��a-��. ��.Il I�33I��.]L�I� Applicant: Location: > 1 L �- 7 Operation Permit � Tax Map �8 Parcel # �(o Subdivision Phase/Section/Lot # # of Bedrooms 3 System Type (From Table Va): IILq Product (IIIg): �z F�ow 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. 2�u� A. SM Y"! � �" `�'►r ia�i3� la (Authorized Age (Date) �Ir�M`� �-�W{5 a Sot,S (Licensed Contractor) � > (0�0 � 'i0 w£LL. Na�s� � Fx.�1 � I $o' i Scale: �}�t -r� Sct �/�fth'� �QAD � r I v e I a ►3 I a- Date) J cJ a J d J d v � � 3 � � Taz Map: Aa8 Parcel #• 4(n Septic Tank System Checklist (Type II-I� System Type: �� Notes: � W��. iriCor+�P�ETE RT �rir��- �f SE�PT'ic, F�� . Pump System Checklist Contracted Certified Operator (Type IV +Systems): Notes• NOTIFIED BUILDING INSPECTIONS: (Revised 12/09 BH) Copy of OP e-mail Date: ��y 7� J.� �� _~ �-� C� � �� .'� n-n�n�am�a-�aa�na��.11 .�Ta�.mv.tE.�n Vi�+ �,� PERNIIT (New�Repair� Taz Map: Parcel: �i _ Subdivision: Lot: Applicant's Name: � ` 5 Mailing Address: $ Z , �a�o,ro . t�(C. ZZS -7 ? Phone Numbers: 5qR — (D9 7 � � /�- ) 5b3 - 7 so.� �G � Location of Property: ��$ l�f 7 � �7 � � _� .A. . _./ _._ �n 33S f3�aw�� ►1LY� 'R5� � �ermit Conditions: 1) See attached site pdan for proposed well location. 2) All applicable State and County regulations governing construction and setbacks apply. � 3) Permits expire 5 years from the d te of issue. I Other Conditions/C"omments: G� i i� a�� S�L��S - Per�it issued I)ate: � — /$=J2 � CER�'�ICA1'E OF COMPLE'TIOI�T New Well Inspection: Liner Inspection: EHSlDate EHS/Date Location: Installer: Grouting: I-1� -1�- Depth: � Well Log: Grout: Well Tag: A s Pump Tag: Well t�bandonment: . Air Vent: 21$ I i3 EHS/Date Hose Bib: � Completed: Casing Height: Method/Material(s): Concrete Slab: y Well Driller: . �, �/ ��i� License #: Pump Installer: �� License#: �Vell Approved by: �. Q. �.�Q, I)ate: 2�?� 13 10'.IS AM � ; Date Sample Collected: 3� 3°��' Date Results Mailed: � a� �3 Person County Environmental Health 325 S. Morgan St., Suite C Roxboro, NC 27573 Phone: 336-597-1790 Fax: 336-597-7808 3/1/08 May 061312:51 p : '�.sT�rF: • -�r�r ,:..... �'k�� .�i ,��J'"�j r.,? "�.n`. . �5 •-� �� - .,'^ _. -: � • .� -�� . .,+'�!` Barnette Well Drilling 336-598-9275 -[iESI.DEN7'IAL WELL CONSTRUCTION RECORD Nonh Carolina Deparonent of Environmeat and Natural Resources- Divisiort of 1�%ater Quality W£LL CONTRACTOR CERTIFICATION # r' l.1YELL CONTRAGTOR: � LYeA Contractor (tndividual �Va( e V1/ �� Qfl��lfl � C. WeII Contracior Comp2rry Name '� B � T�lqBn C� Street Address Roxbaro NC 27574 Crty or Town State Zp Code L33fi � 599-001� Area code Phone number 2 WELL INFORMQ'fION: � WELL CONSTRUCTION PEi�MIT� I �� 07i-IER ASSOCIATED PERMIT#(iEapp�irrble3_ �Q,CCt'� YC SITE WE11 ID #{irappt�cable) � 3. VYELL USE (Check AppCcable BoxJ: Residenlial Wa[er Supply [j� DA7E DRIl1cD� j j ' —� (2 ,_ TfME COMPLETED_TO O q� � PM �/ 4. WEL.L L CATIOt�l: Cf7Y: �� COUNTY,�S.�� {Streai t�tame. IJumbers, Comrnuniy. Subd' sion, Lo IVa, Paroel, Zip CoCe) TOPOGRAPi-IIC J L,AND ETTING: {cheGc apprqpriate box;. ❑Slope �ValEey at ❑Ridge ❑Other LATRUDE 38 ^ 22 ��.f� " DMS OR 3X.x�ooCXx�ooC DD L�fYGfTUDE �?�l •6Z •�J� � pMS OR 7X.XX)OUIXX:O( DD l.atitudellongitude source: �S [+�fopoa�aphic map {locatian of.wel! must be shown on a USGS fopo map andattached to bhis famt if not usfng GPSj 5. VYEEI O �eIJ ( ! S Owner Name - ci�. Street Address � �� °f � Sta�e Zig C e � Q ArEa tode Pho e number 6. WELL pETq1LS: a iOl'AL DEPTN: iL � T' .� b. DQES WELL REpLp,CE ppST1NG WELL? YES C f�0� c. WATER LEVEL BelawTop of Casing: bZ� �. (Use'+' Npbo�e 7op of Casing) d TQP QF CASING IS 'y FT. qbove Land Surtaoe• 'Top of cxsing terminated aUor betow land surface may reqnire a variance in accaeiance wfth 'i5A NCqC 2C .0118. e• �� (s�)� � M�oa oF �sr Blown 20m t DISlNFECTiON-Type HTH amou�t Cu p.1 ^�� 0� g. WA7ER ZONES (depih)� Top- (�, Bokom�6 (�r Top Bottom �oP� Bottocr�7s ;�►rToP Bottom 7op Bottom Top Bottom - ThicknessJ 7. CASiNG: Depih Aiameter Weight Material Top�_ Bottam„� 2. Ft_ G r% �2( �uc Top Bottom Ft. Top Bottom ��. • B. GROUT: Depth Materia! Melhocf � rop� Bottom_Z ��t. SandlCemenl Poured Top Bottom Ft = Top BaitDm Ft 9. SCREEN: Depth Qeameter SfolS¢e Maisrlaf Top Sottom Ft. in. in. Top 8ottom Ft. in, in_ �� ; TflP Boriom Ft. (n. ir�. 90. SAN DfGRAYEt PACK: Depih Size Material Top Bottom Ft. Top Botlom Ft. Top BottOm Ft. �1. DRlLLiNG LOG 7�p Badom _�_/ 2 �`/ Z`p .Z v ._l (� lTJ / ! � 1 / ! ! / 1 / ( 12. REMARKS: �orrnaGon Descriptiort �.� I�O HEREBY CERTIFY THAT i'lilS 41VELL WAS CONSTRUCTEO aN ACCpRDANCE W1Tii 15A NCAC 2C, W Q.L CONSTRUCi'tON SiAND�4RDS, AND TiiAiA COPY OFTtiIS RECORa FipS gEEN PROVIDED TO 7HE WELL O ER � �� SiG R�EO�FCER71 dWELLCONTRACTOR DATE /o�� ,� �.n �� .� � l/� PRINTED MEOF P RSdN C4NSTRCJCTING i'HE WEIt � Submit wi#hin 30 days of compie�ian to: Divisio� of Waier Quafity - Infom�ation Processing, �617 Mail Service Center, Raleigh, NC 27599-761, Phor�e :(919j 807-6300 �� W-ia � Rev. 2/09 . .:�4a1Nlt� " . �,P� J �Z\�Z . � •- :� ,i�'-'�.; ++�:n' .�. . �. i> � a' _ '' .,. - ��' ::,�� ; � "�a �.o"• RESIDENTIAL WELL CONSTRUCTION RECORD North Carolina Departrnen: of Environment and Natural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATTON # � �0 � � 1. WELL CONTRACTOR: t !rl � �^ Welt Contractor (individual Name Bamette Well Drillina Inc Wetl Contractor Company Name 611 Bamette Tinaen Rd Street Address Roxboro NC 27574 Crty or Town State Zip Code . 3c 36 � 599-0015 Area code Phone number 2 WELL INFORMATiON: � J WELL CONSTRUCTION PERMIT# � OI,E"� �1 OTHERASSOCIATEp PERMIT#{itapplicab►e) '� ` S(TE WEL.L ID #(d applicable) 3- WELL USE (Chedc Appficable Box): Residential Water Supply [j� DATE DRILLED�� Ln —(2 TIME COMPLEfED�n d AM p PM � 4. WELL L CAT10N: C1T1'= �B,kJ�o� COUNN - ��i �e%t � /i� ��M (Straet Name, Numbers, CommunAy, Subd� sion, No., Parcel, Zip Code) TOPOGRAPHIC / LAND EITING: (chedc app�opriate boxJ ❑S1ope OVatley at ❑Ridge pOther LAT(TUDE � ' ZZ• q"') (p - DMS OR 3X.X)OOCbUoOC DD LONGfNDE �' b2' -��2 - DMS OR 7X.700o0oc�0( DD Latitude�longitude source: (�'f�S propographic map (location of.well must be shown on a USGS topo map andaflached to �is form ifnot using GPS) 5. YYELL O R _ �o�o �/ /�illl�o s Qwner Name �'i � � �� F- I�f�l /. • IlA Street Address ��,�o,-� J. ( � or own State Zi� �, � - �Q?� Area c�de Pho� number 6. WELL DETAILS: a TpTAL DEPTH:��{1 � b. DOES VYELL REPLACE FXISTING WELL? YES ❑ NO� a WATER LEVEL Below Top of Casing: oZ� �, Nse `+' if Above Top of Casing) d TOP OF CASING IS � FT. Above Land Surface' 'Top of psing terminated aUor below land surface may require a variance in a�dance with 15A NCAC 2C .0118. e• �� (9Pm)= � ' METHOD OF TEST BIOWtI ZOfTI f. DISINFECTION: ry� HTH Amount � Z C g. WATER 20NES (depth): Top� Bottom�6 �!r Top Bottom Top�� Bottor►�t?S ��'`Top Bottom Top Boriom Top Bottom Thicknessl 7. CASING: Depth Diameter Wefght Material Top_� Bottom_� Ft.� �l� �Z( T�� Top Bottom Ft Top Bottom Ft. 8. GROUT: Depth Materiai To� Bottom Z � Ft. Sand/Cemeni Top Bottom Ft. Top Bottom Ft Method Poured 9. SCREEN: Depth Dlameter SlotSize Material 7op Bottom Ft. in. in. Top Bottom Ft in. in. Top Bottom Ft. in. in. 10. SAND/GRAVEL PACK: Depth Size Material Top Bottom Ft. Top Bottom Ft. Top Bottom Ft. 11. DRILLING LOG Top Bottom �_/ 2 � / Z'P Z_l 6 a'J / / 1 i / / / / / / 12. REMARKS: �rtnaGon Description /� 1 DO HEREBY CER7IFY THAT 71iIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL O NER. � / 9'�'�. SIG R�OF CERTIF D WELL CONTRACTOR DATE lo�.► �� c;��, �„ � yd�/� PRINTED NAME OF PERSON CONSTRUCTING THE WELL Submit within 30 days of completion to: Division of Water Quality - Information Process(ng, Fortn GW-1a 1617 Mail Service Center, Raleigh, NC 27699-161, Phone :(919) 807-6300 - Rev. 2/09 �� _ . .� ��.. �.. _�- c�� s � C ��a��.� ��.�� Donald Phillips 821 Blalock Dairy Road Roxboro, NC 27574 Re: Bacteriological Water Sample (Tax Map: A28, Parcel: 46) Dear Mr. Phillips: nsuiing a healthy environment Date: March 26, 2013 Your well water was sampl�d on 3/5/2013 by the Person County Health Department for biological contaminants (total coliform and fecal coliform bacteria). The results of your water sample are as follows: No coliform bacteria were found in your well water and therefore your water can safely be used 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 and fecal coliform bacteria are associated w7th animal and/'or human waste. The presence of either tutal or fecal coliform bacteria in well waier may indicate that a new or repaired well has not been properly disinfected prior to being used, er that contaminated groi.uidwater is entering the well. 'The well should be properlv disinfected usin� the enclosed chlorination procedure. A well contractor or plumber can assist you if needed. Once the chlorinated water has been thoroughly flushed out of the system, the Health Department should be notified so that the well can be re-sampled. If the weil water continues to test positive for coliform bacteria, then there may be a problem with the water source or ��ith well construction. A well contractor or the Health Department can assist you in identifying the problem an� finding a solution. If coliform bacteria are present in your water sample, then the water may not be safe to use. Young childrefa, the elderly, and individuals tivith compromised immune systems are especially vulnerable and their physicians should be notified of the results. Water can be disinfecied by boiling for one minute. If yau need further infoimation please feel fiee to c�ntact our office at 336-597-1790. We are open weekdays from 8:30 am to 5:00 pm. S,�i,,nceprely, c�+.x- �- � Derrick A. Smith, LSS, REHSI Environmental Health Specialist Person County Health Department phone 336.597.1790 fax 336.597.7808 325 South Morgan Street, Suite C, Roxboro, NC 27573 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: ES030613-0076001 � �� ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: DONALD PHILLIPS P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htto://slph.ncoublicheaith.com Phone: 919-733-7834 Fax: 919-733-8695 335 BLALOCK DAIRY RD ROXBORO, NC 27574 Col lected: 03/05/2013 10:15 Received: 03/06/2013 09:00 Sample Source: New Well Sampling Point: Well head Derrick A. Smith Angela Heybroek Well Permit Number: A28-046 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert Present HLBRASWELL 03/07/2013 E. coli, Colilert Absent HLBRASWELL 03/07/2013 Report Date: 03/15/2013 � �� I MAR `? � 2013 13X: 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 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. Report To: North Carolina State Laboratory of Public Health Environmental Sciences Inorganic Chemistry Certificate of Analysis PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET Name of System: DONALD PHILLIPS P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htt�://slph.ncoubiichealth.com Phone: 919-733-3937 Fax: 919-715-8610 335 BLALOCK DAIRY RD ROXBORO, NC 27573 Courier # 02-33-15 ROXBORO, NC 27574 EIN: 566000331 EH StarLiMS ID: ES030613-0094001 Date Collected: 03/05/13 Date Received: 03/06/13 Sample Type: Sampling Point: Well head Sample Source: New Well Temp. at Receipt: 3.2 Sample Description: Comment: Time Collected: 10:15 AM Collected By: Derric A. Smith Well Permit #: A28-046 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 67 mg/L Chloride 19.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.2a 4.00 mg/L Iron 0.94 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 13 mg/L Manganese 0.91 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 8.2 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 13.00 mg/L Sulfate 16.00 250 mg/L Total Alkalinity 205 mg/L Total Hardness 220 mg/L Zinc < 0.05 5.00 mg/L Report Date: 03/21/2013 � „-�;`t :• f ., ,, . . ,. .:i �r.� `ai x �+_ .�.. _a. �.._ >_.. 1�1AR 2 5 20i3 lBX:—.._----.______ ---- Page 1 of 1 Reported By: Arno/d Holl