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A30 159Application Date: � Amount Paid: c5?�. �� Receipt #: � 573 �� - �,�/��'� C�.� �']J � �� f, �� AL t i/�.�/1 � C b�u�- �`��f �I��.�� —S�,n-_ � �� tl�.n-n.v-�i n-cD �cn �rvn Q_-�rn tG�en.➢ TC.�f a-rn.11 R:JI-n ---___ .__. ( _..:.._.___.._.._.._ ___:_ Application for Services �,�;� �Improvement Permit (Site Evaluation) � �°� $200.00/$300.00 (if> 600 g d) (�� Mobile Home Replacement or Building Addition `�i $150.00 (if site visit re uired) �''Well Permit (New%Replacement%Repair) $3 00.00/$200.00/$75.00 Services Reqaested Construction Authorization 'Fee is dependent on the type of Permit Revision Tax Map: �,3.'� Parcel#: �� Repair of Existing Septic System . Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information: 1� Name: ' �c� n G - �t�l vY ►"�i✓� Address: 1 b'-� 5 C i1 a� t� k.l r � ccc� (�e %JbYD �� 'i 2) Name and address of current owner (if different than applicant): Name: .ictme E. � t�e � r�'l�-r Address: r re R 3) Phone (home): 33 (o - 59 � — g3yS (work/cell); �,�io - S9 Z- I bo�— Phone: 33(a- 5qq- S�Ib o '1 .Y3o1 Pro er Descri tion: Lot Size: . o.��t�ubdivision: -- Lot #: :—' V�o P h' P �— _ � � yes p yes q yes p yes [$ no � no I�. no � no Does the site contain any existing wastewater systems? Is any wastewater going to be generated on the site other than domestic sewage? Is the site subject to approval by any other public agency? 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: �R 'd ' 1 r ch,��h � tia►� �►� esi ent�a C�l New Single Family Residence Maximum number of bedrooms: � Occupants: 2 ❑ Expansion of Existing System If expansion: Current number of bedrooms: ❑ Repair to Malfunctioning System Will there be a basement? ❑ yes O na With plumbing fixtures? � yes ❑ no ❑Non-Residential T'ype of business: Maximum number of employees: Total Square footage of Building: Maximum number of seats: 5) Water Supply: �New well � Existing Well ❑ Community Well D Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this property? ❑ yes �i no Please note; any known ground water restrictions.or sources of cQntamination: h(� R� .' � � 6) If �plying for `Authorization to Construct', please indicate preferred system type(s): 6,� Conventional ❑ Accepted O Innovative � Alternative ❑ Other ❑ Any 1 certify that the information�rovided above is complete and correct. I also understand that if the information provided is inaccurate, the site is subsequently altered, or the intended use changes, all permits and approvals shall be invalid. ignature (Owner/ Legal Representative*) * Supporting documentation required. I 1 �2Z � �S 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/l 1) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) ��,s� ��.�� .�� IE�s �.-� a- � �� .Il. IF3I � �,ll�I� Applicant; r.r �'vl�+� Address/ cation: s--� o � C C t__j_ �� -------------- Improvement Permit Permit Valid for: Five Years � Non-expiring Type of Facility: Z� � QP , New �—Addition _ Number of: Bedrooms 2/ Occupants / E ployees / Seats: Proposed Wastewater System: .�B�v'2 '�-cQ Proposed Repair: .('a�(uPvt�'o u Permit Conditions: �P� Sr��2 5��l� Tag Map: 3� Parcel: �� Subdivision Phase/Section/Lot # V4'ater Supply: �f/�� l Projected Daily Flow: Zi�O allons/day Type: Q' Type: � ,6 Authorized State Agent: �r�+^�� ,��t'�/'�� _ Date: 3�2 �! (X) Owner or Legal Rep sentative: y' ��-r-, Date: ?, —7—/ _ � The issuance of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibiliry of the applic�nbproperty 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 lmprovement is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of t6e North Carolina `Luws and Rules for Sewag� Treatment and Du�nsa! Svstems'(15A NCAC i8A .19UQ). Neither Person County nor the Environmental Health Specialist �varrants that �he segtic system will contEnue to fanciion satisfa�torily in the futare, or ihat ti�e water supply wifl! remair potable. Authorization to Cons#ruct Wastewater System See site plan and additional attachn:ents �_1. � Propos d Wastew�ter System: �D�tU�E,�t t�'��t ( (*)Typ�� Design Flow Z��_ gal./day New � Repair _ Expansion _2� • Soil L'ft�R: � 2S gal./day/ftZ Type of Facilit-,�: ��PS �asement: _ Yes � I��o ('�) System Typ�s Illb, IIIbg, IY, and V, require periodic system inspections by thz Ferson County Health Department. Wastewater System Requirements Tank 5ize: Septic Tank ( � �� gal. Pump Tank '—' gal. Urainfietd: Totai Area (�� sq. ft. 'fotal Length 3�� ft. Trench Width � ft. iVlin.Soil Cover � in. Grease Trap ^` gal. Max. Trench Depth � � in. Min:Trench Separation � ft. Distribution: Distribution Box �( / Serial Distribution X/ Pressure Manifold S ecifications: �po1( a� �^%a ( i 5 �� — �'� � �'aK 1��'�'�( �i 4 �- ( \ -- Authoriz,,d State Agent: � '►�"e/ Issue Date: '3 —2 �( �p Permit Expiration Date: 3 2—Z ( Z'he system permitted is: Conventional �/Acezpted / Alternative / Innovative . I accept the cotiditions and specifications of this permit. �' � (X) Owner or Legal Representative: % Date: � � Person Counry Environme�tal Health, 325 S. Morgan St, Suite C, Roxboro, NC27573/ph: 336-597-1790 (rev 5/12) 0 0 _ ...f------""_ �,�,e ��D � 1 5� l�(�e7�. S� �� s� I�I�I�.��T �� .. � � v�z�� aawasc.aa�a�a�m�mll' lE�a�c.A�lla SITE PLAN � / Na Y�Y Tax Map# � � Parcel# [� l Sub vi Section/Lot# � Authorized State Agent Date Syslem components represent approximate contours only. The con�ractor mustJlag the system prior to beginning the installation to insure thal proper grade !s maintained. lVote: An Accepted system may be used in place oja conv¢ntiona! system wilhoul permi� authorization or modification. �20 � ra�e ( �t%� �' �� 2�D � QCY'�0� ��,`�! ri� !� r( � � �'P� � ]`�o ��- ��sd� � o�r,ti� � �-Q� C�+�; � u�..$ , � � �'�Qs��s c� � ( �� . � SQn� �'zQo• S�� l ► s��. I �1��,; I � KELLY R. HORNER ID. B. 212. P. 73� i � I r--- __ -------- IFAMILYI SUBDI I3ION E SEE ` � _ P. C. 16, P. 857 M� N T S 81'47'56" E 246.87 PROPOSED � DISTMEA ED i � �1 1� � � : � � ;i �i� �Y 1�,1 S �.p'Pvp � �:� ti��f�� EXISTING �.\ �SFO ��:`� GRAVEL G,p � DR1YE ��. ��F( � :�; �., Rr�� .� U/e1 � c—��Il� ; PROPOSEa ' v DI �REA �D —~ I �o � � i i PROPOSEC DRAINDIEI DISTURBAN PROPOSED � DISATRUEA ED . .� �� •; . , �, i�� xPca�E I � PROP0�0 � OMEILING pROPOSED i �— DIS7�RUEAED �, � . �_� (3�U� � ��k �,lu-� 3. 03 A�RES D. B. 9 6� P' 857 p. C. 247.60 N 88' 11'39" W � � o iM N M ap O � 3 � Q � o ^ N co r- ^ o � CONTROL CORNER KELLI D. B• __ -� _ 1 \ ` Tax Map: � � Subdivision: ��, sf ��.� �� - � � �� rnwn�r�aa�c�xam�radmIl �'��sIl�Ila Parcel: � s � WELL PERMIT (New� Repair_) Applicant's Name: i �d�6{N1�y �,�..Qi✓ Mailing Address: Phone Numbers: Location of Property: � f y 5� �r Lot: Permit Conditions: ` " ' 1.) See attached site plan for proposed well location. 2.) All applicable State and County regulations governing construction and setbacks apply. 3.) Permits expire S years from the date of issue. 4.) Issuance of a permit does not guarantee a potable water supply Other Conditions/Comments: Permit issued by: '�ew Well: EHS/Date Location: ✓ Grouting: - 29 -( (� Well Log: Date: 3� Z—( Certificate of Completion OLiner: EHS/Date Depth: Grout: Well Tag: f d�( `[ �P Pump Tag: Air Vent: Hose Bib: ✓ Casing Height: �/' Concrete Slab: Well Driller: �Q�j� Pump Installer: Approved by: 'N''� Additional Comments: DAbandonment: Date: Method/Materials: License #: License #: Date: 0 2 c Date Sample Collected: �'ll—� Date Results Mailed: �d2S�� EHS: Person County Environmental Heaith 325 5. Morgan St.,Suite C Phone: 336-597-1790 fax: 336-597-7808 Roxboro, NC 27573 11/26/13 �.��.s� ��.��.� � � �� 1� �n�-n. a- � na�an � ��.Il I� � �m, Il �tl� Applicant: l�r" n � Locatian• l� �u� Tag Map �3 � Parcel # �S Subdivision � Phase/Section/Lot # # of Bedrooms � �perat�on �'ermit System Type (From Table Va): Product (IIIg): C�Q�' �'� Type V& VI Expiration Date: Type V& VI Renewal Date: �� This sysiem 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. � r� � ��►�-f,� 1 �9 - z�{-� � ( thorized Agent) (Date) (�,✓�S %�^2Y�G� ` icensed Contract� (Date) �. �� r ^ � ` � �' • - �I i , J � ��,y � �K ,. �„'t� ��e �k h,4,� Scale �S PCfiD, rev. 12/14/12 ,�o,, \ � �;� Q�o� S�R� �� ' �v �P�1. Line 3 SY' � a�fo` Tax Map: Parcel #: ______ Septic Tank System Checklist (Type II-I� l�Tot��: System Type: ��`a�` h�- �� Pump System Checklist Contracted Certified Operator (Type IV Systems): 1V�tes: Jul 2916 03:39p Barnette Well Drillinglnc WELL C�NSTRUCTLON REGORD ll�is fonnrsn 6c utod for sio�e or�ulup3e wr.11r 1. Wdl ontractor To€ormatioa: ��Qf %1% � �l-` � . . � t � w�u co��a-r�� NC W�31 Contractac Ccr¢ifica4on Numlxx Ba�nette Ytile[I Drilling, lnc. �oaquny Name 2. VYeu Caatirnctiao Pcrmi't#= �� I,is� all opplicabk u�el1 conuauuroa pernriu (!. Cmou�,t Snra Ycrimioc: �c� 3: Well [!se (c6eck we!!. ese): QAgriwlwral QM�uni'cipaUPublic- �Gcothamai (�tinp,�Cooliag SupPly) B'f�tsidcnLiai i�iatetSuPP1Y �singlc) QCndus�allCouuncr�ial ORcsideaaai WzterSuppiy (shared) Supply Wdl: 336-598-9275 p.1 For [ote�a! Usc OT1LY: YIi 1YATER 7.ONES-. ' _ _ . exo� ro o�scx�uoa /do �- /� :,�- 1,�.��1 31�, r�. ; � cL �`� �'rl =:�5:ot��so�rc �rmalo�.i+d� o$tnv�a �rs- �ds .� FROM 70 DCU�[ETFR 171IC[INFSS MA �... � iL ... @+ � 9� c�', /`°- S�sl� zr 11'�- 1fi�iN1YC�CASING l}[i�YilfilNt'r: ' � slated RHON Td DI�tHECER TIl[C[INE59 MA'fF3UAL. . . ft. ft. in. ft fi �- .. . 1L SCREEN-':.." .. . � ; � FRA�4i .TO DIAFIElS:R. SFATSCL£ � 'IHIC�14tSS MA'f�fAL � . tZ ft �a• (L fc �. �Aquifer Rod�e CiGrovridwatrr ii�iediatitm `�i9- s QA uifer SOotage and Itaw �� Q vay . QSiJinstyBarries QAqnifcrTest �SiormwaYer.Dcainage CIE�aimer¢ai Technology OSubsidencc Contml -:2'U:±� �Cet�t6eimai (Closed Loop) OTta�er Fitoi QC:wchmiiaf (I{cdtis� liu lieWm} OOtbcr( iaiunnder#2� Rtinarks O �jd c a: n�to w��u1s� �com��c�a: %-22 r, wdi i� �'� sa wtn ��ho�: , _,�.�i`iy`'/��' t/c�2�.2 FatiliryfQri'occ t3amc FaciG�lyIDR (i!'a(�p&eable) and '7�' %ii It �fE fc I fc It ft IDI'�S'lt:�i'VS�'i!ilC, 7v re. rz. tc rc tk. .� C rr� s�`� � CamcJ C'ua] identifieauoa Na ��'1T13 Sia. La�kude aad Laogifnde ia.degreeslminpfxstsetands:or deeimal acgree� ��r�� f f.rc� Gcl� o� F8[Jlaag is sufficient3 . -� ,� . �C� � z 5 3 ,$ rt _ ? � G 4� 7 � � vY . ��.�c.�S- �— � ��'��__ 1` —a'�"--�6 s;� �fcas�� wds �� nau: �6: Is (are� tfre vVcll(sj: E�PCFinanent or L}TlA�pDil(�' , &fr ,p�lAg.(fiGf fGu'7A f IKlL'I7y CClt��j' f%dm fire+ %Yil�f� 1YQ.t �:1CIEf m7Sfr01dE(i IH � �� nrth !TX NGC OZG.Ol00.dr ,IS�! NC�[C F2� .OZQO Wcll Curamrcit+oir.Sta�larifs �id rhala � ?. is tbis ssr}►sir io an C=istipg;srell: OYts or .flffo eoyrl'ofrl,�sRmndyorburrp.o►+d�da d�e ve!lowRer. If d+is /s a rrpalr. fU oar.bwx'r+ �rci! cansrrsc[con7rr/'ormauon qmdrsp, L'm'n Jrt nauue•of die eeguirander €2l Ku�a►tY set(ion or wt (hcbackofrldi jwix. 2.i. �I.tC' di7tg[f W OCllddiholJ�llPti� iitC�t: Yau m&y vsc tiia �ai� o£ thes �t ba padvide addiunnal wc1f. sito ddaiEs s�r wdl S:�Enmbd of wcUs-consiructcd: � constntdion ddails. 'You aiay also.aCaich. additibaal p�� if nececsary. For muUiple iryectiar or rron-�.arer-su�ify �rclLs OKLY wirh llie smne uan.dYrccffen: ym+am sLb.xrt oae�onr�. 5U��I�AL iNSIUGT[O1V5 F. Totai �ve[L de¢t& brtow land sorf� J��% (ft) 24a Fnr !►ll WdL� Submit ffi�s .6oms v�nihin 30 days of. cuiuplaibn df wel l ,Faramlriplewe!lt�itof/deprhsijdrff'ererit{ac�y�le-3�J1oo'and:1�l007 �oastrudaontothe�fiolia�viitg: 14.5laNc+asiertevelbelo+rtopofeisiog: Z� (fL) 33��SiaRofVYm�erQwBly,[�ufarwafivn.PraccssiugUoit, ��water le:�ef.s abo.+e clsrt�, we ,+` f61,? Mai! Service C�atsr, xi,aleigh, I� C 27699-t6I7 1[. Bor�hotc dia�aeter. � �'ia:) 7i3b_ For ihizdio� '4'STclis: fn addi�on to srnding thc iacns ta ihe addcess in 24a �j/� y� ai�ove al5o s� �t copy ef d�is iamn wiihin:�0 days of oanpietion a.E wetl /i� `i`C / i 1��i9R i c�4tcttiontotlleraltowi:i� i3. WcU coashvcSon.arcthod: J �i•c au8e . rotaY, cabie: diceet Push. etc.? Diviciau at W�tter Qnality, Uadc�grouad.fajectioa Coatrol�Ptognm, FUR'.WATEB SUPPLY FYELLS ONLY: t636 i�a�l.Servicr Center. Itale��, PIC 27fi99-fi3G i� �t,aa �m;. � Meihod uf test B�own20 minat 7At �ar�Vater.Sanbly&.Ts�iectiau'C4dfs [n addiflan to sendingtheforrn so tha �ddiess{es) ebovS aLto svb�i[ one copy of thes f«in wi8iin 34 days af tau. �rKaaa �- HTH Ama�mt '�� CiU(� eoamplie�ion of wdl caiutruction to tFx aounty hpitii departmart of thc eaanty whae coRstrusted Form G W-1 Nonl� Carolina.Depat�ea4of Fitvitoammt �od 1�u�a1 Raoocees - flivisiow oCWalcrQiuliey Aevisedlaa ZOl3 �� ne department of health and human serviees , � , . .� � y � � f� , � f s'.� }'' ` 't / �S { ,'-i I i % � ji E C `� l- �� S }'" (^�f`j r"'� 't' � � . -.� � f R (� € fi � � P `-�� i L1 �� r S�J � � � � i � �,' i � ( � i,1 �,,. ; �, I ( S P � 'r--••. � '-': -- �.,.. , F�`j ( y r � �e, r�� ' r�,. f ` r� �'i� �'� 1 �'_�,_, �"""R �' � ' i �'� � y'�� a r�^• ��,. r � �� .....� �� .� ';z �; �� F = 9 � � _, � � �� ;i? E� � ��' �� For snorganic Chemica/ Confaminants County: So�t Name: � �-, ` ,. Sample ID #: '��-!S Reviewer: k,,,� � TEST RESULTS AND USE RECOMMENDATIONS 1. � Your wel! water meets federzl drinking water sta�dards for inargani� cnentica�s. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inareanic chemical results onlv. You may have other water sampling resuIts tliat are not taken into account in this report. 2. 0 T'he following substance(s) exceeded federal drinking water standards or the North Carolina 2L calculated health levels. The North Carolina Division of Public Health recommends that your well water not be u�ed for drinking and cooking, unless you install a water treatment system to remove the circled substance(s). However, it may be used for washing, cteaning, bathing and showering based on the inorFanic chemical results onlv. Arsenic � Barium � Cadmium � Cluomium � Copper � Fluoride Lead Iron Manganese � Mercury Nitrate/Nitrite Selenium Silver Ma;�nesium Zinc nH 3. ❑ a. Sodiurr. lev�ls exceed the U.S. Environmental Pratection Agency's�(USEPA) Heafth Advisory level for sodium of 20 mg/i. The North Carolina Division of Public Health recommends that only individuats on no or (ow sodium restricted diets not use this water for drinking or cooking. It may be used for washing, cleaning; bathing, and showering has�d on the inorQanic chemical results onlv. ❑ b. Levels over 30 mg/1 may pose aesthetic problems such as bad taste, odor, staining of porcetain, etc. 4. � Re-sampling is recommended in months. 5. 0 Re-sample for lead and /or copper. Take a first draw, 5 minute, and 15 minute sample inside the house (preferably the kitchen) and if possible a first draw, 5 minute and a 15 minute sample at the well head to determine the source of the lead and/or copper. 6. , The following substance(s) exceeded federal drinking water standards. Your water can be used for drinking, cookmg, washing, cleaning, bathing, and showering based on the inor�anic chemical results �nlv, hut aesthetic gr�blems such as bad taste, odor, staining of porcelain, etc. may occur. You may want te install a house�otd water treatment system to address aesthetic problems. Cadmium �hromium Fluoride Iron Selenium Silver pH Zinc For more information regarding your wel! waler results, please cal! the /Vorth Carolina Division of Public Health at 919-707-5900. North Carolina State Laboratory of Public Health 3�2 Distnc�Drve Environmental Sciences Raleigh, NC 27611-8047 htto://slph. ncpublichealth. com Inorganic Chemistry Phone: 919-733-7308 Fax: 919-715-8611 Certificate of Analysis Report To: ADAM C. SARVER Name of System: PERSON CO ENVIRONMENTAL HEALTH BRITTANY HORNER 325 S MORGAN STREET 315 MABEL LANE ROXBORO, NC 27573 Courier # 02-33-15 ROXBORO, NC 27574 EIN: 566000331 EH StarLiMS ID: ES011217-0039001 Date Collected: 01/11/17 Time Collected: 11:25 AM Date Received: 01/12/17 Collected By: A Sarver Sample Type: Raw Sampling Point: Well head Well Permit #: A30-159 Sample Source: New Well Temp. at Receipt: 3.8 GPS #: Sample Description: Comment: 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 24 mg/L ('.hlnrirla < � nn 25o malL Chromium Copper Fluoride Iron < 0.01 < 0.05 < 0.20 < 0.10 0.10 mg/L 1.3 mg/L 4.00 mg/L 0.30 mg/L < 0.005 0.015 m nesium 3 m aanese 0.180 5 0.05 m < 0.0005 0.002 < 1.00 < 0.1 Nitrite pH Selenium Silver Sodium Sulfate Total Alkalin < < 0.05 7.40 < 5.00 N/A Total Hardness 71 mgi� Zinc < 0.50 5.00 mg/L Report Date:01/20/2017 Reported By: Deddie.r'�lancol Page 1 of 1 �� . � ti A � � ��,."�. �+ � � � �.��. V ,L4. � ��na��ia�,cvnnu��.�m:ttf:,a�.� ��"'�.e,�.=1+��n Date: � / ��/� Name: ►-i � � wt�2,� Address: <� MG r�, �'r� �{�C ��7� Re: Bacteriological Test Results Dear Well Owner: Tax Map: 3� Parcel:� Your well water was sampled on (/«/� and tested for both total and fecal coliform bacteria. i'our 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 resu[ts 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 soii. 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. IJcoliform bacteria are present in your water sample, the water may rot 6� safe for use. Young child: en, tlte elde�•ly, and the individuals with con:promised immune systems are especially vulnerable and their physicians should be notified of the test results. A well that tests positive for total or�ecal coliform bacteria should be�roperlv disin%cted and retested ;nrior 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, p(ease feel free to contact Environmental health at 336-597-1790. Our office hours are 8:30 to 5:00, Monday through Friday. Sincerely, � �Y�'�,/ Environmental Health Specialist Person County Health Department (rev. 4/20/16) Person County Environmerrtal Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573, Phone: 336-579-1790, FaY 336-597-7808 North Carolina State Laboratory Public Health Environmental Sciences f�licrobiology 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: ES011217-0124001 � �� ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: BRITTANY HORNER 315 MABEL LANE ROXBORO, NC 27574 Collected: 01 /11 /2017 11:25 Received: 01/12/2017 08:41 Sample Source: New Well Sampling Point: well head P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 httq://slph.ncqublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 A. Sarver Angela Heybroek Well Permit Number: A30-159 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Date Total Coliform, Colilert Absent 01/13/2017 E. coli, Colilert Absent 01/13/2017 Report Date: 01/13/2017 Explanations of Coliform Analysis: Reported By: Susan Beaslev / � � 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.