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A32 92j �'�1 ��. �� p4 a � � The Distrtt� Mealth Department . CASWELL - CHATHANI - LEE - PERSON COUNTIES Water Supply and Sewage Disposal IMPROVEMENTS PER IT I�a � - _..,, Dat ' � � � Owner: ��'= �!1 %.',� r.-;..�; ,'. � '' /t 1_� Location: -� �:ff� / �G % i•^•, ,i;' '"4:k..'#'� Cnntrartnrc % Water ��pplp: Private .f .` " publ�c _,!�r ,�`� ; f•��!� c-L•-�.-ir�j�r�<<��.., ��t ��.1w,�-�il �!'�r.;,,�,1 �;+�...� l� ,�a Sewage Dis _, a�l Facilities: No. bedrooms ��— Dishwasher, Disposal, � wa� machine.�iother automatic appliances �m.." ��% �'1 )i i" , �n � '�ize of tan : �� " � Nitrification line: , ` •-` ;� Other disposal facility: Water supply and sewage disposal facilities location, installation and protection must meet state and local regulations._ 5eptic tank should be pumped out every 3 to 5 years and 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- PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT STAFF BEFORE ANY PORTION OF THE INSTALLATION IS COV- ERED AND PUT INTO USE. . Date approved: Well: Sewage Disposal: By �� . � , n ��A . Signed�� i''"^•- .� � i -_ ,� Sanit�rian � �.J Counter- signed (Owner or his representative) Cerlifica2e of Completion Date Approved: 1—` �B : Sa 'tarian (OVER) Location of well and sewage disposal facilities sketched on back. � w NOTE: Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water supplies, etc. Note special problems existing on �lot. Write in measurements in order that installations may be located at later date. Note location of water supplies on adjacent lots. AQt�iication Date: �-��6'� Amount Paid: Receipt #: �� Tax 9flap #• � �-� QarcE! #: � � �j -- \ •�,�� .�� J�"" �� — - : " —_ cC �CD ZLT1��i'I� �Y � � � � � `� �savaa-oaa�•-�*� .aaa��u.I1 7E--�L��.71�I�a_ � �e� , Improvements Pertnit Improvements Pertnit - $150.00 (Mobiie Home ReplacementlAddition) RepaidReplace Fxisttng 5ystem Pem APPLlCATIOfd FOR SE32VIC8S Pertnit (NewlReplacemerdl- $225.00 Construcfion Authorization far SepUc $'150.00!$200.00 Permit Revisian Fee - $75.00 IF THE IMFORMATiOfd IN THE APPLlCATION FOR AfV IMPROVEMEAIT PERMIT 1S IPICORRECT. FALSIFIE�, CHAiVGED OR THE SITE IS ALTERED THEN THE INIPROVEMENT PERMR AiVD AUTHORIZ�4TIOf�1 TO CONSTRUCT SHALL BECOME INVALID. - 1) Pertni# requested by: (Owrnerlagent/prospeciive owner): -�e /`�D�i"� � Home Phone: � 6 �l- �� Z Address: � �' z Business Phone: �S"g `� �'� Z 9� a r e '� � J� ,__�.,,2) Name and address of current owner: �a,r»e a-.i �. b�� 3) Property Description: Lot size: 1• s�A�Township: Subdivision: Lot # Directions to the property (Including road names and numbers): 4) proposed Use and Structure�escription: answer each of the foliowing questions: a) Proposed , Existing �, Type of Strucfure: Width: Depth: b) Number of Bedrooms: Number of occupants or people to be served: � c) Basement Yes_, No Will there be plumbing in the basement? d) c5arbage Disposal: Yes No _ 5) Water Supply Type: Private (new or existing�. Public_, CammunityJ Spring _ Are any wells on adjoining property? Yes_ No _ If yes, please indicate approximate location on the � site plan. 6) Daes your property contain previously identified jurisdictional weilands? Yes No�� PL�SE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPE�'TY QR SIT� PLAiV MUST BE SUBMITTE� WITH T�11S APPLICATION. ➢ PROP�RTY L1NES AND CORNERS iVIUST BE CLEARLY MARKED, . ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STA6(ED OR FLAGG�D. 9 T'D�iE SITE 1VIUST BE READILY ACCESSIBL� FOR AN EVALUATION B`l TaiE liF�►LTH DEP�►RTMENT STAFF. I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-described property. I agree that the contents of this application are true and represent the maximum faciiities to be piaced on the property. I understand ifi the site is altered or the intended use changes, the permit shall become-invalid. � ,, � or Legat Representative � �� Dat PCND, rev. 06127102 � A�plication Date:' C� Amount Paid: [Z Receipt #: 2� � Zz �� S �" � � . J Tax Map #: Q 3� ��s� �I�I�.� ��T = --_ cC � �1��Y ��-��.:-,. ��.�.n ��.a�� APPLICATION FOR SERVICES Parcel #: 4 c� IF THE INFORMATION IN THE APPLICATION,FOR AN IMPROVEMENT PERMIT IS INCORRECT, FALSIFIED, CHANGED. OR THE SITE IS ALTERED. THEN THE IMPROVE�/IENY,,PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID. � 1) Permit requested by: (Owner/agent/prospective owner): L�M�. o�- �A ��-►'��- � Home Phone: N!►k Address;/ it 04 Business Phone: � Iq -$ lv 3^�i 'l Z G. �-13��. � 2) Name and address of current owner: � k �- �L�hlu.s �(�� '� ��t— I S c•sL. 1� . � � S�1 .�3t� -31�� - �S3o�- c�r\� ��- -E-lunctic �Y1.�115� K`, i�1C.. � �rw-` 3) Property Description: Lot size: Township: Subdivisio Lot # Directions to the„property (in�udin roadi i�mes and numbers): 5U� g�� o�� E�\c I�C `h�,� � � � 4) Proposed Use and Structur Description: answer each of the following questions: a) Proposed _, Existing �, Type of Structure: Width: Depth: b) Number of Bedrooms: � Number of occupants or people to be served: c) Basement: Yes , No Will there be plumbing in the basement? d) 6arbage Disposal: Yes No _ 5) Water Supply Type: Private �(new _ or existing�, Public_, CommunityJ Spring _ Are any wells on adjoining property? Yes_ No _ if yes, please indicate approximate location on the �site plan. 6) Does your property contain previously identified jurisdictional wetlands? Yes_ No � PLEASE NOTE THE FOLLOWING: ➢ A PLAT OF THE PROPERTY OR SITE PLAN MUST BE SUBMITTED WITH THIS APPLICATION. ➢ PROPERTY LINES AND CORNERS MUST BE CLEARLY MARKED. �, ➢ THE PROPOSED LOCATION OF ALL STRUCTURES MUST BE STAI(ED OR FLAGGED. ➢ THE SITE MUSfi BE READILY ACCESSIBLE FOR AN EVALUATION BY THE HEALTH DEPARTMENT STAFF. I hereby make application ,to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the property. I understand if the site is altered or the intended use changes, the permit shall become invalid. �l �-�- �1.c.1, l.p - �c� :1/� IO lo Owner or Legal Representative �Wl�`�dG�F-: TC�.m�rv-c1 Cs h� c. 1 Date PCHD, rev. 06/27/02 , , I � ,�� - . ___' �,� \ .�� . � �� ,-�- _ \� �� p�vs� ' I � �� , .:� � � o � I ,�_� � � � �� {� � 0��/ � 22716 I �\ �� "- V.,�5�-\ '� s- � ,,, � \ � '� � � ' ' PON�/ � 7173 � .�,\ . � / � / j�� WW-6L� `� �� ✓ \/ � 7191 � - ��a L � . � _ �REs\. � � � i I - ��L�-5 _ , _ . \ - i � I � �� 7175'. / � — - � � i - — —, - — — - — — - — — ' � ��RES. / � \ ,, RE� `\ I / � � 24005 � . / � � � � � � � '� 7177 \ � l / " � /Pp RES. � � � �o � �� , . i � I� �-w�a� i 5 r �.�:��,. 0 �� I FARMLAND I WW-1 Q� /��'�' �s0 WW-2�5p� , I 23428 � 7172 `/ J�/ / 1\ �I � y � �,) � fl SITE `' � ` I /� � RE G� � 9 VE� 1 ' � � � �� I, POND �/ ��, � � 0 7170 V POND , l � a i ,- �-'�'� , � U� -1 C�' � - � / � WW-3 � .�, / C�9 S��l � —� � 7136��1 � FARMLAND �I -�- � � ' � RES. � 1 � _�-1- ' 0 �0 _ _ ' � 1 RES. i — � � � ONP D �� 1 1 / � ' � � 7138 � / � 1 / I � � FARMLAND I 1 � � � � � i� ` \� ---—L----- �i �\ 1 ��--.� � '----__- , r � LEGEND: I � � U WATER SUPPLY WELL � FORMER SERVICE STATION SITE �0 UNDERGROUND STORAGE TANK O 150 300 FT S E � Engineering & Geologica! Services, P. C. 5100 Reagan Dr., Suite 7A, Charlotte, NC 28206, Ph# 704-597-4022 FIGURE 3: VICINITY MAP THE COUNTRY STORE LAW S STORE RD. / WALNUT GROVE CHURCH RD. HURDLE MILLS, NC W.O. #: 505840 DATE: 4/18/05 DWG #: CS0840F1 DRAWN BY: JCJ t1�y ) 5� �_i_%1�� V� `_= ' �_.c�;�i �'�� -�,�,.,,-,,,��.m.� �,�:..�� 'I'� ��'�`��; . Name �ia �2 I�orri5 Ta� Map #� A3� Pa�cel #�Z _ Subdivisi � SeL-rion/Lot# 3 —2o—�c� uthorized Sta.te Agent Date ` Systerra com�ionen#s re�iresent ap�ir�xa9saate�contoua�s only. �'lae canta-cectorr vraa�st�'ag �'lae s�ss�na p�r t�a be�in�aing tlae anstallatzo�a t� i�s�er�e th�t pr�ope�grr�e as �intrained, T." � +.s " �` '�b- , � ' ' u'�,f ��' � I.� �: �"� � , � � r � � #:' �; �� '� �. �' � t� `;�� r�=, � ' r , `�,. ' ,. � � �� '� � � � ��'� �� A'� {�� `� i� g'. � � � Vi„� � ��-. �� 5. �� , � � � ,� � � +� ,, �. �� e�� , �� , 5� � � � � �, 4'" � ' �� —�I/l ItSi' a �ou. na o n D�d �J�� prop�er�Y 1 I -- e.asemen ovt+� 6ro� ers vve �rne�wells�+� P P �l � ,A � - � $ � � p } �y� } �; �•�' " �_� � � A M �; � z, �'+.'' �. .. s� q�apd , � 'e�' , � �` :*� �.s��'' �g �� `�. . �O 3� � ��, � � 3 bs . ,�� t � -0 d3i �1�� ,; � � �� s � ., � �"�.�+e ""^ 5 � : t, s' � � k .,.�6' �, ��&r�� ` � , � � 3r�.� � � � «» � , �� Y � y � � � �� 2,a �. "y��, �� e�1 f, � ,� �', t. �� ,�. � � ��. � '' ` " � �� `�. � �� a ,� u �� ,�� i"� � e �� `�� ° � -� � � �� , - " � �� :� .. ��: 5�y . . � � � y� ��F� E �� ' � �� - ; i. St ��,k� i . . e� � a� �.�."� .�x.�« '� � ,,. _ ,��. � x �5 � N �a}:�"a � 3 /j � �y / `/ �, � � ,y. � � y > �.�' ,, { _ .. �, �. .�� .�_ �e f' d / � , ., 1 , �, �� - f � ��^ { ; y �� Y.� �„ 3.� .�� 4 �� / �o •� �y.. � a �� , `�`4� � �� .. � � t 1 . ' a � ��G ��' � �� ; ' �. ��, � �� $" >�} :� .� ; t �' $ v �,J Y '¢� � �Fm y i . �� a�d ¢ ` � s' � �; s � +' �' »�#�a ��,� � � s. � �� : � � � �� ,i�,g� a i, f_ � .• � ��y� � _ �. . E � �,E � �§ �,:.�� '. . .. .. . . ,. , ..,.r..; �_'. ��. .: ., , Scale:l� �35 �a� � � � ��<:�� , � A ��,�°� �y' � � �� ,� �/ � �.� � i� a,�j" . � a � � � � � �/� � , +t ��.�f dJ�� a0, f �, � k� � � �` - a : y hT, ,/ ' �� .m y�� Y � d%� _ .�, . � : . � �� ' �a ,i'. �• � � � � �� ,s i r ' � � .� ��; ; �i �.-$� �� - ,. � y � '� ��. � c +'' < ��tX �'�" �� a"`�.<„ �,�. �� & � � � � 7 II�� .� 1 �._ {q..� :_ 9 � � '� � � �� r a� � �� 6 � � r � � m�;'� � . � �� '�� al � �� gj� 1 + �� S `�� i`� } R '� � � }°�'` : � # b �Q � �� 9^` � � F 4 �� `.� � �� _� � � �^�� . � _ .. � _.�� . . �� e � �. � �t � �4 ` �x� �;:E �c" � ,�x„�; , ��_�� " - �� .; N �. . �cg�� ¢^k �.? yuP`:'�' �"Ypp ,�.. ,�? t a�� yyy��: C � +'�Y, ��T `. ��. '4 Y br.4 ,- �h) � � aa„ y x�it�,� � � { '.. x� �� ' � �� ,,. �"' �� _��° �� :1��3 � � t i 3 . � � �i � � i 'dK .�..a� � �� °9R;�� xq � � �� . � � � . '�' 'k+ �,� y�,�� s i��i� � � z s � . �§ ' � �� i� � �'�� +�F. ��: � �; �� ,� - � * ,.; . � � s A �'� �� _._ U� �u UO �� s � � r � � � �' �' K� �. �, � � ' n K� �- ' � � � - �, � 3 � . � , . � � � � � � � ' � � �• � � � � � �• -�- . c� , � � � � ' "{' � -��; �, �� 3 �- � :� � �, r � d � ' � G> � � � • � � � �- � � � ..� . . � � � � t� - � � . � � � � � � . �- s =� � °� . � � � _ 4 � � � , 6 .-1- , � �, � � � � . ^ � � � � °� � � � �� . y � � � , �' � � � �. � �. � � �� - �� - � � . � � �w� � � �, , `� G t �� G ' 1 . ��) � .. � � � �� T��x Ma�� P��rcel # f S�enc �ili v i•s�i o ia ' < <�� Ph�ase Section Lot # I , , - � 1 I i-- I� 1_ Applicant: Location: Improvement Permit Permit Valid for r%Fiv Years _ No Ezpiration Type of Facility: o� New Addition # of Occupants # of Bedrooms 3 Projected Daily Flow � Water Supply g.p.d. Permit Conditions: Owner or Lega1 Representative Authorized State Agent: c Type: Type: Date: � �. � D o Date: The issuance of this permit by the Health Depart�ient 4f does not guarantee the issuance of other peimits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoning and Building Inspections requirements aze met. '�his Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina Zaws and Rules for Sewa�e Treatment and Disposal Svstems' (15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic tank system will continue to function satisfactorily in the future or that the water supply will remain potable. Author�ation to Construct Wastewater System (Reqnired for Building Permit) * See site plan and additional attachments (�. Proposed Wastewater System: New Repair�Expans'on _ . Type of Facility: � �„t Type Wast ow g.p.d. Soil I,TAR• g.p.d./ ft 2 Basement _ Yes � No Wastewater System Requirements Tank Size: Septic Tank: gal Pump Tank: Drainfield: Total Area: sq ft T � ft Trench Width ' um Soil Cover: in Distribu '. Distribution Box Serial Distribution � Specifications: Authorized State Agent: �- � Permit Expiration Date: gal Trap: gal Ma�mum Trench Depth in Minimum Trench Separation: ft Pressure Manifold � Date: _s��„'2�� The type of system perniitted is Conventional Innovative Alternative. I accept the specifications of the permit. .,_/ Owner/Legal Representahve: �� -l.�/?�'—� Date: � Z D J CHD7/30/2�02 :��,�� -- : � ; � ��7�� .��,�,�,r,.�.��.�. �� s��. s��.��: Name 0�!S 'Ta$ Ti� #� .3 Z Parcel #� Subdivisio � /�D- Section/Lot# . � � ut�iorized S Agent � ' � Date . '� syste�aa components repres� �n�m�te��ontour� orllly. T3:e can�izrctnr muss, flag t31e systeras pri.�r io beginnzng t.�ae instadlatian to insure tdrat pr+upergrYude is maintainer� : �''�,� ,/�/�� T/�%t� � V�GO� L-�a� �� t �,�o.� � �� !� �`°�.,o �� r/o�� / �o�/s , Gv � Scale: � ry `��✓ ovr��r � �� —' G�C i �'C-t �.5� .C�_ - �-� h� [�. 3(vGy � X 3 � � ��s � �a�✓�� y�� .��, . � �g �-� ��a I'G.��, ae�. 09/12/Ol �.�6 i , �/� �1S! �� •• v � �/ � � � � 3L ��n.vra��a��s�.�a�.11. ��.��I�n_ Applicani Location: � / �x M�p ; P�rcel # SUbC11VISiOt1 Ph�se�Section;Lot # # of Bed�rooms ' � � `; �' .. ';' �� != . �� , � ,---- System Type (in Accordance With Table Va): �'�� THIS SYSTEIUI HAS BEEM, INISTALLED IfV COMPLIANCE WITH APPLICABLE NORTH GAROLINA GENERd�►L STATUTES, RULES FOR SEWAGE TREATMENT AND DISPOSAL, AIdD I�LL CONDIT10iVS OF THE IMPROVEMENT PERfVIIT AND CONSTRUCTION AUTHO TIOM. � � . . � . Authorized State Agent Date Installed By: �, �e�%,e Date: . 7//�"iC�'i"' ' W��S � \;r� 6 ��ifl Connecf?,d �^ `�I S� Q� ��to nP��s�" JI�/ N ��ll•e"1 '�__ --� � - --' ,' � .� � �� . �i PCHD, rev. 07/29/Q4 � a J�R� i �4r Y h�91'�� QI��I��a+�1�1�3 4.O��a.rY9�11� 1\' 91"�'� �� Tax Map #� Parcel #.�.�_ Sysiem Type (Tabie Va) Owner/Applicant Subdivision � Address/Location SeclPhase Lot # � State�ID/date Ca aci al. Tee and Filter � Baffle � Sealant Riser if a licable Tank Outlet �eai Permanent Marker . Pump 'iank Waterproof /Sealant Riser � Pump Check Valve/Gate Va(ve � Anti-si on o e Floats/Switches Alarm visable and audible Electrical Com onents � Rate m � A roved Pum 1Viodel Block Under Pum Pum Removal Ro e/Chain . � Distribution. System � Serial Distribution Pressure ani o Low Pressure Pi e A r. Pi e I�laterial and Grade Valves � Trench Width � � ft. Trench Depth in. T,rench Length ft. Trench Grade � Trench Spacing Rock Depth and Qual'�ty Dams/Stepdowns etc. Pressure Laterals � Hole Spac9ng � o e ize Pipe. Sleeve Setbacks From Weils From Propertv fines Surface Waters Public Vllater Suppl Vertical Cuts (>2 ft. Water Lines Vehicle �Traffic Easerrients/Right of V' Other Easements Recorded Coenenents 0 pct�d rev, 3!'i3/0�1 : � : ..,,. ' - �- y • n. t. .K . .. .. �.:..vr • '. ' ' : —• . }�,x-+�y �"+�,!.�� ` . i � ' j t • �-• .y � Y.{ .:��.:'`.y�• ~ .� 'V . ::3y.. x. :�. •,M . �� .��rT ':;''= . A:.�....� �: i� f L��.�, i�'� •�:r'�� .,» ;•:a.:i?•::•:•....,.:�.... ��., .��_'•' :�. �• o,....+�+.++c:; r;.+',:;."o-;';`Y„% :`� :ti :• ' — �aA � m� � '�•;7��-w-�� t . . '�''yii��: �� ,�:i.,v �'.i � r'r �'�� : ��i !ufi� '�� il'4�� '��i I ); � . :� i . i ��.'•w+ii�1Uf'.�i �. . ir'�. �`. �• .rul � � �� j ; •�1 �' t t[T Tau l�p ,32 Parcel # �2 y 'T�ov�inship: ' licant�� J� � � , Sui�division: Lot # � I.ocation: ✓' ,� � %�S /_, � . . : . � � � �i��s��: �ai� �. c�.y �� :.. s� ��easy: � S .f ronting Appmved By: � ' 1.2�� . wen x.o�: . � y� � T� � � w�u Ta�: � . Air Vent: • . Hoee B�: � . Caeing Heigh� � . Concaete S1ab: . � . We�il Dr�le�: �-1 5 . Well Approvec� by: ' ��S�e �t�c�� S�te S�tc�t**'�'� r�: 7nstalled by: , e55 - �� t • . G�a: ��2z�oc� Date: ' ' . wa�ter Sampie: � Wei18 must be 10 fect fivm praped.y line�. Wella mnst be lU0 feet fram �eptic systenns. . �Tells must tie at least 25 fe�t from any building foundation. � Date:. - , . Other conditions• PC"� rev 01/271Q4 • ,� : .�. . . .. . � . - . . North Carolina Division of Public Health � Occupational and Environmental Epidemiology Branch, Epidemiology Section � INORGA1vIC CHENIICAL ANALYSIS REPORT Private well water information and recommendations � �a . Coun : tr� %') Name: o t�/'/� Sam le Id Number: �% �. tY ! �..._.._ Location: Reviewer _ �l�- ANALYSIS REPORT Your well water was tested for 15 metals, plus nitrates, nitrites, and pH. The results were evaluated using the federal drinking water standards. The pH is a measure of the acidity of the water. Drinking water may contain substances that can occur na.turally in water or can be introduced into the water from manmade sources. TEST RESULT5 AND USE RECOD�IlVIEENllATIO1�S ' Your well water meets federal drinking water standards. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering. : The following substance(s) exceeded federal drinking water standazds. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering, but aesthetic problems such as bad taste, odor, staining of porcelain, eta may occur. You may want to install a household water treatment system to address aesthetic problems. Bazium Cadmium Chromium Fluoride Iron Man�anese Selemium Silver Sodium � Zinc The following substance(s) exceeded federal drinking water standards. We recommend that your well water not be used for drinking and cooking, unless you install a water treatment system to remove the circled substance(s). However, it may be used for washing, cleaning, bathing and showering. Arsenic I Barium � Manganese � Mercury � Nitrate/Nitrite � Selenium � Silver Re-sampling is recommended in months. Sodium I Lead I Iron 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 deter�ine the source of the lead andlor copper. OTHER CONSIDERATIONS Routine well water sampling for the above substances is recommended every two to three years. Sample your well water when there is a known problem or contamination in your area, after repairs or replacement of your well, or after a flooding event. Contact your local health department for sampling instructions. For further information please contact your county health department or the Occupational and Environmental Epidemiology Branch at 919-707-5900. Revised January, 2011 ,;�' ; . North Carolina State Laboratory of Public Health 06 N. W?mOngton St. Environmentai Sciences Raleigh, ►vc 2�s„-soa� htt�://siph.ncpublichealth.com Inorganic Chemistry Phone: 919-733-7834 Fax: 919-733-8695 Certificate of Analysis Report To: ADAM C. SARVER PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET Name of System: THOMAS ANDREW NORRIS 11148 HURDLE MILLS RD ROXBORO, NC 27573 Courier # 02-33-15 HURDLE MILLS, NC 27541 EIN: 566000331 EH StarLiMS ID: ES031312-0007001 Date Collected: 03/12/12 Date Received: 03/13/12 Sample Type: Raw Sampling Point: Outside spigot Sample Source: Ground Temp. at Receipt: Sample Description: Comment: Time Collected: 2:00 PM Collected By: ACS Well Permit #: GPS #: �j2� qZ Inorganic Chemical 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 37 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 7 mg/L Manganese < 0.03 0.05 mg/L p H 7.8 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 11.00 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 136 mg/L Total Hardness 120 mg/L Zinc < 0.05 5.00 mg/L Report Date: 03/21/2012 Reported By: �e�ic 7%lorceol , ; -. . > :'.�' .��u� �:;`'... •�� P+�AR � i L�12 R j-?�r : Page 1 of 1