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A40 267Application Date: �23 —I 3 1 �,ac Amount Paid: j 0.D 0 Receipt #: _� 1$0$� i.�� 0 Improvement Permit (Site Evaluation) $200.00/$300.00 (if > 600 �udl �Mobile Home Replacement or Building Addition $150.00 (if site visit required) ❑ Well Permit (New/Replacement/Repair) $3 00.00/$200.00/$75.00 =�� ) ` �� Tax Map: J� � 0 .�.,,.�•� Parcel#c �6 7 �—� �� IL.�cav nn-��,��.m.a�,.Il. 7L-�[�o�.li.�:ln for Services Services Re uested ❑ Construction Authorization (Fee is de endent on the ty e of system ermitted) ❑ Permit Revision $75.00 ❑ Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information: Name: 1�{ u�, fl� Phone (home): 5�i1- g�� Address: 1��o a�v�cr4 ��('+� �1 �a A.. (work/cell): SR—t- �-155 5��1—�.5 w:��'1L kZ C�`1,. ��y bo r�z., n� ` a'-i�`� �1 2) Name and address of current owner (if different than applicant): Name: Address: � 3) Property Description: Lot Size: 5. �l .� Subdivision: Address and/or directions to Property: �� 'P � � Phone: 1� yes ❑ no Does the site contain any jurisdictional wetlands? J�st � 5t / I I � yes �❑ no Does the site contain any existing wastewater systems? ❑ yes � no Is any wastewater going to be generated on the site other than domestic sewage? ❑ yes ❑ no Is the site subject to approval by any other public agency? ❑ yes � 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: �Residential ❑ New Single Family Residence Maximum number of bedrooms: � � Expansion of Existing System If expansion: Current number of bedrooms: � � Repair to Malfunctioning System Will there be a basement? ❑ yes � 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) Water Supply: ❑ New well fl Existing Well ❑ Community Well 0 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): � Conventional ❑ Accepted ❑ Innovative ❑ Alternative ❑ Other ❑ Any I certify that the information provided above is complete and correct. 1 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. Signatir�e (Owner/ Legal Representative*) * Supporting documentation required. �- a3�i� 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/I 1) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 (336-597-1790) � W � a v B 1297 PERSON C(� UN`'�'Y HEALTH DEPARTMENT WELL AND SEWAGE SITE, LOCATION IlVIPROVEMENT PERMIT Not for waste water system construction. No permit(s) for Construction Location or Relocation Activity shall be issued until Authorization for waste water system construction has been issued. Tax Map # A yu Parcel # Z e�7 Zoning T wnship F�.� i�� v� 2 Owner/Contractor �` ^ — - Date ia�l y /9 � Location/Address �} s T/tr � � � ° � �v ��.4 ✓ �s �D %�� o.c/ �.4 Y�lc 5 T4vFi2n� � ry,tE o N Lt,�J$.R.# //`!�L Subdivision Name Lot# SEWAGE SYSTEM SPECIFICATION3 epair Lot Area t, i/ �* c Size of Tank ia� G G-A L SFD 1/ Mobile Home Size of Pump Tank i o ov vA �- Business # of Bedrooms�_ Nitrification Line yo� � x 3' Max Depth Trenches zo "- �� '' Permits may be voided if site i ltered or intended u� cha ed. Well and Septic Layout by G Comments: r��•r-s� 5 Y 5 �� r? — oc� ' X 3 •� �%Ri �� cA Date (�- �,-9 � Installed by, � Y �dC- ell Permit Paid ❑ WELL ✓ Semi-Public Replacement, Approved t/ Head Approved � ' rting Approved�G� Comments: Approved by, � 31- SPECIFICATIONS Required Slab TOC,(� /3o��i'd Air Vent G � R Required Well og � Well Tag � bC, to (�I q$ �auce�� c, �l�a�q� Date �� I�,ol A'� Installed by 1Cp ;�� n e-f-i-� Approved by This report is based in part on information provided the homeowner or his/her representative in the application submitted for this permit. The environmental health specialist is not responsible for false or misleading information contained ia the application. The environmental health specialist is also not responsible for concealed conditions on the property or for statements in this report that may have resulted from false or misleading statements provided to him in the application. 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. c:\amipro\permit.sam O1/95 rev.l.l Tio.c� i TRACT D �.. SADIE M. HESTER ,Sg S� � SSS �'' • QP�'� HE I RS � J�� ,!-. �'.' I F , '?8'�F � � G��' �g0 'O A 100 YEAR STORM � 0� IF FLOOD HAZARD AREA Q � — — — — — — — — — — — — — — _ EXISTS ALONG CREEK �'. IF ��/ � �'��• � S P H. REAMES t36, P. 151 � . �P �,� SS . � � �� ? 27 . PRp� o ��ai/L s8 2B„ Pj r� �� c� Z CT' 1� `��6. F � � � V - � �' � �„ � � � � � \ o�� IF � \ o - CS' \ ' � IF c�n I F 3 � u � �� ` �. o � � � � . -�+ �' .P � q . CZ O r o N �� /i ' ts V . � � R � ' o 5 NF ; - � �FIELD EASEMENT J � I F �a o�� t J FpR LOT A �z ��; `V� � 0 . 25 ACRE ^ /Q�� `,��. � � N � �� '�� i o � �� CONTROL � CORNER IF ��v , �. �� a -rNl /�-40 �I ti � Z� �� y -�-q'8 p�-s -� �o ��-��z � •_� '��J� . �'.e� � �1 �Di�� .. : � Jun-18-98 06:34A Keith Sarnette 336 598 9Z75 ' : PERSON COUI�iTY EtiY1RONHEHTAL �iEALTH NELL LOG Aate:�.-��-s�p' ' Owner. �,��.�.1� Loca�ionJDirections: SR# P.Ol '' �:.. �; :'~. ': K �� . • k; -. . . ,.:�„' �, , :.. i,r� r mcc� ar� ��c,a , Subd2vision �N�me� ,. _ ,_ .__Lot #� ��1-� Drilling Contractor: � c,.�.�.e �s �', p.�_ ._�----- ViTEi.,t, C4N�STRUC�`I�N `�� -��^--^- I�istance from ?�Ieasest Prope; ty Lir:�___�o I�istancc froni Sowce oI� I'ollutiai� ! UU ' "��otal ��cl�tt,:-Stvd -..--. -- ��. Yicic':•._ �_.__ _ GPtvt S;�itic tiz,l�.te- l�vcl � �= Water Bearing Iones: Depth_G�___rt.--/b� Ft-� .-I-t------�Ft. �- �. Casing: l3-�ntl�: Fram_ a_in_`Y� _Ft. Dia�ie=c--- -- .� _.._�Tn�.h�s '1'YP��: S:ee]___�._ � _Galvanixed Stec:l �-�' If St�cl, does owner approve: Yes No ^ � Weiglit: ThicI;ness: t�i� .Hei�t Above Ground:�_�Inches Drivc Shoe: Yes --� No Were �tohlems Encouniered in 5etting the Casing? Ycs Na --- If "yes" gi� e r�.ason; Grout: Type: Neat SandjCcrnenE Coricrcte Arenuiar Space Width Inches Water in Annular Space; Yes No - - �V1ct��od: Pumped - - Pr�ssure Pourad �- - �. � • •. � : . De�th: From_ C� ;o a a Fc. � Materials Used: ?�io. Bags Portland Cemen� Weight of 1 bag�lbs. ]f mixtZ.�re (sand, grav�l, cuEtings7 - �aEio: ;p ID Plates: Yes � No � ��' � 4 x 4 slab Yes � No I HEIt�BY CERTIFY THAT THE AB QVE �NFpRM�'i�pN IS CaRRECT AND TH AT THIS 'WELL WA.S COIVSTRUCTED IN ACCQRDANCE WTTH REGULATI�NS SET fiORTH $y THE PERSO�i CQVi�"I'Y HEALTH DEPARTMEI�IT. � � -�frd _ ignaturc vf Contractor L}a�� ►. 5-98 06:34H Ke�"�n ��tr�nca.a.v ___ __ _ • . PERSON COUi�TY EHViRONMENTl�L BEALTH HELL LOG Date:(-17 p' � Owner. _.��5.� Loca;ionJDirections� � S}2# 5ubdivision �Name' ,. . .�. .__Lot ##_ __ y Drilling Contractor: •��' r � r /�-��_ _._ _-----__- ___ WEI..L C4NSTRUCTIC3N d' I�istance frorn Ne•arest Prope; ry Lir.e___.L,o I�;stance frot�� Soutc:e of' T'ollution_ ! v� _..___.__ ` "1.'otal Dei�ti;:, d�._..._.._ F�t. Yic1.t{•_ �.__ _ GPN1 S;�i:ic �'Jate� I.cvcl �, I=t. Water Bearing lones: Depti� _E�:.__rt.__.JBQ Ft_� _-I�t-------�'t. Casing: 13��ptli: From_ (3 _.io�y� _Ft. Dia:��e�c-:---._±(�----Lic}l�s '1'YPE: Steel-----.- � —Galvanixed Stecl �.'_, �. If Stcci, does owner agjr:ove: Y�s No Weight: Thic�ess: (�k� Hei�t Above Ground: !� �Inches S?rive Shoe: Yes � No Were Problems Encountered in Setting the Casing? Yes No --- If "yes" gi� e r�ason: Graut: Type: Rteat Sand/Cement Coricrete Ar►nular Space �Ttridth Inches Water in Artnular Spaee: Yes_,______ I�to - - Mcthod: Pumped Fr�ssur�e �?ourzd � ._ . . . ,, � - Depth: Fram FJ �o a o Ft. � Materia]s Used: i�iQ. Bags Portland Cemen� Weight of � bag_lbs. Zf mixture tsand, gravel; cuttings� - Ratio: to ID Plates: Yes / No � ' 4 x 4 slab Yes / No J , I HEREBY CERTIFY THAT THE ABC}VE �NFORMA'I'ION TS C4RR�CT AND TH AT TH�S VtiiE�,L WAS CON5TRUCTED IN ACCORDANCE WTTH REG�ILATI�NS SET FORTH $Y THE PERS��I COUi�"t'Y HEALTH DEPARTME%T�T'. .. � -fd_ ignaturc of Contractor �a�� ! �� Tax Map: �� Parcel: 2.(� % ��..,•, ) � � Subdivision - � � � � � � � Phase/Section/Lot # l [�s �rn�n a^ � �'n'*�'�+-�+ � ��.Il IL� � .�.Il �II� Permit Valid for: Fiv_ e Years Type of Facility: � Numner of: Bedrooms � / i Proposed Wastewater System: Proposed Repair: Improvement Permit Non-expiring �_ New _ Addition R / Emnlovees . / Seats: Permit Conditions: ��[}��f��_� I I 5�� . �._G.d�.1Ll'�C�.�t1�lIIZ1__�-�{�►2�-- � Water Supply: c�S n Q � � Projected Daily Flow: gallons/day ype: � Type: Authorized State Agent: c�_ Date: (X) Owner or Legal Repre ntaNve: � - Date: nq� J The issuance of this permit by the Health Department does not guarantee�Ciie issuance of other required permits. It is the responsibility of the applicant/property 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 l�iorth Carolina `Laws anrl Rules %r Sewage Treatment and Disposal Svstems'(15A NCAC 18A .1900). Neither Person County nor the Environmental Health Specialist warrants that the septic system witl continue to function satisfactorily in the future, or that the water supply will remain potable. - Authorization to Construct Wastewater ystem See site plan and additional attachments (�. Proposed Wastewater System: CC ��s`l k� ;a� (*)TYPe� Design Flow �l� gal./day New Repair Expansion Soil LTAR: � ZD gal./day/ft2 Type of �acility: ��V,2� PSr��er�'e, ��l ,�,��on � Basement: _ Yes �No (*) System Types IIIb, Illbg, IV, and V, require periodic system inspections by the Person County Health Department. Wastewater System Requirements �xrsfi�,g Tank Size: Septic Tank Da o gal. . Pump Tank �' gal. ^vrease Trap --�-gal. Drainfield: Total Area ��D sq. ft. Total Length � 50 ft. Max. Trench Depth �� in. Trench Width _� ft. Min.Soil Cover �_ in. Min.Trench Separation � ft. Distribution: Distribution Box / Serial Distribution ✓/ Pressure Manifold � Autt6ori�%d State Agent: � Issue Date: �'- y - /3 Permit Expir tion Date: �-N-/Sj' The system permitted is: Conventional /Accepted v/ Alternative / Innovative . I accept the conditions and specifications of this permit. (X) Owner or Legal Representative: Date: �� ,� � Person County Environmental Health, 325 S. Morgan St, ite C, Roxboro, NC 27573/ph: 336-597-1790 (rev 5/12) �� -� � 1 � . �. ► 4 . ; � � �J .d. �7 � � , . .. 11 1T7T �J �ICD.�71.1C"�]Cll.]t�C11;c�]tiIL��.�L 1111c��.�¢� Building Additions/ Mobile Home Replacements Tax Map #:�, �} 0 Parcel#: 2 Address: I b5(o Pau � es l ave rn �d , nx n �o C- 2.-75 �7 Approval Requested for: Mobile Home Replacement � Building Addition . Applicant Name: /�I Address: _f � S a ne5 1Jra.,P ,- v, t�d � ��n, � t I 2�� 7� Phone #'s: S� 1-g82(� <�FZ,_ �4.�( - lo°�`� �M% ��-!7�(W� Permit Located: V Yes No Installatian Date: �,� j- qS Design flow: 3(�D (gpd) Current Contract with Certified Operator on file (if required): Water Supply: V Well Public ar Community Wastewater system shows na visual evidence of failure on: a- 3"/3 (date) (Applicant's signature if site visit is not required) Addition/Replacement Approved Enviro ental Health Specialist �-��-� Date Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 Phone: 336-597-1790/ Fax: 336-597-7808 www.personcountv.net �' .��j /� � �a �.�� /r� ,/� ' V V r7� i V�y.li7.� . . �7m�Y'II]L•�aniexn�Hy�y'�,�.JL �rt�mLLlCJI�, . , SITE S�TC�-I Name Nd� " Taz Ma.p # 1 D� Parcel # 2� � Subdivision � Section/Lot# � q -�,-13 Authorized State Agent Date System compo�ents r�e, present a�b�i�,nximate�contours only: The contrac�tor must, flag the system1Drior to ; beginning the instalCation to insure that prolbergmde is maintairied r 73JL3d' �r�� :. � ^ .. 2r'172' r4` : �� , t�E�-. . .. . , : hC%� . . � � '3,2�4 � i'i � � � �� _ � < C rn 14'E4 I � � � 4 �.� . : � i S St�lYl ��C AV15(D /yi3R\ —( Zo ��d I B� ��aNs� �� iUfG I J ' � 50' A c�.��l � 5��,�I ��Sf�� a� �I�� 6 �� f a e n�l �F exi Sfi�� S� S�e� — I g'' -�enc� �� . �� 2 I, ^`� V J ��re.--i �t�f`al (4f��►� ,rn ee{�,�q Ma��a . �J � �1,:1UO Feet , � ��►?.�� ' �-�- C� � lL��'I� � I��n.�a��,.-„-„ ��n��.Il I��►.IL�I�n. Applicant: Location: System Type (From Table Va): Type V& VI Expiration Date: Operation Permit Tax Map � Parcel # � Subdivision Phase/Section/Lot # # of Bedrooms y Product (IIIg): �Z Type V& VI Renewal Date: N�H T 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. uthorized Agent) . - (Licens Co�Stractor) Scale e� -ia PCHD, rev. 12/14/12 9-ll-�y (Date) � �`�u-��- (Date) l =�� ,�" � J�. � %"� ,t�'',h Line Length (a0 70 ZQ Total 50' Tax Map: � Parcel #: %(n� Septic Tank System Checklist (Type II-I� Notes: System Type: � Pump System Checklist Pum Tank InitiaUDate State ID & Date: Ca acity: Riser (6" min.) NEMA 4X Box Model: j Piggy back plug ;i Hard wired ,' Alarm functioning Mounted on post ' Above grade (12") ,' Conduit sealed ' P Pressure Manifold Number of ta s: Size and sch: Contracted Certified Operator (Type IV Systems): Notes: Tank Com onents InitiaVDate Pum model: Block (4") Nylon retrieval ro e Float tree and attachments On/Off float swing: in. Alarm float (6" separation) Anti-si hon hole Check valve Threaded union Gate valve Conduit sealed Outlet sealed A proved and secured riser Su I Line Size and material: in. sch. � Length: ft. �� ..� y . , � `�'`^� �� .��" 3�/ Zi t1 �� 11 �~'�s) �i. ii.:i li�� ii�. 5•i..ii'.1. � �L 1� 4i:. �:i. il. °d.:L s1 Date: 3 / 2�_/�_ Name: Tax Map:�O Parcel: Z(o7 Address: � '' R,�6�re�n1s�57Y Re: Bacteriological Test Results Dear Well Owner: Your well water was sampled on 2/ 21 /(�, 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 bacteriologica[ resu[ts only. 1� Total coliform bacteria were detected in the sample. Fecal coliform 6acteria were detected in the sample. Total coliform bacteria are naturally found in the soil. 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. If coliform bacteria are present in your water sample, t/:e water may not be safe jor 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 resumi� 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, � � En ironmental Health Specialist Person County Health Department (rev. 4/20/16) Person County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573, Phone: 336-579-1790, Fax 336-597-7808 North Carolina State Laboratory Public Health Environmental Sciences Microbiology 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: ES022817-0073001 � �� (�� ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: KAY RUDD P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htta://sl�h.ncpublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 1056 PAYNES TAVERN RD ROXBORO, NC 27574 Col lected: 02/27/2017 12:45 Received: 02/28/2017 08:18 Sample Source: Well Sampling Point: Outside spigot J Smith Angela Heybroek Well Permit Number: A40-267 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Date Total Coliform, Colilert Present 03/01/2017 E. coli, Colilert Absent 03/01/2017 Report Date: 03/02/2017 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. �� ne deparfment af health and human services ��ry, k ° k � '., f , �� : �� ':� � �� ;�` t �--� � � � �i i ��° � � r � ' ; � �� _,� �...� �� p � � � �i� � . , �� ;,._ti„ r � ¢ � � 4 � iqy €_, 5 �� `c �,.�� ¢ �� .p•.�t �.s E (� 4 � �t.. � {:� i'� L.. C�� _ � �� ....i �.-%' �__r � `�`>_ 'v1 l� '�. } ^F i { F F `.1 � � ',� �i; l.. F �% t � 4.i For lnorganic Chemical Contaminants County: Name: Sample ID #: �--� Reviewer: —' � � TEST RESULTS AND USE RECOMMENDATIONS 1. ❑ Your well water meets federal drinking water standards for inorganic chemicals. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inor�anic chemical results onlv. You may have other water sampling results that are not taken into account in this report. 2. ❑ The 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 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 based on the inorganic chemical results onlv. Arsenic Bazium Cadmium Chromium � Copper � Fluoride � Lead � Iron Man�anese Mercurv Nitrate/Nitrite Selenium Silver Magnesium � Zmc � pH 3. ❑ a. Sodium levels exceed the U.S. Environmental Protection Agency's (USEPA) Health Advisory level for sodium of 20 mg/1. The North Carolina Division of Public Health recommends that only individuals on no or low sodium restricted diets not use this water for drinking or cooking. It may be used for washing, cleaning, bathing, and showering based on the inorQanic chemical results onlv. ❑ b. Levels over 30 mg/1 may pose aesthetic problems such as bad taste, odor, staining of porcelain, etc. 4. ❑ Re-sampling is recommended in months. 5. ❑ 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. �e following substance(s) exceeded federal drinking water standards. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inor�anic chemical results on[v, but aesthetic problems such as bad taste, odor, staining of porcelain, etc. may occur. You may want to install a household water treatment system to address aesthetic problems. For more information regarding your we!! water results, please cal! the North Carolina Division of Public Health at 919-707-5900. 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: KAY RUDD P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 httq://siph.ncpublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 1056 PAYNES TAVERN RD ROXBORO, NC 27573 Courier # 02-33-15 ROXBORO, NC 27574 EIN: 566000331 EH StarLiMS ID: ES022817-0030001 Date Collected: 02/27/17 Date Received: 02/28/17 Sample Type: Raw Sampling Point: Outside spigot Sample Source: Well Temp. at Receipt: 1.0 Sample Description: Comment: Time Collected: 12:45 PM Collected By: J Smith Well Permit #: A40-267 GPS #: New Well I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mglL Barium < 0.1 2.00 mg/L Cadmium < 0 001 0.005 mg/L Calcium 23 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 63 0.30 mg/L < 0.005 4 0.015 Manganese < 0 03 0.05 mg/L Mercurv < 0.0005 0.002 mg/L pH Selenium Silver Sodium Sulfate Total Alkalinity Total Hardness Zinc Report Date:03/08/2017 < 1.00 < 0.1 7.5 < O.00f < 0.05 9.60 8.90 80 73 < 0.50 Page 1 of 1 N/A Reported By: .xennetFi y'reene , , --,.. �. ._ ,:. .. - - - - - : _..,. . • � , , .. _.. : : _ . .� ., .�. �� _ ,�. ;�� . . �_ ,_: � � , � � � t _ - �,. , - ? ��C'�-- � � � �� . . - ,�� .r.�,ss : � �� . 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