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A23 106"b Oy °:�,t� � y y ., i w r? �'I � � �c' • z ro o ° � � � � b x � w' .�w i o i �� I' N � °�, ' �E�� i w I � � ~ A � N �, tA b ~ 0 I � � �• � H � � y r7 I � o � � � � N w A. � �. � �D � �• a � .7 N w °' c � �s � � � w � � . �• � o °. ! � � �I ~ � I �� w � y I � � � � w. � m �o x � y w b � C A � w w r. ,. � � Persora County Heaith Departrnent Sewage Syster�n irnprovements Permit Date: � ' � This Owner. � Location/Directions: � Void After �$ Years � ; � �fr �. , ° SR# � -�� "''� Subdivision Name: � t4�`r� �''� �y(' � Lot # Lot Siae: ��- Type of Dwelling: `�-� Water Supply: Private: �� Public: Community: Bedrooms: � 7-��1�I+� Garbage Disposal �' B�sement r'� Basement F'ixtures � owner or REPAIR: V� REEVALUATION: Size of Septic Tank: ) �� gallons Size of Pump Tankr Nitrificauon Line: � � � ; � Depth of Stone: 12 inches ^ � Max Depth of Trenches: Alcemative System: Conv. Pump �i LPP Pump � Remarks: ------------------------- Date Well Approved: BY Date S e ys Well should be 100 ft. from any sewer system Sanitarian BY Sanitarian � TIFTCATE OF COMPLETION Contractor. _ � Sewage System location, installation, and protection must meet state and local � regulations. Septic tanlc should be pumped out every 3 to 5 yeazs and shalCbe maintained_ � by owner in such manner as not to create a public health hazard. Septic tank and'd nitrification line must be inspected and approved by a member oE the Person Counry � Health Department before any portion of the installation is covered and put into use. If the site plans or intended use change this pc�mit is subject w revocation. (G.S. 130 A-335F) L.ocation of sewage disposal sewage system sketched on back. , (OVER) � Application Date: —�(�� i .�PQ _�vu,� �� S (' �� Tax Map: !� AmountPaid: D,00 _<�!��. ._..,,'•��- Parcel#: 6 Receipt #: 7 � E_ � � �� ..".�rnwnn-�w�uzcaa�znd,a..� 1��,.a�.�d�in Auplication for Services Services ❑ Improvement Permit (Site Evaluation) $200.00/$300.00 if> 600 [� 1Vlobi ReQlacement or uilding . �� 50.0 if site visit required) VVell P�xr.it (1`'ew/Replacement/Repair) ❑ Construction Authorization (Fee is dependent on the type of system permitted) ❑ Permit Revision $�s.ou ❑ Repair of Existing Septic System Application: No Charge/ CA $150.00 or $300.00 1) Applicant Information: '" � � �.i,,,,,�.F Name: � Er�rxors, 1�1� ►.4 �� `'�S Phone (home): 33 � -SS9 -19 30 0 �'� � Address: PO 3 30 (work/cell): �j 7-1 S � 2. � bc�o I�L C Z.� �3 L�I l 2) Name and address of current o�Y ner (if different than applicant): Name: L.(2�W. S s Phone: 33to 59^Z � 3 4Z � Address: Z �� A c 2W A - '�Z S`� �_� S� 2 L��\ ox boro t�t. C -� 5��. � 3) Property Description: Lot Size: e9y� Subdivision: (��G �o►oa.�E Lot #: Z.� Add�� d/or directions to Property: E.,.o-�- i S .A-r__ E�►� o�__�� I o� S tae a na Gr�ic. 12. D . C:. ❑ yes LQ no 61 yes � no O yes b7 no ❑ yes 9 no ❑ yes 6 no 6 A�. po �►.�-�� ., �., �. � o Does the site contain any jurisdictional wetlands? Q(,�,,�-r�—Z-� n,J ��t 5.�., o,, Does the site contain any existing wastewater systems? �� Is any wastewater going to be generated on the site other thar, 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 T3�pe of Structure: , '�tesidential . � �New Single Family Kesidence Maximum number of bedrooms: ❑ Expansion of Existing System If expansion: Current number of bedrooms: ❑ Repau• to Malfunctioning System Will there be a basement? � yes ❑ no V4'ith plumbing fixtures? � yes � no ❑Nan-Residential Type of business: Maximum number of employees: Total Square foctage of Building: Maximum numUer of seats: 5) Water Supply: � New well ❑ Existing 1�Ve11 ❑ Community Well ❑ Public Water ❑ Spring Are there any existing wells, springs, or existing waterlines on this properly? ❑ yes ❑ no 6) If applying for `Authorization to Construct', please indicate preferred system type(s): L7 Conventional ❑ Accepted � Innovative ❑ Alternative ❑ Other ❑ Any I cert�� that the in,formation provided above is complete and correct. l ulso understand that if the information provided is inaccurate, �r jt�Ze. site j�3'�bsequently altered, or the intended use chcrnges, all permits and approvals sha11 be im�alid. Signature (Owner/ Legal Representative*) � Supporting documentation required. O�t �� Ib Date • Permits are valid for either 60 months or are non-expiring when accompanied by an approved glat. • 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) � � � � � � �d r � � � a N �x � � � J ,t� � � ;,, , ,�� , r' , , �� . � t' � ,'� .;� � {� �.Y��. � � '1• - . �� ! �� -�, t� �4 '�• _ �'� ` � a � ,� � , .. - ,, � �kts 1 ■ '�r- _ t ':/ � rt �` \v � O { � �. . ' . i . , ! A � ` � ~ . �:.�-I �t �' � f c � � • � . , . �s� a .f` , � �� ' � �� ,%' �,L r. ' ; � . ��r � .- ,. . i� ' � _� , y..,.. � y �— � � � C � � r ��S � � (� `r0 � � � �� - � � Y �T . �� t `. ► � �l � � / � � , , `. . t � �'�s , �� .. �,� /k �, �,' �C►'� . ,�� c ` � --��`� �� ` , �, �' � . f ''f. -;''" c� -r ' `. ,y _ ;�:�;, . : _ �j _ � . - - ---- 'I � r' �J , ` t �' , . - . --- . IA f � w�� , ' / _ . � � � n� ` �« � , ,, . �' � �� , ��. L i �1� � � � '� � 1 '� " % ' . � ; , . _ � , „� • - , . - , :',w � ,� .3 � � �' �. 1� A � _ �i"' " "' �y - �s � �{. ,r .�� ;I . , � _ : � . �. �.. ; '� . - ,y � � �' rt ' I � �'� • c� � * � � � � �•� `` . . � � . � .i.; j ` -----'l'��J r •,' '� a»�-'ai� 'r .'�� ,_.� `�1 x k��! C• � a� T ��.��y � � 'F � �t _ 1 ► ,��, �; :�, ` .� �r�E j _r�� '� � , � ��`� , � _. ltd. • _.. ;�; '�,:5 _�d . � . 's�'�r, «1 r *'�'�� `� � '�,,� . . ',., . ' � t�� ' ..._ . .. ._ ___.,_ . �' I l � �.l f �:.�+,.r 4 .. �. :; � � Building Additions/ Mobile Home Replacements Tax Map #: /� 2� Parcel#: �� Address: � �r- ��, �A,� � , _�-�,s_ Approval Requested for: Mobile Home Replacement X Building Addition Applicant Name: _ 5-r-nr,� � p_h-�,��, Address: Z�l .�-,o,, ,� �nPA�Tzo_ . ��. ►.c�, z�� Phane #'�: 3,��q��8 sq7 - �S� Z ,^ Permit Located: ✓ Yes No Installation Date: a Design flow: �(gpd) Current Contract with Certified Operator on file (if required): N-� Water Supply: � Well Public or Community Wastewater system shows no visual evidence of failure on: (Applicant's signature if site visit is not required) (date) • - i� _ . r . s�.:a ... � 1 �:�++^y�.'sa�i��r � �,/�s�' 1 � � l � �L �1�j l Cr { i�iT�'t O,Z vf l L.ir ��f� JA�JLt�( � c11.1 rE Addition/Replac�ment Approved Environme tal ea Specialist � �� EM41 c�i �'D �-� �.?�os�� :�IE ��lG� Date Persan County Environmental Health, 325 S. Morgan St., Suite C, Roxboro, NC 27573 Phone: 336-597-1790/ Fax: 336-597-7808 www.personcounty.net CannectGIS Feature Report Person County Environme�al Health 325 S. Morgan Strseet S�te C Page 1 of 1 '�j , �� Roxboro, NC 27573 Person Printed April 28, 2016 �� '.�:'EP. N�:�n•1��. �. ' See Below for Disdaimer �-�e� �,r.�� q�� o� � -�- �� s�8s � r�-G� / Cae.� r�" � a�-� � �jc� �r� ►� t'---:. _ � �� -�..� , `�,.� . � ; `�' I s,'8? /. S L-1�~r �G t�c�o��_7� W El.� �� `�t sr�M �� I �_ _ : :1 . _- . , ;. _ �- i. i � _��_�_�-- �o, � _ �_ - �, // � - . �_ -- �, .. � �s�� , � -��►�q \ -- ---__ �,��.L.�� ' . _.. _� / � (` � �g� 1 � 1 ` � \ \ \ � '� �S�'T�'�-.t � _ \ ` � � � �� \ ` � ' � \ \ / 'I �� '� `�y � � 4 � \ � \ i.:;5 � � `'., \ \ � \ �o - �t� � � '� '`\� � f �� '' � i 8?9'1 _ � � ' � - 5`�, +{o,?� c � -��-- �� F�M ' ��-�-�.� _ io � -- �.� �-, �� til. - _ �,,v`�� id � — z� +� y�� . ��' `� �~`� � _ _ j,vAiGC. � �; ��s, /�>T� � ,T�I L''. �-i1�'� j��.'d�1o,1!� � � �f/f� . �ni ' �'t I�T� v1�� 1/�-� �i� ' /Z7/i!� . 5j/ i�� ,�' � �� `- � y''� �fv�%�YI��'� O�✓ v�l�i/�fQ - I `5" I ':5C1Feet OTICE: Retently, we have had several users report browser compatibility issues when trying to access our GIS website. Typically, the probiem stems from users who have centiy upgraded to the Windows 8 operaiing system or a new version ot Internei Explorer. We were able to resoive tnis issue by direding users to the Intemet Explore �mpatibility View tool. This link is to Microsoft's "How To" for the tool: http://windows.microsoft.com/en-US/internet explorer/products/ie-9/features/compatibility view this does not solve the problem feel free to contact us at the number listed on our main page. Welcome to the Person County GIS Website. ConnectGlS has been �epared for the inventory of real property found within Person County, and is compiled from recorded deeds, plats, and other publk records. Users of GIS rystem are �tified that the aforementioned public information sources should be consulted for verification of the information in this system. Person County, Mobile 311, ConnectGIS �sume no teqal responsibilitv for the information in this svstem. Grid is based on the NC state plane coordinate system, 1983 NAD. h�tp://gi�.pe:soncoLinty.net/ConnectGIS_v6/Do�,�nloa�'File.ashx?i–_ags_�napc92�ffa4335? ... 4/28/2016 �� "l�f �11lJ�� cn.wn�roaa�raam�ca��.Il ��a�a.�'��:a WELL PERMIT (New� Repair_) Tax Map: � Parcel: fa(o Subdivision: ��ff� Lot: � Applicant's Name: �/yr� ��,� y Mailing Address: � . � Phone Numbers: �q 7 /S/Z Location of Property: ��,� �� b � �y� �„v,l� �4�� LoD� - Permit Conditions: ��5�� 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: �1 Certificate of Completion �Vew Well: } �'� E ' S/Date Location: � ��j �i Grouting: S�t Well Log: �_ Well Tag: Pump Tag: ✓ Air Vent: � Hose Bib: � Casing Height: ,r Concrete Slab: � Well Driller: fti.P, Pump Installer: �� Approved by: �'✓`� Additional Comments: Date: _ Ol,iner: EHS/Date Depth: Grout: DAbaudonment: Date: Method/Materials: License #: License #: Date: — L � � Date Sample Collected: S'�—� Date Results Mailed: EHS: Person County Environmental Heaith 325 S. Morgan 5t.,5uite C Phone: 336-597-1790 Fax: 336-597-7808 Roxboro, NC 27573 11/26/13 � WELL CONSTRIICTION RECORD Thisforsncanbc� ForsmglcormminPl�� . wa� capt,-a ��o�j.� � c � W �K u c2� w�u con�r+� Zy��.— xc w�u ca�c�e�� N� garnette Welt Dritling, Inc, �°�`''N� 10r 2. Wdl Constructioa Primittl_ Z' �� 1� rm Lrsi af! applicoble �re[t coruuuaion permta (t-e Cmm+y. S� Yartanca. erc� 3. Ndi Use (c6eck wep ase): ��[IGG11�Cd� �IYStU11Cip1�llb�IC- oGeothamal Qicacingl�� SnPP�Y) �tcsdaitial Water SupPiY (sn81e) QIndusviaUCommer�ial QFi6idrn6al WataSuPPIY �� oc��xo��n«� 2fC flRd ROCOVC(l� �S2111I111V $3:[lG �$[OIlRFV�dLtX•� ' JTedmol�r ��CQ"� (Ct°sed Im�') oTrrca - - - . _. .. 4. Date�l�tll(s) Comple� s1rl!/�Wdi'ID# —IV saw�n �.o�►a��: r� �= - r�,m$c�� .�a� C.wnq� Sb. L9tit (�Ewel! 5e � 6�Ts (are 7_ Is i6is .�'r� cce ,�,',ox Fvr� sv3a+traa \ 9_ Yotai I�brrm[y 1Q Staf �x+c�� 1L Bor u.wa t� � FOR�i I3a.Yi 13� D. For iotamlUse ONLY: 14:�1(AiBR7�ONES-- . D�o� - - r-x,on '�'Q 1fl a � � � Q '� ZZ �' ��a�� ;�.�... �� - �,,, . fltOM '!'O DL�iUtE[F8 � '� �' � R 2 � � iu.-n�xExci►sn�co�roan�G � �a� _ fRO:H 'ro DL�ME[ER '�� L . tc R m' . � � i°' " : 1?:SCRSHr1' • � DNhtETER SIATSlZ6 THIQ�lESs ..11ATER7AL FROM '�'O � R � � --- �' �-- ' -.""'- .' -- ��-� �:� � ��-� IIl �5�� J ' ' _��=' ��— A � � � � � �t. R R a � � rr 5u�, _� Pa�alidwn6�Na(P!M de and Lo�ae in degre�/m�nt�seooadcar dedm�l deg}ee� 2Z ' �amladlmgamffroao� �a � J I ! � f W � � ��k H f , $ig�aeoFCaufrad Wdl'CsdO[ador thc�(sx OPertmtamt or �'I'emPorn�i By��tsl�lt■+�'O�'�tLc+�(.*i+�f�l�taaamdoAoe. irUlr1S�11�1G(CODCAlOO orlSA NG[CRaC.GZOP �iACo��mdt6ara �repairtoanemstingwelk QYa ar QNo o�J'4f�ramrdLas6ewRrorldadtodxxdlo�a. - qb1r1U/outievs�rwd/oaaso+rd�7�a�►��°�"°�°2OJ�" x{,,�ted'iap,mmoradd'i�oaal�d[det9it� rElt r�misutaou oran dic8ack�ddslorta. Yon suaY rose die liadc af lhis pa�e � P;a°'de aBdEciaaat vrd► site dda�ls � wdi �an de�"Lx Yon�B}►aLtio �+additiooai Prg�ifne�ssary rof�a+dlsm�hnded. � � ,e'rhrbeammea�S�� e�oearm�oaer� SUB�MTITAI.�tUCnOTIs � �z �� Iaad wtfaac (it) �- For !1Q WdL� ��1us �a v� 30 days af omnP1� �ll�aRdq+daU�l�`��d2�100i ��b$tC � �b �� Dit�toa�Wi�ta'�.Worms�'C� b]'� :waterkvd bdow top of as+� 1617M� Sa�!ietCmber,Raid�L+ . tlSabaaeo� �e �+� t6e fiopn t+D dx 8ddt�ss utZAa �p �in.) ?�4b. For Iaiec� Wdt� Tn addd� to � � aoIe diam�tr_ � also � i�Pl/ af tLis fam �v�lim 30 days a� aamp� � � �Jl�h � co�actimmthe� constivdion metiiod: oa CmtroE P�'�rs�. . ��'. � ai�a pa�a �.) �� Sa'v�ce Ce�rII�,R�Ie�.� Z7699-1636 �TSRStJPPLY�YSLLS ONLY: . BIOWn20iAi11 24eFortYAierSrrvolv�iefaf�nNd1� TnadditiemtosrndinStlufam� �— the addce�( i alw m� �°�pY of this faam witbm 30 days of �� Method of tat ��1 �on to the caadY l�8' d�� tt�e eomaY HTH �� p ��. ;oc��_ t�taah CaoLm D� � ud Namaf Rcs��—� �w� Q�Y �_._-------- -. . . Re�ioeaLa.2�13 �� 1�'�'�� ne deparfinent of h¢alth and humen serviees S.e1 ' ` , )( j y � � /" 0 1' ^ i i` f F•_•,S �.. .-' J( E` %_\ � E [ rI j-��i. l.�^ ( n�3 � F �. i r-.! C � �t ` ! �._.� � f f, I� � �•{ � ( � f 7 � i�, I 4 � � i 1P `:I1 L L� `�` if S`J� l �{ � i�`i i � f��1 t,. �� I � `s � � r.. �,`"�� } C j ' '�`� � �j r�.� t ; Fe. (�� ..'i /�? � k ! r ; ^� ^� l� (I i � j �1 1 � +� i i �� t- ` {`I,+ g R ��a ,...,..:� ��% `L: � 't �.• 4.1' i� E i e ° � � � _i ! l ,� �/; .I.! �_ i `,� j i �� For Anorganic Chemical Confaminants County: r-So� Name: �,.e,.v Sample ID#: 3-- ( 6 Reviewer: � A�-•rer � � TEST RESULTS AND U5E RECOMMENDATIONS 1. [] Your wel! water meets feder�l dria4ing water star.dards for inargani� c�ert�ica�s. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inorFanic chemical resulls onlv. You may have other water sampling resuits that aze not taken into account in this report. 2. 0 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 ci�cled substance(s). However, it may be used for washing, cleaning, bathing and showering based on the inorFanic chemicat resul�s onlv. Arsenic � Barium � Cadmium � Chromium � Copper � Fluoride Lead Iron Manganese � Mercury Nitrate/Nitrite Selenium Silver Masnesium Zinc nH 3. a. Sodium lev�ls exceed tha U.S. Environmental Protection Agency's�(USEFA) Health Advisory level for sodium of 20 m 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 hased or. the inorganic 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. 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 dri�king, cooking, washing, cleaning, bathing, and showering based on the inor�anic chemical results onlv, hut aesthetic pr�blems such as bad taste, odor, staining of porcelain, etc. may occur. Yeu may want te instali a household water treatment system to address aesthetic problems. Barium Cadmium �hromium Fluoride Iron Man�anese Selenium Silver pH Zinc For more information regarding your we!! water results, ptease call the North Carolina Division of Public Heallh at 919-707-5900. North Carolina State Laboratory of Public Health 3012 D�st�ct D �e Environmental Sciences Raleigh, NC 27611-8047 httq://siph. ncaublichealth.com Inorganic Chemistry Phone: 919-733-7308 Fax: 919-715-8611 Certificate of Analysis Report To: ADAM C. SARVER PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET Name of System: STAN CREWS 171 CANE CREEK DR ROXBORO, NC 27573 Courier # 02-33-15 SEMORA, NC 27343 EIN: 566000331 EH StarLiMS ID: ES080317-0071001 Date Collected: 08/02/17 Time Collected: 1:55 PM Date Received: 08/03/17 Collected By: A Sarver Sample Type: Raw Sampling Point: Well head Well Permit #: A23-106 Sample Source: New Well Temp. at Receipt: 3.0 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 um <0. Chloride 17.00 Chromium - < 0.01 0.10 G 1.3 m e 0.24 4.00 m ron < 0.10 Lead < 0.005 0.015 Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L Nitrate < 1.00 10.00 mg/L Nitrite < 0.1 1.00 mg/L N/A Selenium < 0.005 0.05 SiNer < 0.05 � 0.10 m Sodium 22.00 ✓ mg/L Sulfate 24.00 250 mg/L Total Alkalinity Total Hardness 250 260 Zinc < 0.05 5.0o mgi� Report Date:08/15/2017 Page 1 of 1 Reported By: Deddie .�Kancol� '1 � � � �� .� . , ,,� �., �* . �'� `5�../ `�.Y � �� .��.oTn�4�cr�rh��::a�n3tf:,�...� 1�""��e.R�,��% Date: � / 2Z �� Name: S� �, �i�f� S Address: (7( H-e. v�-�K �r. s.�� ,vc a?3�� Re: Bacteriological Test Results Dear Well Owner: Tax Map:��3 Parcel: � � Your well water was sampled on �/ oZ /� and tested for both total and fecal coliform bacteria. Your water sample test results are noted beIow: � 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 ihe bacteriological results on[y. Total coliform bacteria were detected in the sample. Fecal coliform bacteria were detected in the sample. Total coliform bacteria are naturally found in the soi;. Fecal colif�rm bacteria are associated with animnal and/or human waste. ThE presence of either total or fecal co(iform bacteria in weli 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, the 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 or total or ecal coliform bacteria should be properly disinfected and retested prior to resumin� 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, • �w�e.% Environmental Health Specialist Person County Health Department (rev. 4/20/16) Person County Em�ironmerrtal 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 i�iicrobiology 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: ES080317-0104001 � �� ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: STAN CREWS 171 CANE CREEK DR. SEMORA, NC 27343 Col lected: 08/02/2017 13:55 Received: 08/03/2017 08:25 Sample Source: New Well Sampling Point: well head P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 htta://slph.ncpublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 A. Sarver Angela Heybroek Well Permit Number: A23-106 Environmental Microbiology - Colilert Profile Method: SM 92236 Test Name: Colilert Analyte Test Result Date Total Coliform, Colilert Absent O8/o4/2017 E. coli, Colilert Absent 08/oa/2017 Report Date: 08/07/2017 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.