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A23 206��' ; ,�f ���� �� � � ���� l.�e na-yn. �z- o �ra�raa� ���.Il IE-� � �.11 �Il-n Applicant: �k'� �"�`'�0"� A dress/Location: _ �,, c 1- �--�' —2Dtr'V✓Oc-' r --.yL(.z,y ��1� — � '� — ��_✓1_� ---.� � Improvement Permit Permit Valid for: Five Years i� Non-expiring Type of Facility: ►'�j'Z I� S. New � Addition _ Number of: Bedrooms �/ 0 upants / Em loy es / Seats: Proposed Wastewater System: Proposed Repair: ; � o � Permit Gonditions: �°2 Sl� � s�'� � l-. Taz Map: �3 Parcel: o� �P Subd:�•ision �wvq, � Phase/Section/Lot # VVater Supply: � � � Projected Daily Flow: � C� o gaIlons/day Type: � Type: �4 Autherized State Agent: �+�+ �"re✓ _ Date: .� -'j—1 (X) Owncr or Legal Representative: Date: 3-� i The issuan�e of this permit by the Health Department does not guarantee the issuance of other required permits. It is the responsibility of the applica�nbpr�perty 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 Improvemeni is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Luws and Rules for Sewag� Treatment and Disnnsal Svstems'(15A NCAC 18A .Y9U(i). N�ither Person County nor the Environmental Health Sp�cialist warrants that �he septic system will c�ntinue to f�nciion satisfactorily in the future, or ihat t�e water supply wiil remair pota5le. Authorization to Construct Wastc;�vater System See site plan and additional attachments (" ✓. n Proposed Wastewater System: �� �g�j�� `��(f �(*)Type �� Design Flow �(o O_ gal./day New � Repair _ Expansion _ � Soil L"Cf1R: � S— gal./day/ft2 Type of Facifir,�: �,2%(,�s- Bssement: � Yes _1`To ('�) System Types Illb, Illbg, IY, and V, require perio�lic sysrem inspections by the Ferson County Health Department. _�� ��.,... Wastewater System Requirements Tank 5ize: Szptic Tank �� � gal. Pump Tank ��� � gal. Grease Trap ^ gal. Urainfield: Total Area ��a sq. ft. 'fotal Length 3��_ ft. Ma�c. Trench Depth �� in. Trench Width _� ft. Mici.Soil Cover � in. Min:Trench Separation ( ft. Distribution: Distribution Box / Serial Distribution__ / Pressure Manifold � Specifications: ��P �C ��_'ff'���< <ul' �5�� �+-���s�' 6 �� ���io�,� �o�� � �q� � Authoriz.,d State Agent: `��M l� �f-ev�� Issue Date: 01�'1�('7 Permit Expiration Date: �--?�ZZ 7'he system permitted is: Conventional /Acczpted �_/ Alternative / Innovative . I accept the coitditions and specifications of this permit. (X) Owner or Legal Representative: ` Date: �- �f-1 7 Person Counry Environmental Health, 32S S. Morgan St, Suite C, Roxboro, NC27573/ph: 336-597-1790 (rev 5/12) � . , ♦ • _ . . . ���i� � �.a ���/ ``.i'� .. .. ' � � � ���� � . . I��.��-.mw,.,-.,...���.Il g—���.Il�]!a STTE PLAN P1ame J v �1 ✓� 4 `Q ►r^�OVI • 'r� �P # �23 r cel # � 'f' . Sub ' ' 'on $ection/Lot# ° �,� z-�,�,� Anthorized Staxe Ageut �a� S,ysrem compoaeats tepieveas appro�mate rnamurs only. 23e roaCactormrucr ilag the system pavr ro beo nni tq rhe iasrallation m iasurr t6stpmpergn�de is n�tataed �%rt u"�� - `"a 1 . �� . _ �.� ��y�� . . . 9 � . ' ;,.... � ,�� �;.�� ;� ; � . � �`' .�:,,, .. : L �! -�i'Ls'a ��' +.�_,_y� �e�� < ' i ', ' ��' ����� �, " «,�� �-' �' j , , �, Sc�l� i ' � � y�y.�, � � � ', � � � ��� �,;= ,� I � � � � � � . >�, �, � z `� r; .,.' '� � }.�� �`� � � � , {y ,;� , � . ;a. , , � � � ,,.�'" � �.' . . • . '; , . �. , .� , . ` ��• • �r, > . ; �,�. . ' � � � r..' ,9 l, i • I �{� .5�. , .. :,: , 1 1 i�', •'` ... � � 'yp . � , 4 ' • t , J' � f. ,i �;�� V 6? . • t � : • � ! w A/i�! ,:;i • i �,` : ' . 1 l �Y {rs ..� � . ' s . � � r ���'� i1�' . . r� � � �f' .� . p'� � / r'' . ..�. '�r� :�1� � � � � : i � ��t � �� ;. f : �A l�i � . �� � � �: � � � �J �'� Y � . ,tr �t _:! 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S" 0 0 6 5 5 � '1 Z ✓�P+a'�'" Llo. irZ .� 9 . 10 . . 3�� ft of line x 65 gal. per 100 ft =2�t7�"'� ; 100 =�� gal 75% x� ga1= ? S g� per d�� �_ gal per minute (gpm) = Flow Iiate �a�icicon �ea€1 I.oss: ��ft per 100 ft o supply line x~ 3S'a ft of supply.line =100 =�•'� ft ft x.1.2 = ft of frictian head 1Via�ai� ��e: �_„ �orrx IViai� �iae: '� " PVC '�o�l Dytt�eic �ead =�ft of Eleva.tion hea.d + ft of Pressure head +�ft of Friction Fiead = ��TDH �ffip flZeaea$a�naent: �� GPM C�_ ft of Head Drawdo�n: � ger dose � 21 gal per inch =_� inch drawdown per dose � ,,:a �� n: �,��.�, : �� �, ,��: : ,�� ��; -� - � _ .. �y _ � `��������t0 , � � 1 1 I � � ,. i _- �� � � � , . �[c�»�o�on - h 1�� 1�� N��**��N�N�►,'Y���!`,ff:�:��������!`�Y ..... :.. ' . 1 1� 1 I ,. . �iM�Nfl�:�' :N°N��!!!i:!l��1N�N , , , , .�. �........ � � :l . � : : : � Y: ��e� I '�"'� -�! ��id 5i�! � Taps P�x iVa. Taps �ff oue side Zn 4 i 3» 9 ��� . . . . . _ , _ �lew ps; T3P �i,e �Ylraeriai Flm.v GtYl' ,.,. Sclieci80 �.� �. �- � SC}!2d -`o : J � �ci:ed 80 l C. ! I .... � <.-•--;� � ,.. ���y �';�.� ���� �� �-_.1 "``� � � ���i� I��w-��-� �,.,-� m��.�.1L 7H]L" � �,.Il�71a 1JEMA 4X Simplex Contml Panel . � �1 , 4" }a 4" Pre.mre Treated Post � Sloped To Shed Watez 12" Separation . � Electxical Con�it — . , <. G Covex •. -• Access Cover• ,':�'Y 1 f �� , � .. � ' M � -. ♦ I �, O � l _ ' • - ,. • •y • ! , ; , Opening Filled With r �nti Siplwn Ho1e' Ixilet Fmm Septie Tank portland Cement Gxvut �� H�� � 4" SCH 40 PVC Pipe '�' ' . . Check .�.N,ylon . Valve Rope . High Watex Alaxrn Level (6" Sepuatiox� , ::., .. High Lev�el - Pum� 4n • �� '�VapoxLock ' , � � Drawdrnvn Hole e � • % � (Up Hill) � � . Low Level -Pump Ofi � . • �nP ::.� _ . ' Pxecast Coxicx�te Tank 4° Conczete - � � Iv4aterial Strex�yth }3500 PSI) Block ' `, �'�. • • � • . • � ' - � ' . . ,r' • � : , , �ti ' , . ' JJ • � 1 � � GAI,L�N FILiVII.' T,Al`� I T�x M�: �� i F�rcel # � � ' � uh ,iivision �� � ' . I'h;��e:"� ction'Lot # Duct SealBoth Exuls Of'The Conduit -� ?4" Mininwxn +"•i•-,•••. � Tluea�ed Gate Valve • :: • ' 'Lip Cosd Ties 1 Concrete Riser 6" Separation _ . ' '• ' . :r..r�'Cf' - � ��„�.aPOYtldfldCO2iCZEtO CrZOtlf . . 25'�aSrf1C - • - . . � Opez�ing Filled With Supply ' portlandCementCsmut Line •• 4utlet To Distnbution 2" SCH40PVC Pipe Float Wues ' . :� i Floats .: r�..Rexnovable '.•' F1oat Tree r ,� \ •� • ,. , 1_ . . � . ��'�_ . ! � ' • ��, , " �.,���J " . . _ �� . • � � "�.,`'�`. � ys � -. �'��.s""��� . . ' ' ,;,� � ��,. . �OW.��� , — r _ ". . .. ( � • ` ' � . . a 4 � � � _ � . . ��' 9 .� l ,�' p't ` � - ^ �^y�' :� � = _ - �: � ���- . � � � � �t. .. � . %�y�, p % �� a� 2� • � � � R � � 7 ` Zit _ ����p� � � ei �' '� �',�* � � � . . _. . � i � . . . � � I �S `� `� •— . _ —'- — � � � ) �� . ' -. _ .:_ �., _ . � , f ., �� �°� ;.� � � �4� '�- � --si � : �. ..� � � /1 ��d, d `'� ' _ � � '.� �, -.,�-rt'�� �f .: - � � ' !y Q _ �, � � �,� � �. � � �O� t�� . �� � -----� � b6 - :. _ . .. � � � � ��oj � p i'� � � � `t . � ^ r. !' 1 r . � �4,� � app ♦}p�''� , F 1 ~ ~`\ ' �� �� 9 � f. � , . .. '� " r 0 � �i � % '" f ,;,` . a � ^ y �� � � �n � �— � : • � ��. - ° �� � � C0: � , a�'�' � y�- �,�� �. �, � �.� a �' ���-� �,,, 3 � � '�9°:'`� ° _�. � �3� � �p .� '�L� �� � � N �`�� n ( �' z � � - � � . � � . „� j�l���n � � " 4 :�,� � �. � w • # �„ �.,, � � `� �F•�, ��� M�S� � r � - � � '� � � 40 �r � �� \ � ` �, �_ � ��Cl` I I-s � �� , ���� . _� = - " � � 3� �/� 4- � � a, p � .. - . �' V � n. � � �� ���f71 � - a ti' - -1� � - . • � . _ : - - ". o � - � . � I . � ~ ' � � 1 . � . � .�. �T . _ , � . .. � � ._-• ' � .. „ � " j ¢��, / , � �� � . . < � � . . � . �, � � , - ���� �� � JI ��� �� �.�•• • -� � � ���� I�.�� a- � �.-� �.� �.�►.Il .IL-3L � .�.Il �I� W���, P�+ 1�[I7C (New�Repair� �'az i�Tap: ��3 ar el• Z� o Subd;visi�n• � �� �QO/ I,ct: Applicant's l`Tame: � ��, V (Oa-�-o.-� 1dlailing Addr�ss: Phone Nuanbers: Locaiion of Permit ConditiQn�: ' � 1) ilee uttached site plan for prolvosed well location. • 2) All applicable State and Coun� regulations gaverning constructivn and�s�tbacks ap�ly. � 3) Permits expire S years from the date of issue. � c�ther C'onditiorrs/Comments: Permit issued b�: Ne�v Well Inspect�on: Locaiion: Grouting: Well Log: Well Tag: Pump Tag: A�r V�nt: Hose Bib: Casing Height: Concrete Slab: IDate: � / ��+ i��`�+'��CA��'�+ ��' CdI' .V��,E'T��I�I -�7 WeIl I)riller: � � ,�_�� •t-f �'_ P-�:mp Install�r: c � Wel! A.ppro�ed by; '"'� � C�''"'� Date Sample Collected: �� �-� �� � Person County Fnvironmenial Health 325 S. Morgan St., Suite C Roxboro, NC 2757� Liner Inspection: EHS/Date Installer: Depth: Grout: Weli �ilbandonment: EH�/Date Completed: Method/Material(s): Lficense #: __`� �' License#: � Da#e: �—Zz�� Date Resul±s M�il�d: Phone: 336-597-1790 Fax: 336-597-7808 8I1/08 WELL CONSTRIIGTFON RECORD n,�r�►�u��a ����+�.� , L Wdpl Coauador Informa6ou: �J I �' T ,Q c.¢._j� � /!1 o N /tJl� . � wai c�N� 3 3.�� � � xc w� co�c���+N�� j Barnette Well DriDing, tnc. ; ��N� �L3- ZO� I 2. Wdt Conshvebon Pcrmitl�: �N � Ym�m+cR uy I l;ttt oll appUmblc uell consuuaton 1�a (►� 3. Ndl Uu (check weA osej: Water Snpplg R'e1L ' pAgricultival OMtmicipaUPublic- � ❑Geothemml (Iia►tiagl�°� SnPP�Y) �i cndsl Water SnpPIY {smglo) aTrtdusuiaVCancna�a! QRcsid�maiwaterSu�ppltY(st�d) u olmeation � Non-WaterSnpply�i%dL• � . no.�..�wrcr i ���Q�ereterRanediati� e QAqui{etScptageandRocove� �Q�3'��. �Aquifcsicst ����� ; pFspr�nien�ITeciuwtogy ��CO°�0� ' aGeothainal (Ciosed LooP) �T� i - - -• ._a..,, Fortatamll�eOi�A.Y ! �. " zOe�- 3 23�''� 2 D �` �s� A :�s.ot�reRcasnv� ���tn.��-•• FROM TO DLAI�lE'[ES O � � � i� t5:7NNER GAbIIiG ORTDBiN� FROM '� . �. �. R � ------� - Z3 ; �.n��du���w�3�zz� �� � Sa.W�tfLom�toA: /� � Z� �o �wl A�n �r ��� � � FmTitYlOw --L-�- � Phyciat A� �PE Cmma � st,.�a r��+ � 6.Ts (are 7_ 7s tLls gt�s rs a �� 8..NumB Formalr4 su5adt on 9 Totsl Ibraedd, 10. Stzt Jfiiva.r! 1LBor u.w� t��s FORF 13aY ]3ic D aa•�w � ''_'�'ui Ll� �ok �O�s � IV C i �as.Cns..naTp ,; I � ' /Z S DsJ Z' O ra�a T�a6ot�rtivo. teA� � 2 r ��sfo� �o r��! � ���� - �� �txraavess � �- s t�2 z, �vG /�� �' �i�G�lJ�/!' S � � tfp 2 N `���N 7� � s,�,o�� /; �e � A �. � �esad L�d�ia ����� dedmal � ZZ Ca�tifinh'o'� ,a,,,��� � ' � C ¢ � , �✓��.� 3 --Z z -- % 3 yl3 2 H 7! • � ��c,�aw�-c� - ,�t ty�lm�b���r�sl�f�+5��'e�""a°dd,aeoondwreoe_ the�f�sx @P� or QrmpoYarY �j's�n� I°rar' ; � xltblStIh�tCOZCAlDOorISAHGtCO2C.QI00�eACoustrrcam�mdtdnta i �y�iG7sieeer�dlntbemA�rotGexepo�wtts irepn�toane�Lng�ceiC OYes � ��emtmenJfke qwtr.I�loQtk�+�elJeorua�ae� � 23.5'itt��'addiiwa+tadldemit� r�2t �js� wm r6cbactei�*� ! You maY vu d�e bsdc of4u`s �� P�^de a�6onat vxU sibe dda�ls or vadt � i �� YonaiaYalmaltaci►addarmat�ifa�Y- - � �� ���SrpNLT�drtbesmmeo�s+��' ����,�j'p(:1iONS � . I (R� Z4a, For Afl Wdls � dvs f�m w�a► 30 da�ts of °°�°Pl� of v�ll � �� � I Ye11dlQ1�bdOir�lIIdfIItf9tC � �CRTb�IC�i4W=� fe�aeAs/tira¢�►l�l��'-��'�?�� i � o[WaLcrQaaGt�,iu[orma8on PruusdnEII� �wata'Ievd6elowiapofasi�,.._ Z � -��) 1&171►�15av�aCeaber,Rstdgb.l�CZ7�99-1617 asr +' the fmm to the addtess � xlBa6oreoc� ; ; ��, Fer Iaiec�am Wdi� � ���in 3U days a� �� holediameta: � �°'� i abpee, aL�o 3�mT a a�Y P � ,� �QQ �p �antotbefoIlai�in� ��on�� % r�tL1�u�_ — Q �aaaCeatrdPro�. ; �r, � �� �1 � i Diyis{oa �Wstsc �l+ �1HC 278991636 2636Ma1Sa4iaeC��-� 36 ATSttSUPPLY�1'St.ISOTII,Y � i � .....rc�..�rtadctntee6on�Vdls Taadditiamtos�nS��tO - i�ownZ� mi �' also ail�sc a�e o�Y ��s fain vritbm 30 days of �d 2 C� Methodoioest'_ the a8dt�(�s) �� m to the aas�EY hdU* d�� °f the eoa�Y �ntaaon amc �H � � 1/2 � Cup �� � � I�a�zor3 - - - _��.,____�v�....Qs_nnrsiavtafwatetQ�Y Fotai�� ! ���.ss ���.��� ������ I���-na-��.�.����.Il IE 3L��.71�. Applioant: ��t�, �r ��i Location: C—.�,.,..,� ,.� . �D►�perat�on Permit System Type (From Table Va): �{� Type V& VI Expiration Date: n/� A., - � Tag Ma l�vZ3 Parcel # �-D � . P Subdivision � �-�tr�J a��= PhaselSection/Lot # �- # of Bedrooms 3 Product (IIIg): � C� a� � Type V 8c VI Renewal Date: � This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all coaditions of tLe Improvement Permit and Construction Anthorization • �,,,� � �v",� �—ZZ 1r/ l (Authorized Agent) (Date) ,� 1—�w%5 �'!5'-1'% (Licensed Con�actorj (Date) � �s &� � 3����7 � 3� '� P/� = Y2�� 18� �, --, , ., ^ _ ., _ �. N, � :��,�,1� . - –� � Scale "�S PCFID, rev. 12/14/12 --� � ,— �.� 3a a��P � Tax Map: Parcel #: Septic Tank System Checldist (Type II-I� System Type: � l�ote�� Pump System Checklist Contracted Certified Operator (Type IV Systems): 1p�0� l� otes: . �.��. sf ���.� �.� ������ IE��.a-�������,Il IE-���.Il� Applicant: � Location• �Jruerat�o� i'ermit Tag Map Par�el # Subdivision Phase/Section/Lot # # of Bedrooms System Type (From Table Va): Product (IIIg): Type V& VI Expiration Date: Type V& VI Renewal Date: This system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions af the Improvement Permit and Conshuction Authorization. (Authorized Agent) _ (Licensed Contractor� I �� Scale (�_ PCfiD, rev. 12/14/12 .� 2� i � 1 Il a{ ✓ � 6'I'fz'` ✓ 6'7'` G 6���11 �_ / � _�,,,, _, � �� (Date) (Date) �2'3�Z0�, ��t; 3�� 0 Tax Map: Parcel #: ______ Septic Tank System Checklist (Type II Ii� System Type: 1�1ote�: Pump System Checklist Contracted Certified Operator (Type IV Systems): 1V�tes: �.. ` , ` F � � � `� € , � � . �...,� ��` e { � 2 E �+.p, ''" ` i �j '-'":l`� r'; .'e _ f � r� � :5'�.'a �n T f S � !'�1 �' f �.J F � d 5M ( � ' � ( � � f �! ��i i L.: �` �r 1� � � � � ; i t,s C � f @ ti...�i tm � �, E � S E � r�. Vt'__.,�. f , - �"; ^� � � 9 �-�, �., �'� a ':^�,.�^ � k v, r'.t i--y i-+� r I� G `•� [ '"' ,(�� � !�? f � E,.f f � i J�� fy�� i j�[I i 5 ��~� f~ t � � ,�.^ ; ..�. �jp 4 � � - _ _ �+._�. : l.. <,,....�' �� ''+_.•v [ �. `..l �...1� �•.=f : € s �2 ! ���/ 0 � �•i �: {� f ,.. � . ��� For Inorqanic Chemical Confaminants � County: ' rSo Name: a o r �, Sample ID#: � 0�, Reviewer: Qw-�r- � TEST RESULTS AND USE RECOMMENDATIONS 1. � Your well water meets federal drinking water standards for inorganic cher�sicals. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inoreanic chemical results onlv. You may have other water sampling results that aze 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 Pubiic Health recommends that your well water not be used for drinking and cooking, nnless you install a water treatment system to remove the cir�led substance(s). However, it may be used for washing, cleaning, bathing and showering based on the inorFanic chemical results onlv. Arsenic � Barium � Cadmium � Chromium � Copper � Fluoride � Lead � Uon Manganese Mercury Nitrate/Nitrite Selenium Silver Ma�nesium Zinc nH 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 inorganic chemical results on[v. ❑ b. Levels over 30 mg/1 may pose aesthetic problems such as bad taste, odor, staining of porce(ain, 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 possib(e a frst draw, 5 minute and a 15 minute sample at the wetl 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, cookin , washing, cleaning, bathing, and showering based on the inor�anic chemical results onlv, 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. Cadmium � Chromium �_Fluoride � Iron Selenium Silver pH Zinc For more information regarding your well water results, please ca!! the North Carolina Division of Public Health at 919-707-5900. North Carolina State Laboratory of Public Health 3012 Dist�ct D ve Environmental Sciences Raleigh, NC 27611-8047 htta://slph.ncaublichealth.com Inorganic Chemistry Fax:ne� 919-715-867�$ Certificate of Analysis Report To: ADAM C. SARVER Name of System: PERSON CO ENVIRONMENTAL HEALTH JOHN NORTON 325 S MORGAN STREET 677 CLEARWATER LN ROXBORO, NC 27573 Courier # 02-33-15 SEMORA, NC 27343 EIN: 566000331 EH StarLiMS ID: ES080317-0065001 Date Collected: 08/02/17 Time Collected: 2:15 PM Date Received: 08/03/17 Collected By: A Sarver Sample Type: Raw Sampling Point: Well head Well Permit #: A23-206 Sample Source: New Well Temp. at Receipt: 2.5 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 76 mg/L Chloride 16.00 250 mg/L cnromium < u.0 i u. �u ���y�� Copper < 0.05 1.3 mg/L Fluoride 0.27 4.00 mg/L Iron Lead Magnesium Manganese Mercury Nitrate Nitrite pH Selenium Silver Sodium Sulfate Total Alkalin < 0.10 < 0.005 16 0.160 � < 0.0005 < 1.00 0.30 0.015 0.05 0.002 10.00 m m < 0.1 1.UU mgi� 8.0 N/A < 0.005 < 0.05 18.00 32.00 0.05 0.10 250 Total Hardness 250 mg�� Zinc < 0.05 5.00 mg/L Report Date:08/15/2017 Reported By: Deddie .�toncol" Page 1 of 1 � �� � � � � .,, � , � �,..-., ,� r�"� '�✓ '�.�✓ � � � � 1 v� � SQ'I�'Y A�` �t1 ]CAIIIr'�:,� 1C� t�d�L 81 l��l �'•�h. �l t� �11 Date: �/ 2Z—/ l �' �— Name: ��h r�'avL Address: 7�i� �' �"u/°� G'� • � 5.�� �,.q �/c ��3 Y� Re: Bacteriological Test Results Dear Well Owner: Tax Map:�3 Parcel:� Your well water vyas sampled on Sl / Z/� 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, coo ing, washing dishes, bathing and showering, based on ihe bacteriological results 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 soi;. Fecal coliform bacteria arz associated with animnal and/or human waste. Tha 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, the water �nay not b� 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 for total or fecal coliform bacteria should be proverlv 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. Sincerel , �Y�-Q„� 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, Fac 336-597-7808 .�;, � North Carolina State Laboratory Public Health Environmental Sciences Nlicrobiology Certificate of Analysis Report To: PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET Name of System: JOHN NORTON P.O. Box 28047 4372 District Drive Raleigh, NC 27611-8047 htto://slph.ncpublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 677 CLEARWATER LN. ROXBORO, NC 27573 SEMORA, NC 27343 EIN:566000331 EH COURIER #: 02-33-15 StarLiMS Sample ID: ES080317-0099001 Collected: 08/02/2017 14:15 A. Sarver IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Received: 08/03/2017 08:25 Angela Heybroek ES Microbiology ID: GPS Number: Sample Description: Comment: Environmental Microbiology - Colilert Profile Test Name: Colilert Analyte Total Coliform, Colilert Test Result Absent Sample Source: New Well Sampling Point: well head Well Permit Number: A23-206 Method: SM 9223B Date 08/04/2017 E. coli, Colilert Absent 08/04/2017 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. . � �o s� �„� �v� � � t�. ��S � � . � �c,— � 7 :,� o,, ;�s,� �� �~ �"'S• � ��� � _ y�-e-�- K, ,gar�.�,�� -�-� ,,��, � �►-`�a �.�,Q s�e�e � ��-� 5 r-� �� �- �' � �� ,�L� (o �.�Uk, � -� �� c���,�� � ���