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A23 207� ��1�� . �c..�.� � �J r��' v�� P��.�� --- �-�= �� iE�-r �.ar��* --- �eaa�a.]L iL�I�.m.11+blEa Tax Map: P�k.� (— ��e� S�s�e� Owner: vt�.yt► `� �Tr% �T � � Parcel #: Date: � i.ine Tap �a� (�c�) Tap �'lowr �ine �,��agtl� �oe� / ��ot # �aanaeier(�) ( m) '• (ft) � z o 5�• s v � - a . s �. c s 80 . �r , � 4 � $ c7 �'� , � 5 6 7 S 9 1� 2C�'� ft of line x 65 gal. per 100 ft= ; 100 = gal 75% x ga1= gal �er dose 2� gal per minute (gpm) = k'iow IBate Frnction � d �� I.oss: � 7 ft per 100 ft of supply line x~� ft of supply. line = 100 =_�ft ,�_ ft x 1.2 =�_ ft of friction head il�Iani%ld Size: 3� " Forc� Main 5ize: 2" PVC TotaI �ynamic �iead =�ft of Elevation head + 2- ft of Pressure head +� ft of Friction Head = � �s _TDH Purrap Requirement: 2s GPM @'✓ ��ft of Head " Drawdown: gai per dose ��3'gal per inch =} 2Sinch drawdown per dose ��—�5� 3° � �+ramea�Y �� nff'orm�t�on . .. �� . . .:� P+TC �me Vetve Se�e�e d0 PVCTaa TS�ap aiap _. . ' 2�PW 1��anm �' �---� . � � �P9CB�Vaha] l�11lm�e. lai/mouroQ .,.,.y.,.+.±.�+•+-...•+ - M� �F� _J_-.M1��Y 9�c�s , �� / _ � � - • ' � �. , ��i�%�omoo ��i*�N� °N°��9��Hf�Nr��N �N•`��N��N�N��NN a Y• iif'oid 5rza! � Taps �l�az No. Taps off one sisie lnce i�v �/± for ta in �oth si �3 3/a� t3i79 i»'� d = g g 3 4� 2? 1 �Z �'low per TaP Size �Llcuerial t�a:v GP?;I !," ;$c}ied 80 .i.� �� ,. ' Scrled sp '.1 �i, �' �cl:ec� 80 1 �.1 ', " Sciieri ?0 ? , ' ��.s� ��..� �� .. ,• ,-�--� -- (� � �� 1CIl.�V'713C �7C]L��"�^ �L�YYL"�.rll.� 1L .1L��1.�1'd�a Sloped To Shed Water 6" Covex• 1 i. Inlet Fmm Septu Tank 4" SCIi 40 PVC Pipe IdEMA 4X Simplex Control Panel +�" X �4" Pressure Treated Post 12" Sep�ration Electrical Conduit -- i • ` Acce t Cover• •• , ' . ;. � 1 ; . � . r . J / � ' �� - . ' �` `' �� • � �,, Opening Filled With �nti Siphon Hole \ Portland Cement Gmut (Dovm Hill) � Check Valve � High Watex Alarm Level ' (6" Separation� High Level- Pu:np On -�._�___,� �� rVaporLock �, � �' Z� Dravrdawn Hole _ ' .' � (Up Hill) � . Low Level -Pump Ofi �-�-' ,:. � P:ecast Concrete Tank � ,.; (IviaterialStrengtk>3500 �•,`.',' , : .' •. ` T�x .�� F�rcel # : ��hcl�vision � � � � � f'h� - 'S ctian'tat # a Duct Seal Hoth Ends Of The Con�it -� 24" Mininnun --1 r• •� Threaded Gate Valve Union / ^� I-1 Zip Cord Tiei � 4" Conczete Hlock . :', : . ,'� Concrete Risex b" Sepaxation • '•� ' . � :r..Jil' • �`_ '�,,:,r.rPortlan,d Concrete Gmut ZVidst]C • - ' � Opening Filled With Supply � ' portland Ceznent C'rxout Lina •� Outl�et To Distnbution 2" SCH40PVC Pipe Float Wires �' � •r i FJaats .. �Removable '• •' F1oat Tree , , .' � � •,�. • ', � . 1 .• ', ' , I�IJ`� GALL�N P�UMP TA,N�� t �� s �1�� _ , _ ' . � , - �� l�_ �� . . I��•�s�,.�,,.-�-,.��.0 IE�m.�.Il�ll�. srrE Pr.niv 23 Name � "'" �� Taa Map # � Parcel # Z� Sub��n_ Section/Lot# � 0 �_ Authorized Srate Ageat Da Sysrem componeats trpteseut appmxrmare rnnrours on1y. The rnarracsormust 9ag the sysiem paor ro beginning the insrdllarion m ' lnsurr �atpropergnde is maiacdaed . . �� v r •� r �v • 4,� .� r . � �....� • . �` `S `�,�,, �5 � PUMP � � �� . . . �� ASE�E�vT � � � � � � � `--�- i � . � 8 � � ,� � ; � � r �..�.� �� '—_ _ � �c�� :4 � �� , � � �` ��. , `'�-�'�-�. � , � �r , ►�� i S , c� ,'� � �`,``'_, � �l 8 � ° 3 2 ' � 9 " �'� J5 � 127.45 . -�.. ; ,\ � � c; � � , � � �� ,� �r ' � � � � ; 1�, � '°� � �` �;' �� . � q �� /� � �� lJNe��G�� . 1 � "` � -� ,�,.5. �.r"".,.. � `�,i j r� ..�-- � � � �.,��_ �� i � __,.-.� �( - � � . �, �. `� � j � Q � s ti s�� g IS � � DRA�h�FIELa ;� � ,;f ;��f '"` D A T A �,2 ' �.�; :,, � ,� �'�o , � � {5� � �m �� 4 �, � � � �'4� �j ; � ; � � 19 �,~ . � t= ' `� � � �� 2a '� Q�,,�( �IoeK S�s�r-, � . �, � �' � �` ��` a ,,� t` � -�� _ -�p� � 1� R � � v� Q►1 � �c �''�' S � �` at r -' � � �; � �P �`� ��'r r�ecvr�►��,a�a��5. -- �, 6 . z0 �`- 5 b-� �� F a r�•�� - I�e c(-�a,,-�y � k� �, ��,�5� ��a�; ov� � �ser�`� CC}NT��f CAR�3L I �A PQ1N�� LTGNT ��MPANY NY�� L��E s ca l .' 1 "� �° � ��.sf: ��.�� I� ��a- � �,.-n-�. ��.�.Il. I�IC � �.Il�I� Operation I'ermit Applicarit: Y� � ��2 Locatiori: n r �' � /1 Tax Map ��3� Parcel # �d ( Subdivision �;1'��°L�� Phase/Sectoin/Lot # �_ # of Bedrooms �'�,� �: 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 Authoriza.tion. System T_�'Pe: (In Accordance with Table Va): �b� E= Product: Q 5 �"�''�'�� Initial: �7� Repair: Expansion: ,, - �^ y�,�" . .� HS/REHSI . �� Licensed Connactor Lv.� r � SaL �,��5 dui Y !z' �'B 4 �-�t� Q �cs' �'�S(t?c�v S� 14Z Scale �p �a-�B �S iS7S !Pf- 25Z. - - _ _. : � . �6 �o _ �/ ,r Date � .�� Date � � Y !o � Tax Map: Parcel #: Septic Tank System Checklist (Type II-VI) System Type: /ly�- �l � Se tic Tank InitiaUDate State ID & Date: ,.e k Ca acity: Tee and filter � Baffle Vent Riser Outlet boot Perm. Marker ' Distribution _D=box .(le_v_els=set) _.. ,_.. _ _ _ _ _ _ - - _ __ _ Serial - Pressure Manifold LPP Notes• -- - ------- �• Nitrification Lines Initia ate Trench Width: y ft. Trench Depth: o ft. Total Length: 2 a o ft. Minimum s acing: $ ft. Rock depth/quality -- Dams/stepdowns � Grade (< .25" in 10') Cover (6" minimum) Setbacks From wells Property lines ---:------ - _-� , � Foundations/basements , L/ SurfaceWater Other: Pump System Checklist , Pum Tank InitiaUDate \ State ID & Date: Ca acity: Riser 6" min.) NEMA 4X Box Model: Piggy back lug Hard wired -- Alarm functioning Mounted on post Above grade (12") Conduit sealed Pressure Manifold Number of taps: Size and sch: � Z!� t� � Contracted Certi�ed Operator (if applicable): Notes: � ` � ��j�.� � -l� �. _�.,� ��; � , �� b 1 � I '�� .�! �� 1�" s�.si��o-,-�, ,,-n-„ «s�.�.�s � �'�' �.�.�',�1� Annlicant: (�� 3 ��°2 a o �, c �h,✓a� e✓ . r��o o � o �pr�w+�esa�.�..�i� �� la� �ar ��e �� aa�aon Type of Faciliiy: � l�ew � Asiditi�n # of Oc�ants aK of Be3ro�ms Proje�te�. D"y Flow 3 � Proposerl Wastewater System: 5 Gtr e�f — .2 � o� Propased Re�air: ' 'e ' - Pezmi.t con�tions: �� es. �� a��p�� 'P�� g.�.d. % �2 �_ TYPe� Typ�: - �L��/—l�I � � � �.i ►' - I •: � , / . " ,�ri{ Y. q ; ' l� • � { " ,��r��'_ � • ' �� t ♦ .- � �Y � � :i�l � iZI ��a ��r �� The issuancr af this pemri# liy the HeaIi� Depar�ie� i�a daes ne�# guara�e� the iss�ca of ottte: pe�niis. I� is t�xe res�ons�uuil�j of the aPPli�r�P�Y o�mer to in saue t3aat all Person Counip Piaunang an3. Z�ing anc3 Biuis�ing Iaspe�ti.ons re�rements aYe me� � ��t �'�t i� s�sjex�i t� r��ati�n if #he sa� p��; ��'�� tia� in$esa�� ase ein�ng�.s. `�a� ��as�e�ae�t ��t i� �� a�e�t� �Sq � c�xge iaa o�mm�s�an� of t9ae gs��g�er#�y, � g�i�i v�� i�saaed �a c��ls�ncr �i� tBa� �a��vis�m� af th� �T�rt� �C�liaa�. .: `.��ws capsal I�rales far 3`esv�¢...�e ?`re�eaent � .PDas,�asal .�vsde�as' {15�i lY�� A. .19�Oj. I�eyt.9n� �a�� u�#�j•: moa��;t��.'' '� �aav�aro��ntt� �eadSh 8pe�,i� �r�s-r.�t� t�nat th� se�atfc #.aa'�a.i sy��a �31 c�nti�ns� t� fnn�on s��aa�Ey iS tRne f�a€�e oe��#��- tga�-�a�r sup�i� avii! rama#a �ao�ie. . . . � �ua�a�a�a�i�n � C��straHa:t �� S�� ' � �� a�ds�g ��$-�.�� *. Ses site plan «�ed addi#ional a#ac3uneats (_��q`,�'�� oGC �yS�Pr►, � , � . y . � Prop�seti Wastewater System:� �'S w�� I�✓�'� D. � Type �'�astewater �lmw 3� 0 g.p.d. New 'i� Re�air E�ansion -�a��l ��.� • 30 g-�.s1J ft Z . 'Fyp� of Fac�ity: -. 2I �T , � � Basee�ent �C Yes _ No � � �'�7��.�� S��$� �e�� . . �� : s�� :� O�D ��a � �� (S�oQ � �� . � . � � . � °�t', ��: �� rW� r000 s� � '�� L�� Z �:� � ' ' � �� D�� 3� � . . . . ��a� �� 2 � I� ��i� im��: ,�_.'� � '��e�a �� S �g �. C , �r Y�.�,� :�� :�:�. , :�; s��,�a �i�a'baa�ao� �o� Sea� ��daibaa��a K �re�� . r�u�o -� _�a.�: _�'+(�P ol.�s�s� _ sl.�-� ,: ;. y, : �►/��. --- - - ':��.0 C:f. r•.�►�� i,_- 2 Date: The 1.yne of system p�iite3 �s Conventicnai � c:.�tea �Alt�rsia.-�ve. I��t t.ile spe�icatians of the F�?- � �rsa�l� �m� ��gps��i�rQ: �• L`at�: 7 a-� � PC'� rev. i � 1101�5._ . ,� .. = . � - : ' �. STAT£; �.. �c+ r„ Jr...,, �k;-�: ��P :�:r � ;t.:.s; � r ' `� �� ` ; :.`�'J �,.`t�-.'i��.�C: .��: . �� a.,..r RESIDENTIAL WELL CONSTRUC'TION RECORD North Carolina Department of Environment andNatural Resources- Division of Water Quality WELL CONTRACTOR CERTIFICATION # � � I'r7 1. WELL CONT CTOR: n .�,� Caq�,-f-� - Well ConVa or Individual) Na Bamette Well Drillina inc Weli ConUactor Comparry Name �� ' Qamette Tinaen Rd Street Address Roxboro NC 27574 Ciry or Town State Zip Code 3c 36 � 599-0015 Area code Phone number 2 WELL INFORMATION: �� aJ }�� 3 WELL CONSTRUCTION PERMIT# �l �c /� 7-0% OTHER ASSOCIATED PERMIT#(Kapplicabte) SITE WELL ID #(d app�icable) 3. WELL USE (Check Applicable Box): Residential Water Supply O DATE DRILLED 2-i �—I (% TIME COMPLETED 23 � AM ❑ PM [� 4. WELI. LOCATION: cmr: �.Mfl �A courm 'P�So ✓\ �'.I��' ✓ ��'" ( � - (Stre arrle, Numbers. Community, Subdmsw�. Lot No., Parc:el, Lp Code) TO GRAPHIC / LAND SETfING: (check appropriaba box) Slope ❑Valley ❑Flat ❑Ridge ❑Other LATITUDE 36 "� �r 2— " DMS OR 3X.)OCXXXXXXX DD LONGITUDE 75 i3'�' I Q�i » DMS OR 7X.XXXXXXXXX DD Latitude/longitude source: �PS • �Topographic map poca6on of.we!! must be shown on a USGS topo map andaBached to this form if rrot using GPS) , 5. WELL O �C.�� JQi I�'> � - Owner Name � f n Cl,eRiwo�fer _ SV ei Address � %� (� �.%�.� Yp� � � ' M `�� / ^ City or Town State Zip Code ('�3 (o ) S�l Z ' 72 Z � , Area code Phor� number 6. WELL DETAILS: � a. TOTAL DEPTH: � � g. WATER ZONES (depth): : Top�'� Bottom�_ : Top�_ Bottom Z ( a Top Bottom Top ' Bottom Tap Bottom Top Bottom T. CASING: Depth Diameter Top � Bottom�� Ft.� Top Bottom Ft. Top Bottom Ft. Thickness/ Weight M� aterial �� — � �L 8. GROUT: Depth Material Meihod Top� BoaomZ� Ft.Sand/Cement Poured Top Bottom Ft. Top Bottom FG . 9. SCREEN: Depth Diameter Stot Size Materiat Top Bottom Ft. in. in. Top Bottom Ft. in. in. Top Bottom Ft. in. in. • 10. SAND/GRAVEL PACK: Depth Size Material Top Bottom Ft. Tap Bottom Ft. , Top Bottom Ft. b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO c. WATER LEVE� Below Top of Casing: 2� � �- (Use '+` if Above Top of Casing) ' � d. TOP OF CASING IS �_ �• �Ye �� SurFace' •7op of casing tertninated aUor below la�d surface may require a variance in accordance with 15A NCAC 2C .0118. e, y�E�p �gpm): � METHOD OF TEST BIOWfI ZOIII ,, � i. DISINFECTION: Type HTH �►mount 1/2 Cul� 11. DRILLING lOG Top Bottom � / �i / -3--� � ,� �� Z J / / / J � � � i / 12. REMARKS: Formation De nption 0 o's� ��7�lfV��e� --c—r � 4 �' V . L (�tY'NA rJ 't-L I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ; ACCORDANCE WITH 15A NCAC 2C, WEIL CONSTRUCTION ; STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN : PROVIDED TO THE WELL OWNER. , . ._ �.6� A ...-�`(6�ro SIG , R F CERTIFI ELL CON A TOR DATE , _ � „ ,, � . PRINTED NAME OF PERSO CONSTRUCTING E WELL Submit within 30 days of completion to: Division of Water Quality - Information Processing, Fortn GW-1a 1617 Mail Service Center, Raleigh, NC 27699-161, Pho�e :(919) 807-6300 Rev. 2109 Report To: North Carolina State Laboratory Public Health Environmental Sciences Microbiology Certificate of Analysis PERSON CO ENV{RONMENTAL HEALTH 325 S MORGAN STREET ROXBORO, NC 27573 StarLiMS Sample ID: ESO42110-0079001 � �� ES Microbiology ID: 15933 GPS Number: Sample Description: Comment: Name of System: BOB ROSE P.O. Box 28047 306 N. Wilmington St. Raleigh, NC 27611-8047 htto://siph.state.nc. us Phone: 919-733-7834 Fax: 919-733-8695 CLEARWATER, LOT 10 Collected: 04/20/2010 14:20 Received: 04/21 /2010 09:14 Sample Source: New Well Sampling Point: Well head J Smith Angela Heybroek Well Permit Number: A23-207 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert Absent Darneice Lyons o4/22/2010 E. co6, Colilert Absent ;' Dameice Lyons 04/22/2010 Report Date: 04/22/2010 Explanations of Coliform Analysis: / �, //.,.`, �' / i P �: � � � ` Reported By: Joy�Hayes � ` ��" � `�d� �`� � � �.� ,� ..,� � r�,,, ;�r .,.i � ` �..:� �: �� 0 ,:� \ /j ti �\ . ��``_ � . 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. North Carolina Division of Public Health Occupational and Environmental Epidemiology Branch, Epidemiology Section ` BIOLOGICAL ANALYSIS REPORT Private well water information and recommendat'ions County: �°� Name: Sample ID Number: %� 3.� Location: Reviewer G� Initial Sample Confirmation Sample BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR PRIV TE WELL WATER (These recommendations are based on biological analysis only.) No coliform bacteria were found in your well water. Your water can be used for all purposes including drinking, cooking, washing dishes, bathing and showering. Total coliform bacteria were detected in the sample.which indicates that harmful bacteria from human or animal waste could enter the well. Do not use the water for drinking or cooking unless it has been boiled for 3 minutes. You may use your water for all other purposes including washing dishes, bathing or showering. � Your well water needs to be re-tested to verify that the result is accurate. Fecal coliform bacteria were detected in the sample. Do not use the water for drinking, cooking, washing dishes, bathing or showering. Your well water needs to be re-tested to verify that the result is accurate. If the re-test shows contamination by bacteria contact your local health department for assistance. There may be a problem with the construction of the well, the groundwater source, or operation of the well. The well needs to be inspected by the local health department or a local well contractor to determine the problem with the well and to give guidance on how to correct the problem. Your well water was tested for biological contaminants (total coliform and fecal coliform bacteria). The results were evaluated using the federal drinking water standards. Drinking water may contain substances that can occur naturally in water or can be introduced into water from man-made sources. Total coliform bacteria are found in soil and fecal coliform bacteria are found in animal and human waste. Total coliform or fecal coliform bacteria in well water indicate that the well may have structural problems or that the well was not properly disinfected. If you have been drinking the well water and are pregnant, nursing, have a child in the household under 5 years of age, or immunocompromised (such as an individual with AIDS, cancer, hepatitis, dialysis or surgical procedures) inform your physician of these results at your next visit. If the contamination continues, you should investigate the possibility of repairing this well, drilling a new well or installing a point-of-entry disinfection unit which can use chlorine, ultraviolet light, or ozone. Contact your local health department for more information or go to www.epi.state.nc.us/epi/oee/index.htmL Report To: North Carolina State Laboratorv of Public Health Environmental Sciences lnorganic Chemistry Certificate of Analysis PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET ROXBORO, NC 27573 Courier # 02-33-15 StarLiMS ID: ESO42110-0045001 Date Collected: 04/20/10 Inorganic ID: Qate Received: 04/21/10 Sample Type: Sampling Point: Well head Sample Source: New Well Temp. at Receipt: 8.0 Sample Description: Comment: Name of System: BOB ROSE P.O. Box 28047 306 N. Wilmington St. Raleigh, NC 27611-8047 http://sloh.state. nc. us Phone: 919-733-7834 Fax: 919-733-8695 ��. � � ,��, j .�� , .- CLEARWATER, LOT 10 Time Collected: 2:20 PM Collected By: J Smith Well Permit #: A23-207 GPS #: New Well (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Total Alkalinity 195 mg/L Arsenic < 0.005 0.010 mg/L Copper < 0.05 1.3 mg/L Lead < 0.005 0.015 mg/L Manganese < 0.03 0.05 mg/L Zinc 1.80 5.00 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Chromium < 0.01 0.10 mg/L Silver < 0.05 0.10 mg/L Selenium 0.005 0.05 mg/L Iron 0.20 0.30 mg/L Mercury < 0.0005 0.002 mg/L Fluoride 0.35 2.00 mg/L Nitrate < 1.00 10.00 mg/L Nitrite < 0.10 1.00 mg/L Chloride 41.00 250 mg/L Sulfate 200.00 250 mg/L pH 6.9 N/A Sodium 35.00 mg/L Calcium 62 mg/L Magnesium 44 mg/L Total Hardness 340 mg/L Report Date: 05/06/2010 \ Page 1 of 1 Reported By: �edfiie 7%to�ecl �� .�� _�� .��a��a��.� ��.�1�� VV�+ I,I, PERMIT (New_Repair� 23 Tas Nlap: arcel• 20 Subdivision: �'I�JQ�d� Lot: l� Applicant's Name l�ailing Address: . Phone i�tumbers: I.ocatnon of Prop CIIM/1 r N � ��t /1,� �D� �4SP t�� l'�rmit Conditaons: 1) See attached site plan for proposed well location. 2) All a�plicable State and County regulations goveNning construction and setbacks apply.� 3) Perrnits expire � years fi•om the date of issue. Other C'onditions/Comments: Permit issued b�: � 1)ate: o`� 0 ��IZTIFICA�'E OF COlVI�I,ETI011�TT New Well Inspec�ion: EHS/Date Location: ds G � Grouting: 2 ` t�' Well Log: Well Tag: Pump Tag: Air Vent: � Hose Bib: i/ Casing Height: Concrete Slab: Well Driller• Pump Installer: Ar I,iner Inspection: EHS/Date Installer: Depth: Grout: VVell Abandonment: EHS/Date Completed: Method/Material(s): _ License #: License#: , C.' �-� �Vell A�pproved by: � 1�°ti Date• o_ Date Sample Collected: Date Results Nlailed: Person County Environmental Health 325 S. Morgan St., Suite C Phone: 33b-�97-1790 Fax: 336-597-7808 Roxboro, NC 27573 8/1/08 J L L ' BOUNDARY � i�. ;0 _.- . ' DATA 3 ~�W��' CURVE DELTA ' + C- 1 06'03'11' � °` IS �6' C- 2 06°00'07' C- 3 17°22'34' • � Ig el' �j 420' C- 4 05'39'49' . t � CONTOUR C- 5 09' S3' 03' `�`�' G z �• 5D C- 6 26' 20' 17'� S �� C w C- 7 01'45'25" �o � S � '?j�P` � C- 8 37°30'38"b � �. °a � IS_� 1� „�/nks C- 9 07°27'S3"b� �. a�.... •� �Q C- 10 28'28'25" q� �, :5 Ci5 IS %� f5' � a� C- 11 54'05' 18" °� a N. � • � � � , �. CAROL I NA POvVER C- 12 1 1 1' 44' 32" n``� � � p p�� 8 LIGHT COMPANY C- 13 64'10'12" �'� " �^ IS �/�V I � �,� o �Ne- (0� a-o �f'2a HYCO LAKE C- 14 . 100'02'40" s � R� � 18; - �'orrfo�t� C- 15 43'34'11" ��t�'a � IS c�2 IS '46 es8„�' �- �iVL ' line, C- 16 09'S4'03", B'� � C- 17 27'44'20" R�• IF ' C- 18 05'22'01" ` 4p 4 C- 19 32'08'37" a �,`J � C- 20 37°58' 45'� a �� '42 C- 21 28'20' 49" � q �`� Z`�s, 15' p C- 22 00' 41 ' 41 " � o � 7 � s �js WASTEWATER Q; � C- 23 10°29'45" .��'- � )� `�o s� TOT .�, � PUMP L T NE `� �y � 1 'S� �� y� s � EASEMENT 8 � 39 1 .`41�� b � `� RES �' ,5.38 ACi�ES � � � �� o :,o`i'' '1 Ns8_.'4>' 60 e, � � ��ij �j 5EE ,. -I�,`I ..` s� 1s, °� ., p� 0 l�4 � ��.BOUNDARY � '��O IS ��` 2 `��.4 � N89'32'S9"W _^ g � � � a �-�j 6v CATA IS s 1.4 ,��r� 15' �v' IS 127.45 IF � WUL � d �� //. �c__� O � . s b � W �� 4. p � I S � .A ~ 5 _�f'� 6 G � a Q �. , � S E E� � 3 12 '. %-'"-F} J �J � ', ,.- i BOUNDARY I S:� r�s� __ _. 3. 4 5 � � �.a � A l �. -� :E��1E?ERY �� 1 p I S/~ 'EE P"1 C R E S /— SEE CONTOUR DATA �. ?PROXIMATE; � Q IS � DRAINFIELQ `^ f � ,� � I � �.�' � DATA S? � , „� , o '�� '�-. 1 IS !� 15' 1' h � � �' 6 1. / � ��'� �' Is -i i� �; �� 18 19 �ti� tF , S, LEGEND �� k i �.�� NF o NA I L FOUND . s`� J5$ �� o�� QY� s� � � IF o IRON FOUND � ^� �' 4g IS o IRON SET � �' 46. 20 �5 I F — PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET ROXBORO, NC 27573 StarLiMS Sample ID: ESO42110-0079001 � �� ES Microbiology ID: 15933 GPS Number: Sample Description: Comment: BOB ROSE CLEARWATER, LOT 10 Coilected: 04/20/2010 14:20 Received: 04/21/2010 09:14 Sample Source: New Well Sampling Point: Well head J Smith Angela Heybroek Well Permit Number: A23-207 Environmental Microbiology - Colilert Profile Method: SM 9223B Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert Absent Darneice Lyons 04/22/2010 E. Coli, Colilert Absent , Darneice Lyons 04/22/2010 i � . . Report Date: 04/22/2010 Explanations of Coliform Analysis: Reported By: Joy Hayes '�• �j�t��—' �� )47 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. 1 �� ;_ � ;�, � �� .! !�. ��',�, "� � `� � -� � �� !� �° T � ��.-�-.�-��e�.�l �-��.�.�.�.�� s.�nu� {�� _. , _ ;�, � �3 �� °2 � �:,ati �, C �►�,✓o� e✓ � �o d� o �gra�e�� r.� �'�-�t Valia aa�� '��v� �'� �.,�io ��n ^'�ce �r Facui��: .'�ew �- �dditian T oi G�.�auis vK 7 oz Bedrooms Proje�i�3 Da�;iy F1aw � rr�co�e3 T�'aste�rat� Sysz�: - F:ano�ed Re�air: �� • :,,�„ �, ., . . . � Owner ar L..-�ai Regrese A,IIL�IOYIZC� St"d'� A gCII� r e�. �� S��p�� Lt/P(� g��d � �2.. �._ TYP�= � 'I`+Ip�: � Date: �Date: 'I'_�e � of ttsis p� by �ae fieaitii Degartment �a da�s n�t guara�#�a the ,'.�„an�a of ather pes�i�. I� is the res�onsx3�ilat� oi the �p�Cp�rty awner tn ia suse t�ax as� Dersou Couni:y I']annau; anci Zanmg a�d Bw�3mg I�spestions requ��ne�ts are me�L �has 3mprove�x Psrarit � sgbje�t tfl r$so��ion if t�e sa� p��a�,;'��''ma� ti� i�tes�de�t �.ase ciaaag4s. 'z'�e ��eme�t �°e�nmma� i� �� uTe� av a �aaag� � owner's�ip ai �he �ra�eriy. 'i3ass per�it �as �suaed � c��Yi�� ii�t f3n� prnvisfin�s �F ih� l�i��tlt �C��, . =?�►s �ad R�les for ..�ewa,Qe ?5'e�sme�a� arsd �isaosal ,�vstesns' (�.� I�t�� .�A .I9��). Nei#Ilae� �axson ��w�dy: m�`''�t�e�.' ` �vironmr.nrai 3eslth Spesi�3ist �varrants ti�at t�.� s��stic :a� �y�rm �T r.�n�nn� t� fn�t�oas s��iaia�t�m�y iri t4nm #aatmpe' �P:t�aan�. �x-wa#rr srz�lp wr'Il remain �otahle. - � - �aaib�o�tto� � Ca�sta�n� ��e� Sps� (� �� y�� uia�g �°�niut� � • � Ses.�te plmi mtd additior�al artac}tmen�s ��,�c�� OGC �S�iP� ' . � . - P=apose3 �A'asrewater system:,��5 w %� ��'►D � - ' Typ��ie '4vas�tewat,�s F1ov� �- �6 g.�•d- '�se�v X Rcpaa �on � . • �a� � ��: • 3_ 0 g.�.dJ �? �� o�F�: � 3� �P,�s- � e��.,, �L��_rro . �7.', . . • --•T :�• • �'��$��:�� i�r�� . 'iaII�i,�3�t CC�[C ��A;�� a� �ffi� �� iT2�.9� �3'��8: � , . , _ . �:��; To#ae. �r-,..�: rOD� s� � 'To� ��a Z �:b � ' ��a Tre�a�n ��a ,�. � � 's'r�nca �id#�i � f# �r�'iu'aa�.� So� �m��: �� a ��a��n�„�, '�e:��3a 9e�aa8�'so� � �it D' C , I3is�uuiio�a 33zs�i3�s�o�a �� Ser�� tri�saa�¢�� K �'ress�e ��d . � . �ie�+�ates: �1?ur''r��/ka.�,`d-�� t�E�S�S� s��5 -- - -. , � �aass�esi �#aas �eia�'� D�i E�' on �ate: Daze: ""�e : fne a;' ��stem ��' :s C:,n�ea^ cnai _c�.,�ie�. ��:t`Ler�ai�re. i a�cr�# t6e sperincaiions af the v� f'� �03! �c't:g¢�^r.._-'��'''Te: C/• ��TtE: � � �„�LJ�. • ' i �D rev. i � 1141475_ : r •• � . y " �