The URL can be used to link to this page

A23 64a � a ' The District Health Department Orange, Person, Caswell, Chatham, Lee Counties Water Supply and Sewage Disposal IMPROVEMENTS PERM No,. �^ f�,� D te � f_�f • � . � Owner: �c� I-�_�' '� I��QV� `�j q�..r�l /C. Location: � ' f ; . '�.._.�� .c'�..ti�:�, � ;� „ , Contractor: � Wa2er Suppl : Private � Pu 1' Sewaqe Disposa acilities: No. bedrooms _�.— Dishwasher, Disposal, � w^ashing machine� other automatic appliances � Size of tank: .�� .-� Nitrification line• , Other disposal facility: Water supply and sewage disposal facilities location, installation and protection must meet state and local regulations. Septic 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 INSPECTEI3 AND AP- PROVEI? BY A MEMBER OF THE DISTRICT HEALTH DEPAKTMENT STAFF BEFORE ANY PORTION OF THE. INST�ILLATION IS COV- ERED AND PUT INTO USE. % j �'. `� ' -- ;,�.J� f, � ,;. ;� Date approved: Signe ' `� ` �� G'' '` Sanitarian Well: , Sewage Disposal: By Counter- signed (Owner or his representative) Certificate of Completio Date Approved: '� BY: nitarian (OVER) Location of well and sewage disposal facilities sketched on back. . : Make sketch of installation showing lot size and shape, location of house, septic tanks, privies, water �s, etc. Note special problems existing on lot. Write in measurements in order that installations may be located �r date. Note location of water supplies on adjacent lots. � � � 1 �-� c2� �� S nc department of health and human services Private Well Information and Use Recommendations counry: � 1J Sample ID #: 2� � For Inorganic Chemical Contaminants .�c.� ��_ c 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 inorQanic chemica[ 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 washir.g, �leaning, bath:ng anri showering based on the inorQanr:, chemical res:�lts en:v. Arsenic Barium Cadmium Chromium � Copper � Fluoride � Lead � Iron Man�anese Mercurv Nitrate/Nitrite Selenium Silver Magnesium Zinc � 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 D:'vision �f Public Health recommends that enly individuals on r►o 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 I S minute sample at the well head to determine the source of the lead andlor copper. 6. �he following substance(s) exceeded federal drinking water standards. Your water can be used for drinking, cooking, washing, cleaning, bathing, and showering based on the inorQanic 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. Barium � Cadmium � Chromium � Fluoride Manganese Selenium Silver pH For more information regarding your well water results, please call the Nort/i Carolina Division ojPublic Healt/t at 919-707-5900. North Carolina State Laboratory of Public Health 43012 D�stnct Drve Environmental Sciences Raleigh, Nc 2�s„-so4� h�://slah.ncqublicheaith.com Inorganic Chemistry Phone: 919-733-7308 Fax: 919-715-8611 Certificate of Analysis Report To: H. KELLY Name of System: PERSON CO ENVIRONMENTAL HEALTH CHESTER BARNETTE 325 S MORGAN STREET 590 EPHESUS CHURCH RD ROXBORO, NC 27573 Courier # 02-33-15 SEMORA, NC 27343 EIN: 566000331 EH StarLiMS ID: ESO42016-0034001 Date Collected: 04/19/16 Time Collected: 2:15 PM Date Received: 04/20/16 Collected By: H Kelly Sample Type: Raw Sampling Point: Outside tap Well Permit #: A23-64 Sample Source: Well Temp. at Receipt: 6.9 GPS #: Sample Description: Comment: New Well 1(Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium Cadmium Calcium Chloride Chromium Copper Fluoride < 0.1 < 0.001 5 < 5.00 < 0.01 < 0.05 < 0.20 1.30 < 0.00: z.00 m 0.005 m m 250 m 0.10 m 1.3 m 4.00 m 0.30 m 0.015 m Magnesium 1 Manaanese < 0.03 0. Nitrate Nitrite pH Selenium < 0.0005 < 1.00 < 0.1 6.8 < 0.005 Silver < 0.05 0.10 mg/L Sodium 7.70 mg/L Sulfate 6.20 250 mg/L Total Hardness Zinc 0.09 5.00 mg/L Report Date:05/02/2016 Reported By: Deddie .�tancol� Page 1 of 1 North Carolina State Laboratory Public Health Environmental Sciences Report To: PERSON CO ENVIRONMENTAL HEALTH 325 S MORGAN STREET Microbiology Certificate of Analysis ROXBORO, NC 27573 EIN:566000331 EH COURIER #: 02-33-15 StarLiMS Sample ID: ESO42016-0070001 I ��I� �� I� ��I�� II�I� �� I�� I ��I ��I ��II I��I� ��I ES Microbiology ID: GPS Number: Sample Description: Comment: Name of System: CHESTER BARNETTE P.O. Box 28047 4312 District Drive Raleigh, NC 27611-8047 http l/slph.ncoublichealth.com Phone: 919-733-7308 Fax: 919-715-8611 590 EPHESUS CHURCH RD SEMORA, NC 27343 Collected: 04/ 19/2016 14:15 Received: 04/20/2016 08:18 Sample Source: Well Sampling Point: Outside tap H Kelly Susan Beasley Well Permit Number: A23-64 Environmental Microbiology - Colilert Profile Method: SM 92236 Test Name: Colilert Analyte Test Result Analyst Date Total Coliform, Colilert Absent Denise Richardson 0 4121 /2 0 1 6 E. Coli, Colilert Absent Denise Richardson 0 4121 /2 0 1 6 Report Date: 04/22/2016 Explanations of Coliform Analysis: Reported By: Susan Beaslev G'�z�c��.�`e�r � 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.