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A24 106f i� •�♦ . � ' ; ' f Person County Health Department Existing Sewage System Report For: Mobile Ho[ne Replacement ;�'�`� _�ddition � � e,G�[ Requestee: Home Phone# � � Business# c�9%' < �� jiC.� � Q� �7� T ax M ap # .,r, _ �i f - � ./✓1 � i � �..11 '�T �� 1 � � 1_ ..� � r! _ Location/Directions: �1.� �� ,,,. � , � Original Permit Located �. Septic System Uesigned Eor: Kesidential Business � 1) � � Other (speci�y) # Bedrooms �_ # E;mployees Other __ �J Uate Tnstalled � �I`-� Water supply �� 'Pype ot System (y �� % Nitrirication Line �C�� X�� o� �v� i�� _ . ., Tank Size Certified Operator Req�ired / V (1 On site wast-ewater disposal system sliowes no visually apparent malfunction on �l�' I� � Yermission is granted to: n According to the attached site plan.- Comments: Environmental Health S��r. b�� DATE 05/24/2066 18:05 3363220533 05I24/2086 1b:34 3365977888 ��: � GIBBS BAUM PER�'�.30N C011NTY ENIJIRD PAGE 02/03 PAGE 01 s�_� . �4z� ia� ��. �-�.�`� .� I�1�IE��1�' ..~= _ + - � � ��--m-� ��.-�.�.,�:,----- �m...a,..w.A �r.��.� :iJ �_' I.L' � ��:" �:iJ ��: � � q �p� -�-�-- 1) PvnNt raqw�6od t� {Orrc�a�rl�+�l�rn�up4dWe Qwieer): l� • � �L�-tu-m "{'�' t�lome Pt�one; fo- (ot} • Addresa;� u r. Bustn�s Phare; 75 • ' ? �) Nauts aed ed�ess ol' c� vwrter. _. tJ. C� �bio'rs T�4v.w� �4- ' �4c '��r1� 'Dr. - • ��,r� cira. 1�t C. • zT,�4 3 � , � S} P*aPaehl Deaai� !�t al�s: 3� TcNa�sh1P: �r� Subdv' '-�U�; �l �c Lot�� ta the qpP�11 i��ud1�9 med naines end nurnba�s� r�'?c.GAces wu 11 =Fa Car. vc�,,,� � -3-r� F�l ur M�: ll 4) Piapoad .�uss �nd s� E1as�ttpaon: at�r eac� aF the fdtawkrg �tla�rx � 'a) �rapos � � _.'�YPe af sNx�ur�s W�dn�:� ' peptt,; b) 1Vt;iRtbe�' oi f.�d�ns: _ � aF ooce�pants ar peopl� tu t� �; ' • '�) 9a�ement Yea,�'No W6i ther� xte ph�mblltg i� #ti� be�ema�t?,�,,,,,,,,,,, . � 6�rb�9e dlapaer� `fe� _, Na _ . ' �] 1!1►abec 9uPPh►'ry1P� ��, {neax ._,_ � sydstirig�j, Publ�.�.� �artmtmaY'.,, sP� .,_ � .� � � 30� � Yea...r,�C No .� �f ye:a. p�ase �e approodmste loc�foti an the 6I o'� Y� I�P�Y �� P��Y W�rtl�d �ietlormi �? Ya�s No pL�A�9� N07'L 7HE t�QW_dWprG': - � . D A PlAT OF7HE PRt��RiY OtZ 9irE PI�W WUST 8E SUB�IiED YY�IN'i'�S APPLIGATIOM. � PR�T1f 1JI�S /Ui1D CORlI�tS �1LfS7 � C1.�JlRLY Sllltif�. •, A Ti� PROPOS� LOCATlf3N O� ALL S7RUCTURES MUST 8� STA�p qR FI.A�G�D. ➢ TH� SR� 1� � READ47 A�SIBLS FpR AN EYAUlAiON BY i'HL IiEAlTH D�RA�+tT STAt�. ' . � i�ehY m� aPpika�n.tn �e Perscn Caurs� N�al�t QeQ�rtrr� ia� a sM aw� i�ar� the an,�iba aew�ge c�osal sys�am ior fhe �bovad�'�ed property. 1 agr�e�that the � vf t!�!s application ar�e 1r� �d repr� tha m2oc�rx,nf `laciiEEiHa ba be piace�d On t1'f9 pnoper�l. ! u� � tlle stte Is al�x'scl Cq' th9 ir�artded use dtailges, the p�m� ahdl became ��vst�. �a� � .S 2�f 1'%� i�f,.• �: r� ir � �..�� ,f ��$.�� , � � �� I��n��.��.11 IE-3L ��.]1�I� T�x Map ' � - P�rcel # • Subd'ivi�sion , .. . .,. L• Fha�s�e Sect�ion Lot x Applicant: (�•�bs �.u.vw Location:�7 n� �(f� �• C�.w�Z Ca� l� � L u� 1'I,I�Y'�� l,t:c (1 -'► �- o� L'd+vas 1��k. �+ ��,n Mc \+�cn� o�. W� .a... �s � cii- �.k —a t31wea1\ low �9 s�Faw�� ►- �-- �•'�c.Q1 lg` �� Improvement Permit Permit Valid for Five Years No Expiration Type of Facility: -- 5' New Addition _ Water Supply �� # of Occupants !� �..r # edrooms �� Projected Daily Flow 3to� g.p.d. Proposed Wastewater System: Type: Proposed Repair: � � Type: Permit Conditions: Owner or Legal Represe Authorized State Agent: Date: � -s � Date: s - �5�►-ocq The issuance of this pernut by the Health Department in does not guarantee the issuance of other pernuts. It is the responsibility of the applicandproperty owner to in sure that all Person County Planning and Zoning and Building Inspecrions requirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected by a change in ownership of the property. This permit was issued in compliance with the provisions of the North Carolina `Laws and Rules for Sewa�e Treatment and Disposal Svstems' (15A NCAC 18A .1900). 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. Authorization to Construct Wastewater System (Required for Building Permit) * See site plan and additional attachments (�). � Proposed Wastewater System: �CCQ,(��Z Type�� Wastewater Flow 3(.c� g.p.d. New � Repair�C Expansion _ �Z5 % +��..� Soil LT�R: , a�5 g.p.d./ ft 2 Type of Facility: � Basement _ Yes � No Wastewater System Requirements Tank Size: Septic Tank: � gal Pump Tank: ^ gal Grease Trap: � gal Drainfield: Total Area: sq ft Total Lengthlo`�j-/�Sb ft Maximum Trench Depth ��L .�(Q in Trench Width3 ft Minimum Soil Cover: �_ in Minimum Trench Separation: g ft Distribution: Distribution Bog �_ Serial Distribution Pressure Manifold Specifications: �11a � at�, 81L� lecl. �tr.. �. � H�S �L.t. p�i Qr� e S hIP'1c 7' Authorized State Agent: �� Date: 5- o�f-c�o Permit Expiration Date: 5 - - The type of system pernutted is Conventional Acce ted Alternative. I accept the specifications of the permit. ' � C Owner/I.egal Representative: Date: J �� PCHD rev. 11/10/OS `1mh� Dist�ic� hie�lth D�pa�t��t . CASWELL - CHATHAM - LEE - PERSON COUNTIES Wa�er Supply �nd Se�vage Dis�osal ,tM�PRO� yEMENTS PERMIT No. _ 1rYl 1 KC� � V�� I 1 Date�,=-�`�� —�' �� Owner: '�. '�'�. �, �. �. ..... Locatlon: 1 j ._�*��`�j��,1 f,1 "� 1 j: 4� F�l' /,..- � t, : I�y � <.. -1 ) t r Contractor: �� ; � `a � b� � �` - Waler Supplp: Private �, -''"� Public Sewage Disposal Facilities: No: be'd washing machine, other automatic 1 .Size of tank: lr��:T; i: DIshwasher, Disposal, Nitriflctation line: % �-.,C -�� i:� f°� �: � d; � .- ��—E% t"'/ t f V f/ Y 1%l'!, V 11rw�� Other dIsposal facillty: • �• ' C;....(>..G.�.,'-'i ' . (,.. '�1'�' Water supply and sewage disposal facilitIes locatioii� installation and protection must meet state and local regulations. Septic tank should be pumped out every 3 to 5�years and shall be rnain- ' taineci by owner in such a manner as not to create a public health hazard. j Septic tank and .nitrification line MUST BE INSPECTED AND AP- PROVED BY A MEMBER OF THE DISTRICT HEALTH DEPARTMENT STAFF BEFORE ANY POR7"IUN OF THE INSTALLATION IS COV- , ERED AND PUT INTO USE. :•'� • 1 '�M, ,� , . !.%` � , Date approved: Signe� �' �- n C Tian Well; � 5ewage Disposal: Counter- � � ...is�,�'� oigned � � BY� (Owner or his repres tati ) Ceriificate of Completion ,,,r, . ,� � ' I9, f1 ; Date Approved: �' � �" L� BY: _ � , _ y� � Sanitarian • , (OVEA) Location of well and sewage disposal facilities sketched on back. ::� ! `��b 1 t " � �Li.lJ � �l �� .. � � � � � � � 1!. ��awn.�-��a�rn�n.��.� g��.�� ax M�p .i F�rcel # i - Subcilivisioia , � , ��, i,,, Phase Section'Lot # # of Bed�rooms Applicant �is.�as �,�„�,� � Locaiion: � .; '`.�, �-: ' . ;� , ' , . . System Type (ln Accordance UVi�th Table Va): �� THIS SYSTEIVI HAS BEEI�I INSTALLED IN! COMPLIANCE WITI-1 APPLIGABLE IVORTH C'AROLINA GENERAL STATUTES, RULES FOR SEWAGE TREATMEAIT AND DISPOSAL, AND A1:L CONDITIONS OF "� THE IMPRUVEMENT PERMIT AND CONSTRUCTION AUTHORIZATION. � � . , � � ��3/a� - Auth rize State Agent � Date � Installed By: '✓• ��is Date: 3�/3�0? � �I -�{-ou�� . - ' � . �a � . � . . V�d� � . � � �/ � ��'L � � �S `�� ..�_..�_-.,^ _ _..,�., �.�..� ._ ' -..__�F��, ,t -.. - . i t�D�.r-� o N �(�t t-t � a� c�, t � � -� 'iT✓4-►�1 DoA� �-i9 ' 6�G � a �. • . L � � � • ��. _ _ _,� � � �!O �t <� �— �.,,_.►. ►., .�..�.'-�' � ^ ��'` -�-_,,.. �. -' ,....-� . d� �i ii j ,�/'�� 4',3��,�j � II' �fT��f ,ri . �Z,�„ C I Z'7" �� . �� „--r.et�t«}- �arrn� PCHD, rev. 07/29/04 � c� 1.,�.�� . _t z �E��'1C T�4NaC 9��P��`��06� �u�E+��CL9�i' (i�e 19 - !4!� Tax Map # Parce! # Sysiem Type (Tabie Va) Owner/Applicant - Subdivision Address/Locatiori Se�lPhase Lot # - S�l�t6C ��8�f 6l9$1� �� Itt'1 IC�#101'9 d81�S P01$6� �$Q.' State �ID/date Capacity Tee and Fiiter Baffie Sealant Riser (if applicable) Tank Outlet Seal Permanent Marker ` Pum� Tank , /Sealant Riser Water Tight ' � Purnp Checic ValveiGate Valve Alarm visable and audii Electrical Com onents � Rate m � A roved Pum Model Blocic Under Pum � Puma Removal RopelCl Trencn �dth � ; ft. � Trench De th in. Trenct� Len h ft. Trench Grade � Tfench S acin Rock De th and Qual' Dams/Ste downs e#c. Pressure Laterais � Hole Spacing � o e �ze Pioe. Sleeve � um- �s�r.rotectors Ftequi�ed� Setbacics From Welis � From Propertv lines � SurFace Waters Public 111later Su iies � Vertical Cuts >2 ft. Water Lines Vehicle �Traffic � � Ad'acent S tems � �Easements/Ri ht: of V Other' . Easements Recorded Low P.ressure Pi e . �ri-I A r. Pi e�lateriai and Grade � � � Valves ' . Comment� pcf�d rev. 3/13/0�1 \�� \� �--- ' �--1^ � � � � � � I��.�a��.��..11 I�-3L �: �.]l�lla Applicant: (.��b� � � .-v Imp�ovement Permit T�x M�p ' + — Pa.rcel # • Subdiivision �.� � � � Fh2se Section Lot # � � Permit Valid for �ive xears No Expiration Type of Facility: 5� New Addition _ Water Supply � 9 # of Occupants (� �.� # edrooms 3 Projected Daily Flow 3c�c� g.p.d. Proposed Wastewater System: Type: Proposed Repair: � � � Type: Permit Conditions: Owner or Legal Representative Si atur •' � ',r''"% �/'�� \' !�r''" "� Date: � � �`� Authorized State Agent: �r� c� (� `'2S Date: s-'��^c�c. The issuance of this perxnit by the Health Department in does not guarantee the issuance of other permits. It is the responsibility of the applicant/property owner to in sure that all Person County Planning and Zoning and Buildi.ng Inspecrions iequirements are met. This Improvement Permit is subject to revocation if the site plan, plat or the intended use changes. The Improvement Permit is not affected by a change in ownership of the property. This permiY was issued in compliance with the provisions of the North Carolina `Laws and Rules %r Sewa,�e Treatment and I)isposal Svstems' (15A NCAC 18A .1900). 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 wili remain potable. Authorization to Const�uct Wastevvater System (Required for Building Permit) * See site plan and additional attachments ( i/). � Proposed Wastewater System: � �ICL2.(��e.� Type� Wastewater Flow 3(oq g.p.d. New � Repair� Expansion �Z3'j. �tr.� Soil Y.T , a'15 g.p.d./ ft 2 Type of Facility: �- Basement _ Yes � No �Vastewater System Requirements Tank Size: Septic Tank: 'Eu �.,s ', gal Pump Tank: ^ gal Grease Trap: �— gal Drainfield: Total Area: �J sq ft Total Lengthlo�j-/�Sb ft iVia�mum Trench Depth �% in Trench Width3 ft Minimnm Soil Cover: � in Minimum Trench Separation: � ft Distribution: Distribution Box �G Serial Distribution Pressure Manifold Specifications: F�-all�� at��.. SL� h�c.A.. l��.v,i,�� . ��S ��1-�-. �c� �3rge �►,la�c Authorized State Agent: l.�.a.� Permit Expiration Date: Date: � - �(-�c:o The type of system permitted is Conventional � Acc� Alternative. I accept the specifications of the permit. , �-------; � ' _ i ; � Owner/Legal Representative: /�"`� �--=- '-'i Date: � J.� `..�'; -�-. ,. � =' � - � ,� -\, `�---� � �� PCHD rev. 11/10/OS � ,, . ,i�, % « . .��+�� V � ! ^ ^_ � V �� ]��-�u-�,�� .�.�.11 ]HI��.11�1�. � - �. �• � •� ■,� . •�• ♦�1� � • � ' � � � ' • • � System components beginning the inst�i 1 �C�e: iVD �- iv �� ,� �� SITE S�TCgI Taa Map # /a�/ Patcel #��_ Section/Lot#_ � . J _�_^ ' 'L D ��`� ate . only. The contractor must, fTag the system,�irior to 'e is maintained I ��'�C-� � -- --��. ��__._�:.__ _ � ,; ;"p:—�--� � � —,na�,� _ ��_1�Sp'x3 �- --- — .- � PGHD, rev. 09/12/01 VOAtIIALS CONTAIN 1:1 HCG ` ai� �iOT Ft��+SE P�RDlEt1M PRQD({CTS � N.C. Department of Health and Human Services PLEASE`�EAD INSTRUCTION SHEET ��'�sion o! Public Health � Si.ate I.abo�atory o� F^ubiic Health P.O. Box 28(347� 306 N. Wilmington St., Raleigh, NC 27611-8047 Environmental Sciences Anal}�sis Report Name oI Owner, atient Or Supply: __ i w� C{� �nn.� �'opOQ.✓ Address: _ St1e ,�a��_ pf • _ Sewtorn z�p:__ Z13� ?elephone M L_) County:_P�rSan ........ ....................................................................��.............� Report to: Telephone #� (_�� c � Address: p�ww�� CoUectrd By: cJ. �� Telephone N (�_5R'? — ('1 q p D�ce Collected: ��-a8 Analysis Desired: L� D•aleReceiced:_Apa 0 2� 2008 ,�/�/r� � .APR 0 8 2008 . ll�te Reported: Date Extracted•_ l°�� /N-5 � 6` F ��6 � t �L_ D�te Analyzed: � � ' 7 g�r,P � �� 7 �o�-�� E\.�� V�� Id By: (1l- �HHS Form 2364 / �,r� APR �� 7�� ' .:.boratory (Rev.06/99) � � <! � �°�� • F anlrpt li_'•�.':__ � DIVISION OF HEALTIi AND IiUMAN SERVICES STATE LABORATORY OF PUBLIC HEALTH PO BOX 28047 - 306 N WILNIDVGTON ST., RALEIGH, NC 27611 �, , Pnrgeable Organic Compounds by Gas Chrnmatography/Mass Spectrometry LABORATORY # � G D � �� • C011�OUND MDL µE/L COMPOUND �L N�, Chloromethane OS µg/L 1.2-DlcLloroprnpane �'S µR/1� Vinyl Chloride �� µ� DibromometLene 0.5 µL�' Bromomethane . �'S µ�' BrnmodichlommetLane T � KE�' Chloroethsne 0.5 µp/L cia-1,3-Dichloropropene 0.5 µg/L TrlchloroIInommethane • �� µ� 4Methyl-2-Pentanone � µ�' 1,1-Dfchlorcethene 0.5 µ�• Tolnene dS �' . Acetone 2.0 µpjL ��1,3-DicLloropmpene �� REZ Iodomethane OS µg/L 1.1,�TrfchloroetLane 0.5 µL�' 0.5 µg/L � Carboa Disolfide Tetrachlorcethene 0.5 Methylene Chloride 0� µ� 2-Hezsnone 0.5 u�/L AcrylonitrIIe 0.5 µg/L D[brnmochlommethane T �'S ��' tratu-1,2-Dichloroethene 0.5 µg/L Ethylene Dibromide 0'S µg/I' . Methyl-�Bntyl-Ether 0.5 µg/L Chlorobenzeae �-5 KF�' 1,1-DicLloroethane 0.5 µg/L 1.1,1,2-Tetrachlorcethane 0.5 µg/L Isoprnpyi Ether 0'S u� Ethyl Benzene �'S ��' cis-1,2-Dicliloroethene 0� µ� Rylenes OS µg/L 2-B�anone �'� �8'�' Stymne �'� KE�' 2.0 µg/L • Teh'ahydrofuran � Brom�foim ' Z' �'S ug�' Chlornform T �� µ� 1,2�,Z-TetracWoroetLane �'S �g�' 1,1,1-TrichloroetLane ' 0� µ� 1,2�-7'rfcliloropropane 0.5 µp/L Carbon TetracLloride �S µ� 1,4-Dichlornbenzene , 0.5 µg/L �e 0.5 µg/L 1,2-Bichlorobtnzcnc 0-5 µE�' 1,2-Dichloroethane 0� µ� 1,2-Dibromo 3-(,7�loropmpane Z.0 R�' Tricliloroethene . 0.5 µg/L . ttace — detected, b� leas fhan 1�IDI, MDIFMinlm�m► DetecHon Limit C- Posdble lab contamtnatloa or background T= trihalomethane J - Fstimated V:lue • • K- Adual value is Imown to be lae tlun value glvea i��a-f1i �` �� V I,'� L- Attua! value h Imown to be greater tlun nlue gfvea ,,, ,. �� U-1liaterla! wac uuiyzed for but not detected. The aumber B the Nfinimum Detecttoa Llmit �( - Tentative WeotiTiatloa n D� � O� O n Q D-Sample diluted. MDIs do not apply. • H f U 0 P.ST: --.- -i------- . _ _. NO VO!_qT�LE CO�y�POUNOS IDENTIFIED DMSION OF HEALTH AND HUMAN SERVICES STATE LA$ORATORY OF PUBLIC HEALTH PO BOX 28047 - 306 N. WILMWGTON ST., RALEIGH, NC 27611 , � � Pnrgeable Organic Compounds by Gas Chrnmat�o�raphy/Mass Spectrometry LABORATORY # D D D� / � L /l% � COMPOUND MDL µE/L COMPOUND NIDL µP/L Qdommethane OS pg/L ' 1,2-DlcLloropropane 0.5 µg/L Vinyl Chloridc �� µ� ITibromometLane 0.5 �Y�' Bmmomethsae . �-5 ��' Bromodichlommethane T 0.5 µE2 0.5 µE/L l�f.2 Qdoroethane cis-1,3-Dfchlornpropene �'S TrichlototiaornmetLane . �� µ� 4Methyl-2-Pentanoae �'S µ�' 1,1-Dichloroethene 0.5 µelL Tolnene OS µg/L . Acetone Z.0 µg/I, ksns-1,3-Dichloropropene �� PE2 Iodomethane 0� µ� 1,1,�TrlcLloroethane �'S ��' 0.5 µg/L � Carban DisolBde Tehachloroethene 0.5 Methylene Qiloride 0� µ� 2-Hezanone 0.5 µg/L Acrylonittale 0.5 µg/L Df6rnmocLlornmethane T �'S P�' trans-1,2-Dfcliloroethene . OS µg/L Ethylene Dibrom[de 0.5 µg/L . MethYl-t-Bntyl-Ether OS µY/L �r'QG `� OS Pg/L C7ilorobew.ene 1.1-Dichloroethane 0.5 µpJL 1,1.1,2-Tetrachloroethaae 0.5 µg/L L�opropyl Ether 0.5 µf/L g,�� Benzene �'S ��' cis-1,2-Dic]iloroethene �� µ� Rylenes 0.5 µE�' 2-Batanone 2.0 µg/L S�ne �'� µ�✓�' 2.0 µg/L � , � Tetrahydrofnran �� 3 Brnmoform T OS µg2 u�' C7�lorofotm T 0� µ� � 1.1,2,Z-Tetracliloroethane �'S µg�' 1,1,1-Trichloroethane � � µ� 1,Z,3-Tricbloropmpane 0.5 µg/L Carbon TetracLloride 0� �� 1,41?ichlorobenzene , 0.5 µg/L Benzene 0� u� 1,2-DichloYrobenzene OS µP�' 1,�Dichloroethane 0� µ� 1,2-Dibromo-3-Chlornpropane �0 u82 Trichlot�oethene . OS µg/L trace — detected, but less tlian �MDL 1►4pIfMinimwn Detectton Li�nit C -Pocst6lelaboontaminatlonorbsckground T=trihalomethane ��,q��(DA�'E: '�� J - Ettimated Value � ��-v y� T K- Actual value 4 fmown to 6e las thsn value givea i�� d.i t.. � A N L- Aetua! vatue b Imown to 6e greater tuao ylue givea U-11�terial wu anaiyzed for 6ut not detscted. The number 4 the Mintmum Detectton Ltmit Q 1� - Tentative identitiatloa A P R 1 0 2 Q � J D-SamDle dituted, MDL do not aPPf9. . " PV' _ �.__ _ N.C. Department of Health and Human Services �+ � M DiVLS10R Of Piltiii� iI2�itii ��J State La6oratory of Public Health PESTIC P.O. Box 28047, 306 N. Wilmington St., Raleigh, NC 27611-8047 Environmental Sciences Analysis Report Name of Owner, Patient rL Or Supply: , r,n�► � J odYL tT��Q,�_ Telephone #�) Address: �Yln� �aoa5e pr County: P2t''Savl 5�� z�p: 2?3�/3 ..........................................................................................., Report to• Telephone # (_) � � �' � � Aaaress: ROOcb01n, NC 27573 Laboratory Number Samnle � Collected By; -S • J M ti� Telephone # �J Sq�'1 —I %�lI Date Collected: _ �' � �0� Analysis Desired: Pes{�� Pi or Remarks 0 Af�Al,YTICAL METfiOD REQU( Results In ATTACHE[ Date Received: APR � 2�08 �' �` �' �' 1 Date Reported: APR 0 9 2008 C�/ 1i15 Date Extracted: �`�" ��,� Date Analyzed:�� ,� �— q' �D �3 �� -�-�-I � � �� a DHHS Form 2364 AP R 1 0 2008 Laboratory (Rev.06/99) F anlrpt p�y- _ _. __.-.._._. ____ ,,-�_.. _- _ . . _ __ _�;._._:_.-_____..---- ,a � , North Carolina State Laboratory of Public Health �` N.C. Department of Heaith and Human Services P.O. Box 28047 - 306 N. �Imington St. - Raleigh, NC 27611- 8047 Pesticide Analysis Report Name: Jim & Joan Hopper Address: Snowgoose Dr. Semora, N.C. Report To: Person Co. Env. Health Address: Person Co. Health Dept. 325 South Morgan Street Roxboro, NC 27573 Courier: 02-33-15 Zip: 27343 Telephone: County: Person Collected By: J. SMITH Telephone: (336) 597-2371 Date Collected: 4/1/2008 Analysis Desired: Pesticides Analysis Method: NC M�had 508. Liquid-Liquid Extractan, Gas Chromatography, Electmn Captiae Detedor. 1996 Analyte Minimum Detection Limit Results Alachlor <0.0001 mg/I None Detected mg/I Bifenthrin <0.0010 mg/l None Detected mg/l Chlor�dane <0.0002 mg/l None Detected mg/I Chlorpyrifos <0.0001 mg/1 None Detected mg/1 Cypermethrin <0.001Q mg/I None Deteded mg/I Diazinon <0.0001 mg/l None Detected mg/I Dieldrin <0.0001 mg/1 trace detected mg/l Endrin <0.0001 mg/1 None Detected mg/I Fenvalerate <0.0010 mg/I None Detected mg/l Heptachlor <0.0001 mg/I � ' None Detected mg/t Heptachlor Epoxide <Q.0001 mg/I None Detected mg/I Lindane <0.0002 mg/I None Detected mg/I Methoxychlor <0.0010 mg/l None Detected mg/1 Permethrin <0.0010 mg/I None Detected mg/l Toxaphene <0.0020 mg/I None Detected mg/I 1 Comments: Trace amount of dieldrin detected by pesticides analysis. Confirmed by GC/MS. ANALYTICAL METHOD REQUfRES SAMPLE TEMP < 6° C Date Received; .4/2/2008 Laboratory No. AA48208 Date Completed�:�4,[9/�p08 noo� Reference #: 080574 Kvy � Date Reported�� Login Batch: 08040010 Reported By: � .E��L.� �e( ' s ervisoi Organic Chemistry �PR 1 0 2008 SY: - � � North Carolina State Laboratory of Public Health Department of Health and Human Services P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27611-8047 INORGANIC CHEMICAL ANALYSIS - NITRATE ONLY Name of System: Hopper, Jim & Joan Address: Snowgoose Dr Semora Zip: 27343 County: PERSON Report To: Person Co. Health Dept. 325 South Morgan Street Roxboro, NC 27523 Courier: 02-33-15 Collected By: JS Location of sampling point: Well head Remarks: ATTN: (336) 597-2371 Date: 4/1 /2008 Source of Water: Ground Source of Sample: Type of Sample: Raw Type of Treatment: None Type of Analysis: Nitrate Category: Time: 12:05:00 PM Parameters Results Units Date Analyzed: Nitrite as N <0.10 mg/I 4/2/2008 Nitrate as N <1.0 mg/I 4/2/2;��\ /� �� - q�� ''° � 1 �� / ��_� EXPLANATION OF RESULTS: Foster/Therapeutic Homes: Nitrate-N level acceptable if less than or equal to 10 mg/I Private Well Guidelines: Nitrite-N level should b�< 1.0 mg/I and Nitrate-f�L< 10.0 mg/I Sample Temperature on Receipt: 5•5 � C Date Received: 4/2/2008 Report Date: 4/17/2008 Reported By: Today's Date: 4/17/2008 Reference: 4291 Login Batch 08040006 � Sample Number: AB70536 Explanations Coliform Analysis: If coliform bacteria are Absent, the water is considered safe for drinking purposes. If coliform bacteria are Present, the water is considered unsafe for drinking purposes. 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. Inorganic Analysis: Recommended limits for drinking water. Sample should not exceed levels listed below. Alkalinity Arsenic Calcium Chloride Copper Fluoride Hazdness s No established limits 0.01 mg/1 No established limits 250 mg/1 1.3 mg/1 4 mg/1 No established limits Iron Lead Magnesium Manganese Nitrate Nitrite pH Zinc 0.30 mg/1 0.015 mg/1 No established limits 0.05 mg/1 10 mg/1(as N) 1.0 mg/1(as N) Not less than 6.5 units 5.0 mg/1 North Carolina State Laboratory of Public Health Department of Health and Human Services ��y P. O. Box 28047 -- 306 N. Wilmington St. -- Raleigh, N. C. 27 11-8i � AP �� . INORGANIC CHEMICAL ANALYSIS - PRIVATE WATER SYSTENf'�� Name of System: Hopper, Jim & Joan Address: Snowgoose Dr Semora Zip: 27343 County: PERSON Report To: Person Co. Health Dept. 325 South Morgan Street Roxboro, NC 27523 Courier: 02-33-15 ATTN: (336) 597-2371 Collected By: JS Date: 4/1/2008 Location of sampling point: Well head Remarks: --_ � �; _� ._; Source of Water: Ground Source of Sample: Type of Sample: Raw Type of Treatment: None Type of Analysis Private Time: 12:05:00 PM Parameters Results Units Date Analyzed• Alkalinity as CaCO3 158 mg/I 4/2/2008 Arsenic <0.001 mg/I 4/2/2008 Calcium 39.7 mg/I 4/2/2008 Chloride IC 26 mg/I 4/2/2008 Copper 0.06 mg/I 4/2/2008 Fluoride <0.20 mg/I 4/2/2008 I ron 0.16 m g/I 4/2/2008 Hardness as CaCO3 (Ca,Mg) 202 mg/I 4/2/2008 Magnesium 25.1 mg/I 4/2/2008 Manganese <0.03 mg/I 4/?J2008 Lead <0:005 ' �rg��l � - 4/2/2008 pH 7.5 . Std. units 4/2/2008 Zinc 0.08 mc�,�f ;� 4/2/2008 Date Received: 4/2/2008 Report Date: 4/15/2008 Reported By: Today's Date: 4/17/2008 Ref: 4265 Login Batch 0$Q4�pQ5;.._,�< Sample Number: AB7051 Explanations Coliform Analysis: If coliform bacteria aze Absent, the water is considered safe for drinking purposes. If coliform bacteria are Present, the water is considered unsafe for drinking purposes. 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. Inorganic Analysis: � � � ' Recommended limits for drinking water. Sample should not exceed levels listed below. � . _ �- ' Alkalinity Arsenic Calcium Chloride Copper Fluoride Hardness � No established limits 0.01 mg/1 No established limits 250 mg/1 1.3 mg/1 4 mg/1 No established limits Iron Lead Magnesium Manganese Nitrate Nitrite pH Zinc 0.30 mg/1 0.015 mg/1 No established limits 0.05 mg/1 10 mg/1(as N) 1.0 mg/1(as N) Not less than 6.5 units 5.0 mg/1 n PERSON COUNTY HEALTH DEPARTMENT 355A SOUTH MADISON BLVD. ROXBORO, NORTH CAROLINA 27573 BACTERIOLOGICAL WATER SAMPLEANALYSIS Name of Owner or Tenant q�,�,��1 �t�� I Address - _ County Q�,So n s-e�,�� Z?3�f3 Collected By �S Date Collected �— �—n� Time Collected�Z: 0� Source: ell ❑ Spring ❑ Other Location: ❑ House Tap I�'well Tap ❑ Other �No Charge harge r ��,_�C�� **�*�**�**�*��*��*��*��***��**��**��*��*��*�**�***��* �***�*��*��*��**��*�*��*��**�**��**��*��*��**�� Total Coliform FecaUE. Coli Reported By � bactreport Results Present Abse t ❑ o d �