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A26 37Aa�niication Date: SJ-8"� � Amount Paid• �__]_00_LY3 Receiat #: 2a2_s.� Z eJ�- �� 3 2 Person Countv Health Department Environmental Health Section APPLICATION FOR SERVICES Tax Map #: J"�1� Parcel #: 3 � IF THE INFORMATION IN THE APPLICATION FOR AN IMPROVEMENT PERMIT IS FALSIFIED CHANGED OR THE SITE IS ALTERED THEAI THE IMPROVEMENT PERMIT AND AUTHORIZATION TO CONSTRUCT SHALL BECOME INVALID 1) Permit requested by: (Owner/agent/prospective owner):� � (U�'� , Home Phone: Address: O M��,1 V� Business Phone: ��-} ��7 QrQ..Z,t�� +� c� e�1�a �ll � l) A Z 4-� �� 2) Name and address of current owner: � l�.l Ann RfL1.S ., �+ v �M C . t�r Z � �� . 3) Property Description: Lotslze: Township: /'') Directions to the prooertv (Includina road names-aud nur�bersY4�.��V �L � F 1C� 4) Proposed Use and Structure Description: answer each of the following questions: �, i i 1��'�U�� a) Proposed O, Existing ❑ b) Stick Built �, Modular ❑, Single Wide �, Double Wide ❑ c) Number of Bedrooms: d) Number of occupants or people to be served: - e) Bas�ment: Yes 0, No �7 If yes, # of basement fixtures: -. -�- �"- ' - -- _� __ -. _ f; Garbags Disposal: Yes �, No ❑ __ \� ", _ _ _ .`_ _ _ g) Dimensions of Proposed Structure: Widt t t� Depth� ��ai,�� ) Co dW � Or ��.��1 �v l'1 N '�`�e�tY� � V ��,k, 5) Water Supply Type: Private �(new � or existing�, Public �, Community �, Spring ❑ A �� Are any wells on adjoining property? Yes ❑ No � If yes, location �\�� (f� �/ {� � ( l\ Y/ 6) Please Indicate Desired System Type: isystems can be ranked in order of your preference�(,�� AG�, _Conventional _Modified Conventional Alternative _Innovative � - `j'�21C�lJi ��2. Other (specify): d � �� --� CLEARLY STAKE ALL CORNERS AND UNES OF TNE PROPERTY. S7AKE THE CORNERS OF ALL PROPOSED STRUCTURES. PLEASE ATTACH SURVEY PLAT OR SITE PLAN TO THIS APPLICATION I hereby make application to the Person County Health Department for a site evaluation for the on-site sewage disposal system for the above-described property. I agree that the contents of this application are true and represent the maximum facilities to be placed on the property. I understand if the site is altered or the intended use changes, the permit shall become invalid. 1 understand that as applicant, I am responsible for identifying and marking property lines, comers and making the site acc,�ssible for the perso el of the Person County Health Department to conduct their evaluations. I understand that I am responsible for notifying the H th ep e' y property contains any wetlands as designated by the Army Corps of Engineers. �—�� Owner or Legal Representative Date PCHD, rev. 10/12/99 �� Person County Health Department Existing Sewage System Report For: Mob' e Home Replacement Addition �� 1. � Requestee: � iGt./� �. Gt�%�/ S 3`� f�lor�� P l� Um �2� KD�C1�c� l'D lU� � %S7 � _ Location/Uirections: C,ol�__�Y �T� �� G`�'u _ J�1 o r �o,� �u �f � �n � Home Phone# Business# O � - /,3� 'Pax Map# �� -3� Original Permit Located '" � Septic System Uesigned � or: 5�`�� "� �r� � Kesidential � Business Other (specify) # Bedrooms � # Employees Other Uate lnstalled C Water �upply �EX-� Type of 5ystem 7 Nitrification Line • 7 Tank Size . Certified Operator Required 'v � On site wasL-ewater disposal system showes no visually apparent malfunction on S/o�o� /� / . � / Yermiss/ �on is granted to: � �� xo�� s�h /'or�� _ l 1 �..� ._ ,..� / According to the attached site plan � Comments: f �� . �%O M � � /� _ a� Environmen�al Health $�C.. � �nf�;� r DATE i r i � �jTE_ � t � � h7sloav � r �, �M! iA t�js �'� �/FO. , �� -Y � \� � �� •\ \ . \ �'OODE-p � \ . F \\` \\\ .� � \ _ ` � 1 — —�� M ✓' I� � � � ,��,��. �1-� � � � � _,1 �.� � �� _ — ` �. � . _ � ; , ; '�� ►�i r � � r'�a �.� • ; ,,� -� `i � � Y� ` - fn.nce /� �f . �F Feef i;? �j�-- �f � // /�� ' � ,�f�� , , �� ,r,<<� � �9T,E' _ �. �o, i�j�y H%I -r--'�-^ �"' \ �� / \, , � / — � '� i BRIIIAAR \ � ��ry \ ! , � I f ��Y... � :=3� f:k.y�y. ��f.: �F,�. 7c a , \ i ' J � �J � _- . I ; � / . I � •� 1 � � �-�..--- - -- � �.� � -�_ ' � s R ►�-' __ , • __- , �. .� � � � \ , � � � _'�!� � \ � o +y.,�, ��. A,� �T�� . � �� . � �a�-3� 1�'•_1�1�i t. ;',.��.�.�i.,�1�,�1 !.%!=r�u�;'.� l�'��LI'� i �J� l�f�r'.i . �i !'.1��.� I]E.If. � r._�.� {>i_.i. �llr,i.:._ ��;\-i:;i0)a t^�F ;'U�L.i�� }'L.:�,LTi� pr:;_•t;t'�1�Il;j`�r�l_ F�',rLj �1�t��''_l_?jV'I\irltiT,�'.I..t�..F�liiF.f✓(i�_)� l_)i`;;� ht��i�':L.i'� DI�NKING �'ATEI: HEALTH F�IS�L E�r'ALUA i�OiV � GENERAL ' l�l°% COUNTY LABORAT�R�' # C'7U.�q`� DATE .� . �� Based on tliese anafytical results, this water shauld be considered safe fQr normal usage. ❑ Chemicai analysis did not show any contamination. Water should be resampled if odor or taste persisis. ►'i C/� CJ The water should not be used for drir�king or cookin� purposes; avoid prolonged batt�ing/showenng. Ba��ed or these anal�ical results, this tivater is highly contaminated and should n�f be used for drinking, cooking, or bathin�showenng. The laboratory�resutts are not conclusive, please resam�le. PLEASE II`IDICATE ON LAB SAEET TkIAT IT IS A R�,SAMPLE AI�D PRO��IDE pREVIOUS SAMPLE NUMBER(S). C'OMMENTS: ��. � �- ,k��J l�l�, ��l �� - i�1 /o �/vi��w� �' �/� l�� ls ;� ��c � �7 / �- For iUrtller informatio�� COI1�RCi i��'. �e� R�ac�o `viti� �l�€: �cc«��tio�a�� ai�c� EcE��-QE�.��e:��i ��ic�er��Eolo�� -ap��l: E�t (9�Sj 7Q7-�}��. Tem;:ora�� (�:sft f on;, 5�2?%0; ,h�: N.C. Department of Health and Human Services � � � �� Di�isian of Pubtic H�alth ��.�a�i�lf ro� �� State Laboratory of Public Health P.O. Box 28047, 306 N. Wilmington St., Raleigh, NC 27611-8047 , �. Environmental Scie�ces Analysis Report Narne of Owner, Patient �r 10. �k�� Or Supply: Address: �� Mi� ��1� a�� \ �.Y`c� �Ci ��lC�Jt�YI> t� Zip: % � � ,� �� i �• : Telephone # (� ) ��t - �.3 �1 � County: ��1 ...........................................................................................� Report to: Telepno„e #�� person County Environmental Health � 0-B Court Street Address:_ RoxbOra, NI� 2757� Collected By:�rv'��e �� Telephone # (� ,�9% � � %�0 Date Collected• �� lv� Analysis Desired:��7D��m Laboratory Number Sam le # Sam le Des ' tion or Remarks Results In $i'IQ`J�:� 2'L (, G (,�L SEE AT1�CH SM�E.T S /— � ��Z� r�� . ` � s S ' ; ` �3E'nl�ar�>o a [� �.�'�If�'��i� • ��.� �►.i�M%�d`�-�� _. �:�3� ,.,.R.� �E ATTACH SH�T{S1 ��. . . Date Received• � � �� Date Extracted: f2 / -O% DHHS Form 2364 Laboratory (Rev.06/99) F_anlrpt /V�� :�i-1 �T�o2 ! �i A �-�f D,� O Date Reported: MAY 0 7 2007 - jGiv GC�i�s Ge/�1.5 Date Analyzed:�'Z��-�%� S - �^�/ � �v 7 Reported By: "'� , �� DIVISION OF HEALTH AND HUMAN SERVICES STATE LABORATORY OF PUBLIC HEALTH PO BOX 28047 - 306 N. WILMIIVCTON ST.. RALEICH, IVC 27611 Purgeable Organic Compounds by Gas Chromatography/Mass Spectrometry LABOR.4TORY q O O � CO�iPOI�ND PQL µg/L COMPOUND PQL µg/L � Chluromethane 2.0 µg/L � 1,2-Dichloropropanc Z•0 µg/L � Vinyi Chloride 2�� ' Dibromomethane 2•� }��L Bromumethane 2•� ��• Brumudichloromethyne 2.0 µgJL Chloroethane 2'� �� —�� 2.0 µg/L �2�� cis-1.3-Dichloropropene ' % vi Trichlurofluoromethane 2'� �� 2.0 µg/L � 4-111eth� 1-2-Pentanone 1,1-Dichloroethent 2'� ��L 2.0 µg/L Toluene % ��r .4cetone 2'� �� 2.0 µg/L � i trans-1,3-Dichloropropene lodomethane Z'� �� f 1 2.0 µg/L U� 1,1,2-Trichloroethane Carbon Disulfide 2'� ��L V 2.0 µg/L Tetrachloroethene �teth�lene C'hloride 2'� ��L s � 2.0 µg/L � 2-Hezanone Acnlonitrile 2.0 µg/L 2.0 µg/L Dibromochloromethane trans-1,2-Dichloroethene 2'� ��L 2.0 µg/L Eth�lene Dibromide 11eth� l-t-Buh l-Ether 2'� ��L 2.0 µg/L Chlorobenzene 1.1-Dichloroethane 2'� �� 2.0 µg/L 1,1,1,2-Tetrachloroethane Isopropyl Ether Z'� ��L 2.0 µg/L Eth�•I Benzene ♦ cis-1,2-Dichloroethene 2'� �� 2.0 µg/L �/ o� Xy lenes �� 2-Butanone 2'� ��L 2.0 µg/L Sh•nne �f Tetrahydrofuran Z'� ��L 3 2.0 µg/L ♦ Bromoform Chloroform 2'� ��L � 2.0 µg/L Z �,2 1,1,2,2-Tetrachloroethanr 1,1.1-Trichloroethane 2'� ��L 2.0 µg/L 1,2.3-Trich loropropa n e Carbon Tetrachluride 2'� �� 2.0 µg!L l,a-Dichlorobenzene Benzene 2.0 µg/L � 2.0 µg/L t,2-Dichlorobenzene 1,2-Dichloroethane 2'� �� 2.0 µg/L 1,2-Dibroma3-Ch loropropa n e Trichloroethene 2•O I��L 1� D e�4,�bpNS PQL — Pryctical Quantitytiun Limit frace—detected, but less than MDL MDL=Minimum Detection Limit C- Possible lab contamination or background J - Estimated Yalue h- Actual value is known to be less than ralue gi��en. L- Actual value is known to be greater than value given. U- Alaterial was analyzed for but not detected. The number is the Alinimum Detection LimiL 1/ - Tentative idenofication. D-Sample diluted. D1DL.s do not appl�•. a:lnanc�•.frm (3/01 � DIVISION OF HEALTH AND HUMAN SERVICES STATE LABORATORY OF PUBLIC HEALTH PO BOX 28047-306 N. WILMINGTON ST.. RALEIGH, NC 27611 Purgeable Organic Compounds by Gas Chromatography/Mass Spectrometry LABORATORY# D D��O CONPOVND PQL µg/L COMPOUND PQL µg/L � C6loromethane 2.0 µg/L � 1.2-Dichloropropane Z•0 µg/L ',// Vinyl Chloride 2.0 µg/L 2.0 µg/L V� Dibromomethane Bromumethane Z•� µg��• Brumudichlorumethane 2•0 µg1L Chloroethane 2'� ��L 2.0 µg/L cis-1,3-Dich loropropene Trichloro0uoromethane Z'� �� 2.0 µg/L �-htethyl-2-Pentanone 1,1-Dichloroethene 2'� �� 2.0 µg/L Toluene Acetone 2'� µg�� 2.0 µg/L trans-1,3-Dichloropropene lodomethane Z'� �� 2.0 µg/L 1,1,2-Trichloroethane Carbon Disulfide 2'� ��L 2.0 µg/L Tetrachloroethene Meth�lene Chloride Z'� ��L 2.0 µg/L 2-Hexanone Acnlonitrile 2.0 µg/L 2.0 µg/L Dibromochloromethane trans-1,2-Dichloroethene 2�� Ethylene Dibromide 2•0 µg/L 1lethy 1-t-Buh l-Ether 2'� �� 2.0 µg/L Chlorobenzene t,l-Dichloroethane 2'� ��L 2.0 µg/L 1,1,1,2-Tetrachloroethane Isoprup� l Ether 2'� �� 2.0 µg/L � Et6y1 Benzene � �C�- cis-1,2-Dichloroethene Z'� ��L 2.0 µg/L ry lenes �� r 2-Butanone 2�� Sh•rene 2•0 µg/L �, � /; L� Cc Tetrahydrofuran 2�� L 3o Bromoform 2•0 µg/L IA V' Chloroform 2'� ��L ( ,� � 2.0 µg/L V, 1.1,2Z-Tetrachloroet6anr 1.1.1-Trichloroethane 2'� ��L " 2.0 µg/L 1,2,3-Trich loropropa n e Carbon Tetrachloride 2'� �� 2.0 µglL l,i-Dichlorobenzene Benzene 2'� µg�L 2.0 µg/L t,2-Dichlorobenzene 1,2-Dichloroethaoe Z'� ��L 2.0 µg/L 1,2-Dibroma3-Chloropropane Trichloroethene Z•0 µg/L PQL — Pryc[icyl Quantiwfiun Limil trace—detected, but less thao MDL MDL=Minimum Detection Limit C- Possible Iab contamination or background J - Esfimated Value K- Actual value is known to be Iess than value given. L- Actual value is known to be greater than value given. U- 111aterial was analyzed for but not detected. The number is Ihe \linimum Detection LimiL I/ - Tentative identification. D-Sample diluted. 111DLs do not apply. TR�� EL�sti�{ (L�A�E: 3� 3— 71 a:lnanc�•.frm (3/01) '� ,�y N.C. Department of Health and Human Services p�l`��L��;�� pRUDUC�s �z �� Divisian of Public Health ��;.� `;, ��.;, �;Z `�� , State Laboratory of Public Health �`'�� '"' P.O. Box 28047, 306 N. Wilmington St., Raleigh, NC 27611-8047 d�. `� -�.. Environmental Sciences Analysis Report �-�-� i"�`� '� ,.:.�r�-�.__ -- � Fp� � ��j 2001 Name of Owner, Patient�t Or Supply: �' ' I.QY�C� t i.�ela Address: � �O�('� �u�� t l 11�1 f�(�i �l� >> . Zip: c�2 � Telephone # County � Y�c� �i`1�� ...........................................................................................� Report to: erson County Environmental Heaith Telephone # (_) Aadress: ROXb01'0, NC 27573 Collected By� t�nie ��1'� Telephone # (3�3,0) �1- � 7 4 � Date Collected:�l aa lc�� Analysis Desired: QP�LiP�VY1 LaLoratory Number Sam le # Sam le Descri tion or Remarks Results In ' ��;�, � �acH p sH��) �`� I-i �. �0-4 PS cC � L 1 a �i',��}�1 �;� �� ,w�`� �,�� • � '� -O �,EE ATIACN _ --__.., � Date Received• �� "�� /Y�" �— Date Extracted: , �� DHHS Form 2364 Laboratory (Rev.06/99) F_anlrpt �z�s � ,� � � 3�S�D A�4 �t.3�"S�/ AP R 0 5 2007 Date Reported: P1'�� M,5 Date Analyzed: � �le -� 7 !7 �- � Z°'�� Reported By: ��- ��r-� /�=-d��v�rr�..��. ��c/L�.r�t.c.2C� Gl�o�';1 rt� GR-�� , DIVISION OF HEALTH AND HUA1AN SERVICES STATE LABORA'(`ORY OF PUBLIC HEALTH PO BOX 28047 - 306 N. V1'ILMINGTON ST., RALEIGH, NC 27611 Purgeable Organic Compounds by Gas Chromatograpl�y/Mass Spectrometry LABORATORY # D �D TCp � COMPOUND hiDL µg/L COMPOUND MDL Hp/L � � Chloromethane 2.0 µg/L -�- �^�p� 1,2-Dichloropropane 0.5 µg/L � Vinyl Chloride 2.0 µg/L �� Dibromomethane 0.5 µg/L � Bromomethane 2.0 µg/L Bromodichloromethane 0.5 µg/L -f '�'�� Chloroethane Z•� µ�L cis-1,3-Dichloropropene 0.5 µg/L � Trichlorofluoromethane Z•� µ�L 4-Atethyl-2-Pentanone 0.5 µg/L 1,1-Dict�loroethene 0.5 µg/L Toluene 0.5 µg/L ` f��' Acetone 2.0 µg/l, �� p � trans-1,3-Dichloropropene 0.5 µg/L lodomethane 0.5 Ng/L � 1,1,2-Trichloroethane 0.5 µg/L Carbon Disulfide 0.5 pg/L -f 'r�� Tetrachloroethene 0.5 µg/L C' 0.5 L 111ethylene Chloride 0.5 µg/L a��. 2-Hexanone PS� Acrvlonitrile 0.5 µg/L Dibromochloromethane � 0..5 µg/L trans-1,2-Dichloroethene 0.5 pg/L Eth��lene Dibromide 0.5 µg/L Methyl-t-Butyl-Ethcr 0.5 µg/L Chlorobenzene 0.5 µg/L l,l-Dichloroethane 0.5 µg/L 1,1,1,2-Tetrachloroeth�ne O.g µg/L Isopropyl Etl�er 0.5 pg/l. Ethyl Benzene 0.5 µg/L !, 5 cis-1,2-Dichloroethene 0.5 µg/L Xylenes 0.5 µg/L 7� ! 2-Butanone 2.0 µg/L Styrene 0.5 µg/L L� Tetrahydrofuran 2.0 µg/L � Bromotorm � 0.5 µg/L Chloroform 0.5 µg/L 3�j � 1,1,2,2-Tetrachloroethane 0.5 µg/L � , l,l,l-Trichloroethane 0.5 pg/L �� 1.2,3-Trichioropropane 0.5 µg/L Carbon Tetrachloride 0.5 pg/L 1,4-Dichlorobenzene 0.5 µg/L Benzene 0.5 µg/L 1,2-Dichiorobenzene 0.5 pg/L 1,2-Dichloroethane 0.5 µg/L 1,2-Dibromo-3-Chloropropane Z•0 NB�� Trichloroethene 0.5 pg/L trace-Jetectcd, but less than �1DL MDL=Minimum Detection Limit '- Possfhle lah rnntamination or backgrounA I - Estimated Value • C- Actual value is kno�cn to be less ihan ��xlue gi�•en. - Actual value is known to be grratcr than value giren. J- Dlaterial Has anal�•zed for but not detrcted. The number is Ihe Minimum Uetection i.imit. J - Tenuti�r identification. )-Sample diluted. 111DLs do not apply. `f' =�i'r� h a�t o m e��n�. a:\nancr.trm (3/01) DIVISION OF HEALTH AND HUn1AN SERVICES STATE LABORATOR i' OF PUBLIC HEALTH PO BOX 28047 - 306 N. VVILMINGTON ST., RALEIGH, NC 27611 Purgeable Organic Compounds by Gas C6romatography/Mass Spectrometry LABORATORY # D - / �/ �� COMPOUND M1iDL µg/L COMPOUND MDL p�L � � Chloromethane 2.0 µg/L -}-rQ�,L 1,2-Dichloropropane 0.5 µg/L � Vinyl Chloride 2.0 pg/L Dibromomethane 0.5 µg/L Bromomethane 2.0 µg/L Bromodichloromethane 0.5 pg/L Cliloroethane 2•� µ�L cis-1,3-Dichloropropene 0.5 µg/L Trichlorofluoromethane Z•� N�L 4-Methyl-2-Pentanone 0.5 µg/L l,l-Dichloroethene O.g pg/L Toluene 0.5 µg/L Acetone 2.0 µg/1, trans-1,3-Dichloropropene 0.5 µg/L lodomethane 0.5 pg/L 1,1,2-Trichloroethane 0.5 µg/L Carbon DisulTide 0.5 pg/L Tetrachloroethene 0.5 µg/L Aiethylene Chloride 0.5 µg/L 3,� � 2-Hexanone O.g pg/L Acrvlonitrile 0.5 µg/L Dibromochloromethane 0.5 µg/L trans-1,2-Dichloroethene 0.5 µg/L Eth��lene Dibromide 0.5 µg/L Methyl-t-Butyl-Ether ' 0.5 µg/L Chlorobenzene 0.5 µg/L 1,1-Dichloroethane 0.5 µg/L 1,1,1,2-Tetrachloroethane 0.5 µg/L Isopropyl Ether 0.5 µg/L Eth��l Benzene 0.5 µg/L cis-1,2-Dichloroethene 0.5 Ng/L Xylenes 0.5 µg/l. 2-Butanonc 2.0 Ng/L Styrene 0.5 µg/L Tetrahydrofuran 2.0 µg/L ` Bromoform 0.5 µg/L Chloroform 0.5 µgJL 1,1,2,2-Tetrachloroethane 0.5 µg/L I,1,1-Trichloroethane 0.5 Ng/L 1,2,3-Trichloropropane 0.5 µg/L Carbon Tetrachloride 0.5 pg/L 1,4-Dichlorobenzene 0.5 µg/L Benzene 0.5 µg/L t,2-Dichlorobenzene 0.5 pg/L 1,2-Dichloroetl�ane 0.5 µg/L 1,2-Dibromo-3-Chloropropane 2.0 µg/L Trichloroethe��e 0.5 µg/L trace - detected, but less than MDL MDL=Minimum Detection Limit C- Possihle lab contamfnation or background J - Estimated Value • K- Actual ralue is known to be less than �•alue gi�en. L- Actual value is known to be grratcr than �elue gi�'en. U- Dtaterial was analyzed for but not detected. The number is Ihe Afinimum Uetcclion f.imit. J/ - Tentati�'r identificatiun. D•Sample diluted. M1iDLs do not apply. TRaP BLANK (DA�E: a -� �� ) a:\nancy.trm (3/01) = North Carolina State Laboratory of Public Health �� N.C. Department of Health and Human Services P.O. Box 28047 - 306 N. Wilmington St. - Raleigh, NC 27611- - 8047 - � ` _ _ V� � Name: Carla Oakiey Address: 33 Morton Pulliium Road Roxboro, NC Pesticide Analysis Report Zip: 27574 Report To: Person Co. Environmental Health Address: Courier. Person Co. Health Dept. 325 South Morgan Street Roxboro, NC 27573 02-33-15 Telephone: I r •� .. � ? ; ^ � � , 7 �, � __. County: Person Collected By: BONNIE HOLT Telephone: (336) 597-2371 Date Collected: 3/22/2007 Analysis Desired: Pesticides Anatysis Method: NC Methad 508. Liquid-Liquid F�Qraction, Gas Chromatography, Electron Capture Detedor. 1998 Analyte Minimum Detection Limit Results Alachlor <0.0001 mg/I None Detected mg/I Bifenthrin <0.0010 mg/l None Detected mg/l Chlordane <0.0002 mg/I None Detected mg/l Chlorpyrifos <0.0001 mg/I None Detected mg/I Cypermethrin <0.0010 mg/I None Deteded mg/l Diazinon <0.0001 mg/1 None Detected mg/l Dieldrin <0.0001 mgll None Detected mg/I Endrin <0.0001 Y mg/l , None Detected mg/I Fenvalerate <0.0010 mg/I None Deteded mg/I Heptachlor <0.0001 mg/l None Detected mg/I Heptachlor Epoxide <0.0001 mg/l None Deteded mg/1 Lindane <0.0002 mg/I None Detected mg/I Methoxychlor <0.0010 mg/I None Detected mg/l Permethrin <0.0010 mg/l None Detected mg/I Toxaphene <0.0020 mg/1 None Defected mg/l ._ Comments: A few small peaks present in pesticide chromatogram. Unable to identify by GC1M5, Date Received: 3/23/2007 Laboratory No. AA43849 Reported By: �,� Date Completed: 4/18/2007 Reference #: 070460 Nancy Jones, su rvisor Environmental Organic Chemistry Date Reporte�t� � 1 g 2Q 7 Login Batch: 07030101 �a� -a� PERSON COUNTY HEALTH DEPA�2TMENT 355A SOUTH NIADISO�' BLVD. RO�YBORO, NORTH CAROLIN� 27573 BACTERIOLOGICAL WATER SAMPLEA_NALYSIS Name of Owner or Tenant � G�V�� t��'i�i� � Address �� 1�� U��2�— County J��Sc�_ Collected By��_ Date Collected �� O`1 Time Collected ( I��? Source: �Well ❑ Spring � Other Location: �House Tap OWell Tap ❑ Other DNo Charge �harge �***�*******��********��*�**�**�**��***��**'**�*�*�****�*�*�**�*****�***�****** ***��***�*��******��t�**��***�**�t******************�*X***�*��**��*�t******�*�** Total Coliform FecaVE. Coli Results Present Abs�nt ❑ d � �Q Reported L I � y,�� G� 3�ac��u� bactreport 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 - PRIVATE WATER SYSTEM Name of System: Oakley, Carla Address: 33 Morton Pullium Rd Roxboro, NC County: PERSON Zip: 27574 Report To: Person Co. Health Dept. ATTN: 325 South Morgan Street (336) 597-2371 Roxboro, NC 27523 Courier: 02-33-15 Collected By: BONNIE HOLT Date: 3/22/2007 Location of sampling point: kitchen sink Remarks: Source of Water: Well Source of Sample: Type of Sample: Raw Type of Treatment: None Type of Analysis Private Time: 11:22:00 AM Parameters Results Units Date Analyzed: � � Alkalinity as CaCO3 26 mg/I 3/23/2007 � �_' Arsenic <0.001 mg/I 3/23/2007 ' t '� Calcium 1.4 mg/I 3/23/2007 j:� .�� J1 Chloride IC 20 mg/I 3/23/2007 %� �'J �� /., ,y'' � Copper 0.13 mg/I 3/23/2007. ;- Q� ` Fluoride <0.20 mg/I 3/23/2007 P Iron 3.82 mg/I 3/23/2007 ,:� • . ,:% Hardness as CaCO3 (Ca,Mg) 5 mg/I 3/23/2007 Magnesium 0.4 mg/I 3/23/2007 Manganese 0.09 _ _ mg/I 3/23/2007 Lead 0.014 mg/I 3/23/2007 pH 6.3 Std. unit 3/23/2007 Zinc 2.39 , , mg/I 3/23/2007 Date Received: 3/23/2007 Report Date: 4/10/2007 Reported By: �j �� - - _ Today's Date: 4/10/2007 Ref: 4432 Login Batch: y07030051 : Sample Number: A654628 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 Hardness No established limits 0.01 mg/1 No established limits 250 mg/1 1.3 mg/1 4 mg/1 No established limits 0 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