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Home My WebLink AboutSAM-02-2016-069368.TIF gA ? Case u SAM-02-2016-069368 ' ' G � CATAWBA COUNTY HEALTH DEPARTMENT 4 E° t Environmental Health Section - vat $42 sm 02/19/2016 WATER SAMPLE APPLICATION Applicant RODNEY SCHELL, PO BOX 128, SHERRILLS FORD NC 28673 H:8284789411C:7046774424 Site Address: 8161 SHERRILLS FORD RD, SHERRILLS FORD NC SELECTED SAMPLES 28673 Coal Ash Name of Subdivision: Hexavalent Chromium Parcel Number: 460802961289 Lot: 2 & UNNArvmak: Specific Directions Description: Coal Ash & Hexavalent Chromium Reason for Sample:concerned about coal ash Type of Well ,li .,1 Is the well on this same ert v r= ro P p Y Yes �.= Is outside spigot available to collect sample? a' Yes= Is power on? Eialitie=111 Has well been tested before? JUnknown Results Does the plumbing come out the top of the well through a sanitary well seal? nknon Does the well ever become cloudy or has there ever been a problem with taste and/or odor? cNo1` Explain Does the well top extend twelve (12) inches above the ground or well slab? The well is in: 177,13 Does this well supply water to more than one home'? 3; y1No >> Water samples will be drawn from an outside faucet unless otherwise specified. Please note that all water samples are taken during one visit. The processing laboratories have different protocols and timeframes for reporting results;therefore,you may receive several different reports concerning your water sample. For questions or more information, please contact Catawba County Environmental Health at(828)465-8270. Date .2. •f @ . oko`J (t, Signature or Owner or Agent/, wi A , ; '2 Area 1 .fir i�:;�^'+s nr . _ r-f q ay 'T' kt6 f i`t e,r*�--" x c '.!i`tai ,. 7a�,n t1.�+�,v^E'YP'°ik s..: s1 FEE DESCRIPTiION M �Ji/il r n � DATE1 4 E;ztg�FEE1AMOUNTr( Coal Ash Water Sample Fee 02/19/2016 5170.00 Hexavalent Chromium Water Sample Fee 02/19/2016 5155.00 e T€ TOTALfFEES r°`It€nit°ittt�° tl_ tip ii `� uil El ::111 aJIA�IN`itl IS:45 oosi[`[r g a3 .t°a5 i t&E°: �tp..x.a_f-gsa-a Caw.vog.zogi t'!+t22.4,u rsamapplication 2/19/2016 Page 1 of 2 it ; [�, � �` Pnnt;F,ormp { Ii 1�\ \ , Catawba County Public Health COUNTY A^ '� www.catawbacountync.gov/environmentalhealth " 4� ! tom No;th earo��na Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 Phone (828) 465-8270. Fax(828) 465-8276 pWater Sample Application Sample Requested By ,-% o p icic j --1 C-./J c-✓'l Home Phones cg, ylfii . 910 Property Address r (n.) 5 3(-1.41a)• ) /.S 7'O J.j A Business Phone Mailing Address c .', LJM JA8 - S1J EN, ' nd _ tt. a. ' cg h, 3 Driving Directions P) e,s a). e 4,/ (me f (,)i ,S {1 c, ad'J Sample Requested: Bacteriological___Inorganic Chemical � � iI . . OM -- Sample reason: CC)Al Cc- m,'� c'! O,r cyVY (o YY/ gl. ). J Type of Well: Drilled V.---- Bored Dug Other Is the well on this same property? Yes J No I Is outside spigot available to collect sample? Yes 11 No Is power on? Yes 1/ No Has well been tested before? Yes No Unknown L. / Results Does the plumbing come out the top of the well through a sanitary well seal? Yes No Unknown Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes No 17 Explain Does the well top extend 12 inches above the ground or well slab? Yes i- No Unknown The well is located in front rear ✓ left side right side of the house. / Does well supply water to more than one home? Yes No Y Date c! i / g . a0✓ a Signature of Owner or Agent e:74:?..-511-14-42 C .w 1-14- 4I "Leading the Way to a Healthier Community" .z...... 88Hea1th <� k IC r si yg,A CATAWBA COUNTY F-T t C‘it 100A SOUTHWEST BLVD RECEIPT NEWTON,NORTH CAROLINA 28658 ipra PHONE: 828.465.8399 a►'i Friday, February 19, 2016 . 0�� 5M www.catawbacountync.gov PAYOR: Schell, Rodney PAYMENTS TRANSACTION NUMBER: TRC-623707-19-02-2016 PAYMENT DATE : 02/19/2016 PAYMENT TYPE: Check 2012 INVOICE NUMBER FEE NAME FEE AMOUNT 02-16-325462 Hexavalent Chromium Water $155.00 Sample Fee OZ 16 325462 a°.-a '1rs ..,.- - „. i elri � l- t �s.._ ,,, * �- CoalAsti�Water�SarrSple Fee.;�,p,E�., �a �$17000 TOTAL PAYMENTS : $325.00 SAM-02-2016-069368 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 8161 SHERRILLS FORD RD, SHERRILLS FORD NC 28673 Applicant RODNEY SCHELL, PO BOX 128, SHERRILLS FORD NC 28673 C:828478941I **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 0211912016 13:02 Page 1 of , sniFq", -'top North Carolina State Laboratory of Public Health 431 Box28047 1 4312 District Drive 1.5 �„ Environmental Sciences Raleigh, NC 27611-8047 http://slph.ncpublichealth.com \ PhonInorganic Chemistry e: 919-733-7308 •:�w Fax: 919-715-8611 Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH RODNEY SCHELL P 0 BOX 389 8161 SHERRILLS FORD RD NEWTON, NC 28658 Courier#09-70-01 SHERRILLS FORD, NC 28673 EIN: 566001814EH StarLiMS ID: ES030716-0006001 Date Collected: 03/03/16 Time Collected: 2:40 PM Date Received: 03/07/16 Collected By: Michael E Cash Sample Type: Raw Sampling Point: Well spigot Well Permit#: SAM-02-2016-069368 Sample Source: Well Temp. at Receipt: GPS#: Sample Description: Comment: Hexavalent Chromium (Profile) Analyte Result CAMA Screening Unit Qualifier(s) Level Hexavalent Chromium 0.26 0.07 ug/L Report Date:03/16/2016 Reported By: Cindy Price CAMA=Coal Ash Management Act RECEIVED MAR 21 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH Page 1 of 1 •aM STATE o'- : P.O.Box 28047 : North Carolina State Laboratory of Public Health 4312 District Drive Environmental Sciences Raleigh, NC 27611-8047 VIII "-yyw` Phone: 919-733-7308 Inorganic Chemistry '•.'cw,u, „,t Fax: 919-715-8611 Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH RODNEY SCHELL P 0 BOX 389 8161 SHERRILLS FORD RD NEWTON, NC 28658 Courier#09-70-01 SHERRILLS FORD, NC 28673 EIN: 566001814EH StarLiMS ID: ES030716-0004001 Date Collected: 03/03/16 Time Collected: 2:40 PM Date Received: 03/07/16 Collected By: Michael E Cash Sample Type: Raw Sampling Point: Well spigot Well Permit#: SAM-02-2016-069368 Sample Source: Well Temp. at Receipt: GPS#: Sample Description: Comment: CA Well Monitoring (Profile) Analyte Result CAMA Screening Unit Qualifier(s) Level Aluminum < 0.05 3.5 mg/L Antimony < 0.002 0.001 mg/L Arsenic < 0.005 0.01 mg/L Barium < 0.1 0.7 mg/L Beryllium < 0.002 0.004 mg/L Boron < 0.1 0.7 mg/L Cadmium < 0.001 0.002 mg/L Calcium 22 mg/L Chloride < 5.00 250 mg/L Chromium < 0.001 0.01 mg/L Cobalt < 0.001 0.001 mg/L Copper < 0.01 1.0 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 4 mg/L Manganese < 0.01 0.05 mg/L Mercury < 0.0005 0.001 mg/L Molybdenum < 0.010 0.018 mg/L Nickel < 0.01 0.1 mg/L pH . 7.4 N/A RECEIVED Potassium 2.55 mg/L Selenium < 0.01 0.02 mg/L 1-2O's Sodium 11.40 20.0 mg/L Strontium 0.539 2.1 mg/I- CAT BA-COUNTY Sulfate 6.80 250 mg/L ENVIRO[ M€NTAL HEALTH Thallium < 0.0001 0.0002 mg/L Total Alkalinity 82 mg/L Total Dissolved Solids 130 500 mg/L Total Hardness 74 mg/L Total Suspended Solids < 5 mg/L Vanadium 0.0007 0.0003 mg/L Zinc < 0.10 1.00 mg/L Page 1 of 2 /'Yy .5, P.O. Box 28047 North Carolina State Laboratory of Public Health Q �� ne 'J 4312 District Drive Environmental Sciences Raleigh, NC 27611-8047 �Qr htto://slph.ncpublichealth.com � i Inorganic Chemistry Phone 919-733-7308 i,w.,-,,c°C Fax 919-715-8611 - = Certificate of Analysis Report Date:03/16/2016 Reported By: Cindy Price CAMA=Coal Ash Management Act Page 2 of 2