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Home My WebLink AboutSAM-06-2016-073280.TIF 113A U Case# SAM-06-2016-073280 WA $ `�� CATAWBA COUNTY HEALTH DEPARTMENT ww� Environmental Health Section / �is"w $'42 sm 06/09/2016 WATER SAMPLE APPLICATION Applicant GARY MARTIN, 2311 21ST AV NE,HICKORY NC 28601 H:828-256-1855 Site Address: 2311 21ST AV NE, HICKORY NC 28601 SELECTED SAMPLES Bacterial Name of Subdivision: Parcel Number: 372305080190 Lot: Block: Specific Directions Description: *Take Sample from Spigot on the Well. Reason for Sample:VA Loan Refinancne Requirement Type of Well MOM i',t Drilled into Is the well on this same property? r,,,T,We ird Is outside spigot available to collect sample? 31 ll Yes flliIiP Is power on? MINICIININA Has well been tested before? Will reiVIIII Results Absent fof"both' .'!TIlL .«'ll'i!:, ' Does the plumbing come out the top of the well through a sanitary well seal? 1111111Mall1R2 Does the well ever become cloudy or has there ever been a problem with taste and/or odor? 111111 G4GMllt Explain Does the well top extend twelve(12) inches above the ground or well slab? #liltYest Ill The well is in: 1112111SIMIC Front 111111MMIS Does this well supply water to more than one home? IKiIgmNomgll fllN 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 infomiation, please contact Catawba County Environmental Health at(828)465-8270. Date LE-a 9 -4, Signature or Owner or Agent Area 2 PT DESCRIPTIIOIVjih:' 1,7c 51,1 i.44 1:;'h i' d DATE l if i '' RIFEE aOUNTU`I( Bacteriological Sample Fee 06/09/2016 $58.00 l' i fl �- ;(POTAL�FE,ESu m ...8tir.It, n,, Iil'diarlvtlk1 `i��)��I�IIt�it':1 Ikhl i llifik ' 9858r00,1�� 1.,:t 1i'h,14:;,:t,. amumorks.:.lvinte mmanviril enisi �temn.arantorwa; ryl u< ,divnmm�an;mmnirrul WWJ➢W, t. rsamapplication 6/9/2016 Page 1 of 2 t' "ar k^Y ', s„ 41,,, ,Form; ;i \I \ t� �� Catawba County Public Health a COUNTY . X44, www.catawbacountync.gov/environmentalhcalth �— ° Environmental Health�, North Carolina P.O. Box 889, 100-A South West Blvd., Newton, NC 28658 Phone(828) 465-8270. Fax (828) 465-8276 � ww t� Water Sample Application Sample Requested By V ,V✓✓/ G t'1 Home Phone 2 C G — 7�SSf Property Address Z 3 </ � f' Le, Z2 'E Business Phone ZALiiii— 3 est `t/ Cat Mailing Address 5 (4,ti 2 Driving Directions 1'u-- U> :C: 0 Ultl V _j. _,� lam- CL ate ' Al .. iry Sample Requested: Bacteriological Inorganic Chemical Other Sample reason: k ,_ Type of Well: Drilled Bored Dug Other Is the well on this same property? Yes i// No / Is outside spigot available to collect sample? Yes ✓ No Is power on? Yes No_ Has well been tested before? Yes i/ No Unknown 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 l/ Explain Does the well top extend 12 inches above the ground or well slab? Yes i/No Unknown The well is located in front V rear left side right side of the house. Does well supply water to more than one home? fl-a Yes No Date 6-- c/ — /6 Signature of Owner or Agent Yg' } kl"`-- iL_ "Leading the Way to a Healthier Community" PPubliC °Health ) �n r i ,'A' CATAWBA COUNTY � IOOA SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT < frxi 150 i PHONE: 828.465.8399 C) ' � Via. Thursday, June 9, 2016 1842 SM www.catawbacountync.gov PAYOR: Martin, Gary PAYMENTS TRANSACTION NUMBER: TRC-688480-09-06-2016 PAYMENT DATE : 06/09/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329229 Bacteriological Sample Fee $58.00 TOTAL PAYMENTS : $58.00 SAM-06-2016-073280 CASE TYPE: Water Sample WORK CLASS: Bacterial SITE ADDRESS: 2311 21 ST AV NE, HICKORY NC 28601 Applicant GARY MARTIN, 2311 21ST AV NE, HICKORY NC 28601 H:828-256-1855 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 06/09/2016 09:25 Page 1 of 1 . Case tt SAM-06-2016-073280 i °t" ),. CATAWBA COUNTY HEALTH DEPARTMENT i Environmental Health Section 1842 sM 06/21/2016 WATER SAMPLE FIELD REPORT Applicant GARY MARTIN, 2311 21ST AV NE,HICKORY NC 28601 H:828-256-1855 Site Address: 2311 21ST AV NE, HICKORY NC 28601 Name of Project: Parcel Number: 372305080190 Lot: Block: Specific Directions McDonald Pkwy, thru stop light at Springs Rd,2nd street left, 21st Ave NE,to end last on riight 2311 on garage Initial Collected by: /1n `P Date/Time Sampled: 6-2«`/ /o: 35'4+7 Type of Sampling Point: 14't i l 1( i.ot,d Well New or Existing? New Existing ,/ Type of Well: Drilled Bored L.---- Dug Spring City Does well meet adequate construction standards from what can be observed: Yes v No Reason for non-compliance: Defective well cap and/or seal ✓ Piping does not exit through top of well by approved cap and sanitary well seal Evidence of improper grouting or no grouting Opening in the well casing or cap Supply too close to source of potential contamination Notification: Existing well owner notified that well does not meet adequate construction ? ✓Yes No Date of Notice: E9 -rsamfieldreport 6/21/2016 Page 1 of 2 $A • Case# SAM-06-2016-073280 tcY 11111�" CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 1 g 4 2 sM 06/21/2016 WATER SAMPLE TEST RESULTS Applicant GARY MARTIN, 2311 21ST AV NE,HICKORY NC 28601 H:828-256-1855 Site Address: 2311 21ST AV NE, HICKORY NC 28601 Name of Project: Parcel Number: 372305080190 Lot: Block: Lab Coliform Analysis Results: Total Coliforms: Fecal/E. Coli: C WK1+ No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials 13-1' Date/Time Received 01 I`,l,I 1 I L.P Ir,�1 C Date/Time Completed 00 RECEIVED JUN 2 3 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH E9 - rsamfieldreport 6/21/2016 Page 2 of 2 North Carolina Division of Public Health Occupational and Environmental Epidemiology Branch, Epidemiology Section BIOLOGICAL ANALYSIS REPORT Private well water information and recommendations County: Catawba Name: Gary Martin Sample ID Number: 73280 Location: 2311 21St Ave NE Hickory, NC 28601 Reviewer: M. Cash Initial Sample: X Confirmation Sample BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR PRIVATE 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. X 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. 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 drilling a new well or installing a point-of-entry disinfection unit which can use chlorine, ultraviolet light, or ozone. For further information please contact your county health department or the Occupational and Environmental Epidemiology Branch at 919-707-5900. gA TT gen CATAWBA COUNTY U .r .,% P O Box 389-Newton, North Carolina 28658 -(828)465-8270 - Fax (828)465-8276-TDD(828)465-8200 5 "Public Health - Environmental Health Division Ig }2 sM GARY MARTIN 6/30/2016 2311 21STAV NE HICKORY NC 28601 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 2311 21ST AV NE, HICKORY NC 28601 WATER ANALYSIS This certifies that a sample of drinking water was taken from the above address on 06121116 and examined under laboratory number SAM-06-2016-073280. Laboratory findings reveal that this sample was potentially unsafe and should not be used unless boiled or otherwise disinfected. Steps need to be taken to correct the condition of your water supply. CONDITION OF SUPPLY Your water supply was observed NOT TO MEET adequate construction standards. Non-Comp Reason: Incorrect Piping Exit NOTES *The results of any water analysis only reflects the quality of the water at the time of the samp If you have any questions concerning your water sample analysis, please call me at the number below. Robbie Phelps (828)320-3077 Environmental Health Specialist S S l s , .,,�-.", "Keeping the Spirit Alive Since 1842!" �aF.rE q=a,'' mPCC`�: HICKORY METRO E9-rsamwatersampleletter 6/30/2016 Page 1 of 1