The URL can be used to link to this page

Home My WebLink AboutSAM-06-2016-073674.TIF $A C'� Case# SAM-06-2016-073674 ,��` f0 $ �1.. CATAWBA COUNTY HEALTH DEPARTMENT d �g K Environmental Health Section lr 06/17/2016 \\g bEJ42 sM WATER SAMPLE APPLICATION Applicant WILLIE AMMONS, 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 H:828-228-1006 MDA1389 @AOL.COM Site Address: 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC SELECTED SAMPLES 28673 Bacterial Name of Subdivision: Parcel Number: 460801157164 Lot: 5 Block: Specific Directions Description: Reason for Sample:Refinance Home Loan Type of Well @Z ; i o PDfilledJ(f,JIj1l13 il' Is the well on this same property? PRepinir Is outside spigot available to collect sample? ffiJM Yes l loll Is power on? Eki.DYe&Ift '1 Has well been tested before? 'Ill 18Yes1,11a Results Plresentfor ColifoimsfleL ■ I •F' I Ih ',.I L-1air Does the plumbing come out the top of the well through a sanitary well seal? goIlk1,':Xes; Al Does the well ever become cloudy or has there ever been a problem with taste and/or odor? ..''A 1NP.°1Nil Explain Does the well top extend twelve (12) inches above the ground or well slab? fitarifes Mc The well is in: EMIICRidtitSiiielnl;(j(I rI Does this well supply water to more than one home? ill man Itigg 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 a Signature or Owner or Agent Area 1 (n IllI ?1811 c T Tiiii.f1lllilltllljlll)[1 i �� '�,'ll![; '"VI 4 11jrp',P^� I I1 irk 'T�fIH'i dJFEFIDFSCRIPTION�m., iiajh1ji 11 Iv. 11V Liu DATE I; ';i 1, FEESAMOUNT,I(; Bacteriological Sample Fee 06/17/2016 558.00 �H�� ; �;,I , pTOTAE!FEFS mitlJIh1il liglilil,` . `n�IMPInii l'illllllnai ll;lillnlll°9il55.sii.0it. �1116..t l ' IEOE liMilliWir 1 4,, 4 ilalllw'.P IliEI .:I BEili,1 ,,4sumE1ENipiaps r , .anal rsamapplication 6/17/2016 Page 1 of 2 41 I', i `Pnnt Form C A rr �y (DA Catawba County Public Health COUNTY www.catawbacountync.gov/environmentalhealth '`t Environmental Health rFr `' '° ' North Carolina P.O. Box 389, 100-A South West Blvd., Newton,NC 28658 Phone (828) 465-8270.Fax(828) 465-8276 \ , / Water Sample Application Q Sample Requested By A l '�LL. `jp1/' � Home Phone ■ Q [r S, P,rgpeerjy_Add ress 0 4 .I ill_., I .l_ Al A business Phone ` �/y�� tr hQl'1'pMlaiilinlrQddfess a I 0 ialhe .' t .' A t A. . ./ L/ !, L' i l soai m Driving Directions " 44142_ COY ► UL( GC Of-. P` c1+'s I4pe et I CV u, Sample Requested: Bacteriological V Inorganic Chemical Other Sample reason: 11/46 t !n 1.40...n t, Type of Well: Drilled Bored Du Other Is the well on this same property? Yes No Is outside spigot available to collect sample Yes No Is power on? Yes i No Has well been tested before? Yes No Unknown Results WLE.CX___ 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 Explain Does the well top extend 12 inches: ::e b the ground or well slab? Yes o Unknown The well is located in front left side right side of the house. Does well supply water to more than one home? Yes No Date 0(0/ 11-19.0 GIP Signature of Owner or Agent i "Leading the Way to a Healthier Community" ¢°Health ra` t BA C'O CATAWBA COUNTY �+ Ti i� 'z. 100A SOUTHWEST BLVD NEWTON, NORTH CAROLINA 28658 RECEIPT U d>� ,,` PHONE: 828.465.8399 Friday, June 17, 2016 '- 1842 SM WWW.catawbacoumync.gov PAYOR: Ammons, Willie PAYMENTS TRANSACTION NUMBER: TRC-693955-17-06-2016 PAYMENT DATE : 06/17/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-329592 Bacteriological Sample Fee $58.00 TOTAL PAYMENTS : $58.00 SAM-06-2016-073674 CASE TYPE: Water Sample WORK CLASS: Bacterial SITE ADDRESS: 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 Applicant WILLIE AMMONS, 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 H:828-228-1006 MDA1389c+AOL.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 06/17/2016 15:43 Page 1 of 1 �$1� C Case a SAM-06-2016-073674 G &T . $ CATAWBA COUNTY HEALTH DEPARTMENT UEnvironmental Health Section 18 42 SM 06/22/2016 WATER SAMPLE FIELD REPORT Applicant WILLIE AMMONS, 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 H:828-228-1006 MDA1389 @AOL.COM Site Address: 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 Name of Project: Parcel Number: 460801157164 Lot: 5 Block: Specific Directions At the corner of Mt Pleasant Road & Hopewell Church Rd Initial Collected by: Pip Date/Time Sampled: 6-22—/ i/ (Z; 3CEA Type of Sampling Point: 14-..JA( Alia Well New or Existing? New Existing ✓ Type of Well: Drilled ✓ Bored Dug Spring City Does well meet adequate construction standards from what can be observed: r Yes 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 6/22/2016 Page 1 of 2 • ,K1131\- Ce Case# SAM-06-2016-073674 , ? Ss G1 CATAWBA COUNTY HEALTH DEPARTMENT U u�tvae:/' ''C l Environmental Health Section 8411 sm 06/22/2016 WATER SAMPLE TEST RESULTS Applicant WILLIE AMMONS, 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 H:828-228-1006 MDA 1389 @ AOL.COM Site Address: 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 Name of Project: Parcel Number: 460801157164 Lot: 5 Block: Lab Coliform Analysis Results: Total Coliforms: rzva4/u_t Fecal / E. Coli: fdYUnJ- No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident y t Lab Tech Initials Date/Time Received�O-�49 114 `� Date/Time Completed ob/d3/ac�b �,tcixe RECEIVED JUN 24 2016 • CATAWBA COUNTY ENVIRONMENTAL. HEALTH E9 - rsamfieldreport 6/22/2016 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: Willie Ammons Sample ID Number: 73674 Location: 2864 Hopewell Church Rd. Shen-ills Ford. NC 28673 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.) X 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. 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. \3A o ' ? CATAWBA COUNTY Uop P O Box 389-Newton, North Carolina 28658 -(828)465-8270- Fax (828)465-8276 -TDD(828)465-8200 '' Public Health - Environmental Health Division /842 SIA WILLIE AMMONS 6/30/2016 2864 HOPEWELL CHURCH RD SHERRILLS FORD NC 28673 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 2864 HOPEWELL CHURCH RD, SHERRILLS FORD NC 28673 WATER ANALYSIS This certifies that a sample of drinking water was taken from the above address on 06/22/16 and examined under laboratory number SAM-06-2016-073674. Laboratory findings reveal that this sample was FREE from coliform bacteria at the time of collection of the sample. CONDITION OF SUPPLY Your water supply was observed to MEET adequate construction standards (in regards to well head protection). NOTES *The results of any water analysis only reflects the quality of the water at the time of the sampling. If you have any questions concerning your water sample analysis, please call me at the number bel Robbie Phelps (828)320-3077 Environmental Health Specialist aDpiH CARp�ry� S OffIAIII Jry �. rP�H 10 'l4 '��l�r�ooeam1 c`jl "Keeping the Spirit Alive Since 1842/" GREATER ' Rmem ncad�' HICKORY METRO E9-rsamwatersampleletter 6/30/2016 Page 1 of 1