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Home My WebLink AboutSAM-06-2016-074105.TIF BA (. Case u SAM-06-2016-074105 �G 7: It I CATAWBA COUNTY HEALTH DEPARTMENT ' "@�sa► Environmental Health Section (..J 11ol€.1dav 't g 1 2 sm 06/30/2016 WATER SAMPLE APPLICATION Applicant TARA WHISENANT, 1471 MURRAY LN, CATAWBA NC 28609 C:828-896-7713 Site Address: 1471 MURRAY LN, CATAWBA NC 28609 SELECTED SAMPLES Bacterial Name of Subdivision: Inorganic Parcel Number: 377007675879 Lot: 3 Block: C Nitrate/Nitrite Specific Directions Description: All 3 Samples Reason for Sample:Required for Well Variance Type of Well ElliiP1E- Drilled oNIRSIN Is the well on this same property? EmilrXesi!j Is outside spigot available to collect sample? E_"Yes Is power on? rirWirijri Unkn'ownj Has well been tested before? Results Does the plumbing come out the top of the well through a sanitary well seal? LP nkP9WPr] Does the well ever become cloudy or has there ever been a problem with taste and/or odor? i IilD N. :NIi I Explain Does the well top extend twelve (12) inches above the ground or well slab? E,Unknown The well is in: nIummil Rea';;imN iit_A Does this well supply water to more than one home? lYesr f l 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 CO - i- l(0_ Signature or Owner or Agent 4,/n_ ktin Area 1 i +I .—I -rii It " !' l7 i ,• ui " plv Iti 'I ' I 15 a 'T ;FEE DESCRIPTION _ kj i . " . DATE �. ,,!!:1w., FEE AMOUNT Bacteriological Sample Fee 06/30/2016 $58.00 Inorganic Chemical Sample Fee 06/30/2016 $1 14.00 � Nitrate Sample Fee 06/30/2016 $85.00 l ",1111j"� ik� TOTAL FEESII;1i1I11111 i111i�1I�i,di dlili17i�h"'�"i'I{�lllu�li111"I� Iilitll :�IYIlli liIIuil✓', 525700,�111ii li.-ji.9 il11I�tt"I>Ii lith l.ulr U011t;•:.._ v tiuJWU r.1:i"@!I-"i:...h_1-PLIL''.1;51"�nliIIiIII wt.._uil11..«._".Ifdiut_:;:cal Lu,... "illy li rsamapplication 6/30/2016 Page 1 of 2 a. F,rl m tit Catawba County Public Health nt�F,or COUNTY www.catawbacountync.gov/cnvironmentalhealti Environmental Health 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 Sample Requested By 1 Home Phone l} (lam —77(5 Property Address I Y ? 1 rY7, C`"6-7 Business Phone Mailing Address Driving Directions Sample Requested: Bacteriological "d/Inorganic Chemical Other It Sample reason: Type of Well: Drilled Bored Dug Other Is the well on this same property? Yes t�No Is outside spigot available to collect sample? Yes No Is power on? Yes No Has well been tested before? Yes 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 Explain Does the well top extend 12 inches above the ground or well slab? Yes 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 Date Signature of Owner or Agent 14(4 "Leading the Way to a Healthier Community" rPublac °Health l l /�. A O CATAWBA COUNTY G 100A SOUTHWEST BLVD a NEWTON, NORTH CAROLINA 28658 RECEIPT ea PHONE: 828.465.8399 se ; U f ..,1 �€,oases? Thursday, June 30, 2016 /842 sm www.catawbacountvnc.gov PAYOR: Whisenant,Tara PAYMENTS TRANSACTION NUMBER: TRC-712269-30-06-2016 PAYMENT DATE : 06/30/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-330019 Inorganic Chemical Sample Fee $72.00 0P6,3300101711,,2, ,,,. 71f II ,,wwa■NltrateSamplk Fee,„ I'IIN,,, , . .I ,x,4$85.00 TOTAL PAYMENTS : S157.00 SAM-06-2016-074105 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 1471 MURRAY LN, CATAWBA NC 28609 Applicant TARA WHISENANT, 1471 MURRAY LN, CATAWBA NC 28609 C:828-896-7713 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 06/30/2016 16:25 Page 1 of 1 4. -)7,7,A CATAWBA COUNTY t� t ��G IOOA SOUTHWEST BLVD v NEWTON,NORTH CAROLINA 28658 RECEIPT e 7 ,,1Pe t s4. PHONE:: 828.465.8399 CJ Sao Thursday, June 30, 2016 /842 m, www.catawbacountync.gov PAYOR: W h isenant, 'Para PAYMENTS TRANSACTION NUMBER: TRC-712268-30-06-2016 PAYMENT DATE : 06/30/2016 PAYMENT TYPE: Cash INVOICE NUMBER FEE NAME FEE AMOUNT 06-16-330019 Inorganic Chemical Sample Fee $42.00 06=163300191ilt1" {llIjlgw, 7 '.(Bacteriological;,SamplelFeelila_°IJI{. IER$5,8_:00] TOTAL PAYMENTS : S100.00 SAM-06-2016-074105 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 1471 MURRAY LN, CATAWBA NC 28609 Applicant TARA WHISENANT, 1471 MURRAY LN, CATAWBA NC 28609 C:828-896-7713 ** NO PEOPLESOFTACCOUNTASSIGNED ** receipt 06/30/2016 16:23 Page 1 of I