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Home My WebLink AboutSAM-07-2016-074434.TIF o3A c Case# SAM-07-2016-074434 �� % CATAWBA COUNTY HEALTH DEPARTMENT Environmental Health Section 1842 sM 07/12/2016 WATER SAMPLE APPLICATION Applicant STEPHEN OLIVER, 9165 GRAYSON GREEN LN, SHERRILLS FORD NC 28673 13:9803875500C:7738488132 SWOLIVERI@GMAIL.COM Site Address: 9165 GRAYSON GREEN LN, SHERRILLS FORD NC 28673 SELECTED SAMPLES Hexavalent Chromium Name of Subdivision: Inorganic Parcel Number: 462801175758 Lot: 81 Block: Specific Directions Description: Hexavalent Chromium & Inorganic Samples. Reason for Sample:testing due to Duke Energy power plant ash Type of Well ""'' [ij iDrilledllI S j Is the well on this same property? 'r(i JTYesQ " 7 p ��Ni i t �.�,�, Is outside spigot available to collect sample? r•i' zYes ll, Is power on? urn-4= Has well been tested before'? I._ Yes.!1711 I Results Norrrial , T`w1: - sn' �•iG17 111 , IIt,, ;ID Does the plumbing come out the top of the well through a sanitary well seal? EgRirernin Does the well ever become cloudy or has there ever been a problem with taste and/or odor? ltl 'IIKNa Explain Does the well top extend twelve (12) inches above the ground or well slab? r1'<n! Yei-71, The well is in: La t.AlYFront smil n1 I' Does this well supply water to more than one home? =1,011(j11111 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 11/L/ Signature or Owner or Agent e / 14� eflb, Area 1 eFuiEll,ESCRIP4tl "i'•�� If�!!itljl4',°i`�``IiiTiAiTl, ��4:1, MO �f �i1= li a, , �.�11 .,r1 FEEIDESCRIPTION„ i1 4 1 iDATE �j �j FFFAMO___ fill Hexavalent Chromium Water Sample Fee 07/12/2016 $155.00 Inorganic Chemical Sample Fee 07/12/2016 $114.00 j"ji 7iiiii �{ TOTAL FEES - 1ltjl!n i. id�s,n1" 1.11111 ri, ''''''V115.10140411 /��i` , � '... ,d 1Alii i Y i I L . 'I�i,';il�l7i��u.:u1i.�h p7J�l!�u�Lw... � .z,z7N i�V i..� �.f.P�4.ttII;J10itl .'+L�J'Ji��. k.u�I rsamapplication 7/12/2016 Page 1 of 2 yo BankofAmerica—WestRJ 7/12/2016 9 : 34 : 22 AM PAGE 1/001 888-294-5658 A 101 • II IL C T j Catawba County Public Health r CO _^ www.catawbacountync.gov/environmentalhealth :�_�4y,, _ „ 3 IVer� .-,4 7 Environmental Health 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 Stephen Oliver Home Phone 773-848-8132 Property Address 9165 Grayson Green Lane Business Phone 980-387-5500 Mailing Address 9165 Grayson Green Lane, Sherrills Ford, NC 28673 Driving Directions Sample Requested: Bacteriological_ Inorganic Chemical X Other Hexavalent Chromium Sample reason: testing due to Duke Energy power plant ash Type of Well: Drilled X Bored Dug Other Is the well on this same property? Yes X No_ Is outside spigot available to collect sample? Yes X No Is power on? Yes X No Has well been tested before? Yes X No Unknown Results normal Does the plumbing come out the top of the well through a sanitary well seal? Yes X No_ Unknown Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes No X Explain Does the well top extend 12 inches above the ground or well slab? Yes X No Unknown_ The well is located in front X rear left side right side of the house. Does well supply water to more than one home? Yes No X Date 7/11/16 Signature of Owner or Agent / ; "Leading the Way to a Healthier Community" 3ZPublac < s µ ° �F °Health *1 , la `a:.7:7:-14•;;;- a ,.; y,A c--- p CATAWBA COUNTY 7" 'u CA 100A SOUTHWEST BLVD l: i!" NEWTON,NORTH CAROLINA 28658 RECEIPT sme1 A/PAl U iMira ''C PHONE: 828.465.8399 Tuesday, July 12, 2016 1842 SM www.catawbacountync.gov PAYOR: Oliver, Stephen PAYMENTS TRANSACTION NUMBER: TRC-729868-12-07-2016 PAYMENT DATE: 07/12/2016 PAYMENT TYPE: Credit Card payment by phone from Stephen INVOICE NUMBER FEE NAME FEE AMOUNT 07-16-330335 Inorganic Chemical Sample Fee $114.00 d7-16-33033 5 1�?"illjjl, jrt tIr;Ij,i yLl, jjjMIH ezavalentiChromiumbWateFL;iJ j l "311211 Ig.1"55,0] Sample Fee TOTAL PAYMENTS : 5269.00 SAM-07-2016-074434 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 9165 GRAYSON GREEN LN, SHERRILLS FORD NC 28673 Applicant STEPHEN OLIVER, 9165 GRAYSON GREEN LN, SHERRILLS FORD NC 28673 6:98038755000:7738488132 SWOLIVERI@GMAIL.COM ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 07/12/2016 11:10 Page 1 of 1 „', y 'P�,M1 P.O. Box 26047 North Carolina State Laboratory of Public Health 4312 District Drive Environmental Sciences Raleigh, NC 27611-8047 �, }I http.lfslph.nenublichealth.com �Z1.',.; . V Inorganic Chemistry Phone: 919-733-7308.:"'�ew.�.*�°:= Fax: 919-715-8611 Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH STEPHEN OLIVER P 0 BOX 389 9165 GRAYSON GREEN LN NEWTON, NC 28658 Courier#09-70-01 SHERRILLS FORD, NC 28673 EIN: 566001814EH StarLiMS ID: ES072216-0010001 Date Collected: 07/20/16 Time Collected: 11:20 AM Date Received: 07/22/16 Collected By: Robbie Phelps Sample Type: Raw Sampling Point: Well head Well Permit#: SAM-07-2016-074434 Sample Source: Well Temp. at Receipt: GPS#: Sample Description: Comment: Hexavalent Chromium (Profile) Analyte Result CAMA Screening Unit Qualifier(s) Level Hexavalent Chromium 0.47 0.07 ug/L Report Date:07/26/2016 Reported By: Debate.Mandl CAMA=Coal Ash Management Act RECEIVED AUG 0 9 2016 CA!-AWBA. COUNTY ENVIRONMENTAL HEATH Page 1 of 1 SL47E o'�,. d�.° n.�� i.'', P.O. Box 28047 North Carolina State Laboratory of Public Health 4312 District Drive g -- . n, 5 Environmental Sciences Raleigh, NC 27611-8047 httn://sInh.ncpublichealth.com 'k,,,, Inorganic Chemistry Phone: 919-733-7308 *,Qew.::, 15:,/ Fax: 919-715-8611 Certificate of Analysis Report To: Name of System: CATAWBA CO ENVIRONMENTAL HEALTH STEPHEN OLIVER P 0 BOX 389 9165 GRAYSON GREEN LN NEWTON, NC 28658 Courier#09-70-01 SHERRILLS FORD, NC 28673 EIN: 566001814EH StarLiMS ID: ES072216-0007001 Date Collected: 07/20/16 Time Collected: 11:20 AM Date Received: 07/22/16 Collected By: Robbie Phelps Sample Type: Raw Sampling Point: Well head Well Permit#: SAM-07-2016-074434 Sample Source: Well Temp. at Receipt: GPS#: Sample Description: Comment: Inorganic Chemical + Metals I (Profile) Analyte Result Allowable Limit Unit Qualifier(s) Arsenic < 0.005 0.010 mg/L Barium < 0.1 2.00 mg/L Cadmium < 0.001 0.005 mg/L Calcium 10 mg/L Chloride < 5.00 250 mg/L Chromium < 0.01 0.10 mg/L Copper < 0.05 1.3 mg/L Fluoride < 0.20 4.00 mg/L Iron < 0.10 0.30 mg/L Lead < 0.005 0.015 mg/L Magnesium 4 mg/L Manganese < 0.03 0.05 mg/L Mercury < 0.0005 0.002 mg/L pH 6.8 N/A Selenium < 0.005 0.05 mg/L Silver < 0.05 0.10 mg/L Sodium 8.60 mg/L Sulfate < 5.00 250 mg/L Total Alkalinity 53 mg/L Total Hardness 39 mg/L Zinc < 0.05 5.00 mg/L Report Date:08/02/2016 Reported By: .xennet/i jreene RECEIVED AUG 0 9 2016 cATAW BA COIiNTY ENVIRONMENTAL HEALTH Page 1 of 1