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Home My WebLink AboutSAM-08-2016-075308.TIF �A C Case t; SAM-08-2016-075308 e ,, ;�, " ' CATAWBA COUNTY HEALTH DEPARTMENT ' vvEnvironmental Health Section ri Vet MCI 1842 4 SM 08/03/2016 WATER SAMPLE APPLICATION Applicant JERRY WILLARD, 2125 PAYSEUR ST, MAIDEN NC 28650 C:82823465I4 Site Address: 2125 PAYSEUR ST, MAIDEN NC 28650 SELECTED SAMPLES Bacterial Name of Subdivision: Parcel Number: 365713133091 Lot: 32 Block: C Specific Directions Description: Bacteriological Only* Outside spigot available behind the house. Reason for Sample:Re Test Type of Well {Di "iDliiled'I r°r i(IIiP Is the well on this same property? jj ul tes" Is outside spigot available to collect sample? 1111E111 Is power on? fillilYe02 Has well been tested before? Results PresentCColiforms iri MIS �I` i '!l ' '! '" IE1 lE Does the plumbing come out the top of the well through a sanitary well seal? !t' Ye51 . 11 Does the well ever become cloudy or has there ever been a problem with taste and/or odor? 1.97702:171 Explain . �" i i • ` • Mak79111011111MIMile9 1x i 117:71 Does the well top extend twelve (12) inches above the ground or well slab? LaYe"s t '- The well is in: t, frk&Rear ""hili t • "'" Does this well supply water to more than one home? LIMIIIITM 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 20/0 Signature or Owner or Agent. - Area 1 l!�FCE�DES PTIONp �r bwn4 D "° vjr; lllFE1E AMOUNT�r .doN p. wulliilIIDATE1 !!I . _� Bacteriological SampleFee08/03/2016 $58.00 fHi'��I(n'n�l ! �TOTAI tI Ecs at��li ii!{i��tl,ll�I.i�hi111lIIITiiIP�� iiiI�IICi `117111N;0, ssa nn i;tpp I� Lil I "•�.i taint! ,. W a Ud'S JIIIIII,IJWL'I:i 014! e u;Nh9IlL�itinow • . Wily"� t I�IIitt ; "i'. rsamapplication 8/3/2016 Page 1 of 2 C � § \. Catawba County Public Health COUNTY y_T,�1tr `.`t'^a wwww.catawbacountync.gov/environmentalhealth " CaF.0. 41 — ntl Environmental Health ruorth ca�o�ir's P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 Phone (828) 465-8270. Fax (828) 465-8276 Water Sample Application Sample Requested By �-3----el-CLIW It \AY'S Home Phone p727 -o23t-(- G575/ Property Address -7 126 Po-Li$PUC S4'. Business Phone Mailing Address t &-t t`^ Nit. 2 R(050 (� (� I ' Driving Directions Occkv- pIAN-4 2 SCQ 1--o Qtvc(ct c�c - 4Q-E4 paLie o14.1) PnysPuv sE 02ND - ai Le&- iK (.cloak, Sample Requested: Bacteriological I./Inorganic Chemical Other Sample reason: a Type of Well: Drilled Aored Dug Other Is the well on this same property? Yes ✓ No Is outside spigot available to collect sample? Yes ✓ No Is power on? Yes No Has well been tested before? Yes ✓ No Unknown Results /J 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 O o'r / Does the well top extend 12 inches above the gr nd or well slab? Yes V 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 Z Date kis C.3 ,-,20(4 Signature of Owner orAgefitJ,1- COO /VI "Leading the Way to a Healthier Community" °Healtht , °, , } ,'Th)e gA CATAWBA COUNTY ` " a Obi IOOA SOUTHWEST BLVD j NE WTON, NORTH CAROLINA 28658 RECEIPT Upla PHONE: 828.465.8399 v. , Wednesday, August 3, 2016 1842 zn+ nvw.catawbacountync.gov PAYOR: WILLARD, JERRY PAYMENTS TRANSACTION NUMBER: TRC-764674-03-08-2016 PAYMENT DATE : 08/03/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331214 Bacteriological Sample Fee $58.00 TOTAL PAYMENTS : $58.00 SAM-08-2016-075308 CASE TYPE: Water Sample WORK CLASS: Bacterial SITE ADDRESS: 2125 PAYSEUR ST, MAIDEN NC 28650 Applicant JERRY WILLARD, 2125 PAYSEUR ST, MAIDEN NC 28650 C:8282346514 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/03/2016 14:08 Page 1 oft ‘-v,A L'� Case ti SAM-08-2016-075308 4Y $ Ca F-7 CATAWBA COUNTY HEALTH DEPARTMENT v I eso.� �C Environmental Health Section 1842 sM 08/11/2016 WATER SAMPLE FIELD REPORT Applicant JERRY WILLARD, 2125 PAYSEUR ST, MAIDEN NC 28650 C:8282346514 Site Address: 2125 PAYSEUR ST, MAIDEN NC 28650 Name of Project: Parcel Number: 365713133091 Lot: 32 Block: C Specific Directions Go East on Water Plant Rd in Maiden, Right onto Circle St, at the end of the circle, Right onto Payseur Rd, 1st house on the Left. Initial Collected by: g i a'/ Date/Time Sampled: 'H 6/ /2, 3 3eeN Type of Sampling Point: JeloIl 6Ah h 4 ovd.t— Well New or Existing? New Existing --- Type Type of Well: Drilled ✓ Bored Dug Spring City Does well meet adequate construction standards from what can be observed: 1- 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 8/11/2016 Page 1 of 2 $A Case u SAM-08-2016-075308 ;371 Y CATAWBA COUNTY HEALTH DEPARTMENT e►:`'` �' Environmental Health Section /8 47, SM 08/11/2016 WATER SAMPLE TEST RESULTS Applicant JERRY WILLARD, 2125 PAYSEUR ST, MAIDEN NC 28650 C:8282346514 Site Address: 2125 PAYSEUR ST, MAIDEN NC 28650 Name of Project: Parcel Number: 365713133091 Lot: 32 Block: C Lab Coliform Analysis Results: Total Coliforms: et-1144-4 4-t Fecal /E. Coli: achntnc - No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab AccidentOft 4� � �4'p �II DE-)- ' Lab Tech Initials Date/Time Received 'V0Date/Time Completed to al aco t p a-rti.t RECEIVED AUG 15 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH E9 - rsamfieldreport 8/11/2016 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: Jerry Willard Sample ID Number:_75308 Location: 2125 Payseur St. Maiden NC 28650 Reviewer: M. McBride 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 arc 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. IgA r7 4 in. CATAWBA COUNTY U �� P 0 Box 389- Newton, North Carolina 28658 -(828)465-8270 - Fax(828)465-8276 -TDD(828)465-8200 =�Ik�� Public Health - Environmental Health Division 1842 sM JERRY WILLARD 8/26/2016 2125 PAYSEUR ST MAIDEN NC 28650 REPORT OF WATER ANALYSIS & CONDITION OF SUPPLY Property Address: 2125 PAYSEUR ST, MAIDEN NC 28650 WATER ANALYSIS This certifies that a sample of drinking water was taken from the above address on 08/11/16 and examined under laboratory number SAM-08-2016-075308. 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 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 9 'L '�: ot jiithiPallcnenie 1011-6xu�mi '5 "Keeping the Spirit Alive Since 1842!" GREATER k "e ,�+` nt HICKORKKOR Y METRO E9-rsamwatersampleletter 8/26/2016 Page 1 of 1