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Home My WebLink AboutSAM-08-2016-075314.TIF $A C Case# SAM-08-2016-075314 til ��v CATAWBA COUNTY HEALTH DEPARTMENT d 'r` t4 sP ; "3 Environmental Health Section X842 SM 08/03/2016 WATER SAMPLE APPLICATION Applicant STEPHEN HILDEBRAN, 3358 WIKE RD, CATAWBA NC 28609 C:8282184398 H1LDEBRANS@GMAIL.COM Site Address: 3358 WIKE RD, CATAWBA NC 28609 SELECTED SAMPLES Bacterial Name of Subdivision: Parcel Number: 377202960436 Lot: 7 Block: Specific Directions Description: Bacteriological Only* Reason for Sample:Processing Loan Type of Well lEjf(jI ijy(1Bored �3 fIli11I177Is the well on this same property? Ij Ygs e» `. w m,n Is outside spigot available to collect sample? I.� -�,Yes`,. .�� Is power on? �,'°•,yYesil;r= Has well been tested before? Driknown Results Does the plumbing come out the top of the well through a sanitary well seal? Elknow Does the well ever become cloudy or has there ever been a problem with taste and/or odor? EZIWITM Explain Does the well top extend twelve (12) inches above the ground or well EiliTrialriTilil The well is in: < i u'ttii ' !'F„ront l'lily Does this well supply water to more than one home? ,`i,`No; ', , 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 3 14,5 o l b Signature or Owner or Agent (- ----z______---- Area 2 F38liI"I'IfS"C • PT0 ,—"Tf9 i rL Yl, �" ' :'''!'hal, IIp , !ITlF INT "11filIIPi IM D _E' ly(„ 1� 4FEE AMOUNTrJ� EEDFR Bacteriological Sample Fee 08/03/2016 $58.00 �fi�ll'w'(��i l',°'TL F OTAEES'ilIlpui,u i ,II4` a rl'@414:1; ll�lliitiiiillihliill tut' 'f!l!iIililrL'a ii1iiiIt NIIIIillti558 oo:niiii i' .li. ......l wawa....._.. ' ....ili!i.......ltii1 osai ttaammIIlWJi96: Nam . v n r. w i LQisd uW t�til rsamapplication 8/3/2016 Page 1 of 2 cATAACatawba County Public Health COUNTY T ' . www.catawbacountync.gov/environmentalhealth le a C:Vrfr- Environmental Health North Carolina P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 h ; ea.v nit ar I ' 6O' Phone (828) 465-8270. Fax (828) 465-8276 / Water Sample Application Sample Requested By --S—tef`lc.V 4; westev Home Phone a?S.01- " CtS- L39� Property Address &35 '' Lc);/<c gc"C, C c.6a 4tc-Business Phone Mailing Address 52ern c a) ado z nl Driving Directions 4#0— 4ffu eZC;f 13Y 71,,v r t lir a e Por✓2�� ' C` p`/J T ;-({ -T -° £' 2Y '7 area.,i es.) !o.- k�"c vru 4e 4-1- Sample l-tSample Requested: Bacteriological l/ Inorganic Chemical Other Sample reason: 1O vicess N'5 Acca-•-• Type of Well: Drilled Bored )( Dug Other Is the well on this same property? Yes ')C No Is outside spigot available to collect sample? Yes X No Is power on? Yes _No Has well been tested before? Yes K No Unknown Results "ootC — /6eica" 2,50 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 F Date 3 A-' a l Signature of Owner or Agent • ' e- '4h' ,�� "Leading the Way to a Healthier Community" co- czPubllil 00c °Health 4'A \CQ CATAWBA COUNTY 4 # 100ASOUTHWESTBLVD ,�.,a�m B NEWTON,NORTH CAROLINA 28658 RECEIPT U IMP PHONE: 828.465.8399 Wednesday, August 3, 2016 /$42 srn www.catawbacountync.gov PAYOR: Hildebran, Stephen • PAYMENTS TRANSACTION NUMBER: TRC-765057-03-08-2016 PAYMENT DATE : 08/03/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331223 Bacteriological Sample Fee $58.00 TOTAL PAYMENTS : $58.00 SAM-08-2016-075314 CASE TYPE: Water Sample WORK CLASS: Bacterial SITE ADDRESS: 3358 WIKE RD, CATAWBA NC 28609 Applicant STEPHEN HILDEBRAN,3358 WIKE RD, CATAWBA NC 28609 C:8282184398 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/03/2016 16:23 Page 1 of KC (..1/4 Case fl SAM-08-2016-075314 iCATAWBA COUNTY HEALTH DEPARTMENT d shit Environmental Health Section \\,,...,_ 8 42 sm 08/15/2016 WATER SAMPLE FIELD REPORT Applicant STEPHEN HILDEBRAN, 3358 WIKE RD, CATAWBA NC 28609 C:8282184398 HILDEBRANS@GMAIL.COM Site Address: 3358 WIKE RD, CATAWBA NC 28609 Name of Project: Parcel Number: 377202960436 Lot: 7 Block: Specific Directions 140 to Exit 138, Right at the end of the ramp onto Wike Rd, Druve 1/2 mile & 2 story cream colored home on the Left. Initial Collected by: 1. ��14 Date/Time Sampled: V/7//6 3`30Ioh Type of Sampling Point: oa--LS: 4 Spz i,ok Well New or Existing? New Existing Type of Well: Drilled Bored PC Dug Spring City Does well meet adequate construction standards from what can be observed: X 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: Esisting well owner notified that well does not meet adequate construction ? Yes No Date of Notice: E9 - rsamfieldreport 8/15/2016 Page 1 of 2 ,< A Cases SAM-08-2016-075314 7 . ,II G� CATAWBA COUNTY HEALTH DEPARTMENT , - �� ► Environmental Health Section C.J *' '1411}— CATAWBA N 18 42 SM 08/15/2016 WATER SAMPLE TEST RESULTS Applicant STEPHEN HILDEBRAN, 3358 WIKE RD, CATAWBA NC 28609 C:8282184398 HILDEBRANS@GMAIL.COM Site Address: 3358 WIKE RD, CATAWBA NC 28609 Name of Project: Parcel Number: 377202960436 Lot: 7 Block: Lab Coliform Analysis Results: Total Coliforms: a.h° x. Fecal / E. Coli: t1.A.otl No Collection Date Over 30 hours old Invalid Results: Excessive turbidity Excessive Chlorine Lab Accident Lab Tech Initials Date/Time Received '�Q 1 ri l 1 i 1 uIC Date/Time Completed d 8/t 8/do l b I&/5 c ! '-C RECEIVED AUG 19 2016 CATAVviiM COUNTY I ENVIRONMENTAL HEALTH E9 - rsamfieldreport 8/15/2016 Page 2 of 2