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Home My WebLink AboutSAM-08-2016-075316.TIF Case# SAM-08-2016-075316 y � CATAWBA COUNTY HEALTH DEPARTMENT d 77124-at Environmental Health Section 842 SM Ajj �1ku(2-)- e yA_Ago - do 08/03/2016 WATER SAMPLE APPLICATION Applicant KURT HULL, 1494 FY NATURE DR,NEWTON NC 28658 C:7045302388 Site Address: 1494 FY NATURE DR, NEWTON NC 28658 SELECTED SAMPLES Bacterial Name of Subdivision: Parcel Number: 372006376879 Lot: F Block: Specific Directions Description: Bacteriologial Only* Reason for Sample:Loan Closing Type of Well Eor.74119,111ili Drilled UM'am Is the well on this same property? „ Yes ril Is outside spigot available to collect sample? E. '4Yes��>='n� Is power on? sixes Has well been tested before? Dnkrown;,�teggr Results Does the plumbing come out the top of the well through a sanitary well seal? jUnknowri': Does the well ever become cloudy or has there ever been a problem with taste and/or odor? F No . Explain Does the well top extend twelve (12) inches above the ground or well slab? ��>Uri'known'. The well is in: TL_e'_fOide;I;,EEC Does this well supply water to more than one home? L =:.Nesak Jii 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 �� Signature or Owner or Agent 4 I Area 2 r�, a i7l(�IIni�IlllifiM'.� Fill01fr •-i1'Inq,ff mi�gW�l?rrr: -.;-'" '- c 7(r1lll11�1"', P�I��{T3ilIlPV•Tmllfllllir i%te N FEE>DESCRII'TION -. I DATFil)J .r ,>II``t� FEE•AMOUNT Bacteriological Sample Fee 08/03/2016 $58.00 m ITOTAL FFF'S �nrul�l�>�I>�ulnlll>f �� r ¢ IlIt d1b'h11S5800 t a-1..,, > ..,,: f r r tw� � > IIBA - I��'�� 1�1 "C141�ILx U1'"LL:w�,ila& 7a gtthii!6zw.iwh,r I�L:9Lu110nuif If= h 11 W'. Villa' rsamapplication 8/3/2016 Page 1 of 2 CATA:\ A Catawba County Public Health COUNTY - • www.catawbacountync.gov/environmentalhealth - �. ,, North Carolinta Environmental Health P.O. Box 389, 100-A South West Blvd., Newton, NC 28658 Phone (828) 465-8270.Fax (828) 465-8276 /ADA* K-5( c Water Sample Application Sample Requested By / /// Home Phone �19 Property Address F/ A/ cif O Business Phone Mailing Address /� (� Driving Directions MVO J3Ol.UJnl hof /0 '''C°S� 7Lo J $EAD.fr'( ' C-d fo i i 1, -aa ee/f cn 1.6?--e+ l l,e/1 fueY Left Olt o TY 4440/10 1 Sample Requested: Bacteriological \/ Inorganic Chemical _Other N� Sample reason: L oA i Type of Well: Drilled I Bored Dug Other / Is the well on this same property? Yes V No Is outside spigot available to collect sample? Yes \/ No Is power on? Yes V No / Has well been tested before? Yes No Unknown V 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 v Explain Does the well top extend 12 inches above the ground or well slab? Yes No Unknown V The well is located in front rear left side right side of the house. Does well supply water to more than one home? Yes '7 No Date /) 3 Signature of Owner or Agent / 4 Jr-) 4 I 1 "Leading the Way to a Healthier Community" ZPubhhc .. °Health ' l • o%� fit SBA CO CATAWBA COUNTY ,y I ION, SOUTHWEST LLVD INA RECEIPT ` NEWTON, NORTH CAROLINA 28658 rnn a Mg• Ark PHONE: 828.465.8399 CJ 4 8 Al oa► Wednesday, August 3, 2016 1842 s wtivw.catawbacountwtc.gov PAYOR: Hull, Kurt PAYMENTS TRANSACTION NUMBER: TRC-765102-03-08-2016 PAYMENT DATE : 08/03/2016 PAYMENT TYPE: Credit Card INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-331228 Bacteriological Sample Fee $58.00 TOTAL PAYMENTS : S58.00 SAM-08-2016-075316 CASE TYPE: Water Sample WORK CLASS: Bacterial SITE ADDRESS: 1494 FY NATURE DR, NEWTON NC 28658 Applicant KURT HULL, 1494 FY NATURE DR, NEWTON NC 28658 C:7045302388 ** NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/03/2016 16:35 Page 1 al gA I,'c Case# SAM-08-2016-075316 � l CATAWBA COUNTY HEALTH DEPARTMENT C3 ,rs? 1 vi9 '-C Environmental Health Section / +as $42 sm 08/16/2016 WATER SAMPLE FIELD REPORT Applicant KURT HULL, 1494 FY NATURE DR, NEWTON NC 28658 C:7045302388 Site Address: 1494 FY NATURE DR, NEWTON NC 28658 Name of Project: Parcel Number: 372006376879 Lot: F Block: Specific Directions Go down Hwy 10 West, Right onto Startown Rd, Left onto Mauser Dr, Left onto FY Nature Dr, 0.1 miles on the Left. Initial Collected by: -Ck"C"" Pck Date/Time Sampled: g/6//‘• 3! "Ails- Type Ai s- Type of Sampling Point: 0,-A-c o or se J°-c--- Well Well New or Existing? New Existing X Type of Well: Drilled X Bored Dug Spring City Does well meet adequate construction standards from what can be observed: K 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 8/16/2016 Page 1 of 2 414'P' case t; SAM-08-2016-075316 H� _AV 4 G1 CATAWBA COUNTY HEALTH DEPARTMENT -, rmm.vAtit:•ij� H U a v�p C Environmental Health Section L��p�!iu /84'1 sm 08/16/2016 WATER SAMPLE TEST RESULTS Applicant KURT HULL, 1494 FY NATURE DR,NEWTON NC 28658 C:7045302388 Site Address: 1494 FY NATURE DR, NEWTON NC 28658 Name of Project: Parcel Number: 372006376879 Lot: F Block: Lab Coliform Analysis Results: Total Coliforms: l/frne l+- Fecal / E. Coli: OW* No Collection Date Over 30 hours old Invalid Results: Excessive turbidity _ Excessive Chlorine Lab Accident Lab Tech Initials PH Date/Time Received 011W I I Li' WI 0:-) Date/Time Completed USI NI I ID ISI-6P4 RECEIVED AUG 19 2016 CATAWBA COUNTY ENVIRONMENTAL HEALTH E9 - rsamfieldreport 8/16/2016 Page 2 of 2