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Home My WebLink AboutSAM-08-2016-076261.TIF $A CO Case# SAM-08-2016-076261 F. �� CATAWBA COUNTY HEALTH DEPARTMENT ", 'ao 1 Environmental Health Section 18 4 2 sM 08/29/2016 WATER SAMPLE APPLICATION Applicant DENISE EVERETT, 1250 QUIET COVE LN, HICKORY NC 28601 H:609-670-6854C:828-670-4678 Site Address: 1250 QUIET COVE LN, HICKORY NC 28601 SELECTED SAMPLES Bacterial Name of Subdivision: Inorganic Parcel Number: 373511754258 Lot: 5 Block: Nitrate/Nitrite Specific Directions Description: Bacteria, Inorganic Chemical, Nitrate/Nitrite Reason for Sample:just moved in Type of Well Is the well on this same property? Is outside spigot available to collect sample? Yes „ Is power on? Has well been tested before? .Unknown „; Results Does the plumbing come out the top of the well through a sanitary well seal? ,.Unknown _ Does the well ever become cloudy or has there ever been a problem with taste and/or odor? Explain Some sulp er order, {even with filter pre_tap,_although dontkriow ageoffilter), x : Does the well top extend twelve(12) inches above the ground or well slab? Unknovn ; The well is in: ,,,,par , Front w , Does this well supply water to more than one home? r Np 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 k6, q//(p Signature or Owner or Agent // / ' Area 2 FEE DESCRTPTTON '1,71/ ,£ � DATE FEE MOUNT Bacteriological Sample Fee 08/29/2016 $58.00 Inorganic Chemical Sample Fee 08/29/2016 $114.00 Nitrate Sample Fee 08/29/2016 $85.00 TOTAL FEES„ ,.. V: I$257.46 ,,,' _ ... � �. , .,; �.. .__ _ ts rsamapplication 8/29/2016 Page 1 of 2 y ,' l Catawba County Public Health az , , c , ,, : , , ft, rP,iikttF. ' ''-- . *Ax.T ,, Yi COUNTY www.catawbacountync.gov/environmentalhealth - '° Nor;TetZuriA 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 (-9° Sample Requested By Je55 i 1)6115"e L V 'Y&1t Home Phone 60q-616'- g',51.1 err 1g78 Property Address Lig Lit Q ' kt Cie law 1 NA6t 7--(40 Business Phone Mailing Address SW�Je.- Driving Directions V.OW 3_Uk 1?\A C( Sc' S � i-&rn oidio Llr1ckk ur� on RaTe f Lon Ole' L Cove. Sample Requested: Bacteriological , V Inorganic Chemical V Other 1 f�u-tQ rPr!v( `- Sample reason: J LA-5-i /Moved (4 7 Type of Well: Drilled Bored Dug Other l f� dcv✓ (cvtv+z...�a -110 hose) Is the well on this same property? Yes ✓ No l rw %rte'+-{ 41-1- ��, ,+, 5L-feen ()Pall • ° 1 e5L r * l on., id5��{ 5cd� � Is outside spigot available to collect sample? Yes V' No / Is power on? Yes 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 L Does the water ever become cloudy or has there ever been a problem with taste or odor? Yes V No So(1AC . L 1 Explain Std 11tt( di? ( ve //aim�) P; (tr ix -tar -at'�iou. l tit doy2�1,;t ioA) o il Pi 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. WW1( t ro '' t.,, 'Does well supply water to more than one home? Yes No " `` +,► �, Date l� Signature of Owner or Agent ,� + Nw RECEIVED "Leading the Way to a Healthier Community" AUG 2 9 2016 a'iPublic C _SA 4! ENVIRONMENTAL YnB COUNTY g3D , `/ t „s CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT PHONE: 828.465.8399 t►'.` Monday, August 29, 2016 1842 sM www.catawbacountync.gov PAYOR: Everett, Denise PAYMENTS TRANSACTION NUMBER: TRC-807411-29-08-2016 PAYMENT DATE : 08/29/2016 PAYMENT TYPE: Check 1788 received by mail INVOICE NUMBER FEE NAME FEE AMOUNT 08-16-332122 Bacteriological Sample Fee $58.00 081 6 3321 22 Nit tae Sample F?e a saf P $85 ,00 08-16-332122 Inorganic Chemical Sample Fee $114.00 TOTAL PAYMENTS : $257.00 SAM-08-2016-076261 CASE TYPE: Water Sample WORK CLASS: Multiple Different Samples SITE ADDRESS: 1250 QUIET COVE LN, HICKORY NC 28601 Applicant DENISE EVERETT, 1250 QUIET COVE LN,HICKORY NC 28601 H:609-670-6854C:828-670-4678 **NO PEOPLESOFT ACCOUNT ASSIGNED ** receipt 08/29/2016 16:51 Page 1 of 1