HomeMy WebLinkAboutSAM-04-2018-098429.TIF -' A \ Case# SAM-04-2018-098429
QlkGH CATAWBA COUNTY HEALTH DI PARTMENT
U �t►o ) ,C Environmental Health Section
J$t�2 sm 04/23/2018
WATER SAMPLE FIELD REPORT
Applicant SANDRA BEAN,4352E MAIDEN RD. MAIDEN NC 28650
C:828234287I
Site Address: 4352 E MAIDEN RD, MAIDEN NC 28650
Nance of Project:
Parcel Number: 367601363655 Lot: 21-26 Block:
Specific Directions Take Hwy 16 to Buffalo Shoals Rd, turn right at PGA,co to Plashing light and turn left to S Olivers
Crossroads, o to stop sign and turn right, first house on the right
GG t tip ( Z,Oc
Initial Collected by: `-'�c Y Imo" J� `/+ f�� Date/Time Sampled: q`
Type of Sampling Point: 7{,f I oh Side, 0 house
Well New or Existing? I New Existing K
Type of Well: Drilled Bored X Dug Spring City
Does well meet adequate construction standards from what can be observed: Yes No
Reason for non-compliance: Defective vveil 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
I Date of Notice:
E9-rsamfieldreport 4/23/2018 Page 1 of 2
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WATER SAMPLE TEST RESULTS
Applicant SANDRA BEAN,4352 E MAIDEN RD.MAIDEN NC 28650
C:828234287I
Site Address: 4352 E MAIDEN RD, MAIDEN NC 28650
Name of Project:
Parcel Number: 367601363655 Lot: 21-26 Block:
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Lab Coliform Analysis Results: Total Col iGams: 0 bowl- Fecal/E.Coli: (1 WI It
No Collection Date Over 30 hours old
Invalid Results:
Excessive turbidity
Excessive Chlorine
Lab Accident OLI
Lab Tech Initials I317 Date/Time Received 041t 1Th IIu I)L
Date/Time Completed ILII " IVA) rphi
RECEIVED
APR 2520th
CATAWBH COUNTY
ENVIRONMENTAL HEALTH
E9-rsamfieldreport 4/23/2018 Page 2 of 2