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�A C c a,�•a WELL-12-2021-162595
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CATAWBA COUNTY HEALTH DE,PARTME:vI'
Environmental Health Section
1 g 4 2 SM (16/21/2023
WATER SAMPLE FIELD REPORT
Owner JOHN PRIME, 1656 N NC 16 HWY,DENVER NC 28037
C:2035095096 PRIMESALESJOHN@GMAIL.COM
( unlractor *SCHUMACHER HOMES OF NC,INC,2715 WISE AVE NW,CANTON OH 44708
B:7046623228C:7045823894F:7046623299 KMERK@SCHUMACHERIIOMFS.COM
Site Address: 3546 MT PLEASANT RD,SHERRILLS FORD NC 28673
Parcel Number: 460701271312
Driving Directions Hwy 16 S to Hwy 115,0,East;Left on Little Mountain RD; Right Mt Pleasant half mile lot on the right.
Sample Collected by: A ifhA M ' t"` Date/Time Sampled: °24Y/013 ri' 3-5-4
Sampling Point: SA.,.11-1- _--Tarp
Is well head accessible? Yes V No Reason for inaccessibility _
Well New or Existing? New 1/ _Existing
Type of Well: Drilled / Bored I land Dug Punch
Does well meet adequate construction standards from what can be observed: ✓Yes No
Items of non-compliance: Evidence of improper grouting or no grouting
Well does not meet a required setback(comment)
Improperly constructed sanitary well seal
Well head not term at>= 12"above finished grade
Well head missing vent
Well head does not have a threadless tap
Well missing identification plate or pump tag
Wire conduit opening not sealed
Other(comment)
Comment:
rsamfieldreport 06/21/2023 11:56 Page 1 of 2
Co case u WELL-12-2021-162595
t CATAWBA COUNTY HEALTH DEPARTMENT
VEnvironmental Health Section O
18 4 Z SM 06/21/2023
WATER SAMPLE TEST RESULTS
Owner 1011N PRIME, 1656 N NC 16 HWY,DENVER NC 28037
C 2035095096 I'R1MESAI I?SJOHN@GMAIL.COM (at 1 17 11
Contractor *SCIRIMACHE;R I IOMPS OF NC,INC,2715 WISE AVE NW,CANTON OH 44708
B:7046623228C:7045823894F:7046623299 KM ERK@SCHUMACHERHOMES.COM
Site Address: 3546 MT PLEASANT RD,SHERRILLS FORD NC 28673 (;r!M{ SQI�S�}o) ' 1,,��.� (to‘
Parcel Number: 460701271312 r
Lab Coliform Analysis Results: Total Coliforms: Fecal/E.Coli:
No Collection Date Over 30 hours old
Invalid Results: Excessive turbidity Excessive Chlorine
Lab Accident
01 .) 0'00 Off. ►��tv
Lab Tech Initials Date/Time Received Date/Time Completed
) 4_ 3 S rot� 106 #�>;Inc, , • - 2.3
Environmental Health
rsanfieldreport 06/21/2023 11:56 Page 2 of2